May 27, 2022

Memorial Day is right around the corner, signaling the start of summer. It’s also the season when people return to wearing white. However, the quest for a brighter, whiter smile begs a big question: should you visit the dentist to whiten your teeth or rely on over-the-counter products like strips? The low price point and convenience of at-home remedies may be appealing, but do they really work?

Understanding the Causes of Dental Discoloration

“For some time, there has been consistent consumer demand for whiter, brighter teeth and an attractive smile,” the American Dental Association (ADA) explained. “Professionally administered (in-office) tooth whitening, also known as dental bleaching, remains a popular esthetic procedure and can be performed using a wide range of techniques and application protocols.  Another common approach is at-home whitening with custom-fitted trays, which patients use to apply professional-strength bleaching gel (for use at night or during the day).  Numerous over-the-counter (OTC) whitening products (e.g., strips, gels, rinses, chewing gums, or paint-on films) are also widely available for self-application at home.”

Dental discoloration is the term dentists use to describe any change in the color or translucency of teeth. Discolorations are typically classified as extrinsic or intrinsic in origin, but can also be the result of a combination between both origins.

Extrinsic stains commonly result from an accumulation of colored compounds on enamel.  Extrinsic discoloration is primarily associated with environmental factors or individual behaviors such as tobacco use, exposure to metal salts (e.g., iron or copper), or the consumption of highly pigmented foods (e.g., dark fruits) or beverages (e.g., red wine, coffee, tea, or cola drinks).

Intrinsic stains occur inside the tooth (within the enamel or in the underlying dentin), and can arise due to systemic causes such as genetic disorders (e.g., dentinogenesis imperfecta, amelogenesis imperfecta) or local factors during tooth development or after eruption (e.g., fluorosis).

“Aging,” the ADA noted, “ is another common etiology of intrinsic discoloration.  With increasing age, enamel becomes more translucent and thinner, which allows the yellower dentin to show through and the overall tooth color may darken. Other causes of intrinsic discoloration include certain antibiotic use in childhood (e.g., tetracycline), caries, amalgam restorations, and pulpal hemorrhage, decomposition or necrosis. Intrinsic discoloration can also occur with prolonged use of antiseptic mouthrinse (e.g., chlorhexidine rinse).”

Do It Yourself?

The oral hygiene marketplace, touting affordability and convenience, has packed store shelves with a wide variety of products that promise to polish the pearly whites of consumers. These offerings generally fall under three main categories.

• Whitening toothpaste includes ingredients that remove surface stains during brushing and may provide gradual brightening.
• Gel strips are applied to the teeth once a day for up to 2 hours. Depending on the strength of the product, people may need to wear them for 10 to 20 days.
• Whitening trays are filled with gel and fitted over the teeth. They resemble the appliances hygienists use during routine cleanings in a dental office.

Yes, over-the-counter products are easily accessible and economical, but they have downsides.

• The bleaching ingredients in whitening toothpastes can cause sensitivity in teeth.
• Whitening trays are not custom-made, so they’re more likely to rub and irritate gums than professional dental devices.
• Strips can be cumbersome to use and usually whiten only the front 6 teeth. If teeth are crooked or misaligned, strips become even less effective in their coverage.
• Many over-the-counter products are less effective than cleanings administered by dentists because their chemistry is either weaker, which prevents them from bleaching teeth for sufficient amounts of time, or stronger, which poses risks to users if ingested.

Visit the Dentist

Tooth whitening is a common elective procedure and a popular, less-invasive aesthetic treatment for patients seeking to enhance their smile and appearance. Whitening treatments provided by a dentist are more controlled, longer lasting, and produce significantly better results. The bleaching agents and devices used by dentists are safe, effective, and made to fit the patient’s mouth.

In-office procedures also help determine the source of discoloration and a treatment plan for long-term care. A clinical exam prior to the start of tooth bleaching procedures, with radiographs and other screening and diagnostic tests as appropriate, can help diagnose various factors contributing to the patient’s tooth discoloration.  A standard dental exam, beginning with a health and dental history, may include questions about the patient’s perception of the cause of the dental discoloration, as well as allergies (which may include ingredients in bleaching materials), and any past or recent history of tooth sensitivity.

Tooth decay or recession can also complicate matters by increasing sensitivity. With over-the-counter products, patients have less control over the ingredients and dosage strength, which increases the risk of sensitivity and gingival irritation.

For the best results, visit your dentist and have a whitening evaluation to find out what system is best for you. If cost is the issue, your dentist can still recommend the best low-cost or over-the-counter whitening system based on your circumstances.

Brighten Your Smile at the Blende Dental Group Today

We’re offering our teeth whitening service for only $125 when booked in conjunction with a teeth cleaning now through September 1, 2022!  Call us at 415-563-4261 (SF) / 646-461-1295 (NY) or click here to book your appointment today.

May 25, 2022

May is a month of many health awareness events, including sleep. Created by the Better Sleep Council (BSC), Better Sleep Month seeks to raise awareness about the benefits associated with a good night’s rest – and the risks that come with disrupted or inadequate sleep. A refreshing respite is critical to optimizing your physical, emotional, and mental health. However, poor sleep cycles can lead to increases in stress hormone production, mood swings, substandard concentration, a weakened immune system, high blood pressure, and weight gain. Sleep apnea represents one of the most potentially serious sleep disorders, and its effects can prove detrimental to your oral health. Your dentist can help mitigate those risks and even offer solutions less cumbersome than continuous positive airway pressure (CPAP) machines.

