As the new year begins, you may be thinking of ways to increase revenue in your practice. Although this approach isn’t new, comprehensive dental care is only routinely followed by about 20% of dental practices. Most procedures on the doctor’s schedule involve one tooth based on an acute condition. The comprehensive approach won’t apply to every single patient, but it will definitely be beneficial for a fair number of patients.

Many dental professionals forget that they are the expert when it comes to dental care, and simply focus on the task at hand. It’s extremely prudent to take a step back and look at the entire picture or the patient as a whole. Also, seeing patients every six months for years and years makes the team tend to overlook potential treatment that has been on the patient’s “to-do” list. Following are some tips to help implement the comprehensive approach:

  1. The Comprehensive Examination- The comprehensive examination is an all-inclusive oral health evaluation usually performed on a new patient. However, it’s also important to do a comprehensive exam on established patients at least every three years. This exam includes a thorough evaluation of the medical history,  a full set of x-rays, periodontal charting, existing dental conditions, short-term treatment, and long-term treatment goals.
  2. The Comprehensive Treatment Plan- The comprehensive treatment plan includes prioritizing needs and creating a long-term strategy. This opens the door for a one on one discussion with the patient and should include plenty of time for discussion and questions. Visual aids should be incorporated and time should also be allotted with the financial coordinator to make any necessary financial arrangements.
  3. Re-evaluation of the Treatment Plan- It’s imperative to revisit the original treatment plan and update as needed. Referencing the original plan at least once per year reminds the patient that you’re valuing their overall health and not just treating immediate issues. The re-evaluation also takes into consideration any new technologies and treatment options. Team members should be included in the re-evaluation process because patients spend a lot of one on one time with them as well.

Taking this approach will not only ensure that patients are receiving the best care but also increase production and satisfaction in the practice.

Crowns, Fillings, Implants, and Bridges are just some of the terms your Dentist may have mentioned during your appointment. Restorative dentistry is the phrase used to describe how missing teeth are replaced or the restoration of damaged or decayed teeth. The goal is to maintain your smile, prevent future issues, and restore proper form and functions thereby keeping you comfortable and happy. What do these common terms mean?

  1. Crowns- also referred to as “caps.” A crown is a custom-made restoration that is permanently cemented to the tooth. The tooth is prepared for the crown by reducing the size and shape. Impressions are taken and usually sent to a laboratory where the crown is fabricated. A temporary crown is placed on the tooth while the permanent crown is being made. Crowns are necessary when there isn’t enough viable tooth structure left for a filling. This procedure is changing and evolving making it easier and more time efficient with the usage of dental scanners.
  2. Fillings- A filling is necessary when the tooth has decayed (a cavity). Before the filling is placed, the dentist will remove the decay and then fill the area with gold, silver (amalgam), or composite resin (tooth-colored). The most common material used today for fillings is tooth-colored composite resin. This resin is available in many different shades and can be matched to most all shades of enamel.
  3. Implants- Although unfortunate, sometimes a tooth must be extracted (pulled). Today, we are very fortunate to have implant technology. An implant is usually a titanium “screw” that is placed into the bone acting as the root of the tooth. An “abutment” goes into the implant and sticks out above the gumline so that a crown can be cemented to the abutment.
  4. Bridges- A bridge is another restorative treatment to replace a missing tooth. It’s usually three teeth in a row and is one solid piece cemented to the adjoining teeth on either side of the missing tooth. On either side of the missing tooth is a natural tooth (referred to as the Abutment) with an “artificial” tooth in the middle (referred to as the Pontic).

These are just some of the more common restorative procedures performed in the dental office. As a patient, please voice your concerns and ask questions regarding your treatment and all available options. Communicate with your dental team to ensure you receive the best outcome for your situation.

Silver diamine fluoride (SDF) is a “colorless liquid that has a pH of 24.4% to 28.8% (weight/volume) silver and 5.0% to 5.9% fluoride”. It has been used globally for decades in the treatment and prevention of decay. The FDA approved Silver diamine fluoride for the use of desensitization in 2014, and it became available in the U.S. in 2015. Although approved for use in desensitization, it is being used off-label to treat decay in specific situations.

There are some reasons why you may have never heard of it or been approached by a company representative to begin using it in your practice. Only one company in the U.S. sells SDF under the brand name Advantage Arrest (Elevate Oral Care, LLC). Perhaps the most important usage note of SDF is that it will stain most oxidizable surfaces black upon exposure to light because of the formation of a silver oxide layer. Skin and soft tissue will discolor within minutes to hours after contact and fade away within a few days as the tissue sloughs off and renews. Dentin and enamel with no demineralization may receive surface stain that can be removed with pumice. However, demineralized tooth structure will stain black permanently.

Permanent black staining may or may not be a deal breaker depending on the location of the tooth. What are some of the advantages and disadvantages of placing SDF?

Advantages:

  1. Provides immediate relief from dentinal hypersensitivity
  2. Strengthens and hardens softened dentin
  3. Arrests active caries if applied at proper intervals
  4. Makes treatment available to patients who can’t afford extensive dental treatment, patients who can’t withstand treatment, or those who are unable to get to the dentist
  5. Can be used effectively to halt recurrent decay and prolong the life of extensive dental restorations or provide relief to questionable restorable teeth
  6. Provides clinical proof of hidden carious lesions
  7. Very cost effective and easy to apply, but caution must be used in application

Disadvantages:

  1. Permanent black staining of demineralized tooth structure and temporary staining of mineralized tooth structure and soft tissues
  2. Requires more than a single application
  3. Unpleasant metallic taste
  4. Can irritate gingival and mucosal surfaces
  5. Insurance may not cover
  6. Can’t be used on patients who are allergic to silver, pregnant patients, or in the presence of open soft-tissue lesions
  7. It’s corrosive to metal and glass

SDF is worth looking into for very specific cases and could be of use in your practice.

Once upon a time, advertising a dental practice included word of mouth, referrals, mailers, phone book ads, and very few other options. Today, while the marketing possibilities seem endless, there is a learning curve. With the introduction of the internet, advertising and marketing have evolved into this awesome opportunity which can be very cost effective for your budget and produce excellent results for your practice.

Participating in social media is mandatory these days because it’s estimated that 75% of consumers turn to social media for help with purchasing and personal care decisions. Therefore, using social media effectively can boost the power of your patient referral marketing programs dramatically and cost efficiently.

Following are strategies to help get your social media campaign off of the ground:

  1. Choose a team member to spearhead the project- Launching a media campaign is extremely important, and a team member who is fluent in social media or can learn it quickly should be in charge of daily handling. A marketing coordinator can either establish and run the campaigns daily, or teach a team member to manage the social media feeds. Social media accounts must be monitored and engaged with daily. It’s time-consuming, but the pay off can be enormous.
  2. Begin with Facebook- Facebook is the biggest hitter in the social media field and attracts the broadest range of media users. Facebook has a wide range of interests, and any person or business can join easily. Other platforms concentrate on specific content and certain demographics making them a little more involved and time-consuming. Facebook also interconnects effortlessly with other social media sites such as Instagram, Twitter, and Google+.
  3. Entice and encourage followers- Simply ask all patients to “like” your page and posts and have them “follow” the practice. Most patients will know what you want them to do and it’s certainly simple. Post interesting and informative material and have straightforward giveaways and contests. You have to give people a reason to want to follow you and take the time to read what you’re posting.
  4. Don’t stray too far from the topic- Be mindful of what you want to accomplish and don’t stray too far off topic in your engagement. Stay focused on dentistry and branding for your practice. Build the value of your practice by discussing continuing education courses taken by the team, new technology, awards, fun trips, and personal experiences of the team. You want to make the practice seem knowledgeable and professional while keeping it approachable and friendly as well.
  5. Don’t be limited to words- Graphics including pictures, meme’s, and gif’s engage people much quicker than words and can be humorous making patients want to see what you’ll post next.

Establishing a social media presence will be one of the most important steps in taking your practice to the next level and establishing what can be an incredible and cost-effective marketing tool.

As 2017 comes to a close, perhaps it’s time to consider an important resolution for your practice. While this can be overwhelming, focusing on one of the most important and often overlooked issues in dentistry is important for the well-being of your practice and your patients. I’m referring to adopting and adhering to the disposal of single-patient-use products after each patient.

Single-use refers to “an item which has been manufactured to be used in a single procedure on a single patient.” The Food and Drug Administration (FDA) requires that medical facilities establish that a reprocessed single-use device is “as safe and effective as it was when originally manufactured.”

More often than not in dental offices, some single-use products are reused which is a bad idea. Even if the item is “sterilized,” it can rarely be as safe and effective for subsequent uses as it was when originally manufactured.

One of the most frequently reused items is burs. When removed from sterile packaging, a bur is in pristine condition exhibiting razor like sharpness and excellent cutting proficiency. After its first usage, debris gets embedded into the surface of the bur making it very difficult to clean and sterilize. Upon repeated use, the burs efficiency is greatly diminished making preps more time consuming and tedious.

As you look forward to 2018, consider disposing of single-use items after each use. It’s more cost-efficient than you may think, and it will make each prep go faster and smoother.

Edna Sheffield, RDH

The American Heart Association and the American College of Cardiology released new guidelines for Blood Pressure which is significant since these guidelines haven’t changed for a decade. What exactly does this mean for patients in the dental chair since the new recommendations eliminate the prehypertension category and lower the threshold for hypertension?

The new guidelines are as follows:

Category              Systolic (Top Number)        Diastolic (Bottom Number)

Normal                              Less than 120       and                     Less than 80

Elevated                            120-129                 and                     Less than 80

Hypertension Stage 1     130-139                  or                          80-89

Hypertension Stage 2     140+                        or                           90+

Hypertension Crisis         180+                   and/ or                      120+

Taking the patient’s blood pressure at each appointment is extremely important considering approximately 85% of people with high blood pressure aren’t even aware of its presence. It’s often called “The Silent Killer” because there are few symptoms until it’s at crisis levels. Untreated hypertension puts patients at risk for heart disease, stroke, kidney damage, dementia, and blindness.

The connection between high blood pressure and dental treatment is twofold. First, taking the patient’s blood pressure at the beginning of each appointment determines if the patient has hypertension, and depending on the reading, whether the treatment will need to be delayed. If the reading is elevated or Hypertension Stage 1 or 2, dental treatment can be performed, but a referral to the patient’s physician will be in order. If the reading is determined to be Hypertension Crisis, treatment must not take place, and the patient should go directly to the nearest emergency room. Hypertension Crisis should be treated as a medical emergency. A reading in this range signifies that the patient could suffer a heart attack or stroke at any moment.

Investing in a couple of quality electronic blood pressure monitors and taking the time to record and evaluate these readings before the procedure could save a life.

This holiday season, you may be wondering about legends such as Santa Claus and the Tooth Fairy. While both are very well known, less is known about the origin of this lovely lady who appears after a child has fallen asleep to retrieve a precious tooth in exchange for a gift or money.

Rituals involving the loss of deciduous (baby) teeth have been followed since the beginning of recorded human culture. These customs were pretty unusual ranging from wearing the tooth on a necklace to throwing it into a fire. Practices such as these were followed to ensure the child be granted good health and prevent bad luck for the family or tribe.

In the 1970’s, Rosemary Wells (a professor at Northwestern University Dental School) made it her life’s mission to find out more about this iconic fairy. Ms. Well’s research uncovered the possible reasons that the tribal rituals transcended into a more appealing way to handle the loss of a tooth.

The Tooth Fairy appeared on the scene during the 20th century. It’s thought that perhaps the emergence of a fairy would lessen the trauma a child may associate with the loss of a tooth. The appearance of a nice woman bearing gifts would take away some of the fear. Parents also benefit from a more pleasant transition as children losing teeth often feels like the child is growing up too fast.

The tooth fairy has also kept up with inflation. These days, a tooth can fetch anywhere from $3-$5 while in years past, as little as one cent was left for a tooth. Whatever the reason may be for this age-old tradition, it seems to lessen the unpleasantness for the child and parent.

You’ve probably seen the term “oil pulling” and wondered if it’s a practice you should adopt. First of all, it’s not a new trend. Oil pulling dates back over 3,000 years as an Ayurvedic medicinal practice. The process involves swishing or pulling a tablespoon of an ingestible oil (sesame, sunflower, or the favorite coconut) around the mouth for 20 minutes. Pulling refers to the process of working the oil in your mouth by pushing, pulling, and sucking it through your teeth with the goal of killing unfriendly bacteria. The idea behind the method is that the fatty molecules in the oil attract and bond with the fatty membrane surrounding each bacterial cell.

Coconut oil is preferred because it contains lauric acid which has tenacious antimicrobial and antibacterial properties. The lauric acid also deters the growth of the bacteria which causes tooth decay. The proposed dental benefits of oil pulling include reversing gingivitis, curing halitosis, reducing tooth decay, and whitening teeth. In addition to these dental benefits, other perceived benefits include alleviating chronic headaches and migraines, managing diabetes, increasing energy levels, detoxifying of the body, and healing skin conditions such as acne, eczema, and psoriasis. It is believed that oil pulling reduces inflammation in the body thus boosting the immune system and detoxifying the body. This, in turn, reduces the occurrence of illnesses and diseases.

Being an alternative health practice, oil pulling has definitely seen its share of controversy. There is little scientific evidence showing this process as effective. There are actually some potential negative side effects which include xerostomia (dry mouth), excessive thirst, muscular stiffness (from moving the muscles for 20 minutes every day), and loss of taste or sensation in the mouth. Another side effect which can hurt your pocketbook is clogged pipes. Spitting the oil into the sink can cause the oil to clog the pipes ultimately costing you a visit from a plumber. If you’re going to oil pull, spit the excess into a trashcan or outside. Don’t swallow the oil because it contains all of the toxins you’ve been trying to remove from your body.

What’s the verdict? There is little harm in giving oil pulling a try. However, it doesn’t take the place of brushing, flossing, and visiting the dentist at least twice per year for prophylaxis and examination. This practice doesn’t miraculously heal decay that’s already present or periodontal disease. The American Dental Association doesn’t recommend oil pulling as a dental hygiene practice based on the lack of scientific evidence.

Losing your natural teeth and getting dentures can be both frightening and exciting. It’s a very emotional time, and being prepared for what you may experience during the process and how to care for your new smile will ease the transition. There is definitely a period of adjustment, and communication with your dentist during this time is paramount.

Let’s discuss what you can expect the first 30 days of wearing dentures.

Day 1:  The first day can be very difficult. More than likely, you’ve had some extractions (teeth pulled), and the dentures have been placed over the extraction sites acting as a band-aid. Pain relievers and antibiotics are most likely prescribed, and you must take them as directed. You will not remove the dentures on this day.  You will return to the dentist on day 2, and he/she will remove the denture. Your diet on day one should consist of very soft foods such as soups, mashed potatoes, ice cream, and macaroni and cheese.

Days 2-14: This is a time of healing, and you may experience increased discomfort from sore spots and also an increase in saliva. You will visit your dentist regularly for adjustments, and this may take many appointments.  Don’t be afraid you’re bothering the dentist. It may take a lot of adjustments to get your dentures feeling just right. Your diet will still consist of mainly soft foods as tolerated. If you’re experiencing a lot of discomfort that is keeping you from eating, you may want to include a vitamin and protein rich drink such as Ensure to supplement your diet.

Day 15 +: Your saliva secretion should return to normal, and the sore spots should be healing. You may still be experiencing trouble speaking and eating, but as time passes, this should get easier. Don’t get discouraged. Your dental team will be happy to support you in this time of transition.

Although they are “false teeth,” dentures must be cleaned at least twice per day as you would your natural teeth. There are special denture brushes and pastes for denture cleaning. There are also soaking tablets you will use once per week to keep your dentures healthy and looking good.

You may or may not find the use of a denture adhesive useful. A denture adhesive is a thin glue-like film placed inside of the denture to form a seal keeping the dentures in place and keeping out food particles.

Deciding to get dentures is never an easy process. However, honest and open communication between you and your dentist can ensure you end up with a smile that is both functional and attractive.

As the end of the year approaches, the last thing on your mind is a visit to the dentist. However, you should reconsider if you’ve been paying monthly premiums all year. Most insurance plans operate on a calendar versus a fiscal year. This means that your benefits start over on January 1st and the benefits from the past year don’t roll over. Following are some compelling reasons to pick up the phone and make an appointment with your dentist as soon as possible.

  1. Deductible- A deductible is the amount of money you will pay out of pocket before your insurance takes over and begins paying for services. The average deductible for most insurances is $50 per year. This amount can be higher if you visit a dentist that is out of network. Also, if you’ve already paid your deductible for the year, it may be worth your while to have additional treatment because your deductible will renew after the first of the year.
  2. Yearly Maximum- A yearly maximum is the maximum amount of money your plan will cover within the calendar year. The average amount is $1,000-1,500 per person/year. If these benefits go unused, they simply go away on January 1st.
  3. Premiums- If you are having money taken out of your hard-earned paycheck each month for dental insurance, you should take advantage of the services for which you’re paying. Even if you aren’t in need of fillings or crowns, the American Dental Association recommends visiting the dentist at least twice per year for prophylaxis (cleaning) and examination.
  4. Fee Increases- Many employers change insurance carriers from year to year, and many dentists increase fees at the first of the year. By not using your current benefits, you run the risk of paying higher copays and higher fees from the dentist.
  5. Exacerbation of a simple fix- Delaying treatment can certainly turn a simple fix into a much more involved procedure. Fillings can turn into root canals and crowns, and gingivitis can progress into periodontitis. Treating problem areas sooner rather than later is a very good idea.

So, call your dentist today to make an appointment and have any outstanding treatment completed if it makes sense. Calling earlier in December is best to guarantee you’re in great shape and treatment is completed before the clock strikes twelve on Dec 31st

Autism is a brain disorder that affects communication, social interaction, and often demonstrates repetitive behavior. Forty percent of autistic individuals are non-verbal, but they may understand language. Social interaction problems include an inability to read facial expressions, poor eye contact, and difficulty with social and peer interactions. The child with Autism may also not comprehend the flow of conversations and may engage in repetitive speech or inappropriate responses.

These children tend to be very sensitive to sensory input and have strong reactions to smells, sounds, taste, sights, texture, or human touch. Being prepared is the key to treating these kids successfully in the dental office.

Autistic patients don’t differ from other patients with regards to dental issues. They may present with tongue thrusting, bruxism, erosion, xerostomia, self-injury, hyper gag reflex, and a high rate of plaque and caries due to poor homecare and increased sugar consumption.

The parent or caregiver plays a key role in the child’s life and serves as a liaison between the clinician and the patient. The parent/caregiver will be concerned about the child having a bad experience and may feel embarrassed if the child demonstrates poor behavior. The parent/caregiver is very important in preparing the child for treatment.

Following are some tips to follow before and during the appointment to ensure a positive experience for all involved.

  1. Before the appointment-
  • Treating the autistic patient begins on the phone when the appointment is made. The front desk must be familiar with how to question the parent/caregiver. For example, what time of day is best for the child? While it may vary, it’s best to schedule mid-morning or mid-afternoon at least 2 hours after breakfast or lunch and not near nap time. Having an empty stomach helps to avoid nausea or vomiting during x-rays or fluoride treatment.
  • Any paperwork should be completed before the appointment.
  • The appointment should begin as soon as the child enters the office. Determine with the help of the parent/caregiver if the child would be more at ease in a private setting or if an open bay setting would be better. Some kids with Autism prefer an open bay setting especially if other siblings are being seen
  • The parent/caregiver will provide most of the information about the child making it easier for the clinician to operate at an optimal level.
  • Based on the information given by the parent/caregiver, schedule the patient with the hygienist or assistant who will be a good fit.
  1. The appointment-
  • Welcome the child taking care not to be too flamboyant or overwhelming. Talk briefly with the parent/caregiver about any last minute instructions or concerns.
  • Some Autistic children are more comfortable with the overhead lights off and a lead apron placed over them.
  • If the child has limited language skills, showing pictures to explain what you’re doing will ease the tension.
  • Use simple and short sentences.
  • Desensitization can also be favorable for the treatment of the autistic patient because of the gradual approach. A first visit may be simply a walk through the office. Each visit has the child experiencing more and more building on the previous visit.
  • Use a calm, soothing, and matter-of-fact tone.
  • Distraction may work, but autistic individuals are very literal and won’t understand being tricked or misled.
  • Homecare instruction should include the parent/caregiver. Give concise instruction without an abundance of steps. A quality electric brush is a good choice for an Autistic child. However, a sonic brush may not be tolerated due to its extreme vibration. An over-the-counter fluoride rinse is a great addition to the child’s daily routine when used with supervision.

Treating patients with Autism can be a very rewarding experience, and they can be awesome patients who are full of surprises once they get to know you.

As the season of eating approaches, it’s interesting to discover why we prefer and react to different types of foods. There are three classifications of tasters: General tasters (50% of the world’s population), Non-tasters (25% of the world’s population), and Supertasters (25% of the world’s population).

General tasters account for most of the world’s population and have a pretty “normal” reaction to most foods. They find most foods tolerable and don’t tend to like overly sweet, bitter, sour, or salty foods.

Non-tasters encompass 25% of the world’s population. This group has a hard time tasting and usually prefer heavy seasonings. They are inclined to prefer hot, spicy, high-fat, and sweeter foods. The only exception is salt because it counteracts the bitterness. Non-tasters also gravitate toward alcohol and have a higher rate of alcoholism. Because of their fondness for sweets, their decay and obesity rates are higher than the other groups.

