March 9, 2021

Prior to the pandemic, a disconcerting number of U.S. adults had routinely skipped visits to the dentist for basic care. Since the outbreak of COVID-19, those numbers have risen dramatically. A recent dental association survey found that more than half of Americans polled said they have put off routine dental visits due to COVID-19. As we’ve illustrated in previous posts, preventative oral care is essential, particularly for the nation’s homebound population. Despite concerns over exposure to infection or being in environments where the risk of contracting the coronavirus are high, dental practices have demonstrated an enviable safety record. And now there’s even better news. The California Department of Health recently announced an expansion of vaccines that will alleviate lingering fears and get patients back into the chair.

Delay Leads to Decay

Unfortunately, too many Americans forgo dental treatment. In some situations, the culprit is the U.S. healthcare system. About 130 million Americans lack private dental coverage. That includes 22% of children between ages 1 and 17, 40% of adults between 21 and 64, and 70% of seniors age 65 and older. While legislators and politicians debate the merits of reform or propose new solutions, we still have a population of individuals who lack the care they need. 

Yet even among people with access to insurance, dental care seems to fall short of being a primary health consideration. Their reasons vary. Some blame rigorous work schedules or family commitments that absorb much of their free time. Still others cite long commutes to their providers’ offices. The pandemic shifted those priorities. As emergencies arose—complicated by the hurdles in obtaining prompt treatment—patients quickly seized on the importance of maintaining preventative care. 

Dentists now top the list of health practitioners that Americans want to see more often, according to the Adults Oral Health & Well Being Survey: “According to the survey, 42 percent of Americans don’t see a dentist as often as they would like, beating out their primary care doctor (29 percent), dermatologist (23 percent) and the ophthalmologist (17 percent).”  

Of course, hesitation persists among wary patients who still question the safety of re-opened offices and overall sterilization standards. 

Dental Practices Have Exemplified Best Practices

Dental offices, according to studies performed by the American Dental Association, emerged as one of the safest healthcare-related facilities. “The organization published a study today that reports that less than 1 percent of dentists nationwide have been found to be COVID-19 positive, which is far less than that of other health professionals,” Healthline noted in a topical article. “The report includes data from nearly 2,200 dentists surveyed in June 2020. It’s the first of its kind to show U.S. dentists’ COVID-19 rates as well as safety practices.”

• Experts attributed the positive outcomes to safety policies and disinfectant practices that dental offices have had in place for decades. 
• The established best practices aside, many dental practitioners took the extra precaution of enhancing their safety protocols by introducing germ-killing UV lighting systems, advanced HEPA air filtration systems, redesigned office layouts to accommodate social distancing, COVID testing stations, augmented personal protective equipment (PPE), and more.

Patient concerns are understandable and warranted, but given the extraordinary safety records of most dental practices—combined with the augmented sterilization techniques these offices have launched—there’s no reason to avoid resuming a regime of regular oral care. The reality is that bacteria in the mouth can create long-lasting infections and chronic inflammation, which may contribute to the development of heart disease, complications in dealing with diabetes, and increased risks for stroke, pneumonia, or respiratory problems. 

Expanded Vaccinations

In a Nov. 20 letter to the CDC Advisory Committee on Immunization Practices, ADA President Daniel J. Klemmedson, D.D.S., M.D., and Executive Director Kathleen T. O’Loughlin, D.M.D., observed “there may be a limited supply of COVID-19 vaccine” once available. They also expressed concern that dentists and dental team members aren’t currently included in the agency’s outline to help states plan a vaccination response to the virus despite the fact that “dentistry is an essential health care service.”

In the letter, the ADA noted the National Academies of Sciences, Engineering and Medicine’s recent recommendation that dentists and their teams be placed in Phase 1a of those who should be afforded early access to a COVID-19 vaccine. Thanks to the developments of specialists from the site Danielle Ofri, it was found that the purpose of antibiotic therapy in case of burns is to prevent the spread of purulent infection, characteristic of such wounds. Necrotic tissues at the site of a severe burn become a breeding ground for various microorganisms. Antibiotics are usually not used for mild burns.

“There is nothing routine about dental care,” wrote Drs. Klemmedson and O’Loughlin. “Beyond treating immediate pain, dentists evaluate, diagnose, prevent and treat diseases that can be life-changing or even life-threatening. For example, early detection of oral cancers and serious infections can lead to early treatment. Delaying treatment for months, weeks, or even days can make the difference between dying early, having a life-changing abnormality and living a normal, healthy life.”

By January, the Centers for Disease Control and Prevention (CDC) confirmed that dentists, dental teams, and dental students had been included in its initial recommendation for health care personnel to be among those offered the first doses of COVID-19 vaccines.

