The "Adrian X-Ray Shoe Fitter" and Musings on Radiation

The Adrian fluoroscope was a popular device in shoe stores from the 1920's to the 1960's. They were used in the UK into the '70's! About 10,000 machines were in use in the US. It was a cabinet about 4 feet tall. You would put your kids foot into an opening in the base and look into a view port in the top. There was often 3 ports- one each for the child, the parent and the salesman.  As the x-rays poured through, you could clearly see the child's toe bones wiggle inside the new shoe. The exposure time was adjustable, usually about 20 seconds.

The dangers of x-rays were known much earlier. One of Thomas Edison's glassblowers, who made the tubes, would test the tubes on his hands. He developed such a tenacious cancer that his arms were amputated and he eventually died. Edison subsequently completely abandoned x-ray research in 1903.

Apparently the shoe fluoroscopes did not result in widespread public health problems. But in a worst case scenario (trying on multiple shoes, maybe damaged shielding in an old machine) a high enough dosage to result in radiation sickness could have resulted from a single visit. Several cancers were reported- salesmen who would test machines on their hands, even a shoe model whose legs had to be amputated. This silly technology was eventually banned.

Now this month we have the stoopid study from the American Cancer Society that resulted in stooopid headlines like "dental X-rays give you brain tumors." The study has resulted in widespread accusations of junk science. It was based on sick old people trying to recall how many dental x-rays they had in childhood. Dr. Nancy Snyderman's report on NBC was especially bad. I hope the x-rays they showed in the background were hers. They were a monument to poor decision making- multiple molars with root canals and no crown, root canal on a wisdom tooth. I think the radiation is going to be the least of that patients problems.

More stoopidity- the American Dental Association has come up with this gem of a guideline in regard to radiation- "As Low as Reasonably Achievable." I can easily achieve zero exposure- don't take any! How's that! This is how I believe that you should decide how many x-rays to get- have a discussion with your dentist about the benefits and risks. Of course we should all limit the amount of radiation we receive. A  dental x-ray dose is about the amount the average US resident gets from living for 2 days. This comes from outer space, from materials in the earth and materials in our food. A coast to coast flight is 3 times higher, a hip x-ray about 65 times more, a shoe fitting fluoroscope about 85 times higher.  The benefits of dental x-rays is to find problems when they're small. Yesterday I saw the Director of one of the largest insurance programs in the state. He hasn't had an x-ray lately and a cavity progressed to the point that he needs a root canal and a crown. It will cost over $2,000. An x-ray and a small filling would have cost less than $200 and insurance would have covered over 80% of that. Not everyone should get the same amount of x-rays. It might be a good idea for someone who has recently had cavities to get x-rays more than once a year- even though insurance might not cover it. Someone who hasn't had a cavity in a long time might want to go 18 months- even though insurance would pay yearly.

The bottom line is to make smart decisions. Life is often harder for those who make stoopid ones.

If Auto Insurance was Like Dental

If auto insurance was like dental insurance-

The executives would make lots more money! My insurance, AutoOwners, pays it's CEO about $300,000. At the height of the recession, Delta Dental paid 5 execs over $3 million a year.

Your insurance would pay 100% for oil changes and wiper blades. They would only pay half if your car is wrecked , and only up to a total of $1,000/year; $500 if its a cheaper policy. They would try as hard as they can to get out of paying the $1,000- pre-existing conditions, non-duplication of benefits, waiting periods, etc.

Your benefits would not be indexed for inflation. The yearly max. was $1,000 in the 1960's, which would pay for a new Beetle. It would still be $1,000, which wouldn't even repair one bumper

Your employer would select your auto insurance company, and pay the premiums. There would not be any gecko ads, or the crazy Allstate guy.

So don't expect your dental benefits to be like insurance. It's actually an employee benefit that pays well for maintenance, but poorly for repairs, and next to nothing for overhauls.

Xylitol- Another Tool for Decay Prevention

Xylitol, pronounced zylitol, is a naturally occurring sugar substitute. It's extracted from corn husks in the US, rice straw in China, and Birch trees in Finland. Through a couple of very cool, to a dentist, mechanisms, xylitol is good for teeth and bad for plaque bacteria. If you're actually interested you can read all about it at xylitol.org. Several studies show a 60% reduction in cavities.

Who needs it? Anyone who doesn't floss or waterpik enough, has ever had a root canal, or ever had a checkup with more than one cavity. That includes children. Want to decrease the chance of your baby getting decay by 60%? One study showed that result for new moms who chewed the gum from the child's age of 6 months to 2 years. Amazing! It affects the transmission of decay causing bacteria.

