Monica Frazier Anderson, D.D.S.

Monica Frazier Anderson, D.D.S.

Monica F. Anderson earned her D.D.S. from the University of Minnesota School of Dentistry in 1988, and a B.A. in biology from Baylor University in 1984. She sold her solo general practice 2001 to pursue her core passion of community engagement. She is currently on staff with St. David’s Foundation, a nonprofit organization that provides free onsite dental services for social service agencies, local musicians, and disadvantaged students at Title I schools in Central Texas.

Dr. Anderson is also a journalist, motivational speaker, and published author of five books. She has been a freelance writer for DrBicuspid.com since 2008. She has also served as an Associate Editor for Northwest Dentistry. After graduating from dental school, she served on the Minnesota Dental Association’s Peer Review Committee and she was appointed to serve on the Minnesota Department of Health Emergency Medical Services Advisory Committee. She has lectured throughout the United States and internationally to civic, corporate, and university groups on topics ranging from The Medical Benefits of Humor to Communication Skills.

She has a exemplary history of community service and has received numerous commendations for her activism, including: Baylor University Alumni Association’s Outstanding Young Alumni award, Fort Worth ISD’s Distinguished Graduate Award, the Texas Legislative Black Caucus’ 2011 Outstanding Community Leader Award, and the Millenium Award for Medicine from Altrusa, International.

She is a member of the Academy of General Dentistry, the American Dental Association, and the National Dental Association.

Robert S. Baratz, M.D., Ph.D., D.D.S.

Robert S. Baratz, M.D., Ph.D., D.D.S., is an internist, dentist, and researcher who resides in Newton, MA. The founder of four companies, he has also served as medical director for two others in the medical device and pharmaceutical industry. He has been involved with issues regarding the safety and proper use of drugs and biomaterials since 1980. He has served on the medical and dental faculties of Northwestern and Tufts Universities. He currently serves on the faculty of Boston University School of Medicine, having initially been appointed in 1976. His broad knowledge of interactions of materials and the body has been sought by numerous licensing boards, regulatory agencies, universities, government agencies, insurance companies, and professional associations. He is also an expert in medical database applications and analyses.

Dr. Baratz has worked for more than twenty years in dental and medical practice for private, public, and government entities, including the Department of Veterans Affairs, The Daughters of Charity, and the Harvard Community Health Plan. Currently he is president and medical director of South Shore Health Center in Braintree, MA; president of the National Council Against Health Fraud (NCAHF); a member of the board of scientific advisors of the American Council on Science and Health; president of International Medical Consultation Services, Inc. of Newton, MA; and medical director of Skin Systems, Inc. of Peabody, MA. In 1992, the American Dental Association gave him a Presidential Citation for his work in advancing oral public health. In 1993, he received the City of Newton's first Good Neighbor Award. He has been listed in Who's Who in America, Who's Who in the World, and Who's Who in Science and Engineering.

Martin J. Davis, D.D.S.

Martin J. Davis received his B.A. from Yale University and both his D.D.S. and the Certificate of Training in Pediatric Dentistry from the Columbia University College of Dental Medicine.

Currently, Dr. Davis is associate dean for Student and Alumni Affairs (including admissions, financial aid, academic, personal and career counseling, alumni affairs, and the Annual Appeal), and is chief information officer, at Columbia University College of Dental Medicine. He was the division director of Pediatric Dentistry for over 22 years at Columbia.

Dr. Davis is a past-president of the American Academy of Pediatric Dentistry and a Diplomate of the American Board of Pediatric Dentistry. He is a past-president of the American Society of Dentistry for Children and a trustee of the ASDC and the AAPD Education Foundations and of the William J. Gies Foundation of the American Dental Education Association. He is a Fellow of the American College of Dentists, AAPD, and ASDC, and a past chair of the American Dental Education Association Section for Development, Alumni Affairs, and Public Relations. Dr. Davis has published over 65 articles and textbook chapters and has presented at numerous national and international symposia.

John C. Deverman, D.D.S.

John C. Deverman, D.D.S., has been in private practice for 35 years. He completed his dental training at the University of the Pacific 1973, and later was a clinical instructor at the school from 1996 to 2001. An active member of the ADA, CDA, and Contra Costa Dental Society, Dr. Deverman's practice offers a full range of services, including on-site Cerec restorations. He's an avid musician (and member of the American Harp Society) and gourmand (and member of the International Wine and Food Society).

Kim A. Gowey, D.D.S.

Kim A. Gowey received his D.D.S. degree from Marquette University School of Dentistry in 1977, graduating in the top 10 percent of his class. He received the Psi Omega Scholastic Achievement Award and was elected to membership in Omicron Kappa Upsilon, a national dental honor society. Dr. Gowey has practiced in Medford, WI since 1977.

Dr. Gowey is past president of the American Academy of Implant Dentistry (2006), a founding member of the American Academy of Cosmetic Dentistry in 1985, and a founder of the Wisconsin Implant Study Club. He is a Diplomate of the American Board of Oral Implantology/Implant Dentistry, an Honored Fellow of the American Academy of Implant Dentistry, and received a fellowship from the Academy of General Dentistry in 1988. Dr. Gowey has been a member of the American Academy of Implant Dentistry since 1980, serving as Central District President, editor of AAID News, and chairman of the Admissions and Credentials Board for five years.

Dr. Gowey has been a contributing editor to Dental Study Club, a national continuing education publication. He was an article reviewer for Quintessence International on the topic of implant dentistry. Dr. Gowey has presented lectures at the local, state, national, and international level.

Dr. Gowey has taught at Baylor College of Dentistry in the Continuing Education Department’s "Hands-on Implant Dentistry" program. He was on the faculty of the Howard University School of Dentistry's AAID Maxicourse in Implant Dentistry.

Frank Hsu, D.D.S.

Dr. Frank Hsu has been in practice since 2003. He earned his D.D.S. from Northwestern University in 2000, and his undergraduate degree from Berkeley in 1994. He completed the Advanced Education in General Dentistry Program, a post-doctoral residency at the University of California, San Francisco,

Each year Dr. Hsu enjoys volunteering in "Dentist with a Heart", an ADA sponsored program providing dental care to underprivileged children. Among other services, Dr. Hsu offers general procedures such as cleanings, fillings, crowns, root canals, dentures, bridges, and sealants for children. His practice offers a number of cosmetic procedures, including bleaching, veneers, implants, and orthodontics. Dr. Hsu recently added laser technology to his practice, for soft tissue surgery, crown lengthening, and other procedures.

Ben Johnson, dental student

Ben Johnson is a member of the class of 2010 attending the Kornberg School of Dentistry at Temple University. He graduated from Utah Valley University in 2006 with a B.S. in biology. He is involved with several dental clubs including the Xi Psi Phi, a national dental fraternity, the Dental Practice Management Club, and the Temple Haiti Club, an organization that travels to Haiti once a year to perform charity dental services. He is the sophomore representative for the Temple Oral Surgery Honor Society and was nominated to the Omicron Kappa Upsilon national honor society during his freshman year. He has been married for five years and has two boys who keep him on his toes. His hobbies include photography, snowboarding, and web sites, including the ever popular DMDstudent.com blog.

David Landau, D.D.S.

David Landau, D.D.S., graduated cum laude from the University of the Pacific in 1982 and completed his dental training at the University of the Pacific School of Dentistry in 1985. He has practiced his entire career in San Diego, working as a solo practitioner for 14 years before forming Complete Dental Health with Dr. Tim Collins in 1999.

Dr. David Landau was honored for his excellence by his peers when he was cited in San Diego Magazine’s 2005 and 2007 Top Doctors issues as one of the "Best Dentists in America".

Dr. David Landau has gone through extensive training to become an accredited member of the American Academy of Cosmetic Dentistry (AACD). Fewer than 250 dentists in the world have earned this prestigious designation. He is one of San Diego’s most respected cosmetic dentists. Dr. David Landau is a past- president and current board member of the AACD affiliate, the Southwest Academy of Cosmetic Dentistry.

Through his affiliation with the AACD, Dr. David Landau has produced numerous seminars on restorative and cosmetic dentistry for local dentists.

James R. Mattingly, V., D.D.S.

