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So what are the saber tooth tigers of today and why are they so dangerous? Our hormones are like computers and cannot determine the origin of stress, however they are 100 percent accurate at responding in no less a manner as they did for our fore parents who foraged for their very existence. When we experience excessive stress, whether from internal worry or perceived external discomfort, the body’s reaction to threatening stimuli can be of organic or psychogenic in origin. Nerve cells firing will activate the well-known chemical adrenaline (epinephrine).

The world seems to be in a tizzy, dithering over hormones such as testosterone, estrogen, progesterone etc. etc while two important hormones, Insulin produced by the islets of Langerhans and Cortisol produced by the adrenal cortex play a far more acute roll and demand than ovarian hormones such as estrogen, progesterone and testosterone as we carry out our daily tasks.

Any sudden change in the “fight or fight” syndrome, adrenaline must be instantaneously secreted and like wise our Insulin levels must be adequate to balance the conversion of Glycogen to glucose on demand.

Our Sympathetic Nervous System (SNS) is a branch of the autonomic nervous system. It is always active at a basal level known as sympathetic tone and becomes more active during times of stress. In other words, stress is the condition that results when our environment transactions lead us to interpret a variance, whether real or perceived – either biological or psychological in nature.

Today, however, most of the saber tooth tigers we encounter are not a threat to our physical survival. Today’s saber tooth tigers are conditions of lifestyle whether it is rush hour traffic, single parent management, missing a deadline, bouncing a check, or having an argument with our partner. Nonetheless, these modern day episodes trigger the same adrenaline release. Road rage, is relatively new, but is a classic example of how powerful and alive is our autonomic nervous system.

Some news broadcast stations reported that the atmosphere around the training of the proposed Michael Jackson European tours had reached catastrophic levels and where the needle was pointing to deep red. In business this is called the treadmill. Once you are on, it becomes almost impossible to dismount. The pharmaceutical companies have become the messenger and we are very familiar with the term ”be careful not to shoot the messenger

Homeostasis must be maintained at all times and our autonomic nervous system will go to all extent to see such a balance is maintained and stable. If such a thing as an irresistible force exists, then no object is immovable, and vice versa. It is logically impossible to have these two entities (a force that cannot be resisted and an object that cannot be moved by any force) in the same cosmos.

These traditions carry significant personal values and stays with one throughout life. Unfortunately too many of us after we have taken on our own life, tend to slowly drop traditions. However as we listened carefully to Michael Jackson’s messages, nothing say it with more emotion and commitment than his song “I am looking at the man in the mirror”. Like Albert Einstein, Elvis Presley and Bob Marley, may they rest in peace.

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Blood vessel dilators and constrictors: Lidocaine, a local anesthetic has dual properties. It acts as a vasodilator or a vasoconstrictor depending on the sight and type of injection. Nitroglycerin is a blood vasodilator – a drug that opens the blood vessel by relaxing the muscular wall of the blood vessel. Nitroglycerin is usually given by pill under the tongue for rapid uptake or intravenously to prevent blood vessel spasm and to minimize the area of damage from the heart attack.

When paramedics are called to a life threatening situation or accident they rely on lidocaine in combination with other drugs to stabilize the injured until they are passed off to E.R. Lidocaine has gained the trust and safety properties of this agent. One must understand there is a clinical difference between a heart attack and cardiac arrest. In a word, there is more time to deal with a heart attack victim as opposed to a one who suffered cardiac arrest. Paramedics are never with out this drug because of its efficacious properties.

Clot busters. Most heart attacks are caused by a blood clot blocking a coronary artery. Using thrombolytic agents or “clot busters” that can break down blood clots and restore blood flow through the artery can limit heart muscle damage. Medications, if given early, also can be effective in reopening arteries. Clot-dissolving medications, also called thrombolytic agents or clot-busters, can open 80 percent of the blocked arteries within 90 minutes. There are many of these agents from which clinicians can use depending on the situation of the patient.

