HPV Oral Cancer in the News Crystal Lake Dentist

HPV (Human Papilloma Virus) Incidence Rising.

A virus lives inside a cell

What is HPV?

HPV is a group viruses. These like all viruses live inside cells. When they enter a cell, they take over and use the cell's reproductive capacity to reproduce themselves and thus spread. Most viruses have a short life outside the body and are usually species specific (you cannot catch a virus from your dog and vice versa).

The HPV virus causes a type of wart (papilloma). 

HPV  papilloma on the skin

What is the History of HPV?

It was first discovered in the 1950's. In 1972 the association with skin cancer and HPV5 was made. A few years later it was learned that there was a link between HPV 16, HPV18 and cervical cancers. More recently a link between these same HPV strains (16 and 18) and certain oral cancers has been established.

How is HPV passed?

HPV can be passed by kissing

HPV is commonly considered a Sexually Transmitted Disease (STD). Skin to skin contact is usually necessary to pass the virus. A sexual act is not necessary to pass it. Deep Kissing and Oral Sex can cause HPV infections of the mouth. It has been postulated that drinking from the same glass has passed the virus from an infected individual to another in rare instances. 

What are the chances of getting HPV?

chances are high thay all of you will get HPV at some time

Almost everyone will be infected with a strain of HPV at some time in their life. There many strains of HPV. The majority of these are usually self limiting and of no consequence. 

Are some HPV infections dangerous?

Some are dangerous but most are not. Most of the time, HPV is self limiting. The virus can be dormant for years and appear/reappear at any time. The body's natural immune system normally will get rid of the virus.

Why is HPV on the rise?

Changes in sexual activity are the driver in the increase of HIV, HPV, and other STD's. People are experimenting with sex at very early ages. Oral sex has become very popular as one way to prevent pregnancy. This is leading to a drastic rise in oral HPV infections.

Why are we concerned about oral HPV?

The 2 strains of HPV that lead to cancer are causing a rapid increase in oral cancer among the younger adult population. This group was low risk for oral cancer in the past and now is the fastest growing group. Oral cancer has a low survival rate when detected late.

What can be done HPV?

Parents, this means your children are at risk as well as you. Since deep kissing is all that is needed to pass this virus, children who are not sexually active can still develop oral HPV and oral cancer.

• Changing social behavior though not easy is the best method of eliminating this epidemic.
• Consider getting vaccinated against the most common and deadly forms of HPV at an early age.
• Get yourself and your children tested for HPV.
• Make sure your gynecologist and dentist are doing regular cancer screenings.

What does the dentist do?

a visual and digital oral cancer screening is a good start

Vizilite for advanced oral cancer screening

oral CDX swabbing a suspected area

Velscope advanced oral cancer detection

There are 4 ways that a dentist can screen for oral cancer.

• A visual and digital exam (look and feel)
• A Vizilite exam using a dye and special light
• Oral CDX swab for cancer cells of a suspicious area
• Velscope exam ( a special light and filter)

Is something is unusual, the dentist may want to check it again in 2 weeks to see if it has cleared up and or refer for a biopsy.

What We Recommend.

If your dentist's office is not doing at least a visual/ digital screening for oral cancer at every checkup, find a new dentist. We use the Velscope VX and strongly recommend an advanced oral tissue scan on everyone age 14 and up every 6 months.

References for HPV vaccine.

http://www.gardasil.com/what-is-gardasil/index.html?WT.mc_id=GL0ES&MTD=2

http://www.cdc.gov/std/hpv/stdfact-hpv-vaccine-young-women.htm

 Dr. Neal answers all of your questions about HPV and advanced oral cancer detection at Crystal Lake Dental Associates.drneal.com


Phillip C. Neal DDS
Crystal Lake Dental Associates
280 B Memorial Court
Crystal Lake, Illinois 60014
                                    815 459 2202                  


www.DrNeal.com


Your comments are welcome

Oral Cancer Detection with Velscope Crystal Lake Dentist

Oral cancer rates are increasing
Currently over 600.000 cases of oral cancer are diagnosed worldwide each year. In the US one person per hour dies from Oral Cancer. Earlyg detection is key for a high survival
Traditionally oral cancer was seen in males over age 50 who use tobacco and alcohol. This is rapidly changing due to the rapid spread of HPV (Human Papilloma Virus).


