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More Oral Health Care Is Needed for Elderly Adults

20 Friday Jul 2018

Posted by landisrefining in dentist, health and wellness, oral health

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Topic Center: Patient Relationships

JULY 19, 2018

Kristen Crossley
A rapidly growing elderly population needs more access to oral health care services, according to a recent report.

But progress is being made in some areas to better care for aging teeth.1

The report A State of Decay, Vol. IV is the latest in a series published by Oral Health America (OHA) that surveys the state of oral health in older adults in the United States.

It found that 33% of older adults have lost 6 teeth or more, and sociodemographic factors play a critical role in oral health outcomes.1

“Tooth loss and poor oral health are not inevitable during the aging process,” Karen Tracy, vice president of strategic alliances and integrated communications for the Gerontological Society of America, said in a statement.

Education, gender, income, and race all factor into oral health care, according to the report.

Twenty-five states received poor overall scores in the report, with Wyoming, Delaware, West Virginia, New Jersey, Arkansas, Texas, Oklahoma, Louisiana, and Tennessee receiving the least favorable scores. Earning “excellent” scores for oral health in older adults were Minnesota, Wisconsin, Iowa, Connecticut, and Colorado.1

“Oral health for older adults is in fragile condition,” Caswell Evans, associate dean for prevention and public health sciences at University of Illinois at Chicago College of Dentistry, said in a statement.1 “Oral health for seniors is important for their diet, nutrition, self-esteem, socialization, and freedom from pain, among many other benefits.”

Many older adults regularly use several OTC or prescription medications, or both, making them more vulnerable to adverse reactions, drug interactions, and medication errors, according to the American Dental Association (ADA).2

The most frequently taken OTC medications by older adults include analgesics, laxatives, vitamins, and minerals.2

The typical aging patient’s baseline health state can be compromised by comorbid conditions, such as diabetes mellitus and hypertension, as well as the physiological changes associated with aging.2 Dental conditions associated with aging include coronal and root caries, dry mouth, and periodontitis.2

The ADA places a “seal of approval” on many OTC oral health products, including mouth rinses and toothpastes containing fluoride, and ingredients for combating bad breath, gingivitis, and plaque, as well as for teeth whitening. The organization has also placed its seal of approval on Sensodyne toothpaste for sensitivity control and on a variety of sugar-free chewing gums that help reduce cavities.

For relief of oral discomfort, the ADA recommends Benzodent Dental Pain Relieving Cream (Focus Consumer Healthcare) and Professional Strength Kank-A Mouth Pain Liquid (Blistex).2 For a tooth that has been knocked out, the ADA has approved Save-A-Tooth (Phoenix-Lazarus), a device that keeps a tooth alive for 24 hours, until a dentist can replant it.3

In addition to OTC products for teeth, the ADA has recommendations for dentures, including adhesives and cleansers. Efferdent Anti-Bacterial Denture Cleanser (Complete Clean and Fresh & Clean), Efferdent Overnight Denture Cleanser, and Medtech Products’ Effergrip Denture Adhesive have all received the ADA seal of approval. They are joined on the ADA’s list by Adhesadent Denture Adhesive Cream (Dr. B Dental Solutions) and Fresh’n Brite Denture Cleaning Paste (Revive Personal Products).2

Adults 65 and older are expected to account for a greater patient population in dental practices in the coming years as the demographic increases in size.2 Since the OHA’s previous report, in 2016, state advocates have implemented actions based on A State of Decay findings, and more states have commissioned surveys to better measure older adults’ oral health. State oral health plans (SOHPs), such as those recently implemented in Alabama, California, Iowa, and Mississippi, have increased the percentage of people in areas served by community water fluoridation and are covering a larger number of adult dental services under Medicaid.1

In addition to SOHPs, some states, including California and Iowa, are offering support for all 13 common dental benefits for Medicaid beneficiaries 65 years and older.1 Other entities, such as the University of Alabama (UA) at Birmingham School of Dentistry, are creating local programs to enact further oral health improvements. The UA program is reaching into some of its more rural and vulnerable communities.1

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Oral care probiotics research on rise – Korea Biomedical Review

19 Tuesday Jun 2018

Posted by landisrefining in dental techniques, dentist, health and wellness, oral health

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landis refining, dental industry, dental healthDomestic microbiome firms such as Bifido are entering the oral care probiotics market following growing interest in the hundreds of microorganisms that live in the mouth and affect general health.

