Archive for the ‘Dental Visits’ Category

It’s a Two-Way Street! Dental Practices and Patient Working Together For The Best Outcome

Tuesday, July 7th, 2015


By: Virginia Moore, Moore Practice Success

We’ve probably all been in the position of being a patient and been kept waiting past our appointed time. Frustrating, isn’t it? We’ve all had that experience of having to pay for something necessary when we’d really like to spend our money on something “fun”.  In both those situations, whether you are the provider of the service, or the recipient, you can work to make it as pleasant an experience as possible.

 Staying on Schedule

Dental Practice:

  • As a dental team, agree on appropriate amount of time to allocate to different procedures. This gives you the best approach to staying on time.
  • Start your day on time. After the morning meeting, make sure patients are seated in the dental chair at their appointed time, not 5-10 minutes later.
  • If you routinely have 3 or more emergency patients each day, consider blocking time in the schedule. If less than, in the morning huddle have the clinical team determine best time for emergencies to be seen.


  • Honor your appointed time. Barring an emergency situation, keep your appointments. Your good oral health depends on it!
  • If you need to make an appointment change, give at least 48 hours notice. This allows the practice to accommodate another patient who has treatment needs.
  • Arriving early can give you the time to relax, check emails, and in many practices, have a refreshment. Relaxed is a great way to start your appointment!

Financial Agreements

Dental Practice:

  • Always discuss the financial aspect of treatment before providing treatment. No one likes a surprise, especially a financial surprise!
  • Consider partnering with a third-party finance company that can offer your patients a longer period of time to pay (and sometimes, for a very low/or no-interest rate).
  • Whenever possible, discuss financial matters in the most private setting. None of us like having to share our financial concerns with more people than necessary.


  •  Be upfront. Let the financial person know what you can commit to when discussing finances. None of us want to commit to something we can’t fulfill.  Ask about payment plans, savings for payment in full before treatment, or how treatment may be phased.
  •  Nothing’s for free! In over 25 years of consulting I’ve never seen a dentist’s fees that aren’t in keeping with their overhead. Most dental practices have significant overhead when you consider they are essentially a self-contained hospital; expenses of personnel, supplies, equipment, facility, lab, etc.
  •  If you are fortunate enough to have dental insurance, remember that it is not designed to cover all your dental needs. In fact, most annual dental benefit amounts are provided to maintain an already healthy situation. In other words, if you have dental needs that have been delayed, you will most likely have expense beyond your dental benefits.  When you think about it, it will be some of the best money you ever invest.  Your teeth and mouth work 24/7!

Working together is the key to the best outcome for all involved.

Here’s to the outcome of great dental health for all!


MooreMs. Moore has been bringing greater productivity and profitability to general dental and periodontal practices thru her consulting practice for the past 20 years. As a speaker, she has presented at the top dental meetings in the U.S. and has spoken at meetings in Canada, the Middle East and Asia. Ms. Moore is a contributor to ADA’s newest publication Expert Business Strategies, is a regular contributor to ADA’s Dental Practice Success, as well as authoring 2 books and co-authoring 8 books on practice management. Her passion is getting results that further the success of dental practices. Ms. Moore is a graduate of the ADA KEMP for dentists. She holds membership in the National Speaker’s Association and is a member and Past-President of Academy of Dental Management Consultants.



Monday, 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.

Dental Professionals Role in Early Intervention of Methamphetamine Addiction

Tuesday, October 7th, 2014

By Noel Brandon Kelsch, RDH


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

Tuesday, September 2nd, 2014

By Paul Feuerstein, DMD


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 Perfect Board Patient

Monday, May 5th, 2014

By Paul A. Levi, Jr., D.M.D.

friendly doctor and pacient

Recently, in the predoctoral clinic at Tufts University School of Dental Medicine, the students were preparing to take the Northeast Regional Board examination. A student excitedly came to me and said, “Please evaluate my patient for the periodontal part of the NERB examination. I believe that she is perfect.” The patient must have 12 surfaces of very discernible subgingival calculus and at least two pockets deeper than 4mm. As we were walking to the operatory, the student further remarked that one year ago four quadrants of scaling and root planing had been completed for this patient. I remarked that, should this patient qualify as a Board patient, we as dentists have failed. The student appeared to be shocked at this remark.

