It’s been about 37 years since I started my college education but there are still some great memories burned into my brain. Stockton, CA was home of the University of the Pacific. Not a very exciting city, but I can tell you that the college life was great.

Looking back as an adult in the workforce for about 30 years I can tell you one of the things I learned about college is that all the adults who told me to enjoy college as they would be the best years of my life were absolutely RIGHT. Think about it, the only responsibility I had was to get good grades…are you kidding me. So to all of you young’uns who are reading this.. Enjoy college..it is the bomb (Josh and Joey..please take note).

I got a degree in chemistry, but sometimes I feel like if I went through it one more time I would actually own the knowledge instead of having borrowed it to get good grades. That is the one beef I have with our college educational system, the emphasis is on getting grades, not actual retention of knowledge. Students need good grades to get to the next level so students have learned how to cram and get grades. Nothing about learning here.

Lucky for me I took a few courses outside of my major for my requirements and was lucky enough to take Sociology. I think I can sum up the entire class with ‘you are a product of your environment’. Of course, as with any statement or rule there are always exceptions, but in general I think this is a fair synopsis of the class.

The most important thing I learned in college, academically speaking, came from my statistics class. The very first thing the professor said and I quote “statistics don’t lie, statisticians do”.
We have seen this numerous times in research where the hypotheses was changed because the data supported a different statement.

I have tried to stay away from politics in my blog and social media(facebook etc) because it is a very hot subject for some people. I have yet to find a reliable source of data that is not somewhat distorted by which ever side is presenting the data. Makes it kinda hard to make an educated decision on your own. If you got a source for me let me know, I hate being lied to by statisticians.

By the way there is something I remember from Chemistry. The second law of thermodynamics states that left to its own everything moves away from order to disorder. I think that Washington DC is a perfect example of this second law of thermodynamics.

Political statement over.

It was sunny; there were 2-3 times more participants than last year and probably twice as many vendors and services offered to the crowd. And I have to say…I am extremely proud of the team at Southern California Dental Health Associates. It was their collective effort at the Healthy Kids Day at the Hollywood-Wilshire YMCA that made it such a success.

Currently our Los Angeles based dental office is in the midst of a 4 month campaign called Smiles for Life. Discus/Philips Dental provide the materials, dentists (who are members of the Crown Council) provide their time and patients get their teeth whitened with 100% of the money raised going to children’s charities. 50 % goes to the national organization’s charities and 50% stay local and in our office our charity is the Hollywood-Wilshire YMCA’s school based programs at your local elementary school.

So, with the help of Ana, Deborah, Gina, Roland and my son Joey, we were at the Healthy Kids day doing dental screenings, answering questions and of course promoting our Smiles for Life campaign that benefits the kids that we were seeing at the fair. It was very gratifying for all. I was able to help parents understand potential orthodontic concerns for their kids. Roland had a great time talking to all the other vendors and trying to get them to participate in the Smiles for Life. Ana, Gina and Deborah were so instrumental in talking to the families and setting up the screenings. And Joey…he was my hard laborer, did the heavy lifting and played basketball with young kids for about an hour and a half.

This is the second year we have done this event and we all look forward to participating again next year.

AND IF YOU OR ANYONE YOU KNOW IS INTERESTED IN WHITENING THEIR TEETH AND HELPING KIDS AT THE SAME TIME..CALL OUR OFFICE. DISCOUNTED TEETH WHITENING AND IT’S ALL A CHARITABLE CONTRIBUTION.

No, this is not a rhetorical question. There is no way in the world anyone would want to let a kid play this type of game. I love kids, I have two of my own and in all honesty, I love it when my patients bring their children into the dental office. Nothing makes my day more than having the opportunity to try and talk with them and find out what they are learning in school or what they are doing for fun. Our dental office is currently doing whitening where are the proceeds go to children’s charities…50% to the charity of my choice which is the Hollywood-Wilshire YMCA’s School Based Programs at your Local Elementary School. Yes I love kids and there is no way I would let a child play with a loaded gun.

Yet, that is what parents around the country are doing all the time when they let their children drink beverages with sugar in them. Sodas, fruit juices, sports and energy drinks are just some of the sugary drinks. Besides helping promote cavities (something I have to deal with daily in my Los Angeles dental office) sugary drinks are helping to fuel the obesity epidemic that is ravaging the United States and is creating similar issues around the world today.

