Dental Practice Employment Law Update: After Measure 91, is Marijuana Just Another Legal Drug?

April 6th, 2015

By Randall Sutton, Saalfeld Griggs PC

Reliable and productive staff is the backbone of every dental practice. It is well known that substance abuse problems can interfere with work. Unreliable attendance, lack of focus, and poor decision making are common outcomes of staff substance abuse. For these reasons, many dental practices find it critical to maintain a drug-free workplace.

With that in mind, it should come as no surprise that the legalization of marijuana for recreational use poses new challenges for dental employers. If the experiences of Colorado and Washington are any indication, Oregon is likely to see a significant increase in the number of employees testing positive for marijuana.  In the year following legalization in both states, positive tests increased by over 20% according to a recent study by a national testing lab.  Moreover, the decriminalization of marijuana and resulting drop in prices, combined with tightened controls on prescription drugs, has led to a surge in the manufacture and importation of heroin into the United States from Mexico.  Given the level of dependability, skill and professionalism required of dental staff, these developments make an enforceable drug and alcohol policy and testing program more important than ever.

The recent change in the law has also brought changes to perceptions and expectations about marijuana use, particularly on the question of whether the drug should be subject to looser regulation by Oregon employers. As of July 1 of this year, marijuana will join alcohol as the only legal intoxicants that can be used recreationally. Given the significant change in the you’re your staff may erroneously anticipate that marijuana use will be treated the same as alcohol use. Under Oregon law, a dental practice cannot test for alcohol use unless a trained individual determines that the staff member is presently (and visibly) under the influence. Similarly, staff may believe that after July 1, 2015, they may use recreational marijuana away from work so long as they do not appear to be under its influence while at work.

However, testing protocols and Oregon employment laws treat marijuana very differently than alcohol, and the new law allowing recreational use does nothing to change that.  Marijuana is fairly unique among the drugs typically included in an employment-related test panel.  Unlike other drugs, which leave one’s system in a matter of hours or days, THC (the active ingredient in marijuana) is stored in fat cells in the body and tests may be positive even weeks or months after the staff member’s last use.  Second-hand smoke can also trigger positive results, but testing cutoff protocols are intended to screen out results that arise solely from spending time around pot-smoking friends or colleagues.  In any event, marijuana is unlike alcohol because there is no recognized test to determine whether your staff member is presently impaired by marijuana.

Not only are testing protocols different for alcohol and marijuana use, but Oregon laws treat them differently—even after legalization of recreational marijuana. Since Prohibition ended in the 1930s, alcohol has been legal at the federal level.  In contrast, marijuana continues to be illegal under federal law.  For employers, this distinction is critical.  Given that federal law continues to identify marijuana as a Schedule I controlled substance with no accepted medical use, the Oregon Supreme Court held in a 2010 decision that Oregon employers can enforce zero tolerance policies, even against authorized medical marijuana users. Measure 91 does little to change that holding, as the new law specifically does not “amend or affect in any way any state or federal law pertaining to employment matters.”

In other words, Measure 91 does not require that you abandon zero tolerance drug and alcohol policies or make significant changes to testing protocols. But, in light of changing perceptions about the drug, we recommend that our dental clients update their policies to address the issue of recreational marijuana use and make it clear that the drug is still illegal under federal law and prohibited under the practice’s drug and alcohol policy.

This is also a good time to ensure that your drug and alcohol policy strictly complies with the myriad of complex drug testing legal requirements.  In Oregon, there are restrictive regulations governing whether or not a termination resulting from a positive drug test affects the staff member’s ability to collect unemployment benefits, and it can be challenging to win unemployment appeals if the practice’s policy is not sound and all regulations are not followed. For these reasons, dental practices should work with employment counsel to review and update their drug and alcohol policies before recreational marijuana is decriminalized on July 1st.

 

Randall Sutton_Saalfeld GriggsSaalfeld Griggs PC is a law firm serving dental practices throughout Oregon and Washington. Randall Sutton is the partner in charge of the firm’s Employment Law and Litigation Practice Group.  He advises dentists on a wide variety of employment matters and represents dental practices in litigation.  www.sglaw.com

Addiction

February 2nd, 2015

By Mark M. Storer, DDS

The terms “substance abuse” and “addiction” have always had negative connotations, and most people associate these terms with a moral failing or weakness. It is very difficult for people unaffected by  addiction to view the entire process as a disease.

