DDS Lister

The study, led by Dr. Shiela Strauss, Associate Professor of Nursing and Co-Director of the Statistics and Data Management Core for NYU’s Colleges of Dentistry and Nursing, examined data from 2,923 adult participants in the 2003-2004 National Health and Nutrition Examination Survey who had not been diagnosed with diabetes. The survey, conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention, was designed to assess the health and nutritional status of adults and children in the United States.

Using guidelines established by the American Diabetes Association, Dr. Strauss determined that 93 percent of subjects who had periodontal disease, compared to 63 percent of those without the disease, were considered to be at high risk for diabetes and should be screened for diabetes. The guidelines recommend diabetes screening for people at least 45 years of age with a body mass index (a comparative measure of weight and height) of 25 or more, as well as for those under 45 years of age with a BMI of 25 or more who also have at least one additional diabetes risk factor. In Dr. Strauss’s study, two of those additional risk factors — high blood pressure and a first-degree relative (a parent or sibling) with diabetes — were reported in a significantly greater number of subjects with periodontal disease than in subjects without the disease. Dr. Strauss’s findings, published today in the online edition of the Journal of Public Health Dentistry, add to a growing body of evidence linking periodontal infections to an increased risk for diabetes.

Dr. Strauss also examined how often those with gum disease and a risk for diabetes visit a dentist, finding that three in five reported a dental visit in the past two years; half in the past year; and a third in the past six months.

“In light of these findings, the dental visit could be a useful opportunity to conduct an initial diabetes screening — an important first step in identifying those patients who need follow-up testing to diagnose the disease.”

“It’s been estimated that 5.7 million Americans with diabetes were undiagnosed in 2007,” Dr. Strauss added, “with the number expected to increase dramatically in coming years. The issue of undiagnosed diabetes is especially critical because early treatment and secondary prevention efforts may help to prevent or delay the long-term complications of diabetes that are responsible for reduced quality of life and increased levels of mortality among these patients. Thus, there is a critical need to increase opportunities for diabetes screening and early diabetes detection.”

Dr. Strauss said that dentists could screen patients for diabetes by evaluating them for risk factors such as being overweight; belonging to a high-risk ethnic group (African-American, Latino, Native American, Asian-American, or Pacific Islander); having high cholesterol; high blood pressure; a first-degree relative with diabetes; or gestational diabetes mellitus; or having given birth to a baby weighing more than nine pounds.

Alternatively, dentists could use a glucometer — a diagnostic instrument for measuring blood glucose — to analyze finger-stick blood samples, or use the glucometer to evaluate blood samples taken from pockets of inflammation in the gums.

“The oral blood sample would arguably be more acceptable to dentists because providers and patients anticipate oral intervention in the dental office,” Dr. Strauss noted. In an earlier study involving 46 subjects with periodontal disease published in June 2009 by the Journal of Periodontology, an NYU nursing-dental research team led by Dr. Strauss determined that the glucometer can provide reliable glucose-level readings for blood samples drawn from deep pockets of gum inflammation, and that those readings were highly correlated with glucometer readings for finger-stick blood samples.

Dr. Strauss’s coauthors on the study for the Journal of Public Health Dentistry include Ms. Alla Wheeler, Clinical Assistant Professor of Dental Hygiene; Dr. Stefanie Russell, a periodontist and Assistant Professor of Epidemiology & Health Promotion; and Dr. Robert Norman, Research Associate Professor of Epidemiology & Health Promotion, all of the NYU College of Dentistry; Dr. Luisa Borrell, an Associate Professor in the Department of Health Sciences at Lehman College of the City University of New York; and Dr. David Rindskopf, Distinguished Professor of Educational Psychology and Psychology at the City University of New York Graduate Center.

