What Really Happens When You Swallow Your Gum?

You’ve heard the warnings: If you swallow gum, it will stay in your digestive system for nearly a decade. Which would mean there’s a decent chance you’ve got some hanging out in your gut right now.

If you look at its ingredients—a delicious mix of indigestible compounds—it certainly seems possible. And if you look at the medical books, swallowed gum has caused some serious problems. Is it possible that your mom’s crazy warnings were right?

The Worst Cases

A 1998 article in the journal Pediatrics discussed three cases in which kids took the act of gum-swallowing to Intervention-like extremes. (Warning: What follows is not for the squeamish!)

The first tale was of a four and a half year old boy who had been addicted to chewing since he was two. By the time his parents finally took him to get help, he was up to seven pieces of gum a day—each one he had conveniently disposed of down his throat. When the mass created a blockage, his doctors had to pull the “taffy like substance” from him manually.

Continue reading at gizmodo.com…

To learn more about endodontic treatment, Dr. Shelley and his team, visit http://elmendo.com.

Ace has been running a dental lab since before I was born, and there probably isn’t anything he hasn’t seen or dealt with in the dental world. He is a Colorado native, has nine siblings and four children, and is the son of a dentist. He took up dental work with his father after returning as an injured Marine in the Vietnam War.   He loves the Broncos, watches the history channel while making dentures, and loves to golf.

It’s been a pleasure having Ace across the hall who is there when I arrive to work, and is still working when I leave. If you’re in need of a removable prosthetics lab in the area, give Ace a call. His prescription form can be downloaded HERE.

Do you know someone who would like to be featured on our blog? Let us know!

Twitter is what is known as a micro-blogging site.  On Facebook you have “friends”, and on Twitter you have “followers”.  Messages can be no longer than 140 characters in length.  If your account is public then anyone can see your posting.  If your account is private, then only your followers will know what you are saying.  When you “follow” people, their posts will flow in to your timeline in chronological order, and you can view what they are saying.  You can post brief messages, link to interesting articles on a website, or attach photos.  Twitter is used by celebrities, businesses, politicians, and regular people to collect and disseminate information to people that are interested in them.

Twitter uses something called a hashtag.  A hashtag is the # sign followed by a word.  For example, during one of the presidential debates CNN may use the hashtag of #cnndebate.  You can search for this hashtag and narrow your timeline to a stream of posts and comments specific to that topic as it is happening.  The Hugh Hewitt radio program uses the hashtag #HHRS (for Hugh Hewitt Radio Show) so that the host can view messages from his listeners while the show is in progress.  I followed the recent Superbowl halftime show (with #halftime) and while Madonna was singing “I’m Sexy and I know it” I found humor someone’s comment that said, “Did Madonna just say “I’m sixty and I know it? #halftime”.

You can communicate directly with other users through @mentions (said “at mentions).  If you wanted to send me a message on Twitter you would address it to @elmendodontics.  This is also how you identify yourself, and is as specific to you as is an email address.  There are specific rules about @mentions  and @replies that you should know and can be reviewed here (http://www.1dental.com/blog/2011/05/20/top-10-dentists-in-social-media/) and here (http://blog.twitter.com/2008/05/how-replies-work-on-twitter-and-how.html).  Study how these work and understand that @mentions are not private messages.

The best way to get to know Twitter is to sign up for a free account, begin following your interests, and watch how it works.  Below are some tips and warnings on how to use Twitter as a dentist.

1.  Information

If you are an information junkie like me, you’ll love Twitter.  Use it to follow things you are interested in.  If you are interested in news and Hollywood, you can follow a few news outlets and a few celebrities.  On the news side you’ll find a continuous stream of breaking news, and on the celebrity side you’ll find occasional comments about their life (or lack there of) and interests.  Whether you are interested in gardens or glamor, you’ll find niches in your area of interest. If you follow the right people in the dental field, you can find a wealth of information an breaking news in dentistry.  Following people in the dental field who are active on Twitter will allow you to observe what works. Take note of what you are interested in, and do the same.

2.  Twitter at Dental Conferences

I have seen very little talk on this topic, but I feel this is one of my favorite and most powerful uses for Twitter.  By using the hashtag, you can filter messages specific to that conference.  The Chicago Midwinter meeting made use of the hashtag #cds12 (for Chicago Dental Society 2012). Manufacturers, speakers, convention leaders, local restaurants, and alumni associations used this hashtag to communicate with attendees.

