Mead Family Dental

What's the diagnosis?

Here's how it's supposed to work.  The patient comes in with a problem.  The dentist (that's me) looks at the patient, evaluates the x-ray, examines the tooth or teeth in question and tells the patient in no uncertain terms "you need a filling," "you need a root canal," or "this tooth can't be saved."  The doctor knows and tells the patient what they should do, right?

Here's the problem.  Each of those treatment recommendations kind of jumps a step.  I shouldn't recommend treatment without first explaining the diagnosis.

Merriam-Webster gives us a few different definitions for the term diagnosis. First is: "the art or act of identifying a disease from its signs and symptoms."  This is probably the most typical way people think of diagnosis.  This is how we can tell a cavity from gum disease.  They present with different signs and symptoms.  A sign is an objective measure of condition in the mouth.  Examples of "signs" are periodontal (gum) measurements or x-rays.  These are collected by the doctor in order to form a diagnosis.  Symptoms are subjective experiences of the patient. Common symptoms of dental problems are pain, "discomfort" and pressure.  They aren't measurable in the same way that signs are but that doesn't make them any less real.  Symptoms are described by the patient and interpreted by the doctor in relation to the objective signs collected.  

Another defintion of diagnosis is: "investigation or analysis of the cause or nature of a condition, situation, or problem."  I prefer this definition because it describes an active search to get to the bottom of the problem presented.

Some dental diagnoses (plural of diagnosis) are very straightforward.  A cavity found on the x-ray and verified with magnification and lighting and recorded with an intraoral photo is dentistry's version of the slam dunk.  This is a very common finding and the likelyhood of a dentist getting it wrong is very low.  

Other conditions require us to be a bit like a detective.  Sometimes we find ourselves settling on a differential diagnosis.  The differential diagnosis is a list of the most likely things that could be causing our problem.  For instance, "the tooth needs a root canal" isn't a diagnosis.  That's a recommended treatment.  A differential diagnosis might be "the nerve of the tooth is inflamed from a deep cavity.  It may be able to heal from this trauma (reversible pulpitis) or it might be on it's way to dying (irreversible pulpitis).  There are some signs and symptoms that help us determine which way it's heading.  And sometimes, we just don't know!

Next time you're visiting your dentist or your doctor, ask them to talk about the diagnosis.  One thing I can promise, they'll be surpised that you asked.  You'll be letting them know that you're an interested patient who wants to take an active part in their care.  I promise that you won't regret asking!

Are you interested in working with a Saginaw dentist who explains the diagnosis?  Then I'm interested in having you as my patient!  Drop me an email at alan@meadfamilydental.com (I always answer my own email!) or call the office at (989) 799-9133.  We'll get you in right away and you won't believe a dental office can treat you so well!  

Saginaw dentist reads minds! Amazing psychic powers???

So I had a patient in the chair earlier today.  I got a look at his teeth and said, "you have heartburn, don't you?  You suffer pain in your chest and throat after eating Italian food."

He got this look on his face.  It was kind of scared but also kind of amazed.  It was as if Sylvia Browne had told him about a relative of his from beyond the grave!

The difference is, Sylvia Browne uses cheap parlor tricks and I'm for real!

What's my secret?  Was I born with this amazing power?  Have I trained under experienced psychics? 

Nope.  I've just seen a ton of gastric reflux patients.  They have telltale acid erosion spots. They show up most often on lower molars. Once you realize they aren't necessarily from bruxism (a.k.a."night time tooth grinding") I see them a lot.  The amazing thing is that 25% or more of patients with gastric reflux don't have any symptoms!  No heartburn, no itchy throat, no noticeable bad breath. On top of that...these erosion area on the teeth usually don't hurt. They're often only detectable by a dental exam. This is particularly scary because untreated gastric reflux is a leading cause of esophageal cancer, and esophageal cancer is particularly bad!  

This Saginaw dentist is trying to impress you with his amazing powers.  But have no fear...there's nothing supernatural here!

Do you have questions about your teeth?  Would you like more information about gastric reflux or other topics I've talked about?  Feel free to email me at alan@meadfamilydental.com (I answer my own email) or call the office at (989) 799-9133.  I'd like to be your Saginaw dentist!

 

pH, your body and your mouth

I recently bought a bottle of water at Walgreen.  The brand was "Iceland Pure Spring Water" and it featured "pH 8.88" prominently on the label.  I read a little further to find:

"...it has one of the naturally lowest mineral contents of any water and a high pH of 8.88.  Icelanders live longer than any other nationality; we believe their secret to long life is their water."

This is an interesting claim.  My research (if you want to call finding a cool chart Wikipedia chart research) shows Iceland coming in 3rd to Japan and Hong Kong.  FYI...the U.S. comes in tied for 36th place with Cuba and Denmark.  So the claim that Icelanders live the longest is in dispute, but what about the pH of their amazing spring water?  Could it account for longevity?  Should I be worried about my pH?

pH is a measurement of acidiy or alkalinity in an aqueous (water based) solution.  A solution that is high in acidity has a low pH and a solution that is more alkaline has a higher pH.  pH is measured on a 14 point scale with 0 being the lowest pH (most acidic) and 14 being the highest pH (most basic or alkaline).  A pH of 7 is considered neutral, neither majority acid or alkaline. This 14 point scale is logarithmic, which means that each number on the scale is 10 times higher or lower than number above it or below it.  For instance, a substance with a pH of 3 is 10 times more acidic than a substance with a pH of 4 and 100 times more acidic than something with a pH of 5.

