Monday, June 28, 2010

Most Dangerous Female Sport.....Cheerleading

On Friday May 14, 2010 I boarded the first Southwest Airlines flight of the day leaving Oakland for Los Angeles. Choosing the seat on the opposite side of the aisle was a familiar looking gentleman dressed in a crisp white shirt with cuff links. As we were pulling away from the gate, I finished reading a recent Daily Cal. The gentleman asked if he could check out the paper. Then it hit me.....As I turned to hand him the paper, I stated, "You're that guy." As he took paper he replied, "I Am that guy.".............It was Captain Chesley Sullenberger of Hudson River landing fame.

I arrived at the Sports Concussion Institute's Forth Annual National Summit on Concussions and Other Sports Medicine Injuries. Again, I was the only dentist present.
The morning program consisted of the following:
Emerging Clinical Solutions for Sports Concussion presented by Jeffrey Kutcher, MD
Assessment and Management of Battlefield-Induced Concussion:
Applications for Sports Concussion
presented by David F. Moore, MD, PhD, Dip PH
Guidelines for On-Field Management of Orthopedic Injuries in Youth presented by Neal S. ElAttrache, MD
An NCAA Update on the Biomechanics of Sports-Induced Concussion:
Implications for Long-Term Outcomes
presented by Kevin Guskiewicz, PhD, ATC
Keynote Address: Preparing Youth for High-Velocity Sports:
The Significance of Nutrition and Hydration
presented by Mehmood Khan, MD

The afternoon session was broken up into four concurrent tracks:
Track A: Evaluation and Treatment of Orthopedic Sports Injuries presenters were Warren Strudwick, MD, Ryan H. Kotton, MD, Larry Lemak, MD, Vernon Williams, MD
Track B: Advancing Health and Safety Outcomes Among Youth and High School Athlete Populations presenters were Gerry Gioia, PhD, Andrew Blecher, MD, Charles Flippen, MD, Barry Jordan, MD, MPH
Track C: Methods of Evaluating Concussion Outcomes Among Athlete Populations presenters were Mark Lovell, PhD, Jeffrey English, MD, Michael McCrea, PhD, Stephen Bailey, PT, PhD
Track D: Advancing Health and Safety Outcomes in Historically Female Sports presenters were Fred Mueller, PhD and Kimberly Archie, BS, Sonia Bell, MD, Anthony Alessi, MD, Terry Zeigler, EdD, ATC

I have heard Mark Lovell speak many times and am pretty well versed on his computerized neuropsychological concussion assessment software, ImPACT.
Since I am the father of a very active 4 year old daughter, I elected to take Track D: Advancing Health and Safety Outcomes in Historically Female Sports. I learned a startling fact, Cheerleading is the most dangerous female sport. Between 1982 and 2008 there were 73 catastrophic injuries in cheerleading, including two deaths. An injury is deemed catastrophic if it causes permanent spinal injury and paralysis. In the same time period, there were only nine catastrophic injuries in gymnastics, four in basketball and two in soccer.

Saturday, April 3, 2010



Monday, February 15, 2010

Savvy, the Unofficial Golden Retriever of the California Golden Bears: 1-15-99 to 2-15-10

From her Rockridge home on Monday February 15, 2010, Savvy set off for Rainbow Bridge with the grateful help of Dr Anthony Smith.

She brought smiles to all that met her

Upon hearing of the sad news, our good friend Richard Shoemaker shared with us a special writing that helped him through his similar experiences which we too would like to share.

The following is borrowed and paraphrased from Eugene O'Neill's "Last Will and Testament of "Silverdene Emblem O'Neill", 1940.


I, Sauvignon Johnson, (familiarly known to my family, friends and acquaintances as Savvy) because the burden of my years and infirmities is heavy upon me, and I realize the end of my life is near, do hereby bury my last will and testament in the mind of my Guardians, Beth, Whitney and Savannah. They will not know it is there until after I am dead. Then, remembering me in their loneliness, they will suddenly know of this testament, and I ask them then to inscribe it as a memorial to me.

I have little in the way of material things to leave. Dogs are wiser than men. They do not set great store upon things. They do not waste their days hoarding property. They do not ruin their sleep worrying about how to keep the objects they have, and to obtain the objects they have not.

There is nothing of value I have to bequeath except my love and my faith. These I leave to all those who have loved me, to Beth, Whitney and Savannah, whom I know will mourn me most, to Cabby, Millie, Hunt and Mary who have been so good to me, to the staff of Every Dog Has It's Day Care, Dr Teri McGinnis and all at Albany VCA, Pauli and - But if I should list all those who have loved me it would force my Guardians to write a book.