Supertasters are a very interesting category. Comprising 25% of the world’s population, they are genetically programmed with a bitter receptor gene (TAS2R38). They react strongly to bitter tastes and find them highly objectionable. They are often referred to as “picky eaters.” These “bitter” tastes are moderately bitter and slightly bitter to general tasters and non-tasters respectively.  Supertasters are also more sensitive to sweet and fatty foods and tend to avoid them. The only exception is salt. As stated earlier, salt counteracts bitterness, so the supertaster tends to consume a lot of sodium. The majority of supertasters are women, African-Americans, and Asians. The supertasters tend to be slim and may have a higher risk of colon cancer because of their dislike for many vegetables.

The type of taster is directly linked to the number of taste buds present on the tongue. Supertasters have more taste buds than general and non-tasters. Non-tasters have fewer taste buds than supertasters and general tasters. Understanding the category to which you belong can certainly explain why you have certain preferences. It’s all genetic!

Permanent (Adult Teeth)  form in the jawbone during early childhood. Except for the Third Molars (Wisdom Teeth), all of the permanent teeth form by the age of 8. Dental Fluorosis occurs when too much fluoride is ingested while the permanent teeth are forming. An excess of fluoride can disturb the formation of the enamel and result in fluorosis. Most cases occur when a child is exposed to excess fluoride in toothpaste, fluoride supplements, or well water that has an occurring natural abundance of fluoride.

There are varying degrees of fluorosis ranging from minor discoloration and surface irregularities of the teeth to severe staining and major deformities. This excess fluoride affects the enamel and not the other components of the tooth.  Once the teeth erupt into the mouth, they are not susceptible to fluorosis.

While fluorosis can be very distressing, it’s considered a cosmetic condition and not a disease. It varies in appearance and may not even be detectable. In severe cases, the enamel has a mottled and brown spotted appearance. The tooth won’t be smooth and shiny like a normal tooth.

A Dentist will be able to identify fluorosis with a clinical examination and x-rays. There are some other conditions which may mimic fluorosis including craniofacial and developmental defects, repeated high fevers as an infant which affects developing teeth, and physical trauma.

Dental fluorosis is a permanent condition, and the spots on the teeth may darken over time. It can be prevented by closely monitoring your child’s brushing habits and the amount of toothpaste placed on the brush. A very small amount (the size of a pea) is imperative, and it’s important to teach the child to spit rather than swallow the paste. Always keep toothpaste and mouth rinses out of the reach of children. It is also suggested that well water be tested for fluoride levels so that children aren’t exposed to too much.

Fluorosis doesn’t usually require restorative treatment unless the teeth are aesthetically unpleasing. More often than not, any cosmetic treatment will be postponed until the child is between 16-18 years of age when they are more mature, and treatments such as orthodontics are complete. Treatment may consist of bleaching, bonding, veneers, or crowns depending on the severity of the situation.

Halitosis or Bad Breath can be a very serious and embarrassing mouth condition. It’s estimated that 75 percent of halitosis originates in the mouth itself due to poor oral hygiene. If you improve your homecare by brushing and flossing on a regular basis and bad breath continues, there may be another underlying systemic condition.

There is a link between halitosis and systemic conditions. Possible causes can be gastric disease, gingivitis, periodontitis, sinus or respiratory infections, external factors, dentures, tonsils, smoking, and Xerostomia (Dry Mouth Syndrome).

Gastric Conditions-   Stomach ulcers and acid reflux can be responsible for bad breath. It’s important that you seek guidance from your primary care physician who may refer you to a gastroenterologist for treatment. Your diet can also play a role in halitosis. Garlic, onion, coffee, and alcohol can account for a foul odor.

Gingivitis and Periodontitis-  Gingivitis is reversible and occurs when the gingival tissue is inflamed. It’s usually due to poor home care and can be treated by brushing, flossing, and visiting the dentist at least twice per year.  Periodontitis involves the deeper structures that hold the teeth in place and is not reversible. Regular visits with your Dentist are imperative for treating Periodontal disease. Furthermore, your Dentist may refer you to a Periodontist who specializes in the treatment of Periodontal disease.

Sinus or Respiratory Infections-  Sinus and respiratory infections can affect your breath. Drainage from the sinuses and coughing up mucus can cause a bad smell. Your primary care physician may refer you to an ear, nose, and throat specialist.

External Factors-  As stated earlier, garlic, onion, coffee, and alcohol can be the source of foul breath. Avoiding these foods and drinks can help.

Dentures-  Dentures can be the origin of bad breath because foods get trapped underneath and cause an odor. Removing the dentures at least twice per day to clean and soaking them once a week in a cleaner designed for dentures should solve the problem.

Tonsils- People who have really large tonsils are susceptible to experiencing bad breath because foods can get trapped in the large folds of the tonsils causing bacterial growth.

Smoking- Smoking is a huge factor in the cause of halitosis. Ceasing smoking will not only help with the breath, but it will also improve overall health.

Xerostomia- Xerostomia or Dry Mouth Syndrome occurs when there isn’t sufficient saliva production causing the mouth to be very dry. It can be due to medications, chemotherapy, radiation therapy, and certain diseases. There are prescription and over the counter products which can help with a dry mouth and improve the breath.

If you are experiencing bad breath on a regular basis and your home care is sufficient, you may need to do some further investigation to determine the cause of this embarrassing problem. A visit to your dentist is a great starting point.

E-Cigarettes have become increasingly popular in the United States, and there is a misconception that they are safe to the oral cavity. While e-cigarettes may be considered safer than traditional cigarettes, they are far from harmful.

Older adults usually begin vaping as a way to quit smoking. Younger adults start vaping as early as middle school thinking that the habit is safe. The health issues with vaping as with traditional cigarettes are nicotine, heat, and harmful additives.

  1. Nicotine- causes halitosis, gingivitis, periodontitis, gingival recession, and inflammation. Nicotine reduces the amount of blood flow and inhibits saliva production. Vasoconstriction can mask gingivitis and periodontitis because restricted blood flow will make it appear that there is no bleeding upon probing or scaling when inflammation and pocketing over 4mm is indeed present. Inhibition of salivary flow can lead to xerostomia and tooth decay.
  2. Heat- One of the greatest harmful effects of smoking or vaping is the heat from the flame or simulated flame. The temperature of the liquid in the cartridge is heated to over 400 degrees Fahrenheit. Stomatitis is observed in patients who vape, and it usually appears on the palate. Chemical burns throughout the oral cavity can also be present in patients who vape. Although rare, explosions of the unit while in use have been reported with varying degrees of injury to the user.
  3. Harmful additives- diacetyl is a flavoring chemical and the most harmful additive. It’s not present in all flavors, but it is prevalent. It’s the same chemical that’s used in some butter flavorings and responsible for “Popcorn Lung.” These additives can have a negative effect on the epithelial cells and fibroblasts within the PDL.

What is our responsibility as clinicians in regards to vaping? Patients who smoke or vape need to be aware of the risks associated with the habit. Again, while vaping does seem to be less harmful than traditional smoking, further research is necessary for the long-term effects on oral and overall health.

Electronic Cigarettes (E-Cigarettes, personal vaporizers, vapes, e-hookahs, and electronic nicotine delivery systems) were introduced in the United States in 2007. Acclaimed as safer than traditional tobacco cigarettes, older adults tend to use them in place of traditional cigarettes while young adults see them as a new experience and may never try traditional cigarettes.

E-Cigarettes are composed of three sections. The component nearest the mouth is the battery. The tip at the other end has a light which simulates a traditional cigarette. The middle section contains a micro compressor and sensor which detects when a puff is taken and signals an atomizer to heat up the cartridge containing a liquid to over 400 degrees. Heating the liquid forms an aerosol that is inhaled and when exhaled, a cloud of smoke is released mimicking a cigarette.  The process of sucking on the device and the production of the aerosol closely resembles cigarette smoking thus making e-cigarettes appear to be an attractive alternative to smoking traditional cigarettes.

The “Liquid” that is encased in the cartridge depends on the smoker, and most liquids contain nicotine in varying percentages. Other ingredients in the liquid include propylene glycol, glycerin, and enticing flavorings. Traces of known Carcinogens nitrosamines, formaldehyde, acetaldehyde, and phthalates can also be found.

Vape stores are popping up all over and visiting one can be a real eye-opener. The liquids are purchased to go into the cartridges, and they come in some pretty enticing flavors such as cake batter, bubblegum, mint, vanilla, cinnamon, pina colada, and every fruit flavor. In these flavors, you can choose varying percentages of nicotine. There are many different types of e-cigarettes. Some are rechargeable while others are disposable. They also vary in size, shape, and volume of aerosol exhaled.

Ironically, many older adults switch from smoking to vaping to avoid the harmful effects of tobacco. While vaping does seem to be less harmful than smoking, the truth is that more studies will be necessary to determine long-term effects. In our next blog, we’ll discuss the oral effects of vaping.

It’s that time of year again. The leaves are turning, there’s a nip in the air, and it’s time for Halloween. The age-old tradition of trick or treating has withstood the test of time, and little goblins look forward to donning their costumes and collecting sugary treats.

Children should be able to enjoy eating Halloween candy without developing cavities given a little guidance. There are different types of candy which can cause decay if proper steps aren’t taken to stop those cavity bugs dead in their tracks.

  1. Taffy, caramel, and other sticky and tacky candies are detrimental to teeth because they stick to everything inside of the mouth, including the grooves on the chewing surfaces of the teeth. The longer food sticks to the teeth, the longer bacteria can feed on it which causes acid production and decay.
  2. Hard candy such as suckers and jawbreakers are harmful candies to eat because they take a long time to dissolve thus bathing the teeth in sugar. The longer candy stays in the mouth, the more acidic the environment becomes.
  3. Sour candies are the worst choice. Any candy with a sour additive is automatically very acidic and can be very harmful to the teeth. It’s important to limit sour candies and rinse with plain water after eating to counteract the acid. Do not brush the teeth for at least 30 minutes following acidic treats because the teeth have been saturated in acid and brushing can cause more damage.
  4. Perhaps the “safest” treats are ones that are chewed and swallowed right away leaving little remnants in the mouth for bacteria to munch away on.

Halloween should be a fun time for kiddies and adults. Indulging in sweet treats in moderation is fine as long as precautions are taken to ensure that decay doesn’t follow. Make sure to drink and/or swish with plain water after sweet treats (especially sour ones), brush and floss at least twice per day, and use a fluoride rinse at home if recommended by your dentist.

10-24-2017

Canker Sores

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A Canker Sore is a very common condition that is identified by painful round ulcers on the tongue, the lining of cheeks and lips, the palate, or the base of the gums. They are symmetrical and shallow and have a red raised border. The exact cause of these ulcers is unknown, but the tendency to develop them is inherited. It’s believed that an immune abnormality contributes to the tendency for them to develop. There are two types of canker sores, Simple and Complex.

Simple canker sores are the most common, last about a week, and appear three to four times per year. Stress or tissue injury seems to be the cause of simple canker sores. Citrus and acidic fruits and vegetables (tomatoes, limes, lemons, pineapple, oranges, figs, and strawberries) can initiate a sore or make an existing sore worse. Mechanical irritation such as a dental appliance, ill-fitting dentures, a broken tooth, a cut with a toothbrush or tortilla chip, or a burn with hot soup or pizza can also trigger a canker sore.

Complex canker sores are less common, more intense, and are brought about by an underlying health condition. Celiac disease, Crohn’s disease, iron deficiency, zinc deficiency, B-12 deficiency, folic acid deficiency, or an impaired immune system may cause cases of complex canker sores. Treatment includes targeting the underlying cause.

While both simple and complex canker sores are very painful, there is no treatment or prevention. For severe cases, lasers and steroids have been successful in providing immediate pain relief. Other treatments include treating the symptoms. Warm salt water rinses and a bland diet helps. Anesthetic over-the-counter topical agents are also available, and when placed on the sore itself, numbs the pain.

Canker sores are not the same as Cold sores (Fever Blisters). Although confused often, cold sores are fluid-filled blisters caused by the herpes simplex type 1 virus. Cold sores typically occur outside of the mouth.

Canker sores usually run their course within a week or so and usually heal without treatment. Make an appointment with your dentist if the sores are unusually large, spread to an extreme, last longer than three weeks, produce intolerable pain, or are accompanied by a high fever.

Angular Cheilosis (also termed Cheilitis) is a condition that causes cracking and inflammation at the corners of the mouth. It can be very painful and occur on one or both sides when saliva gathers in the folds of the skin. This pooling of saliva provides an ideal environment for yeast (Candida) or bacterial infections.

Cheilitis is prevalent in patients presenting with:

  1. Orthodontics- braces contribute to Cheilitis because the brackets displace the lips making the closure of the lips difficult.
  2. Dentures which don’t fit well- Ill-fitting dentures can also cause gaps where the lips would normally close contributing to saliva collecting in the corners of the mouth.
  3. Continuous lip licking- this habit causes the lips and corner of the mouth to stay wet causing pooling of saliva.
  4. Malocclusion- When the teeth don’t properly occlude, a gap may be present forcing saliva out of the mouth.
  5. Thumb sucking- Sucking on the thumb causes saliva to keep the outside of the mouth moistened.

 Medical conditions which contribute to Cheilitis include:

  1. Iron or Vitamin B deficiencies
  2. Blood Cancers
  3. Diabetes
  4. Immune Disorders
  5. Down Syndrome
  6. Kidney, Liver, Lung, or Pancreatic Cancer

Symptoms of Cheilosis include swelling, pain, bleeding, blisters, itching, scaling, and cracking at the corners of the mouth. The lips can feel dry and uncomfortable, and there may be a burning sensation. There also may be a bad taste in the mouth.

Diagnosis includes evaluation of the fit and condition of dentures, oral habits, blood tests to evaluate for anemia or vitamin deficiency, and a culture of the area to determine the presence of yeast or bacteria.

Treatment involves adjusting ill-fitting dentures, steroids, antifungals, and antibiotics. Antifungal and antibiotics may be topical or systemic depending on the severity of the case. Although predominately a problem for the elderly, Angular Cheilitis can occur at any age and is easily managed when identified and treated promptly.

Plaque Biofilm has a very complex design with characteristics such as:   it’s a cooperative community arranged in microcolonies with channels in between, it’s encased in a protective matrix which manages the community and its needs, and it hosts a primitive communication system which sends out signals.

Surprisingly, it’s easy to remove this Biofilm, but it reforms very quickly making it difficult to maintain its absence. Brushing and flossing will remove the biofilm above the gumline, and some studies suggest that using a water jet device can remove or upset the Biofilm up to 6mm below the gumline.

Antibacterial agents in toothpaste are also helpful such as ones containing Triclosan. Mouthrinses containing Chlorhexidine (Prescription) and essential oils with alcohol are also effective.

It’s imperative that patients are seen at least every six months for dental prophylaxis to have the Biofilm removed in areas which can’t be reached underneath the gumline. Patients who are really susceptible to the bacteria in the Biofilm may need to be seen more frequently.

For those patients whose immune systems are suppressed, and are more reactive to the Biofilm, further intervention may be necessary. Antibiotics can be prescribed. However, antibiotics have a difficult time penetrating biofilms because their enzymes can break down the antibiotic before it can become effective. Site-specific antibiotics which are delivered directly into the periodontal pocket have been shown to be effective and less invasive than systemic antibiotics.

Researchers have been performing clinical trials on the amino acid L-arginine. While they’re not exactly sure how this amino acid disintegrates plaque biofilm, it appears to impede the cells from sticking together.

Although there doesn’t seem to be a lot of weapons in the war on plaque, scientists are working on more sophisticated ammunition. Until then, plaque must be fought daily to ensure proper oral and general health.

The definition of plaque and its impact on oral and overall health has developed over time into a complex interpretation. Furthermore, the evolution of an understanding of plaque has transitioned from a single bacteria to a complex community of a pretty sophisticated matrix. Today, we’ll take a look at the progression in the definition of plaque.

In the 1830’s during the Golden Age of Microbiology, it was thought that a single specific bacteria present in plaque was responsible for oral diseases. In the 1930’s, opinions held that decay, gingivitis, and periodontal disease was linked to a cause present in the host’s body such as calculus or a poor restoration. At this time it was thought that the entire bacterial flora of plaque was a factor in these diseases. In the 1960’s, thoughts returned to a specific bacteria in plaque being responsible for oral diseases.

In 1996, plaque was introduced as a “Biofilm.”  A Biofilm is defined as “any group of microorganisms in which cells stick to each other and often also to a surface.” The National Institute for Dental and Craniofacial Research hosted an international conference on microbial ecology that changed the dental professions thinking regarding plaque. What are some characteristics of a Biofilm?

  1. A biofilm is a complex “cooperating community of various types of organisms.”
  2. A biofilm is arranged in microcolonies with channels in between.
  3. These microcolonies are encased in a protective matrix which manages the flow of oxygen, nutrients, enzymes, waste products, and metabolites.
  4. The environments are different within the microcolonies.
  5. The microorganisms have a primitive system of communication which sends out chemical signals. These signals stimulate the bacteria to produce potentially harmful enzymes and proteins.
  6. Although the Biofilm is easily removed by mechanical methods (Brushing and Flossing), they reform immediately and easily.
  7. The microorganisms are resistant to antimicrobials and antibiotics.
  8. Biofilms are very common, and in nature, they can be very helpful. An example of a Biofilm in nature is slime on a rock in a pond or stream. In humans, Biofilms can be very detrimental.

Regarding this information, it’s easy to ascertain that plaque is pretty sophisticated and has complicated characteristics making it difficult to fight on a long-term basis. In our next blog post, we’ll examine ways to fight this incredible Biofilm.

Once upon a time, graduates of dental schools either obtained a loan and opened a practice or joined an established private practice. Economic conditions were certainly different, and getting a loan to open a new practice was easier to secure. Today, there is another option for new grads, and it’s becoming more and more prevalent.

The new option is DSO- Dental Service Organizations. A DSO is an “independent business support center that contracts with dental practices” and “provides business management and support to dental practices, including non-clinical operations.” In other words, the DSO purchases an existing practice or opens a new practice and implements their standards and procedures based on the laws of the State.  

Part of this change has evolved because of the new generation of dentists. At this point, 42% of Dentists are baby boomers over the age of fifty-five. Millennials are at the forefront of the transition to DSO’s because of economic conditions and the impossibility of starting a new practice. Most millennials graduate with an overwhelming amount of debt making opening a new practice impossible. Millennials also expect to practice with the latest and greatest technology which many private practices don’t possess.

With a DSO, you are an employee and the rules and regulations set by the DSO must be followed. Many practitioners see this as a positive because management is controlled by a third party.  A DSO also differs from a private practice in that they provide services seen in most professional businesses such as billing, IT, human resources, marketing, accounting, and payroll.

This business model is very controversial among dental professionals. While there are pros and cons, recent grads are drawn to this type of practice because it allows them to simply be an employee and focus on the practice of dentistry and paying off enormous student loans.

It’s Saturday morning, and you’re enjoying your child’s soccer game. Kids are running around everywhere when suddenly, a tooth gets knocked out. What now? When a tooth is knocked out is called “avulsed.” It usually happens in children’s sports, and it doesn’t have to be the end of the world. Prevention such as helmets and mouth guards help tremendously, but it still happens, and it’s quite scary.

Normally, teeth are connected to the socket by the Periodontal Ligament. When a forceful blow to the face is experienced, this ligament can stretch and split in half.  At this point, the tooth is displaced from its socket in the bone and comes out.

So, what do you do when you have a screaming bloody child with a tooth out? First of all, don’t panic and access the situation. If it’s a baby tooth, nothing needs to be done. Baby teeth don’t need to be reimplanted. A visit to the dentist will be necessary, but losing a baby tooth isn’t necessarily an emergency unless other factors are present such as lacerations or bone breakage.

If it’s an adult or permanent tooth, find the tooth. It may be dirty, but never touch the root surface because it’s covered with cells and fibers that need to stay intact for successful reinsertion. The best outcome is getting the tooth back into the socket by a dental professional. However, this isn’t always the only option.

Getting to the Dentist within an hour is ideal. Place the tooth in “Save a Tooth” kit and get to the dentist asap. “Save a Tooth” is a kit that’s available over the counter and has everything necessary to prepare a tooth for reinsertion by you or a dental/medical professional. If you can’t get to the dentist, use the save a tooth kit and follow the directions by rinsing the tooth very gently and then reimplant the tooth in the socket taking care to place it correctly. All sports complexes should have save a tooth kits, and it’s a good idea always to keep one on hand.

If you don’t have a save a tooth kit, you can use whole milk to gently rinse the tooth (only if it’s dirty) and reimplant it into the mouth. If the child has other injuries, it will be necessary to transport the tooth with the child to the ER or urgent care. Milk or Saliva are the best transporters if you don’t have a Save a Tooth Kit. Try to avoid ice water, salt water, and sports drinks. Also, keep the tooth submerged in the suggested liquid. Do not wrap the tooth in a napkin or handkerchief.

Reimplantation within an hour provides the best outcome for the tooth to reattach successfully. Don’t be afraid of handle the tooth by the crown and place it back into the socket. It’s much easier than you think, but if it’s not going in easily, turn it around to see if you’re putting it in backward. If it still doesn't go in easily, transport the child and tooth to the dentist, ER, or urgent care with the tooth in the suggested fluid.

It’s estimated that nearly 30 million Americans have diabetes and many aren’t aware of the impact on their oral as well as overall health. Research reveals that there is an increased incidence of gum and periodontal disease for those with diabetes. Further research also suggests that oral disease affects blood glucose levels.

