Neal Oral Surgery Blog

Seen this photo before?

If you have, keep reading…

If nothing else, it catches your attention, right?  That’s what I thought when I first saw it.  I saw it when I read a story written by David Ammons of the Associated Press, entitled, “Dentist implanted boar tusks in woman”.  The story I first read describes an irresponsible, thoughtless oral surgeon who played a practical joke on his own assistant while under anesthesia, and then gets paid from his insurance company after his despicable actions.  Unfortunately, for Dr. Robert Woo, most of the story was untrue.  I can only assume the lies and twisted half truths were written purely for sensationalism, and it’s sad to think that anyone would destroy someone else’s reputation, so thoughtlessly.  Want to know what really happened?  Read on.  You’ll get the real story of what happened and the letters that follow are from an assistant to Dr. Woo, an attorney connected to the case, and a representative of the Seattle Times.

I can only imagine the ordeal that Dr. Woo has endured since this article was written, and I’ll definitely be much more discriminating about what I read and choose to believe in the future.  What happened to telling the whole truth?  It makes me sad that we have to work so hard to find things that are honest and truthful in our world these days.  I’m so sorry, Dr. Woo, and I’m trying to do my part to use this post to help to spread some real TRUTH.

Here’s the real, true story:

In 1999, one of my four surgical assistants Tina wanted to have #C & #H extracted under local anesthesia.  The other three surgical assistants and I decided to play a joke on her with a pig teeth flipper.  On the day of surgery Tina decided that she wanted to go to sleep for the surgery.  Instead of showing her the pig teeth flipper right after surgery we made the mistake of taking photo of her with the pig teeth flipper thinking we could show it to her on her birthday to make her laugh.  I was not there when they first gave her the pig teeth flipper on her birthday.  I was told later that she asked pictures to be taken and my staff gave her the photo we took.  Tina laughed and helped out in surgery that afternoon.  Then everything went down hill after she talked with her stepfather.  We later found out he was a local bankruptcy lawyer.  By the way, the photo did not go anywhere, even my front office staff had no clue about the joke and the photo.  Only the four surgical assistants and I saw the photo.  There were also no implants, temporarily or not.

Tina avoided our attempt to contact her.  I finally reached her stepfather who told me on the phone that everything was fine and we didn’t have to worry.  Few days later law suits were delivered to each and everyone of us including the lab man who make the flipper.  Tina, her husband and her mother were suing us for over 2 million dollars.  Why her husband?  Why her mother?  I did multiple free surgical services on her over the five years that Tina worked for me.  Greed.

When Tina learned that we found out many of her lies she threatened to take the story to the media instead of going through the court system.  We could not trust the media to tell the truth, see what the media had done with this story.  We had no choice and settled with her.

Dr. Robert Woo

     From: Andrew Bergh <andy@berghlaw.com>

     Date: August 22, 2007 10:33:32 PM PDT

     To: ‘Robert Woo’ <robertwoo@mac.com>

     Subject: RE: times letter

Bob, in response to Dick’s email, I would agree with the advice he gave you regarding Ammons and the AP article, if you think calling him would have some therapeutic value for you.  Otherwise, I don’t think I would bother.  In my view, journalists tend to think they are bulletproof and can write anything they want because of the First Amendment.  And as the Siderus letter shows, even those journalists who maybe have a conscience won’t do anything because they are too busy getting out today’s news, not fixing yesterday’s.  (No, I don’t have a high opinion of journalists.)

I enjoyed reading Jayna’s letter, as it was nice to read something truthful for a change.  If more people only knew the actual facts.  If they did, they would react and want to send a message just like our jury did.

I hope both your family and practice are thriving, and providing excellent diversions for you as we approach the final chapter of this saga.  Its days are numbered.

Best regards,

Andy

Law Office of Andrew Bergh, P.S.

www.berghlaw.com

Fr            From: m marshall <tacoma1956@hotmail.com>

Augu       Date:August 21, 2007 3:35:11 PM PDT

          To: robertwoo@comcast.net

                    Subject: times letter 

When an employee praises a supervisor the way you do, that speaks for itself. It sounds like that office was a wonderful place to work for you, as well as other employees.  Dr. Woo has to be happy about that, as well as his victory in court.

I thank you for writing and giving me your perspective. It is difficult — if not impossible — to address every angle of a story on deadline, so I am glad to hear your side.              

