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.

“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.”

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.

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.

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!!!

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/

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.

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

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.

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.

Happy New Year from the Blende Dental Group!

2017 is a new year, bringing with it a new opportunity to recommit to resolutions of health, like weight loss or adopting a healthy lifestyle. Many of you might be sharing your workout goals on social media via Facebook and Instagram posts tracking how many miles you’ve run or what you’re cooking. While physical exercise and portion control in moderation are reasonable changes, it’s easy to let the enthusiasm of a fresh start impair your ability to be rational about how capable your body is. You might have jumped on board the latest fad diet or eating habit, but have you considered the possible effects these behaviors might be having on your dental health?

The American Dental Association recently reported on the dangers of the “chew and spit” diet, and how social media may be promoting disordered eating behaviors, particularly in young adults. According to a study published in 2011 at the University of Haifa, there is a correlation between eating disorders and weight concerns and the length of time girls aged between 12 to 19 years old spend on Facebook. Dieting and weight loss “hacks” featured on blogs may also be a culprit, promoting unhealthy or unrealistic diets. While it’s relatively well-understood that poor nutrition leads to poor health, it’s not always apparent that the negative effects of vitamin and nutrient deficiencies manifest themselves in the mouth. Your dentist may be one of the first people to note the tell-tale signs of an eating disorder, such as dry mouth, enlarged salivary glands, and broken or eroded teeth. Cosmetically, you might notice the shade of your teeth yellowing or becoming gray as the inner layer becomes exposed and the edges wear and chip more easily. Teeth with diminishing enamel also feel more sensitive. Consider that these changes could be because of your new diet.

Although you may not be swallowing, to your teeth it’s all the same. Each time food enters your mouth, the pH inside drops as bacteria encounter sugars in what you’re eating. This leads to the production of acid, which actively breaks down tooth enamel, leading to decay. The more frequently this happens, the more acid and enamel destruction. It’s also likely that the food you’re craving while chewing and spitting is fattier and sweeter, meaning more ammo for bacteria to use against your teeth.

Inadequate nutrition, such as with anorexia and chew and spit, also leads to saliva that lacks volume and mineral/immune system components needed to fight tooth decay. Dry mouth is the result of inadequate salivary flow and is correlated with a steep and sudden onset of dental disease. Without saliva, teeth that were healthy a few months ago might be riddled with cavities today. Excessive chewing is also tough on your jaw joints, leading to fatigue and pain, and contributes to the tough enamel shell on your teeth wearing down due to overuse.

If you think you’ve fallen for a disordered eating habit, we urge you to seek counseling and consult trusted medical and dental professionals. From a dental standpoint, staying well-hydrated and increasing your fluoride intake will help combat the aforementioned effects, but those with advanced enamel breakdown may need replacement options, such as veneers or crowns. In any case, a good new years resolution is to keep up with regular dental visits so that any issues like these can be spotted and resolved before it’s too late.

“Researchers have found that frequent recreational cannabis use – including marijuana, hashish, and hash oil – may be associated with elevated risk of periodontal (gum) disease.” The study recently published by the American Academy of Periodontology (AAP) is the first of its kind.

The use of marijuana results in salivary reduction and increased appetite. When that hunger strikes, the food group that users tend to reach for are cariogenic or sweet foods which in turn can increase the risk for decay. The lack of saliva (dry mouth) causes the sugar to stay in the mouth longer and also increases risk of decay.

Oral mucosa and gingival tissues exhibit changes such as Leukoedema, which may be in part due to the irritating marijuana smoke. Gingivitis and alveolar bone loss are a result of the chronic inflammation which lead to periodontal disease and an “increased prevalence of opportunistic infections.” Cannabis use can ultimately allow for the suppression of the immune system, thus reducing the body’s resistance to bacterial or viral infection.

The mechanism by which marijuana may act as a carcinogen is unclear. The difficulty exists when measuring the use of marijuana, tobacco, alcohol and other drugs in this population of patients.

Marijuana may have short-term benefits and provide medicinal therapy for a variety of ailments, but the long term effect on oral health should not be ignored.

If you have any changes to your oral health, unusual symptoms, or suspect you may have gum disease, schedule an appointment with your dentist right away.

Sarah Marie is 90 years old and has dementia. Age Song’s memory care unit in San Francisco referred her to the practice. By performing a simple house call to her residence, The Blende Dental Group determined a treatment plan to address urgent dental-medical issues, including periodontal bone loss. Now that the work is done, she will be receiving regular maintenance via house calls.

After an initial house call, The Blende Dental team coordinated with Sarah Marie’s primary care physician and the California Pacific Medical Center (CPMC) to maximize her safety. They also worked closely and interactively with Sarah’s daughter and her memory care unit to insure that all perspectives were incorporated into her care plan. She was treated successfully under light general anesthesia at CPMC.

Sarah Marie recovered very well from her procedure. The Blende Dental Group made a house call two weeks after her treatment to cement the permanent crowns. Consistent with all house call patients, The Blende Dental Group also made a referral to an essential part of their extended team, a mobile hygienist. This professional, a licensed RDHAP (a Registered Dental Hygienist in Alternative Practice), focuses on serving patients with special needs. Sarah Marie has visits from her RDHAP for maintenance cleanings every 3-4 months.