So how do you get xylitol? If you're the type who reads ingredient lists you know that most sugarless chewing gum has it. The problem is that it doesn't have enough. Research shows that you need around 4 to 6 grams per day. Most gum has other sugar substitutes but only .1 grams xylitol . Gum and mints that are made for dental benefits have 1 gram of xylitol. So 4 to 6 pieces of the right gum or mints gives the recommended daily dose. Too much can give you the runs.

Where do you get it? The biggest producer is a company in Orem, surrounded by wacky multi-level nutritional companies. They claim to be the largest importer of xylitol in the US. To me that means they get it from China. Smart Sweet does not contain Chinese xylitol and is available online here. Ultradent is a Salt Lake dental company that makes a line of xylitol products- gum, mints, mouthwash. They have tested Chinese ingredients and will not use them. They are a great company run by great people. We will be stocking their products, and using them ourselves. We'll sell them at our cost which turns out to be less than the competitors. Ask for a sample at your next check up.

Saint Apollonia Patron Saint of Dentistry

Saint Apollnia is the patron saint of dentistry, also for those suffering from toothache. She was one of a group of virgin martyrs who suffered in Alexandria in about AD 250. A mob threatened to burn her alive if she did not deny her faith. She refused so the mob broke all her teeth and threw her into the fire. Miraculously the fire did not harm her. She ended up decapitated.

Her feast day in celebrated on February 9th. She is represented in art with pincers in which a tooth is held. She is one of the two partron saints of Catania, Sicily. In Germany she is one of the Fourteen Holy Helpers that are singled out as the patron saints of daily life; Apollonia protecting against toothache. Her relics were preserved in the Church of St. Apollonia in Rome, which no longer exists. Her head went to a church in Trastevere, her arms to a Papal Basilica in Rome and parts of her jaw to St. Basil's. Other relics, sometimes a single tooth, to several churches in Belgium and France. One of the principal train stations in Lisbon is named for her. The Island of Mauritius was originally named for her in 1507 by Portugese navigators. In England, there are 52 known images of her that remain in various churches, mostly in stained gless.

Most Effective Pain Pill for Wisdom Teeth

This month's British Dental Journal has a study on this topic from Oxford. The winner- ibuprofen and Tylenol together! That's one ibuprofen and one extra-strength Tylenol! It achieved a tie with a COX-2 inhibitor not available in the US. They scored the percentage of patients who started out with moderate or severe pain and achieved at least 50% pain relief.

Ibuprofen/Tylenol scored 74%

Naproxen (Aleve) and 2 ibuprofen (separately) "scored well"

Lortab was only 24%

Placebo was 7%. It's always amazing how well placebos do.

Pain control is tricky. This study shows that even the best drugs fail to provide good relief in 30% of patients. No single drug is effective for everybody. Some people believe that a drug must make you stoned to really relieve pain- probably not true. While narcotics (Lortab) do make you sleepy, they also causes nausea, dizziness, constipation and massive problems with addiction. There are probably better medications to make you sleepy. The conclusion of the authors of the study was that if one medication doesn't give you relief, try another.

Think about this before genetic testing

It used to cost a million bucks to have your genes sequenced, to get a print out of all your DNA. It now costs about 20 grand. Recent developments should bring the cost down to much less than a thousand. There are many issues to think about before you buy any genetic tests- including the periodontal disease tests that I have been recommending. One important issue is to keep your information private. You don't want the insurance companies to know what your risk of any disease is. Their job is to share the risk in general, and charge appropriate premiums. Don't give them the answer so they can charge you more!
I made a mistake with my elbow. I went to the M.D. who diagnosed tennis elbow and sent me to physical therapy. When he makes the diagnosis, the medical insurance will cover it. Six months later, the physical therapy didn't help and it affected my insurance rate. Not only medical insurance, I paid more for life and disability insurance for years. I will probably buy some genetic tests at some point. I just think the science is cool. It may also help make some decisions in the future. But I will carefully protect my private information. I don't want any insurance company to know. I don't want my M.D. to write anything down. Of course we protect your privacy with the gum disease tests, no results are reported to anyone but you.

Breast Cncer and Gum Disease

The first study showing a link between breast cancer and periodontal disease was just published. The study was done at The Karolinska Instute and published in Breast Cancer Research and Treatment. Periodontitis seems to be closely associated with human cytomegalovirus and Epstein-Barr and Herpes virus co-infection. It is believed that these viruses act together to suppress immune response to bacterial challenges. The authors conclude that these viruses and bacteria act together to lead to low-degree chronic inflammation and carcinogenesis.