Unfortunately, on examining the patient, she qualified. Somehow we did not motivate this patient sufficiently to take care of herself, and although we provided the patient a service of calculus removal last year, we did not provide the service of health. The patient explained that since the student said, “I completed the scaling,” her periodontal treatment was completed, and now she could get her fillings done and her dental therapy would be finished.

I discussed with my student that the procedure of scaling and root planing is not just the mechanical act of taking calculus off of the teeth and smoothing roots, but is educating the patient to understand that it is her responsibility to remove the plaque/biofilm thoroughly on a daily basis. Since biofilm is invisible to the patient they must concentrate on their techniques and be seen for professional hygiene at regular intervals consistent with their needs.

The student then asked, “How frequently should a patient be seen for hygiene maintenance therapy? The sacred cow of dentistry is every six months. This began many years ago when it was said that it takes six months to develop caries, and thus we should see our patients to prevent the caries from becoming large and significantly compromising the tooth. Prevention today, especially with fluoride and sealants does not mean preventing the caries from becoming too deep. It means preventing caries from initiating and preventing periodontal diseases including gingivitis. The latter taking only a few days to occur.1

I suggested that in determining a hygiene interval for our patients, we look at the hygiene status at the time of the maintenance appointment as well as their susceptibility to dental caries and/or periodontal diseases. A hygiene maintenance interval of six months is appropriate for patients with no caries experience and no gingival/periodontal diseases; however, those who present with susceptibility and presently excellent plaque control would do best on a four month interval rather than six months shortening the interval by two months. As humans our lives change and other concerns can affect our routines, thus we may change our hygiene thoroughness. If seen that one time more during the year, we are likely to intervene before dental disease occurs and truly be preventive.


1. Loe, Harold, Else Theilade, and S. Borglum Jensen. “Experimental Gingivitis in Man.” Journal of Periodontology. 36.3 (1965): 177-187. Web. 24 Feb. 2012



Dr. Levi was born and raised in Newton, MA. He attended Hebron Academy, then St. Lawrence University, where he decided to study dentistry after graduating from SLU.  He attended dental school at Tufts University School of Dental Medicine after which he accepted a residency in general dentistry in Burlington, VT.  He joined the Navy as a dental officer and served in Great Lakes, IL for two years.  Following that he earned a certificate in Periodontics from Tufts School of Dental Medicine after which he and his family moved to Burlington, VT to open his practice in Periodontics in 1971.  Among the many positions that he has held are Treasurer of VT State Dental Society, AAP Board of Periodontics, AAP Board of Dental Examiners and is now an officer as well as an examiner, and president of the AAP Foundation.  He has taught at the UVM School of Dental Hygiene and is presently on the faculties of Harvard University and Tufts School of Dental Medicine  and Universidad International de Catalunya.


Oral Cancer – A Patients Perspective

Tuesday, February 4th, 2014

By Eva Grayzel

Eva Grayzel, a professional interactive performance artist, was diagnosed with late-stage oral cancer at age 33 and told she had a 15 percent chance of survival. A non-smoker, she was bounced among dental professionals while the ulcer on her tongue grew more prominent and painful. “It was two years and nine months from my first appointment with a dental professional until the day I was finally diagnosed with stage IV squamous cell carcinoma of the lateral tongue. During that time, no one EVER mentioned the words ‘oral cancer’ as a possible cause. Finally, I made an appointment with Dr. Mark Urken, the chief of head and neck surgery at Beth Israel Medical Center. I took the bus into Manhattan that fateful day of April 1, 1998 not having the slightest idea that what was on my tongue was remotely serious, and received the cruelest April Fool’s joke of my life.”


Eva endured a partial tongue reconstruction, a modified radical neck dissection and a maximum dose of radiation therapy. Through an extraordinarily successful treatment plan, Eva not only survived but also regained her ability to speak clearly. With a second chance at life, Eva couldn’t let the same thing happen to someone else. A champion for early detection, Eva founded Six-Step Screening™, an oral cancer awareness campaign for dental professionals and the general public. For her initiative, she was recognized by the American Academy of Oral Medicine and awarded honorary membership.


