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Bacteria and Good Health

Many of us have noticed the newest trend in health: Bacteria. I have noticed so many commercials for Activia Yogurt, and in the stores all the containers say that they promote intestinal health. We have good bacteria and bad. Bad bacteria are those that can get out of the control of our immune system. These cause infections and illnesses. Ironically the bacteria that are in the mouth are a double edged sword. The very bacteria that give us cavities are the bacteria that compete with and help prevent the growth of periodontitis. So bacteria in a BALANCE with our bodies are beneficial. Likewise the digestive system is inhabited by bacteria that help us digest certain foods. If through stress, illness, antibiotics these bacteria are killed off or imbalanced our system can suffer. This brings us to the advent of PROBIOTICS. These "Good" bacteria are put into foods, yogurt, pills in order to replace what was lost. This theory has been embraced by the dental community as well and resulted in a new product. This daily mint is filled with "Probiotics that promote oral health". Soon to be available to the professional Butler/Sunstar Periobalance is currently available online to everyone. In cases where I find people have been coming in for their cleanings, they are using a Sonicare toothbrush, they are flossing, but still I find their gums are bleeding I recommend this product. As we have more feedback from the use I will update you again.

As Probiotics and proper nutrition go hand in hand, I have made comments about nutrition prior but a good source of information that I trust can be found:

http://theziedguide.wordpress.com/

Help! My Child's Tooth was Knocked Out!

I have been trying to select topics that one day could be of use to people in different dental situations. I thought what of the person who witnesses a tooth getting knocked out...what would they do? Of course your dentist will know but they probably are not with you at the time.

Firstly don't panic. If you are concerned enough for the tooth then obviously the person connected to that tooth is not so badly injured. Teeth can be replaced. More importantly has this person bumped their head or suffered any other concerning trauma. Should we mention again the untimely death of Natasha Richardson from what should have been very preventable.
Secondly be sure to pick up the tooth and just quickly put it in cold milk. The milk has the proper balance of certain chemicals that help keep the important cells of the tooth alive. Water can work but Milk is FAR better. If all else fails the tooth can be quickly rinsed and kept in the patient's mouth. This depends on the age and awareness of the patient!!!!!!!! ( The saliva will help to keep the tooth cells alive ) We would not want anyone to swallow the tooth! Again Milk is so much better.

Third CALL THE DENTIST. Any dentist with an emergency contact number can walk you through the process. If the tooth is placed back in the socket within one hour the success of replacement is much better.

What to do for Jaw Pain?!

Today I am all full of information. Maybe it is the spirit of St. Patrick's Day...who knows. I had 2 patients come to me in the past few days with Jaw Pain. Interestingly both are right handed and both had right side pain. One patient had an accident many years ago and the Jaw has Locked open at times ever since. This happened while he was in my chair. The thing to do was and is: remain calm, massage the side of the jaw muscles. Right around the area of the bull's eye in the photo above. After a little time of gentle (GENTLE) effort it closed. Another patient had a stressful week at work and it has been hurting. Her entire masseter muscle was tense to the touch and almost rock hard. With a little massaging we broke the spasm it has been fine since. Stress causes tension, tension and constant clenching of the muscle can result in "Little Charlie Horses" in the joint and masseter muscles of the jaw. A warm towel will help to bring blood to the area and warmth to RELAX that muscle. As some of my prior posts have said, rest (in the form of sleep, muscle rest, etc) is so important.
Hopefully everyone will enjoy. The DAY today.

How Long Do I have to Wear My Invisalign?

This morning I met with one of our new Invisalign patients. He said he was comfortable enough but found that he would rather keep them out during work. When I asked how many hours that translated into per day he said "Maybe 12". Ooooh not good. The whole purpose of the Invisalign is to put pressure on the teeth. This pressure is the same as fixed appliances (metal braces) but it needs to be in the mouth and on the teeth to do this. The great thing about Invisalign is it can be removed to clean the teeth properly BUT this is the bad thing as well. The reason we need to keep the aligners in at least 20 hours per day is simple and yet very complex. When pressure is placed onto any living thing it will respond. Put sunlight on our skin after a while it will turn red. Put pressure on muscles they grow. Put pressure on bone and it will change shape. The same applies to the bone around teeth. If you put pressure on the teeth half of the day and release that pressure for the rest of the day there is no NET movement. As the aligner places pressure the body responds in a very complex concert of events. The pressure translates into signals that move from tooth to ligament to bone to the circulation to the brain and back. Many chemicals are released and the bone shape changes. This all allows tooth movements.

