THE FIRST NEWSLETTER OF THE NEW MILLENIUM

Some people are arguing that the year 2000 is actually not the end of two millenniums because the count would have begun at one instead of zero. Now I think we can all agree we are definitely entering the third millennium. Or is it more realistic to talk about the 21st century?

OUR NEWS

I had been so busy through the whole year, no time for a newsletter anytime sooner. Again it comes by the end of the year, just in time to wish you the best for the Holiday Season. I will try to get together the news in my practice that can interest you. First you probably heard about hard times Rene is going thru with her right wrist. Of course you understand she needs it badly as a hygienist. News is good though, after few surgeries and rests, she feels she got her wrist back to full operation. I might sound like I talk about the bionic woman, but I believe she worked very hard to get out of the handicap. This ski accident almost compromised her carrier. You already heard about Barbara, she is our third hygienist, she came to the rescue with Erin while Rene was healing. Also, Amy is a new aunt, her niece Brianna was born this September.

In the next paragraphs, I will try to keep your interest in reading me. What about the purple most recent items? Ah ah. I will share with you stuff I heard at conventions this year. I attended a symposium in Orlando about bleaching, very stimulating. The usual Florida National Dental Congress in Orlando allowed me to shop for the right technology among the manufacturers. I especially appreciated a seminar given at the New-Orleans Dental Conference by Dr. Jane Soxman. This speaker is a wonderful pedodontist practicing in Pittsburg. Of course I will also discuss our new equipment and finish with office news such as our new brochure, new WEB site and new e-mail address.

MORE MORE PURPLE

You know how I am silly about purple. You figured that out when you saw our purple carpet, the purple counter formica, purple gloves, the lilac verticals, the violet dental chairs and the lavender drinking cups, paper, charts, etc, etc, etc. What do you think of our new purple fan, computers, keyboards and mice? Notice the deep purple secretaries' chairs. Not that I want to be called the PURPLE dentist but I sure made it a trademark… Did you see our purple Christmas tree? Really!

READY FOR THE QUIZ?

Here's what you ought to know from your dentist's continuing education. I might surprise you with a quiz next cleaning appointment, read carefully… Just kidding, so often seminars teach dentists very technical or specialized concepts. I really enjoy being aware of most recent developments in dental healthcare. It feels good to know you're heading in the right direction with recognized techniques and approved materials.

WHITENING

The bleaching Symposium was probably the best investment in continuing education I ever attended. While I felt I needed to improve our whitening approach with expensive "Laser lights" or "Power Bleaching" systems, the research scientists and teachers then stated that none of these additional devices were improving the efficiency of the teeth whitening. Actually the results were only depending on the concentration of the carbamide peroxide and the duration of the treatment. All the participants of the panel confirmed that the treatment as we currently provide is the most comfortable and cost effective for whiter teeth. By the way, "bleaching" is the word to avoid. "Whitening" is more appropriate since it is not using any bleach, don't try that at home! A little hint: it can be done on teens too when their teeth are genetically yellower.

FLUORIDE

Dr. Soxman doesn't recommend fluoride toothpaste anymore before the age of 2 or 3 years. Fluorosis on excess of fluoride intake causing permanent teeth to have a marble looking, forced the ADA guidelines to lower the recommended fluoride supplementation a couple years ago. As much as I followed religiously the old recommendations for my own kids, I kind of abandoned any suggestion of supplement since I considered other sources of fluoride such as toothpaste and mouth rinse to be more than sufficient. Because permanent teeth enamel is in formation from birth to about 7 years old, there is no concern about fluorosis after this age. She mentioned drinks and juices due to the fluoridated water used on their making. Higher concentrations come with white grape juice and chicken-made food. Unless it can be shown that all these sources are avoided, supplementation is not only unnecessary but practically negligible (in the case of excess in the diet).

Dr. Soxman further confirmed what the Canadian Dental Association announced months ago, that fluoride is not that great systemically (ingested) as it is topically (applied on tooth surface). This means that fluoride rinses, toothpastes and professional applications are preferred for kids after 2, 3 years old through their adulthood! Yes, according to these findings, adults will be offered fluoride treatment after their bi-annual cleanings. We know how it was beneficial to older patients with root cavities often due to dry mouth, this is surely a new way to look at fluoride.

Let's go thru parents guidelines. Forget fluoride supplementation in general. Brush your kids teeth until 6 years of age and floss for them until they are 11 years old. Use toothpaste without fluoride before 3 years old. Spread less toothpaste on the brush by applying it transversally rather than all along the brush. Home fluoride rinse after brushing is suggested after 6 years old if the child enjoys soft drinks.

