The general public has no excuse when the Wall Street Journal has succinctly and comprehensively explained why dentistry is so important to patients’ overall health. Make copies, post a link from your Facebook page, tweet about it. Just make sure that EVERYONE IN YOUR NEIGHBORHOOD reads this article, watches the video, or interacts with the snapshot graphics. Click on the title below to visit:

If Your Teeth Could Talk…

The Mouth Offers Clues to Disorders and Disease; Dentists Could Play Larger Role in Patient Care

Way to go, WSJ.

The results of a national survey conducted a few months ago were released today:

Majority of Americans Support Mid-Level Dental Provider to Expand Access to Dental Care

Four-in-Ten Americans or Their Family Members Put Off Dental Care Due to Cost, according to the W.K. Kellogg Foundation.

BATTLE CREEK, Mich. – Millions of Americans cannot find affordable dental care in their communities and many want to explore mid-level providers as a way to improve their access to needed oral health care, according to a national survey released today by the W.K. Kellogg Foundation.

The survey reveals that many Americans are struggling to get the care that they need. Forty-one percent of Americans report they or someone in their household has put off dental care because of cost and 30% say they do not have a place to receive dental care.

Based on a poll of 1,023 adults, the survey, conducted by Lake Research Partners, finds that more than 80% of Americans believe it is difficult for people to get free or low-cost dental care in their communities, and think the number of Americans who cannot access dental care is a problem.

>> Read more of this original story at WK Kellogg Foundation News.

Here’s my thoughts on this survey: We are born with teeth, we don’t have to purchase them, so why should we have to keep paying for them? This mentality is what leads people to get away with the least cost for medical care as possible, because they don’t want to have to pay for something that they originally got for free. “Every tooth in a man’s head is more valuable than a diamond.” – Miguel de Cervantes, Don Quixote, 1605

So duh, of course the survey would reflect such an attitude. Whether it’s economically feasible to create a midlevel provider position or not shouldn’t even be in question; the current markets of dentists and hygienists are already flooded in metropolitan areas. The solutions should be incentive-based: forgiveness of school loans, possibly more independent preventive care delegation to hygienists in public health settings, much more education-based intervention, aggressive messages from AdCouncil or whatever it takes to get the word out that natural teeth are an investment; at the going rate a full set of implants is what? 50 grand? THERE’S your message.

Originally I posted this statement at Dr. Bicuspid but thought it could stand an airing-out here as well. And I know, as a card-waving member of the American Dental Hygienists’ Association you’d think I’d be all for the creation of a midlevel provider position, right? I probably would be, except for one thing: the current anticipated incomes of midlevel providers are significantly less than the average hygienist incomes in this country. It’s almost like there was a deal in the back corner of a committee, saying: hahaha, you GO to school two more years, girlie-girl. The dental boards will assure that it’s not economically worth your while to further your education.

Until the in-fighting between the militant factions of dentists and hygienists simmers, I believe that this survey only serves to get under the skin of those who will use it to justify their own stances. Something’s got to change though, when doctors and patients alike are excessively frustrated with some questionable treatments that are performed in dental clinics primarily funded with Medicaid dollars.

Here’s how I know something’s wrong with our government dental care programs: the majority of today’s Medicaid offices aren’t even hiring hygienists. So much for midlevel providers. So much for prevention.

by Trish Walraven

I’m taking flossing to the airwaves. Mah NUMPH bErrr BEHRRRRR… Don’t my riffs sound great?

No?

But it’s air guitar, man, use your imagination! Feel the energy, the passion, the creative flow that turns all of us into rock stars on our gaming consoles!

Something you may not have realized is that you are already a star, at least in the eyes of your patients. A Dental Star. Rock on. Your opinions are gold. Patients ask which toothpaste is best? Which mouthwash should they be using?

One question they never ask is “What should I use to clean between my teeth?” Do patients even register a thought about their interproximal surfaces? Here’s a question for you as a person, not as a dental professional: how often do you think about the skin between your toes? (toejam. eww.)

My point exactly.

But we think about the skin between teeth all the time. That’s where we see the most gingivitis, the highest plaque scores, the most room for improvement. And we’re tired of laying guilt trips on our patients when we realize that they’re not flossing.

That’s when you want to be able to point to alternatives and say to your non-flossers, “Maybe this will work for you.”

Water Piks are wet, messy, and have been around since the 1960′s. Still, they are my go-to recommendation for non-mechanical biofilm reduction because I see improvements in bleeding scores with patients who use them daily. They are also ubiquitous and affordable, making them more attractive than some of the higher priced or obscure dental water jets.

