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From Know Your Teeth

When Should My Child First See a Dentist?
Your child's first visit to the dentist should happen before his or her first birthday. The general rule is six months after eruption of the first tooth. Taking your child to the dentist at a young age is the best way to prevent problems such as tooth decay, and can help parents learn how to clean their child's teeth and identify his or her fluoride needs. After all, decay can occur as soon as teeth appear. Bringing your child to the dentist early often leads to a lifetime of good oral care habits and acclimates your child to the dental office, thereby reducing anxiety and fear, which will make for plenty of stress-free visits in the future.
How do I prepare my child and myself for the visit?
Before the visit, ask the dentist about the procedures of the first appointment so there are no surprises. Plan a course of action for either reaction your child may exhibit – cooperative or non- cooperative. Very young children may be fussy and not sit still. Talk to your child about what to expect, and build excitement as well as understanding about the upcoming visit. Bring with you to the appointment any records of your child's complete medical history.
What will happen on the first visit?
Many first visits are nothing more than introductory icebreakers to acquaint your child with the dentist and the practice. If your child is frightened, uncomfortable or non-cooperative, a rescheduling may be necessary. Patience and calm on the part of the parent and reassuring communication with your child are very important in these instances. Short, successive visits are meant to build the child's trust in the dentist and the dental office, and can prove invaluable if your child needs to be treated later for any dental problem.
Child appointments should always be scheduled earlier in the day, when your child is alert and fresh. For children under 36 months, the parent may need to sit in the dental chair and hold the child during the examination. Or, parents may be asked to wait in the reception area so a relationship can be built between your child and the dentist.
If the child is compliant, the first session often lasts between 15 and 30 minutes and may include the following, depending on age:
A gentle but thorough examination of the teeth, jaw, bite, gums and oral tissues to monitor growth and development and observe any problem areas
If indicated, a gentle cleaning, which includes polishing teeth and removing any plaque, tartar buildup or stains
A demonstration on proper home cleaning
Assessment of the need for fluoride
The dentist should be able to answer any questions you have and try to make you and your child feel comfortable throughout the visit. The entire dental team should provide a relaxed, non-threatening environment for your child.
When should the next visit be?
Children, like adults, should see the dentist every six months. Some dentists may schedule interim visits for every three months when the child is very young to build up a comfort and confidence level or to treat a developing problem.
How do I find a good dentist for my child?
Many general dentists treat children. If yours does not, ask for a referral to a good dentist in your area. A word-of-mouth recommendation from a friend or family member can also yield the name of a quality dentist.
How can I protect my child's oral health at home?
Parents typically provide oral hygiene care until the child is old enough to take personal responsibility for the daily dental health routine of brushing and flossing. A proper regimen of preventive home care is important from the day your child is born.
Clean your infant's gums with a clean, damp cloth after each feeding.
As soon as the first teeth come in, begin brushing them with a small, soft-bristled toothbrush andwater.  If you are considering using toothpaste before your child's second birthday, ask your dentist first.
To avoid baby bottle tooth decay and teeth misalignment due to sucking, try to wean your child off of the breast and bottle by one year of age, and monitor excessive sucking of pacifiers, fingers and thumbs. Never give your child a bottle of milk, juice or sweetened liquid as a pacifier at naptime or bedtime.
Help a young child brush at night, the most important time to brush, due to lower salivary flow and higher susceptibility to cavities. Perhaps let the child brush their teeth first to build self-confidence, then the parent can follow up to ensure that all plaque is removed. Usually by age 5 or so, the child can learn to brush his or her own teeth with proper parental instruction.
The best way to teach a child how to brush is to lead by good example. Allowing your child to watch you brush your teeth teaches the importance of good oral hygiene.

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No one wants to hear that they have a dental cavity and need a cavity treatment. If you’re a bit apprehensive about undergoing cavity treatment, here are a few things to consider and discuss with your dentist before the big day. Discussing these important topics will help you be prepared and know what to expect when you walk into the dentist’s office the day of your appointment.

What type of filling will you get? There are numerous types of materials used for cavity treatment. The most common types include amalgam and composite. Ask your dentist what they recommend and do your research to determine which you might prefer.

What type of treatment will your dentist use to help you relax and avoid discomfort? Depending on the complexity of the cavity treatment you need, your dentist may simply administer a local anesthetic to numb your teeth and gums, or they may choose to administer nitrous oxide gas. (1) For really complex procedures, the dentist may even completely sedate you.

Can this cavity be fully treated in one visit? Heavily decayed teeth may need more than a traditional filling for cavity treatment. These procedures include inlays, onlays, veneers, crowns and bridges. (2) Your first visit will include a fitting for the cavity treatment and the second appointment is for the actual procedure.
How long will it take? The length of your visit will vary greatly depending on the type of cavity treatment and also on the type of sedative or anesthetic you are given. Ask your dentist how long the procedure should last.

How much will it cost? Cost will also vary greatly depending on your insurance coverage, type of cavity treatment and type of anesthetic. You can work with your dentist and insurance provider prior to the cavity treatment to get an estimate of the total cost.
Knowing all of these details before your cavity treatment will help you relax and be prepared for your visit.

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From Healthy Mouths Healthy Lives

It’s important to be prepared to help ensure that you select the right dentist for you and your family, and that you make the most of your dental visit. Here are some helpful questions to consider when selecting a dentist, and then before and during your dental appointment.

Selecting a Dentist

You may wish to consider several dentists before choosing the dentist that’s right for you. When calling or visiting dentists, consider the following questions:

How much does the dentist charge for dental checkups, X-rays, cavity fillings and other procedures?
If you have a health insurance plan, does the dentist participate in it?
When and how are you expected to pay? Make sure you understand the fees, method and schedule of payment before you agree to any treatment.
What types of dental procedures can the dentist perform? Are dental specialists, like orthodontists and periodontists, available at the dentist’s office? If not, will the dentist refer out to the appropriate dental specialists?
Are special arrangements made for handling emergencies outside of office hours? Most dentists make arrangements with a colleague or emergency referral service if they are unable to tend to emergencies.
What are their office hours and is the appointment schedule convenient for you?
What is the office location—is it conveniently located for you? Can you get there using public transportation if you need to?
Download questions to ask when selecting a dentist. (PDF)

Preparing for the Dental Visit for You or Your Child

Make a list of any pain or issues you are experiencing, or questions you would like to ask the dentist during your appointment. You can start with this list below, or make up your own. The important thing is to tell your dentist about any concerns or issues you have, even if they are minor, so that they can treat them now and help prevent bigger problems later on.

Do you have sensitivity or pain in your teeth? How bad is it?
Do you have pain or bleeding in your gums, tongue or jaw? How bad is it?
Do you have any unusual spots or sores in your mouth?
Do you have dry mouth or a lack of saliva?
Do you have an unpleasant taste or odor in your mouth?
Are you taking any prescription or over-the-counter medications? Make a list of those to take to the dentist.
Do you have any allergies?
Do you have trouble breathing when you sleep?
Do you grind your teeth when you sleep?
Download questions to consider when preparing to visit the dentist. (PDF)

Questions to Ask During Your Dental Visit

In addition to discussing with your dentist any pain or issues you are having in your mouth, here are some general questions you could ask to help improve your overall dental health.

Does my mouth look healthy?
What can I do to improve the health of my teeth and gums?
Is there anything I should tell my family doctor about?
What foods can I eat to improve my dental health?
Which treatments are absolutely necessary? Which are optional? Which are cosmetic? Which procedures are urgently needed, and which ones are less urgent?

Questions to Ask the Dentist About Your Child’s Teeth

The Partnership for Healthy Mouths, Healthy Lives recommends taking your child to the dentist by the time they turn one. Then once you schedule a regular routine, here are some questions to ask the dentist about your child’s dental health.

How can I ensure that my child’s teeth are clean?
How can I prevent baby bottle tooth decay?
Do you have any advice on how to get my child to brush their teeth?
What foods will improve my child’s dental health?
Should my child get sealants to prevent cavities?
How are the teeth and jaws developing and, if there are any problems, when will you refer my child to an orthodontist?

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From How Stuff Works Health

Every time you visit the dentist for a checkup, there's one question you're almost certain to hear: "Have you been flossing regularly?" For a lot of patients, the answer isn't always yes. Many people make a point of brushing their teeth twice a day, as the American Dental Association (ADA) recommends, but fewer people follow the recommendation to floss at least once a day [source: ADA].

What many of these non-flossers don't realize is that this step plays an important role in dental health. Unlike a toothbrush, which cleans the tops and outer surfaces of the teeth and gums, floss is an interdental cleaner-- it's designed specifically to clean the tight spaces between the teeth and the gap between the base of the teeth and the gums. These are places that a toothbrush can't reach. And while antimicrobial mouthwash can kill the bacteria that form plaque, it can't remove the stubborn tartar and bits of food that can lodge in these places [source: ADA].

An increasing body of evidence suggests that proper dental care -- including regular flossing -- can do more than keep your smile pretty and healthy. A healthy mouth can also help prevent much more serious diseases, some of which can be life threatening [source: CDC]. But if you're still not convinced that you should add flossing to your daily routine, we've got five examples to make the case that flossing is extremely important.

If you're like a lot of people, your first response to your dentist's flossing recommendation may be "I brush my teeth, so I'm fine." While brushing your teeth twice a day will go a long way toward maintaining oral health, you're not getting the optimal cleaning if you leave the floss unused in the back of your medicine cabinet.

A toothbrush works by physically removing plaque -- a sticky, bacteria-laden film -- from your teeth with its soft bristles. Toothpaste enhances the effect of the toothbrush, and kinds that contain fluoride help reduce the amount of bacteria in your mouth. But brushing has one big drawback: A toothbrush's bristles can't adequately clean between the teeth or under the gums [source: ADA].