The most commonly used clot-dissolving drugs are tissue plasminogen activators (Activase and Retavase), streptokinase (Streptase and Kabikinase) Inohep and anistreplase (Eminase); all are given intravenously. The earlier these drugs are given, the better the chance of opening the artery quickly. If these drugs are given too late (more than 6 hours after the onset of chest pain), most of the damage to the heart muscle has already occurred.

There is another class of vasodilators, which are given orally after a heart attack to improve the heart muscle healing process. These medications reduce the stress on the heart, thereby allowing damaged muscles to recover.

Opening the artery quickly. If these drugs are given too late (more than 6 hours after the onset of chest pain), most of the damage to the heart muscle has already occurred. Clot-dissolving drugs may be combined with antiplatelet agents, such as aspirin and ReoPro, or anticoagulants, such as heparin and Coumadin. By reducing the tendency of blood platelets to clump and initiate clot formation, antiplatelet drugs lessen the possibility that the artery will reclose and improve chances of survival. An anticoagulant, such as heparin, often given intravenously in the hospital, thins the blood to prevent blood clots and to maintain an open artery during the initial 24 hours after a heart attack. The most serious complication associated with clot-dissolving drugs is excessive bleeding. A small number of patients who receive clot-busting drugs for a heart attack will experience some spontaneous bleeding. Such bleeding is most serious when it occurs in the brain.

A cardiac arrest, As reported what Michael Jackson suffered, known as cardiopulmonary arrest or circulatory arrest, is the abrupt cessation of normal circulation of the blood due to failure of the heart to contract effectively during the pumping stage.

A cardiac arrest is different from (but may be caused by) a heart attack or, where blood flow to the still-beating heart, is interrupted as in cardiogenic shock. Cardiogenic shock is based upon an inadequate circulation of blood due to primary failure of the pumping valves (ventricles) of the heart to function. To put it bluntly the muscular integrity of the heart has failed due to possibly atrophy. Since this is a category of shock there is insufficient muscle mass tissue (i.e. the heart) to meet the required demand for oxygen and nutrients. This leads to cell death from oxygen starvation and nutrient starvation (e.g. hypoglycemia). Because of this it may lead to cardiac arrest.

“Arrested” blood circulation prevents delivery of oxygen to all parts of the body. Cerebral lack of oxygen supply to the brain causes victims to lose consciousness and to stop breathing, although breathing is abnormal or characterized as shallow may still occur. Brain injury is likely if cardiac arrest is untreated for more than 5 minutes.

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North Americans are lucky. Throughout all facets of healthcare and that includes oral care, we tend to take it all for granted. I recently returned from Tehran, Iran and other Middle East countries where I was visiting with some friends. One of my passions is reading and writing and being a pharmacist, there is a never ending list of questions that the general public will seek you out at any type of gathering.

I found there was great interest in sedative dentistry being the latest “in-word” for those patients labeled as “difficult to freeze”. This has resulted in a new discipline at many universities in North America where an accredited post graduate program appropriately called Dental Anesthesia is hot ( no pun intended) as the continuing education course one should take.

One question from a culture that has coffee stands similar to how we have hot dog or sausage vendors and where people stop to buy a snap of strong coffee and toss it down as though it was a shot of vodka all seemed strange to our customs.

Two questions were at the top of the list:

• Why are my teeth sensitive when I have a hot drink?
• Why are my teeth sensitive when I inhale air or have a cold drink?

Some time the questions were aimed at both situations.

Pharmacists do not diagnose and therefore a consultation with their dentist was my first advice. However this much I knew. Sensitivity to temperature – usually heat but also cold – is a classic symptom of the pulp of the tooth being inflamed.

