While more Americans now have health insurance, cost remains a particular barrier to oral care, according to the Commonwealth Fund. The private foundation recently conducted an international survey of 11 nations, revealing that adults in the United States are far more likely than those in other countries to go without needed care because of financial barriers. 

According to the survey, 32% of US adults skipped dental care in the past year because of costs. A lack of dental care also was a concern in other countries, though not as pronounced, with more than one in 5 adults in Switzerland, Canada, France, Australia, and New Zealand saying they skipped dental care or checkups because of costs. Only 11% of adults in the United Kingdom and the Netherlands reported this problem.

These rates paced Americans’ inability to pay for other medical needs, with 33% of US adults going without recommended care, seeing a doctor when they were sick, or filling prescriptions because of cost. Additionally, 15% of US adults reported worrying about having enough money for nutritious food, and 16% reported struggling to afford their rent or mortgage.

“Previous surveys have shown that, especially compared to other industrialized nations, the US has far too many people who can’t afford the care they need, even when they have health insurance,” said Robin Osborn, vice president and director of the Commonwealth Fund’s International Program in Health Policy and Practice Innovations and the study’s lead author.

“We can learn from what is working in other nations,” said Commonwealth Fund president David Blumenthal, MD. “If we’re going to do better for our patients, we need to create a healthcare system that addresses the needs of everyone, especially our sickest patients, and those who struggle to make ends meet.”  

The study’s authors say that overcoming some of the major barriers to access and affordability in the United States could address many of the concerns voiced in the survey. For example, they recommend expanding Medicaid eligibility in the 19 states that have yet to do so, limited the amount of money people must spend out-of-pocket for healthcare, and supporting a strong primary care system.

The study, “In New Survey of Eleven Countries, US Adults Still Struggle With Access to and Affordability of Health Care,” was published by Health Affairs.

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Partially necrotic cases can be very difficult to diagnose, even for many endodontists. This was the case on tooth No. 2, in which the patient had a sinus tract on the palatal that could not be traced. Tooth No. 2 did not have any prior dental work. Teeth No. 2 and 3 responded within normal limits to thermal pulp testing. However, upon percussion, tooth No. 2 was slightly more percussion-sensitive than tooth No. 3. Also, tooth No. 2 had a microscopic crack that contributed to this issue.

Figure 1. The pre-op photo shows the sinus tract on the lingual aspect. It wasn’t traceable with gutta percha. Figure 2. This pre-op radiograph shows tooth No. 2 with no restorations in place and tooth No. 3 with a posterior composite.
Figure 3. The radiograph shows endodontic treatment initiated with Ultradent’s UltraCal calcium hydroxide placed. Figure 4. The radiograph shows endodontic treatment completed on tooth No. 2.
Figure 5. This post-op photo shows the resolution of the lingual sinus tract.

Based on my previous experience with these cases, I decided to do endodontic treatment on tooth No. 2. I told the patient that if the area did not heal, I would refer her to an oral surgeon for a biopsy. The tooth was opened and the pulp was partially necrotic. The palatal root was completely necrotic. Calcium hydroxide was placed, and the patient returned in 2 weeks to complete endodontic treatment. Proper endodontic therapy caused the sinus tract to resolve.

What would you have done? Email me at This email address is being protected from spambots. You need JavaScript enabled to view it., or visit our related posts on Facebook at or

Rico D. Short, DMD, attended the Medical College of Georgia (MCG) School of Dentistry to attain a Doctor of Dental Medicine degree in 1999. In 2002, he earned his postdoctorate degree in endodontics from Nova Southeastern University and became a Diplomate of the American Board of Endodontics in 2009. Dr. Short is an expert consultant in endodontics to the Georgia Board of Dentistry and assistant clinical professor at the Dental College of Georgia in Augusta. Dr. Short also has published articles in several magazines and peer-reviewed journals including Dentistry Today, Inside Dentistry, Rolling Out Magazine, Upscale Magazine, and the Journal of Endodontics. He has lectured throughout the United States and the Caribbean. Dr. Short is endorsed by the American Association of Endodontists speakers bureau, and his private practice, Apex Endodontics PC, is located in Smryna, Ga. Dr. Short also has authored a book, Getting to the Root of Your Problem: 365 Days of Inspirational Thinking.

