August 26, 2022

From August 23 to 26, the 26th conference of the International Association for Disability and Oral Health (iADH) takes place in Paris. “The rights of vulnerable populations to achieve an equitable standard of oral health are increasingly enshrined and we hope to showcase examples of best practice and scientific evidence to make this premise a reality worldwide,” the iADH said in announcing the event. Treating patients with special needs is a cornerstone of our practice at the Blende Dental Group, home of the House Call Dentists. Our participation in the iADH conference not only upholds our ongoing commitment to supporting these underserved and underrepresented populations, but empowers us to collaborate with a community of other experts to learn, share, spread awareness, and enhance the care we provide.

Scientific, Educational, and Specialized Oral Health Focus

The scientific content covered in the conference will include all aspects of Special Care Dentistry, with a concentration on pediatric dentistry, gerodontology, restorative dentistry, oral medicine, dental public health, prosthetic dentistry, implantology, oral surgery, periodontology, sedation, teledentistry, multidisciplinary car, and much more. 

The event will also highlight broader topics associated with Special Care Dentistry, including education, ethics, political lobbying, and disability representation and inclusion. These areas are particularly relevant in helping to solve the growing problems we discussed in our July article, “People with Special Needs Are Facing a Growing But Seldom Discussed Oral Health Crisis.”

States across the nation are confronting serious challenges in protecting the oral health of patients with special needs. In Wisconsin, a team of investigative journalists discovered that special needs patients in the area languished on waiting lists for years to receive dental care that required “crucial in-house or hospitalized sedation.”

Oral health is instrumental to overall physical health and quality of life. Without a network of dentists trained in advanced sedation modalities and in treating people with special needs, the dental problems of an already underserved population will continue to exacerbate. In response, the budget passed by the state legislature appropriated $2.5 million to “increase payments for dentists providing dental care to people with cognitive or physical disabilities who needed anesthesia during care.”

Other states are also experiencing similar issues. For example, tens of thousands of Californians with disabilities require special accommodations for dental care, but only a limited number of centers in the state can treat them. Traditional dentists outside of these specialized facilities lack the training and tools to care for the special needs population. A typical dental office cannot perform general anesthesia, nor are its teams or facilities equipped to handle patients with specific behavioral, physical, or cognitive challenges.

California Dental Association (CDA) president Ariane Terlet called the situation “untenable.” As in Wisconsin, advocates in California are imploring state lawmakers to include funding in the budget for developing solutions to alleviate this growing oral health crisis. The CDA has requested $50 million to be allocated for these purposes.

Addressing the problem and developing solutions are tasks not solved by dentists alone; they require visibility, legislative action, political engagement, and advocacy. Associations such as the iADH are dedicated to these causes and help fulfill the wider mission of bringing care to those with special needs. We at the Blende Dental Group are proud to participate in the conference and support the iADH.

About the iADH

The International Association for Disability and Oral Health “is a global organization with over 8,000 members from all sectors of health and social care interested in disability and oral health.”

 Since 1970, iADH has hosted a biennial congress that provides members from all over the world with an opportunity to assemble in one place to share their scientific knowledge and collective experience for improving oral health outcomes for people with disabilities.

“Quality of healthcare is a key component of the route to equity and dignity for people with disabilities and disadvantages,” iADH President Alison Dougall said. “Quality care has to be based on scientific knowledge and evidence-based guidelines and we anticipate that the 26th iADH conference will offer a phenomenal international scientific program with world-class keynote speakers and a showcase of the best available research in Special Care Dentistry.”

About the Blende Dental Group, Home of the House Call Dentists

Over 61 million people in the United States live with special needs, including 7 million children. Yet as we’ve seen, these individuals go without proper oral care given the lack of dentists who have the specialized skills, training, and capabilities to serve these unique patients. It’s important to understand that you and your loved ones can get the care you need through in-home care, facilitated by advances in mobile dentistry, and the evolution of sleep and sedation options. This has been the hallmark of the Blende Dental Group. We have devoted our practice to supporting the under-supported.

Patients with special needs require a level of care above and beyond what can be provided in a conventional dental office. This is why 60% of our disabled patients are referred to us by other providers. The category of special needs encompasses a broad population of individuals with unique circumstances. Some are homebound seniors, some are children, some experience severe anxiety or phobia, some have physical or cognitive challenges, and others live with complex medical conditions that make dental care difficult to obtain.

The Blende Dental Group is one of the few practices that is qualified to treat those with special needs. And we’ve been doing it for more than 20 years. Our dentists are longstanding and active members of the American Academy for Persons with Disabilities. They lecture nationally on special needs dentistry. Our genuine compassion for the person, understanding of their disability, and grasp of its possible complications form the core of our care. Our teams are licensed to treat special needs patients in our offices, at a hospital, or even in their homes through its House Call Dentists practice.

“Here at Blende Dental, our mission has been to help people who need dental care and give them the dental care that they deserve,” Dr. David Blende said. “That’s why our at-home service is so important. We provide care for the underserved, people who can’t leave home. Our mission is to break that barrier that keeps people from receiving dental care: geriatric and assisted living, the physically disabled, and people with cognitive disabilities.”

August 19, 2022

Fictional stories can have profound impacts on our perceptions. So it’s fair to say that films like “Marathon Man” and “Little Shop of Horrors” did no favors for dentists. Modern dental techniques and tools have transformed the industry. Sedation dentistry, in particular, has heralded new possibilities and treatment options for those who otherwise could not tolerate even simple procedures. Yet with the news of anesthesia-related fatalities out of North Carolina, patients wonder: “Is it safe?” It is, and we’ll explain what to know and what to look for when considering sedation dentistry.

Unsafe Practices in North Carolina

As WSOC-TV’s Allison Latos reported, “For 32 years, the North Carolina Board of Dental Examiners’ rules have allowed dentists to sedate patients and perform procedures at the same time. There have been eight anesthesia-related deaths –six in the past four years – and now the board is considering changes.”

North Carolina allows a dentist to administer sedation or general anesthesia (after receiving a permit based on verified training) and perform the procedure at the same time. In each of the six cases cited, the dentists were found to be in violation of the rules in place at the time. State regulations governing sedation vary widely.

In her article, Latos referenced a man who needed two teeth extracted. The patient noted in his paperwork, under the question concerning existing health conditions, that he had undergone a heart transplant in 2002.

Records from the North Carolina Board of Dental Examiners state that the doctor failed “to seek a medical consultation or request medical clearance for patient Roman M. and document any clinically sufficient reason(s) or justification(s) before administrating deep sedation or general anesthesia.” The patient’s heart stopped and the doctor was unable to revive him. The North Carolina Board of Dental Examiners revoked the dentist’s license.

Stories such as these stoke an increase in fear over medical and dental procedures. And anesthesia is not without certain risks. In a German academic journal on dentistry, the authors included a bit of interesting history:

“There should be no deaths due to anesthesia [sic] (Sir Robert Macintosh, 1949). These were the poignant words used by the first holder of a chair in anesthesiology in Europe, Sir Robert Macintosh, some 60 years ago, in order to emphasize that administering anesthesia is always dangerous and for this reason should be undertaken only by physicians with specialist qualifications.”

Since Macintosh’s time, the practice of using anesthesia has continued to become safer and more effective, largely because of the introduction of safety standards and improved training. During the 1940s, about 6 people in 10,000 died due to anesthesia-related complications. Today, the mortality rate is incredibly low at about 1 person out of every 200,000 to 300,000. 

As the Mayo Clinic assessed, “General anesthesia is overall very safe; most people, even those with significant health conditions, are able to undergo general anesthesia itself without serious problems.”

Understanding Sedation Methods

The first step in understanding sedation options is to recognize that not all of these modalities are the same. Put another way, sedation doesn’t always mean you’re going to sleep. Let’s take a look at the primary modalities and how they work in order to magnitude.