One of the first problems with drinking sweetened beverages is that there are calories in them. Unfortunately, most people do not account for the calories in these beverages so they eat as many calories as if they were drinking water. These extra calories add up and before you know it the weight gains begin. Drinking just one can of soda a day adds over 30 pounds of sugar consumption a year (this is the low number. According to the NYC Health Department the figure is closer to 50 pounds of extra sugar a year) and can lead to 15 extra pound of fat (and weight gain). But have you notices how there are no longer any 16 ounce bottles of Coke, but they are now 20 ounces. The Super Big Gulp at 7-11 can hold 64 ounces of soda (only 8 servings …that’s all)

The next problem with drinking sweet drinks is that it keeps conditioning the body to want sweet. According to Dr. David Katz of the Yale Prevention Center, sugar (and it’s various forms including the fake stuff) may be the most addictive ingredient in food. The more sugar in our food means we will go after even more sugar. And the manufacturers are happy to provide it. Dr. Katz even goes as far as to say manufacturers have actually helped create the addiction. And that means more calories and more obesity and diabetes and high medical costs.

Anyone who really knows me understands that I have a mission in my life. My job is as a dentist, that is how I support my family and my ability to give back to the different charities that I support. But I really want to make a difference on a bigger scale. I know that the only truth I know about health care is that it is all about personal responsibility. And the advertisers and food manufacturers are making it hard for personal responsibility to win.

So here is my challenge to you. Stop drinking sugary drinks. That means sodas, sports drinks and even fruit juices. Stop putting sugar in your coffee and your tea. You just don’t need it. I am not worried that Coke or Pepsi won’t make as much in profits anymore….I am concerned about your health. And drinking sugary drinks is just not healthy.

The symptoms of gingivitis and periodontitis (periodontal disease) are often painless but the cost to you as a patient might be greater than you think. Just as certain medical conditions can increase ones’ susceptibility to gum disease, it is now known that the reverse is also true. Gum disease can actually put you at higher risk for many medical issues. That’s right, now is the time for the physicians and dentists to work together to help you, our patients, live a longer and healthier life.

If healthy gum tissue fits like a cuff around each tooth, what are some signs of gum disease? Gum bleeding when you brush or floss, inflamed gums (red, swollen or tender), gum recession around the neck of your teeth and bad breath that won’t go away are just a few of the symptoms of gum disease. None of these described symptoms would necessarily mean that you would have any pain.

But what are the costs to the patient? There is the cost of treatment, the time involved and of course, the mental aspect worrying about the pain involved with the treatment. If one does not get treatment for their gum disease it can ultimately lead to teeth extraction and the loss of function. In some instances there might be some real cosmetic issues if the gum disease is in the front of their mouth or where their friends can see it.

For most of you these costs should come as no surprise, dentistry has tried real hard to educate America about the value of preventive health care, and in particular preventive dentistry. But there are several other costs out there that new research is turning up. While we knew for years that gum disease can be influenced by other health conditions that the patient has, we now know that it is a 2 way street and that gum disease can in turn, turn around and contribute to multiple medical issues, two of the biggest being cardiovascular disease and diabetes. Surgeons have started postponing elective surgeries if the patient has gum disease. So, perhaps the ultimate price to pay for gum disease is a shortened life span.

As a Los Angeles dentist, I know what the high cost of treatment for gum disease can be in a dental office. Here is the kicker though…..gum disease is 100% preventable just like most issues we are having in health care today. I hate to sound like a broken record but it is all about someone taking responsibility for their own health. It might be hard in the beginning or time consuming, or even come at a cost….but prevention beats all the alternatives that health care can provide.

My hope, my goal, is that I can affect the life of someone every now and then by helping them to understand the value of prevention. Having been a dentist in Beverly Hills and Los Angeles the last 30 years I know how hard it is to get people to change their habits. I probably have heard just about every story in the book, but my passion is to help people to get healthy and stay healthy. So look for more blogs about issues regarding health care and prevention.