The Risks of Losing Sleep

According to the American Medical Association (AMA), about 30 million U.S. adults suffer from sleep apnea, yet only 6 million are diagnosed. Sleep deficits pave the way for far-reaching health consequences. “Because of how it affects oxygen balance in the body,” the Sleep Foundation noted, “untreated sleep apnea raises dangers for various types of cardiovascular issues including high blood pressure, heart attack, heart disease, and stroke.”

Types of Sleep Apnea

There are three main types of sleep apnea, defined by the Mayo Clinic as:

• Obstructive sleep apnea, the more common form that occurs when throat muscles relax
• Central sleep apnea, which occurs when your brain doesn’t send proper signals to the muscles that control breathing
• Complex sleep apnea syndrome, also known as treatment-emergent central sleep apnea, which occurs when someone has both obstructive sleep apnea and central sleep apnea

Common Symptoms

“The signs and symptoms of obstructive and central sleep apneas overlap, sometimes making it difficult to determine which type you have,” the Mayo Clinic explained. The most common indicators of obstructive and central sleep apneas are:

• Loud snoring
• Episodes in which you stop breathing during sleep — which would be reported by another person
• Gasping for air during sleep
• Awakening with a dry mouth
• Morning headache
• Difficulty staying asleep (insomnia)
• Excessive daytime sleepiness (hypersomnia)
• Difficulty paying attention while awake
• Irritability

The Effects of Sleep Apnea on Oral Health

Sleep apnea also presents problems for maintaining oral health. The condition often forces people to breathe through the mouth, which leads to dry mouth – a major cause of tooth decay. The ill effects of dry mouth also encompass plaque, mouth sores, gingivitis (gum inflammation), and periodontal disease.

Treatment Options

For those who suffer from some form of sleep apnea, several options exist. In extreme cases, a doctor may recommend surgery, but most patients receive treatment through the use of breathing machines. 

• A continuous positive airway pressure (CPAP) machine is the most common and reliable method for treating people with obstructive sleep apnea.
• A bi-level positive airway pressure machine (BiPAP), while similar to a CPAP in functionality, does not issue constant pressure all the time. Some people on CPAP experience difficulty with exhaling under the steady pressure.
• Adapto servo ventilation machines (ASV) adapt and adjust airflow based on the patient’s breathing, providing different amounts of air during the breathing process.

Your Dentist May Have a Better Alternative

Although the various PAP machines have a demonstrated track record of results, people still encounter challenges with using them. Common complaints involve limitations in sleeping positions, bulky or restrictive masks, discomfort with the level of air pressure, and others. Fortunately, there are non-mechanical options that your dentist can assist with. 

For less severe forms of sleep apnea, patients may benefit from oral appliances called mandibular advancement devices (MAD). The most common mouthpieces bring your jaw forward to open your airway. Other appliances are designed to hold your tongue in place. While over-the-counter devices exist, the most effective mouthpieces are fashioned by a dentist who customizes the fit to your mouth. If your medical doctor has determined that an oral appliance could work for your condition, consult a dentist today to see if you’re a candidate.

 

May 19, 2022

Need a drink after a rough day? Is it “beer-thirty” yet? Are you meeting colleagues for an adult beverage at the local happy hour? Have you been to Napa and Sonoma so many times that you’ve started a wine journal? Alcohol has become a regular facet in the lives of many adults. To call it a “social lubricant” wouldn’t be far from the truth, and  it’s also one of the most widely consumed drugs in the world.  As the science journal Nature points out, “Alcohol has been linked to many oral health effects. These include oral cancer, caries, periodontal disease, halitosis, tooth wear, staining and trauma. Alcohol also has many other wider effects on the general, social and psychological health of patients, which can influence dental treatment.”

The Effects of Alcohol on Oral Hygiene

Drugs like alcohol and caffeine remain mildly psychotropic substances by classification, but they have become highly normalized in society over a long and rich history of use. “Known to mankind for several centuries, alcohol, nicotine, and caffeine have become an important part of culture, serving as a vehicle for social Interaction, shaping the urban landscape with dedicated places – from the Ottoman coffeehouse to the German Brauhaus and the Parisian café – stimulating the opening of international trade routes and bringing substantial tax revenues to governments,” wrote Dr. Marc-Antoine Crocq in an academic medical report for Dialogues in Clinical Neuroscience (Dialogues Clin Neurosci. 2003 Jun; 5(2): 175–185. doi: 10.31887/DCNS.2003.5.2/macrocq).

Although alcohol is not categorized as a “hard drug,” it shares many of the same properties with those illicit substances in relation to oral health. Drugs often cause users to crave sugar. Methamphetamine and heroin lead to dry mouth, which reduces the flow of saliva and increases the risks of tooth decay and gum disease. Bruxism is often a byproduct of taking ecstasy and cocaine. Teeth grinding elevates the chances for cracked or broken teeth. And the euphoric state, or “high,” produced by these substances can make people forget to brush and floss.

With alcohol, the dental effects aren’t much different. “Alcoholic drinks such as white wine, beer and cider can be very acidic,” the Oral Health Foundation explained. “This will cause erosion of the enamel on your teeth, possibly leading to pain and sensitivity. Spirits such as vodka and whiskey are very high in alcohol and will give you dry mouth. Many mixers and alcopops are high in sugar. This can cause dental decay.”

Let’s break this down a bit further.

• When drinking anything acidic, your teeth come under what the Oral Health Foundation refers to as an “acid attack.” During this time, the enamel is weakened and the mouth attempts to produce more saliva to restore a neutral pH level. However, with alcohol restricting the flow of saliva, teeth remain under attack for longer periods of time.
• Many alcoholic concoctions contain sugar, which react with the bacteria  in your mouth to produce acids. These acids cause dental decay.
• The sensation of being tipsy or outright drunk can incapacitate people, similar to other drugs, which can also hinder a person from remembering to brush and floss.