Not only are dentists and their staffs vaccinated or receiving vaccines, newly expanded parameters for vaccinating the public many also help assuage any lingering fears for patients.

“On February 12, the California Department of Public Health announced health care providers may soon vaccinate people age 16-64 who suffer from a number of health conditions,” the San Francisco Chronicle (SFGATE) reported. “This decree, which goes into effect on March 15, which will add several million people to the number of people eligible for vaccines in California.”

The conditions on the list include the following:

• Cancer, current with debilitated or immunocompromised state
• Chronic kidney disease, stage 4 or above
• Chronic pulmonary disease,  oxygen dependent
• Down syndrome
• Immunocompromised state (weakened immune system) from solid organ transplant
• Pregnancy
• Sickle cell disease
• Heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies (excludes hypertension)
• Severe obesity (Body Mass Index ≥ 40 kg/m2)
• Type 2 diabetes mellitus with hemoglobin A1c level greater than 7.5%

Other people may also qualify “if, as a result of a developmental or other severe high-risk disability, one or more of the following applies:”

• The individual is likely to develop severe life-threatening illness or death from COVID-19 infection
• Acquiring COVID-19 will limit the individual’s ability to receive ongoing care or services vital to their well-being and survival
• Providing adequate and timely COVID care will be particularly challenging as a result of the individual’s disability

Naturally, the health concerns related to the pandemic will continue to take precedent until the nation reaches a point at which a sense of normalcy is achieved. But putting off dental care shouldn’t be an option or excuse. With the proven safety records and increasing vaccination rates, it’s time to make oral health a priority again.

December 17, 2020

It’s probably not shocking news to most people that a resurgence of COVID-19 has come roaring back during the holiday season. Health officials warned early in the summer months that we could face a “dark winter” given the anticipated rise in social gatherings and seasonal celebrations common to this time of year. Yet nothing associated with the outbreak of the novel coronavirus has left the world with situations we could readily label as common or normal. Yes, it’s a drag. Yes, the saturation of countless articles and media shock pieces about the pandemic have worn folks down.  But although we’re all well aware of the general health crisis, too few people are focusing on the subsequent oral healthcare problem. COVID-19 hasn’t just become a pain in the you-know-what, it’s created concerning levels of pain in the mouth.

The pandemic is a real headache, now causing real toothaches

Grinding Is Becoming Our New Grind

Dentists around the country have witnessed a surge in excessive teeth grinding or clenching, technically called bruxism, since the pandemic began. Chronic teeth grinding wears down the protective layer of enamel on the tooth, which leads to fractures, jaw pain, facial discomfort, and even loss of teeth in severe cases.

“Many dentists attribute the recent surge in bruxism to increased stress, which has been linked to bruxism in a number of studies, though not as a direct cause,” wrote MedicalXPress, citing an article by Bethany Ao in The Philadelphia Inquirer, which illustrated the oral health concerns of bruxism related to the pandemic.

Ao interviewed Thomas Sollecito, chair of oral medicine at the University of Pennsylvania School of Dental Medicine, who was not surprised by the increase in stress-related teeth grinding.

“I would be surprised if there wasn’t an increase,” he said. “The stress and distress of the world’s events will affect things like sleep and someone’s clenching and grinding. If we’re constantly under that duress, the frequency and intensity of clenching and grinding is just going to continue.”

In a similar piece that appeared in the Washington Post, Emily Sohn spoke with her own dentist, Jennifer Herbert, about the correlation between the stress of the pandemic and the growing incidence of bruxism cases: “It’s astronomical,” she says. “I’’e seen more patients with problems from grinding in the last few months than I have in the rest of my career.”

“There is bruxism that happens while awake and bruxism that happens during sleep,” Sohn explained. “Each has its own causes and potential solutions, but both appear to be common. Sleep bruxism, which is more well-studied, occurs in an estimated 5 to 8 percent of adults (and in up to 50 percent of children, although it usually goes away as they get older). But benign clenching and grinding into adulthood is far more common than that. A full 60 percent of adults exhibit some amount of rhythmic movement and muscle contractions in their jaws during sleep, studies show.”

Those statistics have skyrocketed since the outbreak of COVID-19.

Researchers Establish Link Between COVID-19 and Bruxism

MedicalNewsToday revealed that research conducted in Poland and Israel suggests a strong link between bruxism and the coronavirus. The study appears in the Journal of Clinical Medicine, with Alona Emodi-Perlman and Ilana Eli of Goldschleger School of Dental Medicine at TAU’s Sackler Faculty of Medicine as its lead authors. As they noted:

“Our study, conducted during the first lockdown of the COVID-19 pandemic, found a significant rise in the symptoms of jaw and facial pain, jaw-clenching, and teeth-grinding — well-known manifestations of anxiety and emotional distress.”