Best,

Christina

Christina Siderius

The Seattle Times

 On behalf of Craig, Galia, and myself, I would like to truly apologize to Dr. Woo and his family and staff for being so irresponsible as to not properly oversee the postings on our blog.  I have known Bob for over 30 years and consider him a valued friend and colleague.  If I had seen the blog I would have not allowed it to be posted or taken it off as soon as it was.  The whole purpose of this blog is informational and educational and not a gossip column. It is especially not a forum for negatively commenting on other practitioners.  Our actions, however, added to Bob’s already considerable pain and anguish and for that we are deeply sorry. This article is a great example of the kind of “yellow journalism” that is all too common in our society.  A lazy, opportunistic writer looking for a quick salacious headline, and a greedy equally opportunistic attorney smelling an easy buck by blowing a harmless joke among friends and co-workers into a phony complaint and lawsuit that causes more heartache and considerable bad

feelings for all concerned. This action was not to right a terrible wrong, but to get money or advance a byline. The surgery assistant involved lost the respect of valuable friends and colleagues, and any money received (that not spent on attorney’s fees) was not worth her loss of self- respect.  It is a good lesson for all of us in the use of the internet.  It is a wonderful source for information on just about anything, but what you say can be accessed by almost everyone and some may have a different agenda. 

Sincerely, 

Jack E. Neal

Neal Oral & Maxillofacial Surgery

Dental Anxiety
It is estimated that approximately 30 to 40 million Americans avoid seeing the dentist because of dental anxiety or dental phobia (fear of dentists). People with dental anxiety have fears that are often greatly exaggerated and overwhelming. Severe dental phobia is a more serious condition, causing those affected to cancel or avoid their dental appointments altogether. Various sedation dentistry techniques can be used to treat those who suffer from dental anxiety or dental phobia.

Dental Phobia – Fear of Dentists
Many people who experience dental phobia are hesitant when visiting a dentist. They often have a fear of the office, the equipment, or the dentist themselves. Individuals that suffer from this dental anxiety frequently delay their appointments, hoping to avoid the experience altogether.

Severe Dental Phobia
Dental anxiety can also turn into severe dental phobia, making a dental appointment an overall horrific experience. People with severe dental phobia are terrified and panic-stricken when it comes time to see the dentist and they often avoid the dental appointment completely. If they do force themselves to go, they usually do not sleep the night before or may become sick in the waiting room.

Many patients with severe dental phobia have put off dental treatment for years because of their fear of dentists, resulting in poor oral health. Individuals suffering from dental anxiety or severe dental phobia commonly have infected gums and teeth, severely compromising their ability to chew and digest food properly. Many also lack self-confidence and feel insecure because of bad breath or an unattractive smile.

If you have a fear of dentists, including severe dental phobia or dental anxiety, there are several dental sedation techniques that can help. controlling this condition and obtaining a beautiful, healthy new smile.

Treating Children Who Fear the Dentist
Some children have a deep-seated fear of dentists, making dental appointments a traumatizing experience. However, it is important that children have regular dental checkups. There are tips for dealing with children who have dental anxiety or severe dental phobia, including:

Start dental checkups at an early age, so the child will be comfortable and familiar with dental appointments.
Enforce good oral hygiene, so trips to the dentist are minimal.
Be careful not to convey your fears of the dentist to your child.
Offer kid-friendly environment so its inviting and comfortable for children.

If not addressed during younger years, dental anxiety can develope into severe dental phobia as one gets older. To prevent bad oral hygiene later in life, the above suggestions can work to calm your child’s fear of dentists.

Speak with our dentists about Sedation Alternatives.

Teething, the emergence of the first teeth through a baby’s gums, can be a frustrating time for little ones and their parents. It helps to know what to expect when your child is teething and how to make the process a little less painful.

The Teething Process

Teething can begin as early as 3 months and continue until a child’s third birthday.

Between the ages of 4 and 7 months, you’ll notice your baby’s first tooth pushing through the gum line. The first teeth to appear usually are the two bottom front teeth, also known as the central incisors. These are usually followed 4 to 8 weeks later by the four front upper teeth (central and lateral incisors). About a month later, the lower lateral incisors (the two teeth flanking the bottom front teeth) will appear.

Next to break through the gum line are the first molars (the back teeth used for grinding food), then finally the eyeteeth (the pointy teeth in the upper jaw). Most kids have all 20 of their primary teeth by their third birthday. (If your child experiences significant delay, speak to your doctor.)

In some rare cases, kids are born with one or two teeth or have a tooth emerge within the first few weeks of life. Unless the teeth interfere with feeding or are loose enough to pose a choking risk, this is usually not a cause for concern.