Preventing Substance-related Oral Health Problems

Potent potables are proven problems for dental health, but an ounce of prevention still goes a long way in combating the ill effects of a dram of your favorite spirit. Of course, reducing the intake of alcohol and drugs is always the first recommendation. Here are some other steps people can take to maintain good oral hygiene practices.

• Brush at least twice a day, performing the second cleaning at the end of your night.
• Use a toothpaste that contains between 1350 and 1500 ppm (parts per million) of fluoride.
• Do not brush your teeth for one hour after eating or drinking. Brushing before this time may remove small particles of softened enamel, which leads to dental erosion.
• Clean in between teeth at least once a day using floss, interdental brushes, or tape.
• Alcohol-free mouthwashes with antibacterial properties and fluoride are recommended.

See Your Dentist and Talk to Your Dentist

Keeping a bright and healthy smile requires more than good daily habits – you also need to visit your dentist every 6 months. For people at higher risks of oral diseases caused by alcohol or drugs, it’s also imperative to discuss usage honestly with your dentist. Levels of consumption are crucial factors in prevention and treatment. Dentists record this information in their charts and provide appropriate feedback or advice to patients. Withholding vital details such as these could exacerbate serious health risks like oral cancer, which can be fatal if detection, monitoring, or treatment are delayed.

May 13, 2022

In 1984, the Asthma and Allergy Foundation of America (AAFA) declared the month of May to be “National Asthma and Allergy Awareness Month.” They chose this time of year because it represents the peak season for 65 million Americans who live with asthma or some form of allergies. Naturally, we think of asthma and allergies as respiratory issues, but they can impact a person’s oral health and how they receive treatment from a dentist.

The Oral Health Risks of Asthma and Allergies

As the AAFA noted, more than 65 million Americans overall have asthma and allergies. Some people may have one or both of these conditions.

• About 25 million Americans have asthma (20 million adults and 5 million children)
• About 32 million Americans have food allergies (26 million adults and 6 million children)
• About 24 million Americans have rhinitis (hay fever), or nasal allergies (19.2 million adults and 5.2 million children)
• There is no cure for asthma or allergies.

“These numbers paint a picture of how many people in the U.S. are managing asthma and allergies,” the AAFA said. “But they don’t paint a picture of the overall impact these diseases have on people, their caregivers, and communities.”

The statistics also fail to portray the risks of dental disease that asthma and allergy sufferers face.

• Increased risk of caries and enamel defects
• Heightened risk of gingivitis and periodontal disease
• Higher rates of malocclusion and overjet, overbite, posterior crossbite, and high palatal vault
• Oral candidiasis, xerostomia, and decreased salivary flow

Research around the world has shown a correlation between these respiratory ailments and greater risks of dental problems. ​​A Swedish study of children and young adults with similar backgrounds and habits assessed the links between asthma and caries. Within the asthma group, 19 out of 20 subjects developed tooth decay. In the group of asthma-free subjects, 7 out of 20 developed tooth decay. So, 95% of those children and young adults with asthma demonstrated substantially higher risks for caries as opposed to the 35% of asthma-free people.

In a Korean study, poor oral health was “significantly correlated with the prevalence of asthma/allergic rhinitis/atopic dermatitis throughout life in Korean adolescents. Based on our comparative data, oral health-related education may be considered to adolescents with allergic disease for good oral health.”

Why Do Asthma and Allergies Increase Dental Risks?

Two of the primary oral health risk factors associated with asthma and allergies are related to breathing and medications. People with asthma, for example, may breathe through their mouths due to nasal allergies and tightened airways. Mouth breathing often leads to dry mouth, which in turn increases the chances of calculus, caries, oral candidiasis, enamel defects, gingivitis, periodontal disease, and even TMJ.

Some asthma medications reduce saliva and salivary enzymes in the mouth. The decreased flow of saliva also contributes to dry mouth and other health problems such as “oral thrush,” a type of yeast infection.

Risks Associated with Dental Treatment

It’s important to understand that people with allergies may require a different approach to dental treatment. Some of the equipment and materials used by dentists or hygienists may trigger allergic reactions in patients. They include:

• Prophy paste
• Sealants
• Rubber dams
• Tooth enamel dust
• Acrylic liquid
• Acrylic dust

Best Practices for Patients

At the Dental Office

Prior to undergoing any treatment or procedure, make sure that you list any known asthma symptoms or allergy triggers on the medical history form you receive from the dental team so that they can earmark those items on the dental charts. On the day of treatment, take the following actions:

• inform the dental staff of any allergies related to latex or other materials;
• bring your quick-relief inhaler, with spacer (if needed);
• provide the dentist with a list of all medications, including those contained in the daily control inhalers; and
• bring your EpiPen if prescribed.

Remember to work together as a team with your dentist and ask questions to ensure that your provider understands how to treat patients with allergies or asthma. For instance, if you’re allergic to aspirin, the dentist should not recommend aspirin, other salicylates, and NSAIDS like ibuprofen as they can provoke an asthma attack in some patients. Your dentist should know this and recommend acetaminophen instead.

At Home

There are preventative steps that people with allergies and asthma can take each day to reduce their risks of oral health complications.

• Ask your medical health provider for an asthma action plan to help guide self-management efforts.
• Hydration is key. Always rinse your mouth with water after using a corticosteroid inhalant and do not swallow the water; swish it around your teeth, then spit it out.
• Consider chewing gum with xylitol sweetener, not sugar, to help keep your mouth moist between meals. It also reduces bacteria in the mouth, which contributes to cavities.
• Use a spacer with your inhaler. This allows the medication to enter the lungs directly and more effectively, rather than lingering in your mouth.
• Dutifully follow daily oral hygiene practices: brush at least twice a day, floss at least once a day, and visit your dentist every 6 months.