It is also important to follow the prescribed time. Each aligner will be changed at a maximum of 2 weeks. There is a maximum speed that the bone can change and the teeth can move.

I find that our patients who are very diligent in wearing their aligners follow the prescribed treatment and time very well. The more patients give "excuses" for themselves (and some may be very necessary) the less the teeth will move and the longer treatment will last.

This is one of the reasons that I meet monthly with my Invisalign patients. It is easy to take for granted how complex the movement of teeth is because Invisalign makes it feel so simple.

And with a bit of commitment it is!

Why do I need a Dental Implant?

This week I saw a few of my patients who have had me surgically replace teeth with dental implants. It made me proud to see my work function well and look like a real tooth. The dental implant is the closest replacement dentists have to a brand new tooth. One day I expect to inject genes below the surface of the gum and generate a new tooth biologically. Until then I must rely on my training as a surgeon....which is along the lines of an orthopedic surgeon actually. When a tooth is lost immediately the gum tissue and bone below start to heal. If nothing is done this will heal completely, however significant changes will occur to the shape of the area. If we were to place bone or some grafting material into the socket and cover it up there is much less change to the site. The body will deposit bone and grow new gum tissue. Minimal changes occur. An implant placed here will do well. If the space is left alone the lack of use (lack of tooth) will allow the bone to deteriorate and shrink. Finally if a tooth is removed and it is possible to place an implant immediately minimal changes occur to the site. In fact one of the patients that I saw this week was such a case. The photos before and after show the gum tissue has really not changed at all. This is ideal when a front tooth and there is little room for change. As for the other patient timely implant placement has allowed little change in the area. In both instances we are very happy with the results. Dental implants have been in dental use for about 25 years. They have a great success rate (98%) when placed and cared for properly. I look forward to the day when we can clone teeth or grow them in the site. Until then, my artistic and surgical skills will be an important thing to maintain.

Preventing Decay: Chew Gum !

Who would have thought that one day the dentist would tell you to eat candy to prevent decay! Well almost. Sugarless chewing gum is actually a benefit to the oral dynamic. In previous posts I have mentioned how eating sugars fuels the bacteria in our mouths to make acid, this in turn dissolves the teeth. That dissolving becomes decay. Sugarless chewing gum has the added benefit of stimulating saliva. Just last post I spoke of the repairing quality of saliva.
When we chew gum sugarless or otherwise it causes saliva to flow. Anytime we eat as a matter of fact saliva will flow. (or should) If we chew sugarless especially Xylitol gum we get saliva flow without the negative effect of sugar. So we can prevent decay with gum right?
There is one caveat: if we chew gum too long we will dry the mouth out of saliva and find that the benefit of having sugarless gum is cancelled out.

SO we should chew a bit of Xylitol or Sugarless gum after meals to clean the teeth and get our saliva flowing again but STOP after about 10-15 minutes.
Yes you can have your gum and eat it too!

PS. I noticed some good information on the science behind xylitol at http://www.healthyfellow.com, I cannot comment on other articles that I did not read but the commentary on Xylitol was quite sound!

OH and PPS
Animal lovers and owners. Do NOT let pets eat anything containing Xylitol. It effects them by releasing their stores of insulin and they can die of hypoglycemia. My thinking is that some cake frosting below the tongue of an ill or unconscious animal could save their life but be sure to check with the veterinarian.

Xerostomia (Dry Mouth)

