Bite Point

Integrative Medicine- Guest Post by Michelle Niesley, N.D., M.S.

Integrative Medicine is a relatively new concept that goes beyond the treatment of symptoms to address the causes of disease.  It involves personalized care and is highly concerned with prevention, not only treatment.

Here to explain Integrative Medicine in a guest post is Michelle Niesley, N.D., M.S.  Her website is http://www.theaspireclinic.com/ 

 

Dr. Niesley introduces us to the field:

“Integrative medicine”—it’s the newest buzzword in medical care.  Almost everyone knows someone who received acupuncture for chronic pain or to help them quit smoking, or saw a chiropractor for back or neck pain.  Integrative medicine is not ‘alternative medicine’, which is used in the place of standard medical care.Integrative medicine blends the best of our scientific understanding used in standard medical practice with lifestyle interventions to provide patients with unique care that is optimal for them.

The word ‘doctor’ comes from the Latin word docere which means ‘to teach’.  Most doctors received medical education that centered on surgical interventions and prescribing of medications.  These are vitally important to the healthcare of many.   But medical doctors who do not seek out additional training receive approximately 8 hours of education on ‘nutrition, vitamins, and minerals’—which makes it challenging to ‘teach’ patients about lifestyle changes they can make to improve their health.  As such, many patients are looking for ways to fill in their healthcare gaps, and seek out healthcare providers who have expertise in lifestyle modifications such as dietary changes,herbal or nutritional supplements, exercise physiology, homeopathy, acupuncture and Chinese medicine, or chiropractic care.  Most patients could greatly benefit from an ‘integrative care team’, with medical doctors sharing patients with acupuncturists, chiropractors, therapists, naturopathic doctors, nutritionists, and other providers who were provide their own expertise in helping you achieve and maintain optimal health.

For example, many are taking medications for high blood pressure.  But the reason(s)whythey have high blood pressure can vary greatly from one person to the next.  Integrative care will provide you with a ‘roadmap to wellness’ that includes detailed dietary recommendations, a feasible exercise regimen, and guidance on herbal or nutritional supplements (such as magnesium, fish oil, and CoQ10).  We also determine if any other factors may be contributing to the condition—such as stress at work or home, too much alcohol, cigarette smoking, etc…  and can help provide resources to help you change your environment to ensure success.

Many integrative providers analyze the same labs your family physician does—but we look to see if the results are ‘optimal’ as compared to ‘within normal limits’.  Most patients don’t want to be ‘okay’; they want to feel as well as possible.  The goal is provide you with the tools you need to put control of your healthcare back into your hands.  Integrative providers believe that everyone would benefit from an individual analysis of our health so that we can pinpoint which small lifestyle modifications may lead to big changes in how we feel.

 

MB2 Canals and Global Microscope Magnification

Ah, the canals of Venice, and other places I've never been:

 
Yet I do spend quite a bit of time in those other canals, the very small ones, the ones inside of the roots of teeth that sometimes go awry and give patients pain. 

 

The root canal systems inside of human teeth are very complex.  It's like having a main street, but then lots of side streets and interconnecting avenues that all have to be cleaned up in detail.  And they all curve; no straight lines.  It's most definitely not one simple straight tube that we have to deal with when we are faced with cleaning this system of infected tissue.

Upper first molars are particularly difficult to cleanse.  The above graphic depicts one.  There are often four main canals in these teeth.  The palatal goes off towards- you guessed it- the palate, or roof of the mouth.  The disto-buccal is the one farther back (distal) and towards the cheek (bucca means cheek in Latin).  The  mesio-buccal 1 is the one towards the front and cheek. 

The problems tend to occur around the mesio-buccal 2, or MB2 for short.   This canal is usually very small and difficult to find even in the best of circumstances.  As we get older, or have many procedures done on a tooth over the years, the canals get smaller.  Often so much smaller that they cannot be found at all, which is not good, because if they cannot be found, they cannot be cleaned. 