The AMA first classified addiction as a disease in 1953.  It is defined as “ a primary, chronic, and neurobiological  disease with genetic, psycho-social, and environmental factors influencing its development”.  Addiction is characterized by impaired control over drug use, continued use despite harm, and craving the use of the drug when unavailable.

Dentists should be concerned about addiction because there are alarming statistics that show a tremendous increase in the amount of drugs, including alcohol, that are being abused by the general population:

  • the most widely abused drugs are oxycodone, valium, xanax, and adderall; opioids, CNS depressants, and CNS stimulants
  • non-medical use of prescription drugs occurs by seven million Americans per month, which is greater than the number abusing cocaine, heroin, hallucinogens, and inhalants
  • the number of drug overdoses from prescription narcotics has exceeded deaths from heroin or cocaine overdoses.
  • drug overdoses have become the ninth leading cause of death in the United States, exceeding the number of deaths caused by auto accidents.
  • adults between the ages of 18 and 25 years make up the highest percentage of non medical use of prescription drugs.

With these statistics in mind, it becomes evident that as dentists, we are very likely to treat patients who are abusing drugs, have employees with substance abuse issues, or deal directly with addiction through our own abuse, or that of a family member or friend.

 

StorerDr. Storer, a 1976 graduate of the University of Notre Dame, obtained his Doctorate of Dental Surgery from Loyola University in 1980.  Upon graduation, he completed a Residency Program in Hospital Dentistry at Illinois Masonic Medical Center in 1981. Dr. Storer was an Assistant Clinical Professor in the Department of Oral Diagnosis at Loyola University School of Dentistry, and for the past 32 years has been a member of the Attending  Medical  Staff at Resurrection Medical Center, where he is currently the Chairman of the Department Dental Services and a member of both  the Credentials and the Bylaws Committees. Dr. Storer is also a clinical instructor and attending dentist in the Residency Program of Emergency Medicine at Resurrection, and is a guest lecturer for the Department of  Family Practice. Dr. Storer and his wife Katie have five children, Jeanette, Tim, Chris, Courtney, and Corey, and they reside in Wilmette‘ Illinois.

Global Diagnosis In Dentistry

January 12th, 2015

By William Robbins, DDS, MA

With the increased emphasis on interdisciplinary treatment in recent years, the deficiencies associated with traditional methods of diagnosis and treatment planning have become more evident and problematic. Many years ago when I was in dental school, I learned to gather a lot of information about the patient and then sit down and make a treatment plan. Dentistry was much simpler in those days. In a complex patient, the treatment plan was primarily dictated by information provided by study casts which were mounted on a sophisticated articulator in centric relation. At that time in history, the primary tools available for treating the complex restorative patient were functional crown lengthening surgery and increasing the vertical dimension of occlusion. The treatment plan was simply based on restorative space, anterior tooth coupling and resistance and retention form of the final preparations, with no focus on placing the teeth in the correct position in the face.  Practitioners did not have access to advanced periodontal, orthodontic, orthognathic surgery and plastic surgery tools that are currently available. With the advent and common usage of these new treatment modalities, the historical method of diagnosis and treatment planning is no longer adequately serving our profession. This style of treatment planning is only effective when prescribing single tooth dentistry. When the case becomes more complex, the old style of treatment planning doesn’t tell the dentist where the teeth and supporting structures fit into the patient’s face.

Global Diagnosis is a treatment planning strategy that guides the dentist through the process of diagnosing and sequencing an interdisciplinary treatment plan. It provides a systematic approach to diagnosis and treatment planning the complex interdisciplinary dental patient with a common language that may be used by the orthodontist, periodontist, and oral and maxillofacial surgeon, as well as the restorative dentist.

 

Robbins photoDr.  Robbins maintains a full-time private practice and is Clinical Professor in the Department of Comprehensive Dentistry at the University of Texas Health Science Center at San Antonio Dental School.  He graduated from the University of Tennessee Dental School in 1973.  He completed a rotating internship at the Veterans Administration Hospital in Leavenworth, Kansas and a 2-year General Practice Residency at the V.A. Hospital in San Diego, California.  Dr. Robbins has published over 80 articles, abstracts, and chapters on a wide range of dental subjects. He coauthored a textbook, Fundamentals of Operative Dentistry – A Contemporary Approach.  He is a diplomat of the Federal Services Board of General Dentistry and the American Board of General Dentistry. He is past president of the American Board of General Dentistry, the Academy of Operative Dentistry, the Southwest Academy of Restorative Dentistry, and is currently president of the American Academy of Restorative Dentistry.

