Smile Studio Orthodontics Blog

Dr. Marie Farrar and Smile Studio do not endorse any products for financial gain.  Dr. Farrar speaks candidly about products and services she uses and likes.  Any recommendations made on this blog are her own personal--though well-reasoned--opinions.

Tuesday
Feb142017

Pacifiers and Thumbs Suck

Note:  This is a reprint of an article published in February 2017 Natural Awakenings.

Finally, science is confirming what orthodontists have long understood.  Pacifiers cause children to need braces later on.  And not just pacifiers, but thumbs, fingers, blankies, and any other comfort device an infant may habitually suck on to soothe himself.

A systematic review and meta analysis published in the December 2016 Journal of the American Dental Association concluded that non-nutritive sucking behaviors are strongly associated with malocclusion as late as the mixed dentition.  By pooling 15 different studies, Australian researchers Drs. Esma Dogramici and Giampiero Rosse-Fedele were able to provide the strongest evidence yet that sucking habits are definitively associated with anterior open bite (front teeth that don’t overlap or touch), posterior crossbite (top teeth that don’t overlap the bottom ones), and class II (top teeth that protrude and/or bottom teeth that retrude).

Local orthodontist, Dr. Marie Farrar, says she struggled when her children were infants with how to proceed regarding sucking habits.   Having seen the after-effects of sucking behaviors, she was anxious to prevent as much orthodontic treatment as possible for her own children.  But she totally gets why it’s such a hot-button issue for stressed out parents.

“It’s easy to say no ‘paci’, no thumb.  But when it’s your child suffering -- or your own self, suffering from lack of sleep and sanity – I know from experience that you’ll do whatever it takes to keep your child comfortable and happy,” Dr. Farrar relates. 

The thumb vs. pacifier debate has raged for years.  Dr. William Sears promoted the thumb over the pacifier because baby can always find it in the night and self-comfort herself for years. 

“But I’d read,” Dr. Farrar continues, “that babies’ suckling instinct starts to decline from about six months and that six to nine months is the magic age for weaning them from the paci, before they get too emotionally attached to it.  We were successful in getting our oldest off his pacifier that early, but our daughter was a different story.  She had started day care earlier and got in that cycle of recurrent ear infections, so for our sanity and hers, we weren’t able to get her off her pacifier until she was almost three.”

Dr. Farrar suggests offering a cozy “lovey” at the time of weaning off the pacifier to transfer the child’s emotional attachment to something more tactile.

“I’m actually less concerned with the dental after-effects of sucking habits—those can be fixed with orthodontic interventions and treatments, Dr. Farrar states.  “But I’m a lot more concerned about the successful transition from tongue thrusting.  Non-nutritive sucking just seems to delay that transition, and some adults never develop proper tongue function.  Normal tongue posture happens naturally at the right time if a baby doesn’t have a thumb or pacifier in the way.  But the longer it goes on, the harder it is to correct.  And improper tongue posture and function WILL create lifelong dental problems; that’s what I treat all day long every day.”

Dr. Farrar asserts that dental arch and even airway development would be improved if babies were swaddled, carried, and nursed on demand for at least the first nine months of life, and never offered a pacifier, bottle, or sippy cup.  But with a laugh, she says, “that’s highly unlikely and unreasonable in our 21st century society, so we orthodontists are here to help pick up the pieces.” 

Thursday
Jan302014

Sugar Substitutes for your Sweet Tooth

So last week my daughter shopped for and took in snacks for her home room: a bag of Cheetohs, a 2L Coca-Cola, cupcakes made from a mix, and 2 containers of store-bought frosting.  Where, oh, where did I go wrong?!?  My only consolation is that she said she was just thinking about what her friends like.  Hmmmm.

If you follow our Smile Studio facebook page, you know I’m on a huge tirade against refined sugar. You see, I run across SOOO many patients (and it’s not just kids), who have tons of plaque and get white spots and cavities because they have a bad sugar habit (combined with less than stellar oral hygiene!).  And this isn’t just associated with braces.  I’ve seen it before braces are even applied, with clear aligners, and in retention. 

I’m not a whole lot happier at the thought of using artificial sweeteners, especially chemicals such as saccharin (Sweet’N Low), aspartame (Equal) and sucralose (Splenda).  Besides the long-standing concerns about the toxicity of these substances, lately I’ve been reading how artificial sweeteners trick the brain and end up contributing to weight gain and not improving diabetes

Other sweetener substitutes are the sugar alcohols such as mannitol, sorbitol and xylitol.  These are frequently used in sugar-free candies and gum but are rarely used for baking because they’re not as sweet as sugar, still have calories, and can cause bloating and diarrhea.  These are the sugars that “don’t promote tooth decay”, because they don’t feed the bacteria that cause cavities. 

The one I want you to pay attention to, though, is xylitol, because there have been numerous studies demonstrating that it is actually antibacterial to the pesky bugs in the mouth that cause tooth decay, and even to the pesky bugs in the nasopharynx that contribute to ear infections, sinus infections, allergies, and even asthma.  Some people use it as a nasal spray, and some even take it as a supplement.   What I recommend is that you find a xylitol chewing gum that you like, and use it instead of any other gum you are accustomed to using.  Now these can be expensive and hard to find (think Whole Foods).  I have found that Mentos PURE has xylitol as its number one ingredient, though it also has sorbitol and mannitol.  It’s readily available on most candy aisles.  Just be aware that xylitol is toxic to dogs.

I must caution you that I can’t wholesale recommend all products with xylitol or sugar alcohols as 100% good-for-you, because I can’t vouch for their pH.  We know that acidity in our foods and drinks are causing as much trouble for some folks as sugar due to acid erosion.  At least one report questions the widespread use of sugar alcohols without further study of the acidity of other additives.  

