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If you watched a recent episode on Dr. Oz, you would initially think that everyone should race to the dentist and have all their amalgam (silver) fillings removed because of mercury vapors that are released from amalgams. Sensationalism makes money on TV, so may I suggest you watch all three parts of the episode before you call the dentist. The tone at the end is very different than the fear at the beginning. The debate about amalgam fillings has been going on since the 1980’s when there was concern raised about the mercury that is part of the silver filling. Studies have been done with suggestions that mercury vapors are released from amalgams and in fact, some countries in Europe have banned the use of amalgams. Research still is not complete and part of the issue is that we don’t know how much mercury is released and how much is too much. The main concern with mercury is that it is neurotoxic – meaning that it affects your nervous system. The following is a list of symptoms that have been associated with mercury toxicity: memory loss, auto immune disorders, fatigue, tremors and the inability to concentrate. Patients who suffer from these conditions may ask to have amalgams removed in an effort to eliminate the symptoms. In fact, over the years, I have had a few patients with multiple sclerosis and others who felt they had metal toxicity, request removal of their amalgams. We developed a plan for those patients and replaced amalgams, but I didn’t see significant improvement in their symptoms. My patient sample in this case was too small and no research study was conducted by me to prove or disprove any theories. As a dentist who has been practicing for 22 years, these are my thoughts on silver fillings: • Amalgams are a solid, dependable restoration that many adults have had in their mouths for 30-40 years. I had a 91 year old patient in recently who had stable silver fillings in place for over 50 years! • Amalgams were a popular material in the past, and are still used by many dentists today, because they are easy to place, hold up for a long time and are inexpensive. • Amalgams require more tooth removal than the new restorations that we have. Because amalgams don’t bond to teeth, you have to cut an undercut in a tooth to hold it in place. In small cavities, that doesn’t normally present a problem, but with larger cavities it can significantly undermine the tooth and lead to fractures later on. • There are alternatives to amalgam that are more supportive to the tooth, look better and don’t come with the suspicions associated with amalgam. They range from bonded composites to porcelain crowns and onlays. Because these materials are more technique sensitive and sometime involves multiple visits and lab fees, they cost more than amalgams. I believe the alternative materials are better, and therefore, I don’t place amalgams. For patients with insurance, many times policies will not cover these restorations and pay an “alternative benefit”, which is the fee of the less expensive amalgam. Personally, I have issues with insurance companies deciding which restoration is the ideal material for my patients….but that’s another topic. • The most exposure to mercury from amalgams is when they are removed and the fillings are aerated. Appropriate suction and isolation are important to limit exposure to patients. Dr. Oz suggests that if you have eight or more fillings you should have them replaced, but I question that because removing eight fillings at once creates a lot of mercury exposure. I would prefer addressing the amalgams as there is a problem, or if there are one or two next to one another, instead of taking them all out at once. Dr. Oz’s guests discuss the reasons why you might be at greater risk and how you can prevent toxicity. The belief is that grinding teeth together and having high acid levels (from coffee, soda, vinegar, oranges) elicit more mercury vapor. They suggest drinking soda and coffee with a straw (I prefer eliminating soda for many reasons). They recommend incorporating garlic, cilantro and Chlorella (a fresh water algae supplement) in your diet because they all help to bind and remove mercury from the body. They suggest removing amalgams if you have eight or more fillings, if you grind your teeth or if there is a sign of corrosion or decay. So, what’s my plan….I have seven amalgams in my mouth! They’ve probably been present for at least 35 years. I actually had eight, but had one replaced in dental school with a gold onlay because of decay around the old filling. I have no