Dental Applications with Cold Laser

The dental profession has been on the leading edge of research using cold laser, with over 100 clinical trials in the last year alone.  The cold laser is effective in reducing pain and inflammation, as well as accelerate soft tissue repair by increasing collagen formation.  The five following dental conditions are common and have shown excellent results by applying cold laser:

TMJ Dysfunction is dentally addressed with TMJ splints to realign a bite issue, but it is often treated in conjunction with manual therapy, as there is increased soft tissue pain and headaches when the splint is adjusted.  Studies have shown that there is a clinically significant reduction in jaw pain and increased mandibular movement with cold laser, as effective as splinting.  Even greater results are shown when using both splints and cold laser together. 

Gingivitis improved dramatically with the inclusion of cold laser with traditional periodontal treatment than with traditional treatment alone.  There was a reduction in bleeding, gum inflammation, and plaque, all important to prevent advancement of dental cavities.

Dental extraction pain can be substantially reduced with using cold laser following the extraction. Studies showed substantial reduction of pain and inflammation and improved healing compared to the control groups.

Orthodontic forces involving braces were split mouth studies, where laser was applied on one side of the mouth only, so the patient is their own control.  There was significant reduction of pain on the laser side after brace readjustments and interestingly increased tooth movement, which could decrease treatment time.  Cold laser was also used in a clinical trial involving maxilla expansion, and there was not only a reduction of pain, but increased opening of the midpalate suture and accelerated bone regeneration compared to the control group. 

Oral ulcers and cold sores are seen secondarily in the dental profession, and using cold laser has shown to not only reduce pain, but speed healing of these conditions and in the instance of cold sores, even help prevent reoccurrence. 

 The amount of time involved for dental applications of laser is minimal, as the area is often small, so only minutes would be required, allowing an easy integration into the dental practice.  But best of all would be improved patient outcomes, and less pain, making it less fearful to go to the dentist!

Negative Self Talk

Self-talk can have a powerful impact on your emotional well-being and motivation.  Unfortunately negative self-talk has a way of becoming a self-fulfilling prophecy, which can occur when there is a stressful life event, when you are anxious or when you are feeling down on yourself.  At these times, you are least able to be truly rational and objective. The key is to recognize flawed self-talk and replace the errors with more appropriate thinking, a strategy often used in cognitive behavioral therapy. 

Some examples of flawed thinking:

·         All or nothing thinking: if anything is less than perfect, you see it as total failure

·         Filtering out the positive: you think positive outcomes were just dumb luck

·         Jumping to conclusions: either mind reading, when you conclude someone is reacting negatively to you or fortune telling, where you predict things will turn out bad

·         Magnification: you exaggerate the importance of your problems or short comings

·         Should statements: you tell yourself that things should be the way you expected them to be, often not reality

·         Labeling: instead of saying I made a mistake you attach a negative label, I am a loser

·         Self blame: you hold yourself personally responsible for events not in your control

Positive self talk can give you the confidence to use your talents to the fullest.  Remember your positive traits and skills when your thoughts turn negative. Review your previous successes in your mind and correct your flawed self talk.  The ultimate purpose of examining your self-talk is to change actions that are self defeating.  The real power of self talk lies in how it changes your behavior.

How Does Cold Laser Work?

Cold laser, or low level laser, was added as a new service at the White House in May 2011.  Since using this new technology, we have been having great results with a variety of muscle, tendon, ligament, joint, and nerve conditions. 

Cold laser works by activating three biological pathways:

·         Adenosine Triphosphate (ATP) Pathway:  The mitochondria (the cell engine) absorbs the light energy and chemically converts it into ATP, which is the cell’s fuel.  This process accelerates tissue regeneration by increasing synthesis of collagen, the building block of all soft tissue.  Secondary reactions include increased protein synthesis and stimulating cell division.

