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Many dental students who are now entering their final year of school are wondering how they’re going to pay off their debt, which is averaging $255,567 these days. Fortunately, they can find significant relief while giving back to the community, with enrollment opening August 17.

The National Health Service Corps (NHSC) Students to Service Loan Repayment Program (S2S LRP) provides up to $120,000 to DDS and DMD students in their final year of school in return for a commitment to provide primary healthcare full time for at least 3 years at an approved NHSC site in a health professional shortage area of greatest need.

Dr. Courtney Levine, for example, practiced at the Kenosha Community Health Center in Kenosha, Wis, where she served a significantly low-income, underinsured and uninsured population. She was part of a team of 12 dentists and 12 hygienists at a new and expanded dental clinic with 43 operatories, greatly increasing access to oral care.

“There is a lot of diversity in the community health setting—some patients having received great dental care all their lives, and others have received very little care,” Levine said during her tenure there. “So I’m able to practice all scopes of dentistry from routine procedures to things that are usually seen only in textbooks.”

“We are a federally qualified healthcare center, which means we see people regardless of their ability to pay,” said Dr. Sean Boynes, NHSC member and director of dental medicine at CareSouth South Carolina, which has multiple locations across the state.

“If it wasn’t for us being there, they would have nowhere to go, and I mean that literally. Nowhere to go,” said Boynes. “The NHSC is actually just one of the ways we incentivize to put good providers in places of need.”

Interested students can begin with the 2016 S2S LRP Application and Program Guidance document. It details the program eligibility requirements and selection criteria, as well as the rights and responsibilities of those selected for the program.

Next, potential applicants can view the S2S LRP Application and Program Guidance Recorded Webinar, which reviews the application process, eligibility requirements, and service commitment. They also should create a Federal Student Aid ID before beginning the application process so federal loan information can be electronically imported.

Students then should gather the relevant documentation, including loan information verification, school transcripts, verification of good standing, proof of passing Step/Level 1 of their board exams, letters of recommendation, and a curriculum vitae or resume.

The NHSC Jobs Center provides information about the kinds of sites where S2S LRP participants serve after completing their residencies. Once applicants review the opportunities listed there, they should continue to the application.

“This is a tough job, and what we do here is different. We’re trying to change the complexion of the way care is delivered,” said Boynes. “The environment created by the NHSC allows a provider to enact the most amount of change.”

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Vitamin D helps people absorb calcium, making it essential to strong bones and healthy teeth. But with nearly one in 5 people in the United Kingdom (UK) lacking sufficient vitamin D levels, the Science Advisory Committee on Nutrition (SACN) in the UK is now recommending that people triple their daily intake.

“Until now it has been assumed that sunlight would provide the vitamin D needed by most of the population all the year around,” said Professor Hilary Powers of the Department of Oncology and Metabolism at the University of Sheffield and chair of the SACN’s review.

The body makes most of its vitamin D from direct sunlight on the skin, though people get small amounts from oily fish and fortified foods like cereals and fat spreads. According to the review, people older than age one need 10 micrograms of vitamin D each day. The average intake from food and supplements is only about 3 micrograms.  

Groups most at risk of vitamin D deficiency include:

  • Those who don’t spend much time outdoors, such as the elderly;
  • Ethnic minority groups with darker skin, which doesn’t make vitamin D as easily;
  • Those who cover their skin for religious and cultural reasons;
  • People in occupations with limited sunlight exposure such as nightshift workers.

“There are very few foods that contain a good source of vitamin D, so it is very important to ensure we include a variety of oily fish such as tuna, salmon, and sardines; eggs; and certain fortified breakfast cereals in our diets,” said Powers.

A lack of vitamin D can lead to serious conditions such as rickets in children and osteomalacia in adults, which can cause bones to soften, weaken, and become deformed in some cases. Other diseases such as diabetes and cancer have been linked to low vitamin D, though the evidence is still not strong.

“In the 1950s after World War II, the government issued a dose of cod liver oil to children every day to supplement their diets with a good source of vitamin D, but it was later thought to be unnecessary,” Powers said. “The government now needs to look at the evidence and recommendations in the report and consider a strategy to help people in the UK increase their vitamin D intake.”

