Archive for the ‘Dental News’ Category

ODA Introduces New Endorsed Services as Additional Member Benefit

Thursday, November 12th, 2015

ODA_Logo_horiz_RGB_ Endorsed Program

By: Conor McNulty, CAE, ODA Executive Director

In late 2014, the Oregon Dental Association (ODA) convened a task force to review  important benefits and offerings for ODA members. After getting feedback from members and approval from the Board of Trustees, ODA is happy to announce the following NEW  line-up of additional endorsed services for our members.

ODA and its endorsed service  program partners offer you the resources you need to help manage your dental practice…and your life.

Aspida –  Encrypted  e-mail service provider www.aspida.us/oregon

Offers all ODA members an exclusive discount on their HIPAA compliant email encryption services

  • First three months at $1/each
  • 20% lifetime discount on all Aspida mail plans (after the 3 month trial)

OHSU Sterilization Monitoring Services sms@ohsu.edu  l   503-494-4641

  • 24 hour turn-around for test results
  • Emailed test results directly to you,
  • Is the test is not sterile you will also get a phone call to ensure the most rapid retesting options.

WEO Media – website and dental marketing services    weodental.com/oda

Offers ODA members discounts on services:

  • Up to 25% on selected set-up fees
  • Up to 15% on selected service fees

Sofi – Student debt refinancing      sofi.com/OregonDental

ODA members get an additional .125% rate discount

  • Average savings for members is $39,000 for the life of a loan
  • Quick and user-friendly process for application and review

Dentists Benefit Corporation (DBC) – Disability insurance through Ameritas  

shelley.campbell@bdicins.com  l  503-952-5271

  • ODA members recieve a 15% discount on new individual disability insurance plans.

For a complete list of ODA Benefits of Membership visit:

http://www.oregondental.org/member-center/benefits-of-membership

New innovations in nanomedicine may be coming your way soon!

Tuesday, August 4th, 2015

By Dr. Kim Wright

It’s amazing the innovations happening in labs around the world right now.  Very soon we may have treatments for many more cancers that use nanoscale vehicles to deliver chemotherapy directly to tumors sparing healthy cells.  These drug vehicles are 200 times smaller than a red blood cell.  According to Scientific American’s April 2015 issue, labs at the University of Tokyo are researching several versions of nanodrug vehicles and are completing the final stages of clinical trials.  It is expected that research development speed will escalate in the next 5 years showing rapid growth in this exciting field.

The particles used to make up these drugs are cloaked in a variety of ways.  One way is they are made to “blend” in with the normal body tissues and therefore do not alert the immune system as a foreign body thus triggering their degradation.  They can also be constructed in a way to resist degradation by the bodies’ enzymes creating a longer life, thus allowing more of the chemotherapeutic agent to attack the cancer.  Some nanodrugs are created to be soft and flexibile allowing them to enter cancer tumors more readily and then degrade in the more acidic environment of the tumor where the chemotherapy drugs are released and are needed exclusively.  Other scientists are attaching cancer protein antibodies to these nanovehicles so that they are attracted to the cancer cells making delivery of their drugs very target specific.

This growing field of medicine could soon be the dominant way in which we fight cancer.  If you or someone you know is fighting cancer do your research and find out all the ways your cancer is being treated, your cancer may be the one where this therapy is being used!

 

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Are e-Cigarettes Safe??

Tuesday, May 5th, 2015

ecigcuse

 Dr. Kim Wright

According to the May 2014 Scientific American online article e-cigarettes generally contain 3 ingredients, nicotine, propylene glycol and flavorings.  Nicotine is a highly addictive stimulant and now there is new science suggesting that it may also impair the immune system.  Propylene glycol is used to keep products moist.  When it is eaten or applied to the skin the FDA has given it a “generally recognized as safe” designation.  However, there is not much human scientific research on the effects when this substance is vaporized and inhaled into the lungs.