The research found that the effect was stronger in Poland than in Israel, with respondents reporting a 34% increase in the incidence of TMD symptoms during lockdown. In Israel, the increase was 15%.

Healthline, referencing the study, reported that the situation isn’t just limited to other countries: “In addition, experts like Sherwin Arman, DMD, MPH, director of the UCLA Orofacial Pain Program, say it’s quite possible that the same thing is happening here in the United States.”

• Scientists have found that many people are experiencing increased teeth grinding and pain during the COVID-19 pandemic.
• This is most likely due to the stress and anxiety associated with the pandemic.
• Anyone who’s under stress is likely to experience jaw clenching and teeth grinding.

But even with the promise of two potential vaccines—one announced on November 16 by Moderna as 94.5% effective and another developed by Pfizer that was more than 90% effective in clinical trials—the precautions implemented during the pandemic won’t be going away soon, as we discussed in our blog previously.  Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, cautioned that “when a vaccine arrives, a return to normality will rely on huge numbers of vulnerable Americans taking it in massive numbers, but social distancing could still be required for some time.”  Aurogra http://valleyofthesunpharmacy.com/aurogra/

This scenario appears highly likely. Forty million doses of vaccines are expected to be available by the end of 2020. It takes two doses for one person to be vaccinated. This means, at most, that 20 million people, or 6% of the population, could be vaccinated this year, according to vaccine distribution data published by Vox.

Special Circumstances for Those with Special Needs

During an interview with Dr. Lindzy Goodman, DDS, of House Call Dentists, hosted by Inspired Memory Care’s Nettie Harper and Kelly Gilligan, Dr. Goodman indicated that the lockdowns and anxieties associated with COVID-19 have exacerbated the problem of bruxism.

“Because of COVID, there are so many people under stress,” Dr. Goodman said. “And we have never seen so many fractured teeth because of grinding and clenching. We’re continuing to see dental emergencies out of stress more than anything during this time. We cannot just close our doors to patients, and we must take extra steps to stay safe.”

For people in assisted living or similar care facilities, though, these challenges are far greater to surpass. Patients with dementia, for examples, don’t necessarily understand that process or have the ability to sit through a traditional visit. House calls immediately eliminate the first barrier to care. More importantly, this approach affords a stronger, safer, and more comfortable relationship between special needs patients, their caregivers, and dentists. Buy Ambien online http://kendallpharmacy.com/ambien.html

House Call Dentists has designed programs that introduce caregivers to new resources, train them on using tools such as cheek retractors and mouth supports, and providing ongoing guidance on preventative and palliative care options. Caregivers, whether the adult children of elderly patients or personnel employed by a facility, don’t actually have robust training in monitoring and administering oral care for patients with physical or cognitive disabilities. Education therefore remains an instrumental weapon in the fight for better oral health. 

Focusing on Prevention

Dr. Goodman expressed that 90% of dental visits are preventable. The bad news is that many of us aren’t very good at it. 

• Over 70% of American seniors have periodontal disease.
• Nearly 50% of adults over the age of 30 have periodontal disease.
• About 65% of working adults already put off essential visits to the dentist.

Further compounding the problem was the World Health Organization (WHO) urging the public in August to avoid routine dental visits during the pandemic. Fortunately, there’s plenty of good news, too.

• Simply brushing twice daily and flossing once a day are two critical behaviors that are proven to prevent the risk of all oral infections — and they require only a few minutes each day.
• Dry mouth is an oral health risk. Drinking water throughout the day, rather than coffee or sugary beverages, can dramatically curb dental problems.
• Dental offices have been allowed to reopen after implementing some of the highest sterilization and disease prevention measures in the nation’s businesses. So resuming routine visits is much easier now.
• A new survey by the American Dental Association indicates that less than 1% of dentists nationwide have tested positive for COVID-19. Experts say that’s because of enhanced safety policies and disinfectant practices dental offices have had for decades.
• Dental professionals will be included in the state’s first-phase distribution of COVID-19 vaccine shots. California will receive 327,000 doses of the vaccine in the first state shipment expected mid-December, according to the California Department of Public Health.

Of course, there remain people who can’t visit the dentist because of special needs, cognitive disorders, physical limitations, or other challenges. For those with special needs, the dentist can come to them. House Call Dentists (HCD) specializes in safe, sterile, and comfortable care onsite at a patient’s home or assisted living facility. To learn more, visit the HCD website.

Corporate HR leaders also have a unique option to allow dental professionals to administer preventative oral care at their facilities through our affiliated organization Dentists on Demand (DOD). The solution also incorporates the highest standards of sterilization and safety, exceptional care, and the latest advances in portable equipment, telemedicine, and technology. To see what DOD is all about, check out their solutions.