What’s that? Philips has a new gadget that competes with Water Pik? Well, Philips products can be bought everywhere, too! Can you say, “market penetration?” Can you say, “a funhouse explosion in your mouth?”

It’s called the Sonicare AirFloss, and it was introduced to the world a few weeks ago at the International Dental Show in Germany. Philips is being cheeky about it at the moment, but it looks to be making its American debut at the California Dental Association Meeting in Anaheim next week.

The Sonicare AirFloss is said to replace flossing with micro-bursts of water and air. Fill its reservoir with a few teaspoons of mouthwash or water and you’re ready to blast the little legs off your biofilm bugs.

As of this writing, the only way to learn more about the AirFloss is to sign your office up for a Lunch and Learn at the Sonicare website. Who would turn down free food and a nugget of sponsored CE credit to expand their knowledge base about a product that patients will soon be coming to us for answers about its worthiness?

I am always intrigued by the buzz about new preventive products. As an idea that Philips recently acquired with the purchase of Discus Dental, the Air Floss is being presented in a warm fuzzy cushion of patient acceptance. Do patients like this more than flossing? Do they like it more than using a Water Pik? This presentation makes me think that the science behind the product hasn’t shown the health results that Philips had hoped it would. Watch this video from the IDS in Cologne and see what you think. This is Maria Perno Goldie, RDH Village eFocus editor:

And then there’s me. My family will be so thankful when we get an AirFloss because it might just keep me from pretending to be on American Idol when I think I’m alone in the bathroom:

Concert yell, WooOOOOOOOO!

Living the dream, baby.

Thanks, Star Dental, for the shirt. You rock, too.

5/13/11 Update: The AirFloss is now live on the Sonicare Website!

by Trish Walraven

The Dramatization:

At first it was small. The outbreak began in Florida’s Tampa Bay Area as local hospitals noticed an influx of patients with complaints of turquoise discolorations of their lips and aversion to simple carbohydrates. Once case histories were correlated it was noticed that all those who were affected had either recently received an inoculation of a mutant version of Streptococcus mutans at their dentist’s office or had been in close contact with someone who had.

Initially the culprit was thought to be excessive consumption of blue raspberry slushies, but by the time the CDC discovered that an organism was responsible for these symptoms and that it was bacterial in origin and highly contagious the disease had spread far beyond Florida and had affected millions throughout the US and abroad.

There have been no reports of mortality, save the demise of the soft drink and candy industries. Sugar consumption has plummeted as more of the population becomes infected by this new strain of bacteria which was originally created to cure the problem of dental decay. Because persons who are affected display a noticeable change in their appearance, blue lips have become a strong signal of exclusion due to the fear surrounding this epidemic. However, as more evidence points to the positive outcomes of having been infected, the “blue look” is currently trendy in the larger cities. Blue-lipped patrons that had been banned from public venues such as restaurants and arena events are slowly trickling in, thanks to the assurances from the World Health Organization that this current situation has actually caused more good than harm. The long-term effects will be felt by dentists, who, in the next 30 years, will see an attrition of their necessity as caries becomes extinct, and possibly within the cosmetics industry with a shift in lip color preferences.

The Reality

Um, Yay? It’s been like, since the early 70′s that everyone’s been asking for a caries vaccine. And wouldn’t you know it? A company in the United States is already so ON this. Oragenics first initiated their first Phase 1 Clinical trials in 2005 but were halted by the FDA because of the fear of something happening like the above scenario. Think I’m kidding? Okay, maybe I was being sensational. But there can be genuine risks when you fiddle with a few genes, and the FDA seemed to be mainly concerned with the lack of a plan to eradicate attenuated strains in the test subjects’ children. AHHHHH!

It starts to get interesting when you look at the solution that Oragenics came up with to begin their second Phase 1 testing announced last week: The trial subjects will be inoculated with a strain of S. mutans that cannot survive without the amino acid D-alanine, which is not found in a normal human diet. This means that the subjects will have to feed their germs daily with a mouthwash to keep them from dying.

Are you excited yet? Well, you’d better hold those horses back for a while. A long while. It’s going to take a bunch of time and a lot more money to get this to the market.

The inoculation is designed to be a painless 5-minute treatment with a cotton-tipped swab to deliver the suspension of Oragenics’ patented bacterial strain into a patient’s mouth during routine dental visits. But this one won’t die without feeding. It will live forever.