Local Anesthesia

Local anesthetics like novocaine or lidocaine numb a specific part of the body to prevent pain during procedures. The dentist numbs only the part of your mouth where you need a filling or extraction. Local anesthesia is always used, even in combination with any other sedation methods.

Nitrous Oxide

Nitrous Oxide  is a gas that helps decrease anxiety and allows you to feel more relaxed when inhaled. It’s administered through a small rubber inhaler placed over your nose. The recovery time is very short, and the effects pass within minutes, so you’ll be able to drive yourself home.

Oral Conscious Sedation

Oral Conscious Sedation involves taking a pill about an hour before your treatment, which makes you feel relaxed and drowsy. You’ll still remain awake during your treatment so you can interact with and respond to the dentist. The sedative effects can last for up to four hours. The most commonly used medications are Halcion or Valium. For the majority of dental practices that advertise sedation, this is typically the highest level they provide, in combination with nitrous oxide and local anesthetics.

Intravenous Sedation

Intravenous Sedation (IV) induces a lower level of consciousness. Sedative and analgesic medications are run through an IV, but patients still have full control of their breathing. IV sedation is fast acting, taking hold within one minute. The flow of solution can be controlled to increase or decrease the level of sedation safely and precisely. For people who have deep phobias of dental work, IV sedation allows them to sleep through the treatment with no discomfort, trauma, or memory of the procedure. It’s predictable, comfortable, and ensures that your dental treatment can be easily completed. The recovery is simple and quick.

General Anesthesia

General Anesthesia produces a state of unconsciousness where patients are completely asleep during their treatment. It is typically performed in a hospital by an anesthesiologist. General anesthesia is fast acting, taking effect within one minute, and can be controlled to increase or decrease the level of sedation safely and precisely. Because this level of sedation is so deep, a tube is also inserted to control the patient’s breathing. For people with  special needs—physical or mental disabilities, recovery from an addiction, or complex medical conditions—general anesthesia may be the safest option.

Choosing the Right Dentist

Despite what you might think, most dentists can’t offer the full range of sedation services. Patients who require modalities beyond nitrous oxide often find themselves being referred to specialists for oral conscious sedation, IV sedation, and general anesthesia.

When you receive any type of sedation, the medications must be administered by a trained and licensed professional. Only qualified and credentialed individuals can monitor the sedation level achieved, vital signs, and adverse effects while being equipped to handle any emergencies that arise.

Some general dentists have qualification permits to administer IV sedation. In that case, you’ll need to determine your comfort level for having the dentist monitor the results of your sedation while working on delicate tooth structures.

A dentist anesthesiologist (DA) provides advanced anesthesia and pain management services for dental and oral surgical procedures. Some dentist anesthesiologists also attend medical surgeries. Post-doctoral specialty programs that train dentist anesthesiologists are rooted in medical anesthesia residencies, with DA residents closely and in some instances identically following the medical anesthesia residency training as their physician cohorts. These doctors bring a heightened level of experience and qualifications to sedation-based treatments.

At Blende Dental Group, we recommend that patients look for practices that have developed a multidisciplinary approach to managing the complexities of treating patients with diverse needs, staffed by physician anesthesiologists, medical doctors, and leading dental specialists who deliver care in office or at  local hospitals. Unlike dentist anesthesiologists, physician anesthesiologists are medical doctors just like your primary care physician and surgeon. They specialize in anesthesia care, pain management, and critical care medicine, and have the necessary knowledge to understand and treat the entire human body.

When an anesthesiologist is present, he or she is dedicated solely to monitoring your wellbeing as the dentist works.

As we learned from the cases in North Carolina, these best practices weren’t being followed. The dentist administered the general anesthesia and performed the procedure. At Blende Dental Group, every patient is attended and treated by a physician anesthesiologist (in office or at the hospital), who remains present during the entire procedure to focus exclusively on monitoring the patient and the sedation. The dentist performs the procedure separately. Our commitment to this level of quality and care has ensured that every patient we’ve treated has had a safe, effective, and comfortable procedure with minimal risk.

Consulting with Your Dentist

People should approach their selection of a dentist with the same diligence they use to hunt down a good car mechanic. No one would want an unqualified, uncertified, untrained, and unskilled grease monkey messing around with an expensive piece of machinery. Consider your body a very high-performance vehicle that requires precision, experience, and expert care. Also like a good mechanic, you want a dentist who can evaluate your condition and your needs to deliver an honest recommendation for treatment.

After speaking with your dentist, you may realize that you don’t need general anesthesia. Oral conscious sedation might be the best option for you. Conversely, you may discover that general anesthesia will offer the best outcome. But beyond that, you also need to verify that the dentist has the qualifications and training to safely administer the sedation.

Sedation modalities represent a breakthrough in dentistry. Patients with special needs, phobias, developmental or cognitive challenges, and physical limitations can receive the care they need without discomfort. For patients and dentists alike, sedation options open up new treatment approaches to those who would otherwise struggle to access oral health care. However, with hundreds of practices currently advertising sedation and sleep options, people need more insight to make informed decisions.

At Blende Dental Group, we’re a team of medical dentists with over 40 years of experience in all sedation modalities. Our doctors have hospital privileges and rely on MD anesthesiologists to provide the safest treatment outcomes available. To learn more or schedule a consultation, contact us today.

August 12, 2022

The good news? Tobacco use has reached an historic low. The bad news? Vaping (using electronic cigarettes filled with juice or nicotine salt) and marijuana use are climbing. Vaping may not be as harmful as cigarettes, Johns Hopkins’ Dr. Michael Blaha noted, “but it’s still not safe.” Cannabis, meanwhile, has proven to yield a host of therapeutic and medical benefits, particularly among patients with cancer, AIDS, cardiovascular disease, multiple sclerosis, or other neurodegenerative diseases. Health officials like the FDA have approved cannabis for medical use. Harvard researchers prefer CBD and medical marijuana as safer options than opiates.  But weed, too, is not without its unknowns and risks. The reality is that any form of smoking presents big challenges in maintaining proper oral health.

Peering Through the Smoke Screen

Cigarettes and Tobacco

“Current smoking has declined from 20.9% (nearly 21 of every 100 adults) in 2005 to 12.5% (nearly 13 of every 100 adults) in 2020,” according to the most current data from the Centers for Disease Control and Prevention (CDC). That represents a “decline of approximately two-thirds in the more than 50 years since the first Surgeon General’s report warned of the health consequences of smoking.”

Cigarette smoking has a storied and lurid history of health-related pitfalls. There really are no positive health effects to be gained by tobacco use. If anything, smoking amounts to little more than elevated health risks, as CDC estimates demonstrate:

• For coronary heart disease, risks increase by 2 to 4 times; for stroke, by 2 to 4 times
• Men are 25 times more likely to develop lung cancer if they smoke
• Women are 25.7 times more likely to develop lung cancer if they smoke

“Smoking causes diminished overall health, increased absenteeism from work, and increased health care utilization and cost,” CDC concluded. Even puffing one ciggie a week dramatically increases a person’s susceptibility to cardiovascular disease, respiratory disease, cancer, poor bone health, trouble with fertility and pregnancy, diabetes, decreased immune function, and rheumatoid arthritis.

Vaping

As awareness of the dangers of smoking spread across society, so did the habit’s decline. Unfortunately, that also led to a rise in vaping, which electronic cigarette manufacturers promoted as a safer alternative.

“There’s almost no doubt that vaping exposes you to fewer toxic chemicals than smoking traditional cigarettes,” Dr. Blaha wrote. But in the same article for Johns Hopkins Medicine, Blaha also pointed out a less rosy scenario: “Research from The Johns Hopkins University on vape ingredients published in October 2021 reveals thousands of chemical ingredients in vape products, most of which are not yet identified. Among those the team could identify were several potentially harmful substances, including caffeine, three chemicals never previously found in e-cigarettes, a pesticide and two flavorings linked with possible toxic effects and respiratory irritation.”