Zero what? Xerostomia (Zero-Sto-Mia). I have a good friend who true to the movie would break down the greek for us... :). Dry mouth is actually not so funny. I saw a patient this week who had photographs of her mouth just 5 years ago. She had a beautful smile. Since then she had been placed on anti-depressants. Since then she has been getting cavities and having teeth pulled. Presently she is in pain and honestly embarassed of her teeth. Sadly no one picked up that all this could have been prevented . HOW? Lets look at why this is happening, lets get to the root of the problem and build up from there. Xerostomia occurs when the saliva drys up. This can be for generally 3 reasons: Disease, stress/age and antidepressants (medications). Diseases can be for instance Sjogren's syndrome...it is an autoimmune disease that damages the saliva glands. Stress and age I place together because each will dry the mouth somewhat but may still be stimulated normally. Age will slow the saliva production as will occur in general with our bodies as we age. Stress is something that can change with time. It may be for a time and when over our saliva will return to normal. We all experience this when we get nervous and our mouth gets dry. Medication however as well as disease may not change for a long time. The devestation from lack of saliva occurs from day to day. The saliva contains antibodies, antifungals, and minerals we need to combat decay. If each day we lose a little ground to decay eventually as months pass and years pass we will find that tooth damage can be quite severe. It is important to recognize each of these reasons because each is treated differenly. Disease can be treated with medications and there is much information available for patients with Sjogren's syndrome. If saliva is dry due to age we can treat with topical methods. Toothpastes that have extra fluoride, (Prevident 5000) meticulous oral hygiene as well as certain rinses (Biotene products) and toothpastes (Colgate Sensitive with ProArgin technology) can be useful to help saliva flow and help prevent decay. Stress and depression can be treated in many ways: if medication is needed then physicians need to be mindful of the dry mouth that can follow anti-depressants. We can change the frequency and time of dosages to alter saliva flow. We can try different medications that may interact differently with certain genetics. The main point is that if diagnose the root cause we can treat and take proper action. Without a proper diagnosis all the dental dollars spent to spot treat symptoms of decay will be wasted and lost.

My comments to my new patient were, "This was not your fault! and it is not because you are a bad patient or neglectful person! This happened because you had an outside event cause damage to the balance of your oral health."

I am so happy to have asked the right questions and have seen Xerostomia and its affects and effects in my research at dental school. I can help our new patient get back in shape and smiling as good as new!

The Digital Makeover

The Digital Makeover Term may have been coined by someone else, but I like to think it is my invention...

I majored in Studio Art in my college years. Sculpting in bronze, clay and wax and painting in oil and watercolour I have gained a skill set I believe is perfect for dentistry. In the digital world we live in I am happy to have trained in Photoshop. Merging digital ability to change photographs and knowing the limitations of dentistry I can effectively show my patients realistic before and afters. When we are going to commit much time, energy and finances to a large proceedure I produce a digital mockup of what we should expect. I find this helps patients physically see what I can do for them and not just "trust me"....For the most part it gets us to share the vision and come into agreement on proposed treatments. Above you will see an actual case that we have completed and continues to looking and feeling great two years later. In fact...people think their teeth look better than the Digital Makeover does!

The Antidote, Anesthesia Reversal

Recently I have adopted a new product. Oraverse. Essentially this is the antidote to numbness. Many patients hate to get numb simply because the after-effects are bothersome. Only a handful of people opt not to have anesthesia because the alternative is possible pain. I "unlike the popular belief" do not like pain, nor do I wish to inflict it. So obviously for the most part we will get patients numb BEFORE working. On occassion it is useful to cause the anesthsia wear off faster.

For example I had a patient going to a parent teacher meeting after his appointment. Not wanting to drool and give a bad impression to his son's teacher he opted for the Oraverse.

As we were finishing up his eyes got wide and he touched his face...he gasped "WOW".

I questioned his comment and he said that the anesthesia wore off like a wave. His feeling had come back in a few minutes rather than a few hours.

Although reversing anesthesia is not necessary...we can leave the body alone and it does wear off on its own. If necessary technology has allowed us (as I call it) the antidote to anesthesia.

Why are my Teeth Senstive?

This Monday I will be interviewed by a writer about sensitive teeth. Interestingly enough this month I have had many patients (more than usual) tell me their teeth are sensitive. I am attributing it to the cold snap we have here in New York. It is not just cold air that afflicts the teeth, it can be cold water, sweets, tooth paste, or brushing. To give some background all teeth have pores. These pores are not on the white enamel that we smile with, rather they are right at the border of the tooth and gum. As we abuse our teeth with brushing too hard, grinding our teeth, not flossing, or even not having cleanings often enough our gums can receed. That yellow line you see at the border of the gum and enamel is exposed root. Roots are porous. These pores will go all the way down to the nerve of the tooth. So if something covers these pores, like gum tissue, enamel or calicium (as it should) the tooth is NOT sensitive. If an acidic diet (any drink having Citric Acid), brushing too hard, grinding our teeth, brushing with too strong of a toothpaste (for your mouth) can cause the tooth to be cold sensitive. Cold sensitive to: water, foods, ice, or the COLD New York air. There is a simple solution: cover the pores. This can be done by your dentist by multiple products, or by you at home with Sensodyne ProNamel toothpaste. The paste with Potassium Nitrate "quiets" the nerve of the tooth and soon via Calcium, Fluoride and saliva repair the pores get plugged up. A more "quiet" tooth means a more comfortable tooth. That being said on a tooth that is very sensitive, after brushing and flossing, one could rub a bit of the paste on that sensitive tooth (right at the level of the gum) and let it sit overnight.

