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From Colgate Oral Care Center
By Donna Pleis

Balancing the requirements of a special needs child can be very challenging for parents. Pressing medical issues often take focus and dental care can take a back seat. The problem is that, according to the Maternal and Child Health Bureau, those children are almost twice as likely to unmet dental problems compared to children without special needs. If you are the parent of a special needs child, it's important that you pay particular attention to his dental health care. Below are some tips on how to approach it.

Common Special Needs Conditions

The Academy of Pediatric Dentistry defines special needs children as those with chronic physical, developmental, behavioral or emotional conditions. They usually have limitations on daily activities, and require more extensive dental and medical services. Cleft lip or palate, Down syndrome, neurological disorders, cerebral palsy, and vision and hearing impairments are common medical conditions requiring special dental care, as well as learning and developmental disabilities.

Oral Conditions

Down syndrome and other genetic disorders can cause delays in tooth eruption, sometimes up to two years according to the National Institute of Dental and Craniofacial Research. These children may also have malformed or extra teeth erupt, or congenitally missing teeth. And crowding and poor alignment in general can leave children prone to gum disease and tooth decay because their teeth are difficult to keep clean. In cases of severe intellectual disability or cerebral palsy, children may habitually grind their teeth, making them flat as they gradually break down the enamel.

Tooth decay and gum disease can also be a result of a child's impaired immune systems and connective tissue disorders. Many of the medications they're eligible for contain sugar or cause dry mouth, which is especially conducive to tooth decay. Certain medications can also cause an overgrowth of the gum tissue, so be sure to ask your doctor about side effects.

Home Care and Nutrition

Start your infant's home care routine as soon as you come home from the hospital by wiping his or her gums with a wet gauze pad. Once teeth have erupted, brush his teeth at least twice a day with a soft toothbrush, and floss daily. Ask your dentist when to start using fluoride toothpaste and how much to use. If your child can't rinse or gags easily, you can brush with a fluoride rinse such as Colgate® Phos-Flur®, which can improve your child's defenses against tooth decay. Only do this with older children.

Serving nutritious meals and restricting sugary or starchy foods can help baby teeth develop properly and limit exposure to the decay that causes acid attacks. Keep healthy snacks in the house, and save special sweet treats for during meal time. Brush your child's teeth after eating or have him drink or rinse with water to neutralize the acids from those sugary foods.

Finding a Dentist

Dentists recommend children have their first dental visit before the age of one, and this is especially important for special needs children. Many general and pediatric dentists are equipped to treat children with physical or behavioral disabilities. If you're not sure which dentists in your area are up to the job, call your local dental society or contact the Special Care Dentistry Association for suggestions. During these first visits, the dentist can evaluate your child's dental development and help you create the most appropriate home care routine for your family.

There is ample opportunity for children with special needs to get good dental health care. By working closely with your child's dentist to put a prevention plan in place, many potential dental problems can be avoided entirely.

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From Dental Economics
By Lou Shuman, DMD, CAGS and Diana P. Friedman, MA, MBA

Your essential social media platforms
Think of social media platforms as your online marketing toolbox. The questions are which tools in that toolbox are necessary, and what is the best way to use them?
In order to determine which social media outlets and content will reach and resonate with patients, you must first understand the delivery mediums.

Possible marketing objectives include:
Search engine optimization so new patients can find my practice
Provide educational materials to help facilitate treatment plan adherence
Provide helpful advice to improve patient retention
Drive more cosmetic treatment opportunities from existing patients
Improve potential referral business from existing clients
Setting a clear marketing objective will act as a guide to ensure you derive value from your social media marketing efforts. Patients have different expectations for each social platform and it's imperative that your objectives align with those expectations.

Vital networking tools
The blog -- Adding a blog to your website gives your practice a simple way to share information, whether it's office news, photos, videos, or other information. A regularly updated blog educates patients, promotes your dental brand, differentiates your practice from the one down the street, and keeps your patients up-to-date on exciting developments in dentistry and your dental practice. A blog can be used as an extremely effective channel to promote new dental technology and cutting-edge products and services sold in your office, share in-depth information about specific treatments performed, or promote community events.

Fifty-seven percent of companies have acquired a customer from their company blog. A blog has the ability to provide expansive information in each posting, giving readers a more thorough understanding of the featured topic as well as an inside look at who you are as a person, who your team is, and what your practice philosophy is. Who will manage the blog? A blog needs to be updated regularly if it is to be successful. Designate a staff member to update the blog at least once a week or make time on your schedule to do so, even if it's just to remind patients about a contest. Alternatively, hire a company with dental-specific social media expertise to manage the postings on your behalf.

Facebook -- Facebook has become an integral platform for all individuals to connect, and an effective platform for businesses to reach new and existing clients. Sharing photos, events, and information through specially designed Facebook Business Pages is easy and enormously productive. The additional benefit is that this channel introduces your practice to prospective new patients through information delivered to them from a member of their own trusted network.

Twitter -- Twitter is widely regarded as a powerful marketing tool, used to share quick and focused updates, connect with patients, learn from customers' past experiences, and connect with professional peers. Maintaining a Twitter presence is fairly easy. It is much more convenient to tweet a message in seconds than to use a time-consuming media platform. Your dental office can reach out to millions of potential patients in a matter of a few clicks. How it works: Twitter is an interactive stream of messages that are limited to a maximum of 140 characters each.

In order to optimize the benefits of Twitter, it is important to:
Post often with relevant information to patients.

Monitor your newsfeeds for interesting stories that relate to the field of dentistry.
Even if it is not related to your dental practice, if it's interesting and relevant to patients, tweet it!

Don't forget to link back to your own website and/or Facebook page often.
Remember, keywords, site links, and intriguing content are the key ingredients of a great tweet.

Follow as many dentistry-related accounts as you can find. That includes other dentist offices, dental associations, dental bloggers, dental specialty fields, and dental product manufacturers.

Google+ -- Google+ is Google's answer to Facebook. Their services are a powerful social media resource that dentists cannot ignore. Its primary benefit is the way it positively influences Google search results. Google's social sharing feature is proven to drive traffic to your website, increasing your visibility in the networks' integrated search results. One of the key features of Google+ is "Circles," which are simply groups that contain your contacts. Set up a profile for your dental practice and then start adding your patients (if they agree to it), local businesses, and other dental-related professionals to your public circles.

YouTube -- Despite being known as a video network first, YouTube is also the second largest search engine in the world, with 100 hours of video uploaded every minute and 4 billion videos viewed on a daily basis. There are many different ways you can utilize the power of video. Whether filming patient testimonials, a demonstration of a treatment, or just a simple office tour, dental practices are harnessing the marketing power of YouTube. When patients enjoy your content, they share it with their friends and families on their own personal social networks.

Pinterest -- Pinterest is a pin-board, or bookmark style, photo-sharing site. Users create theme-based image collections that include favorite events, hobbies, interests, and more. It is interactive; users can browse other boards, repin images to their board, or "like" images. For example, your dental practice may pin items such as "Top 5 Ways To Keep Teeth Healthy," "Teeth Whitening Techniques," or "Foods You Can Eat While in Braces." If they agree, using your patients' before-and-after dental photos can create valuable content on Pinterest. Pinterest drives more referral traffic on the web than Google+, YouTube, Reddit, and LinkedIn -- combined.

Sweepstakes and contests -- No matter which form of social media you use, contests and sweepstakes are an excellent and quick way to expand your social media footprint, while serving as a proven way to market your dental office, increase your contacts, and energize your patient base. Contest platforms that integrate with social networks, particularly Facebook, allow your practice to run anything from a simple enter-to-win sweepstakes to a more involved "Share Your Smile" photo contest, while offering appealing prizes to patients like electronics, gift cards, and more.

While sweepstakes and contests can be a powerful addition to your social marketing efforts, it is important to pay attention to the finer details and rules surrounding online contests. Work with a provider who monitors and keeps your promotions within Facebook guidelines and government regulations, while assisting in driving activity through promotional email blasts and newsletters to patients. Furthermore, ensure the contest platform you choose allows you to capture entrant contact details for later marketing efforts.

The benefits of online contests and sweepstakes for a dental practice are documented in a 2012 study by Sesame Communications looking at 48 dental and orthodontic practices and 64 distinct contests and sweepstake campaigns. The results showed that, on average, these patient engagement campaigns drove 194 new "Likes" per practice, per campaign, as well as four appointment requests that originated with filling out an entry form. Just as significant, for each sweepstakes and contest, participating practices received an average of 17 recommendations on Facebook -- testimonials that will exist on their page and benefit them indefinitely.