After speaking at the 2003 ADA Annual session, Eva realized the impact she could have on saving lives by sharing her personal story. The audience doesn’t just hear her story, they ‘experience’ it, as they travel the journey with Eva from a delayed diagnosis of late-stage oral cancer, through the surgery and treatment. When dental professionals hear Eva’s presentation they say, “I never want what happened to Eva to happen to any of my patients.” Because of the personal nature of her story, and the fact that someone such as themselves could have prevented it, motivates them to change how they practice. In contrast to the clinical perspective at educational conferences, Eva humanizes oral cancer, inspiring the audience both professionally and personally. “I share my personal story hoping it will inspire dental professionals to perform oral cancer screenings on all their patients, as well as demand them for themselves and for those they love. Together, we can save lives. It’s more than my mission to educate. It’s my tribute to all those that came before me and my obligation to those that will follow. By publicly sharing my personal journey to help others, I’m gaining back all the years and more of life that oral cancer took from me.”


GrayzelMs. Grayzel a nationally recognized Master Storyteller was diagnosed at age 33 with stage IV oral cancer and given a 15% chance of survival. After regaining her deep vibrant voice, Ms. Grayzel applied her stage skills to communicate the depth of her experience in a unique and powerful way. A champion for early detection, Eva founded the Six-Step Screening™ oral cancer awareness campaign for which she was recognized by the American Academy of Oral Medicine. Ms. Grayzel is the author of two children’s books, ‘Mr. C Plays Hide & Seek’ and ‘Mr. C the Globetrotter,’ in the Talk4Hope Family Book Series.

Teeth Healthy Snacks for Kids

Monday, January 6th, 2014

By Dr. Andrea Beltzer

Happy carrot chomping girl

Feeding my kids isn’t always easy.  As parents, we are constantly bombarded with information about what is healthy and what is potentially harmful for our children’s little bodies.  As a parent, I take these decisions very seriously knowing that the choices I make for my kids now will likely impact the choices they will make for themselves when they are older.

I have two children, Lucy who is five and Charlie who is two.  They couldn’t be more different in their eating preferences and habits.  Lucy has a major sweet tooth.  We were recently at her friend’s birthday party at OaksPark.  There were lots of treats being served, including lemonade, fruit punch, cotton candy, chocolate cupcakes, and cups of ice cream.  The kids were sitting at a long picnic table, and the adults were chatting at another table.  It was crowded, and I wasn’t really keeping a close eye on what Lucy was choosing to eat at the other table.  As the kids’ table emptied out, Lucy was still sitting there finishing her chocolate cupcake after having a cup of lemonade, most of her cotton candy and the cup of ice cream.  Most of the other kids had abandoned their treats half-eaten, but not Lucy.  This was her chance, and she was going to consume as much sugar as possible in one sitting, since I wasn’t right there to monitor what she was eating.  I went over to her, and we had a little conversation about making good choices, and how eating all of those treats so quickly was probably going to make her feel a little sick later on.   Then I proceeded to try to wipe off all of the gooey chocolate and sticky cotton candy that was all over her face and hands and have her drink a cup of water to try and neutralize some of the acid that was being produced by those sugar-loving bacteria in her mouth.  Some of the parents who were standing around us chuckled with me knowing that I am a pediatric dentist, and it’s my kid who is the last one sitting at that picnic table trying to devour every last gram of sugar that she can.  Parenting fail?  No, not really.  I was more amused by the situation than embarrassed.  I know that what really matters in the long run is the every day choices that we make, not the very occasional big treat that sometimes happens during special occasions and holidays.

Charlie, my two-year old, is the exact opposite of Lucy in many ways, including his eating preferences.  He enjoys something sweet here and there, but will typically have a few licks of a popsicle after dinner in the summertime, and then decide he’d rather get down and play instead of finishing his treat.  My challenge with him is that he’s a grazer.  He is two years old and easily distracted, so unless he is starving, mealtime can take a very long time, and sometimes can result in him not eating much at all.  As a result, he likes to snack or “graze” in between meals.  His top choice of snack would be crackers or chips, and he could graze on chips and crackers all day long if we let him.  We know though that a diet of chips and crackers is not good for his body or his teeth!

