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National Dental Hygiene Month

ADHA Daily 4

National Dental Hygiene Month is celebrated in October each year and is dedicated to the recognition and celebration of dental hygienists for their position in the dental community and commitment to raising awareness of proper oral hygiene.

This year, the focus of dental hygiene month is on the Daily 4 campaign which launched to help incorporate the four daily habits that improve the oral and overall health of the public. The Daily 4 consists of brushing, flossing, rinsing, and chewing.

  • Brushing- Placing the brush at a 45-degree angle to the gums, gently move back and forth in short strokes. Brush all outer surfaces first, then inner surfaces, and the chewing surfaces last. Place the brush vertically to clean the inside of the upper and lower front teeth using up and down strokes. The American Dental Association (ADA) recommends brushing twice per day with a size appropriate soft-bristled brush and fluoridated toothpaste for two minutes. The tongue should also be brushed with a toothbrush or tongue scraper.
  • Flossing- The ADA recommends flossing once per day to eliminate plaque and food debris not removed through brushing. Plaque that’s left on the teeth can mineralize and become a hardened deposit called calculus and requires a dentist or hygienist for removal. The lingering plaque also causes tooth decay.
  • Rinsing- There are other structures inside the mouth other than the teeth that require attention. Rinsing with a product that’s approved by the ADA can help eliminate organisms that cause gingivitis and decay from the teeth and the soft tissue in the mouth. There are many excellent rinses on the market that are dedicated to different needs. Dental professionals recommend rinses based on patient
  • Chewing- Studies have shown that chewing sugarless gum can help with many oral Chewing increases saliva flow which dislodges food and other debris and neutralizes acid. Some gums contain helpful ingredients that fight dry mouth syndrome, demineralization, and other issues. However, if a patient experiences Temporomandibular Disorders (TMD), chewing gum may not be advised.

For further information regarding the Daily 4, visit http://www.adha.org/daily4 where you’ll find many resources for your office to celebrate Dental Hygiene Month by encouraging excellent oral health.

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Opioid Use Following Dental Procedures

opioid addiction

The abuse of opioids in the United States is astounding. All doctors are being monitored closely in regards to prescribing opioids, and dentistry is no exception. In mid-August 2018, the Center for Opioid Research and Education (CORE) released new guidelines based on the number of opioids necessary in relation to the procedure. Also, the number prescribed will vary depending on the situation and the invasiveness of the procedure.

These guidelines refer to common procedures and suggest that the first drug of choice should be OTC acetaminophen and/or ibuprofen. These two can be used in conjunction on an alternating basis and work very well in this manner.

Following is the maximum number of opioids that CORE recommends with respect to the specific procedure:

  • Wisdom tooth or impacted tooth extraction – (15) 5mg oxycodone
  • Surgical extraction- (12) 5mg oxycodone
  • Routine tooth extraction- 0
  • Implant placement- (10) 5mg oxycodone
  • Periodontal bone graft and regeneration- (6) 5mg hydrocodone
  • Soft tissue graft- (10) 5mg oxycodone
  • Osseous procedure- 0
  • Tooth resection/ root amputation- 0
  • Apicoectomy- (4) 5mg oxycodone

These guidelines can be confusing for the dentist because they don’t want their patients suffering. However, they are merely recommendations at this point. The bottom line is that CORE wants all clinicians across the board to stop prescribing more opioids than they deem truly necessary.

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Managing your child’s oral health from zero to thirty-two

lost tooth fairy

Attention to oral health should begin the minute your baby is born because bacteria starts forming in the mouth from day one. Your child will also go through many oral developmental stages, so it’s important to be prepared.   Following is a guide to help navigate the transition from zero to thirty-two teeth.  