Some specific uses for twitter at a convention:

While sitting in a lecture, you can tweet poignant facts and add the tag #cds12. An attendee in another lecture can see what you are learning, while sitting in their own lecture.  So if you’re not learning much in your own lecture, you could participate virtually in someone else’s.

If a presenter is on Twitter, you can connect directly with him after the lecture.  If they choose to implement it, presenters could even use a hashtag specific to their lecture that would allow listeners to interact specifically with them with questions and tips.  This may be a less common use in the dental field, but is quite popular in the tech world.  In the future, expect a presenter to ask members of the audience to share a case that they have stored on their iPad.  With a quick hashtag specific tweet and a photo attachment an attendee can post his case on the big screen for discussion.  Although we may be a couple years off from this, I’m sure we will see it soon enough.

-Alumni associations can tweet messages to their alumni for gatherings and updates.
-Manufacturers can tweet information about their products and specials.
-Attendees can tweet problems about the convention that can be addressed by convention staff
-Local restaurants can advertise their services for conference attendees.

3. Twitter to Connect with People and Patients

Dentists can use Twitter to connect with people.  By following people in your community, and having them follow you, you can begin to talk with others. Imagine that a crowd of people followed you everywhere you went (your Twitter following) and imagine walking through the crowd and hearing specific concerns, questions, or interesting conversations from that crowd.  That’s what Twitter is.

The best way to do this is to talk to people via @replies.  If someone makes an interesting comment, you can reply by writing “@username, I loved your comment about the weather”.  If you are doing this with your patients you can begin to build relationships outside the twice yearly visit.  You will also find with which patients you share common interests.

Another good way to connect with people is to retweet their comments.  If you read something interesting from one of the people you follow, you can click on the “retweet” icon and send the message out to all the people you follow.  Likewise, if you tweet something interesting and your followers retweet your post, then, even though you only have a couple hundred followers, your message could reach tens of thousands.

By using the advanced search feature at www.search.twitter.com (click on the “advanced” button) you can search local tweets specific to your search criteria.  Search for the words “dentist” within 25 miles of Westminster, CO and see what people are saying: http://twitter.com/#!/search/dentist%20near%3A%22Westminster%2C%20co%22%20within%3A25mi  You’ll finally hear the truth about what patients think about the dentist.  You can even reply to them and encourage them to visit your office.

Finally, you can use Twitter to connect with local businesses.  By following and promoting local businesses and their clients, you will begin to connect with a diverse audience. They will appreciate it when you promote their business and events and will do the same for you.  By doing so you start to connect your patients with others in the community who may choose you as their next dentist.  When they do, they’ll likely try you out and will probably promote you amongst their friends.  It will take a while to build this kind of a following, but even if you become casually involved with it, you will begin to establish lasting relationships.

A Few Ways NOT to use Twitter

1. Constant Self Promotion

I know you love dentistry, and your patients are aware of that as well.  Think of your followers as your friends.  When your friends come over to your house do you constantly promote your latest tooth whitening special or how they should floss daily?  If you use it to constantly promote yourself, you’ll find that people won’t want to follow you, just like no one likes to be around someone who can only talk about themselves.  If you have something special going on then tweet about it, but don’t make it the only thing you do.  Consider tweets that uplift and contribute to the knowledge or well-being of your followers.

2. HIPPA Still Matters

I saw one dentist who would tweet thanks to each patient he saw that day using the patient’s full name.  I believe that would be a clear violation of HIPPA to advertise to the world who your patients are.  Imagine if your plastic surgeon tweeted your name after a visit to his office.  Mortified?  I’d say so.  Keep in mind that you are still a professional, and you do not want to advertise patient specific data.  Also be aware that nothing is truly private online, and if you find that you are getting very personal messages from patients, you may need to institute some office policies and consent when it comes to these types of relationships.

3.  Controversial Material

You may not like the current president, but statistics admit that probably half of your patients probably do.  If you feel inclined to comment on controversial material such as politics, abortion, religion, etc. then you may want to establish a separate personal account that you can use as your soapbox.  You don’t want to begin losing patients by tweeting inappropriate material.

4.  Mundane Material

Don’t bore your followers with tweets about your daily habits, your meals, or what your pet just did on your favorite couch cushion.  Too many useless tweets is a turn-off for most people who will simply “unfollow” you.  Keep your tweets to no more than a couple per day.