James Mattingly, D.D.S., received his bachelors degree from the University of California at Davis. He then graduated in 1997 with high honors from the University of the Pacific, School of Dentistry in San Francisco, CA. He has been in private practice in Walnut Creek, CA, for 11 years.

Dr. Mattingly has been inducted into both local and national dental honorary societies for the pursuit of excellence in dentistry. He participates in community outreach and world missionary dentistry. Dr. Mattingly is happily married and the proud father of a beautiful little girl and a boy. Dr. Mattingly is an active member of The American Dental Association, the California Dental Association, the Contra Costa Dental Society, the American Academy of Cosmetic Dentistry, the Omicron Kappa Upsilon National Dental Honor Society, and the Tau Kappa Omega Local Dental Honor Society, and is a Diamond Certified professional.

Edwin T. Parks, D.M.D., M.S.

Dr. Edwin T. Parks is a full professor at Indiana University School of Dentistry. He rejoined the faculty in 1997 after a two-year absence, during which time he had a solo oral medicine practice in Tallahassee FL. After graduating from Centre College Danville, KY in 1977 with a B.S. in both biochemistry and molecular biology, he attended the University of Kentucky College of Dentistry at Lexington and received his D.M.D. in 1981. Until he came to Indiana University School of Dentistry for postgraduate study in 1991, Dr. Parks held positions in Kentucky at Hazard Community College and Western Kentucky University (Bowling Green), and had a solo private practice in general dentistry in Whitesburg.

While pursuing his postgraduate degree, he became the staff dentist for the Marion County Juvenile Detention Center and began his training in forensic odontology. He received his M.S. in Dental Diagnostic Sciences in 1995. Dr. Parks is a Diplomate of both the American Board of Oral Medicine and the American Board of Oral and Maxillofacial Radiology. He is also a member of the American Dental Education Association, International Association for Dental Research, American Academy of Oral and Maxillofacial Radiology, and American Academy of Forensic Sciences.

Dr. Parks has published multiple book chapters and articles in such journals as JADA, Practical Procedures and Aesthetic Dentistry, Dermatologic Clinics, The Journal of Contemporary Dental Practice, and the Journal of the Indiana Dental Association. As a speaker, Dr. Parks is in great demand, making presentations around the world covering various oral medicine and radiology topics. Dr. Parks sees radiology, oral medicine, and TMJ/TMD/facial pain patients at Indiana University's Center for Oral Diagnosis and Treatment.

Ines Velez, D.D.S., M.S.

Ines Velez, D.D.S., M.S. is director of the Oral and Maxillofacial Pathology Section, Department of Oral Diagnostic Sciences, at Nova Southeastern University College of Dental Medicine. She is a diplomate of the American Board of Oral and Maxillofacial Pathology, and a fellow at American Academy of Oral and Maxillofacial Pathology.

Dr. Velez has been a practicing oral maxillofacial pathologist for 22 years. A graduate of Colegio Odontologico Colombiano, she received her postgraduate training in oral and maxillofacial pathology from the University of Florida. In addition, Dr. Velez received her master's in education from Universidad De Los Andes, Colombia.

She has contributed to a number of clinical journals, including Journal of Oral and Maxillofacial Surgery, Journal of Endodontics, JADA, Dentomaxillofacial Radiology, Today's FDA, and New York State Dental Journal.


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Monica Frazier Anderson, D.D.S.

Silver dental fillings may not harm kids' brains

February 14, 2008 -- NEW YORK (Reuters) Feb. 13 A new study adds to evidence that mercury-containing dental fillings do not harm children's brain development, as some have feared.

Silver fillings, called amalgams, have been used to treat cavities for more than a century. The fillings are made from a combination of metals, including mercury, and research has shown that small amounts of mercury vapor are released from the fillings over time.

Because mercury poisoning is known to damage the central nervous system and kidneys, consumer groups and some experts have concerns about the potential health effects of low-level mercury exposure from amalgam fillings.

In the new study, researchers in Portugal and the U.S. followed 507 children who had received either amalgam or resin-based fillings when they were between 8 and 12 years old. Over seven years, the two groups showed no differences in their rates of neurological symptoms, such as tremors, vision or hearing deficits, or coordination problems.

Dr. Martin Lauterbach, a neurologist at the University of Lisbon in Portugal, led the study. The findings are published in the Journal of the American Dental Association.

The results add to evidence from two recent studies -- including one of this same group of children -- that found no evidence that amalgam fillings harmed children's intellectual or behavioral development.

Still, mercury-containing fillings remain controversial. An advisory panel to the U.S. government recently said that while existing evidence suggests the fillings are generally safe, more study is needed into certain unanswered questions -- such as how amalgam fillings in pregnant women might affect fetal development.

Some consumer groups, dentists and lawmakers believe that amalgam fillings should be banned. The American Dental Association (ADA) maintains, however, that the weight of the scientific evidence indicates that the fillings are safe, and should continue to be an option for patients.

According to the ADA, strong, durable amalgam fillings may be the best choice in certain situations, such as when treating the molars -- the large teeth in the back of the mouth that bear much of the work of chewing.

As newer filling materials have become available, however, fewer people in the U.S. and Western Europe have been receiving mercury-containing fillings. In recent years in the U.S., less than one-third of new fillings have been the amalgam variety.

Copyright ? 2008 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.



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Dentists play the dating game at work

Dentists play the dating game at work

February 14, 2008 -- When it comes to mixing business with pleasure, dentists are not far behind James Bond. One of five dentists admitted to dating a co-worker or employee, according to a recent Wealthy Dentist survey.

Highlights from the survey:

Of the surveyed dentists, 21% admitted to having office romances.
Of the surveyed men, 24% had been in office relationships, while of the surveyed women, only 10% admitted to work romances.
Most office romances take place in suburban areas, with 24% of the polled dentists saying they had been in a relationship at work. In urban areas, 21% said yes; rural areas had the lowest rate at 10%.
A higher percentage (24%) of specialists said yes to office romances than general dentists (20%).
"While it was quite passionate and enjoyable, it clouded my judgment on some important office dynamics," said one Illinois dentist quoted in the survey results. "It almost cost me my office in that it killed morale. Thanks to a great staff, they stuck with me."

"At a time in my life when I needed a sympathetic ear, I found my dental assistant to be loving and caring," said a New York dentist in the survey. "My feeling is this: If the relationship is consensual, and the two colleagues can separate business from personal issues, try to make a go of it. My personal life, if kept private from the day-to-day operations of the office, is my own business."


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BSML offers cheaper faster veneers

BSML offers cheaper faster veneers

February 14, 2008 -- BSML, Inc., a provider of teeth whitening systems, has released a new veneer product called BriteVeneers.

BriteVeneers eliminates the need to remove or alter healthy tooth structure or administer injections/anesthesia. This product uses an all-in-one tray that permanently fits over teeth. Patients go in for two visits: The first one for photos and impressions, and the second one for the veneer fitting.

"Typically, the patients who need veneers the most can not afford them," claims a company press release. "The new BriteVeneers process offers all of the results of custom crafted veneers at a price that fits comfortably into the budget of the average dental patient."


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Dentists attack sleep apnea

Dentists attack sleep apnea

February 13, 2008 -- Dentists can do a lot more than give their patients healthy smiles these days. They can also help them get a healthy night’s sleep.

Dentists are becoming leaders in the fight to combat sleep apnea, an under-diagnosed disorder that can lead to high blood pressure, heart disease, and strokes. The American Academy of Sleep Medicine declared in 2006 that oral appliances -- fitted by dentists -- could be used instead of breathing machines to control mild to moderate forms of this debilitating condition.

"Physicians really have a choice," said David B. Rosen, D.M.D., an assistant clinical professor at Tufts University’s dental school, who taught dentists how to treat sleep apnea at the Yankee Dental Congress 33 recently held in Boston. "There’s a lot of good quality research that shows that oral appliances work."

People suffering from sleep apnea stop breathing for at least 10 seconds at a time throughout the night. They may wake up choking or gasping for breath, and are often excessively sleepy during the day. Yet only 5% of sufferers are ever diagnosed with the problem, in which the entire upper airway is blocked.

