Guatemala Mission Trip

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Friday, March 15, 2013

As Lisa, Prema, and I head to Guatemala, I am excited to be a part of this Christian Dental Mission Trip. As we go out to serve as the body of Christ, it is really a great experience every time I have served in the capacity of giving away dentistry to people who are less privileged and otherwise would go without. There is really something to giving of yourself. For me it is not just the joy of a selfless act, as described, #2 of the “22 Things Happy People Do Differently”, but instead there is a deep and lasting fulfillment that comes from living your life with purpose.

I was teaching a class about missions recently to my 9th grade students. I separated out the key elements of how to go about mission work. Understanding that there are several elements: (Purpose, Who is Going, Supplies, Knowledge of the Subject, Knowledge of the Culture, and Goals). Ultimately, I tried to drive home the idea that having a purpose is the single most important piece of the puzzle. The Great Commission

Acts 1:8 (NIV)

But you will receive power when the Holy Spirit comes on you; and you will be my witnesses in Jerusalem, and in all Judea and Samaria, and to the ends of the earth.”

Once we understand the purpose, the other pieces start to fit as they are all supporting that greater cause. All of the other components arise as we try to fulfill the greater purpose. Let me explain by illustrating how this is true.

We may think that the people who are going are critical. In fact, many times we cheer who will be able to go with us and lament when we learn of those who will not go with us. I wish my assistants and my dentist friends could have joined us, but I am genuinely thrilled that my hygienists will be joining me on this trip. The difference between a secular charity and a Christian mission trip is that we believe God will use us to further His kingdom. So, even if one person we know that is really good at one aspect of dentistry or teaching cannot go, we believe that God will use the people who do go.

Supplies may seem critical, and when doing dental charity there are a lot of pieces to the puzzle. I sought out donations and I have to thank Allan Day at Hewitt Dental and Michael Zuelke of Burkhart Dental for the generous donations of everything from composite (white filling material) to a Cavitron (for cleaning teeth) and 2 more boxes of stuff. Donations like this make trips like the one I am taking possible. But, even if we had none of these supplies, they still fall under purpose in importance in terms of dental mission work. I will strive to do the best dentistry on these small children, but I believe that their salvation is a greater good than a filling or an extraction. So, in many ways, as my young friend M. Hunter pointed out, the dentistry is just one of the supplies – a very valuable thing that some of them need desperately (if they have dental infections for instance), but that I do primarily to serve a higher purpose.

Knowledge of the Subject is a critical piece of the pie. You might think – ‘well, how can you teach the good news of the gospel if you don’t know it well?’ Certainly, understanding the redemptive power of forgiveness and justice being served in the same token is critical to sharing the story of Jesus Christ. But, Christ did not call us to speak the words of truth alone, rather he called us to live out those words through the way we act, serve, love, and care for one another. So, there is no greater teacher than teaching by the actions of caring for people and treating them well. Discipleship is about modeling the behavior you have learned.

Knowledge of the Culture is an important part of the relationship with the community you are entering, particularly with international mission work. It is fundamentally important that you connect with the existing community of believers who are there. When you are only there for a week, but others are there year-round, you want your efforts to go hand-in-hand with the work being done in that area. This cultural integration allows the work you do for that one week to play into the greater collage of all the work being done by the Body in that place. Furthermore, in the work of dentistry, you need a local body to help with follow-up so that more complex cases get the attention that they need and deserve.

Goals are the way we try to carry out our purpose. We go in with a clear idea of the type of work we are there to do, (in this case that is cleanings, fillings, extractions, teaching the Word, and caring for the children). We have more specific goals of seeing hundreds of patients over the course of the week in this rural part of Guatemala. Goals are convenient because they are very tangible. By our nature, it is easy to get caught up in the nuances of our goals and forget the nature of serving our purpose. When a specific goal begins to overshadow the higher purpose, the goal, in that moment, actually works against the purpose. Imagine a difficult filling, it is better to take a deep breath and relax. If you allow ambition to take over and it becomes a question of keeping a tally, I can assure you that your hope of sharing the Word and spreading the good news has been thrown on the floor.

So, it is with purpose that I go to the airport tomorrow, knowing that in working on this mission, I am made whole as I fulfill the purpose that has been put in my heart.

Guatemala before and after

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Thursday, March 28, 2013

A lot of people think that when you go on a mission trip to Guatemala that you will do nothing but extractions and that the majority of your impact will be on the physical health of patients as you remove a major source of infection and inflammation from their body.