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The holidays are coming. And the bad habits that accompany many celebrations may lead to bruxism that could damage teeth, according to a team of researchers from Brazil and Canada. They conducted a systematic review of 7 studies ranging from 51 to more than 10,000 subjects between the ages of 18 and 55 years.

According to the data, smoking tobacco can more than double to odds of bruxism. Drinking alcohol nearly doubles the odds. And, drinking more than 76 mg of caffeine increases the odds of bruxism by one and a half. Bruxism also has been linked to stress and sleep disorders, which affect many people during the holidays as well, in addition to abnormal bite.

Bruxism most often occurs during the early stages of sleep before deep sleep, according to the American Sleep Association (ASA), which notes that it affects 10% of all people. Symptoms include dull headaches, jaw soreness, and muscle pain. Bruxism also may produce painful, loose, or fractured teeth.

The ASA adds that bruxism has no cure, though avoiding caffeine and nicotine before sleeping may help. The ASA also recommends the use of oral devices like mouthguards, changing sleeping positions, and using relaxation techniques such as practicing yoga, listening to gentle music, taking a hot bath, or drinking green tea to ameliorate bruxism’s effects.

“Dentists and patients alike should be aware of the potential health effects from overuse of tobacco, alcohol, and caffeine,” said Michael Glick, DMD, editor of JADA, which published the study, “Association Between Sleep Bruxism and Alcohol, Caffeine, Tobacco, and Drug Abuse.”

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Tooth decay remains a key challenge for general practitioners. Drilling and filling doesn’t have to be the only answer, though. A startup company called Auxomel formed at the University of Southern California (USC) Herman Ostrow School of Dentistry is developing a peptide-gel prototype to regrow superficial human tooth enamel and slow decay. 

The university recently recognized Auxomel with an award for innovation at the USC Stevens Student Innovator Showcase, an annual competition that gives the school’s entrepreneurs an opportunity to present their ideas to the business community. Auxomel also won the Venture Validation award sponsored by the Lloyd Greif Center for Entrepreneurial Studies at the USC Marshall School of Business.

The fledgling company will use the $10,000 Stevens Student Innovator and the $2,500 Venture Validation prizes to fund the clinical translation and commercialization of its prototype. Kaushik Mukherjee, a graduate researcher with the Ostrow School of Dentistry’s Center for Craniofacial Molecular Biology and a member of the Auxomel team, shared his insights about the startup’s work with Dentistry Today

Q: Mature enamel doesn’t regrow. Why is this an issue in terms of oral health?

A: The failure of tooth enamel to regenerate after exposure to a microbial attack in the mouth predisposes it to an irreversible state of tissue destruction. Dental diseases have an economic impact amounting to billions of dollars annually, particularly affecting young children. In the United States alone, 92% of adults aged 20 to 64 years have had dental decay in their permanent teeth. Hence, designing innovative approaches aimed at repairing superficial enamel defects is imperative to advancing dental material science and curbing the progression of dental caries, or tooth decay.

Q: What can you tell us about your peptide-gel prototype, and how does it solve this problem? 

A: We have developed a peptide-gel prototype that mimics natural enamel-forming proteins (amelogenin) to repair superficial enamel defects. When applied on dental lesions, it entraps calcium and phosphorous mineral ions from natural saliva to form a highly oriented enamel-like mineralized layer that restores up to 80% of the hardness of healthy enamel. These peptides can infiltrate the pores created by the acidic dissolution of enamel by microbes and recover the lost minerals. The major value propositions for our prototype are that it’s a pain-free, non-invasive, speedier, preventive strategy that restores diseased tooth structure and confers significant mechanical strength to the repaired tissue. Currently, other preventive strategies such as fluorides, which have been routinely used for decades, have proven ineffective in treating patients at high carious risk.

Q: What previous work led you to this hypothesis? 