Here are some possible causes if your tooth is sensitive to cold:

• They is evidence of deep decay. The problem can usually (but not always) be fixed with a restoration such as a filling or maybe a crown. Once the pain in response to cold has progressed to being sensitive to heat, you will have a tooth infection and endodontic therapy (root canal treatment) is required to save the tooth.
• If you recently had a new filling or crown treatment, and there is irritation directly after, this is normal and nothing to be concerned about as long as it comes immediately after the dental treatment and it gradually gets better. However if you had the treatment a week or more ago and your tooth is now beginning to react to the cold, or if the sensitivity gets worse over time, it is possible that your tooth already had some latent undiagnosed condition. Now, with the added irritation of being worked on, the condition is aggravated and requires further treatment.

Exposed roots. If your gum has receded or if the enamel or cementum of your tooth has worn to where the sensitive part of the tooth is exposed, it can make your tooth experience pain from cold. A filling or protective coating can keep your tooth from becoming too irritated. If this is the case, your tooth will also be sensitive to air. Any special toothpaste for sensitive teeth can help with this type of problem.

You can do a bit of diagnosis by checking these symptoms.

• If the cause (deep decay, exposed root) can be determined, address that cause. Remove the decay and fill the tooth, or cover the exposed root.
• When the tooth is irritated, does it hurt only briefly or does the pain linger? If the pain lingers for more than a couple of seconds (which is the time required for the tooth to warm up) it also indicates an irreversible pulpitis, and endodontic treatment will be required.

  Sensiivity to heat. Sensitivity to hot on a tooth is a classic symptom of a dead nerve. The empty space in the center of your tooth that once held a healthy nerve now contains dead tissue and one of the components of decaying flesh, methane gas. When heat is applied to the tooth, the gas expands putting pressure on the large nerve outside the tooth that connects all you teeth. You need to have a root canal on this tooth in order for these symptoms to disappear.

  Dentinal sensitivity. occurs when the dentin (middle layer) of a tooth is exposed. Normally, the dentin is covered by enamel above the gum line and by cementum below the gum line. Dentin is made up of tiny openings called tubules. Inside each tubule lies a nerve branch that comes from the tooth’s pulp (the center of the tooth). When the dentin is exposed, cold or hot temperature or pressure can affect these nerve branches. This causes sensitivity.

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I can remember vividly as though it was yesterday. The first statement from my professor in pharmacodynamics was profound. “Drugs are most efficacious (best results) when given precisely as were intended by the manufacturer. This will be on the product’s monograph”. I thought for a moment I had missed some of my notes, so profound was his statement. However, he continued, in a raised voice more like a general in the military and with greater forcefulness ,”and that includes suppositories, parenteral, IV injections and even nitroglycerin tablets”. It then dawned on me the profundity of his statement and where he was heading.

When drugs are distracted off course or miss their intended receptors, then little pharmacological action is derived or unfortunately side effects may develop and require termination of the compound. This example therefore speaks to the complexity and unique of each one of us anatomically. However correct prescribing instructions are critical. As an example if one suffered angina and were required to take nitroglycerin, the response would be instantaneous when the little pill is placed under the tongue. Conversely if the same pill were to be swallowed, the benefits would be negligible and severe heart pain would continue.

Drugs in some small way are like computers. They are encoded with specific data and armed with these instructions, set out to disguise themselves or to trick certain receptor cells that in fact may not be occurring. In other words drugs are agents that block, inhibit or by any other mechanisms get to have their way and in so doing,  the clinician will have achieved the purpose for which the drug (agent) was administered.

Unfortunately shift happens and things do not always work out as planned due to variances of the structure of one’s anatomy and or physiology, when compared to another. Since we are addressing reasons for the lack of being completely frozen when visiting the dentists, we will explore the reasons for failure. It has become so wide spread that a few individuals and even dentists have labeled some patients as “difficult to freeze”. This has resulted in a new discipline at many universities in North America where an accredited post graduate program appropriately called Dental Anesthesia is now listed and running or shortly will be.