Of course more can be wrong with the tooth, the sensitivity could be from a dying nerve and need a root canal, it could be from grinding your teeth, it could be from a crack in the tooth or a cavity, but this is a good start. I have to of course end with the comment "you should seek the advice of your dentist if symptoms persist for more than 2 weeks". That is just good advice no matter who is interviewing you. :)

There is some good information to also review on the Sensodyne website.

http://www.pronamel.us/

Snow Day

The Northeast has been slammed with snow. Manhattan is not too bad but it is really snowing fast. I cannot be sure what the rest of the tristate area looks like. For sure the surrounding areas get hit harder than the city. Even at that I have shoveled the steps twice in one hour. It was not much work but I feel if it covers up that quick... "Its a snowin' kids". Today our faithful patients are showing up! Amazing to me. Thank you all and travel safely. (If it keeps up this way we may close early to get our team home safely). Well as I work and get to see snowfall (I love that we have windows in the operatories) enjoy a photograph I took out on Long Island a few years ago.

Diet and the Genetics of Decay

Sitting on my couch I simultaneously rest and blog. I have for 3 days chosen to only ingest a liquid diet. An experiment of sorts on myself. I am juicing vegetables and fruits and "drinking" my meals. I have gone without solid food for 2 days now. I must say I feel fine. I am drinking alot of water, and I am having soup for dinner. Breakfast and lunch I had fruit juices. Interestingly enough (and those who know me will be amazed) I am not hungry. This is due to multiple things: first I have some extra weight that can support my metabolism, and I am getting nutrition. In our society we eat many foods, however are they nutrient rich foods? I can eat fast food all day and still be hungry...my body is trying to eat enough junk till it gets the proper nutrition. I can consume only fluids containing proper nutrition and my brain is satisfied. My real life lies someplace in between those 2 extremes. It does show me though that provided with the right fuel the body does not need the AMERICAN sized caloric intake. Interesting.
I of course must relate this to dentistry, as therein rests my purpose for blogging.
Our diet also impacts our teeth. While still forming our mothers' health and nutrition has been shown to prevent birth defects. While we are young our diet can start the clock of our lifespan. Yes the length of our lives have been shown (read TIME magazine "Epigenetics" Jan 18 2010) to be altered for better or worse by our young diet.
In the presence of sugar the bacteria in the mouth can live and thrive. Their metabolic by products will produce lactic acid. The more they eat the more acid they make and the faster our teeth will dissolve. On the contrary when we do not eat sugar at all bacteria that eat protein will thrive by default. These same bacteria can actually harm our gum tissue. Ps they are the same bacteria that make our breath smell when we have not eaten anything or brushed our teeth before talking to someone in the morning. There is much changed by eating right. Your teeth are just as affected by diet as the rest of your body.

Do I need a Root Canal?

The day almost slipped by without my promised weekday entry. Whew.

Having worked on 3 cases of root canal therapy I feel that today we should talk along these lines.

First case was a long standing root canal. This tooth was restored more than 10 years ago. Over time the bacteria that originally caused this problem can slowly grow again. They can hide in accessory canals or have remained from first treatment. It is imperitive for the dentist to CLEAN the canals. It is not just enough to fit a filling material into the tooth, it is PARAMOUNT to clean the inside of the tooth.

The second was a tooth that we had treated and finished today. At times a tooth will be very "HOT" everything will bother it, hot, cold and pressure. This patient had a large cavity but no exposure of the nerve. Over time however

When a patient presents with acute symptoms it is easy to tell that a root canal is needed. However our last case today did not result in a root canal. This patient had pain but no sensitivity to hot or cold (at least nothing out of normal). After viewing his X-ray and finding no infection I proceeded to ask him questions. The tooth did not throb, it did not respond to hot or cold abnormally. It did not hurt when he bit down on a test instrument. It did hurt him in the morning of an appointment to his doctor's office. His concern for that appointment resulted in stress and that caused him to clench his teeth while asleep. A tooth needing root canal will throb and throb with pain. A tooth as this last patient hurt only at times and only when the patient was stressed. This tooth did NOT need a root canal. It needs protection from stress. I suppose going into the weekend should alleviate some stress...from his life and hopefully all of us needing to rest.