Final Considerations

You’ll find that Twitter can be a fun tool for gathering information, making the best use of conferences, connecting with people, and promoting your cause.  Keep in mind that many of the people you meet there will probably visit your website.  If you haven’t established a decent website, you may want to consider that as a priority.  Search engines also look favorably on a website that is linked to active social media accounts such as Facebook, Twitter, and YouTube.

Finally, you may find that you don’t have time for all this tweeting.  This is a task that could be assigned to a staff member, but not without supervision and guidance.  If you are delegating this task, you will need to establish some clear guidelines of what is and is not an appropriate voice for your practice’s account.

Twitter is not a replacement for any of the marketing and practice building tools that you are already using. Consider it as an adjunct and an opportunity to build stronger relationships with others.  Start today by signing up for a free account and begin searching for people to follow.

Case #1: You Better Keep that Tooth

This patient presented with a referral slip for tooth #3 saying “Evaluate restorability and treat if necessary.”  The deep distal decay on #3 presented a generally unfavorable long-term prognosis without crown lengthening.  Treatment options included endodontic treatment of #3, build-up, and crown; extraction of #3 and placement of a bridge from #2 – #4; or extraction and implant of #3.  A CBCT was taken to evaluate the true relationship of the decay to the crestal bone.  A surprise finding was that the impacted wisdom tooth had caused an area of resorption on the distal buccal and palatal root of #2.

Because of the CBCT findings, we could determine that #2 was not restorable.  With the removal of #2, adequate access to the distal of #3 can be made for a more predictable and favorable restoration.  Had the CBCT not been taken, and if the patient had decided to remove #3 in favor of a bridge, she would have eventually lost #2 as well.  CBCT imaging thus saved the patient the cost of a bridge and the unnecessary removal of tooth #3.  Although the argument for an implant in this case could be made, a favorable long-term prognosis is expected with endodontic treatment and restorative.  Further evaluation of the impacted #32 still needs to be performed and is suggested. (Click thumbnails below for full images)

Case #2: You Better Lose that Tooth

This patient presented having discussed options with his dentist on whether he should keep or remove tooth #2.  The bitewing radiograph demonstrates that the tooth is in limited function.  Periapical radiographs show that tooth #1 is in close proximity, but that the relationship is relatively benign.  Despite the limited value of this tooth, the patient opted to keep it through endodontic treatment and a crown.

CBCT imaging revealed that the cusps of tooth #1 are driving into the palatal root of tooth #2.  Although the damage appears to be minimal, I could not guarantee the long-term favorability of this tooth given the already present damage to the palatal root.  The findings from the CBCT added the final piece of evidence to suggest a less than favorable long-term result, and the patient opted for removal of the tooth.  Once again, the CBCT findings offered information that saved the patient the unnecessary expense of endodontic and restorative treatment.

Case #3: Your Problem is a Different Tooth

This frail 87 year old female patient presented with pain in the lower left side.  She was referred for possible re-treatment of tooth #19 silver points due to vague symptoms of a dull ache on the lower left side.  Whereas standard radiographs suggested a problem with tooth #17, CBCT imaging confirmed an irregular radiographic finding consistent with decay.   Our ultimate diagnosis was an irreversible pulpitis of the impacted tooth #17, and she was referred to an oral surgeon for evaluation and removal.  In this case the CBCT provided information that allowed for proper treatment planning and discussion of the possible loss of #18 due to the proximity of the wisdom tooth.  Standard radiographs provided information about the integrity of the distal margin of #19, which was also discussed.

We learn at least two things from theses three cases.  1) Impacted third molars can cause damage to adjacent teeth and should be removed at an early age when morbidity is low.  Although many potential complications were present with removing the wisdom tooth on the 87 year old female, reports from the oral surgeon suggested a successful outcome.  2) Use of the CBCT, even when you think you have all the information you need with standard radiographs, provides treatment planning information that suggest endodontic treatment is needed, that endodontic treatment is not needed, or a different treatment is necessary.  These ultimately offer value to the patient with proper treatment planning leading to improved longevity of dental treatment.

Simply viewing these pictures helps to understand and appreciate that the root canal system can be very intricate. Having the proper instruments to address this anatomy is important. Although this anatomy is challenging to even the most expert endodontist, having a CBCT, a microscope, a large variety of hand files, and lots of patience is necessary when trying to achieve a positive outcome.

Thanks to Dr. Versiani and his team for their dedicated effort to improving the field of endodontics.