Why don’t all my fans see all my posts in their newsfeed?

December 15th, 2014

Facebook phoneBy Edward J. Zuckerberg, D.D.S.

 

If you are like most Facebook business page owners, you are probably wondering why not all of your posts reach everyone who has subscribed to your page, especially if you were one of the first to build a Facebook page for your business back in 2008 when the feature first rolled out.  Back then, Facebook had just reached the 100 million user milestone and businesses were just starting to develop pages.  Contrast that with 1.3 billion individual users today and 30 million business pages.  30 million may not seem like a lot compared to the number of individual users, but when you consider that most businesses post more often than individual users and use tools available only to businesses to increase newsfeed penetration, the number is significant.  The net result is that competition for the limited space at the top of the newsfeed is ever increasing.  The newsfeed is the heart of Facebook’s product offering.  It’s the default screen that users see when they first log in to the site and it’s the place where users get the personalized information that keeps them glued to the site an average of 20 minutes a day, and for many, an hour or more each day.  It is in Facebook’s best interest to have the content here be of high value and interest to the user to sustain them on the site longer, generate more page views, clicks on ads and links and generally create more value for advertisers that allows them to charge higher ad rates.

So how do they make the experience the best it can be for their users?  The key is their algorithm to determine the popularity or value of each post to the users.  The formula favors posts that have generated a lot of engagement.  This is measurable whenever a post gets a like, comment or share, or a link in the post is clicked on.  The more measurable engagement, the higher the score a post gets and the higher the likelihood that the post will viewable in the newsfeed among fans in the case of a business post, or among friends in the case of a personal profile post.  In addition friend statuses are divided further into categories such as close friends and family which naturally score higher.  Also, any individuals and businesses which a user has engaged with in the past will be assumed to have a special interest to the user that will allow those posts to score higher as well.  Lastly, only businesses are allowed to pay to increase newsfeed penetration of their posts.  The two most popular methods are to directly boost a particular post which will allow a business to gain increased views of a post that they believe to be valuable to gain a large reach, or to create a sponsored post which can be used to reach the newsfeeds not only of existing fans, but also to prospective new clients who might be personal friends of existing fans or who might fall into some demographic that Facebook has allowed the business to use to target audiences for their messages.

The bottom line is that in order for your posts to reach as high a percentage as possible of your target audience, you need valuable content that your users will engage with and a budget to boost your messages to compete with the ever increasing numbers of businesses that are utilizing Social Media Marketing in an effort to reach their audiences.

 

ZuckerbergDr. Zuckerberg maintains two facebook pages: Facebook.com/painlesssocialmedia to support other Dental Offices and small businesses in their social media marketing efforts and facebook.com/painlessdrz for the patients of his Dental Practice.

Using Attachments in Dental Treatment Planning

November 14th, 2014

By George Bambara, DMD, MS, FACD, FICD

Before I discuss how using dental attachments allowed me to enhance my treatment planning skills, I would like to give credit to one of my dental school professors who recently passed away, Dr William Cinotti; a man and a friend who knew no boundaries and who contributed greatly to my professional development.

Using attachments in dental treatment planning simply requires a knowledge of how attachments are designed to allow the prostheses to move in certain directions, if not all directions. Using attachments does not change how we fabricate our crown and bridge, partial dentures, overdenture and segmented fixed bridgework. We continue to follow all the steps that lead us to creating a successful prosthesis except that attachments are used in the process.

Attachments are rigid or resilient connectors that redirect the forces of occlusion. By being rigid, occlusal forces can be redirected to tooth or implant bearing areas and away from maxillary or mandibular ridges as in the case of partial dentures or overdentures. By using resilient attachments, those same occlusal forces can be redirected to the maxillaiary or mandibular ridges for support since the tooth or implant bearing areas may not be suitable to bear most of the chewing forces.

Segmenting fixed bridges simply means to fabricate a long span fixed bridge into two or more components utilizing a rigid or resilient attachment between the segments. Using attachments in this fashion creates shorter spanning bridgework that is easier to cast and seat while creating a rigid or resilient unit. A resilient unit acts as a stress releaser or stress breaker, depending on the attachment used while a rigid unit can function exactly as a cast fixed bridge with the ability for easier retrieval.