Research and commercialization of beneficial bacteria in the human body are in full swing due to the interest in human microbiomes. Markets and Markets, a market research company, estimate the global microbiome market to reach $500 million by 2022 and $900 million by 2025.

Although gut microbiomes research has been the most prominent, there has been growing interest in oral lactobacillus that protects the health of the mouth from oral diseases such as dental caries, gingivitis, and chronic periodontitis.

The World Health Organization raised concerns that non-infectious diseases or diseases that occur without pathogen infection are closely related to gum disease and that harmful bacteria in the mouth affect general health.

Both industrialists and consumers have since become increasingly interested in creating healthy oral microbial ecosystems.

“Oral care probiotics is the most active field of commercialization of microbiome research following intestinal microorganisms. With the recent interest in the microbiome industry, the sales growth of oral lactobacillus products is expected to increase further,” a Bifido official said.

Bifido is a Korean microbiome firm known as the provider of probiotics such as ProsLab and BioGaia. The firm has also been developing a rheumatoid arthritis therapy with Catholic University Seoul St. Mary’s Hospital since 2017.

Bifido is leading the commercialization of human microbiome products, having successfully cultivated CMU strains through technology developed from studying microorganisms for 30 years, cultivating egg culture bacteria, and commercializing products.

Along with the development of patented human-derived Bifidobacteria BGN4 and BORI and commercialization of intestinal probiotics, Bifido is now expanding into the oral lactobacillus market to create oral probiotics such as Bifidus Denti for inflammatory diseases of the mouth and bad breath, the company said.

It had reportedly led the market by commercializing a CMU strain for oral health. Weissella cibaria strain CMU, a representative oral care probiotic, is a patented oral lactic acid bacterium that is effective in suppressing bad breath.

via Oral care probiotics research on rise – Korea Biomedical Review

Suffering from diabetes? Take extra care of your teeth | Health24

07 Monday May 2018

Posted by landisrefining in dentist, health and wellness, oral health

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dentist with pat

Diabetic? See your Dentist regularly.

Many adults with diabetes don’t see the dentist often enough, even though they’re at increased risk for gum disease, researchers say.

In a new study, investigators analysed data from just over 2.5 million American adults who took part in an annual federal government health survey.

The survey results showed that people with diabetes or prediabetes were least likely to visit the dentist. The study included about 248 000 diabetics, 30 500 people with prediabetes and over 2.2 million without diabetes.

Study author Huabin Luo, of East Carolina University in Greenville, North Carolina, was concerned by the results. “Those who need dental care the most seem to be the least likely to have it,” said Luo, an assistant professor of public health.

Why should diabetics go to the dentist more often?

People with diabetes are at increased risk for gum disease, which can hamper blood-sugar control and speed the progression of diabetes, the study authors explained.

Between 2004 and 2014, annual dental visits fell from 66% to 61% among people with diabetes; from 66% to just under 65% among those with prediabetes; and from nearly 72% to 66.5% for people without diabetes, the study found.

With about 6% of South Africans suffering from diabetes, it’s just as important in this country that diabetics visit the dentist regularly.

The study’s senior author, Bei Wu, says, “For people living with diabetes, regular dental check-ups – paired with proactive dental and diabetes self-care – are important for maintaining good oral health.” Wu is director of Global Health and Aging Research at New York University’s Rory Meyers College of Nursing in New York City.

Avoid diabetic complications

“Regular dental visits provide opportunities for prevention, early detection, and treatment of periodontal [gum] disease, which can potentially help with blood-glucose control and prevent complications from diabetes,” Wu explained in an NYU news release.

Health care workers should encourage people with diabetes to visit a dentist at least once a year, she suggested. “Increasing access to dental services is vital to achieving this goal,” she added.

The report was published online in the Journal of the American Dental Association.