That's where floss comes in. It's a tool specifically made to remove plaque from the tight spaces between the teeth and under the gums. The ADA suggests that flossing before you brush also helps make brushing more effective: With less plaque caught between your teeth, the fluoride in toothpaste can get to more parts of your mouth. Think of floss and a toothbrush as a detail paintbrush and paint roller, respectively. You could paint your living room walls with just one of the tools, but using them together will provide a much more satisfactory result [source: ADA].

What About Mouthwash?
Brushing and flossing get more buzz in discussions of oral care, but an ADA-approved antimicrobial mouthwash can also offer powerful protection for your mouth. Like toothpaste, mouthwash helps kill the bacteria that create plaque. It can get into the tight spaces between the teeth and gums, especially after flossing to clean plaque and food particles from those areas. While it can't physically scrub the teeth and gums like brushing or flossing, mouthwash that contains fluoride can strengthen tooth enamel, helping prevent cavities.

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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.

As the pain from Gamba's back molar intensified, he found support online through a forum for people with dental fear. He also found a dentist, Fred Eck, DDS, of Bonita Springs, Fla., who advertises his skill with fearful patients. Before going, Gamba says, "I convinced myself that I wasn't going to have any procedure, that I was just going to talk with the dentist." But Eck put him so at ease that he agreed to the extraction of the back molar on the first visit. And it was painless, he says.

Comfortable with his new dentist, Gamba finally got some much-needed dental work done. He spoke to WebMD just an hour before an appointment to get his final wisdom tooth removed. "It's been miraculous," he says. "I've gained such strength, hope, and courage by getting through these experiences."

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From Dental Town

Have you ever asked why the Dental Association and your dental specialist prescribe you to visit regularly? This is on the grounds that consistent dental visits are vital for the support of sound teeth and gums. Furthermore, in the middle of those examinations, it's vital that you work to keep your teeth and gums perfect and sound. In the event that you require extra help, your dental specialist might even recommend more regular visits.

What Goes On During a Regular Visit?

Checking your teeth for tooth rot is only one part of an exhaustive dental examination. Amid your check-up arrangement, your dentist in downey will probably assess the strength of your gums, perform a head and neck examination and look at your mouth for any signs of oral tumour, diabetes or vitamin inadequacies. Try not to be shocked if your dental practitioner additionally looks at your face, chomp, spit and development of your lower jaw joints. Your dental specialist or dental hygienist will then clean your teeth and anxiety the significance of you keeping up great oral cleanliness at home between visits. Sustenance, drinks and tobacco can recolor teeth too. If not evacuated, delicate plaque can solidify on the teeth and bother the gum tissue. If not treated, plaque can prompt gum illness.

Once your examination and cleaning have been performed, they'll let you know about the soundness of your teeth and gums and afterward make any extra suggestions. It's imperative that you see your dental practitioner like clockwork and that they give you routine examination and cleaning. Keep in mind, by seeing your dental specialist all the time and taking after day by day great oral cleanliness rehearses at home, you will probably keep your teeth and gums sound.

Why Regular Check Ups are Really Important

In the event that you hold up until you are encountering dental torment to go visit your dental in downey, you are putting yourself at danger for various badly designed results! In the first place, the torment you experience could keep going for a considerable length of time—even weeks—and toothaches, as we as a whole know, are a standout amongst the most uncomfortable sorts of agony. Second, holding up until you are in torment could imply that a cavity has deteriorated—notwithstanding requiring a root channel! With consistent check-ups at the dental practitioner, this entire circumstance can be maintained a strategic distance from, as your dental specialist will perform cleanings and pit checks.

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From National Institute of Craniofacial Research

You probably know that a dental cavity is a hole in a tooth. But did you know that a cavity is the result of the tooth decay process that happens over time? Did you know that you can interrupt and even reverse this process to avoid a cavity?
This web page explains how the tooth decay process starts and how it can be stopped or even reversed to keep your child from getting cavities.
What's inside our mouths?

Our mouths are full of bacteria. Hundreds of different types live on our teeth, gums, tongue and other places in our mouths. Some bacteria are helpful. But some can be harmful such as those that play a role in the tooth decay process.
Tooth decay is the result of an infection with certain types of bacteria that use sugars in food to make acids. Over time, these acids can make a cavity in the tooth.
Back to Top
What goes on inside our mouths all day?

Throughout the day, a tug of war takes place inside our mouths.

On one team are dental plaque—a sticky, colorless film of bacteria—plus foods and drinks that contain sugar or starch (such as milk, bread, cookies, candy, soda, juice, and many others). Whenever we eat or drink something that contains sugar or starch, the bacteria use them to produce acids. These acids begin to eat away at the tooth's hard outer surface, or enamel.

On the other team are the minerals in our saliva (such as calcium and phosphate) plus fluoride from toothpaste, water, and other sources. This team helps enamel repair itself by replacing minerals lost during an "acid attack."
Our teeth go through this natural process of losing minerals and regaining minerals all day long.​

How does a cavity develop?
When a tooth is exposed to acid frequently -- for example, if you eat or drink often, especially foods or drinks containing sugar and starches -- the repeated cycles of acid attacks cause the enamel to continue to lose minerals. A white spot may appear where minerals have been lost. This is a sign of early decay.
Tooth decay can be stopped or reversed at this point. Enamel can repair itself by using minerals from saliva, and fluoride from toothpaste or other sources.
But if the tooth decay process continues, more minerals are lost. Over time, the enamel is weakened and destroyed, forming a cavity. A cavity is permanent damage that a dentist has to repair with a filling.

How can we help teeth win the tug of war and avoid a cavity?

Use fluoride

Fluoride is a mineral that can prevent tooth decay from progressing. It can even reverse, or stop, early tooth decay.
Fluoride works to protect teeth. It . . .

prevents mineral loss in tooth enamel and replaces lost minerals
reduces the ability of bacteria to make acid

You can get fluoride by:

Drinking fluoridated water from a community water supply; about 74 percent of Americans served by a community water supply system receive fluoridated water. (If you have well water, see "Private Well Water and Fluoride" from the Centers for Disease Control and Prevention.)
Brushing with a fluoride toothpaste
If your dentist thinks you need more fluoride to keep your teeth healthy, he or she may—
Apply a fluoride gel or varnish to tooth surfaces
Prescribe fluoride tablets
Recommend using a fluoride mouth rinse

Keep an eye on how often your child eats, as well as what she eats.
Your child's diet is important in preventing a cavity. Remember . . . every time we eat or drink something that contains sugar or starches, bacteria in our mouth use the sugar and starch to produce acids. These acids begin to eat away at the tooth's enamel.
Our saliva can help fight off this acid attack. But if we eat frequently throughout the day -- especially foods and drinks containing sugar and starches -- the repeated acid attacks will win the tug of war, causing the tooth to lose minerals and eventually develop a cavity.
That's why it's important to keep an eye on how often your children eat as well as what they eat.
Tooth-friendly tips:
Limit between-meal snacks. This reduces the number of acid attacks on teeth and gives teeth a chance to repair themselves.
Save candy, cookies, soda, and other sugary drinks for special occasions
Limit fruit juice. Follow the Daily Juice Recommendations external link from the American Academy of Pediatrics.
Make sure your child doesn't eat or drink anything with sugar in it after bedtime tooth brushing. Saliva flow decreases during sleep. Without enough saliva, teeth are less able to repair themselves after an acid attack.

Make sure your child brushes

Illustration: Girl Brushing Teeth Copyright © 2000 BSCS and Videodiscovery. All rights reserved. Used with permission. Brushing with fluoride toothpaste is important for preventing cavities.
Here's what you should know about brushing:
Have your child brush two times per day
Supervise young children when they brush –
For children aged 2 to 6, you put the toothpaste on the brush. Use only a pea-sized amount of fluoride toothpaste.

Encourage your child to spit out the toothpaste rather than swallow it. Children under 6 tend to swallow much of the toothpaste on their brush. If children regularly consume higher-than-recommended amounts of fluoride during the teeth-forming years (age 8 and younger), their permanent teeth may develop white lines or flecks called dental fluorosis. Fluorosis is usually mild; in many cases, only a dental professional would notice it. (In children under age 2, dental experts recommend that you do not use fluoride toothpaste unless directed by a doctor or dentist.)
Until they are 7 or 8 years old, you will need to help your child brush. Young children cannot get their teeth clean by themselves. Try brushing your child's teeth first, then let her finish.
Talk to a dentist about sealants

Dental sealants are another good way to help avoid a cavity. Sealants are thin, plastic coatings painted onto the chewing surfaces of the back teeth, or molars. Here's why sealants are helpful: The chewing surfaces of back teeth are rough and uneven because they have small pits and grooves. Food and bacteria can get stuck in the pits and grooves and stay there a long time because toothbrush bristles can't easily brush them away. Sealants cover these surfaces and form a barrier that protects teeth and prevents food and bacteria from getting trapped there.

Since most cavities in children and adolescents develop in the molars (the back teeth), it's best to get these teeth sealed as soon as they come in:
The first permanent molars — called "6 year molars" — come in between the ages of 5 and 7.
The second permanent molars — "12 year molars" — come in when a child is between 11 and 14 years old.
Take your child to the dentist for regular check-ups

Visit a dentist regularly for cleanings and an examination. During the visit the dentist or hygienist will:
Remove dental plaque
Check for any areas of early tooth decay
Show you and your child how to thoroughly clean the teeth
Apply a fluoride gel or varnish, if necessary
Schedule your next regular check-up

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From Ask the Dentist
By Mark Burhenne DDS

Q: Dr. B, how important is it to clean your tongue? I’ve seen tongue scrapers at the drugstore but am wondering if they really help.
A: You might be under the impression that brushing your teeth and flossing them daily are the two most important things to achieve good oral hygiene.