When using attachments, the first things that must be considered is how this newly designed prosthesis will function. Will it be rigid or resilient? Will it be tooth or implant supported or tissue supported? Evaluation of the remaining teeth or implants in terms of number, position and periodontal condition has to considered to determine exactly how much load the teeth, implants or ridges can bear. We need to determine our philosophy on loading teeth, implants and tissue and examine carefully what is on the opposite arch. Then, select the attachment that will suit our treatment planning purposes. Maxillary arches are usually bound down areas with much surface area and firm supportive areas  Here, in many cases, rigid attachments can be used. The mandible, which has less surface area and less supportive areas can benefit from either rigid or resilient attachments depending on the type of prosthesis designed as well as the existing or planned prosthesis for the opposing arch integration.

In consideration of all these factors, attachment dentistry can provide the opportunity to create long lasting prostheses and many happy and satisfied patients.

 

DrGeorgeEBambara-863kbDr. Bambara is on faculty at the Rutgers School of Dental Medicine and holds Fellowships in the American College of Dentists, the International College of Dentists, and the International Academy of Dento-Facial Esthetics. He is an Adjunct Assistant Professor at the College of Staten Island and lectures nationally and internationally on attachment prosthetics.  He has been selected as one of Dentistry Today’s Leaders in Continuing Education for the past seven years. Dr Bambara has published articles on attachment dentistry and has authored a chapter on Precision and Semi-Precision Attachments in the recently published textbook Contemporary Esthetic Dentistry.

 

Dental Professionals Role in Early Intervention of Methamphetamine Addiction

October 7th, 2014

By Noel Brandon Kelsch, RDH

iStock_000038322898Small

You never know just who you might get to sit next to on a plane and what you might learn. This past flight for me was a great learning experience.

I had a dental professional sit next to me and she soon discovered I was working on my slides for a course on the impact of meth.  She told me she has never seen anyone with a methamphetamine addiction and that she is sure of it. She saw no reason to attend a lecture about meth because none of her patients would EVER consider doing anything like that, they were educated, well informed professionals in general. She lived in a suburb where things like that just did not happen. “That happens in rural areas and big cities.” She said. She also explained to me that seizure rates had been cut in half in her state and that the war on drugs was well on the way to being resolved there.

Meth does not care where you went to school. Nor does it care what your profession is, how much money you make or what area you live in. The crisis this drug creates impacts all age and economic levels of our society, including adult professionals, teenagers and children. Because most people don’t believe someone they know could be using or don’t realize that this drug is available and abused by people at all levels of our society regardless of income or ethnic background, it sometimes interferes with diagnosis.

The seizure of meth labs across the country has gone down. That is exciting! The problem is that because of new systems of manufacturing it no longer requires a complete lab to create meth. For example the “shake and bake” method uses a liter soda bottle and has increasing emergency room visits as this very explosive process comes into play. Successes are happening with a decline in use in some areas, but the war is not over. Early intervention plays a major role.

All dental professionals have a role that is vital in early intervention because the first signs of meth use appear in the mouth. This non-pre-judicial drug is enormously addictive and eventually rots the teeth down to the gum line.

According to the National Survey on Drug Use and Health 2012 age 12 and older 4.6 percent have used meth sometime in their life. That means for every 100 people that sit in your dental chair 4.6 percent of them have used meth sometime in their life. It is so vital to have that information before you treat them.

Early warning signs and symptoms exhibited by people using methamphamine:

•   Obvious deterioration of teeth

•   Malnourished and disheveled appearance

•   Abnormal vital signs

•   Grinding of teeth

•   Pale complexion and red eyes

•   Aging in appearance

•   Irritability or euphoria

•   Nervousness; sweaty and clammy skin

Dental professionals play a role in early intervention by connecting patients to the resources they need for drug rehabilitation, treatment and recovery. With greater awareness, the odds for early intervention and positive outcomes increase.

 

 

Dentistry goes High Tech

September 2nd, 2014

By Paul Feuerstein, DMD

iStock_000014692951Small

The world of computers and smart devices has not escaped dentistry. Simple things like looking for cavities with a little bent sharp wire (the explorer), waiting for xrays to be developed or having a mouthful of putty impressions are things of the past. Also the way that small cavities are treated is changing with new chemistry including calcium that can replenish some lost enamel.

A new buzz word in dentistry is CAMBRA- Caries Management By Risk Assessment.  It basically states that the dentist does not need to pick up the dental handpiece very time there is a suspicious lesion.  There are many cases where you will get a “stick” and there is not conclusive radiographic evidence that there are caries in that tooth. If this is a patient with a high level of oral hygiene and few cavities, vs one who sits with a can of Mountain Dew at their desk all day, the proposed treatment is different.  New devices allow the dentist to measure the small cavities with lasers, heat and fluorescence and give a measurable marker to determine if this is something to fill, perhaps watch digitally or treat with new fluorides and recalcification products.

