DentalBuzz Staff

These identical twins can both be your dentist

February 8, 2019 By DentalBuzz Staff 6 Comments

The novelty of seeing someone’s face repeated on another human creates a positive moment of surprise that will be instantly apparent on your own face. Do you feel genuine happiness when you encounter the miracle of identical twins? Well, maybe there’s a dental practice in your area that will engage that joy, one that will take care of that big broad smile that they bring out of you every time you visit.

Duplicate Dentistry is what you’ll get with twins! At least that’s the general idea. Two individuals who chose the same path in life, right down to their profession and where they would live. It makes sense, though, that twins would find a sense of trust and companionship with one another enough to form a complimentary way to be in the world.

It’s pretty common for spouses to meet in college and then to build dental practices together, or for children to follow their parents’ leads and then join them as dentists in the towns where they were raised. Identical twin dentists practicing together is quite exceptional, and rare, which is a little surprising! As an identical twin, it makes sense to weigh your natural clone’s career ideas along with those that you are considering. Then again, it’s a lot to ask someone to join you for eight years of college and then open up a business with you.

That’s exactly what these wonderful people have done, though. They are identical twins who work together to make dentistry a more enjoyable part of their patients’ lives. Keep reading to see if there are a set of twin dentists or orthodontists that are close enough for you to visit.

Charlotte, North Carolina

Drs. Lindsey Rennick Salone and Lauren Rennick Lockhart

Dual Image Smiles

One of the taglines for this practice is “Laugh Frequently. Smile Proudly.” Dr. Salone, Dr. Lockhart, and the other doctor Lockhart (Lauren’s husband) have been providing family dental care and orthodontics in the Charlotte area with the high level of expertise that comes with the rigorous years of additional training they have all received in their professions. The twins were featured recently on a local morning show where they shared why their practice is a great dental home for all members of the family, from toddlers to grandparents. On their website, Dr. Lauren gives us a taste of what it’s like to be her patient. She states, “I love to laugh, I love to smile, and am excited to share these gifts with you!” If you’re lucky enough to live in the Charlotte, NC area, visit them in their office (a renovated house!) or schedule an appointment with them at DualImageSmiles.com.

1315 Matheson Ave, Charlotte, NC 28205 Phone: (704) 334-6907

Midland, Michigan

Drs. John McLaren and Charles McLaren

McLaren Dental Associates

Some sets of identical twins can be harder to track down than others! Especially when they’re very humble about themselves. You would think that McLaren Dental would make it well-known that twin dentists would be caring for you! If it weren’t for this article written 15 years ago when the two took over an existing practice in Midland they may not have ever been included here. In the article’s interview, Charles echoes the feelings that many twins have about their lives together. “I have yet to meet any brothers or sisters that are closer than us. That’s the way we grew up,” Charles said. “A lot of our decisions in life were at least in part based on what the other was doing. We’ve both had the same interests and skills. I’ve called him up before, and thought I was talking to myself.” They can be found at McLarenDental.com.

308 Northgate Drive, Midland, MI 48640 Phone: (989) 631-7880

Frisco, Texas

Drs. Pantea Nooraee and Kelara Gandy

Twins Family Dentistry

This is the first of THREE (!) sets of identical dental twins in Texas, located in the far north Dallas area of the state. If you don’t see them both on the same day, however, that’s because they now work from two locations in Frisco to make it even more convenient for their patients. What’s it like to visit them? Here’s one reviewer’s take: “Dr. Nooraee and Dr. Gandy are the pinnacle of dentistry, the office has state of the art technology, SUPER sweet staff and convenience is their specialty. (I don’t know who my dentist is as they really are twins) I think I like them both though.” You can request an appointment and more from their website at TwinsFamilyDentistry.com.

8811 Teel Pkwy Suite 270, Frisco, TX 75034 Phone: (972) 335-3000

2626 Stonebrook Pkwy Suite 400, Frisco, TX 75034 Phone: (214) 872-2200

Austin, Texas

Drs. Kip Nielson and Cody Nielson

Starlight Dental and Orthodontics

Need a dentist (or two) that are fluent Spanish speakers and live in central Texas? It would be surprising to learn that the twins are both undergraduate Spanish majors, until you realized that their education was a continuation of the experience gained as each served as missionaries in Central America for two years. Dr. Kip’s time was spent in El Salvador, while Dr. Cody worked in Costa Rica. They both value building long-term relationships with their patients and providing a level of dental care that will endure as well. Dr. Kip shares his feelings about his work in this way: “l feel extremely blessed and fortunate to provide healthy and beautiful smiles to all those that l treat. I am thankful for the opportunity l have as a dentist to meet and serve so many wonderful people in the Austin area.” You can read more about them at StarLightDentalAustin.com.

10123 Lake Creek Pkwy #2, Austin, TX 78729 Phone: (512) 250-8101

Amarillo, Texas

Drs. Austin Hodges and Patrick Hodges

Hodges and Hodges Orthodontics

Austin Hodges and Patrick Hodges are identical twin dentists with additional specialty training as orthodontists. Which means that while you won’t be able to visit them for your regular dental care, they can make sure that you and your family’s teeth are in the best possible position to enhance your smile. Their childhood orthodontist in Amarillo hired them once they both graduated from Texas A&M University, and after his retirement, they moved to a new office built on the family land that is shared by their dad’s veterinary practice. Dr. Austin and Dr. Patrick were drawn to dentistry as their profession after participating in mission trips to Mexico with local dentists and experiencing profound gratitude from the people they served during those visits. Why did they choose to practice together? In this recent Amarillo Globe-News interview, Patrick addressed the question. “It’s never been a plan that was set in stone, but we always thought it would be nice to work together. We were roommates for almost 30 years, so we figured we’d be pretty good (business) partners.” They now have three locations where Texas panhandle residents can get their teeth straightened. To view a tour of their offices, visit HodgesAndHodgesOrtho.com.