intention of removing the others until they break, have decay or open margins. I believing in treating my patients the way I would treat myself or my family. • For me, the biggest reason to replace an amalgam (or any other filling) is because it is no longer doing what it should be doing. If the margins are open, there is a cavity around it or it isn’t supporting the tooth, it needs to come out and be replaced. • Do I worry about amalgams? No, I don’t worry about the existing amalgams that are in my patients mouths. However, I am very careful when I remove them to limit their exposure to the aerated mercury. Which brings up something to consider…if removing the amalgams puts you at greater risk for neurotoxicity, wouldn’t you expect every dental staff member to have issues since they are the ones constantly being exposed? I suggest if you have amalgams present, that you have a conversation with your dentist. I urge you to make decisions based on fact and your individual situation, not television hype. I’ve included the link to Dr. Oz, but be sure to watch all three parts of the episode. http://www.doctoroz.com/episode/are-your-silver-fillings-making-you-sick?video=18173
The DDC and MACA have partnered to create a sidewalk art gallery, with original works of art on display outside from May through October. Interested artists can learn more about the program at: http://www.madisonartsnj.org/madison-arts-a-public-art-banner-program/
Sam Romano , a Madison, NJ physician/pediatric health professional has been selected by "New Jersey Family" for NJ's Favorite Kids' Docs in the category Dentistry: General: Pediatric. MADISON, N.J., Jan. 18, 2013 /PRNewswire-USNewswire/ -- New Jersey Family, the essential source for NJ moms, has published its 4th annual list of NJ's Favorite Kids' Docs and is happy to announce that Madison's Sam Romano has been selected through its parent nomination process for the annual recognition. (Photo: http://photos.prnewswire.com/prnh/20130118/DC44918 ) New Jersey Family's 2012 listing was published in the December 2012 issue of New Jersey Family magazine and on its website njfamily.com. It includes over 475 of New Jersey's favorite pediatric doctors, dentists, speech/language therapists, and many other professionals, who work hard to keep kids healthy. Being included on the list is like having a trusted word-of-mouth referral from good friends. About Sam Romano : a short profile by and about the honoree: "I believe the foundation to a lifetime of good health starts when you are young and continues throughout your life. Your oral health is an important part of your overall well-being. Our team is dedicated to helping you achieve the highest level of wellness. We create a safe and comfortable environment where children can learn about the importance of dental care. I have dedicated the past 27 years to caring, integrity, and commitment to my patients." New Jersey Family magazine had this to say about Sam Romano 's inclusion in their annual recognition: "New Jersey is home to a huge number of excellent pediatric healthcare professionals. Being nominated for NJ's Favorite Kids' Docs means this professional stands out as truly exceptional in the eyes of a very important constituency: the parents. We thank all the parents who submitted over two thousand nominations and heart warming stories, and we owe our congratulations to John Smith . Thank you for your dedication to kids' health." To find out more or to contact Sam Romano of Madison, NJ, call 973-377-7088, or visit www.DrSamRomano.com. This press release was written by American Registry, LLC and New Jersey Family with approval by and/or contributions from Sam Romano and was distributed by PR Newswire, a subsidiary of UBM plc. New Jersey Family's passion and purpose is to be the essential source for NJ moms on everything about parenting in New Jersey. We are committed to excellence in all we do. A professional's inclusion in NJ's Favorite Kids' Docs 2012 does not imply endorsement by New Jersey Family; it is a parent-to-parent-referral resource only. Learn more at http://www.njfamily.com. American Registry, LLC, recognizes excellence in top businesses and professionals. For more information, search The Registry™ at http://www.americanregistry.com. Contact Information: Sam Romano Phone: 973-377-7088 Email Address: email@example.com Website: www.DrSamRomano.com PR Newswire (http://s.tt/1yEvt)
Dr. Sam Romano has been selected as one of New Jersey Family Magazine's Favorite Kids' Docs. He is featured in the December 2012 issue. "Thanks to all my dedicated patients who nominated me."