HPV Spread
You will most likely be infected with some form of HPV in your lifetime*. Most strains of HPV are self limiting, however HPV 16 and HPV 18 have been strongly linked to cervical and oral cancer. The various ways HPV can be spread through skin contact is quite alarming.

Oral Cancer Screening in the News
The spread of oral cancer and need for screening has been  in the media and on some of the more popular TV doctor shows. In this clip Dr. Oz discussed oral cancer and the need for the Velscope exam at every checkup.  Velscope Oral Cancer Screening - Dr. Oz June 2011
In tghis link, Several doctors  on "the Doctors" show discuss sexual transmission of HPV and the need for a Velscope exam. VELscope on The Doctors. 


ORAL ASSESSMENT

Velscope is easy to use

Why Use the VELscope Vx?

The VELscope's blue light stimulates natural fluorescense in the soft tissues of your mouth.
Natural fluorescence, seen through the VELscope Vx, allows dental professionals to see disease not visible with the naked eye
The VELscope Vx helps us discover oral disease BEFORE it can be seen under ordinary light.



VELscope Vx:

The Two-Minute Exam That Could Save Your Life

How many little sores do we find in our mouths? Dozens? Hundreds? More? Most of the time we ignore them, and they simply go away.
But sometimes our mouths keep secrets. That's why we use the VELscope Vx Enhanced Oral Assessment system.

normal oral tissue under white light

normal tissue under Velscope

oral cancer under white light

oral cancer under Velscope ( note the dark area)

The VELscope Vx Helps Us:

Improve our assessment of your overall oral health.
Ensure that the delicate tissues of your mouth are healthy.
Protect you from oral disease, including oral cancer.
All this in two minutes, with no rinses, stains or discomfort.



VELscope Vx - for a Clean Bill of Health

Helps dental professionals find oral mucosal abnormalities, including oral cancer
Over 10,000,000 examinations performed
Recognized by the World Health Organization
The most powerful tool available for assisting in the discovery of oral abnormalities


Oral Cancer and Oral Disease

The VELscope Vx helps us identify oral disease early, while it's still easy to treat.
One of the VELscope's most important tasks is to help locate areas that might, if not treated, progress to oral cancer.

• Found early, oral cancer's 5-year survival rate is good: approx. 83%
• Found late, oral cancer's 5-year survival rate is poor: approx. 32%
• Clearly, finding oral cancer in its early stages is key to survival.

The VELscope Vx offers hope for the early discovery of oral disease, including precancer and cancer.


Risk Factors

Tobacco and chewing tobacco, along with alcohol, are the leading causes of oral cancer. Over the last four decades, the Human Papilloma Virus (HPV), known for its role in cervical cancedr, has been showing up in increasing numbers of oral cancer cases.


*http://www.healthywomen.org/condition/human-papillomavirus-hpv



Dr. Neal answers all of your questions about advanced oral cancer detection at Crystal Lake Dental Associates.drneal.com


Phillip C. Neal DDS
Crystal Lake Dental Associates
280 B Memorial Court
Crystal Lake, Illinois 60014
                        815 459 2202            


www.DrNeal.com


Your comments are welcome

Improved Cavity Detection Crystal Lake Dentist

Why Digital X-rays?

The diagnostic ability of digital x-rays now exceeds that of film with up to 90% radiation exposure.