Lou Shuman, DMD, CAGS, is the president of Pride Institute. He is a sought-after educator in digital marketing methods and operational practice management. You can contact him at lou@prideinstitute.com.

Diana P. Friedman, MA, MBA, is president and chief executive officer of Sesame Communications. She has a 20-year success track record in leading dental innovation and marketing. You can contact Diana at Diana@sesamecommunications.com.

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By Marvin W. Berlin, DDS
From Dental Economics

In this age of ever-evolving technology, consumers have never had more options, information, and education at their fingertips. With a few keyboard strokes and mouse clicks, people can learn more about a product or service they're searching for, identify hundreds of businesses that provide that product or service, and pinpoint the right price. Consumers are now more knowledgeable and savvy than ever before, meaning it's necessary for businesses to adapt to these changes.

The dental industry is not immune to this consumerism shift. In the business of dentistry, patients are the consumers to whom dental offices market-consumers who are researching available dental care, comparing your services with others in your area, and expecting more from you and your team. This shift is not necessarily a bad thing, as it creates many opportunities to positively impact the health and livelihood of more people. As technology gives patients an increased power of choice, it also gives dentists the power to influence that choice through the values they communicate.

Causes of the consumerism shift
The largest reason for this "shopper" culture is the rise of the Internet. The sheer volume of information, services, and products that can now easily be accessed online has radically changed how businesses and consumers operate. In the dental industry, patients are researching dental services and becoming much more educated on oral health. As more information about the importance of lifetime care and the effects oral health on overall health is circulated online, patients are becoming much more health conscious. When choosing a dentist, they have the ability to browse all of the dental practice websites in their communities so they can compare services.

Office websites are not the only sources of information. Patients can access social media, reviews, and rating sites (Facebook, Google+, Yelp, Angie's List, etc.) that have office recommendations (and oppositions) left by patients. All of these sources have helped create the new "dental consumer."

There are other contributing factors. With a tightening of insurance taking place, patients are often responsible for more out-of-pocket expenses. This leads them to evaluate dental services extensively in order to choose more economically. Saturation of dentists in certain areas is another factor. Several dental offices in one area that offer comparable services lead patients to evaluate other factors besides general care, such as online reviews, convenience of appointment scheduling, a wide variety of restorative and cosmetic options, and more. Patients looking for the most cost-effective, convenient, and accommodating dental care will turn to the Internet to compare what is available.

Acclimating your actions
What actions can you take in your practice to adapt to this consumerism shift? First of all, evaluate your marketing methods. Are you communicating the right messages and values? Do you fully understand what your target demographic wants? It's important to build a brand for your office that stands out, especially if your area is highly competitive.
When marketing your services, promote "why" this care is important rather than simply "what" you provide. Define what positive outcomes can result and what negative consequences can be avoided. Since more patients are searching for dentists online, use this to your advantage. A well-designed, user-friendly website that clearly communicates your mission and values will go a long way in setting you apart from others.

As the popularity of social media increases, I encourage you to also use these platforms. Proactively communicating your message through Facebook, Twitter, etc., is a great way to reach a large audience easily and inexpensively. In our latest initiative involving donating a smile makeover, we had potential candidates send us selfies as a way of introducing themselves. This drove tons of traffic to our website and created quite the buzz in our community. Check it out at mckinneydentist.com/selfie-smile-contest.

The services you offer can determine how you are perceived by dental consumers. Today's educated patients are looking for more than root canals, fillings, or extractions. Meeting these expanded wants and needs requires you to advance your skills in order to offer more services. We've seen the rise of Invisalign, immediate implants, treatment of snoring and sleep apnea, lasers for both dentists and hygienists, same-day CAD/CAM restorations (Planmeca CAD/CAM Solutions), and other expanded services.

No longer can you just tell patients you will make their smiles beautiful. They want to see it and see it now. With that in mind, we can now instantly, within minutes, digitally design smiles for our patients with Planmeca Romexis Smile Design. These advancements are helping patients enjoy more effective results in a more convenient manner. Providing all of these services under one roof is another way to stay in front of this ongoing consumer wave.

Acclimating your surroundings
Today's dental consumers expect Wi-Fi throughout your office. We've taken it a step further and provided our own Internet Cafe to better facilitate patient laptop use. TV monitors in each operatory provide entertainment or patient education. Comfortable blankets, headphones, warm after-treatment towelettes, coffee, and cookies all add to the modern dental environment.

Acclimating your mindset
To carry out the right actions to satisfy dental consumers, you'll need to maintain the right mindset. Offering a wide variety of services will take you only so far. Today's patients need to know you will go above and beyond. You must treat people like they want to be treated. If a patient is in need of immediate emergency care, we get them in immediately.

It's time to step away from all the online dental forums, roll up your sleeves, and get to work. I've heard other doctors say, "I want to work smarter, not harder." This is simply not possible. Sometimes you have to work through lunch, rearrange your schedule at a moment's notice to accommodate emergency care, or have extended hours for patient convenience. You've got to be willing to do what the guy down the street isn't willing to do. This "extra mile" mentality has helped us distinguish our practice from the others and build ongoing relationships with our patients.

Also, cultivate patient education. More patients are taking the time to learn about oral health on their own, so foster this. Clearly communicate why you are recommending a specific treatment, the benefits that will result, and the problems that will be avoided. Educate patients; don't dictate to them. This will give them more trust in you and the treatment plan you present.

This consumerism shift is here to stay. As dental consumers become more knowledgeable and have access to more choices, they will expect more of their dentists. Embrace this. They will expect you to be hip to and understanding of this new digital dental environment. The next time a patient pulls out his or her cell phone to sneak a "mid-appointment-selfie-Instagram-Tweet," I suggest you go for the "photo-bomb."

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From Medical News Today
By Christian Nordqvist Knowledge center

Gingivitis means inflammation of the gums (gingiva). It commonly occurs because of films of bacteria that accumulate on the teeth - plaque; this type is called plaque-induced gingivitis. Gingivitis is a non-destructive type of periodontal disease. If left untreated, gingivitis can progress to periodontitis, which is more serious and can eventually lead to loss of teeth.

A patient with gingivitis will have red and puffy gums, and they will most likely bleed when they brush their teeth. Generally, gingivitis resolves with good oral hygiene - longer and more frequent brushing, as well as flossing. Some people find that using an antiseptic mouthwash, alongside proper tooth brushing and flossing also helps.

In mild cases of gingivitis, patients may not even know they have it, because symptoms are mild. However, the condition should be taken seriously and addressed immediately.

There are two main categories of gingival diseases (1999 World Workshop in Clinical Periodontics):

  • Dental plaque-induced gingival disease
  • Gingivitis caused only by plaque
  • Gingivitis caused by systemic factors
  • Gingivitis caused by medications
  • Gingivitis caused by malnutrition
  • Non-plaque induced gingival lesions
  • Gingival diseases - caused by a specific bacterium
  • Gingival diseases - caused by a specific virus
  • Gingival diseases - caused by a specific fungus
  • Gingival diseases - caused by genetic factors
  • Gum inflammations caused by systemic conditions
  • Gum inflammations caused by traumatic lesions
  • Gum inflammations caused by reactions to foreign bodies
  • Gum inflammations without known causes


What are the signs and symptoms of gingivitis? A symptom is something the patient feels and describes, such as painful gums, while a sign is something everybody, including the doctor or nurse can see, such as swelling.

In mild cases of gingivitis there may be no discomfort or noticeable symptoms.

  • Signs and symptoms of gingivitis may include:
  • Gums are bright red or purple
  • Gums are tender, and sometimes painful to the touch
  • Gums bleed easily when brushing teeth or flossing
  • Halitosis (bad breath)
  • Inflammation (swollen gums)
  • Receding gums
  • Soft gums

What are the causes of gingivitis?The accumulation of plaque and tartar

The most common cause of gingivitis is the accumulation of bacterial plaque between and around the teeth, which triggers an immune response, which in turn can eventually lead to the destruction of gingival tissue, and eventually further complications, including the loss of teeth.

Dental plaque is a biofilm that accumulates naturally on the teeth. It is usually formed by colonizing bacteria that are trying to stick to the smooth surface of a tooth. Some experts say that they might help protect the mouth from the colonization of harmful microorganisms. However, dental plaque can also cause tooth decay, and periodontal problems such as gingivitis and chronic periodontitis.