SEALANTS

Definitely recommended for the grooves of both primary and permanent teeth before decay take place in these weaknesses. Sealants are a resin coating recognized to prevent cavities in the grooves where nothing can help, not even fluoride. I was reassured as the concerns about possible chemical similarity of resin components to oestrogens were expressed lately. Because we prefer bonding composites to amalgams, I am delighted to hear good news about their safety. Without them, we would go back to the middle age!

HAVING A COLD?

Or a sinusitis, a bronchitis, a strep throat? We know that toothbrushes can incubate bacterias and viruses. Dr. Soxman suggests that you soak the toothbrush in Listerine 24 hours a day while under treatment. You should get a new brush to replace the contaminated one once the antibiotic is finished.

MORE HINTS

Some people reported allergies to tarter fighter toothpaste. Apparently a color or flavor ingredient made with oil of "wintergreen". A rash or swelling during sleep associated with a change of toothpaste should be investigated.

Among all the medications you buy for blisters or ulcers in the mouth, vitamine A is a quick remedy. You squeeze the oil out of the capsule and apply it directly.

Chewing gum is advertised for busy people that cannot brush their teeth for lunch or after a sweet treat. It works thanks to the stimulation of salivary glands, more saliva neutralizes the pH of the dental plaque and helps rinsing away the food. It appears that Xylitol chewing gum would also fight bacteria in the plaque directly. Trident "for kids" seems to please everybody. Of course, the best is still to avoid the most sticky foods like caramel.

BRAUN ORAL-B 3D

I can't say enough good for this electric toothbrush. It may sound like another luxury gadget that stores want to sell for the modern appeal of it. I did feel that way for a long time. Despite this reluctance of mine, we sure recommended it to people, handicapped or unsuccessful on their oral hygiene. I then began to recommend to patients brushing in such a manner they were actually wearing their teeth, creating notches, cuts, abrasions (gums and roots) for an acute hypersensitivity. These hard brushers have to find a safe technique, the best remedy: the Braun Oral-B 3D. Once I got myself to use it, I understood they are really a real improvement to hand brushing for everybody. Think about the 50 strokes a second on the surface of your teeth, you have only to concentrate on positioning it on each tooth for few seconds. A mechanism adds a third dimension vibration (toward the tooth surface) and prevents any excessive pressure for you.

Guess what, it comes with as many brush tips as you need for each member of your family. I wish I had shares in the company…nevertheless, it makes the smarter Holiday present! This is really the way of the future. Dr. Soxman, the pediatric dentist, added it is a great toy to kids, encouraging them in their teeth care.

ALWAYS IMPROVING…more toys.

This year 2000 was one of conclusion of an old dream: going all digital. To me, reduction of radiation was a goal, right from the beginning of my Florida practice. Four years ago, the technology existed and I couldn't stay away from it. Obviously, one unit was not sufficient and practical. Now the whole office is computerized for a full integration of radiology. I am also very proud of the ozone purifiers I equipped every room with. These guarantee a very safe quality of water in treatment. You see, they are not only toys!

OZONE PURIFIERS

The dental industry had been working on water lines for quite sometime but with not much of solutions. The American Dental Association put pressure on manufacturers to come up with a better control of the quality of the water reaching the mouth. The ADA imposed a standard of 200 cfu/ml maximum for the year 2000. This is a count of coliforms, bacteria. The food and Drug Administration (FDA) already has a standard for drinking water at 500. While most dental companies use chemicals such as chlorox and glutaraldehydes, I preferred to stay away from these equipment damaging liquids. I have concerns also about their taste and the risk of allergic reactions to these chemicals.

I chose the only technique that appears safe to me: the ozone treatment of the water. Samples testing proved the distilled water we used to supply each room, not to be perfectly sterile. It is scary to learn that bottled water of all kind of sources is often pretty contaminated. Some people will tell you that bugs are needed to develop our immune system. Anyway the results from samples of water going thru my waterlines for the handpieces and air-water serynges, were overwhelmingly stunning: the treatment by ozone made that water pure, sterile, ZERO unit of anything! It is even more remarkable that the lab performing these tests is one to promote their own chemical. That's the kind of toys I am proud of. If I should get a spa, give me a chlorine free spa, I insist on ozone! For the skeptical ones, get an ozone air cleaner, it works, the odors go quick. Does my office smell the typical "dentist"?

DIGITAL X-RAYS

Vive la technologie! The digital imaging technology had been around for quite a while in Europe. Trophy, a health care digital radiography business in France, went thru the FDA. Despite the merge with the American medical radiography firm, Trex, there are still some pieces of hardware we need to wait for due to the exportation over seas, amazing. Even some words escaped the translation in the software, no problem for me.

Since the first version of their software and hardware, Trex-Trophy made another great move. The digital x-ray can be accomplished on a panoramic format. I am proud to be one of the very few dental offices offering this technology for a panoramic x-ray. They also produced a much more improved sensor. For the first time in the history of radiology, a CCD sensor could beat the resolution of the legendary Kodak film. Not only we get even a better precision of the picture than the conventional film, but we get it with less radiation. Depending if we choose a higher resolution or a higher sensitivity, we save from 60 to 90%.

