Can Dental X-rays cause Brain Cancer?

The release of a recent  article, on the possible link between dental x-rays and brain cancer published in the journal Cancer,  has created quite a lot of discussion in the media and the dental community. I would like to share a review of this research done by an orthodontist friend of mine who practices in Litchfield Park, Arizona. I hope you find the  information helpful and that it answers some of the questions you may have. I would love to hear any feedback.
~ Dr. Pat DiCiccio 


Dr. John Graham DDS, MD:
As you may have heard by now, an article has just been published in the journal Cancer that has been picked up by the NY Times, CNN, FOX and most major news outlets. As you might imagine, we all have a responsibility to our patients to practice impeccable radiation hygiene, and maintain the principles of ALARA in our practices.  All of that being said, I wish to give you my take on this research:

STUDY BACKGROUND AND BASICS:
As stated in the background statement: “Ionizing radiation is a consistently identified and potentially modifiable risk factor for meningioma, which is the most frequently reported primary brain tumor in the United States.

The primary author of the article, Elizabeth Claus, MD, PhD, a faculty member in the Department of Epidemiology and Public Health at Yale University School of Medicine, postulates that because dental x-rays are the most common form of ionizing radiation – a cause/effect relationship exists.

The study is based on self-reported dental radiation histories of 1433 patients who were diagnosed with meningioma, as compared to the self-reported dental radiation histories of 1350 controls.

For those with tumors, the location of the tumors was subdivided into supratentorial vs. infratentorial as well as those with skull base tumors.

Subjects were interviewed over the phone for an average of 52 minutes by independent examiners. Participants were questioned about the onset, frequency and type of dental care received over their lifetime, including orthodontic work, endodontic work, dental implants, and dentures.

Participants were asked to report the number of times they had received bitewing, full-mouth, or panoramic films during 4 periods: Less than 10 years, 10-19, 20-49 and over 50 years.

FINDINGS:
Over a lifetime cases were more than twice as likely as controls to report ever having had a bitewing.
Significantly elevated risk was observed across all ages except those older than 50.
Individuals who report to have received bitewings were at a greater risk than those who reported having full-mouth x-rays.

Panoramic films were less frequently reported than bitewings or full-mouth series.
Significant increases in the risk of meningiomas was associated with young age at receipt of screening x-rays.
Those with meningiomas were no more likely to have had CT scans than controls.

MY THOUGHTS:
This study is fraught with troubling variables that, on their own cast significant doubt as to the validity of the study, but when compounded really degrade the veracity of any of its findings.

Let’s just talk about two:
FIRST: This is a self-reported study.  This study doesn’t examine ANY dental records. Only medical records are used, and this is only  to identify the tumor cohort.  As such, the study wholly relies upon the memories of subjects going back before the age of ten.  Let’s think for a moment about an individual who unfortunately has been diagnosed with a brain tumor.  A tough, tragic and shocking diagnosis to anyone.  Even before contacted by examiners to participate in the study, I wouldn’t be surprised if those with tumors hadn’t already spent a lot of time thinking about why they might have had a brain tumor.  More than any other tumor in the body, thinking about dental radiation would be a natural mental exercise.  Thinking about ANY radiation around the face, head and neck in an individuals past would be something I would expect from any patient with a brain tumor.  Now, have an examiner call by phone, and spend 50 minutes discussing their history of dental x-rays…. it wouldn’t surprise me at all to think that the bias in the patient would lean towards a more acute recollection of dental x-rays.  Think about it as compared to an individual control who never gave it any thought at all until the examiner posed the dental x-ray questions. THE COMPARISON OF THESE TWO COHORTS OF PATIENTS BASED ONLY ON PERSONAL REPORT SHOULD RAISE SERIOUS QUESTIONS AS TO THE VALIDITY OF THIS STUDY.

SECOND:  The time span which this study encompasses includes (and heavily weights) radiation delivered prior to the common use of digital radiography or even faster speed films.  In my opinion it is safe to say that radiation delivered today is a fraction of what it was during the scope of time covered with this study.  THIS FACT ALONE SHOULD ALLOW ALL PRACTITIONERS TO CONFIDENTLY DISCUSS THE DIFFERENCE BETWEEN TODAY’S RADIOGRAPHIC STUDIES VS. THE CONCLUSIONS DERIVED FROM THIS STUDY.