Many parents are surprised to learn that even snacks like crackers can contribute to tooth decay.  Any snack that is rich in carbohydrates can lead to tooth decay, even it’s not necessarily considered a “sugary” snack. This is particularly true for kids that tend to graze all day long on carbohydrate-rich snacks, including crackers, chips, cereal bars, fruit snacks, raisins and dried fruits.  Studies have shown that it is not only the quantity of sugar consumed that can lead to decay, but it is also the frequency with which the sugars are consumed.  It is much worse for a child to sip on juice or snack on crackers if they are sipping or snacking over a long period of time, than if they were to have a few ounces of juice with their breakfast.  I’ve alluded to the role that bacteria play in tooth decay.  We all have bacteria in our mouth and some of these bacteria are responsible for contributing to decay.  The bacteria consume the sugars that we consume, and then produce acid which breaks down tooth enamel causing cavities.  If the bacteria are fed all day long by those who graze on carbohydrates throughout the day, they are constantly producing acid, and the mouth remains at an acidic pH for long periods of time which results in tooth decay.  Preventing your children from grazing throughout the day on carbohydrate-rich snacks is important for the health of their teeth.

Limiting juices, flavored milks, and other sweetened beverages, as well as encouraging your children to drink a lot of water in between meals can go a long way to prevent cavities.  Chewy snacks that are high in sugar, such as fruit snacks, raisins and dried fruits should be avoided in general, but especially for children with deep grooves on their molars.  These snacks really stick to teeth and are hard to remove from teeth even with good tooth brushing.

I have discussed a lot of things to avoid, so now I will talk about some of my kids’ favorite “teeth-healthy” snacks.  My kids love avocado, and that makes a great snack all on its own or sliced lengthwise with sliced turkey or ham rolled around it.  If your child is old enough and doesn’t have any nut allergies, nuts are a great snack food too.  My kids love almonds and cashews.  Whole fruits (not dried) and veggies are great.  My kids really started taking more of an interest and were more adventurous with trying different fruits and veggies when we planted a vegetable garden.  They love picking strawberries, cherry tomatoes and yanking carrots from the ground in their own backyard!  Other favorite fruits and veggies in our home are celery sticks with cream cheese, apple slices, Satsuma oranges, and carrot sticks.  Bananas are always a good portable snack when you are on the go.  They are nutritious and filling.  For kids that can tolerate dairy, cheese sticks are another easy “tooth-healthy” snack.  My kids also really love hummus, and almost any veggie tastes good dipped in a little hummus.  Costco sells boxes with individual servings of hummus that are very convenient for snacking.  Olives are popular in my house, not only because you can have fun putting them on your fingers but because they taste good too.  I also try to ask Lucy for ideas when I think she is getting bored with our usual lunches and snacks.  She often sees her friends at school eating things that I would never think to pack for her!  One of her school friends often enjoys red peppers stuffed with tuna salad for her lunch.  I would never think that a 5-year-old would enjoy something like that, but Lucy was interested in that because she saw her friend eating it.  Now she loves red bell beppers!  For some reason, kids always think their friends’ lunches look better than their own, so ask your kids what their friends are eating, and if they are interested in trying some new things!  You might just be surprised at what your kids will eat!


090725PTTBBELTZNERA11Dr. Andrea Beltzner received her certificate in Pediatric Dentistry from the University of Connecticut in 2007, and became board-certified in the specialty of Pediatric Dentistry in April 2008.  Along with her husband, adorable children and  two adorable dogs, Dr. Beltzner lives and works in Portland, Oregon. Passionate about helping underserved children receive the dental care they so desperately need, Dr. Beltzner volunteers regularly at Creston Children’s Dental Clinic, on the Tooth Taxi, at the annual Children’s Health Fair along with being a co-lead for the pediatric department at Oregon Mission of Mercy, and a volunteer on the Emanuel craniofacial team.

Dental Emergency First-Aid

Thursday, December 12th, 2013
By Dr. Weston Heringer, JrTooth First aid

Dental emergencies, especially with children, can happen any time.  Listed below are the most common types of emergencies and what action to take following the emergency.   It is always better to be prepared!