Perhaps it is vain of me to boast when I am so near death, which returns all beasts and vanities to dust, but I have always been an extremely lovable dog.

I ask my Guardians to remember me always, but not to grieve for me too long. In my life I have tried to be a comfort to them in time of sorrow and a reason for added joy in their happiness. It is painful for me to think that even in death I should cause them pain.

Let them remember that while no dog has ever had a happier life, (and this I owe to their love and care for me) now that I have become weak from the cancer that we thought I had dodged and the arthritis that developed over the years, I no longer have the energy to go on.

It is time I said goodbye, before I become too sick a burden on myself and on those who love me. It will be sorrow to leave them, but not a sorrow to die.

Dogs do not fear death as men do. We accept it as part of life, not as something alien and terrible which destroys life. What may come after death, who knows?

I would like to believe with those of my fellow Golden Retrievers who are devout optimists, that there is a Paradise where one is always young and full-bladdered, where all the day one dillies and dallies with a playful multitude of hounds, beautifully combed; where squirrels that run fast and lakes that are cool and prestine; where each blissful hour is a mealtime; where in long evenings there are a million fireplaces with logs forever burning, and one curls oneself up and blinks into the flames and nods and dreams, Guardians.

I am afraid this is too much for even such a dog as I am to expect. But peace, at least, is certain. Peace and long rest for weary old heart and head and limbs, and eternal sleep in the earth I have loved so well. Perhaps, after all, this is best.

One last request I earnestly make to others that may read this. I have heard others say, "When my dog dies I must never have another dog. I love her so much I could never love another one." Now I would ask them, for love of their dog, to have another.

It would be a poor tribute to our memories never to have a dog again. What I would like to feel is that, having once had a dog in the family, now one cannot live without a dog!

I have never had a narrow jealous spirit. I have always held that most dogs are good, (and one cat, Jack, the tabby I had permitted to share the living room rug during the evenings, whose affection I had tolerated in a kindly spirit, and in rare sentimental moods, even reciprocated a trifle).

Some dogs, of course, are better than others. Golden Retrievers, naturally, as everyone knows, are best. So I am pleased Cabby is my successor. He can hardly be as well bred or well mannered or as distinguished and handsome as I was in my prime. My Guardians must not ask the impossible. But he will do his best, I am sure, and even his inevitable defects will help by comparison to keep my memory green.

To him I bequeath my floating Kong, my Cal bandana and jersey, purchased in 2002 at the ASUC book store (I wish him better luck in his anticipation of a Golden Bear Rose Bowl appearance and victory). He can never wear them with the distinction I did, walking around the Cal campus, the streets of Berkeley, and the trails of the East Bay Regional Parks (my favorite, of course being Tilden with its Lake Anza and Steam Train) all eyes fixed on me, in admiration; but again I am sure he will do his utmost not to appear a mere gauche provincial dog.

Here at home, he may prove himself quite worthy of comparison, in some respects. He will, I presume, come closer to squirrels than I have been able in recent years. And, for all his faults, I hereby wish him the happiness I know will be his in my old home.

One last word of farewell, Dear Whitney, Beth and Savannah. Whenever you visit the place of my ashes, say to yourselves with regret but also with happiness in your hearts at the remembrance of my long happy life with you: "Here lies one who loved us and whom we loved."

No matter how deep my sleep I shall hear you, and not all the power of Death can keep my spirit from wagging a grateful tail.

Sunday, December 20, 2009

A Little Knowledge Can Be Harmful With Respect to Mouthguards

Recently, a number of young athletes were asked by their team dentist, and an instructor of a dental school Sports Dentistry course, to exchange their PlaySafe Heavy Pro mouthguard in favor of wearing a special mouthguard to help bring awareness to breast cancer.

It was a touching suggestion by the dentist. The athletes were eager to help. Little did they know, that in doing so, by placing their trust in the dentist, their lives would be drastically effected.

For those of you that are not familiar with Glidewell Lab's PlaySafe Heavy Pro mouthguard, it is a custom fitted athletic mouthguard that is fabricated over a dental cast of an athlete's teeth using multiple layers of EVA (Ethyl Vinyl Acetate), heat and pressure. The final product being one of the most protective types of athletic mouthguards available. PlaySafe Heavy Pro mouthguards offer a protective cushion of 4-5 millimeters of thickness. PlaySafe Heavy Pro mouthguards offer the best possible protection to the athlete's teeth and soft tissue, and may reduce the incidence and severity of concussions.