New Software and Hardware Improves Cavity Detection


We have been using digital x-rays since 2000, and now with our new Kodak imaging system, we can  detect decay (cavities) with 90% accuracy (verses 70% previously)* Logicon  is a computer-aided-detection tool that provides  important decision-support instrument for better patient care. Logicon provides an electronic second opinion by analyzing tooth density and demineralization patterns for interproximal (between the teeth) caries (decay) to help search for caries (cavities or decay) and determine whether they exist in the enamel or dentin. With one click, Logicon automatically scans all proximal (between the teeth) surfaces in a bitewing radiograph and gives a preview of the patient’s state of proximal (between the teeth) caries.

Improved Patient Care 

The program also dramatic graphics and visual aids to help us communicate our diagnosis to patients in a way you can easily understand.treatment recommendations.

Automatically scans x-ray

Close up of decay pattern 

Density changes across decay site 

Probability of decay

We Diagnose Caries with More Confidence 

Logicon analyzes shades of gray (many more than the human eye can resolve), 

extracts caries related image features and correlates them with a database of 

known caries problems. In doing so, the software automatically highlights possible 

abnormalities on digital dental radiographs that otherwise might be missed, 

signaling the dentist to take a closer look at the tooth and surface involved. 

How It Works 

Logicon uses detection algorithms based on laboratory data produced in 

association with a leading school of dentistry. With one click Logicon scans all the 

proximal surfaces in a radiograph and highlights the decay sites on all of the teeth 

in one picture for quick review. Detailed information about the change in tooth 

density and lesion probability are saved for each surface and can be retrieved in 

graphical format. 

*Gakenheimer, David C. “The Efficacy of a Computerized Caries Detector in Intraoral Digital 

Radiography”. Journal of the American Dental Association133 (2002): 883-890 

In addition to our new Logicon Kodak imaging software, we have upgraded out sensors to Kodak 6100 system which provides a higher resolution for improved images.  

Added to that is our new quickcam intraoral imaging system. 

Quickcam

Images

Our ability to detect and treat tooth decay is the best around with the use of DIAGNOdent, Carifree, Loupes (all clinical team members wear these to enhance our ability to diagnose and treat you).

Carifree 

DIAGNOdent

Loupes

We have also introduced our new Kodak 8000 pan/ceph machine which enables us to now take digital panoramic images and lateral cephalometric images.

Dr. Neal answers all of your questions about advanced decay detection at Crystal Lake Dental Associates.drneal.com

Phillip C. Neal DDS

Crystal Lake Dental Associates

280 B Memorial Court

Crystal Lake, Illinois 60014

            815 459 2202      

www.DrNeal.com

Your comments are welcome 

Sports Drinks and Tooth Decay-Crystal Lake Dentist

Sports Drinks and Tooth Decay 

Hydration and energy are important facets to athletic success. But new studies have shown that they can be just as harmful to the strength of your teeth as soft drinks. Due to their acidic nature and high in sugar contents, all these drinks can wear away the enamel from your teeth.
The Academy of General Dentistry released findings in 2005 that showed that over the course of years, sports drinks and energy drinks caused tooth decay just as fast (and in some cases faster) than soft drinks. Many young athletes suppose that as they exercise and play sports, these drinks are vital to their performance and health. While they do assist in endurance and hydration, especially for athletes engaging in strenuous physical activity, you can often get the same benefits from juice or even water with fewer risks to your teeth and your overall health.

Certainly during this hot summer season, a cooling sports drink should not be seen as a healthier alternative to soda when it comes to dental health. If you or your children find sports drinks as a frequent hydrator, you may want to rethink your sugar intake.



Dr. Neal answers all of your questions about Sports Drinks and Tooth Decay at Crystal Lake Dental Associates.


Phillip C. Neal DDS
Crystal Lake Dental Associates
280 B Memorial Court
Crystal Lake, Illinois 60014
            815 459 2202      


www.DrNeal.com


Your comments are welcome

Dental Insurance Revisited Crystal Lake Dentist

I have dental insurance, now what?