Source:

• New York University

At last, someone has taken a stand against the tooth whitener ad menace. It’s no tiny or obscure ad network: it’s Google. The company has decided to live up to its “don’t be evil” motto and ban advertisers who place ads that lead to sites peddling products like scammy free trials, get-rich-quick schemes, and malware. Previously, they would ban individual ads, but not advertisers. This was akin to playing a massive game of whack-a-mole with thousands of identical “local moms” who had identified the secret to weight loss. Or tooth whitening. Or stretch marks. Or…

Chadwick Matlin at The Big Money explains:

Up until now [Google] has taken action against ads, not advertisers. If an ad violated one of Google’s terms of use, the search giant would take it out of circulation, but that’s it. Google briefed TBM on its new policy: It will now ban the advertiser, not the ad, effectively neutering the advertiser’s ability to shift from one ad and shell site to another. Think of it like the struggle between the police and a graffiti vandal. Up until now Google has only been erasing the tags after they’ve been put up. Going forward, they’re going to take away his spray cans and put a GPS collar on him, making sure he never does it again. It would be a principled stand by any company, but especially by Google because of its position in the market.

The problem with permanent advertiser bans is that it can lead to false-positives, but this is a promising start on Google’s part.

If you’ve struggled with the discomfort and inconvenience of traditional dentures, you might be considering dental implants to replace removable dentures with permanent replacements for your teeth. With today’s advanced technology, mini implants can offer a less invasive alternative.

Narrow diameter dental implants, or mini implants, are similar to traditional implants, but can be placed in a single procedure. Traditional implants, by contrast, require a two-part procedure and a significant healing interval.

Traditional Dental Implants

Traditional implants are often used for:

• Replacing single teeth
• Replacing a bridge or full denture
• Holding removable dentures in place

If you’ve suffered bone loss in your jawbone, through aging or as a side effect of wearing traditional dentures, implants might not be the best option for you. If you’ve suffered bone loss, the jawbone can be augmented with bone grafts, or the implants can be placed to avoid the places where the loss is the greatest. Consult with a cosmetic dentist experienced with implants to determine if they’ll work for you.

When traditional implants are placed, the titanium screw section is implanted directly into the jawbone. After a healing period of a few weeks, the screw bonds to the bone. The top half of the implant can then be added, along with any attached appliances. Dentures attached to an implant can be permanent or removable.

Mini Dental Implants

Mini implants, by contrast, can be placed in a single visit. It’s not necessary to make incisions in the gums, nor are there any stitches to be removed later. The mini implants are fixed with a special attachment that fits into the bottoms of your dentures, holding them securely in place. The dentures can still be easily removed for cleaning, but they won’t shift while you’re chewing or talking, giving you new self-confidence and a more natural look.

Much like traditional implants, mini implants can also securely hold a single replacement tooth or a partial bridge, as well as full dentures.

Your particular situation will determine whether traditional implants or mini implants will work best for you. If you want to find out more about implants, a consultation with a certified cosmetic dentist who’s had experience with traditional and mini implants can help you decide if you’d like to pursue this procedure.

Source:

• 24/7 Press Release

Although 72 percent of Americans have fillings, caps or crowns and one in six had a dental emergency during the past 12 months, most are not prepared to deal with a dental emergency, according to a recent survey conducted by Majestic Drug Company, a leading provider of oral care products.

Interestingly, in the national survey of 1,000 Americans, those with a lower income (less then $35,000) were more likely to have had a dental emergency in the past 12 months (vs. 14 percent of those who make $100,000 or more).

Of those who had a dental emergency, 23 percent involved a loose crown or cap, 10 percent involved a lost filling, while 72 percent said their dental emergency involved something else.

Among those who had a dental emergency involving a loose crown/cap or a lost filling, 67 percent immediately went to a dentist, and 14 percent looked for a temporary solution to purchase, while 19 percent did nothing at the time.

“You keep medical supplies on hand for cuts and bruises, but what about your teeth? It’s important to be prepared for a dental emergency in case one happens, especially if the emergency occurs on a weekend when your dentist just isn’t available or you are on the road and cannot seek immediate dental care,” according to Brian Gold, D.D.S., who practices in Monticello, NY.

Dental emergencies can range from a dislodged cap/crown or lost filling to a knocked out tooth to pain or a cracked denture. Majestic Drug Company explains some common dental emergencies and suggestions for treatment.