If blood glucose levels are poorly controlled, you are more likely to develop gum and periodontal disease because you are more prone to infections overall. Gum disease is reversible and limited to the gingiva. However, if left untreated, it can develop into Periodontal disease which affects the surrounding structures and isn’t reversible. Furthermore, Periodontal disease may have an impact on blood sugar increases making diabetes more difficult to control.

Other mouth issues that plague people with diabetes include Thrush (Fungal Infection), dry mouth syndrome (Xerostomia), bacterial infections, and decay. Thrush is common in people with diabetes who have dentures if the dentures aren’t removed and cleaned regularly.

Dry mouth syndrome can cause an increase in decay as saliva is a natural cleanser. A dry mouth is also very uncomfortable and problematic. There are several over the counter and prescription remedies which can be recommended by your Dental professional. Decay can also be arrested by treating a dry mouth.

The most important things you can do if you have diabetes is controlling your blood glucose levels and having impeccable oral hygiene. This means visiting your dentist at least twice per year for routine cleanings and brushing and flossing at home on a regular basis. Your Dental professional may have you come in more than twice per year depending on your oral health. Brushing at least twice per day and flossing at least once daily is mandatory. Many patients find a quality electric brush to be of great value.

Your Dental team should be kept aware of your diabetic condition. You may want to avoid any nonemergent visits if your glucose levels are not regulated. Working with your Dental professionals will ensure that having diabetes and a healthy mouth is not impossible.

In part 2 of this blog, we’ll discuss some ways to deal with the common fears that keep people from going to the Dentist on a regular basis.

  1. Nitrous Oxide- Laughing Gas- This is a form of sedation which is easy and effective. Nitrous Gas mixed with Oxygen is inhaled to create a feeling of relaxation. Nitrous is great because the feeling only lasts while inhaling, so you don’t need anyone to drive you to and from the appointment. Many patients report feelings of “lightness” and “relaxation” to the point where they don’t mind dental treatment. The amount of Nitrous inhaled can be easily adjusted so there’s no need to worry about overdosing. Nitrous is also safe for children since the percentage can be altered.
  2. IV Sedation- This is used for more involved dental procedures such as oral surgery (extraction of wisdom teeth & Implant placement). An IV is placed in the arm to achieve full sedation which certainly makes sense if the procedure is surgical in nature. The effects will last after the procedure, so you will need someone to drive you to and from the appointment. Most general Dentists don’t provide IV sedation because the procedures in general dentistry aren’t surgical. However, some Dentists perform routine dentistry (Crowns, Fillings, Cleanings, etc..) with IV sedation.
  3. Laser Dentistry- For many, the dental phobia stems from the sound of the drill, and as a result, Laser dentistry may be able to alleviate this fear because Lasers are very quiet.  Dental Lasers work by delivering high energy light and are used for surgical and dental procedures. They perform as a dental drill would by cutting through hard or soft tissues in the mouth. Furthermore, other dental problems can be addressed with the laser such as Periodontal Disease and Root Canal Therapy.
  4. Dental Hypnosis- This may seem a little “out there, ” but hypnosis has been used in the dental world to help alleviate fears and phobias. The exact way that hypnosis works is not fully understood by experts. However, it has been described as controlling or quieting the conscious mind. Perception of harm and pain is the problem with dental phobias, and a hypnotist can help achieve a state where the subconscious mind can be accessed. The hypnotherapist will give suggestions while in this state to help you visualize what it is you want to accomplish. Some of the issues addressed with hypnosis can be a strong gag reflex, general dental fear, and habits such as nail biting or teeth grinding. Some dentists have training in hypnotherapy, or you may have to find a hypnotist that specializes in dental phobias.
  5. Fear of the Needle- This is a big one, but it’s not impossible to overcome. Most, if not all, Dentist’s today use Topical Anesthesia before inserting the needle into the tissue. This gel numbs the tissue so that the needle isn’t felt entering the tissue. If left on the tissue for at least two minutes before the injection, patients report that they don’t feel the needle entering. There is also an invention called a “painless injection.” It’s a wand that looks like a pen, and it’s designed to deliver the anesthetic at a slow rate which increases comfort during the injection. Patients report that it’s more comfortable than traditional delivery. The painless injection device isn’t standard, so you’ll have to inquire if your Dentist uses this technology.

So, as you can see, there are many ways to overcome or at least deal with dental phobias. It’s imperative that you don’t wait until you’re in excruciating pain because it’s very difficult to be treated comfortably if the pain is too severe. The first step is making an appointment and discussing your feelings with a Dental professional. You may be surprised at how stress-free an appointment can be.

When was your last dental visit? Do you go religiously every six months or only when you have a problem? Dental anxiety is the most common reason people avoid the dentist, and that puts them at risk for many dental diseases including gum and periodontal disease and cavities. More often than not, avoiding the dentist for too long will have you facing a much bigger problem that was once an easy fix. Also, if you wait until you’re in excruciating pain, the visit will most likely be uncomfortable.

So, why are people so afraid of the dentist? Here are some common reasons.

  1. Bad childhood Dental experience: This is the most common reason for dental anxiety, but thankfully, it’s becoming less prevalent. Dentistry has come a long way in patient comfort, and today, the patient’s well-being is a top priority. Also, with the introduction of fluoride and sealants, the incidence of decay has dropped dramatically in children.
  2. Painful Dental Experience: This is the second most popular reason for avoidance which is very unfortunate these days because there is no reason for a painful experience at the dentist. However, if you wait until the issue is really bad, it may be very difficult to maintain comfort during treatment.
  3. Poor self-esteem related to Dentistry: Some people shun the dentist because they feel embarrassed about their mouth. They might hate the way their teeth look, have bad breath, a sensitive gag reflex, or chronic pain.
  4. Fear of Needles: Also very common is a Fear of needles which certainly makes sense. Who wants to get a shot in the mouth?

While these fears are common, they must be dealt with because dental issues and disease don’t just disappear. In part 2 of this post, we’ll discuss ways to conquer these common fears.

Should parent’s be allowed in the operatory during treatment with their child? While some practices don’t allow adults back for any reason, some leave it up to the parent and child. Most clinicians will agree that the child is much easier to deal with than the adult. If you’ve ever had to ask a parent not to come back or leave the operatory, you’ve probably witnessed some pretty awful behavior from the adult and not the child. What are some of the reasons adults feel compelled to be present in the operatory?

  1. They simply don’t want the child to go back alone because they feel it makes the child more comfortable being in the room. In reality, it’s most likely the adult who is anxious.
  2. They feel that their presence makes the child behave better. In most cases, this is not true, and the child’s demeanor will improve greatly once the parent is out of sight.
  3. They think they have to accompany the child. This is easily addressed once the adult understands your office policy regarding staying in the treatment room.
  4. They distrust the medical profession. This is also easily addressed once the adult understands your office policy and why it’s in place.

So, should the parent be allowed to come back? That depends on what type of parent and child with which you’re dealing. Some parents are quiet and simply observe while others are tremendously overbearing and need to stay in the reception area. With all parents, education is key.  It’s imperative to educate the parent as to why their presence would or wouldn’t be acceptable. If you do allow the parent’s presence, you must make it clear that they are to be quiet observers.

How do most kids feel about having their parent in the room? It depends on their age, but the answers might surprise you. Children five and younger like mom back to come back and hold their hand or just be present. Kid’s ages seven to ten don’t seem to care either way. Most teens aren’t nervous at all and are embarrassed if their parent comes in with them. I’ve witnessed many teens asking mom to leave and wait out front.

There are some situations where a parent should be present, such as during first visit exams while they get to know you and your team. This helps to build trust and is also the time to discuss your policy on parents being in the operatory. Other times when you may relax your policy is with special needs patients and trauma situations. By making your policies clear, you’ll prevent the uncomfortable situation of being watched like a hawk and constantly interrupted while you’re trying to complete a procedure.

How old is too old to start orthodontic treatment and why would an adult even consider getting braces? There are a number of reasons ortho is an excellent choice for adults, and it’s not just a perfect smile. Orthodontic screenings for children begin by the age of seven because early intervention can help the Orthodontist take advantage of growth and development. While treatment for adults can’t take advantage of these growth spurts, it’s still quite possible for these patients to undergo therapy with excellent results.

Many adults have never considered ortho because they put their children first and neglect their dental health. Once the nest is empty, they may begin to consider straightening their teeth. However, they may not even realize that by properly aligning their teeth, they will also obtain a fully functional occlusion. Furthermore, braces can be advantageous in the placement of implants or bridges which are prevalent since more people are keeping their teeth for life.

There are some risks involved with adult Orthodontics. Some of the risks include Periodontal disease, Xerostomia, treatment time table, and osteoporosis.  

Periodontal disease can play a major role in whether or not a patient can safely go through treatment because the condition of the periodontium is critical. Bone loss is serious and must be carefully considered before moving the teeth.

If a patient experiences xerostomia (dry mouth syndrome), the lack of saliva can cause demineralization and the dreaded “white spots” on the teeth. The risk of tooth decay also rises without sufficient saliva. Adults are more likely to be taking medications which can cause a dry mouth.

 The amount of treatment time may also impact the adult patient who is unwilling to go through 2 years or more of treatment. However, most adults are very compliant making treatment time go much faster, and their home care is usually stellar following any instruction that is given to the letter.

Osteoporosis and osteoporosis medication can also play a role in treatment due to the possibility of Osteonecrosis.

Even with any of these risk factors, ortho treatment may still be safely possible as long as each specialist is involved with the case. The next time your patient asks you if it’s too late for Orthodontic treatment, consider referring to the Orthodontist, regardless of their age.

Do you and your team have regularly scheduled meetings, and are they considered to be productive and helpful? Running effective meetings is crucial to the health of your practice. On the other hand, poorly organized meetings can simply be disastrous turning into gripe sessions and waste precious time.

Meetings should be scheduled on a routine basis and conducted by the dentist or office manager. Equally important, this scheduled meeting is not the time to handle staff emergencies or be used as criticizing sessions. They must be valued by you and your team and used productively to solve problems, make goals, educate, and praise.

The following are five tips to create and maintain meetings which are successful.

  1. Agenda- An agenda is a list or outline of things to be considered or done and ensures a logical plan of what needs to be accomplished. An agenda also keeps everyone on topic and moving along promptly. It’s very easy to go off on a Therefore, an agenda keeps this from happening. Some items to consider for the agenda include policy changes, production numbers, plans for the future, and continuing education. Specific points need to be covered, and someone must be in charge of taking notes or minutes so that issues discussed receive follow-up attention.
  2. Schedule- Holding meetings on a specific day and time ensures that everyone knows when meetings will be held. They can be per week, every two weeks, or monthly, and should be an hour The dentist and office manager must be present. There are varying opinions as to whether it should be during lunch with food provided. Having the meeting at lunch encroaches on employees free time and eating during the meeting causes distractions. For these reasons, having a scheduled time without patients in the office is the best way to have the meeting. Lost revenue for this hour shouldn’t even be considered because these meetings are essential for the well-being of your practice.
  3. No Griping Allowed- No gossip or rumors are allowed during these meetings. Team members should be encouraged to communicate, but this communication must be constructive and encouraging. Also, these meetings are not for handling management functions.
  4. Training and Role Playing- Role playing can be very valuable in helping team members learn how to handle situations with other team members and patients. These meetings can also incorporate mini continuing education sessions.
  5. Praise and compliments- Take a minute to pat yourselves on the back for the service you provide to your patients. Share patient testimonials and compliments. Honor a staff member for something they did to make a patient or team members day. Always end on a positive note.

If you follow these simple steps, you will find that you and your crew look forward to the team meeting and become more productive in the process.

Unless you’re a child, losing a tooth can be devastating. Tooth loss occurs due to a number of reasons including decay, periodontal disease, and trauma. So, what happens if you don’t replace a missing tooth?

First and foremost, bone loss occurs at the source of the missing tooth, and over time, the jaw bone deteriorates. This deterioration is referred to as bone resorption, and without the stimulation from the roots of the teeth, it’s irreversible.

Neighboring teeth try to move into the space of the missing tooth. The teeth on either side of the space and the tooth above the space will, over a period, try to move into the open space. Although the movement takes many years, once the teeth have shifted, getting them back into their original spaces without Orthodontics isn’t possible.

You may lose the ability to eat certain foods depending on which tooth is extracted resulting in changes in nutrition levels. It may become difficult to bite and chew certain foods and can also lead to overuse of the remaining teeth to compensate for the void.

If the missing tooth is in the front of the mouth, it can impact your speech and ability to pronounce certain words. You may develop a Lisp forcing you to avoid speaking in certain situations. This can impact your social and professional life and can be very distressing.

The good news is that there are many options for replacing a missing tooth and they range in price making it affordable for most patients. The most important thing to do when you lose a tooth is to communicate with your dentist to find out what your options are and prevent these obstacles from negatively impacting your life.

Congratulations! You’re expecting a child! The last thing on your mind is your oral health. However, it should be first and foremost. Practicing great oral hygiene before, during, and after your pregnancy is imperative to prevent health issues for you and your baby.

First, we’ll discuss some misconceptions regarding oral health and pregnancy.

  1. It’s unsafe for a pregnant woman to visit the dentist- FALSE

It’s extremely important for a pregnant woman to visit her dentist regularly, just as she would if she weren’t pregnant. Furthermore, your dentist may have you come in more often during your pregnancy if you are experiencing gingivitis. X-rays aren’t generally taken during pregnancy, and many procedures are postponed until after delivery. There’s no reason to fear harm to the baby if you go to the dentist.

  1. Massive amounts of Calcium are lost during pregnancy to support the growing baby- FALSE.

We hear this quite often in the Dental office. Calcium isn’t moved from the teeth to other parts of the body to support the growing baby. Most Dental problems that occur during pregnancy are due to hormonal changes. Your physician will prescribe a prenatal vitamin which will support healthy growth and development of the baby.

Secondly, we’ll examine the oral health risks during pregnancy.

  1. Gingivitis (Inflammation and bleeding of the Gums)- the most prevalent issue during pregnancy is Gingivitis due to increased levels of the hormone progesterone in the blood. This hormone increases acid production in the mouth. Symptoms include bleeding, red, and swollen gums that bleed spontaneously or during brushing and flossing. While reversible, gingivitis shouldn’t be ignored. It can progress into Periodontitis which isn’t reversible. This increased acid in the mouth can also transfer to the unborn baby increasing the risk for low birth weight or premature birth.
  2. Tooth Decay (Cavities)- another dental issue during pregnancy is an increase in Cavities, especially if you experience morning sickness and frequent vomiting. Vomiting increases acid in the mouth which breaks down tooth enamel. It’s extremely important not to brush your teeth following vomiting. Brushing while having acid on the teeth can cause further breakdown. The best thing you can do is rinse with plain water to neutralize the acid.

Pregnancy should be a glorious time in your life. Being informed and cautious will ensure the best outcome for you and your baby. Visit your Dentist and follow their recommendations before, during, and after your pregnancy.

Part three of this blog deals with HIPPA concerning emails and texts originating from the patient and a wrap up of do’s and don’t's.

The patient may use unencrypted emails and texts to communicate with providers because HIPPA applies to health care providers and not the patient. Unless the patient has specifically stated otherwise, the provider can assume that responding to the patient using unsecured texts and/or emails is acceptable to the patient. Patients probably have no idea of the risks of using unencrypted texts and/or emails, and therefore, the provider may want to educate the patient and have signed consent and a preference form from the patient before replying to their email or text.

Signed HIPPA consent should also include a section regarding emails and texts that confirm the patient's preferences regarding communication. The Telephone Consumer Protection Act (TCPA) is a federal law protecting consumers from unwanted calls and faxes. TCPA prohibits making pre-recorded or auto-dialed texts and calls to cell phones without the prior consent of the party being phoned or texted. This refers to auto-generated appointment reminders. Violating this law can cost the violator $500 per violation- call or text.

The bottom line is to have every single patient sign an HIPPA consent form that includes a section on emails and texts and the patient’s preferences regarding this communication.

One last note, including a confidentiality notice or disclaimer in an email, doesn’t make the email HIPPA compliant. An email originating from the practice going outside of the office containing PHI must be sent through an encrypted server.

Part 2 of this blog will discuss the specific rules about communication originating from the practice to third-party providers (specialists, other practices, & insurance companies) or the patient.

  1. Emails within the parameters of the office- The key here is to have a secure server and network. You shouldn’t be using a web-based email service. As long as the practice has a secure server and network, encryption isn’t necessary for sending information within the office.
  2. Emails to anyone outside of the practice (excluding the patient)- Encryption or secure messaging is mandatory if the patient’s PHI (private health information) is being sent outside of the parameters of the practice.
  3. Emails to personal email accounts- Emails originating from the office to a personal email account must not contain PHI or any attachments which include a patient’s PHI. If working from a computer outside of the practice, you must use a secure remote connection or an encrypted flash drive.
  4. Text messaging to anyone other than the patient- Text messages aren’t secure or encrypted unless the practice has a secure text messaging platform. Texts should never include a patient’s PHI because it’s very easy to have the text intercepted.

Texts and emailing is extremely convenient, and most patients will welcome this type of communication. To be compliant, you must either use a messaging system with encryption or incorporate a patient portal which requires a patient to log in.

If you wish to use a system which isn’t encrypted, the patient must be informed of the risk of information becoming obtained by a third party. As long as permission is obtained from the patient and kept on file, the practice may communicate in this manner.

Part 3 of this blog will deal with HIPPA concerning emails and texts originating from the patient and a wrap up of the do’s and don’t’s.

HIPPA. This acronym strikes fear in most health care professionals. Just when you think you have all your bases covered and are compliant, yet another issue concerning this important policy arises making you question your sanity. There may be some ways in which you interact with and in regards to patients that you haven’t considered. This blog is concerning text and email interaction.  Many dental professionals don’t realize that HIPAA also restricts the way they and their staff can use email and text messages to communicate with patients and other providers (specialists & insurance companies) in reference to patients.

Hippa refers to the use, storage, and disclosure of an individual’s identifiable health information, and is also referred to as protected health information. Examples include name, demographic information, mental or medical condition(s) (the past, present, or future), planned or completed treatment, radiographs, intraoral pictures, and financial information.

HIPPA regulations do apply to text messages and emails whether they are for scheduling appointments, appointment reminders, or any information sent to another provider (Insurance companies or specialists). This regulation also pertains to any email account from any computer at the workplace or home. Also, the dentist must obtain written consent from the patient to send any information regarding their protected health information.

HIPPA requires that security measures must be followed with these forms of communications such as secure messaging platforms or encryption. Encryption or secure messaging platforms doesn’t refer to password protection. Password protection merely protects against unauthorized access. Once the intruder uncovers the password, the information is presented easily. With encryption, the information gets jumbled so that it’s not legible without the key to decode the jumble.

In Part 2 of this blog, we’ll delve further into the specifics of what it means to be HIPPA compliant concerning texts and emails.

Traditionally, it was recommended for patients with certain heart conditions and joint replacements to premed before dental procedures with an antibiotic. However, recent studies have suggested that requiring premed across the board may be a bit of overkill.

According to the American Orthopedic Association and the American Heart Association, taking an antibiotic before dental procedures may become a thing of the past. So, to premed or not premed? That is the question.

Patients with heart murmurs, MVP, Artificial Heart Valves, Heart Transplant, and Artificial Joints come in and out of the practice daily. Does the patient decide to stop taking the premed? Not necessarily and it’s not a wise decision without their physician's guidance for many reasons. For a patient to safely stop taking this medicine, the doctor who prescribed the medication in the first place must give the authorization, and you must keep this authorization in the patient's file.

While it may be perfectly acceptable for the majority of patients to stop with the premed regimen, a select few may not be able to stop. This includes patients who have diabetes, have a suppressed immune system, or any other condition in which their doctor insists they continue with the medication before treatment.

As dental professionals, we shouldn’t make the determination regarding a patient’s premed. Contacting the physician who prescribed the medication is paramount as they are the professional who should be making this decision. 

In May 2017, the American Academy of Pediatrics released new guidelines for children ingesting fruit juice. This was the first update on children drinking fruit juice in sixteen years and long overdue.

It is now recommended that parents abstain from serving fruit juice to infants under the age of 12 months.

These new recommendations are divided by age group:

Birth to age one: 

According to the new guidelines, breast milk or infant formula should be the only nutrient supplied to infants until six months.

There is no indication that an infant under six months should ingest fruit juice. Important nutrients (fat, protein, calcium, and iron) supplied by breast milk or formula can be eliminated if the baby ingests too much juice.

Parents can begin to introduce mashed or pureed whole fruit after six months.

Toddlers- Ages 1 to 4:

Toddlers may have four ounces of juice per day which replaces the previous allowance of six to eight ounces. Also, labels must be carefully investigated. Avoid the words drink, beverage, or cocktail. Look for 100 percent fruit juice which is pasteurized.

Furthermore, the juice should be finished in one sitting, perhaps with a meal. Sippy cups and bottles should be avoided. The key is to have the child finish the juice promptly and not carry the beverage around for long periods of time because sipping on even 100 percent juice all day can lead to cavities. Diluting the juice with water doesn’t lower the odds of forming cavities either.

Children ages 4 to 6:

Children ages four to six may consume four to six ounces of 100 percent juice per day. The same guidelines apply to this group as the toddlers in regards to finishing the juice in one sitting.

Children should be encouraged to eat whole fruit with an abundance of fiber such as apples, oranges, berries, and pears. Ingesting too much juice can lead to obesity and kids who fail to thrive.