Other sweeteners you might consider (though you should know that they aren’t calorie-free or necessarily useful in preventing tooth decay) are whole, natural sweeteners such as medjool dates, molasses, honey, and maple syrup.  I prefer to use these at home in place of sugar when possible, because they are natural sugars that haven’t been refined.  They’re far easier for our bodies to process and less addictive.  You can find lots of recipes online but here’s my favorite “raw” brownie made with dates.  A side benefit to honey is that it is naturally antimicrobial and local honey supposedly helps to reduce allergies to local pollens.  I buy unsweetened yogurt and mix in a dollop of honey to sweeten it to my taste.

Stevia is another good sugar substitute that’s also naturally occurring, but it’s generally sold as a refined product extracted from the stevia plant.  You can buy it in many grocery stores, though it’s a lot more expensive than sugar and artificial sweeteners.  It’s got zero calories, and appears to have multiple health benefits in addition to not promoting tooth decay.  I’ve never tried baking with it, but I do buy it in packets for sweetening tea and coffee.

So the long and short of it is that we Americans have insatiable sweet teeth, and sugar substitutes don’t seem to take away our desire for more.  My personal rule of thumb is that if Mother Nature made it, it’s probably OK in moderation.  If it’s been manufactured by humans, I try to avoid it.  Of the refined or processed naturally occuring sweeteners I prefer Stevia and Xylitol, because of their proven health benefits.   

Dr. Farrar’s tips for managing your sweet tooth:

  • eat fresh, whole fruits, or drink juices or smoothies made from them
  • nibble on a small piece of dark chocolate, savoring the flavor with a warm beverage
  • chew xylitol gum (Mentos PURE will do just fine), especially after a meal for up to 20 minutes
  • sweeten hot beverages, oatmeal, and plain yogurt with local honey
  • if you bake, try some recipes using whole, natural sweets such as medjool dates or maple syrup or honey
  • if you must sweeten your beverage, use xylitol or stevia packets instead of Equal, Splenda or Sweet’NLow
Wednesday
Jan222014

Resolved to make your smile a priority this year?

Of course, an orthodontist can check out your bite and give you advice.  But your very first step should be calling your dentist’s office.  He or she can take care of any active tooth decay and/or gum disease, get you on a maintenance program of dental cleanings, and give you treatment options to improve the esthetics of your smile and the function of your bite. 

You don’t necessarily have to go to a dentist who promotes him- or herself as a cosmetic dentist.  There is no formally approved specialty in cosmetic dentistry, as all dentists are trained to replace and repair teeth cosmetically.  Wikipedia states that the only two dental specialties with formal advanced training in dental esthetics are Prosthodontics and Orthodontics.  (So, if you're looking for esthetic options in the Chattanooga area, I think Dr. Baldree and I could be a "one stop shop" for you!)

Often, esthetic concerns have an underlying bite issue that can be treated orthodontically for far less money and with greater stability and longevity than by treating them with facings or caps.  So before having any healthy teeth cut down for crowns or veneers, you should also consult with an orthodontist. 

Please know that many of the highly advertised aligner and “six month” treatments are often limited to correcting just mild to moderate alignment issues without correcting underlying problems with the fit and function of the back teeth.  Be aware that many dentists who provide these orthodontic services are not specialty-trained orthodontists.  An actual orthodontist can offer both limited and comprehensive plans, and advise you regarding the risks and benefits of each approach.

Be sure to ask about how long you can expect your results to last, as well as how much you will need to commit in terms of money and time.  And before expending your life energy on this process, be sure to do your homework and research both your provider and the procedures he or she recommends.  The Tennessee Board of Health has a practitioner lookup here that gives you licensure and educational background as well as disciplinary actions.

Tuesday
Dec172013

Sugar, Sugar Everywhere!

‘Tis the season for holiday gatherings and gift giving, and all the sugar and heavy foods are making me feel just plain yucky.  Do you feel it, too?

I KNOW the dental and physical harms of too much sugar in our diets, and yet here I am again this year, in the kitchen baking.  I baked 5 dozen cookies to take to my daughter’s school last week, baked a few more this weekend for teacher gifts, and still have 2 cakes to bake for family gatherings.  Ah, what’s a good dentist to do?!? 

I don’t have to tell you that the evidence is piling in that we Americans eat far too much sugar, and consequently we are growing heavier and more unhealthy.   We are also hearing more about the dangers of the sugar we consume not only in sweet drinks, desserts and treats, but also from hidden sources such as spaghetti sauce, crackers, and salad dressings. 

From the dental perspective, we know that the bacteria responsible for tooth decay thrive on the sugars that pass through our mouths and stick to our teeth in the form of dental plaque.

So how do we handle the onslaught of sweets during the holiday season?  Here are just a few tips I’ve learned through the years.

A little bit goes a long way.  Unless you’re a diabetic or on a special diet, you don’t have to feel guilty for an occasional indulgence.  They’re best enjoyed at the end of a meal and in small bites.  When my husband and I are eating together and there are multiple desserts on a buffet, we will make up a small plate of tiny servings and each sample a bite of all the offerings. 

Avoid sweet drinks, especially between meals.  I’m a big fan of water; it’s inexpensive, readily available, and hard to get too much of.  Herbal teas are my second favorite.  (I found Candy Cane Lane tea at Target this week, OMG it’s my all time favorite, and harder to find than hen’s teeth!  Sorry Chattanogans, but I bought the last two boxes.)   If you must sweeten your tea or coffee, use xylitol packets (they’re expensive and hard to find, but worth it).   Stevia, honey, and maple syrup are all more natural options than refined sugar or sugar substitutes that may be somewhat better for your health if you must drink sweet drinks.  The whole issue of sugar substitutes is a “whole ‘nother topic” for a separate blog post. 