Here are the most common reasons for local anesthesia failure

• Anatomical abnormal wide flaring mandible (lower jaw).
• Technical errors during administration. Too rapid an injection of under 1.5 minutes.
• Highly anxious patients. Fear, anxiety, apprehension;
• Inflammation and infection.
• Cartridge warmers – heat and light will cause break down of ingredients.
• Pharmacological: chronic alcohol abuse, chronic narcotic drug abuse.
• Pathological: trismus, infection, inflammation, previous surgery;
• Nicotine and cannabis smokers – (significant high liver enzyme levels).
• High levels of antioxidants which cause dilation of blood vessels.
• Bolus injection directly into blood vessels.
• Injection into the temporalis muscle.

Poor technique : this is the most common reason for failure of the conventional inferior alveolar nerve block. We emphasize the three most commonly occurring problems with this technique.

Inadequate mouth opening. The target area for this block is the mandibular sulcus, which is at the level of the coronoid notch and above the mandibular foramen.3 When the mouth opening is not adequate, the inferior alveolar nerve, which descends from above, is relaxed and away from the medial wall of the ramus. Consequently, it is at a distance from the target area, which leads to inadequate anesthesia. When the mouth opening is adequate, the nerve is flush against the medial wall of the ramus and at the target area.3 Hence, the patient reports experiencing almost immediate onset of anesthesia. This is why the block does not work in cases of trismus and the closed-mouth block needs to be administered.

Improper needle placement. a common mistake is to insert the needle too far forward or backward of the target area.2 Clinicians need to insert the needle just medial to the pterygomandibular raphe such that it approaches from the opposite side of the premolar region and bisects the thumbnail (or fingernail) placed at the deepest portion of the coronoid notch.1 The needle is inserted to a depth of 20 to 25 millimeters.1

Haste. Malamed recommends waiting three to five minutes after the injection before starting the procedure. We believe these minutes can be used to build rapport with the patient and make him or her feel at ease. While waiting for a mandibular block to take effect, the practitioner should ask the patient to sit up. This postural change often facilitates the onset of anesthesia.1 Every extra attempt just increases the acidity of the tissue and correspondently reduces any hope of achieving full anesthesia. Two strikes are you are back to the dug-out!

Conclusions. Several alternatives to the inferior alveolar nerve block are available. Clinicians should investigate them, rather than repeat the inferior alveolar nerve block after it has failed.

Practice Implications. Mastering anesthetic techniques maximizes success in the dental office. It enables clinicians to provide better and more comfortable treatment to patients.

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Deep inside the mouth often referred to as the oral cavity; there is a basket weave of muscles, arteries, nerves and veins which perform their function in human physiology like a well tuned Suisse watch. Any tinkering or injury is sure to result into symptoms ranging from minor to clinically significant which may need the skills of a well trained and experienced dentist. Trauma to any part of this entire integrated network can as subtle and varied as during a meal, kidding around as so often done by children, the natural course of growing anatomy or while having dental work done.

To add insult to injury, there are anatomical variances from on person to another. These, arteries, veins, nerves and muscles are so closely platted, that dentists must be given credit when administering local anesthesia because there is literally only a few millimeters with which to accurately direct the needle, bearing in mind that as the needle advances through the tissue before gently touching bone, there are minor deflections (of the needle) which have to be factored in.

According to Dr. Stan Malamed’s Hand book on local anesthesia, which is considered the “bible” for most dentists, states that a slow injection is by far the preferred way to avoid any mishaps. Because of the tight maneuvering through the maze of integrated net work of arteries, nerves, veins and muscle, if an error is made the patients feels it instantaneously and a slight correction can be made by slightly withdrawing and redirecting. Were it a rapid injection the needle would have already penetrated and exited the muscle or vein and the patient pays the price the next day.

