By kindergarten, 40% of children have been diagnosed with early tooth decay or cavities, reports the American Dental Society of Anesthesiology. Children at that age face significant anxiety in going to the dentist, though, which is why many practitioners use sedatives in treating them. Researchers at the Ohio State University in Columbus recently investigated common anesthetic regimens to determine the best course of care for reducing anxiety and uncooperative behavior in young patients to improve treatment.
Midazolam is the most commonly used pediatric sedative. The researchers examined the use of oral midazolam alone, nasal midazolam, and oral midazolam in combination with other sedative and analgesic medications in 650 cases during a 24-month period in a hospital-based pediatric dental clinic staffed by pediatric dentistry residents. The subjects included 333 boys and 317 girls. Success rates were determined by procedure completion, behavior during sedation, sedation effectiveness, and number of teeth treated.
Though the cases all were short in duration, all 3 regimens had completion rates of more than 85%. Oral midazolam alone was the most effective, followed by nasal midazolam and then the combinations. Fewer than 4% of cases involved post-procedural nausea or vomiting, and 62% of those involved the combination regimen. Paradoxical reaction, where the sedative caused the opposite effect due to the loss of emotional control, was only present in 6% of cases, with no significant difference among the regimens.
Overall, the researchers found all 3 regiments to be effective and safe for children undergoing dental procedures, with minimal side effects. The study, “Safety and Efficacy of 3 Pediatric Midazolam Moderate Sedation Regimens,” was published in Anesthesia Progress.
Dearly beloved, we are gathered here today to bid our farewells to email…
Wait... what? Stop listening to the alarmists, people. Email is alive and well! And it is more useful than ever as a marketing tool. We’re not talking about bombarding your patients’ inboxes with a newsletter every week. But with the correct strategy, you can reach the right patients at the right time with the right message.
It’s Not For Everyone
Using emails for formal memos or letters is a thing of the past, and if your patients aren’t into it, that’s okay. Sending weekly emails, particularly if they’re not relevant to the needs of your patients, is only going to increase the likelihood that your patients will hit that “unsubscribe” link to clean up their inbox.
However, it’s still a useful tool. If you know what people want to see and have an effective strategy, email can still reach your patients. They’re still checking email. They’re just checking it on phones and tablets instead of their desktop computers. That’s why you need to make sure the content of your email is:
- Clear and concise: Get to the point quickly or you will lose your audience.
- Lighthearted: You want your emails to be read, right? Keep them fun, light, and personable so patients look forward to receiving them.
- Easy-to-read: Use short paragraphs and numbered or bulleted lists whenever possible. These are scannable items, and items that can be scanned are more likely to be read.
Email is especially useful for deepening relationships with your current patients (and in some cases, driving more value). Consider the following email strategies:
- Targeted emails: In the last month, you’ve spoken with 38 patients about adult orthodontics. Out of those, 35 have stayed on the fence. Send an email out to only those 35 patients as a reminder of your discussion. Your email will let them know you were thinking of them, which will create loyalty. It will also reintroduce the idea of something they’ve already considered, making them more likely to follow through with treatment. When they love their results, they will remember that it was your encouragement that gave them the courage to commit.
- Benefits versus features: You purchased a new intraoral scanner and are excited about sharing it with your patients. The problem is, they don’t care that it has a smaller footprint or uses some fancy new digital technology. They care about how it is going to affect their treatment. Share what matters, such as the fact that digital technology might allow them to forego the uncomfortable, goopy impressions of the past, or that digital scans are more precise, so their final product—say, a veneer—is correctly fitted and matched the very first time, and they won’t have to visit your office for further adjustments.
- Remind them that you’re an expert: If you attend special trainings or receive designations that set you apart from the other dentists in your area, brag a little bit! Remind your patients why they’re in capable hands when they visit your office. This information could also result in more patient procedures. When your patients find out that you have recently become a Premier Preferred Invisalign Provider, for example, they may feel more comfortable inquiring about treatment.
If you ask patients for their email address and they decline, it’s not a big deal. There are other ways to reach people. But don’t give up on email just yet. To paraphrase author, essayist, and avid letter writer Mark Twain, the reports of email’s death have been greatly exaggerated.
Candida albicans, a type of yeast, takes advantage of an enzyme produced by Streptococcus mutans to form a particularly intractable biofilm that can lead to early childhood caries. Now, researchers at the University of Pennsylvania School of Dental Medicine have pinpointed the surface molecules on the fungus that interact with the bacterially derived protein. Blocking that interaction impairs the yeast’s ability to form a biofilm with S mutans on the tooth surface.
