Dr. Von Bulow's Articles

So I’m part of a really progressive national dental organization (Crown Council) that includes big-time educators, top clinicians, and even a few molar jocks that get regular TV face time. The group is really committed to the community and has collectively raised more than $25 million over the last decade to help children in need.

This week, the group wasn’t too thrilled with energetic Oprah disciple surgeon/author/TV personality Dr. Mehmet Oz. And it’s one thing to get feisty with another know-it-all physician but it’s quite another matter to annoy Ms. Winfrey.

I happen to like ole Mehmet and I appreciate his personalized, human approach; he connects with people the way I wish all physicians could.

But this time Doc Oz goofed up when he, in passing, carelessly cautioned folks regarding dental x-rays and a possible increased thyroid cancer risk. These days, lead protective aprons come with collars protecting the thyroid from radiation that’s a drop in the bucket compared to what we get from five-minutes of SoCal sunshine. One more thing, dentists can’t diagnose or treat disease without x-rays.

I visited Dr. Oz’ website to check out the “x-ray” interview. Something I found in the process was one of the most clearly written pieces I’ve seen on the importance of seeing the dentist.

Here’s the article (and of course, I’ve improved it without editing content.) I give you Dr. Oz:

“When you think of efforts that can stave off a heart attack or stroke, you don’t immediately zero in on your teeth and gums. But a growing body of evidence says that what goes on in your mouth could harm the health of your heart and beyond. Dodging the dentist can actually put your life at risk.

If the eyes are the window to your soul, then the mouth should be the door to your heart. Not just because it’s key to a loving kiss, a pretty smile and savoring a meal, but also because poor oral health can be the root cause of some serious health problems, including heart disease. Yet, many Americans, even those with good access to healthcare and insurance, don’t give oral care the attention it deserves. We bypass brushing, forgo the floss and dodge the dentist until there is a problem. Some adults have enough dental anxiety that they never set foot in a dentist’s office.

But research is unearthing evidence that says skipping mouth care is a dangerous strategy because what begins quietly at the gum line can later set off a chain of events that can lead to heart attack, memory loss, stroke and miscarriage. And of all the measures we know that can avert a potentially life-threatening disease, oral care is probably one the most effortless activities one can do.

Even a healthy mouth is home to bacteria. And bacteria love plaque because it is a particularly cozy environment in which to grow. As soon as plaque begins to build, bacteria colonize. And so begins the insidious infection we know as periodontal disease.

And periodontal disease not only impacts quality of life (cosmetically, nutritionally and socially), but also our overall health…and even length of life. The problem with chronic inflammatory diseases like periodontal disease is the assault can be relentless and when unchecked, the body doesn’t get a chance to recuperate. It’s in a perpetual defense mode.

The theory holds that the high load of inflammatory chemicals and leakage of bacteria into the bloodstream can wreak havoc elsewhere in the body. Researchers are finding chronic infection and inflammation can make blood vessels more favorable for the build-up of fatty deposits, and affect insulin resistance, blood clot formation and brain cell activity. Conditions linked to periodontal disease include heart disease and heart attack, stroke, diabetes, preterm birth, lung diseases, and, cancer of the blood, pancreas, tongue, lung and kidney.

Major risk factors for periodontal disease include genetic susceptibility (30% of the population), diabetes, medications (oral contraceptives, antidepressants, blood pressure drugs, and chemotherapy), autoimmune diseases (Rheumatoid arthritis, Crohn’s disease, and lupus), pregnancy, and poor diet.”

So please be responsible; live longer and better. Listen to Dr. Oz…and see your dentist.

*Evaluation and treatment of periodontal disease cannot be performed at a professional standard of care without dental x-rays.

So one of my select Bruin buddies also happens to be a patient and the Equinox Fitness spin class/Pilates instructor to the stars. And Pearl knows enough to not take UCLA football very seriously so that means the two of us agree on just about everything (scary.)

As I’m writing I am now old enough to hear Office Manager (OM) Dalila chant “Platinum, Platinum, Platinum” every time she opens up someone else’s mail that has AARP written on the envelope. The good news: I’m mature and smart enough to consistently actively listen to women (on a good day, even OM Dalila.) And I’ve always listened to Pearl.

A few days ago, Pearl was telling me that in the course of helping her Pilates students gain strength, balance, and flexibility, she hears all kinds of complaints about stuff like headaches, TMJ type soreness, and even some riffs on teeth grinding and clenching.

So can you really truly be physically fit…but not so fit above the shoulders? And how can our body run like a Ferrari if our chewing machine has gone 300,000 miles without a tune-up?