Marijuana

Then there’s pot, which is to many recreational users a “harmless giggle” as John Lennon quipped, and a potential pharmacological boon to medical researchers. In many ways, cigarettes, vapes, and your ex-roommate’s “kind bud” are different, apart from the actual smoke they rely on as a transport mechanism for their substances. Yet all three products have one big thing in common: they all contribute to oral health and dental problems.

Smoking and Oral Health

People who smoke are at a higher risk of developing oral cancer, gum disease, tooth decay, and tooth loss. They’re also more likely to experience complications such as dry socket after extractions or oral surgeries.

The most common oral problems affecting smokers include:

• Gum (or periodontal) disease
• Oral cancer
• Whitening of the soft tissue in the mouth (called smoker’s keratosis)
• Poor healing after tooth removal (dry socket)
• Tooth decay
• Tooth loss
• Poor healing after mouth and gum surgery
• Decreased taste
• Bad breath (halitosis)

Blende Dental Group’s Dr. Lindzy Goodman explained that dry mouth is perhaps the biggest oral health issue caused by smoking, outside of cancer. Also known as cottonmouth, and technically called xerostomia, dry mouth occurs when salivary glands fail to produce sufficient saliva to keep the mouth moist. Dry mouth is a leading culprit in the cause of dental complications, akin to “meth mouth.” Common adverse effects include:

• Increased plaque
• Rampant decay, often gum line decay
• Mouth sores
• Oral yeast infections (thrush)
• Sores or split skin at the corners of the mouth
• Cracked lips
• Poor nutrition resulting from related difficulties with chewing and swallowing

The American Dental Association pointed out that “reduced salivary flow can cause difficulties in tasting, chewing, swallowing, and speaking; it can also increase the chance of developing dental decay, demineralization of teeth, tooth sensitivity, and/or oral infections.”

Apart from this, cannabis use can also hinder efforts at maintaining oral hygiene routines. People who use marijuana to relax or sleep may forget to brush and floss before going to bed in the haze of their relaxed state. This can be especially troublesome when combined with the munchies. Pot’s active ingredient is tetrahydrocannabinol, or TCH, which stimulates the part of the brain responsible for influencing appetite. This is why many who partake in the drug develop cravings for salty, sweet, or fatty carbohydrate-rich foods. But falling asleep with food particles left in the teeth becomes a sure-fire recipe for dental problems.

Oral Health Tips for Smokers

Of course, the best advice for smokers is to quit. People who stop smoking ultimately reduce their dental risks to the same level as non-smokers. For those who have no desire to kick the habit, there are some things you can do to mitigate tooth and gum problems.

• Try to reduce the amount of smoking you undertake in a day.
• Clean your teeth and gums twice daily with fluoride toothpaste.
• Use dental floss or interdental brushes once a day to clean between your teeth.
• Visit the dentist every 6 to 12 months. They can provide advice about the proper care of your teeth and gums while detecting prospective problems early.
• Avoid dry mouth. Drink plenty of water and keep water nearby when partaking in any kind of smoking to stimulate saliva flow. Chewing sugar-free gum can also help induce the production of saliva.

For more tips or an examination to assess the state of your oral health, get in touch with the Blende Dental Group today.

August 5, 2022

According to the July report “Cosmetic Dentistry Market Size, Share, Trends, By Product Type, By Patient Type, By End-Use, and By Region Forecast to 2028,” cosmetic dentistry is booming. Analysts expect the global market value to exceed $35 billion by 2028. There are several factors influencing the growth: rising incomes of middle-class populations, increasing consumer knowledge about cosmetic dentistry, and a stronger focus on wellness and quality of life improvements since the pandemic. However, it’s the advances in technology, materials, and techniques that have propelled the evolution and expansion of the market. As with many other industries, dentistry is reaping the benefits of modernization and innovation in an increasingly tech-savvy society.

New Remedies for Old Pains

The World Health Organization (WHO) estimates that over 2 billion people across the globe have cavities, which represents one of the most common dental diseases. People want to improve their smiles and repair damage, but many have long considered dental procedures to be invasive, painful, and frightening. A study conducted by ​​market research platform DentaVox, which polled 18,000 people worldwide, found that 61% of respondents claimed to suffer from dentophobia (dental fear), with 4% admitting to having never seen a dentist. The smells of chemicals, equipment such as drills and scalers, and injections often top the list of anxiety inducing aspects of treatment for patients. Whether the procedure involves teeth whitening, orthodontics, or implants, new technologies and practices are paving the way for effective and minimally invasive treatment options that have fueled the momentum for the flourishing cosmetic dentistry market.

“For instance,” Business Wire reported recently, “in June 2019, Zumosun Healthcare launched its new product Zumosun Smile, which is an advanced teeth whitening system that uses LED light technology. This product offers various benefits such as pain-free treatment, immediate results, and cost-effectiveness. Such products are expected to fuel the growth of this market in the coming years.” The use of lasers is also being explored to increase the comfort, speed, and effectiveness of cosmetic procedures while substantially mitigating the more invasive processes associated with traditional instruments. These tools, however, are just part of the burgeoning array of advances taking shape in the industry.

New Materials

The industry has witnessed a transformation from conventional materials to new technologically advanced materials such as dental cements, bonding agents, and others. The widening use of these advanced materials to design dental restorations has resulted in more natural looking teeth. Omnichroma is a great example of modern dental filling materials that match every tooth shade.

Artificial Intelligence, Robots, and Implants

As we discussed in a July article, artificial intelligence (AI) is fast becoming a mainstay in the evolution of dentistry, enhancing countless processes including prevention and maintenance, caries detection, periodontics, dental implants, oral and maxillofacial surgery, oral cancer screening, endodontics, prosthetics, and more. Specific to cosmetic dentistry, AI is having a profound impact on implants.

Different AI models have been successful in recognizing implant types by scrutinizing images and x-rays. They have also demonstrated high reliability in determining implant prognosis, implant design, and identifying fractured implants. “The overall accuracy for AI models applied for implant type recognition ranges from 93.8% to 98% for prediction of osteointegration,” the ADA wrote.

Dr. Lindzy Goodman of the Blende Dental Group said that oral surgeons are already using robotic devices such as Yomi by Neocis to place implants. This type of robot-assisted surgery, augmented by AI-driven improvements, has already received FDA 510(k) clearance for use in patient procedures.

3D Printing

Eventually, 3D printers will be able to further enhance treatment outcomes. Using dedicated materials, labs and practices can produce orthodontic models, highly accurate crown and bridge models, surgical guides, castable or pressable restorations, aligners, retainers, long-term biocompatible dental products like splints or dentures, and more. At some point, the entire wax-up to production process could take place right in the office within a matter of hours or minutes, rather than weeks or days.

Orthodontics

According to the American Association of Orthodontists (AAO), around 4.5 million patients in the United States are currently undergoing orthodontic treatment. That’s 3.9 million children and one-in-four adults. One of the reasons for this increase comes from the latest developments in orthodontic materials and techniques.

“Ceramic braces, which are made of clear or tooth-colored materials, are becoming increasingly popular due to their aesthetic appeal,” Business Wire noted. “Invisalign is another popular treatment option within cosmetic dentistry that uses clear, removable aligners to straighten teeth. According to the AAO, the number of Invisalign patients has increased significantly in recent years, reaching almost 700,000 in 2017.”

Lingual braces represent another option. They adhere behind the teeth to remain hidden from view. Patients see many benefits from the less invasive, less visible structure of traditional braces, as we explained in a May article.