Children ages 7 to 18:

Older children and teenagers are allotted two to two and one-half cups of fruit per day. 100 percent fruit juice can be one of those servings. It’s easier for this age group to serve themselves, so parents can make whole fruit more available by purchasing fresh and frozen fruits. Many teens like making smoothies by using conveniently frozen fruits.

The bottom line is that even 100 percent juice must be used sparingly. It’s far better to have children and adults eat whole fruits to reap the nutritional benefits.

HB 154 was signed into law on May 8th in the state of Georgia by Gov. Nathan Deal. The new law allows Dental Hygienists to practice under general supervision in private practice and a variety of “safety net settings”.

Georgia now joins more than forty other states which allow Georgia licensed dentists to allow the Georgia licensed dental hygienists in their employment to perform oral prophylaxis, apply fluoride, sealants, and in certain cases, take X-rays, without the dentist being physically on site.

A “Safety Net Setting” includes the following types of institutions:

Federally Qualified Health Centers

Family Violence Shelters

Long-Term Care Communities (Nursing Homes)

Title I Schools and Hospitals

Volunteer Community Health Settings

It’s estimated that approximately 1 in 4 children in Georgia do not  receive preventive dental care.  Furthermore, senior citizens are also at high risk for undetected dental abnormalities. Dental Hygienists will now be able to provide preventative services to these overlooked citizens and refer them to a dentist when necessary.

This is a very positive outcome for the field of dentistry and the state of Georgia. Preventative assistance will be available to patients who would otherwise be unable to receive these services.

Chances are you’ve never heard of the term Concierge Dentistry. It’s becoming more common in medical practices and is gaining popularity in the dental world. So, what are Concierge services? It refers to private pay for procedures without the intervention of insurance. I know what you’re thinking. Why in the world would my patient pay full price for services when they have dental insurance? Stay with me. There are many reasons your patient might consider this option.

The days of a privately owned dental practice are dwindling. Corporate dentistry is becoming more and more mainstay. You probably pass several on the way to your privately owned office. With these new corporate practices come changes in the way your and your patients are accustomed to treating and being treated. When a practice is corporate owned, the control goes to the corporation. The dentist may no longer have a say in the way the office operates. Some dentists are fine with this while others are not comfortable with this type of business.

Some physicians and dentists are turning to Concierge services. There are many ways of operating this type of practice. In all scenarios, the patient is responsible for any reimbursement from Insurance or any other type of reimbursement program usually provided by their employer. Some concierge programs mandate the patient pay a flat rate per year which provides them with preventative services (cleanings, exams, and x-rays) as well as a percentage off of restorative services.

Upon doing the math, it may be more cost effective for the patient to deny coverage from their employer and simply pay the flat rate to their dentist thus saving monthly premiums. This type of practice seems foreign, but it may be time to do some investigating. Studies show that providers who choose this path receive a very healthy income and a daily schedule that is more than manageable.

By: Nicole Giesey, RDH, MSPTE

It is nice to have a break in your schedule and get the occasional sealant patient. They are definitely a change of pace from the routine cleanings. Some sealant placements go quickly and some become very challenging. When you are tight on time and want to adhere to your schedule, making sure you have the perfect products for the procedure will help not only yourself but your patient as well. There are so many products on the market that can save you money but making sure that you are also utilizing the right product to get the job done efficiently may be worth its weight in gold. If you are using products just because they are a cheap replacement to the more efficient method, it may just end up costing you more in the long-run.

One product we can really narrow down would be the saliva control product used during sealant placement. Cotton rolls vs. absorbent pads in the buccal mucosa, to be a little more specific. The parotid gland is a wonderful, beautiful gland and when working properly is very useful….just not during sealant placement. Wouldn’t it be so nice if we could just turn it off until our procedures are complete? We can use products that would make us think that the gland is turned off. The right absorbent pad would make your life so easy compared to using a cotton roll. The key word is the right absorbent pad. The hard cardboard stiff saliva absorbents are not the products I am referring to. You need to think of the area that is being isolated and fit a product like a key into it. Not only make it seem like there is no gland present, but also shine some light on your tight working situation. I was introduced to the reflective NeoDrys about 2 years ago while temping in an office that used them regularly. Not only did I feel like the field was extremely dry and easy to work in, the product stayed in place and the reflective surface transilluminated the light so I could actually see my working field. I went back to my office and told my boss about the experience and called my product company for samples. He tried them and now it’s like our normal. I researched a little more into the product and this is what I found:

The anatomy of the area needs something that conforms to the curvature of the patient’s cheek. This product is not so stiff but flexible. It literally fits not only over the source of saliva, but it conforms nicely to the area and is retained there as well during the procedure. When you use a cotton roll it slips and slides all over the place and they always seem to fill with saliva quickly, becoming a slimy roll of cotton that ultimately falls out of place. The whole prep that you just worked on to be perfectly etched for sealant placement gets contaminated. The NeoDrys do not move because they are nicely tucked in close to the mucosa and held in place by the teeth. They also do not leak out of the other side because they have a core that takes in and retains all the saliva. They puff like a pillow evenly and do not leak onto the prep. They also take awhile to really fill up, about 15 minutes, giving you plenty of time to place the sealants on the side you are working on and then easily move to the next side without using a ton of product. Typically you would go through 2-3 cotton rolls for one side at least. There is definitely a time and place for cotton rolls, like for lingual saliva control where a roll would be used in the right anatomical space but just not for the buccal arena. After you have ruined sealant preps from bad isolation a couple of times, you can really justify with your time and product loss the use of a good isolation product. These can also be used in conjunction with the new all-in-one multifunctional cheek retracting, isolating, and suction products.

The bottom line is that there are really nice products out there for all procedures that will make your life a lot less stressful. You can totally justify using them with the production time you will save by doing the procedure right the first time, not having to extend that precious time or your nerves. It is very frustrating to both the hygienist and the patient to start from scratch after you were almost done. Most companies will let you try before you buy their products. Have fun, test products and learn about different ways to make your day easier and you can keep on smiling. 

All dental clinicians dream of a dry field. It’s the one thing we must have for a procedure to be successful. How in the world do we maintain a site without saliva? Thankfully, this has become much easier since the ingenious development of Microcopy’s NeoDrys. This simple addition to my tray has revolutionized my most difficult patient situations.

Being a dental hygienist, I don’t have the luxury of having an assistant. NeoDrys have allowed me to triumphantly and comfortably finish the procedure without repetition. However, they aren’t just for hygienists. Dentists and assistants also love Neodrys because they make the most challenging patient easier to handle. Let me tell you how we accomplish the impossible with the aid of NeoDrys.

  1.  “Ouchless” Comfort Edge- New technology creates flexible edges with no corners while retaining integrity. This allows for no cutting or binding, retracts the cheek, and serves as a mouth prop keeping the patient’s mouth open effortlessly. However, the patient can still move their cheek without any discomfort.
  2.  Gentle to the Buccal Mucosa- The Medical-grade poly netting which faces the Buccal Mucosa adheres gently and prevents any irritation while maintaining exceptional sealing. They are also the perfect size to cover the entire area and can be placed far enough back to easily treat even third molars.
  3. Superior Absorbent Core- Acrylate polymer retains moisture as a gel when in contact with saliva. It traps the saliva and doesn’t allow even a drop to escape. There is also very little swelling of the NeoDry as it fills with saliva. With a fifteen-minute working window before there is a need to replace, I rarely have to replace the NeoDry during a procedure.
  4. Core Stiffener- Polystiffener Insert provides optimum rigidity for cheek retraction. We’ve all had that patient with very full cheeks. They open their mouth, and you can’t even see their teeth. NeoDrys solve this problem beautifully. By keeping the cheek retracted, not only is visibility improved greatly, but also the cheek is physically out of the way providing excellent access.
  5. Protective Backing- Choice of Original white or Reflective backing brightens the oral cavity while providing cheek protection. As stated earlier, I’m a hygienist working alone. The addition of the Reflective backing has been a life saver for me because it allows for phenomenal lighting.
  6. Saves You Money- Forget all those “parotid shields,” gauze, and cotton rolls which fall apart and get saturated quickly. NeoDrys save you time and money by getting the procedure done right on the first attempt. Nothing is worse than getting near the end of the procedure only to have it become contaminated with saliva. I dislike having to tell a 6-year old that we have to “start over” because it makes us both feel like a failure.
  7. Easy Placement and Simple Release-   Select the NeoDrys size which adequately covers your patient’s mucosa. Insert gently with the color side against the cheek and point to the back of the mouth. In mere seconds, the NeoDrys will begin to adhere to the tissue. The NeoDrys will stay exactly where placed and won’t move until you’re ready for removal. You simply wet the absorbent side facing the mucosa for easy extraction. It comes out as one piece without any loose fibers to be cleaned out after the procedure.
  8. NeoDrys Outperform the Competition and Have a “No Questions Asked Guarantee”- perhaps the main reason you should try Neodrys. You have absolutely nothing to lose and everything to gain. Microcopy has developed this remarkable award-winning product, and you won’t want to waste another day struggling with yourself and your patient. When you try NeoDrys, you’ll wonder how you ever performed procedures without their help.
  9. Available in Two Sizes- NeoDrys are available in Large (Blue) and Small  (Yellow) color coding for quick identification.

When you combine all of these qualities, NeoDrys become an intricate part of your routine. They are the “extra set of hands” I need to perform a rewarding procedure which is effortless for me and comfortable for my patient. This product is a game changer, and it will make your life as a clinician easier and more efficient.

Zirconia cutters from Microcopy NeoDiamond 1116.8M

The recovery period for wisdom teeth extraction usually lasts a couple of days. You will be given prescriptions for pain and antibiotics to prevent infection after the surgery. Follow the dosage exactly to prevent any problems which could delay healing. Also, try to have something in your stomach before taking the medications to prevent nausea and vomiting.

Following the procedure, you will be given plenty of gauze to take with you. Bite gently on the gauze pad periodically, and change pads as they become soaked with blood. The bleeding should slowly subside. Phone your dentist or oral surgeon if the bleeding persists after 24 hours.

While your mouth is numb, be careful not to bite the inside of your cheek, lip, or tongue. Also, be careful of very hot foods as they can burn your mouth without your knowledge.

You should keep your head elevated to help stop the bleeding. Don’t lie flat. An ice pack is imperative during the first 24 hours following surgery. Place the ice pack on the outside of the cheek for 20 minutes on and 20 minutes off. You can begin using moist heat the following 2-3 days.

Be prepared to relax after surgery for at least three to four days. Physical activity can increase bleeding. No heavy lifting.

Your diet post surgery should consist of soft foods such as gelatin, pudding, soup, and ice cream. Gradually introduce solid foods as your healing progresses.

It will seem easier to use a straw after surgery. This is a NO-NO. Do not use a straw for the first few days. Sucking on a straw can loosen the blood clot and delay healing.

After the first 24 hours, you will begin gently rinsing with warm salt water three times a day for 7-10 days to reduce pain and swelling. Be very careful with rinsing and don’t swish too hard to prevent dislodging the clot. A salt water rinse consists of 1 teaspoon of table salt dissolved in 8 ounces of warm water.

Do not smoke for at least 24 hours after your surgery. The sucking motion can loosen the clot and delay healing. Also, smoking decreases the blood supply to the area and can bring germs and contaminants to the surgical site.

Continue to brush your teeth and tongue carefully and avoid touching the extraction sites the day after surgery. You will be given a large curved syringe to help clean the extraction sites with which you will begin using after five days. Fill the syringe with the warm salt water solution and carefully cleanse the site.

Your oral surgeon will remove the stitches after a few days if needed. However, many surgeons use dissolvable sutures which don’t require removal.

The key to a speedy recovery is to be prepared before the surgery. If you’re being sedated, you’ll need someone to drive you and be with you for at least 24 hours after the procedure. Have your prescriptions filled beforehand and obtain the necessary supplies such as food, ice packs, and awesome movies!

Wisdom teeth or third molars are an issue for most people at some point in their lives. Usually erupting between the ages of 17 and 25,  most adults have four wisdom teeth, one in each of the four quadrants. However, it’s possible to have fewer or more. Wisdom teeth commonly affect other teeth as they develop due to becoming impacted. Most people don’t have adequate room for these teeth to erupt fully in the mouth. Therefore,  they are often extracted when or even before they present a problem.

Impaction of these teeth means that they are enclosed within the soft tissue and/or the bone. Occasionally, they only partially break through or erupt through the gum which allows an opening and optimal habitat for bacteria to enter around the tooth and cause an infection. This situation can result in pain, swelling, jaw stiffness, and systemic illness. Partially erupted teeth are also more prone to tooth decay, gum disease, and periodontal disease because their location and awkward positioning makes brushing and flossing nearly impossible.

So, how do you know if the pain you’re experiencing is related to wisdom teeth? If the discomfort is coming from any far corner of your mouth, the source may be a third molar. A visit to your dentist will be necessary. A panoramic x-ray will determine if you have wisdom teeth and their position. It’s very common to be referred to an oral surgeon for an evaluation and extraction, if necessary.

Failing to have wisdom teeth removed when it has been recommended can cause ongoing complications such as:

Pain- The most prevalent complaint regarding wisdom teeth is pain which is frequently due to the presence of infection. The pain can be present in your jaw, throat, ear, face, or the site of the tooth.

Systemic Infection- Bacteria present at the site of the wisdom teeth can enter the bloodstream and cause a systemic infection. This can be very dangerous for patients with a weakened immune system.

Proper Cleaning- It’s difficult to clean partially erupted wisdom teeth properly because of their position in the mouth, and as a result, food and plaque buildup can cause a gum infection around the tooth. This type of infection is usually reoccurring until the source of the infection is removed. Infected wisdom teeth can also promote decay of surrounding teeth.

Shifting Teeth-  Impacted wisdom teeth can create pressure by trying unsuccessfully to erupt. This type of pressure can cause teeth to shift. That’s why it’s recommended to have them extracted after orthodontics.

Cysts-  Although not too common, cysts in the bone can occur around the impacted wisdom tooth. This type of cyst can cause the destruction of bone.

If it has been recommended that you have your third molars taken out, give it some serious consideration. The younger you are, the easier it is overall to recover from the surgery, and the recurring complications aren’t likely to resolve without treatment.

Dental practices are busy. Running and running and running is what we do all day long. However, how long are your patient’s waiting for you?  I’m not referring to running behind schedule from time to time. I’m talking about chronically keeping your patients waiting for unacceptable periods of time.

What’s making it impossible to stay on schedule? Today we are going to focus on the Hygienists schedule. The good news is that hygienists rarely have emergencies placed on their schedule making it easier to manage the day. However, it’s still very easy to get behind.

Perhaps the biggest reason hygienists run behind is waiting for the doctor to perform the exam. Notice I didn’t say perform the exam at the end of the appointment. One of the biggest improvements in my schedule as a hygienist regarding staying on time is having the doctor examine the patient when they have a break in their schedule.

Here’s how it works. Seat your patient, go over their medical history, do the initial exam including X-rays and intraoral pictures, and note any concerns or problems. You’re then ready to have the doctor perform the exam at any time during the appointment.

This system will need compromise from the hygienist and doctor. The hygienist must be ready when the doctor presents for the exam, and the doctor may have to examine a mouth that isn’t perfectly clean.

Making these simple adjustments improves the schedules of the Doctor and Hygienist immensely. Futhermore, having the Doctor examine all the hygienist’s at the same time will make a huge difference in keeping all of the team on time resulting in happy patients.

Dental practices are busy. Running and running and running is what we do all day long. However, how long are your patient’s waiting for you?  I’m not referring to running behind schedule from time to time. I’m talking about chronically keeping your patients waiting for unacceptable periods of time.

What’s making it impossible to stay on schedule? Today we are going to focus on the Doctor’s schedule which can be very complicated due to having regular scheduled appointments and emergencies. It’s imperative that your appointment coordinator fully understands how to schedule appointments and handle emergencies while respecting the allotted time.

With regards to emergencies, you have to establish the meaning of a true emergency. Many times, the patient will call in a panic when the situation isn’t a true emergency. Also, it’s not mandatory to provide full treatment to a patient with an emergency. Triage is certainly acceptable, and the patient can be reappointed for further treatment.

Many Dentists have an all or nothing mentality. They feel that they have to provide full treatment during an emergency appointment which can prove to be detrimental. It’s absolutely prudent to get the patient stabilized and reappointed. When you treat an emergency as a scheduled appointment, you risk putting yourself and the rest of the team behind.

Sit down with your front desk and iron out appointment times and what constitutes an emergency. Much of the stress can be avoided by not scheduling a patient in an emergency slot who isn’t truly experiencing an emergency.

Another strategy to consider is performing hygiene exams whenever you have a break. Meet with the hygienists and form a protocol, so that patient information is collected at the beginning of the appointment allowing you to pop in whenever. Furthermore, check all hygienists at one time, so you’re not jumping up and down more than once per hour.

By incorporating these simple strategies, you can rest assured that everyone’s time is respected and your days will run much smoother.

Although April is Oral Cancer Awareness month, as dental professionals, it’s our responsibility to pay close attention at each visit to any abnormality in the patient’s mouth and refer to an oral surgeon if necessary.  It is estimated that 49,750 people in the United States will be initially diagnosed with oral cancer this year and that one person will die from it every hour. These statistics are staggering.

Another somewhat shocking fact is that while smoking, other tobacco products, and alcohol are still major risk factors, the fastest growing segment of oral cancer patients are healthy, young, nonsmoking individuals who possess the HPV virus.

The following are symptoms of most oral cancers. Sometimes, there is no obvious cause of oral cancer. If any of these symptoms are present, a referral to an oral surgeon is imperative.

  1. Any sore which doesn’t heal within 14 days
  2. A sensation that something is stuck in the throat when attempting to swallow
  3. Red and/or white discolorations of the soft tissues
  4. Hoarseness which lasts for prolonged periods
  5. Unexplained numbness
  6. A sore underneath a denture which doesn’t heal
  7. Unilateral ear pain
  8. A lump or thickening that develops on the neck or in the mouth
  9. Swallowing difficulty or difficulty moving the tongue or jaw

With early detection survival rates are higher, and side effects from treatment are less intense. By evaluating each patient at each visit, many lives can be saved, and we can play a role in decreasing the devastating effects of oral cancer. 

Historically, Dental Hygienists and Assistants go through several rounds of interviews, including working interviews, when seeking a new position. They also meet with the existing team members to ensure that the right person is chosen for the position.

However, when it comes to hiring team members for front desk positions, little to no consideration is taken in making the perfect choice for the office. Many offices hire a friend of a friend for the front desk who has no customer service or dental experience whatsoever. Why do so many dentists give such little thought to the first person potential and existing patients encounter?

For many offices, the front desk is a whole other world. While the hygienists and assistants have daily interactions with the front desk, many dentists have very limited contact with these very important team members. The dentist rarely interacting with the front office may sound crazy, but it’s very true.

Let’s take a look at some of the characteristics which are imperative for a front office team member:

  1. Customer Service Mentality- Potential candidates must possess a customer service mentality which includes excellent phone etiquette, always putting the patient first, and the ability to problem solve with a win-win result.
  2. Multi-tasker- The front desk is a very busy place with many things going on at once. Being able to multitask is absolutely necessary. Phones are constantly ringing, patients are checking in and out, and so many other tasks must be completed simultaneously.
  3. Willingness to learn- When considering a new team member for the front office, evaluate the personality along with the skill level. The candidate you’re considering may possess all the right skills to work in the front. However, if this person has no personality, keep looking. Find a candidate who has a wonderful personality and is willing to learn.

Each team member is vitally important to the success of the practice. However, the patient’s first and last encounter is with the front office. Bear this in mind when choosing these important members and your patients and team will be happy.

It’s that time of year again. High School graduations are upon us, and many young adults are embarking on a new path which will determine the course of their lives. So, what about dentistry as a career choice, and what does it take to become a dental assistant?

State requirements vary regarding licensure of dental assistants. Some states don’t require licensure while others do require a license. Licensure also affects the procedures the assistant is allowed to perform. Some dentists prefer a licensed assistant regardless of state requirements.

A dental assisting program can be from nine months to two years to complete, depending on whether it’s a certificate, diploma, or degree program. After completing educational requirements and passing any required certifications, Dental assistants perform many vital duties in the dental office.

Front office tasks may include scheduling and confirming appointments, maintaining patient records, and filing charts. Clinical duties include assisting the dentist in all procedures, taking x-rays and impressions, sterilizing instruments, and educating patients.

Dental Assistants are an integral part of the dental team. If you enjoy working with your hands and serving others, Dental Assisting may be the perfect choice for you.

It’s that time of year again. High School graduations are upon us, and many young adults are embarking on a new path which will determine the course of their lives. So, what about dentistry as a career choice, and what does it take to become a dental hygienist?

First, determine if you have the characteristics to become a dental hygienist. You will need a high aptitude for science and chemistry, exceptional manual dexterity, and excellent communication skills. A Dental Hygienist is a licensed professional who specializes in preventative oral health.

Upon graduating High School and taking the SAT or ACT’s, you’ll apply to a technical college, community college, or university. High school records and college entrance exams will show your proficiency with english, biology, math, and chemistry. It’s helpful to attend an institution with a dental hygiene program although you can transfer to another school if the courses are compatible.

There is a misconception that becoming a dental hygienist takes two years of total schooling. The dental hygiene program itself is two years. Most students must complete most of their core classes before entering the hygiene program. The total amount of time in college is three to four years to receive an Associates Degree in Dental Hygiene.