Over 43 million Americans suffer the consequences of teeth clenching; some 23 million more live with migraine headaches (and still millions more with tension headaches.)

It’s interesting (to me anyway) that only about 6% of the 43 million grind their teeth. Chronic teeth grinding actually flattens teeth down until they look like table tops. The cause is neurological; there’s no stopping the habit pattern, only managing it. A traditional plastic bite splint allows the jaw to move smoothly while protecting tooth structure.

So if your teeth don’t look like table tops and you’re not grinding away as you’re reading, you don’t need a traditional bite splint or mouth guard. And if you wear the traditional appliance at night it might be doing more harm than good for about half of you reading this. In fact, 20% of the folks suffering from chronic headache, muscle soreness, clenching (all migraine sufferers also clench), and limited jaw movement do so while being treated.

So when I use the term “deprogrammer” I am not referring to some kind of intense debriefing session you’d have to go through if you were kidnapped by and then rescued from a cult. I’m just talkin’ dental appliances.

Deprogrammers are appliances that fit like upper orthodontic retainers; they’re modified so that only the upper and lower two front teeth touch. Back teeth do not touch and can’t trigger the muscle contractions associated with tension and migraine headaches. When the muscles of mastication finally get a chance to relax or recover; they are deprogrammed.

The FDA found such appliances provide at least 75% relief 85% of the time for migraine headache sufferers.

In addition to helping gain relief for folks, the deprogrammer is a great diagnostic tool. The appliance actually guides the clinician to making the right choices in resolving functional/TMJ-type challenges. When the muscles are relaxed and the jaw joint is seated the only variable remaining is teeth alignment and occlusion (the way upper and lower teeth meet.)

If the trigger for all the symptoms comes from a collision in back, the bite can be balanced so all contacting teeth can meet evenly. If the front teeth are disrupting the harmony of things, the solution is more likely orthodontic.

And almost all headaches have at least an overlay of symptoms generated by glitches coming from oral function.

The deprogrammer appliance is an excellent instrument in the dental toolbox. If you suffer headaches or have difficulty chewing everything you want or just don’t feel comfortable with your bite, ask your dentist about the deprogrammer. Relief could be less than the cost of passing through the Sheriff’s latest traffic sting operation on Las Tunas (or your visits to Starbuck’s between now and Tax Day.)

Whoopi Goldberg talks about her recent experience at the dentist caused by neglecting her teeth and how the health of your mouth is linked to your overall health.

I’m not sure I selected this title because I just saw a movie or because I just dropped 11 grand on new hardware that doesn’t seem to let me put the dang title in the middle of the page just the way I like. But then maybe I’m just looking for some capitalistic love in all the wrong places.

So alright, you win. It was the movie.

And admit it; you guys probably have some innocent guilty pleasures just like me. Stuff like chocolate, purses, shoes, cigars; or maybe even flossing, or something totally cool…like USC football.

Don’t know about you but I don’t necessarily need any company when I’m indulging. Especially when I’m watchin’ Trojan road games or going to Michael Moore movies.

Why am I such a fan of Moore’s stuff? There are times when I’m practically positive I think Moore is awesome just because most of my molar jockey brethren can’t stand him (that alone is better than any fish oil or load of amino acids for my heart and soul.)

There’s more. I’m at least open to Moore’s views most of the time and again, that could just be my basic, usual, and customary anti-conservative DDS reflex. But I do have to admit I like the guy’s audacity; he’s totally fearless. Fearless enough to pull an armored truck up to AIG’s double-doors and ask for the Bailout money back. Audacious enough to surround all of Wall Street with yellow crime scene tape and reassure the Gordon Gecko wannabes inside, “You’ll like Federal prison; it’s a nice place.”

So how in the world does someone who graduated from conservative USC become an ardent fan of Michael Moore? I guess maybe the avocado doesn’t fall too far from the SoCal tree.

Moore didn’t go to college and I went mostly on my Dad’s check from the Teamsters Union. Moore’s Dad supported a family with a union job and gave his children advantages he never had. My dad had twice my brains and never had the educational opportunities he gave me. I bet Moore’s Dad never turned away from folks down on their luck; I know my Dad didn’t.

It might just be me, but Capitalism: A Love Story seemed more like a tribute to whom we used to be more than a sarcastic reference to what we’ve become im Moore’s eyes: a Facebook Fan Page where we fall in love with the concept of being the 1% that has more than 95% of the rest of us all put together.

So do we really want what the B of A and Wal-Mart have become? Do we really want to profit from the death of co-workers and cynically refer to company-owned life insurance as “Dead peasants” policies? Or do we want to send our best science/math students to Wall Street “derivatives” grad school where they can bet we lose our mortgage and hedge that bet by betting against themselves?