Until the next blog….stay healthy my friends

Today has been an incredible struggle for me to write. I wanted to write about the hypocrites we see in life. Think about it..do you want a hygienist with puffy bleeding gums cleaning your teeth? How about if she had the worst breath in the world? It would not give you a whole lot of confidence that you are in good hands.
How about going to a cardiologist because you had a heart attack and you can smell the cigarette smoke on his clothes? Or the endocrinologist who is telling you to lose weight but he himself is a good 20-30 pounds overweight?

I was going to try and weave it into where have all the role models gone. Hopefully all can find someone to look up to, but most of them have been ripped from our midst as well.

But my thoughts keep going back to a family in Florida that doesn’t have a son anymore. I have made it a point not to discuss politics when I write. It is a very touchy subject, that and religion. But I cannot get over how a young man, the same age as my son, had his life snatched away. And usually I am one for saying let it work itself out and I just don’t get it still.

For the last couple of years my wife and I have bought close to a dozen different hoodies for our 17 year old, Joey. Heck, I even got one for myself (something about a 54 year old trying to look cool). It’s a fashion today for the young men. I can easily see my son walking down the street with his hoody over his head on a cold night, walking to a friend’s house or home. It could have been anyone’s son. Lucky for us the laws are a lot different in California so I am not so sure this type of killing could even be attempted to be justified.

I will not go into an analysis of what happened and what is being reported. I just feel I need to make one simple statement.

I STAND WITH ALL OTHERS OUTRAGGED AT THE SENSLESS KILLING OF TRAYVON MARTIN.

If you drive about an hour each way to work like I do you probably have developed some kind of formula for how you get to work. And if you are anything like me you have seen people do some scary things while you drive. People texting, ladies putting on makeup (sorry I haven’t seen a single man do this yet…but I am only 54), men shaving, doing crossword puzzles and looking at maps…(Hello Google Maps) A few years back a woman got pulled over for flossing her teeth while she was spending at over 70 miles an hour in the UK. I don’t know how she was holding on to her wheel if she flosses like I do (using two hands) maybe she was using floss holders…

I have been doing my commute for about 20 years now and I do have a routine. I usually try to have a cup of low carb cereal (dry of course) and wash it down with 32 ounces of water. And for the longest time I would listen to the radio, and with XM I could listen to sports talk radio or the news…that’s how I could stay up with the world. Once or twice a month I would listen to an informative CD about some aspect of dentistry. Not a bad use of time, or so I thought.

But recently, thanks to a purchase of an iPhone (thank you Verizon for welcoming this technology) I have discovered Audible books. In the last 2 months I have listened to 3 books and all of them helped me focus better on my life. The first book was called The Five Love Languages by Gary Chapman, the second was The Success Principles by Jack Canfield and the third was Talent is Overrated by Geoff Colvin.

It is the fourth book that is right up my alley and it is called The Blood Sugar Solution by Dr. Mark Hyman. Over the last few years I have developed a thirst for knowledge about health care prevention. Dr. Hyman is very passionate about the prevention of what he calls diabesity, a combination of diabetes and obesity. He, along with several health care providers, are trying to sound the alarm of the perils of this deadly combination of health issues and the huge cost both of lives and money that the world (not just the US) faces. In 25 years, from 1983 to 2008 the number of reported diabetics in the world went from 35 million to 240 million a 7 fold increase. But in the three years after that there were 110 million more cases added to the rolls. His point is that governments should be looking to see why the numbers are increasing not just trying to figure out via big drug companies how to medicate.

Unfortunately there are big powers that are out there that don’t want to help. I have already mentioned how invested big drug companies are because they are trying to come up with different ways to combat diabetes. I remember about 15 years ago a golfing buddy gave me an article to read about investing…and it was about companies that work on drugs for diabetes. The article called diabetes the perfect investment disease….rarely fatal but it keeps constant monitoring and drugs….for the life of the patient. But there is another big player in the cause of diabetes and it is the food industry. All the sugar in our food (and in particular liquid sugars..soda, sports drinks, energy drinks etc) is a major contributing factor. It is changing how our body works and now people who are not obese are at higher risk of diabetes as well particularly people in the far east…the change to the westernized diet started to take a toll, just ask the Chinese who now have an epidemic as well. Up until a decade or so ago diabetes was a rare diagnosis in China but now it is estimated that almost 1 in 10 Chinese adults has it. WOW

So let’s go back to what Dr. Hyman is really saying. You can’t call diabetes hereditary when you see the astronomical increase in cases being diagnosed. There has to be a strong environmental aspect to it and we have to learn to control it to stop this epidemic.