That’s unfortunate because their disrupted sleep leaves them more prone to morning headaches and reflux. People with sleep apnea have ten times more car accidents than the general public, Dr. Rosen said. They spend more than $5 billion a year on sleep studies, medications, and other therapies.

And if left untreated, sleep apnea can shorten adult life spans by as much as half, said Richard B. Drake, D.D.S., a Texas dentist on the board of directors of the American Academy of Dental Sleep Medicine.

Obstructive sleep apnea is surprisingly common, with doctors estimating that 12 million Americans suffer from the life-threatening condition. That’s more Americans than suffer from asthma.

The condition is much more common in men than women and progressively worsens with age and weight gain, Dr. Rosen said. So as the U.S. population gets older and fatter, the number of apnea sufferers is increasing.

The treatment of choice for sleep apnea remains a cumbersome machine that delivers air pressure. Called CPAP (pronounced "see-pap"), short for continuous positive airway pressure machine, the device is difficult to use. Patients have to be hooked up to the noisy machine throughout the night. Even if the racket doesn't keep them awake, they must also get used to wearing a mask all night long -- a tricky maneuver for the typical sleeper who tosses and turns all night long. Because of the hassles, as few as 30% of patients who own a CPAP use it regularly, researchers have found.

Enter the dentist. There are now 54 different kinds of oral appliances that dentists can offer patients, with new models coming out all the time, Dr. Rosen said. Most work by pushing the patients’ jaw forward, which pulls their tongue forward and guarantees that their air passages stay open.

Patients find using them more palatable than the machines, said Dr. Rosen, noting studies show compliance for the oral appliances is as high as 93%.

Comfort does not come cheap, however. Appliances cost about $2,500 and the initial exam for creating them costs $250, Dr. Rosen said.

By contrast CPAP machines cost between $1,000 and $2,500 to buy and can be rented for about $100 a month. Renting is a good option, according to Dr. Drake, because so many people decide that the machines are too much trouble.

What to watch for

Dentists should be on the lookout for patients who report waking up with a sour taste in their mouth or have an excessively dry mouth in the morning. They may say they are extremely sleepy during the day and report that their spouses hear them snore loudly, with occasional, long pauses in the snoring. Patients who grind their teeth may also be suffering from apnea.

The condition is often found in people with large tonsils, large tongues, or tongues that have scalloping on their tips. It is also found in people with large necks -- typically more than 17 inches in men and more than 15.5 inches in women. People with a lot of nasal congestion may be more likely to suffer from apnea, too.

If you suspect a patient has sleep apnea, you should refer these patients to a sleep specialist (five specialty boards offer certificates in sleep medicine) because dentists can't legally diagnose sleep apnea. Confirming the diagnosis often requires an overnight sleep study, called a polysomnogram, which is performed at a hospital or sleep lab. Once the diagnosis is confirmed, the patient comes back to the dentist to have an oral appliance fitted.

Doctors have been searching for the best way to treat apnea patients for more than a century, Dr. Rosen said. In the early 1900s, doctors sutured infants’ tongues forward if they had apnea problems. Later, they encouraged patients to wear helmets with chin straps to reposition jaws.

Some doctors perform a tracheostomy to bypass the obstructed area or remove part of the patient’s soft-palate tissue -- a procedure that is successful about half the time, Dr. Rosen said.

But turning to dentists for help has long been popular, too. Dentists created the first oral appliance in 1934, and by the 1980s were using tongue-retaining devices.

Patients’ biggest problem today is choosing among the various devices on the market (about half have been approved by the U.S. FDA), Dr. Rosen said. He often recommends the SomnMed or Klearway appliance because they are easier for dentists to fit and relatively easy for patients to use.

The SomnoMed MAS, the only two-piece appliance on the market, is popular with patients because it's easier to put in and take out. But patients who tend to open their mouths wide while they are sleeping are not good candidates for the SomnoMed, Dr. Rosen said, because the device comes apart when the mouth is opened past a certain point.

Once an oral appliance is fitted, patients typically undergo another sleep study to make sure it is working properly. These studies are often done at home.

While oral appliances are often well-tolerated, there can be side effects, Dr. Rosen said. Some patients will experience shifting teeth or jaw pain, so regular dental follow-ups are important.

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ADA Foundation offers $300K grant to train pediatricians

ADA Foundation offers $300K grant to train pediatricians

February 12, 2008 -- The American Dental Association Foundation (ADAF) has announced a $300,000 grant -- to be issued in annual installments of $100,000 -- to fund oral health summits and other educational ventures for pediatricians.

At the summits, pediatricians will learn to conduct oral health risk assessments and teach families about oral health and prevention. All 66 chapters of American Academy of Pediatrics (AAP) will get the opportunity to send representatives, who will then lead training programs in their home state. Also, the grant will fund a preceptorship program for pediatricians in underserved areas.

"We're grateful to the ADA Foundation for recognizing the importance of the role pediatricians can play in maintaining the oral health of young children," said Renee Jenkins, M.D., F.A.A.P., president of AAP, in a press release. "By arming pediatricians with the tools they need to assess oral health risk, we can begin to reduce the number of children who need but don't receive dental care and build a solid foundation for their oral health."

"The ADA Foundation is excited about this grant's potential to broaden the reach of oral health messages to parents," said Arthur Dugoni, D.D.S., M.S., president of the ADA Foundation. "Our alliance with the American Academy of Pediatrics seeks to facilitate pediatrician and dentist collaboration at the national, state and local levels."

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Furor over no-drill technique

Furor over no-drill technique

February 12, 2008 -- Is placing a crown without preparing the tooth a brilliant innovation or dangerous negligence? Debate on that question is heating up as Scottish researchers spread the news of their no-drill Hall Technique around the globe.

The Hall Technique gets its name from Norna Hall, B.D.S., a general dentist in rural Scotland where there are many children with caries and few pediatric dentists available. To avoid the need for both drilling and anesthesia, Dr. Hall developed a technique of carefully cementing preformed metal crowns over untreated primary molars. The approach works, say proponents, because it seals the lesion, starving the bacteria and arresting the progress of the caries on that surface.

But the notion of placing a crown without preparing the tooth may come as close to heresy as dentistry gets. One reader called DrBicuspid.com "irresponsible" just for reporting about a recent study on the Hall Technique. On the other hand, a contributor to the DentalCom online forum called the technique "a big revolution in children's dentistry."

To get deeper perspective, we asked Steven Adair, D.D.S., M.S., chair of pediatric dentistry at Georgia Medical College and editor-in-chief of Pediatric Dentistry, to comment on the study. His reaction was scathing, so we also got a response from one of the study's co-authors, Dafydd Evans, B.D.S., F.D.S, Ph.D., senior lecturer in pediatric dentistry at the University of Dundee, Scotland. Here are Dr. Adair's criticisms with a point-by-point rebuttal by Dr. Evans.

Adair: "While the authors stated that the patients' occlusions rapidly equilibrated to the hyperocclusion of the crowns, I'm concerned that such a fit could lead to pain and/or TMD [temporal mandibular disorder] symptoms in some patients. Leaving restoration 'high' is not, in my opinion, good practice."

Evans (and co-authors, quoted from the study): "In this study, no child [who] re-attended their dentist following placement of a Hall PMC [preformed metal crown] [showed] signs or symptoms of occlusal dysfunction, and no child or parent reported difficulty with eating or symptoms of TMJ [temporal mandibular joint] dysfunction syndrome."

Adair: "I could not find any reference to examinations for gingival inflammation or periodontal problems in the study [as a possible result of poor marginal fit]. Again, this could be a significant issue for some patients, and does not meet current standards of care, in my opinion."

Evans: "The fact is that our clinical trial found no evidence that any of these concerns might be valid, with some of the children now in the fourth or fifth year of recall."

Adair: "Compression or stretching of the PDL [periodontal ligament] of adjacent teeth .... could lead to further periodontal problems and unwanted orthodontic tooth movement."

Evans: "The compression of the PDL is no more than most children will experience when separators are fitted prior to orthodontic band-up. The mesial of the first permanent molars were also assessed for periodontal problems which might be visible radiographically as part of the radiographic review of bitewings taken at recall visits, and again, no problems were noted."