Take care of your teeth

In a previous Health24 article, Cape Town-based dentist Dr Mark Sher emphasised the importance of dental care for diabetics because of the added risk of gum disease, mouth sores, and other issues.

Here are ways to take care of your oral hygiene of you are diabetic:

  • Schedule your dental appointments in accordance with your meal and insulin times to avoid hyper- or hypoglycaemia.
  • If you are diabetic, you will need a more rigorous approach to dental care. Go for teeth cleanings every three months and dental checkups every six months.
  • Brush and floss gently after each meal.
  • Mention bleeding gums to your dentist, as this might be a sign of gum infection.
  • Keep note of any changes, pain, sensitivity or possible mouth sores and mention these to your dentist.

Image credit: iStock

Read more via Suffering from diabetes? Take extra care of your teeth | Health24

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Simplified and Predictable Aesthetic Adhesive Cementation of Indirect Restorations | Dentistry Today

30 Friday Mar 2018

Posted by landisrefining in dental techniques, dentist, health and wellness, oral health

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Choosing an appropriate adhesive resin cement for definitive cementation of indirect restorations can be challenging for patients requiring restorative treatment. Ideal bond strength is necessary to ensure functional treatment durability. Likewise, cement shade stability is also important for long-term aesthetics; the color of adhesive resin cements affects how the shade of tooth substrates interacts with the optical properties of restorative materials and also affects shade matching with adjacent restorations or natural teeth.

To simplify durable and aesthetic cementation of indirect restorations, a universal dual-cure adhesive resin cement system can be used (G-CEM LinkForce [GC America]). G-CEM LinkForce is a 3-component system for predictably and securely placing ceramic, resin, and metal-based inlay, onlay, crown, and bridge restorations. Ideal when adhesive bonding is required to ensure adequate strength of stacked feldspathic ceramic, pressed leucite ceramic, and/or lithium disilicate restorations (eg, GC Initial LiSi Press High Density Micronization (HDM) high-strength pressable lithium disilicate), it is also beneficial when a lack of retention form prevents mechanical retention—as with partial coverage, inlay, onlay, or veneer restorations—regardless of restorative material.

The G-CEM LinkForce self-cure mode is advantageous in situations in which restorations are thick, opaque, or located in areas that cannot confidently be thoroughly light cured. It is also indicated for the cementation of metal, ceramic, and fiber posts, as well as cast post and cores. Its universal application also includes permanent cementation of crowns and bridges on implant abutments.

Figure 1. View of the intaglio surface of the full cast gold crown for tooth No. 31 prior to micro air abrasion/etching. Figure 2. View of the intaglio surface of the full cast gold crown after micro air abrasion.
Figure 3. To begin loading cement into the crown, the nozzle was placed at the base. Figure 4. Using the nozzle to paint the internal walls of the restoration with cement, the cement was introduced into the crown.
Figure 5. Postoperative view of the crown restoration following cementation, with excess cement removed and ready for full function.

Unlike other dual- and self-cure cements that color shift over time, G-CEM LinkForce remains color stable, exhibits tooth-like fluorescence, and is available in corresponding try-in pastes. This allows dentists and patients to accurately preview aesthetics before permanent cementation.
The G-CEM LinkForce system includes (1) G-CEM LinkForce Resin Cement; (2) G-Multi Primer for stable chemical adhesion, coupling between adhesive-treated and restoration surfaces; (3) G-Premio BOND universal adhesive bonding agent for self-etch, selective-etch, and/or total-etch adhesive bonding; and (4) G-Premio BOND Dual Cure Activator for achieving high bond strengths when self-curing is required.

In the case of a 71-year-old male patient, G-CEM LinkForce was ideal for cementing a full-cast gold crown restoration to treat tooth No. 31. Prior to delivery, the intaglio surface of the restoration was properly prepared chairside with micro air abrasion (Etchmaster [Groman]).

At the cementation appointment, the provisional restoration was removed and the preparation thoroughly cleaned. The definitive restoration was tried in. After confirming patient approval, the restoration was removed and dried. G-Multi Primer was applied to the intaglio surface of the restoration and dried with an air syringe.