The movie’s not about the “S” word. Moore’s concern is that capitalism (more accurately a plutocracy) is causing us to lose sight of democracy. During the last several decades, Moore sees only one surviving American value: Money. Humanity, responsibility, and compassion seem to be fading fast.

By the time the credits are rolling, it’s clear that Moore is anything but maybe the only living lifetime NRA member/Socialist. Instead, Moore comes off as an unrepentant, modern day FDR-admiring New Dealer inspired by the possibilities of a restored democracy fueling opportunities for everyone, including hard-working Americans in the survival mode. And Moore sees the steady decline of unions and the country’s current dilemma as no coincidence.

I’m pretty sure my Dad would agree. And I may be a Trojan molar jockey but I still have my Teamster withdrawal card.

So if you go to Webster’s and look up “insure” and “ensure” the words are virtually interchangeable. And when I’m paying premiums these days I’m seriously wondering exactly what’s been made secure, certain, or safe.

And I also totally realize it was only a couple of weeks ago that I last went on and on about insurance. But that was before I got jumped on the Internet. And I didn’t even call the other guy a bruin.

I’m proud to be part of an awesome E-mail network comprised of leading-edge dentists throughout the country and I love participating. Of the truly engaged component of our Molar Jockey Internet crew, about 80% would probably fist pump Rush (some are on a first name basis) if he were only a little more conservative and slightly more self-expressed. Sometimes it gets a little weird.

After spending way too much quality time on the network I actually start getting kind of paranoid. Suddenly, I’m looking for Socialists everywhere. On TV, in my gym bag, even behind the crummy fence lining TC’s “The Piazza (coming soon.)”

Seems like government doing anything these days is Socialism. And I guess if you’re one of the 47 million with no health insurance or one of 25 million with not enough insurance maybe you’re looking for some “security” or “safety” wherever you can find it. Think you’ll find relief from caring, sympathetic insurance companies? In the health insurance industry, relief is spelled P-R-O-F-I-T.

Between 2000 and 2007, the top ten health insurance companies increased profits by 428%, mostly because they could. Premiums for employer-provided health insurance (that’s me) have doubled since 2000. Even in dentistry, the annual maximum benefit that was $1000 in 1971 remains $1000 today in spite of inflation that makes everything 7-8 times more expensive now than almost 40 years ago.

So I dunno; some key reasons I’m a healthcare provider today and an employer who provides full health insurance for my co-workers go to my public school education K-12 and later at Cal State LA. And without my “socialized” education I could easily be one of some 72 million folks who are one banana peel away from losing everything. As it is, I’m just another small businessman ensured of getting hosed by insurance.

Maybe I’m crazy but the public sector was there for me when I wanted an education. The private sector dropped my worker’s comp coverage after 15 years because a dental assistant hit her elbow on a counter top while cleaning up a treatment room.

Funny thing is, not having dental insurance actually keeps folks away from the dentist when the tab for x-rays and exam are the investment equivalent of a microwave oven. And the preventive value of a visit to the dentist can be tens of thousands of dollars in terms of quality of life and even years of life.

So part of dealing with healthcare is being responsible and doing what you know you oughta do to take care of yourself. We’ve worked to encourage folks by offering complimentary x-rays and exam (or if there is dental insurance coverage, a rebate of similar value for future care.) Now if we could just get a similar commitment from a few health insurance companies. Or maybe some decent competition and competitive prices.

But see ya; gotta run. I’m off to the public 210 and the public driving range; might even listen to some public radio coming from public Pasadena City College on the way. Just hope I’m not getting a lesson from some freakin’ socialist golf pro…

So I guess I’m supposed to write about stuff like oral health, health insurance, and the impending national healthcare transformation but what about my health? What about me? What about my mental health?

Without Trojan football, I’d probably kick the cat and that’s no good because I don’t have one. And without Salute to Troy, I probably couldn’t get through August and everyone else’s vacations…or even last weekend.

And you try writing this column every week for going on twelve years and see how you like it. I have this ritual where I write the thing the Friday before the Wednesday deadline, the actual column coming out on the following Monday. Like I said, you try figuring out the method to that madness.

This Friday was totally out of the question because it was bookkeeper visitation day. No way to be even slightly creative when someone is interrupting you every five minutes reminding you how much it costs to be a dentist (“Was this bill for marketing or continuing education or equipment? Is this for Worker’s Comp; thought you paid that one with the really big one you send into Anthem for everyone’s health insurance? Is this a new consultant or is it the old one with a new company name?“)

Back in the Day, when ole Mel Gibson used to ride a horse and paint his face all blue just like some re-caffeinated Seahawks fan a few years before he bought Malibu, didn’t he used to scream something all the time? Wasn’t it something like, “FREEDOOOMMM!!!“? Bet he meant freedom from insurance.