And they are!

But there’s one more thing that needs to be done for a clean and healthy mouth and that’s using a tongue scraper to clean your tongue.

Tongue scraping is painless and easy. You might even find you become addicted to the feeling of a clean tongue that can taste flavors better and makes your mouth feel clean and fresh.

What is a tongue scraper?

A tongue scraper is designed to clean the bacterial build-up, food debris, yeast cells, and dead cells from the surface of the tongue. This bacterial build-up and food debris is related to many common oral and general health problems, and is important to remove.

There are a few different kinds of tongue scrapers, but they’re all cheap and available at drugstores and grocery stores. You might even be able to snag a free one at your dentist’s office.

The benefit of a plastic tongue scraper is that they’re often disposable.

I like to use a stainless steel tongue scraper to reduce my exposure to plastics. The stainless steel also makes it easier to clean. For the exact tongue scraper I use, click here.

Why is it important to clean your tongue?

It’s essential to oral health. Cleaning your tongue, especially the back part, removes bacteria and toxins responsible for plaque, tooth decay, and gum disease.

It will enhance your taste buds and the flavors you experience. Your taste buds can be blocked by all the junk that builds up on your tongue and removing this buildup will better expose your taste buds and enhance the flavor of the food you eat.

It will boost your immunity. Scraping all that bacteria and food buildup off of your tongue will prevent toxins from getting reabsorbed by your body. Tongue scraping is especially crucial while you’re sick since a lot of junk can get built up back there.

It will improve your digestive health. Tongue scraping promotes saliva production, which helps with your digestion.

It will banish bad breath. Some estimates are that 80 to 95% of bad breath comes from the build-up of food, bacteria, fungi, and dead cells that accumulate at the very back of the tongue. The front of your tongue might look pink and healthy, but if you stick your tongue out all the way and look in the mirror, you’ll see that buildup way in back – and that’s what people can smell.

An analogy I like to use is this: Imagine your tongue is a carpet of mushrooms (which are actually your taste-buds). Whenever you eat or drink something, tiny particles get trapped within the network of these mushrooms. These particles can’t detach through normal rinsing or brushing. This is when tongue scraping becomes important. A clean tongue ensures that your mouth is free of harmful bacteria that can cause oral problems like decay of teeth and bad breath.

1. Take your tongue scraper and keep your mouth wide open as you push your tongue out a little bit. By doing this, you make your tongue easier to reach.

2. Hold the two ends of the tongue scraper and take it to the back most portion of the tongue. You may experience a gag reflex when the scraper touches the rear part of the tongue. Initially you may not be able to control your gag reflex, but you’ll quickly get used to it and become able to scrape further back on the tongue.

3. Gently run the scraper from the back of your tongue to the front of your tongue. During this stroke, the scraper rubs against the tongue surface and the food debris gets collected on the rough surface of the scraper while it’s in contact with the tongue.

4. You will find a yellowish exudate coming out on the scraper if you haven’t scraped in a while. As you do this more and more, the exudate will be clear in color. Initially you may have to scrape your tongue everyday and then taper it off to once every few days or once a week, depending on your preference.

What are the benefits of tongue scraping?

Scraping your tongue can reduce bad breath substantially. Bad breath (or halitosis) is due to the action of bacteria on the food particles stuck on the tongue which causes the release of volatile sulphur compounds (VSCs). They are foul smelling compounds.
Tongue scraping is an effective remedy for coated tongue. Your tongue can get coated due to bacterial or fungal colonization. A mesh is formed due to trapping of dead cells and food particles. This complex network gives the look of a layer on the tongue.
An unscraped tongue can lead to taste alterations due to clogging of taste buds. A tongue scraper can solve your problem of metallic taste.

It will change the color of your tongue from a darkly stained one to a normal one.
If bad breath continues, see your dentist. Bad breath can be an indicator of a more serious condition if it persists even if you’re scraping your tongue, flossing, and brushing properly.

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From Harvard Health Publications

Aging isn’t always pretty, and your mouth is no exception. Today, three-quarters of people over 65 retain at least some of their natural teeth, but older people still suffer higher rates of gum disease, dental decay, oral cancer, mouth infections, and tooth loss. While these problems are nothing to smile about, you can still do a lot to keep your mouth looking and feeling younger than its years.

Wear and tear

Teeth are amazingly strong. But they’re not indestructible. A lifetime of crunching, gnawing, and grinding wears away the outer layer of enamel and flattens the biting edges. Tooth surfaces are also affected by exposure to acidic foods such as citrus fruits and carbonated beverages, which dissolve the protective enamel. Weakened enamel can set the stage for more serious dental problems.

Just because you’ve got a few gray hairs doesn’t mean you’re out of the woods when it comes to cavities, either. A prime target of cavities in older adults is around the neck of the tooth, adjacent to the gum line. Gum tissue naturally recedes with age, so the soft root tissue becomes exposed. In addition, adults who grew up before the advent of fluoride products and dental sealants often have fillings from childhood and adolescence that eventually break down.

While there’s not much you can do to stem the natural erosion of the tooth surface, the pillars of cavity prevention — brushing, flossing, and regular cleanings at the dentist’s office — remain the same at any age. Fluoride rinses and gels, and varnishes applied by a dentist, may be able to halt the progression of root decay and in some cases reverse the damage.

You may have also noticed that your once-sparkling smile has dimmed over the years. There’s no shortage of whitening products these days. Dental bleaches containing peroxide (available over the counter or through your dentist) will lighten your teeth a few shades, although the results are less dramatic in older teeth. Whitening toothpastes and rinses can temporarily lift superficial stains, but don’t expect the effect to last. Before deciding on a bleaching method, it’s a good idea to talk to a dentist.

A strong supporting cast

While sturdy teeth are the stars of a healthy mouth, they can’t perform without a strong supporting cast — the gums and soft, wet tissue that line the oral cavity. Periodontal disease, characterized by receding gums, wobbly teeth, and deterioration of the jawbone, is the primary culprit in tooth loss among older adults. Fortunately, periodontal disease is treatable at any age with a combination of scaling to remove the hardened plaque and infected gum tissue, antibiotics, and — in advanced cases — surgery.

Make the moist of it

Hundreds of medications list dry mouth (xerostomia) as a side effect. Lack of saliva is more than just uncomfortable. It makes eating and swallowing difficult, causes bad breath, and leads to irritation and infection of oral tissues. Good oral hygiene can combat this problem.

You can moisten a dry mouth by chewing sugarless gums or sucking on sugarless candies. Simply drinking more water can help; try holding it in your mouth for a few seconds before you swallow.

The mouth-body connection

The well-being of your aging mouth is tied to the health of the rest of your body. There’s evidence of an association between gum inflammation and conditions such as diabetes, heart disease, stroke, and respiratory problems, all of which are more prevalent in later life. Scientists postulate that bacteria from gum infections travel through the bloodstream to trigger inflammation in organs and tissues at distant sites.

Keeping your mouth young in old age requires diligent do-it-yourself care: brushing with fluoride toothpaste and flossing at least twice a day. Regular dental appointments are also important.

February 2010 update

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By Lisa Zamosky
From WebMD Magazine - Feature Reviewed by Alfred D. Wyatt Jr., DMD

Every six months, you visit the dentist for a cleaning -- and likely a lecture about the importance of flossing. But if you're like many dental patients, the advice travels in one ear and out the other -- much like, well, dental floss gliding between the spaces of your teeth.

"There is no instant gratification with flossing -- that's the problem," says Alla Wheeler, RDH, MPA, associate professor of the Dental Hygiene Program at the New York University School of Dentistry. "Patients don't think it does anything."

But flossing does about 40% of the work required to remove sticky bacteria, or plaque, from your teeth. Plaque generates acid, which can cause cavities, irritate the gums, and lead to gum disease. "Each tooth has five surfaces. If you don't floss, you are leaving at least two of the surfaces unclean," Wheeler explains. "Floss is the only thing that can really get into that space between the teeth and remove bacteria."

Flossing, Wheeler says, might also be an overlooked fountain of youth. Gum disease can ruin the youthful aesthetics of your smile by eating away at gums and teeth. It also attacks the bones that support your teeth and the lower third of your face. People who preserve the height of that bone by flossing look better as they age.

Choosing the Right Dental Floss
Most floss is made of either nylon or Teflon, and both are equally effective. People with larger spaces between their teeth or with gum recession (loss of gum tissue, which exposes the roots of the teeth) tend to get better results with a flat, wide dental tape. If your teeth are close together, try thin floss (sometimes made of Gore-Tex) that bills itself as shred resistant.

Bridges and braces call for a defter touch to get underneath the restorations or wires and between the teeth. Use a floss threader, which looks like a plastic sewing needle. Or look for a product called Super Floss that has one stiff end to fish the floss through the teeth followed by a spongy segment and regular floss for cleaning.

The most important thing, though, is to choose floss you'll use. "I tell my patients, 'I don't care if you use shoe laces as long as you floss,'" Wheeler says. (Just kidding, of course.)

Flossing Tips
Keep it clean with these flossing tips from Edmond Hewlett, DDS, associate professor of restorative dentistry at the University of California, Los Angeles School of Dentistry:

Perfect your flossing technique. Use a piece of floss 15 to 18 inches long, slide it between the teeth, wrap it around each tooth in the shape of a "C," and polish with an up and down motion.