• Knocked out tooth. If a permanent tooth is dislodged from the socket, try gently replacing it into the tooth socket. Do not scrub the tooth clean–you can damage the fibers needed for reattachment. If that doesn’t work, place the tooth in a glass of milk to keep it moist. Get to a dentist immediately.
• Mouth pain. A throbbing pain from a toothache may indicate an infection and a dentist should be consulted as soon as possible. Tooth sensitivity can be combated by the use of desensitizing toothpaste such as Sensodyne. Irritation from mouth sores can be alleviated by the use of specialized oral pain relief products such as Orajel.
• Lost filling. Rinse out the cavity with warm water. Apply a temporary filling product such as Dentemp(R) O.S. which can be made into a ball and pressed firmly into the cavity.
• Cracked or broken denture. According to Dr. Gold, all denture wearers should have a spare pair to use until the other is repaired. If not, it is good to keep on hand an emergency denture repair kit such as D.O.C. Emergency Denture Repair Kit, available at your local pharmacy.
• Dislodged cap/crown. Apply a temporary dental holding product such as Dentemp(R) O.S. and gently replace the cap onto the tooth. Make sure you get a proper fit.
• Irritation from Braces. Sharp wires can be coated with special dental wax available at your local pharmacy.

Remember, temporary dental solutions are just that–they are temporary. Make sure to seek professional assistance from your dentist as soon as possible.

Source:

• PR Newswire

Personal profiles on Facebook and other social-networking sites are a trove of inappropriate and embarrassing photographs and discomfiting breaches of confidentiality. You might expect that from your friends and even some colleagues — but what about your doctor?

A new survey of medical-school deans finds that unprofessional conduct on blogs and social-networking sites is common among medical students. Although med students fully understand patient-confidentiality laws and are indoctrinated in the high ethical standards to which their white-coated profession is held, many of them still use Facebook, YouTube, Twitter, Flickr and other sites to depict and discuss lewd behavior and sexual misconduct, make discriminatory statements and discuss patient cases in violation of confidentiality laws, according to the survey, which was published this week in the Journal of the American Medical Association. Of the 80 medical-school deans questioned, 60% reported incidents involving unprofessional postings and 13% admitted to incidents that violated patient privacy. Some offenses led to expulsion from school. (See the top 10 celebrity Twitter feeds.)

“I didn’t expect to find so many incidents of unprofessional conduct,” says Dr. Katherine Chretien, medicine-clerkship director at the Washington, D.C., Veterans Administration hospital and the lead author of the study. As a physician responsible for counseling medical students and residents, Chretien says she assumed that students were “educated about professional conduct online and used better judgment.”

But medical students, it seems, are no different from the rest of us when it comes to posting drunken party pictures online or tweeting about their daily comings, goings and musings — however inappropriate they may be. Many students feel they are entitled to post what they wish on their personal profiles, maintaining that the information is in fact personal and not subject to the same policies and guidelines that govern their professional behavior on campus. Though medical students would agree that physicians — and other professionals, like teachers — should be held to a higher standard of integrity by society, the new study suggests that they’re confused by how rules apply, especially in cyberspace, once the white coat comes off. “They view their Facebook pages as their Internet persona,” says Dr. Neil Parker, senior associate dean for student affairs for graduate medical education at UCLA’s David Geffen School of Medicine. “They think it’s something only for their friends, even though it’s not private.” (See 10 ways Twitter will change American business.)

That attitude is largely dictated by age, says Parker. In focus groups involving students, faculty, administrators and staff, the school has found a clear generational divide between those who tend to blur the line between their personal and professional lives and those who don’t. Younger students were more likely than older staff members to believe that their thoughts and opinions were valid to post online, regardless of their potentially damaging or discriminatory impact on others.

The issue is especially relevant when it comes to discussing patient cases. Laws prohibit doctors from talking about patients using individually identifiable information. However, as Chretien notes, sharing patient-care experiences can be a useful and powerful learning tool for medical students that encourages “reflection, empathy and understanding,” she writes in the paper. Although discussing their experiences online may be allowed, students must be made aware that identifying information is not limited to patients’ names and that divulging other characteristics and details often violates patient-privacy laws.