Never thought I’d say this but Mel, I understand.

Oh, Friday also means a chance to go across the street to the bank and squeeze in one final deposit for the week. Imagine my elation on seeing six insurance envelopes in the mail. Imagine my dismay when the contents of the six messages from the folks in the tall buildings Downtown revealed payment delays, a missing detail, or the lack of coverage for a given procedure. Not a single check.

And Friday, at least three different people told me they don’t go to the dentist because they don’t have insurance. Hmmm, I was wondering if that was sort of like living forever because you don’t have any life insurance.

When I finally made it to Friday night CNN, I saw a bunch of knuckleheads calling the President a Nazi because he wanted to mess with health insurance. Thought maybe they had him confused with the guy who wire-tapped citizens, tortured folks, and invaded a sovereign nation posing no threat to the U.S. But let’s leave the past in the past.

Turns out, the leading cause of bankruptcy in the U.S. is a health-related catastrophic event. Turns out, half those bankruptcy folks have health insurance; just not enough.

Friday night, I tossed and turned, somewhat stressed over my concerns for another fat monthly check due to Anthem Blue Cross, team members ill or on vacation, and the uncertainty of unchartered economic waters.

But on Saturday, I took a mega-dose of life’s best medicine. And what else would you call exercise, laughter, and the company of friends and family? Did I leave out the Salute to Troy, another year of USC Trojan football domination, and a whole fall season of Saturdays that take you back to being a kid again?

And a few days in the sun…with absolutely no thoughts of freakin’ insurance.

My Mom and Dad both had diabetes. And I know having the disease wasn’t part of their plans. My experience helping out my parents has helped me in more ways than one; here’s a shot at passing it forward.

My Dad was diagnosed with diabetes at age 50; he had had no obvious symptoms. The elevated blood glucose level showed up in a blood test taken during a check-up. Dad immediately transformed his diet; couldn’t possibly have been more compliant. Never saw Dad drink another cold one; good thing he wasn’t allergic to salmon and vegetables.

When Mom was diagnosed with the disease in her late-70s; she had loads of symptoms. In a health care/gender role reversal, Mom almost had to be dragged to an appointment with a physician. By the time Mom finally agreed to a visit, we nearly had to carry her in.

Dad enjoyed going to the dentist the way I enjoy Bruin football. In fact, one story has it he once sneaked out of a waiting room on hearing some distressing sounds coming from some poor soul receiving dental care nearby…and no, it wasn’t my office. Dad died of a heart attack a couple of months after I opened my practice here in Temple City, just one year into his retirement. We never did get around to even an exam and x-rays.

My Mom loved going to the dentist. After an early debate over Mom’s vision of ideal painless care with no local anesthetic (a rare debate I actually won) and some early fillings, Mom pretty much cruised through the next 15 years or so with no cavities or gum problems.

Mom didn’t walk anywhere up until about age 75. She ran. Mom used the Diabetic Diet way before she’d ever heard of it. Dripping wet, my 5-foot tall Mom never weighed more than 100 pounds. Up until diabetes-related neuropathy, mini-strokes, and progressive kidney failure, Mom could have danced teenagers off the floor.

A diabetes symptom I happened to pick up during a dental check-up explained my finding Mom with a whopping totally out-of-character 13 cavities. The cavities had resulted from “dry mouth,” an oral condition common with diabetes.

An even more common oral condition is periodontal disease (or gum and bone disease.) It’s estimated that 80-90% of people with diabetes also suffer from periodontal disease. Diabetes has a major impact on the ability of small blood vessels to facilitate the flow of nutrients to and removal of waste from body tissue. The result is tissue that doesn’t effectively heal.

So it’s bad enough that periodontal disease is a leading cause of tooth loss. For diabetics, the worse news is periodontal disease makes controlling diabetes even more challenging. And I often wonder about my Dad’s periodontal risk. Could proper diagnosis, continuing care, and consistent monitoring of possible periodontal disease have made a difference?

The irony is both diseases have so much in common. Diabetes and periodontal disease are both chronic and episodic; they’re managed not cured. Both diseases have an insidious onset but can easily, painlessly be diagnosed by objective numbers; and both have been proven to be connected to other health challenges such as heart disease and stroke.

If you’ve been diagnosed with diabetes, seeing your dentist is a must. And as in my Mom’s case, 6.3 million Americans suffer from the disease without the benefit of a timely visit to a physician and a diagnosis.