The counter argument is that if the dentist can complete the injection as quickly as possible the patient is free of the needle. Nothing could be further from the truth since the variances in the pH of the local anesthetic and that of the tissue is too great to allow a smooth transition. One should also bear in mind that at this slow speed (1.5 minutes) the local anesthetic is actually numbing the tissue ahead of the needle.

Some dentists have chosen to use an automatic device which is programmed to deliver at the rate for any given patient. Dentists who use these mini computers admit that patients say they felt nothing. This is a win-win situation because the dentist can start to work right away and avoid having to give another injection before rushing off to another room. You do have their undivided attention form start to finish. This is the normal procedure they are taught in dental school. This can be a warning to the patient if they see the dentist darting from room to room, it will be a bad “hair day”, as sure as they are little green apples.

When a certain muscle is penetrated, invariable a condition called a trismus will develop. A trismus is defined as a motor disturbance of the trigeminal nerve, especially spasm of the masticatory (chewing) muscles, with difficulty in opening the mouth to the full extent. Although post injection pain is the most common local complications of local anesthesia (due to hurry and speed), trismus can become one of the more chronic and complicated problems to manage. Some dentists also develop the habit of swiping the diaphragm of the cartridge with an alcohol or cold sterilizing solution cotton swab. A residue of these solutions may diffuse into the tissue during injection, and may produce irritation to the muscle which adds to the discomfort and or the trismus. Bleeding is another cause. Large volumes of blood can cause irritation, which leads to muscle dysfunction as the blood has a tendency to be resorbed. A low grade infection can add to the severity of the trismus.

Less is best and most dentists will try for as few injections in the same general area. Excessive volumes of local anesthetic (”an extra one for the pot”) is a bad practice since tissue around the teeth are taught. Excessive volume will cause tissue expansion which again will lead to the severity and length of enduring a trismus. Some of the newer more effective local anesthetic solutions are now supplied as double strength, therefore, where it normally took one cartridge to do a procedure, one half is now required. For the patient it is far better to toss the left over rather than to use it all, for the reasons mentioned above. It makes good sense to follow this habit since using it all will cause the unnecessary discomfort of distention and swelling around the area.

In an acute (sudden) phase of a trismus, pain produced by bleeding, leads to muscle spasm and limitation of movement. The chronic or long lasting, phase usually develops if treatment is not begun immediately. The inability to open one’s mouth widely is the result of the hematoma, fibrosis and eventually scar contraction. Infection may also produce reduced ability to open the mouth widely, due to pain, increased irritation and scarring. In extreme cases physio-therapy may be necessary.

The above incidences of trismus are quite common when a block is given. Fortunately, the majority are resolved in a few days. You should request a slow injection over a period of 1.5 minutes and also excessive shots are being avoided. Contrary to popular opinion, a dentist can increase patient load by 4 -5 more per day, if the time is spent completely with one patient from start to finish, rather than the perceived popular idea of rushing from operatory to operatory.

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The analogy of the swinging sword or even the “The pit and the pendulum” by Edgar Allan Poe and the torments endured by a prisoner of the Spanish Inquisition, are probably too strong a comparison for Hepatitis C, and it certainly will not get the footage and exposure as H1N1 (swine flu), however me thinks this is a force to which our bio-chemists should be paying greater attention. Explanations for the slow work on creating a vaccine (HCV) are explained later in this article. In general, medical doctors, traditionally have taken more precaution to avoid contacting hepatitis C than their cousins, the dentists. It was not until the late eighties that dentists started to wear masks, gloves, splatter glasses and this was driven mostly by the publicity of AIDS.

There are other kinds of viral hepatitis such as hepatitis A, hepatitis B, hepatitis D, and hepatitis E. These diseases and the viruses that cause them are not related to hepatitis C even though they also insult the performance of the liver. They may have other, different symptoms and different modes of transmission. This means that there are different ways of spreading the disease and different means for preventing and controlling precisely these diseases.