·         Nitric Oxide Pathway:  Nitric Oxide relaxes the lymphatic system, which allows reabsorption to occur, reducing inflammation and pain.  There is also an increase in vasodilation, to get more blood and oxygen to injured tissues.

·         Lipid Absorption Pathway:  Increased porosity of the cell membrane allows a rebalancing of the sodium-potassium pump, thereby decreasing the pain signal.  Low level laser also reduces pain by stimulating endorphin synthesis, the body’s natural pain reliever.

The end result of cold laser treatment is to not only reduce pain and speed up healing time, but by naturally increasing collagen synthesis, you have true tissue repair at a cellular level! 

Why Europeans are Skinnier than North Americans

I am late publishing a monthly blog as my family spent three weeks in Europe visiting four countries (Netherlands, France, Austria and Croatia).  While it has been 10 years since returning to Europe, I was even more "hit in the face" at how much slimmer Europeans are compared to North Americans. 

The food was very similar to what we would eat (McDonald's is everywhere), and they seem to eat more bread, cheeses and processed meats, but I found it difficult to see any native Europeans that were obese.  An observation was also made of not only the higher amount of alcohol consumed (beer is cheaper than coke), but also the large number of smokers, particularly in Paris. 

So why are the Europeans slimmer?  My only conclusion can be that they walk more, as many do not own cars in the city, due to lack of parking and high cost, and also excellent transportation systems.  In Amsterdam, they have also developed an impressive bike system, with bike lanes paralleling roads and bike parking lots.  I had never seen women in short skirts and high heels bike before, but it can be done! 

On spending time in rural Austria, however, I did find much more "weighty" people, as they were more reliant on vehicles.  So a conclusion can be made,  that we have to encourage more people to get out of their cars and on to their feet or bikes.  This will only be possible if we have more compact cities, and also improved public transit.  A three times expected load of the light rail transit system in one year happened in Vancouver after the Canada Line was constucted for the Olympics.  So the old saying goes "build it and they will come"! 

Neck Pain: No Drugs Required

A January 2012 study published in the Annals of Internal Medicine has found that conservative care consisting of either spinal manipulation or home exercise to be more effective than over the counter and prescription medication for relieving both acute and subacute neck pain.  The study involved 272 adults with nonspecific (muscle-ligament-joint) neck pain of 2-12 weeks duration, excluding more serious pathologies such as discs, fractures, and instabilities. 

Subjects were randomized into three groups for 12 weeks: spinal manipulation (SMT), home exercise and medication. Self report outcomes (pain, function) were measured at 2, 4, 8 and 12 weeks during the trial period,  and at 6 and 12 months follow up.  Results were as follows:

12 week comparisions of pain reduction

Improvement                   >50%                     75%                        100%

SMT Group                       82 %                       57 %                       32 %

Exercise Group                 77 %                       48 %                       30 %

Medication Group           69 %                       33 %                       13 %

At long term follow up, 75 % at 6 months, and 81 % at 12 months of SMT group reported at least a 50 % reduction of pain.  71 % at 6 months and 69 % of 12 months of exercise groups reported at least a 50 % reduction of pain.  59 % of 6 month and 69 % at 12 month of the medication group had a pain reduction of at least 50 %. 

What can be concluded is that both the SMT and exercise groups had similar short and long term outcomes, more favorable than the medication group.  This further reinforces past research which has shown active therapies for neck and back pain (exercise and manipulation) to be the most effective treatment for these common and reoccurring conditions.

Four Pillars to Manage Osteoarthritis

Osteoarthritis (OA), common in 80% of the population after age 50, is considered an inevitable part of aging, but research is showing that there are steps you can take to minimize OA or stabilize further joint erosion once you have it.   A contributing cause of OA is now thought to be due to age related decline in the body’s synthesis of glucosamine after the age of 40.  Glucosamine is important in making proteogylcans, the ground substance to form joint cartilage; as well as hyaluronic acid, which is used to increase viscosity of synovial fluid to reduce wear and tear on the joints and allow nutrition to the cartilage.