Birth- Tooth Eruption-

  • Gently wipe your baby’s gums with a clean, damp washcloth after feedings and at bedtime
  • Wash the cloth after each use
  • Don’t use any pastes or gels for cleaning the gums

Tooth Eruption-3 years

  • Gently brush your child’s teeth with an age-appropriate brush that’s approved by the American Dental Association (ADA)
  • Use a gel “toothpaste” formulated for infants and toddler’s that are approved by the ADA
  • Don’t use any toothpaste formulated for kids or adults
  • Don’t use any product with fluoride until around age two and follow the directions to the letter
  • Begin flossing when their teeth are in contact with one another
  • The first dental appointment should be around age two

4-6 years of age

  • All primary teeth should be present
  • At four, your child can start brushing their teeth with your guidance
  • Use an age-appropriate toothbrush and fluoride toothpaste approved by the ADA
  • Floss for them until age six. Then, they can use over-the-counter flossers designed for children
  • Primary front teeth will loosen around 5-6 years
  • The first adult molars (6-year-old molars) will begin to erupt behind the last tooth in each quadrant
  • They should be going to the dentist for cleanings and exams every six months and receiving proper brushing instruction, x-rays, fluoride treatments, and sealants on permanent molars
  • At six years old, it may be prudent to add an over-the-counter fluoride rinse under very close supervision. Consult with your dentist

7-12 years of age

  • Developmental changes are taking place
  • Your child will have a “mixed dentition” which means that they have baby and adult teeth in their mouth at the same time
  • Orthodontic appliances are likely
  • During this period, power brushes are helpful because of orthodontics and having different sized teeth
  • It’s imperative that they see the dentist every six months or as recommended
  • It’s very common to have poor oral health during this stage, so remind them of the need to brush and floss at least twice daily
  • An over-the-counter fluoride rinse is usually necessary due to poor oral hygiene
  • Sealants are highly recommended and placed by your dentist or hygienist
  • Around age seven, they should have the manual dexterity to brush and floss on their own, but you should still check after them

13-16 years of age

  • All permanent teeth should be erupted by age fifteen except for the third molars (wisdom teeth) which may or may not erupt until age 16-20
  • Your child will become more and more independent, but their oral hygiene may not be so great
  • It’s often difficult to keep up with brushing and flossing because of their age and shifts in their attitude. Sometimes, it’s best to have the dental team talk with them and encourage them to stay diligent with their oral care
  • They must be seen by a dentist every six months or as recommended
  • An over-the-counter fluoride rinse is most likely necessary
  • It’s highly probable that they will be going through some type of orthodontic treatment
  • Sealants are recommended and placed by your dentist or hygienist


  • During this time, your child has most likely finished orthodontic treatment and is in the maintenance phase. Retainers must be worn until further notice from the orthodontist, or the teeth will relapse
  • If recommended, wisdom teeth are usually ready for extraction
  • Going off to college is in the near future, and oral hygiene usually declines
  • Include toothbrushes, toothpaste, and over-the-counter fluoride rinse in their essentials and care packages
  • Although tricky due to scheduling, make sure they have a dental cleaning and exam every six months

There will be difficulties along the way, but being a good example to your child with your oral care routine will instill proper habits that will last a lifetime.

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Hiring a Dental Associate - The Role of the Associate

Efficiency of Practice

Have you considered joining a practice as an associate dentist? Many clinicians prefer to accept a position in an established practice instead of having their own because of student loans, the expense of owning a practice, and the responsibility associated with being the owner. Following are some tips to help with your decision:

  • Consider all offers- There are often many associate opportunities available in the field of dentistry, and each should be reviewed Make a list of pro’s and con’s and trust your instincts. Take some time to observe the office you’re considering. While the interviews and introductions may be fantastic, seeing the way the office runs in a day to day setting is important.
  • Make meeting the team a priority- The dental team will be your support system, and it’s crucial that you meet each person and observe their You’ll also want to observe the behavior between the senior doctor and the team. Again, the interview can seem awesome, but you can tell a lot about a doctor and their team by the way they interact with patients and one another.
  • Never gossip or speak negatively about the senior dentist or the team- If you have a legitimate problem with a team member, it’s best to go to that person and resolve the issue. If you have an issue with the dentist/owner, sit down with them and hash it out. Be honest and direct, and never get defensive. If the doctor gets defensive, alter your approach and make sure you’re handling the situation properly.
  • Diagnosing will most likely be tricky- diagnosing for some practices goes one of two ways. Under-diagnosing is a real problem, and you may find yourself in an office where periodontal disease isn’t diagnosed or treated, decay isn’t dealt with until it’s advanced, and the equipment isn’t the latest and greatest. You may not even realize it’s happening at first, but it’s not a lost cause. The practice may need an overhaul, and you’ll need to decide whether it’s worth staying. Over-diagnosing is the opposite end of the spectrum. You may begin working in an office where you’re expected to suggest treatment plans that aren’t entirely necessary or procedures based on cosmetic versus restorative needs. This type of practice rarely changes, so you may have to keep looking. Staying in either situation without improvement is detrimental to your career. There are plenty of offices that fall somewhere in the middle and deliver excellent care without practicing supervised neglect or unethical dentistry.
  • Be prepared to ask for what you need (within reason)- You may have had state-of-the-art equipment at your last practice or in school, but your new office equipment may be less than ideal. You’ll have to take into consideration the age of the practice and the location. Rural settings may not have the most up-to-date equipment and instruments, but that doesn’t mean that you can’t achieve excellent results. If the equipment is truly unusable, you may need to have a heart-to-heart with the senior dentist. Most likely, they are fully aware of the necessary Approach this situation by being honest, non-threatening, and ready to discuss how specific improvements will increase doctor/team satisfaction, patient comfort, and production.
  • Have a signed contract in place- never accept a position without a contract that you and your attorney have read and understand. If you make counter offers or changes, ensure that they’re in the contract before signing. A signed document protects all parties and outlines all aspects of your role in the practice.
  • Beware the “sink or swim” office- in some practices, you may be thrown into the water and left to sink or swim. Whether you’re an experienced doctor or not, you must have support and encouragement. Don’t be afraid to speak up and ask for what you require to succeed and become an asset to the office.

Choosing the best fit for you will take some investigation. If an office is pressuring you to decide after a short period, it’s probably best to keep looking. Don’t get discouraged because the perfect setting for you is out there, and you’ll be glad you took the time to find a practice in line with your goals and standards.

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Hiring an Associate - The Role of the Senior Doctor

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Have you reached a point in your career where you’re considering adding an associate? While the thought can be unnerving, the following guidelines can help make the transition more comfortable and exciting.  

Guidelines for the senior doctor-

  • Prepare the team for the new associate well in advance. Skipping this step isn’t an option. While recognizing that it’s your practice, your team has a stake in the practice too, especially if they’ve been with you for a number of years.
  • Welcome the new doctor into the practice with open arms. Don’t talk about them in a negative way to anyone-especially your team.
  • If the candidate is a new grad, expect to take on the role of mentor, and be patient while they adjust. Demonstrate procedures in a calm and non-threatening manner. Remember, you were new to the practice of dentistry once upon a time.
  • Jealously is not permitted. Patients must be shared unless a patient requests you, and you’ll also have to accept that some may prefer the new dentist. However, the new doctor should be expected to bring in new patients to build their patient base.
  • Consider an open house meet and greet. Don’t be afraid to introduce them to patients and the dental community. This gathering should be positive and uplifting. Don’t keep the news a secret.
  • Have a contract in While this seems like common sense, some doctors fail to include this step. A signed contract is crucial to protect all parties.
  • Give it time. A new grad or even a clinician with tons of experience needs time to acclimate. A new grad may need a lot of hand-holding, so offer guidance and support on a daily basis.
  • Never compare the new dentist's skills to your own or any other clinician. Everyone has strengths and weaknesses. Keep an open mind, and you may find that you compliment one another nicely.
  • Be very careful in setting monetary and other professional goals. Give the new grad a full year before deciding on production expectations, and the experienced clinician at least six months. When the year or six months has passed, sit down with them and make realistic goals based on skill level, professionalism, and quality of work. Also, invest in the entire team by supporting continuing education, fun trips, and activities.
  • Be fair in scheduling procedures. Don’t expect the new dentist to be bogged down with simple fillings and hygiene exams. They need to be challenged and Communication is key, and you should sit down with them every week or as needed to go over any questions, problems, or comments.

Hiring an associate should be an exciting time for you, your team, and your practice. While it can be a daunting task, following the guidelines can make for a smooth and positive transition.

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