Adair:"Follow-up examinations of the children in this study could not be done in a 'blind' manner. I found no mention of this shortcoming in the paper. Therefore, one has to consider that examiner bias was not controlled for."

Evans: "We deliberately chose to run the study .... using general dental practitioners. We felt that the advantages of testing the efficacy of the interventions in the environment where they would normally be provided outweighed the disadvantages of necessarily having to have the dentists evaluate their own restorations.However, all the radiographs from the study were separately evaluated by the study coordinators."

Adair: "While I am a proponent of minimally invasive dentistry, in my opinion the Hall Technique is 'sloppy' dentistry which may appeal to practitioners who loathe to use local anesthesia with children and/or who do not know how to properly place an SSC [stainless steel crown]."

Evans: "This is fairly typical of comments we have from specialist practitioners in the UK [United Kingdom], but not, interestingly, from general dental practitioners. I wish that every child in every country had instant, free access to specialist pediatric dental care, with inhalation sedation as standard. If that were the case, then there might be no need for the Hall Technique.

"However, this is not the case. Look at the figures from our study; 19 of the teeth restored conventionally had a pulpal event, compared with just 3 of the Hall teeth, and this was for children accessing dental care! Conventional management of primary teeth in the UK is not addressing the problem of dental sepsis in children, so we need to take a fresh look. Such a look, I suggest, might also be needed in disadvantaged communities elsewhere in the world.Just because a technique is different doesn't make it 'sloppy.'

"We're all on the same side, trying to keep children free from pain and sepsis, and manage their disease without making things worse for them. Our study needs to be repeated, of course, but the evidence from it, and from our audit of Dr. Hall's practice records, indicates that the Hall Technique can be an effective option (option, note, and not the only one!), for managing carious primary molar teeth.


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Delta Dental/AARP pay for three cleanings

Delta Dental/AARP pay for three cleanings

February 12, 2008 -- Breaking the cliché of two annual dental cleanings, AARP Dental Insurance Plans administered by Delta Dental now covers a third annual cleaning.

"Our members continue to cite dental benefits as one of their most pressing needs and areas of concern," said John Wider, vice president of Health Products and Services, AARP in a press release. "Expanding the program to deliver additional preventive services adds value for our members and supports a holistic strategy to promote overall health."

"There is increasing evidence that poor dental health is associated with several serious and chronic medical conditions, so the opportunity to provide more coverage for preventive dental care in the plan benefit design should boost the overall value of the AARP Dental Insurance program, which has proven effective and affordable for many members," said Lowell Daun, D.D.S., a senior vice president with Delta Dental.

New members will receive the added service when they sign up; existing members will get it when they renew the membership.


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Biolase's Waterlase MD Derm cleared for dermatological and general use

Biolase's Waterlase MD Derm cleared for dermatological and general use

February 11, 2008 -- A version of Biolase Technology's Waterlase MD Laser System has received 510k clearance from the U.S. Food and Drug Administration (FDA) for dermatological, general, and plastic surgery use.

"Our singular operational focus today is executing in the dental suite and building on the success of our hard and soft-tissue dental laser franchise," said Jake St. Philip, CEO of Biolase in a press release. But, he added, this FDA clearance will add value to the existing product and can lead to future partnerships and products.

The Waterlase MD Derm can be used for incision, excision, ablation, vaporization, and coagulation of dermatologic tissues. In general surgery procedures, it can be used for incision, excision, vaporization, and coagulation of soft tissue where skin incision, tissue dissection, excision of external tumors and lesions, complete or partial resection of internal organs, tumors and lesions, tissue ablation and/or vessel coagulation may be indicated.

"The company won’t be selling it (the laser) directly in the near term, but is currently looking at different options for licensing, partnerships or product development," said a Biolase representative in an email to DrBicuspid.


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BCBS of Illinois launches new dental care service

BCBS of Illinois launches new dental care service

February 11, 2008 -- Giving a nod to the oral-systemic link, Blue Cross Blue Shield of Illinois (BCBSIL) has launched a new service to help its members improve their overall health by improving their oral health.

BlueCare Dental Connection is an integrated medical-dental program that combs through members' medical and dental data and contacts those at risk for health conditions complicated by dental disease, such as diabetes, cardiovascular disease, and pregnancy via direct mailing of educational material. The service also aims to catch patients early who are at a high risk for dental caries or periodontal disease.

"This approach is designed to help users optimize their overall health by helping them make better decisions about their oral health," claims a company press release. "The goal of the BlueCare Dental Connection program ... is to help members identify potential opportunities for dental health intervention and prevention and realize the benefits to their overall health."

Member can also use the Dental Wellness Centre -- a component of the program -- to:

Ask questions from licensed dentists and get answers within 24 hours.
Find a network dentist with the "Provider Finder" feature.
Compare price range for dental procedures in a certain location by using the "Dental Cost Advisor."
Access information on topics such as pediatric care, prevention, and dental treatments etc.

"This program is both critical to maintaining our members' overall health and assisting us in reducing increasing health care costs," said Dr. Timothy Custer, dental director for Dental Network of America, in a press release. "By combining online support tools with a coordinated outreach component, BCBSIL can target members most in need of education and intervention."

BlueCare Dental Connection is available free of cost to BCBSIL members. The service is also being offered by Blue Cross Blue Shield of Texas, Blue Cross Blue Shield of New Mexico, and. Blue Cross Blue Shield of Oklahoma.


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Study links marijuana smoking to gum disease

Study links marijuana smoking to gum disease

February 7, 2008 -- WASHINGTON (Reuters) Feb. 5 Smoking marijuana, much like smoking tobacco, may increase a person's risk for gum disease that can lead to tooth loss, researchers said on Tuesday.

A study of 903 New Zealanders found that people who smoked marijuana frequently had triple the risk for severe gum disease and a 60 percent higher risk for a milder form of it compared to people who did not smoke the drug, also called cannabis.

People who smoked marijuana less frequently had a smaller increased risk for gum disease, the researchers said.

Gum or periodontal disease is an infection of the tissues surrounding and supporting the teeth. In advanced stages, the gums and bone that support the teeth can become seriously damaged and the teeth can become loose, fall out or have to be removed.

"While it has been known for a few years that tobacco smoking is bad for the periodontal (gum) tissues, no one has investigated whether any other type of smoking is also a risk factor," W. Murray Thomson, a professor of dental public health at the University of Otago in New Zealand, said by e-mail.

"We suspected we would indeed find that cannabis smoking was a risk factor, but what surprised us was the strength of the relationship," added Thomson, who led the study published in the Journal of the American Medical Association.

His team tracked a group of people in Dunedin, New Zealand, since their births in 1972 and 1973. They were age 32 when the researchers identified the "strong association" between marijuana use and gum disease.

The researchers defined heavy marijuana users as those who reported smoking it an average of 41 or more times annually between ages 18 and 32 -- almost once a week.

Many heavy marijuana users also were tobacco smokers, but the researchers said their statistical analysis showed that marijuana increased the risk for gum disease separate and apart from tobacco use.

"Cannabis smoking appears to have an effect which is not far behind that of tobacco," Thomson said.

Thomson said the study adds to the understanding of health consequences from smoking marijuana. "We already knew that it had respiratory and mental health effects on some people, but this is a totally new angle on its effects," Thomson added.

Researchers think tobacco smoking can lead to periodontal disease by interfering with immune function, inflammatory response and blood flow in the gums. Thomson said he thinks marijuana smoking may act in a similar way.

James Beck of the University of North Carolina School of Dentistry, who also worked on the study, said he hopes further research is conducted to confirm a link between marijuana and gum disease.

A U.S. group supporting legal sales and regulation of marijuana faulted the study. "I think they've raised an interesting question, but I don't think they're close to giving a meaningful answer," Marijuana Policy Project spokesman Bruce Mirken said.

Mirken called the study's definition of heavy marijuana use arbitrary and said additional factors like alcohol or other drug use may help account for the findings.

Copyright ? 2008 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


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Lead reported in imported crowns

Lead reported in imported crowns

February 28, 2008 -- Forget amalgam and fluoride. Could lead be dentistry's new bogeyman? The ADA said today that it is investigating reports of potentially dangerous levels of the element in imported crowns.