It’s that type of education that medical schools need to include more in their curricula, says Chretien. Ensuring that students are aware of privacy settings on social-networking sites is another. At UCLA, Parker has assigned a task force, which includes students, to devise guidelines that students can follow when making decisions about what to post and what to keep to themselves. “It’s going to be difficult,” he says. “Most students want us to provide them with education and guidelines, but not policies. It is a different culture; we always say we have to be culture-sensitive to our patients, but we have to be culture-sensitive to our students as well.”

Source:

• Time

Monica Gagnier skipped a checkup at a routine cleaning session to save money, but ended up with a $400 bill when the hygienist told her she needed antibiotic shots for a gum infection.

Many employer-sponsored health care plans do not include dental insurance, and those that do will typically offer only limited benefits. Individual private insurance is often too costly to be feasible. And Medicaid and Medicare offer only limited safety nets.

For most people, a toothache that turns into an expensive procedure like a crown or implant means thousands of dollars out of pocket. Routine checkups, cleanings and fillings can set you back hundreds. No wonder 35 percent of Americans have not visited a dentist in the last 12 months, according to a Gallup report in March.

Even if you’re fortunate enough to have some kind of coverage, you have probably discovered just how little it pays if you have big problems. Most dental policies pay for preventive care like twice-a-year checkups, but cover only a fraction of higher-cost procedures like root canals. Even fillings can get short-changed, if the insurer decides the tooth-colored filler the dentist used was too “cosmetic” for the pothole being patched.

At the same time, dental care costs are rising faster than inflation, just as the evidence mounts that taking care of your mouth can be a critical gateway to good overall health.

The health care bills circulating in the House and Senate include dental care provisions for children, which is good. But it also means that for most of us relief from dental bills is not likely to come soon. That leaves it up to consumers to find smart ways to reduce their dental care costs without sacrificing their oral health. So we asked experts and patients for advice.

PREVENTION Taking care of small problems keeps them from becoming big ones. Enough cannot be said about prevention, according to Dr. Matthew Messina, consumer adviser for the American Dental Association and a dentist in Cleveland.

Left unchecked, a small cavity that would cost about $100 to fill can easily turn into a $1,000 root canal. Skip those $80 cleanings each year, and you may be looking at $2,000 worth of gum disease treatments. An abscess that lands you in the emergency room will set you back hundreds of dollars for the visit, “and you’ll still have to go see a dentist, because emergency rooms don’t handle dental work,” said Dr. Messina.

Finally, your dentist also routinely looks for more serious problems, like oral cancer. More than 35,000 cases are diagnosed each year, according to the American Cancer Society. Early detection, usually during a dental checkup, is critical to successful treatment.

FULL DISCLOSURE It’s important to know the price before you agree to the procedure. Often patients sit down for a routine cleaning and checkup, only to find they have a problem. The dentist offers to take care of the situation on the spot, and the patient agrees — but then is socked with a surprising bill at the end of the visit.

That happened to Monica Gagnier of Beacon, N.Y., on a recent visit to her Manhattan dentist for a twice-yearly cleaning. Looking to save money, Ms. Gagnier was careful to tell the office when she made the appointment that she wasn’t due to get X-rays and didn’t need to see the dentist for a checkup. Without those two items, she figured she would save more than $100 on her bill.

During the cleaning, however, the hygienist told her that her gums were infected and she needed antibiotic shots. Her total bill was $400.

“The antibiotics may well have been necessary,” Ms. Gagnier said. “But what I hate is being hit by surprise costs and treatments when I’m lying on my back, my mouth is wide open, and I can’t talk about it.”

You should always be given an opportunity to discuss any treatment, sitting up, without equipment in your mouth, says Dr. Messina. In addition, whenever you are facing an invasive dental procedure that is not an emergency, it makes sense to refuse treatment on the spot and get a second opinion, says Elizabeth Rogers, a spokeswoman for Oral Health America, a nonprofit advocacy and education group based in Chicago.

The range of prices on treatments like root canals, for instance, can easily differ by $1,000 or more.

SPREADING THE COST Patients can often space out treatments or negotiate payment plans with the dentist for extensive work. Working with the dentist on payments, says Dr. Mark Wolff, associate dean at the New York University College of Dentistry, is much better than putting the bill on your credit card and paying high interest.