5212 S Coulter St, Amarillo, TX 79119 Phone: (806) 353-9862

1801 4th Ave, Canyon, TX 79015 Phone: (806) 353-9863

1401 E. 1st St, Dumas, TX 79029 Phone: (806) 353-4442

Tuscaloosa, Alabama

Drs. Belinda Rhodes and Melinda Rhodes

Rhodes & Rhodes Family Dentistry

Meet BeBe and MeMe, the Rhodes twins who grew up in Sawyerville, Alabama. They’ve been practicing together in Tuscaloosa since 2013 and work with a loving group of dental staffers that know how to put patients first. Although they still practice under their original last name, both dentists are married, and enjoy spending their time serving their communities. After obtaining undergraduate degrees at Stillman College in Tuscaloosa, Belinda and Melinda earned their DDS degrees from The University of Michigan School of Dentistry. Learn more about the Rhodes and the rest of their team at RhodesFamilyDental.com.

6000 Old Greensboro Rd, Tuscaloosa, AL 35405 Phone: (205) 409-9088

Cincinnati, Ohio

Drs. Dave Rothan and Mike Rothan

Twin Dental

The Rothan brothers may not be exact duplicates of one another, but as twins that have practiced together for over 30 years, they deserve a place in this lineup. They are known for their ability to provide a wide range of dental services so that patients can have both general care and specialty care provided in the same office without needing referrals to other dentists. You’ll find that everyone in the practice is down-to-earth yet professional, and that they have the experience and technology needed to make dentistry less scary. Most importantly, Dr. Dave and Dr. Mike focus on prevention so that their patients are less likely to need more complex care in the first place! You can schedule a free virtual consultation online at TwinDental.com.

11430 Hamilton Ave Suite 1002, Cincinnati, OH 45231 Phone: (513) 825-6111

Monroe, Louisiana and Baton Rouge, Louisiana

Drs. Katina Beverly and Kredenna Beverly

TWINkling Smiles of Monroe

TWINkling Smiles of Baton Rouge

How do you know that your dentist has the right focus to take care of children? When that dentist originally wanted to be a kindergarten teacher. Both Katina and Kredenna were studying at Southern A&M College when a recruited suggested that they should look into becoming pediatric dentists instead of kindergarten teachers. They now practice independently, but that doesn’t mean they practice alone. On two Saturdays a month, the twins operate a satellite pediatric dental facility in Oakdale, Louisiana where they provide joint care to underserved kids, and they mentor each other throughout the week. Their slogan, “Twins Making Tiny Smiles Twinkle” helps them fulfill both their professional purpose as well as deepening their personal worldview. Katina expressed this to the News Star in 2018, stating, “When I talk about my journey, I always include my sister, because I think about our lives as one story.” And then there’s the $2 Bill Initiative that they use to teach kids about their origin and purpose. Learn more at TwinklingSmilesOfMonroe.com and TwinklingSmilesOfBatonRouge.com.

203 North 5th St., Monroe, LA 71201 Phone: (318) 805-9000

2314 Weymouth Dr., Baton Rouge, LA 70809 Phone: (225) 926-4444

Porterville, California

Drs. Elwin Hutchins and Erwin Hutchins

Hutchins Dental

Residents in the Porterville area were very appreciative when Elwin and Erwin Hutchins quickly filled in for a retiring dentist several years ago, and they are keen to share their kind demeanor and dental care with new patients as well as long-time patients. The identical twins started in mission dentistry, serving patients in Puerto Rico, Trinidad and Tobago with very busy outreach clinics where they worked for almost two decades before returning back to their California roots. Their wives have also joined them in practice – Elwin’s wife Sonia is an assistant while Sandy is the office manager. Visit them in either of their offices, or online at HutchinsDental.net.

350 N. Second Street, Porterville, CA 93257 Phone: (559) 781-1163

100 N. Palm Street, Woodlake, CA 93286 Phone: (559) 564-8878

Sarasota, Florida

Drs. Amy Nulty and Leslie Nulty

Mirror Image Dentistry

If there ever were a dental practice you could visit where it seemed like the dentist had cloned themselves so that they could be in two places at once, Mirror Image Dentistry would be the place. Dr. Amy and Dr. Leslie are very identical twins. New patients find it very hard to tell them apart from one another, given that they prefer to dress the same, participate in conversations where one’s sentence overlaps naturally into the others, and even work in the same close office space where they’ve been since 2001. The sisters grew up in Philadelphia and graduated from Temple University School of Dentistry. Find out why they proudly state “Our Patients Like To Go To The Dentist” by getting in touch with them at MirrorImageDentistry.com.

2140 Bispham Road, Sarasota, FL 34231 Phone: (941) 929-9332

Milwaukee, Wisconsin

Drs. Austin Dodge and Ryan Dodge

As recent graduates of Marquette University, Ryan is currently practicing out of state at Howell Comprehensive General Dentistry in Virginia, but once his brother Austin completes his periodontal residency at Marquette, they could end up in a complimentary practice together, somewhere. For now, though, we’re including them here because, look at them! They’re young, they haven’t settled down yet, there’s potential for them to practice together, and who knows? They may read this and decide to cozy up to one another for convenience, for camaraderie, and for the commercial appeal held by the novelty of being an identical twin. Watch this space for updates!