As kids begin teething, they might drool more and want to chew on things. For some babies, teething is painless. Others may experience brief periods of irritability, and some may seem cranky for weeks, with crying jags and disrupted sleeping and eating patterns. Teething can be uncomfortable, but if your baby seems very irritable, talk to your doctor.

Although tender and swollen gums could cause your baby’s temperature to be a little higher than normal, teething doesn’t usually cause high fever or diarrhea. If your baby does develop a fever during the teething phase, it’s probably due to something else and you should contact your doctor.

Easing Teething

Here are some tips to keep in mind when your baby is teething:

• Wipe your baby’s face often with a cloth to remove the drool and prevent rashes from developing.
• Give your baby something to chew on. Make sure it’s big enough so that it can’t be swallowed and that it can’t break into small pieces. A wet washcloth placed in the freezer for 30 minutes makes a handy teething aid — just be sure to wash it after each use. Rubber teething rings are also good, but avoid ones with liquid inside because they may break or leak. If you use a teething ring, be sure to take it out of the freezer before it becomes rock hard — you don’t want to bruise those already swollen gums!
• Rub your baby’s gums with a clean finger.
• Never tie a teething ring around a baby’s neck — it could get caught on something and strangle the baby.
• If your baby seems irritable, acetaminophen may help — but always consult your doctor first. Never place an aspirin against the tooth, and don’t rub alcohol on your baby’s gums.

Baby Teeth Hygiene

The care and cleaning of your baby’s teeth is important for long-term dental health. Even though the first set of teeth will fall out, tooth decay can hasten this process and leave gaps before the permanent teeth are ready to come in. The remaining primary teeth may then crowd together to attempt to fill in the gaps, which may cause the permanent teeth to come in crooked and out of place.

Daily dental care should begin even before your baby’s first tooth emerges. Wipe your baby’s gums daily with a clean, damp washcloth or gauze, or brush them gently with a soft, infant-sized toothbrush and water (no toothpaste!). As soon as the first tooth appears, brush it with water.

Toothpaste is OK to use once a child is old enough to spit it out — usually around age 3. Choose one with fluoride and use only a pea-sized amount or less in younger kids. Don’t let your child swallow the toothpaste or eat it out of the tube because an overdose of fluoride can be harmful to kids.

By the time all your baby’s teeth are in, try to brush them at least twice a day and especially after meals. It’s also important to get kids used to flossing early on. A good time to start flossing is when two teeth start to touch. Talk to your dentist for advice on flossing those tiny teeth. You can also get toddlers interested in the routine by letting them watch and imitate you as you brush and floss.

Another important tip for preventing tooth decay: Don’t let your baby fall asleep with a bottle. The milk or juice can pool in a baby’s mouth and cause tooth decay and plaque.

The American Dental Association (ADA) recommends that kids see a dentist by age 1, when six to eight teeth are in place, to spot any potential problems and advise parents about preventive care.

Risks: A Warning on Asthma and Acetaminophen
By RONI CARYN RABIN
Young teenagers who use acetaminophen even once a month develop asthma symptoms more than twice as often as those who never take it, a large international study has found. And frequent users also had more eczema and eye and sinus irritation.

Other studies have linked acetaminophen (often sold as Tylenol and in other over-the-counter remedies for pain, colds, fever and allergies) with an increased risk of asthma. But the new study’s authors cautioned that the findings did not mean children should stop using it.

“Acetaminophen remains the preferred drug to relieve pain and fever in children,” said the study’s lead author, Dr. Richard W. Beasley, a professor of medicine at the Medical Research Institute of New Zealand. He noted that aspirin and ibuprofen should not be used in children with asthma, since they can bring on an attack.

Although the study does not prove that acetaminophen actually causes asthma, the authors speculated that the drug might have systemic inflammatory effects and result in greater allergic immune response.

The report, from the International Study of Asthma and Allergies in Childhood, or Isaac, was based on data from more than 322,000 children age 13 and 14 from 50 countries.

There are important oral health elements to the health care reform law – the Patient Protection & Affordable Care Act
(PPACA) – signed by President Obama in March 2010. Most significant, oral health is considered an “essential benefit” for children up to the age of 21. This is an important step in the right direction to incorporate oral health to overall health and focus on prevention of disease in our young population.  As an essential benefit, health insurance – including dental – will need to cover a core set of oral health benefits starting in 2014 through either a state-sponsored Exchange or later through private-employer sponsored health insurance.  Washington Dental Service and its oral health partners will be working closely to ensure that core benefit requirements are
designed to prevent dental disease at the earliest possible age.Other Important Oral Health Elements
Contained In The PPACA Law:

* Oral Health Prevention Campaign – The law
establishes a five-year oral health campaign targeted
at children, pregnant women and minorities.