Another important point is to make sure you attend a college which is accredited by the Commission on Dental Accreditation which operates under the American Dental Association.

Once you’ve received your degree in Dental Hygiene, you’ll be ready to take the National and State Boards. National Boards are written while State Boards are clinical and require that you treat patients.

Upon passing National and State Boards, you’ll be ready to enter the world of dentistry as a practicing dental hygienist. If you possess these skills and are willing to work hard, dental hygiene may be the perfect career for you.

It’s that time of year again. High School graduations are upon us, and many young adults are embarking on a new path which will determine the course of their lives. So, what about dentistry as a career choice, and what does it take to become a dentist?

First, determine if you have the characteristics to become a dentist. You will need a high aptitude for science and chemistry, exceptional manual dexterity, and excellent communication skills. Dentists “diagnose and treat problems with patients’ teeth, gums, and related parts of the mouth.” They also provide advice and instruction on caring for the mouth and overall health.

Prerequisite undergraduate courses necessary to apply to dental school will be taken at a college or university. Also, be aware that most dental schools will require that you have a bachelor's degree. You’ll be enrolled in a pre-dental program which focuses on sciences, physics, biology, and chemistry. It’s also a great idea to take some business courses because a dental practice is a business.

After receiving a bachelor’s degree, you’ll take the Dental Admissions Test (DAT). Upon receiving results from the DAT, you’ll apply for admission to a dental school. It’s a good idea to apply to more than one dental school and only apply to schools that are accredited by the ADA's Commission on Dental Accreditation.

Your score on the DAT, undergraduate grades, recommendations, and interviews are considered in the admission process. Admission in dental school is very competitive so ensure that you have an advisor to guide you to take steps to differentiate yourself from other qualified candidates.

Upon graduating dental school, you will receive your degree as a Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD). Which title you receive depends on the school you’ve attended. The next step is taking the national and state boards. National boards are written while state boards are clinical and require treatment of patients.

Once you’ve passed the National and State Boards, it’s time to begin practicing dentistry. Most dentists enjoy four day work weeks and a very nice salary. If you possess these skills and are willing to work hard, dentistry may be the perfect career for you

Eating disorders are psychiatric conditions resulting in inappropriate attitudes toward eating and body image and are often accompanied by improper and dangerous methods of weight control. It is estimated that more than ten million Americans are affected by these distressing illnesses, and most of its victims are teen and young adult women. The three most common eating disorders are anorexia nervosa (intentional starvation), bulimia nervosa (binge-purge), and binge eating disorder (bingeing without purging).

As Dental professionals, we spend our days discussing brushing, flossing, decay, periodontal disease, and various other procedures, however, we may find ourselves at a loss when it comes to discussing eating disorders with patients. While we can’t diagnose eating disorders, we can alert the patient of any findings which may be indicative of these illnesses.

Dental symptoms of eating disorders include red and swollen gingiva (appears glossy), acid erosion mostly on the lingual surfaces of the maxillary and mandibular anterior teeth, mouth sores, xerostomia, TMD, swollen parotid glands, and redness and cuts on the soft palate. Another easy to identify symptom is cuts, calluses, or bruises on the knuckles as a result of forcing their fingers down their throat.

When broaching this discussion with a patient, we must provide an environment in which they feel comfortable and safe. It’s imperative that communication is free of judgment. Victims tend to keep their condition a secret due to shame, so it’s crucial to commend them for their honesty.

If the patient refuses to discuss the situation, we can still share our findings and educate and encourage them to follow up with their primary care physician. Eating disorders are potentially fatal, and by carefully addressing the situation, lives may ultimately be saved.

As dental professionals, our days are spent working in small spaces which increases the risk of back pain, headache, neck fatigue, and eye strain. Investing in a pair of quality dental loupes can improve posture, allow for better vision, and protect against eye strain because we can clearly see every tooth surface while still maintaining a better posture.

Dental Loupes are a “magnification device that helps attain better and larger vision of things that are usually not clearly visible with the naked eye.” They are worn like glasses and can prevent a myriad of problems which plague the dental profession such as back and neck pain, eye strain, and headaches.

Wearing loupes allows us to see every part of the tooth clearly thus providing more accuracy and quicker identification of problems. Moreover, loupes aren’t just for aging eyes. Studies show that using loupes at the onset of a dental career can significantly improve and prevent conditions caused by improper positioning over a patient.

There are some things to consider before investing in loupes as they do come with a hefty price tag and some clinicians may have a difficult time adjusting to magnification. It’s best to choose a well-known company with a local representative and risk-free trial periods.

Some other considerations before buying loupes:

Taking all of these tips into consideration will make the transition from seeing things with the naked eye to magnification much more comfortable. Loupes are designed to be a long-term investment in the wearer's career and health and are definitely worth a second look.

Many patients who visit your office each day experience bruxism and it’s clear that they grind their teeth. It may be evident with wear facets forming, or it may be in the beginning stages where the patient experiences headaches upon waking or other TMJ symptoms. Bruxism is usually treated with the patient wearing a night guard of either hard or soft plastic material. However, studies now show that tooth grinding at night may be closely linked to sleep apnea with the treatment involving a CPAP machine.

Although the reason for bruxism is unknown, many factors seem to contribute to the condition. These factors include alcohol, smoking, stress, caffeine, fatigue, and sleep apnea. It’s estimated that eight percent of the general adult population experience bruxism and most are Caucasian males. So, what’s the link between clenching and grinding and sleep apnea?

There are two types of sleep apnea. Today’s focus will be on Obstructive Sleep Apnea (OSA) because it’s linked to bruxism. OSA is the most common type of sleep apnea and is caused by airway blockage when the soft tissue at the back of the throat collapses.

When the soft tissue collapses, the body fights to keep the airway open thus repositioning the jaw and grinding the teeth. This scenario happens over and over during the night as a defense mechanism with the body trying to keep the blood oxygenated.

By treating the patient with an occlusal guard, you may be overlooking the real cause of the grinding, and this could be detrimental to the patient. The next time you evaluate a patient with bruxism, consider having the patient consult with their primary care physician to see if a sleep study is in order. Not only will you save their teeth, but you may also save their life.

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Toothpaste is used every day with little thought. Choices range from whitening, tartar control, sensitivity control, cavity protection, enamel rebuilding, and many more. The one thing they all have in common is a degree of abrasiveness.

Abrasives make up at least fifty percent of a typical toothpaste and are used to remove plaque and stain. They are insoluble particles and can be detrimental to the enamel, dentin, and cementum. Types of abrasives used in toothpaste include particles of aluminum hydroxide, sodium bicarbonate, calcium carbonate, various calcium hydrogen phosphates, silicas and zeolites, and hydroxyapatite.

The size of the abrasive particle determines the abrasiveness. Toothpaste abrasiveness is measured by its Relative Dentin Abrasivity (RDA).

The RDA table

0-70 = Low Abrasive

70-100 = Medium Abrasive

100-150 = Highly Abrasive

150-250 = Harmful Limit

FDA Recommended Limit is 200

ADA Recommended Limit is 250

RDA of some common Toothpastes:

Straight Baking Soda 7

Arm & Hammer Tooth Powder 8

Arm & Hammer Dental Care 35

Oxyfresh 45

Tom’s of Maine Sensitive 49

Arm & Hammer Peroxicare 49

Rembrandt Original 53

Tom’s of Maine Children 57

Colgate Regular 68

Colgate Total 70

Sensodyne 79

Aim 80

Colgate Sensitive Max Strength 83

Aquafresh Sensitive 91

Tom’s of Maine Regular 93

Crest Regular 95

Sensodyne Extra Whitening 104

Colgate Platinum 106

Crest Sensitivity 107

Aquafresh Whitening 113

Arm & Hammer Tarter Control 117

Arm & Hammer Advanced White Gel 117

Close-Up with Baking Soda 120

Colgate Whitening 124

Ultra Brite 130

Crest MultiCare Whitening 144

Colgate Baking Soda Whitening 145

Pepsodent 150

Colgate Tarter Control 165

These numbers are definitely worth a second look as you recommend toothpaste. Depending on the patient's needs and current oral health, the abrasiveness should be a factor in determining which dentifrice would be beneficial and effective without causing long term undesirable effects.

Air polishers were introduced in the field of dentistry in 1954 for the removal of decay. Although they aren’t used for decay removal today, these devices incorporate an abrasive powder with a stream of compressed air and water to clean and polish a surface. Air Polishers are mostly used by the dental hygienist to remove stain, plaque, and polish the enamel above the gum line.

However, recent technology has been introduced in the USA regarding air polishers that employ a unique nozzle design and specialized powders to transport a very low abrasive powder into the subgingival area for the removal of biofilm. This procedure is very different from supragingival air polishing due to the specialized tip and the type of powder used.

In supragingival polishing, the powder of choice is usually sodium bicarbonate which is abrasive and helpful with the removal of heavy stains and soft deposits above the gumline. With subgingival air polishers, the tip is specialized to be able to effectively enter the periodontal pocket and deliver a very low abrasive powder. The powder of choice with subgingival air polishing is Glycine. Glycine is an amino acid and is significantly smaller in particle size than sodium bicarbonate. It appears to have an active role in the disruption of bacterial recolonization making it both preventive and therapeutic.

The main goal in subgingival air polishing is root debridement resulting in the removal of biofilm. This biofilm elimination can result in a beneficial shift in the oral microbiota. Studies have shown that subgingival air polishing tends to have less adverse effects for the patient such as pain and sensitivity versus hand instrumentation. Moreover, the subgingival air polisher is much more effective in reaching the base of pockets over 5mm and removing biofilm than hand instrumentation.

Subgingival air polishing is also proven to be clinically efficient and effective for the removal of biofilm without endangering soft tissues, enamel, dentin, or cementum. The procedure is very quick and simple. The tip is placed at a 90-degree angle to the long axis of the root, and a 5-second application disperses air, water, and glycine powder for the removal of biofilm.

These units aren’t inexpensive by any means, but they show much promise in the ongoing fight against Periodontal disease. They can also be used safely around implants perhaps preventing Peri-Implant Mucositis and Implantitis. When it comes to combating Periodontal disease, this new technology deserves a second look.

04-05-2017

Peri-Implantitis

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Peri-Implantitis is an “infectious disease that causes inflammation of the surrounding gum and bone of an already integrated dental implant, leading to loss of supporting bone.” Most inflammatory episodes are caused by plaque biofilm colonizing around the implant. Peri-Implantitis begins as Peri-Implant Mucositis which is an inflammatory condition of the mucosa and can be compared to Gingivitis because it’s reversible and doesn’t include bone loss.

Without proper treatment, Mucositis can progress to Implantitis by involving the mucosa and supporting bone. Implantitis is characterized by Crestal Bone level loss along with bleeding upon probing and exudate, and there may or may not be deepening of the pocket around the implant.

It’s estimated that one in five patients will exhibit Peri-Implantitis and the shocking part is that many patients will never have any symptoms of Peri-Implant Mucositis or Peri-Implantitis. Either condition can also occur immediately following placement of the implant or years later.

Risk factors for this condition include smoking, diabetes, osteoporosis, periodontal disease of natural teeth, poor home care, compromised immune system, and bruxism. Sometimes, there is no reason at all for Peri-Implantitis. The good news is that it’s rare and treatment is available.

Symptoms of the disease include deepening pockets around the implant, exudate, bleeding, progressive loss of supporting bone, swelling, metal thread exposure, and mobility of the implant.

Causes of this disorder are soft bone, vertical bone graft placement, implant size too big for the site, lack of tightness when placing the implant, overheated bone, excess cement at the implant site, malocclusion, occlusal overload, and bruxism.

Treatment options consist of thoroughly cleaning the area, site-specific and/ or systemic antibiotics, bone grafting, surgery, and removal and replacement.

If you see any changes in an implant site such as bleeding, exudate, bone loss, sensitivity, loosening of the implant, and swelling, immediately refer the patient back to the specialist who placed the implant. As stated earlier, the patient may have no symptoms so a thorough exam including radiographs at each appointment may keep the implant from failing. Reassure the patient that just because one implant may have failed or developed peri-implantitis, it doesn’t mean that the second one will fail or develop any complications.

Most dental professionals have heard of digital dental scanners which take the place of traditional impression material. Considering incorporating this piece of equipment into your practice may be scary at first. How can a simple wand scan a prep or arch with the accuracy of traditional impression material? Believe it or not, it’s happening in more and more offices around the world. Furthermore, these scanners are state of the art and take incredible impressions, and the finished restorations are flawless often needing no adjustment.

Imagine prepping a tooth for a crown, and instead of loading impression material into a tray, you use this magic wand to go around the prep methodically and send the scan off to the lab for fabrication of the restoration. Additionally, if you choose, you can purchase a machine that is placed in your office milling the crown at the same appointment. The patient comes in for a crown and leaves with the permanent crown on the same day.

Being able to tell the patient that you will no longer have to load their mouth with undesirable impression material while they gag may be a game changer. They may also be able to leave the appointment with their permanent crown in place negating the need for a temporary crown and another appointment.

Scanning dental impressions are growing more and more popular and cost effective because they are continuing to drop in price, and some manufacturers offer the scanner at a much-reduced price as long as you use their lab for the restoration fabrication.

If you’re debating as to whether or not to try a scanner, go ahead and at least give it a try. Most companies will send a representative to your office with a scanner and provide a demonstration. This opportunity will be instrumental in your decision. There is a learning curve, but if you keep an open mind and give it a chance, you may find it to be a great addition to your practice.

The intraoral camera was introduced in 1989 and has come a long way since its introduction. In the beginning, the resolution wasn’t great by any means, and they weren’t user-friendly. Today, with improved technology, intraoral cameras should be an integral part of the patient appointment.

LED lighting, small wand size, and improved software have made the intraoral camera easy to use and accurate. Most can zoom into an image at least 100 times making the images they produce crucial for properly diagnosing and patient education. Examining the mouth with a small dental mirror is essential, but incorporating the camera makes it possible to see the most remote areas. Additionally, by placing the image on a computer screen, the patient can see what their mouth looks like and where the breakdown is occurring.

The intraoral images are also beneficial in sending information to the patient’s insurance company.The images can be emailed to the insurance company which increases the probability of quick processing and optimal payment. Radiographs are an important piece of documentation for the insurance company, but including the actual images of the tooth is an excellent way to maximize the patient's benefits.

Not only can you show the patient a broken tooth, but you can also show them: Gingival Inflammation and bleeding, filling breakdown, plaque and calculus build-up, and decay. When a patient can see their mouth magnified on a computer screen, they can see why treatment is necessary and be more likely to consent. Using the camera takes some patience and practice, but it is worth the extra time and effort in enhancing the patient’s dental health.

Xerostomia or Dry Mouth Syndrome is a very serious condition which results from a decrease in saliva production by the salivary glands. Dry mouth isn’t only uncomfortable for the patient, but also very detrimental to their general health. A lack of saliva can cause tooth decay, gingivitis, halitosis, mouth sores, fungal infections, acid erosion, burning and tingling, and changes in taste which may result in poor nutrition.

There are many factors leading to Xerostomia. Let’s explore some of the more prevalent causes of this common medical predicament.

  1. Medications- There are more than 500 drugs which side effects include a decrease in saliva production. Depending on the condition for which the medication is taken, the physician may decide to alter the dosage or change to another drug without this side effect. Geriatric patients tend to experience mouth dryness more often because they are more likely to be on medications.
  2. Cancer Therapy- Chemotherapy and Radiation are very likely to cause Xerostomia. When Chemotherapy is ceased, the situation may correct itself. Radiation treatment that is focused on the head and neck may result in irreversible damage to the salivary glands. If the damage is extensive, the patient may have to fight a lifelong battle with dry mouth syndrome.
  3. Sjogren's Syndrome- This autoimmune disease causes damage to the salivary glands and a decrease in saliva. Medication may be beneficial in stimulating salivary flow.
  4. Snoring and Mouth Breathing- This common condition may be successfully handled with a sleep study and CPAP machine.

While this condition can be very distressing to the patient, there are two categories of treatment which may provide varying degrees of relief. The remedies include salivary substitutes and salivary stimulants. The success of these regiments depends on if there is damage to the salivary glands, and if so, the extent of the damage.

Salivary Substitutes are over the counter and treat the symptoms by providing some topical comfort. Many patients also report that continuously sipping water helps tremendously.

Salivary Stimulants are more effective than salivary substitutes because they help stimulate the salivary glands to produce more saliva. These include Xylitol chewing gums and the prescription drugs, Pilocarpine and Cevimeline.

As dental professionals, we are in a position to help patients recognize and treat Xerostomia. In working in conjunction with the patient’s physician, a course of treatment can be very successful and beneficial.

Spring is definitely in the air, and as this anticipated time of year approaches, many begin thinking about spring cleaning. When considering deep cleaning of the home, perhaps it’s also time to consider your dental cleaning routine. We’re going to go beyond toothbrushes and discuss two products which clean an often overlooked area in the mouth- in between the teeth.

Dental Floss- Using dental floss is an excellent way to clean in between the teeth. However, it can be difficult to master, and it’s not the only method which is effective. There are many different types of floss ranging from waxed to unwaxed, and varying thickness and materials. Studies show that the type of floss chosen doesn’t matter. Find a brand and type that works well for your mouth and use it daily. Using floss pics and floss holders are also acceptable.

Interdental Brushes- Interdental Brushes are a dark horse in the dental world. They were initially used to clean between wide gaps. They are becoming more and more popular for even tight spaces due to increasing choices in diameters. Many companies are making assorted sizes, and some are very small. Just about anyone can use an extremely small brush without any force needed to insert the brush between the teeth. The key is not to force the brush between the teeth thus avoiding creating a space where one doesn’t exist. Furthermore, Interdental Brushes are often more user-friendly than floss for many individuals.

Always consult your dental professional before making a decision and never force any interdental cleaning aid between your teeth. While these are but a few choices in dental cleaning, they’re a great start in getting your mouth in order this spring!

02-23-2017

X-Rays... Again?

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While visiting your dentist every six months for a cleaning, how often are you asked to update X-rays? Chances are, at least once per year. Why is your dental professional asking for a yearly update? Taking films allows the dentist to diagnose conditions not seen by the naked eye. There are different types of X-rays. Usually, bitewing X-rays are taken once per year, and a full set or a panorex is taken once every three to five years.

Bitewing X-rays are four smaller films taken of the back teeth, two on each side. They mainly show the chewing surface of the teeth and are used to diagnose cavities between the teeth and evaluate bone level. Because they are taken once per year, previous and subsequent years can be used as a comparison thus monitoring any condition and evaluating if there is a progression of any abnormality.

A full set of periapical or a panorex X-ray is usually taken every three to five years. These types of X-rays allow the clinician to view the entire tooth and surrounding structures. They assist in diagnosing decay, abscesses, periodontal disease, atypical growths, and any other abnormality which may be present.

Dental team members truly understand the patient’s trepidation regarding too much radiation. Quite honestly, dental radiographs use the least amount of radiation when compared to other types of X-rays. Furthermore, many offices are utilizing digital radiographs which cut the amount of radiation exposure to one-third that of traditional X-rays in most cases. In using the aid of radiographs, the dental professional can diagnose many conditions at an early stage thus preventing more invasive treatment in the future.

The introduction of a new CDT Code in January 2017 could prove to be very promising for closing the gap between a regular prophy (D1110) and Scaling and Root Planing (D4341, D4342). Many times, a patient falls between these two codes, and if this is the case, a regular prophy (D1110) would be under coding and Scaling and Root Planing (D4341, D4342) would be over coding.

D4346 is “Scaling in the presence of generalized moderate or severe gingival inflammation- full mouth, after oral evaluation.” If you are considerating using D4346, the following criteria must be examined:

-30% or more of the patient’s teeth at one or more sites are affected

-No periodontal disease (no bone loss) is present

-Pseudopocketing may be present

-Moderate to severe bleeding on probing is present

-Full mouth is treated in one appointment after an oral examination (D0120, D0150, or D0180)

-Supra and subgingival calculus may be present

-Perio chart (pseudopocketing & BOP) and X-rays are submitted when filing

-code is based on the extent of inflammation not the intensity of calculus buildup

-There is no waiting period after D4346 for a prophy (D1110), but you can’t file both on the same day

-(D4346) can’t be filed with SRP (D4341, D4342) or Debridement (D4355)

-There may be a limit as to how many times in a given period in which insurance will cover D4346

As long as these guidelines are followed, this new code will be very useful in your practice. We’ve all been presented with the patient who is too compromised for a regular prophy (D1110) but isn’t compromised enough for Scaling and Root Planing (D4341, D4342). Using D4346 is perfect for this scenario and provides the best treatment for the patient while maximizing their dental benefits.

It was once thought that patients taking blood thinners would need to stop the medication days before an invasive procedure due to the patient’s inability to clot easily. However, physicians are now reconsidering the risk of stopping the medication versus having the patient bleed easier during and after the procedure. Given the use of hemostatics in dentistry, the incidence of clotting difficulties has lessened.

Blood Thinners: These include Coumadin (Warfarin), Pradaxa, Eliquis, Xarelto, Plavix, Effient, and Brilinta.

Coumadin, Pradaxa, Eliquis, and Xarelto are recommended to prevent and manage strokes that can develop as a result of heart valve replacement, atrial fibrillation, or DVT (Deep Vein Thrombosis).

Plavix, Effient, and Brilinta are prescribed to prohibit restenosis of vascular stents.

Depending on the procedure, clotting can be a complication and must be taken into consideration. Before any treatment that is going to result in a moderate amount of bleeding, the patients prescribing doctor must be consulted and ultimately decide how you are to proceed. With respect to patients with a vascular stent, the probability of restenosis goes up drastically even with stopping the medication for a few days.