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Though it’s home to more than 350,000 people, the city of Iquitos in the jungles of Peru can’t be reached by road or rail. Visitors must fly there or sail on the Amazon River. Since 2004, the Amazon Hope project has carried volunteers aboard a pair of refurbished Royal Navy tenders into the region to provide needed medical and dental care.

Volunteer teams comprise up to 8 people, which may include doctors, dentists, dental hygienists or therapists, nurses, dental nurses, physiotherapists, or opticians. They work with Peruvian healthcare staff to treat residents of the Iquitos region. The Vine Trust, a Scottish charity dedicated to helping poor children and communities around the world, facilitates the program.

“This coming summer marks my 14th trip with the Vine Trust on the Amazon,” said Shona Mason, an honorary clinical teacher at the University of Dundee School of Dentistry in Scotland. “I’m still here because this project is executed well. We take care not to undermine the existing local healthcare system. Rather, we aim to encourage its development, help it to achieve its goals, and make life better for people in the region.”

Since 2007, more than 60 students from the dental school have volunteered for the program, which typically includes about 10 days spent on one of the tenders. A qualified dentist from the United Kingdom accompanies them as they carry out basic restorative procedures or extractions. During their downtime, they get to explore the region, meet villagers, and socialize with their hosts.

“There are many motives for being involved in global volunteer dentistry—faith-based ones, humanitarian ones, or a desire to see a different world and be part of it for a while,” said Mason. “We dentists and dental care practitioners have skills that are transferrable globally. We are a practical people who see a need and want to respond to it.”

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Congress has passed the Department of Veterans Affairs Dental Insurance Reauthorization Act of 2016, which will continue the current veteran dental insurance pilot program established by legislation authored by Sen. Richard Burr (R-NC) in 2010. It also will expand eligibility to all veterans who currently don’t receive dental benefits from the Department of Veterans Affairs (VA). The bill has been presented to President Obama.

“Making sure veterans have dental care is the right thing to do,” said Burr, author of the new bill. “The veterans’ dental insurance pilot program has a track record of success, and it is time to open it up to all veterans. Medical professionals have long known that proper dental care is linked to better overall health. I am pleased the Senate has recognized the value of this dental benefit for veterans and has passed my bill.”

The VA only provides full dental care to a few select classes of veterans: 100% disabled veterans, former prisoners of war, and veterans who have a service-connected dental disability or condition. As a result, most veterans do not have access to dental care through the VA.

Established in 2014, the pilot program gave veterans access to care for 3 years. It is operated through contracts with Delta Dental and Metlife, and veterans pay low premiums. For example, in Raleigh, NC, the premium is $13.88 per month for a single veteran who chooses the standard plan. Premiums cover the program’s expenses, so there is no burden on taxpayers other than nominal administrative costs.

“This program has proven to be successful in helping to ensure that nearly 100,000 veterans who don’t qualify for dental care through the VA can get high-quality dental insurance plans that they can afford, and signing this bill into law will ensure that all veterans have that same opportunity,” said Rep. Kathleen Rice (D-NY), a member of the House Committee on Veterans’ Affairs.

Without the new bill, though, the program will expire and participants will lose these benefits. According to Burr, the veterans, their survivors, and their dependents who now participate in the program have given it high marks for access to care and quality. The new bill will make the pilot program permanent. Veterans who receive their dental care from the VA will continue to receive their care through the VA.

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“What Dental Patients Want” reveals the attitudes that patients have towards dentists and dentistry in 2016, according to its producer, Futuredontics. Based on a nationwide online survey of more than 3,000 consumers, the report analyzes candid feedback about their decision-making process. It also explores online reviews, appointment availability, dental websites, marketing, insurance, and more.

“I’m completely blown away by the revelations in this report,” said Fred Joyal, cofounder of 1-800-DENTIST, a subsidiary of Futuredontics. “More than ever, dentists are under siege by a highly competitive marketplace. I believe these new findings will really help them to better understand the unpredictable mind of today’s dental patient.”