Limerick, Ireland

Drs. Cormac Shields and Conor Shields

Shields Dental & Implant Clinic Limerick

Ireland is fortunate to have a set of identical twin dentists in Conor and Cormac Shields, but it wasn’t by coincidence that they chose their profession. Their father and grandfather, both named Frank Shields, were dental surgeons before them. The twins’ grandfather qualified as one of the first dental surgeons in Tyrone in 1917, and their father was a pioneer in oral surgery and sedation in Dungannon. Americans will be surprised to see that the brothers list out their prices for dental procedures on their website and that they are also open on Sundays.

Ever wondered what a modern dental practice looks like in Ireland? Peek into the world of Dr. Conor and Dr Cormac in the video above, as they share their history, a hint of twin dynamics, and learn more about their philosophy as they explain how they provide not only dentistry but facial esthetic services in their offices.

10 Ashdown Ctr, Courtbrack Ave, South Circular Rd, Limerick, V94 K5TX Phone +353 61 480070

Brno, Czech Republic

Drs. Eva Luskačovy and Hana Luskačovy

DuoSmile

In the United States it is rare for dentists to also have double degrees in both medicine and dentistry. So when identical twins each have a double degree, is this the mathematical equivalent of a being a doctor to the 4th power? This is what you’ll find if you travel to the Czech Republic to visit Dr. Eva and Dr. Hana, who established their practice together in 2017. Language is not a barrier here, as you’ll discover that both doctors and many of their team members are fluent in English. You’ll find their Facebook page enchanting, with video vignettes that range from random silly office moments to informative dental health tips. Be sure to visit their website, too, at DuoSmile.cz.

Pekařská 84, 3rd Floor Brno, 602 00 Phone +420 720 02 32

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If you know of any other sets of identical twins practicing together that you’d like to see featured here, let us know in the comments below. Thank you to all the practices, and most importantly, to the people who have made this exploration of twins in dentistry a fun journey.

Amabrush cleans your teeth in ten seconds

June 27, 2017 By DentalBuzz Staff 21 Comments

IMPORTANT UPDATE: The Amabrush is extinct. This article is useless. Scroll to the bottom to learn why.

What do you get when you start with a silicone sports mouthguard, embed it with hundreds of tiny bristles, and magnetize a rechargable toothpaste ball that vibrates and cleans all of your teeth at the same time? DentalBuzz recently sat down with the inventor of the new Amabrush to find out where this thing came from, where it’s going, and how to get one.

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DentalBuzz: Hi Marvin. Thanks for joining us here at DentalBuzz. What’s the story? Tell us about yourself and your company, how you got into the business of toothbrushing, where the name Amabrush came from.

Marvin Musialek: Thank you for having me! Well, my name is Marvin and I’m the founder of Amabrush, a completely redefined toothbrush. I came up with this idea 6 years ago. I brush my teeth twice a day, not because I want to, but because I have to, and this is every dentist’s advice.

Six years ago I stood in front of the bathroom-mirror as usual, and asked myself, “Why are we on the edge of self-driving cars, but we all still have to stand in front of the mirror and put a stick with nylon-bristles into our mouth, in order to clean our teeth?” Since then I thought about an autonomous cleaning-robot-thingy everyday. Three years later there was still no product like this on the market, and I simply decided to “do it on my own.” I did a lot of research and put a strong team together from many disciplines: dentists, biomedical engineers, physics engineers, electronic engineers and even a psychologist. We had to clarify even the simplest questions with a scientific approach. Why are we brushing our teeth? How should we do it correctly? How much toothpaste? What angle should the bristles have? And so forth. We have been developing Amabrush for the last 3 years and have also received grants from the Austrian Government and the European Commission. With our own money and these grants we were able to finance the cost-intensive development of numerous different prototypes, test-units, pre-production-devices and expert-consultations. Our redefined toothbrush should be seen as a stable and good friend, who takes over an annoying and time-intensive task (toothbrushing) for everyone. So we decided to call it Amabrush, so people who ask “what’s that?” will get their answer: “I’m a brush.”

DB: Since it doesn’t look like a typical brush, that’s perfect! And endearing. Kind of like the name talks back to you when you say it.

Now, you’re in Austria but also have offices in San Francisco? Before everyone in the United States gets addicted to using your brush, we want to make sure that replacements will be easily available. What percentage of your sales do you see coming to the US once you’re in the retail market?

MM: Yes that’s right. We estimate that 50% of our sales will take place in Europe, especially in German-speaking Europe (Germany/Austria/Switzerland) and the other 50% will take place in North America, especially in the United States. This coincides with our research and as well with our current subscribers, who are also equally distributed between these two regions. Because of that we want to produce Amabrush in these two different regions in the long run.

DB: You have subscribers already? For a product that they can’t even get yet? Okay, so we haven’t even talked about the toothbrush. You’re estimating that its retail price is going to be around $200. While you can’t put a price on good dental health, there have been regular electric toothbrushes in this range for years that have proven not to work any better than the $60 version of the same brand (yes, we’re talking about you, Sonicare). Explain what it is about the Amabrush that puts it far ahead of its competition, and why it is a value at $200.