Hepatitis C is an infectious liver disease caused by the hepatitis C virus (HCV). Infections of hepatitis C occur only if the virus is able to enter the blood stream and reach the liver. Many compounds can be diverted and excretion without causing clinically significant toxic effect to the liver.

For reasons that are not completely understood, about half of all people who develop hepatitis C never fully recover and can carry the virus for the rest of their lives. These people have chronic hepatitis C, and some may eventually develop cirrhosis of the liver and liver failure.

The hepatitis C virus is spread primarily by exposure to blood. Some people who get hepatitis C do not know how they were infected with the virus.

People may get hepatitis C by sharing needles to inject drugs, through exposure to blood in the workplace, from unsterile equipment used for body piercing, tattoos or acupuncture, exposure to dental or medical practices with poor infection control practices or by sharing personal care items including nail clippers, razors, scissors with infected people. The risk of getting this virus from a blood transfusion is minimal but still exists. All donated blood is now screened for the hepatitis C virus.

Hepatitis C has been transmitted between sex partners and among household members. However, the degree of this risk still needs to be accurately defined. An infected mother can pass HCV to her child at birth.

There is no evidence that hepatitis C virus is spread by casual contact. Sneezing, coughing and hugging do not pose the risk for hepatitis C. In addition, there is no evidence that hepatitis C virus is spread by food or water.

An estimated 270-300 million people worldwide are infected with hepatitis C. Hepatitis C is a strictly human disease. It cannot be contracted from or given to any animal. Chimpanzees are able to carry the disease for lab work, but the animals do not get sick. The inability to perform animal testing has severely limited attempts to study and cure the disease in a nonhuman in vivo environment. No vaccine against hepatitis C is available. The existence of hepatitis C (originally “non-A non-B hepatitis”) was postulated in the 1970s and proved conclusively in 1989. It is one of five known hepatitis viruses: A, B, C, D, and E.

In the U.S. as of 2008, an estimated 2,500,000 people are infected with HCV. Less than 25% of those initially infected have symptoms and 75-85% progress to the carrier (chronic) state. It is estimated that 35% of those with chronic hepatitis do not know they are infected and may not have symptoms for many years. Rates of hepatitis C between 1999 and 2006 are highest in the 40-59 age group and higher in males than females. The total rate of infection is declining during this period.

Some people who are infected with hepatitis C virus have no symptoms and can infect others without knowing it. These persons are at risk of becoming ill at some time in the future. It has been estimated that it may take 10 years to develop symptoms. The symptoms of hepatitis C infection include fever, nausea and vomiting, loss of appetite, stomach pain, extreme fatigue, and yellowing of the skin and especially in the eyes of darker skin people (jaundice).

The incubation period (the time between initial contact with the virus and the onset of the disease) for hepatitis C ranges from 2 weeks to 6 months, most commonly 6 to 9 weeks.

The risk of acquiring hepatitis C from the workplace depends on the amount of exposure to human blood or blood products and needle stick injuries. In general, occupational groups with increased risk include workers such as dentists, nurses, and laboratory personnel who are repeatedly exposed to human blood and who are at risk of needle stick injuries.

The common tests for hepatitis C the polymerase chain reaction (PCR) test, liver function test, the liver biopsy test are the antibody test, When a person becomes infected, the body creates antibodies to protect itself from the virus. However, sometimes a “false negative” test can result if there are not enough antibodies in the blood for the tests to detect accurately. A doctor should also do a complete medical examination and get information about your activities in order to make a clinical diagnosis of hepatitis C.

Additional general information on Universal Precautions is available on this web site.

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The exact cause of Attention Deficit Hyperactive Disorder (ADHD) is not really known but research does point to a likely genetic connection. So if your family has an ADHD history, there could be a small possibility this can be encoded on the “X – Y” chromosome linkage of off springs. Consult your family doctor.