Additionally, the report ranks the most popular ways that patients find dentists, the top 5 influencers patients consider in selecting a dentist, little known factors that cause patients to leave a practice, and more. Dental professionals can obtain a complimentary copy of the report by participating in a short demonstration of 1-800-DENTIST’s new patient leads program.

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Most people think they know how to brush their teeth. Most don’t. Dentists understand that this dichotomy exists, but they typically struggle to convince patients that they can and must do better.

In many cases, the challenge is because the problem, the consequences, or both are hidden. For example, one of my patients is an investment banker in her thirties who is diligent about brushing. Yet she would always miss a groove on the outside of her last molar, and decay set in. She was unaware of this, since it hadn’t advanced to the point of pain. I videotaped the area when I discovered the decay during a cleaning appointment exam and scheduled a follow-up for removal and a filling.

When she returned for that appointment two weeks later, I initially did not see the decay. Upon closer inspection, it turned out to be hidden under a fresh layer of plaque. Every other area on that molar was spotless. I videotaped the spot a second time and showed her. She then understood why, even with a great deal of cleaning effort, she was still getting decay. There are two morals to this story.

First, even people who brush and floss diligently still miss not only a lot of surfaces, but typically the same spots. One reason is because they don’t watch themselves in the mirror, and even if they do, they have limited visibility.

Other cleaning activities in life require people to create access so they can adequately see and reach the object that needs to be cleaned. The future of oral hygiene will take a great leap forward when people are empowered to have clear access to their teeth, so they can clean the sides and concavity of every tooth. As a result, the grooves and other places where plaque builds up will be removed, and the subsequent tooth and gum destruction will be diminished.

Second, unless the plaque or decay has advanced to the point that it’s noticeable or painful, patients are unaware of the problem. This is understandable. I use a microscope and loupes to treat the patient. Patients have neither. How can we expect them to see decay with their naked, untrained eyes?

For patients, ignorance isn’t bliss because eventually they pay the price. Sometimes it’s in the form of the discomfort and cost of a filling, crown, root canal, extraction or gum graft, to name just a few. Or it could be decades from now in the form of dementia, heart disease, and other systemic conditions now known to be associated byproducts of poor oral hygiene.1,2,3

In fact, these long-term consequences could reach epidemic proportions. People are living longer, so they’ll increasingly have to deal with oral-hygiene-related conditions that previous generations didn’t simply because they died at a younger age.

Time for A Paradigm Shift

The good news is that most people can be taught how to take better care of their teeth and gums. The bad news is that there are several reasons why this is easier said than done.

Figure 1: A “busy life” leaves no time to care for teeth. 

Figure 2: Plaque can hide in the mouth very well. 

Figure 3: Use video to explain bleeding gums.    

Figure 4: Plaque can seep under fillings.      

Most dental practices are designed around treatment rather than teaching. For example, the displays in exam rooms typically are there to show x-rays rather than videos about how to brush and floss more effectively. That’s a shame because there’s no shortage of instructional videos that practices can purchase to share with patients.

In my office, the initial exam is the best time to teach people about their dental health. Typically, a 10-minute video of the patient’s mouth creates an eye opening experience, where patients understand their current dental problems. They are in a teachable state and want to know how they can improve their oral health. Real life videos of similar dental problems also show how improvement can occur when the patient participates. My hygienists then reinforce the custom-made plan for each patient while they get their teeth and gums cleaned.

Also, insurance providers typically don’t reimburse for teaching. As a result, patients have to be willing to pay for the extra hour or two that it takes to learn how to use a rubber pick, how to floss without cutting their gums, and other key practices. It’s not easy convincing patients that this is a good investment, even with demonstrable payoffs such as keeping their teeth and avoiding numerous preventable conditions.

In my experience, video is key for making the case. In the hectic pace of life, oral hygiene is often left behind. When patients discover how bad their teeth and gums are becoming, they are more likely to spend the money, time, and energy to improve the situation.

Last year I had a new patient with a significant gum condition. Her gums were deteriorating, and she wanted help improving her oral health. As with all my patients, I videotape my procedures as a form of education. Though she was embarrassed to watch the video, she wanted to clearly understand the severity of her condition.