One of the most useful and yet confusing benefits that patients have is dental insurance. It does not work exactly like health insurance and the benefit can be quite confusing.

History of Dental Insurance

Blue Cross began dental insurance in the 1960's as an added benefit. The average coverage back then was $1,000 per year. Does this number look familiar? As more employers began providing it, over the years, dental insurance has morphed into many different plans.

Costs have certainly gone up since the 1960's, why is maximum coverage still the same?

Insurance companies rely on the fact that only 50 percent of the population go to the dentist regularly. When these plans were first introduced, the likelihood of every member maximizing the usage of the insurance was very low. Costs of care have risen over the years and insurance utilization has increased accordingly. As utilization increased, dental insurance companies basically held the benefit the same wile increasing he cost of the premium in order to control costs.

What is UCR?

UCR stands for usual and customary rate.This is a term that is used to determine how much a dental insurance company will pay for a procedure in a given zip code. How UCR determined is a secret that insurance companies will not share. Typically dentists set their UCR fees based on their fixed (rent, utilities, etc ), and variable costs (supplies, lab) for a procedure.

Why is UCR so confusing

Dental insurance companies may offer several plans in the same state to the same employer. These plans are chosen based on what the employer can afford to pay. The more the employer pays for a dental plan, the better the coverage for the user. The problem with UCR is that insurance companies use different UCR tables for different insurance plans. This is confusing for patients.

How does dental insurance work?

Dental insurance works basically like regular health insurance, so there's no real mystery or confusion there. It's very similar to basic health insurance in that it's covered by HMO and PPO plans or payment structures. Occasionally, you may find an indemnity dental insurance plan, which allows for the ultimate freedom in choosing dentists and procedures, but these are becoming rare in this day and age.

Understanding a dental HMO and PPO is the same as understanding a regular health insurance structure. An HMO plan you pick will require you, as the patient, to choose either a single dentist or a dentist group to handle your dental care. After you select the dentist and/or facilities, all procedures deemed usual by the insurance company and performed per your plan will be covered. With a PPO plan, you will have the option of being able to select dentists from around your immediate area, so you're not locked in with only one option

What is covered?

This can vary widely from plan to plan.

Coverage for a typical Indemnity plan would be something like this:

• $100 per person deductible
• $1,000-$1,500 per year maximum coverage
• preventive services (exam, x-rays, cleanings) paid at 80-100% of the insurance company's UCR
•  basic services ( fillings, extractions) are paid at 70-90% of the insurance company's UCR
•  Major services (considered most expensive like crowns, bridges, root canals, dentures) is typically included but paid at 40-50 percent of the insurance company's UCR
• Many procedures that are considered cosmetic (veneers, witening, bonding, braces) may net be covered at all. 
• the patient pays for fees over the amount covered

PPO, HMO and other plans like these may have set fee schedules for the dentist who has signed up for them. The patient portion is variable and determined by the insurance plan. The plan may have a similar annual maximum benefit.

We can help you with your dental insurance.

We have team members who specialize in helping you understand your coverage. As a courtesy, we will file your claim for you and work hard to make sure you have the highest possible coverage for every procedure.

Dr. Neal answers all of your questions about Dental Insurance at Crystal Lake Dental Associates.

Phillip C. Neal DDS

Crystal Lake Dental Associates

280 B Memorial Court

Crystal Lake, Illinois 60014

815 459 2202

www.DrNeal.com

Your comments are welcome 

Does gum disease cause heart disease? Crystal Lake Dentist

What do we know for sure?

Periodontal disease is one of the most common diseases of mankind and the main cause of lost teeth in adults. Periodontal disease is a destructive infection/inflammation/trauma related disease. Heart disease (vascular disease) is the number one killer in America today. Both of these diseases can be diagnosed, managed and treated quite successfully today.

Headlines proclaim “Gum disease does Not Cause Heart Disease”

As of now that is true. We have no direct cause and effect established, however the AHA (American Heart Association) study points up a definite relationship between periodontal disease and vascular disease.