The mouthguard that the dentist wanted the athletes to wear instead offered little protection, in one case, a mere 1.2 mm. Research and literature shows that to be adequately protective, mouthguards must offer at least 3mm of protective EVA.

If one looks closely to the top photo of the Breast Cancer Awareness mouthguard, one can see the outline of the teeth on the exterior of the mouthguard surface. One can see immediately that there is not enough thickness to be protective. Visually, it is similar to a teeth whitening tray.

These young athletes were now, unknowingly, putting their bodies in jeopardy and the dentist either had no idea or didn't care.

During one game an athlete wearing a pink Breast Cancer Awareness mouthguard received a concussion. The following week, the same athlete received a second concussion which ended his playing time for the rest of the season. During the same game, a second athlete wearing a pink mouthguard sustained a blow that resulted in slamming the mandibular teeth into the maxillary teeth and the fracture of 4 molars on the left side.

I treated the four fractured molars. At that time I took a panoramic x-ray. By viewing the film, the mechanism of injury was obvious, as well as preventable. The panoramic film was made using an Instrumentarium OP100D. The anterior bite stick has a known thickness of 2.0 mm. Using the built in calibration and measuring tool, it was determined that with the anterior teeth separated by 2.0 mm, the occlusal separation on the left side after the injuries were 1.7mm between teeth #14 & 19, 1.0mm between Teeth #15& 18 and 0.8mm between teeth #16 & 17. Clearly, the pink mouthguard DID NOT provide enough separation to be protective.

I contacted the team trainer and strongly urged that the pink mouthguards be immediately removed from action.

To be fair, mouthguards are a strong deterrent to injury, but cannot guarantee that they will totally prevent injury. Just like the football helmet cannot guarantee prevention of head injury. That being said, we need to do everything we can to provide the very best helmets according to research of product materials and fabrication technique. Same with athletic mouthguards. We need to provide state of the art mouthguards according to research and literature review.

The athlete's dentist maintains that the injuries are just a coincidence and that the pink Breast Cancer Awareness mouthguards are adequately protective and played no factor in the athlete's injuries.

The sad fact is the athlete's dentist could have had it both ways. He could have fabricated mouthguards that were both protective as a PlaySafe Heavy Pro mouthguard and promote Breast Cancer Awareness. The dentist chose not to.

Sports Dentistry courses are quickly becoming popular among dental professionals and dental students. Dental professionals and dental schools need to be aware that, in many cases, the instructors of these courses have no formal training in the subject. The best resource for obtaining sports dentistry education is through the Academy for Sports Dentistry, the foremost authority on the subject; or from an instructor that has earned an Academy of Sports Dentistry Fellow award (F.A.S.D.). To become a Fellow, one must be a member of ASD for a minimum of 5 years and have earned at least 400 continuing education units in Sports Dentistry. Dental professionals, as well as athletic organizations, need to be aware that mere membership in the Academy for Sports Dentistry may not reflect the true knowledge of the course instructor or the team dentist candidate. As seen, a dentist with a little knowledge can be harmful with respect to mouthguards.

If you would like more information regarding PlaySafe Mouthguards contact Glidewell Dental Lab at 1-800-854-7256. If you would like more information regarding the Academy For Sports Dentistry, please visit their website:

Tuesday, August 25, 2009

How did I get here?

My father, Huntley Johnson, practiced dentistry here in Berkeley, California for 43 years.
For the first 20 plus years, he was also a clinical professor at the College of Physicians and Surgeons, which became The University of the Pacific, School of Dentistry and is now known as the UOP, Arthur Dugoni School of Dentistry in San Francisco. Every dentist that came out of that dental school between 1954 and the early 70’s had to go through my father. Apparently he wasn’t a push over, more on that later.

In 1986, my father fired his office manager. He asked me if I could help out at the front desk for a short time while he searched for a replacement. That short time turned out to be almost 4 years. During that time I learned a lot about the business of dentistry. Prior to working in my father’s office, the thought of me being a dentist never crossed my mind.
However, while I was there, I observed my father enjoying going to work everyday.
For the most part, his patients actually seemed to enjoy seeing him as well.