  • TOOTHACHE Clean the area of the affected tooth thoroughly.  Do not place aspirin on gum tissue or aching tooth. If face is swollen, place cold compress to the outside of the cheek.  Contact a Dentist.
  • CUT OR BITTEN TONGUE, LIP OR CHEEK If there is bleeding apply firm but gentle pressure with a clean  cloth or gauze. If swelling is present, apply cold compresses. If bleeding doesn’t stop readily or bite is severe, contact a Dentist.
  • BROKEN TOOTH If center nerve of tooth is exposed or center shows pink color contact a Dentist immediately.  For comfort, the injured area may be covered with a moist warm cloth.  If edge or corner is broken seek care at your convenience.
  • KNOCKED OUT PERMANENT TOOTH   Time is critical, find the tooth.  Quickly rinse the tooth, if possible, and reinsert it in the socket.  Have the patient hold the tooth in place. A tooth that cannot be reinserted should be kept moist.  The patient must see a Dentist immediately.
  • KNOCKED OUT BABY TOOTH  Primary teeth are not reimplanted, if you have questions about the injury, contact a Dentist.
  • BLEEDING AFTER BABY TOOTH FALLS OUT  Have the child bite on a folded gauze placed over the bleeding area for 15 minutes.  If bleeding persists contact a Dentist.
  • BROKEN BRACES AND WIRES  If a broken appliance can be removed easily take it out.  If it cannot ,cut it off.  Cover the sharp or protruding portion with cotton , chewing gum or wax.  Loose or broken appliances do not usually require emergency attention.
  • POSSIBLE FRACTURED JAW If suspected, contact a Dentist immediately or take the  individual to Hospital Emergency Room.
  • COLD/CANKER SORE  Over-the-counter preparations often give relief. Stay away from salty or acidic foods.  If sores persists over two weeks contact a Dentist.

 Editors Note: Please consider this non clinical advice and always consult your dentist with any questions or concerns.

Dr Weston Heringer

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.



Dental Implant Concerns Related To Patient’s Health

Monday, July 8th, 2013

Capped Dental Implant Model

By Dr. Don Callan

The goal of dental implants is to provide function, longevity and esthetics for dental patients in an environment that can be maintained with routine oral hygiene procedures. Dental implants are no longer experimental, exotic or rare. Implants are the treatment of choice for an increasing number of people who want the best that dentistry has to offer. Dental implants have proven to be a valuable treatment of choice for replacing missing teeth and have been developed from the anatomy of natural teeth. Dental implants are also subjected to periodontal disease (periodontitis) caused by oral bacteria (periodontal pathogens). Both patients and dentists should be aware of possible complications that can affect the patient’s oral and systemic health when implants are placed, even if excellent esthetic results are achieved. Professional implant maintenance and diligent patient home care are important factors. However, because a portion of the implant is below the gum level (subgingival), patients and clinicians have limited control over hygienic measures to prevent infection. Therefore, implant design is an important factor.

Periodontal pathogens have been linked with increased risk of systemic illness and complications in existing diseases.  Recently, several articles detailing these findings have been published, emphasizing the importance of the association between periodontal disease and systemic health problems.  In fact, recent reports of oral infections have been shown to be associated statistically with mortality. With periodontal disease, millions of oral bacteria are in direct physical contact with gum tissue, which provides an easy portal to the circulatory system.  After entering the bloodstream, periodontal pathogens have been shown to increase the risk of cardiovascular disease, strokes, lung disease, rheumatoid arthritis and may hinder glycemic control in diabetes. Sufficient evidence exists to conclude that both periodontitis and Peri-Implantitis involve the same bacteria. This same inflammatory process can damage healthy tissue and lead to bone loss around the implant.

In addition to optimizing esthetic and functional results, infection (Peri-Implantitis) of gum and bone tissue surrounding the implant is of major concern. These infections have driven many developments in dental implant design and use. Treatment of dental patients is rapidly moving from an approach focused primarily on esthetic and functional concerns toward an approach, which focuses on optimal health as a critical goal. Numerous published studies promote the prevention of oral bacteria harboring around implants as a key outcome in addition to traditional measures of implantation success.

Studies have shown periodontal pathogens surrounding dental implants will contribute to implant infections and is the main cause of implant loss and systemic concerns. Some patients may have significant infection and bone loss with no symptoms and may not pursue adequate follow-up care that would identify those conditions. Researchers have identified specific periodontal pathogens around and within the micro-gap of implant systems as the same seen in periodontal disease. Some implant companies are developing new designs for the elimination of the microgap issue. Therefore, it is important for all implant patients to see the dental professional for routine care and evaluation of the health around the implant.  It is possible for patients who maintain optimum hygiene care to suffer from implant infections if bacteria are harbored within, around, and between implant components.

In summary, the patient, dentist and the implant manufacturer have their respective areas of responsibility to maintain implant success. Infection about dental implants is the number one cause of failure; therefore, the patient must maintain excellent home care procedures of the implant and visit the dental office for routine cleanings. The dentist is responsible for proper surgical procedures and instruction to the patient for home care procedures. The implant manufacturer must be aware of the causes of implant failures in order to change or correct the design of dental implants as needed to promote long-term success. A poor implant design will affect esthetics, function and the ability to allow proper home care as well as professional cleanings of the implant and its restoration. IMPLANT SUCCESS IS A TEAM EFFORT: THE PATIENT, DENTIST AND MOST OF ALL THE MANUFACTURER OF THE IMPLANT.