Key Takeaway from the Cosmetic Dentistry Report

The cosmetic dentistry forecast included some key findings that could shape market trends between now and 2028. From the report:

• By product type, dental implants segment accounted for significant revenue share in 2020. Dental implants are artificial tooth roots that provide a strong foundation for fixed or removable replacement teeth. They are an ideal option for people who have lost a tooth or teeth due to periodontal disease, injury, or any other reason. Moreover, these implants improve the appearance of your smile and also boost your confidence and self-esteem. They also provide a natural feel and appearance as compared to other options, which is expected to drive the segment growth.
• The Porcelain veneers segment among product types is projected to grow at a significant CAGR during the forecast period. Porcelain veneers are wafer-thin, custom-made shells of ceramic that are bonded to the front of your teeth. They are used to improve the appearance of your smile and are an effective treatment option for chipped, stained, or misshapen teeth. They can also be used to close small gaps between your teeth.
• The growing demand for minimally invasive cosmetic dentistry procedures is expected to fuel market growth during the forecast period. Minimally invasive cosmetic dentistry is a type of procedure that uses the least amount of intervention to achieve the desired results. It is a popular choice among patients as it requires less time, is less painful, and has a shorter recovery period as compared to traditional cosmetic dentistry procedures.
• The North America market is projected to grow at a significant CAGR (compound annual growth rate) during the forecast period. This can be attributed to the rising awareness about dental aesthetics and the growing demand for minimally invasive cosmetic dentistry procedures in the region. The presence of major players in the region is also expected to contribute to market growth.

New Tech, New Smile

It’s often said that every company is a tech company these days. Those involved in healthcare, whether medical or dental, have long served as pioneers in the advancements of technology to promote better health and wellness. In this digital era, the innovations may have changed in nature, but the outcomes they promise continue to ensure an ongoing commitment to brighter smiles, healthier teeth, and improved quality of life for all patients.

July 15, 2022

It requires little effort to peruse the daily news and uncover stories related to the growing health crisis in the country, whether the issues involve post-pandemic outbreaks, staffing shortages for critical healthcare workers, soaring drug costs, supply chain constraints, or other challenges. The media loves to wade into the collective sense of dread and drama. Unfortunately, this approach tends to overshadow other crucial topics. Oral health is a prime example. And local reporting on the subject from states such as Wisconsin and California reflects a burgeoning problem, with nationwide implications, for special needs patients who suffer from a lack of timely and proper dental care.

Local Spotlights on Widespread Dental Problems

Woes in Wisconsin

On July 11, Wisconsin’s News 3 Now unveiled an investigation from May that revealed “how experts estimated hundreds were on years-long waiting lists in Wisconsin as the number of dentists trained for sedated care dwindled.”

In her article, Naomi Kowles explained: “While exact data on the problem isn’t available, experts estimated it was potentially impacting hundreds in the state in cases where people need sedated care because of disabilities or health needs. A combination of factors like key dentist retirements in Dane County, as well as the closure of a hospital dentistry program in 2016, are contributing to the worsening problem, according to Dr. Patrick Tepe with the Wisconsin Dental Association.”

The team of investigative journalists discovered that special needs patients in the area languished on waiting lists for years to receive dental care that required “crucial in-house or hospitalized sedation.”

Kowles quoted the parent of a special needs adult:

“This is getting to be an emergency now,” Karen Scullion in Iowa County said of her adult son Trent, who has cerebral palsy and had gone three years without care as she frantically searched for a dentist able to take him. “The other day he told us his tooth on this side was hurting. I looked; his crown fell off.”

Oral health is instrumental to overall physical health and quality of life. Without a network of dentists trained in advanced sedation modalities and in treating people with special needs, the dental problems of an already underserved population will continue to exacerbate. In response, the budget passed by the state legislature appropriated $2.5 million to “increase payments for dentists providing dental care to people with cognitive or physical disabilities who needed anesthesia during care.”

As California Goes, So Goes the Nation

The saying “As California Goes, So Goes the Nation” exists because of its veracity. The issues that stem from the Golden State – the largest sub-national economy in the world – inevitably influence or impact the course of national trends. So given the fact that California is experiencing the same oral health hurdles as Wisconsin, we can infer that the problems transcend regional events and reach much farther across the whole of the United States.

As Kristen Hwang reported for Cal Matters, “For Californians with special needs, getting to see the dentist can take years.” Sound familiar? This piece, like the Wisconsin investigation, also came out in May.

Tens of thousands of Californians with disabilities require special accommodations for dental care, but only a limited number of centers in the state can treat them. Traditional dentists outside of these specialized facilities lack the training and tools to care for the special needs population. Hwang recounted the story of one patient in her article:

The first time Namirah Jones visited the dentist at age 5, her meltdown brought the office to a halt. Her mother, Mia Costley, her grandmother and a dental assistant held her down while she screamed. The dentist couldn’t even get a mirror in her mouth.

“That’s when it was determined that no dentist could ever work on her; she would have to be put to sleep,” Costley said from their apartment in Corona.

Jones is now 19 years old. She suffers from severe autism and cognitive disabilities. But in this, she is not an outlier – Jones is one of tens of thousands of patients in California who cannot receive care from most of the 30,000 dental practices in the state.

These underrepresented patients, as Hwang wrote, live with conditions that range “from cognitive and physical disabilities like autism and cerebral palsy to complex health conditions like Alzheimer’s and Parkinson’s.” To receive treatment, they “require sedation during dental procedures, making basic dental care largely inaccessible.”

A typical dental office cannot perform general anesthesia, nor are its teams or facilities equipped to handle patients with specific behavioral, physical, or cognitive challenges.

“Instead,” Hwang pointed out, “disabled patients languish on waiting lists for years at the few places that can see them — usually dental schools. When they get an appointment, it’s frequently a financial hardship requiring time off of work for caregivers, long drives from remote areas of the state, overnight hotel stays and out-of-pocket surgical fees.”

California Dental Association (CDA) president Ariane Terlet called the situation “untenable.” As in Wisconsin, advocates in California are imploring state lawmakers to include funding in the budget for developing solutions to alleviate this growing oral health crisis. The CDA has requested $50 million to be allocated for these purposes.

Blende Dental Group: Specialists in Special Needs

Over 61 million people in the United States live with special needs, including 7 million children. Yet as we’ve seen, these individuals go without proper oral care given the lack of dentists who have the specialized skills, training, and capabilities to serve these unique patients. It’s important to understand that you and your loved ones can get the care you need through in-home care, facilitated by advances in mobile dentistry, and the evolution of sleep and sedation options. This has been the hallmark of the Blende Dental Group. We have devoted our practice to supporting the under-supported.

Patients with special needs require a level of care above and beyond what can be provided in a conventional dental office. This is why 60% of our disabled patients are referred to us by other providers. The category of special needs encompasses a broad population of individuals with unique circumstances. Some are homebound seniors, some are children, some experience severe anxiety or phobia, some have physical or cognitive challenges, and others live with complex medical conditions that make dental care difficult to obtain.

Blende Dental Group is one of the few practices that is qualified to treat those with special needs. And we’ve been doing it for more than 20 years. Our dentists are longstanding and active members of the Special Care Dentistry Association (SCDA). They lecture nationally on special needs dentistry. Our genuine compassion for the person, understanding of their disability, and grasp of its possible complications form the core of our care. Our teams are licensed to treat special needs patients in our offices, at a hospital, or even in their homes through its House Call Dentists practice. All of our dentists are also hospital trained, have completed postdoctoral General Practice Residencies (GPRs), and are privileged at local hospitals for sedation dentistry.

“Here at Blende Dental, our mission has been to help people who need dental care and give them the dental care that they deserve,” Dr. David Blende said. “That’s why our at-home service is so important. We provide care for the underserved, people who can’t leave home. Our mission is to break that barrier that keeps people from receiving dental care: geriatric and assisted living, the physically disabled, and people with cognitive disabilities.”