When plaque is not removed adequately, it causes an accumulation of calculus (tartar - it has a yellow color) at the base of the teeth, near the gums. Calculus is harder to remove, and can only be removed professionally.

Plaque and tartar eventually irritate the gums.

Gingivitis may also have other causes, including:

  • Changes in hormones - which may occur during puberty, menopause, the menstrual cycle and pregnancy. The gingiva may become more sensitive, raising the risk of inflammation.
  • Some diseases - such as cancer, diabetes, and HIV are linked to a higher risk of developing gingivitis.
  • Drugs - oral health may be affected by some medications, especially if saliva flow is reduced. Dilantin (anticonvulsant), and some anti-angina medications may also cause abnormal growth of gum tissue.
  • Smoking - regular smokers more commonly develop gingivitis compared to non-smokers.
  • Family history - experts say that people whose parent(s) has/had gingivitis, have a higher risk of developing it themselves.
  • Diagnosing gingivitis A dentist or oral hygienist checks for gingivitis symptoms, such as plaque and tartar in the oral cavity.


Checking for signs of periodontitis may also be recommended; this may be done by X-ray or periodontal probing. What are the treatment options for gingivitis? If the patient is diagnosed early on, and treatment is prompt and proper, gingivitis can be successfully reversed.

Treatment involves care by a dental professional, and follow-up procedures carried out by the patient at home.

Gingivitis care with a dental professional:
Plaque and tartar are removed. This is known as scaling. Some patients may find scaling uncomfortable, especially if tartar build-up is extensive, or the gums are very sensitive.
The dental professional explains to the patient the importance of oral hygiene, and how to effectively brush his/her teeth, as well as flossing
Periodically following-up on the patient, with further cleaning if necessary
Fixing teeth so that oral hygiene can be done effectively. Some dental problems, such as crooked teeth, badly fitted crowns or bridges, may make it harder to properly remove plaque and tartar (they may also irritate the gums).
What the patient can do at home:

  • Brush your teeth at least twice a day
  • Bear in mind that in most cases, electric toothbrushes do a better job than we can do on our own
  • Floss your teeth at least once a day
  • Regularly rinse your mouth with an antiseptic mouthwash. Ask your dentist to recommend one.
  • What are the possible complications from gingivitis? In the vast majority of cases, if gingivitis is treated and the patient follows the dental health professional's instructions, there are no complications. However, if the condition is left untreated, gum disease can spread and affect tissue, teeth and bones, leading to periodontitis.


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From Dentistry Today

Believe it or not, many kids want braces these days. The Australian Society of Orthodontists (ASO) reports that 7 out of 10 kids react with happiness or excitement when they learn they need braces. Also, 94% of orthodontists say parents have brought their children in for a consultation because the children wanted braces. Also, 9 out of 10 orthodontists have seen children become visibly upset when told they don’t need them.

Current treatment options are much more attractive than previous orthodontic gear, making the shift in attitude no surprise, the ASO says. Still, the organization notes that braces aren’t just a cosmetic solution and that orthodontists need to determine if treatment is even the right course for the patient.

‘There’s no denying that braces can be one of the best things you can do for your child, and no one’s questioning the benefits,” said Dr. David Mastroianni, a practicing specialist orthodontist and spokesman for the ASO. “But it’s our responsibility, as specialist orthodontists, to distinguish the ‘need’ from the ‘want’ to determine the best course of action, if any is required.”

Today’s braces, Mastroianni said, are small and comfortable with colored and even glow-in-the-dark options, leading many adolescents to see their braces as another avenue for personalization. Meanwhile, kids in the United States are seeing a similar shift to a positive perspective when it comes to orthodontic treatment.

“Youngsters can take some ownership of their treatment by selecting colors for their ligatures, which hold wires to brackets, so they feel involved and that orthodontic treatment isn’t something being done ‘to’ them,” said Pam Paladin, manager of marketing and member/consumer relations with the American Association of Orthodontists (AAO). “They’re part of the team.”

Paladin agreed that today’s braces are more aesthetic than their forebears, as teeth are no longer encircled by bands. Also, wires are lighter and last longer. The average interval between appointments to change them today is 6 weeks. And, braces require smaller brackets now as well.

“Another attitude shift can be credited to expected outcomes,” said Paladin. “Patients know that at the end of their treatment, their teeth will look better. Of course, the orthodontist knows that the end result is a healthy bite. The nice side effect of a healthy bite is a beautiful smile that comes from orthodontic treatment.”

Affordability may play a role in the warmer reception, too. Downpayments may or may not be required, with in-office financing for as long as 24 months, often with no interest charged. Third-party financing may be available, though these companies may charge interest. Some insurance plans and flexible spending accounts can cover braces as well.

And, Mom and Dad always have some influence.

“It could be too that children pick up cues from their parents, who may have had orthodontic treatment and who may have commented about how much easier or better it is today than when they were kids,” said Paladin.

While the number of adults getting orthodontic treatment has increased recently, growing by 16% from 2012 to 2014, the number of children ages 17 years and under actually has decreased from about 4.7 million patients in the United States and Canada in 2012 to 3.9 million in 2014.

The AAO attributes part of this decline to a US population decrease of about 970,000 children ages 8 to 17, though Paladin also speculates that 2012’s peak could be do to parents finally seeking treatment that was postponed during the recession. She also notes that 2014’s total of 3.9 million was still slightly higher than 2010’s 3.8 million and 2008’s 3.7 million tallies.

And among these millions of families, one of the most common questions that parents ask before beginning treatment is when their children should first see an orthodontist.

“The ASO recommends parents book their children in for an initial consultation between the ages of 7 and 10,” said Mastroianni. “Early assessment allows the orthodontist to determine what type of treatment, if any, is needed and when it should commence in order to possibly reduce cost and duration of treatment down the track.”

- See more at: http://dentistrytoday.com/news/todays-dental-news/item/1180-today-s-kids-look-forward-to-getting-braces#sthash.cEOl2CaV.dpuf

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From US News and World Report
By David Oliver

What if you could skip that visit to the dentist because your teeth could heal themselves?

Researchers from the University of Nottingham and the Wyss Institute at Harvard University developed new regenerative dental fillings that use the stem cells inside your teeth to repair tissue – potentially making root canals ancient history.

During a root canal, the pulp of the tooth and the nerve are removed. If the new treatment becomes the norm, fillings made of synthetic biomaterials would be inserted, stimulating dental stem cells to repair and regenerate dentin, which is the bony substance that accounts for most of a tooth.

Stem cells can serve many different functions in the body, including repairs, according to the U.S. Food and Drug Administration; they're currently used, for example, to help treat spinal cord injuries, arthritis and diabetes.

For patients who suffer from dental disease or undergo dental surgery, the new treatment could be extraordinary.

The promising research earned second place at the Royal Society of Chemistry's Emerging Technologies Competition 2016, competing in the materials category.

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From Delta Dental

Injuries to the teeth and mouth are common. Approximately 80% of dental injuries affect one or more of the front teeth and may cause damage to soft tissues – the tongue, lips, and inner cheeks.

In the very young child, injuries to baby teeth usually result from learning to walk. There may also be damage to the unerupted permanent teeth. Sports injuries are the main source of tooth and mouth injuries in older adolescents and adults. Up to 40% of dental injuries in older adolescents and adults occur while playing sports.

Tips to Prevent Sports-Related Tooth and Mouth Injuries

Mouth Guards : When playing sports, the best way to protect your teeth and mouth is by wearing a mouth guard.
Face cages: This equipment protects against trauma to the face, especially when playing certain sports positions, like baseball catcher or hockey goalie.
Helmets: It's always wise to wear a helmet made for the activity that you are participating in. Although most helmets won't protect the teeth and mouth, they will protect another important area – your head, to help protect against a brainconcussion.

Can Knocked-Out Teeth Be Repaired?
Yes, knocked-out teeth can be repaired, and the sooner you can get to your dentist's office, the better. Knocked-out teeth with the highest chances of being saved are those seen by the dentist and returned to their socket within one hour of being knocked out. If a tooth has been knocked out, gently rinse any debris from the root and attempt to place it back into the socket. If that’s not possible, hold it in the mouth on the way to the dentist. If all else fails, keep the tooth in milk until you get to the dentist's office.