Asthma and allergies have no cure. But oral health problems do. And better yet, they can be prevented with vigilance, attention, and routine care. If you haven’t seen a dentist in a while, schedule an appointment.

May 12, 2022

All the kids are on TikTok, they say. TikTok has emerged as an immensely popular social network that relies on ​​short-form user videos that span genres such as pranks, stunts, tricks, jokes, dance, entertainment, and even attempts at promoting social justice. The clips generally come in. at between 5 seconds and 10 minutes. Why are we mentioning this? Well. one video by user @tasneemmahmoodd, which boasts over a million views, floated a question about whether one could “catch cavities” by kissing his or her partner. To some, the idea of contagious cavities might sound like conspiratorial satire – a wicked nod to attitudes that arose during our pandemic era. Dentists, however, say it’s not that absurd a notion. In fact, it’s entirely possible that making out could make for potential dental issues.

Can Locking Lips Lock in Dental Problems?

Close oral contact and sharing saliva are often culprits in spreading viruses. Recent studies indicate that dental decay is also a communicable disease, capable of being transmitted from one person to another.

Dr. Lindzy Goodman, director of House Call Dentists, stated, “Studies reveal that bacteria in the oral cavity causing dental decay can be transmitted through close contact such as kissing. This is the same bacteria that feeds on sugar creating an acid product, eroding dental enamel and causing decay.”

Goodman also explained that transmission can occur outside of the romantic realm. For instance, “vertical transmission” can take place between parent and child. A parent with high oral mutans streptococci, the main bacterial culprit of dental decay, will have children with a higher oral bacteria load.

To be clear, the act of kissing does not directly cause cavities. Bacteria represents the leading factor that contributes to the formation of cavities. Through oral contact, bacteria are easily transmitted from person to person. Yet while cavities may be considered communicable in this context, prevention is key.

An Ounce of Prevention Is Still Excellent Advice

Whether cavities manifest from dietary choices, infrequent brushing, or even good old-fashioned osculation (kissing to scientists), maintaining regular oral hygiene habits is the best method for mitigating dental health risks. That means:

• Brushing at least two times a day
• Flossing at least once a day
• Using alcohol-free mouthwash
• Cleaning your tongue during brushing
• Visiting the dentist every six months

Many people, prior to diving in for a kiss, pop a breath mint or chew some gum. The latter is actually decent advice. Sugar-free gum, the kind that relies on a sweetener called xylitol, can reduce bacteria in the mouth. One study found that chewing xylitol-sweetened gum reduced the amount of bad bacteria in the mouth by up to 75% (“Effect of xylitol on cariogenic and beneficial oral streptococci: a randomized, double-blind crossover trial,” Bahador, Leslan and Kashi, Iranian Journal of Microbiology, 2012 Jun; 4(2): 75–81). In 2012, researchers at the University of Illinois at Chicago also discovered that Big Red – a popular cinnamon-flavored chewing gum made by Wrigley’s – reduced bacteria in the mouth.

Several other biomedical studies have also credited chewing gum with alleviating stress. As we wrote in April, elevated stress levels in society have led to increases in bruxism, or teeth grinding. 

Healthy Habits, Healthy Mouth, Healthy Love Life

Taking care of your mouth is essential to your overall health. Oral hygiene is also a make-or-break factor in how far that budding romance may go. Hitting the gym, dressing well, and planning the perfect date will open a door. However, a mouth brimming with bacteria could slam it shut. Spring is the season of love and new beginnings. How about making it the start of a new focus on oral health? 

May 5, 2022

With Mother’s Day fast approaching, people around the country are preparing to pay tribute to the matriarchs of their families. Celebrations often include outings, gifts, flowers, cards, and meals at favorite restaurants. But not every mother gets to enjoy these traditions and festivities. For the 5 million seniors who are permanently homebound, simple things like enjoying a meal out are challenging, if not impossible. Even the act of eating poses significant obstacles for many of America’s elderly because of neglected dental care. Adult children and caregivers have an opportunity to demonstrate their affection and respect by helping their homebound loved ones lead healthier, more enriching lives. And with the advances in mobile dentistry, care comes to them.

Oral Health Challenges for Seniors

The Invisible Homebound

An academic study published by Mount Sinai (“Oral health status and needs of homebound elderly in an urban home-based primary care service,” R Gluzman, H Meeker, P Agarwal, S Patel, G Gluck, L Espinoza, K Ornstein, T Soriano, R V Katz, Spec Care Dentist 33(5): 218-226, 2013) projected the elderly population to reach 88.5 million by 2050, echoing concerns about the number of permanently homebound individuals:

In 2012, when that study was published, about 13% of the population was 65 years or older. Today, that number has risen to 16.5%, based on data from the Population Research Bureau. More distressing, according to the Department of Health and Human Services, 51% of these seniors live alone. The bigger challenge, however, is finding a way to treat the permanently homebound—a group of over 5 million seniors, an increase from 2 million in 2012, who have functional limitations that confine them to their homes. Many of them experience profound difficulty accessing office-based care. Some can’t at all. Because of this, they rely on overwhelmed family caregivers or succumb to illness.

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 by 2060, 24% of the population will be over the age of 65. And they face growing oral health risks:

• 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.

Solutions

Maintain Routine Care

The Blende Dental Group recommends that seniors take preventative steps to mitigate their risks of oral health problems and diseases.