Early in his career, Dr. Blende toured a hospital where he saw children suffering from extreme bottle syndrome (a special form of tooth decay caused by prolonged exposure to milk and sugary liquids) and other serious ailments. His focus quickly shifted toward discovering ways to use his specialized skills to help patients who would otherwise struggle to receive traditional care. As time progressed, he broadened his services to treat people with disabilities, cognitive impairments, dementia, and homebound situations, bringing the past experience of house calls full circle into a modernized practice.

Today, Dr. Blende continues to champion the growth of this alternative approach to dentistry, mentoring a new generation of dental professionals to carry on the legacy and teach others. This focus on new skills develop and training will become essential in helping states care for citizens with non-traditional needs. And the Blende Dental Group is planning to be at the forefront of these efforts. As CEO Carla Caramat said in this year’s publication to patients and referring dental providers:

I’m so thrilled to announce the fulfillment of a concept we’ve been working on for years. It is the next step in our journey, an important new direction in the evolution of dentistry. The number of dental providers with the training to deliver specialized care for homebound and special needs patients has not kept up with the expanding population. For this reason, we are preparing to launch a nonprofit organization that will train dentists to carry on our mission—who in turn, will mentor other generations of dental practitioners. The foundation will provide services to these underserved populations: special needs patients, the homebound, and individuals in need of extensive treatments they cannot receive elsewhere.

Photo by Kenny Eliason on Unsplash

July 8, 2022

Artificial Intelligence (AI) and Augmented Intelligence (AuI), once inhabitants of a realm relegated to science fiction, have become increasingly ubiquitous aspects of modern life. Every day, people tap into the advances of AI and AuI without necessarily realizing it. Examples include smart speakers such as Alexa and Siri, predictive search results, robotics, chatbots, video games, adaptive cruise control, automated parking assistance, and the nascent development of autonomous (self-driving) vehicles. However, AI and AuI have grown more prevalent in the field of healthcare, including dentistry. The American Dental Association (ADA) recently released a draft whitepaper on the applications of AI and AuI in oral health, which presents sweeping and intriguing insights about the evolution of dental care in our digital world.

Our Augmented, Computer-Aided Reality

It’s been 25 years since IBM’s AI-fueled supercomputer “Deep Blue” bested chess master Garry Kasparov by 3.5 to 2.5 in a six-game rematch. Kasparov had won the tournament the previous year by 4 to 2 before IBM upgraded the system. The results were controversial, accusations of cheating abounded, and the computer company remained relatively cagey about the second match – ultimately dismantling Deep Blue when Kasparov requested a third showdown. But the experiment helped solidify a breakthrough for AI and AuI – technologies that have come a long way from chess in a short span of time.

Today, people have shed much of the fear they once associated with thinking machines. AI and AuI now heavily influence how we shop, how we deliver goods, how we decide what shows to watch or what music to explore, and even how we find romance. Yet the broader, more robust elements of AI and AuI are beginning to infuse health practices to reshape the ways in which providers help us maintain our physical and oral health, or even run their businesses.

In the “Proposed ADA SCDI White Paper No. 1106 for an Overview of Artificial and Augmented Intelligence Uses in Dentistry,” the American Dental Association “introduces the use of artificial and augmented intelligence in clinical disciplines, including prevention, caries and periodontal disease, implants, oral and maxillofacial surgery, endodontics, imaging, orthodontics and more.”

The paper also covers the adoption of AI and AuI for nonclinical areas, “with a focus on payer topics, such as claims processing, payment integrity and dental practice administrative issues.”

AI and AuI in Dentistry

Between 2017 and 2019, consultancies such as Accenture and McKinsey began predicting the rise of AI and AuI applications in dentistry. The Food and Drug Administration (FDA) authorized the first robotic dental surgery for implant procedures in 2017. Since then, as the ADA noted in its paper, “AI models have been used in detection and diagnosis of dental caries, vertical root fractures, apical lesions, salivary gland diseases, maxillary sinusitis, maxillofacial cysts, cervical lymph nodes metastasis, osteoporosis, cancerous lesions, alveolar bone loss, predicting orthodontic extractions, need for orthodontic treatments, cephalometric analysis, age and gender determination.”

Researchers analyzing the AI tools described their ability to “mimic the precision and accuracy of trained specialists. In some studies it was found that these systems were even able to outmatch dental specialists in terms of performance and accuracy.”

The paper in its entirety is a fascinating read, but let’s break down the core areas.

Prevention and Maintenance

Incorporating AI into diagnosis could expedite intervention and preventative treatment, while allowing for monitoring that can assist dentists through ongoing evaluation of their existing data. The ADA cited the example of periodontal disease, which is best treated through early detection and intervention. AI has the ability to inspect existing data, including images, and then identify changes that help facilitate preventative or early treatment.  AI can also prove instrumental in treatment planning by assessing clinical evaluations, patient dental history, and interpretations of diagnostic materials.

Caries Detection

Dentists typically detect tooth decay through clinical examinations using a mirror, an explorer, and x-rays. Advances in digital imaging and scanners have offered enhancements, but these systems can’t differentiate between active and arrested cavities (areas of decay that have stopped progressing and are usually limited to parts of the teeth where plaque hasn’t built up). AI provides dentists with several new opportunities here.

• AI can create baselines and monitor changes over time.
• Through this process, for example, AI could quantify the percentage of enamel loss and assess trends to drive recommendations for earlier treatment.
• AI has the ability to “autocorrect” dental images and better discern active caries from arrested caries.

Periodontics

Dentists gather data for gum disease using periodontal probes and various types of x-rays or imaging. Thorough and accurate measurements are crucial in determining diagnosis, risk, prognosis, and care options. Yet as the ADA points out, “Comprehensiveness and measurement accuracy are subject to clinician bias, skill, tools, and time.” AI may improve these outcomes when applied to images.

AI and AuI can correlate patterns in images to other similar patterns associated with diagnosis, risk, or prognosis. This matters because gingival inflammation and loss of periodontal support (e.g., tissue or bone) can occur for reasons other than periodontitis. “For example,” Blende Dental Group’s Dr. Lindzy Goodman clarified, “progressive gum recession alongside tooth attrition (flattening) may indicate untreated bruxism (grinding).”

As AI collects a variety of historical data and patterns, it can rapidly determine the cause of the problem – along with optimal courses for treatment. In subsequent studies, AI was also found to be more effective than traditional tools in analyzing radiographic bone levels, another important consideration in making a periodontal diagnosis.

Dental Implants

Different AI models have been successful in recognizing implant types by scrutinizing images and x-rays. They have also demonstrated high reliability in determining implant prognosis, implant design, and identifying fractured implants. “The overall accuracy for AI models applied for implant type recognition ranges from 93.8% to 98% for prediction of osteointegration,” the ADA wrote.

Dr. Lindzy Goodman said that oral surgeons are already using robotic devices such as Yomi by Neocis to place implants. This type of robot-assisted surgery, augmented by AI-driven improvements, has already received FDA 510(k) clearance for use in patient procedures.

Because AI is a learning-based system, existing dental imaging technologies still have a part to play – the datasets they provide can help AI continuously expand its knowledge to increase the accuracy with which it identifies implant types and predicts successful outcomes.

Oral and Maxillofacial Surgery

Results of current studies involving AI models in surgical procedures have been encouraging. Research suggests that AI tools may assist Oral and Maxillofacial Surgeons in better diagnosing and planning treatment with the “least possible errors.” A 2018 study of extractions found that AI was able to predict post-operative swelling with 98% accuracy. Gauging the severity of swelling in advance of a procedure empowers dentists to proactively mitigate patient discomfort after surgery.

