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.


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!


"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

(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.) 


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.


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. 

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