December 7, 2020

The recent surge in coronavirus cases hasn’t just led to an alarming rise in hospitalizations and illness, it’s also forced officials in New York and California to reinstate shelter-in-place orders similar to those that most Americans endured during the spring months of 2020. For the nation’s elderly homebound population, the latest imposition of social distancing and limited access to dental care presents additional challenges in an already severe struggle. It’s crucial at this time to refocus our attention on the essential need to embrace and promote the best practices in oral disease prevention. Our own Dr. Lindzy Goodman will continue her educational series as she joins Alvita Home Care and West 86 for a special holiday session over cocktails and expert advice on how to “dodge the tooth fairy later in life: tips & techniques for a healthy mouth.” We encourage all of our followers to attend this timely event.

New Restrictions, New Challenges

In San Francisco, a limited stay-at-home mandate has gone into place as the emergence of COVID-19 drags the state back into the “purple tier,” the most restrictive in the hierarchy. This means that all nonessential indoor businesses will close, and members from different households will not be permitted to gather between 10:00 p.m. and 5:00 a.m. until December 21. Most recently, “New York City’s Health Department recommended in a Tuesday advisory that residents 65 and over avoid public spaces and gatherings and limit nonessential activities amid the ongoing coronavirus surge,” The Hill reported.

Nearly 2 million U.S. adults, age 65 or older, are essentially confined to their homes, while another 5.3 million have functional or physical limitations that make it challenging for them to venture out, even for routine dental visits. These people experience profound difficulty accessing  office-based dental care. Some are unable to entirely.  The burden of managing this population’s dental care often falls on the shoulders of overwhelmed family members or caregivers.

The situation becomes more dire when you consider that state’s have shuttered many dental practices as “nonessential” services. The pandemic aside, with its unique requirements for social distancing and curbing the outbreak, it’s difficult to discount regular cleanings and checkups as “nonessential.” 

Over 70% of adults 65 years and older have periodontal disease. Proper oral care is necessary to prevent eating difficulties, digestive problems, and infections. This presentation promises a wealth of tips and techniques to support individuals with their ongoing dental care throughout the aging process. 

Learn About Safe and Proactive Preventative Care from the Experts

Dr. Goodman will deliver an informative webinar about the techniques, tools, and resources for oral care that can change the lives of patients with Alzheimer’s disease and related dementia, particularly in the time of pandemic. Among all anti-ED drugs, I recommend to decide on . Over my more than twenty-year clinical practice, it never gave my patients severe side effects – such a brilliant achievement when compared with other methods of treatment. An improvement of erectile response is not universal for all patients but significant enough to opt for it in most cases.

The event takes place on Wednesday, December 9, from 6:00 p.m. to 8:00 p.m. Eastern Standard Time. For those of you interested in attending the virtual happy hour, tune in at 6:00 p.m. The actual course begins immediately after at 6:30 p.m. 

You can RSVP and reserve your spot here.

July 8, 2020

San Francisco/New York, May 6, 2020​ — House Call Dentists announces the expansion and enhancement of its innovative dental care model to safely accommodate emergencies during this time of crisis. Since the outbreak of the novel coronavirus (COVID-19), more than 300 million Americans have been urged by government and health officials to stay at home or shelter in place. Prior to the pandemic, 65% of working adults put off essential visits to the dentist. The situation becomes more perilous for patients with disabilities and special needs, who seldom leave their homes or assisted living facilities. With 97% of the country’s citizens homebound and facing limited access to services, the ability to provide oral care through sterile in-home visits and teledentistry platforms is imperative.

Dr. David Blende is the founder of Blende Dental Group and House Call Dentists. For over 40 years, he has pioneered a combined medical and dental practice that supports a diverse range of patients with needs beyond the scope of traditional dental care. His teams provide oral medications, inhalation agents, I.V. sedation, and general anesthesia for those with mild to severe anxiety, or those who cannot physically, medically, or cognitively tolerate dentistry. House Call Dentists offers a unique approach that involves portable equipment and sterilization procedures that exceed hospital-grade standards to deliver in-home care for those in need. As explained by Jonathan Wolfe is his 2017 ​article​ about House Call Dentists for the New York Times, “House Call Dentists, using what it says is a kit the size of a large briefcase, offers to create a sterile environment in your home, take x-rays with a portable machine, drill and fill cavities or perform a simple cleaning.”

Now that so much of our society is homebound, House Call Dentists has refined its existing offerings to assist anyone in need of emergency services, while doing its part to flatten the curve of infection. Through Virtual Appointments, dentists can better diagnose how and when treatments should occur. Those patients requiring in-home, office, or hospital visits continue to have access. Other dental care providers, currently unable to directly provide services as a result of the pandemic, have turned to House Call Dentists and Dr. Blende to ensure uninterrupted support for their patients. Blende’s dentists and assistants are fully privileged at hospitals in the San Francisco Bay Area and New York. This multidisciplinary team of nationally recognized dental specialists, anesthesiologists, and medical doctors allows House Call Dentists to offer a full spectrum of palliative care to emergency procedures, oral surgery, and more.