Oral Cancer

“AI has great potential in simplifying the diagnosis and treatment of odontogenic cysts and tumors,” the ADA paper explained. “A lot has been done to help in the early diagnosis of oral cancer detection. This can help to reduce the mortality associated with missed or late diagnosis. OMFSs are using AI technologies to assist them in precise diagnosis, the need of surgery, type of surgery, and postoperative outcomes.”

Endodontics

Although the applications of AI and AuI for endodontics are in their infancy, research points to three focus areas where they can offer potentially powerful benefits.

• Detection: Incorporating AI and AuI into diagnostic tools could support clinicians in identifying lesions, crown and root fractures, apical foramen (the tooth’s natural opening at the tip of the root) determination, and the quality of existing root canal fillings.
• Pre-treatment Planning: AI could deliver data such as working length determinations, along with root and root canal system morphology, such as measuring the degree of the canal’s curvature.
• Prediction: AI is currently being utilized to predict outcomes for endodontic retreatment and the viability of using stem cells.

Prosthetics

Prosthetics represents an area where AI has been thriving for more than 20 years. “This first started with the introduction of chairside scanning in conjunction with chairside design and milling,” the ADA noted.  In the modern laboratory setting, technicians have been relying on digital AI-based software rather than traditional wax-up methods for years. The dental design software allows them to create models from scans rather than physical casts, bolstered by the AI. The process dramatically improves cost savings, speed, and reproducibility.

Eventually, 3D printers will be able to further enhance the outcomes. Using dedicated materials, labs and practices can produce orthodontic models, highly accurate crown and bridge models, surgical guides, castable or pressable restorations, aligners, retainers, long-term biocompatible dental products like splints or dentures, and more. At some point, the entire wax-up to production process could take place right in the office within a matter of hours or minutes, rather than weeks or days.

Teledentistry

Teledentistry surged in use throughout the pandemic. Now, it has emerged as a convenient and immediate solution for patients and dentists. In many ways, teledentistry’s virtual face-to-face interactions are comparable to in-office visits. Dentists can ask patients questions, examine their teeth, and more. With AI, however, the efficacy of these consultations can be vastly improved: “AI can assist clinicians in interpreting these images to provide timely feedback. Additionally, many dental offices have digital records of their patients such as digital radiographs, intraoral scans, digital CBCT scans and intraoral and extraoral photographs. These existing images can aid the clinician and the AI in diagnosis and treatment planning in teledentistry.” ADA expects teledentistry to experience significant growth as AI becomes more integrated.

Non-Clinical

AI and AuI are not just advances for treatment, they can also be instrumental for running a business. For example, Pearl, a dental software firm, uses AI to flag claims. The system compares x-rays and intraoral scans to duplicates or near-duplicates from previous claims to verify the integrity and consistency. During a pilot, Pearl’s AI identified up to $6 billion in insurance fraud. One provider submitted the same panoramic image to get dentures approved for nearly 40 patients. Pearl earned a patent in August 2021 for its fraud, waste, and abuse detection abilities.

For claims processing, as the ADA explained, “Currently available products can utilize AI systems to determine whether an attachment is a radiographic image, a periodontal chart, photographs, copies of patient treatment records, or other types of correspondence. These AI products can perform the validation of submitted attachments to identify whether the required documents have been submitted, and whether the contents of the attachments include all necessary information.”

AI can also assist dental practice leaders in quality assurance. Developers are already working with AI to monitor staff performance by comparing dental consulting decisions to those of their peers and an established “gold standard” model of performance. Through analysis of the decisions, AI can recommend where training and retraining may be needed to ensure consistency and accuracy.

Future Applications

The ADA whitepaper cites myriad future applications for AI that include orthodontics, temporomandibular joint disorder (TMD), sleep disorders, electronic dental records, telemonitoring, data collection, treatment planning and risk assessment, scanning improvements, and much more. The ADA is also encouraging dental professionals to review the paper and suggest content by August, so we encourage our referring providers to review the document and consider participation.

AI and AuI’s potential for influencing the field of dentistry is not a hypothetical thought experiment – the applications are real and will unfurl in the near future. “Dentistry is already beginning to see many changes including image analysis for caries and bone loss, robotic implant placement, and the many uses already implemented in prosthetic design and product construction,” the ADA concluded. “Many of the contributors to this paper would go further and suggest it will actually transform how dental care is delivered.”

To download and contribute remarks to the whitepaper by August 15, 2022, visit the ADA’s site.

July 1, 2022

 With the July 4 holiday right around the corner, the nation gathers to reflect on the nature of independence. Through fraught and bold decisions, the would-be founders of the United States launched a unique democracy by breaking free from the shackles that constrained the young country’s autonomy, as imposed by ruling factions abroad. Today, we ponder less on our emancipation from foreign tyranny and more on the themes of our freedoms and individual liberties. Independence is a cherished American value. Yet for a rapidly aging demographic, independence becomes harder to maintain, increasing their reliance on the assistance of others. This shift also brings changes and challenges to healthcare. And dental health, easily overlooked in too many situations, should be elevated as an imperative in ensuring the longevity, comfort, and physical and mental health of seniors. The importance of this issue is echoed by the American Dental Association (ADA), which is hosting a symposium in August on “improving oral healthcare of the aging population.”

Less Independence, Greater Vulnerability

The ADA symposium, “From Policy to Chairside: Improving Oral Healthcare of the Aging Population,” will offer a wide range of content “including academic trends, current policy, access to care, and the oral-systemic connection.” The event intends to shine a light on the multidisciplinary approaches needed to treat some of the nation’s most vulnerable patients. This follows in line with the 2020 passage of Resolution 77H-2020, which affirms the value of integrating elder care strategies into the ADA’s public advocacy efforts.

A Young Nation Getting Older

The Population Reference Bureau’s Population Bulletin, “Aging in the United States,” examines recent trends and disparities among adults ages 65 and older, and how Baby Boomers born between 1946 and 1964 are reshaping America’s older population. The current growth of the population ages 65 and older is unprecedented in U.S. history. Several demographic shifts will occur as a result.

• The number of Americans over the age of 65 is projected to double from 52 million to 95 million by 2060.
• The accelerating changes in racial and ethnic composition of the population under age 18 will likely create a diversity gap between generations.
• Many parts of the country, particularly the rural Midwest, are aging in place because disproportionate shares of young people have relocated elsewhere.
• Average U.S. life expectancy increased from 68 years in 1950 to 78.6 years in 2017, in large part due to the reduction in mortality at older ages. Despite the positive trends in longevity, longer life spans create increasing reliance on physical and oral healthcare in a system where the demand is outpacing the supply of skilled healthcare and dental professionals.
• The aging of the Boomer generation could fuel more than a 50% increase in the number of older Americans requiring nursing home care, to about 1.9 million in 2030.
• Demand for elder care will also be driven by a steep rise in the number of Americans living with Alzheimer’s disease, which could more than double by 2050 to 13.8 million, from 5.8 million today.

Medical and dental experts recognize that oral health is a vital aspect of overall health; as patients age, declines in oral health can have profound impacts on seniors with medically, functionally, or cognitively complex conditions.

The Importance of Dental Care for Seniors

Mental Health

People may not readily associate good oral health with physical and mental wellbeing, but the connection is undeniable. The simple joys of eating a cherished meal or being able to speak without complication are crucial aspects of interaction, socialization, engagement, and happiness. These actions also underscore elements of independence. As we age, we often lose the ability to pursue favorite activities such as driving, athletics, or other pastimes. The loss of being able to participate in these activities often signals a sense of forfeiting independence. Socialization – even something as simple as sharing a meal with friends or family – remains an act that reinforces independence. In this way, maintaining oral health is tantamount to maintaining mental health.