 Albert Einstein happened to have lived at a time when the diagnosis of ADD or ADHD was not listed in medical dogma. While we must encourage the work of today’s  bio-chemist, clinicians and physicists, we must be grateful, such ailments were not listed or treated, and god forbidding we would have been denied the law of Relativity and quantum mechanics and the entanglement between atoms.

Although we have not as yet been privileged to the memoirs of Bill Gates, there are strong rumors that like Albert Einstein, he too was expelled from school. Albert Einstein was preoccupied with a bizarre persistent internal question of wanting to know the feeling of traveling along side a beam of light. This annoyed and was beyond any reasonable challenge to his teacher as to why the need to know, consumed student Einstein. The natural course of events followed and of course Albert Einstein was expelled but continued to study at home. Without not so much as an apology to his father who worked as a civil engineer in the family business, Albert told his father he had lost respect for his professor and would probably achieve his grades by studying at home.

In Germany there was zero tolerance for students who exceeded the art of processing complex equations faster and more accurately than their teacher. In time will no doubt be informed whether Bill Gates’ childhood was a mirror image of Albert Einstein. I find it ironic these days that student in bio-chem, often look down at their colleagues in arts or technical vocational computer studies, and yet they eventually meet at the apex when the equation e=mc2 finally meet. ‘No Man is an Island’ – John Donne

Before I loose my audience, it was important to set the scene. The crust of this article, as silly as this may sound and the stereo-typical attitude the general public entertain towards students of arts and computer sciences, speaks directly to kids diagnosed with ADHD who think and act outside of the norm. It also begs the question; could this compulsive incessant, physical or mental activity be a substitute for Ritalin or Adderall? To understand this question is to get a better grip of ADD and ADHD.

People with ADHD are very creative. They see time in seconds or even nano seconds and for them every second should be used or accounted for. This may  explain the in vogue tongue “barbell”. The continuous swirling of the tongue around the barbell completes a continuous figure “8” pattern or configuration and in the world of an ADHD brain process person, this completes an endless loop and acts as a pacifier. When ADHD people have no outlet or are restricted from being creative, this is when problems start to escalate.      

Here is how the true story was told. Any names have been changed to protect the identity. “I finally got the nerve to take my 10 years son to the dentist. He needed quite a bit of work to be done, and as I dreaded and delayed, it became more and more foreboding. I questioned and worried myself into a bundle of nerves, just thinking what was going to be the outcome.

First was what would be the opinion of the dentist who would be coming face to face with a kid who wears a tongue barbell? Those of you who are on the outside the world of an ADHD child will probably advise “tuff love”. Let me counteract and remind you of Albert Einstein. Tough love would have robbed us of a genius. Paul (our son) would object to the removal of the metal object if X-rays had to be taken, to which he would question the dentist’s ability as to why he (the dentist) could not readily observe an object which was radiolucent as opposed to radiopaque. Furthermore what does it matter since I have silver amalgam fillings. Do you want to remove them also before you can take an x-ray”?

Questions are never ending with an ADHD kids. They are not meant to confront but rather to learn. Paul was on Ritalin and therefore any anxiolytics like Ativan would half been counter productive. Most clinicians send a double message. Knowledge is welcomed and encouraged so long as it does not require him/her to recite the Krebs cycle. If the questions are perceived as passive, then all is well.

The dentist was secure and it showed. No panic was ever evident, even when the nitrous oxide and the local anesthetic was attempted to be administered. Paul was intrigued and was more interested in the mixture combination and what effect he would feel.  Paul looked like any normal 10 year old. The procedure was terminated mostly because of unknown sequela of multiple meds. He showed no symptoms of Tics, bipolar episodes or Parkinson’s disease. An appointment was rescheduled.

People with ADHD are highly sensitive. Many ADD people appear to be the exact opposite though. This may be because society does not want us to show our feelings. This is especially hard for males. We wonder why little boys with ADD/ADHD are fighting a lot. If they cry like they feel like doing they may be told that crying is for babies and to “suck it up”.