Another way to negotiate, says Dr. Wolff, is to plan extensive treatments in phases. Say you need a crown. Your dentist may be able to put in a temporary filling for several months while you use that time to save for the permanent crown.

“It’s quite possible to phase in many dental procedures,” said Dr. Wolff. “And when it is, most dentists are willing to spread the work out over time.”

DENTAL SCHOOL CLINICS Almost every dental school offers affordable care provided by dental students and overseen by experienced, qualified teachers. You can expect to pay as little as a third of what a traditional dentist would charge and still receive excellent, well-supervised care, Dr. Wolff says.

That is what Julie Kingsley of Portland, Me., did after a checkup for her two young children at a pediatric dentist set her back a total of $375. “I realized that was as much as a car payment or a good chunk of our monthly food bill,” said Ms. Kingsley. “There had to be a better way.”

Ms. Kingsley started asking around for less expensive alternatives and found out about the University of New England’s dental college clinic, at the Westbrook campus in Portland. The bill for her children’s latest checkups: $100.

Ms. Kingsley was pleased with the quality of care her children received. But she did warn that patients may sacrifice time for money. “What was a 45-minute visit at the private dentist ended up taking three hours at the clinic,” she said.

If you have trouble finding a dental clinic in your area, you can seek help from Oral Health America (oralhealthamerica.org or 312-836-9900).

Many communities also subsidize low-cost dental clinics that offer free services to those who qualify, or charge fees on a sliding scale. To find a clinic in your area, you can check with your state’s dental director. A state-by-state list is on the Web site of the Association of State and Territorial Dental Directors, at bit.ly/kCCo7.

MUCH has been said and written about the tens of millions of Americans without health insurance. But often overlooked in these discussions is another vital medical statistic: more than 100 million Americans go without dental coverage.

DISCOUNT NETWORKS Alternatives to employer-provided dental insurance are often a bad deal, Dr. Wolff said. But for the uninsured, a discount network can make a difference.

Some networks like those on DentalPlans.com have formed to fill the void. Consumers pay roughly $100 to $200 a year in exchange for 15 to 50 percent discounts on service and treatments from participating dentists. “Be sure to compare plans carefully,” said Ms. Rogers of Oral Health America.

And, she added, make sure the discounts you are likely to use will be enough to cover the annual fee — and look carefully for any limits and restrictions.

Source:

• NY Times

Dental patients, accustomed to seeing sharp tools and paper bibs, should get used to seeing a computer nearby. The digital age has hit dentistry, and patients can see that change in the way crowns are built and X-rays are taken.

The new technology is radically reducing the amount of time it takes to create a crown, and it’s also giving dentists faster, more precise views inside their patients’ mouths.

In a classroom at Dallas’ Baylor College of Dentistry, a computer screen showed a 3-D digital image of a patient’s teeth taken by a wand with a laser sensor. A light green tint on the screen marked the soon-to-be crown to set it apart.

Dr. Paul Nelson moved the cursor around and suddenly, the crown on the screen became skinnier or fatter until it filled the gap between the teeth.

He clicked the mouse again. Then in the next room, a machine the size of a large printer came to life. In it, two diamond-studded drills carved into an enamel block. In about 20 minutes, the machine produced a crown that fits exactly into the patient’s mouth.

The traditional process of creating a crown means forming a mold of the patient’s teeth and shipping it off to a lab that produces the crown, which could take weeks. Complicated crowns might require multiple visits, taking even more time from the dentist and patient.

“With something like this in a normal dental office if somebody knows how to use it, the patient would go home the same day,” said Nelson, an assistant professor.

The technology is pricey, part of the reason why in 2004 only 3.3 percent of dentists nationwide used digital impressions, according to the American Dental Association. The system used in the Baylor example costs more than $100,000, Nelson said.

Dr. Stan Ashworth, another assistant professor, admitted he was skeptical of the technology until he saw how accurate the final products were.

“With this technique, the first 50 of these that we did in here, 49 fit without any kind of adjustment at all, which is just amazing,” Ashworth said. “Dentists in private practice would love to have that level of success.”

That accuracy persuaded Dr. Mark Palmer, who has a private practice in North Dallas, to get digital impressions about five months ago. With his system, the images are sent to an outside lab that makes the crown and sends it back to him.