I was at meeting of a group of physicians, dentists, speech and physical therapists, other health care providers and the public that works to educate and provide integrated care for children and adults. The focus of the meeting was airway and how it impacts the health and development of children. “What is airway?” Airway refers to the passage by which air reaches the lungs. The issue is that airway can be affected by anatomical issues like large adenoids and tonsils or a deviated septum, congestion, allergies, asthma and a narrow jaw. All these things contribute to a change from healthy nasal breathing through your nose, to mouth breathing. Mouth breathing is not as efficient because of the way the air flows. “Why is airway important?” Quite simply, your airway and the shape of it or anything that interferes with it, prevents good breathing and the flow of oxygen to the lungs, and therefore, the brain. Many children (and adults) who have problems breathing due to allergies or large tonsils and adenoids may snore at night – a sign that their airway is interrupted. Some even have apnea, a situation where the breathing stops for up to a minute at a time, many times throughout the night. The stops in breathing lead to poor sleep. Consider what happens to a developing child’s brain if there are regular interruptions in oxygen. Snoring in children has been associated with problems in memory, language and poor academic performance. The AmericanAcademyof Pediatrics thinks airway is so important that they have issued new guidelines for screening children and adolescents for snoring at routine visits. “What does any of this have to do with ADHD?” ADHD (attention deficit hyperactivity disorder) in children is characterized by impulsivity, hyperactivity and difficulty focusing. If a child is not sleeping well because of problems with their airway (or any other reason for that matter) they will be tired. A sleepy child acts different than a sleepy adult. Adults who are tired become withdrawn, and quiet and consider taking a nap. Children, on the other hand, try to keep themselves awake! To do this, they try to move around a lot, seem impulsive or talk to themselves to stay awake. Many doctors believe that children are mistakenly diagnosed with ADHD when really they are suffering from sleep apnea and are just tired. “What are the signs that my child may have an issue with their airway?” There are both medical and physical changes that may occur with airway issues. Medical Allergies or asthma Snoring Large adenoids or tonsils Bedwetting Hyperactivity Physical – because breathing uses so many muscles, visible physical changes are common, many related to tooth and jaw position. Narrow upper arch Long, narrow face Poor tongue posture Crossbite Small, poorly developed nostrils Gummy smile Open mouth posture (anterior open bite) Short and turned up upper lip “What do you do to treat airway issues?” Removal of adenoid and tonsils helps resolve about 90% of the issues. Speech and myofunctional therapy that retrain tongue position and encourage nasal breathing. Orthodontic intervention that expands the jaw and the airway. Medication to treat allergies or asthma The most important step in this process is diagnosis. If you suspect airway issues in your child, see their pediatrician, an ear-nose-throat specialist or a dentist who understands airway problems. Remember to be an advocate for your child. You know them better than anyone else so it is your responsibility to find a professional who understands and can help you.
There is a lot of talk these days about Sedation Dentistry. It has become a life changing experience for many. Millions of people avoid going to the dentist each year because of fear, anxiety, negative childhood experiences, or a bad gag reflex to name just a few. Sedation dentistry is an alternative to traditional dental treatment. When your body gets into the anxious mode it releases hormones and chemicals that can leave your muscles tight and tired. While sedated, your body is relaxed. Afterward, you feel refreshed and relaxed. You can get more dentistry done in one visit making it convenient and less stressful. Sedation may be a more appropriate alternative for people who are nervous or apprehensive about dental procedures or who require complicated or lengthy treatments. During sedation you will remain conscious (unlike general anesthesia) but you will be in a very relaxed state. Your vital signs are constantly monitored. When your visit is over you will feel refreshed and have little memory of the procedure. If you have avoided going to the dentist because of fear, anxiety, or a negative childhood experience, consider sedation dentistry it could be a life changing experience. For more information visit www.drsamromano.com
Last week I discussed children and sleep and mentioned something called sleep hygiene. I promised I would give a list of sleep hygiene rules. When speaking about it at the office this week, someone looked at me like I was crazy when I said “sleep hygiene.” So, let me explain: Sleep hygiene is anything that helps you maintain a restful sleep pattern. Sleep is as important as eating and exercise in staying healthy, and many people have developed bad habits over the years that lead to poor sleep. Sleep hygiene “rules” are just guidelines. They are mostly common sense, but like most things in life, we forget or ignore what our mother used to tell us. 12 RULES TO BETTER SLEEP HYGIENE Sleep hygiene is a way to develop healthy sleep habits that lead to consistent, restful, restorative sleep. 1. Sleep as much — at night – as needed to feel refreshed and healthy during the following day. Aim for a standard number of hours of sleep every single night. Excessively long times in bed seem related to fragmented and shallow sleep. 2. Avoid daytime napping. If needed, nap for less than an hour and before 3 p.m. 3. Have a regular wake-up time in the morning. This seems to strengthen circadian cycling and leads to waking up in the morning on your own without the use of an alarm. 