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White Spot Lesions: Three Factors of Interplay

8/27/2017

Dr Chris Baker's book on pediatric dentistry and orthodontics, Your Child's Smile is a priceless guide to the oral health of young people.

White spot lesions on teeth result from acid-producing pathogenic bacteria that demineralize the tooth surface.

For years, Dr Chris has used Pro-Seal, from Reliance Orthodontics, to help orthodontic patients avoid white spot lesions on their teeth.

A patient's high plaque level can cause white spot lesions to form.

If you look closely, you can see early stages of white spot lesions on this patient's upper teeth.

Damage to the teeth from white spot lesions often begin near the gum line or between teeth.

Dr Chris' book, Your Child's Smile, is a parent's perfect guide to their child's oral health.

White spot lesions on teeth result from acid-producing pathogenic bacteria that demineralize the tooth surface.

This begins the process of tooth decay. While these lesions occur in patients without any orthodontic or other dental intervention, they also occur during orthodontic treatment. The tooth damage results from the bacterial acids etching and eating away at the tooth structure. There is something you can do to greatly reduce the risk - more on that below.

The interplay between three areas will determine the risk and actuality of damage during orthodontic treatment: These are the orthodontic treatment (medical intervention); secondly, the complex human body existing in its environment, nature, including the trillions of microbes we call the microbiome; and third, the patients’ and parents’ degree of participation in care of that body.

Which of these areas can you impact to reduce the risk of damage? How can you provide that impact? The answers to these questions are important to all of us who offer and provide orthodontic treatment to transform lives.

To address these, we examine the aforementioned three factors of interplay:

The Medical Intervention
The Human Body Existing in its Environment, Nature
The patient’s (and, for a child patient, the parents’) degree of participation.

Our ability to reduce the risk lies almost completely in the first area of the medical intervention, the orthodontic treatment.

The health of the human body and its microbiome is almost completely out of our purview, except that we can encourage the patient/parent to be aware of healthful practices that strengthen, not weaken, the microbiome.

The degree of participation of the patient/parent is again, almost completely out of our purview. But, we can encourage the oral health care practices (regular dental care, excellent oral hygiene and related) and the proper participation in orthodontic therapy. This includes wearing elastics and appliances and controlling oral hygiene so as to reduce the time of the orthodontic appliances being in situ (on the teeth).

The area of medical intervention is the area where we have some ways to mitigate the risk of white spot lesions. Unfortunately, this amounts to only one-third of the total factors at play. Remember that each human body is part of the complexity of nature and has its risks of harm, both with and without medical intervention.

Remember, there are two other huge factors at play. Even with your best efforts and knowledge, you cannot absolutely prevent white spot lesions. Fortunately, you can mitigate the risks. First, identify your patients who are most at-risk and consider the following.

Mitigate the risk:

ProSeal (Reliance Orthodontic Products, Inc.)1

ProSeal is a fine way to support patient efforts to reduce white spot lesion risk. Use this with EVERY ORTHODONTIC PATIENT on every tooth to be bracketed.

ProSeal is a smooth surface sealant that sets completely without an oxygen-inhibited layer. This creates a smooth hard surface that protects the enamel. It resists toothbrush abrasion and can be used under any bracketing system. After using ProSeal/LED ProSeal with all orthodontic patients for many years and after seeing the results, including with extremely high-risk decay patients, I would not provide orthodontic treatment without it. With ProSeal usage, white spot lesion incidence is minimized. And, the sealant contains a UV fluorescing agent for easy monitoring of its presence over treatment times, so you can reapply as needed. This provides significant protection against acidic damage to the enamel surface.

Fluorides Some of these may be placed by your office or by the patient’s regular dentist. Most require patient participation and compliance. The patient must go for the office treatments, for the instructions, and/or utilize the recommended fluorides at home The fluorides may include, both in-office and home products. Fluoride agents like stannous fluoride and titanium fluoride deposit reservoirs on the tooth surface that may resist even low pH and severe decay challenges. Because it is critical that the patient maintain regular preventive and evaluative care, it is best to have the pediatric dentist or GP dentist provide the in-office fluorides, every 3-6 months, whether varnish or other preparation. Fluoride toothpastes, including Cari-Free, which claims to restore pH balance are at-home preparations.
Other adjuncts. These include
- Caseine treatments, like MI paste, which can be used at home daily,2
- Carbamide peroxide to restore pH balance3
- Xylitol gum. Be sure to recommend one that is bio-effective such as Xlear, and does not have other harmful ingredients such as artificial sweeteners that may interfere with the healthy microbiome.
- Probiotic supplements to work to maintain/restore the healthy microbiome.
As Short-As-Feasible treatment time, to reduce the time over which the damage occurs. Although, it is important to know that the demineralization typically presents within the first six months of orthodontic bracket presence, and continues slowly over the next months.4
Communication with patient/parent 5
Communication with the patient’s Pedo/GP dentist 5
Awareness of the Risk, and Refer, Refer, Refer

It is important to communicate to the patient/parent the importance of regular evaluative and preventive care. A big part of your job is to communicate and refer!