“Instead of just targeting bacteria to treat early childhood caries, we may also want to target the fungi,” said senior author Hyun (Michel) Koo, DDS, MS, PhD, professor in the Department of Orthodontics and Divisions of Pediatric Dentistry and Community Oral Health. “Our data provide hints that you might be able to target the enzyme or cell wall of the fungi to disrupt the plaque biofilm formation.”
Candida can’t effectively form plaque biofilms on teeth on its own, nor can it bind S mutans, unless it’s in the presence of sugar. Children who consume sugary foods and beverages in excess are at risk for early childhood caries. The researchers previously discovered that the GftB enzyme, secreted by S mutans, uses sugar from the diet to manufacture glue-like polymers called glucans. Candida promotes this process, resulting in a sticky biofilm that lets the yeast adhere to teeth and bind to S mutans.
The researchers suspected that the outer portion of the Candida cell wall, comprising molecules called mannans, might be involved in binding GftB. So, they measured the binding strength between various mutant Candida strains and GtfB using biophysical methods. They found that the enzyme bound much more weakly to mutants that lacked components of the mannan layer than the wild-type Candida.
Next, the researchers examined the abilities of the mutant Candida to form biofilms with S mutans in a laboratory assay. The mutants that had impaired binding with GftB were mostly unable to form biofilms with S mutans, resulting in significantly fewer Candida cells and reduced production of the sticky glucans molecules.
Additionally, the researchers tested how stable the biofilms were when attached to a tooth-like surface. While low-shear stress, roughly equivalent to the force generated by taking a drink of water, removed only a quarter of the wild-type biofilm, the same force removed 70% of the biofilms with mutant Candida. When the forces were equivalent to a vigorous mouthrinse, the mutant biofilms were almost completely dislodged.
To ensure their findings translated to in vivo conditions, the researchers examined biofilm formation in a rodent model that can mimic the development of early childhood caries. When animals were infected with both S mutans and either of the wild type of defective mutant yeast strains, the researchers observed clear differences. While biofilm formation was abundant if the wild-type yeast was used, it was substantially reduced in animals infected with the mutant strain. More precise analysis revealed that these defective biofilms lacked viable Candida cells, and S mutans were reduced by more than fivefold.
According to the researchers, these findings point to a new direction for treatment of early childhood caries. The current standard of care, beyond the use of fluoride as a preventive approach, is to target only the bacteria with antimicrobials or to use surgical interventions if the tooth decay has become too severe. The researchers now are working on therapeutic approaches for targeted interventions with potential for clinical use.
“The disease affects 23% of children in the United States and even more worldwide,” said Koo. “In addition to fluoride, we desperately need an agent that can target the disease-causing biofilms and, in this case, not only the bacterial component but also the Candida.”
Dentists are turning to silver diamine fluoride (SDF) to prevent caries in children and adults alike. Fortunately, researchers at the University of California, San Francisco (UCSF), found that topical SDF was safe and effective in arresting dental caries in preschool children. Meanwhile, researchers at Rio de Janeiro State University agree that SDF is efficacious for caries prevention, compared to fluoride varnish.
The UCSF study was a Phase III multi-site double-blinded randomized placebo-controlled trial with a pair of parallel groups and primary endpoint of caries inactivity 14 days after the intervention. Conducted in community settings in Oregon, 36 subjects were treated with a placebo, while 30 were treated with SDF. The researchers completed follow-up evaluations of 64 of the subjects.
The subjects treated with SDF showed a 0.72 mean fraction of arrested caries, while those who received a placebo only showed a 0.05 mean fraction, which the researchers called a significant difference. While there were 4 adverse events in each group, none were attributed to the SDF. The researchers then concluded that topical SDF was effective and safe in arresting dental caries in preschool children.
The Brazilian researchers reviewed 9 electronic databases, 4 registers of ongoing trials, and the reference lists of identified review articles to examine if SDF application results in caries prevention. They found 49 publications addressing randomized or quasi-randomized trials on SDF for caries prevention in primary teeth with at least 12 months of follow-up. After further review for potential bias, 4 trials met their inclusion criteria.