E-cigarettes utilize heating coils to vaporize the ingredients.  Metals from the coils and solder joints could potentially dislodge from the apparatus and particulates accumulate in the lungs.  Tin, chromium and nickel are among the majority of metals used in the coils but other heavy metals could be used since there is little regulation of these products.

The concerns are that the children appealing flavorings such as chocolate and bubble gum has contributed to the doubling of the U.S. high school student use from 4.7% in 2011 to 10% in 2012, as reported from the CDC.

The e-cigarette industry has used the “substantially similar” argument to prevent the FDA from stringent regulation of e-cigarettes as drug delivery devices but the same legislative laws that protect target marketing youngsters with regular tobacco cigarettes does not apply to e-cigarettes, a dichotomy that is unbelievable.

In summary, more controlled non-e-cigarette industry supported research must be conducted before declaring e-cigarettes as safe.

 

wrightDr. Wright is a general dentist practicing in West Linn, Oregon. Dr. Wright earned the prestigious Masters Award from the Academy of General Dentistry (AGD) in 2011. She has actively served professional associations in leadership roles, such as the past president of the Oregon AGD and past trustee for the Oregon Dental Association (ODA).

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

Monday, 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

Global Diagnosis In Dentistry

Monday, 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.

Dentistry goes High Tech

Tuesday, September 2nd, 2014

By Paul Feuerstein, DMD

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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.

The Ethical Case for Confidentiality

Wednesday, March 6th, 2013

By Gary T. Chiodo, DMD, FACD and Phyllis Beemsterboer, EdD

 

All health care providers are well-aware of the legal protections extended to patient information via the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.  With few exceptions, all information that patients provide to us in the form of their medical history and all data related to the care we deliver to them are protected by the HIPAA rules and may not be released to any third party without patient consent and authorization.  While HIPAA may impose strict legal parameters on how patient information must be protected and how it may be released, there are ethical obligations that provide even more persuasive arguments for the bond of doctor-patient confidentiality.  These ethical obligations are based in the ethical principles of respect for autonomy and nonmaleficence.

Respect for autonomy is the ethical principle that allows, with few limitations, patients to determine what will and will not be done to their bodies.  In normal health care practice, patient autonomy is facilitated and respected through the process of informed consent.  The well-informed patient who has capacity to consent has the right to select from various treatment options, the treatment or treatment plan that is most concordant with his/her values and wishes.  Because the informed consent process is essential in this dynamic, health care professionals must collect and analyze complete information about the patient.  For example, surgical options for repair of a periodontal defect may very well change if the dentist knows that the patient has a bleeding problem.  Plans to remove teeth may be mitigated by a history of bisphosphonate therapy.  In cases like these, patient autonomy cannot be truly facilitated and respected unless the dentist has complete and accurate information about the patient’s medical conditions and history.  If the patient is not entirely comfortable with complete disclosure because he/she doubts that confidentiality will be respected, then important information may be withheld.  When this happens, not only will the patient’s autonomy be compromised, but the dentist’s obligation of nonmaleficence, or avoiding harm to the patient, will be in jeopardy.  While most patients would not be reluctant to reveal a bleeding problem or a history of bisphosphonate therapy, some may hesitate to reveal things they consider to be embarrassing or intensely personal.  For instance, the patient who is receiving treatment for mental health issues or chemical dependency may opt to omit that from the medical history out of concern that it will not be treated with strict confidentiality.  The male patient who is using a phosphodiesterase-5 inhibitor on occasion, may decide to leave that out of his medical history so he does not need to worry about who may have access to that information.  A young woman who takes a hormonal contraceptive may decide that her dentist simply does not need to know that.  While we are well-aware of the potential harms that may come to patients when we do not have complete medical information, patients are less likely to appreciate those harms or, if they are aware of them, may simply decide to keep the information private and accept the risk.