See:

http://rickwilsondmd.typepad.com/rick_wilson_dmds_blog/2010/09/dental-pulp-calcification-spelunking-in-the-dentin.html

http://rickwilsondmd.typepad.com/rick_wilson_dmds_blog/2011/01/dental-pulp-calcification-and-changes-with-age.html

When using the Global Operating Microscope, I find that the whole game has changed.  Tiny MB2 canals that I struggled to find are now things that I trip over in broad daylight.  Here is an image to show you what I mean:

 

(These video captures show what we see through the eyepieces of the microscope, but they do not at all give the 3-D visceral feel that one gets by looking through the actual optics.) 

The other three canals that can be seen in this image have been enlarged and cleaned up already in the course of treatment.  The MB2 is now readily apparent, magnified, and lit up with the dental equivalent of Kleig lights.  This is a tremendous benefit to our patients, as we can now find (and clean) a much higher percentage of these canals than before we had this device.

 

Digital Radiography in Dentistry

As I post about so many of the new technologies that we've adopted recently, I'd like to revisit one from a few years ago.  In 2007 we changed our imaging to fully digital, including digital radiography, or X-rays.  Since approximately half of the dentists in the U.S. have adopted this technology, it still is more than worth examining as a new innovation.

There are many advantages to digital X-rays over analog film in dentistry.  The radiation doses are significantly lower for the same diagnostic information.  The diagnostic information itself is far higher quality, since images can be made larger, sharper, altered in their brightness and contrast, and manipulated in other useful ways to ensure that we see all that there is to see. 

From an environmental standpoint, the total absence of developer and fixer chemicals reduces to zero the emissions of pollutants into the wastewater stream.  The only direct pollution footprint is the energy used by the computers and processor, and the clear infection control sheaths that cover the imaging plates or sensors.  It is worth noting that my own studies revealed that the energy cost of continuously running computers throughout the day is less than the cost of an intermittently running mechanical film processor/dryer, with all of its rollers and heater elements.

We also can email radiographs around to specialists that our patients consult with.  This reduces the use of paper, printer ink, and fossil fuels consumed by post office vehicles. 

There is a significant initial cost to adopting this technology, of course.  Our Scan-X phosphor plate developer unit:

 
-cost as much as my 2003 Prius automobile.  Then there were computers and wiring and software... 

Yet the cost was all worth it because of this:

 
Hahaha!  No comparison.  Those are films of the same area in my own mouth.  Which would you rather look at if you were trying to figure out if I had a cavity, a root canal infection, or something even more serious like an osteosarcoma, with its characteristic vague "star-burst" radiating pattern in the bone?

My favorite feature of digital film manipulation is the edge-clearing algorithim.  Here are before and after images with this treatment:

 
 

See how the first image is fuzzy wherever there are two contrasting shades of gray, and how the second image is all crips and clear?  Push of a button, push of a button.  Someone kindly did the math for me ahead of time!

Which reminds me of a recurring theme from one of my favorite comedies of all time, 1965's "The Great Race". 

"Push the button, Max!"

http://www.youtube.com/watch?v=Lzaj0bdduHM&feature=related

 

Global Surgical Microscope- Those Teeth Look As Big As My Car!

This friendly-looking fellow:

 

-who looks a bit like an affable alien who just discovered tobacco products- is our new Global Surgical Microscope.  Here's another view; we have him engaging in some botanical research on the side:

 

This is a magnificent instrument which is designed to allow dentists to work with magnification and vision enhancement and to provide a whole new level of treatment, especially in endodontics, the arena of root canal treatment.  Many endodontists who specialize in that part of dentistry have adopted this technology; we are now one of the first general dental offices in the Philadelphia area to do so.  For this device is useful in most all of the treatments which we perform in dentistry.

Over time, I'm certain to post more images.  For now, let's have a look at an all-ceramic crown at two magnifications.  The crown is still on its die, the model (here in epoxy resin) made from the impression which we take at the first visit:

 
 
Wow!  I had to spend quite some time blowing stray dust off this baby for such a photo and I still didn't get it all!