THIRD: NO CORRELATION BETWEEN CT STUDIES AND MENINGIOMAS WAS MADE WITH THIS STUDY. QUOTING FROM THE STUDY “TO OUR KNOWLEDGE, NO STUDIES HAVE REPORTED ON THE ASSOCIATION BETWEEN USE OF COMPUTED TOMOGRAPHY (CT) AND MENINGIOMA RISK…. IT IS NOTEWORTHY THAT CASES (OF HEMANGIOMA) WERE NO MORE LIKELY TO HAVE RECEIVED A HEAD CT THAN CONTROLS.”

FOURTH – AND THE MOST TROUBLING FOR THE AUTHORS OF THE STUDY: There was a statistically significant increased risk of hemangioma for patients who reported having bitewing radiographs, yet no statistically significant increase for patients with full-mouth films.  THIS CONFOUNDING FINDING IN THE STUDY IS NOT ADDRESSED BY THE AUTHORS, AND FLYS IN THE FACE OF THEIR CONCLUSIONS. VERY, VERY TROUBLING, YET NEVER ADDRESSED. IT MAKES NO SENSE WHATSOEVER.

FIFTH (CIRCLING BACK TO THE FIRST) - The problems with this study are discussed in the paper: “Limitations of this study include the possibility of either under-reporting or over-reporting of dental x-rays by study participants.” YA THINK? WHAT IF UNDER REPORTING BY HEALTHY INDIVIDUALS AND OVER REPORTING OF AFFECTED INDIVIDUALS OCCURRED IN THIS STUDY?  IT CAN’T BE AND ISN’T DISPUTED IN THE PAPER THAT THIS IS POSSIBLE.  WHAT IF THE OVER/UNDER REPORTING BIAS ERASES ALL STATISTICAL SIGNIFICANCE?

Please read this study stem to stern and become familiar with its findings, the strengths and the weaknesses.  I’ll help you with this: The only strength in the study is the number of patients.  Large numbers gives any study statistical POWER.  Yet without truth in the variate, even POWERFUL studies aren’t valid.

Dr. John Graham

www.litchfieldparkortho.com
www.facebook.com/grahamortho

5 Stars ★★★★★

A fabulous smile will benefit you for the rest of your life. Not only does a stable, healthy smile help maintain your general overall  health but it gives you confidence that will help you succeed. Choosing the right orthodontist to treat your family is a very important decision.

We have been told by our patients and their families that one of the most helpful things they did when trying to make their decision was to read the reviews on Google. So here is where you can help us...

Click on this link to Google Maps:

1. Type DiCiccio Orthodontics in the search window, then click on our name.
2. Click the Write a review link located under the address.
3. Give your review a title and rating. Be sure to give us a 5 star rating if you feel we deserve it.
4. Click Save.

Choosing the Best for your Child

Parents want was is best for their kids, that is a fact. Of course they want them to have a healthy smile but the main reason they seek care is that they want them to look great. Straight teeth, no spacing or over-lapping is generally what is expected. Great! The trick comes with choosing the right doctor to accomplish this, and the choices are seemingly endless. There is however a misconception that all doctors with a license can accomplish the same results.
 
Not all dentists are orthodontists. An orthodontist is a specialist with intensive training after dental school to learn the details of the complex biological system we will call a "bite". Just as a specialist in the medical field, such as an orthopedist and a dermatologist, deal with their specific part of the body, an orthodontist limits his practice exclusively to orthodontic care.

Dr. DiCiccio is an orthodontic specialist. He has been specially trained to see past your child's six crooked front teeth and see their bite three dimensionally. He uses his extensive knowledge to put together an individualized plan to create a beautiful, yet healthy and stable bite. Dr. DiCiccio is able to visualize how your child's smile should look at the end of treatment and then coordinate all of the variables that go into achieving that outcome.

Dr. DiCiccio also has a private, single-doctor practice. The benefit of this  is that  Dr. DiCiccio and his team see fewer patients each day than a larger, multi-doctor or clinic type practice. This allows them the time to create a very specific, individualized treatment plan to insure great results for your child's specific needs. They have flexibility at each appointment to do what it takes to "get things right". Achieving a great result does take more time than just doing an average job.

Sure, you want your child to have a dazzling smile, we want that too! Your child deserves the best—a dazzling smile with stable, long-lasting results. The orthodontist you choose does make a difference.

What's in a Smile?