* School-based Sealant Grants – Grants will be made
available in all 50 states.

* Surveillance Activities – the Department of Health &
Human Services (HHS) will update and improve
Pregnancy Risk Assessment Monitoring System with
a specific focus on improving oral health.

* Workforce – Oral health was called out as a special
area of need, and HHS will be empowered to extend
grants to dental schools.

Washington Dental Service fought hard during the health care reform debate to allow dental-only plans, including
members of the Delta Dental Plans Association, to participate and compete in the Exchanges as they do now in the
traditional marketplaces.  As a leader in dental benefit plan design, Washington Dental Service is well poised to bring
our innovative and disease prevention focus to the individuals and small employers on the Exchange market.
The results of health care reform provide additional attention and exposure to the importance of oral health to overall health. Washington Dental Service and its partners will continue to be closely involved as the new PPACA law is implemented in Washington and around the country.

-Washington Dental Service ‘Word of Mouth’ Newsletter   Summer 2010

Introduction

Background

The oral mucosa is lined by stratified squamous epithelium and has topographic differences that correlate with physical demands or a higher degree of specialization. For example, the epithelium lining the floor of the mouth, the ventral side of the tongue, the buccal mucosa, and the soft palate is nonkeratinized; however, the epithelium associated with the gingiva and hard palate is usually keratinized. The dorsal surface of the tongue is also keratinized, but it is referred to as specialized mucosa because of the presence of papillae. The dorsum of the tongue, the hard palate, and the gingival tissues are keratinized to better respond to masticatory demands.

Hyperkeratinization (excessive formation of tenaciously attached keratin) may be present in a variety of clinical conditions, including genetic, physiologic, inflammatory, immunologic, premalignant, and malignant conditions. The change may result from a local insult, including chemical, thermal, or physical irritants. This article focuses on the oral hyperkeratinization that results from friction. Friction (the constant rubbing of 2 surfaces against one another) in the oral cavity may result in the development of clinically observable white patches.

Various names have been used to describe particular examples of frictional keratosis (FK). These include frictional keratosis arising from excessive force while brushing the teeth (toothbrush keratosis); the constant rubbing of the tongue against the teeth (tongue thrust keratosis); the constant sucking, pressure, and irritation of the teeth against the buccal mucosa along the plane of occlusion (linea alba); and the habit of chronic cheek, tongue, or lip biting (cheek- or lip-bite keratosis).¹ Injuries to the oral mucosa, using items such as a pen, toothpicks, or fingernails, may result in frictional keratosis.

Pathophysiology

The white patches of frictional keratosis that develop in the oral cavity represent a chronic, low-grade, mechanical process that is analogous to the formation of a callus on the skin. The most common local factors involved in this process are tissue chewing (mainly on the buccal mucosa or lips), ill-fitting or irregularly surfaced removable dental prostheses (dentures), fractured or malposed teeth, poorly adapted dental restorations, orthodontic appliances, improper toothbrushing, and constant mastication on edentulous alveolar ridges. The constant irritation stimulates the production of excessive keratin, with a subsequent change in the thickness and the color of the involved mucosa.

Frequency

United States

Few large epidemiologic studies documenting the prevalence of various oral lesions, including oral frictional keratosis, have been published.

• The most comprehensive survey on the prevalence of oral mucosal lesions is the Third National Health and Nutrition Examination Survey (NHANES III). Oral examinations were performed on 17,235 noninstitutionalized civilian adults. Cheek and lip biting had a point prevalence of 3.05% and ranked third in oral lesion prevalence, while frictional keratosis had a point prevalence of 2.67% and ranked fourth.² In the same national survey, when 10,030 children aged 2-17 years were evaluated, the point prevalence for cheek and lip biting was 1.89% and 0.26% for frictional keratosis.³
• In another extensive survey of 23,616 white American adults from Minnesota that evaluated a wide range of oral lesions, the number of cases of cheek-biting keratosis was 1.2 cases per 1000 individuals.⁴ In this same study, frictional keratosis was not differentiated from leukoplakic lesions, so the prevalence of frictional keratosis alone cannot be determined.
• Linea alba is a common mucosal variation that is rarely singled out as a specific entity in prevalence studies. In a limited study of young men, 13% had this mucosal alteration.⁵