Here are some views of teeth in situ, as we could say. 

 
Here's a close-up of the edge-wear on that incisor at the top of the image:

 

I've placed composite resin restorations at these magnifications and I can say that what looks good at five times life size looks unreasonably great from a conversational distance. 

These images, grabbed through a video feed, don't even come close to capturing the feel of looking through the eyepieces, which are stereoscopic, after all.  It's very 3-D, very powerful, and very Visceral.

So far, in using the scope, I find my posture to be incredibly relaxing.  The microscope and the mirror do all the work. 

Patients have also commented that the whole dental procedure seems more gentle when performed under the microscope.  This is interesting, as I've just gotten started with it.  So far, I surmise that the actions performed during treament are more focused; more is accomplished with less movements of the instruments, in less time.  This makes sense, because even though there is certainly a learning curve with any new medical technology, I've been consistently faster when using the microscope than not- without trying to be.  In fact, I feel like I'm working more slowly.

Focus.  It all comes down to focus.

At Sukoneck & Wilson, we've adopted a number of new technologies recently, as you can see by looking back through my posts.  This one- this one just might win First In Show.  I certainly look happy using it:

 

The hardest part, actually, is resisting the urge to frequently call out, "Fire one, Kowalski!" like I'm captain of the USS Becuna or something.

 

Let It Be A Wakeful One

"And in my place, what profession would you choose?"
"Ah, that I cannot say. I do not know your circumstances."
"I must earn my bread, like other sons of Adam."
"Well, earn it then in such manner that the eyes of the world shall be upon you; that men and women shall talk of you, and newspapers have your name in their columns. Whatever your profession, let it be a wakeful one; not one that you can follow half asleep."

Anthony Trollope, The Bertrams, 1859 

 

Go. Make a difference.

And Happy 210!

2011 Super Bowl Gatorade Shower Part Two

Wall of Calories!

 

See http://rickwilsondmd.typepad.com/rick_wilson_dmds_blog/2011/01/2011-super-bowl-gatorade-shower.html

Did you know that one of the big side bets that the Super Bowl generates is: what color Gatorade will the winning team's players drench their coach in?  Amazing, the power of this sports mythology.

Here, then, thanks to youtube, are frames from the orange Gatorade shower this year, at Super Bowl XLV:

 
 
 
 

And just to give you a little something to mull over, here are the logos from the Green Bay Packers (one of my favorite teams, ever since Lombardi, by the way) and Vitamin G:

 
 

Unless you go hard for more than about two hours and actually do manage to burn off some serious electrolytes (it takes that long), I have one word:

Water.

  

http://rickwilsondmd.typepad.com/rick_wilson_dmds_blog/2010/08/gatorade-open-gulp-repeat.html

http://rickwilsondmd.typepad.com/rick_wilson_dmds_blog/2009/12/gatorade-selling-the-sizzle-not-the-slake.html

 

Soprolife Certainty

As we employ our new Soprolife Caries Detection Device to snoop out decay as early as possible in our patients' teeth, we find that it gives us a tremendous sense of Certainty.  Consider this groove system on a molar:

 

These sorts of grooves, all stained and yet hard to the touch of a dental explorer, are the ones that give us pause.  Is there decay?  Is there not decay?  It the enamel is stained but not soft, what should we do?

In the age of fluorides, the problem is compounded.  Fluoride prevents and slows decay drastically.  Yet when it happens, it sometimes leaves the outer enamel intact and as the underlying dentin softens, the first sign is a rather large dark area on an X-ray.  The enamel stays intact until it finally "caves in" at some point.  It never feels sticky to our dental explorer up until that time.  Yet we'd rather treat cavities in the grooves of teeth before they get large enough to show up obvious on X-rays.