Bad breath, malodor, often called halitosis, is a condition commonly experienced by the general population at one time or another. In most cases the origin of oral malodor in healthy individuals in the mouth is particularly at the back of the tongue. Bacteria in the oral cavity produce a range of malodorous species including volatile sulfur compounds (VSC), particularly hydrogen sulfide, methyl mercaptan and dimethyl sulfide.

Bad breath is usually caused by the breakdown of proteins by bacteria in the mouth. Chronic bad breath, known as mal odor, does not come from the stomach. The only odor that comes from the stomach is when you burp. Food eaten such as garlic and spicy foods once absorbed into the body can release odor through the lungs when you breathe. This is not to be confused with chronic bad breath which persists days after the residue of rich and spicy foods have been naturally broken down and eliminated. Therefore odors after lunch and dinner are transitory and should not be confused with bad breath. Human’s sense of smell has the ability to adjust to odor. Therefore, most people with halitosis are not aware of their bad breath.

Bad breath can be,  in a way elusive in that the origin is multifaceted. Many bio-chemists who have made this subject a part of their thesis can relate interesting incidences where body language plays a part in one’s perception that they may have bad breath. The most obvious is the TV interview pose. The next time you are viewing an interview between two people you will notice the subconscious “pull back” or what some people call the comfort zone space.

Another classic example of the elusiveness of a bad breath situation is a clinical diagnosis caused by the chronic use of oral anabolic steroids. All things being equal, and there is no evidence of unusual sequela, anabolic steroids taken orally produces a pungent distinctive odor There is at least one published case of a muscular young football player who consistently demonstrated an unusual mal odor at each of his hygienist appointments for a cleaning. All x-rays ruled out gingivitis or periodontal disease, yet the malodor was evident. Unfortunately the youth died suddenly during a foot ball practice. When his parents cleared out his room, to their surprise they discovered at least 24 one litre empty containers of Listerine mouth wash.

Oral malodor in the younger generation, who are void of gingivitis or periodontitis, is primarily the result of poor oral hygiene. Bacteria and food debris which are not removed by brushing and flossing can be the source. Whether one uses a power tooth brush or a manual one, each quadrant takes 30 seconds to do a good job. In other words brushing one’s teeth takes a minimum of 2 minutes which should be done after flossing. Electric tooth brushes have a built-in auto alert.

There are some simple checks one can do as a self-diagnosis to determine whether they do suffer from mal odor since as we mentioned before it is difficult to know because human’s sense of smell has the ability to adjust to odor. There are some simple tests one can do such as licking the wrist and then sniffing the area once the saliva has dried. However, this may only indicate any problems with the front of the tongue. Others will form their hands in a cusp, then exhale into it and quickly sniff the captured air. Again this does not give a true picture of the back of one’s tongue. Tongue scrapers are useful tools once you can tolerate the gagging effect. However the best home test is the floss sniff. One can readily detect an odor if oral hygiene is lacking.

If periodontitis has already set in, this will require a visit to your dentist. Periodontitis is easily recognizable because it appears that one’s teeth are showing signs of elongation or that the gum is receding. There is always a mal odor due to inflammation and does not disappear with the chewing of gum. An aggressive schedule will be set up for deep scaling where most cases will require the use of local anesthetics. If periodontal disease is diagnosed and goes untreated, the maxillary and or mandibular bone is quickly eaten away by certain micro-organisms and the tooth or teeth will eventually have to be removed since the bone and gum can no longer support the structure. With the use of antibiotics, these micro-organisms will be brought under control and bone degeneration will cease providing it is caught in time.

A rigid program has to be followed in order to save these teeth. Furthermore dentists today are especially skilled and with new equipment, they can place local anesthetic solution to one part of a quadrant or even to one single tooth. This eliminates the many hours of frozen drooling jaws or the possibility of developing a trismus. This approach allows one to enjoy a luncheon date or be present at the dinner table in the evening.

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