Wednesday, April 29, 2009

Brainy

The internet is wonderful, Emily ordered me a year's subscription to The Surfer's Journal as a present. We got introduced to it by a friend. Semi-book, semi magazine, it's an amazing thing with lots of great pictures and stories. We got the first issue a little later and it looked like this.Not only is it an amazingly awesome picture, but Emily and I agree her unique suit is super cute. Looking closely at the folds, you can tell it's a wetsuit of some kind, but the logo is unfamiliar. The picture is of Australian surfer Belinda Baggs. Searching the internet, we checked any wetsuit company we could find to see who makes it. We tried looking up info on Belinda to see who she was sponsored by or anything that would hint at this wetsuit. Nothing. Then, yesterday morning, I tried one more time and found an obscure website that had some personal bio-type info on her. On it it's mentioned that she likes Rash Wetsuits from Japan. Yup, they make it. When Emily asked how I even found it, I tried to show her the bio-site that I found using the same search terms I used before. Not there. Go figure. They seem like nice wetsuits from what I can figure using iGoogle's handy little Translation gadget to poorly translate (by copy and paste) the Japanese to English (just now in googling for the translator page, I miss-typed and searched for "igoogle translort" and still got it as the first result, awesome). Turns out, there's even a single California dealer of these wetsuits located not far from my hometown in Oxnard, CA via Laina Imports.

So, from a picture and a name, in 3 hours we figured out the makers of an obscure wetsuit company (obscure to us in North America, at least) based out of Japan and a local dealer to purchase them from (not that we can afford it, they're nice, but out of our range. The colors are all customizable on order. Emily wants a pink wetsuit now).

Another set of gems on the internet are recorded TED talks. TED is a conference held in Monterey, CA every year where a variety of experts come and present on a large variety of topics and technologies all loosely based on the theme of improving mankind. A gathering of nerds of the glorified kind.

This one I thought was fascinating, especially after performing less-than-stellar on a hand-skills practical exam to prepare a plastic upper-right 1st molar for a 3/4 gold crown this morning. It gives some comfort regarding my slowly budding handskills, and the take-home message at the very end is worth watching. He speaks of the brain's plasticity and ability to re-wire itself, mostly focusing on handicapped children and elderly. It's about 23 minutes long.



To be honest, I don't actually watch many of these. I hang out on Digg and when the description of one catches my interest, I'll check it out. Digg is full of nerds (or endlessly-curious and fascinated-with-technology sociopaths) and I find lots of good stuff on there to keep me interested in learning about whatever.

Friday, April 24, 2009

Dentistry II

So I left off explaining that fluoride fit quite nicely into the crystals of teeth and stuff. This is true. This turns "calcium hydroxyapatatite" into "calcium fluoroapatite" and happens almost entirely on the surface of teeth, providing a protective coat on the outside. Problem is that the fluoride version tends to look brown, while the hydroxy version looks the nice white/translucent of normal teeth. The plus side is that teeth are quite a bit more resilient to dissolving by acids. 

Almost 100 years ago, people discovered that communities that had fluoride naturally in the water supply had fewer cavities and tooth decay and that communities that had higher amounts of it had almost no tooth decay and kids with brown teeth. It's since been discovered that people who grew up with fluoride but move to an area without it, will get more cavities in the new area, and that those who grew up without it but move to it, will have less cavities in the new area. It is a temporary effect that's mostly environmental. 

This is the reason that dentists promote fluoride: (Not for the brown teeth) It's good for stronger teeth in small amounts. After that, the benefits are pretty minimal, and they're not shy about that in class. In at least three different courses they've taught us the advantages and disadvantages of fluoride. Fluoride tends to bind to and soak up free calcium in your blood (which is valuable for enzyme activity and crucial to proper nerve conduction) making it unusable by the body. It can also interfere in cellular processes to some degree if taken into cells. This makes fluoride a weak anti-microbial as well, but it's a small effect.

Fortunately, as a water soluble ion/mineral, it is easily filtered by kidneys and urinated out. Since the kidneys can filter an entire person's blood supply several times a day, fluoride is quickly passed into urine in the small amounts we encounter it in nature and daily living.

This amount is small. In most communities, fluoride is added to water to be 1 part per million (ppm), that's one miligram per liter of water. Studies have shown that between .7 ppm and 1.2 ppm, the maximum benefit can be had per risk. Above this, there is very little extra advantage and increasing risk of undesirable effects. The effect is a topical one. For a while, it was taught that fluoridated water worked by getting fluoride into a person's system and becoming incorporated into growing and developing teeth, but this has been refuted a lot recently and most researchers agree the effect works on the surface more than anything. Small concentrations in water and higher concentrations on topical pastes and things provide the needed fluoride.