Don't worry about a little blood. "Bleeding means the gums are inflamed because plaque has built up and needs to be cleaned away. Don't let that deter you," Hewlett advises. Bleeding after a few days, however, could be a sign of periodontal disease. Talk to your dentist.

Get a floss holder. If you lack the hand dexterity to floss, try soft wooden plaque removers, which look similar to toothpicks, or a two-pronged plastic floss holder. Both allow you to clean between teeth with one hand.

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From Mouth Healthy

Bad breath happens. If you’ve ever gotten that not-so-fresh feeling on a date, at a job interview or just talking with friends, you’re not alone. Studies show that 50 percent of adults have had bad breath, or halitosis, at some point in their lives.

What Causes Bad Breath?

There are a number of reasons you might have dragon breath. While many causes are harmless, bad breath can sometimes be a sign of something more serious.

Bad breath can happen anytime thanks to the hundreds of types of bad breath-causing bacteria that naturally lives in your mouth. Your mouth also acts like a natural hothouse that allows these bacteria to grow. When you eat, bacteria feed on the food left in your mouth and leaves a foul-smelling waste product behind.

Dry Mouth
Feeling parched? Your mouth might not be making enough saliva. Saliva is important because it works around the clock to wash out your mouth. If you don’t have enough, your mouth isn’t being cleaned as much as it should be. Dry mouth can be caused by certain medications, salivary gland problems or by simply breathing through your mouth.

Gum Disease
Bad breath that just won’t go away or a constant bad taste in your mouth can be a warning sign of advanced gum disease, which is caused by a sticky, cavity-causing bacteria called plaque.

Garlic, onions, coffee… The list of breath-offending foods is long, and what you eat affects the air you exhale.

Smoking and Tobacco
Smoking stains your teeth, gives you bad breath and puts you at risk for a host of health problems. Tobacco reduces your ability to taste foods and irritates gum tissues. Tobacco users are more likely to suffer from gum disease. Since smoking also affects your sense of smell, smokers may not be aware of how their breath smells.

Medical Conditions
Mouth infections can cause bad breath. However, if your dentist has ruled out other causes and you brush and floss every day, your bad breath could be the result of another problem, such as a sinus condition, gastric reflux, diabetes, liver or kidney disease. In this case, see your healthcare provider.

How Can I Keep Bad Breath Away?

Brush and Floss
Brush twice a day and clean between your teeth daily with floss to get rid of all that bacteria that’s causing your bad breath.

Take Care of Your Tongue
Don’t forget about your tongue when you’re taking care of your teeth. If you stick out your tongue and look way back, you’ll see a white or brown coating. That’s where most of bad breath bacteria can be found. Use a toothbrush or a tongue scraper to clear them out.

Over-the-counter mouthwashes can help kill bacteria or neutralize and temporarily mask bad breath. It’s only a temporary solution, however. The longer you wait to brush and floss away food in your mouth, the more likely your breath will offend.

Clean Your Dentures
If you wear removable dentures, take them out at night, and clean them thoroughly before using them again the next morning.

Keep That Saliva Flowing
To get more saliva moving in your mouth, try eating healthy foods that require a lot of chewing, like carrots or apples. You can also try chewing sugar-free gum or sucking on sugar-free candies. Your dentist may also recommend artificial saliva.

Quit Smoking
Giving up this dangerous habit is good for your body in many ways. Not only will you have better breath, you’ll have a better quality of life.

Visit Your Dentist Regularly
If you’re concerned about what’s causing your bad breath, make an appointment to see your dentist. Regular checkups allow your dentist to detect any problems such as gum disease or dry mouth and stop them before they become more serious. If your dentist determines your mouth is healthy, you may be referred to your primary care doctor.

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From  Dentaltown
by Starla Fitch, MD

Whether you're a dentist, an oral surgeon or a hygienist, my guess is you could use a little more balance in your life.

We all have 168 hours in a week. At first glance, it seems like we could squeeze in some fun, doesn't it?

I'm feeling your pain. It's 8 p.m. and my husband, an oral surgeon, just walked in the door. Late for dinner again. As a surgeon myself, I understand those late-day emergencies, and we just shake our heads.

On the other hand, his brother, a general dentist, finally took off two weeks in a row to spend with his wife and daughters on a family vacation.

So what is the secret to work-life balance, and how do you find it?

Well, when I work with my clients (in my spare time I'm a certified success coach for health professionals), I start by having them spend some time writing down everything that's on their plate.

They actually carry around pen and paper, or jot down a list in their phone, of everything they do on a daily basis. This contains everything from showering, eating breakfast, and driving the kids to school on their way to work, to picking up the dry cleaning at lunch. It all goes on the list. Stay with me, there's a point to this tedious task!

Next, it's time to prioritize.

Martha Beck, my mentor and Oprah's Life Coach, taught me the system of the three B's: Bag it. Barter it. Better it.

Bag it
My clients go through their list and decide: Can I bag it? Those are the things that don't need to be done at all (do you really need to have the car washed every week?) or can be done by someone else who would be grateful for the opportunity. (If you are working full-time, you need to consider hiring a housekeeper to pop in every week or two and do the things you don't have time to do.)

Barter it
Next comes the decision to barter it. Can you ask your spouse to cook (since you burn everything that goes on the stove) and you volunteer to do the dishes instead? Can you do the laundry (to avoid everything turning pink from your son's red socks) and have your partner go to the grocery store?

Better it
And finally, look at how to better those things that must be done. If you have to walk the dog, do it while listening to a book or your favorite tunes on your phone. If you must fold the towels, call up your best friend and catch up on the past week's events while you zone out on the towels.

What's so cool about this system?

One thing I've discovered is that it's hard to implement these changes without some firm groundwork.

Prioritizing what works best can help you see where you're falling short and where you really need to focus your time and energy.

If you think that there's no more help to work-life balance, you're wrong. There are lots of tips out there that are quick, practical and totally doable.

Will that get my husband home any sooner, so we can have some "balanced time" together? Probably not, unfortunately. But it will keep us on track to celebrate our next anniversary, and spend some quality family time, in the coming weeks.

It's all a matter of prioritizing the three B's and figuring out what works best for you and your schedule. Once you do, you'll find more balance in both your work life and your personal life.

And better yourself
Hand in hand with the three B's is the concept of putting yourself first.

We don't like this idea because it strikes us as selfish. We're busy, we say; we're the ones who take care of other people. Meeting our own needs is last on our list of things to do.

The only problem with this concept is that by putting ourselves last, we risk burnout. And once we've burned out, not only do we become ineffective at helping anyone else, but we also need help, ourselves!

Like they say while the airplane is taxiing for takeoff: "Put on your own oxygen mask, first."

Selfishness is cutting someone off in traffic. Selfishness is telling the world that everything was created for you, and everyone else can go scratch.

Good self-care is not the same thing. Relax.

By putting your own needs first, you are, in effect, creating a firm foundation for the skyscraper of your life. If you take care of your physical and emotional health, then everything else—your professional life, your family and your relationships—will be well supported.

That's all well and good, you say, but how do I do it?

Six quick self-care tips
Eat a good breakfast. Try to avoid a lot of sugar—it will pull you down and you'll bolt for a caffeine boost halfway through your morning. Instead, start your day with something substantial, like a bowl of plain, steel-cut oats topped with unsweetened yogurt and a banana, or a green smoothie packed with antioxidants (you'll find plenty of recipes from a simple Google search). "Eating the rainbow"—choosing foods in a range of colors—will help your body get the nutrients it needs for optimal function.

Drink plenty of water throughout your day. A lack of hydration can negatively affect your brain function—even if you don't feel thirsty. Research published in Frontiers in Human Neuroscience in July of 2013 indicated that test subjects who drank water prior to a task had faster reaction times than those who did not drink. So stay hydrated to help keep yourself sharp. Keep a reusable water bottle handy so you can drink before a procedure.

Get moving. Take motion breaks during the day. Take the stairs to the third floor. Walk around the office (or the hospital) on your lunch break. Get outside. Breathe the air. Refocus your eyes. Watch the clouds sailing the sky. Identify the birds chasing each other through the trees. Stop for a yoga class on your way home. Give your body a boost, and your mind a rest.

Avoid Facebook; take 20 minutes to meditate, instead. According to, meditation can ameliorate many of the physical problems that accompany our Type-A personalities. It can lower blood pressure, boost the immune system and improve concentration—all thanks to how the practice reduces stress in the body.

While Facebook can be fun, it also encourages us to compare our lives to our friends'—and that can raise our stress levels, too. If you have to choose between the two, go with meditation.
Pay attention to your medical needs. Schedule your exams, tests and checkups. Doctors are just as prone to addictive behaviors as anyone else—they smoke, they're sedentary, they don't eat right. And a 2011 study in Occupational Medicine showed that most doctors resist becoming patients themselves—instead, they tend to self-medicate. I don't have to tell you how risky this behavior is. Go for your checkups. Schedule those tests. Take care of yourself.

Get familial support. Your son can hang up his own jacket or cook dinner. Your daughter can water the garden and bring in some broccoli. Your spouse can vacuum the living room or bring home Chinese food. Time set aside for self-care or meditation should be sacrosanct—for every family member. Don't be a martyr. Don't let your spouse or partner be a martyr, either. Set boundaries. Learn how to say "no." Children who have chores learn responsibility—and have less frazzled, more enjoyable parents. If everyone pitches in, the whole family can then spend more quality time together. Go see a movie. Ditch the phones. Talk.

Once you have started these steps of self-care, especially if you have involved your family or those closest to you, you will all reap the benefits. Try these tips to use your 168 hours more healthfully, and you will feel your life becoming more balanced. Your body, your mind—and your patients—will thank you.