We treated 600 patients alongside a group of 33 Christians, comprised of 21 dental students, 3 dental hygiene students, 5 dentists, 2 hygienists (thank you Lisa and Prema for coming on this trip!!), and 2 assistants. Above I have included the before and after for one of the cases we treated. There were others like this. This patient had teeth like rotten apple cores in the front. Without treatment these teeth would have continued to get worse until they would be non-restorable. Instead, we were there in the rural community of San Raymundo at the critical moment to get in there and correct these teeth by removing the decay and placing esthetic composite resins.

Most of the patients we treated were small children. A few of the patients we treated were their care takers and people who work with the children. We took time to visit the University of Francisco Maroquin and learn about Mayan culture one afternoon. We met with the committee that runs the Christian school and hospital, where we were working. We made a little leisure time to play soccer with our local translators. FUN!! But, most of all we went to honor God. We served the children from 7:30 – 7:00. Long days out there in Guatemala. It was fun working alongside others with a shared goal in mind. We had dental units – with handpieces, and burs, and white filling material. One of the best things we brought was a hygiene team. All those components together serve to allow for high level care, not just pulling teeth in the jungle.

Above is a before and after picture of a patient completed by me (Russell McFarlane) in Guatemala 2013.

Before and After: 2011 to 2014 (Extreme Esthetics)

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Wednesday, May 14, 2014

When we started this case, the patient came to me stating unequivocally she was not interested in jaw surgery (orthognathic surgery), but she wanted to improve the look of her smile. I explained that if she was willing to do the work that together we could improve her esthetics and her function as well; conceptually, I think of this as functional esthetics. In 2011, she could bite down and stick her entire pinky in her mouth with her teeth closed completely together. Based on the narrow archform and relative jump between her posterior teeth and her anterior teeth in the maxillary arch, we decided the only way to achieve substantial and meaningful closure of her overjet (the space her pinky could fit through without dragging on her teeth) was to remove 2 teeth, so we removed her 1st premolars on the upper right and the upper left. This created the necessary space we needed.

To take advantage of this space, we moved the teeth with clear aligner therapy using Invisalign. We also attached buttons to her mandibular first molars and her maxillary canines. She faithfully wore her elastics to help encourage the movement of these teeth. It was not by magic that we achieved this movement, but instead by daily dedication of my patient to continue with the ongoing 22 hours per day wearing of her aligners, and additionally wearing her elastics. Week after week, then, month after month, little by little, we carefully moved her teeth to close the space between her upper and lower arch. One day along our journey, we were looking at the progress we had been making and she informed me that she bit lettuce, which was one of our bell weather goals. Later she told me that she bit a sandwich. Once she started being able to chew with her front teeth, the idea of truly life-changing therapy really started to set in.

I knew from the outset that this would be a fun case because it would be challenging. I was excited to work on this case. I feel a great sense of accomplishment knowing that what we did here really made a difference. By the end of treatment, it wasn’t just the teeth that had changed.

The last piece of the puzzle was to replace some old bonding that was looking old and starting to fail. The old composite had been placed to repair the teeth after an injury, which is very common on teeth that are overjet. This composite had been bonded to her teeth over 10 years ago, no longer matched her teeth, and was very stained and falling off. So, we repaired these teeth using all-ceramic crowns that will act as a lasting solution to restore where they were previously fractured. My patient enjoys smiling now. I think the before and after pictures really tell the story.

Wednesday, May 14, 2014

Before and After: 3 Years of Invisalign with Orthognathic Surgery

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We started this case with our eyes wide open. We knew it would require 3 stages: Stage 1: Invisalign to straighten the crooked teeth. Stage 2: Advancement of the lower jaw. Stage 3 below.

From the beginning, we knew that this case included a mandibular jaw insufficiency, Class II div 2. We spent a lot of time developing a plan that allowed all the teeth to remain and would allow us to finish with a correction to the crowding, canting, overlapping anteriors, and the midline correction.

After three years, a course of Invisalign, placing brackets on the teeth so that the jaw could be held in place post-operatively, continued correction using aligners, and a refinement phase using clear buttons and elastics, we finished stage 3. Stage 3: Finish straightening the teeth and settling the bite.

Here is the smile line improvement.

Another beautiful day

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A couple of really big dental changes took place for this patient over the past 3 years. I am going to detail the three most significant changes we accomplished with Invisalign, and bonding.

  1. I.I corrected end-on-end occlusion to finish the occlusion in mutually-protected occlusion.

Before her teeth were end-on-end, leaving her anteriors hitting tip-to-tip, which is not a protected occlusion and leads to the teeth chipping at the biting tip.

After we were able to correct the final position, we were able to move the lower arch behind the upper arch. This repositioning allows for a more nearly ideal very slight overbite so that the upper teeth disclude the lower teeth with “anterior guidance” and when the patient moves, her teeth are protected from contact in excursive movements.