• See a dentist twice a year to have teeth cleaned and examined
• Rinse with mouthwash once or twice a day (only if it can be done without swallowing)
• Floss at least once daily
• Brush twice a day
• Seek solutions for missing teeth, such as dentures, implants, or full mouth restoration for serious conditions
• Oral cancer screenings (at Blende Dental Group, we include screenings as part of every checkup and cleaning for patients of all ages)

Sometimes, however, these “simple” practices are far from easy for seniors with mobility or cognitive challenges. But forgoing dental care should never be an acceptable option. The modernization of house calls, mobile dentistry, and portable equipment overcomes these hurdles for seniors and those who care for them. It’s also a cornerstone of the Blende Dental Group, which is home to House Call Dentists.

Let Dental Care Come to You

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 everything from 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.

Give Your Mother the Gift of Health

Most people would probably question the notion of dental care as a Mother’s Day gift. But if you’re the adult child of a homebound senior, you understand how vital quality of life can be. The simple joys of eating a cherished meal or being able to speak and smile without complication are crucial aspects of interaction, socialization, engagement, and happiness. At Blende Dental Group, we adamantly believe that no barriers to dental care exist. We’ve built on our practice on this concept. So this Mother’s Day is an opportune time to spread the smiles and the love.

May 4, 2022

For many teens and adults, orthodontics offers a clear path toward straighter teeth and a more confident smile. Misaligned teeth are common and don’t generally pose oral health risks. So the decision to see an orthodontist is, more often than not, based on a person’s desire to achieve a cosmetically favorable result. But until recently, the only options available were braces, which not everyone found aesthetically pleasing. Clear aligners and “invisible braces” have since become incredibly popular, although differences exist between braces and products such as Invisalign – and those disparities go beyond appearances. Let’s explore the benefits of both and how to choose the approach that’s best for you.

Clear Aligners

Clear aligners are mouthpieces fashioned from medical-grade plastic. They’re custom-fitted to the patient’s mouth and work by applying pressure to teeth, directing them to the desired position. 

The Pros

Esthetics

In terms of looks, they are considered a discreet alternative to traditional braces because they can’t be noticed as easily. While they do offer some benefits over traditional braces, they also come with some tradeoffs. 

Comfort

Because clear aligners are made of plastic, they reduce the risk of cuts and minor irritation that braces can cause. Patients will still experience some discomfort while teeth are repositioned, just as with traditional braces. 

Eat What You Like

People with braces are cautioned against eating chewy or hard foods that can damage the orthodontics and provoke irritation. Examples include popcorn, gum, taffy, nuts, and others. Clear aligners, conversely, are removable devices. That means you can eat formerly forbidden foods. Brushing and flossing are also less challenging since the aligner can be taken out.

Fewer Dental Visits

Recommended treatments occur every four to six weeks with clear aligners, although some online companies offer products directly with no required visits to an orthodontist. Braces must be adjusted routinely. The convenience of clear aligners is a bonus for some patients, but they may not be the best option for every individual.

The Cons

Designed for Simple Corrections

Clear aligners are best suited to people who need only minor adjustments with their teeth and duration of treatment may take longer. They are poor substitutes for traditional orthodontics when treating more complex issues such as overbite, crossbite, abnormalities with the jaw, and other types of malocclusions. 

Must Be Removed

On one hand, the removable nature of clear aligners allows patients to eat whatever foods they crave. On the other hand, the devices must be removed while eating or drinking beverages other than water to prevent damage or staining to the plastic. Not every person will find this convenient. 

Discipline and More Frequent Care

On average, patients should wear clear aligners between 20 and 22 hours a day. And since the devices must be removed and reapplied regularly for eating and drinking, diligence is imperative for successful outcomes. Aligners are not a good option for those with compliance issues and those likely to misplace their aligners, for example in young children. The products can also cause halitosis and increase the risk of cavities for users with substandard oral hygiene practices. As a result, people may need to brush and floss more frequently throughout the day.

Braces

Braces have been and still remain the gold standard in orthodontics. Even though they’ve earned a reputation as aesthetically unappealing and uncomfortable, they offer a wealth of proven benefits. 

The Pros

Simple Solution for Complex Cases

Braces can universally treat even the most complex cases. Because they fasten to each tooth individually, they pack a more powerful punch than aligners. Orthodontists can make precise adjustments that deliver exceptional results, often faster.

Options

Many patients may think of braces as unsightly metal work in the mouth, but the devices have evolved. There are now braces that fit behind the teeth (lingual) or others made of ceramic, which provide a greater level of discretion and invisibility. 

No Need to Remove

Braces can’t be removed like clear aligners. Patients can drink what they like and eat most foods without worrying about taking the device out. They offer a straightforward approach to treatment without the compliance issues and additional maintenance that comes with clear aligners.

The Cons

Discomfort

Metal braces in particular have a reputation for causing small cuts and other irritation. Wax helps buffer against the potential problems, but patients will need to grow accustomed to wearing them. 

Appearance

The biggest advantage of clear aligners is that they are harder to detect than braces. Even lingual or ceramic braces are more noticeable than an aligner. 

Food Limitations and Frequent Treatments

As we pointed out previously, those who choose braces are slightly limited in what they can eat. Patients must also visit their orthodontist regularly for adjustments.

Pricing

Naturally, patients will also consider the price of treatment in their oral health decisions. And in that regard, braces generally win out over clear aligners. The average cost of traditional braces for a two-year treatment plan ranges from $2,000 to $6,000. Clear aligners are more expensive, coming in at $3,000 to $7,000.