Part of the challenge in obtaining complete and accurate medical information from our patients comes from making sure they understand why we need this information and this process takes chairside time.  However, another important part of the challenge is in ensuring that they trust us to keep it strictly confidential.  If we are not successful in creating that trust, critical information may be withheld and we will not be able to meet our ethical obligations of respect for autonomy and nonmaleficence.  In the best case scenario, breaching confidentiality will result in a patient who feels betrayed and goes elsewhere for care.  In the worst case scenario, the patient will develop a lack of trust in other health care providers, will withhold vital information, and will be seriously harmed.  If we emphasize the protections that we afford their personal information and assure them that they may trust us to keep it strictly confidential we are honoring our ethical principles and serving our patients best.

 

 

Gary Chiodo, DMD, FACD is currently the interim dean at OHSU School of Dentistry. Most recently, he served as the Chief integrity Officer for OHSU, a position he held for 10 years. He is a professor of Community Dentistry and Association Director of the Center for Ethics in Health Care. Dr. Chiodo received his Certificate in Health Care Ethics form the University of Washington School of Medicine in 1992.

 

 

 

Phyllis L. Beemsterboer, MS EpD, FACD is a Professor and Associate Dean for Academic Affairs in the School of Dentistry at OHSU in Portland. She is and associate director in the Center for Ethics in Health Care at OHSU and co-chairs the inter-professional ethics education program. Her research interest is in bioethics education and she is currently president of the American Society For Dental Ethics, a special section of the American College of Dentists.

Portland City Council Unanimously Votes to Fluoridate Water!

Tuesday, September 18th, 2012

Over the past year and half, the Oregon Dental Association, as a member of the Everyone Deserves Health Teeth Coalition, has been working on a new effort to fluoridate the Bull Run water system. The Bull Run system serves about 900,000 people, or almost one-fourth of Oregon’s population. More than 74 percent of the United States is served by optimally fluoridated community water supplies to protect dental health – and Portlanders will soon join them.

Last week, after a colorful public hearing on September 6th, the City Council unanimously voted in favor of fluoridation. Portland is no longer the largest city in the U.S. that has yet to approve fluoridation to combat tooth decay. The ordinance calls for the city water to be fluoridated by March 2014.

Oregon Dental Association has long been an advocate of community water fluoridation and we were not alone in the fight this time. As a founding member of the Everyone Deserves Healthy Teeth Coalition,  made up of dental and medical professionals, children’s advocates, business leaders, and Portland citizens, we called on the Portland City Council to fluoridate Portland’s water as a safe, effective and affordable way to increase the oral health of our community.

One in three Oregon children has untreated cavities, jeopardizing their health and educational success. Financially, dental decay accounts for 30 percent of all health care costs for children. Dental–related emergency room visits by Oregon’s Medicaid enrollees jumped 31 percent in the past few years, causing a tremendous increase on healthcare costs.

Fluoridating Portland’s water is affordable and will save money. Initial start-up costs are estimated to be about $5 per person with an annual cost of $0.61 per person, based on average water use.That is less expensive than providing fluoride treatments in dental offices and schools. The return is very high: every $1 invested in fluoridation saves over $30 in decreased treatment costs for fillings and more serious dental work. Cheers to healthier teeth!

Visit www.everyonedeserveshealthyteeth.org to learn more.

William E. Zepp, CAE, is the Executive Director of the Oregon Dental Association. Bill previously served as Executive Director of both the Virginia and Montana Dental Associations and has been involved in association management for twenty five years. Bill is also active with the American Society of Association Executives, serving as a past chair of the Small Staff Associations Committee. He has given presentations on non-dues revenue and management at several ASAE Annual Sessions. He is a past-president of the Oregon Society of Association Management.