The pH of the human body is variable depending on the part of the body you're talking about.  The stomach has a pH of about 1...very acidic.  This is useful in breaking down the food into smaller, more digestible pieces.  Lysosomes, the small bags of chemicals found inside cells are used to break down damaged cell parts.  They can have a pH of 4-4.5.  Our blood is at a relatively steady pH of 7.34-7.45. The body keeps the pH of our tissues relatively constant completely separate from our diet.  

Our mouths are a bit of an exception.  The pH can range quite significantly in our mouths due to the presence of acid producing bacteria.  Some of the bacteria in our mouths can turn the carbohydrates that we eat into acid.  I've talked quite a bit about this in previous posts.  This acid can dissolve the surface of the tooth if it reaches a critical pH.  The critical pH, or the pH at which tooth structure begins to dissolve is 6.7 on the root surface of the tooth and 5.2 on the enamel.  Diet, habits and saliva flow have a lot to do with how well an individual defends against pH drops in the mouth.  But these localized oral pH fluctuations are not the same as pH change of the body.  

 You often hear claims that the pH of your body being off or unbalanced are the cause of disease.  Whether these claims are indirect like my water bottle or more direct as in some blogs or books, they need to be looked at critically.  Most of these claims have no basis in science or actual physiology.  Beware of diets or claims that talk about "changing your body pH."  Often they direct you to test your saliva to evaluate your body's pH.  That would be akin to checking the inside of your furnace to evaluate what the temperature of your house is!  Your body has very specific control mechanisms for regulating your pH through the lungs and kidneys.  Your diet makes no difference with regard to your body's pH, except in your mouth!

Some disease states can result in pH changes.  Diabetics can experience diabetic ketoacidosis, which can lower the pH of the blood.  This is a consequence of their inability to use sugar in their bodies. However, in healthy individuals this is not a concern.

So, do I think my Iceland Pure Spring Water at a pH of 8.88 will prolong my life?  Not really.  However, it was cold and delicious and made it so I wasn't so thirsty.   So it did what I was hoping it would!

Do you have comments or questions about this or any of my other posts?  Do you like what you see on my blog?  Leave a comment here on the blog or feel free to email me at alan@meadfamilydental.com.  This Saginaw dentist writes all the posts and answers his own email.  Thanks for taking the time to read!

diet pop, obesity and stroke: evaluating medical claims critically

Recent headlines suggest that those who drink diet soda are more likely to have cardiovascular problems, specifically stroke.  Let's review some of the headlines:

"Diet pop can be hard on your heart"

"Want to have a stroke?  Keep drinking diet sodas"

"Diet Drinks Help Waist, But Still Lead to Heart Problems, Stroke"

"Drinking diet pop might increase risk or stroke"

If you don't look any harder you could walk away with the idea that drinking diet soda will lead to strokes.  And if you're anything like me, this will lodge in your mind until the next sensational headline tells you something else that many people do on a regular basis is unhealthy and damaging.

Does drinking diet soda really make you more likely to have a stroke?  A stroke is damage to the brain due to a temporary interruption of the blood supply.  It's very similar to the damage to the heart during a heart attack.  What exactly is it in diet soda that makes it more likely for a stroke to happen?  According to the articles this same risk isn't found in people who drink regular soda.  So are we to assume that it's the artificial sweeteners?  

This is a perfect example of preliminary "science" prevented as fact used as a scare tactic.  Many news sources have gotten honest about the source of this information, but many others have not.  Retractions or good explanations of the methods don't make headlines, but scare tactics do.  

The correlation between diet soda and stroke was made in a poster presentation at the "International Stroke Conference."  Poster presentations are not the same as peer reviewed medical journals and definitely do not carry the weight of medical consensus.  This misinterpretation is not the fault of the scientists presenting the poster so much as the media drawing unsupported conclusions.  Simply stated, the connection presented has not been studied enough to make the statements that a lot of news sources are making.

Most news stories do not bother to mention that correlation isn't the same thing as causation.  There very well could be a correlation between intake of diet soda and stroke, but by no means does that mean drinking diet soda causes strokes.  It's that the individual data points of stroke risk and diet soda intake are often found together.   Perhaps overweight and obese people, who are clearly more likely to have strokes and heart attacks, are more likely to report drinking diet soda because they are attempting to lose weight.  Perhaps there really is some stroke inducing ingredient in diet soda.  The study that is referred to really doesn't make that evident.  There needs to be a lot of research and verification to reach a point where causation of disease can be determined.

The news media and others reporting the "drinking diet soda = greater stroke risk" are jumping the gun.  They're not interested in reality as much as a good story.  A story that might frighten you, but will hopefully be forgotten until the next scary headline.  

Is this ever done in dentistry?  I think it is.  I'll discuss that in another blog soon!