Is there a cause and effect?

Maybe, but not established conclusively!

There is definitely a correlation!

The AHA says that more and better studies are needed to establish the exact relationship between periodontal disease and heart (vascular disease). There is evidence that the treatment of gum disease does affect vascular disease, but the extent and value of this periodontal treatment is as yet inconclusive.

Are there common factors in gum disease and heart (vascular) disease

Both periodontal disease and heart (vascular) disease have complex multi-factorial causes. A lot of studies for both periodontal disease and vascular heart disease reveal common factors including several lifestyle (smoking, unhealthy diet, hygiene) and systemic( inflammatory diseases, diabetes), and a genetic predisposition. Control of both heart (vascular) disease and periodontal disease requires a lifetime commitment to lifestyle and preventive management.

What do dentists think?

It is natural that we (dentists) would see correlations between medical conditions and dental conditions because dentists:

• ·         See their patients more often than physicians.
• ·         Are often the one to recognize other conditions like high blood pressure, nighttime bruxism, TMJ disorders, oral cancers, and Sleep Apnea.
• ·         Regularly review health histories, dental home-care, diet, as well as the dental conditions.
• ·         Often see periodontal disease, in conjunction with heart (vascular) disease and other diseases in the same patient.

What do I think?

The associations are very complex but the results are quite similar.

There is a strong correlation between periodontal disease and other systemic diseases. The factors involved are complex and include stress, psychological (emotional-spiritual), education, economics, access to care,  lifestyle (recreational activities, diet, rest, smoking and other drug/medication use), genetics, environmental  (family of origin values and customs), infections, trauma {physical, emotional}, allergies, other environmental exposures), hygiene, age, function, and structure, snoring (and other sleep disorders), and perhaps Others unlisted.

When periodontal diseases is seen, it often shows up in combination with sleep apnea, nighttime bruxism, high blood pressure, and advanced heart disease, or other inflammatory or systemic diseases.

Now what?

The article suggested more studies and better study designs as well as ongoing research into both of these diseases and the associated factors.

What will future studies show?

Better designed studies will lead to more effective treatment and prevention of both conditions. Clearly as my list of related factors shows the associations are complex.


What can you do?


As you look at the list of factors, you will see that many of them are dependent on the patient taking responsibility for and controlling as many as possible. This includes regular dental/medical checkups and taking good care of yourself.

Dr. Neal answers all of your questions about Dental Implants at Crystal Lake Dental Associates.

Phillip C. Neal DDS

Crystal Lake Dental Associates

280 B Memorial Court

Crystal Lake, Illinois 60014

815 459 2202

www.DrNeal.com

Your comments are welcome 

Dental X-rays and Mengioma (Brain Tumors) Crystal Lake Dentist

Do Dental X-rays cause Minengioma as stated in the press?

This question troubles me due to the sensational nature of the media. I will present the facts first .I will answer that question by the end of this article. A cancer or tumor claimed to be caused by a common procedure is highly newsworthy. It needs to be looked at carefully before jumping to a conclusion that can cause mass hysteria.

What is a Minengioma?

It is a thickening of the of the brain sac. (a lining covering the brain). Minengiomas are a class of growths with varying properties. They are almost always benign and extremely slow growing.

Are Minengiomas common?

Yes, they are fairly common in all populations worldwide (even where dental x-rays are never taken). These tumors are rarely detected until autopsy as an incidental finding (not the cause of death). Actually they are discovered in  at a rate of about 1-2% worldwide during routine autopsy. This high incidence coupled with a low incidence of symptoms and disability/death is important to note.

So is a Minengioma dangerous?

Very few are dangerous. In most cases once discovered they are observed to see how fast they change. If slow growing and symptomless, they are not even treated. If the Minengioma is causing symptoms, then treatment is instituted.

How are Minengiomas diagnosed and treated?