 

 

EVERYONE DESERVES  HEALTHY TEETH COALITION

African American Health Coalition

African Partnership for Health

African Women’s Coalition

American Medical Student Association, OHSU Chapter

Albina Head Start

Asian Health & Service Center

Asian Pacific American Network of Oregon (APANO)

Capitol Dental Care

Causa

Center for Intercultural Organizing

Central City Concern

Children First for Oregon

Coalition of Communities of Color

Coalition of Community Health Clinics

Component Dental Societies

Dental Foundation of Oregon

Familias en Acción

Friends of Creston Children‘s Dental Clinic

Health Share of Oregon (Tri-County CCO)

Kaiser Permanente Northwest

Knowledge Universe

Latino Network

Legacy Health

Lutheran Community Services Northwest

Native American Youth Association (NAYA)

Northwest Health Foundation

Medical Teams International

OEA Choice Trust

OPAL Environmental Justice Oregon

Oral Health Outreach

Oregon Academy of Family Physicians

Oregon Community Foundation

Oregon Dental Association

Oregon Dental Hygienists’ Association

Oregon Dental Services Companies

Oregon Head Start

Oregon Health & Science University

Oregon Latino Health Coalition

Oregon Latino Agenda for Action

Oregon Medical Association

Oregon Nurses Association

Oregon Oral Health Coalition

Oregon Pediatric Society

Oregon Primary Care Association

Oregon Public Health Association

Oregon Public Health Institute

Oregon School Nurses Association

Oregon School-Based Health Care Network

Pew Center on the States

Philippine American Chamber of Commerce of Oregon

Physicians for a National Health Program, OHSU Chapter

Portland African American Leadership Forum

Providence Health & Services – Oregon

P:ear

Regence BlueCross BlueShield of Oregon

SEIU Local 49

Urban League

Upstream Public Health

Virginia Garcia Memorial Health Center

Willamette Dental

The Truth about Fluoride – Debunking the Myths

Monday, August 27th, 2012

By Dr. Weston Heringer, Jr.

Fluoride is natures cavity fighter with small amount present in all water sources such as lakes, rivers and wells. Communities fluoridate their water supply as a cost-effective public health measure to help prevent tooth decay and cavities in both children and adults. According to the best available scientific evidence, water fluoridation is safe and effective. Thousands of studies and more than 65 years of experience tells us that water fluoridation is effective in preventing tooth decay and is safe for children and adults. Even with all the science, there are still a lot of misconceptions about community water fluoridation so let’s talk through them.

 

1. Fluorosis. Fluorosis can occur before teeth erupt from the gums if teeth are exposed to too much fluoride. The vast majority of fluorosis is very minor, barely detectable white spots on the teeth, that does not affect how they function or a person’s overall health. There are studies that suggest that fluoride occurs more frequently in African American children, however more research is needed on the topic. Fluoridation is implemented because dental decay is widespread, the burden of which falls unfairly  among some  population groups.  The National Dental Association, representing African American dentists, and the Hispanic Dental Association both endorse community water fluoridation as safe and beneficial.

2. IQ. According to the best available scientific evidence, there is no association between fluoridation and brain development or lower IQ. The studies often cited are from China, India, and Mexico where environmental conditions are significantly different than those in Oregon. The vast majority of these studies have never been published in peer-reviewed journals and the quality of these studies does not stand up to scientific scrutiny.

3. Osteosarcoma. In 2011, a team of researchers from Harvard University, the Medical College of Georgia and the National Cancer Institute published a study that analyzed hundreds of bone samples from nine hospitals over an 8 year period from patients with osteosarcoma and a control group to measure fluoride in levels in the bone. Considered the most extensive study to date, the results indicated NO CONNECTION between fluoride levels and osteosarcoma. All the other organizations and agencies that have looked at this issue – including the FDA, National Cancer Institute, California EPA Office of Environmental  Health Hazard Assessment – have concluded the same thing.

4. Infant Formula. Although we encourage all parents and caregivers to talk to their dentist of physicians about their child fluoride intake, community water fluoridation has been proven to be safe for children, including babies. Babies who are fed powdered or liquid concentrate infant formula mixed with optimally fluoridated water might develop mild enamel fluorosis, which is a cosmetic condition and has no effect on how they function.