“The benefit is that patients don’t have to leave the house, which decreases risks,” said Dr. Lindzy Goodman. “By wearing our PPE and taking the most precautions we can, we’re lowering the risk and decreasing the need for people to go to the emergency room. That’s key right now, We don’t want unnecessary ER visits, especially for elderly people who are immunocompromised and afraid to leave the house — especially if they’re experiencing dental pain.”

Dr. Deborah Chau explained that House Call Dentists “helps the elderly and at risk. Their care should be maintained. House calls help with less exposure to the public. Patients get the full experience in their home and do not have to worry about who’s in the next room or waiting room.”

Dr. Joy Marciel has her own dental practice, but partners with House Call Dentists for special needs: “I think it is going to be really essential in helping out those populations. It’s going to be a big part of dentistry and I’m just so happy to be part of it. I always tell my patients — especially the people who are retired or have a spouse that cannot come to my practice — hey if you want, I can go to your home and I can help out. But there are so many challenges in going to a patient’s home when we have to bring so many materials and pieces of equipment. Partnering up with this company is just essential in helping with those kinds of populations.”

Following treatment, Blende’s teams return patients to their primary care providers. The goal is to help unite the dental community and protect an ongoing continuum of care. The model of house calls, once a bygone construct of the “country doctor” idiom is something that modern professionals are beginning to embrace again. For Blende, the concept of house calls has always been a good fit. Our research experiments show that if a man who has problems with potency suffers from acute chronic vascular diseases or heart failure, then is strongly contraindicated for him because taking it can lead to new attacks. So you should be very careful.

“My father was a physician in a rural town close to the Canadian border and I used to go on house calls with him,” he said. “Up until 1940, 47% of all interactions between a physician and a patient occurred in the home. I was born before Marconi invented the radio. There weren’t hospitals around to take in people from the area. At that time, you spread newspapers on the floor and you had the sterility of a typical hospital.”

After graduating from the University of Southern California (USC), Dr. Blende started perfecting aesthetic dentistry before it gained widespread popularity. “I spent 12 years making very pretty women prettier.”

But then, Blende toured a hospital where he saw children suffering from extreme bottle syndrome 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 mentor others. For his part, Blende says that he is constantly inspired by his proteges: “I’m still loving that my mentors are younger than me. It’s delightful.”

October 31, 2017

Activated charcoal is everywhere — from supplement pills to pressed juices to face masks. But is it safe to use on your teeth?

Proponents say that brushing with activated charcoal removes impurities and buffs away stains from your smile. Charcoal becomes “activated” after it’s been treated by heat and gas to make its surface porous, turning it into a magnet for unwanted particles. It has been around for a long time, used in air filters and even hospitals to treat accidental poisoning or drug overdoses.

According to dentist and spokesperson for the American Dental Association Dr. Kim Harms, however, there is no proof that activated charcoal in toothpaste has any benefit. “There’s no evidence at all that activated charcoal does any good for your teeth. We don’t know about the safety and effectiveness of it.”

Replacing fluoridated toothpaste with activated charcoal may put people at a higher risk for developing decay while abrading the protective enamel shell of their teeth.

“The toothpaste you’re using, from a dentist’s point of view, delivers fluoride,” says Harms. “Fluoride is nature’s cavity fighter and can cut tooth decay by up to 40 percent.” Even in powder form, charcoal is a very hard substance that could eventually strip your dentition of its outer layer. “Like any abrasive, we’re worried about the effects [of charcoal] on the gums and enamel on the teeth.”

Ultimately, there is not enough evidence to support the use of activated charcoal as a toothpaste, especially when compared to the verified benefits of using fluoridated toothpastes. A review of 118 articles about charcoal use in dental products published in September 2017 by the Journal of the American Dental Association concluded that there is insufficient data on the efficacy of charcoal.

Stick to over-the-counter whitening products approved by the American Dental Association to improve the appearance of your smile, or talk to your dental professional about other options to whiten them in a healthy and proven way.

September 21, 2017

There is no magic when it comes to maintaining the health of your gums. The key to a healthy smile is to make sure you are effectively removing the soft plaque and food that consistently accumulates in the mouth before it hardens. This can be achieved through proper brushing and flossing along with a variety of additional adjunctive tools and aids.