MM: Yes indeed. We already got 7000 subscribers within a month, which is really, really great. That proves to us that our community is as excited as we are about a toothbrush that takes over the task of toothbrushing. There are many low-priced electric toothbrushes available, but also many high-priced ones. The cost of Amabrush is more to the mid- and high-range, but the brush itself is really high-end. We had to develop everything from scratch, like the micro-pump that foams the toothpaste, the specially formulated toothpaste itself, and the mouthpiece, which was one of the most complicated parts. Not only because we use an uncommon material (anti-bacterial silicone) with a specific toughness, but also because of the integrated, carefully arranged bristles and the micro-channels that deliver the toothpaste directly to the customers’ teeth.

DB: This has the potential to change everything we think we have to do to take care of our teeth. A silicone mouthpiece instead of a handle that you hold as you move a small brush around your mouth, brushing every tooth at the same time, Bass method bristle alignment, self-contained toothpaste, sonic vibrations. If this brush is capable of consistent and thorough plaque removal, then you may have just created the holy grail of preventive dentistry. When and where will customers get the Amabrush once they’re available to the general public?

MM: We have to explain this completely new concept of toothbrushing to people a lot. Amabrush is currently “online-only.” The simplest way for people to inform themselves about Amabrush is over the internet with our online-shop and our website. But in the long run we definitely want to bring Amabrush into grocery stores and drug stores, because the majority of people still buy personal care products “offline.”

DB: Do you see an application for people whose hand dexterity is limited?

MM: Amabrush is definitely also for people with hand disabilities. We developed Amabrush on purpose as a hands-free device, not only that it is as convenient and automatically as possible, but also that there is no barrier in order to use it.

DB: What does it feel like to use?

MM: It feels like if someone else brushes your teeth with a soft bristled toothbrush paired with the feeling of a gingival massage.

DB: So it’s sort of like having your teeth cleaned by a professional? We would imagine that would be pretty effective. What kinds of plaque index scores are you getting; in other words, how well does the Amabrush actually clean compared to manual or other electric toothbrushes?

MM: That’s true, it does a pretty good job at cleaning your teeth! We’ve had plaque index scores calculated by an independent clinical institution and have been pleased with the results. What’s worth knowing is that Amabrush is not necessarily better than a regular manual or electric toothbrush, because common toothbrushes work good enough if they are used properly. The thing is, Amabrush is way more convenient. You can do so many things wrong with a regular toothbrush, as you have to be highly concentrated for at least 120 seconds each time you brush your teeth. And while brushing, you should use different methods like the Bass method paired with the red-white technique. This is not only time-consuming, but also annoying for most people. Because of this, people usually tend to do something else while brushing their teeth. Furthermore, they put too much pressure on the toothbrush which can damage their gum. What’s more, most of the people don’t brush their teeth long enough. Amabrush cleans your teeth the same every time, with the right technique, and does not depend on your concentration.

DB: What it sounds like you’re saying is that the problem with electric toothbrushes is that manual ones are just that – they have to be moved around with your hand, so even if they’re the best at what they do, they’ll still miss areas because the human being attached to the hand doesn’t apply the brush properly. The Amabrush provides hands-free brushing at a fraction of the time? Very novel.

Back to your subscribers, then. How can subscribers order the Amabrush? How can I get one as a consumer? What do I need to do?

MM: Interested customers can subscribe to our newsletter right now on our website. We created a landing-page that explains all relevant information and details about Amabrush and the upcoming Kickstarter campaign. Speaking of which, this will be the first opportunity for our customers to get Amabrush. We will start our crowdfunding-campaign on Kickstarter next week (end of June 2017). Customers have the ability to support our project, and as a return, get Amabrush at a strongly discounted price ($69 instead of $199)!

Regarding your question what the customer needs to do: simply sign up for our newsletter on our website (www.amabrush.com). We will send a reminder with the exact date of our Kickstarter-campaign to all subscribers. When the campaign is live, simply choose a package that suits best for you. All of them are strongly discounted, as this is our way to say “Thank you” to all of our supporters and the community!

DB: Dentists and dental hygienists are particularly interested in finding new ways like yours to pass on to our patients that help them keep their mouths healthy. Do you have anything more you’d like to say to us?

MM: Our pre-production units are already in the making, in order to be shipped around the globe to various dentists. We highly appreciate feedback and input from every professional expert in order to make Amabrush as perfect as it can be. We are really looking forward to the support of our community!

DB: Thanks again, Marvin for sharing your story with us, and we sincerely hope that you get all the attention that this Kickstarter campaign deserves.

MM: We hope that too. Thank you very much for the interview and the great time!

UPDATE 6/28/2017: Amabrush announced today that the launch date for their Kickstarter campaign is next week – July 5, 2017.

UPDATE 7/5/2017: The campaign is now live, with the Amabrush expected to begin shipments in December 2017. This video shows close-up vibrations of the prototype. We imagine that the production version will be even more refined.

UPDATE 8/31/2018: It’s taken quite a bit longer than expected, but today Amabrush announced that they will start to ship brushes very soon. The best part? Their testing suggests that all the hard work means that this is a true 10-second toothbrush and not a gimmick. Here’s what came in the mail:

Many patients took part in our dental studies, which took place on 3 different dates with a minimum interval of 24 hours. The tests were performed and evaluated by independent dentists. Amabrush was tested simultaneously with two different institutions and two different sets of patients.

The TQHPI (Turesky modified Quigley Hein Plaque Index) which we used as the method determines how much plaque was present on the teeth – the lower the value, the less plaque on the teeth.