Meticulous isolation was established, the preparation was rinsed and dried, and then the preparation was selectively etched and dried. When light-curing, G-Premio BOND is applied, allowed to set for 10 seconds, air dried for 5 seconds, and light cured for 10 seconds. When using dual-cure mode, G-Premio Bond and DCA are applied in a 1:1 ratio, allowed to set for 20 seconds, and air dried for 5 seconds.

G-CEM LinkForce in Shade A2 was extruded directly into the restoration, which was immediately seated onto the preparation while maintaining pressure. The cement was tack cured for 2 to 4 seconds to facilitate easier, atraumatic cleanup by allowing for easy peeling off of the excess. The restoration was then light cured from each surface/margin for 20 seconds. Overall, using G-CEM LinkForce contributed to a more comfortable patient experience during a simplified cementation appointment while simultaneously ensuring a secure, aesthetically predictable restoration.

Choosing an appropriate adhesive resin cement for definitive cementation of indirect restorations can be challenging for patients requiring restorative treatment. Ideal bond strength is necessary to ensure functional treatment durability. Likewise, cement shade stability is also important for long-term aesthetics; the color of adhesive resin cements affects how the shade of tooth substrates interacts with the optical properties of restorative materials and also affects shade matching with adjacent restorations or natural teeth.

To simplify durable and aesthetic cementation of indirect restorations, a universal dual-cure adhesive resin cement system can be used (G-CEM LinkForce [GC America]). G-CEM LinkForce is a 3-component system for predictably and securely placing ceramic, resin, and metal-based inlay, onlay, crown, and bridge restorations. Ideal when adhesive bonding is required to ensure adequate strength of stacked feldspathic ceramic, pressed leucite ceramic, and/or lithium disilicate restorations (eg, GC Initial LiSi Press High Density Micronization (HDM) high-strength pressable lithium disilicate), it is also beneficial when a lack of retention form prevents mechanical retention—as with partial coverage, inlay, onlay, or veneer restorations—regardless of restorative material.

The G-CEM LinkForce self-cure mode is advantageous in situations in which restorations are thick, opaque, or located in areas that cannot confidently be thoroughly light cured. It is also indicated for the cementation of metal, ceramic, and fiber posts, as well as cast post and cores. Its universal application also includes permanent cementation of crowns and bridges on implant abutments.

Figure 1. View of the intaglio surface of the full cast gold crown for tooth No. 31 prior to micro air abrasion/etching. Figure 2. View of the intaglio surface of the full cast gold crown after micro air abrasion.
Figure 3. To begin loading cement into the crown, the nozzle was placed at the base. Figure 4. Using the nozzle to paint the internal walls of the restoration with cement, the cement was introduced into the crown.
Figure 5. Postoperative view of the crown restoration following cementation, with excess cement removed and ready for full function.

Unlike other dual- and self-cure cements that color shift over time, G-CEM LinkForce remains color stable, exhibits tooth-like fluorescence, and is available in corresponding try-in pastes. This allows dentists and patients to accurately preview aesthetics before permanent cementation.
The G-CEM LinkForce system includes (1) G-CEM LinkForce Resin Cement; (2) G-Multi Primer for stable chemical adhesion, coupling between adhesive-treated and restoration surfaces; (3) G-Premio BOND universal adhesive bonding agent for self-etch, selective-etch, and/or total-etch adhesive bonding; and (4) G-Premio BOND Dual Cure Activator for achieving high bond strengths when self-curing is required.

In the case of a 71-year-old male patient, G-CEM LinkForce was ideal for cementing a full-cast gold crown restoration to treat tooth No. 31. Prior to delivery, the intaglio surface of the restoration was properly prepared chairside with micro air abrasion (Etchmaster [Groman]).

At the cementation appointment, the provisional restoration was removed and the preparation thoroughly cleaned. The definitive restoration was tried in. After confirming patient approval, the restoration was removed and dried. G-Multi Primer was applied to the intaglio surface of the restoration and dried with an air syringe.

