Cavity Wars

OK, lets talk decay. After all, the name of this blog is Cavity Wars. So I would think the first place to start with is, what is decay? There is a lot of misconception out there about that question. It seems most people believe decay (cavities) are caused by bacteria munching on their teeth, making holes. Wrong.

There are three things needed for cavities to occur. First of all, you have to have teeth. Second, you have to have bacteria and we all do. And finally, there has to be some kind of sugar substrate the bacteria can digest.

So, just what is decay? Or perhaps better, what causes decay? Your teeth are made of a few crystalline materials, the most prevalent being enamel and dentin, the molecular make up of I won't bore you with. Suffice to say that there is Calcium in those materials. That calcium is in a constant state of movement into and out of the crystalline structure, which way it is going depending on the pH of your mouth. The more acidic, the more calcium moves out, the more alkaline, the more calcium moves back in. So, in a nut shell, decay is caused by acid dissolving out calcium. Oh, and why do dentist seem to like Fluoride so much? Because it has a greater affinity to the crystalline structure of enamel than calcium does. What does that mean to your teeth? If there is fluoride present in your mouth while all this demineralizing and remineralizing is taking place, the fluoride molecule fits back in very nicely where the calcium molecule was and it takes a lower pH to get it to come back out, therefore making your enamel less susceptible to acid. Fewer cavities! And yes, as a dentist, I would LOVE to see fewer cavities!

Where does this acid come from? For the most part, for most people, it comes from the bacteria. When ever you eat food with digestible sugar in it, the bacteria ingest that sugar, metabolize it, and then crap the waste products onto your teeth. The waste product? Acid. After exposure to sugar, the pH in your mouth drops for about 20 minutes, out goes calcium. Do this enough and you have cavities.

But a lot of people, particularly young males (particularly young military types), like to take a short cut to decay in the form of acid ingestion. Yeah, they drink acid almost on a constant basis. Have you ever heard of the experiment done with Coke and some kind of meat? Cover the meat with Coke overnight and in the morning it is dissolved. Why? Because Coke (Pop in general) is a very strong acid. So you have these guys, sipping away on pop all day, constantly soaking their teeth in acid, dissolving them away.

Finally, lets talk "Cavity Creeps, Sugar Bugs", bacteria. Dental decay is a communicable disease! Most people don't know that you are not born with these bugs in your mouth (Streptococcus Mutans). You have to be inoculated with them, which cannot occur until you have teeth. Where do they come from? Your primary care giver (usually your Mom) shares hers with you. She kisses on you, or she samples your food before giving it to you, thereby taking the bacteria culture from her mouth and placing it in yours! However, not all strains of Step Mutans is as good at making acid as others, so if you are lucky enough to have a Mom with good teeth, you will get the same strain. Unlucky, and you get bugs that do their job really well and you get all kinds of cavities.

So, the lesson here? You need bugs to make cavities therefore, keep the population down by brushing and flossing. The bugs need sugar to make acid, so avoid sugars or if you have sugar, make it short and sweet and then at least rinse your mouth. And,choose your parents well. Jeremy was lucky enough to have a mother with NO decay, so she had a strain of Step Mutans that was not good at making acid. Lucky for him I didn't inoculate him, as my bacteria are a lot better at that.

Per your request Aaron. This is a photo of a procedure called an apicoectomy and retrograde filling. The idea here is that for various reasons, a tooth that has had a root canal does not heal properly. I believe the history on this tooth was trauma at the age of 10, followed by a root canal. The root canal was done at least one more, maybe two more times. It still didn't heal. So, at that point you are faced with the prospect of either extracting the tooth (most people prefer not to lose front teeth, unless of course you are from Virginia) or doing the above mentioned procedure.

The surgery is done by peeling (I love that, PEELING) the gums off the bone to expose the end of the root. The root tip is then cut off and a filling is placed in the end of the root (that is the kind of whitish area at the end of the root on the tooth on the left). The tissue is sutured back in place, and hopefully, the patient is in the 50% that heal with no further problems. He was.

Anyway, it is fun to do. As they use to say in school, "A chance to cut is a chance to cure"

Having spent a night in the hospital recently (my first and hopefully my last for a long time), I learned some interesting things about them. First of all, I am convinced that somewhere in that hospital there was a sign-up list with my room number to make sure there was always someone available to wake me up! "Oh crap, it's 3 AM, I have to go wake Pegg up"! I also suspect since there isn't a lot happening on the floor at 3 AM, that the nurses sit back at the nurses station and watch your heart monitor. As soon as it starts to slow and they know you are relaxing and going to sleep, here they come! "Sorry to wake you up, but we need to check your pulse and blood pressure". What the heck, doesn't that monitor tell you what my pulse is! Then, if that isn't enough, they have a fail safe backup plan. They run an IV into you, pump fluids in like there is no tomorrow. If someone forgets to wake you up, no problem, you have to get up and take a leak every half hour anyway. Hospitals are no place to get any kind of rest! Sorry, Parker, but you have to know it is true.

And I always suspected people where just making up how bad the food is. I mean really, food is food, right? Is that liquid diet some kind of masochistic twist in the cook? First thing I did when I left that hospital was stop and get a big, juicy cheese burger! I thought they wanted to starve me to death.

I also learned some interesting vocabulary. Actually, I learned it after I left the hospital and had a chance to talk to the local fire chief, who is a friend, and the first to my house when I had my little episode. He taught me what DRT is (dead right there - you know, they guy is shaving and just falls down, dead on the spot) and that they call guys that are not responding or didn't respond, drains, they are spiraling down the drain and there ain't no stopping them. And did you know, a lot of medical emergencies and deaths occur in the bathroom? Some old guy sitting on the throne (thank God not in a public restroom - wouldn't that just put Aaron over the top), straining to get out the prunes, and the strain is to much for his fragile blood vessels in his brain - pop goes the weasel - you guessed it - DRT.