More On Sleep Apnea and Brain Power

Today I read an article in Consumer Reports' Health section (March 2010 pg. 12). The author Orly Avitzur MD tells of the rising use of Ritalin and Adderall among adults. Once given as a treatment for children with ADHD, users have found that adults benefit from these drugs with increased concentration abilities. A word of caution from the author states that among the adult population the cause of this "aging, lack of focus and loss of memory" can simply be lack of sleep.
That lack of proper sleep she states can be sleep apnea! Certain medications including antihistamines, pain relievers, incontinence and ulcer drugs can make the mind cloudy and forgetful. Before turning to antihistamines to sleep and attention medications to like Provigil to sharpen us again SIMPLY be sure sleep is part of our 24 hours. Not just in the bed on a pillow but as I put in a previous entry REAL body repairing REM sleep!

Invisalign Braces and Straight Teeth

Around 4 years old I was sitting in the dental chair having my first filling. I thought it was cool. You might think I was crazy but truly it was the birth of my career. I found all through my schooling that the things I enjoyed were just the skills I would need to be a dentist. It was a perfect match..or maybe a calling. I went through my teen years with a mouthful of metal. I had major orthodontic work due to a missing tooth. In my situation with our current technology I would still have needed traditional braces. Invisalign is a great new (relative to my orthodontic treatment) technology available. The principles of tooth movement work if we use metal, plastic or rubber bands. The beautiful thing about invisalign is that it can be removed. The teeth can be brushed, and flossed normally. Yes there is physically something on your tooth most of the day, however with metal braces this is true as well AND unsightly. With mild to medium movements invisalign is a great choice. I have patients from family members to TV stars who find using invisalign quite simple. Usual treatments range from 6 months to one year. Straighter teeth that are easier to clean and keep clean, the gum tissue also remains healthier.
Dental proceedures and products have changed dramatically since I was in braces but straight teeth have always looked nicer. The great thing is now they can look nice AS we straighten!

Coumadin and Dental Appointments

Coumadin, Warfarin or any other anticoagulant therapy (Blood Thinners) may affect your dental visit. In years past it was thought that someone on any theraputic level of Coumadin needed to stop 3 to 4 days prior to dental visits. Really we find that this need not be the case. It is very important however to have consistent montioring while taking anticoagulants. Too high a level and the body can begin to bleed spontaneously. Too low a level and unwanted blood clots can cause internal problems like stokes and heart attacks. INR is a measure of bleeding time and thus the level of medicine in your system. If the INR levels are below 3.5 then anyone can have a routine cleaning or simple filling. If the level is below 3.0 then complex restorations can be preformed. If the INR is below 2.5 simple extractions can be preformed. If below 1.9 more complex dental surgeries can be preformed.

These values can be found at http://www.warfarinfo.com/dentalprocedures.htm.

There is no reason to postpone dental visits while on anticoagulant therapy. While there are many reasons for someone to take coumadin, diseases such as heart disease and stroke, in fact it is more beneficial to have a clean mouth rather than fear too much bleeding.

How Often Should I Floss?

There is a dynamic balance in the mouth. Each person's oral environment differs by genetics, eating habits, hygiene habits and bacteria. For the most part all of these are INHERITED. We inherit tooth and jaw shape from one or both parents. we inherit our eating and hygiene habits from whoever we spent the most time with growing up. We inherit bacteria from whoever fed you those first meals and "tested" your food for you. Interestingly enough we can only play the hand we are dealt however we can play a big roll to influence those cards.

Some people will build up Plaque very quickly and need to brush often or they will get Cavities between their teeth. Some people will build up Calculus quickly (this is hardened plaque) and they NEED to floss or they will get irritation of the gums called gingivitis and eventually lead to periodontitis and tooth loss. Some people seem to put little effort into their hygiene and have perfect teeth. I suppose in such a vague sense "IT DEPENDS". In a perfect world the dentist will tell you to floss everyday. In reality many people do not. Many people do not have to. It is great to get into a daily habit. Prevention goes so far in the mouth! It is better to stay ahead of the curve and not allow disease to set in. To spend time with your dentist and find out what is the right regimine for YOUR oral dynamics.

