Receding Gums: Treatment Options and Causes

According to Medical News Today (MNT) receding gums are also known as gingival recession. The pink gum tissue normally covers the root of the tooth. This can become exposed when the gum is pushed back or if the tooth is in an abnormal position.

Receding gums are common and often unnoticed at an early stage. There are many risk factors, but age is a main one 88 percent of people older than 65 have receding gums in at least one tooth.

The main concern with receding gums is that when the roots of the teeth become exposed, they are at risk for decay, infection, and loss. Treatment can stop or reverse the process of gum recession if begun at an early stage.

If the recession is severe and the patient has symptoms such as tooth sensitivity, pain, or infection, a variety of treatment options are available. These include deep cleaning, medicine to fight infections, and even tissue grafts.

To read more about recession and how to treat it, check out the MNT article here!

Treating Anxious Patients

Treating Anxious Patients

As Published in Today's FDA Vol. 28, No. 6 September/October 2016

Treating anxious patients is nothing new to dentists.  However, I have always been astonished by how much a patient’s anxiety affected me while treating them.  Despite my best efforts, it is difficult to separate my anxiety from their’s when a patient is rude, short, squirming, or crying while under going treatment.  I believe that part of our humanity is in our ability to be empathetic. Because of this I would imagine (and hope) that many clinicians feel their own anxiety as we treat scared and fearful patients.  As dentists we need to have a strong understanding of what anxiety is, how a patient’s anxiety can affect us and the efficacy of our treatment, how it can affect our practice economically, and how it can impact our own stress level.  

Anxiety is defined as a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome.  While anxiety is a normal and valuable emotion, with some dental patients, anxiety regarding dental procedures can become an excessive and persistent fear about routine procedures. As a result, many patients cope with this anxiety through avoidance behavior. Dental fear or phobia, that leads to avoidance of treatment, affects from 5-10 percent of the population.   Avoidance behavior can increase cancelations of appointments, thus having a detrimental impact on production. 

Nearly 60 percent of patients have moderate to severe anxiety about certain dental procedures, and perhaps more importantly, nearly all of the patients that proceeded with treatment had have low anxiety.  In order for patients to accept treatment they need to have little fear regarding the proposed treatment.  This is essential to understanding case acceptance in practice.  Assessing a patient’s anxiety level can help dentists understand how to present treatment to patients in an appropriate manner. Likewise, managing a patient’s anxiety can increase their trust and confidence in the practitioner. Trust and confidence in the dentist and his/her staff is critical.  Patients that trust their dentist are more likely to be pleased with treatment regardless if there were any complications.

A study completed in 1981 investigated the affects of fear and anxiety on the productivity of dental practice.  The findings showed that patients with significant fear required about 20 percent more chair time than low fear patients.  The time required to prepare the teeth was basically the same for both groups, as measured by drilling time, but the fear group was shown to have more frequent interruptions during treatment. This additional time required to manage an anxious patient ultimately results in increased stress and anxiety for the dentist as our schedule gets behind and productivity drops. 

Because we work in a field that involves so many anxious patients, it is imperative that we, as clinicians, spend time understanding how patient’s anxiety can cause us to be anxious.  Psychologists refer to this as mirroring. Mirroring is the behavior in which one person subconsciously imitates the gesture, speech pattern, or attitude of another. In most situations, mirroring is a beneficial reaction that can help people relate to one another in social situations. However, in the situation of a nervous or frustrated patient, mirroring can be disastrous. It can be difficult to overcome our “pre-programmed” need to mirror others.

It is paramount that dentists focus on their own stress level during treatment; failure to do so can contribute to the patient’s anxiety. The inability to understand when a patient is suffering from severe anxiety before, during, or after treatment and failure to address the problem can allow the patient to incorrectly believe that chaos is about to unfold.  

Two critical considerations must be addressed when treating patients with significant dental anxiety, these are: 

1. Reminding patients that they are in control of the situation and/or symptoms.

2. Helping patients interpret their symptoms as nervousness, or a normal and explainable physiologic change that should be present. 