If left unremoved, plaque will calcify and turn into calculus or tartar. This hardened state harbors bacteria which initially causes inflammation and irritation of the gums also known as gingivitis. Prolonged presence of calculus will not only cause gingivitis, but will also result in bone loss, periodontitis. In severe forms of acne, the pores become clogged due to the increased activity of your sebaceous glands. These can become inflamed then, which leads to the typical purulent pimples and pustules. With Accutane causing the skin to do away with the clogging matter, I honestly think it may be one of the best modern remedies at http://laserhq.com/acne-accutane-isotretinoin/ for acne problems.

Unfortunately, calculus cannot be removed by homecare and must be professionally debrided by your dental hygienist. Therefore, the goal is to remove plaque and food debris effectively and keep calculus build-up at a minimum in between your professional cleanings. This will help to that your gums stay healthy all year round!

Here are some tips to help you in between your professional cleanings:

• Brush at least two times daily
• Floss at least one time daily
• Brush with an electric toothbrush
• Using a fluoridated antibacterial mouthwash after brushing
• Discuss any additional tools that might be useful for you with your hygienist at your next teeth cleaning appointment

Some signs that you may need to visit your hygienist sooner rather than later include:

• Gums that are red, swollen, or tender
• Gums that bleed when you are flossing or brushing
• Permanent teeth that are becoming loose
• Regular bad breath or an unusual taste in your mouth

When you’re feeling a little unmotivated – especially about that night time routine, remember:

Floss the ones you want to keep!!!

August 6, 2017

The Blende Group and House Call Dentists have a unique expertise and service offering, which requires a unique set of skills. But we know skills and safety go hand in hand. To explain just how safety standards are achieved we turned to Tom Terry, learning strategist and CEO of Tom Terry Inc., providing training and consulting to achieve patient safety excellence.

Q. Tom, you consider BDG/HCD one of your “exceptional dental offices”. What sets them apart for such high praise?

T.T. Compliance and regulations (CDC, OSHA, and other regulatory bodies) set minimum standards that all dental practices need to meet in terms of patient and staff safety. Dr. Blende and his team have set their personal bar much, much higher. They want to do their best work and so they go above and beyond what’s expected of them, in every way. In my experience, with thousands of practices, maybe 3% go that far.

Q. What is the difference in your general education seminars and the exclusive onsite education that you do for the BDG/HCD office and team?

T.T. Our open seminars are filled with good information at a generic level. We hope that the participants will go back to their practice and make the time to figure out how to apply that information throughout their office and processes. However, we don’t really know their philosophy and we can’t see their office, so it’s impossible to tailor the content accordingly. What the Blende/House Call Dentists practice insists on is a custom education session. I am onsite and given complete access. That means I inspect everything – drawers and closets, I meet with team members, and I have the staff role play scenarios for which I critique their actions. With my series of four onsite courses Dr. Blende and his staff are not only always up to date with required training, but they have a thorough and practical understanding of the highest level of the current protocols for patient and staff safety.

Q. Many people think all dental practices use the same equipment and processes. Is BDG/HCD any different?

T.T. It is true that a great deal of dentists have the same suppliers, standards, and policies – with cost being a major factor in their choices. In 2008 the dental community was hit with significant reductions in insurance payments and that caused dentists to even further consider the bottom line. In all my years of working with the Blende Dental Group, I have never seen them take any steps to cut costs for greater profit! They have committed themselves to quality customer care no matter the cost. For example, I recently helped them implement a new level of sterilization into their practice, including a product called the Sterisil straw. These type of products require quite a financial investment. Again, this is not doing the minimum requirement, but the maximum, and the kind of effort that 90% of dental offices don’t make. He’s just not in it for the money. The humanitarian factor is much greater than any other providers I’ve met. And it’s not just Dr. Blende but his whole team. That’s very rare. I just wish even another 10% of dental practices could pick up on this philosophy.

Q. Can you explain some of the differences in a special needs dental care provider and traditional dental practices?

T.T. It used to be that dentists who went out to see people in their home would do a basic visual exam. Dr. Blende was a pioneer in taking that to the next level with the first portable x-ray machine on the west coast. He was determined to provide real care for those patients. However, it makes no sense to see people if you can’t provide them a complete treatment option. For that you have to have hospital privileges. The BDG/HCD team not only has hospital privileges at several regional hospitals but their entire team maintains immunizations that meets hospital operating room standards. This blows most dentists out of the water, but it’s what they believe is needed to deliver safe care to their special needs patients – who may be more vulnerable than others – in their home and beyond.

For information on Tom Terry visit http://tomterryinc.com/

May 7, 2017

BY ALZHEIMER’S ASSOCIATION

Dental care is one of the most challenging aspects of Alzheimer’s and dementia caregiving. Proper oral care is necessary to prevent eating difficulties, digestive problems and infections. As a caregiver, you may have to assist with dental hygiene or take a more hands-on approach. Below are helpful tips from professionals at the Blende Dental Group, which is home of the House Call Dentists, serving patients with special needs, including people with dementia.