This was a young female with a root canal done several years earlier by her general dentist.  She presented with swelling and deep pocketing around the tooth related to an abscess around the roots.  CBCT three dimensional imaging confirmed the presence of bone loss around the root consistent with infection.  Also evident was a missed canal – the MB2 canal which is commonly missed in this tooth when root canal treatment is not rendered with proper magnification and lighting such as a dental operating microscope.

The prior root canal was done through the existing crown.  The chamber was poorly cleaned at the completion of treatment and the filling was poorly placed with voids and inadequate bonding, which allowed leakage of bacteria into the root canal space.  The previously missed MB2 canal was immediately located and was found to join the adjacent canal.  The MB2 canal is clinically present close to 75% of the time.  This canal as well as the rest of the chamber were badly contaminated, and a black sludge was present, which is likely a combination of bacterial by-products and pulp tissue that was never adequately removed.

All four canals were re-treated in two visits with resolution of symptoms and pocketing by the second visit.  The canals were filled, and the chamber thoroughly cleaned.  The dentin and porcelain were prepared and a filling was bonded in a manner to create an esthetic appearance.

This tooth has a favorable chance of complete healing after being properly treated.  Errors made in the initial treatment were not treating all four canals, not thoroughly removing pulp tissue, and not adequately sealing the access.  Had the root canal been treated with proper lighting, magnification, experience, and skill the canal would not have been missed, the access would have been adequately sealed, failure would likely not have occurred, and this patient would not have needed to endure further discomfort and expense of root canal re-treatment.  Some would challenge that an implant is better than a root canal because root canals “don’t work”.  What we see in this case is that they don’t work when they aren’t done properly.  Proper treatment equals proper healing.

The following images were taken throughout treatment and are labeled with explanations.

The ultimate reason why root canals fail is bacteria.  If our mouths were sterile there would be no decay or infection, and damaged teeth could, in ways, repair themselves.  So although we can attribute nearly all root canal failure to the presence of bacteria, I will discuss five common reasons why root canals fail, and why at least four of them are mostly preventable.

Although initial root canal treatment should have a success rate between 85% and 97%, depending on the circumstance, about 30% of my work as an endodontist consists of re-doing a failing root canal that was done by someone else.  Root canals often fail for the following five reasons:

1. Missed canals.
2. Incompletely treated canals – short treatment due to ledges, complex anatomy, lack of experience, or lack of attention to quality.
3. Remaining tissue.
4. Fracture.
5. Bacterial post-treatment leakage.

1. Missed Canals

The most common reason I see for root canal failure is untreated anatomy in the form of missed canals.  Our general understanding of tooth anatomy should lead the practitioner to be able to find all the canals.  For example, some teeth will have two canals 95% of the time, which means that if only one canal is found, then the practitioner better search diligently to find the second canal; not treating a canal in a case where it is present 95% of the time is purely unacceptable.

In other cases, the additional canal may only be present 75% of the time.  The most common tooth that I find to have a root canal failure is the upper first molar, specifically the mesio-buccal root, which has two canals more than half the time.  I generally find two canals in three out of four cases, yet nearly every time a patient presents with a failure in this tooth, it is because the original doctor missed the MB2 canal.  Doing a root canal without a microscope greatly reduces the chances of treating the often difficult to find MB2 canal.  Also, not having the right equipment makes finding this canal difficult.  Not treating this canal often leads to persistent symptoms and latent (long-term) failure of the root canal.  Using cone beam (CBCT) 3-dimensional radiographic imaging, like we have in our office, greatly assists in identifying the presence of this canal.  In addition, when a patient presents for evaluation of a failing root canal, the CBCT is invaluable in helping us to definitively diagnose a missed canal.

The bottom line is that canals should not be missed because technology exists that allows us to identify and locate their presence.  If a practitioner is performing endodontic (root canal) treatment, he or she needs to have the proper equipment to treat the full anatomy present in a tooth.  Although getting a root canal from an endodontist may be slightly more expensive than getting one from a general dentist, there is a greater chance of savings in the long-term value of treating it right the first time.

See Photos below or read the entire case report HERE.

2. Incompletely Treated Canal

The second most common reason that I see for root canal failure is incompletely treated canals.  This usually comes in the form of “being short”, meaning that if a canal is 23 millimeters long, the practitioner only treated 20 millimeters of it.  Being short increases the chance of failure because it means that untreated or unfilled root canal space is present, ready for bacteria to colonize and cause infection.