Inflammation occurs with the degeneration of cartilage and causes the pain associated with OA.  Inflammation occurs when the body makes a hormone like substance called prostaglandin-2 (PG2), whereas the synthesis of PG1 and PG3 exert and anti-inflammatory effect and can control the symptoms of OA.  PG2 is produced by the polyunsaturated fats that we consume, mainly from high fat meat and dairy products.  Omega-3 fats from fish and flaxseed provides the building blocks for PG3 and borage oil, evening primrose oil and black current oils for PG1.  There is also a natural anti-inflammatory that is often used in OA, MSM, which research shows not only helps inflammation but the sulfur in MSM is used to make enzymes that are needed for connective tissue, such as cartilage.

The first two pillars of managing osteoarthritis involve dietary changes and supplements to improve the structural integrity of the joint itself.  The other two pillars involve improving the function of the joint.  As cartilage has no blood supply, it relies on its nutrition from the synovial fluid, but if there is no movement in the joint, this increases the likelihood of OA changes to develop.  Movement of the joint involves exercise, which is important even in advanced OA to decrease joint stiffness and slow progression of the disease.   If the joint becomes fixated, periodic treatment from a manual therapist such as a chiropractor to mobilize and manipulate joints is also recommended to maintain joint function. 

Four Pillars of Osteoarthritis Prevention and Treatment

1. Eat a diet low in saturated fats: reduce red meat, dairy products above 1% MF, fried foods, high fat pastries
2. Supplement with Omega -3 (1200 mg/day) and Gluscosamine Sulfate (1500 mg/day) with additional MSM (400 mg/day)
3. 30 minutes at least 3 times a week of endurance exercise (walking,biking,swimming), adding strengthening  and flexibility exercises is also beneficial
4. Periodic mobilization or manipulation of fixated joints (monthly maintenance)

Patellofemoral Pain Syndrome

Patellofemoral pain syndrome (PFPS) is a common cause of knee pain in athletes, particularly young women and those who are involved in running.  The pain is felt around or behind the kneecap, and is often of gradual onset unless trauma is involved.  There is increased pain with prolonged sitting (knee flexion), stair climbing, squatting, running, kneeling and jumping.  Generally there is no swelling around the knee cap, nor is there any pain in the patella tendon or surrounding ligaments.

PFPS is usually a functional problem rather than a structural one.  It has to be differentiated from another patella condition, chondromalacia, which is the wearing down of the cartilage under the knee cap, and may accompany PFPS.  The causes are multifactorial and can be broken down into three categories:

Biomechanical, or patellar tracking problems, are caused by lower extremity malalignment, which pulls the patella out of its groove.  Factors such as flat feet which cause the knee to internally rotate (knock knees) and wider Q angles of the hip, which are more common in women, contribute to PFPS.  A “J” sign can be seen with lateral patellar tracking, as the knee is extended from 90 degrees of flexion to full extension. 

Muscular imbalance is another factor, with weak quad muscles (particularly the medial quad) and a tight iliotibial band and hamstring, as well as weak hip extensors/abductors and tight hip flexors. Overuse or overload of the patella caused by repeated weight bearing impact, such as with running, is also a contributing factor in PFPS. 

 Conservative treatment is multipronged, based on the underlying reasons for the PFPS.  Relative rest from aggravating activity (running) to another non impact activity (swimming, elliptical); icing after activity; cold laser therapy to reduce pain/inflammation and heal the tissue; taping or a knee brace with a U shaped insert to keep the patella in alignment; orthotics to help support the arch; and specific exercises to strengthen weak muscles (quads and gluts) and stretch tight muscles (TFL ,hams and psoas).  Rarely surgery is indicated, but true chondromalacia may be amenable to arthroscopic surgery to smooth out the cartilage under the knee cap, and lateral retinaculum release if the problem is caused by excessive lateral pulling.