Other Considerations

The reason braces endure as the go-to recommendation by most orthodontists is because they can treat any condition. Crooked teeth are caused by a variety of factors that include genetics, jaw size, poor myofunctional habits (e.g., thumb sucking, tongue thrusting, mouth breathing, etc.), malocclusion, poor nutrition, facial injuries, and more. While misaligned teeth usually pose no health risks, that’s not always true. As Healthline noted, crooked teeth can lead to some oral health complications.

• Periodontal disease. It can be hard to clean in between crooked teeth. This can result in tooth decay and gum disease. If left untreated, gum disease can lead to periodontitis, a more serious infection that can damage bones and teeth.
• Chewing and digestion. Crooked teeth can also interfere with proper chewing, which may cause digestion problems.
• Excess wear. Crooked teeth can also cause excess wear and tear on the teeth, gums, and jaw muscles, resulting in cracked teeth, jaw strain, temporomandibular joint disorder, and chronic headaches.
• Speech difficulties. If your teeth are misaligned, they can affect the way you articulate sound, causing problems with speech.

Our Advice

Simply put, always confer with your dentist to determine the best option and get a referral to an orthodontist. For minor corrections, clear aligners may do the trick. Overall, however, braces endure as a time-honored, proven, and affordable treatment option for any patient with any condition. 

 

Photos by Diana Polekhina on Unsplash and Rainier Ridao on Unsplash

April 29, 2022

We learned a lot during the past two years of dealing with a pandemic. For many people, one of those things was the word “bruxism.” Dentists around the country have witnessed a surge in excessive teeth grinding or clenching, technically called bruxism since the pandemic began. In 2022, however, the situation 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 new poll from the American Psychological Association. Of course, all of that has also created a spike in chronic teeth grinding, which wears down the protective layer of enamel on the tooth and leads to fractures, jaw pain, facial discomfort, and even loss of teeth in severe cases.

Grinding Is Our New Grind

“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.

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 are just going to continue.”

Prior to the global outbreak of COVID-19, 50% of adults exhibited some form of grinding and muscle contractions in their jaws. Those statistics have continued to soar, even as the worst aspects of the pandemic fall behind us. “The top sources of stress were the rise in prices for everyday items due to inflation – namely gas prices, energy bills, and grocery costs – followed by supply chain issues and global uncertainty,” Carolyn Crist wrote in a recent article for WebMD. “About 87% of respondents said inflation was a significant source of stress, followed by 81% for supply chain issues and 81% for global uncertainty. In addition, 80% said they were stressed about potential retaliation from Russia through cyberattacks or nuclear threats, and 80% cited overall concerns about the Russian invasion of Ukraine.”

Despite the lack of a definitive connection between stress and chronic teeth grinding, researchers have demonstrated strong links between bruxism and emotions such as anxiety, stress, anger, frustration, or tension. Yet as the Mayo Clinic clarified, these are most often correlated with awake bruxism rather than sleep bruxism.

Bruxism Symptoms and Complications

As the Mayo Clinic states, in most cases, bruxism doesn’t cause serious complications. But it can produce complications that lead to discomfort or pain:

• Damage to your teeth, restorations, crowns, or jaw
• Tension-type headaches
• Severe facial or jaw pain
• Disorders that occur in the temporomandibular joints (TMJs), located just in front of your ears, which may sound like clicking when you open and close your mouth

The following signs and symptoms may indicate that you have bruxism:

• Teeth grinding or clenching, which may be loud enough to wake up your sleep partner
• Teeth that are flattened, fractured, chipped, or loose
• Worn tooth enamel, exposing deeper layers of your tooth
• Increased tooth pain or sensitivity
• Tired or tight jaw muscles, or a locked jaw that won’t open or close completely
• Jaw, neck, or face pain or soreness
• Pain that feels like an earache, though it’s actually not a problem with your ear
• Dull headache starting in the temples
• Damage from chewing on the inside of your cheek
• Sleep disruption

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 COVID-19 and other anxieties have exacerbated the problem of bruxism.

“We have never seen so many fractured teeth because of grinding and clenching,” Dr. Goodman said. “We’re continuing to see stress generated dental emergencies more than ever 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, these challenges are far greater to surpass. Patients with dementia, for example, don’t necessarily understand that process or have the ability to sit through a traditional visit. House Call Dentists 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. 

House Call Dentists, operated by Blende Dental Group, has designed programs that introduce caregivers to new resources, train them on using tools such as cheek retractors and mouth supports, and provide 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.

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.
• Since the pandemic, dental offices have implemented some of the highest sterilization and disease prevention measures in the nation’s businesses. So routine visits remain completely safe.

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 teams specialize in safe, sterile, and comfortable care onsite at a patient’s home or assisted living facility. 

Photo by JESHOOTS.COM on Unsplash

April 26, 2022

Health officials are warning of fresh COVID-19 outbreaks with new variants such as BA.2.12 and BA.2.12.1, surging across the United States. The fallout from the pandemic’s initial outbreak severely impacted the nation’s oral health. Dental practices around the world were forced to close. And when they did reopen, even after implementing enhanced safety measures, patients still put off routine visits. In 2021, the FDI World Dental Foundation declared this outcome a “dental disaster,” citing the adverse effects of a “catastrophic aftermath of the virus on the health of people’s teeth and gums in dental practices around the globe.” The good news is that vaccinated people remain at low risk of becoming ill from these variants and that dental practices continue to operate openly and safely. The bad news is that people are still skipping regular dental visits. Here’s what patients should know and why they should resume regular checkups.

A Dental Disaster We Can End Now

Disrupted dental care and treatments have generated exponentially augmented problems for patients, particularly those in high-risk groups. Many have since developed advanced tooth decay and related complications, including infections. Others missed soft tissue screenings for oral cancer. However, these conditions were largely preventable given that practices began opening their doors between the first and second wave of the pandemic. Because of exposure concerns or being accustomed to staying at home, patients have persisted in postponing  appointments.