Pick your poison.  When eating sweets, I choose dark chocolate with nuts, and fruit-based over ones made from milk chocolate or nougat.  I also choose homemade sweets over ones that look like they’ve come in a package from a store. 

Clean your mouth after meals and snacks.  If you can’t get to a toothbrush, then swish your mouth with water and/or chew some sugar-free gum (preferably xylitol-sweetened like Mentos PURE).

Out of sight, out of mind.  Graciously accept the wonderful sweet treats given to you by well-intentioned friends and family, but put them on a shelf in the cupboard rather than out on the counter top.  That way you won’t be tempted to sneak a snack. 

It’s better to waste the food than to waste your body.  Don’t hesitate to throw out sweets you won’t eat or don’t like, or in excess of what you and your family should consume.  Or drop them by your community’s homeless shelter to supplement their meals.

Add in AT LEAST one dark, leafy green per day.  This one comes from my friend Jenni Lee at Greenlight Health Coaching.  Collards, kale, and spinach can be eaten raw as in a salad or can be easily added into soups and stews.  Enzo’s, just down the street from my office, makes a fabulous kale salad that I often crave.  And here’s a simple recipe for a great looking collard green salad. 

Grab a piece of fruit or a handful of nuts to satisfy your craving.  A sugar craving indicates you have been eating too many refined sugars and carbs.  Clementines, apples, and bananas are easy to grab and go and are surprisingly satisfying.  Nuts and nut butters are also healthy options for between meal snacks.  Almond butter spread on apple slices satisfies my sweet tooth far better than most syrupy sweet dessert offerings. 

Consider recipes using natural products for sweetening.   There are so many whole and nutritious food bloggers out there on the internet.  Check out this great recipe a friend shared with me for delicious and healthy “raw” brownies using medjool dates instead of refined sugar.

Bake only what you need as you need it.  At home, I refrigerate my cookie dough and pop a few in the oven to bake as we are eating dinner.  You can even bake cakes in small loaves.  This helps you serve small slices of cake and freeze the extra loaves that you don’t need immediately. 

Bake with love from scratch using fresh ingredients.  Store-bought packaged sweets and boxed mixes are full of all kinds of preservatives and ingredients I can’t pronounce.  When you bake, bake from scratch using fresh ingredients.  

Experiment with your recipes.  While I've never tried baking with Stevia, I have learned through the years that I can reduce the sugar content by as much as half in several of my family's favorite recipes with little effect on our enjoyment of them.

Get fresh air, sunshine, and exercise.  All of these help clear your head and lighten your mood.  Physical exercise strengthens your muscles and your heart as well as improves your metabolism and helps you burn off excess calories.  Try to get in a workout before a holiday feast, or talk a walk with a friend afterwards - rather than a nap!   

Learn from your mistakes.  When you do give in to temptation and overindulge, pay attention to the way it makes you feel afterward.  Do you feel sluggish and heavy, and are you left with a bad taste in your mouth? Was the transient sugar high worth the longer-lasting side effects?  The next time you are tempted, you will be less likely to fall victim to sugar’s allure.

Here's my family's favorite cookie recipe.  They are so indulgent that I only bake them at Christmas.  I have a bowl of dough sitting in my fridge right now, but I'm not sure when I will bake them because we have so many sweets coming into the house at the moment!

Holiday blessings to you and your family this holiday season.

 

 

Thursday
Sep122013

No Pain, No Gain?

One of the things new patients always ask about is pain.  They’ve heard that braces hurt.  Let me reassure you that the vast majority of patients are pleasantly surprised that braces hurt far less than thought it would.

Here’s what I can tell you about the discomfort of tooth movement:  

There is some inevitable discomfort associated with the start of the tooth movement process, whether the tooth movement is associated with braces, aligners, or tooth-moving retainers.  This is typically described as a dull ache that can be intermittently sharper when chewing or biting or even brushing your teeth.  Most patients report that this soreness gradually increases over several hours, peaks about a day after the tooth-moving force is applied, then lasts for 2-5 days after braces are placed, and for 1-3 days after adjustments.

For teeth to move orthodontically, we rely on the periodontal ligaments that hold the teeth in the bone, to relay the pressure from the archwires (or aligners or retainer springs) to the bone, causing bone to resorb on one side of the tooth and fresh bone to be deposited on the other side.   The pressure should be constant for this process to get under way.  Intermittent pressure from rubber bands, retainers, or aligners will just cause the bone around the teeth to get dense, and the fibers between the teeth and the bone will get tighter as the body “bucks up” to the new challenge. 

This is why it takes so much more discipline to move teeth with retainers or aligners.  But if you do try it, just remember that your teeth won’t always be as sore as they are in the first few days.  The teeth don’t stay sore the whole time they are moving.  They will keep moving throughout the entire time between adjustments even though the soreness happens in the first few days.

The tooth movement process happens most efficiently (with less overall discomfort AND faster movement) when the periodontal fibers get “stimulated” through chewing, vibration, or light pressure.  This stimulation basically pumps fresh tissue enzymes and oxygenated blood into the site while moving out the inflammation and pain mediators.  It also helps to release minor frictional binds that can occur between the wire and the brackets.  

There is a device currently being marketed, specifically to accelerate tooth movement through a light vibration, but it requires patients to sit with this device in their mouths, biting on it for 20 minutes daily.  This seems impractical to me, as well as costly.  You can get virtually the same effect with sonic toothbrush, but I don’t know who would actually brush for 20 minutes a day!

You should know that in my practice, I start braces treatment with light, flexible, archwires in an effort to minimize the discomfort and other adverse effects of tooth movement.  The gentler the tooth-moving force, the fewer pain mediators are found in the tissues.