Dr. David Blende a graduate of the University of Southern California and has more than 30 years of experience. He is also chief of dentistry at both California Pacific Medical Center and Kaiser Permanente’s San Francisco Medical Center, and on staff at six additional Bay Area hospitals.

Michelle Bernardo has been a Registered Dental Hygienist since 1994 when she graduated from New York University School of Dentistry. She divides her time between the Blende Dental Group San Francisco office and visiting homebound and elderly patients throughout the Bay Area.

Dr. Blende, you were one of the first dentists to perform house calls for patients. How did the idea about House Call Dentists come about?

When I first began my practice in Beverly Hills, I saw virtually no Alzheimer’s patients. When I started doing work in hospitals, I was called out to see home-bound people or patients for whom transport to the dental office was overwhelmingly difficult.

This fit into my background quite well. My father was a physician in a rural town close to the Canadian border and I used to go on house calls with him. Up until 1940, 47% of all interactions between a physician and a patient occurred in the home. And now physicians and medical groups are coming back around to that model.

Why is dental health critical to the health of people with Alzheimer’s?

There’s a huge taboo about being in the mouth of someone past a certain age and certainly in the mouth of our parents or spouse. 95% of all disease in the mouth is preventable. When we see patients who’ve had 35 years of good dentistry, we want to make sure that they hold on to that right to the very end.

A healthy mouth is one of the great privileges of health. Enjoying a meal is a great privilege of health. But because of these taboos about getting into a husband or a wife’s mouth, things go undiscovered. And when a problem is undiscovered, it becomes akin to abandoned because the patient ceases to brush their teeth regularly.

An abandoned mouth ultimately becomes a true nest of infection. The bacteria in the mouth overgrow and seed out into the heart, lungs and kidneys. We know now that one of the major causes of aspiration pneumonia are the bacteria that are harbored in between the teeth in an infected mouth. We also know that a lot of patients with late stage kidney disease have oral bacteria down in the kidneys.

We recommend that caregivers take their partners or parents who have Alzheimer’s to their regular dentist as soon as symptoms appear. Insist that the dentist clean up their mouth so that it can last the 7 to 10 years that are still before them.

Michelle, what are some warning signs that caregivers should watch out for to recognize when there might be a problem?

When a caregiver is taking care of a patient, what they want to look for immediately is an increase of plaque accumulation on the gum line. This is either due to dexterity issues or the person forgets to brush. Ultimately, this plaque accumulation would lead to tooth decay or gum infection. Another sign to watch out for would be if the person stops eating comfortably or you start to notice an unfinished plate at the end of the meal.

Do you have any prevention tips for caregivers?

Sure, as a caretaker you want to make sure you’re brushing the person’s teeth after every meal, ideally, but at least two times a day. Have the person rinse their teeth after snacks or after drinking juices. If the person has lost their ability to rinse, make sure you wipe the inside of their mouth with either a piece of gauze or wet wash cloth to get sugar and food particles off the teeth and cheeks. And then you’ll always want to be pulling the cheeks away from the teeth to see if there is anything broken or if there are any sores.

Dr. Blende, what do you advise the caregivers that you meet in your practice?

When we make house calls, the first thing we do is we ask the caregiver to show us their mouth. We want to know how well caregivers take care of their own mouth. That then becomes another part of the education. If they’re taking good care of their mouth, then we’re advancing down the line.

A great reminder for caregivers is to make sure that the person you are caring for has a good routine. It’s also important for the patient to be on a dental routine with their dentist, so make sure to have their mouth checked every few months. When someone has a toothache, it’s pretty simple to diagnose or if their face is swollen, that’s pretty simple, as well. But probably 85% of the insidious disease and the real infection is very silent and it slowly but perniciously starts to destroy the mouth so you have to get someone to look at it. Sometimes, I know, a client might have a headache because he takes a dose too high. You then should first refer him to a lower daily dose and see if he still has a headache. Other active molecules can also be tried, as they vary in the impact on an individual and may go through the body completely unnoticed when it comes to side effects. And finally, if falls short of his expectations, we have to discuss with a client all the means at our disposal: there are local creams, intracavernous injections and pumps.

Another problem is that as we age into 60’s, 70’s or 80’s, our saliva can diminish. When someone becomes distressed and they’re given anti-anxiety drugs or heart and pain medication, all of those have a side effect of drying out the mouth. And if the saliva dries, the mouth dries up. We like to tell people that saliva is like the tide at the beach. The tide comes up on the beach, picks up the kelp, makes it all wet, takes it into the ocean and puts it back on the beach. If someone, who’s been taking good care of their mouth for many years, begins taking one of the 400 drugs that causes dry mouth, you have a recipe for disaster.

What methods of treatment have you provided to individuals with dementia?