“The only reason that I got it is because it improves the quality of dentistry that I do,” Palmer said. “It’s an amazing technology.”

Patients are more familiar with digital X-rays, which have grown in popularity among dentists nationwide.

Rather than film, a digital sensor is placed inside a patient’s mouth to capture an image, which appears instantly.

Digital X-rays look similar to film, but they’re easier to transfer, and dentists can optimize the image to make a better diagnosis, said Dr. Byron Benson, who heads Baylor’s radiology division.

“If you were doing something where you needed high contrast or low contrast, you had to know that before you took the picture,” Benson said. “Now, you take a digital radiograph and, with the software, you can change the contrast.”

The ADA said about 16 percent of dentists used digital X-rays five years ago, but Benson figures that has grown to about 25 percent or 30 percent.

Palmer has used them in his practice for about five years and saved money on chemicals, film and processing.

“As far as I’m concerned, it’s a no-brainer,” he said. “There’s no reason not to be in digital X-rays.”

However, Benson points out to dentists who can’t afford the technology that film X-rays have the same quality as digital. He teaches his students both methods but makes clear that digital is the future.

“We teach them to a level of familiarity with film, but we teach to a level of competence with digital,” he said.

Chris Whitley is a Dallas freelance writer.

Source:

• Dallas News

Coverage for Implants, Posterior Composite Resin Fillings and Analgesia Now Available to Small Groups

According to the Academy of General Dentistry, 25 million Americans do not visit the dentist because they are afraid.

But whether it’s the pain, a feeling of losing control or just plain fear of sitting in the dental chair, there are things you can do to relax.

Sarah Darling, dental hygienist at Diamond Dental Care in Arlington, offers these tips:

• Schedule your appointment at a time during the day that you’re most relaxed.

• Wear comfortable clothes.

• Stay away from caffeine before your appointment.

• Look at the person working on your teeth as a friend instead of someone in an authority position.

• If you’re really anxious, tell your dentist. He or she can give you a small amount of either nitrous oxide or an anti-anxiety medication such as Valium. Just remember someone will then need to drive you home.

• Think of it as going to the hairdresser, only it’s your teeth instead of your hair.

• Try some deep breathing and mini-meditations. Breathe in and take long deep breaths. When someone is working on your teeth, just think about something you enjoy.

• Bring an MP3 player loaded with the kind of music you enjoy and listen to it during the procedure.

• Communicate your fears and phobias to your dentist. Virtually every fear can be addressed by communicating properly.

Source:

• Dallas News

New research has supported a shift in the role that a dental hygienist plays in a patient’s treatment. A dental cleaning is no longer just the art of calculus (tartar) removal…it is the art of disease prevention! Periodontal (gum) disease is caused by pathogens (bugs, germs). When these pathogens are disrupted and their numbers reduced, the immune system can once again assert itself in self-defense. Gums stop bleeding. Bone stops receding. Infection is arrested. Tissues regain their firm, pink glow of health.

One of the newest technologies to accomplish this disruption is micro-ultrasonics. Micro-ultrasonic instruments produce a phenomenon called cavitation. When ultrasonic cavitation bubbles collapse (implode), they release enough energy to destroy pathogens and, literally, blast the plaque from the tooth! Additional benefits of the slimmer micro-ultrasonic tips is a more thorough removal of calculus bacteria in hard to reach areas and improved comfort due to less sensitivity, resulting in less apprehension.

In order to provide patients in Vail, CO with this comfortable, effective, state of the art dental cleaning, Wende Struthers, RDH, of Streamside Dental has advanced her instrumentation skills to incorporate micro-ultrasonics as the backbone of the practice’s preventive and therapeutic program.

With continual advancement of her skills and knowledge, Wende has dedicated her professional career to understanding and improving oral and systemic health. Her mission is to assess, educate, and be a resource regarding the importance of oral disease prevention and its relationship to optimum total health.

This investment in dental technology is one of the efforts that Streamside Dental makes to provide patients with overall oral health, general well-being, and to rejuvenate and revolutionize their experience. If you have further questions, please feel free to contact Streamside Dental.

Source:

• Streamside Dental