International

In a Danish study of 20,333 people aged 15 years and older, the prevalences of cheek and lip biting and frictional keratosis were slightly higher than those reported in the US studies.⁶ The prevalence for cheek and lip biting was 5.1%, and the prevalence for frictional keratosis was 5.5%. Similarly, the prevalence for frictional keratosis from a small study sample⁷ of Kenyan adults was 5.5%. In Slovenia, the prevalence was 2.7% for cheek and lip biting and 2.2% for frictional keratosis.⁸ In a study of Turkish adolescents, linea alba was the second most common lesion, with a prevalence of 5.3%.⁹

When studies were limited to individuals seeking care in oral medicine clinics, a wider frequency of occurrence was noted. In a limited study of patients treated at a dental school in Spain, the rate was 11.5% for frictional keratosis, 10.7% for linea alba, and 6.8% for cheek biting.¹⁰ In an India dental school study, frictional keratosis was the most common oral lesion detected, occurring in 5.8% of the patients.¹¹ When referred hospitalized and clinic patients were evaluated in an Australian oral medicine clinic, hyperkeratotic lesions, including tobacco-induced lesions, were documented in 11.6% of the hospitalized patients and 10.3% of the clinic patients.¹²
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The largest study of 23,785 patients, attending a Mexican dental school clinic, found frictional keratosis to be the third most common oral mucosal finding, with a prevalence rate of 32 cases per 1000 patients, while cheek-biting lesions were ranked fifth, or 21.7 cases per 1000 patients.¹³

Mortality/Morbidity

Frictional keratosis and its variants do not cause symptoms and are benign mucosal lesions that remain localized with no associated mortality or morbidity.

Race

No racial predilection seems apparent for oral frictional keratosis.

Sex

In general, frictional keratosis has no known sex predilection, except for cheek biting and lip biting, which are twice as prevalent in women compared with men.¹

Age

Oral frictional keratosis affects persons from a wide range of ages, and contributing factors determine which age group is more commonly affected. In general, oral frictional keratosis lesions are more common in adults.

Clinical

History

• Most patients with frictional keratosis are free of symptoms, with the exception of those with aggressive cheek and lip biting habits. In some individuals who repeatedly traumatize the tissues, tenderness, swelling, and a burning sensation may be presenting symptoms.
• Patients with persistent cheek and lip biting habits tend to have increased stress and psychologic disorders.
• A patient may notice a thickening or roughness of the involved mucosal site, or frictional keratosis may be discovered as an incidental finding during a routine oral examination.
• Individuals with a cheek and lip biting habit often report they are able to remove thin strands or tags of mucosa from the involved site.
• Patients may report that they are aware of sucking the mucosa or thrusting their tongue against their teeth. Some patients report that their cheeks and tongue feel swollen. Occasionally, the affected fungiform papillae in persons with a tongue biting or thrusting habit may be tender and sometimes associated with a burning sensation.
• When the gingival tissues are involved, patients may report using a medium- or hard-bristled toothbrush or other oral hygiene aids.
• In some instances, patients give a history of wearing orthodontic appliances or removable full or partial dental prostheses that may traumatize the soft tissues. Occasionally, ill-fitting or broken mouthguards or occlusal splints irritate the oral mucosa, resulting in frictional keratosis.
• Sucking on the cheeks, lips, or sides of the tongue may be a habit to relieve the discomfort from temporomandibular disorder or burning mouth syndrome. Forceful or aberrant nutritional sucking on the nipple of the bottle or breast may result in calluses on the lips of infants.
• In rare examples, individuals may give a history of picking the oral mucosa with long fingernails or some other external object.

Physical

The first step in the identification of white patches suspected of being associated with physical trauma is to use a 2 X 2-inch sterile gauze to wipe off the lesion or lesions. If the patch is not easily wiped off, this suggests the presence of hyperkeratinization.

• The lips, the lateral margins of the tongue, the buccal mucosa (mainly along the occlusal line), and the edentulous alveolar ridges are the most common sites to find frictional keratosis and its variants.
• Typically, the lesions appear as distinct, focal, and translucent-to-opaque white asymptomatic patches with sharply delineated borders. The surface of a lesion may appear irregular and feel rough to the tongue.
• Slight variations in the clinical presentation are directly related to the nature and the source of the physical trauma.
• One of the more common presentations of frictional keratosis is the linea alba (white line). This feature manifests as a horizontal thickening of the buccal mucosa along the occlusal line of the teeth. Linea alba is thought to result from chronic cheek biting or sucking of these tissues (see Media File 1 and Media File 3).
  • In one patient, the surface of the last molar tooth showed considerable occlusal wear, which is evidence that the patient had the habit of grinding his teeth (see Media File 1). This habit most probably led to the biting of the cheek mucosa.
  • Occasionally, the line reflects the irregularity of the adjacent teeth and has a somewhat scalloped appearance (see Media File 2).