Test procedure

1.) 24 hours before the test, participants were not allowed to brush their teeth. For the plaque test, the patients chewed plaque disclosing tablets so that the dentist could then determine the initial plaque values (tablet is used to make plaque visible).

2.) Patients had to brush their teeth with a regular manual toothbrush for at least two minutes. The remaining plaque values were determined afterwards.

3.) The same process was repeated for the second appointment one week later, but this time with using the Amabrush instead of the manual toothbrush. Teeth were cleaned for just 10 seconds and the dentist determined the plaque values again.

Results

The plaque index decreased statistically significant and there was no statistically significant difference between Amabrush (with 10 seconds brushing time) compared to a regular manual toothbrush (with roughly 3 minutes brushing time on average).

These results make us truly proud and show us that hard work, clever engineering and patience pays off for all of us. We hope that you also like those results, which we would have never reached without your support, help, and feedback!

Want to know when we post a detailed review of the Amabrush once it’s available and we’ve had a chance to chomp on it? Be sure to subscribe to DentalBuzz by adding your email address and you’ll automatically get notifications each time we add a new article.

FINAL UPDATE 6/5/19: Nevermind. Amabrush is officially done. No surprise there, unfortunately, because they’ve been propping up their company with delays for the last two years. Here at DentalBuzz, we never even received our super early bird Amabrush. What’s worse though, is our role in this for convincing our readers to invest in the Kickstarter campaign. At this point, we feel sort of like everyone who invested in Theranos, with their fake blood testing. Great ideas still depend on that which is physically possible, but Marvin still doesn’t seem to get this! You can read the litany of excuses here from Amabrush: https://www.amabrush.at/blogs/news/important-information-regarding-amabrush-company. Bottom line? We’re sorry, and you still have to brush your teeth for two minutes.

Best ways to get numb at the dentist

February 3, 2017 By DentalBuzz Staff 5 Comments

Why “Painless Dentistry” Doesn’t Have to Be An Oxymoron

Dentistry has got a bad reputation!

“No offense doc but I hate dentists.” …said everyone who ever came to see me.
“I was in Vietnam and I’d rather be shot at than come see you.” …said one of my veteran patients.
“My last dentist put his foot on my chest and pulled a tooth out while I wasn’t numb!” …said most people who ever had a tooth extracted.

Why so much hate? In my personal experience, most of the people who hate dentists have had really bad experiences in the past. They’ve got legitimate reasons to be fearful. As a profession, we dentists, especially in years past, haven’t done a great job with pain and anxiety management. Uncontrolled pain and anxiety creates lifelong dental phobics.

So here’s the secret… While dentistry isn’t ever something that will be fun, it doesn’t have to be the traumatic experience that many people expect. Dentists have a huge number of different tools at their disposal to make dentistry as painless and easy as possible. For the most part, all it takes is a willingness to listen to a patient’s fears and address them with whatever tool is most appropriate.

What?!? We have more options than just “Open wide”, “It’ll only pinch a bit” and “Suck it up”? Yes! I’m going to cover all your options here, from techniques that have been around forever, to the latest advances in painless dentistry.

If you’re a dentist who thinks all dental phobics are over-dramatic and that the previous statements are appropriate, this article may not be for you. You should probably go hang up your drill and find a job that doesn’t require contact with the public. I hear dental insurance companies are always looking for cranky dentists to deny claims. Everyone else, let’s get working on ways to make dentistry better for our patients!

Old School

Let’s start with some options that have been around for a long time. Just because these options are technically “old school” doesn’t mean they shouldn’t be used. It’s my opinion they should be used far more often than they currently are today.

Laughing Gas / Nitrous Oxide
Laughing gas is almost synonymous with going to the dentist but somehow many dentists don’t offer this at all. I’ve heard from many that they find it to be too much hassle. I’ve had the exact opposite experience in my practice. The benefits of laughing gas include decreased anxiety, increased pain tolerance, quick acting effects, and an almost perfect safety profile compared to any other type of sedation. The downsides… ummm…. occasionally people don’t like how it feels and we have to stop using it. So why aren’t more dentists using laughing gas? Beats me. It is the absolute easiest and quickest way to make a dental appointment easier. I often give it away free because it makes the appointment easier for me and the patient. Easier for me + Easier for the patient = A good day!

Sedation
Sedation can range from taking an oral medication before a dental appointment (with or without nitrous oxide) all the way up to IV sedation or general anesthesia. Of all the techniques we go over here, this is by far the most challenging to get trained in and implement due to safety and liability issues with sedation. It is also the most effective option for treating patients who are truly terrified of any type of dental experience. If you’re able to offer this safely and effectively, you’ll really set yourself apart. One option for sedation if you don’t want to go through training is to look for a traveling anesthesiologist who comes to your office and does sedation while you do the dental work. This is a fantastic option where you can focus exclusively on treating your patient instead of worrying about anesthesia at the same time. There are more and more anesthesiologists who offer services like this today. If you’re especially lucky, you might even find a dental anesthesiologist who understands the special challenges that come along with sedating a patient for dental work (dental work is essentially an anesthesiologists worst nightmare).

Air Abrasion
Air abrasion uses a high pressured jet of abrasive particles to conservatively remove smaller to medium sized decay in teeth. As it doesn’t generate any vibrations, pressure, or heat most people don’t need any shots of anesthetic (yay!) to have the procedure done. Many people think air abrasion is a new technique in dentistry. It actually has been around over 60 years! Early on, it wasn’t something that was typically used because the bonding materials needed to do minimally invasive dentistry weren’t invented yet. Now that we’ve got all these great bonding techniques, somehow air abrasion still isn’t routinely used. Very few dentists own an air abrasion device and even less use it routinely. It can be especially useful on children as it is far less “scary” than a dental drill and doesn’t require a shot! Kids who have good dental experiences are far less likely to become dental phobics in the future.