Traditional film xrays have been replaced by digital sensors which are faster, more accurate, use less radiation and don’t need environmentally unfriendly developing chemicals.  New advances have also brought us 3D xrays (Conebeam CT)  to enhance diagnosis and treatment planning. The dentist can now essentially do a CT scan on a tooth, group of teeth or the jaws. This is quite helpful in diagnosing patient problems as well as helping guide the development of a child’s teeth. Formerly difficult to diagnose problems such as root fractures, precise location of pathology or anatomical structures is now extremely accurate. Planning for tooth replacement with implants has also become more predictable, and in the realm of the general practitioners.

Impressions and laboratory techniques have also gone digital with  3D optical scanning devices replacing the puttys in the mouth, and CAD/CAM allows dental  labs to create extremely accurate restorations out of new more aesthetic materials that are more durable than ever before. This has also spilled right into the dental office with new milling units and software that allow the dentist to create the final restoration in just one visit so that patient does not have to come back for the “final” one.

In recent months, there has been an amazing convergence of these technologies.  Digital intraoral scans are being merged with Conebeam 3D scans. Many companies have standardized their devices allowing integration of components from different companies (like stereo components) creating more choices for the dentists to be able to personalize some of these systems. This comes with a large amount of new studying of the industry, which to some is troubling but to most is exciting.

It is a great time to be a dentist and a better one to be a patient.

FeuersteinDr. Feuerstein received his undergraduate training at SUNY Stony Brook studying chemistry, engineering, computer science and music. A 1972 graduate of UNJMD he maintains a general practice in Massachusetts. He installed one of the first in-office computers in 1978, teaching and consulting since then. As Technology Editor of Dental Economics, author of several technology articles, he lectures at many national and local dental meetings. His work with CAD/CAM helped develop the LAVA COS intraoral scanning system.  He was named Clinician of the Year at the 2010 Yankee Dental Congress and is an Adjunct Assistant Professor in General Dentistry at Tufts University.

Creating the Ultimate Doctor-Hygiene Patient Exam

August 4th, 2014

By Karen Davis, RDH, BSDH

Dental Clinic. The dentist explaining to his young patient how t

It seems as though the examination portion of the hygiene visit often lends itself to increased stress, but it doesn’t have to. Creating an ultimate experience is realistic and implementation of these tips will assist.

1.  Let go of the idea that a prophylaxis appointment is all the patient needs!

In practice after practice, dental hygienists are desperately attempting to educate the patient, change behavior, scale all calculus, remove all stain and plaque, perform and record periodontal evaluations, update radiographs, apply fluoride, identify restorative concerns, and so on, all in ONE appointment that lasts 45 – 60 minutes, IF you get started on time!  Sound impossible?  It is. The American Dental Association has done a great job defining the difference between a prophylaxis, scaling and root planing, and periodontal maintenance.  Early in the appointment, if data collected reveals a periodontal diagnosis, it is easy to determine which patients need additional therapy and which patients need preventive care.

2.  Don’t wait until the last five minutes of the appointment to have the exam

In most busy dental practices, waiting until the hygienist is completely finished before notifying the doctor for an exam is almost a guarantee of running behind. Notifying the doctor once data has been collected and potential treatment discussed enables the dentist to look for a natural break in a procedure, interrupt the hygienist during his or her treatment, perform the examination, then both return to completion of their treatments.

3. Use visuals to replace wordy descriptions

Patients will understand and retain information significantly better if audible and visual learning takes place together.  Instead of us doing all of the talking (while working on the patient with sharp instruments) clinicians should intentionally let  “pictures speak 1000 words”.  Intraoral pictures, before and after pictures, educational pamphlets, radiographic pictures, periodontal records, Caesy ®, etc., all assist in the co-discovery process necessary for patients to really understand and desire what we recommend.

4.  Sit the patient upright for communication

Contrary to how most of us commonly communicate with patients in the treatment room, if we are willing to pause, sit the patient upright to describe conditions and discuss possible treatment, we find we actually have to say less, because the patient’s ability to hear and retain information is significantly greater with the use of good eye contact and body positioning.  Sitting the patient upright also allows the patient to feel more comfortable and ask questions and enables us to become the listener. Most patients will not proceed with treatment until their questions have been answered!