Helping patients with significant dental anxiety develop cognitive-behavioral measures such as relaxation and cognitive-restructuring techniques can help reduce patient’s anxiety to a manageable level .  Reducing patient’s anxiety level can reduce the anxiety level of the dentists and ultimately provide greater job satisfaction.

When we care about our patients and the quality of treatment we provide, dentistry can be both extremely rewarding and an extremely stressful profession. Steps should be taken to mitigate both the stress of the clinician and the stress of the patient as the emotional states of both parties can be interdependent. Taking the time to asses the anxiety level of patients and yourself can make a dental practice more productive, improve the satisfaction of patients, and improve your quality of life.

Hurricane Matthew

Due to the upcoming hurricane, we have closed our office temporarily.  We will be closed starting Thursday (October 6, 2016) at noon and the entire day Friday (October 7, 2016). We anticipate to reopen Monday (October 10, 2016). 

Please be safe and know that we are always available even if the office is closed.  Please call the office and the on-call doctor number is on the voicemail. 

Pancreatic Cancer Risk Linked to Changes in Mouth Bacteria

Written by Catharine Paddock PhD - Medical News Today

The presence of certain bacteria in the mouth may indicate a raised risk for pancreatic cancer - a disease that often begins with no symptoms and for which there is no routine screening test.
A study led by NYU Langone in New York, NY suggestS certain bacterial changes in the mouth could potentially show us who is most at risk of developing pancreatic cancer.

The researchers suggest the finding may lead to earlier, more precise treatments for pancreatic cancer, a disease with a pitifully low survival rate as it often escapes early diagnosis.

A history of gum disease and poor oral health have been linked to raised risk of pancreatic cancer, and some studies have also suggested certain types of mouth bacteria may also play a role, but this is the first study to directly evaluate such a link, note the authors.

Senior author Dr. Jiyoung Ahn, epidemiologist and associate professor of population health and environmental medicine at NYU School of Medicine, says:

"Our study offers the first direct evidence that specific changes in the microbial mix in the mouth - the oral microbiome - represent a likely risk factor for pancreatic cancer along with older age, male gender, smoking, African-American race, and a family history of the disease."

Estimates suggest over 46,000 Americans were diagnosed with pancreatic cancer and nearly 40,000 died of the disease in 2014.

Two mouth bacteria linked to raised risk of pancreatic cancer

For their study, the team compared the mouth bacteria sampled from 361 American men and women before they developed pancreatic cancer with those sampled from 371 similar individuals who did not develop the disease.

The participants were taking part in larger, ongoing studies of cancer risk, where they had been given mouthwash samples when they joined the studies. They were followed for nearly 10 years, during which any cancer diagnoses were noted.

When they analyzed the results, Prof. Ahn and colleagues found that participants whose mouth bacteria contained either of two certain types had a higher risk of developing pancreatic cancer, compared with participants whose oral microbiome showed no evidence of the microorganisms.

Specifically, they found presence of Porphyromonas gingivalis was linked to a 59% overall higher risk of developing pancreatic cancer. Similarly, presence of  Aggregatibacter actinomycetemcomitans was linked to a 50% overall higher risk. Both types of bacteria are known to be associated with gum disease or periodontitis.

The figures did not change when the researchers took out cases where participants were diagnosed with pancreatic cancer in the 2 years following collection of the samples. They did this to reduce the chance that the figures were influenced by "reverse causation," that is, the presence of the cancer preceding the presence of the two bacteria.

In another study published recently, the team shows that smoking is tied to dramatic - but not irreversible - changes in mouth bacteria, both in amounts and mix. However, they note that only further studies can show whether changes to mouth bacteria linked to smoking cause pancreatic cancer or affect the immune system. In the meantime, Prof. Ahn suggests:

"These bacterial changes in the mouth could potentially show us who is most at risk of developing pancreatic cancer."

Rally Round the Flagpole: By Donna Snively Hulsey

Rally Round the Flagpole: By Donna Snively Hulsey

I believe that part of what makes our practice so amazing is our patients.  I am always amazed by how much they accomplish.  Most recently Donna Hulsey finished her first book, Rally Round the Flag Pole.  

When Donna Snively Hulsey found out in July 1989 that she'd be the first principal of a state-of-the-art elementary school, she teamed up with the community and got to work.