Three reasons why a root canal treatment was shorter than it should be can be natural anatomy that does not allow it (sharp curves or calcifications), ledges (obstacles created by an inexperienced practitioner, a practitioner not using the proper equipment, or even an experienced practitioner in a complex situation), or pure laziness – not taking the time to get to the end of the canal.

Two factors that contribute to successfully treating a canal to length are proper equipment and experience.  One example of proper equipment is an extra fine root canal file.  Having the smallest most flexible root canal file (instrument used for cleaning) allows the practitioner to achieve the full length of the canal before damaging it in ways that are not repairable.  If the doctor is using a file that is too large (and therefore too stiff) then he may create a ledge that is impossible to negotiate and will therefore result in not treating the full canal and could possibly lead to failure.  Endodontists generally stock these smaller files, and general dentists often do not.  Ledges can occur even with the most experienced doctor, but experience and the proper equipment will greatly reduce their occurrence.

The second factor that contributes to successfully treating a canal to length is experience.  There is no substitute to having treated that particular situation many times before. Because endodontists do so many root canals, they develop a sensitive tactile ability to feel their way to the end of a canal.  They also know how to skillfully open a canal in a way that will allow for the greatest success.  Root canal treatment from an experienced endodontists greatly increases the chances that the full length of the canal will be treated and that failure will be reduced.

3. Tissue

The third reason I see for root canal failure is tissue that remained in the tooth at the time of the first root canal.  This tissue acts as a nutrient source to bacteria that can re-infect the root canal system. Root canals naturally have irregular shapes that our uniformly round instruments do not easily clean.  Two common reasons why tissue is left in a root canal is lack of proper lighting and magnification, which is achievable with a dental operating microscope, and a root canal that was done too quickly.

Immediately before filling a root canal space that I have cleaned, I stop to inspect the canals more closely by drying them and zooming in with the microscope to inspect the walls under high magnification and lighting.  Even when I think I have done a thorough job, I will often find tissue that has been left along the walls.  This tissue can be easily removed with experienced manipulation of the root canal file under high magnification.

The second reason why tissue may remain in a root canal treated tooth is that it was done too quickly.  I am completely aware that the patient (and the doctor) want the root canal to go as quickly as possible, but one of the functions of the irrigant used to clean during root canal treatment is to digest tissue – the longer it sits there, the cleaner the tooth gets.  This is good because areas that are not physically touched with a root canal instrument can still be cleaned by the cleaning solution.  If a root canal is done too rapidly, the irrigant does not have time to work and the tooth does not become as clean as it possibly could be.  Practitioners continually make judgment on when enough cleaning has occurred.  Whereas we would love to have the patient’s tooth soak for hours, doing so just is not practical.  Therefore we determine when the maximum benefit has been achieved within a reasonable time period.  If a root canal is done too rapidly and has not been thoroughly flushed then tissue may still remain and latent failure of the root canal may occur.

4. Fracture

Another common reason for root canal failure is root fracture.  Although this may affect the root canal treated tooth, it may not be directly related to the root canal treatment.  Cracks in the root allow bacteria to enter places they should not be.  Fractures can occur in teeth that have never had a filling, indicating that many of them simply are not preventable.

Fractures may also occur due to root canal treatment that was overly aggressive at removing tooth structure.  This is more common with root canals performed without magnification (such as the dental operating microscope) because the practitioner needs to remove more tooth structure to allow more light to be present.

Sometimes a fracture was present at the initial root canal treatment.  When a fracture is identified, many factors go into determining if root canal treatment should be attempted.  The prognosis in the presence of a fracture will always be decreased, but what we can never know is by how much. Sometimes the treatment lasts a long time, and sometimes it may only last six months.  Our hope is that if root canal treatment was chosen to treat the tooth, then it will last a long time.

Fractures generally cannot be seen on an x-ray (radiograph).  However, fractures cause a certain pattern of infection that can be seen on the radiograph which allows us to identify their presence.  The cone beam (CBCT) 3-dimentional imaging system in our office can show us greater radiographic detail that helps us determine if a crack is present better than traditional dental radiographs.  I have had many cases where I decided that root canal treatment or re-treatment would not solve the problem because the likelihood of a fracture was too high to justify treatment to save the tooth.