4. A steady daily amount of exercise helps deepen sleep in the long run, but occasional one-shot exercise does not directly influence sleep during the following night. 5. Give yourself a wind-down time each day. Use this time to tie up the day’s loose ends and organize tomorrow. It is better to do this when you are awake and alert than to wait until the lights are out and your head has hit the pillow! Anxiety about things you can do nothing about at night interferes with sleep. Give yourself a scheduled, routine 30-60 minutes to do this end-of-the-day. 6. Create a structure to your day (even week-ends) that requires you to do certain things at certain times. Eating and taking medication at the same time helps to maintain your body’s internal clock. 7. You should associate your bed with sleep. Avoid using your bed to watch TV, eat, talk on the phone or work on a laptop. 8. Avoid sleeping pills or use them sparingly. They may be of some benefit, when properly prescribed by your physician, but the constant use of sleeping pills is ineffective at most and detrimental in some insomniacs. It is better to understand why your body is not sleeping, and to correct the root cause. 9. Avoid caffeine and alcohol before bed. Be aware of the many hidden sources of caffeine, ex: Mountain Dew, chocolate. Alcohol does help tense people fall asleep fast, but the ensuing sleep is then fragmented. Alcohol also suppresses REM (dreaming) sleep. 10. If you’re not asleep in 20-30 minutes, get up and do something that will relax you, but definitely with very dim light. 11. Your bedroom should encourage sleep. Everyone has their own image of comfortable – just be sure your bedroom is ideal for you. Regarding temperature, don’t have the room too hot or too cold. 12. Think about light and dark: Get as much exposure to light as you can during the daytime and as much darkness you can during the nighttime. Look at the amount of “extra” light in your bedroom from things like alarm clocks and consider wearing an eye mask to block out all light. Adapted from the 2012 American Academy of Dental Sleep Medicine Annual Meeting
Don’t get too excited – I don’t have the answer for getting a baby to go to sleep. This is part two of my report from the recent American Academy of Dental Sleep Medicine conference. There was actually a lot of interesting discussion on children and teenagers sleep patterns and snoring in children. Here are the interesting things that were reviewed: 1. There are an increasing number of infants, children and teenagers being diagnosed with obstructive sleep apnea (OSA), a disorder where breathing is interrupted during sleep. Many of these children may have been incorrectly diagnosed with ADHD. The reason for the increase in OSA is unclear, but the following things may help identify those who have it: *snoring more than three times a week *allergies, frequent colds or habitual mouth breathing *large tonsils and adenoids *being born prematurely *obesity *long narrow faces and crowding in the front teeth *daytime sleepiness *bedwetting If your child snores, you should discuss the situation with their pediatrician, an ear-nose-throat specialist or a dentist who understands sleep disturbances. Many times a combination of tonsillectomy and adenoid removal along with jaw expansion is successful at eliminating snoring, creating changes in the jaw and face, expanding the nasal passages and reducing daytime sleepiness. 2. There was discussion about teenagers and how their natural sleep patterns vary from adults. The average adolescent requires 10 hours of sleep per night, however, at least two-thirds of those adolescents get less than an average of seven hours of sleep. Many sleep very little during the school week and then make up their lost sleep by sleeping extra hours on the weekend just to get to seven hours. 3. One reason teenagers suffer from sleep disturbances is because their circadian rhythms (their internal clock that regulates sleep) does not coincide with their school pattern. Teenagers are naturally programmed to sleep late in the morning and not go to bed until very late at night. However, when school starts early, it requires teenagers to wake before their final REM phase has completed. This final REM phase is critical because memory consolidation and other important functions occur in it. This constant interruption in sleep can cause issues with school performance, lead to daytime sleepiness and affect growth and development. While many of the signs of lack of sleep like excessive irritability, mood swings and difficulty concentrating can be mistaken for just being a teenager, it is important to be aware of the signs. When the previous signs are coupled with a craving for carbohydrates, sudden shifts in feeling hot and cold, or odd sensations of having things crawling on their skin, you might begin to suspect a sleep disturbance in a teenager. 4. OSA, narcolepsy and delayed sleep pattern are the three most common sleep disorders found in teenagers. As with snoring in children, if you suspect a sleep problem, seek professional help. There are many local sleep centers with specially trained sleep physicians that diagnose and treat sleep issues. 5. The final topic that is worthy of mentioning is sleep hygiene. While it sounds like a strange term, it refers to developing and following healthy sleep habits. Many teenagers, and adults alike, sleep poorly due to overstimulation from TV, phones and computers prior to sleep. For example, the light from computers is a stimulant that wakes you, like mimicking daylight in the morning, so using a computer or texting before bedtime can interfere with the time it takes to fall asleep. Next week I will post 12 Rules for Sleep Hygiene. Remember, if you or a loved one snores or suffers from daytime sleepiness, speak to a professional to determine possible causes and treatment.
