Are dental professionals overlooking the importance of mouth rinses?

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Toothbrush, toothpaste, and floss are given to most patients at their prophylaxis appointment, but are clinicians overlooking a key element in homecare? Mouth rinses are available in every store and are usually chosen by the patient based on TV commercials or ads on mobile devices. While using mouthwash isn’t a replacement for brushing and flossing, it can be a helpful adjunct to the oral health routine. Rinses are relatively inexpensive, easy to use, and take around 30 seconds. They flow into hard-to-reach areas and have ingredients based on varying mouth conditions. Becoming familiar with mouthwashes is important for the dental team so that they’re ready to recommend a product based on the patient’s diagnosis.

Therapeutic and cosmetic are the two types of mouthwashes. There are sub-categories for each type, and some are over-the-counter while others are prescription only. Children under the age of six shouldn’t use mouthwash because of underdeveloped swallowing reflexes which could lead to ingestion of the product. If a doctor recommends a rinse for a child six and under, extreme care must be taken to avoid ingestion unless the doctor recommends swallowing the product.

Therapeutic rinses contain active ingredients that help control plaque, halitosis, gingivitis, and reduce the incidence of caries. These active ingredients include chlorhexidine gluconate, essential oils with alcohol, peroxide, fluoride, and cetylpyridinium chloride. Chlorhexidine gluconate and essential oils with alcohol assist in controlling plaque and gingivitis. Peroxide is useful in whitening rinses. Fluoride is an excellent choice in helping to prevent decay. Cetylpyridinium chloride is used to treat halitosis. All of these are sold over-the-counter except for chlorhexidine which is by prescription only. Cosmetic mouth rinses are mainly used to freshen the breath and do little to assist with serious mouth conditions.

One other crucial factor when considering mouthwashes is whether they have earned the American Dental Association’s (ADA) Seal of Acceptance. This seal assures that the product is safe and effective based on scientific evidence and approval from the ADA Council on Scientific Affairs.

As with toothbrushes, toothpaste, and floss, it’s best to educate the patient as to why adding mouthwash to their home regiment is essential.  Once the benefits, ease of use, and cost-effectiveness are pointed out, the patient should see that adding this step at home is beneficial to their oral health.

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Sterilization of the Dental Handpiece?

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Reusable medical devices such as high-speed, slow-speed, electric (cordless), endodontic, and surgical handpieces should be cleaned and properly sterilized after each patient use. This includes all parts of the handpiece (nosecone, head, and motor) and attachments (reusable contra or prophy angle). In fact, any intraoral device that can be removed from air or waterlines should be cleaned and sterilized according to the Centers for Disease Control (CDC), the American Dental Association (ADA), and the manufacturers of such devices.

Studies have found that the internal gears of handpiece motors can become contaminated during a procedure and, as a result, may contaminate the rest of the handpiece. Therefore, using an unsterile device could lead to cross-contamination between patients. Surface disinfection and immersion in a chemical germicide isn’t acceptable. Chemical vapor and autoclave sterilization are the only approved methods.

Most handpieces sold today can withstand heat and chemical vapor sterilization. Handpieces that can’t tolerate the process may be retrofitted to allow for sterilization. The FDA has very clear guidelines regarding the use of older devices that can’t be cleaned and sterilized properly. If in doubt as to whether or not a device can be sterilized safely, the FDA provides a searchable database online of devices that can tolerate the procedure.  

Buying multiple handpieces can be expensive, but following the manufacturer’s directions can ensure that they have a long lifespan. Cleaning and lubrication is the most important part of keeping the device in great shape and ensures durability and top performance.

Mandatory sterilization of handpieces is controlled by each state dental board. As of this writing, it’s mandated in the following states: Florida, South Carolina, Virginia, Ohio, Oregon, Indiana, Kansas, Missouri, New Mexico, and Washington State. It’s estimated that most states will require proper sterilization at some point, so it may be wise to go ahead and make the investment. Being compliant now will help with the transition and keep the practice running smoothly.

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The Interesting Field of Forensic Dentistry (Odontology)- Part Two

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As discussed in part one of this blog series, forensic dentistry is a fundamental part of forensic science. Forensic dentists know as Odontologists, aid in the identification process of the deceased and the living. Part two of this blog will discuss bite mark analysis in the living in relation to crime solving, and with heroes who perish because of their high-risk career.

A bite mark is the pattern teeth make when they come together, also known as occlusion. Everyone has a unique bite which can be reproduced and compared. Criminals can be identified from the bite mark they’ve left on a victim. Additionally, high-risk employees such as military personnel, firefighters, police, EMT’s, and search and rescue teams usually have their bite registration on file in case of a deadly consequence. Their premortem and postmortem registration can be examined, and a positive ID made.