5. Leakage

The goals of root canal treatment is to remove tissue, kill bacteria, and seal the system to prevent re-entrance of bacteria.  All dental materials allow leakage of bacteria; our goal is to limit the extent of leakage.  At some unknown point the balance tips and infection can occur.  The more measures we take to prevent leakage, the more likely success will occur.  Four measures that can help reduce root canal failure due to leakage are rubber dam isolation, immediate permanent fillings, orifice barriers, and good communication with your general dentist.

Rubber Dam

A root canal should never be done without using the latex (or non-latex) barrier called a rubber dam.  I was taught in school that root canal treatment without a rubber dam constitutes malpractice, and most practitioners would agree on that point.  The rubber dam protects the patient in two ways.  The first way that the rubber dam protects the patient is that it prevents small instruments from falling to the back of the mouth and being aspirated.  The second way the rubber dam protects the patient is that it prevents bacteria rich saliva from entering the tooth and allowing for infection.  A root canal done without a rubber dam is doomed to failure from bacteria.  Although not required, use of the rubber dam at the time the access is restored can also hedge against failure from bacterial leakage.  The first step to a successful root canal is to prevent the entrance of bacteria by using a rubber dam.

Permanent Filling (Build-Up)

When a root canal is finished by a specialist, it is a highly common practice for the endodontist to place a cotton pellet and a temporary material, which will then be replaced by the patient’s general (restorative) dentist.  This temporary material can begin leaking right away, but is generally sufficient for a period of 7-21 days while the patient makes an appointment with their general dentist.

The best way to reduce the chance of bacterial leakage is to have a permanent filling placed at the time root canal treatment is finished.  This will assure that the tooth is  sealed as much as possible against bacterial leakage.  This filling is called an access restoration or a build-up.  Although many endodontists place restorations to seal the access, many still place a temporary.  Whether the patient receives a permanent filling or a temporary filling is largely dependent on a combination of factors including the practice philosophy of the endodontist, the preferences of the referring dentist, the complexity of the treatment plan, and the time allotted for treatment.

Orifice Barriers

When a permanent filling cannot be placed at the time a root canal is completed, an orifice barrier is the next best alternative.  The opening to the canals is called an orifice, and the barrier can be a variety of materials.  The material used in our office is a purple flowable composite that is bonded to the floor of the tooth and hardened with a high intensity light.  Research will never prove whether this technique is effective or not in improving the long-term prognosis, but the general feeling in the endodontic community is that a bonded orifice barrier is better than nothing.

Good Communication and Timely Follow-up with the Restorative Dentist

Finally, leakage can be reduced when the patient sees their restorative dentist as soon as possible after root canal treatment has been completed.  This can be accomplished when there is efficient communication between the endodontist and the restorative dentist.  In our office we also send a monthly summary of patients to each doctor that they can use as one more layer to confirm that treatment on their patient has been completed and that the patient needs to be seen as soon as possible for restorative treatment.   Much of the responsibility for timely restorative care is in the hands of the patient. Patients who delay restorative treatment after root canal therapy are risking failure of their root canal treatment, which may necessitate re-treatment at their expense.  Patients should not delay in getting their root canal treated tooth permanently restored with a filling and in many cases with a crown.

The best way a patient can prevent failure of a root canal is to seek care from a practitioner like an endodontist that has experience, that has the proper equipment (including a microscope and possibly a cone beam CBCT 3D imaging), and to receive timely restorative treatment either at the time root canal treatment is completed or shortly thereafter.

First of all, I had a tough time choosing what to order as everything on the menu looked excellent. Our party ordered four different dishes, and I was able to sample each of them. The presentation was candy for the eyes. Although there were no pictures in the menu, each dish we ordered could have easily served for a front page photo. The ingredients were fresh, colorful, and meticulously arranged.

The meal started with an appetizing plate of sliced bread and herbed butter. I’m a huge fan of bread before the meal, and I especially like the Italian style of bread and oil. Although there was no oil, the herbed butter added a silky texture to the course bread with a dense crust. I didn’t find the bread to be particularly amazing but it was definitely welcome to both the kids and adults in our party.

I started with the Spinach & Apple Salad with blue cheese and candied pecans. This was a very simple salad that offered visual appeal with dark greens accented with large brown pecan nuts. This was a great salad with a light density that served as a great appetizer to the pasta that followed. This salad could only be perfected with the addition of a few cranberries or fresh raspberries for visual appeal and flavor.