"Private, have a seat in the dental chair" Picture the dentist sitting in the operatory with dark glasses and doing the Stevie Wonder head weave. "Private, we here at Camp Pendleton support the Blind Dentist Association (BDA) and Commander Jones here is our token blind dentist. He will be working on you today" "OK Doctor Jones, we are ready" Dr. Jones stumbles around the operatory and finally sits in the dental assistants chair. "No, no, over here" as the assistant guides him to his chair. Dr. Jones pickes up the drill, rev's it up to full speed and says, "OK, put my finger on the tooth we are working on"

Oh for crying out loud! What is with these guys that come to the dental office, all covered with tattoos, multiple body piercing, and tongue bars and then they act like whining babies in the chair! Had another one today. I swear, this guy had tats up and down his arms, a lip ring and a tongue bar and he was practically crying in the chair. Sounded like some little four year old. Geezzz, grow some hair, will you. I wanted to slap this guy heavily about the head and shoulders. He was embarrassing to the male gender of this planet. And of course there was the obligatory, "Nothing personal Doc, but I hate dentist." Wanted to say, "No offense taken, I hate babies."

There are several pet peeves that I have. Number one would be people who drive in the fast lane and can't seem to understand the simple words, "Slow Drivers Keep Right" and, "Keep Right Except To Pass". If you can't follow simple directions, you shouldn't have a driver's license.

But let's focus on dental patients, shall we. Now granted, the last post made it look like I enjoy inflicting pain, albeit, mental in those cases. And let's remember, it was the military and the Marines. Those guys are supposed to be tough. I was just doing my part to make sure they didn't get any pansies in the Marines. The truth of the matter is that like the majority of the dentists out there, my goal is to make the visit to the office as comfortable as possible.

The thing with dental patients is that a vast majority of them don't seem to be able to take responsibility for their teeth and the pain they cause them. You can't neglect your teeth, eat and drink nothing but junk, soak them in soda pop and not brush them, only see the dentist when you have a problem, and expect that you are going to have a wonderful dental experience. You are already in pain and now you want something done about it. I get the typical statements all the time, such as, "Doc, nothing personal, but I just hate going to the dentist". I would too if the only time I went was when I was in pain! And the real topper to me is that these are the same guys that don't seem to have a clue which end of a tooth brush to use, judging from the crap built up on their teeth. Lord Almighty, if you don't like going to the dentist, take care of your freaking teeth!

And the comment that really chaps my hide is the veiled threat, "I won't hurt you if you don't hurt me!" Hey, you are already hurting, you want me to get you out of pain and you THREATEN me. What kind of an idiot are you? Do you really think that makes me feel all warm and fuzzy inside? I'm about to poke you with a needle and you want to make me mad? Hello! I have told more than one patient, "Listen, I am here to help you but if you think threatening me is improving your odds, you need to find someone else to take care of your problem." So far, every patient I have said this to, has backed down, explained they are stressed and they are sorry. Granted, I understand all that, but sometimes, it is just to much. I didn't get your teeth in the shape they are in, you did. How any sane person thinks that the 2 hours a year at the dental office can make all the difference to their teeth, is an idiot. If you ain't doing the homework, nothing we do will matter. It is very distressing to get someone fixed up, only to have them return a year later all messed up again. It may be hard to believe, but I don't need that. However, the best dental care in the world will break down in a matter of months in a mouth with poor dental habits. It is one of the most frustrating aspects of dentistry. The truth of the matter is that something like 20% of the population drives 90% of dental treatment.

Ah, Camp Pendleton Marine Corp Base. What sweet memories. The heat, the dead vegetation, the jarheads. Having served in the Navy Reserve Dental Corp for eight years, I had plenty of opportunity to observe each and particularly our Marines. Those guys will face live machine gun fire, exploding hand grenades and falling mortars with barely a qualm. But get them in a dental chair, that is a entirely new story. Sometimes I think the only thing keeping them in the chair was their exact attention to military courtesy and rank.

I often traveled with the same Dental Tech, Alan. For a guy that was not a working dental assistant, he was one of the best dental assistants I ever have worked with. Well, Alan and I had a few routines that we liked to "pull", pardon the pun, on a Marine now and then.

One of my favorites involved a glass eye that Alan had one of the Medical Techs make for him, very realistic. I would palm the glass eye and shortly after seating the patient and leaning him (yeah, him, the female Marines were to tough to pull this on) back, I would start blinking rapidly. That was Alan's clue to ask, "What's the matter Doc, that glass eye bothering you?" Upon which I would put my hand up to my face and bring the glass eye down and ask, "Yeah, you see anything on that?" Clean the eye off, put it back up to my face. For the rest of the appointment, that poor Marine would be staring into my eyes. Alan would make a point to tell him now and then to quit looking into Doc's eyes.

Alan had another prank he really liked. Dental Dynamite. Dye a cotton roll red, tape some thread or floss to it. We would be working on an extraction and might be having a little trouble and Alan would look up, "Dental Dynamite?" "Yeah, looks that way". I would leave the room and Alan would get out the "dynamite" and tell the patient, tough extraction, need some help, dental dynamite. Then he would tell the patient he was going to put it in the patients mouth and for him to bite gently. Once in place he would pull the fuse and run out of the room to wait for the thing to go off. So, he would very slowly place the cotton roll, ask the patient to close, "No, No, not to hard!", jerk the string and run. Don't know why we never got court marshaled.