Here, then, is the same tooth at the same time with the 450nm wavelength light that fluoresces  red when there's a cavity, green when healthy:

 
 Healthy tooth!  That little hint of red is not sufficient to represent decay.

The Soprolife device is going to make cavity diagnosis a lot more accurate in our office.  Early treatment is less treatment, and no treatment is always best, as long as that's what's called for.

Soprolife Optical Cavity Detection System

Light.

For most of our lives, we live in a realm of "white light", which is the entire visible part of the electromagnetic spectrum.  Yet the white light we see is a very small portion when you consider the entire range:

 
Interesting things happen when we use just a very small portion of this spectrum to accomplish a particular goal.  The key concept here is that any given portion of the spectrum, any wavelength of light/energy, interacts with the medium in which it travels in different ways.  Light traveling through the vacuum of interstellar space travels faster than light traveling in our atmosphere, which in turn travels faster than light traveling through seawater.  Or Woodford Reserve Distiller's Select Kentucky Bourbon.

We can see the effects of the interaction of light in various media even in common things around us, such as the diffraction of light between air and water:

 

I remember reading some interesting things about this over the years.  For instance, when our Navy submarines dive deep, it's very difficult to commumicate with the surface because seawater blocks most forms of electromagnetic radiation pretty thoroughly.  It turns out, though, that a certain wavelength of green laser light, as well as extremely low frequency radio waves (ELF waves!), can get information through to the briny deeps.  So ELF is used, and submarine captains can get new orders, but they come through very slowly.  The bit-rate is like the Internet in 1996 or so, when primitive dial-up reigned. 

In dentistry, light is used for many things.  For over one hundred years, X-rays have been used to "see through" structures in the mouth and look for a dizzying array of pathologies: cavities, root canal infections, bone loss due to periodontal disease, cysts, tumors...  Judicious use of X-rays is of incalculable diagnostic value to us as we strive to achieve and maintain oral health in our patients.

Our Trimira Identifi 3000 makes intelligent use of soft tissue fluorescence in the early detection of oral cancer and other conditions in the mouth:

 

 

Now, there is a new way to examine teeth with light and expand our diagnostic abilities when it comes to cavities, which still qualify for that ugly word "scourge" in our carb-saturated society.  The Soprolife Light Induced Fluoroescence Evaluator (I would have preferred the term "Bat-Light" and hung the device on my trusty Utility Belt but you can't have everything) is new technology that we have incorporated into our practice for the purpose of early detection of cavities.

Here is the Soprolife device:

 

 

And here is a shot of the light that emanates from the device in Caries (Cavity) Detection Mode:

 

How does it work?  Well, it turns our that light at a wavelength of precisely 450 nm (nanometers, in the bluish part of the spectrum diagrammed above) that enters a tooth excites the dentin, the inside structure of teeth.  And you thought science was often boring...  Dentin fluoresces green when it's healthy.  When there's a cavity, it fluoresces a rather angry red.  Here' s a diagram of the effect:

 
 

Here, then, are some images from actual practice in our office.

This is one of my own premolars.  I'm all green and thus cavity-free in the grooves on the biting surface of my tooth:

 

Molars often have deeper grooves, and we see that effect here with just a hint of reddish hue in my molar; this is not a cavity:

  

Here is an early occlusal cavity (in the surface grooves of a molar) showing in deep red (not my tooth anymore):

 
Here is an early cervical cavity (at the gumline):

 

 This photo is of recurrent decay around a composite resin restoration:

 

Lastly, we often worry about the health of teeth under crowns when time passes and the gums recede away from the margin, or edge, of the crown.  The exposed root can be very prone to decay.  This photo reassures us that the tooth is indeed healthy and has no cavity in the visible areas.  The patient may wish to replace this old crown for appearance reasons, but does not have any obligation to due to decay.

 

Overall, we are very happy to have the Soprolife Bat-Cavity Detection Light as part of our high-tech wizardry that enhances the diagnosis and treatment of you, our treasured patients.