Meticulous isolation was established, the preparation was rinsed and dried, and then the preparation was selectively etched and dried. When light-curing, G-Premio BOND is applied, allowed to set for 10 seconds, air dried for 5 seconds, and light cured for 10 seconds. When using dual-cure mode, G-Premio Bond and DCA are applied in a 1:1 ratio, allowed to set for 20 seconds, and air dried for 5 seconds.

G-CEM LinkForce in Shade A2 was extruded directly into the restoration, which was immediately seated onto the preparation while maintaining pressure. The cement was tack cured for 2 to 4 seconds to facilitate easier, atraumatic cleanup by allowing for easy peeling off of the excess. The restoration was then light cured from each surface/margin for 20 seconds. Overall, using G-CEM LinkForce contributed to a more comfortable patient experience during a simplified cementation appointment while simultaneously ensuring a secure, aesthetically predictable restoration.

via Simplified and Predictable Aesthetic Adhesive Cementation of Indirect Restorations | Dentistry Today

42% of Americans Want to See Their Dentists More Often | Dentistry Today

23 Friday Mar 2018

Posted by landisrefining in dentist, health and wellness, oral health

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42% of Americans Want to See Their Dentists More Often

Americans still aren’t seeing their dentist as much as they would like. For a second year, dentists topped the list of health practitioners Americans want to see more often, Delta Dental reports. According to its survey, 42% of dentists don’t see a dentist as often as they would like, beating out their primary care doctor (29%), dermatologist (23%), and ophthalmologist (17%).

Delta Dental suggests that this desire to see the dentist more is because 85% of Americans believe oral health is very or extremely important to their overall health. Also, only 25% of Americans are extremely satisfied with the health of their mouth, teeth, and gums, and 49% are somewhat satisfied. Only 15% rated their oral health as excellent.

“Recognizing the importance of seeing a dentist is a good start,” said Bill Kohn, DDS, chair of the Delta Dental Plans Association Dental Science Committee. “Why not take that next step and make an appointment for a checkup?”

The survey also found that:

  • 58% visit the dentist at least one time per year, down from 62% in 2016
  • 52% made their most recent appointment to get a regular checkup
  • 17% made their most recent appointment to have a procedure performed
  • 15% made their appointment because they were experiencing mouth pain

The Adult’s Oral Health & Well Being Survey was conducted between December 13 and December 28, 2017, among 1,008 nationally representative Americans age 18 and older with a margin of error of ±3.1%.

 

Read more via 42% of Americans Want to See Their Dentists More Often | Dentistry Today

Using Your Personal Credit Card for Business Is a Terrible Idea | Dentistry Today

20 Tuesday Mar 2018

Posted by landisrefining in business prtactices, dentist, health and wellness, market

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credit cardsMany of us have a preferred credit card in our wallet—the one we reach for first to swipe at checkout or shop online. We use it to pay for just about everything to accumulate points, earn rewards, and build our credit scores.

This is fine for personal purchases. But I hope you’re not also using your favorite card to cover your dental practice expenses, not only for the sake of your credit score, but for simplifying taxes and accounting as well.

For big-ticket expenses like equipment, technology, staff salaries, or expansion, you likely tap into a business line of credit or working capital loan to cover the costs. The lines may get a little blurry when it comes to covering smaller or daily expenses like driving to or between offices, buying employee meals at a tradeshow, or paying lab bills. It may be convenient simply to pay with that favorite credit card, but it’s not the best approach.

You would be surprised by how many professionals do this—dentists and other small business owners alike. But this practice can cause issues and annoyances for both your business finances and personal finances. 

It Can Negatively Impact Your Personal Credit Profile 

To some, using a personal card more often may feel like a favorable way to build credit, but this is not always the case.

It doesn’t matter if you have a perfect credit history. Charging a business expense to your personal credit card will only draw you closer to your borrowing limit, leaving you with little room for personal expenses or emergencies.

Continually using a personal card for business charges will also have you maintaining a higher credit balance and further reducing your available credit ratio, a primary factor in determining your credit score.

You Won’t Be Building Business Credit

Like an individual, your practice has its own credit profile and score. Oftentimes, this business credit score is just as important as a personal one when seeking financing for your practice.