Even if your tooth can't be saved, you haven't necessarily lost your smile. Due to advances in dentistry, a dental implant -- a freestanding artificial tooth – can now be anchored directly onto your jawbone, and with a porcelain crown attached, to aid in biting, chewing, and for esthetic reasons.

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From The Huffington Post

I always hoped more people would talk about flossing — but never like this!

By now, everyone has read or heard about the Associated Press article throwing shade at flossing. To summarize: Last year, the AP, under the Freedom of Information Act, asked the departments of Health and Human Services and Agriculture to provide the publication with evidence that flossing works. When the flossing recommendation was removed from this year’s federal dietary guidelines, the AP figured they were on to something, so they decided to take a look at the available research.

Reviewing about 25 studies comparing the effects of brushing alone with brushing and flossing, the AP concluded the research used to previously recommend flossing did not actually meet the criteria that the Department of Health and Human Services requires to write something into its Dietary Guidelines. The studies the government did have, said the AP, suffered from short durations and small sample sizes.

The article spread like wildfire. People were quick to conclude that flossing has no health benefits and therefore people could stop doing it.

Let’s be clear about one thing. No study, and certainly no dentist, would ever claim or even imply that flossing is harmful. You would be hard-pressed to find a study that concludes a person’s health is improved by eliminating flossing from her oral health routine. In fact, the conclusion that most studies draw is that even though the data are limited, the potential benefits of flossing outweigh the risks.

For example, a 2012 scholarly review, while cautious in its conclusions, states that “despite the uncertain or low quality of most of the studies, and given the importance of avoiding plaque deposition, plus the absence of any major disadvantages, these results support the use of regular flossing with toothbrushing.” In other words, we’ve got a few studies that say it’s good, and no studies that say it’s bad, so let’s keep doing it — especially because we know proper flossing can help remove plaque, which can lead to cavities, gingivitis, and periodontal disease.

I say “proper flossing” because that’s an important term that might be being overlooked by some in their furor to invalidate flossing. For a 2006 study titled “Dental Flossing and Interproximal Caries: a System Review,” researchers wanted to see whether flossing at home had the same health benefits as being flossed by professionals. They recruited 808 children aged four to 13 and split them into three groups: kids professionally flossed five days a week; kids professionally flossed once every three months; and kids who self-reported flossing at home.

The study lasted 18 months, and the findings were hardly surprising. Participants who were flossed professionally five days a week had a 40 percent decrease in their risk for cavities. The other two groups, those flossed professionally once every three months and self-reported home flossers, didn’t show any decrease of cavity risk. While this might at first seem to give some fodder to the “Stop flossing!” crowd, it’s important to clarify what exactly the study is showing. The researchers don’t conclude that flossing doesn’t help prevent cavities; they conclude that the key is flossing properly.

The conclusion of the study, then, is that when flossing is done correctly, it strengthens patients’ oral health.

Another major problem with the AP report is how shady it makes all of us dentists look by implying that we’re colluding with floss distributors to help them see increased profits, which we allegedly get a chunk of. Companies like Proctor & Gamble, who sell floss, have “paid for most studies and sometimes designed and conducted the research,” writes the AP.

So dentists are giving out floss because we want to make more money? In actual fact, we would make more money if we stopped handing out floss. In 2009, for instance, dental expenses for children aged five to 17 totaled $20 billion!

There’s a more obvious reason dentists might give you floss: because we’re convinced it will help you!

Patients should be aware that flossing isn’t the only kind of interdental cleaners. There are several options to choose from, including water picks and small brushes. Many of these carry the ADA seal. Regardless of which tool you use, it’s important to clean in between your teeth.

We know that our patients don’t love flossing. In fact, we know they’d rather spend the time doing other things — like cleaning a toilet.

To be honest, I am not even the world’s most reliable flosser. However, when I floss and see plaque or a tiny bit of dinner dislodge from between my teeth, I can’t deny that I have done something beneficial for my oral health.

That’s the thing about flossing. It’s a common sense thing to do. If you don’t floss, you only clean 60 percent of your teeth’s surfaces. Imagine you left 40 percent of your body unshowered. Even if there were a couple articles circulating around Twitter about how that might be OK, wouldn’t you still feel gross about your hygiene?

Of course, appeals to common sense don’t replace rigorous scientific study. But the unanimous advice of the American Dental Association is hardly the stuff of Old Wives’ Tales. According to its guidelines, flossing ought to be part of everyone’s daily oral health routine.

In response to the fuss over the AP story, the ADA released a statement reiterating its position that flossing is “an essential part of taking care of your teeth and gums.” A spokesperson for the U.S. Department of Health and Human Services also said that flossing is an important oral hygiene practice, and clarified that the Department never intended to imply that it wasn’t.

At the end of the day, flossing is your call. Patient autonomy is essential to health care, and as dentists, we can only advise you on what we think is best for you on an individual level.

But the next time you’re holding that tiny piece of string, ask yourself this: Would you rather floss, or get a filling or a root canal? The floss will cost you a few bucks every month or so. The dental work — well, that’s not as cheap.

Plus, it comes with a needle.

Read the original here.

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From Delta Dental

Brushing regularly is considered vital for healthy teeth and gums, but dental experts warn that you can overdo a good thing. Known as “toothbrush abrasion,” overbrushing can lead to sensitive teeth and receding gums.

Vigorous brushing can wear down the enamel on the teeth as well as damage and push back the gums, exposing the sensitive root area. Receding gums can also lead to other dental problems such as periodontal disease and cavities on the roots of the teeth and may lead to the need for treatments such as fillings, root canals and tooth extraction. According to the Wall Street Journal, dentists estimate that between 10 to 20 percent of the population have damaged their teeth or gums as a result of overbrushing.

The people most at risk for tooth or gum damage from overbrushing are those who are particularly diligent about their oral care and those who use medium- or hard-bristled toothbrushes. Other factors, such as a genetic predisposition to receding gums, clenching or grinding your teeth or having had your teeth straightened with braces, can increase your risk for damage from overbrushing.

Brushing vigorously isn’t necessary to remove plaque. “Plaque is so soft that you could remove it with a rag if you could reach all the surfaces where it hides,” says Dr. Kevin Sheu, managing dental consultant for Delta Dental. “Thoroughness is what is required for plaque removal, not aggressive brushing. You’re not going to achieve any extra benefit by brushing hard.”

Changing brushing habits can usually stop the problem from getting worse. In cases of severe toothbrush abrasion, dentists can fill in the grooves with bonding material.

Proper brushing technique

What’s important when brushing your teeth is not how hard you scrub, but that you use the proper technique and that you do a thorough job. And that takes time. Dentists recommend that you brush your teeth for two to three minutes to get the most thorough cleaning. The following are some other tips for brushing your teeth correctly:

Use a soft-bristled toothbrush to prevent gum damage and wear on the soft tooth dentin (the less mineralized layer of tooth found just under the enamel) and in the root area. If you are accustomed to a hard-bristled toothbrush, even using a toothbrush that is softer than you are accustomed to will help.
Place the head of your toothbrush with the tips of the bristles at a 45-degree-angle to the gumline when brushing.

Move the toothbrush with short strokes and a scrubbing motion, several times in each spot – don’t saw back and forth across the teeth with your toothbrush.
Apply just enough pressure to feel the bristles against the gums. If you are squashing the bristles, you're brushing too hard.

Read the original here.

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From Medical News Today

The risk of periodontal disease may be increased with long-term marijuana use, suggests a new study published in JAMA Psychiatry.

However, the study found no link between long-term use of the drug and greater risk of other physical health problems.

Marijuana - also referred to as cannabis - is the most commonly used illicit drug in the United States.

According to a 2014 survey from the National Institute on Drug Abuse (NIDA), around 22.2 million Americans report using the drug in the past month.

Marijuana use is particularly common among adolescents and young adults. NIDA report that in 2015, almost 35 percent of 12th graders had used marijuana in the past year, while 21.3 percent were current users.

The short-term health implications of marijuana use are well established. For example, some users may experience feelings of fear, anxiety, delusions, psychosis, and hallucinations.

However, the long-term effects of marijuana use on physical health are less clear, and this is something the researchers of this latest study set out to address.

Periodontal health at risk with persistent marijuana use
Study co-author Madeline H. Meier, Ph.D., of Arizona State University, and colleagues analyzed the data of 1,037 adults who were part of the Dunedin Multidisciplinary Health and Development Study of New Zealand.