I also give patients a rubbery “therabite” wafer to chew on periodically after braces are placed, and aligner “chewies” after delivering aligners.  However simply chewing normal foods and biting your teeth together periodically will also help.  If you notice a specific tooth that is getting particularly sore, it’s probably because it does not hit when you bite your teeth together.  So you can just take your finger and lightly press on that tooth periodically until the soreness passes. 

The key to the ligament stimulation method of managing discomfort and speeding up tooth movement is to start the stimulation before the teeth actually get sore.  If you wait until the soreness has set in, you will find it more uncomfortable to stimulate the tissues—but even then it will be more effective than no stimulation at all.

If you are still uncomfortably sore, I suggest taking the recommended dose of over-the-counter Tylenol (or generic acetomenophen).  Never take more than the recommended dose because there is not a lot of margin before Tylenol becomes dangerously toxic!

If the Tylenol hasn’t had the disired effect after an hour, try adding a dose of a NSAID such as ibuprofen (Motrin or Advil) or Alleve.  Tylenol and Motrin act in different ways, and some studies indicate that, when taken together or alternatingly, they can be just as effective as a narcotic.

An adult can actually take a prescription strength of ibuprofen using OTC pills: up to 1000 mg as a loading dose, followed by 600 mg every 6 hours or 800 mg every 8 hours.   The maximum daily dose is 3200 mg.

If you are still in a lot of pain after taking the maximum dose of Tylenol and the maximum dose of ibuprofen, especially if the discomfort does not improve over the course of a day or two, it may be a sign that a tooth has abcessed and will need a root canal treatment.

I no longer recommend starting out with a NSAID (even though they are more effective against tooth movement pain) because they have been shown to actually slow tooth movement by blocking both bone resorption and ligament and cartilage repair.  Management of tooth-movement discomfort should be managed without ibuprofen if all all possible.

In summary, follow these steps to manage your tooth movement discomfort and provide for the fastest movement:

  • Stimulate your periodontal fibers periodically before the discomfort peaks, and continue stimulating until it subsides.
    • chew normal foods (no “babying”)
    • chew gum (if you are in stiff wires)
    • bite on a therabite or aligner chewy
    • press on your tooth/teeth with your finger
    • brush with a sonic toothbrush
  • If you become too uncomfortable, take over-the-counter acetaminophen (Tylenol) at the recommended dosing—never more than the dosing recommended on the label!
  • Add in an OTC NSAID (Motrin, Advil, or Alleve) only as needed to get you through the peak discomfort.
  • If you are trying to move teeth with rubber bands or a removable aligner or retainer, it is vital that you minimize the time they are out of your mouth, at least until this initial soreness is resolved.  
Thursday
Aug152013

Don't focus on the potholes

I had a revelation the other day when out with my 15 year-old practicing her driving.  I found myself describing to her how to avoid potholes: focus on where you want to be, rather than on what you don’t want to hit. 

I first heard this years ago from a trail bike guide at a resort in the Sonora desert.  This guide would huddle us novice cyclists up periodically to prepare us for the desert trail’s upcoming twists, turns and obstacles.  He would remind us that if we focused on the cactus at the side of the trail, we’d be sure to brush against it.  He encouraged us to instead note and acknowledge its presence, but focus our attention on the clear part of the trail.

My mind took me to my conference room table, explaining the informed consent for braces treatment—the litany of all the pitfalls that I legally have to explain to patients before they start treatment.  Like the surgeon explaining that you can die on operating table.

I’ve always hated telling patients all the terrible things that can befall them, because I’d rather set the expectation for the beautiful results at the end.

Do you know anyone who likes to expect the worst, so they can be pleasantly surprised when things actually go smoothly?  Watching these pessimists go through life, I sure wonder if they don’t bring more bad things upon themselves with their fear and worrying. 

On the other side of the fence are the Pollyannas who refuse to acknowledge potential pitfalls.  They can easily be blindsided when things go wrong. 

I prefer to be aware of the problems that can arise—whether in the road ahead, in medical treatments, or just in life in general.  With that awareness, I can acknowledge the potholes, yet focus my attention on the clear spots and aim for a clear passage.  In orthodontic treatment planning, I set the intention for a desired outcome that can be realistically achieved, and chart the course to get us there.  While I legally have to tell patients all the things that could go wrong, I try to shift the focus back to the expectation of smooth sailing to a successful outcome.

What about you?  Do you consider yourself a pessimist or an optimist?

How do YOU avoid the potholes in life?

Tuesday
Aug062013

Why visit an orthodontist by age 7?

Don’t kids need all their permanent teeth for braces?

Yes, the American Association of Orthodontists recommends that all children be screened by an orthodontist by age 7.  And yes, comprehensive orthodontic treatment should align all the permanent teeth through the 12-year molars.  But you should know that actual braces are rarely recommended for a child at age 7.

By age 7, your child should have lost several baby teeth and grown in their permanent replacements as well as the permanent 6-year molars.  A panoramic x-ray taken at this time will identify any missing permanent teeth or problems with wayward teeth that are not erupting properly.  

An orthodontist will be able to identify issues with crowding, crossbites, or jaw size imbalances, which are often best addressed during the transition from baby teeth to permanent teeth before jaw growth is complete.  Since lip, cheek, and tongue forces help guide the teeth as they erupt, an orthodontist will also help manage any oral habits such as thumb or finger sucking, lip trapping, tongue thrusting, or mouth breathing.

Most treatments I recommend at this age are passive guidance of tooth eruption and arch development aimed at intercepting bigger problems, minimizing the need for permanent teeth to be pulled and reducing the time spent in full braces.

Can all of this be handled after all the permanent teeth are in and jaw growth is complete?  Perhaps.  But know that your child’s treatment may involve more time, money, and effort if he or she doesn’t see an orthodontist until after the dental development is complete. 

Wednesday
May222013

We are certifiably green--AGAIN!