Putting any business expenses on your personal card will hinder your ability to build business credit for your practice (because you’re not doing it by using a personal card), making it more difficult to attain a loan for your practice in the future.

To build business credit for your practice, consider a business credit card. 

It’s An Accounting Nightmare. 

Using a personal credit card to cover both personal and business expenses can set your accounting team up for a potential, yet avoidable, headache.

When tax season comes around, you’ll need to deduct your business expenses. By charging both business and personal payments to your personal credit card, it’s going to be more difficult and time-consuming to go through and separate what may and may not be deductible.

And vice versa. When using a business credit card, don’t make personal charges. By keeping these two accounts separate, it will simplify the lives of both you and whoever is in charge of your practice’s bookkeeping, allowing for a clear perspective of your spending on the business side.

You May Be Missing Out on Perks that Benefit Your Business 

Your personal credit card probably rewards you for consumer purchases, incentivizing things like paying at the grocery store or eating out at a restaurant. But many business cards offer rewards and perks that align with your business spending. Think about your everyday operational purchases and the targeted rewards you may be missing. 

The road to financial discipline is paved by both practice and persistence. So next time if it may seem more convenient to cover a business cost with your personal card, pause. Being proactive and keeping these two cards separate can set you and your practice up for continued financial success.

Mr. Gruebele is senior vice president at Bankers Healthcare Group, the leading provider of financial solutions for healthcare professionals. Contact him directly at kgruebele@bhg-inc.com or visit the BHG website at bankershealthcaregroup.com.

Related Articles

The Costs of Starting a Private Dental Practice

Proactively Promote Preventive Care for Patients

Evolve or Become Extinct: Smart Equipment Investments Can Improve Your Practice

Read more via Using Your Personal Credit Card for Business Is a Terrible Idea | Dentistry Today

Seven Keys to Preventing More Patients from Dying from Dental Sedation

16 Friday Mar 2018

Posted by landisrefining in dental techniques, dentist, health and wellness, oral health

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kid at dentistThe number of patients—and, particularly, children—who have been injured or killed by dental sedation indicates that there are gaps in the standard of medical care being used during these procedures. Here are just some of the cases that we know about:

  • 6-year-old Caleb Sears stopped breathing after receiving several different kinds of intravenous anesthetics during a tooth extraction.
  • 5-year-old Amber Athwal suffered brain damage after receiving general anesthesia to extract some of her teeth.
  • 17-year-old Sydney Gallegher died nearly a week after she suffered cardiac arrest after having her wisdom teeth pulled.

An investigation by the local ABC affiliate in Austin, Texas, identified at least 85 patients in Texas who died shortly following dental procedures from 2010 to 2015.

We offer seven keys to preventing more patients—especially children—from dying from dental sedation.

The Dentist Should Not Be the Anesthesia Provider and Monitor

In many of the fatalities following sedation for dental procedures, the same person was performing the dental procedure and monitoring the patient. As the American Academy of Pediatric Dentistry (AAPD) “Guideline for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures” states:

“The use of moderate sedation shall include the provision of a person, in addition to the practitioner, whose responsibility is to monitor appropriate physiologic parameters and to assist in any supportive or resuscitation measures, if required.”

Clinicians Should Be Trained to Recognize Respiratory Compromise and Be Able to Intervene Appropriately

The AAPD guideline, which applies not just to dental procedures but to sedation for all procedures, notes that children under the age of 6 years (and especially those under the age of 6 months) are particularly likely to suffer adverse events during sedation. It emphasizes that there is a very narrow margin in children between the intended level of sedation and much deeper sedation or anesthesia.

Therefore, the practitioner must be trained in moderate sedation and have the skills to rescue patients from such deeper levels. This would include the skills needed to:

  • Rescue a child with apnea, laryngospasm, and/or airway obstruction
  • Open the airway
  • Suction secretions
  • Provide continuous positive airway pressure
  • Perform successful bag-valve-mask ventilation
  • Insert an oral airway, a nasopharyngeal airway, or a laryngeal mask airway (LMA)
  • Perform tracheal intubation

The guideline notes that these skills are likely best maintained with frequent simulation and team training for the management of rare events. Without appropriate and trained personnel attending to the sedated dental patient—­and, particularly, children, as noted in the AAPD guideline—the safety of the patient is at risk.

