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.
The University of California at Los Angeles (UCLA) will lead a pilot program to expand preventive dental care for 500,000 Los Angeles children enrolled in Medi-Cal, California’s Medicaid healthcare program. It will be the largest of 15 such county and community programs approved by the state’s Department of Health Care Services as part of the Medi-Cal 2020 Dental Transformation Initiative, running through December 2020.
The Centers for Medicare & Medicaid Services report that only about a third of the state’s 6.1 million children and adolescents enrolled in Medi-Cal receive preventive dental care each year. The UCLA program will focus on 3 primary goals: using information technology to enhance the quality and continuity of care; developing new ways to expand preventive services both within clinics and community settings; and integrating oral healthcare services across dental, medical, and community providers.
“The Dental Transformation Initiative provides an incredible opportunity to expand UCLA’s recent work with local community partners to improve the oral health of children at greatest risk for dental disease throughout Los Angeles County,” said James Crall, DDS, MS, ScD, project director, professor of public health and community dentistry, and director of the UCLA-First 5 LA Oral Health Program.
“Our First 5 LA-funded work has demonstrated the power of combining resources from the university and community partners to address challenges that require collaborative solutions,” said Crall. “Given that one quarter of all California children enrolled in Medi-Cal live in Los Angeles County, we clearly need to engage more critical stakeholders to create the meaningful system changes that will truly transform oral healthcare for children on Medi-Cal.”
“This is an excellent opportunity for UCLA Dentistry to further engage the Los Angeles community and improve oral healthcare for generations to come,” said Paul Krebsbach, DDS, PhD, dean of the UCLA School of Dentistry. “This program is on par with our broader vision for the dental school to get our student dentists, residents, and faculty members providing dental services to underserved Angelenos.”
The dental school also will seek partnerships with Los Angeles County agencies, organizations, and community programs focused on improving the health and well-being of children and families. Awards for the 15 selected local dental pilot projects led by UCLA will total $150 million over 4 years. Each of these projects is unique and uses local entities to leverage existing infrastructure to address the oral health needs of their respective communities.
For example, the Sacramento County Division of Public Health’s “Every Smile Counts!” program will use $10 million in grant funding to build dental services capacity for children and bridge the gap between dental care and primary care in systems currently used by low-income families. It also will work with the Arthur A. Dugoni School of Dentistry to provide virtual dental homes using teledentistry equipment at local schools.
Also, the Cavity Free Sonoma program from the Sonoma County Department of Health Services will work with Santa Rosa Junior College’s community health worker certification program to deploy workers to 10 community health centers to serve as “Health Coaches” who will conduct oral health assessments of children, coordinate their care with the clinic, educate parents about oral health, and provide encouragement and coaching for children to adopt healthy behaviors. Also, a smartphone app will remind parents about dental appointments and provide access to dental health records and healthcare coverage information.
Scientists at Northwestern University have designed a bioactive nanomaterial that stimulates bone regeneration. While studied in an animal spinal fusion model, the scientists believe it can be used in back surgery in human beings as well as in repairing bone trauma, treating bone cancer, and facilitating bone growth in dental implants.
“Regenerative medicine can improve quality of life by offering less invasive and more successful approaches to promoting bone growth,” said Samuel I. Stupp, PhD, director of Northwestern’s Simpson Querry Institute for BioNanotechnology, who developed the new nanomaterial. “Our method is very flexible and could be adapted for the regeneration of other tissues, including muscle, tendons, and cartilage.”
Sugar molecules on the nanomaterial’s surface provide its regenerative power, the scientists report. They studied in vivo the effect of the sugar-coated nanomaterial on the activity of a clinically used growth factor called bone morphogenetic protein 2 (BMP-2) and found that 100 times less BMP-2 was needed for a successful spinal fusion.
According to the scientists, the reduced amount needed for success is very good news because the growth factor is known to cause dangerous side effects when used in the amounts required to regenerate high-quality bone. It’s also expensive.
The biodegradable nanomaterial functions as an artificial extracellular matrix that mimics what cells in the body usually interact with in their surroundings. BMP-2 activates certain types of stem cells and signals them to become bone cells. The matrix, which consists of tiny nanoscale filaments, binds the protein by molecular design so natural sugars bind it in the body and then slowly releases it when needed instead of in one early burst, contributing to the side effects.