There is even more advantages to that High-Tech. I myself appreciate that the picture can be seen right away, no processing in the usual dark room. You will enjoy overall to view your x-rays right in front of your eyes on flat screens in every room, full magnification. No more x-ray hiding on the unit viewer behind you. The different tools this software offers, allow me to highlight specific observations to show you better results of the radiographies. All the competent high tech reps agree that we have the best combination of software and sensors on the market.

COMPUTER IMAGING

It took a while but we finally have specialized software capable of modifying teeth on the screen. Computers can easily change your smile in few seconds, the color before whitening or bondings, the shape before preparation of veneers or crowns. When hesitating at the commitment for a cosmetic improvement, computer imaging will be very useful. The decision deserves some guidance, what better than before and "after" pictures of yourself.

NINTENDOS

Playing Nintendo is a fascination for kids. It distracts the kids from any stress or worry. I saw some being addicted to the games, actually disappointed if they couldn't get into one of the 2 rooms equipped with it. I am working on installing more Nintendo. Keep in mind you can always bring your own game, a CD of yours, a VHS movie or your favorite DVD. Of course, we have our collection you can choose from as usual. Don't forget these technologies are not only for kids!

FUTURE TECHNOLOGY

You know that the laser "drill" is always in my dream. Unfortunately, to me, the laser is pretty limited to the management of soft tissue, very useful to periodontist (gums) and oral surgeons. Applications of recent lasers to hard tissues (teeth) are getting interest but too little use in my opinion. Lasers are not recommended for primary teeth, old fillings removal, cavities between teeth, crown preparation. What's left? And you still need to finish the work with conventional handpieces. Let's hope for major improvements on lasers.

Something more realistic to me gets my attention. I am always very impressed by the German engineering toward dentistry. I enjoy my Siemens x-ray heads and the top-of-the-line handpieces KAVO, the best "drills" in the world, the BMW of dentistry! This manufacturer made a "fluorescent" laser to detect cavities when hiding in grooves of teeth. This could be a great complement to the conventional explorer ("pic") for a certain diagnostic before to seal the grooves or to prepare a cavity.

INSURANCE

No surprise for anybody, I don't trust the insurance business. Years ago the name of an insurance company was sufficient to dentists to know what was the policy and the rules in details. Nowadays every company have all the plans possible, from conventional indemnity to PPOs and even HMOs, all with different deductibles, percentages, exceptions and limitations, etc. Thanks to computers, the specific plan your employer signed for with the insurance company chosen, can be identified so we can help you the best possible.

Don't ever consider your benefits book or any predetermination to be guaranteed. Even when written, your insurance can always deny claims after the service is rendered. That leaves the patient with the responsibility of the balance, very frustrating. Never as frustrating than HMOs plans… Some patients believed they had to choose a HMO dentist on the list because the plan was given by the employer. Now we see them back to the practice, they find the HMO worst than having no insurance at all. They simply prefer to stay away of the network, even if the premium is free to them. When in doubt, I always said: have a second opinion!

I wish I could trust insurances to serve my patients genuinely. Why do they reduce benefits such as fluoride treatment when research proves it to be effective in cavity prevention. While fluoride is recognized to be helpful to adults, the insurance industry is rather limiting it to younger individuals and lately to one treatment per year instead of the biannual application in the past. The same rational applies to panoramic x-rays. Some insurances don't want to pay for another panoramic film within 5 years. Few years ago the waiting period was 3 years at the most. The industry though knows that high tech panoramic x-ray machines uses 30 to 60 times less radiation than the older units, so there is no reason to reduce the access at this great diagnostic tool. They care about their profits more than your health. Shame on them.

PARKING

I invite all my patients to use the "customers" parking on the main entrance side (North side toward Port-Malabar) where you see the outside stairs. It is for you. Note that the handicap access and parking is on Bank entrance side (East toward Babcock).

WEB SITE RENOVATIONS

At the time you read this newsletter, my son Simon should have finished with his touch on my Website, will it be a total remake or some design additions or more interactive features? Check it out, the site is always at WWW.ABERUBE.COM. Feel free to send your comments at the new e-mail address . The old address is still functional.

BROCHURES

Go thru the new brochures I sent to you. We made a new one to update the content, the new equipment, new pictures, etc. You can use them to refer family, friends and co-workers to my practice. If you need more brochures, give us a call or stop by, we'll gladly furnish you with many extra. They are a great tool to show other people what you are talking about. Referrals are appreciated, they are the best compliment you can give us, they keep the practice going, thank you.

Enjoy the Holidays and have a Happy Millennium!

Yours sincerely,

Andre J. Bérubé