Because white spot lesions appear much more frequently in males than in females, (the Tufekci study showed 76% of patients with such damage were male) observation with appropriate referral to Pediatric Dentist or GP for regular evaluative and preventive care is especially important in boys, and appropriate encouragement of adjunctive therapies, as above, should be considered especially in boys with higher plaque levels. 6

That’s what you can do in your Medical Intervention of Orthodontic Treatment!

The Second Factor: The Human Body Existing in its Environment, Nature

Our human bodies are not capable of regulating themselves, like “physiologic islands,” but each body rather, exists and is regulated - or not - in tandem with trillions of microorganisms, hosted by the body. As science discovers and reports this amazing interplay of bacterial life and the human body, we begin to be awed and quite frankly, stymied by how to best reduce risks and control the “bad bugs,” and allow the “good bugs” to flourish. If they do not, the human body does not survive. You have heard the idea of ingesting “good bugs” called “probiotics,” which are micro-organisms that keep us healthy and alive.

The National Institute for Health, NIH, Human Microbiome Project defined normal bacterial makeup of the body, and reported that microbes inhabit almost every part of the human body, including the skin, the GI tract and respiratory tract. Most of the time these bacteria live in harmony with the body and provide necessary functions for human survival, including major immune and anti-inflammation functions.

These microbes outnumber human cells in your body by ten times. Remember, there are trillions of them in your body, though the microbes are much smaller than human cells, so they are only about 1-3 percent of your body weight - about as much as your brain. In a 200 pound man, that would be 2-6 pounds of weight of bacteria.

The project calculated that more than 10,000 different microbial species are in human bodies, and the researchers believe they have identified 81-99 percent of those microbes.

What do the friendly bugs do for us? They provide enzymes so we can digest our own food, and absorb what we need. They produce vitamins and anti-inflammatories that we cannot. They help pregnant women prepare for birth, changing the vaginal microbial population to a healthy one for the baby to pass through, and provide the baby with its first dose of microbes that the baby will need. The friendly bugs help your body deal with the unfriendly bugs.

Researchers found that almost everyone routinely carries pathogens or “bad bugs.” In healthy people, they cause no disease, and just co-exist with the body (their host) and its total microbiome. However, these pathogens are etiologic in disease states such as infections, heart disease and cancers.

Additionally, nutrition and diet are critical parts of the body’s interaction with its environment, as frequent snacking and high carbohydrates and sugars help the pathogens overtake the friendly microbes.

In dentistry we are most aware of the potential pathologic bacteria-host interactions that cause gingivitis, decay, periodontal disease and other oral pathology. This is a factor about which you, as the doctor, can contribute little to reduce the risk of white spot lesions. The most healthful lifestyles and habits are up to the patient. Your encouragement might be helpful - but often the lifestyles and habits do not change.

Finally, the third factor which is the patient’s (and, for a child patient, the parents’) degree of participation, again, offer your encouragement. But expend your energy on the medical intervention - your treatment - and consider terminating treatment if it is appropriate to help the patient whose participation is inadequate. A word about prevention - if before treatment is begun, a parent says to you, “My child won’t…” - the parent is right. Save yourself the headache, save the parent and child the angst, and don’t start treatment.

As you consider the interplay between these three areas that determine the risk and actuality of damage during orthodontic treatment, you can know where you can impact the risks and how you can do so. Once you determine these, you can then happily provide orthodontic treatment that transforms lives, including your own, and help people have beautiful smiles, the best possible self-view, and the most comfortable and functional occlusion possible.

https://www.relianceorthodontics.com
Lapenaite E, Lopatiene K, Ragauskaite A. Prevention and treatment of white spot lesions during orthodontic treatment: A systematic literature review Stomatologija, Baltic Dental and Maxillofacial Journal, 18: 3-8, 2016,
https://www.speareducation.com/spear-review/2013/06/how-to-manage-white-spot-lesions.
Tufekci E, Dixon JS, Gunsolley JC, Lindauer SJ. Prevalence of white spot lesions during orthodontic treatment with fixed appliances. Angle Orthod. 2011 Mar; 81(2):206-10. doi: 10.2319/051710-262.1.
Maxfield BJ, Hamdan AM, Tüfekçi E, Shroff B, Best AM, Lindauer SJ. Development of white spot lesions during orthodontic treatment: Perceptions of patients, parents, orthodontists, and general dentists. March 2012. V 141: (3), 337–44.
Tufekci E, Dixon JS, GunsolleyJC, and Lindauer SJ. Prevalence of white spot lesions during orthodontic treatment with fixed appliances. The Angle Orthodontist: March 2011, Vol. 81, No. 2, pp. 206-210.https://doi.org/10.2319/051710-262.1

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What You Do to Limit Your Life the Most

8/21/2017

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"Fear is merely our imagination running amok -- worrying and assuming what MIGHT happen."
-- Dr Chris Baker

Taekwondo Master Brian Chewning's inspirational lectures motivate students nationwide.

What do you do that limits your life the most? — You live in your fear.

Unless there is immediate and present danger, fear is merely our imagination running amok - worrying and assuming what MIGHT happen.

And how do you get rid of those limits?