A: Our study is based on the fact that amelogenin, the most predominant protein in the enamel matrix, plays a vital role in regulating the orientation and elongated growth of enamel crystals. The initial project was spearheaded by professor Janet Moradian-Oldak, MSc, PhD, and postdoctoral research associate Qichao Ruan, PhD, at USC, who developed a novel amelogenin-chitosan hydrogel to treat artificially induced tooth decay in sectioned human molars.

I started working closely with Dr. Oldak in 2014 towards making this methodology clinically viable. Inspired by the functional role of native amelogenin in orchestrating enamel mineralization and based on a critical understanding of its active domains, we designed 2 smaller amelogenin-inspired peptides. The objective was to evaluate the mineralization efficacy of the smaller synthetic peptides while drawing comparison to their full-length natural counterparts.

Q: Could you tell us about some of the experiments or trials you performed in developing your gel? 

A: The first step was developing the amelogenin-chitosan hydrogel. Once we had this material, we started to optimize the treatment protocol by testing different parameters such as the protein concentration and gel viscosity. We first investigated how well the hydrogel stimulated the growth of synthetic enamel on a section of a tooth outside of the body, in artificial saliva under different conditions, to evaluate the structure, attachment, and mechanical properties of the newly grown mineral. From there, we designed smaller amelogenin-inspired peptides for clinical translation. One key step was the addition of matrix metalloproteinase-20 (MMP-20) proteolytic enzyme that degrades the amelogenin protein, creating spaces to enable the volumetric expansion of enamel-like crystals. This eventually forms a highly mineralized layer composed of hydroxyapatite crystals, the principal ingredient of tooth enamel.

Q: What led you to make the jump from research to startup? 

A: The lack of a robust treatment strategy to combat the silent epidemic of dental caries motivated us to develop a gel-based prototype and assess its commercial readiness for the global market. Based on valuable input from financial advisers and dental specialists, we created a business model canvas that gave us a positive indication of the potential impact of our innovation globally. Hence, we would like to keep the window of opportunity open and consider a potential startup.

Q: What is the next step for Auxomel? 

A: Right now, our next step is to complete efficacy tests to compare our product with what is commercially available in the market. It will also be very important to conduct cytotoxicity tests to demonstrate the biocompatibility of the peptide-based gel in the oral environment. We are also pursuing regulatory requirements for US Food and Drug Administration approval, which is a necessary step towards the design of our clinical trials.

Using this gel application, we would like to target initial signs of dental caries (white spot lesions), dentin hypersensitivity, and root caries. We are currently investigating the application of peptides in deeper lesions extending to the dentin and cementum. Compared to enamel, dentin poses a greater challenge in guiding mineralization due to a more complex organic matrix that delays the kinetics and growth of residual crystals.

Q: Finally, how do you anticipate dentists using the gel in their treatment? 

A: The gel could be loaded on a customized tray for overnight application at home. Alternatively, we have also considered a method of directly applying the peptides to a defect during a dental office visit. Clinical trials will give us a clearer picture as to which of the 2 strategies would work best.

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Effective infection control is an essential responsibility of every healthcare provider. Yet as dental practices juggle an ever-expanding list of demands involving clinical care, insurance regulations, financial management, marketing and promotion, and much more, ensuring the safety of patients and professionals alike gets equally difficult—and sometimes overlooked.

Jessica S. Wilson, MPH, an infection prevention and instrument management specialist with Hu-Friedy, discussed the critical role of infection control during a seminar at the Greater New York Dental Show in New York City on Tuesday, November 29. After her presentation, she shared additional insights with Dentistry Today—and why each dental office needs an infection control coordinator to maintain best practices.

Q: Generally speaking, why is infection control so important?

A: Infection control is not new for the healthcare profession and the dental care environment. Every patient deserves a safe visit to the dentist, and healthcare providers deserve to work in a safe environment free from the transmission of infectious diseases while they’re trying to perform their clinical tasks. So, there are little nuances of infection control that without attention being paid to it and the changes in technology, and the evolution of products in the dental environment, that can contribute to infectious disease transmission. So, there’s a need for education and awareness, just to make sure that we’re doing the things we're supposed to be doing.

Q: When it comes to infection control, where are some of the “hot spots” that dental professionals need to pay attention to?