Fluoride is considered poisonous above a few grams. The least amount of fluoride known to kill someone was 4 grams eaten by a little kid within an hour. Generally, 5-10 grams is fatal. It is dangerous. But very few people have access to that much fluoride. The FDA allows water at around 1 ppm, and readily available toothpastes at 1000 ppm, which aren't supposed to be swallowed. That comes to about .15% in almost every toothpaste since that is the cap set by the FDA. Some fudge numbers due to rounding and marketing tactics, but it's all the same.  A small child should be okay if they happen to eat a whole tube of toothpaste, that's why it's available over-the-counter. Prescription toothpastes can have up to 5000 ppm and would have a good chance of making a child sick were they to eat the whole tube, but they'd probably survive the encounter. 

University of the Pacific's Dental School promotes some mouth rinses with calciums, fluorides, and other things to make teeth strong as well as varnishes smeared onto teeth following a polishing. These can have up to 22,500 ppm. The high concentrations are compensated by the very small amounts needed and the monitoring of the use within the clinic. A very very small amount of varnish goes a very long way and is released/dissolved slowly over several hours. Fluoride Foams are looked down on in the clinic here since children tend to swallow them, most of it is wasted not being on the surface of the teeth, and they're pretty messy. Also, they teach us that until children learn to spit out toothpaste, don't bother using a fluoridated toothpaste. They'll lose those teeth anyway and don't need to be swallowing something that's not going to help them in the long run. 

Recommendations of the school based off of research and study go loosely as follows: if a person has healthy teeth, great. If they live in a fluoridated community, that's okay/good. If teeth are only okay, fluoridated water is recommended. Bad teeth, fluoridated water and fluoride treatments strongly encouraged. They encourage fluoridated toothpase for anyone (just don't eat it).

There are various forms of fluoride. Most common in toothpaste and mouthrinses is sodium fluoride, NaF. It's a salt that dissolves in water, is pretty tasteless, and inert (this is not to be confused with sodium fluoroacetate, which is a natural plant poison that's been mass produced and used in Australia as a pest poison). Sodium fluoride is most commonly and most abundantly produced as a by-product of making fertilizer. Some people see this fact as proving that fluoride is bad. Being a by-product of another process doesn't make anything bad by itself, as long as the product is purified and used appropriately. Biologically it doesn't matter how it was made. 

Other forms of fluoride are Stannous fluoride, SnF2. Stannous is tin. Tin fluoride, literally. A few toothpastes use it and try to market off the fact that there are two fluorides in it (literally, the Colgate saleswoman presented it as "Polyfluorite Technology"). The concentration of fluoride ion in the toothpaste is still the same, 1000 ppm. The tin can help with tooth sensitivity for some people, although it causes surface stains and leaves a metallic aftertaste.

There are also acid-fluorides for very specific cases to be used very carefully. The idea is to partially dissolve the hydroxy groups by the fluoridated toothpaste so that fluoride can step right into the empty spots. Not used very often. 

For water supplies, some communities use hexafluorosilicic acid (H2SiF6, it's an acid because in water, one or both of the H's drop off, leaving fluoride ions and Silicon ions), others use sodium fluoride. 

An argument that deserves thought is that fluoridating water is forced medication of the public by the government. In at least 4 states who have had the issue go to the supreme court, the courts have ruled that, at least legally, this is not true and that mineral content of water does not constitute a medication. Also, since most communities vote whether to fluoridate water or not, leave it to the community to decide. It is of biggest advantage to the 20% of people in of lower socio-economic status, who tend to have poorer diets, hygeine, and less access to dentistry, and who have 80% of tooth decay in this country. 

A few people bring up the relationship of fluorine (a deadly gas) to fluoride. Fluoride is the ionic form of the element Fluorine. Fluoride occurs naturally, Fluorine does not (it is too reactive and too quickly becomes Fluoride by taking an electron from whatever it can). Thus said, fluoride is not the same as fluorine and the notable similarities end with the first 5 letters of the name. Someone once skeptically told me, "Yeah, I've heard that argument before...." I kinda wanted to recommend he take a basic chemistry class, but I bit my tongue. I'm much meaner in my head than I am in person. 

Lastly, there was a theory that floated around about fluoridated water being a communist plot to subvert the US government, and that it was used by Nazi's to force the countries they conquered into submission. Someone told me once that a study was done in China once that showed fluoridated water led to lower IQ's in children, but there was no source, and I've never heard this one anywhere else. Nothing valid has come of any of these ideas/theories.

So, that's fluoride as I know it.  Consider yourselves edumacated.

Break Time

Finished a crazy boot-camp of learning to do root canals!! (Bah bah buuuuummmM!!!!! *dramatic music*). Lucky me, I finished the assignments a little early and found this while taking a break.