  1. II.I corrected the archform in which teeth were very crowded and required movement to improve them into a harmonious position.

Before Invisalign, the upper arch had approximately 3mm of overlap with the canine (#11) positioned facially to #9, (#10 was missing and the canine was being used in lieu of a lateral).

After Invisalign, we were able to make archform smooth and harmonious.

  1. III.I reshaped the canine and added composite bonding to make the tooth look and feel like a lateral, improving the esthetics.

Before composite veneer bonding, the canine looked fairly obvious. The shape of a canine is pointed, leaving a triangular gap where the teeth should meet.

After composite bonding, we were able to approach the more square and ovoid shape of a natural lateral. If you look closely, you will note that the triangular space is gone and the spacing of the teeth looks more natural.

The before and after photos help to paint a picture of what is possible with a combination approach of orthodontics using clear aligners with some cosmetic bonding added to complete the esthetic effect.

Wednesday, July 9, 2014

Why Glass Ionomers? Why now? 2014, (Austin, TX)

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McFarlane Dental Announces a New Dental Material

McFarlane Dental presents… I am proud to announce that we have added Riva glass ionomer to our offerings of restorative materials. This addition follows the principle of evidence-based dentistry, making decisions based on what research shows is best for patients and long-term outcomes. This material complements our array of restorative options and gives patients a material that is highly rated for it’s strength and handling. The material has been highly rated by Dental Product Shopper, as well as The Dental Advisor, and notably by my friend and colleague Dr. Matt Strepka (of Sandalwood Dental in Houston, TX)

Glass ionomers are biocompatible materials, which can stick (adhere) to tooth structure in difficult to restore areas. The only other material we have in dentistry that is as generous with the exposure to blood and/or saliva is amalgam. The only other white restorative material we have is composite, which is very dense, and very placement sensitive. It is worth noting that as a material glass ionomer has continued to develop; it has improved so markedly from it’s nascency as to become a virtually a new material.

In many patients, you find worn areas at the gumline, which is the result of wear and tear on the teeth. The myriad examples of this type of wear and tear include: grinding, clenching, bruxism, a history of toothbrush abrasion (using a hard brush or an overly aggressive technique), root exposure from recession or bone loss, and erosion caused by an acidic diet or G.E.R.D. These lesions come in many shapes and many forms, but almost none of them come from the traditional caries process. All of the forms of tooth loss that I mention in the list above come from physical and/or chemical wear. Only a small percentage of the gumline cavitation (tooth loss) in the gingival (Class V) gum area come from bacteria emitting acid as a secondary response to a sugary diet. Furthermore, as patients age, the prevalence of recession increases and likewise the weaker areas of the cementum and dentin found in their roots tend to erode away more quickly than their enamel.

Let’s talk briefly about why in cases of erosion, and abrasion in the area of gingival (Class V) fillings glass ionomer is so attractive. Glass ionomer is slightly porous and allows for a more natural biologically compatible integration into the tooth. Glass ionomer allows fluoride to pass through it into tooth, which our other materials do not. For these types of fillings, it is more ideal because it is slightly softer, which means if a person grinds with excessive force causing flexion and abfraction of the tooth, the filling does not chip away at the edges. Glass ionomer does not require any additional preparation of the tooth, which makes it a minimally invasive treatment. Minimally invasive treatment is a hallmark of modern healthcare because it limits the amount of secondary damage being done to repair the tooth.

In (Class V) gingival restorations, composite (being a very durable, dense, and hard material) under abfraction forces of chewing and grinding, which may cause tooth flexure, tend to show signs of chipping at the edges when used in these types of cases. Amalgam has fallen into disfavor within our world for 4 reasons: 1 – it is less aesthetic (it looks silver instead of tooth colored), 2 – it is hard to collect creating a difficult long-term ecological problem, 3 – poorly informed people casting aspersions about it’s safety (while the ADA scientifically-based evidence concluding it is a safe and effective material), and 4 – it requires a minimum 2mm preparation of the tooth with undercut retentive walls so that the filling can be retained (sometimes leading to cracks).

Here is the conclusion of the Dental Research Journal: “In recent decade there has been increasing attention to the use of “smart” bioactive materials in dentistry, especially with the aim of remineralizing dentin… particularly in an attempt to control the prevalence of primary and recurrent caries.” (accessed through NCBI on 9/8/14, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3793401/)

I am genuinely excited about the addition of this new material and I am making an effort to let people know about it. It is one more small way that we are trying to do the best work we can. 🙂

Sincerely,

J. Russell McFarlane DDS

AED Automated External Defibrillator

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Tuesday, October 21, 2014

Why AEDs?

Well, I’m glad you asked.