Subjects were born in New Zealand in 1972-1973 and were followed up from birth until the age of 38 years. Participants underwent regular health and lifestyle assessments during follow-up.

Meier and colleagues looked at the frequency of marijuana use among participants between the ages of 18-38 and assessed whether this impacted physical health at the age of 38.

Specifically, they looked at whether marijuana use affected later-life periodontal health, lung function, systemic inflammation, and metabolic health.

Compared with participants who did not use marijuana, the researchers found persistent marijuana use for up to 20 years was associated with greater risk of periodontal disease at the age of 38.

Periodontal disease arises as a result of infection and inflammation of the gums and bone surrounding the teeth.

It presents as gingivitis in its early stages, characterized by red, swollen, and bleeding gums. As it becomes more serious, it can lead to periodontitis, where the bone around the teeth is lost. This can cause the teeth to fall out.

The researchers note that previous studies have indicated that marijuana users tend to brush their teeth and floss less frequently than non-users, and they are also more likely to have alcohol dependence - all factors that can contribute to periodontal disease.

When it came to other later-life physical health problems, however, long-term marijuana users were found to be at no greater risk than non-users of the drug.

Commenting on their results, the authors say:

"In general, our findings showed that cannabis use over 20 years was unrelated to health problems in early midlife.

Across several domains of health (periodontal health, lung function, systemic inflammation, and metabolic health), clear evidence of an adverse association with cannabis use was apparent for only one domain, namely, periodontal health."

They add that the results should be "interpreted in the context of prior research" that shows marijuana use may raise the risk of accidents and injuries, bronchitis, cardiovascular problems, infectious diseases, cancer, and poor mental health.

The team points to a number of study limitations. For example, marijuana use was self-reported, and some participants may have been reluctant to disclose their use of an illegal drug.

Additionally, the study only looked at the effect of marijuana use on specific health problems.

Read the original here.

From American Dental Association
A message from the ADA President

Dear Colleagues:

We have all heard the stories of celebrities who have died from overdosing on prescription painkillers. The stories are tragic, and they are not limited to the rich and famous. In 2014, over 47,000 people died from drug overdoses, and 40 percent of those (18,893 deaths) involved opioid analgesics, according to the Centers for Disease Control and Prevention. This doesn't count the nearly 2 million Americans the Substance Abuse and Mental Health Services Administration said reported abusing or being dependent on prescription pain relievers.

This month's Journal of the American Dental Association revisits dentistry's role in preventing prescription opioid abuse. The good news is that data from South Carolina's prescription drug monitoring program shows that a "notable minority of dental patients had incidents of multiple preexisting opioid prescriptions." The bad news is that research on dental prescribing practices is still scant, leaving lawmakers to make far-reaching policy decisions based on anecdotal evidence and haphazard assumptions.

Patients have a responsibility to use opioid painkillers only as prescribed and to keep their unused medications from getting into the wrong hands. We can empower them by being more judicious in our prescribing when less aggressive treatments are indicated. We can also make sure patients leave our offices knowing about their abuse potential and how to safely secure, monitor and discard them at home.

Today, I am asking dentists everywhere to take several specific steps to help prevent opioid pain medications from being inadvertently misused and abused. These actions would complement what the ADA has been doing for several years to raise professional awareness about prescription opioid abuse and provide resources to help prevent it.

Register for the next ADA Continuing Education Recognition Program webinar on model opioid prescribing in the context of modern drug-seeking behavior. The webinar is free, convenient to access and available to members and nonmembers alike. Plus, the ADA CERP credential provides a sound basis for state regulatory agencies to accept the continuing education credit for licensure. The next webinar is scheduled for Aug. 24. To register, visit ADA.org/opioids.
Use your state's prescription drug monitoring program. These state-run databases can help dentists quickly identify doctor shopping patients based on their prescription history. Find your state prescription drug monitoring program at NASCSA.org.
Review the "ADA Practical Guide to Substance Use Disorders and Safe Prescribing." This easy-to-use reference manual includes techniques dentists can use to identify and respond to suspicious drug-seeking behaviors, including after-hours requests for prescription drugs. The guide is available at Catalog.ADA.org.
Visit the ADA Center for Professional Success to review ADA resources and previous webinars on opioid prescribing and abuse prevention topics. Learn more at Success.ADA.org.
Tell your patients to visit MouthHealthy.org/meds, where they can learn about the dangers of using opioid pain medications for non-medical purposes. Many do not know that using these drugs other than prescribed is illegal, dangerous and can even be fatal.
Urge your patients, especially parents, to sign the Medicine Abuse Project pledge to safeguard their medicines and talk with their families about medicine abuse. Unused prescription drugs can be easier to get than illegal drugs, especially when they are left unguarded in the family medicine cabinet or dumped in the trash. Learn more at MedicineAbuseProject.org.
Participate in (or possibly host) a National Recovery Month event in September. The Recovery Month campaign is designed to help overcome the stigma associated with addiction and recovery. A broad base of support can inspire those struggling with an addiction to begin the lifelong journey of recovery. Learn more at RecoveryMonth.gov.
We are also revisiting the ADA's Statement on the Use of Opioids in the Treatment of Dental Pain.

Make no mistake: Dentistry has not been idle on this issue. Between 2003 and 2012, dentists dropped from being the second most frequent prescribers of opioid pain medications, according to the Food and Drug Administration, to fifth in the National Prescription Audit —behind family practitioners, internists, general practitioners, and surgeons. In fact, the greatest percentage decrease in opioid prescribing rates between 2007 and 2012 occurred in emergency medicine (–8.9 percent) and dentistry (–5.7 percent), according to a study that looked at opioid prescribing rates by specialty between 2007-12 that was published in the September 2015 edition of the American Journal of Preventive Medicine. It is a part of the story that needs to be told.

We can all do more to keep opioid pain medications from becoming a source of harm. For its part, the ADA will continue raising professional awareness about the issue and offering resources to help prevent it. It will also continue pressing for common sense policies that weigh the need to use opioids for effective pain management against their abuse potential.

Together, we can help stem the tide of opioid abuse that has been devastating our families and communities.

Find out more at ADA.org/opioids.

Sincerely,

Carol Gomez Summerhays, D.D.S.
ADA President

Read the original here.

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From Modern Hygienist

From toothbrushes to water flossers and more, here are seven must-see innovative products.

A true high-tech oral health routine should treat the cause of oral health problems, not just the symptoms.
In this roundup, we've compiled a great list of must-have products that fit the bill, including next-gen toothbrushes, space-age water picks, futuristic sanitation pods and more.  Click through the following pages to see these cool tools.

Steripods

The point of brushing our teeth is to keep things clean, but what we don’t realize is how much dirt we put back in our mouths every time we use our toothbrushes. Steripod is a clip-on protector for any standard or electric toothbrush and keeps your toothbrush fresh and clean for up to three months – thanks to patented “active vapors." ($5.99 for two)

VioLight Zapi Luxe

What do ninjas, penguins and rainbow creatures have to do with oral hygiene? They can all deep clean your toothbrush! The Zapi Luxe UV sanitizer reportedly eliminates up to 99.9% of germs with UV light. Rinsing just got high-tech — you’ll feel like you’re using a brand new toothbrush every time you use it. ($39.99)

 Pink Aquarius Water Flosser

Waterpik Aquarius Professional Water Flosser brings your dentist to your bathroom for a daily, healthy cleaning. Water flossers are proven to be more effective than traditional dental floss, and are great for sensitive gums and those with braces. The pink color keeps a daily chore cheerful. ($89.99)

Foreo Issa Toothbrush

If Sonicare is the popular kid on the block, consider the Foreo ISSA its chic, Paris-residing cousin. The soft silicone bristles generate the ideal amount of friction for plaque busting, but won’t damage precious enamel. Plus, it looks great on a bathroom counter! ($199)

Tom’s of Maine Antiplaque Floss

There’s nothing worse than floss that splinters and sticks between crevices. Tom’s Antiplaque Floss is made from nylon and coated with natural bees-, carnauba-, and jojoba waxes to keep things moving along. It’s strong enough to get between teeth but gentle on sensitive gums — throw it in your bag for when you can’t get to your water flosser! ($4.45 each)

Rembrandt Intense Stain Dissolving Strips

Gone are the days of goopy whitening trays — these little strips adhere to your teeth and dissolve in 5 to 10 minutes for quick, mess-free whitening. Not only will your chompers be whiter in just two weeks, they’ll be more resistant to new staining as well. ($19.97)

CloSYS Oral Rinse

Follow up your high-tech routine with alcohol-, sugar- and gluten-free CloSYS Oral Rinse. This stuff is specially formulated to kill 99% of bacteria and germs in seconds, and leaves your breath fresh for the entire day – burn not included. ($11.39 for 32 oz.)