This is really not much different than I have been saying about dentistry. As a dentist my job is to put myself out of business. Simply said, there is not a child born in the United States today that should ever have a cavity or gum disease (which by the way is a contributory factor to diabetes). All it takes is education (I give our country a D here) and parental control (I won’t even venture to give a grade). I mean, do you really have money to spend on diseases that can be prevented. And on a larger scale, do our governments have the money to spend on treating a disease that by all estimates costs over 1 out of every 10 dollars spent in health care (and probably a lot more if you add all the other medical issues diabetes brings up).

After almost 20 years of commuting 2 hours a day I have found a way to make the most out of that time…to further educate me as to what I can do to better the health of my patients and those I care about. I call that time well spent.

If you don’t know what sleep apnea is then I guess the title of this blog sounds like a new TV sitcom. But trust me, as I learned last weekend, sleep apnea and the dentist is no laughing matter. In fact, for some it could be a life or else matter. Let me explain.

Last weekend my good buddy, Steve G and I had the opportunity to listen to one of the leaders in the field of sleep disorders and dentistry, Dr. Kent Smith, present about sleep apnea. Dr. Smith was one of the most entertaining and engaging speakers I have ever heard (in fact 14 hours of lectures and I did not even come close to nodding off once…even after lunch both days) but his message was pretty sobering. Approximately 20% of all Americans suffer from sleep apnea but only 4% of the population shows any signs of it. And according to the American Academy of Periodontology sleep apnea ranks just under smoking as the #2 lifestyle factor that impacts oral health.

Simply put sleep apnea is when you stop breathing (or takes less than 25% of a normal breath) while you sleep. The only way to be diagnosed with sleep apnea is with a sleep study that is read by a physician. What they study in the test is how often and for how long you stop breathing for. Any time you stop breathing for more than 10 seconds it is considered an apnic event. Based off of the test results you can be diagnoses as either not, mild, moderate or severe. However, it is not just the fact that you stop breathing that is on its own very dangerous, but it affects your overall quality of sleep. Dr. Smith gave us some pretty keen insights as to what goes on while we sleep and why good sleep is so important to our health.

Here are some sleep facts:
1. The right amount of sleep (good sleep) is about 7 hours a night for adults
2. The neurophysiological effects of sleep include improved ability to concentrate, mood enhancement, you feel less stress, your immune system functions better and you actually have better pain inhibition.
3. REM sleep, which is when we also tend to have vivid dreams, is essential for allowing our brain to store data from the previous day, kinda like storing it on the hard drive of the brain.
4. When you sleep hormones that affect your diet self-regulate. If leptin and ghrelin don’t work right it is harder to lose weight. This is a catch 22 for many because being overweight is a risk factor for sleep apnea
5. Numerous studies have shown a correlation between less sleep and increased risk of cardiovascular issues. The less sleep you get the greater the levels of IL-6 and C reactive protein you have, both risk markers for heart disease.
6. Lack of sleep can lead to microsleeps (like nodding off while driving). The number of driving fatalities due to these events is on the rise.

Now, I can go on and on about facts, heck Dr. Smith spent several hours going over this stuff. The bottom line is having enough sleep is great for you, not having enough sleep hurts you and in the worst case scenario it can shorten your life span. And if you have sleep apnea, think of the pressure put on your heart when you are gasping, trying to breath to get oxygen into the lungs and then into the blood etc.

Here are some sobering facts about sleep apnea:
1. About 1/3 of patients with coronary artery disease have sleep apnea.
2. 65-80% of stroke victims have sleep apnea
3. People diagnosed with sleep apnea have a 5 times greater risk of diabetes (independent of risk factors such as obesity)
4. New studies show that bruxism(clenching/grinding of teeth) during sleep may be secondary to sleep related micro arousals (and not as much due to the bite as we have previously thought)

But why is sleep apnea and the dentist the title of this blog. For a very simple reason. The standard of care for treating sleep apnea is the C-PAP machine, a device that forces air down the nostrils via a constrictive mask while one sleeps. But for mild or moderate sleep apnea or for those who cannot tolerate the machine there are dental appliances which are medically accepted as treatment options. And while not all sleep physicians like to go that way there is an increasing number who recognize these treatment options. The dentists in essence act as the lab technician for the sleep doctors who are not trained to make oral appliances.