Although it’s rare that a patient would bleed out because of a dental procedure, anything is possible. As previously stated, the use of hemostatics in dentistry has helped tremendously. On the other hand, stopping the drug and having the patient suffer a stroke or heart attack can be devastating. Before treating patients on anticoagulants, obtain written consent from the physician stating which action to take and keep it on file. Also, ensure that the patient understands the directions and the importance of following the recommendation. Treating patients taking a drug in this classification can be precarious, but with guidance from their physician, the outcome can be safe and beneficial.

As a patient, you may be wondering why it’s recommended you take an antibiotic before dental procedures. What does your oral health have to do with your general health? In a word, everything. It’s like the old song, “The knee bone is connected to the leg bone.” Everything is connected, and it’s imperative that you adhere to the guidelines set by your physician if they have advised you to take an antibiotic before dental appointments. There are two major reasons you would require an antibiotic before dental appointments; artificial joint placement and certain heart conditions.

Do you have any artificial joints? Knee and hip replacements are very prevalent today, and the chances are that you or someone you know has had this operation. If so, your surgeon will probably require you take an antibiotic before dental visits in light of the human mouth having up to one thousand different bacteria. While this is normal, some are good and help you while others can be harmful. When you have a dental procedure, these bacteria can enter your bloodstream, go to the site of the prosthesis, and cause a severe infection. While this chance is remote, the resulting infection can be very serious requiring a hospital stay and possibly surgery. Taking a prophylactic antibiotic will help ensure that you have protection against this bacteria.

Do you possess any heart maladies such as a heart transplant, a damaged heart valve or artificial heart valves, a heart murmur, mitral valve prolapse, or rheumatic heart disease? Again, the human mouth hosts lots of helpful and harmful bacteria. During a dental visit, this bacteria can infiltrate the bloodstream and go to the heart causing a rather dire situation. Bacterial endocarditis is an infection which can affect the lining of the heart and heart valves. While the AMA guidelines have changed over the years, at present writing, premedication is no longer necessary for most heart murmurs and mitral valve prolapse. Having a heart transplant or artificial heart valves still requires prophylactic premed.

While there are many opinions regarding the need for antibiotic prophylaxis and the overuse of these medications leading to antibiotic resistance, your physician should be the one who determines whether or not you need this type of intervention based on your specific medical history.

Decay on the occlusal surface is still the easiest place to acquire and prevent decay. Due to the anatomy of the occlusal surface, brushing and applying fluoride can’t effectively reach down into the grooves of the tooth and decay can develop quite easily. Pit and fissure sealants are very instrumental in the prevention of occlusal cavities.

What is the origin of the sealant? Although they were introduced in the sixties, they weren't widely used until the eighties. With the introduction of phosphoric acid for use in dentistry, it was found that acrylic resin could be used to flow onto the porous surface produced by the acid, therefore, locking the resin into these pores. This action “seals” the tooth reducing the occurrence of decay on the chewing surface.

Thankfully, changes have been made in the sealant material itself over the years making it easier to manipulate. In the early days, there was a “self-curing” sealant that would set up rather quickly thereby giving the clinician very little time to work with the material before setting. Most materials today require the use of a curing light giving the clinician more time to place the sealant perfectly.

While there are some materials today which don’t require an entirely dry surface before placing the sealant, it’s still very important to have a moderately dry field for the sealant to adhere. Some allow for a slightly moist surface, but this isn’t easily achieved with a patient who is heavy salivator. A relatively dry field is mandatory for proper adherence. Furthermore, the use of Microcopy’s NeoDrys has personally been an absolute lifesaver. Even if using a material that allows for a moist surface, this product is fantastic for keeping the field from being drenched in saliva.

How safe are sealants? In a word, extremely. The materials used today are BPA free, and the prevention of decay negates the need for more invasive procedures such as fillings. The proper placement of a sealant will ensure the health of the dentition for years to come.

Many dental software companies offer excellent practice management software, and the new trend is operating systems which are Cloud based. What does this mean with respect to the safety of a patient’s personal information? The “Cloud” is a group of computers on the internet that a company uses to offer certain services such as storage, backup of files and folders, and plenty of storage space making management more cost-effective and convenient. It allows you to deposit and access data, programs, and applications you’re operating over the Internet rather than storing and acquiring this data from your computer’s hard drive or a server somewhere in the office. Considering you have internet capability, you can access backup and sync your data with most devices. This feature is extremely beneficial when you’re away from the office, however, doing so entrusts your data hosting to someone else. Therefore, the service provider you choose can view the data you store whenever they wish.

Consequently, how safe is your patient’s vital information being stored off-site? While opinions vary, it seems that on-site storage is safer than cloud-based options. Although the on-site material is kept within your walls, the information isn’t necessarily safe. The biggest problem with a security breach in your office is by whom the information is disclosed. Security is usually breached by an employee, and when this happens, it can take a long time for the infraction to be discovered and handled properly.

If you are thinking about a cloud-based option, the most important thing you can do is thoroughly investigate the provider you’re considering. Following are critical points to examine:

1.     Double check that the company has an excellent reputation and strong security policies.

2.   Encryption is essential. Confirm that your information is encrypted when it’s uploaded to or downloaded from the cloud. Additionally, establish that your application or browser necessitates a connection which is encrypted before downloading or uploading your data. The “padlock” symbol must be adjacent to the URL in your browser.

3.   Verify that your data is encrypted when saved in the cloud. Moreover, you should have knowledge of who has the authority to decrypt the data and why they are decrypting the information. You should be the only one with the ability to decrypt. The decryption is done automatically when you access the files.

4.   Make sure you know all of the details if your service provider allows for sharing access to your online folder with others. When sharing data, your files are at risk for being viewed, changed, or made public.

5.   Clarify the protocol if the service provider is hacked, or your data is lost. A system should be in place by the vendor clearly outlining what will be done in the case of an emergency.                                          

There are many advantages to storing your data in the cloud. Information can be accessed from anywhere with an internet connection, storage space is incredible, and the uptimes are quicker than with on-site storage. As along as you investigate, carefully read their TOS, and choose the right provider, being “in the cloud” can make sense for your practice.

For the 3rd consecutive year Microcopy, a leader in the design and development of innovative products for the dental industry, has finished 2016 on a positive note. Microcopy ended the year with its 3rd annual “Pink to Make You Think” campaign. Just as we did in years past, our industry-leading NeoDrys saliva absorbents go PINK to promote breast cancer awareness. A portion of the sales of all pink NeoDrys from the months of October through December are donated to the American Cancer Society.

For over 100 years, the American Cancer Society has worked relentlessly to eliminate cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and service.

According to BreastCancer.org about 1 in 8 U.S. women will develop invasive breast cancer over the course of her lifetime. In 2017, an estimated 255,180 new cases of invasive breast cancer are expected to be diagnosed in women in the U.S., along with 63,410 new cases of non-invasive (in situ) breast cancer. “Too many women are affected by this disease. That is why this campaign is so important to us, the fight to end breast cancer starts with one commitment.” said Heather Siler, Marketing Manager for the program. Microcopy plans to run the campaign again in the latter part of 2017 and hopes the proceeds will be even greater! Together we can make a difference.

In 2016, Microcopy released the new blended neck NeoBurr 5572. Now available on the 5572 and other select shapes, the patent-pending blended neck was developed because other burs on the market were breaking frequently and causing interruptions in what should be smooth dental procedures. Microcopy wanted to change that.

Since the product release, NeoBurr has been tested and evaluated by numerous publications and labs. Everyone wanted to find out how the blended neck burs really performed.

After extensive evaluation, the NeoBurr 5572 has been recognized as Best Product 2017 by the Dental Product Shopper, Preferred Product 2017 by the Dental Advisor, selected as a 2016 Top 100 Product by Dentistry Today, and finally, NeoBurr 330 was ranked #3 in the Top Carbides 2017 by Clinician's Report. All of the evaluations came back with excellent results.

Doctors are more concerned about dangerous, breaking burs than they let on.Since the release of the blended neck carbides, we have heard from many doctors pleased about making the switch to NeoBurr.

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Gingival recession is a very gradual process by which the tissue wears away or pulls back from the tooth exposing more of the tooth or root surface. It’s very common and can be painful and look unsightly for the patient. There are many reasons for recession, and the decision to refer to a periodontist may be unclear.

First of all, interviewing the patient as to the cause of the recession is paramount. The results of this conversation will guide you as to whether or not to refer. Furthermore, the classification of recession will help in your decision.

Referral may not be necessary if the patient has class I or II recession which is determined to be caused by:

Bruxism- An occlusal guard can be fabricated to prevent further damage.

Overaggressive brushing- Proper brushing instruction is vital, or better yet, have the patient purchase a mechanical brush which is approved by the ADA. These brushes will have a safety mechanism which prevents overaggressive brushing.

Improper flossing- patients who floss improperly and too harshly can cause recession. Instruct the patient as to how to floss.

Heavy Calculus Deposits- If it has been many years since a proper dental cleaning, there may be heavy calculus deposits above and below the gumline. Removal of these harmful deposits usually helps the gingiva to return to a normal appearance.

Use of Tobacco products- Smokeless tobacco (chewing tobacco, dip, or snuff) causes the most damage in relation to gingival recession due to the product sitting on the tissue. Smoking also causes recession. Having the patient cease tobacco use will be the only way to prevent further damage.

Piercings of the lip or tongue can cause recession as the stud or ring rubs the tissue. The patient will have to remove the piercing to prevent further damage.

The causes of these types of recession can be controlled by the patient stopping or correcting the behavior which caused the recession in the first place.

Referral may be necessary if the patient presents with Class III or IV recession and has the following risk factors:

Genetic predisposition- 30% of adults possess a genetic predisposition for gingival recession. These patients must be referred as soon as possible to treat and prevent further damage.

Bulimia- This eating disorder must be resolved before any treatment will be successful because stomach acid coming up in the mouth can cause gingival recession. A referral to an eating disorders specialist may be in order.

Malocclusion- Referral to an orthodontist is recommended. Correction of the bite can prevent the condition from worsening.

Any class III or IV recession may require referral if any of the risk factors are present. These classes of recession extend to or beyond the mucogingival junction with periodontal attachment loss and possible bone loss. A Class I or Class II recession may become III or IV over time without treatment. If a patient presents with Class I or II recession, and you are uncomfortable treating the condition, refer the patient. It may be more desirable to have the patient alternate routine dental prophylaxis between your office and the periodontist to monitor the condition over time.

Making a New Year’s resolution isn’t a new concept. Most people make them, and over 85% are forgotten by the end of January. Whether it’s losing weight or becoming more organized, most resolutions are made for one’s personal life. Have you ever given any thought to setting practice resolutions? Now’s the time to consider making some intentions for your professional life.

Setting resolutions for your practice should be a team effort. Sit down with your team and have a discussion about making some resolutions for the practice. By making it a team effort, you can hold one another accountable ensuring that changes are made, and policies stay in effect.

It’s time to pull out some pen and paper and evaluate your office and procedures. Be honest about where you stand and what needs to be improved. Below is a list of some common areas of the dental practice which may be overlooked.

Team performance- take a long hard look at yourself and the team. More time is spent with these people than with your family in some cases. Being honest and open with one another ensures that the practice doesn’t suffer due to inappropriate behavior or inadequate job performance. However, this must go both ways, if your team members have constructive criticism for you, the doctor, you must listen with an open mind and try to resolve the issue.

Equipment review- Perhaps it’s time to evaluate your equipment. Taking stock and testing equipment is paramount to the safety and efficiency of your practice. Start at the entrance of your office and go through it as if you were the patient. It may be time for an update in the reception area or new paint on the walls. Even chair reupholstering can go a long way in giving the office a much-needed facelift.

Patient reviews- have you ever reviewed your patient base? Are you attracting and keeping the type of patients you desire? We all have less than perfect patients. However, if you are consistently receiving patients who make your professional life miserable, dental practice consultants may be an option to help you change or tweak your image thus attracting a better patient base.

These are but a few suggestions. Upon returning to the office in January, sit down with your team and agree upon some issues which need to be addressed. By being in this together and being honest, you’ll be able to keep these resolutions until it’s time to set new ones in 2018.

Your patient comes in with a toothache. This particular tooth has had fillings, a crown, and two root canals. Is it time to have the tooth extracted and place an implant? More and more patients are inquiring about extraction and implant placement rather than spending countless dollars on a losing battle.

First of all, you must consider the history of the tooth. For most patients in this dilemma, a filling is necessary usually during childhood due to decay. Depending on the size of the filling and possibility of recurrent decay, a second filling may occur resulting in less tooth structure the second time around. If that second filling is close to the nerve, the nerve may die requiring a root canal. After the root canal, a crown is usually necessary.

Sometimes a second root canal is necessary or an apicoectomy thus further traumatizing the tooth. Also, with all this manipulation, the roots may fracture.

This poor tooth has been through several fillings, root canals, and had a crown placed. It may be painful and symptomatic or not distressing at all. The only indication that something is wrong may be evidence on an x-ray at your routine check-up showing that there is an infection and surrounding tissue destruction.

What are the options? If there is a root fracture, the tooth must be extracted. If it’s not fractured, do you continue to spend more money on this poor hopeless tooth or do you cut your losses, give it to the tooth fairy, and have an implant placed?

That’s the million dollar question. If you totaled the amount of money spent on this one tooth, it would be around $3800-4000. An extraction and implant placement can run around $3500-4000. Altogether, this tooth will cost you almost $8000. Granted this is spent over a period of years, but still impressive nonetheless.

If a tooth with no previous treatment needs a filling, by all means, have it filled. However, if it comes to a second filling, root canals, and crowns, you should ask your dentist if extraction and implant placement is a viable option. This will depend on the overall prognosis of the tooth in question. Implant therapy is very common these days, and most insurance companies provide coverage. Implant success is excellent depending on the oral and general health and habits of the patient. Although not common, sometimes implants fail for no reason at all. However, it’s definitely worth the risk if your dentist confirms that the tooth has seen better days.

Have you been down the oral care aisle of your local store lately? There are so many choices when it comes to keeping your teeth and gums healthy. One of the biggest decisions is whether to use a manual or electric brush. Let’s examine the pros and cons of using this type of toothbrush.

The first power-driven toothbrush was invented in Switzerland in the 1950’s. They’ve improved greatly over the years and became mainstream in the 1990’s. A mechanical brush works either through oscillation-rotation or sonic-ultrasonic vibration and while each delivers excellent results, it’s a matter of personal preference as to which feels better to the user. Whichever technology you choose, it’s very important that you purchase a brush which is approved by the American Dental Association. Most dental practices have display models so you can view and try the brush.

Pro’s for using an electric brush- With a bigger handle, an electric brush is easier to maneuver which is especially helpful for an elderly or special needs patient whose mechanical skills may be compromised. A manual brush usually has a smaller handle and is more difficult for the patient who is handicapped to maneuver.

Patients with gingival recession may benefit from a quality electric brush. Some brands approved by American Dental Association possess a safety feature in which the brush will “stall” or use some other alert if too much pressure is applied thus preventing the patient from brushing too hard and causing gingival recession. It’s quite hard to believe, but a manual brush can cause recession because of the force of the user.

Most electric brushes offer a variety of sizes and brush heads for certain conditions such as orthodontics, sensitivity, interproximal areas, and many other specific needs. Numerous models also feature a timer allowing the user to brush for the recommended amount of time which is two minutes.

Although many studies state that electric brushes don’t provide a cleaner mouth than manual brushes, many patients report that they do indeed feel that their teeth are cleaner. I have also found that patients who use an electric brush do exhibit cleaner teeth and better oral hygiene.

Cons for using an electric toothbrush- The biggest concern when considering an electric brush is cost. A quality brush which is approved by the ADA can run between $39-$200 depending on the technology. The more expensive models have lots of bells and whistles which may be attractive to some consumers. When properly used, a less expensive mechanical brush can provide many years of superior benefits. Another factor is the cost of replacement brush heads. You will need to replace the head after three months of use or after an illness.

The size of the brush and need to recharge can make it difficult while traveling although some companies sell travel size electric brushes. Many brushes also hold their charge for up to two weeks making the charger unnecessary for periods of time.

Most people who make the investment in an electric brush are very happy with the decision. Therefore, talk with your dental professional to see if this option is right for your situation. They will be able to guide you before taking that long walk down the dental aisle.

Whitening or bleaching of the teeth has been around much longer than you may think. Some reports suggest that even the Ancient Romans attempted to make their teeth whiter. What is the obsession with a pearly smile and how is it achieved safely? Studies show that having white teeth boosts confidence and makes you feel more attractive than if your teeth are dingy. Understanding the two types of staining will allow you, along with your dentist, to choose the best method of getting your smile luminous.

Extrinsic stains are on the surface of the teeth and are removed and prevented by daily plaque and stain removal, i.e., brushing and flossing. Your bi-annual dental cleaning will also remove the more stubborn extrinsic stains caused by smoking, certain foods, and some medications. Intrinsic deposits exist within the tooth. Therefore, administering a bleaching solution will be necessary for optimal results.

First of all, who is the perfect candidate for whitening? Your Dentist will perform an examination and decide if, depending on your oral condition, you would benefit from a whitening procedure. Moreover, your dentist should be consulted first even if you are considering an over-the-counter option.

Anyone considering bleaching should be at least sixteen years of age, have no presence of gingivitis or periodontal disease, possess untreated decay, or is pregnant or nursing. Furthermore, you must take into consideration existing crowns, fillings, or bonding that shows when smiling or talking. These restorations will not lighten with bleaching, so you must decide if you’re prepared to replace any dental work that doesn’t match your new smile.

Whitening regiments used in dentistry today, as well as the over the counter options, are comprised of Hydrogen or Carbimide Peroxide. Both provide excellent results. However, Hydrogen Peroxide tends to work faster. Your dentist will decide which option is best for you based on the results of your examination and causes of staining. The different processes are as follows:

1.   In-Office Whitening- while this is the quickest way to achieve whiteness, it can be very expensive, and you may have to undergo more than one session and follow up with bleaching at home. Choosing this treatment is ideal if you have an important life event coming up and you need results quickly. This method encompasses one or more appointments with your dentist. A barrier will be placed on the soft tissues, and the bleaching solution will be applied to the teeth. A special light or laser will then be positioned near the teeth to activate the solution. Although any bleaching process can cause tooth sensitivity, this method is more likely to produce discomfort. Your dentist may suggest a prescription fluoride paste or a toothpaste containing Potassium Nitrate to counteract the sensitivity.

2.   At-Home Bleaching with custom made trays- this is perhaps the most prevalent dentist prescribed method. Again, Hydrogen or Carbimide Peroxide is administered depending on the type of staining present. In this scenario, impressions of your teeth are taken by the dental professional and made into models which are used to fabricate custom made trays. Your dentist will instruct you on how to fill these trays with the gel and how often to wear them depending on your discoloration.

3.   Over-the-counter products- Retail whitening products range from toothpaste, mouth rinses, or gels. Toothpaste removes stains by incorporating abrasive particles thus polishing the teeth and removing surface stains. They may also contain ingredients such as Hydrogen Peroxide for whitening purposes. Mouth rinses may also contain Hydrogen Peroxide for the purpose of lightening the teeth. Over-the-counter gels work by transferring the gel to the teeth through a thin strip or a tray which aren’t form fitting like the one your dentist would manufacture. There are also gels incorporated in a pen which you paint onto the tooth. Commercially purchased solutions usually contain a much lower percentage of Hydrogen or Carbimide Peroxide than ones obtained through a dental professional.

The bottom line in deciding which avenue to take regarding bleaching is dependent on the severity of your staining. Possessing a yellowish hue is the most common and simplest correction with whitening. Those with a grayish staining will require professional treatments over a longer period. With any bleaching, tooth sensitivity may be an issue. A desensitizing toothpaste containing Potassium Nitrate will remedy this inconvenience. Achieving a sparkling smile is not that challenging and is worth a conversation with your dentist.

Occlusal Disease may be one of the most overlooked and detrimental conditions in dentistry today. It also can be one of the simplest issues to correct. Accessing the occlusion isn’t just confirming the crown or restoration you just placed is occluding properly. An issue may arise a week or a month later when your patient returns and announces that the filling or crown you finished last month is sensitive or chipped. On the other hand, it can materialize when you’re performing a hygiene exam. Just as you’re leaving the room, the patient says, “Oh, by the way, I’ve been having pain on the left side, but I can’t tell which tooth it is.” Also, it may be discovered during an exam when you notice significant wear in one or more areas.

Obtaining ideal occlusion can be very intricate. However, the slightest adjustment can be the difference between occlusal disease and proper form and function. Why is taking the time to evaluate the patient’s bite carefully so critical? What happens if you don’t slow down and do some investigating? Having even one area of interference with full closure can contribute to multiple undesirable conditions such as tooth sensitivity, pulp damage, abfraction, significant incisal and occlusal wear, tooth or restoration fracture, headaches, TMD, and periodontal trauma including tooth movement, mobility, or loss.

Conceivably, the most important part of the evaluation is to slow down. While some adjustments will take minutes others, being more involved, may require a separate appointment. Taking your time and studying the marks left by the articulation film will deliver the best outcome. Ensure the teeth are dry before marking and carefully advise the patient on how you want them to bite. Instruct with your hands as well so that the patient understands fully the movements you desire for an accurate registration. At the end of the adjustment, bring the patient to an upright sitting position and check the bite once more. Analyzing while sitting upright is many times overlooked, but paramount. Furthermore, consider referring the patient to an occlusal specialist if the case is more involved than you’re comfortable treating.