Read the original here.

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From Delta Dental

Summer is the time for enjoying the great outdoors. However, some popular summer sports – such as swimming and softball – can expose your teeth to danger. Here are several seasonal activities that could lead to dental injuries and ways to keep your smile safe:

Swimming

Frequent swimmers may be at risk for developing yellowish-brown or dark brown stains on their teeth.

Those who swim more than six hours a week continually expose their teeth to chemically treated water. Pool water contains chemical additives, which give the water a higher pH than saliva. As a result, salivary proteins break down quickly and form organic deposits on teeth. These hard, brown deposits, known as "swimmers' calculus," appear most frequently on the front teeth.

Swimmers' calculus can normally be removed by a professional dental cleaning.

Diving

Scuba diving, a sport enjoyed by more than 4 million people in the U.S., can lead to jaw joint pain, gum tissue problems or "tooth squeeze" – pain in the center of the tooth.

All of these symptoms add up to what's called "diver's mouth syndrome" (also called barodontalgia), a condition caused by the air pressure change involved in scuba diving and by divers biting too hard on their scuba air regulators. Tooth squeeze is caused by the change in air pressure, particularly if a diver has a big cavity, a temporary filling, gum disease, periodontal abscess or incomplete root canal therapy.

The best way to avoid these problems is to visit your dentist before scuba diving and make sure your dental health is tip-top. Ask your dentist's advice about fitting the mouthpiece of an air regulator. Sometimes dentures can be inadvertently swallowed during a dive, so denture-wearers should consult with dentists before diving to discuss any potential problems.

Contact sports (soccer, softball, basketball, etc.)

Soccer players are more likely than football players to sustain a dental-related injury – and these statistics do not include people playing pick-up games with friends.

Soccer is a sport where mouthguards and face masks are not mandatory, upping the odds for mouth and face injuries. Softball, basketball and pick-up games of touch football involve similar risks. In addition to causing injuries during contact, these sports also may be costly for people who have had extensive dental work, especially people who wear braces.

When participating in such sports, a mouthguard is your best ally. The AGD estimates that mouthguards prevent more than 200,000 injuries each year. Using a mouthguard can prevent damage to braces or other orthodontic work, as well as prevent mouth cuts, jaw injuries and tooth damage.

There are several types of mouthguards. Ask your dentist for advice about which mouthguard solution is best for you.

Stock mouthguard: The lowest cost option is an item that can be bought "off the shelf" from a drug or sporting goods store. This type of mouthguard offers the least protection because the fit adjustment is limited. While better than nothing, a stock mouthguard is not considered acceptable as a facial protective device.
Mouth-formed protectors: These mouthguards come as a shell-liner and "boil-and-bite" product from sporting goods stores. The shell is lined with acrylic or rubber. When placed in an athlete's mouth, the protector's lining material molds to the teeth and is allowed to set.
Custom-made mouth protectors: The best choice is a customized mouthguard made by your dentist. This is the most expensive option (and may not be covered by your dental plan – check your Evidence of Coverage booklet), but a custom mouthguard offers the best protection, fit and comfort level because it is made from a cast to fit your teeth.

Read the original here.

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From Science Daily
From University of Louisville


In a study of patients entering the hospital for acute stroke, researchers have increased their understanding of an association between certain types of stroke and the presence of the oral bacteria (cnm-positive Streptococcus mutans). Robert P. Friedland, M.D., the Mason C. and Mary D. Rudd Endowed Chair and Professor in Neurology at the University of Louisville School of Medicine, was a co-author of the study, published online this month in Scientific Reports, a journal of the Nature Publishing Group.

In the single hospital study, researchers at the National Cerebral and Cardiovascular Center in Osaka, Japan, observed stroke patients to gain a better understanding of the relationship between hemorrhagic stroke and oral bacteria. Among the patients who experienced intracerebral hemorrhage (ICH), 26 percent were found to have a specific bacterium in their saliva, cnm-positive S. mutans. Among patients with other types of stroke, only 6 percent tested positive for the bacterium.

Strokes are characterized as either ischemic strokes, which involve a blockage of one or more blood vessels supplying the brain, or hemorrhagic strokes, in which blood vessels in the brain rupture, causing bleeding.

The researchers also evaluated MRIs of study subjects for the presence of cerebral microbleeds (CMB), small brain hemorrhages which may cause dementia and also often underlie ICH. They found that the number of CMBs was significantly higher in subjects with cnm-positive S. mutans than in those without.

The authors hypothesize that the S. mutans bacteria may bind to blood vessels weakened by age and high blood pressure, causing arterial ruptures in the brain, leading to small or large hemorrhages.

"This study shows that oral health is important for brain health. People need to take care of their teeth because it is good for their brain and their heart as well as their teeth," Friedland said. "The study and related work in our labs have shown that oral bacteria are involved in several kinds of stroke, including brain hemorrhages and strokes that lead to dementia."

Multiple research studies have shown a close association between the presence of gum disease and heart disease, and a 2013 publication by Jan Potempa, Ph.D., D.Sc., of the UofL School of Dentistry, revealed how the bacterium responsible for gum disease worsens rheumatoid arthritis.

The cnm-negative S. mutans bacteria is found in approximately 10 percent of the general population, Friedland says, and is known to cause dental cavities (tooth decay). Friedland also is researching the role of oral bacteria in other diseases affecting the brain.

"We are investigating the role of oral and gut bacteria in the initiation of pathology in the neurodegenerative disorders Alzheimer's and Parkinson's with collaborators in the United Kingdom and Japan."

Read the original here.

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From WebMD
By Richard Sine

John Gamba was 9 years old when a dentist failed to anesthetize a back molar properly and hit a nerve dead-on. The result was a lifelong fear of dentists that reached a peak in his 20s, when he stopped going to the dentist entirely. "I couldn't even drive by a dentist's office without getting stressed out," he tells WebMD.

Gamba was 38 when a chipped back molar began to decay, eventually causing him constant pain. "I was paralyzed. I couldn't even consider going [to the dentist's office]," says Gamba, an Internet entrepreneur from Naples, Fla. "It was much easier to accept the pain, sick as that sounds."

Few people look forward to a spell in the dentist's chair. But serious anxiety prevents millions of Americans from seeking proper preventative care. The consequences of this problem may go far beyond dental pain or lost teeth. Gum disease is a serious infection that can affect other parts of the body. Studies now link it to illnesses including heart disease, stroke, and diabetes.

Fortunately, many dentists are specially trained in handling fearful patients; a variety of methods and treatments are available to reduce pain and alleviate fear in the dentist's chair.

The 'Root' Causes
Between 5% and 8% of Americans avoid dentists out of fear, estimates Peter Milgrom, DDS, director of the Dental Fears Research Clinic at the University of Washington in Seattle and author of Treating Fearful Dental Patients. A higher percentage, perhaps 20%, experiences enough anxiety that they will go to the dentist only when absolutely necessary, Milgrom tells WebMD.

Milgrom's dental practice specializes in fearful patients. About two-thirds of them relate their fear to a bad experience in the dentist's office, Milgrom says. Another third have other issues for which fear of dentists can be an unpleasant side effect, such as various mood or anxiety disorders, substance abuse, or posttraumatic stress experienced by war veterans, victims of domestic violence, and victims of childhood sexual abuse.

Fear of dentists stems not so much from the experience of pain as from the lack of control that patients experience in the dentist's chair, says Ellen Rodino, PhD, a psychologist in Santa Monica, Calif., who has studied dental fear. "You're lying prone, a dentist is hovering above you, and he's putting you in a situation where you can hardly talk or respond. That creates a lot of anxiety for some people because they don't feel in control."

Still, many dentists create unnecessary anxiety in patients because they assume that all patients have similar pain thresholds and will handle dental procedures in the same way, Milgrom says. "If all dentists were a lot more careful about pain control, took the time to be sure patients were comfortable, and didn't go ahead if they weren't [comfortable], then we would create fewer phobics."

Fearful patients need to be more assertive about their needs, Milgrom says. Patients should say to their dentists, "I want to talk about what can be done to make me more comfortable. I don't want someone to tell me something doesn't hurt me."