In addition, most physicians, if they are not sleep doctors, do not routinely screen patients for sleep disorders. So, Dr. Smith and the other leaders of sleep dentistry are doing their best to get dentists to start asking the questions of their patients. And here are some of the things we are to look for: large necks, small or recessed chins, snoring, being overweight, eroded enamel, large tonsil and tongue bars/studs to name a few.

So if you don’t feel like you are getting good sleep, or if you find yourself nodding off often during the day, you may want to ask your doctor or your dentist to screen you to see if you might have signs of sleep disorders.

What I have figured out is that one of my driving passions in life is to try and expose as many people to the current teachings of preventive health care, and in particularly, dental prevention.

So, I figured I would spend my blog this week discussing a term that it now becoming common place in the discussion of disease process and that term is Biofilm. Initially, cavities (actually an infectious disease) and gum disease (also infectious) were thought to be caused by bacteria (and the science behind what bacteria is too much to go over here). In the last several years the concept of biofilm has come to the forefront of what causes dental disease. And once you understand biofilm you might understand why it is a lot harder to beat that just plain old bacteria in your mouth.

Biofilm is, according a one dictionary, a thin, slimy film of bacteria that adheres to a surface. In dentistry we deal primarily with two different biofilms, ones that adhere to tooth surface ( and are primarily responsible for cavities) and biofilms in the gum tissue pockets (responsible for gum disease). The problem with fighting biofilms is that bacteria in biofilms do not act the same way as individual (planktonic) bacteria do.

Traditionally, bacteria were studied on petri dishes in the lab, where you could grow an entire colony of an individual bacteria…and then you could see how medications, like antibiotics, affected the colony of bacteria. Easy…..

But biofilms change all of that because bacteria behave differently in biofilms than they do as individuals, they mutate quicker, become strong allies of other bacteria, and develop different abilities than planktonic bacteria. Researches have even found that there are over 30 different bacteria, that when studied as planktonic bacteria DO NOT react with sugar to demineralize teeth and cause cavities but when they are in acidic biofilms THEY DO cause cavities. The biofilms make these seemingly benign bacteria become teeth killers.

In my office I often give the analogy that studying individual bacteria colonies is like putting a mop handle in the middle of the desert in the sand……. not too hard to pull it out. But if you would bury that mop under a garage building in the middle of a downtown Manhattan block and it would be pretty hard to get the mop out. That is one bacteria living in a biofilm of Manhattan.

The biofilm on teeth present an even more unusual challenge to fight. The tooth, which in some ways is the hardest substance in the human body, does not shed its outer layer of cells like skin does for an example. This allows the biofilm on teeth to become more mature than other biofilms making it even HARDER to fight.

And because of the nature of the slime that maintains the biofilm, it is very hard to eliminate the biofilm when treating gum disease. That is why it is said that you never eliminate gum disease, you only control it.

There is good news on the horizon for patients who are really interested in fighting the biofilms that infect their mouths. There is the CariFree system to help fight the biofilm that causes cavities and there is PerioProtect, another system specifically designed to help fight the biofilm of gum disease.

If you are tired of always dealing with getting new cavities (the results of the infection) and bleeding gums there are tools to help you…..Just ask.

There is a very interesting woman out there named Fran Pangakis. She is one of the minds behind CareerFussion and I was lucky enough to spend some time with her at the annual meeting earlier this year in January. Fran has been involved in dentistry for over 30 years and has just about seen it all. What I found so interesting about Fran was her ability to peel the inion and see what was really going on in any situation.

Fran suggested a book for me to read, the Five Love Languages by a Dr. Gary Chapman. Well, being someone who has so much to do I went ahead and got it on MPs so I could listen to it on the commute to and from work. It was very easy to listen to and it was about the different ways people want to hear “I Love You”, but in reality it can be about every relationship you have. I kinda always knew my main language was that of affirmation. (This is a new concept for me in the sense that I used to think it was wrong to have a high “Needs Approval” as a personality trait).