Physical and Cognitive Impairments

According to the American Dental Association (ADA), the physical and cognitive impairments associated with aging hinder efforts at self-care for normal oral hygiene. Seniors with dementia may forget to brush their teeth. They may not remember how to brush. Seniors with arthritis may struggle with brushing and flossing because of pain in their hands or fingers. And for seniors who must take prescription medications regularly, the side effects of certain drugs produce adverse changes in oral health.

Health Risks Increase with Age

“​​Dental health is a vital component of your overall health,” wrote Lucy Wyndham in Dental News. “Oral health issues like periodontal disease and tooth decay have been linked to systemic conditions such as heart disease, stroke and infection. With age, the risk of tooth loss and other oral health problems increases, with more than 27% of people over age 65 having no remaining teeth. Edentulism can make it difficult to enjoy a varied, nutritious diet, which leads to further health complications and can diminish a person’s overall quality of life. For people in assisted living communities, it is important for caretakers to be aware of the dental needs of seniors and to take steps towards preventing dental and periodontal disease.”

The Centers for Disease Control and Prevention (CDC) pointed out that oral health risks grow alongside us.

• Untreated tooth decay. Nearly all adults (96%) aged 65 years or older have had a cavity; 1 in 5 have untreated tooth decay.
• Gum disease. A high percentage of older adults have gum disease. About 2 in 3 (68%) adults aged 65 years or older have gum disease.
• Tooth loss. Nearly 1 in 5 of adults aged 65 or older have lost all of their teeth. Complete tooth loss is twice as prevalent among adults aged 75 and older (26%) compared with adults aged 65-74 (13%). Having missing teeth or wearing dentures can affect nutrition, because people without teeth or with dentures often prefer soft, easily chewed foods instead of foods such as fresh fruits and vegetables.
• Oral cancer. Cancers of the mouth (oral and pharyngeal cancers) are primarily diagnosed in older adults; median age at diagnosis is 62 years.
• Chronic disease. People with chronic diseases such as arthritis, diabetes, heart diseases, and chronic obstructive pulmonary disease (COPD) may be more likely to develop gum (periodontal) disease, but they are less likely to get dental care than adults without these chronic conditions. Also, most older Americans take both prescription and over-the-counter drugs; many of these medications can cause dry mouth. Reduced saliva flow increases the risk of cavities.

Dental Care for Seniors on Their Terms

Dental professionals who have come to specialize in treating elderly patients continue to hone the practices, tools, and procedures needed to care for their unique circumstances. The challenge, however, centers around the nature of independence. In traditional dental practices, the onus rests on the patient to find a way to the office. Some seniors don’t have the means and ability to travel. And for them, forgoing preventative dental care increases in likelihood. This is why the modernization of house calls has become an inspired innovation. At Blende Dental Group, we are home of the House Call Dentists. 

Mobile dentistry: Care in the comfort of familiar surroundings

Our fully equipped team of dentists, registered dental assistants, and mobile hygienists provide in-home dental evaluations and treatments with portable dental equipment. Based on our assessment, we determine the level of care required and whether treatment can be delivered in the home or under sedation in our office or the hospital. Providing sedation in any of these locations allows us to complete care in as few as one or two visits.

Caring for Seniors Is Our Specialty

We partner with families, care facilities, and health care providers – including dentists, physicians, care managers, and social workers – to develop a targeted daily dental care plan that complements successful treatment. When homebound seniors experience discomfort, we’re dedicated to making treatment as comfortable as possible. Initial visits include exams, digital x-rays, cleanings, and emergency care as needed to rapidly eliminate infection or pain. Our medical and dental teams meet or exceed hospital grade standards for sterilization safety.

Our multidisciplinary team of nationally recognized dentists, anesthesiologists, and MDs allows us to offer palliative treatment to full-mouth restoration in the safety and comfort of your home. We bring state- of-the-art mobile dental technologies to people who are homebound or have difficulty traveling to a dentist. We provide preventative, restorative, and emergency care 24/7/365.  Our teams handle the setup and breakdown of all portable equipment, as well as access to our teledentistry platform, which provides real-time access to video visits with your dentist, treatment plans, and more.

We adamantly believe that no barriers to dental care exist. We’ve built on our practice on this concept. Caring for underserved seniors is our mission and our passion.

June 24, 2022

There’s an old joke that goes, “You brush your teeth at night to keep your teeth, you brush your teeth in the morning to keep your friends.” Humor aside, the morning cleaning ritual for many people underscores cosmetic concerns. They’ve just eaten breakfast, perhaps had some coffee, and now they’re en route to interact with colleagues and clients at work. Who wouldn’t want a shiny smile to start the day? But even with the best intentions, our brushing habits may be causing more harm than health. Abrasive pastes, hard bristles, and antiseptic rinses can be more problematic than productive.

Oral Health Has Not Improved Much for Many People

Despite all of the advances in dentistry, including at-home care products, oral heath hasn’t significantly improved in over 30 years. The pandemic made matters worse. During the outbreaks and quarantines, teeth grinding and other dental damage increased. New data from practicing dental professionals and the American Dental Association Health Policy Institute indicate nation-wide spikes in dental conditions such as chipped teeth, cavities, and grinding, technically called bruxism. Yet as we wrote in April, the situation today appears to have worsened, with a majority of Americans reporting high-stress levels due to financial concerns, inflation, the ongoing outbreak of COVID-19 variants, and Russia’s invasion of Ukraine, according to a poll from the American Psychological Association. Although people may not realize it, depression correlates to poor oral health.

Recent situations like the pandemic, however, can’t be viewed as the sole culprits in substandard oral hygiene. Roughly half of American adults suffer from some form of gum disease. That figure climbs to 70% for seniors over the age of 65, according to the Centers for Disease Control and Prevention (CDC).

The real issue is one of extremes: people either neglect their teeth and gums or swing to the opposite end of the spectrum by disinfecting and sterilizing their mouths to such lengths that they disrupt the balance of the oral microbiome. Although it may sound counterintuitive, using products that eradicate all the bacteria in one’s mouth will have negative consequences.

Practicing Healthy Habits

Antiseptic mouthwash is usually advertised as killing 99% of, well, everything. And it’s true; the products actually live up to their claims. That’s not necessarily a good thing. Stringent antiseptic rinses leave behind tough, hardy, and detrimental microbes. Without others to keep them in check, they begin to repopulate the mouth and take over. This leads to myriad problems, including gum disease, tooth decay, and more.

So what should you do? Stick with the tried and true basic best practices.

• Clean your teeth before breakfast or 30 minutes after. The mouth becomes acidic when eating, in order to break down food. Brushing immediately after can damage your enamel.
• Choose an non-alcoholic mouthwash and rinse after waking. This will restore the pH of the mouth and loosen any plaque or particles that accumulated during sleep.
• Floss. Yes, floss. Any floss is better than no floss at all. String-based flosses tend to work the best.
• Use a soft bristled toothbrush (electric or manual) and don’t apply too much pressure.
• Clean your tongue with the brush or a tongue scraper made for that purpose.
• Use toothpaste from a reputable brand that’s fluoridated, effective, and bears the ADA seal of approval.

And, as we always advise, make sure to visit your dentist for routine checkups and cleanings. An ounce of prevention is worth a pound of cure.

June 10, 2022

Endorsed by the American Dental Association (ADA), Oral Health Month is a reminder about the importance of maintaining good oral hygiene. Every June, we celebrate the pioneering advances that have been made since the early 20th century in the field of dentistry.  And because Oral Health Month also marks the beginning of summer, it’s a perfect time to visit the dentist before hitting the beaches and resorts.

Oral Health Month Is a Celebration of History

People may not associate the evolution of dentistry with the march of history, but oral health has played its part in the progress of our nation. In 1906, a Connecticut dentist named Alfred Fones trained his cousin to assist in cleaning his patients’ teeth and performing preventative treatments. He coined the term “dental hygienist,” and Irene Newman, his cousin and assistant, became the world’s first person to hold that title.