 

Dr. Marie Farrar at the first ever Green Dentistry Conference with Ina and Dr. Fred Pickross, founders of the EcoDentistry AssociationI am pleased to announce that Smile Studio Orthodontics has achieved the Gold level of GreenDOC Dental Office Certification by the EcoDentistry Association!

Being LEED certified was a big part of our reaching Gold.  You can read here about all the measures we took to become certified as LEED Silver for Commercial Interiors.  Listed below are some of our additional initiatives that make us EcoDentistry Certified Gold.

Waste Reduction & Pollution Prevention

  • we use a steam autoclave with reusable instrument cassettes instead of paper-plastic pouches, and we distill our own water
  • we have reduced the use of plastic barriers and disposable supplies
  • we use eco-friendly disinfectants for surfaces and equipment lines
  • we have eliminated the use of toxic cold sterilants by selecting instruments that can be heat sterilized
  • we have a digital x-ray system, which eliminates chemical waste
  • we subscribe to a recycling service and even our sharps waste is recycled
  • we collect and recycle ink and toner cartridges, batteries, fluorescent bulbs, propane and oxygen bottles, and small appliances
  • we recycle the disposable toothbrushes used by patients in our office, and collect their toothbrushes and empty toothpaste tubes and floss dispensers
  • we compost our kitchen waste
  • we provide filtered drinking water in our break room and reception room to eliminate the need for bottled water
  • we save transportation and shipping waste by having an in-house lab for our models and retainers
  • we use rechargeable batteries where possible
  • we purchase in bulk and choose recycled content, recyclable, and/or compostable supplies when available
  • we purchase supplies from eco-friendly vendors when possible
  • our cleaning service uses green cleaning products and processes
  • we utilize a green landscape management company
  • our stationery and prnted communications are printed on FSC-certified paper
  • we send appointment reminders and many other communications electronically
  • we print and copy double sided when possible
  • we send patients’ take-home supplies in a reusable shopping bag

 

Water Conservation

  • we use hand sanitizer instead of soap and water when possible
  • our landscape plantings are drought tolerant and we do not irrigate automatically

 

Patient Care, Workplace Policies, & Community Contribution

  • we participate in charity dentistry projects such as Smiles Change Lives
  • we participate in community service such as the Oral Cancer Foundation’s Walk for Awareness
  • my staff and I take continuing education about green dentistry
  • we use only BPA-free adhesives
  • I provide patient education regarding whole-body health
  • we provide honey, Stevia, and xylitol as sweeteners at our hot beverage station for patients
  • we give patients a BPA-free reusable water bottle with Xylitol-sweetened candies and gum when patients get their braces off
  • we send healthy gifts to referring offices, such as oranges, chocolate covered strawberries, and trail mix

 

Oh, and did I mention I drive a Prius?  And since my husband works next door, we frequently carpool to and from work!

As a healthcare provider, I seek to practice sustainably and in a way that "does no harm" - either to patients or to the environment.  As eloquently put by Christopher Gavigan, co-founder with Jessica Alba of the Honest Co.: "Most people think living greener is about safeguarding the Earth, but my approach is about living for your health, which ultimately has positive impacts for the planet."

Friday
May102013

Got Gardasil?

Our Smile Studio team at the 2013 Oral Cancer Walk

April was Oral Cancer Awareness month, and our Smile Studio team was proud to walk in support of oral cancer awareness at the Oral Cancer Foundation's 4th annual Walk for Awareness in Chattanooga.   I was happy to participate again in the free oral cancer screenings and enjoyed getting to use the Identifi screening light generously loaned by Patterson Dental.  When I got back to my office, I was pleased to verify that my new UV curing can also double as a screening light.  

Thankfully, I personally have never diagnosed oral cancer in one of my orthodontic patients (knock on wood…), but now I have a tool for screening suspicious lesions before having to send patients to have a biopsy.  

I have, unfortunately, seen oral cancer's devastating results far too many times.  Imagine not being able to chew, swallow, or talk because a big part of your jaw or tongue or throat has been cut away.  This is truly a destructive disease that has devastating effects on quality of life.

Back when I started practicing, the main candidates for oral cancer were tobacco chewers and older adults who smoked and drank alcohol heavily.  Not the type of patients typically treated in the orthodontic chair—though I’ve seen my share of teenage and young adults with suspicious lesions due to smokeless tobacco through the years.

For a while, oral cancer rates dropped, thanks to the remarkably successful national campaign against tobacco use.   I’m around smoking so little now <thank heavens!> that I can smell a smoker 20 feet away!

But now the oral cancer news is all about the rise of oral cancer in a younger, more health-conscious demographic.  And it’s specifically related to the human papilloma virus (HPV), specifically HPV-16.  HPV-16 is one of the versions known to be sexually transmitted—yep, from oral sex, but also apparently from “French” kissing.  Pretty scary, huh?

Parents, and maybe some teens, are aware of the new Gardasil vaccine, which is effective against HPV 6, 11, 16 & 18.   We’ve been hearing about how Gardasil can prevent sexually transmitted cervical cancer in girls, but there’s now a push to have boys immunized as well.  Preferably, this vaccine should be given before sexual exposure, but it’s specifically recommended for males and females between the ages of 12 & 26.  Now THAT demographic is about 80% of my practice! 

Soooo... I’m on the bandwagon!  

Parents:  Get the Gardasil vaccine for your teens!  Do it now!   Summer physicals are coming up, so make a note to ask your pediatrician and get the series started.   And since it’s a 3 shot series over 6 months, don’t wait until your teen is headed to college.   (I learned that one the hard way.) 

Young adults:  It’s not too late!  Even if you’ve possibly been exposed to HPV, you may not have contracted one of the forms Gardasil prevents.  Getting the vaccine now will protect you from contracting it from in the future!  Ask your doctor to start the series right away.