 

Water that has been fortified with fluoride is similar to fortifying salt with iodine, milk with vitamin D and orange juice with vitamin C. Community water fluoridation saves more than it costs. Studies show that community water fluoridation prevent at least 25 percent of tooth decay.

Want more information on fluoride? You can find extensive information in Fluoridation Facts, the ADA’s comprehensive publication with facts from over 350 scientific references.

 

Dr. Heringer is a retired pediatric dentist and has served on 19 overseas dental trips. He operated a private practice in Salem for 30 years with a satelite office in Lincoln City for 26 years. For the last two years of his career he was the full time dentists on the Tooth Taxi, a mobile dental van providing free care to children in Oregon. Dr. Heringer is a past president of the Oregon Dental Association and is a board member of the Dental Foundation of Oregon.

Does Botox Have a Role in Dentistry? Yes!

Wednesday, August 22nd, 2012

By Dr. James Catt

Does Botox have a role in dentistry?  This was what I was determined to discover when I registered for my first introductory Botox course.  The course was instructed by Dr. Warren Roberts from the Pacific Training Institute for Facial Esthetics (PTIFA) in Vancouver B. C. .  I was drawn here because of its recognition by both ADG PACE and ADA CERP as well as this being the most thoroughprogram that I could find. I was in search of answers, not a diluted course that spoon fed material and handedout a flowchart of “how to’s”.  I needed both a didactic and clinical perspective in order to arrive at a sound judgment on the practicality and safety of the possible utilization of Botox in my practice if Oregon were to allow dental professionals access to this therapy.  PTIFA fulfilled this requirement for me.

Admittedly, prior to attending the training I had some pre-existing bias on two levels.  Apprehension of the drug’s effects and unwanted clinical outcomes made up the bulk of my bias.  In addition, understanding the psyche of the patients who seek this type of therapy also added to my unease.  The latter was less of an issue since I learned multipleclose acquaintances evidently received Botox therapyregularly provided by individuals who at first glance appeared to have fewer head and neck anatomy credentials then I.Also, all of these acquaintances seemed like normal people and their outcomes were as expected.  In reality, it was only due to my close relationship with them and their voluntary divulging of this informationthat I had any idea they had received treatment at all.  So the question lingers; how does Botox apply to dentistry?

In short, the education that I received allayed my misgivings concerning Botox.  Let me repeat that.  The educationallayed my misgivings concerning the safety and utilization of Botox.  I’ve since taken an additional 16 hours of continuing education from PTIFA (totaling  32 hours) which focused on specific dental applications and hands on exercises.  There is absolutely no question in my mind that this treatment can provide dental advantages.  The next question would pertain to who specifically should be providing the therapy for dental applications.

In making my assessment and attempting to answer this question, I began to systematically review what my particular “job” as a dentist currently entails.  My “job”, as I would describe it, may be quite different then my dental colleague’s “job” who practices next door if he were to describe his own duties.  We are both D.M.D.’s, obtained our degrees from the same dental school and we are both required to meet the same standard of care.  However, he may state that his “job”entails extensive endodontic and pediatric treatment.  Theoretically, in these cases, I may state that my “job” is to schedule these patients with a great specialist.  My colleague has taken additional training and provides a high level of care in these cases that I don’t necessarily feel comfortable becoming involved in.  The converse may also be true.  After dental school I chose to pursue a greater level of understanding of occlusion.  I began a four year post graduate path that ultimately provided a competence in treating complex occlusion cases.  Coincidently, often times, this therapy helps with head and neck pain.  My colleague may not report this as one of his “job” objectives.  We are both working within our scope but our focuses differ.  I believe that it is well established that while working within our scope the discretion of what services we provide is based on our education.  Likewise, one practioner’s voluntary dispassion for a type of dental procedure does not, nor should it ever, preclude other practioners from focusing on this said procedure as long as it’s within the scope of dentistry.   Which dental professionals should be allowed to administer Botox for dental purposes?  The answer is the dental professionals who have taken advanced Botox training for dental purposes.   Dental purposes include, but are not limited to, muscle/frenum pulls leading to gingival recession and other periodontal concerns, bruxism and hypertrophic facial muscles, excessive gingival display, and muscle related TMD symptoms.