Most often Minengiomas are found on CAT scans (an x-ray),b or MRI’s or  other heat x-ray images. Treatment interestingly is often done non-invasively with radiation. In some cases surgery is used in conjunction with radiation or alone.

Can Minengiomas recur?

Rarely they will recur. The very rare more aggressive form is more likely to recur.

Are dental x-rays dangerous?

Modern x-rays are extremely safe. Any form of radiation can cause changes to tissue. The more radiation, the more likely this will happen. As a result of this knowledge, healthcare providers and manufacturers have been developing products and methods to reduce radiation for the past 60 years. Methods developed includes faster film which needed lower x-ray doses to create a picture.

 Here is a brief history of intraoral dental x-ray film

1913 x-ray film is put in packets and used to check teeth.

1940  D-speed film (Ultraspeed ) developed

1980 E-speed film (Ektaspeed) developed

1982 digital intraoral sensors developed

Crystal Lake Dental Associates have been using low dose digital x-rays since 2000

Dental x-rays are also extraoral

1948 panoramic x-ray developed

panoramic x-ray

1976 digital computed tomography developed

2000 digital cone beam computed tomography developed

Cone Beam 3D imaging Low Dose

Dental x-ray machines have also underdone changes over time

Early 1900’s dental x-ray machines become available

Early Dental X-ray Machines

Dental x-ray machines evolve over the next 50 years with little improvement in safety

1960's Style dental Office

1970’s lead collimation of the x-ray beam is developed to reduce scatter radiation.

Safety for patients has additionally evolved by the use of lead apron and thyroid barriers.

X-rays are much safer today due to the use of digital sensors and superfast film.

Who is most susceptible to damage from x-rays?

Children seem to have a higher risk from radiation as they are still growing, and radiation damage is a lifelong cumulative process.

Is there a risk of Minengioma from dental x-rays today?

We need to first consider the risk-benefit ratio of a dental x-ray. The risk is extremely low compared to the benefit of the timely and successful treatments for various dental conditions. When considering the current  state of dental radiographic techniques and devices, the risk seems nominal. I personally would not hesitate in exposing any members of my own family when determining their dental health

What do you mean about risk-benefit ratio of dental x-rays?

Dental caries (tooth decay or cavities) and periodontal disease are 2 of the most common and debilitating diseases around. the cost of treating both diseases is billions of dollars annually. Early detection and treatment of these and other oral conditions saves time from work school and other activities , pain and money. Dental x-rays are an important part of prevention and treatment of these and other oral conditions. You are thousands of times  more likely to suffer from a dental problem than a Minengioma.

 Complications from dental problems can be life threatening.

Abscessed tooth

Periodontal Disease

Progression of a cavity to abscessed tooth

I have enclosed a link to a blog response to the recent press article on Brain Cancer and dental x-rays. You can view it here and comment.

http://drnealblog.blogspot.com/2012/04/dental-x-rays-and-mengioma-brain-tumors.html

PS I am still learning how to use the HDC mail system so I apologize in advance for any multiple mailings.

Phillip C. Neal DDS

Cavity

Impacted wisdom tooth

Undiagnosed dental problem leading to massive infection

What about the Study quoted in the press?

The study quoted recently and other studies have an inconsistent set of conclusions. Dental x-rays have undergone a great deal of improvement over the lifetime of several of the people surveyed. As a result the patients surveyed are not representative of the average patient in a modern dental office. If you read the entirely article, conclusions drawn are inconsistent with the amount of x-ray exposure reported. Using memory of people over a large period of time will also lead to inaccuracies as noted. In conclusion the doctor did not recommend that patients refuse necessary x-rays. The subject however could benefit from  further study. 

Dr. Neal answers all of your questions about dental x-rays at Crystal Lake Dental Associates.

Phillip C. Neal DDS

Crystal Lake Dental Associates

280 B Memorial Court

Crystal Lake, Illinois 60014

815 459 2202

www.DrNeal.com

Your comments are welcome