In the end, occlusal evaluation and equilibration are going to always be an important part of your day to day treatment. Carefully interpreting the markings and subsequently adjusting will safeguard the patient's dentition thus preventing unnecessary discomfort and the possibility of occlusal disease.

The practice of orthodontics has changed somewhat since I wore braces in the eighties. In those days, the Orthodontist usually waited until all deciduous teeth were absent before beginning orthodontic treatment, which is around age thirteen. Parents are always asking why we are referring their five-year-old to the Orthodontist. Their biggest concern may be why they would spend money now versus waiting until all the baby teeth are gone thus needing treatment only once. This type of misconception can be detrimental. Today, we see children as young as five with some type of orthodontic appliance in their mouth. Why is this happening? There are many different reasons for committing to multiple phases of orthodontics. Suggesting Phase One results when the child has a mixture of primary and permanent teeth. Phase Two occurs when all permanent teeth are present.

Many orthodontic issues can be corrected efficiently when the permanent dentition is in place, but there are some conditions which would be better served with Phase One intervention while the child is younger. These include crossbite, open bite, overbite, underbite, tooth eruption difficulties, and malocclusion due to damaging habits. Delaying treatment until all the permanent teeth have erupted can cause increased complications in correcting the original problem, atypical jaw growth, unstable results, and abnormal tooth wear. Let’s review the different malocclusions you may encounter on a daily basis.

A crossbite occurs when the mandibular teeth rest outside of the maxillary teeth in one or more areas. An open bite/overjet transpires when the maxillary and mandibular front teeth are protruding so greatly externally, they don’t touch even upon closing the mouth. An overbite exists when there is a significant horizontal overlap of the maxillary incisors over the mandibular incisors. An underbite develops when the mandibular incisors rest outside of the maxillary incisors. Tooth eruption difficulties arise when a permanent tooth erupts in the wrong position or fails to enter the dentition due to blockage by a primary tooth. Additionally, a child may possess a habit such as sucking the thumb, pacifier usage, or mouth breathing in which they create a dysfunctional bite.

Perhaps the most important reason for an initial consultation is age itself. Evaluation before age seven is imperative for guiding tooth eruption, improving facial symmetry, and influencing jaw growth. Many innovative appliances used today are extremely beneficial in taking advantage of growth spurts and may prevent the need for more involved and extensive treatment in the future.

In summary, reassure the parent that the referral is key to optimal health and proper development of their child. Many Orthodontic offices offer an initial exam free of charge which may encourage the parent to make an appointment. It’s not just about aesthetics. Proper occlusion prevents a myriad of issues such as TMD, headaches, and chewing difficulties. Guiding the teeth into proper alignment will ensure not only a beautiful smile but also a healthy dentition. Conversely, an initial examination doesn’t always result in mandatory intervention. The Orthodontist may simply recommend a six month or yearly exam until treatment is necessary, if at all. Working together as a team, (You, the parent, and the Orthodontist) with open communication and commitment will ensure the best possible outcome for the welfare of the child.

You may be wondering why a patient without natural teeth would require a cleaning and exam twice per year as well as a panoramic radiograph yearly. Often overlooked in dentistry, bi-annual visits for patients with traditional dentures or implant retained prosthetics are critical because many undesirable conditions can develop inconspicuously regarding the underlying structures.

What might be lurking underneath a prosthesis? An infection is possible as a result of the porous nature of the acrylic being a breeding ground for microbes. You may also find abnormal tissue or bone growth precipitating a visit to an oral surgeon for evaluation and biopsy. Moreover, tissue irritation is a possibility due to an ill-fitting prosthesis rubbing the exposed tissue. A simple adjustment will usually alleviate this annoyance. Another culprit might be calculus present on the denture itself causing friction. Although the patient is adequately caring for the denture at home, calculus can still form on the surface and pose as an irritant to the tissue. A dental professional will be able to place the prosthesis in an ultrasonic device with a chemical solution and loosen the calculus. After removal of any hard deposits, the denture can be polished and returned to the patient.

Most patients with a total prosthesis only visit a dentist if they’re experiencing pain or the prosthesis breaks. These limited appointments usually focus on addressing the acute problem and not the overall health of the remaining oral structures. Furthermore, edentulous patients are often self-conscious without their prosthesis in their mouth and refuse to remove it on a daily basis, so you can imagine the panic they feel when you request they remove it for an extended period. The thought of being in a public place (the dental office) without any teeth is overwhelming for many people. Therefore, it’s imperative that the dental team is sensitive to this fact while stressing the importance of regular appointments to ensure proper oral health. Examining the patient in a private area may alleviate their fears and make them much more cooperative.

It is the responsibility of the dental professional to educate the patient on the necessity of continued dental care, and the misconception that professional prophylaxis and exams are no longer necessary because of the absence of natural teeth. Most people with dentures honestly believe that regular check-ups are unnecessary and it’s the duty of the dental professional to advise them otherwise.

Should you hire a Dental Practice Consultant? I’m guessing that all depends on who’s reading this post. Some Dentists would give a resounding “YES” while their team members might be screaming “NO”!

Why would your team respond with a resounding “NO”? Hiring a consultant without communicating with your team first is not a good idea. I realize that the practice is yours and the final decision is and should be up to you. However, please take your team members feelings into consideration especially if they have been with you for a number of years. It can be very intimidating for the team and sharing the purpose and proposed outcomes will help tremendously in the transition.

Being in dentistry for nearly 30 years, I have weathered this storm more than once. It doesn’t have to be as daunting as it sounds. When a consultant is brought into the practice, things will change. Their services are quite expensive and if you’re going to take the leap, you’ll want to get your money’s worth.

You must ask yourself why you’re considering hiring a consultant. What do you want to achieve? Perhaps the practice has hit a plateau and it’s time to “shake things up”. There’s nothing wrong with breathing new life into the practice especially if you’re planning on bringing in an associate. You must question your reasons for making this commitment.

Choosing the right consultant for your practice is absolutely the most important part of this process. As stated earlier, the cost can be pretty substantial and you don’t want to waste time and money with someone who doesn’t share your goals and values. Interview many different candidates with a clear picture of what you want to achieve.

Once you’ve found the perfect fit, keep an open mind. Change can be very scary and some people don’t assimilate as quickly as others. Keep an open communication with your team and be willing to address fears and concerns. Remember, the consultant is there to help you implement programs to achieve your goals. On the other hand, if the consultant has suggested protocols and procedures that don’t seem compatible with your practice, speak up and find another candidate if necessary.

In conclusion, is this something you’re willing to see through and make the necessary changes? Take an inventory of how things are truly going in your practice. Are the numbers (collection and production) on track? Is your team performing at a level with which you’re happy? Is the overall environment in the office pleasing for the team and your patients? Could things run smoother? Be honest with yourself and then decide if this is the right move for you.

Water fluoridation is a highly controversial topic that’s dividing the nation. While there is a huge benefit to adding fluoride to water in the United States, particularly from an oral health point of view, there are concerns that increasing fluoride intake could heighten the risk of developing certain health conditions; most notably those related to bone health. So where do you stand on the great fluoride debate?

What is Fluoride?

Contrary to popular belief, there’s nothing fancy about fluoride. In fact, fluoride is simply a mineral that happens to be naturally present in many sources of drinking water. This happens because water travels across rock, and in doing so picks up a number of minerals along the way, including fluoride. However, in many places, the natural fluoride levels in water are very low, which is why water fluoridation exists.

The Fluoride Controversy

The fluoride debate in the United States certainly isn’t new. In fact, it’s essentially been around since 1945 when Grand Rapids, Michigan, started to add fluoride to their drinking water, becoming the first community in the US to do so. While most states now impose water fluoridation laws stating that drinking water from faucets must be supplemented, there are still 8 states who have not implemented these regulations: California, Arizona, Texas, Oregon, Kansas, New Mexico, Florida, and Colorado. Why?

Fluoride Concerns

Previously, one of the biggest concerns of water fluoridation was the increased risk of certain types of cancer, especially bone cancer. These fears stemmed from research which found a link between fluoride and bone tumors in rats. However, these results have not been seen in other animals, or in humans, and the National Cancer Institute states that there is no known association between fluoride and cancer.

However, while cancer should not be a concern, it may be possible that fluoride could impact overall bone health. Studies have found that fractures, particularly hip fractures, are more common in areas of high fluoride, which leads to questions as to whether it could increase the risk of osteoporosis. From a dental standpoint, there is also a concern about dental fluorosis, which could leave teeth vulnerable.

Fluoride Benefits

Water fluoridation is a hot topic in the oral health industry, and that’s because it could significantly help to reduce tooth decay. In fact, the Centers for Disease Control and Prevention claim that water fluoridation could reduce the risk of cavities by up to 15 percent in both adults and children.

The problem that we have is that, according to the Congressional Research Service, water sources need to contain between 0.7 and 1.2 milligrams of fluoride per liter in order to be effective in minimizing tooth decay. However, the World Health Organization claims that, in North America, natural fluoride levels in drinking water are typically between 0.05 and 0.2 milligrams, although some areas have even less.

Low Fluoride Areas

If you live in an area of naturally low fluoride, and your state does not impose water fluoridation laws, then don’t worry. If you are in favor of the addition of fluoride in water due to the oral health benefits, you can opt to brush with a fluoride-enriched toothpaste, which can help to protect your teeth and reduce the risk of tooth decay. Ask your dentist if a fluoride-enriched toothpaste could be a good choice for you.

Many of us have suffered with a mouth ulcer, or canker sore, at some point in our lives, and while they’re not dangerous, they can be quite painful and frustrating. These sores can sometimes last for up to 3 weeks, which is a long time to feel uncomfortable. That’s why it’s important to know the best ways to manage a mouth ulcer, and how to minimize the risk of developing new canker sores in the future.

Do I Have a Mouth Ulcer?

Fortunately, it’s simple to tell if you have a mouth ulcer without needing an official diagnosis from your dentist. A mouth ulcer often occurs on the inside of the lips, on the gums, or on the inside of the cheeks. They are usually round in appearance, and can either be sunken, or slightly raised. Mouth ulcers may hurt when touched, or when eating. Most are small and will not leave any scars or marks.

Causes of Mouth Ulcers

Some mouth ulcers are caused by physical trauma to the inside of the mouth, such as ill-fitting dentures or jagged, fractured teeth which rub against the gums. However, most cases of canker sores don’t have a definite cause that can be pinpointed confidently. These sores usually begin in childhood, and around 20 percent of the population will experience recurrent mouth ulcers over the course of their lifetime.

Although we can’t always pinpoint a cause, some people may notice a pattern in the occurrence of mouth ulcers. Studies have found that stress, menstruation, and stopping smoking could all increase the risk, with the American Academy of Oral & Maxillofacial Pathology suggesting that mouth ulcers could be a symptom of an allergic reaction to internal bodily processes. Other experts say it’s all about genetics.

Mouth Ulcer Treatment

Unfortunately, there’s no magic cure for mouth ulcers; we simply need to let them run their course. However, there are ways to help minimize the pain and make the healing process much more bearable. Antiseptic mouthwashes, over-the-counter anti inflammatory medications, and topical pain-relieving gels can all help. It’s also advised to steer clear of salty or acidic foods which can cause a stinging sensation.

Prevention of Mouth Ulcers

As we don’t know the exact cause of mouth ulcers, it is unclear which prevention techniques could prove to be effective. However, regular trips to the dentist can help to reduce the risk of trauma to the mouth, which is known to be a common cause. For those who believe their mouth ulcers are the result of stress or anxiety, practicing some relaxation methods at home, such as yoga, could prove to be beneficial.

When to See a Dentist

Most mouth ulcers do not need to be seen by a dentist, with home care often the best medicine. However, if you have a very large ulcer, a lot of ulcers at the same time, or if you are experiencing your first ulcer as an adult without any previous history of canker sores, then it’s worth making an appointment. In rare instances, a mouth ulcer could be a sign of an underlying condition, but in most cases they are simply plain old mouth ulcers. They’re painful, they’re frustrating, but they’re temporary!

When it comes to Thanksgiving food, things are a little ironic, don’t you think? A traditional Thanksgiving dinner in the United States typically includes lots of healthy components; cranberries, pumpkin, apple, and sweet potatoes, for example, and yet they’re prepared in ways that make them rather unhealthy (though definitely tasty!) From sweet potatoes that have been candied and covered in gooey marshmallow, to pumpkin that’s been transformed into a sweet pie, Thanksgiving can wreak havoc on our teeth.

The Thanksgiving Sugar Problem

Although sweet apple ciders and thick cranberry sauces are mouthwateringly delicious, they often contain very high amounts of sugar that are not only likely to push you above the recommended daily allowance, but also put your oral hygiene at risk. Research states that dietary sugar is the most influential factor in the development of dental cavities, leaving us vulnerable to pain, problems eating, and potentially even the loss of our teeth. What’s worse is that there’s so much temptation at this time of year.

During the last few months of the year, we’re inundated with candy-filled holidays; Halloween, Thanksgiving, and Christmas. It’s easy to overindulge during the holiday season, and while many of us can tell we’ve had too much by the way our clothes fit, it’s much harder to know what’s going on in our mouths. This means that early stage tooth decay can easily go untreated if no symptoms are present.

Happily, it is still possible to enjoy a tasty Thanksgiving without all the sugary treats and snacks. Here are a few Thanksgiving recipes to whip up that are much better for your teeth, and your general health:

Instead of Canned Cranberry Sauce, Try…

Soften some fresh cranberries in a pan with a little water, and add just enough unsweetened orange juice to bring it to a sauce consistency. The natural sweetness of the orange juice should be just enough to take away from the tartness of the cranberries, leaving you with a delicious sauce for your turkey.

Instead of Pumpkin Pie, Try…

A pumpkin pie-inspired dessert that’s sure to go down a treat after dinner. Mix together 100% pure pumpkin puree with enough unsweetened almond milk (or coconut milk) to achieve a thick, creamy consistency. Add cinnamon, nutmeg, and other warming spices to find that perfect pumpkin pie taste.

Instead of Candied Sweet Potatoes, Try…

Normal sweet potatoes! Contrary to popular belief, sweet potatoes contain enough natural sweetness to make them a delicious addition to Thanksgiving dinner, without the need for sugar and marshmallows. There are lots of different ways to prepare them, including mashed, fried, baked, and even pureed.

Instead of Sugary Apple Cider, Try…

Gently heating an unsweetened apple juice in a large pan. If that sounds a little boring, you can easily jazz this up by adding some halved lemons, limes, and oranges to the liquid, and popping a few cinnamon sticks in there, too. If it’s still a bit sour, a splash of honey will sort that cider out nicely.

While some dental surgeries enforce a strict dress code, more and more are opting to keep things a little more casual in an attempt to create a friendlier, more relaxed environment for their patients. The ultimate aim is to move away from the white, sterile, and clinical feel, in a bid to address the fears of the 9 to 15 percent of Americans who feel anxious and nervous about visiting a dentist for a routine check up.

A vital question we need to be asking, however, is; ‘is it working?’. Is casual dress really helping to ease anxiety? Things are a little complicated when it comes to dental surgeries, and it’s important to remember that there’s a fine line between coming across as being friendly and professional, and coming across as entirely inappropriate for the environment. Professionalism is objective, so without a dress code, anything goes. At the end of the day this is, after all, a medical facility; it’s a place where patients need to have trust and confidence in their healthcare provider. Can casual clothing really help to achieve this?

What Patients Want

Studies have found that, contrary to popular belief, traditional (and somewhat stereotypical) dentist attire is actually far more beneficial in easing patient fears than casual clothing. Patients prefer a traditional white dental tunic, along with necessary safety equipment such as safety glasses and a mask. While this may sound very clinical, the addition of a name tag can help to make a dentist appear far more accessible to their patients; it helps to make a dentist more human by putting a name to the face.

Why Traditional?

Considering traditional healthcare attire is usually linked to very strict and formal environments, while casual clothing is seen as much more approachable, we have to question why it is that patients seem to prefer the more clinical look. Experts in the field believe this is because of association. Despite a dentist looking more ‘frightening’, professional attire is naturally associated with professional behavior. Quite simply, a patient is more likely to believe in the skill of the dentist, and the quality of the work, if a dentist is dressed in high quality, professional attire, as opposed to denim jeans and shirt, for example.

The Exception to the Rule

There is one area of dentistry where the professional attire rule doesn’t quite ring true; pediatric dentistry. Studies have found that the majority of children also prefer dentists to dress in traditional clothing, but this may not be the right approach for all children. Children who have previously had an upsetting experience at a dental surgery, such as treatment for an oral disease for example, or children who have had a previous instance of fear and anxiety at the dentist, often prefer a more casual style of dress. Pediatric dentists may wish to consider retaining the white tunic, but minimizing the use of attire that obstructs the face, such as glasses and masks, to ensure they’re always approachable and accessible.

A visit to the dentist’s office is a great opportunity to ask questions about the best ways to care for our teeth, but what sort of advice should our healthcare professionals be giving us? There are some areas where the best advice is very clear cut, such as cutting down on added sugars, for example, which are proven to cause cavities, and brushing regularly to remove plaque build up and keep the mouth fresh and clean. There are other areas, however, which are a little more unclear, such as alcohol consumption.

Alcohol: Good or Bad?

The main dilemma surrounding alcohol consumption from a health perspective is that there are both advantages and disadvantages. On one side of the coin, wine and beer are shown to contain a number of different vitamins and minerals which can be beneficial to the body, and moderate alcohol consumption could even help to protect against heart disease. Research studies have also been published which strongly suggest that moderate alcohol consumption could reduce the risk of certain types of cancers, including colon cancer, ovarian cancer, and prostate cancer, and also minimize the risk of stroke.

It appears that, from a general well being point of view, moderate alcohol consumption can be beneficial, but what about from an oral health standpoint? Unfortunately, there doesn’t appear to be any well documented evidence suggesting that alcohol could provide any benefits to oral health. In fact, around 75 percent of upper aerodigestive tract cancers are thought to be related to alcohol and tobacco use, alcohol has been shown to damage oral tissue, and it could also increase the risk of cavities because of the high sugar content. Overall, excessive drinking could wreak havoc on general oral health.

Everything in Moderation

So what sort of advice should your dentist be giving you regarding alcohol and oral health? Ultimately, there’s no right or wrong answer here, although many dentists will come back to the old saying ‘everything in moderation’. Due to the large number of health benefits associated with moderate alcohol consumption, it would be irresponsible to suggest that an otherwise healthy adult abstain from drinking alcohol completely. However, it would be equally irresponsible to advocate drinking, due to the substantial risks to oral health. ‘Everything in moderation’ appears to be a sensible middle ground.

Looking After Your Mouth

If you do decide to consume alcohol, make sure that you pay special attention to your everyday oral health. While the sugars in alcohol are bad for the teeth, you can help to minimize the effect by ensuring you brush regularly – at least twice a day – as well as floss, and, if necessary, use a mouthwash. This type of oral care routine can help to get rid of sugars from the teeth and lower the risk of decay. If you’re out on the town and don’t have access to toothpaste after drinking alcohol, even a swish with plain water is better than nothing, and it might be worth carrying some sugar-free gum with you at all times, too.

Although there are a few benefits to added sugars in the diet – they’re a good source of essential energy, for example, and potentially pose a lesser threat to health than factory-derived sweeteners – dentists should still be advising patients to minimize the amount of sugar that they consume on a day-to-day basis. The obvious reason for dentists giving this advice to their patients is because sugar can cause cavities to develop. However, as more and more research becomes available, and as we begin to understand more about the role of added sugars, we can see how sugar can affect other aspects of health, too. The fight against sugar is continuing, and we need to be ready to provide the best advice.

Why We’re Fighting Sugar

Added sugars in the foods we eat can greatly increase the risk not only of oral diseases, but of other conditions and illnesses, too. Sugar is known to raise blood pressure and lower levels of ‘good’ cholesterol in the body, which can increase the risk of cardiovascular disease, even in children.

Sugar is also very closely associated with the development of cancerous tumors in the body. The high calorie content of sugar can contribute towards obesity, for example, and people who are overweight are believed to be at greater risk of cancers such as kidney cancer, thyroid cancer, and gallbladder cancer. Similarly, sugar promotes the production of insulin, and those with high insulin levels may be more at risk for cancers such as colon cancer, prostate cancer, pancreatic cancer, and particularly breast cancer.

Perhaps even more worrying for parents is that high sugar intake has been linked to obsessive behaviors, such as bingeing, craving, and deprivation. Research shows that girls aged between 6 and 12 are statistically most likely to be concerned about their weight, and are at highest risk for developing eating disorders such as anorexia nervosa, or bulimia. Additionally, sugar has been likened to a ‘gateway drug’, opening up doors to other dangerous addictions, like alcohol addiction or drug dependence.

The Guidelines

Current guidelines state that no more than 10 percent of daily energy should come from added sugars, although the World Health Organization says that bringing this down to 5 percent could bring with it additional health benefits. Unfortunately, as a nation, we’re failing to meet these targets, with studies finding that the average American gets between 14 and 17 percent of their daily energy from sugars.

One of the latest organizations to back these guidelines is the American Heart Association, who say that men should be having no more than 9 teaspoons of sugar per day, and women no more than 6. They also recommend looking for ‘hidden’ sugars in foods which may appear on labels under misleading names, such as ‘fructose’, ‘molasses’, ‘sweetener’, ‘syrup’, ‘honey’, and ‘fruit juice concentrates’.