The concern stems from an investigation by WBNS-TV of Columbus, Ohio, which sent eight dental crowns from China to a certified testing facility. The facility found 210 parts of lead per million in one of them.

Is that enough lead to sicken a patient? The answer is unclear. The lead found in this crown falls within the current limit set by the Consumer Product Safety Commission of 600 parts per million for consumer products. But crowns are unlike most products regulated by the commission because they are used inside the consumer's mouth raising questions about whether they should meet a different standard. Congress is currently considering a limit of only 90 parts per million for toys.

The root of the problem, according to Bennett Napier, co-executive director of the National Association of Dental Laboratories, is that dental labs are under-regulated. Standards are too low for U.S. domestic labs, but the problem is even more severe for foreign ones.

"The FDA is inspecting less than 1 percent of the dental work coming in from overseas," Bennet told DrBicuspid.com. "We are not aware of any reported cases of domestic products contaminated with lead. However, there are four documented cases of contaminated foreign products."

For its part, the American Dental Association is taking the report "seriously," but keeping it "perspective."

"There simply isn’t enough information available to presume that the presence of lead in dental crowns or other prostheses is widespread," says the ADA Web site. "An estimated 15 to 20 percent of prostheses used in the U.S. originate in foreign labs, and an even smaller percentage originate in China."

Still, the ADA has alerted its members about the report, and announced its own investigation into the matter.

It has issued a list of questions that patients are likely to ask about dental restorations:

Do you fashion your own crowns, bridges, etc., or purchase them from a dental laboratory?
Where is the dental lab located?
Does the lab outsource crowns or bridges to a foreign country?
If the lab is in a foreign country, does it provide written documentation that it is registered with the FDA?
Does the lab provide written documentation that it uses FDA-approved materials?
Have you noticed any problems with the crowns, bridges or other items produced by this dental lab?
It had also issued a tip sheet for dentists concerned about lead contamination.


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Dentist criticized for selling supplements

Dentist criticized for selling supplements

February 27, 2008 -- As patients prescribe more and more nutritional supplements for themselves, some dentists see an opportunity. "You can improve the health and well-being of your patients and increase your revenue substantially," says Alphonse Matrone, D.M.D., a Scranton, PA., dentist.

Dr. Matrone sells his patients subscriptions to "customized" nutraceutical packages provided by Bioceutica of Newbury, MA. Dentists who sell subscriptions get a cut of at least $12 out of the $69.95 that each patient pays per month.

In addition, packages can be printed with the dentist's name and contact information. "Talk about free advertising!" says Dr. Matrone.

The nutraceuticals are "customized," because patients submit urine samples, which Bioceutica has analyzed by Metametrix Clinical Laboratory, to determine which of the company's 48 formulas is right for that patient. Most people can benefit from Bioceutica's wares, because they aren't eating healthy foods, Dr. Matrone argues. "We need something, because we're not getting it in our diet, that's for sure."

company's urinalysis provide enough information to prescribe the right supplements? When Dr. Matrone made his case at the Yankee Dental Congress 33 recently held in Boston, some dentists in the audience worried that patients might get the wrong nutrients. Others suggested that Dr. Matrone's presentation was biased because he gets paid by Bioceutica for selling the supplements. One called the presentation "an infomercial."

Interviewed separately, Jessica A. Alexander, a University of Texas, San Antonio clinical anesthesiologist who devotes most of her time to studying nutraceuticals, also expressed skepticism. "You can take the pH of someone's urine and make all sorts of statements," she says.

Bioceutica doesn't actually rely on pH, David Macallen, N.D., director of clinical operations, told DrBicuspid.com. Instead the company (which also markets its nutraceuticals directly to consumers under the name Ideal Health) measures lipid peroxides to determine antioxidant needs, sulfates to reveal liver functioning, and nitrates to examine immune functioning. These measurements are combined with age, weight, and sex to determine which formula to prescribe.

The formulas are made up mostly of vitamins and minerals, with an occasional herb, such as milk thistle, says Dr. Macallen. Although the vitamins and minerals typically exceed U.S. recommended daily allowances (sometimes by more than 10 fold), "we don't megadose," Dr. Macallen says.

If patients have any concerns, he recommends they show the formulas to their primary physician or a pharmacist and ask "is there any reason I shouldn't take this?"

Dentists should make sure their patients ask such questions, says Dr. Alexander. "They should be coordinating with the patients' primary care physicians," he says. "The number of potential drug interactions is staggeringly high."

Underlying disease conditions can pose problems as well, argued one member of Dr. Matrone's Yankee Dental Congress audience. He pointed out, for example, that some patients with thalassemia might be endangered if they took a supplement with too much iron.

Dr. Matrone responded that the Bioceutica formulas were at least better than what patients find for themselves. "It's a lot better than just buying a multivitamin package off the shelf of a health food store," says Dr. Matrone. "Our patients are already [taking supplements] on their own, and they have no idea what they're doing."

And there's a lot of money to be made. The more patients you sign up, the more the company pays you. For example, a dentist who sells subscriptions to 500 patients could bring in $114,000 a year, says Matrone.

But so far, he told DrBicuspid.com, he has only sold "30 to 50" of his own patients on the program.


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Gendex unveils new cone-beam 3D imaging system

Gendex unveils new cone-beam 3D imaging system

February 27, 2008 -- Gendex Dental Systems -- a provider of dental radiographic products -- launched the GXCB-500, a cone-beam 3D imaging system at the recently held Chicago Midwinter dental show.

Its unique ‘medium’ field-of-view allows dentists to take smaller images, focused on a specific location. For example, if you are planning implants and don’t need a full-skull view, the GXCB-500 can generate a molar-to-molar view. Powered by i-CAT, it can be used in Standard Scan mode (8 cm x 8 cm) or Extended Diameter Scan mode (14 cm x 8 cm). It is specially useful for diagnosis and treatment-planning of implants, TMJ analysis, and small oral surgery procedures

The GXCB-500's decreased field-of-view makes it more affordable to dentists, and also reduces radiation exposure for the patient, Jackie Poole, media relations manager for Gendex told DrBicuspid.com. It also has the fastest scan and reconstruction rates in the industry (8.9 seconds and 20 seconds, respectively) according to the company, and can also be used for digital panoramic imaging to capture 2-D data.

"We are very excited to take our x-ray products to a new dimension with this cone-beam 3D imaging system," said Gendex vice president of marketing Stanzi Prellin a press release. "The GXCB-500 demonstrates our commitment to offer innovative, high-quality solutions in imaging equipment that enhance the diagnostic capabilities, shorten treatment planning time, and boost surgical success of dental practitioners around the world."

The system costs $129,000 and will be available nationwide in April 2008 through select dental distributors.

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Former Biolase managers launch new company

Former Biolase managers launch new company

February 26, 2008 -- Two former members of Biolase Technology's management have formed a new company called Technology4Medicine, which offers a range of laser products and related technology.

The company has a dental lasers (Lasers4Dentistry) division, and a laser therapy (Technology4Therapy) division.

"While developing the dental laser industry and growing Biolase from approximately $1 million to $70 million in sales...we gained extensive experience... [in] the needs of the dental community," said Jeffrey W. Jones, Technology Medicine CEO in a press release.

"Over the coming weeks and months Technology4Medicine will be introducing a broad range of advanced technology and laser based products focused on enhancing efficiency, the quality of clinical care, the patient experience and the bottom line of dental practices," said Keith G. Bateman, Technology4Medicine president in the same release.

Jeffrey W. Jones is the former president and CEO of Biolase, and Keith G. Bateman is a former Biolase executive vice president


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The 'Four Seasons' practice

The 'Four Seasons' practice

February 25, 2008 -- A rippling waterfall. A soothing foot massage. The scent of lavender wafting in the air. Not what you'd ordinarily expect from a trip to the dentist, even in a tourist mecca like Honolulu. And at Dr. Wynn Okuda's Dental Day Spa, that's the whole point.