A: I think one of the basic things that can’t be spoken enough of is hand hygiene. It’s just making sure that we wash our hands, knowing when to, knowing how to do so properly, and making sure that we’re doing so properly. Another area is going to be instrument reprocessing. It actually is a very complex process, but there are several ways to take the complexity out of it. And that’s part of what I try to do in my education, make infection control easy to understand and easy to perform. And there’s assistance that’s needed by way of education and product selection.

Q: There have been some recent cases of infections involving dental unit waterlines. What do dentists need to know about the dangers they present?

A: I think, number one, is just to have the education and awareness that transmission through dental unit waterlines is possible, and I think we’ve seen that with some of the cases that have made it into mainstream media. Not only in Anaheim and Georgia, but there was also Louisiana a couple of years ago. I think knowing it’s possible, even one transmission case or one infection case from contaminated water is too many. Dentists need to know that waterlines are a source of contamination and are a source of infectious transmission within the dental practice. So, there are protocols that can protect patients when they’re in the chair that can also protect dentists from risking liability. Really, it’s as simple as testing your water to make sure that you are in an acceptable range of patient treatment water, which is 500 colony-forming units of biofilm per milliliter. If you’re testing at more than 500, then perform the proper antimicrobial cleaning protocols with a maintenance product. And, repeat the testing periodically as the Centers for Disease Control and Prevention (CDC) recommends to make sure you’re staying within that 500-mL limit, regardless of what your protocol is. It’s as simple as that.

Q: Within the dental office, who should be responsible for taking the lead in infection control?

A: Every practice should have a designated infection control coordinator to take on the tasks of infection control, the responsibility and the education that’s required, to help the practice stay compliant with the recommended infection control protocols that ultimately help provide a safe dental visit for the patients.

Q: How does one become an infection control coordinator?

A: It’s actually pretty simple. You just have to already have an education or express an interest. One resource that’s good for someone who says, “You know what? I want to do that, and I don’t know where to begin,” is the Organization for Safety & Asepsis Procedures (OSAP). is about to embark on an initiative specifically targeted at the infection control coordinator to provide education, training, and walk through the multitude of resources that OSAP has specifically targeted at preparing the infection control coordinator to take on these tasks. It is free for people to participate. All they have to do is show an interest, and that’s what makes it so great.

Q: Are there any other resources that dental professionals can use?

A: I think you can look at the CDC guidelines. The CDC oral health website also has a new summary that they released, the CDC 2016 summary, which is an interpretation of the 2013 guidelines. It has a free checklist in addition to the summary for practices to use as a self-assessment. Also, dental manufacturers—I’m an employee of Hu-Friedy, which has a very robust educational website, where there’s on-demand webinars that people can take at no charge, and they can get continuing education credit. And then they can also provide resources, literature, and checklists that are not only objective when it comes to CDC guidelines and compliance, but it also has resources for different products that will help aid in that compliance as well. 

Q: Do you have anything else you'd like to add?

A: I think it’s very exciting to see the response to the infection control initiatives that are coming about and the interest that dental practices are seeing. We are always looking for new and emerging leaders to help champion this message, keep the message of patient safety going, and keep dental infection control in a very positive spotlight with patients and with the profession.

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Using digital technology and social media for marketing is nothing new. Whether the content is templated or customized, most practices know that, at the very least, they need to have a website and a Facebook page to further engage their patients.

One aspect of technology that dentists seldom use, however, is video. Using video on your site or in your emails is a cinch. Social media is another channel that can be used for videos of your office shenanigans. Facebook, Twitter, Instagram, SnapChat, and all of the most frequently used sites provide an option for their users to incorporate video. 

Why Use Video?

There are many reasons why you should be using video to promote your practice. Most importantly, videos are an easy way to show your personality to the outside world. Patients may know you as the person in the white coat who pokes around their mouths twice a year. But what else do they know about you? Video is a surefire way to show people that you are fun, compassionate, and active the other 363 days of the year.