Here's a great video to watch and share with your loved ones.  Perhaps one day we’ll be able to say that HPV & HPV associated cancers are totally eradicated, like smallpox. 

Wednesday
Apr032013

Yes, braces are truly worth all the time, money, and trouble!

My favorite part of what I do is sitting down with patients at the end of treatment to review their before and after pictures.  And I've never had a patient regret their investment of time, money, and life energy in achieving a great smile and balanced bite.

Like it or not, numerous studies show that people with straight teeth are judged to be more attractive, intelligent, happy, and successful than those with unsightly smiles.  Studies also show that not only do we smile because we are happy, but we can also become happier because we smile!  So if you cannot smile confidently, perhaps you are not as happy or successful as you could be.  Check out this great TED talk for more info.

Scientists suggest that we are hardwired to judge each others’ smiles because our teeth are indicators of overall health, and are therefore an important factor in choosing a future mate.  As an orthodontist, I can tell you that 99% of the time, a healthy and functional bite is also esthetically pleasing.

There are numerous benefits when your teeth are aligned relative to each other and relative to the jaws, and when they fit and function properly:

  • They are easier to keep clean (and therefore, free from cavities and gum disease).
  • They help improve your overall health, because gum disease is linked to diabetes and cardiovascular disease.
  • They help you chew your food better.
  • They help you speak more clearly.
  • They help prevent abnormal stresses on your jaws.
  • They help to prevent excessive or uneven tooth wear.
  • They help you keep your teeth for a lifetime!

 

I see many adults who seek orthodontic treatment because they have begun to experience some of the long-term side effects of a bad bite.  Malocclusion (improperly fitting teeth) is a “disease of civilization” that is increasingly causing problems for adults.  Thankfully, we are living longer and keeping our teeth longer than ever before.  But eventually an uneven bite will lead to one or more of these problems (depending on the patient’s weakest system):

  • worn down, chipped or broken teeth
  • broken down bone and/or gum tissue supporting the teeth
  • painful jaw joints and/or facial muscles

 

These issues may take decades to appear, but eventually they will become a problem that will affect your quality of life and require extensive dental care to treat.

So invest in yourself to enjoy the benefits now and head off bigger problems in the future!

Thursday
Apr192012

Smile Studio is Certifiably GREEN

We are pleased to announce that we were recently awarded LEED Silver certification for Commercial Interiors by the US Green Building Council.  We are grateful for the grant from green | spaces that covered the expenses associated with documenting and commissioning the project.  And we couldn't have done it without Berry Construction and Hefferlin + Kronenberg architects.

These are the measures we took to achieve the silver certification level:

Water Conservation- To conserve water, we installed all water conserving fixtures, including low flow sinks, a bubbler for brushing teeth, and new low flow toilets.

Natural Lighting- Because our space has only one wall with exterior windows, we capitalized on the available natural light by using translucent panels at partitions and for many of the doors.

Location- Our office is located on Main Street, within a quarter mile of over ten other shops offering basic services. This allows people to park in one place and take care of various needs without the use of a vehicle. Additionally, we are located within a half mile of three public bus stops.

High Recycled Content- In selecting materials for our office construction and furnishings, we opted for materials that contain a high level of recycled materials. Twenty percent of all materials in our project are recycled.

Biking- To encourage biking to work, we have provided a shower for the use of all employees. We have also provided a bike rack adjacent to the parking lot to allow both employees and guests to secure their bikes if they choose to use alternate transportation to the office.

Energy Star- Over ninety percent of the power from office equipment we use is Energy Star qualified.

Recycling- We recycle paper, cardboard, plastics, and metals. We also participate in a sharps recycling program, along with Dr. Baldree’s office. During construction of our space, we recycled over 75% of construction and demolition waste.

Good Air Quality- We do not allow smoking anywhere within 25 feet of the entrance to our space and we exceed the requirement of national standards for fresh, outdoor air intake. Additionally, all paints, adhesives, sealants, flooring materials and composite wood products used in the building have minimal to no VOCs (volatile organic compounds). Even our furniture is low-emitting.

Efficiency- Our connected lighting density is over thirty percent less than what is required by national standards and every employee has the ability to adjust the lighting in their area to suite their tasks. To ensure that our HVAC, lighting, and hot water systems were operating at the efficiency we expected, a commissioning authority was employed and verified the installation and performance of all the building systems.

 

Tuesday
Apr172012

Are dental x-rays safe?

Recently, there have been several high profile reports about the dangers of dental x-rays.

Last year Doctor Oz reported that dental x-rays contribute to a rising incidence of thyroid cancer, and just last week a highly publicized study was published in the journal Cancer that reported a link between dental x-rays and meningioma, a common type of brain tumor.

So what is a patient to do?

I always encourage my patients to assess the risks vs. the benefits of treatments, and I believe in the vast majority of cases that the dangers of dental x-rays are negligible compared to their benefits.

First off, when you look carefully at the study reported in the journal Cancer, you see that the data is based upon patients’ self-reported frequency of dental x-rays rather than on their actual dental history.  My personal experience is that my patients remember far more frequent x-rays than they’ve actually had.  (I do this at the doctor’s office, too:  “Of course, I had my mammogram just a couple months ago”—when in actuality it’s been closer to two years.)  Plus, I think there is psychological tendency to search for easy explanations when we are struck with a disease or illness.  (Such as, “that slightly pink hamburger I ate last night must be the cause of my stomach upset”—even though no one else who ate the same meal was affected.) 