DPCDr. Callan received his B.S., B.A. degree from the University of Arkansas in Business Management and Marketing. He received his D.D.S. degree and a Certificate in Periodontics from the University of Missouri at Kansas City. Dr. Callan maintains a private practice and hospital appointments limited to Periodontics with an emphasis on tissue regeneration and implant dentistry in Little Rock, Arkansas. Dr. Callan has authored 61 publications about dental implants and tissue regeneration. Dr. Callan has presented lectures in the United States and internationally, including the University of Moscow, Russia, China, Japan, UK, Mexico, Canada, Central America, and South America, on various topics including dental implants, Peri-Implantitis, bone regeneration, soft tissue regeneration, implant maintenance, oral and systemic periodontal health, marketing to the dental patient and treatment planning of the edentulous patient.




Look Before You Leap… The Treatment of Snoring and Obstructive Sleep Apnea

Monday, June 3rd, 2013

 By Gail Demko, DMD

Sleep Apnea and CPAP

All medical and dental professionals are looking for ways to offset decreases in reimbursement, often by acquiring new skills that allow expansion into previously untapped patient populations. Many dentists have become interested in providing oral device therapy for patients who snore and or have obstructive sleep apnea. All dentists possess the skills required to fabricate oral devices, we learned them in dental school. We are adept at using many different impression materials, adjusting and modifying multiple types of mouthpieces, can analyze occlusal contacts on complete dentures and have a passing knowledge of clonic bruxism and tonic bruxism (clenching).

The treatment of patients with snoring and obstructive sleep apnea requires not only these basic mechanical skills but an understanding of the overall disease process. This is a medical disease with medical complications and comorbidities. Just as untreated caries will lead to endodontic involvement and possible tooth loss, untreated sleep apnea can lead to hypertension, heart attack, stroke or an increased incidence of various cancers. Dentists are fully in control of treating all outcomes of the carious process but we are not trained to deal with the severe medical outcomes of untreated sleep apnea.

You must understand that we are part of the medical team. We work with physicians to appropriately treat patients with snoring and sleep apnea. Diagnosis of disease, be it snoring or sleep apnea, lies within the arena of medicine, not dentistry (just ask your malpractice insurer). To treat a patient who complains of snoring without appropriate medical consult and medical diagnosis may result in the resolution of snoring without control of the underlying sleep apnea. This patient could go on to suffer heart failure, have a motor vehicle accident or develop hypertension. Resolution of the patient’s symptom of snoring may allow both you and the patient to assume that the underlying sleep disordered breathing has also been controlled; snoring often resolves before there is control of the obstructive sleep apnea. This presumption can be very dangerous to the patient and could have serious consequences for your practice.

Many companies now market legal medical diagnostic sleep testing equipment directly to dentists. The sales rep tells you that this will allow you to “screen” patients in your practice for snoring and sleep apnea. These are not screening devices; these are legal medical diagnostic tools. The standard of care requires evaluation of the patient by medical provider not just remote evaluation of the data obtained through home sleep testing by a physician licensed in your state.

So approach this field in a responsible way. Learn about the diseases of sleep disordered breathing. Understand all available treatment options and know when oral appliance therapy may not be appropriate for the individual patient in your practice.

Treating medical diseases requires that you be part of the team. Physician, surgeon, general dentist, orthodontist, nurse practitioner and respiratory technician: all of these have a part to play. As dentistry evolves and continues to move back in synchrony with medicine it is time to forge new alliances with our medical colleagues to provide improved outcomes for all of our patients.



Dr. Gail Demko started her career in dental treatment of OSA at Beth Israel Deaconess Medical Center in 1989. In 1997, she was the first dentist in the US to limit her practice to the treatment of OSA. She became the expert advisor to the FDA in the area of oral appliance therapy in 2004 and has been active in professional groups for some time. At present , she is President of the AADSM, a member of  the Board of Directors of the Massachusetts Sleep Society, on the editorial board of the Journal of Sleep And Breathing and holds the distinction of having the first certified dental sleep medicine office in New England. She continues to practice full-time in Weston, MA.