Oral Cancer

February is Dental health month. I find myself thinking of the impact dentists can have on their patients lives. In my career I have found 3 lesions which were diagnosed as cancer. Fortunately they were all small and completely cured. Each of these cases were OUTSIDE of the mouth. Two were on the face one on the tip of an ear (one person was an extended family member). As dentists we share a very close and personal space with our patients, we may notice things others do not. In general we look for things that are Brown, Red, or White. We look for lumps or bumps and things that look like un-explained wounds. I read this morning on the Oral Cancer Foundation website http://oralcancerfoundation.org/facts/pdf/Us_Cancer_Facts.pdf that 1.47 million Americans developed cancer in 2009. Of those 71440 were oral cancer. That means about 10% of all cancers found in America are found in the mouth.

In my efforts to keep our patients healthy, I have purchased an oral cancer screening light.
I have attached a video of how it works but the summary is this: normal mucous membrane cells will fluoresce when certain wavelength light is shined on them. Abnormal cells will not reflect light, they will absorb it. This allows me to see a dark spot before a color change or other clinical sign of cancer appears. Having lost an aunt to breast cancer I have been too close to the fact that EARLIER IS BETTER.

TMJ Appliance part II

I have worn my night guard (created special to keep my jaw in the proper resting position) for two nights now. I noticed my muscles more at rest on morning one. For the second morning I realize that my jaw sits more forward with the new appliance. Due to my missing lateral incisors my top jaw is smaller than the bottom. This should be opposite in fact. My bottom jaw is then constantly held to far backward. This produces muscle stress which builds over time. It seems that this new appliance allows my bottom jaw to rest in a more forward position and my muscles are resting. In reference to my post yesterday, rest is good for the muscles of the face as well!

Sleep Apnea and the Dentist

Rest is a vital part of our general health. During the night our bodies repair our cells. Without proper rest even the mind suffers. Recognizing sleep deprivation is important for everyone especially those of us in health care. If you are feeling tired through the day, if you fall asleep during the day or if you feel a general mental cloudyness there is a chance you are not resting properly. Some of us just need to get an early night and ACTUALLY REST. At times we find that there are other underlying issues. Sleep Apnea is at times an unrecognized root cause. Sleep Apnea can be caused by many issues: be they genetic, small lower jaw size, excess weight, alcohol consumption etc. Apnea is occurs when during deep sleep the soft palate or the tongue touches the back of our throat. This stops air flow and thus stops oxygen from getting into the body. The lack of oxygen causes us to wake up just a little bit. We don't remember this happening but it stops rest. If this continues for a long time it can cause deadly health problems.

Sleep Apnea can be recognized by your dentist. If confirmed with a sleep study dentists can actually fabricate a special night-guard that can alleviate or improve symptoms. By holding the bottom jaw more forward we open the passageways that allow us to breathe. If we are breathing normally we are sleeping properly and resting properly. With proper rest we will remain healthy longer!

TMJ appliance

As the Hair Club president was also a client; so I must also tend to dental issues.
I am genetically missing a tooth. A lateral incisor to be exact. As a result my orthodontist did the best he could with a compromised situation. My jaw as you could imagine is not perfectly lined up. I wear a night guard and this helps greatly. It relieves the clicking and popping. The guard buffers improper pressures and helps to relax the muscles. I have taken a course on such problems and learned to take specific measurements and realign the jaw. Today I received my new "Digitally Corrected" night guard. By placing the jaw in a corrected position (allowing my muscles to relax) I should help relieve muscle tension and jaw stiffness. I will wear it tonight and give feedback as to what I am feeling.

New Office Photo

This coming week I will be mounting a six foot version of this photograph in our reception area.
I took this just after our big "pre-Christmas" snow storm this year.

this is a link to the Flickr site in case you cannot see it here.
http://farm5.static.flickr.com/4001/4270968661_c4dac7964c_o.jpg

I suppose the bridge motif is echoed within the dental profession :)

Thyroiditis

Today we had a patient return to thank us for referring her to an ENT.
She had a sore throat for weeks. Her physician had her on antibiotics but with no help.
On her dental examination we noted that she had swelling in her neck (near her Adam's Apple).
It turns out that her sore throat was due to Thyroiditis. An endocrinologist who completed a blood work up which diagnosed the condition. Fortunately the Thyroiditis resolved on its own.