A smile can convey all sorts thing. Ever hear the saying..."A smile is worth a thousand words"? A smile can convey friendliness, show compassion, create laughter, and even the devious side of a person. While we know how to read smiles and gauge their meaning, does the real secret lie in teeth themselves? Did you know the different shapes of the teeth suggest personality types?

Analyzing Your Teeth

The two front teeth, or the incisors, show a person’s age. Generally, the younger you are the more rectangular and rounded the corners of your incisors are. As you age, your front teeth become squarer and the corners begin to shorten.

Next to your incisors are your lateral incisors, which indicate gender. More feminine lateral incisors are slightly shorter and more rounded at the ends. The womanly look is referred to as a “gull-wing” silhouette. More masculine lateral incisors are almost the same size as central incisors and more squared.

Cuspids, or the teeth to the immediate left of your lateral incisors, show aggressiveness versus passivity. More pointy canines indicate more aggressive and powerful personalities. People with a more passive nature typically have flattened canines that are rounded at the tip of cuspids. 

Not only does the shape of the teeth reveal your personality but the straightness and health of the teeth say something as well. An individual with a bright, beautiful smile is going to have a healthier self-image and greater self-confidence. It's not a secret that someone with greater self-confidence will be more energetic and go further in life. Dr. Pat DiCiccio and team love helping to create beautiful smiles and improve the self-confidence of their patients.

You can't change your personality! You are who you are. But by doing what you can to straighten your teeth and taking care to keep them healthy with good oral hygiene, you will certainly go a long way toward keeping a positive self-image and making you who you want to be.

Committed...PROVE IT!

Have you noticed that when you are fully committed to something...whether it is a cause, a goal or even a relationship that you become bold, decisive, gutsy and unstoppable? 

When you are committed, you have lots of energy and are driven by a strong sense of purpose to achieve what you want. You unlock the doors of your imagination, your vision expands and your creativity is boundless.

There are two fundamental conditions for commitment. The first is having a set of beliefs. As the old saying goes, "Stand for something or you'll fall for anything." The second is sticking to those beliefs with your actions. Possibly the best description of commitment is "persistence with a purpose".

All of us at DiCiccio Orthodontics are committed to making your experience at our office reach far beyond your expectations. We are committed to delivering excellent customer service and providing outstanding patient care. We care about our work and the work of each of our team members. Each day, we show up and we make a commitment to each other and to our patients to have fun, to be engaged and to put our commitment into action.

Please share your experience of our commitment here and with anyone who might be be in need of our services. If you aren't a patient and would like to be...give us a call at (559) 225-2251.  We would love to put our commitment into action for you!

What's the WORD?

We are taking our mission statement to a whole new level...have you noticed?

Our mission statement is important to us at DiCiccio Orthodontics.  It reflects not only our commitment to each other but also our commitment to our patients.
Starting this week, you will notice each team member wearing a colored ribbon corresponding to one of the 10 key points in our mission statement. We wear these ribbons as a reminder of our commitment!

POSITIVE ATTITUDE is our first ribbon and we would like to share this week's winning story...

One of our dear families lost their father/husband very recently this past year. It was very unexpected and rather sudden. We were all very saddened by the loss and it's nearness to the holidays made it that much worse. With the approach of the holidays, this amazing family had the choice to sit at home and mourn their loss, which they would have had every right to do, but instead they chose to make a difference for someone else. They helped 15 other families decorate and prepare for the holidays. Their Positive Attitude made a huge difference in the lives of many other people and allowed them to celebrate as well.

We look forward to sharing the rest of our mission statement with you in the coming weeks. Feel free to ask us what each of the words or phrases mean to us or tell us your story!

Earlier this year we posted a blog which included our mission statement...if you are interested in reading the entire mission statement, check out the link below:
http://diciccioorthodontics.blogspot.com/2011/07/our-commitment-to-you.html

Project 365

If you were going to do one thing everyday for an entire year, 

what would it be?

I don't just mean brush your teeth, comb your hair or sleep. I mean something that could change your life or the lives of others.

Our team at DiCiccio Orthodontics challenge you to find your passion for 2012. Let's call it Project 365! Find something you enjoy doing and decide how you can use that to make life better for someone else. Maybe you like to take pictures? Maybe you are passionate about food? Or maybe you just like to smile?

The world is in your hands, so take hold and see what you can do with it! The possibilities are endless.