"People come to us looking for something different," says Dr. Okuda, an accredited cosmetic dentist and past president of the American Academy of Cosmetic Dentistry (AACD). "We tend to attract patients who want to create a positive experience for themselves, rather than simply going to the dentist because they have to."

Dr. Okuda's motivation for creating a dental spa was as much personal as professional. As a child, he was terrified of his dentist. "I still remember the smell of cigars on his fingers and the lack of anesthetic," he says. Even worse, his dentist lived right next door. "There was nowhere to run and hide. I didn't even have the opportunity to be pried out of a car. My mother would simply drag me through the hedges and up five stairs to his office."

In 2000 Dr. Okuda decided to do something about it. "At that point in my career I realized I could help heal my own fears and anxieties about dentistry by helping to heal those of others," he says. "A lot of what the spa environment does is help counter the negatives of dentistry."

Although it's the rare practice that reaches the opulence of Dr. Okuda's, "spa" dentistry isn't a new concept. A 2004 survey by the American Dental Association found that half of all dentists now offer some kind of extras -- such as headphones, warm towels, or complimentary snacks -- while about 5 percent go the beauty salon route with massages, facials, and manicures.

percentage of practices offer so-called "concierge" service, skipping the frilly amenities but offering enhanced services -- such as 24/7 access to a doctor or same-day appointments for routine procedures -- to patients willing to pay a premium.

"The key difference between concierge and spa practices is access," says Dr. Cameron Jayson, chair of the Minnesota Dental Association’s Dental Marketplace Committee and a general dentist in Virginia, Minnesota. "Spa care doesn't improve a patient's access, it just adds whistles and bells. Concierge service gets doctors on the phone faster and patients in the office faster."

Why do practices do it? At minimum, it's a market differentiator - a way to show the world that your practice stands out above the rest, says Dr. David Landau, who operates Complete Dental Health in San Diego.

"It's all about the marketplace," says Dr. Landau. "Because dentistry isn't debilitatingly expensive, it's possible to pull off a high-end practice that mimics the service and feel of the Ritz Carlton or the Four Seasons."

With the right systems in place, it can also be a real money maker, says Dr. Roger P. Levin, CEO and president of Levin Group, a national practice management consultancy with offices in Arizona and Maryland.

But running a "Four Seasons" style dental practice is a riskier and more costly proposition. Hiring and training good personnel is much more difficult, and the return on investment isn't guaranteed. Sometimes going upscale can even backfire.

Atmospheric Effects

Before you can turn your House of Pain into a Palace of Pleasure, your office must look the part. For Dr. Kourosh Maddahi of Beverly Hills, that meant a floor-to-ceiling remodel. With its elegantly tiled floors, arched entries, high ceilings, and a wall lined with paintings, Dr. Maddahi's office looks more like a modern art gallery than an operatory.

"In 2000 we got rid of everything that looked or smelled like a dentist's office," says Dr. Maddahi. "We don't have before and after pictures of people's smiles on the walls, we have art. I didn't hire planners and designers who designed dental offices. I wanted my office to look like a custom home."

Similarly, Dr. Okuda uses a lot of interior real estate to help negate the invasion of personal space dentistry usually entails. His main operatory is twice the size of a typical one. The halls are wider, the ceilings higher. As a result, Dr. Okuda says many first-time patients mistake his offices for a restaurant or the lobby of a four-star hotel.

(Dr. Okuda and Dr. Maddahi declined to reveal how much they spent on remodeling their offices; another dentist who asked to remain anonymous estimates the cost of a complete spa makeover between $500,000 and $1 million.)

But the spa experience can't end when the patient travels from waiting room to dental chair or it's all for naught, says Dr. Maddahi. His practice offers exotic tea service, in-chair massage, personal movie glasses, and a limo service for out-of-town patients. Dr. Okuda's practice offers all of those amenities plus facials and aromatherapy.

Sometimes just a warm blanket and cookies will do quite nicely, especially if you practice in Farmington, Minnesota, like Dr. Kimberly Harms of River Edge Dental.

"We don't have a lot of limos in Farmington," says Dr. Harms, who's also a consumer advisor for the ADA. "The extras dentists offer depend a lot on where they live and the character of their community. If limos and massages are what it takes to make your patients feel comfortable, that's just fine."

Often it's the little things that make the difference. The most popular extras in Dr. Kent Smith's Dallas-area practice, 21st Century Dental, are the milk shakes he offers patients after they've undergone long procedures. For San Diego-based Dr. Landau, it's the Sony Playstation in the reception area and the diaper changing table in the bathroom.

"That was my partner Tim Collins' brainstorm," says Dr. Landau. "We get compliments on it all the time. It's the kind of thing that gets noticed."

Pick Your Patients

But the spa approach can sometimes backfire. Some patients don't go for the full-service treatment. Type A business people want to get in, get drilled, and get out, says Dr. Smith, who sees a lot of multitasking business people who work in high-tech hubs like Dallas. So you need to adjust your service offerings accordingly.

"I had a patient walk in yesterday with his laptop open in his arms while he was walking and talking on his cell phone," he says. "We put him in an operatory, he put his cell on speaker and was having a conversation while my assistant applied a topical anesthetic. We have some very time-conscious patients who rarely want to be sedated in any way, emotionally or physically. With a spa-style practice, you might lose that segment of the population."

Speed of service is very important, agrees Dr. Maddahi, who uses electric handpieces that can cut teeth more quickly, speeding up procedures by 20 percent. "If you just offer amenities -- and the quality and speed of service aren't there -- your patients will complain." Or go elsewhere.

Some amenities just plain flop. Dr. Smith says he put in a tanning booth in the mid 90s to attract walk-in customers, but took it out a couple of years later because it wasn't conducive to promoting good health. Paraffin wax treatments have fallen out of favor with some practices because of the time involved in providing them. And some patients get spoiled, which can backfire if you stop providing services they've grown accustomed to.

"One week we didn't make it to Costco to resupply the fresh muffins and cookies we serve in the reception area," says Dr. Landau. "One of our regular patients came in and said 'This is like a third-world practice ' where are the muffins and cookies?'"

Assess Your Market

Some geographical areas simply won't support a spa practice, no matter how well it's executed.

"Spa practices appeal to a particular market segment," says Dr. Levin. "You can't just put them anywhere, just like Ritz Carlton can't build a hotel just anywhere and expect it to be successful."

Dr. Levin advises dentists interested in opening a spa practice perform a careful demographic assessment of their market. Not surprisingly, the ideal spa practice caters to patients who are slightly older (age 40+), stable (families with children), have upper middle class incomes, high home values, and live in an area where the population is on a growth curve, such as San Diego and Charlotte, NC.

Dr. Levin suggests dentists consult the local chamber of commerce and talk to realtors in the area. "One of the best ways to get useful demographic and psychographic market research is by talking to real estate agents," he says. "They have this information at their fingertips."

Good Help?

Here's another downside: Operating a concierge practice makes finding good assistants, hygienists, and front office personnel harder than ever. Dr. Maddahi says he hires one person for every 80 who apply. And when you do find them, you'll probably have to pay them more. Success in spa dentistry is less about paraffin wax treatments and smoothies, and more about attitude.

"We wasted a lot of time trying to take experienced hygienists and office staff and turn them into people with the right service mentality," says Dr. Landau. "Now we hire for personality, verbal skills, and personal presentation, and hopefully train them in the rest."

Dr. Okuda agrees.

"I don't hire for experience anymore, I hire for attitude," says Dr. Okuda. "You can't train someone to be nice or helpful - they're either born with it or they're not. I'd rather take someone with the right attitude who has no experience and train them to be a dental assistant."

Hiring friendly people isn't enough. You must train them in the basics of customer service and make sure they have the proper mindset.

"Creating a total patient experience goes way beyond being nice, smiling, and shaking hands," says Dr. Levin. "Your staff will need training in additional skill sets, such as communication and internal marketing. And they'll want to be compensated for it." He advises practices use bonuses to reward staff instead of higher salaries, to minimize fixed costs.

Such training should be ongoing, not just a one-time event.