Also, radiation safety is vastly improved in the last 20-30 years, the time it theoretically takes for malignancies to develop following radiation exposure.  Modern dental offices use a number of means to reduce patient exposure, including:

  • lead shields
  • collimated tube heads
  • high speed films
  • intensifying screens
  • digital sensors
  • and annual registration and inspection of machines 

Modern dental x-rays create a tiny radiation exposure relative to even just living on earth.  Folks who live in Denver are exposed to twice as much cosmic radiation as those living at sea level, and a cross country airplane trip exposes a person to more ionizing radiation than a set of bitewing x-rays or a panoramic x-ray.  However, many routine medical x-rays create exposures hundreds of times greater than dental x-rays.  

That said, some new 3-D cone beam imaging systems being used by dentists today can provide much higher radiation doses than typical x-rays, depending on the machine used.   There are some valid concerns about the routine use of cone beam radiography in children in particular.  Personally, I do not find the need for cone beam studies in my orthodontic practice except in rare circumstances.

Moderation in all things.

There is growing evidence that mild challenges to our bodies’ systems are actually therapeutic.  We use tiny doses of tetanus, polio, diphtheria, etc., to stimulate our bodies’ immune systems to recognize and fight off larger challenges later in life.  The hygiene hypothesis asserts that we spend to much time indoors in homes that are too clean - we clean and filter and block out too much dust and pollen.  Therefore we and our children are more likely to develop environmental allergies, asthma, and a host of autoimmune and immunolgogical disorders.  I'm interested that several studies report that small amounts of chocolate, fats, alcohol, and many other seeming vices actually seem to be more healthful than none at all.

Interestingly, studies of folks who live at higher elevations vs. those who live near sea level, consistently show that those at higher elevations (and therefore receiving double the daily radiation exposure) not only live longer but also have lower incidences of cancer.  This is totally counter to the idea that all radiation is bad.  Could small doses, such as from dental x-rays, actually provide some degree of protection? 

That said, you might actually be justified in asking your dentist to extend the time between routine dental x-rays if:

  • you’ve never had a cavity
  • you don’t have any unerupted or impacted teeth
  • you brush and floss religiously (not many people really do, you know)
  • you have little or no plaque or tartar or bleeding gums
  • AND you get your teeth cleaned every six months,

But if you have any symptoms or evidence of disease, PLEASE do not hesitate to get the necessary x-rays your dentist needs to diagnose your problems.  You would never consider driving in the dark without your headlights, so don’t ask your dentist to treat you without x-rays!

Monday
Nov142011

"The Smile Chapel"

Most folks who walk into my office comment immediately about how happy the space makes them feel.  I think this is in large part due to the great design (shout out to Hefferlin + Kronenberg!), but also due to the fabulous art in the space. Since I am located on the Southside, which is full of art studios and galleries and generally creative types, I wanted my space to reflect the spunk and verve of the neighborhood.  Many thanks to my friend Jas Milam for catching my vision and understanding exactly what I had in mind.

Here's what Jas has to say about the large piece named "The Smile Chapel" in my reception room:

“I have been making altar art for years… creating sacred little spaces in mostly mundane places: kitchen window sills, dashboards and tree stumps. These little altars brighten my day and remind me to pay attention in the now. I call my series of large paintings ‘Chapels’. They are designed to create and hold bigger sacred spaces. I have developed a personal, secular vocabulary that I use to capture the marriage of light and color and beauty. The Chapel painting I made for the Smile Studio works with its clean, bright space for patients that reverberates with a higher vibration. I believe that art can impact a space, change an attitude, brighten a day and make us smile.”  -2011

About the artist:  Jas Milam is a native Chattanoogan who lives on Missionary Ridge. She graduated from Sarah Lawrence College in 1983 and recently completed a Masters degree in Art and Art Therapy. Jas is one of Allied Arts’ teaching artists and has designed and taught programs for Hunter Museum, Chattanooga Parks and Recreation and the Hamilton County school system. She is a former board member of AVA and has been nominated for Tennessee Woman Artist of the Year. Jas conducts workshops for individuals and groups at the Rivoli Art Mill in East Lake. She also facilitates art therapy groups at local treatment centers and at the AIM Center downtown. Jas believes in the healing inherent in the creative process and makes art that draws on both religious and secular imagery. Jas is currently making altar art and chapel paintings. Contact Jas at 423.322.2514 or visit www.jasmilam.com

(Note: You'll have to come see the pair of Jas' paintings in my exam/conference room.  She had recently completed them when I first went to her studio to view her work, and we were both astounded at how they were a perfect match for my space.  She also completed two other pieces for my treatment bay, one of which you can see on SmileStudio204's facebook page.) 

Monday
Oct242011

Bleaching CAN be good for your oral health! 

For good or bad, having bright, white teeth has now become the cultural norm.  Thanks to the beauty industry’s current photoshopping practices (as depicted in Dove’s Campaign for Real Beauty) and the prevalence of whitening products and procedures, most adults and teens I talk with are dissatisfied with the natural color of their teeth.

Personally, I’ve long been suspicious of whitening products and procedures, mostly because the peroxides break down into free radicals, which are thought to cause tissue damage and cause cancer.  When bleaching first became popular, there was a lot of concern that it might cause weakened enamel or damage the gum tissues long term.  I personally have had so much tooth sensitivity and gingival irritation when bleaching that I have been less than enthusiastic in not only bleaching my own teeth but also in recommending it for my patients.

But lately, I’ve had a change of heart.  Folks have been using bleaching products for years now with really no data to indicate any long term adverse effect on either the tooth enamel or gum tissues.  And there is new evidence that CARBAMIDE peroxide can actually improve oral health with minimal side effects.   The beneficial effects of carbamide peroxide come from its antiseptic properties as well as its tendency to increase salivary pH, reducing acidity.  Note that this effect is not found with HYDROGEN peroxide, which decreases salivary pH and makes a more acidic environment in the mouth.  Another benefit of carbamide peroxide is that it is active in the mouth for up to 10 hours, while hydrogen peroxide is no longer effective after one hour.  Unfortunately, there aren’t currently any over-the-counter tooth bleaches that use carbamide peroxide.