5.  Ask for a commitment to treatment

In the treatment room, where value is created and treatment recommendations are made, prior to handing the patient off to an administrator, clinicians need to ask a closing question such as, “So, James are you ready to get started?” Even when the product we are “selling” is optimal oral health, asking the patient to make a commitment fosters ownership of their health.

 

Davis

Ms. Davis is founder of Cutting Edge Concepts®. She is an international speaker and practices dental hygiene in Dallas, Texas. She has served on numerous advisory boards, is considered a key opinion leader to many corporations in the profession and is recognized by Dentistry Today as a “Top Clinician in Continuing Education”.  She is an accomplished author related to her passion of practicing on the cutting edge of the profession. Ms. Davis is a member of the American Academy of Oral & Systemic Health and the American Dental Hygienists’ Association.

 

You and Your Sleep Deprived Patient

July 16th, 2014

By Dr Uche Phillip Odiatu BA, DMD 

woman in bed awakening

You thought you had it all figured out –  during your new patient exam health history section you ask patients what meds they take; if  they have ever been in a motor vehicle accident; and some dentists ask about specific supplements their patients are taking. Well, that is only part of the equation when it comes to your patients’ health history. Current sleep research has shown if you are regularly sleeping less than 7 hours a night you are more likely to suffer from cardiovascular disease, stroke, cancer, diabetes and any number of other inflammatory conditions. Think gingivitis and periodontitis.

Most dental professionals are aware of sleep apnea and its grave consequences on the heart and brain. If sleep apnea is severe a CPAP machine is prescribed by the patients’ health care professional. If the diagnosis is mild a MAD or Mandibular Advancement Device can be made by the dentist. This article is not about obstructive breathing issues but about patients who simply do not get to bed on time, work shift work or have evening habits that disturb their sleep quality and quantity. If you read this article you will receive insightsthat will help you expand your New Patient exam questions or it will support your own healthy living goals.

“There is plenty of compelling evidence supporting the argument that sleep is the most important predictor of how long you live, perhaps more important than whether you smoke, exercise or have high blood pressure or cholesterol levels” ~ Dr William Dement, one of the world’s most prominent sleep researcher and founder of the Stanford University Sleep Disorder Clinic.

  1. Current sleep research has shown that 4 out of 10 people reported they sleep poorly.
  2. 20-40% of Americans work some type of evening or overnight shift.  Michael Howard PhD has reported that people who do shift work spend most of their waking time in a “jet lag” state.
  3. There is an important part of your brain –SUPRACHIASMATIC NUCLEUS – that  is your brain’s circadian clock which does not function well with cross country travel / time zone changes, poor sleep habits, nights shifts, sleep apnea, etc .
  4. When working into the wee hours of the night, cross time zones with cross country air travel to “four on four off” shifts the body’s reserves do not get replenished. From wound healing to trying to recover from a cold or a flu, a sleep debt can bankrupt your good intentions.
  5. Cumulative sleep debt costs you and your patients. People with disrupted sleep from rotating shifts have 3 times as many GI problems such as constipation, abdominal pain, heartburn and reflux (think acid erosion of lower molars) than those who have regular day time work hours
  6. REM (rapid eye movement) sleep is a vitally important part of your night. For optimal emotional health, adults need approximately 100 minutes of REM a night. (This can only be measured in a formal sleep study – called POLYSOMNOGRAPHY).  REM sleep has also be shown by UC Berkeley experts to help processes stressful memories and experiences and bring enhanced well-being into your life. Are you thinking of certain patients with bruxism habits?
  7. Research has shown that visual learning , especially learning to do NEW things gets consolidated while you are asleep – especially during REM sleep. A 2010 Harvard study on memory had their 100 volunteers do a test on finding their way around a maze on a computer. During a five hour break some stayed awake another group napped before taking the test again. The group who napped did the maze 162 seconds faster than the ones who stayed awake when doing the test again. Those who actually dreamed while napping did  their second test maze 225 seconds faster. TAKEAWAY for dentists on three day intense implant courses or leadership training? Take a nap midday or after an 8 hour workshop to internalize, consolidate the information and make it your own.
  8. A prominent Canadian dental journal Oral Health had a cover story demonstrating a relationship between obesity and periodontitis. This relationship was based on the inflammatory mediators released from visceral fat. CDC reported that 30% of Americans are overweight or obese (BMI over 30). What’s the link between lack of sleep and developing an overweight condition? Case Western University research showed that women who sleep less than 7 hours a night were 15% more likely to become overweight; women who had less than 5 hours were 30% more likely to develop obesity. A 2010 JADA article reported that dentists are interested in giving wellness guidance but felt they needed more evidence that losing weight would make for a healthy oral environment. If you are reading current periodicals the evidence is arriving.
  9. Sleep is a critical time enabling the body to heal, repair, restore, and regenerate itself reports Mary O’Brien MD author of The Healing Power of Sleep. Next time when giving post op instructions after an extraction or periodontal surgery tell your patient to get 7-9 hours sleep for the next week for optimal healing and recovery.
  10. Alcohol is the most common drug people use to get to sleep. Admittedly it does get you to sleep quickly. Downside, your sleep is lighter – you don’t get enough of the DEEP SLEEP where your pituitary gland releases growth hormone (the youth hormone for fat burning and maintaining muscle mass). With a single glass of wine before bed it spikes your insulin which also takes you out of fat burning mode. Alcohol before bed encourages snoring and sleep experts report even snoring reduces valuable oxygen flow to your brain
  11. As dentists we are aware of the link between inflammation in the mouth and a diabetic condition. Did you realize that poor sleep disrupts may disrupts good blood sugar management?  Four nights of shift work has been shown in scientific studies to bring about pre-diabetic blood glucose levels in those workers during their shifts.  If someone is not responding favorably to your soft tissue management therapy, you need to question those patients about their sleeping habits.
  12. Contrary to belief older people still require 8 hours sleep if they want to age gracefully. Sleep architecture changes with age (they spend less time in DEEP SLEEP and more time in LIGHT SLEEP) and with slower wound healing people over 60 needquality shut eye.