"One day I took my staff to the Ritz Carlton for lunch," says Dr. Landau, who closes his office at least one day every quarter for staff training. "I wanted them to see what first-class service really looks like. Every person in the hotel - every waiter, every busboy, even the house cleaners - stops, looks you in the eye, and says hello. You don't get that kind of attention at your average mid-level Marriott. Or when you're shopping at Nordstrom and you pay for something, the cashier steps out from behind the register and hands it to you, face to face. We try to teach our staff that it's the extra warm fuzzies that make the difference."

Show Me the Money

Remodeling offices, renting limos and masseuses, and retaining talented office staff all cost money. Dr. Levin estimates a spa-style practice spends from 15 to 18 percent more than a traditional one on offices, personnel, and amenities.

The return on investment can be even greater - from 25 to 100 percent higher than normal, Dr. Levin says. But, he cautions, the risk of failure is also higher. Dentists must first have all their systems in place - from scheduling to insurance management to budgeting - and their staff adequately trained.

"Nobody's doing this out of the goodness of their heart," says Dr. Levin. "There are many reasons dentists want to pursue spa dentistry. They may determine this is their growth path or they're doing it to gain a competitive advantage for their practice. We work with our clients to ensure they do the right planning to help them make an excellent return on investment."

If you've got a rock star practice in Hawaii or LA, you might get away with recouping your costs by charging higher overall fees. But most dentists are limited by what the market will bear. Dr. Landau says most patients will notice the better care you provide and be willing to put up with slightly higher (say 20 percent higher) fees.

"The bottom line is that most people will pay more to be taken well care of," says Dr. Landau. "Even if they don't have the money now, they'll save up so they pay to be taken care of later."

The good news is that the trend toward concierge dentistry means patients are probably getting better care overall.

"If patients are more likely to have dental work because they like going to the dentist, they're more likely to get the preventative care they need," says Dr. Kimberly Harms of River Edge Dental. "Bottom line is making sure people are getting good care."

Even if you never plan to hire an office masseuse or give patients a hot wax, upscale dentistry is changing the expectations of many patients. Dentists who don't adjust their practices accordingly will pay the consequences.

"Whether you provide spa service or not, it's pressured the industry to become more service oriented, to treat not just the teeth but also the people attached to them," says Dr. Okuda.


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ADEA to Senate: Show us the money!

ADEA to Senate: Show us the money!

February 22, 2008 -- Dental schools can't afford to hire professors, students can't afford to serve the poor, and millions of Americans do not have access to dental care, American Dental Education Association (ADEA) president James Q. Swift D.D.S. told a Senate Committee last week.

He asked the Senate Committee on Health, Education, Labor, and Pensions for millions of dollars. His comments came at a hearing for the reauthorization of Title VII of the Public Health Service Act, which funds programs for dentistry training and student diversity.

Last year there were 406 vacant faculty positions at U.S. dental schools, Dr. Swift told the committee. The shortage of dental faculty can become a serious problem as more schools open. Recently Arizona, Nevada, and Florida have opened dental schools, while plans are underway in California, North Carolina, and New Mexico.

"Profound disparities in the oral health of the nation’s population have resulted in a ‘silent epidemic'," says Dr. Swift. "These disparities, in combination with the current shortage of dental school faculty, the scarcity of underrepresented minority dentists, and the need to draw dentists to practice in rural and underserved communities, make this committee’s examination timely and necessary. "

He also called for the restoration of nearly $50 million recently cut from low-interest health student loan programs, and an increase in the aggregate unsubsidized Stafford Loan limits so dental students are not forced into taking more expensive options like GradPLUS or private loans.

"[Because of] the staggering debt new dentists have upon graduating, many seek practice opportunities in relatively affluent areas where they are likely to earn higher salaries," says Dr. Swift. "This cycle has repeated itself year after year leaving underserved areas chronically understaffed."

Dr. Swift asked the committee to pass Deamonte’s Law which would mean $5 million in grants to support training for dental students, dental residents, and dental hygiene students in oral healthcare to children.

He also pushed the senators to include dentistry in three Title VII programs for which dental institutions are currently ineligible -- the Academic Administrative Units in Primary Care, Faculty Development in Primary Care, and Predoctoral Training Programs. Finally he encouraged the Senate to fund more dentistry for the poor.

"We must acknowledge that the current dental workforce is unable to meet present day demand and need for dental care," says Dr. Swift.

For a full list of his recommendations click here and scroll down to page nine in the PDF, to the heading "Recommendations to Address Dental Workforce Challenges."


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Aribex releases new handheld x-ray unit

Aribex releases new handheld x-ray unit

February 21, 2008 -- Aribex, a producer of handheld X-ray products, has unveiled its latest offering -- the Nomad Pro.

As with earlier Nomad models, the unit is fully mobile, so the operator can stand next to the patient to take a radiograph. It features both internal radiation shielding and external backscatter shielding to protect the operator.

What sets the new Nomad Pro apart, the company says, are its color LCD screen, touch controls, preset exposure settings, and other modifications intended to save time. This will especially benefit children, sedated patients, or special needs patients, Aribex claims.

"The Nomad has forever changed the way that dental radiography is performed by allowing an operator to safely stay in the room during a dental x-ray procedure," said Dr. D. Clark Turner, president and CEO of Aribex, in a press release.

The Nomad Pro also boasts a sleeker design and weighs 5.5 lb. Fully charged, it has enough battery life for a few hundred radiographs and works with all digital sensors, standard films, and phosphor plates, the company said.

Launched this week at the Chicago Dental Society Midwinter Meeting, the Nomad Pro is available for purchase by U.S. customers for $7,465.


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Are supplements endangering your patients?

February 20, 2008 -- A new patient comes to you needing a tooth extraction. As always, you ask," are you on any medications?" The patient says, "no." You pull the tooth and the next thing you know, the patient is rushing to the emergency room with bleeding that just won't stop.


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What complicated this fairly simple procedure? Nutraceuticals.

Increasingly patients are treating themselves with nutraceuticals (used here to include herbs, vitamins, minerals, and other dietary supplements) under the mistaken belief that what's packaged as "natural" can't possibly do harm. "Only around 40 percent of patients will tell their health care practitioners what [nutraceuticals] they're on," says Jessica A. Alexander, M.D., a University of Texas, San Antonio clinical anesthesiologist who devotes most of her time to studying these substances.

In some cases, such alternative treatments may benefit patients' oral health. But they can also pose serious complications for dental procedures. Some prolong bleeding, others increase the risk of cardiovascular events, potentiate anesthetics, affect blood sugar regulation, or interact with a wide range of other medications.

The market for vitamins and minerals is growing at a rate of about 4 percent per year, according to Karen A. Baker, M.S., R.Ph., an associate professor in both dentistry and pharmacy at the University of Iowa, while "specialty supplements" such as fish oil and probiotics, are growing at 13 percent per year, she says. Already Americans are spending tens of billions on such substances, even though the health effects are often poorly understood.

"You should ask specific questions about supplements," Baker told an audience at the Yankee Dental Congress 33 recently held in Boston.

Querying patients

Getting patients to talk about their herbs and supplements isn’t always easy, though. Many won't understand the connection to dentistry. "It's like when you ask if people are taking birth control pills," says Baker.

When Baker has trouble getting patients to talk about the supplements they take, she hands them a copy of Dr. Alexander's brochure for patients, "What You Should Know About Herbal and Dietary Supplement Use and Anesthesia," published by the American Society of Anesthesiologists(ASA).The society can provide brochures for your patients, and a more technical version for physicians. Dr. Alexander is working on updates for both.

Beware these nutraceuticals
Almost any substance taken in large enough amounts can have important effects on a patient's health -- and so pose problems in the dental chair. No article can address all the possibilities. Instead, here are a few of the most commonly used nutraceuticals and the potential effects on dental care.

Kava -- used for sedation and anxiolysis -- may increase the sedative effects of barbiturates, benzodiazepines, and alcohol. Baker warns that it is also on her "dirty dozen list" because it can cause liver failure.

Valerian, likewise used for sedation, may potentiate barbiturate effects and decrease symptoms of benzodiazepine withdrawal.

Echinacea, which stimulates cell-mediated immunity, is blamed for allergic reactions ("it's ragweed," says Baker). It may also decrease the effectiveness of immunosuppressants, and also cause immunosuppression itself if used long term.