Carbamide peroxide’s improvement of salivary pH is significant because it results in less plaque, fewer cavities, and less periodontal disease.  The bacteria that form plaque and cause cavities and periodontal disease thrive in acidic (low pH) environments.  This is one of the reasons drinking carbonated drinks--even if they are sugar-free--is so bad for your oral health! 

So the benefits of bleaching actually outweigh the risks, in my opinion, IF we can manage the short term side effects of tooth sensitivity and gingival irritation.  The best way to do this is with custom-fitted trays (made by a dentist), the use of a toothpaste with potassium nitrate and without sodium lauryl sulfate (I like ProNamel, and a low concentration (10-12%) carbamide peroxide gel used in the tray overnight.  It may take up to 6 weeks to get the maximum result, but rest assured the result will be longer lasting and more beneficial than what would be achieved using higher concentrations of peroxide over a shorter time period.

Borrowing from Aesop, this is one of those situations where the tortoise beats the hare.  I don’t recommend in-office (or in-mall!) treatments using UV lights and high concentrations of peroxide.  Most of the whitening from this process comes from dehydration of the tooth, which only lasts a week or so.  Plus high concentrations of peroxide have been shown to cause extreme sensitivity for most people.  I’ve heard of brides who’ve had their wedding day AND honeymoon ruined because of the extreme pain caused by such techniques.  Ouch!

Our office is happy to assist you if you are interested in bleaching after getting your braces off.  We offer the low concentration carbamide bleach that can be used in the clear upper retainer we provide all our patients. 

So you can reduce plaque, reduce (and even reverse!) cavities, and improve your overall oral health, with the side effect of a brighter, whiter smile?  Sounds like a win-win to me!

Click here for Dr. Farrar’s bleaching instructions.

Friday
Jul012011

Treatment philosophy

I believe in a straightforward approach that utilizes the body’s natural tendencies for health in an effort to minimize time in active appliances.  Knowing that teeth seek a position of equilibrium based upon the balance of forces from the tongue and facial muscles is the key to establishing facial harmony and dental stability. 

In a perfect world, we would have no malocclusion and no need for extraction of permanent teeth.  Our bodies were designed for a life of hunting and gathering, much as we envision the Garden of Eden.  We are not adapting well to traffic jams, smart phones, junk food and TV.  It is clear that our bodies respond negatively to the prolonged stresses of life in postmodern society.  As civilization has advanced, humans have developed a series of disease states such as cardiovascular disease, cancer, diabetes, and yes, even dental malocclusion.  It is rare to find malocclusion in ancient skull records or in the small pockets of aboriginal populations found in the world today.    

Unfortunately, human arch lengths are progressively decreasing (which means there is now less space on the jaws for teeth to be aligned) and rates of malocclusion are increasing.  Some of this is due to genetics, as we are selecting mates from a much wider gene pool than ever before.  And parents who have had orthodontic treatment are far more likely to have children who need treatment.  

But a big part of the reason is environmental:  We use baby bottles and pacifiers.  We eat highly refined and processed foods.  Our sinuses are chronically blocked so we mouth-breathe and snore and learn to hold our tongues low in our mouths.  We respond to daily stress by clenching and grinding our teeth, chewing gum all day, pursing our lips, biting our cheeks.  Because our teeth don’t fit right as we grow and develop, we learn abnormal muscular activities such as tongue thrusting and lip trapping.  

The net result is that there is increasingly more jaw size imbalance and less space available to align all of our teeth.  The good news is that our bodies are designed in such a way that we can often avoid extractions of permanent teeth if we closely manage the transition from baby teeth to permanent teeth. The best chances for avoiding extraction of permanent teeth to achieve ideal occlusion come with early diagnosis and interception of developing problems. 

This is why the American Association of Orthodontists suggests that all children be screened by an orthodontist by age 7.  By this age, we can see if there are tooth size and/or jaw size imbalances developing.  If an orthodontist isn’t consulted until all the permanent teeth are erupted or until growth is completed, there is a greater likelihood of longer, more involved treatments which often require extractions and/or surgery.

The good news in all of this is that we live in a remarkable time of increasing knowledge about how to treat all of these problems.  Even if we haven't had the opportunity to "intercept" problems during growth and development, the techniques and treatments available today are so much more efficient and comfortable than ever before!

So what happens if you choose not to treat crooked teeth or a bad bite?  Well, for one thing we know that it only gets worse with time.  The forces that caused the tooth position problems in the first place continue to exert forces on the teeth that make them get worse.   The patient may not notice any bad effects from a bad bite early in life, but eventually he or she will start to have problems.  Over time, the body will respond to the dental imbalance in a number of ways, depending on the individual’s weakest system. 

Sometimes the tooth enamel is the weakest link, and the teeth get worn unevenly or excessively.  Sometimes the ligaments and joints are the weakest link, and the jaw joints will pop, click, or grind and the patient will often experience head, neck and/or facial pain.  Sometimes the periodontal tissues are the weakest link, and periodontal disease will cause bone loss, loose teeth, and eventually tooth loss. 

These long term effects may not cause problems or be symptomatic for decades.  But often by the fourth or fifth decade, they are becoming major issues and patients with untreated malocclusions are needing significant (read: expensive and time-consuming) dental work.  Considering that we are living longer and keeping our teeth longer due to advances in healthcare, it is that much more important to ensure that your dentition is healthy and stable and can last as long as the rest of your body's systems!

Dr. Marie Farrar is an orthodontist in Chattanooga, TN.  She is board certified by the American Board of Orthodontics.  Dr. Farrar provides orthodontic treatment for children and adults at Smile Studio, 204 W Main St, Chattanooga, TN 37408.