• Occasionally, the frictional line is somewhat more diffuse, and this type of change is more likely to be associated with the habit of cheek chewing, also known as morsicatio buccarum (see Media Files 4-5), rather than the occasional accidental friction of teeth against the mucosa during the normal eating process. These white patches are associated with either a conscious or an unconscious chronic oral habit.
• The effects of the habit of chronic biting may also manifest on the anterior and lateral borders of the tongue and appear as white, shaggy or mildly wrinkled plaques (see Media File 6).
• A frictional keratosis lesion may be elevated from the surface, and patients may find that they develop the habit of nibbling further at these thickened mucosal sites. Media File 4 shows a frictional keratosis lesion that displays marked keratinization. The patient admitted to nibbling at the thickened mucosa (see Media File 5), which, in turn, made it thicker and easier to feel and, therefore, encouraged further nibbling.

• Occasionally, patchy erythema with or without petechiae is observed with recent trauma to the site.
• Lesions associated with a tongue thrusting habit often demonstrate prominent crenations of the lateral tongue. In addition, the affected fungiform papillae may be red and enlarged from the chronic irritation.

Causes

In most patients with frictional keratosis, the cause is easily identified.

• An oral habit of cheek biting, cheek chewing, tongue thrusting, or mucosal sucking can often be identified as the cause if the site of the lesion is carefully examined in relationship to the occlusal plane.
• An ill-fitting, rough, or broken removable dental prosthesis or orthodontic appliance or a fractured or irregular tooth surface frequently affects the adjacent soft tissues.
• Occasionally, a frictional keratosis lesion may develop as a result of the constant rubbing of an external object, such as a tobacco pipe; a musical instrument; or, perhaps, a worker’s tool, which, for convenience, is held in the mouth for long periods.
• Another cause may be manipulation of the tissues with long fingernails, which may shred the mucosa.
• Improper toothbrushing and other oral hygiene aids affect the attached gingival tissues.

• Irritation from masticatory function may cause frictional keratosis when the alveolar mucosa and retromolar pad bear the stresses of eating.

• Pregnancy may significantly increase the risk for cheek biting.¹⁴
• In rare cases, the overuse of topical anesthetics, overuse of antiseptic mouthrinses, or oromucosal delivery of medications (eg, cannabis) causes keratosis from chemical irritation.¹⁵
• The identification of such habits depends on obtaining a thorough history.

What Do You Lack? Probably Vitamin D
By JANE E. BRODY
Vitamin D promises to be the most talked-about and written-about supplement of the decade. While studies continue to refine optimal blood levels and recommended dietary amounts, the fact remains that a huge part of the population — from robust newborns to the frail elderly, and many others in between — are deficient in this essential nutrient.

If the findings of existing clinical trials hold up in future research, the potential consequences of this deficiency are likely to go far beyond inadequate bone development and excessive bone loss that can result in falls and fractures. Every tissue in the body, including the brain, heart, muscles and immune system, has receptors for vitamin D, meaning that this nutrient is needed at proper levels for these tissues to function well.

Studies indicate that the effects of a vitamin D deficiency include an elevated risk of developing (and dying from) cancers of the colon, breast and prostate; high blood pressure and cardiovascular disease; osteoarthritis; and immune-system abnormalities that can result in infections and autoimmune disorders like multiple sclerosis, Type 1 diabetes and rheumatoid arthritis.

Most people in the modern world have lifestyles that prevent them from acquiring the levels of vitamin D that evolution intended us to have. The sun’s ultraviolet-B rays absorbed through the skin are the body’s main source of this nutrient. Early humans evolved near the equator, where sun exposure is intense year round, and minimally clothed people spent most of the day outdoors.