Treating Fear of Dentists
Some dentists who specialize in treating fearful patients go out of their way to create a nonthreatening environment. The place where Jack Bynes, DMD, works in Coventry, Conn., is barely recognizable as a dentist's office. It's housed in a renovated historic gristmill, with a treatment room that overlooks a waterfall. The waiting room contains a fireplace and soothing photography; it's free of posters depicting the horrors of gum disease. Bynes himself fancies bow ties rather than scrubs. Many "people have a fight-or-flight reaction" to the sights, sounds, and smells of a dental office, and taking away these cues has a calming effect, Bynes explains. And Bynes should know. He specializes in fearful patients today because he himself had to overcome his own medical phobias as he trained to become a dentist.

Bynes first talks with patients in his office, rather than in the dental chair. "I tell them they can leave anytime they want," he says. "Only one has done it in 40 years. It's so they know they have control."

The best dentists use simple methods to enhance that feeling of control, Milgrom says:

They gently explain what the patient will soon feel, and for about how long.
They frequently ask the patient for permission to continue.
They give the patient the opportunity to stop the procedure at any time the patient feels uncomfortable. ("I give them a cue," Bynes says. "If for any reason they need to stop, raise your left hand.")
They make time for breaks as requested.
Many dentists lack the patience to treat fearful patients with the care they deserve, Bynes says. Even those who advertise that they "cater to cowards" may not do a good job of it. If you're looking for a new dentist, Bynes suggests being honest about your fears from the first call. Ask to speak to the dentist about your fears before you come in. If the receptionist seems dismissive, or the dentist never returns your call, don't go, he says. "That's not the right office for you."

Taking Charge
Chances are, visiting a dentist won't be nearly as painful as you expect. Surveys of patients before and after the most dreaded procedures -- such as a root canal or wisdom tooth extraction -- have found that they anticipated much more discomfort than they actually experienced, Milgrom says.

The root canal in particular gets a "bad rap" because it is typically preceded by painful toothaches, Milgrom says. The procedure itself relieves this pain, often in just a single visit. Wisdom tooth extractions get a bad name because of occasional jaw pain experienced several days afterwards, which can be treated with pills.

Still, even if your mind tells you you'll be just fine, your body may still fear that dentist's chair. Here are a few tips that may help you overcome your fear of the dentist:

Go to that first visit with someone you trust, such as a close relative who has no fear of dentists, Bynes suggests. Bynes even encourages friends and relatives to sit with the patient during treatment.
Seek distraction while in the dentist's chair. Listen to your own music on headphones --"a new CD, not one you've heard a lot, so you'll be a little more interested in it," Milgrom suggests. Or find a dentist with a TV or other distractions available in the treatment room.

Try relaxation techniques. Milgrom suggests controlled breathing -- taking a big breath, holding it, and letting it out very slowly, like you are a leaky tire. This will slow your heartbeat and relax your muscles. Another technique is progressive muscle relaxation, which involves tensing and relaxing different muscle groups in turn.

Review with your dentist which sedatives are available or appropriate. Options include local anesthetic, nitrous oxide ("laughing gas"), oral sedatives, and intravenous sedation. While oversedation can be dangerous, too many dentists are uncomfortable using any oral sedation, Milgrom says. And only some dentists are qualified to perform IV sedation.

If you can't bring yourself to go to any dentist, you might want to try seeing a psychologist first, says Ronald Kleinknecht, PhD, a clinical psychologist at Western Washington University and co-author of Treating Fearful Dental Patients. The most "tried and true approach" to treating dental phobia (and other phobias) is what Kleinknecht calls "direct therapeutic exposure." It involves introducing the patient to feared items -- say, a needle -- in a gradual and controlled manner.

Read the original here.

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From ADEA
Dental hygienists have a diverse set of personality traits that allow them to work very closely with patients.

A successful dental hygienist is...

Patient and understanding.
Some patients may be uneasy about dental work and oral examinations. A good dental hygienist is patient with people who may be afraid of coming into the dental office and will be understanding about their fears. A dental hygienist should work to make the patient relaxed and comfortable and should fully explain the health reasons and steps behind everything he or she does inside the patient’s mouth.

Detail-oriented.
The mouth is a very small space, so it’s essential that a dental hygienist pays careful attention to detail when working in a patient’s mouth. Dexterity is also incredibly important in such a small space, as the slightest nudge to a sensitive tooth can be extremely painful for a patient.

Passionate.
Part of a dental hygienist’s job is to educate patients about good oral health practices. A dental hygienist that is passionate about oral health and general health can be a role model to patients and help them modify their behaviors to focus on preventative maintenance on their teeth and gums to avoid disease in the future.

Sturdy on his/her feet.
Dental hygienists are moving throughout the day sometimes sitting, standing, working with repetitive motions, and moving around the clinical environment. It is important that a dental hygienist possesses the physical stamina to keep this up throughout the entire day.

Positive.
A positive attitude goes a long way as a dental hygienist. Many patients prefer energetic, friendly and outgoing hygienists to ease some of their stress about coming to the dentist’s office.

Read the original here.

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From Guy Sports

What does a dentist's award look like?  We don't have a picture, but apparently it's a big plaque with a little cavity.

The Buddhist:

Did you hear about the Buddhist who refused a Novocain injection during root canal treatment?

He wanted to transcend dental medication.

Anaesthetist :

Dwayne is recovering from surgery in St Peter's, Chertsey, UK, having had a local anaesthetic when a nurse asks him how he's feeling.  'I'm O.K. but I didn't like the four-letter-word the doctor used in surgery.'

'What did he say?' asks the nurse.

'OOPS!'

Toothache:
The pain that drives you to extraction.

Visit to the Dentist:

The Marshes were shown into the dentist's surgery, where Mr Marsh makes it absolutely clear that he is in a big hurry.

'No expensive extras, Doctor', Marsh demands, 'No gas or needles or any of that fancy stuff. Just pull the tooth and get it over with.'

'I wish more of my patients were as strong minded and as brave as you, Mr Marsh, 'said the dentist admiringly.  'Now, which tooth is it?'

Mr Marsh turns to his wife and says:

'Show him your tooth, honey.'

Dental Treatment Hits Right Note

A patient sits in the dental chair with severely fractured front teeth.  After discussing with the orthodontist how they will be restored and what the fee would be the patient says,  'Before you start, I gotta know: Will I be able to play the clarinet when you are finished?'

The dentist replies 'Sure you will!'
The patient replies 'Great, I couldn't play a note before!'

Fast - or Slow? Recession Painkiller

Patient: How much will it cost me to have this tooth extracted?
Dentist: $300

Patient: $300 for just a few minutes work, that expensive.
Dentist: O.K. I'll pull it out slowly if you prefer.

Another Batch of Good Dentist Jokes

A Good Dentist?

When a new dentist set up in town he quickly acquired a reputation of being the 'Painless' dentist.  However a local little girl called Gemima disputed his claim.

'He's a fake!' Gemima told her friends.  'He's not painless at all.  When he stuck his finger in my mouth I bit him - and he screamed like anyone else.'

He Made a Good Impression!

Joe Simpson goes to his dentist for a new set of choppers
The dentist said to his assistant, 'Please get an impression from Mr Brown'

Mr Brown replied 'Just like that'.

(A slow burning joke sent in by a Tommy Cooper fan)

Martin Goes to the Dentist

Martin and his wife Debbie walk into a dentist's office.  Martin says to the dentist, "Doc, I'm in one heck of a hurry I have three buddies sitting out in my car waiting for us to play golf, so forget about the anaesthetic, I don't have time for the gums to get numb. I just want you to pull the tooth, and be done with it! Today is Friday and we have a 10:00 AM tee time at the best golf course in town and it's 9:15 already... ".

The dentist thought to himself, "My goodness, this is surely a very brave man asking to have a tooth pulled without using anything to kill the pain." So the dentist asks Martin, "Which tooth is it sir?"

Martin turned to his wife and said, "Open your mouth and show him dear......."

Biting Off More Than You Can Chew?

In my busy dental surgery, I see several patients at the same time.  As soon as I finish with one, I run to the next room to resume treatment on another.  One day, I returned to a second patient without saying good-by to the first.  As my first patient was leaving, she gave a friendly wave. Acknowledging her, I said loudly, 'Byyy...' My other patient obediently chomped down and bit my fingers.

From  'All In a Day's Work' by Stiew Tan.

Read the original here.