This article by Dr. Gordon Christensen goes into a bit more detail about air abrasion and why he thinks it should be used far more often… http://www.dentaleconomics.com/articles/print/volume-100/issue-6/columns/ask-dr-christensen.html

New-Fangled Stuff

Distractions
I spent about $400,000 several years ago to build a brand new office. You know what makes the biggest impression on our patients? It sure isn’t the $50k panoramic machine, several thousand dollar chairs, or amazingly efficient layout. It is the $300 television mounted on the ceiling that they can watch during treatment while wearing a pair of noise canceling headphones. OK, OK so televisions aren’t exactly new to the scene. CHEAP flat screen televisions sure are though. I just saw a 37 inch TV at Best Buy the other day for about $150. This is what most dentists charge for a single filling. Considering the benefits, calling it an affordable investment is an understatement. I’ve found it to be equally effective for both adults and children.

Vibraject™ / DentalVibe™
The Vibraject™ and DentalVibe™ play off our overall distraction theme. These devices vibrate a patient’s lip while the injection is being given in order to distract them from the sensation. They’ve been proven to be quite effective and many dentists say they wouldn’t want to give injections without them anymore. If you’re talented you can pull off this trick yourself without the device. Just vibrate a patient’s cheek quickly while giving the injection. Dentists have used this technique successfully for a long time. That is about the only thing I remember about the dentist from when I was a child.

For more information on these devices visit https://www.physicsforceps.com/vibraJect-comfort-solution or https://www.dentalvibe.com/.

Compounded Topical Anesthetic
Topical anesthetic has been used for a long time to reduce the pain associated with the needle stick. Unfortunately the only topical anesthetic that is widely available is 20% benzocaine. This works OK but there are a lot better options out there. The downside… you have to get them specially compounded at a pharmacy. It’s unbelievable that none of the big dental companies have come up with a better topical anesthetic (OK I do actually know why… The FDA approval process is a bureaucratic nightmare and costs a fortune for approval of a new formulation). If anyone in dental product R&D is reading this, I’D BUY A BETTER TOPICAL IN A HEARTBEAT! Get working on it!

My favorite formulation is a compounded gel with 10% lidocaine, 10% prilocaine, and 4% tetracaine. A SMALL dab of this a couple of minutes before an injection does wonders to almost entirely eliminate the pinch of the needle stick.

There are a good number of other formulations but most are some variation of these anesthetics. Some compounding pharmacies offer to add 2% phenylephrine to the gel to prevent but I do not recommend this. Any of these gels with phenylephrine seems to cause high incidence of tissue sloughing in the area where the gel was applied. I’ve only rarely seen minor tissue sloughing with the plain mixture of anesthetics. Once you use compounded topical you’ll never want to go back to plain benzocaine again!

Buffered Anesthetics
Even if the needle stick during a shot is totally painless, the shot can still hurt. Why is this? Most anesthetics used in dentistry are quite acidic. When they are injected they cause quite a burning sensation. This sensation can be minimized by injecting very slowly but people will still occasionally feel it. A couple of years ago a system known as Onset™ was introduced that buffered the anesthetic with sodium bicarbonate in order to bring it up to a more neutral pH level. Buffering solutions is commonly done in medicine but really hasn’t been used in dentistry up to this point. When anesthetic is injected with a pH close to physiologic levels, the burning sensation is almost entirely eliminated. In addition to reducing the burning it also dramatically increases the speed that the anesthetic takes effect. Mandibular blocks are fully complete within a minute and a half. You don’t even have to leave the room before getting started. There are a couple of other buffering systems that have come out since then but Onset™ remains the standard.

Stanley Malamed (You know, the guy who basically wrote the book on dental anesthesia) is a big fan. You should be too!

For more information on Onset™ visit http://www.orapharma.com/products

The Wand™
The Wand™ is a computerized anesthesia device that injects anesthetic at a controlled rate. As we discussed with buffered anesthetics, the rate at which anesthetic is delivered determines whether that uncomfortable burning sensation is felt. The Wand™ keeps this from happening by injecting at an extremely slow and controlled rate that is controlled by a computer, instead of your hand. Interestingly enough, the slow injection rate also provides higher success rates of getting people numb. One additional benefit to The Wand™ is that it looks far less scary than a typical dental syringe. Perception counts for a lot in how pain is experienced. The Wand simply looks like it will hurt less.

For more information on The Wand™ visit their website at http://www.thewand.com/.

Lasers
Lasers are very slowly making headway into dental offices. They can be used to remove tooth structure, oftentimes without any need for an injection. Due to how the laser pulses it actually induces some analgesia in the nerve of the tooth. It is truly needle free dentistry. There are some major downsides with lasers at this point. They can’t remove all types of materials from a tooth like a dental drill can, there is a huge learning curve, major magnification is required, and lastly the units still are wildly expensive (think $100kish). When the price comes down, I think they’ll start showing up in more dental offices but I don’t expect them to replace dental drills anytime soon.