Two trials compared SDF to a placebo, one compared SDF to a placebo and to a sodium fluoride varnish, and one compared SDF to high-viscosity glass ionomer cement. After 12 months, glass ionomer cement was more effective than SDF, but the difference was not seen as statistically significant. After 24 months, SDF was more effective than the placebo and the sodium fluoride varnish. The researchers concluded, then, that SDF is an effective preventive treatment.
Jeremy Horst, DDS, PhD, of UCSF presented “RCT of Silver Diamine Fluoride for Caries Arrest in Children” and Branca Oliveira, DDS, of Rio de Janeiro State University presented “SDF for Caries Prevention in Primary Teeth: A Systematic Review” at the 95th General Session & Exhibition of the International Association for Dental Research at Moscone West in San Francisco in March.
The United States Court of Appeals for the Fifth Circuit has ruled that Texas, Louisiana, and Mississippi may not enforce provisions that prohibit dentists from advertising as specialists in areas not recognized by the ADA. Ruling in favor of the American Academy of Implant Dentistry (AAID), the court said that such rules would be an unconstitutional restriction on the right to free commercial speech. The ruling affirmed a lower court decision by a 2 to 1 majority.
The lower court declared Texas administration regulation Section 108.54 of the Texas Administrative Code unconstitutional. The regulation restricts specialties in Texas to only those recognized by the ADA. AAID, along with 3 other dental organizations and 5 individual Texas dentists, filed suit challenging the regulation.
The Court of Appeals wrote that “Section 108.54 completely prohibits the plaintiffs (AAID, et al) from advertising as specialists in their fields solely because the ADA has not recognized their practice areas as specialties. The Board [Texas State Dental Board of Examiners] has not justified Section 108.54 with argument or evidence.”
“This is a major step forward for patients throughout the Fifth Circuit. More information will now be available to help them decide who to use for their dental needs,” said AAID president Shankar Iyer, DDS, MDS. “Patients won’t need to guess whether a dentist who is trained in treating gum disease or extracting teeth is also experienced in the complex and comprehensive field of implant placement and restoration.”
“This affirmation by the Court of Appeals clearly validates the recognition of Diplomate status earned through our board,” said Arthur Molzan, DDS, president of the American Board of Oral Implantology/Implant Dentistry. “Our requirements demand extensive knowledge of both the surgical as well as the restorative phases of implant dentistry.”
“This Court of Appeals decision continues a string of legal victories supporting the proposition that non-ADA recognized specialties in fact do exist, are bona fide, and dentists board certified in those fields such as implant dentistry may inform the public of their specialization,” said Frank Recker, DDS, JD, AAID general counsel.
A trip to the dentist can be noteworthy, but not always for the right reasons. That can make marketing a challenge. But with the right mix of brand assets, marketing tools, and outstanding customer service, you can make your dental practice more pleasantly memorable and create a positive association with your work.
There are many ways to influence how your patients feel about your dental practice. The overall reputation of your brand is the combination of these factors, many of which you as the practice owner and your team are able to control. Here are 5 suggestions for how you can take advantage of that control to make your dental practice more memorable.
Start with Service
In every business, a positive brand reputation begins with a product or service that you can be proud of. After all, customers can’t be expected to spread the word about a business if they don’t feel strongly about the service!
With that in mind, make sure that you understand the aspects of your dental practice that patients love. If you specialize in making kids feel comfortable when heading for a checkup, emphasize that in your marketing materials. If it’s the luxury or technology available at your facility that makes patients come back, be sure to have pictures and references that reflect that quality.
Just as importantly, make sure that you quickly address any common areas of complaint that patients raise. You won’t be able to rectify everything, but eliminating basic service issues gives your practice a platform to build upon as you expand your branding.
Remind Happy Patients About Reviews & Referrals
Once you have service to shout about, it’s time to convince your clients to do some talking. Online and offline, reviews and referrals are the lifeblood of your dental practice. We all know how much more likely clients are to talk about a negative experience than they are a positive one, which is why you need to encourage your best patients to spread the word about your practice.
Make it easy by setting up a review and referral program that anyone can follow. For example, pick your favorite platform for online reviews—usually the one that brings you the most business, be it Google, Yelp, or some other service. Write a step-by-step process for customers to follow when they’re willing to leave you an honest review. Better still, set up a dedicated public workstation where they can take a few minutes to do so before they leave your practice.
Take the same approach with referrals.
Set up a simple program to credit your existing clients when they recommend a friend or family member. This could be a free cleaning, some complimentary dental products, or a discount on a common procedure. This combination of a reminder and small incentives is a powerful way to generate word-of-mouth marketing and build your brand.