“As a species, we do not get as much sun exposure as we used to, and dietary sources of vitamin D are minimal,” Dr. Edward Giovannucci, nutrition researcher at the Harvard School of Public Health, wrote in The Archives of Internal Medicine. Previtamin D forms in sun-exposed skin, and 10 to 15 percent of the previtamin is immediately converted to vitamin D, the form found in supplements. Vitamin D, in turn, is changed in the liver to 25-hydroxyvitamin D, the main circulating form. Finally, the kidneys convert 25-hydroxyvitamin D into the nutrient’s biologically active form, 1,25-dihydroxyvitamin D, also known as vitamin D hormone.

A person’s vitamin D level is measured in the blood as 25-hydroxyvitamin D, considered the best indicator of sufficiency. A recent study showed that maximum bone density is achieved when the blood serum level of 25-hydroxyvitamin D reaches 40 nanograms per milliliter or more.

“Throughout most of human evolution,” Dr. Giovannucci wrote, “when the vitamin D system was developing, the ‘natural’ level of 25-hydroxyvitamin D was probably around 50 nanograms per milliliter or higher. In modern societies, few people attain such high levels.”

A Common Deficiency

Although more foods today are supplemented with vitamin D, experts say it is rarely possible to consume adequate amounts through foods. The main dietary sources are wild-caught oily fish (salmon, mackerel, bluefish, and canned tuna) and fortified milk and baby formula, cereal and orange juice.

People in colder regions form their year’s supply of natural vitamin D in summer, when ultraviolet-B rays are most direct. But the less sun exposure, the darker a person’s skin and the more sunscreen used, the less previtamin D is formed and the lower the serum levels of the vitamin. People who are sun-phobic, babies who are exclusively breast-fed, the elderly and those living in nursing homes are particularly at risk of a serious vitamin D deficiency.

Dr. Michael Holick of Boston University, a leading expert on vitamin D and author of “The Vitamin D Solution” (Hudson Street Press, 2010), said in an interview, “We want everyone to be above 30 nanograms per milliliter, but currently in the United States, Caucasians average 18 to 22 nanograms and African-Americans average 13 to 15 nanograms.” African-American women are 10 times as likely to have levels at or below 15 nanograms as white women, the third National Health and Nutrition Examination Survey found.

Such low levels could account for the high incidence of several chronic diseases in this country, Dr. Holick maintains. For example, he said, in the Northeast, where sun exposure is reduced and vitamin D levels consequently are lower, cancer rates are higher than in the South. Likewise, rates of high blood pressure, heart disease, and prostate cancer are higher among dark-skinned Americans than among whites.

The rising incidence of Type 1 diabetes may be due, in part, to the current practice of protecting the young from sun exposure. When newborn infants in Finland were given 2,000 international units a day, Type 1 diabetes fell by 88 percent, Dr. Holick said.

The current recommended intake of vitamin D, established by the Institute of Medicine, is 200 I.U. a day from birth to age 50 (including pregnant women); 400 for adults aged 50 to 70; and 600 for those older than 70. While a revision upward of these amounts is in the works, most experts expect it will err on the low side. Dr. Holick, among others, recommends a daily supplement of 1,000 to 2,000 units for all sun-deprived individuals, pregnant and lactating women, and adults older than 50. The American Academy of Pediatrics recommends that breast-fed infants receive a daily supplement of 400 units until they are weaned and consuming a quart or more each day of fortified milk or formula.

Given appropriate sun exposure in summer, it is possible to meet the body’s yearlong need for vitamin D. But so many factors influence the rate of vitamin D formation in skin that it is difficult to establish a universal public health recommendation. Asked for a general recommendation, Dr. Holick suggests going outside in summer unprotected by sunscreen (except for the face, which should always be protected) wearing minimal clothing from 10 a.m. to 3 p.m. two or three times a week for 5 to 10 minutes.

Slathering skin with sunscreen with an SPF of 30 will reduce exposure to ultraviolet-B rays by 95 to 98 percent. But if you make enough vitamin D in your skin in summer, it can meet the body’s needs for the rest of the year, Dr. Holick said.

Can You Get Too Much?

If acquired naturally through skin, the body’s supply of vitamin D has a built-in cutoff. When enough is made, further exposure to sunlight will destroy any excess. Not so when the source is an ingested supplement, which goes directly to the liver.

Symptoms of vitamin D toxicity include nausea, vomiting, poor appetite, constipation, weakness and weight loss, as well as dangerous amounts of calcium that can result in kidney stones, confusion and abnormal heart rhythms.

But both Dr. Giovannucci and Dr. Holick say it is very hard to reach such toxic levels. Healthy adults have taken 10,000 I.U. a day for six months or longer with no adverse effects. People with a serious vitamin D deficiency are often prescribed weekly doses of 50,000 units until the problem is corrected. To minimize the risk of any long-term toxicity, these experts recommend that adults take a daily supplement of 1,000 to 2,000 units.