High-risk patients, for example, tended to develop multiple problems, often exhibiting up to four simultaneously, according to FDI research. This population is generally advised to see a dentist every three to six months. Instead, the average today is nine months to a year – if at all.

There exists no direct evidence to support a conclusion that COVID-19 itself impacted oral health outcomes, but it certainly impacted core health behaviors, which influence the negative outcomes we’re witnessing. There are several factors to consider.

• Public health data reported significant increases in sweets, cookies, and other sugary foods during the quarantine and shelter-at-home periods.
• Purchases for oral health products declined below consumer averages in 2019 when lockdowns began.
• U.S. alcohol sales increased by up to 20% between 2019 and 2020,  according to data from Columbia Public Health.
• With shortages of fresh food products, people purchased more packaged goods, canned foods, and prepackaged meals, all of which contain preservatives and higher volumes of sugars and salts.
• More people relied on having meals delivered, which increased their intake of fast food and less healthy dietary alternatives than home-cooking.
• “More than 49 million US residents live in areas designated by the Health Resources and Services Administration as Dental Health Professional Shortage Areas,” the Centers for Disease Control and Prevention (CDC) said in its 2020 report on Oral Health Care and COVID-19.

All said, the combination of these behaviors and the lack of routine dental visits have led to the recent situation.

Getting Back on Track with Oral Care

In March of 2020, when the lock down of dental offices occurred, the Blende Dental Group remained open for their own patients as well as to handle the emergency overflow from the San Francisco Dental Society as well as both dental schools, which had effectively closed.  For roughly two years, dental offices have now been open to seeing patients. Yet, industry intelligence still suggests that too many patients are observing pandemic behaviors – particularly a reluctance to get back on track with regular dental visits. If the issue involves safety, patients should understand (especially those who have been vaccinated) that exposure risks are incredibly low.

“Between the first and second wave, dental practices in many countries were able to reopen,” FDI noted. “Dentists have always abided by the most stringent infection prevention and control protocols and have also revised hygiene measures mandated by governments during the COVID-19 pandemic. In addition, a recent survey indicates that oral health professionals have significantly lower SARS-CoV-2 infection rates than other healthcare workers in most parts of the world.”

At the Blende Dental Group, our teams have always incorporated hospital-grade sterilization techniques. Because of the COVID-10 outbreak, we strengthened those measures by exceeding all standards of immunizations for transmissible diseases. And we are continuing to embrace those protocols today. Our staff is fully vaccinated, outfitted with the best personal protective equipment, adhere to  stringent hand-sanitizing practices, and undergo regular health screenings.

Because our dentists as well as the entire clinical team are hospital trained, we were in full compliance with the state’s safety approach, which includes a minimum 2-week supply of PPE for our dentists and staff: N95 respirators, face shields, goggles, surgical masks, and other infection control equipment. The protocols we implemented during the waning stages of the outbreak remain in place to protect our patients.

• Optimized office layout, appointment scheduling procedures, and capacity limits
• Rigorous cleaning and sanitizing processes across every inch of the office
• Air purifiers with HEPA filters and UV-C lights in all lobbies, exam rooms, and workspaces

For patients who still feel hesitant or have difficulty commuting, Blende Dental Group’s robust offerings can accommodate them. Our practice modernized and reinvented the concept of house call with the inception of House Call Dentists, where our mobile teams use the latest innovations in mobile dentistry technology.

We have also helped pioneer the adoption of virtual dentistry. As the CDC explained, “The COVID-19 pandemic has thrust alternative modalities such as teledentistry to the forefront of policy considerations. Teledentistry supports the delivery of oral health services through electronic communication means, connecting providers and patients without usual time and space constraints. Teledentistry’s unique ability to connect disadvantaged, primarily rural communities and the homebound with dental providers makes this method particularly well-suited to address lack of access during and after the pandemic.”

We developed a comprehensive teledentistry solution called CUSPID. Video consults connect patients to a dental provider through a laptop, tablet, or smartphone, allowing a dentist to diagnose problems and accelerate treatment options, which may include electronic prescriptions. When follow-up care is required, next-day appointments can be booked. CUSPID includes dedicated portals for dental providers and patients. The software is private, secure, and fully compliant with HIPAA.

Patients Have Options, Not Excuses

The barriers to accessing dental care continue to erode every day. Patients can return to dental offices confidently as stringent safety protocols remain in place. Advances in mobile dentistry and teledentistry further break down the hurdles to seeing a dentist. This is a critical point for high-risk patients who were disproportionately impacted by the pandemic, most commonly affecting seniors and children. But options for care exist. And putting off checkups only increases the risks of problems, which lead to more complex procedures.

There are also regulatory issues to take into account. California law, for instance, requires children to receive a dental checkup before their first year of public school. The deadline to get the exam and fill out the paperwork is May 31.

Oral health isn’t just isolated to the teeth, gums, and mouth – it affects so many other parts of the body. It’s time to start seeing the dentist regularly again, and leading practices have created more pathways for accessibility, convenience, and peace of mind.

April 22, 2022

Images courtesy of the Oral Cancer Foundation, www.oralcancerfoundation.org

More than 65% of working adults put off essential visits to the dentist. Their reasons vary. Some cite rigorous work schedules or family commitments that absorb much of their free time. Still others blame long, arduous commutes for skipping routine trips to the dentist. However, advances in mobile dentistry, the modernization of house calls, and the rise of teledentistry platforms now give patients more options for resuming regular checkups. Maintaining good oral hygiene is important. Early detection of oral cancer, which is performed only by dentists during screenings, is critical. Because April is Oral Cancer Awareness Month, let’s learn more about the disease and how your dentist can help.