There are many ways in my practicing of dentistry that I can get affirmations left and right. “That didn’t hurt at all”, “That crown looks just like my own tooth” and on and on. And they are all very important to me since it is my desire to provide the most esthetic dentistry in an environment that fosters mutual trust and respect.

If you know about my passion for prevention and my belief that the best dentistry is no dentistry then you would not be surprised to find out that perhaps my favorite affirmation of all in the office is when my patients get what taking care of their mouth at home is all about. And not once this past week, but twice, was I fortunate to have the feedback that makes me feel that I am actually making a difference.

The first time came from a new patient, a woman in her middle age, who when she first came to the office about 6 months ago had gum disease. With the help of the hygienists in our office, this woman went ahead with treatment meant to help get her gum tissues healthy. This in itself is not unusual. What is unusual is how a woman, who for the better part of her life never really took care of her teeth, got it because we took the time to teach her. And the payoff is how much she says she feels better because she is doing what she has to do, and how her long term costs are going to spiral downward because she is taking care of her mouth. And she sat and credited our office for her shift in her ou look for her own dental health.
The second affirmation is just a little second hand story…but it is still my favorite type of success story in my office…because it involves a young patient, an 11 year old girl, who I had only met once in the office. Her mother was in and she told me that what I ever I had said to her daughter impacted her so much that she has been flossing her teeth religiously since her exam and hygiene in the office.

Doesn’t seem like much but to me our office has greatly impacted these two patients in a way that should help them for the rest of their lives. I can’t speak for any other dentists in the world, but for me this is the true purpose that I was put on earth form to help people. Not just in my office but in ways that impact them for the rest of their lives. That’s what it’s all about.

I knew what I wanted to write about today, but I had no idea of what I wanted to title it. I turned on the computer and put on Neil Young on Pandora and guess what the first song was…one my favorites…LONG MAY YOU RUN

I don’t know about you but in my mind the ability to run is an indication of relative health. And it is becoming an even bigger passion of mine…trying to stay healthy.
And once again I have to remind myself that as much as I would like to make tons of changes all at once I really have to go with just a few at a time.

One of my favorite magazines is Men’s Health. There are pages that have single to several paragraph snippets of advice, any of which I could follow and improve my health. I also get their daily emails with all sorts of ideas of how to improve my diet and fitness tips. About a month ago I started doing one of the exercise routines they posted online. I start by doing 10 pushups and then 1 full body squat. I immediately do 9 pushups followed by 2 squats. You get the picture, by the time I am done I have done 55 pushups and 55 squats. I do this 3 times a week and I know it sounds crazy but I can already see the physical changes. At the ripe age of 53 this makes me feel like I did in high school when I did a lot of weight lifting.

I just finished watching Dr. Robert Lustig’s most currently posted lecture on the evils of sugar. It is called Sugar: The Bitter Truth and he just breaks it down so well as to why sugar is root of the obesity issue facing not only the United States, but the entire world. (Brazil, an emerging economy has had the highest percent increase of obesity and diabetes in the world the last few years). And as he sees it whether it is sugar or high fructose corn syrup it is the same poison. Even worse, if you look at what criteria makes a substance become an addiction….Sugar fits the bill so it is safe to say our bodies are getting addicted to sugar at an alarming rate.

Where am I going with this…simple. If you drink a serving of a sugary beverage (and that is 8 ounces….not the new 20 ounce soft drink bottles) and you don’t need those calories you would drink 15.5 pounds of fat a year. The problem is that the average kid is drinking 4 servings a day. It is no wonder we face an obesity epidemic in health care that has caused our premiums to go up over 50% to treat.

My strong recommendation for one of the quickest ways to start improving your health is to eliminate sugary drinks from your diet (and this includes fruit juices which are mostly sugar). Water, coffee, tea and milk are great choices. And guess what? Your chances of getting cavities may be greatly reduced as well.

Don’t take my word for it…go look at the video on YouTube yourself. And then see if Dr. Lustig makes sense. And then you can start making choices so that

LONG MAY YOU RUN