Are you camera shy? Don’t worry. You don’t always have to be in the video, and the statistics on video usage indicates that you should be using video, anyway. According to YouTube, mobile video consumption rises 100% every year—100%! Also, the mere mention of the word “video” in an email subject line improves open rates by 19% and click-through rates by 65%, while reducing unsubscribes by 26%.

Best Practices

Impressed by the stats but still not convinced that video is for you? Are you worried that you have limited skills and aren’t interested in hiring a videographer? Fear not, since candid videos from your phone will work just fine. In fact, sometimes candid is better. The most important thing is to have good light and a steady hand, which, as a dentist, you already do. Here are a few easy hints on how to incorporate video into your marketing campaign.

First, be silent: You want people to be able to watch their video from anywhere. If they’re at their office and worried that the boss might hear them goofing around online, they will not play your video. You can still have sound, of course, but you’ll need titles or a crawler at the bottom so viewers can read the content they’re missing by watching on mute.

Next, strategize. Think about what your patients are interested in and ask you about frequently. What grabs your attention when you’re scrolling through your news feed? Also, consider how long you’re willing to pay attention. Marketing research has proven that most users won’t invest their time in a 7-minute video, so the videos you share should be much shorter. If you’ve posted videos before, see which ones were successful and which ones weren’t and use that data to inform your future decisions.

Finally, entertain. There are a number of ways that you can engage your patients with a short video spot. For example:

  • Take your audience on an office tour. As your camera walks though, you can show staff members, patients, and any number of things that happen every day at work.
  • Do “How To” or “FAQ” spots every so often. You know that some of your patients scrub their teeth like they’re trying to brush off some deadly contaminate. Maybe they need to learn the proper technique to save their enamel.
  • Post patient testimonials. These are especially effective when combined with before and after pictures.
  • Share educational videos that explain the benefits of complicated or elective procedures. Knowing exactly what is involved in dental implants might be all it takes to convince a patient to finally make an appointment.
  • Use videos to show your personality. Maybe it’s a video of you crossing the finish line in a charity 5K, or maybe it’s just you and your staff playing “floss wars.” In whatever case, allowing patients to see that side of you makes them feel connected and creates loyalty.

The next time you’re considering how to take your marketing to the next level, consider using video. Whether you use it in email or on your social networking sites, it is a guaranteed way to remind your patients that you’re with them year-round, not just when they’re in your office.

With over a decade of experience in corporate dental laboratory marketing and brand development, Jackie Ulasewich decided to take her passion for the dental business and marketing to the next level by founding My Dental Agency. Since starting her company, she and her team have helped a wide variety of practices all over the nation focus their message, reach their target patients, and grow their practice through effective marketing campaigns. When she isn’t helping dental practices reach their full potential, she can be found at the beach with her three dogs or immersed in everything food-related with her large Italian family. For more information, call (800) 689-6434.


New York, NY – In an exclusive media event on Monday, November 28, 2016, Scientific American and Colgate-Palmolive celebrated their collaboration on a new supplement, which is meant to be a tool to help drive the conversation of oral health’s future and the science behind it.


The supplement, The Future of Oral Health, was created with the informed consumer and the medical and dental professions in mind, said Ian M. Cook, the chairman and CEO of Colgate, in his opening remarks. Jeremy Abbate, the vice president and publisher of Scientific American, led the panel’s discussion and welcomed the audience to partake in the interactive session after. The panel included: Michael C. Alfano, president of the Santa Fe Group and professor, dean, and executive vice president emeritus at New York University; Dr. Marko Vujicic, chief economist and Vice President of the Health Policy Institute of the ADA; and Sharon Guynup, editorial director of The Future of Oral Health, Scientific American Custom Media. The panel discussion covered the history of the project and touched upon issues, such as changing public thinking about the importance of oral health.


Written to cover a broad range of topics, such as technology, The Future of Oral Health brings the facts and figures of the global state of oral health to the general public in layman’s terms. Its message is to improve upon public knowledge about oral care’s affect on overall body health. By sharing recent data with a larger audience, which includes the government, the emphasis of the publication is the impact of oral disease on whole-body health and the monetary savings due to the prevention of oral disease. Its articles examine the philosophies and technologies that have fueled changes to the profession in respect to improving access to care on a global level. This issue includes a 200-year pictorial timeline of dental innovation accompanied by an essay on the dental digital revolution and a look to the tech in the not-so-distant future.