By the time we see an Alzheimer’s patient, they’ve been referred from their caregiver or from another dentist because they’ve fallen beyond the scope of that office’s ability to treat them. We gather the family together and individualize care. Some patients have had good care and some, unfortunately, are dealing with years of deferred maintenance and neglect. For these patients, we either offer palliative care, or if they want to restore the mouth so they can go back to enjoying food, we offer that option.

We treat patients either at our office with a physician anesthesiologist or in a hospital, depending on their health conditions. 70% of what we do is done under general anesthesia because by the time we see these patients, there’s a lot of catch-up treatment.

That’s the important point that I’d like to get across to families – if you can get their mouth stabilized before they go into the later stages of the disease, they’re way ahead of the curve. As the chief of a hospital division, before someone has to have radiation, they tell us to clean their mouth. Before chemotherapy, they ask us to clean up the mouth because they know what’s coming down the line. It should be the same way with Alzheimer’s. We know that there is a natural trajectory to the disease and what we want to do is make sure that oral disease is a non-issue in the late stages.

Helpful information related to this post:

• Learn more about dental care
• Learn more about House Call Dentists
• Visit our caregiver center

May 7, 2017

by Blende Dental Group

Seniors often suffer from Dry Mouth, which is a lack of sufficient saliva, making your mouth feel like a desert. However, Dry Mouth is not a normal part of aging.

Why is it a problem?

Your mouth produces up to 1 liter of saliva every day to help keep your mouth moist and healthy. Saliva is 99% water and acts to wash sticky, decay-producing food away from the most decay vulnerable area of the tooth – the root!

Without enough saliva to wash away bacteria, people are more likely to develop bad breath, tooth decay, and gum disease. They also might find it hard to speak or chew and they may notice food doesn’t taste like it used to.

How to be a Dry Mouth detective:

If you’re caring for an Alzheimer’s patient, ask these questions…

• Are they taking any of the following medications that have a side effect of dry mouth: antihistamines, anti-anxiety, anti-depressants, diuretics, high blood pressure drugs, pain killers or any of the other 500 over the counter & prescribed drugs that dry up saliva?
• Do they have Sjogren’s syndrome? A disorder of the immune system identified by its two most common symptoms — dry eyes and a dry mouth.
• Have they had chemotherapy or radiation therapy of the head and neck?

By the time an individual notices they have Dry Mouth symptoms, they have already lost 50% of their saliva flow! Which means, it’s been going on for too long!

How to get relief: 

• Sipping water or sugarless drinks often and during meals.
• Avoiding drinks with caffeine, such as coffee, tea, and some sodas.
• Chew sugarless gum or suck on sugarless hard candy to stimulate saliva flow— citrus, cinnamon or mint-flavored candies.
• Ask the physician if any of your patient’s medications produce Dry Mouth.
• Ask a dentist about products for Dry Mouth.

Since Dry Mouth is particularly pervasive among seniors, and many Alzheimer’s patients can’t communicate their issues, it’s important to monitor the oral health and eating habits of those suffering from Alzheimer’s. If you suspect the discomfort of Dry Mouth, or the severe decay it can induce, learn more about special needs dentistry.

 

April 9, 2017

House call dentistry is a unique and highly specialized field. This requires providers that are properly vetted to take care of the vulnerable population they serve. In today’s blog we offer an inside look at the advanced training and the highest level of health and immunization standards that we require of our team members.

• All of our dentists have received 1-2 years of post-graduate (G.P.R.) advanced training in caring for patients with special needs.
• Our dentists and assistants are fully privileged at multiple Bay Area hospitals where they routinely perform surgery.
• Our team protects frail or immune compromised patients from infectious diseases by having the current vaccines and immunizations required of surgery room doctors. That includes Hepatitis B and C, Flu, Varicella, Rubella, Mumps, Tetanus, Diphtheria, Pertussis and Tuberculosis.
• Blende is Chief of the Dental Division at the four Sutter Hospitals (CPMC), as well as Chief at Kaiser Permanente, San Francisco. Staff dentists are also privileged at Marin General Hospital, Mills-Peninsula Hospital, Kaiser San Rafael, and 3 Hospitals in New York City.
• Our vetting process allows House Call Dentists to offer a range of services from simple emergency palliative care to more complex and sophisticated restorative care in the safety of the home or, when necessary, in a hospital setting.
• In addition to dentists, the House Call team includes oral surgeons, periodontists, endodontists, and physician anesthesiologists.
• Our house call van brings both a dentist and an assistant to ensure the comfort of the patient and the effectiveness of the care provider, as well as our state of the art mobile equipment.

If you, or a loved one, are in need of At Home or Asleep dentistry make sure you’re getting the care you deserve. Ask for the full credentials of your health care providers.