My wife had the Farmer’s Salad with fresh corn, baby tomatoes, peas, avocado, onions, toasted pine nuts, shredded Jack cheese, and a poppy seed dressing. This was an amazing medley of flavors that served as the perfect appetizer for the person who can’t decide what they want in their salad.

I ordered the Bowtie Pasta with roasted chicken, tomato, spinach, and pine nuts. This dish offers a visually appealing pallet of green spinach and red tomatoes. Multiple textures were present: chewy chicken that melts in your mouth; pine nuts that are smooth but offer a satisfying crunch; cheese that is rough and that gives an occasional pop of flavor; and spinach and tomato that melts as you chew. I found it difficult to take it slow and savor every bite, and I was not disappointed by this pasta dish.

My wife ordered the Ever Changing Ravioli, which that day was a spinach ravioli. This dish was visually similar to the Bowtie Pasta that I had, but had distinctly different flavor and texture with the spinach and cheese stuffing. My eight-year-old son enthusiastically ordered this dish, but was a little overwhelmed with the taste calling it “too adult.” If you are a ravioli fan, this is a dish definitely worth trying.

Another guest ordered the Certified Angus Beef Cheeseburger with white cheddar and wild mushrooms. He is a huge fan of In N’ Out Burger in California, and wasn’t accustomed to a gourmet burger. Nevertheless, he enjoyed this wonderful presentation of burger and salad. The bun appeared freshly made with a perfect density and a powdering of flour for texture and visual appeal. The meat was perfectly cooked to a medium temperature and had a deep smoky flavor that was appropriately accented with the white cheddar cheese. Next to the burger was a visually appealing mixed greens salad with tomato and cucumber topped with what seemed like creamy cucumber vinaigrette dressing with a pickle spear to add a little punch. Finally the dressing was lightly peppered to add visual appeal, texture, and a more flavor. This dish is perfect for the patron looking for a dense burger with a healthy salad.

Our final guest ordered the Fresh Fish & Chips with coleslaw, malt vinegar, aioli, and a side of fries. Although I’m not a huge fan of fried foods, this dish is perfect for the individual looking for a traditional fried food reminiscent of a menu item at an arts and crafts festival. I found this dish to be less visually appealing being saved only by the side of coleslaw, like an oasis in a desert. The fish flavor is not lost to the fried batter, and the aioli sauce (which we simply called a tartar sauce) and malt vinegar, like two trusty sidekicks, added power and pop to the flavor. This is a great dish for the kids not accustomed to adult flavors and would probably go well with a side of mac and cheese, which is also offered in the menu.

Finally, we finished the meal with a desert of Key Lime Tart with creamy key lime custard, sweet pastry, macadamia crunch, vanilla bean chantilly, and blueberry ginger sorbet topped with fresh blackberries and raspberries. All I can say is “WOW!” We are dying to go back just for this pie. This desert offers an amazing display of color and texture assembled in a culinary masterpiece. You’ll want to save time to savor this dessert as you chose between the unique sorbet, the dense crust, the fresh berries, or the creamy filling. I lived in Italy for two years, and being a huge fan of gelato, and I was impressed with this unusual blend of blueberry and ginger in this sorbet. This dish was a great blend of sweet and tart and was the perfect way to top off a great meal with flavors that pop and a density that doesn’t make you feel guilty or bloated.

The facility is clean and decorated in modern style. The restaurant offers a private mezzanine with a bar that will accommodate corporate parties. Their website emphasizes a unique selection of wines. The great menu accompanied by the clean professional environment should make Bloom in Broomfield, Colorado an easy choice for your next dining experience or corporate party. I for one am a new fan of Bloom, and although I wasn’t planning to throw a client party, I certainly am now.

After much searching and planning, I was able to assemble a competent team able to deliver on my vision.  Let’s face it, most professionals have a website because they’re told they have to.  Web 1.0 thinking was to have a website so that people can find you – like a fancy phonebook.  Web 2.0 made it more interactive – a tool to build and enhance relationships.  Whereas so many have adopted social media in their personal lives, many dental professionals have failed to take advantage of what the web has to offer to help them reach out and share their experiences with their patients and other interested citizens.

I hope you find our site to be informative and our blog to be interesting, and that you will want to return.  Like us on Facebook, Follow us on Twitter, and subscribe to our newsletter.  Stick with us and you will learn more about the dental profession, our community in the Denver area, and the ability to build a web presence that will enhance both your personal and business relationships.

Happy New Year to all!