And what is it supposed to do once it goes viral? Err… bacterial? Oragenics calls this treatment SMaRT Replacement Therapy™ and it promises to:

• Offer lifelong protection against tooth decay caused by S. mutans

• Eliminate the creation of lactic acid by oral bacteria

• Dramatically reduce the ability of S. mutans to cause tooth decay

• Be genetically stable

• Grow at a rate similar to non-genetically-altered S. mutans

• Aggressively displace the native, decay-causing strains of S. mutans and preemptive colonization of its niche

• Not cause any acute or chronic adverse side effects

I think it’s a foregone conclusion that this sort of genetic manipulation is probably the only way we’ll and break caries’ hold on humanity and the loss of teeth caused by decay. We can’t just kill all the bugs in our gut – all the Jamie Lee Curtis Activia commercials have given us TMI about probiotics lately – so it makes sense that this same premise is true in our mouths.

And the raspberry slushie is still your best bet for getting blue lips. Sorry, Oragenics will probably not be helping you there.

by Trish Walraven

Stanky Moufs, Stanky Moufs, I want to rid the world of Stanky Moufs. When a patient sits down in a chair with a freshly-stanked cigarette mouf, that smell hangs in the operatory longer than their jacket.

Is the American Lung Association with me? NO! Maybe it’s because they’re still getting a part of that $206 billion settlement from Big Tobacco back in 1998. Can’t put their sugar daddy out of bidness.

Well then, is the government with me? Not really. The government wants to tax those stanky moufs for recreational nicotine use, and they want to regulate the patches, gums, and lozenges being sold as medical devices designed for smoking cessation.

How many smoking patients do you have that don’t want to quit? They’re not supposed to admit to you that they really love smoking, now. Especially not to you. But more and more of them are coming into my practice, breaths a-bloomin’, tissues pinkin’, and when I ask them if they quit smoking, they don’t say yes. They say that they’ve switched to e-cigarettes.

RRRrrrRRT ( that record scratch stop noise that’s used too much in media but I can’t help myself). WHAT THE?  WHAT IS AN E-CIGARETTE?

I Gurgled it. Gurgling is kind of like Googling except that you ask your patient an open-ended question while they’ve got a little spit in the back of their throat that they really don’t have but they think they do and they want you to suck it out before they answer the question.

Best answer I got: “Well, everyone in our office either got a supply of E-Cigarettes if they would quit using regular cigarettes, or $200 to use on themselves if they weren’t smokers.” An employer has gone out of their way to get tobacco out of the bodies of their workforce. This sounded BIG.

That’s when the internet got much more handy than Gurgling. Here’s a great description of an E-Cigarette from AlterNet:

The e-cigarette was invented in China in 2004. It’s a cigarette-shaped tube that contains a rechargeable battery, a mini-vaporizer, a small reservoir, sensors and, in most cases, a light on the tip. The sensor notes when you take a drag on the tube and turns on the vaporizer, which more-or-less instantaneously turns the substances in the reservoir into a stream of visible water vapor that mimics the taste and feel of tobacco smoke. The tip glows like the end of a lit cigarette with each drag. It’s infused with the taste of tobacco – or tobacco combined with other flavors for those who are into that sort of thing – and nicotine, in various doses (including none at all). The refill cartridges – which look like the butt of the cigarette–give you about the same number of drags as a pack of cigarettes, but cost around $3 each – a bit more than half the national average and a third of what a pack of smokes go for in places like New York City.

The next question everyone asks is “Is it safer?” (I must stop with the Marathon Man references…this is only my second offense, sorry!). But really. Are e-cigs safer than tobacco? I for one am totally convinced that they will kill you much, much slower than tobacco, and far slower than water (if you’re drowning in it, of course). It’s the combustion that creates the majority of carcinogens found in cigarettes, which is why no real smoke is safe. The vapor ingredients in an e-cigarette – propylene glycol or glycerin – are Generally Recognized As Safe (GRAS) by the Food and Drug Administration. The problem arises when you don’t know what else is being added to the cartridges. Like Cialis. No joke. You can get some Cialis to smoke in an e-cigarette here. What about a dangerous, banned weight loss drug? They’ve got that too.

These extreme additives are all the excuse that e-cigarette opponents need to try to get them banned in the United States. That’s why no one will touch this issue, especially with the FDA coming down hard on new tobacco products in March. The federal courts are leaving it alone for now, but arising is a vast current of e-cigarette fanboys. They call themselves Vapers, and their recreation? Vaping.

What do you prefer? Stank Mouf or vape mouth? If your patients are committed to their cigarettes, it might not be such a bad idea to turn them on to something that may do less harm than their current habit.

I don’t know about you, but my ops are smelling better already. 