Also crazy cool is this guy who raised a grizzly bear from newborn to fully-grown (it was even his best man at his wedding, sort of)


Monday, April 20, 2009

Dentistry

Fluoride's come up a lot recently. I'll try to give a good picture of it, but it might take two parts (since I don't have many readers with long attention spans ;-) 

This first part will give the background about tooth decay and set the stage for the use of fluoride.

 The crystals in bones, enamel, and dentin (all the hard tissues of the body) are a form of calcium hydroxyapatite. It's a complicated crystal of calcium, phosphates (PO4), and hydroxide (OH) groups. Intermixed is a meshwork of proteins that promote the collection of these minerals and allow soaking and diffusion of substances throughout the tooth structure to a small extent. 

Most minerals can dissolve in water to some extent and each mineral has a different amount they will dissolve to and this depends on acidity and temperature of the fluid.  An acid is a substance that can easily let go of a proton, or, a hydrogen that has lost its electron (H+) or it can be a fluid with lots of extra H+'s in it, as specificed by pH (1 is most acidic, 7 neutral, and 14 most basic/alkaline). Each person has taste buds for acids, it's known as sour/tart. 

Hard water deposits are an easy example. When in the hot-water pipes, the minerals remain dissolved, but upon cooling, they "precipitate" out and form deposits/stones/crystals on the insides of some pipes, tiles, showerheads, etc. Limestone that has been eroded by acid rain is an example of acid dissolving. The crystals that make enamel are similar. When acids get to them, they will dissolve a bit. Over time, this erodes tooth structure and decays the tooth.

Dental Caries is the disease of tooth decay. It is influenced by diet, personal behavior, and bacterial species that live in the mouth. Some people have more virulent and dangerous species of bacteria in their mouth than others and these can spread from person to person, or the bad species can dominate the other less-bad species if given the chance. All the bacteria in the mouth take simple sugars (glucose, fructose, sucrose, etc), and use them to create meshes of plaque that stick to teeth where they hang out in permanent residence and hide from oxygen and do their thing. This involves eating sugar and spitting out the remains as various acids: lactic acid (the same that cultures milk into yogurt, made by lactobacillus bacteria), acetic acid (aka vinegar), propionic acid, and formic acid. Lactic is made by the most damaging species: streptococcus mutans and the lactobacillus groups and when lactic acid is the dominant acid found in the mouth, it's a sign that S. Mutans and LB's have taken over.

The longer these bacteria remain, the more damage they do, since they just hang out sharing in the food you eat and spitting out the remains to dissolve your teeth more and more. To combat this, the minerals in saliva will settle into teeth and remineralize them, buying time, but not combating the source of the problem. Brushing helps, eating less sugar helps, and killing off the bacteria in your mouth with antibacterial mouthrinses helps, but if you've got the really bad guys in your mouth, teeth are still the losers in the end. There are stronger mouthrinses available, and are sometimes necessary to gain an advantage and get ahead of the infection. They're not for the squeamish and contain either sodium hypochlorite (aka bleach/"pool chlorine") or chlorhexidine (which does funny things to taste buds and can cause removable surface stains on teeth). They are flavored and sweetened with xylitol, but it still takes some bravery to use them. They apparently work pretty well. Having a mouth full of bad-uns, myself, my wife and I plan on trying them out in the near future to take care of chronic teeth problems I've got. I plan on recording the use and results for faculty to use in an ongoing study. 

Side note: Xylitol is similar to sugar in taste and structure, but different enough that bacteria usually don't have the ability to use it for food. Thus, they eat it and it plugs up their enzyme machinery. In people, xylitol sweetens food while providing about 2/3 the amount of calories (we have enzymes that can use it, bacteria don't). It's found naturally in many plants and fruits to small extents. 

When a person eats, the pH of their mouth drops from a safe 6-7 range down into the acidic low 5's and 4's. Calcium hydroxy apatite begins to dissolve below 5.5. It takes some time for saliva to clean out the mouth and restore the pH back to safety. The whole time, tooth structure is being slowly lost. Once restored to normal, the minerals in saliva precipitate/deposite onto the dissolved areas and make it normal again too (provided too much isn't lost and that saliva can reach the eroded areas). 

Important to remember is that any acid will dissolve teeth whether it's sports drinks, sodas, and lemonade (with pH's down in the 2-3 range) or stomach acid (also with pH down in the 2 range) from bulimia or acid reflux. Bacterial acids are especially dangerous, because they are always in the mouth and maintain permanent residence on the tooth surface. 

That's where fluoride steps in. Fluoride ions fit nicely into calcium hydroxyapatite crystals by replacing the hydroxy (OH) groups. The flouride doesn't leave as easily and postpones dissolving until the pH drops below 4.5. This makes teeth significantly more resistant to acidic dissolvement, erosion, and decay, but the dilemma is, how much do we need, and how do we get it?

to be continued.....