To create the nanostructures, the scientists synthesized a specific type of sugar that closely resembles those used by nature to activate BMP-2 when cell signaling is necessary for bone growth. Rapidly moving flexible sugar molecules displayed on the surface of the nanostructures “grab” the protein in a specific spot that is precisely the same one used in biological systems when it is time to deploy the signal. This potentiates the bone-growing signals to a surprising level that surpasses even the naturally occurring sugar polymers in the body.
In nature, the sugar polymers are known as sulfated polysaccharides, which have super-complex structures that are impossible to synthesize with current chemical techniques. Hundreds of proteins in biological systems are known to have specific domains to bind these sugar polymers to active signals.
Such proteins include those involved in the growth of blood vessels, cell recruitment, and cell proliferation, all very important biologically in tissue regeneration. Therefore, the scientists’ approach could be extended to other regenerative targets.
“There is a real need for a clinically efficacious, safe, and cost-effective way to form bone,” said Wellington Hsu, MD, coauthor of the study and professor of orthopedic surgery at the Northwestern University Feinberg School of Medicine. “The success of this nanomaterial makes me excited that every spine surgeon may one day subscribe to this method for bone graft. Right now, if you poll an audience of spine surgeons, you will get 15 to 20 different answers on what they use for bone graft. We need to standardize choice and patient outcomes.”
In the in vivo portion of the study, the nanomaterial was delivered to the spine using a collagen sponge, which is how surgeons currently deliver BMP-2 to promote bone growth. The scientists now plan to seek Food and Drug Administration approval to launch a clinical trial studying the nanomaterial for bone regeneration in human beings.
“We surgeons are looking for optimal carriers for growth factors and cells,” said Hsu. “With its numerous binding sites, the long filaments of this new nanomaterial is more successful than existing carriers in releasing the growth factor when the body is ready. Timing is critical for success in bone regeneration.”
In the new nanomaterial, the sugars are displayed in a scaffold built from self-assembling molecules known as peptide amphiphiles, first developed by Stupp 15 years ago. These synthetic molecules have been essential in his work in regenerative medicine.
“We focused on bone regeneration to demonstrate the power of the sugar nanostructure to provide a big signaling boost,” said Stupp. “With small design changes, the method could be used with other growth factors for the regeneration of all kinds of tissues. One day we may be able to fully do away with the use of growth factors made by recombinant technology and instead empower the natural ones in our bodies.”
The study, “Sulfated Glycopeptide Nanostructures for Multipotent Protein Activation,” was published by Nature Nanotechnology.
Fewer adolescents are using tobacco these days, according to the Centers for Disease Control and Prevention (CDC). The number of current tobacco users among middle and high school students, defined as those who have used a tobacco product in the previous 30 days, dropped from 4.7 million in 2015 to 3.9 million in 2016.
The CDC attributes this decline primarily to a drop in e-cigarette use among middle and high school students from 3 million in 2015 to just under 2.2 million in 2016. The number of high school students who used 2 or more tobacco products, any combustible tobacco products, or hookahs declined from 2015 to 2016 as well.
“Far too many young people are still using tobacco products, so we must continue to prioritize proven strategies to protect our youth from this preventable health risk,” said CDC acting director Anne Schuchat, MD.
According to the CDC, tobacco prevention and control strategies at the national, state, and local levels likely contributed to the reduction in tobacco use, particularly for e-cigarettes. Yet the CDC also notes that continued surveillance of all forms of youth tobacco product use is important to help determine whether the current downward trend continues.
“The Food and Drug Administration (FDA) has invested heavily in compelling, science-based education campaigns such as ‘The Real Cost’ that have already helped prevent nearly 350,000 kids from smoking cigarettes and continues to enforce important youth access restrictions,” said FDA commissioner Scott Gottlieb, MD. “We plan to build on these vital efforts to reduce tobacco-related disease and death.”
The CDC found that 20.2% of high school students and 7.2% of middle school students were current tobacco users. E-cigarettes were the most popular choice for the third consecutive year, used by 11.3% of high school students and 4.3% of middle school students. Last August, the FDA began enforcing new federal regulations that prohibited the sales of e-cigarettes, cigars, hookah tobacco, and pipe tobacco to anyone under the age of 18 years.
The declines in tobacco use may be good news for this generation’s long-term oral health, as smoking stains the teeth, impairs healing, and causes gum disease and oral cancer. The drops in alternative tobacco usage paired with new regulations may be particularly encouraging, as studies have shown that e-cigarettes kill epithelial cells, damage tissue, and may cause cancer.