Currently, the supplement is being given out to health and dental practices throughout the United States and Canada to reach the patient population. Both companies hope to promote this discussion of oral disease prevention on a global level. For more information, or a free digital download of the issue, visit the website To keep this public dialogue going, more information and videos will be added to the site in early 2017

Effective mouthguards are essential in ensuring both safety and performance in athletics. But many kids don’t have access to personalized gear and have to settle for off the shelf solutions, if they have mouthguards at all.

GuardLab, which uses digital scanning technology to create custom mouthguards for athletes of all levels, teamed up with Henry Schein to provide free pieces to student athletes during the Greater New York Dental Meeting this week.

Aidan Butler, CEO of GuardLab, discussed his company’s outreach with Dentistry Today

Q: Can you tell us a little about GuardLab?

A: Absolutely. We make sports mouthguards. We started with neuromuscular guards, and we use digital technology to capture the images we need to make them. We look at mouthguards as a really good addition for dentists who have digital equipment or for dentists who are looking to get into digital dentistry. It’s an easy way to get in there. You start with a scan and you're able to produce a product that is not overpriced and of very high quality, and that is a really good entree to get patients to see how digital dentistry can be applicable. 

Q: What are the advantages of a custom mouthguard over the typical mouthguards you can buy in any sporting goods store?

A: This is where digital plays a big part. It's really all about comfort and fit. Old fashioned mouthguards, you put them in hot water. They're no good for man nor beast. They block your airway. One size fits all fits none, as we say. Your teeth can be compared to a fingerprint. Everybody is so individual. Dentists always joke that it's still one of the things they use when they find a dead body. They look for dental records. How you can get a “small” mouthguard or a “large” mouthguard to fit a population makes no sense. So, we start with accuracy and comfort. And because of that, you get all the benefits of a mouthguard. It's seated better from a protection standpoint and from a performance standpoint. If your airway is unobstructed, you can breathe. You can perform better.

Q: How did GuardLab get involved in community outreach? 

A: We're partners with a couple of quite cool charities, one of them being Right to Play International, the other being Big Brothers Big Sisters New York. We're trying to be a socially responsible company. We understand that even though we've reduced the price of a normal dental-made guard because of efficiencies, we realize that not everybody can afford high-quality mouthguards. We don't feel that protection should be dictated by your personal wealth. If you want sneakers, I get it. Some people want fancy sneakers. That's not my place. But protection should be for everybody. So, we try our best to give back and really help a lot of the inner-city kids who wouldn't ordinarily, not necessarily afford them, but they wouldn't have any access to a dental office that could produce them.

Q: How many student athletes do you expect to help out during the show this week?

A: Over 3 days, we've got 70 kids coming through, primarily from the Business of Sports School up on the Upper West Side of Manhattan. We've got 2 charities that have provided the kids. And, FC Barcelona, the football team, has actually given a lot of stuff for the kids as well.

Q: How old are the students who are going to be receiving these mouthguards?

A: They're all high school kids. Though to look at some of them, there's a guy who's 6 foot 8. It's hard to believe, but he's definitely a high school kid.

Q: How many programs like this do you do throughout the year?

A: We are literally just announcing the partnership with Henry Schein, between the 2 companies. And we hope to be at a lot of the shows. If Schein is there, we think this is a nice offering to come along as well. We will be doing a lot of shows throughout the year, not just in the United States but internationally. We are the official mouthguard of the Ultimate Fighting Championship. In Australia, we are the official mouthguard of Australian Rules Football. So globally, we are really starting to get out there.

Q: Do you have anything else you'd like to add?

A: We love just how we can show off a very simple use of digital technology. A lot of dentists look at scanning and ask, “Is it really going to change my practice?” The answer is yes. With the number of products coming online, it really starts with the scanning. It gets people back into the dentists' office. In particular, you should buy mouthguards from a dentist. Protecting teeth should be through your dentist. That's a great utilization of digital technology.





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