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From ADEA Go Dental


Dentistry is an unusual profession because while dentists are mostly focused on patient care, they also often own and run their own businesses. Many dentists have a diverse set of personality traits that allow them to work both closely with patients and be successful managers of their practices.

A successful dentist is…

Comfortable with close personal interaction. 
If you think about it, much of a dentist’s time is spent with his or her face and hands extremely close to patients’ faces. Successful dentists are comfortable with being very close to other people, even if sometimes patients have bad breath. 

Easy to talk to.
Successful dentists try to learn about patients on a more personal level before beginning treatment to make patients feel more comfortable. This puts patients at ease and makes them feel like the dentist truly cares about them as whole healthy people, not just about their mouths. 

Since dentists are working with sharp metal objects in the mouth, a very sensitive area of the body, it is really important that they are trustworthy. Patients need to trust that their dentist will try his or her best not to hurt them and will take all precautions necessary to make their experience pain free. 

A detail-oriented person.
The mouth is an extremely small space to work in, so dentists must be detail oriented. The smallest misalignment of something in the mouth can wreak havoc on a patient’s bite and tooth health. 

Dentistry is often referred to as an art. It requires mastery and technique unique to the profession. Dentistry is largely based on maintaining proper oral health, but is also an aesthetically focused practice. A large part of dentistry involves restoring teeth and making a smile beautiful, one that the patient is happy to show to others. 

A leader.
Dentists may own or work as practitioners within a practice, so they often are natural leaders. They must not only lead a team of dental hygienists, technicians and assistants, but must also manage any other employees, such as the receptionist, while also making high-level business decisions for the practice.

Excited about the profession of dentistry.
Successful dentists enjoy the work they do every day and are fascinated by the mouth and all of the connections it has to the rest of the body.
Passionate about providing care to those in need.
Dentists often participate in community service, helping those in need with oral care and treatment. Many dentists enjoy helping those with no access to care receive treatments for painful or unattractive parts of their mouths.

Caring and concerned about how the patient feels during procedures.
Because dentists work in a very small and sensitive space of the body, a good dentist communicates with the patient during every step of a procedure, making sure they are okay and not in too much pain. Good dentists go to great lengths to make their patients comfortable and relaxed without pain. 

Good communicator. 
A successful dentist has a keen ability to distill complex procedures and processes into simple language so that the patient can understand exactly what is going on in his or her mouth and any procedures that the dentist suggests.

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What Is Good Oral Hygiene?
From Colgate Oral Care Center
What is Good Oral Hygiene?
Good oral hygiene results in a mouth that looks and smells healthy. This means:

Your teeth are clean and free of debris
Gums are pink and do not hurt or bleed when you brush or floss
Bad breath is not a constant problem
If your gums do hurt or bleed while brushing or flossing, or you are experiencing persistent bad breath, see your dentist. Any of these conditions may indicate a problem.

Your dentist or hygienist can help you learn good oral hygiene techniques and can help point out areas of your mouth that may require extra attention during brushing and flossing.

How is Good Oral Hygiene Practiced?
Maintaining good oral hygiene is one of the most important things you can do for your teeth and gums. Healthy teeth not only enable you to look and feel good, they make it possible to eat and speak properly. Good oral health is important to your overall well-being.

Daily preventive care, including proper brushing and flossing, will help stop problems before they develop and is much less painful, expensive, and worrisome than treating conditions that have been allowed to progress.

In between regular visits to the dentist, there are simple steps that each of us can take to greatly decrease the risk of developing tooth decay, gum disease and other dental problems. These include:

Brushing thoroughly twice a day and flossing daily
Eating a balanced diet and limiting snacks between meals
Using dental products that contain fluoride, including toothpaste
Rinsing with a fluoride mouthrinse if your dentist tells you to
Making sure that your children under 12 drink fluoridated water or take a fluoride supplement if they live in a non-fluoridated area.

Proper Brushing Technique

Tilt the brush at a 45° angle against the gumline and sweep or roll the brush away from the gumline.

Gently brush the outside, inside and chewing surface of each tooth using short back-and-forth strokes.

Gently brush your tongue to remove bacteria and freshen breath.

Use about 18" of floss, leaving an inch or two to work with.

Gently follow the curves of your teeth.

Be sure to clean beneath the gumline, but avoid snapping the floss on the gums.

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From Dentaltown
By Steve Carstensen, DDS and Gy Yatros, DMD

Dental sleep medicine (DSM) is currently one of the fastest-growing areas in dentistry.

In fact, Frost and Sullivan, an independent market-research firm, predicts a fivefold increase in DSM over the next five years. That could raise annual revenues to more than $0.5 billion by 2020.

Why all of the attention? Patients with sleep-disordered breathing (SDB) are on the rise, public awareness is at an all-time high, and there is increasing acceptance that dentists can provide a great solution for many patients afflicted with this disorder.

In short, DSM can be a very rewarding service to add to a dental practice.

Providing these services in our offices allows us to help our patients live better and longer lives, while simultaneously increasing our revenues and career satisfaction.

Then why isn't every office involved in DSM? Because treating the disorder isn't simple, and it comes with challenges. If an office can build “pillars” of knowledge and processes that will help support these challenges, then DSM can rapidly become profitable and enjoyable for the whole practice.

Here are the four pillars needed to support a DSM practice.

Pillar 1: Screening
Screening patients is where it all begins. Even dental practices not involved in treating SDB should be screening their patients. Most dental offices routinely do oral-cancer screenings, but have you considered why? Is it because we were told to do so, because oral cancer occurs in the mouth, to avoid litigation, or because we care about our patients' well-being? All are good reasons, and the same can be said for screening our patients for SDB.

Most offices may find only one or two instances of oral cancer in a year. Yet we still do it, because it is an important service and we care about our patients.

Screening for SDB takes no more time than an oral-cancer screening, while the number of our patients with airway problems far exceeds the number of oral-cancer patients we will encounter.

SDB affects more than 35 percent of the adult population, and as many as 20 percent of adults have obstructive sleep apnea (OSA). Yet less than 10 percent of patients are aware that they have the disorder.

SDB is often a hidden disease—it can be difficult to pinpoint and harder to diagnose. But leaving the disorder untreated can have serious, cascading health consequences for the patient, including inattention at school or work, academic and professional underachievement, headaches, an increased risk of motor-vehicle accidents, diabetes, high blood pressure, depression, cardiac arrhythmia, heart failure and cardiac arrest.

Compared with other medical caregivers, we spend more time annually with our patients and we are more familiar with the details of their craniofacial anatomy, which factors into the risks of SDB and OSA.

The first pillar needed for our DSM practice is to build a system to quickly identify our at-risk patients. This can easily be accomplished through sleep-screening questionnaires readily available online. Do an Internet search for “sleep questionnaire,” and you will find dozens of them at your fingertips.

Some of the more popular screening forms are the Epworth Sleepiness Scale, STOPBang, and the Berlin Questionnaire. You may even want to combine some of these or create one yourself. Regardless of which you choose, you just need a system that can quickly identify at-risk patients.

The questionnaire should also include common OSA comorbidities like hypertension, diabetes, weight gain, gastroesophageal-reflux disease (GERD), and cardiac problems.

Be sure there are questions about excessive daytime sleepiness, snoring, sleep quality, witnessed apneas/gasping while sleeping, morning headaches, and difficulty in maintaining sleep.

Once these at-risk patients are identified, there is still another brick that needs to go into this pillar of dental sleep medicine.

Our team needs to be educated and prepared to discuss these results with our patients. We need to be passionate and caring as we help our patients understand their risks.

The result of our informed and sincere conversation should be moving the at-risk patient to the next pillar of DSM—undergoing a sleep test. If screened correctly, the majority of at-risk patients who are tested will be shown to have at least mild OSA.

Pillar 2: Testing
The goal of sleep testing is to determine if the patient has an airway problem. Specifically, we need to measure—at a minimum—the patient's breathing, SPO2 readings (the estimates of arterial oxygen saturation) and heart rate, to determine if he or she has airway restrictions that meet the criteria for an OSA diagnosis.

This data needs to be reviewed by sleep specialists who are trained and licensed to make these determinations. Ideally, a registered polysomnography technologist (RPST) will review the data first, followed by an interpretation and diagnosis by a board-certified sleep specialist.

Sleep testing is one of the many areas of DSM that has dramatically improved over the last few years.

In the past, the only option was to refer our patients to a sleep lab where the patients would spend the night. Now a patient can take a sleep test in the comfort of his or her own home.

Dentists cannot diagnose OSA, but we can facilitate testing and work closely with the patient's other health-care providers to treat the problem. Our job is to build a pillar to support sleep testing for all of our patients. The last thing we want is to successfully screen our patients and encourage them to be tested, and then drop the ball there.

To build the testing pillar, we will need to have several systems in place. First, we should become familiar with a local sleep lab to which we can refer patients. We'll want to meet with the lab's director to discuss the referral process and protocols. We will also want to connect with a local sleep physician with whom we can consult.

Our office can then refer patients to local medical professionals for home sleep testing.

The other methods of completing home sleep testing are a bit less defined. There is debate in the medical community about whether dentists should be directly involved in facilitating sleep testing.

Furthermore, federal and state laws may regulate or prohibit our offices from these practices. (Check with the American Academy of Dental Sleep Medicine for more information.) Some practices request sleep tests from companies that provide these services directly for their patients. These companies have sleep specialists who provide an interpretation and diagnosis, and bill the patient directly.

Other dentists directly provide their patients with the test and submit the data to sleep specialists, who make the interpretation and diagnosis.