Patients Should Be Monitored for Adequacy of Ventilation with Capnography

The updated AAPD guideline emphasizes the role of capnography in appropriate physiologic monitoring:

“A competent individual shall observe the patient continuously. Monitoring shall include all parameters described for moderate sedation. Vital signs, including heart rate, respiratory rate, blood pressure, oxygen saturation, and expired carbon dioxide, must be documented at least every 5 minutes in a time-based record. Capnography should be used for almost all deeply sedated children because of the increased risk of airway/ventilation compromise. Capnography may not be feasible if the patient is agitated or uncooperative during the initial phases of sedation or during certain procedures, such as bronchoscopy or repair of facial lacerations, and this circumstance should be documented. For uncooperative children, the capnography monitor may be placed once the child becomes sedated. Note that if supplemental oxygen is administered, the capnograph may underestimate the true expired carbon dioxide value; of more importance than the numeric reading of exhaled carbon dioxide is the assurance of continuous respiratory gas exchange (ie, continuous waveform). Capnography is particularly useful for patients who are difficult to observe (eg, during MRI or in a darkened room).”

Do Not Delay in Calling 911

In analyzing 78 cases of mishandled sedation or anesthesia, the Blue Ribbon Panel on Dental Sedation/Anesthesia of the Texas State Board of Dental Examiners found that, of the factors contributing to dental sedation incidents, the most common was that “the provider was slow to activate EMS [emergency medical services].”

Sure, the practitioner may be embarrassed over having allowed an adverse event to occur. However, any embarrassment is preferable to the death of the patient. We cannot stress this point enough. Do not delay in calling 911.

Practice, Practice, Practice

We must emphasize that every person in the dental practice, including clerical and front office staff, has a responsibility in an emergency. The only way to prepare all for such emergencies is to practice or perform drills. Since many dental practices employ part-time employees, that means drills must be performed on multiple occasions so all employees are familiar with their roles in emergencies.

In discussing factors that might have helped avoid the death of Joan Rivers, Kenneth P. Rothfield, MD, MBA, chairman of the Department of Anesthesiology at Saint Agnes Hospital in Baltimore and a member of the board of advisors of the Physician-Patient Alliance for Health and Safety, probably said it best when he told the Washington Post, “Unless you have drilled for it, and trained for it, it can be hard to pull off.”

Be Prepared

Being prepared is a key to managing adverse events and taking steps to avoid patient deaths. We recommend two related tools to be prepared: pre-procedure huddles (briefings) and post-procedure debriefings. These meetings offer the opportunity to both plan for contingencies ahead of time and to analyze things that might have been done better after a procedure.

We also encourage the use of checklists as a reminder of the key steps to be followed. The American Dental Society of Anesthesiology provides a Safety Checklist for Office-Based Procedural Sedation/Anesthesia (see the figure). This checklist has broken down key considerations along the continuum of care: procedure room setup, pre-operative encounter, post-operative recovery, and records.

Restraints Should Only Be Used With Extreme Caution

Dentists sometimes use a papoose board when treating pediatric patients. Papoose boards restrain the patient from interfering with the dental procedure and may have contributed to the adverse outcomes in several cases. The AAPD guideline provides the following cautions to using papoose boards or other restraining devices:

“Immobilization devices, such as papoose boards, must be applied in such a way as to avoid airway obstruction or chest restriction. The child’s head position and respiratory excursions should be checked frequently to ensure airway patency. If an immobilization device is used, a hand or foot should be kept exposed, and the child should never be left unattended. If sedating medications are administered in conjunction with an immobilization device, monitoring must be used at a level consistent with the level of sedation achieved.”

Conclusion

Although we cannot say for certain whether these seven keys would have saved the lives of Caleb, Amber, and Sydney, we do know that the application of a higher standard of care, in accordance with AAPD recommendations, might indeed save the life of another patient.