We were impressed that when put on the spot between inaugural balls today, President Barack Obama was able to outline his plan to give all people in the United States of America the right to a beautiful, healthy smile. The big question is: just who are his dental advisors?

Obama’s Mastication Initiative for America (MIA)

The people of the United States should realize that teeth are a quality of life issue. The government cannot force a citizen to take care of his or her body, nor should a person be penalized for issues that are beyond their control. We have seen the insurance industry take hold of healthcare and overvalue its services. Furthermore, dentists throughout our great nation have resisted the tide of managed medicine and are now capable of not only improving the quality of their patients’ lives, but even the very length of the average American lifespan.

When we look at the technological advances that have been made in dentistry, we know that now is the time for change. It is this administration’s hope that by combining personal responsibility with expert guidance, my Mastication Initiative for America will fulfill the needs of all Americans, not just the ones barely getting by; not just the wealthy, but every one of us.

The details will be forthcoming when I have more than a few breaths of air between dipping my wife on dance floors, but here is a brief outline of the plan:

1. Participation in the plan is voluntary, both for dental providers and for patients.

2. Payments will be made directly to patients on a yearly basis, with the exception of the Lump Sum plan that is described in line 6.

3. All participating dental practices will engage the use of a government-approved method of data gathering and reporting, to be agreed upon in the future, but possibly a special watermarked panoramic digital image that can be submitted to the Department of Health and Human Resources. This will significantly decrease the ability for fraudulent reporting on patient status.

4. Each person under the age of 30 will be required to have yearly dental images submitted on their behalf for reimbursement by the federal government. There will be a fixed amount allowed per person, regardless of actual care rendered. i.e. $500 per year per person under 30. Under no circumstances will any funds be reimbursed if basic preventive measures were not pursued by the patient or their family.

5. Third Molar Extraction will be considered a medical expense, as will any congenital deformity that is currently considered the arena of oral maxillofacial surgeons, so is excluded from the MIA plan.

6. At the age of 30, regardless of previous dental history, all citizens will be eligible for Dental Implant Screening (DIS). Because of the excellent properties of implants versus natural teeth regarding the elimination of the periodontium and thus the link to systemic disease, it is the MIA’s recommendation for DIS to be implemented before dental disease is likely to permanently affect a person’s whole health. Those who are at risk for losing their teeth, who have already lost teeth, or who simply make the choice of not wanting to maintain their teeth will, at this time in their lives, be given the opportunity to have all their teeth removed and have dental implants placed instead. This is a Lump Sum, and will include a preventive appliance to be worn at night. Any person who has implants with DIS will not be able to participate in the MIA after having implants placed.

7. DIS practitioners will work directly for the government, be well-trained, and well-compensated for their expertise.

8. From the age of 30 onward, payments from the MIA will be based on the number of healthy, maintained teeth that a patient displays in the accepted yearly imaging submitted. Included as healthy teeth: those with no restorations, restored teeth with no active defects, teeth with successful root canal therapy, periodontally involved teeth with no bone loss noted within the past year, and dental implants. Teeth that would not be counted for MIA payments: Broken teeth, retained root tips, teeth with active decay, and teeth showing periodontal involvement that has progressed since the previous submitted image.

This is the plan that will ensure that all Americans will be able to smile proudly, whether it is a God-given smile or one granted to them by choice, and no longer will we as a nation be faced with lost work time, emergency room visits, and other troubles caused by bad teeth. After all, this is the very soil where the “Hollywood Smile” was born, and so I ask you to consider what is best for our country, for our children, and for dentistry in the new economy to come.

In so many ways, the BrytonPick is the best all-around new product in patient oral health care. 

It’s Green: One pick is reusable for up to 30 days.

It’s Cute: The BrytonPick looks like a little boomerang.

It’s Practical: Patients who absolutely will not use dental floss will be thrilled that a new option is available for food removal. This means they can stop using paper clips, business cards, matches, and fingernails.

It’s Portable: the BrytonPick comes with a credit card-sized carrying case.

It’s Brandable: the back of the carrying case can be printed with the name of your dental practice.

It’s Affordable: BrytonPicks each cost less than $2.

There’s only one problem: It’s made of metal, which makes it hard to watch the video on the BrytonPick website without getting that watery-mouth, galvanic shock sympathy shudder.

We finally figured out why the German guy was asking Dustin Hoffman “Is it safe?” in the movie Marathon Man. Obviously his wife was planning on having her third child and he was worried about the folk saying from his native country, “Every child costs the mother one tooth.”

Leave it to the Americans to show that these words actually hold a great deal of truth. Across the socioeconomic strata the results of data examination were consistent: women who gave birth to more children tended to lose more teeth during their lives.