Some may say that the general dentist should stick with treating teeth and gums.  Some may say that facial musculature isn’t something that the general dentist should involve themselves with.   At this point I am going to use my own training as an example of how the general dentists in our state, who have had the proper advanced training, currently involve themselves with facial musculature every day.   The application of Botox by the general dentist is not an expansion of scope.  On the contrary, Botox is simply a potentially powerful new tool in our armamentarium of treatment options.    The question at hand is,which dental professionals can use Botox in a comprehensive manor and safely maximize the benefits of this therapy?By no means is this example to imply a specialty on my part.  Like many of my dental colleagues, this is simply one aspect of my “job” as I’ve defined it through advanced education and is what I’ve chosen to study and implement in my practice.

 All of us dentits have seen severely worn dentitions.  We as dental professionals know that severe dental attrition is only one sign of a systemic problem.

After ruling out other biological etiologies such as medications, eating disorders and gastric problems, it is inherent that we address the facial musculature system which attaches to and controls the grossly worn hard tissues.  It is impossible to predictably treat the teeth alone since the hard tissues and the soft tissues are reliant on one another.  Without superfluous explanation since the methods vary, the facial muscles need to be relaxed, the jaw joint needs to be passively stabilized, a diagnosis made and treatment options proposed.Botox therapy could often times be useful atmany of these junctures.After consent is given, irreversible procedures are performed on the hard tissues.  The treatment objective is to provide therapy which will lead to permanent stabilization of the occlusion and therefore provide a state of musculature stability which coincides with this new stable occlusion.    As I mentioned earlier, the consequence of this treatment is often times a reduction in myofacial pain.  Below are several photos of one of my own cases.  These photos document the muscular changes that occur when advance occlusal therapy is performed.   There is no refuting that there are permanent changes to this individual’s facial musculature.  This is an irreversible and, might I say, quite an invasive procedure.  However, the results are predictable and successful due to advanced education.  This treatment falls within today’s scope of practice for our state’s general dentists.  Not all dentists perform this type of invasive, advanced, irreversible procedures whichaffect the hard AND soft muscular tissues.  This is a voluntary choice made through the practitioner’s involvement in advanced education.  Botox therapy, even though reversible, should have similar educational requirements.

 Before and After Occlusal Therapy and Muscle Stabilization

So, should a general dental professional be allowed to provide Botox Therapy?  The answer is a resounding, YES!  The caveat being, the general dental professional should be required to meet a standard of competency based on educational requirements.  It is obvious that there are well trained general dentist who treat facial musculature every day and we do this with irreversible procedures.  Botox therapy can be used as an adjunct to such treatment as well as others. Not only is Botox proven safe to use in the right circumstances, it is completely reversible.  The real question is, who better to provide dental Botox to our patients?  Logic requires that the treating doctor has the knowledge of the masticatory system, complex occlusion, head and neck anatomy, as well as possesses the dexterity for specific injection techniques.  Certainly this treatment option isn’t for every dental practitioner, but let’s not withhold this from those general dentists who have the ability, desire, and education to serve their deserving patients.

 

Dr. Jim Catt  practices health centered comprehensive cosmetic restorative dentistry in Medford, Oregon. He received his Bachelor of  Science from  Oregon State University and was Magna Cum Laude from Oregon Health and Sciences University with his Doctorate in Dental Medicine.  Dr. Catt is  a past president of the ODA and has served as an  Trustee for 13 years, participating on many Boards and Committees. He is a member of the International College of Dentists, American College of Dentists, and Pierre Fauchard Academy. In addition, he facilitates dental health in children through dental health awareness in Medford schools, volunteering at Jackson County Children’s Dental Clinic, and acting as the Project Lead for the Southern Oregon Mission of Mercy.