My father did not practice in a rut. He constantly was seeking out new ways to give his patients the best dental care available. Continuing education was a very important component in his dental philosophy. In the early 1970s he began to introduce tooth colored fillings into his practice. By the early 1980s he had totally eliminated dental amalgam from his practice, in favor of a technique known as “bonding.” In the mid 1980s, he along with another general dentist and an oral surgeon brought dental implants to the community.
This service would greatly improve the quality of life in many edentulous (missing teeth) individuals. Over my 4 years in my father’s office I would see that dentistry can be enjoyable and rewarding, and there is no better feeling than having just changed someone’s life for the better.

Also in the mid 1980s, my father had an associate. I owe much of my decision to become a dentist to his associate. The associate moved on and is now a well known and well respected dentist. But in the mid 80s, I concluded that if this guy can be a dentist, anyone can. So began my quest for attending dental school.

In July 1990 I walked into my first dental school classroom at 2155 Webster Street, home of the University of the Pacific, School of Dentistry. I very quickly discovered that though I was there to learn all I could about the art and science of dentistry, many of my instructors approached my education differently and critical thinking was not well received. Suffice to say we both had a challenging three years together. I can say I enjoyed the entire experience.

The teaching philosophy at UOP was "do what we say and you will attain the information to become a licensed dentist in the state of California." Asking why one does what one says upsets the process. Suffice to say, I upset the process.

The tone was set early in my first year.

On this particular day, I was in my Pre-Clinical Operative Dentistry Class. This day’s topic was “Tooth Colored Bonded Fillings.” Our instructor was the chairman of the Operative Dentistry Department. He began his lecture. I was all ears. He got to the part where he was describing the need to etch a cavity preparation with 37% phosphoric acid for only 15 seconds, then rinsed vigorously off with water spray. He forcefully stated that this solution should NEVER, EVER, EVER come in contact with a part of the tooth known as dentin. Listening intently, I became perplexed. A short time earlier, I was in my Pre-Clinical Fixed Prosthedontics Class. The topic of the lecture was Zinc Phosphate Crown cement. This is the cement that we were being taught to use for luting crowns onto teeth. Now without getting too technical, we were taught that in order for a tooth to be sufficiently prepared to accept a crown, the tooth had to be ground away approximately 1.5 mm around its sides and biting surface. This procedure, if fact, guarantees that virtually 100 percent of the exposed tooth is dentin. Zinc Phosphate cement is made from zinc oxide, magnesium oxide and phosphoric acid. Once mixed and placed on a tooth it takes almost 7 days to reach a neutral pH. Another way to say this is that the tooth is exposed to an acid environment for almost a week! Something doesn’t make sense. I raised my hand.

“Excuse me, Dr Simon, I’m confused. Can you repeat what you just said?”
The chairman of the Operative Department said again, “NEVER, EVER, EVER, ETCH DENTIN WITH PHOSPHORIC ACID.”

“Uh…well, Dr Simon, I’m still confused. Earlier we were taught about using zinc phosphate cement for placing our crowns on teeth. We were told that it takes 7 days for the cement to become neutral pH. If that is true, why are you stating so emphatically not to get phosphoric acid on the small amount of exposed dentin in a cavity preparation, especially since it will be rinsed off after 15 seconds?”

The room got very silent. One hundred and forty dental students all got suddenly interested in the discourse.

Dr Simon replied, “Because that is what I am saying.”

Now I’m sure that answer was good enough for 99% of my class, but it wasn’t good enough for me. I replied, “All do respect Dr Simon, I do not pay forty thousand dollars a year to be taught “because.”

The tone was definitely set.

Until next time……


Monday, August 24, 2009

Greetings and Welcome!

The purpose of this blog is to educate.
I believe one doesn't know what one doesn't know.

I get many questions regarding dentistry and my dental practice.
Some of the most frequent are:
  • What is Sports Dentistry?
  • How can you practice restorative dentistry for 15 years and never use dental amalgam?
  • Why don't you do root canals?
What really surprises me is that these questions are asked by other dentists!
  • Sports Dentistry is the treatment and prevention of oral/facial athletic injuries and related oral diseases and manifestations. Many dental injuries are a result of trauma to the head. It is important that the dentist not only focus on the dental injury, but also be knowledgeable to determine whether or not the patient/athlete has suffered a mild traumatic brain injury (concussion). Smokeless tobacco use is common among athletes. Are you aware women athletes use chew too? Do you know what to look for?
  • I have never used dental amalgam in my practice. I do not use dental amalgam because of its mercury content, but simply because there are better materials.
  • The vast majority of my patient's dental pain can be resolved without the need for a root canal. However, should my patient require root canal, I refer to a specialist.
I hope you enjoy reading my future posts. Please feel free to comment.

I'm hungry for knowledge.
Are you?

Dr J