Be Aware of Oral Cancer and Its Risks

“Oral and pharyngeal cancer (cancer of the mouth and upper throat) collectively kills nearly one person every hour of every day of the year,” the American Association of Oral and Maxillofacial Surgeons (AAOMS) explains. “Of the people newly diagnosed with these cancers, only about 60% will live longer than 5 years. Moreover, many who do survive suffer long-term problems such as severe facial disfigurement or difficulties eating and speaking. The death rate associated with oral and pharyngeal cancers remains particularly high due to the cancer being routinely discovered late in its development.”

Last year, an estimated 54,000 cases of oral cancer were diagnosed. 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. That’s why dental associations across the nation attempt to raise awareness of the problem every April during Oral Cancer Awareness Month. 

For 23 years, these organizations have joined the non-profit Oral Cancer Foundation in this campaign. They include the Academy of General Dentistry Foundation, the American Academy of Oral and Maxillofacial Pathology, the American Academy of Oral and Maxillofacial Radiology, the American Association of Oral and Maxillofacial Surgeons, the American Academy of Oral Medicine, the American Academy of Periodontology, the American College of Prosthodontics, the American Dental Hygienists’ Association, and the California Dental Hygienists’ Association. 

Oral Cancer Symptoms and Risk Factors

The Oral Cancer Foundation encourages people to “regularly check for signs and symptoms of oral cancer between dental visits and to see a dental professional if they do not improve or disappear after two or three weeks.” Although the causes of oral and pharyngeal cancer vary, the predominant culprits are tobacco use and/or excessive alcohol consumption. Symptoms include the following.

• Any sore or ulceration that does not heal within 14 days
• A red, white, or black discoloration of the soft tissues of the mouth
• Any abnormality that bleeds easily when touched (friable)
• A lump or hard spot in the tissue, usually on the border of the tongue (induration)
• Tissue raised above that which surrounds it – a growth (exophytic)
• A sore under a denture, which even after adjustment of the denture, does not heal
• A lump or thickening that develops in the mouth
• A painless, firm, fixated lump felt on the outside of the neck, which has been there for at least two weeks

Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the United States – and it can contribute to oropharyngeal cancer. HPV-caused oral cancer generally includes one or more of the following symptoms.

• Hoarseness or a sore throat that does not resolve within a few weeks
• A swollen tonsil on just one side, which is usually painless
• A painless, firm, fixated lump felt on the outside of the neck, which has been there for at least two weeks
• A persistent cough that does not resolve after many days
• Difficulty swallowing – the sensation of food getting caught in your throat
• An earache on one side (unilateral) that lasts for more than a few days

“Research has identified a number of factors that may contribute to the development of oral and oropharyngeal cancers,” the Oral Cancer Foundation said. “Historically, those at an especially high risk of developing oral cancer have been heavy drinkers and smokers older than age 50, but today the cancer also is occurring more frequently in nonsmoking people due to HPV16, the virus most commonly associated with cervical cancer.”

Getting Screened for Oral Cancer

Screenings are tactile and visual in nature. They’re also quick, painless, and non-invasive.

How Often Should You Get Screened?

The Oral Cancer Foundation recommends that patients undergo screenings for oral and oropharyngeal cancers on an annual basis, beginning around age 18. If individuals are smoking or chewing tobacco, screenings should commence at the age they begin using those products. At Blende Dental Group, we include screenings as part of every checkup and cleaning for patients of all ages.

“Oral tissue scanning is standard for every patient, despite their age,” said Dr. Lindzy Goodman. “We perform a soft tissue exam, palpate the thyroid, and check for hard  lumps or abnormalities.”

“Soft tissue exams should take place from the patient’s first experience,” noted Tanvi Obrock, Blende Dental’s head hygienist. “During annual dental exams, extraoral and intraoral screenings are always performed.”

Dr. Debra Chau added that “any time you get a cleaning is a good time to get looked at.”

What’s Involved in a Screening?

Some early warning signs can be observed with the naked eye as visible pre-cancerous changes in tissue, most often for those who smoke or drink heavily. Oropharyngeal cancers are located in the back of the mouth. They occur frequently in the tonsils and at the base of the tongue, where it begins curving down into the throat. These areas can’t easily be detected by sight alone. With cancers resulting from HPV, this area of the mouth is particularly vulnerable. There are a variety of methods dentists use to identify cancer.

• Dialog with your dentist is equally important. Part of detecting whether oral cancer exists involves interviewing patients to determine potential symptoms.
• A visual examination of the mouth, tongue, and throat helps our dentists spot red or white patches along with mouth sores.
• During a tactile examination, the dentist runs his or fingers through the patient’s mouth to feel for bumps or other abnormalities.

“Right now, more oral cancer cases are coming from people with HPV, especially men,” Dr. Goodman noted.

What Happens if the Dentists Suspects Cancer?

“Dentists won’t diagnose cancer,” Dr. Goodman explained. “If something looks suspicious, next steps involve a biopsy or a referral to a specialist. Biopsies are the gold standard for detecting cancer.”

During a biopsy procedure, a sample of cells is removed for laboratory testing to determine whether cancer is present. We also refer patients to an oral or maxillofacial surgeon.

“An oral surgeon is the first referral,” said Dr. Chau. “We may also suggest that patients see a head and neck physician.”

Always remember that early detection can boost your chance of survival from 50% to 90%. That’s why it’s imperative to attend annual screenings and report any symptoms to your dentist if they fail to improve within two to three weeks.