“Conquer fear and live today,  participate in life today -  or some day you will look back and say, what was I so afraid of?

"Sometimes imminent death causes people to live a fearless life.  You may have seen people that get a bad report from the doctor and a man made limit by a mortal man has caused a paradigm shift.

"A doctor tells someone that they have six months to live and during those six months they climb the mountains, do karate class with their family, they go on the vacations, they ask the girl out, they ask the boy out. They have absolutely no fear.

"Here is the deal. God only gave you today and only He knows your days on earth. Set goals, start businesses, take well-calculated risks, enjoy the sunshine, listen to the birds and enjoy your freedom.” --   Brian Chewning (Taekwondo Master, pictured left)

“The only thing we have to fear is fear itself” ~ Franklin D. Roosevelt

In love and courage,

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Remember?

8/15/2017

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Remember when you wanted to become someone just like you?

You used to want the things you now have.

You’re now the kind of person you once dreamed you'd become.

You dreamed and thought about the education you now list on your resume.

You once pictured doing what you now do for a living.

You planned to have a precious relationship.

You only dreamed of vacations that you’ve now experienced

You wanted to trip the light fantastic.

You knew you’d be grateful IF….

In gratitude,

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Practicing Orthodontics in Abu Dhabi is a great experience!

8/13/2017

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Do You Have Enough Reasons?

8/10/2017

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You can find beauty, your life's true passion, and overcome obstacles -- all at the same time. (Dortmund-Ems Canal, North Rhine-Westphalia, Germany . Wikimedia Commons photo.)

Find your life's priorities and passions with guidance from REAL, Dr Chris Baker's book on life strategies and living on a grand scale.

"If you have enough reasons, you can do the most incredible things." - Jim Rohn

Jim Rohn's legendary little book "The Twelve Pillars," details how to set goals and motivate oneself towards success in life.

Here’s something to make your day brighter:

It’s a lesson from master life coach Jim Rohn, on overcoming challenges, finding your true passion and purpose in life, and “going for the gusto.”

He says, “If you have enough reasons, you can do the most incredible things.”

Imagine your life filled with enough reasons to do the things that seem difficult or impossible now.

Imagine how you would feel - AND ACT - if you woke up with the energy and desire to tackle any difficult challenges that you encounter.

Imagine that you find yourself happy and passionate every day, achieving your goals!

You can.

You will.

IF - You find your reasons.

If you feel you have your reasons, your philosophy, and you’re not taking pain-free, easy decisions and actions toward your goals, they aren’t really YOUR reasons.

When you find YOUR reasons / philosophy, you’ll never look back.

How do you build YOUR new philosophy? How do you commit yourself to YOUR new life? How do you decide to change YOUR life?

Some experiences put you in a place where you experience emotions that really cause you to change your old thoughts and habits, and really take action. (Another Rohn gem)

Disgust with yourself.

Making a decision when your back is to the wall.

Desire that won’t be extinguished.

Resolve to do or die.

Here are 5 ways to help you develop YOUR reasons:

1. This is the greatest challenge: Think about what you are thinking about. You get what you think about. Your philosophy is the greatest determining factor in how your life works out.

2. Read everything you can. Learn from people who do well!

3. Journal. Write about your life. It will slow down your thinking and let you realize what you are thinking about.

4. Spend your time wisely. If you are watching videos or reading, and it’s not helping you grow and amend your philosophy, it’s hard to make the best choices in your life,

5. Practice gratitude. When you are happy with what you have, the Universe will provide you with more.

6. Fill your day with decisions that take you to your goals - healthful foods, exercise, reading, journaling, gratitude. “Neglect is the major reason people don’t have what they want. “ (Jim Rohn)

Focus on your daily disciplines.

Keep looking forward.

Never look back!

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Hiding in Plain Sight

8/7/2017

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Friedrich Eduard Meyerheim's 19th-century painting of three children playing hide and seek in a forest.

"Life's joy is masked by emotions. When the mask falls, you will inhale deeply and see how beautiful it all really is." -- Dr Chris Baker

Remember playing hide-and-seek?

Remember how you could hide behind a tree, in plain sight?

In your moments of sadness, fear, confusion, grief, desperation, loneliness, anger and worry, the preciousness of life is hiding in plain sight.

How’s that?

Life’s joy is masked by emotions.  When the mask falls, you will inhale deeply and see how beautiful it all really is.

And when you once again see how beautiful and precious it is, even the emotions that belied the beauty will illuminate the sparkling treasures of your life.

“Free!”

You’re “It!”   Ready or not, here I come!

Love,

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Dr Chris Baker

Dr. Chris Baker is Past President of the American Orthodontic Society, a pediatric dentist and teacher of orthodontics, An author, dental practice consultant, mentor, and a current or former faculty member of three U.S. dental schools, Dr Chris practices and blogs in beautiful Abu Dhabi, UAE, and glorious Texas, USA.

White Spot Lesions: Three Factors of Interplay

What You Do to Limit Your Life the Most

Remember?

Practicing Orthodontics in Abu Dhabi is a great experience!

Do You Have Enough Reasons?

Hiding in Plain Sight

Dr Chris Baker

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