Regardless of how we build this DSM pillar, we need a foundation that will work for all of our patients.

Pillar 3: Treating
Once a patient has been diagnosed with a sleep breathing disorder, fixing it isn't always easy, but ignoring it isn't an option. The most common therapy, continuous positive airway pressure (CPAP), is used ineffectively by more than half of patients.

Sleep-disordered breathing is caused by the oropharynx either narrowing or closing down, which will cause the sympathetic (fight or flight) nervous system to react.

To avoid this, mandibular advancement devices (MADs) support the movable parts that lie ventral to the airway. The mandible, hyoid bone, and all the soft-tissue parts are stabilized or stretched forward a bit to keep the airway open. The differences in body shape, adaptations over time, and genetically influenced muscle tone explain the variations among people and make any diagnosis and treatment choices necessarily customized for each patient.

All effective MADs allow the jaw position to be changed until, hopefully, the optimum position is found and the airway is open during all phases of sleep and body position. There is no easy way to predict the effective position.

Surgery is helpful, but comes with risk. Oral appliances, including MADs, also create complications. It comes down to you, the sleep doctor and the patient, to choose which course has the fewest side effects, while still achieving the critical health goals.

Treatment can't be done without collaborating with other health-care professionals—especially board-certified sleep physicians, as MAD therapy requires a medical diagnosis and a prescription. Devices must be cleared by the FDA, and there are some 130 clearances, thanks to variations of materials, size, shape, adjustability, quality and cost. The trained dentist will master a few of them and be adept at a few others, and will be able to match the patient to the best choice of device. Dentists are the experts at fitting and dealing with oral appliances, while physicians are trained in evaluating whole-body systems and making sure treatments take many details into account.

To fully contribute, the entire dental team must be comfortable with the collaborative systems. This pillar is made sound through education that is readily available online, at meetings, and within each practice. That education should be led by the dentist and his or her team.

Pillar 4: Billing
As a medical problem, this is not covered by dental insurance, so it's left to either fee-for-service or medical insurance to pay for therapy. It is no surprise that a dentist's primary concern when thinking about providing sleep medicine services is whether he or she will get paid.

Dentists and financial coordinators are used to the frustrations that come with limited dental insurance plans. Many chose fee-for-service to work around those problems. That works fine in dentistry, in no small part because often what we propose for treatment exceeds dental benefit limits and are out-of-pocket expenses for patients.

Also, many dental treatment choices are elective and not covered by any plan.

Medical necessity drives coverage for MAD therapy into a different, mostly unfamiliar, arena for many financial coordinators. The easy route of fee-for-service, however, is all but unknown in medical care, so patients don't expect to have to pay for medical services out of their own pockets and medical colleagues don't know what to say when their patient reports to them that the dentist requests payment up front.

Additionally, most insurance companies require a preauthorization of benefits before treatment, which means that even if you give people a properly filled-out form, they may not get any insurance payment because the claim wasn't filed prior to date of service. It's easy to see how this creates unhappy patients and unenthusiastic referring physicians.

Several years ago, medical billing companies realized dentists need help; some of the medical-record software companies include billing within the range of services, while other billing companies stand alone. There are dozens of these companies in the market, and every town has professional billing companies who work for medical offices and can also work for dentists to support MAD therapy. Often these are independent contractors who bill by the hour or by a percentage of collections.

How would you choose what billing service is right for you? Here's a suggestion. Assign a task force consisting of your main financial coordinator and one clinical assistant, to search for solutions.

Have them do a Google search for billers, interview companies and individuals, and then come to you with a suggestion or at least a couple of choices. Have them ask about services offered, how the money is collected, and the fee. Is there only one person doing the billing, or will there be backup to cover for illness/vacation? Will they handle the preauthorizations? Most importantly, does your financial coordinator feel comfortable working with this person or company?

There will be considerable interaction between your office and the biller, so you want people who get along well. The professional biller will train your staff on what records are required to support the claim, and this involves proper notes, so ensuring that the clinical staff is involved will help you give the biller what is needed.

These four pillars describe what is critical to make a difference in your practice and community health.

Obviously, there is much to learn to be able to provide this medical treatment. If you've been thinking about adding these services, or you've done a few and hit barriers, maybe this information will encourage you to pursue additional training.

There is no shortage of learning opportunities. Choose training that is not based on a particular appliance, includes more than one lecturer, and offers some hands-on work with patients, home sleep testing, and appliances, and soon you'll feel confident to embrace what may become the most rewarding part of dental care!

Dr. Steve Carstensen is a diplomate of the American Board of Dental Sleep Medicine. He treats patients in Bellevue, Washington, and maintains a busy international teaching schedule helping dentists learn how to improve their patients' health. He directs sleep courses at Pankey Institute and Spear Education.

Dr. Gy Yatros has been practicing dental sleep medicine for more than 14 years and is an international lecturer in the field of sleep-disordered breathing and dental sleep medicine. His offices in Bradenton, Sarasota and Tampa, Florida are devoted exclusively to the treatment of sleep-disordered breathing. Yatros is a diplomate of the American Board of Dental Sleep Medicine (ABDSM), past president of the Manatee Dental Society and is an affiliate assistant professor of the Department of Internal Medicine with the University of South Florida College of Medicine. He is a cofounder of the Dental Sleep Solutions system for successfully implementing dental sleep medicine in dental practices.

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From Dentaltown

As dentists, we know quite a bit about tooth and gum pain, but when it comes to chronic facial pain and neuropathic pain, our dental school education leaves us unprepared. The objective of this article is to explain the differences between men and women with chronic orofacial pain and the relationship to proper functional breathing, using a case study as demonstration.

the United States, nearly half of all adults lived with chronic pain in 2011. Of 353,000 adults aged 18 years or older who were surveyed by Gallup-Healthways, 47 percent reported having at least one of three types of chronic pain: neck or back pain, knee or leg pain, or recurring pain.2

A study published in The Journal of the American Dental Association October 2015 stated: "One in six patients visiting a general dentist had experienced orofacial pain during the last year. Pain in the muscles and temporomandibular joints was reported as frequently as that in the teeth and surrounding tissues in patients visiting general dentists."

The practical implications for this study were as follows: "Although the dental curriculum is concentrated on the diagnosis and management of pain and related conditions from teeth and surrounding tissues, it is imperative to include the training for other types of orofacial pain, particularly those from temporomandibular joint and musculoligamentous tissues."3

Pain in the orofacial regions affects 21.7 percent of the population in the United States and costs more than $32 billion each year.4

Patients over the age of 45 and women have the highest prevalence of facial pain. Women have higher incidence for musculoskeletal pain.5 Hormones play a role in chronic pain/TMD, as testosterone reduces pain transmission6 and estrogen exacerbates pain in the face and jaw.7

An established relationship exists between OSA and TMD.8, 9 Two studies tested the hypothesis that OSA signs and symptoms were associated with TMD: the OPPERA prospective cohort study of adults aged 18–44 years at enrollment (n = 2,604) and the OPPERA case-control study of chronic TMD (n = 1,716). Both studies supported a significant association between OSA symptoms and TMD, with prospective cohort evidence finding that OSA symptoms preceded first-onset of TMD: patients with two or more signs and/or symptoms of OSA had a 73 percent greater incidence of first-onset TMD.

So breathing and facial pain/TMD are linked by sleep bruxism (SB), as the method of chronic irritation to the joint structures and facial muscles. SB has been linked to maintaining airway patency in OSA,10 however the most recent research published in Chest 2015 demonstrates that respiratory-effort-related arousal may be the most likely cause (nasal obstruction or mouth breathing).11 Rising C02 (hypercapnia) in a patient with a sleep-breathing disorder (including mouth breathing) specifically stimulates the superficial masseter muscles to contract.12

Identifying the structural area of obstruction (Four Points of Obstruction; Fig. 1) of the airway will insure the most effective treatment for a sleep-breathing disorder and effectively reduce the facial muscle contraction, which in turn will result in reduction of facial-pain complaints and nerve entrapments (trigeminal neuralgia). It will also insure proper swallowing and tongue posture that will result in reduced orthodontic relapse (anterior and lateral open bite).13

Trigeminal neuralgia
Classical trigeminal neuralgia (TN) is a disease of severe, stabbing neuropathic facial pain of the second and third divisions of the trigeminal nerve.14 It is estimated that one in 15,000 people suffers from trigeminal neuralgia; however, numbers may be significantly higher due to frequent misdiagnosis.15 The incidence is greatest in people more than 50 years of age, and in women more frequently than men.16

It has also been reported that 26 percent of the American population is at high risk of obstructive sleep apnea (OSA), a sleep breathing disorder (SBD), indicating as many as one in four Americans could benefit from an evaluation for OSA.17 In the same report, 57 percent of obese individuals were at high risk for OSA. Obesity is defined as a BMI (body mass index) of 30 or greater.

This case study seeks to demonstrate a long-term cure for trigeminal neuralgia utilizing low-level laser therapy and treatment for nasal obstruction.

This case demonstrates relief of chronic facial pain of the mandibular division of the trigeminal nerve as it innervates the muscles of mastication (Fig. 2).

Trigeminal neuropathy can have many origins, such as a neoplastic growth compressing the nerve as it leaves the pons and before it leaves the cranium through either the foramen rotundum (maxillary division, blue arrow) or foramen ovale (mandibular division, green arrow) (Fig. 3). Tumors, usually posterior fossa meningioma or neuromas, are found in 2 percent of patients who present with typical TGN.18 Surgical excision is indicated for these conditions as diagnosed via MRI.