For more information on dental hard tissue lasers you can visit http://www.Biolase.com, http://www.convergentdental.com/solea/, or https://www.lanap.com/laser-dentistry/periolase-mvp-7/

Kovanaze™
Kovanaze™ is the first needle free anesthetic option that I know of. Kovanaze™ was approved in the summer of 2016 by the FDA for use as a dental anesthetic and became available for purchase towards the end of the year. Kovanaze™ is a combination of the anesthetic tetracaine and oxymetazoline. This solution is sprayed up the nostril and provides anesthesia from the premolars to central incisor on the same side. Second premolars have a success rate around 64% while the first premolar through central incisor have a success rate of 96%. For major anterior work, such as veneers, this is a game changer. I know that I personally hate giving injections for the maxillary anterior teeth due to the sensitivity of the tissues in this area, especially around the centrals. Going from multiple painful injections to several painless nasal sprays makes these procedures far easier and essentially painless for patients.

The big downside at this point is cost. As of the time of this writing it costs approximately $600 for 30 sprays (or 15 doses as each dose requires two sprays). This is cost prohibitive for routine use by most dentists. Hopefully the price will start to come down and it will come into more routine use in practice. This would be a huge win for patients in general. Injections don’t bother me that much and I’d still pay extra just to have this type of anesthesia. My guess is that I’m not the only one.

As cool as needle free anesthesia is, the real story I’d like to hear is how the inventor originally came up with the idea of nasal spray anesthesia. Also, who was the unlucky person to be the original test subject?!?

For more information on Kovanaze™ you can visit their website at http://www.Kovanaze.com

There are so many different options out there for making dental care easier for patients. Not all of them have to be difficult or expensive. I’d highly recommend that you pick just one of these tools to implement well in practice and see what a difference it can make. Even better, pick several that you don’t currently offer and put them in place. I believe that comfortable patients will be happier, trust us more, and follow through with treatment which is ultimately a win-win for everyone.

About the Author:
I’m Dr. M, a regular dentist with aspirations of being a tooth saving superhero. My website, The Healthy Mouth Project is dedicated to educating and equipping patients to take control of their oral health.

A hygienist’s answer to “what do you do?”

March 11, 2015 By DentalBuzz Staff 8 Comments

If you read Dentaltown Magazine, you may have received the edited, paper version of this article today in your snail mail box. But because I don’t have to make room for saliva ejector advertisements in the sidebar (seriously, this article helps sell SALIVA EJECTORS!) you can enjoy the original here in its more raw form.

A hygienist’s answer to “What do you do?”

by Trish Walraven RDH, BS

You’re at a gathering of acquaintances, a general hob-nobbery of casual conversing, one of those social obligations that you love/hate because you’re really more of an outgoing introvert, someone who plays well with others but enjoys their quiet, navel-gazing world too. Sooner or later you know that the question will be asked.

“So, what do you do?”

No hesitation here. You know what your profession is. You have a title, a position, a calling.

Then that inner part of your thinking begins to twitch.

You weren’t asked about your job title, actually. You were asked a direct question: What do you do?

The typical reaction of hearing that you’re a dentist or hygienist involves a full disregard of the art and compassion that you put into your profession. People want to tell you about their bad experiences as a child, or how much they hate you (but don’t take it personally!). They just nod, warily, quietly, at your response and quickly think of a way to change the subject.

Instead of giving away the conversation and letting it slide into other people’s thought bubbles, then, you can steer the dialogue back to the original question, and the feel-good answer you’ve prepared instead.

“I take care of people’s teeth.”

You’re a regular Mother Theresa now, aren’t you? The way you dedicate your life’s work to helping others, it’s so freaking noble. This response elicits a smile of comfort and familiarity from your obligatory small-talk partner. The conversation can move forward now that your profession has been deemed socially acceptable.

An hour later, driving home, you’re blissfully alone with your thoughts, rewinding your earlier social interactivity, musing over the highlights, and you really, deeply, ask yourself in hindsight, “what do I do?”

I can’t speak for dentists, but if you’re a dental hygienist, you do some pretty strange things, actually.

First of all, perfection to you is wave-shaped. It’s the curve of a thin scallop of attached pinkness that anoints each interproximal space with a coral-tipped point of the healthiest gingiva imaginable. Anything less than this in your patients’ mouths is limbo. Chaos is the reason your job exists, but you always hunger for order and balance. To achieve this imagined perfection in a mouth that is not optimal, then, means that you often resort to some diversions along the way. It’s about the journey, not the destination, right?

How do you handle the patient whose lower anterior linguals are piled with a couple of grams of Grade A calcium phosphate? Sure, you could just chunk the calculus off. But sometimes, when you’re feeling a little dastardly, you carve out the top and the bottom of the tartar evenly, so that you’ve left a neat chalky white mustache, complete with curlicues. With artistic satisfaction, you turn your attention back to your duty and politely erase the Banksy-esque dental graffiti from your patient’s teeth.

This is not something you tell people that you do.

You also tell no one that your deepest fear is running into anything artificial while you’re cleaning someone’s teeth. Your ultrasonic scaler turns into a fierce lead pencil in those situations, which means not only that you are wearing down your precious metal antennae into useless nubs, but also that you’re leaving dark lines where there was once only whiteness. Every last bit of old orthodontic cement has now been revealed like a charcoal rubbing, thanks to you. And you would never admit to leaving a grey streak on a brand new porcelain crown. How could you slip like that? You hope like heck that the prophy paste will get that scary line off before anyone notices.

When it comes to things that you enjoy, then, there’s a bit of hesitation about sharing those stories as well. Like hovering around the periapical abcess that’s begging to be relieved? Or when you’re spraying baking soda slurry under a bridge and the patient becomes aware that its odor speaks more than the thousand words that you could ever say about superfloss? To you the stink is like scoring a point. Or why your trophy at the end of a particularly difficult appointment is a 2×2 gauze loaded with something that looks like buckshot, but is really your patient’s carefully extracted calculus? Fun times.