The video motivated her to change her oral care health habits. She returned for 2 sessions of cleaning and learned how to clean her mouth using a rubber tip, floss, and gentle brushing. Three months later, her condition had significantly improved. There was minimal bleeding and she had firmer gums, but most of all, she was educated on how to clean her mouth.

She has since been extremely faithful in her oral care and has had her husband come in for treatments as well. His condition was even worse because he thought he was too busy and did not think he had a problem. After seeing the video of his oral condition, he too became an exemplary student of oral care (Figure 1).

Furthermore, people typically don’t understand plaque, including how relentless it is. As a result, they don’t understand why flossing, brushing for 2 minutes, and using appliances such as rubber picks are things they have to do day in, day out.

One way I educate patients is by explaining that even after a professional cleaning, bacteria are back at work within 20 minutes, laying down a matrix (or pellicle) that becomes plaque by the end of the day. Patients often still do not understand, but a video of how sticky and tenacious plaque can be is helpful. They are motivated to keep the problems that are seen in the video from happening in their mouths (Figure 2).

Plus, patients often assume that their mouth is normal. For example, one of my new patients is 24, has never flossed, and hadn’t been to a dentist in about 3 years. She wasn’t alarmed that her gums were irritated because she had nothing to compare them to—and probably because it never occurred to her to make a comparison.

Video was key for educating her because it was easy to show the dark red tissue in some areas and the healthy pink gum in others. My other patients have had similar epiphanies when they watch a video where I gently tap their gum with a periodontal probe, and it either bleeds or the color changes.

In my experience, there is simply nothing as effective as video when it comes to leaving a lasting impression: the kind that convinces patients to take charge of their oral hygiene (Figure 3).

Finally, many people are unwilling or unable to get past the first step. A person who never exercises gets sore after starting a regimen and gives up. Likewise, a person who has never flossed gets discouraged by the initial discomfort and gives up. Both people never reap the benefits because no one showed them how to do things correctly to minimize discomfort to get past it.

Many young adults in their twenties and thirties are open to improving their oral hygiene habits, if they can see what is occurring in their mouth. If they realize their teeth need to be taken care of for better overall health and nutrition, they will spend more effort learning how to accomplish the task. In the long term, this will save them money, pain, inconvenience, and bad breath. As more tools are developed to encourage and provide feedback on how they are doing, they will be more motivated and reap the benefits.

Older adults are perhaps the most resistant to change. They have either been relatively successful and think that they do not need any help, or they have had painful experiences that keep them away from dentistry. The ones who think they are successful are often quite unhappy when conditions in their mouth change over the years.

For example, new medications are common with aging, and the side effects of more than 300 medications can cause a dry mouth. The plaque is harder to remove when it is dried and often leads to root decay and greater advancement of periodontal disease.

Also, the accumulation of occlusal factors loosens teeth and old fillings that deteriorate, which creates cracks and grooves where plaque can hide. These fillings accumulate plaque as well as decay and can create serious problems if left untreated (Figure 4).

Finally, the years of inflammation from plaque that has been consistently missed, though periodically cleaned by the dental professional, have an effect. This can be disheartening for the dental professional because the patients have been trying as hard as they can, but slowly their condition worsens.

The bottom line is that most people think they know how to care for teeth and gums but actually don’t. The fact that roughly 90% of adults have gum disease is just one example of why that assumption is mistaken.4,5 Thus, it’s crucial that dentists and hygienists help them understand that they don’t, as well as the short-term and long-term consequences, and then educate them on how to improve their hygiene.

References

  1. Stewart, Ralph, MD. “Increasing Evidence for an Association Between Periodontitis and Cardiovascular Disease.” American Heart Association Journal, 04 Jan. 2016. Web. 08 June 2016.
  1. Singhrao, S. K., S. Harding, S. Poole, L. Kesavalu, and S. Crean. “Porphyromonas gingivalis Periodontal Infection and Its Putative Links with Alzheimer’s Disease.” National Center for Biotechnology Information. U.S. National Library of Medicine, 30 Apr. 2015. Web. 08 June 2016.
  1. Shoemark, D.K., and S. J., Allen. “The Microbiome and Disease: Reviewing the Links between the Oral Microbiome, Aging, and the Alzheimer’s Disease.” National Center for Biotechnology Information, U.S. National Library of Medicine, 2015. Web. 08 June 2016.
  1. World Health Organization Oral Health Fact Sheet
  1. Pihlstrom, Bruce L., DDS, Bryan S. Michalowicz, DDS, and Newell W. Johnson, MDSc. “Periodontal Diseases.” The Lancet, 19 Nov. 2005. Web. 9 June 2016.