This article has been revised to reflect the following correction:

Thanks to a new gel, soon this won’t hurt . . .
A gel that can help decayed teeth grow back in just weeks may mean an end to fillings.

The gel, which is being developed by scientists in France, works by prompting cells in teeth to start multiplying. They then form healthy new tooth tissue that gradually replaces what has been lost to decay.

Researchers say in lab studies it took just four weeks to restore teeth back to their original healthy state. The gel contains melanocyte-stimulating hormone, or MSH.

We produce this in the pituitary gland, a pea-sized gland just behind the bridge of the nose.

MSH is already known to play an important part in determining skin colour - the more you have, the darker your flesh tone.

But recent studies suggest MSH may also play a crucial role in stimulating bone regeneration.

As bone and teeth are very similar in their structure, a team of scientists at the National Institute for Health and Medical Research in Paris tested if the hormone could stimulate tooth growth.

Their findings, published in the American Chemical Society journal ACS Nano, could signal hurtnot just an end to fillings, but the dreaded dentist drill as well. Tooth decay is a major public health problem in Britain. Around £45m a year is spent treating decayed teeth and by the age of 15, teenagers have had an average of 2.5 teeth filled or removed.

Decay is caused by bacteria, called streptococcus mutans, that live in the mouth and feed on sugar in the diet. Once the bacteria stick to the enamel, they trigger a process called demineralisation - they turn sugar in the diet into a harmful acid that starts to create holes in the teeth.

For decades, the main treatment for cavities has been to ‘drill and fill’. However, an estimated one in five Britons suffers from dental phobia, a fear of dentists which means some would rather endure pain and suffering than face the prospect of having their teeth drilled.

The new treatment is painless. And although fillings halt decay, they can come loose and sometimes need refilling.

Experts believe new tooth cells would be stronger and a permanent solution.

The French team mixed MSH with a chemical called poly-L-glutamic acid. This is a substance often used to transport drugs inside the body because it can survive the harsh environments, such as the stomach, that might destroy medicines before they get a chance to work.

The mixture was then turned into a gel and rubbed on to cells, called dental pulp fibroblasts, taken from extracted human teeth. These cells are the kind that help new tooth tissue to grow.

But until now there has been no way of ’switching’ them back on once they have been destroyed by dental decay. The researchers found the gel triggered the growth of new cells and also helped with adhesion - the process by which new dental cells ‘lock’ together.

This is important because it produces strong tooth pulp and enamel which could make the decayed tooth as good as new.

In a separate experiment, the French scientists applied the gel to the teeth of mice with dental cavities. In just one month, the cavities had disappeared. The gel is still undergoing testing but could be available for use within three to five years.

Professor Damien Walmsley, the British Dental Association’s scientific adviser, said the gel could be an interesting new development, but stressed it is unlikely to be able to repair teeth that have been extensively damaged by decay.

‘There are a lot of exciting developments in this field, of which this is one,’ he said. ‘It looks promising, but we will have to wait for the results to come back from clinical trials and its use will be restricted to treating small areas of dental decay.’

• Scientists have developed a ‘tongue’ gel as part of a new approach to tackling bad breath and preventing tooth decay.
• Halitosis is usually caused by bacteria in the mouth. The latest treatment, developed by Meridol, takes a mechanical and chemical approach. It consists of a tongue scraper, gel and mouth wash.
• The extra-flat tongue cleaner is used to scrape bacteria off the tongue. The tongue gel and mouthwash are anti-bacterial and contain chemicals that attach themselves to odour-producing compounds, which are then flushed out with the mouthwash. Both gel and mouthwash contain fluoride.

Definitely an interesting article- hope you enjoyed!             - Caitlin

http://www.dailymail.co.uk/health/article-1297850/Gel-help-decayed-teeth-grow-end-fillings.html

This is in regard to a post on Neal OMS’s blog about a year ago.  It turns out that some information in an article that was copied and posted was not true, and in retrospect, posting it wasn’t such a good idea, whether it was true or not.  I never intended for the article itself or my comment to hurt anyone, or for it to reflect poorly on the practice I’m fortunate to be a part of.  I’m genuinely sorry, Dr. Woo, please accept my apology.  Sometimes you experience a lapse in good judgement, and a stupid mistake snowballs  into something much bigger.  Can anyone relate?

Sincerely,

Tricia