Please be responsible and see your physician and dentist. The statistical consequences for unmanaged periodontal disease alone equal about seven years of life expectancy and untold years of life quality.

So just do the right thing.

So here’s the thing; when DDS-types like me start yammering around in dentalese right in front of patients, that’s bad enough.  But when we minimize disease and then go extreme on describing the proper care, that’s just plain stupid.

I’ve seen the dentalese approach practically put folks into a deep trance.  Patients just sit there absently nodding with eyelids aflutter hoping somehow I’ll finally stop verbalizing so they can escape.  But these days my dental assistants do a good job keeping me on track (Singing Dental Assistant Kolleen just points to her watch while Dental Assistant Extraordinaire Dani prefers a more dramatic Sicilian hand gesture.)  And I guess if I hired on assistants to support me in every aspect of life I’d have more friends and fewer broken tennis rackets.  But I digress.

(more…)

This morning I sat down to write about oral cancer awareness.

I realize oral cancer gets its share of space around here and I was a little concerned about my maybe just going through the motions. I think I was also feeling self-conscious about being repetitious or perhaps just a bit short on material.

When I started out writing for the Weekly I really didn’t like my chances for coming up with a topic every single week. I wondered exactly what was in store for the readers after about Week Eight. I soon developed a routine or ritual where I would go see a movie Friday afternoon and then write the article. Something about being moved by what I saw on the big screen (if I wasn’t moved, I rented a favorite that would do the job) inspired me to look at the past week with a fresher perspective. This morning was sort of like Week Seven…until I remembered a certain video.

(more…)

I know; what a ridiculous title? But you have to admit, you’re probably totally intrigued about what the Tommy Cruise I’m thinking about or maybe you’re already moving on to unravel that tangled puzzle we know as the City Manager’s Weekly Report.

So I’m not talkin’ about Old-Time Rock n Roll or even the yucky HAZMAT breed of biomechanics that grosses out most of us non-medical specialists. But I just did have an SAT flashback even though back in The Day I didn’t even know I was taking The SAT when I was taking it.

Anyway, I’m just talking about teeth.

So most of us know teeth can be risky business; some of us know the hard way. Here’s the thing; please don’t feel so guilty about having a track record of tooth decay and fillings that seem to expand in size every time the Trojans mop up on the Bruins.

Okay, you win. You can feel guilty if you’re not trying and you know better. And sometimes guilt is good for you; just ask my Sicilian traveling production manager, Aunt Clara.

But getting cavities and suffering from tooth decay is mostly the outcome of our lack of resistance to disease. And yeah, it’s okay to think of tooth decay as a disease. Not being able to stop shoving Jolly Ranchers into your pie hole is not a disease; armies of aggressive bacteria using sugar as a medium to produce acid that will rot away weakly resistant enamel is a disease. Tooth decay, when it comes right down to it, is a bacterial infection. And some folks are more vulnerable to the infection than others.

Doesn’t it make sense to figure out who’s at risk sooner rather than later? Once dentists can assign a degree of risk to a particular oral health challenge, we’re better able to personalize care and make the care more preventive than interventive. Shucks, my world-famous continuing education guru, Seattle’s Doc Kois actually says stuff like, “No dentistry is as good as no dentistry” (And to think I pay Dr K 5Gs a pop to figure out how to best restore broken down teeth and mouths.)

The message is materials and approaches for restoring damaged teeth have made the restorative experience far less invasive than in the past. And the earlier significant tooth decay risks are identified, the more effectively we can follow the natural design of our enamel-coated chewing body parts. Kind of like the dentistry version of “keepin’ it real.”

Today, systems exist that can measure risk before tooth decay disease has even started. One particular technology, the Carifree system, takes only a few minutes in the office to quantify risk. Clinically, the experience is pain free and involves swabbing plaque off two different tooth surfaces. Carifree can even be used to measure risk in infants. The cost of the screening is less than the cost of one filling.

We can also detect risk for tooth decay just by studying patterns. If someone has active tooth decay or has had a history of tooth decay on the smooth enamel surfaces between teeth, we know there’s an increased risk. And we’re all at greater risk as we age and produce less saliva. Reduced saliva flow is also a common side effect of numerous medications.

Folks with a higher risk for tooth decay can receive fluoride in any number of ways and increase their cavities resistance. And we know the sugar substitute Xylitol potentiates the anti-bacterial capability of fluoride. Antimicrobial rinses help. Oral hygiene instruction and heightened monitoring are musts. Plus today, laser technology helps us detect tooth decay at very early stages.

So don’t feel guilty…unless you don’t stop by for a quick risk analysis from your dentist.