Probably the most difficult part of your career, though, has to do with patient management. Unless you’re regularly disengaging people from their mouths via nitrous oxide, there are forceful tongues, and lip pulls, and saliva ropes, and people who forget that it’s safe to swallow their own spit. Suck. Suck. Suck. Ten times a minute. At least this way they’re remembering to breathe. When they forget to breathe they feel like they are drowning. It’s not the water; they’re just suffocating because you’re blocking any chance of mouth breathing. Never mind that noses are much more optimal for breathing but whatever. Not everyone has learned how to snorkel either. And how do you convince patients that unless they just ate a handful of almonds, brushing immediately before their dental appointment won’t make your task any easier?

Then there are the patients themselves. Not just their mouths, but the whole person. Patients whose embarrassment about their teeth are the reason they haven’t been to a dentist in a while. People who not only open their mouths but open up to you, tell you their secrets, their fears, their wishes and hopes. People who trust you to take care of them, to love them, to nurture them towards health. They see something special in your eyes, and they open wide.

So go ahead and make it known out there in the big world that you’re hygienist. Or a dentist. You scale teeth. You drill teeth. No biggie. That’s what you do.

What really matters, though, are the reasons why.

Trish Walraven RDH, BSDH is a mom and practicing dental hygienist in the suburbs of Dallas, Texas. She is a bit of an an introvert when she’s writing dental articles, but you get her together with her best friend from high school and Irish festival beer and she begins to make faces like this. She also makes faces like this under her mask if her patients aren’t paying attention to her flossing instructions.

I wanna be sedated

July 28, 2014 By DentalBuzz Staff 3 Comments

By Amanda Kaestner

Oh yeah, that’s all we need.

Back in 2006, a research psychiatrist at the National Center for Post-traumatic Stress Disorder, H. Stefan Bracha, M.D., suggested upsetting dental experiences could install PTSD in patients, which might then last their entire lives. Along with another couple of miscreants, Bracha advised that any caption including the word “phobia,” or “anxiety,” wasn’t humorless enough to describe the unfounded fear of our selfless, albeit remarkably remunerative, healing art.

What, then, is it exactly that sends our patients into states comparable with returning warriors who’ve experienced an imminent threat of death on the battlefield?

Thanks Again, Sir Larry

Well, patients who are edging onto the chair for an invasive procedure, obviously enough, are more fearful than those who’re scheduled for a cleaning (though we’ve all seen hygienists who seem determined to even out that particular playing field).

Assuming the dentist is warm and caring, rather than emulating Sir Larry, better known as Laurence Olivier’s character Christian Szell in 1976’s Marathon Man, the single most intimidating factor may well be unconsciousness. When you’re out, you’re unable to inhibit a negative event or experience. It’s not so much that patients expect us to slip ’em a roofie and wreak havoc with their innocence, it’s just that – in all fairness – being utterly helpless is an intimidating event for most animals. It’s lack of control… it’s…

Sedation and Anesthesia

Choose your poison. Of the several methods of dentistry sedation that ensure reciprocity on the recliner, each has its proponents, but most have problems, too.

Local Anesthesia. The injection of local anesthetic directly into the area where the work’s to be carried out; this blocks nerve impulses, thus moderating or eliminating pain signals. But it’s the jab, man. The. Jab. That needle heading inbound at their head is, for many patients, the very image which sets off their trip-hammering heart. Not nice.

Inhalation Sedation. Nitrous oxide/oxygen is a great deal of fun at frat parties, sure. It has its place in our surgeries, also, after the light-headedness and giggles give way to euphoria and sleepiness. Improperly administered, though, adverse effects can range from vertigo and nausea, through active vomiting to hallucinations and unexpected flash-backs (and couldn’t we expect that to bring on driver lawsuits, were the fact widely known).

Intravenous General Anesthesia. Voila! The Cadillac of the comatose. An intravenous (IV) catheter is inserted into a vein and from there, an infinitely-controllable amount of anesthetic happiness is introduced. Just a few good drips and the patient is in a safe state of unconsciousness, allowing the professionals to get to work without any major side effects after all procedures are said and done. To the patient’s benefit, there’s no sensation of pain at all, and no memory exists afterward of the entire time he or she was “under.” More and more practices are looking to this form of sedation as being their one and only form because it’s just that safe, comforting, and effective. For example, Advance Dentistry, a well-known practice in Cincinnati, has found that IV sedation helps the dentist because it reduces the risk of movement, and it provides maximum comfort (or minimal discomfort, I suppose) to the patient no matter how much work he or she may need done. It’s not uncommon to see IV sedation being their primary option for dental anesthesia. Furthermore, recovery from this form of anesthesia is typically swift and complete, with little or no “hangover” effect as one would see in the other forms listed earlier, so the patient’s free access to their credit card is seldom impacted.

We’ve come a long way since the early 19th century where anesthesia wasn’t even a thing in any surgical practices, much less dentistry. But thanks to Horace Wells first introducing nitrous oxide to his procedures back in 1845, we can honestly say that going to the dentist in today’s world really isn’t that scary of a thing. So look at your options when you go to the dentist and ask about other forms of sedation. It’s a far cry from “pass the liquor and bite down hard on this stick and let’s hope we don’t have to amputate anything from aftermath infection.”