Dr. Truax of the Truax Group is board-certified in neurology and internal medicine. A clinician and educator with more than 20 years of experience in medical administration, he has been involved in patient safety for more than 25 years. He was trained at Johns Hopkins Hospital and Massachusetts General Hospital. And, he was a clinical association professor of neurology at the SUNY Buffalo School of Medicine. He can be reached at btruax@patientsafetysolutions.com.

Mr. Wong is the founder and executive director of the Physician-Patient Alliance for Health & Safety. A graduate of Johns Hopkins University and a former practicing attorney, he is a recognized healthcare and patient safety expert. Also, he is a founding member of the American Board of Patient Safety and a member of the editorial board of the Journal for Patient Compliance. He can be reached at mwong@ppahs.org.

Related Articles

Pediatric Sedation Safety Guidelines Get Updated

Dental Offices Need Emergency Preparedness Standards

Try Communication, Not Sedation, in Pediatric Dentistry

Read more via Seven Keys to Preventing More Patients from Dying from Dental Sedation | Dentistry Today

 

 

Sensitive Teeth? Try Green Tea

04 Friday Aug 2017

Posted by landisrefining in dentist, health and wellness, oral health

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green tea

photo courtesy of Dentistry Today

Current approaches to treating tooth sensitivity don’t last very long. Now, a team of Chinese researchers has developed a material based on an extract from green tea that provides longer relief and may help prevent cavities as well.

Sensitivity occurs when teeth are worn down to the dentin and to the hollow microscopic tubes found there. When hot and cold liquids and food contact the underlying nerve endings in the teeth via these exposed tubes, pain follows. Unprotected dentin also is vulnerable to cavity formation.

Typically, these tubes are plugged with nanohydroxyapatite, which doesn’t stand up well to regular brushing, grinding, erosion, or acid produced by bacteria. The researchers, though, encapsuled nanohydroxyapatite and a green tea polyphenol known as epigallocatechin-3-gallate (EGCG) in silica nanoparticles, which can stand up to acid and wear and tear.

Read more via Green Tea Extract Fights Tooth Sensitivity and Cavities | Dentistry Today

Eat Healthy and Protect Your Heath

07 Friday Jul 2017

Posted by landisrefining in dentist, health and wellness, oral health

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fruit heartDiet has a significant effect in the development of dental caries. Yet the role that food plays in systemic inflammation and subsequent tooth loss has not been extensively examined, even though 46% of adults in the United States have periodontitis, reports the Centers for Disease Control and Prevention (CDC).

Using data from the 2009-2010 and 2011-2012 National Health and Nutrition Examination Survey (NHANES), a multi-university research team assessed dietary inflammatory potential using the Dietary Inflammatory Index (DII), a composite measure based on the association between nutrients and systemic pro-inflammatory cytokine levels.

Subjects in the highest quartile of the DII, indicating a pro-inflammatory diet, had lost an average of 0.84 more teeth than those in the lowest quartile of the DII, indicating an anti-inflammatory diet. The researchers concluded that an anti-inflammatory diet could be associated with fewer missing teeth.

Georgios A. Kotsakis, DDS, MS, of the University of Washington School of Dentistry Department of Periodontics recently shared his insights about the study with Dentistry Today.

Q: Oral inflammation often is attributed to bacterial factors and infection. How does diet fit into its mechanics?

A: We know very well that dental caries are largely attributed to cariogenic dietary habits, with carbohydrate-rich diets being a key modifiable risk factor for disease prevention. The effect that dietary habits have on tooth loss is such that a diet restricting fermentable carbohydrates (eg, simple sugars and complex carbohydrates) can prevent caries. Nonetheless, little information was available on the effect of diet on periodontitis.

Read more via Anti-Inflammatory Diets Prevent Tooth Loss | Dentistry Today

Oral Health

15 Thursday Jun 2017

Posted by landisrefining in dentist, health and wellness, oral health

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Oral health touches every aspect of our lives but is often taken for granted. Your mouth is a window into the health of your body. It can show signs of nutritional deficiencies or general infection. Systemic diseases, those that affect the entire body, may first become apparent because of mouth lesions or other oral problems.

mouth openRead more via What is Oral Health? – American Dental Association

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