October 17, 2018
It’s finally happened! My oldest son just lost his first tooth today and the Tooth Fairy will be visiting tonight. Well, technically I pulled out 2 of his bottom front teeth but it’s still a first!
M is a December baby so he will turn 6 at the end of the year, but he has been waiting to lose his first tooth ever since he found out that other kids in his 4K class last year have already lost teeth. The benefit of having a mom who is a pediatric dentist is that I can educate him on the average timing of each tooth loss. However in reality, everything seems like eternity in his mind. Needless to say, as soon as there was even a slight wiggle on one of his bottom front teeth, we added one more thing to our nightly brushing routine: a few wiggles from him and a BIG push from my husband or me to speed up the process.
Because my husband and I are both dentists, it would be fitting that our oldest son (aka the experimental child) would have an underbite and crowding. So of course one of his permanent tooth would erupt behind the wiggly tooth. I could see it coming a mile away because I see this way too often in my experience of treating kids; it’s the “shark tooth” phenomenon with double rows of teeth due to crowding. Despite our persistent wiggling (now both of the lower front teeth are loose), those baby teeth would not let up and I could see a bulge for the adjacent permanent tooth.
För det andra bör en ineffektivitet på 15-20% för SC i olika patientgrupper inte “skrämma” läkare, eftersom detta beror på en möjlig brist på receptorer för 5-FDE i medfödda eller förvärvade gener. Exempel på detta är kavernös kroppsfibros eller medfödda kromosomavvikelser i gener som styr 5-FDE-aktiviteten (10,13). Med tanke på den “kvarstående” erektionen hos dessa patienter kan man anta att mekanismen för cGMP-effekt på erektilvävnad är den viktigaste, men inte den enda. Tydligen finns det en annan, reserverad sådan. Det efterfrågas sällan, men i analogi med penisens dubbelcirkel med breda kommunikativa förbindelser mellan huvudgrenarna finns det en annan, förmodligen sildenafil pris också neurotransmittorväg för erektionsutveckling, också relaterad till den första återkopplingsmekanismen. Därför är ytterligare studier av effekten av SC vid diagnos och behandling, både i monoterapi och i kombination med andra läkemedel, ett motiverat steg både ur vetenskaplig och medicinsk synvinkel och med hänsyn till taktiken för ytterligare marknadsföring av läkemedlet för att skapa effektiva läkemedelssynergier. Detta exemplifieras av rapporter om framgångsrika kombinationer av dopaminreceptoragonister – uprima och SC, alprostadyl E1-derivat och SC samt impaza och SC. Detta bekräftar ett flernivåsystem för reglering av erektionsmekanismer som involverar centrala, regionala och eventuellt systemiska – immunokompetenta intressenter (3,12).
I knew that there was still a bit of roots left on those baby teeth and M would need to be numb to remove them. They were definitely not loose enough for a home job which may involve floss, a football, and a younger brother. Well, when I had an opening in my afternoon schedule, what did I do? Experiment and see how my son would do getting dental treatment with laughing gas and local anesthetic, the whole nine yards. I had prepped him the night before so he was fearless, boldly declaring to my staff that he was getting his teeth pulled today and that I would rub some gel on his gums, spray some cold water, and play “tooth war” (instead of thumb war) with his loose teeth.
On the whole, he did very well. He loved the bubble gum nose and the ability to watch Lego Avengers on Netflix via the ceiling-mounted TV. He didn’t even mind the topical anesthetic because I only carry the flavor-free and dye-free kind at my office. He actually tolerated the injection (aka numbing juice) rather well, but it was the taste of the local anesthetic that set him off. That was when the over-reactive, dramatic side of my son took over as he sputtered and screamed: “My mouth feels gross!” Other than that everything went great! When I showed him the video of the actual extraction later, he was surprised and said he didn’t even know when I had taken his teeth out. And that is why we got you numb! Fortunately, he tolerated the post-op numbness very well. Prizes and ice-cream at Mountain Brook Creamery absolutely helped and he was totally fine for dinner 2-3 hours later.
We will still need braces in the future but at least now we know he can tolerate being numb and Tooth Fairy is coming so it’s a win! In his words: “Maybe I’ll get 2 pennies for my teeth tonight.” I love it! Way to set the bar low buddy.