Newman’s training consisted in large part in learning to clean teeth under Fones’ guidance. For teaching aids, Fones took the many extracted teeth from his practice, mounted them in a modeling compound and painted plaster of Paris around the neck of each tooth to represent calculus and stains. Newman started performing oral prophylaxis for the public in 1907. Seeing the success of the program and the position, Fones established the first school of dental hygiene in 1913.

Newman later received the world’s first license as a dental hygienist in Connecticut in 1917, and she became the first president of the Connecticut Dental Hygienists Association. Fones forged ahead in his efforts and eventually formed the American Dental Hygiene Association (ADHA). Shortly after the organization’s creation, all 50 U.S. states had licensed dental hygienists.

The ADHA continued to influence not only oral health standards in America but contributed to its social progress, as well. During the Civil Rights era of the 1950s and 1960s, the ADHA played a part. The ADHA lifted previous restrictions for admissions based on race, color, and creed. The association also struck the word “female” from the ADHA constitution, allowing males to graduate in dental hygiene. Jack Orio became the first male student to do so. 

The Importance of Oral Health

Most of us know the basic steps of keeping our mouths healthy: brushing at least twice a day, flossing, regular dental checkups, and cleanings. What people may not understand is how oral hygiene contributes to better overall health.

Compared to other parts of the body, people are more likely to ignore problems that manifest in the mouth.  Bleeding gums, pain, and infections are common problems that negatively impact physical health and quality of life.  They affect how a person speaks, eats, and socializes. There are also more serious risks.

As we wrote previously, an estimated 54,000 cases of oral cancer were diagnosed last year. About 43% of those individuals were not expected to survive beyond the five-year mark. Unlike other cancers, this disease is less frequently discussed in the media. And with only 35% of adults attending routine dental screenings, the risks are high.

Ways to Honor Oral Health Month

Maintaining oral hygiene is not difficult, but it does require a little diligence. Here are some best practices to incorporate into your daily routine.

• Use fluoride toothpaste
• Brush your teeth for at least 2 minutes, covering all four quadrants for 30 seconds
• Don’t forget to brush your tongue
• Alcohol-free mouthwashes can reduce plaque formation, curb infection, and eliminate bad breath
• Eating healthy foods goes far in helping the body fight or prevent infection
• Avoid acidic beverages like orange juice and carbonated beverages, which can erode the enamel on your teeth 
• Sugary foods, as we all know, cause cavities
• Check your mouth for any warning signs of oral cancer, such as red or white discolorations, bleeding, sores, or bumps

Most importantly, be sure to schedule regular cleanings and checkups with your dentist. Over 116 years ago, the first dental hygienist began practicing critical work that continues to advance in effectiveness. So schedule a visit and be a part of the rich dental history we celebrate every June.

June 8, 2022

June 1 marks the first day of LGBTQ+ Pride Month. Equality, inclusion, acceptance, and support for friends and loved ones in the community are critical to the advancement of our society. We talk a lot about these issues during Pride, but the subject of health is often pushed aside. It shouldn’t be. The National Institute on Minority Health and Health Disparities identifies the LGBTQ+ community as a “health disparity population” due to lowered access to health coverage – including dental care. Clinical research shows that sexual and gender minorities who live among high levels of prejudice will die sooner – 12 years on average – than those residing in more accepting environments. Because oral health affects physical and mental health, the issue is too important to discount.

A Growing Community

The number of people in the LGBTQ+ community has risen steadily over the years. According to the most recent Gallup Poll on the topic, published in February 2021, 5.6% of U.S. adults identify as LGBTQ – up from 4.5% in the 2017 survey. Within the ranks of Generation Z (those born between 1997 and 2002), the number climbs to 15.9%. Given these facts, combined with the problem of “health disparity,” providing LGBTQ+ people with access to safe, comfortable, and compassionate oral health care is vital.

LGBTQ+ Dental Issues

Risks Associated with HIV and Hepatitis

Academic research data indicate that bisexual, lesbian, and gay individuals are more likely to rate their oral health unfavorably when compared to their straight peers. Because oral and physical health are intrinsically linked, dentists must be open to discussing concerns beyond oral health to support the needs of this patient group.

Although LGBT people experience higher rates of HIV and hepatitis, these diseases do not represent the singular causes of health risks for the population. They persist, however, as serious risk factors. HIV lowers the body’s immune system and ability to fight infection, which includes infections in the mouth or gums. Some HIV medications also produce side effects that lead to oral health problems.

Substance Abuse and Homelessness

As a result of systemic discrimination and disadvantage, LGBTQ+ people often succumb to higher rates of homelessness and substance abuse than the general population. These circumstances make routine oral hygiene challenging, with dental avoidance leading to tooth decay and other dental complications. For transgender people undergoing hormone therapy, there are additional risks of osteoporosis, changes in bone density, and gum disease.

Mental Health

LGBTQ+ people experience unique hurdles and different stresses than other underrepresented groups, which can contribute to poor mental health. What patients may not realize is the impact of mental health challenges on dental care. For example, people living with anxiety or depression are less likely to maintain a regular oral hygiene regimen. They’re also less prone to scheduling routine dental checkups and cleanings. In certain cases, mental health issues can result in eating disorders, which propel the onset of dental problems.

Communication

Facing ongoing and widespread discrimination, LGBTQ+ are naturally reluctant to divulge their gender identities or orientations openly, but this lack of transparency complicates treatment. Failing to disclose relevant health conditions, medications, hormone therapy, and even lifestyle behaviors will likely jeopardize favorable treatment outcomes.

Dental teams must know and understand their patients’ medical histories along with any medications they are taking. This includes medicines prescribed by physicians for HIV or Hormone Replacement Therapy. If a patient has HIV or hepatitis, the dentist must also know about that. Openness is critical to good results and effective treatment.

Dentists are dedicated to improving your oral health, not judging your life or identity. That said, finding a dentist that instills comfort, ease, a sense of security, and trust is imperative. LGBTQ+ people should do their research, seek referrals from other members in the community, and schedule consultations to find a dentist whom they consider ideally situated to care for their unique needs. And with that, we would like to offer a very special case study to demonstrate our commitment to the LGBTQ+ community.

New Smile, New Beginning

Damon Fassett, a courageous young man, was referred to the Blende Dental Group by Western Dental for treatment beyond their dentists’ skill sets.

Damon endured a difficult childhood, underscored by bullying and ostracization. As a transgender male, his early adult years were equally frightening. He developed bulimia and anorexia, causing dental decay, pain, and abscess.

For Damon, who never felt a real sense of belonging or self-confidence growing up, correcting the issues with his teeth and having a beautiful smile became important aspects of his transition to a new life, where he could finally embrace his genuine identity. But the importance of restoring his oral health extended far beyond cosmetics. In order to secure approval for his gender affirmation surgery, he needed to gain back enough weight to undergo testosterone treatment. His oral health complications made eating difficult.

The level of treatment involved would typically require long hours and multiple visits. Dr. Blende accomplished all aspects of his treatment in two sessions. Damon was first seen at Sutter Hospital where he underwent general anesthesia, allowing our team to comfortably and safely complete his dental work. His second visit included the cementations of crowns and bridges in the office using nitrous sedation.

Because of the costly procedure, Damon had initially feared that he wouldn’t be able to move forward with the treatment. Given Damon’s unique and sympathetic circumstances, Dr. Blende’s team performed the procedure at no cost. Damon’s gratitude for the exceptional care and generosity of Dr. Blende brought him to tears. He described Dr. Blende’s attitude and approach as “inspiring.”

Damon has since focused the next stage of his journey on helping others in need by training service animals to assist people suffering from emotional, behavioral, and physical distress. He credited Dr. Blende as a primary impetus for encouraging him to realize his dream.