So the next time a pregnant patient is worried about the baby “robbing calcium from her teeth,” dentists can acknowledge that there is a real correlation between making babies and an increase in dental disease. And then take steps with the mother-to-be to minimize the oral flora aggression that seems to rise in their mouths.

Hopefully this will mean fewer drills aimed directly through the central incisors.

Throw away all your battery-powered unmentionables and welcome a familiar friend to your bedside drawer!

The Oral-B Pulsar disposable electric toothbrush is the discreet answer to better pleasure, vitality, and all-around good vibes.

Once found only in the oral care department of superstores, the Oral-B Pulsar has now been endorsed by a pioneering gynecologist and may soon be the first product on the market to simultaneously receive the ADA Seal of Acceptance and the ABOG Standard of Therapy Seal. “Never before have we realized that a single product can fulfill two needs – perhaps even at the same time if the spouse is an enthusiastic brusher,” said one dental hygienist who wishes to remain anonymous.

Furthermore, the low cost of the Oral-B Pulsar opens the door to many more users who could not otherwise afford a vibrating device or who would stoop so low as to think of handling a toothbrush in this manner.

Readers of this blog who want to be further humored are highly encouraged to first read this actual news article from the Palm Beach Post, then to go play with the Pulsar Flash Video on Oral-B’s website. It will definitely change the way you look at power toothbrushes forever.

In our last episode, we left as the two camps bickered over what they were going to do once they had actually tracked down the elusive Maxillus mandibularis. The leader of Camp NeuroMuscular had leaned toward the fire, cradling the bowl of his pipe in his fingers and clenching its stem in his teeth like an NTI device. Removing the pipe, he suggested that the solution was to deprogram this infernal beast.

“Nonsense!” replied Sir Centric Relation from under his handlebar moustache. “Everyone knows that you must guide the cuspid. It is the only way to stop the nightly rampage.”

As we return to the scene, Sir Centric stands up and peers into the encroaching darkness.

“But ho, what is this?” Out of the shadows steps a keen-eyed gentleman in a light blue seersucker suit and an obvious combover.

The man approaches the fire and begins his spiel. “You know what is the real problem, right? You just want to keep the Maxillus mandibularis from crashing in here and destroying everything. Do you think all those villagers care about why? They want this problem fixed, and they want it fixed today.”

The gentleman swiftly rolls out a sheet of something, squishes it around the beast’s water-hole, and waits for it to harden.

“There ya go. Problem solved. And it’ll cost you less than having those timberlogs dragged in from the forest. Besides, who has two weeks?”

“Certainly that shouldn’t be a problem. The villagers have been living with this for years.” says the leader of Camp Neuromuscular.

“Yes, but they came to you today for an immediate solution.”

“It’s only a stopgap. It doesn’t correct the underlying problem. And eventually the barrier will fail,” chime in the leaders of both camps.

The gentleman brings his fist up to his chin in thought. “Well, even if you can kill the beast, you do realize that it’s a protected species.”

“But no way is it in danger of going extinct. It must be laid to rest!”

“Yet, still so hard to kill quickly. Goodnight gentlemen. If you change your mind, just ask around. Everyone in these parts knows where to find me.”

The man in the suit slinks back off into the darkness, leaving the two leaders alone in silence, once again glaring at each other from across the campfire.

*********

When it comes to parafunction that eventually will whittle your patients’ teeth down to stumps at night, it only makes sense to fabricate some sort of cushion to soften the blow. Dentsply-Caulk has recently been advertising the inTerra iNoffice Nightguard. This product appears to break down some of the obstacles that come up as the dental profession seeks to eradicate bruxing from the planet.

The iNterra Nightguard’s VLC (visible light cure) material is packaged in three arch sizes. This soft tray is formed directly on the patient’s teeth while in the chair, tack cured in the mouth for a few minutes, and then completed in the lab in another 20 minutes, which makes same-day delivery a snap.

With an existing light-curing oven in your lab, the cost to begin fabricating nightguards in-office makes the iNterra system a decent value, cutting the usual lab fees for nightguards at least in half. Otherwise, be prepared to spend a few thousand dollars on a curing unit before you insert your first case.

Look at the iNterra Nightguard from an efficiency standpoint. Single appointment, no lab transportation issues, minimal doctor chairtime. You may also be able to improve case acceptance when passing on the reduced overhead costs to patients.

Is it the best way to prevent occlusal wear? Who’s to say? But the inTerra Nightguard is much better than doing nothing about parafunction.