Dr Romano received the “Extra Mile Award” last night at the Annual Chamber of Commerce Awards Dinner. We are all so proud of him. He is honored and humbled to receive this outstanding award! Dr Romano is a compassionate man who always goes that extra mile not only for his patients but for his entire team. As you can see his 84 year old mother Caroline Romano and his Aunt Rose Ferdinand are also very proud of him. These three Madisonians share in their vision to go the Extra Mile to make Madison the town that it is and always has been. Thank you Dr Romano for always going the Extra Mile! The award is given to a Madison Business or employee who is chosen by the community to receive the Extra Mile Award for outstanding customer service. Patients were able to nominate him and the nominations included some of the following comments: http://www.drsamromano.com/the-extra-mile-award/
I just got back from the annual American Academy of Dental Sleep Medicine conference and was amazed at the amount of new research being done regarding sleep. I took a ton of notes and want to share everything I learned with you, but I think it will be too overwhelming for one blog so I am going to divide it up over the next few weeks. I'm going to do a series that addresses the following topics: • general information related to sleep • children and sleep • geriatrics and sleep • diseases associated with sleep disturbances First, I'll answer the question that many people ask me: why, as a dentist, do you even care about sleep? Very simply, we all need sleep and when it's interrupted, for whatever reason, it affects our overall health dramatically. Because our practice focuses on prevention and education, we discuss sleep with our patients. Additionally, dentists are in a unique position to work with sleep physicians in making oral appliances that eliminate snoring and treat obstructive sleep apnea (OSA). One of the most common sleep disorders is obstructive sleep apnea, a condition where breathing is interrupted many times a night due to a blockage or collapse of the airway. People may stop breathing for 10-60 seconds, hundreds of time a night. This stoppage leads to problems in many areas of the body and is linked with an increased risk for: high blood pressure, depression, stroke, diabetes, metabolic syndrome, heart failure and impotence. OSA is treated with either a mask called CPAP that blows air and prevents collapse of the airway or an oral appliance that repositions the jaw and opens the airway. Interesting new research shows: • OSA patients treated with either oral appliance therapy or CPAP were able to reduce their high blood pressure medications after one year of use. Because high blood pressure is common with OSA, I always suggest that patients with it evaluate their sleep to determine if they have OSA. • Custom-made oral appliances to treat both snoring and sleep apnea fit better and, therefore, are more comfortable. The reason this is important is because the more comfortable the appliance, the more compliant a person will be in wearing the appliance. • People who suffer from sleep disorders are more sensitive to pain. This is especially important for chronic pain sufferers - perhaps correcting sleep patterns will decrease pain levels. • Excessive wear on front teeth can happen at night while a patient is struggling to sleep. Many people deny being aware of grinding their teeth but still have wear. OSA may be the cause. OSA is not the only sleep disorder that exists and without an evaluation by sleep physician, and many times an overnight sleep study, it is impossible to diagnose what is wrong. Other sleep disorders include restless leg syndrome, insomnia, delayed sleep response and chronic partial sleep deprivation. Some signs that point to a sleep disturbance are: • Difficulty falling asleep or staying asleep • Daytime sleepiness • Depression • Loud snoring that disturbs the sleep of others • Difficulty concentrating • Gasping for air during sleep • Waking up with a bad taste in your mouth • Chronic morning headaches If you believe you have issues with sleep, I suggest contacting a sleep physician or discussing your concerns with your doctor. For more information, visit: http://www.aadsm.org/whatisdentalsleepmedicine.aspx, http://www.ahsleepcenters.com/ For any additional questions, please contact our office at 973-377-6500 or firstname.lastname@example.org.