With criminal investigations, bite marks are left on victims in instances such as rape, homicide, assault, domestic violence, elder abuse, self-defense, and infanticide. The marks on the victim are compared with the suspect's bite registration for a positive ID. Odontologists commonly evaluate evidence, consult, and testify in court as an expert witness.

Some odontologists specialize in bite mark analysis and identification and must follow rigorous guidelines and standards for analysis developed by the American Board of Forensic Odontology (ABFO). Additional education, experience, and training are required as well as proficiency with digital imaging.

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The Interesting Field of Forensic Dentistry (Odontology)- Part One

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Forensic dentistry is a fundamental branch of forensic science using dental experience in recognition of human remains and evaluation of the bite. A forensic dentist is a DMD or DDS who have furthered their education and specialize in the field of forensic dentistry.

Part one of this blog will be focused on tools such as clinical exams, radiographs, DNA, and Ameloglyphics in the examination of the deceased. Part two will explore the use of bite mark analysis in the living and post-mortem.

Comparison of fingerprints is the first step in the identification process.  However, fingerprints are often destroyed by decomposition, trauma, or fire. With natural disasters such as tornados, hurricanes, tsunamis, and wildfires, the odontologist joins the recovery team to investigate when fingerprints have been destroyed. Furthermore, caskets can become unearthed due to floods, and bodies may have to be re-identified.

The assessment of the deceased when fingerprints aren’t available begins with charting existing and missing teeth. Special attention is given to implants, unusual restorations, bone patterns, and any anomalies that would help with a positive ID. Radiographs are also taken and compared to premortem dental records if they exist. The age of the individual is determined based on eruption patterns and occlusal wear.

Another way Odontologists authenticate findings is by retrieving DNA from the pulp chamber for cross-matching and with a relatively new process called Ameloglyphics. Ameloglyphics is a promising new approach that involves studying the enamel rods of the tooth which are like fingerprints in that they are unchangeable and very resistant to destruction.

Although forensic dentistry is quite an odd job, it has become more commonplace with the number of television shows dedicated to the identification of victims and crime scene investigations.  This specialty is held in high regard with helping families put loved ones to rest, and in the prosecution of criminals.

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A Patient's Perspective - Why Are Dental Implants So Expensive?

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When considering a dental implant, you may have experienced some sticker shock if you’re not aware of what’s involved in the process. Three pieces are normally used in the entire implant procedure, and they include the fixture, the abutment, and the restoration (crown). Even if your insurance covers implants and restorations(crowns), the average fees can range from $2500- to $5000 for the completed project. With most plans maxing out at $1500-$2000, you can be left with a pretty hefty remainder. 

First of all, the implant itself consists of two segments which are the fixture and the abutment, and because it’s considered a surgical event, it’s usually performed by a  periodontist or an oral surgeon. The fixture is screwed into the bone where it becomes integrated and acts as the root of the tooth. The abutment protrudes from the gumline and serves to secure and support the restoration (crown). Sometimes the specialist positions the abutment, and sometimes it’s placed by your dentist. The fixture and abutment are made of titanium as a result of it being a lightweight, strong, and long-lasting metal. Titanium is the choice of metal because the implant is a prosthesis that’s integrated inside of the body, and therefore, must be medical grade. The fee for the fixture and abutment varies between $1500-$3000.

The third portion of an implant is the restoration (crown) and is usually performed by your dentist after the implant has been established for a designated period. As soon as the specialist gives the clearance,  it’s time to fabricate a crown on top of the abutment so that the “tooth” is functional in your mouth. An implant crown is usually more expensive than a regular crown because your dentist may have to purchase special materials and instruments to install it properly. The cost of the restoration (crown) of a single implant can be anywhere from $1200-$2000.

There are some other factors to examine when thinking about an implant because, at times, surgeries such as a bone graft or a sinus lift are necessary to ensure a successful outcome. A bone graft is required on the lower jaw and upper anterior jaw when there’s insufficient bone to support an implant. Cadaver or synthetic bone is normally used, and the price varies from $500-$3000. A sinus lift can be mandatory on the upper jaw in the posterior if the bone is inadequate or if the sinuses are low and encroaching on the bone. The sinus is “lifted” to make room for bone to be inserted between the upper jaw and the sinus cavity. The charge of a sinus lift fluctuates between $500-$3,000. As with the bone graft, cadaver or artificial bone is commonly used. Additional expenses you may incur are radiographs and occasionally, a CT scan.

Although typically uneventful, an implant is a complex surgical method usually including a specialist and your general dentist. Years and years of education and experience go into the whole operation, and you’ll want clinicians who are proven to deliver excellent results. Although in reading this blog, it may seem that the bottom line can be upwards of $8000. However, the entire price of an implant and restoration is generally between $2500-$5000. Price discrepancies depend on where you live and if the additional surgeries are required.

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