It didn't matter that the school in Jacksonville, Florida, would not open until the fall of 1990: Before the first steel girder of Alimacani Elementary School was erected, the community began to spread a positive image of the school.

Within seven years of opening, the school was recognized as a National Blue Ribbon School and a National Safe and Drug-Free School, and accordingly was honored twice by the president of the United States at the White House.

Redbook magazine named Alimacani the top school in Florida for its "uncompromising commitment to excellence in school and community partnerships." Three Alimacani teachers were individually tapped as Duval Teacher of the Year, Florida Physical Education Teacher of the Year, and Florida Media Specialist of the Year.

Whether you're a parent, an educator wanting to fix problems at an existing school or establish a solid foundation at a new one, or a concerned citizen working on behalf of children, you'll find a blueprint for educational success in Rally Round the Flagpole.

Donna Snively Hulsey is an award-winning principal who has served America and its youth as a teacher, principal, and regional director in the Duval County Public Schools in Jacksonville, Florida. She has also taught undergraduate and graduate level courses. She has two children, five grandchildren, and lives in Jacksonville with her husband.

We are very proud of Donna and we encourage you to please support her by purchasing a copy of her new book!

It can be found on amazon https://www.amazon.com/Rally-Round-Flagpole-Snively-Hulsey/dp/1458219941

New York Times: The Value of Sealants

In an article published in the New York Times, "a review concluded that sealants are effective in reducing cavities for at least four years after each application." and that "when your dentist offers sealants for your children, it’s not an upsell, but a deal you should accept."  

We agree! We routinely recommend that children have sealants placed on permanent teeth when appropriate. Moreover, it is important that sealants are done properly to ensure that they will last a long time.  

Read the entire article here

Cancer drug 'like taking Tylenol' developed in Australia, given fast-track approval in US

A revolutionary drug that melts away cancer in some stage four patients has been given fast-track approval in the United States.  Developed in Australia, Venetoclax is one of a new generation of targeted drugs which attack specific cancer-causing biological factors like cell-structure mutations.

Read more at ABC News Australia

FDA: No More Antibacterials In Consumer Soaps

In an article published today on NBC News  the FDA has ordered antibacterials from consumer soaps. The Food and Drug Administration says they do little or nothing to make soap work any better and said the industry has failed to prove they're safe.

Companies will have a year to take the ingredients out of the products, the FDA said. They include triclosan and triclocarban. Soap manufacturers will have an extra year to negotiate over other, less commonly used ingredients such as benzalkonium chloride.

Read more at NBC News 

http://www.nbcnews.com/health/health-news/fda-orders-antibacterials-removed-consumer-soaps-n642036

FDA Approves Intranasally Administered, Needleless Dental Anesthetic.

UPI (8/26, Feller) reported in continuing coverage that the US Food and Drug Administration has approved Kovanaze, “a nasal spray anesthetic” for use during a restorative procedure “after it was shown to be safe and effective in clinical trials.” The FDA approved Kovanaze, which is a combination of tetracaine and the nasal decongestant oxymetazoline, “for use with patients over 88 pounds, though the company plans to investigate its use with children, as well as for other procedures.” The article noted that the results of the phase 3 trial are published in The Journal of the American Dental Association.

        In a release carried on EurekAlert (8/25), the University of Pennsylvania stated Kovanaze “was deemed safe and effective in a recent Phase 3 clinical trial led by University of Pennsylvania School of Dental Medicine researchers.” Dr. Elliot V. Hersh, the study’s lead author and a professor in the Department of Oral and Maxillofacial Surgery/Pharmacology at Penn Dental Medicine, said, “This is obviously a great thing for needle-phobic individuals, and it can reduce inadvertent needle-stick injuries in the clinic as well.”

McDonald's pulls fitness trackers from Happy Meals amid reports of rashes

The USA Today reports that McDonald’s pulled "Step It!" fitness trackers from Happy Meals on Wednesday after reports that children experienced "skin irritations" from the toy's wristband, the company said in a statement.

The “Step It! Activity Band” came in six colors and strapped on like a watch. It was part of a promotional campaign to get kids moving again. The device counted steps and blinked according to how quickly or slowly the person wearing the device is moving.