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From American Dental Association
By Jennifer Garvin

Washington — The Food and Drug Administration announced May 20 that it has finalized new requirements for Nutrition Facts labels, which for the first time emphasize the amount of added sugars in packaged foods.

The new label is consistent with the 2015-2020 Dietary Guidelines for Americans, which advise limiting added sugars to less than 10 percent of the total calories consumed each day. FDA said it hopes the new label will make it easier for consumers to make “better informed food choices.”

“We applaud FDA for giving consumers another tool to make informed decisions about their added sugars intake,” said Dr. Carol Gomez Summerhays, ADA president, in a press release. “For years, we’ve encouraged consumers to monitor — and minimize — their added sugar intake. Now they can do so simply by reading a nutrition label.”

The ADA has long advocated for greater scrutiny of added sugar’s effect on oral health. In May 2015, the Association filed comments on the Scientific Report of the 2015 Dietary Guidelines Advisory Committee, which served as the basis for developing the new guidelines. In November 2015, the ADA House of Delegates formally endorsed the World Health Organization’s recommendation to limit added sugar consumption to less than 10 percent of daily caloric intake.

“We need more data about the extent to which dental caries rates fluctuate with changes in total added sugar consumption, and over what periods of time,” Dr. Summerhays said. “Until we have better data, limiting added sugar intake to less that 10 percent of energy intake seems like a reasonable public health goal.”

Most food manufacturers will be required to use the new label by July 26, 2018, according to FDA, although “manufacturers with less than $10 million in annual sales” will have until 2019 to comply. The FDA said it plans to “conduct outreach and education efforts” on the new label requirements.

“For more than 20 years, Americans have relied on the Nutrition Facts label as a leading source of information regarding calories, fat and other nutrients to help them understand more about the foods they eat in a day,” said Robert Califf, M.D., FDA commissioner, in a news release. “The updated label makes improvements to this valuable resource so consumers can make more informed food choices — one of the most important steps a person can take to reduce the risk of heart disease and obesity.”

Other key updates to the nutrition label include:
A new design to highlight calories and servings.
For packages that are between one and two servings, the calories and other nutrients will be required to be labeled as one serving because people typically consume it in one sitting. For instance, a 20-ounce soda will be considered one serving.
Updated daily values for nutrients such as sodium, dietary fiber and vitamin D that are consistent with Institute of Medicine recommendations and the 2015-2020 Dietary Guidelines for Americans.

For more information about the Association and nutrition, visit ADA.org/nutrition.

Read the original here.

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From Dental Town
By Jeffrey J. Tonner, JD

The word ethics comes from the Greek ethikos and ethos, meaning "the character of an individual." Ethics is a branch of philosophy that deals with the general nature of moral choices, including a dentist's relationship with patients and staff. The preamble to the American Dental Association Code of Ethics frames this concept in terms of "honesty, compassion, kindness, integrity [and] fairness."

Dentists generally are bound by two sets of written codes or laws: the ADA Principles of Ethics and Code of Professional Conduct (applicable by adoption to all ADA and state dental association members), and state laws—most notably, dental practice acts. While statutes vary between jurisdictions, all principled practitioners accept certain universal standards.

This article examines three specific areas, conveniently beginning with the first three letters of the English alphabet.

Altering records
The Arizona Court of Appeals, in a recent decision, said that altering records reflects "notations [that] were written to appear as though they were made contemporaneously with the original entries."

My first brush with this unethical conduct occurred before the dental board—I had just completed what I thought was a winning argument when the patient explained that the progress notes I quoted were not found in his copy of the records. Unbeknown to my client, the patient was dating his receptionist and had obtained a copy of the records before proceeding with the board.

Upon reviewing the complaint, the dentist determined that his entries needed help and altered them before forwarding the doctored copy to the board.

Since then, I have defended perhaps a dozen cases involving altered records. I had no knowledge of any rewrites beforehand but a common denominator can be gleaned: The punishment for altering the records was far worse than for the underlying deficient dentistry. So never, ever alter records.

While altering is taboo, amending records is acceptable. When doing so, one must indicate both the current day and the amended day, so a reader understands that the entry is not contemporaneous. An example:

03/04/16 amending the
03/01/16 entry:
The patient was told ....

A caveat: As a practical matter, don't bother amending records after two weeks or so. I recently defended a dentist who properly amended his record one year after treatment. Not only did the board not believe that his memory improved with age, but his belated attempt to better explain himself cast a pall of implausibility over the remaining proceedings.

Bloodborne pathogens
According to the ADA Code of Ethics, all dentists have an ethical obligation to immediately inform any patient who may have been exposed to blood or other potentially infectious material, of the need for post-exposure evaluation, and to immediately refer the patient to a qualified health care practitioner. Typical exposures include HIV and hepatitis B and C.

If this occurs, you or the potentially infected staff member must be immediately tested and sequestered until the results are known. Then, all possibly exposed patients must be notified by letter. There are private companies who specialize in this type of triage.

You cannot refuse to treat a patient with a bloodborne pathogen. The ADA Code of Ethics considers it unethical not to provide treatment to an individual based solely on their infection with HIV, hepatitis B or C, or other bloodborne pathogens.

Confidentiality
Q: Who holds the dentist-patient privilege?
A: Patients may divulge any element they want about your treatment, to whomever they wish, but you are not equally entitled to do so.
Q: Can patients waive that privilege?
A: Yes.
Q: How?
A: By filing a legal action, by publishing treatment in a public forum or on social media, or through certain statutory exceptions, such as insurance company audits.

If a patient files a board complaint or dental malpractice action, the dentist would be handcuffed unless she or he freely could discuss what took place. Filing an action waives the privilege, and you can fully defend yourself free of any restraint.

Bad reviews present a thornier situation. Yes, the patient has waived the privilege by voluntarily placing certain information in the public arena—but is it a full waiver or merely a limited one?

For example, suppose the patient had a drug problem resulting in xerostomia, which in turn led to recurrent caries. If the social media review stated that you failed to diagnose decay, then perhaps the drug issues would be fair game.

On the other hand, if the patient's complaint were merely financial, then discussing this illegal activity would extend beyond the subject at issue and potentially expose you to legal damages.

When confronted with bad reviews, do not respond in kind—nobody will read it. Instead, ask your better patients to flood social media with positive reviews. I know one dentist who held an emergency staff meeting and identified 50 patients to provide rave reviews. They flooded Yelp with positive comments, thereby dwarfing the single bad review in the process.

Alternatively, respond with a short retort like this:

"Julie, there are two sides to every story. Your version omitted many important facts. Will you waive HIPAA and permit me to share some relevant information? Dr. Smith"

Even though you now know that permission is unnecessary under these circumstances, I have seen this type of challenge used effectively. The typical response—crickets! The patient will not reply, which only reinforces your point.

While ethical principles can feel like something of a minefield, having a solid working knowledge of the pertinent laws and rules can help you feel more confident in coping with the daily challenges that come from running a dental practice.

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From Dentistry Today

Fatty acids from bacteria present in gum disease may cause Kaposi’s sarcoma (KS)-related lesions and tumors in the mouth.

The information comes from a study by Case Western Reserve University. The researchers analyzed how byproducts in the form of fatty acids cause the growth of the lesions.

This finding could result in early saliva testing for bacteria. The person could then possibly be treated for signs of cancer or cancer before it would become malignant.

The information appears in the Journal of Virology.

The study primarily looks at the bacteria Porphyromonas gingivalis and Fusobacterium nucleatum, both of which are connected to gum disease. People with periodontal disease show high levels of these bacteria in their saliva.

KS affects many people with HIV because their immune systems can’t battle many infections. KS initially appears as lesions on the mouth that could turn into malignant tumors. Early detection is a key to surviving the disease.

The goal of this study was to pinpoint why most people don’t develop this type of cancer and what it is that spares them from it.

To compile the data 21 patients were studied. The first 11 had an average age of 50 and dealt with severe chronic gum disease. The other group of 10 maintained good oral health and had an average age of 26.

Numerous aspects of the saliva of each participant were studied. The research team was interested in the two bacteria, specifically, in addition to five short-chain fatty acids.

After first testing the byproducts, researchers concluded the fatty acids impacted the replication KS. They then introduced clean versions of the fatty acids into cells with the KS virus to see what the reaction was. Essentially, the body was prevented from trying to stop the growth of KS.

The study magnifies the importance of oral health for people with HIV.

Read the original here.