Staying Up-to-Date

As an increasing amount of research is being taken on the health effects of added sugars, we can reasonably expect the published guidelines to change to reflect the latest findings. As dentists, it is important to stay up-to-date on the available information to ensure you’re always able to pass on the best advice to your patients, helping them to keep their teeth, their bodies, and their minds healthy.

Tooth decay is something that can affect us all, whatever our age, but the effects on children can often be much more severe that the effects on adults. While a cavity may cause us to experience pain in the area, for children the symptoms can be much worse, and they may find that tooth decay causes problems with eating, speaking, learning, and playing. Unfortunately, tooth decay in children is very common, with around 20% of 5 to 11 year olds in the United States suffering with at least one cavity.

The good news is that there are many ways we can help to reduce the risk of tooth decay in our children, such as purchasing fluoride-enriched toothpaste, for example, and taking them to visit their dentist regularly. However, with Halloween just around the corner – a holiday traditionally filled with sweet treats – we want to ensure that we’re not encouraging little ones to overindulge in sugary snacks.

The Risk of Sugary Treats

Added sugars in foods and drinks are very closely associated with tooth decay in children, and at this time of year it’s hard to avoid the candies on sale in the grocery stores. According to American Heart Association guidelines, children aged between 4 and 8 years should be having less than 3 teaspoons of sugar per day, or less than 12 grams. A fun size bag of Skittles contains 11 grams of sugar, and 8 pieces of gummy bear candy contains a whopping 21 grams of sugar – way above the recommended amount.

Healthy Halloween Alternatives

If you’re trying to stay away from added sugars and their risks this Halloween, then here are a few healthier alternatives that you can whip up at home that the kids are sure to love:

Fruit

Compared to Halloween candy, fruit might seem a little boring, but there are lots of different ways you can add the spook factor. A bit of black food coloring can help to transform a regular clementine into a miniature Jack-o-Lantern, for example, or how about dipping strawberries into thick, Greek-style yogurt and freezing to make ghoulish ghost figures? You could even use some Halloween-themed cookie cutters to make fun fruit shapes, like watermelon bats and apple witches hats. The possibilities are endless.

Not-Candy-Corn

If your kids simply can’t get through the holiday without a little candy corn, why not make them a healthy alternative? Before you put your popsicle molds away for the winter, use them to make “not-candy-corn” popsicles; a sweet yet healthy Halloween treat. Pour in some Greek yogurt first and freeze until firm, then add a layer of orange juice and freeze, and finally a layer of pineapple juice. Once the final layer has been frozen, you’ll have yourself a healthy popsicle that looks just like the real thing (but even bigger!)

Trick or Treat

If you’re looking for something to hand out to Trick or Treaters in your neighborhood, then you really want something that’s the perfect combination of tasty and healthy. A great idea is to melt some dark chocolate and drop teaspoon-sized portions onto some baking parchment. While still wet, sprinkle with some dried fruits, nuts, and ‘superfoods’ like goji berries, and leave to set in the fridge. You may wish to make some nut-free versions of these treats, too, so that everyone can enjoy your healthy snacks.

During October, there’s normally only one thing on our minds: Halloween! Halloween is, of course, a time to let loose, have some fun, and indulge in a few naughty treats, but this time of year is also about much more; it’s about taking care of ourselves, and ensuring we’re doing what we can to stay healthy.

Although we should be aiming to stay healthy all year round, October is a very special month in terms of health, happiness, and wellbeing. October not only marks National Dental Hygiene Month in the United States, but also Breast Cancer Awareness Month and Healthy Lung Month, along with other important days such as Depression Screening Day and World Psoriasis Day, too. There’s a lot going on this month!

Take Charge of Your Health

If you’ve got any concerns about your physical, oral, or mental health – or even if you haven’t – now is a great time to book a routine checkup or screening appointment to make sure your body is working just as it should. An aspect that many diseases and health conditions have in common is that it’s usually best if the condition is caught early, which can often mean there’s a better chance of successfully treating it.

The first stage of gum disease, called ‘gingivitis’, is reversible with proper care and treatment for example, but there is no cure for periodontal disease, which is a later stage of gum disease. Similarly, the 5 year survival rate for breast cancer identified in Stage 1 is close to 100%, which sadly reduces to 22% for breast cancer diagnosed in Stage 4, according to the American Cancer Society. Being proactive and taking charge is one of the very best ways to reduce risk and help yourself to stay happy and healthy.

Why October?

Many of us lead busy lives, and it becomes very simple to push any health concerns to the back of the mind. These awareness events in the United States are intended to serve as useful reminders that your health – and the health of your family – should always come first, especially at this time of year.

Reports show that around 2000 Americans die each and every year from weather-related causes, with more than half occurring throughout the winter. Coronary disease and respiratory diseases are more common in the winter, and a large number of people also suffer with seasonal affective disorder which can significantly affect mental health. In terms of oral health, holidays such as candy corn-filled Halloween, pumpkin pie-filled Thanksgiving, and peppermint bark-filled Christmas can all contribute towards tooth decay. October is a great time for a reminder to take care of yourself this winter.

So what are you waiting for? Get in touch with your doctor, dentist, or therapist to discuss your health and wellbeing and determine if a checkup or screening program could be beneficial for you. October is a time to take charge, to put your health first, and to demonstrate your strength. You can do it!

Safety is key to running a successful dental practice, but hectic day-to-day operations can mean that, sometimes, health and safety is put to one side and shortcuts are taken. Unfortunately, these shortcuts may increase risk within the clinic, not only to you and your employees, but to your patients. Here are some ways that you can quickly and easily improve safety and reduce risk in your clinic.

Your Tools & Equipment

All dental practices should consider switching from multi-use to single-use tools and equipment where possible. Not only can this help to save your employees' time by not having to sterilize equipment, but it also goes a long way towards minimizing human error and reducing the risk of patient infection. Single-use diamonds, for example, are safe, hygienic, and reduce chair time due to their precise cutting.

Clinic Layout

Patients don’t sign up with dentists for their ultra sleek offices; they sign up because they want the advice of a trained, experienced dentist. Don’t focus too much on style and design, but instead ensure your clinic is laid out in the most effective and efficient manner to improve safety within the building. For example, where possible, it is important for decontamination to occur away from the surgical room.

Regular Training

Initial training upon hire is essential, but it is not enough to ensure good, lifelong processes. Employees should undergo regular training to ensure they not only retain, but also enhance their skills and knowledge. Training should always include details of how infections are transmitted, decontamination policies, personal protection, and accident & emergency processes, as well as standard tool use.

Business Safety

As well as looking at the safety basics for dental practices specifically, it’s also important to remember that a clinic is an operational business open to the public, and should be treated as such. This means ensuring you have the correct insurance policies in place, install fire and safety doors where necessary, reduce risks to the public by fitting non-slip flooring, and prevent access to non-public areas at all times.

Privacy Policy

An important yet often overlooked aspect of health and safety is ensuring you have a secure privacy policy in place. An employee diagnosed with a bloodborne virus, or who suspects may have a BBV, should not carry out work in exposed patients, and it is essential that these employees have access to a safe and secure environment in which they can privately disclose this information to their employer.

Have a Plan

Sometimes, despite best practices, accidents can and do happen. That’s why all dental practices should have an accident and emergency plan that can easily be accessed by employees at any time. For blood spillages, for example, it is generally advised that stains are blotted with paper towels before being treated – as soon as possible – with a 10,000 ppm sodium hypochlorite solution or granules.

Be Flexible

If you want your health and safety practices and protocols to be effective, then remember that one method of improving safety won’t fit every dental practice in the United States. Devising your own plan is about being flexible, and doing what works well for you, while still meeting the necessary legal guidelines. Some practices today are drawing up checklists, for example, to give employees a standardized step-by-step list for procedures, but this may not work for your clinic. It’s worth discussing with your employees the best way to proceed, and accepting that there may be some trial and error.

Science is built on the foundations of facts and figures, but sometimes it’s not always as straightforward as it should be, especially when it comes to oral health. If you delve into the dental world, you’ll find that there are many ideas that are open to debate, and one of the hottest topics right now is whether or not dried fruit can be included in a diet as a healthy snack.

There are two sides to the coin from a dental perspective when it comes to dried fruit. On the one hand, some dentists are calling dried fruits ‘sugar bombs’. This is because fruit has a high water content, so when dried the fruits become small, and yet they still contain the same amount of sugar. While we may eat 5 grapes as a snack, for example, we could easily eat 20 raisins, essentially giving us 4 times the sugar.

Flip the coin over, and what we see is some researchers suggesting that not only could dried fruits not affect the teeth negatively, but they could actually benefit oral health, too. It’s important for dentists to consider not just oral health, but overall health, as well. Tooth loss is more prevalent in overweight and obese individuals, and shifting from candies to healthier dried fruits can help to reduce weight.

What Research Says

There is a general understanding that evidence against dried fruits as part of a healthy diet is severely lacking. This is especially true when it comes to the idea that sticky dried fruits like raisins can cling to the teeth, giving the sugars more opportunity to wear away at the enamel. Recent studies that have been undertaken actually confirm that sticky fruits don’t adhere to the teeth any longer than other foods.

Raisins especially are believed to benefit teeth, due to their high levels of specific chemical compounds that can benefit the body. Antimicrobial phytochemicals present in raisins, for example, could actually help to minimize the risk of cavities, and reduce the likelihood of the development of periodontal disease, by suppressing the bacteria and viruses that are known to contribute towards these issues.

Raisins: Yay or Nay?

Although much more research is being undertaken to learn more about how dried fruits could benefit oral health, we are still very much in the early stages. As with many types of food, from a dental perspective, it appears as if the saying ‘everything in moderation’ applies to this debate. Despite its high sugar content, dried fruit has all the benefits of fresh fruit, is a healthier alternative to candies, and is easy and convenient for kids to carry around with them during play, or pack away in their school lunch.

Dried fruits can – and should – be included as part of a healthy diet, but it’s important not to go overboard. The United States Department of Agriculture (USDA) recommends that about ½ a cup of dried fruit is a good sized serving, or 1 small box of raisins as you’d buy from your local grocery store.

Sugar tends to get a bad name when it comes to our health, and there’s a good reason for that. Refined sugars, which are natural, and raw sugars that have undergone a number of different chemical processes to remove impurities, are believed to be very detrimental to health, not only increasing the risk of dental cavities, but also causing a number of other issues, including bloating as a result of a sluggish gut.

As parents, we all want what’s best for our kids, and sometimes this means making a few changes to the types of snacks and treats we have on offer at home. While many kids have a sweet tooth (which is completely normal!), satisfying this sweet tooth with sugary goodies can increase their risk of tooth decay. Fortunately, there are many different types of sugar-free snacks that we can whip up in the kitchen:

Spiced Cookies

If your kids love cookies, then these healthy spiced cookies are sure to be a big hit. All you need is a cup of rolled oats (if you opt for gluten-free oats, you can easily make a gluten-free version of the cookies), half a cup each of coconut flour and melted coconut oil, and 2 eggs. Mix well, and add a cup of grated carrots and some warming spices like nutmeg and cinnamon before baking. Think of it as being a healthier version of pumpkin pie! If your kids like their treats sweeter, drizzle with a little honey.

Roasted Chickpeas

There’s nothing quite like a big bowl of sugary popcorn when you’re watching a movie… or is there? Believe it or not, chickpeas make an excellent alternative to the traditional theater snack, and they’re sugar-free, too. Toss your ready-soaked chickpeas, or garbanzo beans, with a little olive oil and some herbs or spices of your choosing – smoked paprika works great, as does a sprinkling of Parmesan. Roast in a hot oven for around 30-40 minutes, turning regularly. They should be crunchy but not burnt.

Yogurt Bark

At Christmas time (and any time of year, for that matter), it seems that kids can’t get enough of chocolate bark. So what’s a good, sugar-free alternative? Well, how about yogurt bark? Your favorite sugar-free yogurt, mixed with a spoonful of matcha powder (which is chock full of antioxidants), a drop of vanilla extract, and topped off with a handful of pistachios, makes for a very healthy and tasty snack. The hard part is waiting for it to freeze; we suggest keeping a small bowl out of the freezer for snacking on while you wait!

Your Secret Weapons

There’s really no limit as to the healthy, sugar-free treats you can whip up for your kids at home. The secret is to know what’s good to use to make your snacks taste irresistible. If you’re trying to steer clear of refined sugars, look for natural alternatives like honey or maple syrup, try some natural cacao powders or unsweetened cocoa, or you might even wish to look into store bought natural sweeteners or unsalted nuts, which can drastically transform the texture and tastes of your recipes. Head to the kitchen today and see what you can create!

In a market that appears to be becoming more and more competitive by the day, there has never been a more important time to analyze patient trends and identify areas for improvement, when it comes to both retention and new sign ups. Over the past few years, we’ve seen how companies that target new customers exclusively through special offers have failed to retain their existing valuable clientele, resulting in high turnover rates that not only affect profits, but can significantly impact reputation, too.

One of the ‘secrets’ to building a successful dental practice is to keep existing clients happy and satisfied, while also demonstrating the advantages and unique features of the practice to new customers. There are a number of ways to achieve these aims, ranging from marketing campaigns to staff training.

Communication

It’s always nice when you feel that you’ve really gotten through to a patient, but you may not have connected on quite the level you thought you did. Research shows that patients often don’t remember as much advice as dentists think they do, potentially increasing the risk of suboptimal oral health at home and boosting the likelihood of unhappy, unsatisfied patients. Communication is key. It may be worth producing take-home patient leaflets that can be referred to between dental appointments.

Representation

Receptionists, administrators, and other front-of-house staff are often the first impression a patient will have of your dental practice, which means that excellent service at this stage is essential. Unfortunately, heavy workloads can impact upon behaviors, particularly friendliness and professionalism, so take some time to determine whether your front-of-house is adequately filled, and consider undertaking staff training courses to ensure standardization and uniformity between all members of staff.

Localized Marketing

When it comes to marketing your dental practice to new patients, it’s important to think local. Research suggests that retention rates for patients living within a 60 mile radius of a practice are much higher than those visiting from further afield, so localized language, tones, and references could be a significant contributor to attracting the most suitable demographic for your business. Although digital marketing is the hot trend, it’s a good idea also to consider advertising in local publications such as newspapers.

Vital Aspects

Take some time to look at your practice through the eyes of a potential client, and consider what it is you’d want to know about the business. While you may be proud of your state-of-the-art offices, for example, this may not be the most beneficial piece of information for those looking for a new dentist. Studies have found that dentist competence is the most important aspect for new patients, with personal recommendations coming a close second, so don’t underestimate the power of word-of-mouth.

It’s important to remember that there is more to running a successful dental practice than simply high tech and expensive marketing campaigns. While these may work for other types of business, they’re perhaps not the most useful when it comes to promoting oral care. The good news, however, is that there are many ways to retain patients, and attract new patients, too. You just have to know how!

Toothbrushes have certainly come a long way from the horse hair versions of the 1700s, and although they are an essential part of oral hygiene today, they’re still not an all-in-one solution. While we have all sorts of different shapes and sizes of bristle designed to get into all those hard to reach places, there’s still one part of the mouth that often gets missed out: the area in between your teeth.

The reason, of course, is that toothbrush bristles simply aren’t small enough or fine enough to reach through the gaps in the teeth, which can sometimes be very tiny. Small food particles can easily get trapped in between the teeth, increasing the risk of bacteria and plaque build ups. This is why a lot of dentists across the US are now striving to improve awareness of the importance of interdental care.

What is Interdental Care?

Interdental care refers to oral hygiene methods and techniques that are designed to target the areas in between your teeth. There are already a number of interdental care methods commonly used in the United States, such as dental floss and antimicrobial mouthwashes, but there’s also another technique that is becoming increasingly popular, and is already being backed by many dentists: the regular use of interdental brushes.

Interdental brushes are simply very small toothbrushes, with minute bristles that can easily fit in between the teeth to ensure a good, thorough clean. They come in many sizes depending on how large the gaps between your teeth are. Many people find that they need to use two – or even more – brushes to make sure they’re able to clean between all teeth effectively. Using an interdental brush is very similar to using floss.

What’s Wrong with Flossing?

Despite what you may have read recently, nothing! Flossing, in addition to regular brushing, can be a great way to maintain excellent oral health and hygiene, but interdental brushes have been found to be more effective at plaque removal than floss, which is why many people are choosing to make the switch. Some studies have also found that interdental brushing can be more than twice as effective at reducing gingivitis. There are also a few extra advantages of interdental brushes over flossing, such as the ability to get a more thorough clean.

Troubleshooting

A lot of people using an interdental brush for the first time will notice that their gums bleed slightly during use. This is completely normal, and the bleeding should subside once the gums become healthier. If you find that the bleeding continues, or that your gums are very sore, it’s well worth going to see your dentist – and taking your brush with you. Your dentist will be able to check that you’re using the right sized brush for your teeth, and that you’re using the brush correctly. Your dentist will also be able to check for other causes of bleeding, such as periodontal disease, for example, which should be treated.

When it comes to our health, there’s always more than one opinion about what’s right. It sounds ironic, but sometimes science isn’t always a science, and there seems to be a lot of wiggle room and opportunity for debate regarding best practices. Alcohol, for example, is said to be bad for us, although red wine is believed to have many health benefits. A similar dilemma, and perhaps more interesting to dentists, is that flossing is said both to spread bacteria around the mouth, and remove it. Which is it? Should we be flossing or not?

Two Sides to the Coin

If you were to ask two different dentists whether or not you should be flossing, you’d probably get two different answers. There’s a lot of confusion – even among the experts – when it comes to flossing, and that’s because there are studies that demonstrate evidence both for and against the technique.

Let’s see what these studies say…

* For Flossing

There are two significant arguments for flossing. The first, of course, is cosmetic, as regular flossing helps to remove trapped foods, especially in people with mild diastema. The second argument is that flossing has been shown to be effective at reducing the frequency of bleeding between the teeth. In fact, in this capacity, flossing could actually be twice as effective as a standard toothbrush. Flossing alongside toothbrushing has also been shown to reduce the risk of gingivitis (a form of periodontal disease).

* Against Flossing

There are some dentists who advise against flossing because of the risk of spreading bacteria around the mouth and increasing the risk of infection. While this can happen, we need to remember that bacteria can be spread around the mouth even without the use of floss, simply during our day-to-day activities. Some also say that flossing is ineffective. As we can see from the research above, it’s not, but it may not be the most effective solution. Antimicrobial mouthwashes, for example, are usually much better.

Time to Toss the Floss?

Whether or not a person wishes to floss should be their own personal decision. There is no right or wrong answer here. Flossing isn’t dangerous or painful when done correctly, and although flossing alone isn’t enough to maintain excellent oral health, it can be effective when used alongside other techniques, such as brushing and rinsing. If a person wishes to floss, dentists should advise that they…

  • brush and then floss, rather than the other way around. This is more effective overall.
  • use around 45 cm of floss, with approximately 2.5 to 5 cm of floss inserted between teeth.
  • gently curve the floss so that it is adjacent to the tooth, and tension can be felt.
  • see a dentist if flossing causes bleeding. This could be a sign of gingivitis or other disease.
  • use floss holders if flossing is difficult, to make the process much more simple.

Halitosis, better known as bad breath, can be a very frustrating and embarrassing problem. It’s also very common! It’s estimated that there are around 80 million people worldwide with bad breath, and around half of all cases are believed to occur within the United States. Sometimes, we can’t always tell if we have bad breath, but there is a trick – lightly lick the inside of your wrist and allow the saliva to dry. If it smells, then you may be suffering with halitosis. The good news is that halitosis can be easy to manage.

Morning Breath

It’s important to understand that halitosis and ‘morning breath’ are not the same. Most of us wake up with a bad taste – and bad smell – in our mouths, but this usually disappears when we brush our teeth. If that smell doesn’t disappear, and instead lasts throughout the day, then that’s a sign of halitosis.

Why Does Halitosis Happen?

There’s a common misconception that bad breath happens because a person doesn’t brush their teeth. While this can be true, having bad breath doesn’t necessarily mean you have poor oral hygiene. In fact, it could just mean that you need to extend your regular brushing routine to include some additional oral health techniques, such as flossing or using a tongue scraper, for example. Flossing helps to remove food caught between the teeth that can attract bacteria, while a tongue scraper can help to remove bacteria from the back of the tongue. This is especially beneficial in people suffering with sinus problems, as a post-nasal drip onto the back of the tongue can increase the build up of foul-smelling bacteria.

If you already follow an excellent oral health regime at home, halitosis may be due to the foods that you eat, or even your habits. Very strong smelling foods like onions and garlic can significantly contribute towards bad breath, along with alcohol and smoking. A few lifestyle changes may help reduce the smell, or you may wish to mask the odor using chewing gum, sprays, or mints for a temporary solution.

When to See Your Dentist

There are many different reasons why a person may develop halitosis, and unfortunately it can sometimes be difficult to pinpoint an exact reason. If you’re struggling to figure out why your breath isn’t as fresh as you’d like it to be, it’s worth making an appointment to see your dentist, as halitosis could be caused by periodontal disease, or cavities. In fact, it’s believed that around 90 percent of cases are caused by cavities in the teeth. It's important to remember, however, that these issues can be addressed relatively easily.

Your dentist will be able to check your teeth and fill any cavities that may be causing halitosis. A visit to the dental hygienist can also be beneficial, as techniques such as scaling and polishing can really help to minimize the risk of developing periodontal disease, helping to keep halitosis at bay.

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