Dr. Craig S. Kohler, DDS, MBA, MAGD, has been practicing on the North Shore of Chicago for more than 30 years. After completing his general hospital residency at Evanston Hospital, he earned his Fellowship and master’s from the Academy of General Dentistry. He has been a visiting faculty member for the Spear Institute in Scottsdale, AZ, since 2009, as well as a staff member at NorthShore University Hospital General Hospital Residency Program, Evanston, IL, since 2000. He is the also the founder and CEO of ONVI, LLC, and the inventor of the first video toothbrush, Prophix.

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After seeing healthy growth during the past decade, the global dental equipment market will continue to expand with a compound annual growth rate of 4.9% from 2016 to 2021 to total $7.52 billion, according to MarketsandMarkets. The research company attributes this increase to the rapid growth of the aging population, increasing demand for cosmetic dentistry, and growing incidences of dental caries and other periodontal diseases.

In calculating this figure, MarketsandMarkets split the market into diagnostic, therapeutic, and general equipment segments. The diagnostic segment includes extraoral and intraoral radiology gear as well as hybrid units. Therapeutic equipment comprises dental lasers. And the general classification covers casting machines, instrument delivery systems, ceramic furnaces, electrosurgical systems, CAD/CAM systems, chairs, light-cure equipment, and handpieces.

General equipment accounted for the largest share of the global market, primarily driven by the growing adoption of CAD/CAM systems that aid the simplification of procedures, increase patient comfort, and reduce procedure duration. MarketsandMarkets expects this segment to register the highest compound annual growth rate during the forecast period.

Geographically, Europe has held the largest share of the market due to the favorable reimbursement scenarios there, increasing government expenditures on healthcare, and growth in its geriatric population. Looking ahead, though, MarketsandMarkets says the Asia-Pacific region will have the highest growth rate due to less stringent regulations there, growing demand for dental procedures, and growing dental tourism.

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The Dentsply Sirona Endodontic Clinical Suite will open at the New York University (NYU) College of Dentistry in September. The cutting-edge facility will feature new equipment from the company as it serves the Dr. Ignatius and Sally Quartararo Department of Endodontics, which is celebrating its 90th anniversary this year and is the oldest department of endodontics in the nation.

“With our new state-of-the-art facility, NYU will have one of the most sophisticated endodontic clinical suites in the nation, thus ensuring our ability to provide the finest endodontic education and to help alleviate patients’ suffering in a manner that reflects truly patient-centered care,” said Dr. Charles N. Bertolami, the Herman Robert Fox Dean of NYU College of Dentistry.

The suite will feature a fully integrated computer network with best-practice case management software, along with a fully equipped surgical suite, fully equipped restorative and endodontic treatment centers, intraoral x-ray stations, endodontic motors, ultrasonic units, intraoral sensors, and a CBCT device that produces 3-D images of teeth, soft tissues, nerve pathways, and bone in a single scan.

Dentsply Sirona believes that our next generation of endodontists and general practitioners should have the opportunity to learn in the most innovative training facilities with the latest technology available,” said Jeffrey T. Slovin, CEO of Dentsply Sirona. “We couldn’t be more excited to enter into this collaboration with the NYU College of Dentistry, one of the most advanced dental schools in the world, and thereby continue to support the profession through research and education.”

In addition to serving students at the dental school, the suite will be home to a pair of full-time continuing education series, the Advanced Programs for International Dentists in comprehensive care and aesthetics.

“It is altogether fitting that we announce this collaboration at the celebration of the 90th anniversary of the establishment of the department of endodontics at NYU,” said Bertolami, “as it ensures that the department will continue to play a leadership role in endodontic specialty training in the future as it has in the past.”

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