RECOMMENDATONS:

  1. Sleep in a cool (65-68F) bedroom for deeper sleep
  2. Create a pitch black environment so your melatonin levels remain high during the night
  3. Don’t eat before bed as it subtracts from the rejuvenating role sleep plays as your body is trying to digest a meal that should have been eaten at supper time
  4. If you have to cross multiple time zones and want to perform well in business or a sporting event, give yourself an extra day for each hour off your regular time zone.
  5. Sleep scientists say if you are going to workout 4-7pm is the ideal time in terms of supporting muscle adaptation and also to take advantage of the post exercise body temperature adaptation that sets the mood for sleep in the following 3-4 hours. Early AM workouts is still very productive  and they are the best strategy  to make time for exercise in a busy life. It’s just that current research by Michael Howard PhD has shown that late afternoon evening exercise sets the tone for a healthy sleep later that night
  6. “If you are not sleeping well it is almost impossible to heal well”  – NATIONAL SLEEP FOUNDATION
  7. Guided visualization and relaxation exercises are two of the best ways to support healthy rejuvenating sleep
  8. A clear conscious and a peaceful mind make for a short “sleep latency” (the time it takes to get to sleep – ideally 5-15 minutes).
  9. If you want to support healthy REM sleep and utilize its ability to process emotion and consolidate memory, give yourself a mental suggestion right before you sleep to focus on a specific subject or challenge you are currently undergoing
  10. Napping for 20-30min in the mid afternoon has been shown in numerous studies to enhance emotional well-being and productivity. As long as the naps don’t go longer than 30 minutes night time sleep is not impacted
  11. Find the right mattress for your body type. There is no one best type. Studies have shown that medium to firm is most likely to fit most people’s needs
  12. If you get up in the AM earlier than you wanted to, stay up. After a long continuous sleep, expose yourself to bright full spectrum light or sunlight and get your Sleep-Wake routine formalized.
  13. Don’t do anything else in bed except for the two S’s (sleep and _____). Watching TV, doing your taxes, eating  willdistract you from one of the most important health habits you might have. The brain loves cues that it is preparing to sleep. Lugging your laptop onto your lap to answer emails is highly distracting for your night-time brain
  14. Develop a bedtime ritual which cues your brain for slumber. Following the same steps before bed gets your brain ready for zzzzz.
  15. Many over the counter sleep aids are meant only for short term challenges with sleep. Prescription meds work wonders but they too have a number of side effects and many are not designed for long term use. There are herbal supplements but they too pale in comparison to learning relaxation techniques and developing good sleep hygiene rituals (evening/ pre-night time sleep habits).

This subject is new for the dental industry and I hope to share with you further information in the future. In the meantime “sleep well tonight and don’t let the bed bugs bite.”