Make Sure Your Logo and Visuals Are Unique
Once you know that existing patients are happy with your practice, it’s time to make a first impression that lasts for prospective new clients. To that end, your practice needs visual brand assets that reflect the best of your business. For instance, small things like consistent colors, fonts, a tag line, memorable contact details, and a clear value proposition will help your practice stand out in a competitive field.
Take the time to translate your defined services and value into a uniquely compelling visual identity that patients will instantly recognize. Ensure your marketing tools and channels reflect these visuals consistently so that they become ubiquitous, whether clients find your practice online or in the real world.
Get an Unforgettable Phone Number and Website
When prospective clients see your ads, will they remember your call to action? If your practice has a complicated domain name and a random set of digits for its phone number, the chances are they won’t. This is especially true with offline ads on billboards, in print, or on the radio, when patients often can’t write down your contact details.
Don’t make it hard for potential patients to remember you. Getting a custom domain link and a vanity number instantly makes your dental practice more memorable. If you can associate that custom contact point with your services—words like teeth, smile, and shine, for example—that’s all the better for your brand. These are simple and affordable brand assets that many practices overlook. Take advantage of them!
Act on Feedback
As you get closer to clients and encourage your patients to engage with your dental practice, you’re likely to receive a lot of commentary on how you’re doing, positive and negative. Use this feedback to improve your service offering and show clients that you’re listening.
If the opinions aren’t coming in as fast as you would like, get the ball rolling yourself. Send a survey to longstanding clients to ask what you can do better. By creating these feedback channels, you can loop back to our earlier suggestions and work to build on your service offering, further defining your brand. This extra connection also creates more opportunities to ask for reviews and referrals from clients who have yet to answer those requests.
Much like a winning smile, a memorable dental brand takes a little planning and a lot of care. Start from a commitment to excellent service, then make sure your brand assets and patient followup make it easy for clients to reach your practice and refer it to others. From that base you can build a memorable dental practice that patients are excited to talk about.
The American Dental Hygienists’ Association (ADHA) installed its 2017-2018 officers at its 94th Annual Conference in Jacksonville, Fla. Tammy Filipiak, RDH, MS, of Mosinee, Wis, will serve as the organization’s president.
“In our changing healthcare environment, ADHA is working tirelessly to support our members in every stage of their career,” said Filipiak. “I am privileged to collaborate with this great leadership team to move the organization and profession forward.”
A member of the ADHA since 1986, Filipiak has served the organization as a council member and chair, as a member of the task force that developed the Standards for Clinical Dental Hygiene Practice, and as District VII trustee.
Also, Filipiak has held a number of leadership positions within the Wisconsin Dental Hygienists’ Association, including a term as the organization’s president. She received a presidential citation from the ADHA in recognition of her leadership and vision as well.
Filipiak succeeds Betty Kabel, RDH, BS, of Fort Walton Beach, Fla, as president. Kabel will remain on the Board of Trustees serving both as ADHA immediate past president and as the 2017-2018 chair of the ADHA Institute for Oral Health.
Additional officers installed at the conference include Michele Braerman, RDH, BS, of Fallston, Md, as president-elect; Matt Crespin, RDH, MPH, of West Allis, Wis, as vice president; and Donnella Miller, RDH, BS, MPS, of Clarksville, Tenn, as treasurer.
The newly installed district trustees for 2017-2018 are Rachelle Gustafson, RDH of Thompson, ND, District VII; Cynthia Baty, RDH, BS of Tulsa, Okla, District IX; and Trinity Cleveland, RDH, of Chandler, Ariz, District XI.
Your dental unit waterlines are very likely contaminated. As discussed previously, dental unit waterline problems result mainly from how water is used in the operatory and from the design of dental delivery units:
- Low flow rates and long periods of stagnation
- Small-diameter waterlines and high surface-to-volume ratio
- Increasing water temperature
- Waterline termination, or “dead legs”
- Contaminated source water and “suck back” from patients.
Years ago, delivery system manufacturers introduced independent bottle systems primarily to mitigate issues with municipal source water. While filling bottles with purified water helps by removing certain contaminants and dissolved solids commonly present in city water, using bottle systems does not solve the other issues that contribute to waterline contamination.
In fact, if not rigorously maintained, independent bottle systems can make waterline problems worse. Having to remove bottles to refill them exposes delivery systems to additional environmental contaminants. It’s basically like causing small water-main breaks every day!