St. John's wort, used for mood disorders, may interfere with benzodiazepines, midazolam, methadone, and other anesthetics; heart medications such as digoxin and calcium channel blockers; and other drugs.

Milk thistle, which Dr. Alexander says was the top selling herb for 2007, is used in treatment of liver disease. Researchers suspect that it interacts with drugs, including lorezepam and estrogen. It may lower blood sugar.

Ginseng, in addition to its effects on bleeding, may cause cardiovascular instability and interact with calcium channel blockers and digoxin. It may antagonize morphine-induced analgesics and interact with oxycodone and fentanyl.

Cranberries, a common treatment for urinary tract infections and preventative for E. coli infections, is frequently taken in juice cocktails high in acid and sugar. It may interact with warfarin and enhance renal elimination of drugs. It’s contraindicated in patients with a history of calcium stones.

Saw palmetto, used for benign prostate hyperplasia (BPH), may lead to cardiovascular instability, including heart attacks.

Black cohosh, used for menopausal symptoms, has been linked to tachycardia, bradycardia, hypotension, and liver toxicity in addition to prolonged bleeding.

Chondroitin, used (generally with glucosamine) for arthritis, may trigger allergies to shellfish or iodine, may interact with anesthetics and cyclosporine as well as other medications.

Coenzyme Q10, in addition to prolonging bleeding, may also decrease blood pressure and blood sugar, and alter thyroid hormone levels.

Vitamin C, in high doses, may increase the adverse effects of aspirin and acetaminophen. It has been associated with kidney stones, severe diarrhea, nausea, and gastritis.

Calcium, in high doses, may cause kidney problems and potentiate digoxin toxicity.

Dirty dozen. Besides kava, Baker listed 11 other supplements "no one should take," not because of their specific relationship to dentistry, but because of other dangerous effects: aristolochic acid, comfrey, androstenedione, chaparral, germander, bitter orange, extracts from animal organs or glands, lobelia, pennyroyal oil, skullcap, and yohimbe.

Patients often assume that dietary supplements have to comply with the same regulations as pharmaceuticals. In fact, they don’t come under the FDA's scrutiny unless the company selling the nutraceutical claims it will affect a disease.

If patients do take supplements, Baker recommends asking if these regularly include Echinacea, garlic, ginger, ginseng, kava, St. John's wort, valerian, vitamin E, or fish oil. The list corresponds to one featured in a 2001 article from the Journal of the American Medical Association (JAMA) that describes the risks each of these herbs can pose and how long before surgery they should be discontinued.

It's worth noting, however, that fads in neutraceuticals change rapidly. Dr. Alexander suggests frequently updating patient histories, with particular attention paid to the question of nutraceuticals, asking the patient, "I see you didn't check the box next to dietary supplements? Are you sure you don't use any vitamins, minerals, or herbs -- chopped, whole, in teas or tinctures?" The key is to help patients think of everything they consume regularly that might seriously affect dental procedures.

So what should you do if a patient's nutraceutical might pose a problem? "Prudence suggests discontinuation two weeks prior to any elective procedures," says Dr. Alexander.

Of course, this rather broad recommendation was formed for anesthesiologists and may not apply to patients who are just coming to you for a routine cleaning. "You have to take each case on an individual basis," acknowledges Dr. Alexander. "You’re not going to be able to tell all your patients to get off all these things for two weeks."

As a fall back, dentists can do some monitoring. Baker recommends using a blood pressure cuff (not a finger clamp) for all patients, such as one made by Omron. Dr. Alexander recommends investing in a thromboelastrogram, a machine that can measure the clotting potential of blood, and using it whenever you are concerned about the effects a nutraceutical or other drug might have on bleeding.

Bleeding

Although prolonged bleeding isn't the only effect -- or the most serious one -- that nutraceuticals can have (see sidebar), it may be the most common. Baker was recently called in to consult on the case of a retired dentist whose gums kept bleeding. The problem was that he was combining aspirin with ginkgo biloba, both of which inhibit platelet aggregation.

Ginkgo biloba is the supplement "that causes the largest number of post operative cases of bleeding in dentistry," says Baker. "People take it but they forget to tell you. So it's going to be something that comes up in your practice."

But other supplements can also increase bleeding when taken in sufficient doses, among them black cohosh, feverfew, panax ginseng, fish oil, evening primrose oil, garlic, ginger, licorice (but not anise), poplar (which contains salicylates), sweet clover (which contains courmarin), coenzyme Q10, chondroitin, St. John’s wort, soy, calcium, and vitamin E.

On the other hand, other supplements, such as alfalfa, may actually promote coagulation. In fact, it's worth mentioning to any patients taking alfalfa that it might inactivate warfarin, a drug used to prevent blood clots in some heart patients. (Soy -- despite having anticoagulant effects of its own -- may also interfere with warfarin metabolism.)

Dental products pro and con

Concerned about synthetic ingredients in dental products, many patients are looking for alternatives. That has created a market for companies selling "natural" versions that are of dubious value. Among those ingredients without good scientific evidence for their effectiveness are loturbark, myrrh, neem, tulsi, peelu and propolis, Baker says.

Some oral care ingredients can be harmful, says Baker. For example, vitamin C, whatever its benefits in food, doesn't belong in toothpaste, she says. "What you get is acid demineralization. Vitamin C's 2.7 pH is about like that of Coca-Cola."

Other supplements that have benefits when taken orally -- such as coenzyme Q10 and antioxidants in general -- are just a waste of money because they don’t work topically, says Baker.

Baker also listed a handful of alternative oral care ingredients with potential benefits:

Melaleuca (tea tree oil) does seem to have some antimicrobial effects.
Essential oils can reduce bleeding.
Green tea extract might have mild anti-inflammatory and anti-bacterial effects.
Aloe vera may enhance the healing of oral ulcerations (though it probably won’t help with gingivitis.)
The labels on some "natural" products boast about the things they don’t have. On the top of the list of unwanted ingredients is sodium lauryl sulfate. This common foaming agent in toothpaste may cause canker sores (regardless of the fact that it's made from "natural" coconut oil).

But it's hard to avoid, even in many alternative toothpaste brands such as Tom's of Maine. Baker came up with a short list of toothpastes that are truly free of sodium lauryl sulfate: Biotene, CloSYS (which also doesn't contain fluoride), Rembrandt, Squigle, TheraBreath and Sensodyne ProNamel. But read the labels closely since some of these brands also make products with sodium lauryl sulfate.

What to recommend

While some patients may not want to talk about their supplements, others may ask your advice. When that happens, says Baker, "Don't scoff. Stay involved and direct them toward some of the more rational products." After all, it's just as nonsensical to say that all herbs and supplements are bad as it is to say that all of them are good.

The supplement Baker endorses most enthusiastically is fish oil, which she says at a dosage of one to four grams per day can "reduce trigycerides 20 percent to 50 percent." (The product should include a combined EPA/DHA total of 1,000 milligrams per day.) Fish oil may also reduce symptoms of attention deficit-hyperactivity disorder (ADHD) and bipolar disorder.

It can increase bleeding as well. But "the biggest problem is the burping," says Baker. "You're working face to face people and you don't want to have that happen." To combat the burping, tell patients to refrigerate or freeze their fish oil before taking it.

The lactobacillus bacterium is likely effective for rotaviral diarrhea and -- of particular note to dentists -- antibiotic-associated diarrhea, Baker says. (In case anyone asks, she adds, yogurt every day can reduce risk of vaginal infections -- eaten, not applied vaginally.) When shopping for lactobacillus, Baker points out, the organism has to arrive alive, otherwise "you're just swallowing millions of carcasses." One way to find products with verified live cultures is to consult Consumer Lab.

Baker also endorsed B vitamins for cardiac disease, glucosamine for arthritis (including TMJ arthritis), and zinc for the common cold. Tumeric "looks like a pretty good anti-inflammatory" while melatonin may stop cluster headaches.

Dentists should also know about capsaicin, the active ingredient in hot peppers, which, surprisingly, can be an effective treatment for burning mouth or burning tongue.

If these - or any other nutraceuticals - cause a problem for one of your patients, you can help protect others by reporting it to the FDA.


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