Another source of trigeminal neuralgia can be enlargement of the middle meningeal artery that can compress the mandibular division as it leaves the skull through the foramen ovale.

The middle meningeal artery is a branch of the maxillary artery in the infratemporal fossa. It enters the skull through the foramen spinosum (yellow arrow, Fig. 3), and is within the dura mater lining the cranial cavity. The critical abnormality is vascular contact at the dorsal root entry zone, rather than more distally; such is seen in 3 percent to 12 percent of trigeminal nerves at autopsy.19, 20 Brain surgery (microvascular decompression) is necessary to treat this condition.

The most common source of trigeminal neuralgia is peripheral entrapment of the nerve by the muscles it innervates, or mechanical trauma (injury). There is damage to the myelin sheath that lowers the capacitance of the nerve that lowers its threshold for conduction. There is a spontaneous transmission of pain in a sensory nerve by contractions of the muscles it innervates or a structure that it passes through. It has been my experience that mandibular trigeminal neuralgia is often present in combination with a movement disorder termed bruxism. Bruxism is an exacerbation of normal rhythmic masticatory muscle activity that results in wear of dentition and muscle-pain disorders. The brain is stimulated by a variety of factors, including pain, medications and sleep-related breathing disorders.21 Treatment for trigeminal neuralgia is usually medicinal. Membrane-stabilizing drugs, anticonvulsants, centrally acting muscle relaxants—individually or in combination—are used. Doses are increased over time as tolerance and metabolism of the drugs increase and their effectiveness decreases.

When maximum dosage for each individual drug has been reached it is lowered and an additional drug is combined until maximum dosage is reached and a third drug or new combination is tried. Commonly used drugs are Tegretol (carbamazepine), Neurontin (gabapentin), Lamictal (lamotrigine), Klonopin (clonazepam), Baclofen, and Lyrica (pregabalin).

The clinical efficacy of low-level laser therapy (LLT) in the treatment of neuropathic pain is well established in many studies.22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32 This is a very important tool for the treatment of nerve injuries, as all other treatments are palliative, while the laser therapy is truly therapeutic.

Case study
Craig, a 66-year-old man, was referred to our office by an oral maxillofacial surgeon for the relief of left mandibular episodic facial pain neuralgia. His chief complaints were chronic pain (four years) when chewing, jaw and facial pain. He had spontaneous shooting pain on the left side of his face. He said he could relate it to a Novocain injection and a tooth implant. He was currently being treated with carbamazepine 100mg four times daily, but the pain was not controlled. He had previously been treated with gabapentin 300mg three times per day until it became ineffective. He sometimes took alcohol and sedatives for pain relief or sleeping.

Positive findings from his health history were high blood pressure, stroke, asthma, hepatitis, and frequent wakening at night. Our clinical findings at the time of examination were: BMI 31.07, B.P. 166/100, pulse 64, respiration 16, temperature 98.2°. Orthopedic mandibular ranges of motion were 56mm without pain, left and right lateral movements of 10mm, and 9mm of protrusion. Dental examination demonstrated molar Class I occlusion, with 4mm of overjet and overbite, with worn dentition (bruxism, see Fig. 4).

Oral evaluation demonstrated Mallampati Class IV, furrowed tongue, coating of the tongue (indicating mouth breathing from nasal obstruction), and scalloping of the tongue, which are both indicative of a sleep-related breathing disorder (Figs. 5 & 6).

There were no positive findings for muscle, tendon and ligament palpation. Imaging utilizing CBCT (cone-beam computed tomography) demonstrated a significant cant of the mandible to the left side (affected side) and was confirmed with a photograph of the patient with a tongue blade (Figs. 7 & 8). This indicates that the elevator muscles or muscles of mastication are shorter on the left than the right. When muscles are shorter than their resting length, they have greater resting tonus or tension.

Nasal obstruction was observed from the iCAT CBCT, with deviation of the septum to the left with nasal soft-tissue hypertrophy (Fig. 9). The oropharyngeal airway appears to be within normal dimensions while the patient is awake, however it does not measure how much it can collapse while asleep (Fig. 10).

The diagnosis for this patient was trigeminal neuralgia with suspected sleep-related breathing disorder, nasal obstruction, nasal-valve compromise, and bruxism. The treatment plan consisted of:
Decompression appliance therapy, a night orthotic that prevents mandibular retrusion, reduces clenching forces and opens nasal valve (Fig. 11), for cant correction and leveling of the occlusal plane utilizing the phonetic or sibilant phoneme registration33 and reducing of oropharyngeal airway collapse while sleeping; with combined use of weekly treatments with the ASA Mphi laser at 50 percent intensity, frequency of 100 Hz, for two to three minutes, utilizing energy of 30 joules; and carbamazepine 100mg, four times per day. Treatment time 10 to 12 weeks and re-evaluation.
Referral to sleep physician for diagnostic PSG (polysomnography).
Referral to ENT physician for evaluation and treatment of nasal obstructions.
Treatment results
At four weeks of the combined treatment of decompression, carbamazepine and weekly applications with the Mphi laser, the facial pain and jaw pain had resolved, and the pain when chewing had reduced between 40 percent to 50 percent.

The unique synergistic use of two wavelengths of energy (808 and 905), using both pulsed and continuous (chopped) application is superior to either pulsed or continuous laser systems. The laser was used from the peripheral point of the innervation of the masseter nerve working back centrally toward its origin.

The laser stimulates regeneration of tissue by increasing the function of the mitochondria, therefore changing the DNA and biometric form of the cells.34, 35 This is stimulating and therefore the patient needs to be on the membrane- stabilizing medication during the healing process to prevent excitation by the laser. Once the nerve healing is complete and it retains its normal threshold or capacitance, the need for medications is unnecessary.

At eight weeks of combined therapy and weekly applications of the Mphi laser, the pain when chewing was resolved as well as the facial and jaw pain. At this point I recommended reduction of the carbamazepine dosage by one third and continued reduction until elimination of the drug or return of pain symptoms. The patient finally agreed to have a sleep study (PSG), and I wrote the prescription for referral.

At 11 weeks he had attended a sleep study (PSG) and the results were overall moderate apnea with an AHI of 26.0 and a REM AHI of 40.4 (severe). He had zero (0) stage 3 delta wave restorative sleep and his lowest oxygen desaturation was 82 percent. His periodic limb movement (PLM) index was 21.4. He was diagnosed with obstructive sleep apnea and PLM disorder.

Upon re-evaluation at 13 weeks of treatment, the patient had completely weaned off all medications and was symptom-free. He chose not to treat his OSA, and his PSG testing was performed without the decompression appliance. He found that he had a slight tingling of the same injured nerve when he did not wear his oral decompression appliance for three nights. It was explained to the patient the severe health risks of untreated OSA.

This article demonstrates the relationship between trigeminal nerve injury and muscle contraction disorders such as those found in patients with sleep-related breathing disorders. Most importantly, it demonstrates the value of low-level laser therapy, utilizing the unique delivery of the Mphi laser system on healing injured nerves. This is the most remarkable tool that I have seen in my 30 years of treating chronic-pain disorders.

Hiestand DM, Britz P, Goldman M, Phillips B (2006) Prevalence of symptoms and risk of sleep apnea in the US population: Results from the national sleep foundation sleep in America 2005 poll. Chest 130 (3):780-786. doi:10.1378/chest.130.3.780
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Cairns BE, Hu JW, Arendt-Nielsen L, Sessle BJ, Svensson P. Sex-related differences in human pain and rat afferent discharge evoked by injection of glutamate into the masseter muscle. J Neurophysiology 2001:86:782-791.
Fischer L, Clemente JT, Tambeli CH. The Protective Role of Testosterone in the Development of Temporomandibular Joint Pain. J Pain 2007 Mar 12.
Flake NM, Bonebreak DB, Gold MS. Estrogen and inflammation increase the excitability of rat temporomandibular afferent neurons. J Neurophysiology 2005 Mar;93(3):1585-97.
Smith MT, Wickwire EM, Grace EG, et al. Sleep disorders and their association with laboratory pain sensitivity in temporomandibular joint disorder. Sleep 2009; 32: 779-90.
Sanders AE, Essick GK, Fillingim R, et al. Sleep apnea symptoms and risk of temporomandibular disorder: OPPERA cohort. J Dent Res 2013; 92: 70S-7S.
Simmons JH, Prehn RS. Nocturnal bruxism as a protective mechanism against obstructive breathing during sleep. Sleep 2008; 31: A199.
Mayer P, Heinzer R, Lavigne G. Sleep Bruxism in Respiratory Medicine Practice. Chest 2015.
Hollowell DE, Bhandary PR, Funsten AW, Suratt PM. Respiratory-related recruitment of the masseter: response to hypercapnia and loading. J Appl Physiol (1985) 1991; 70: 2508-13.
Olmos S. CBCT in the evaluation of airway- minimizing orthodontic relapse. Journal of Orthodontic Practice, March/April 2015, pg. 35-37.
Katusic S, Beard CM, Bergstralh E, Kurland LT. Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945-1984. Ann Neurol. 1991;27:89-95.
Cheshire WPJ, Wharen REJ. Trigeminal neuralgia in a patient with spontaneous intracranial hypotension. Headache. 2009;49:770–3.
National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
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Cheng TMW, Cascino TL, Onofrio BM. Comprehensive study of diagnosis and treatment of trigeminal neuralgia secondary to tumors. Neurology 1993; 43: 2298–302
Hamlyn PJ, King TJ. Neurovascular compression in trigeminal neuralgia: a clinical and anatomical study. J Neurosurg 1992; 76: 948–52
Hardy DG, Rhoton AL Jr. Microsurgical relationships of the superior cerebellar artery and trigeminal nerve. J Neurosurg 1978; 49: 669–78
Pierre Mayer, Raphael Heinzer and Gilles Lavigne. Sleep Bruxism in Respiratory Medicine Practice. Chest 2015, online published,
Iijima K, Shimoyama N, Shimoyama M, Yamamoto T, Shimizu T, Mizuguchi T. Effect of repeated irradiation of low-power He-Ne laser in pain relief from postherpetic neuralgia. Clin J Pain. 1989;5:271–4.
Walker J, Akhanjee L, Cooney M, Goldstein J, Tamayoshi S, Segal-Gidan F. Laser therapy for pain of trigeminal neuralgia. Clin J Pain. 1988;3:183–7.
Iijima K, Shimoyama N, Shimoyama M, Mizuguchi T. Evaluation of analgesic effect of low-power He:Ne laser on postherpetic neuralgia using VAS and modified McGill pain questionnaire. J Clin Laser Med Surg. 1991;9:121–6.
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Dr. Steven Olmos has been in private practice for more than 30 years, with the last 20 years devoted to research and treatment of craniofacial pain, temporomandibular disorder (TMD), and sleep-disordered breathing. He obtained his DDS from the University of Southern California School of Dentistry and and is Board Certified in both chronic pain and Sleep Related Breathing Disorders.