Even sterile water can become contaminated very quickly once it enters the dental delivery system. That’s why it’s extremely important to follow a 3-pronged approach to proper dental waterline care:
- Following basic waterline protocols daily
- Testing waterline contamination periodically
- Using waterline cleaners and antimicrobial agents regularly.
Let’s discuss each necessary component of this comprehensive approach one at a time.
Daily Waterline Protocols
Regardless of whether dental operatories are plumbed directly to municipal water supply lines or utilize independent bottle systems, and regardless of the presence or absence of any water filtration system that might be installed, the following protocols and guidelines should be observed at all times:
- Purge all water-bearing lines at the beginning of each work day by flushing the waterlines thoroughly with water for a minimum of 2 minutes. This should include all handpiece, syringe, and quick-disconnect lines with handpieces and tips removed.
- Purge all water-bearing lines for a minimum of 20 seconds after each patient, as recommended by the CDC and Canadian guidelines.
- Do not use waterline heaters, as they serve to increase the growth rate of any microorganisms that might be present in the lines tremendously.
- Never use water from a standard dental delivery system during surgical procedures. Instead, use sterile water or saline delivered by sterile means, such as autoclavable bulb syringes or autoclavable or disposable sterile tubing.
Anecdotally, I’ve seen levels of microbiological contamination reduced by 90% or more simply by following waterline purging protocols consistently. That said, testing water samples periodically and using waterline cleaners and antimicrobial agents regularly are both critical components of proper dental waterline care.
Dental Waterline Testing
The microbiological quality of water is often quantified by heterotrophic plate count (HPC). This time-tested method of gauging water quality dates to the 19th century, and it provides a good general indication of how well a water system is being maintained by counting the number of colony-forming units (CFU) of bacteria that a water sample contains.
Both the CDC and the ADA have set guidelines for the dental industry based on HPC counts. The CDC and ADA both recommend that water used in nonsurgical dental procedures contains fewer than 500 CFU/mL.
This threshold is based on a former standard originally set forth in the Safe Drinking Water Act, which once specified 500 CFU/mL HPC for public water. However, the Environmental Protection Agency’s standard for HPC is now “N/A” because, according to the EPA’s National Primary Drinking Water Regulations:
“HPC measures a range of bacteria that are naturally present in the environment and has no health effects; it is an analytic method used to measure the variety of bacteria that are common in water. The lower the concentration of bacteria in drinking water, the better maintained the water system is.”
To verify compliance with this guideline, I always recommend that dental practices spot-check their water quality throughout the operatory environment at least quarterly by submitting water samples to a laboratory for HPC testing or by using some type of in-office testing product.
Waterline Cleaners & Antimicrobial Agents
Due to the nature and complex design of dental delivery units, the periodic use of waterline cleaners and antimicrobial agents is extremely important for proper dental waterline care. As mentioned earlier, even sterile water introduced to dental delivery systems can become contaminated very quickly and exceed CDC and ADA-recommended guidelines for maximum microbiological contaminant levels of 500 CFU/mL.
At a minimum, practices should use a strong, antimicrobial “shock” treatment in waterlines on at least a quarterly basis, or as needed, as indicated by HPC test. This type of powerful antimicrobial treatment, conducted only when patients are not being treated, should be performed if bacteria count ever exceeds the 500 CFU/mL threshold.
In addition to periodic “shock” treatments, some practices find it beneficial to use some type of residual chemical waterline treatment on a daily basis, during the normal course of patient care. Most of these products utilize compounds of chlorine, silver, or iodine—each of which has its own pros and cons that should be taken into account considering the total office environment and in consultation with knowledgeable dental dealers and equipment representatives.
Dental unit waterline contamination is a nearly universal (and often overlooked) problem that, if left unchecked, can have serious ramifications for dental practices and their patients.
Dental practitioners understand that a comprehensive approach to good oral health involves regular brushing and flossing, periodic in-office cleanings and exams, and a healthy diet. In much the same way, a 3-pronged approach to waterline “health” consisting of following basic protocols daily, testing contamination periodically, and using antimicrobial agents regularly is best for preventing, monitoring, and controlling microbial growth comprehensively.
Disclosure: Mr. Chandler is the author of The Book on Dental Water and the president of Vista Research Group, which manufactures several products designed to meet the water treatment, purification, and processing needs of dental practices.