REFERENCES:

  • Wamsley&Stickgold, Current Biology, 2010, 20(23)
  • National Sleep Foundation
  • CDC
  • Obesity and Periodntal Health: What’s the link? Should I be concernded? W. Ward et al. OralHealth October 2012
  • Sleep and Your Memory by Michael Howard PhD © 2010 Biomed
  • The Healing Power of Sleep by Mary O’Brien MD Biomed © 2012
  • “Dentists Attitudes About Their Role in Addressing Obesity in Patients” Curran et al.  JADA 2010
  • Geyer, Talachi& Carney, Introduction to Sleep and Polysomnography, 2005

 

OdiatuDr Uche Phillip Odiatu BA, DMD is the author of The Miracle of Health and Fit for the LOVE of IT! This busy practicing dentist is also a NSCA Certified Personal Trainer and a professional member of the American College of Sports Medicine (ACSM). He lectures at most of the major dental conferences in the USA, Canada, the Caribbean and England.www.fitdentist.com

 

Dental x-rays: What’s in Your Dose

June 2nd, 2014

By Dr. Dale Miles, BA, DDS, MS, FRCD (C), Diplomate American Board of Oral Maxillofacial Radiology

Doctor with xray

It doesn’t matter whether it’s a periapical, bitewing a panoramic or even a cone beam CT x-ray examination, our patients always seem to be questioning us as to the need for the x-ray. There isn’t a week, possibly even a day, that goes by the dental practice where a dental assistant, dental hygienist her dentist doesn’t hear the following question from the patient, “Why do I need these x-rays?”. And, unfortunately our answers are usually “all over the map”.

“Don’t worry Mr. Jones it’s just like spending one hour in the sunshine.” Don’t worry about Johnny Mrs. Smith it’s like flying across the country in an airplane.” Obviously somewhere at sometime the dentist or auxiliary has been told, heard in the lecture 10 years ago or read in the magazine a comparison made for dental x-rays to everyday activities. Patients are now becoming more sophisticated and actually are demanding real answers and real information to their questions. It is not appropriate to offer them a platitude without any data. It just isn’t that professional. And it doesn’t instill confidence.

The data is out there, and it’s somewhat easy to find. But searching for it really isn’t high on the list of tasks for most of us. In addition, talking about “milliesieverts” is just as foreign to many dentists and auxiliaries as it is to their patients. There is real data about the approximate dose for each x-ray modality, from periapical to cone beam imaging. You can find studies that look at receptor types with round versus rectangular collimation, studies that compare the dose from a panoramic to a certain number of periapicals and x-ray dose even between the various cone beam machines. However, with the myriad of factors that affect x-ray dose, from something as simple as our KV or MAs settings, or the fact that not all cone machines have the same size FOV (field of view), the dose data can be confusing.

So how do we answer our patients question. To date, the best data, or at least the best way that I found for you to use to talk to your patients about x-ray dose actually compares the risk equivalents of dying from everyday activities to the dental x-ray procedure we call on FMS (full mouth series).  Of course even this data comes from comparisons to a full mouth series of film-based radiographs. However, there are still 55% of us out there dental practice using film, despite the fact that faster receptors are available which also will reduce patient x-ray dose.

So, if this initial blog on x-ray dose doesn’t stimulate conversation, nothing will in the dental profession. You need to seek out good data, use something called selection criteria when determining the need for an x-ray exam and transition to the fastest receptors possible and rectangular collimation, which is now been made simple, in order to protect your patient in the best manner possible. Are you up to the task?

Time now to start peppering me with the questions which I’m sure will arise from this initial blog posting. I look forward to your comments and questions. BTW, this is the first time that I’ve accepted an invitation to “blog”. My time, like yours, has become my most precious commodity. But I’m willing to help you find the answers you seek.

 

Miles

Dr. Miles is a diplomate of the American Board of Oral and Maxillofacial Radiology and the American Board of Oral Medicine. He has authored over 130 peer-reviewed articles and 6 textbooks, including the best selling atlas on Cone Beam CT, Color Atlas of Cone Beam CT for Dental Applications published by Quintessence Publishing. Dr. Miles is in full-time practice of Oral and Maxillofacial Radiology in Fountain Hills, Arizona. He is the President and CEO of Cone Beam Radiographic Services, LLC., a CBCT reporting service for dentists and dental specialists and President of EasyRiter, LLC, which produces a simple CBCT report generating software for the profession.