Dr. Olmos is the founder of TMJ & Sleep Therapy Centres International, with 35 licensed locations in six countries dedicated exclusively to the diagnosis and treatment of craniofacial pain and sleep disorders. Dr. Olmos is an adjunct professor at the University of Tennessee School of Dentistry.

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From Dentaltown

NEW YORK—Remember when you visited the dentist as a kid, and had to chew on pink tablets that showed where plaque had gathered on your teeth… then, brushing away until you revealed a beautiful, bright smile?

Meet that concept for the 21st century—Introducing Plaque HD.

It’s a new and first-of-its-kind toothpaste, invented by dentists and orthodontists to help their patients brush better and smarter. Plaque is clear, so it’s difficult to detect with the naked eye. Plaque HD acts as a tool to show the user exactly where plaque has gathered, using an indicating dye to turn it teal. The color only disappears once you’ve brushed all the plaque away.  

Imagine a brushing experience so powerful that it feels like brushing and using mouthwash at the same time. With patented Targetol technology, users remove the plaque from their teeth and fight cavities simultaneously, once again revealing a bright and beautiful smile.  Perfect for all ages, it instills strong brushing habits in kids, keeps teeth healthy while teens are in braces, and is a fantastic tool for adults to maintain a great smile.

Independent studies conducted in the orthodontic department at University of Illinois at Chicago College of Dentistry show that patients who used Plaque HD had twice as much plaque removal when compared to patients who used a standard toothpaste on the market.

PlaqueHD is much more than just a toothpaste—it is a unique product that not only cleans teeth, but removes plaque and bacteria to ensure overall health. The plaque and bacteria that is left undetected after brushing can lead to periodontal problems—and studies show that periodontal disease has a connection with heart disease and stroke.  Improving oral health can potentially decrease the risk.

For more information or to purchase, visit

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From Dentaltown Magazine
By Tom from Dentaltown

This is a question that we have all answered at some point in our lives. Maybe you've been answering, "dentist" since you were very young. Either way, I hope you still believe you made a great decision.

There are many factors that might lead you to a career in the dental profession and these paths are neither short nor easy. Being close to someone who is a dentist can be a big influence. My brother and I are the first two people in my family to join the dental profession, but I remember meeting many people in school who had a parent or relative in dentistry. Those relationships significantly influenced their decision to choose dentistry.

I have often wondered if that next-generation influence is as strong as it was when I was in dental school more than 20 years ago.

This year, as part of our annual Townie Choice Awards ballot, we had a few optional questions on a variety of topics. One of the questions was: "Would you advise your son, daughter or close relative to choose dentistry as a profession?"

While the results were not all sunshine and flowers, the overwhelming response was positive. Of the more than 700 dentists who responded to this optional question, only 17 percent indicated that they would not recommend the dental profession to a young family member.

Another 7 percent had family members who have already selected another profession. The remaining 76 percent either had a family member already in the profession or said they would most certainly recommend this profession to their family members if they expressed an interest.

I found that the presence of interest or desire was a common theme in the group who would endorse dentistry as a profession. Essentially, the price you pay, the challenges you face, and the time invested require a sincere desire to join the profession.

This has always been the case, but it seems especially important today due to the enormous cost of a dental education. For those who were not going to recommend dentistry to their loved ones, common themes for dissent include: the influence of insurance companies, and the lack of autonomy.

The sentiment indicated that this profession is not what many people thought it was when they started and they believe there are better opportunities for success in other fields.

This word cloud is a representation of some of the more popular words used in response to the survey question.

As for me, I've wanted to be a dentist since high school. I witnessed my own dentist and orthodontist working with smiles on their faces, enjoying a flexible schedule and the freedom to do what they liked in their spare time.

While my life as a dentist is not the same as it was for them, I am still very grateful for this profession and I would not change my decision.

After all, even when dentistry has me down, I cannot think of a better option to provide for my family, make my own choices, work with my hands and help other people. And on top of all that, technology continues to provide new opportunities for better care and improved materials, which allows us to enjoy better outcomes.

I hope you will take this opportunity to reflect on the reasons you selected dentistry as your chosen career, and I encourage you to share your thoughts on this question in the digital version of this article online at

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By Brent Cornelius from Brent Cornelius Dentistry

If you brush your teeth twice a day religiously with fluoride toothpaste, good for you! You’re taking an important step toward preventing cavities and tooth decay.

But while brushing your teeth every day is important, doing so isn’t going to prevent cavities. Why not? Read below:
Brushing your teeth does get a good amount of plaque from your teeth, but it can’t get all of it.

Why can’t it get all of the plaque that builds up on your teeth? Because brushing with a toothbrush can’t get between your teeth! That’s why it’s important to floss at least once a day. (It’s best to floss and brush at the same time, but you should floss at minimum once a day).

In fact, if you’re ever stuck on a desert island, make sure you have floss with you because if you don’t have a toothbrush, your tongue can get a good amount of bacteria off your teeth, but your tongue can’t get between your teeth. So if stuck between flossing and brushing, floss! (But you’re more than likely not on a desert island or far from a toothbrush and fluoride toothpaste, so there’s no excuse: brush your teeth!)

We eat so much sugar, it’s a wonder our teeth aren’t completely cavity-riddled.

The American Heart Association reported in 2014 that the average American eats about 20 teaspoons of sugar each day, an amount more than double what we should be consuming. (According to the American Heart Association, women should consume less than six teaspoons a day and men should consume no more than nine teaspoons.)

You may think that you’re safe because you rarely eat sweets, but so much of the food we eat today has a ton of “hidden” sugar in it. One tablespoon of ketchup, for example, has four grams of sugar (more than in a chocolate chip cookie)!

Tooth decay starts when sugary or starchy foods and drinks stay on our teeth and then interact with the bacteria-producing acid that’s on our teeth to dissolve our tooth enamel. Once the enamel is worn down, the inside dentin layer of our tooth becomes exposed, leading to a cavity.
And it doesn’t take long at all for sugars/starches to start teaming up with the bacteria to start dissolving our tooth enamel: if you eat frequently (snacks) between sessions of brushing, the sugars remain there and can keep a thin layer of acid on your teeth, allowing for plaque buildup.

So the best thing to do is to brush your teeth each time you eat. That’s probably not possible, but that’s why it’s best to cut your way back on your sugar/starch intake.

Visit your dentist at least twice a year to get rid of the plaque brushing and flossing didn’t remove.

Plaque buildup will lead to tooth decay. End of story. Since brushing and flossing won’t get all of it from your teeth (because even the best of us skip sessions every now and then), it’s important to visit your dentist’s office at least twice a year to get that remaining plaque removed from your teeth.

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From Dental Town

CLEVELAND—In a new advisory policy statement, the Nevada State Board of Dental Examiners at their November 20, 2015 meeting has confirmed that Nevada dentists and dental hygienists who possess the necessary skills and training are now permitted to administer botulinum toxin (Botox/Xeomin) and dermal fillers.

Nevada dental hygienists may only administer facial injectables to patients under the direct supervision of a Nevada licensed dentist who has the same skills and training to administer facial injectables.  

“The bottom line is that Botox and dermal fillers are allowed within the scope of dental practice for use by Nevada general dentists and dental hygienists in the oral and maxillofacial areas for esthetic and therapeutic uses with appropriate training,” said Dr. Louis Malcmacher, president of the American Academy of Facial Esthetics. “Now Botox and dermal fillers in Nevada is just like any other area of dentistry and will be treated as such. Comprehensive training is essential for dentists and dental hygienists to be proficient in Botox and dermal filler procedures for esthetic and therapeutic facial pain uses which is what we teach in our courses and relates to 99 percent of these procedures done in the oral and maxillofacial areas. The AAFE is working with the dental board to create the proficient training curriculum necessary for dental professionals to use facial injectables.”   

Nevada now joins the vast majority of states that allow dentists to perform Botox and dermal filler procedures for all uses in the oral and maxillofacial areas.  Nevada also becomes the first state to allow the use of facial injectables by dental hygienists under direct dentist supervision.  

In addition, the American Academy of Facial Esthetics (AAFE) is presenting its first limited attendance Nevada live patient training courses for dentists and dental hygienists on January 28-29, 2016 and February 25-26, 2016 in conjunction with Cornerstone Esthetics.   For registration and more information about AAFE course offerings, visit, email or call (800) 952-0521.

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