About 600,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths.1

When I was in dental school, one of the electives I took was to become a certified teacher of the CPR class. This elective requires you to pass additional tests and discuss in depth CPR, use of AEDs, and prepare the skillset required to train your classmates in safe and effective CPR.

So, let’s go over some basics:

Common question – Isn’t CPR all you need in a cardiac emergency?

In short, no. Let’s examine this question further. Here we must differentiate between heart attack and sudden cardiac arrest (SCA). “A heart attack is when a blockage in an artery results in a lack of oxygen to the heart muscle, ultimately causing damage. …Heart attacks are serious and can lead to SCA. However, SCA may occur independently from a heart attack and without warning. 2

So, in the event of a heart attack, CPR may be adequate, but when the rhythm of the heart is not functioning correctly, such as in atrial fibrillation or ventricular fibrillation, or when the heart rhythm has stopped completely – as in SCA, the heart needs an electrical jumpstart. This critical juncture is when you need an AED.

BLS – basic life support (current thinking)

The current protocol is compressions are #1 in importance. 30 compressions: 2 breaths, or if you are not comfortable breathing for that other person, then, at least do continuous compressions until help arrives. Compressions that are adequately deep and adequately strong will very likely be the difference between whether the person you are performing CPR on will live or die.

Is an AED required in a dental office?

Currently, the state of Texas does not require an AED in dental offices.

Why now? What made you get an AED?

I have always wanted to have an AED in the office for patients, staff or even to be used on myself in case of an emergency. I finally settled on the idea that we have: an aging patient population, an increasing number of surgical sedation cases, and we are seeing a number of special needs (intellectually disabled) patients – many of whom are delicate and are medically complex. These factors pushed me to buy an AED, so we got an AED with a good track record the Powerheart AED G3.

What difference does 10 minutes make?

If defibrillated within the first minute of collapse, the victim’s chances for survival are close to 90 percent. For every minute that defibrillation is delayed, survival decreases by 7 percent to 10 percent. If it is delayed by more than 10 minutes, the chance of survival in adults is less than 5 percent. 3

In an emergency situation, you need the tools to act quickly. How far away is your closest AED? Do you know?

  1. 1.CDC. “Heart Disease Facts.” <http://www.cdc.gov/heartdisease/facts.htm> accessed on: 10/21/14

  2. 2.Heartsine. “About SCA” <http://heartsine.com/support/about-sca/> accessed on: 10/21/14

  3. 3.Sudden Cardiac Arrest Association. “About AEDs.”<http://www.suddencardiacarrest.org/aws/SCAA/pt/sd/news_article/43774/_PARENT/layout_details/false> accessed on: 10/21/14

Tuesday, October 21, 2014

Best Practices – Sports Mouthguards

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Monday, Ferbruary 16, 2015

If you even casually watch NCAA football, NFL football, or high school football, you have probably noticed a significant change in the discussion of concussions. A professionally designed and fabricated sports mouthguard can make a significant difference in the risk of injury. “Because a professionally-made guard is the most comfortable and provides the best protection against injuries, and they are more durable than many over-the-counter varieties,” they offer the best chance we have at preventing traumatic injuries (AGD Impact, August 2014). The AGD Impact article, “Sporting Mouthguards” relies heavily on positions espoused by the Academy for Sports Dentistry.

Custom-made pressure-laminated sports mouthguards were shown in a study published by the dental research journal General Dentistry to reduce the incidence of MTBI mild traumatic brain injury/ concussion injury by 50%, when compared to OTC (over-the-counter) mouthguards. Wow! So, why isn’t every high school football player wearing a custom mouthguard?

I offered a local high school the opportunity to donate custom-made pressure-laminated guards to their team. We offered to come out for a practice; make impressions for all the players. They could then come in to the office and receive their donated guard from the dental office. The only charge would be a replacement fee in the case that they lost or destroyed their guard. FIRST GUARD FREE.

For fear that some of the players would lose their guard and not be able to afford a replacement, the coach decided against it. The players and teams in AISD are actually penalized if the players are found by referees not wearing their guards. It seemed so obvious to me. Last year, I upgraded my practice by buying a positive pressure dental device fabricating machine, the Mini Star, made by the Great Lakes Ortho company. Here is an example of the thought that goes into this type of professionally-made device.

It is reasonable to surmise from the available research that sports mouthguards reduce the risk of concussions, which would logically imply correlation to a reduced long-term risk of CTE (Chronic Traumatic Encephalopathy) – the dreaded disease of old boxers and once-great football players.

It is indisputable that they reduce the incidence of fractured and injured teeth. Dentist made pressure fabricated sports mouthguards are a great investment in your mouth health, and brain health.