The Dental Operating Microscope

The dental operating microscope (DOM) has been around in the field of dentistry since the eighties, and has grown slowly in popularity to this day.  It is used by many endodontists and by some dentists.  Endodontists vary in the degree that they use the DOM; some use it on every case from start to finish, and others use it only when they think they need it.  The DOM improves the treatment experience in at least four ways.

The first way that it improves the treatment experience is that it offers improved ergonomics for the doctor.  This is important so that by the end of the day the doctor is less fatigued and will be able to perform as well on the last case as he did on his first.  It also allows for consistency in treatment procedure and quality.

The second way that the DOM improves the treatment experience  (when an assistant scope is attached) is that the assistant can be more engaged in the treatment.  This allows the assistant to be quicker to deliver care like suctioning or passing instruments, ultimately resulting in a more efficient, and thus quicker, appointment for the patient.

The third reason why the DOM improves the endodontic experience is that it allows the doctor to see and treat the finer details of the case that may affect the long-term success of the root canal treatment.  Obstacles such as calcifications (pulp stones) may be present in the root canal space that may not even be seen if the endodontist is not using a microscope, and thus may block the canal in a way that makes it impossible to fill completely.  When I do a root canal procedure and the case is nearing completion, I will pause and inspect the inside of the tooth under high magnification.  Often I will find remaining pulp (nerve) tissue along the walls.  This tissue can be easily removed when I am aware of it, but would otherwise remain in the tooth if I didn’t use the microscope for close inspection.  Dental loupes (the magnifiers typically worn by dentists) don’t provide enough magnification and lighting to see these fine details.  Leaving tissue in the tooth provides bacteria with a nutrition source and may contribute to failure of the root canal many years later.  Keep following this blog where I will post more examples of how the microscope helps in treatment.

The fourth reason why the dental operating microscope improves the root canal experience is that it can easily allow the doctor to take pictures of the case and to share that information with the patient or doctor.  Taking a picture of the patient’s actual cracked tooth or periodontal probing and using that picture in discussion with the patient makes for a more powerful teaching tool than using canned, pre-fabricated drawings or images.  In addition, it improves communication with the referring dentist.  I have on many occasions emailed a photograph of a patient sitting in my chair, called the dentist, and made treatment planning decisions over the phone that expedited treatment for the patient, allowing them to get immediate treatment rather than waiting for time-consuming exchange of information and decision making.

The Cone Beam CT (Computed Tomography)

This radiographic tool has entered the field of endodontics only in the last couple of years.  Very few endodontists have one, but the number of those who do is slowly growing.  At the time of this writing I am aware of only about a half dozen endodontists in the Denver area that have a CBCT.  This tool allows us to image an area of the patient’s mouth in three dimensions, allowing us to see the tooth from a minimum of three sides including the top.  Traditionally the endodontist would point to a small radiograph on a light box and try to explain what was going on, and the patient would just have to take the doctor at his word. Then the last decade brought us digital radiography that allowed us to display the tooth on a computer screen.  This greatly improved doctor-patient communication because the patient could now see what the dentist was pointing at.  For years I would use this tool and try to verbally explain to the patient how the two dimensional image represented their three dimensional tooth.  Although patients would nod and agree, I didn’t feel like they truly understood what I was trying to explain.

With the CBCT, I can now show the patient’s actual tooth from the front, side, or top view and show the actual missed canal, infection into the sinus, or many other scenarios. Because the areas of infection are represented more clearly, I can see in their faces that they understand more clearly why I am recommending treatment. The CBCT therefore not only helps to improve the delivery of care, but it acts as a great communication tool to explain endodontic treatment.

Our Website

The third tool that helps to improve the patient’s endodontic experience is our website.  Although many patients welcome a referral to a specialist, many are a little apprehensive to get treatment from someone new.  I understand that fear and anxiety in dentistry stem primarily from a lack of trust.  I have designed our website so that patients can get to know us and our procedures before they arrive.  I feel that this tool will remove some of the mystery behind the referral process and specialty care.  Patients can also register on our website which will reduce the time they spend addressing administrative items when they arrive.  If we put this amount of effort into our website, imagine the effort we put into our actual treatment.

We have added advanced technology like the microscope and the cone beam CT to our office to deliver both simple and complex treatment in an efficient manner.  The primary goal is to deliver high quality care, but a great benefit is that it improves patient education, reduces anxiety, and creates a better experience for the patient.