Word Of Mouth – A Dental Blog

GUMS GINGIVITIS GENES

What’s the connection?  Researchers at the University of North Carolina- Chapel Hill along with Procter & Gamble Oral Care published a report in the December 2009 Journal of Periodontology documenting a connection between swollen gums and the genetic code.

Traditionally when your dentist discussed with you that you had “swollen gums” he usually suggested you improve your oral hygiene habits; brush more, brush more effectively, floss more, remove plaque more effectively.  It now appears that our ability to prevent and fight gum inflammation (gingivitis) may involve factors other than diligent brushing and flossing.

According to Dr. Steven Offenbacher, a lead researcher in the above study, over 9,000 genes (30% of the total genes in the body) are expressed differently during the onset and healing process of gingivitis.  “Details of this discovery indicate that the same biological pathways that are associated with activation of the immune system are the major pathways activated during the body’s reaction to the buildup of plaque on the teeth” according to the AGD Impact news magazine(Feb, 2010) discussing the research.  Furthermore “the gene expression pathways associated with thwarting plaque overgrowth are the same as those involved in wound healing and skin repair.” The genetics associated with gum inflammation and healing may therefore apply to other areas throughout the body.

Researchers are hoping that their understanding of gum inflammation on the molecular level will not only help clinicians eventually improve our understanding of prevention and treatment of gingivitis but will help others better understand and explain what is occurring in a person’s body at the onset of disease and how it relates to their overall health.

This study is just another that shows the increasing connection between dentistry and medicine and how clinicians and researchers are attempting to better understand the dental-medical connection.

As always-just my thoughts. Thanks for listening.

RMS

Who would have ever thought that business would condone “sleeping on the job”?  It’s true.   According to a recent article in the Harvard Health Letter (Vol 35, Nov 2009), companies like Google are encouraging naps at work.  How can this be?

Recent sleep studies have shown sleep improves learning, memory and creative thinking.  According to the HHL, several studies have shown that when people are asked to memorize things, and then they nap, they will remember more than they would if they had not napped.  Short duration naps of 5-6 minutes have even been show to improve information retention.

We all have a form of a biologic clock in the part of our brain called the hypothalamus.  The cells located here help to set up a certain circadian rhythm controlling among other things, body temperature, blood pressure, sleeping and wakefulness.  Normally we are awake during the day and sleep at night. But it’s common to have a little “hump” of mid- afternoon sleepiness programmed into the body’s rhythm.  The afternoon nap can get us through this afternoon period where we may get tired.

Robert Strickland, a Harvard sleep researcher, says “napping makes people more effective problem solvers”.  And he goes on to say that recent findings make a case for employer policies that encourage napping.  This has led some companies to set up nap rooms or “nap pods” that block out sight and sound.

Of course, some fear abuse of mid day napping at work, and understandably so.  But in fact, there may be a case made for strategic napping.  Next time someone says they are just “resting their eyes” there may be a biologic reason behind it and a benefit to themselves and their employers.  Who would have thought? Maybe someday not only will we get a lunch break, but nap time too!

As always, thanks for listening.  Hope you got through this without falling asleep!

RMS

As I’ve said before, as dentists we wear many different hats; we’re clinicians, biologists, artists and scientists.  As scientists and clinicians we should be basing our treatment decisions and recommendations on scientific facts and evidence, not hearsay.  That’s the basis of evidence based science.
Two articles in this past Sunday’s newspaper caught my attention.
The first article, on the front page of the href=”http://www.nytimes.com/”>New York Times, addressed the relatively new technique of robotic surgery.  The pros and cons of robotic assisted surgery vs. the old fashioned way of using human hands were evaluated.  The author, Gina Kolata, discussed the lack of scientific studies proving that robotic assisted prostate surgery resulted in better results for patients.  Only one long term study has been done that included robotic surgery, but that study didn’t really differentiate between robotic results vs. non-robotic results. 

In the absence of definitive conclusions, the author goes on to discuss the role of marketing in the patient decision making process; newer being interpreted in many instances as being better.  She also discusses how popular robotic surgery is becoming even in the absence of studies citing its clinical superiority!  And finally, she points out the pressure placed on medical institutions to provide these services because of the huge initial investment in the robotic technology.  All with no evidence that robotic surgery gives better results.

The 2nd article, also in the New York Times (Style section),  dealt with stress and tooth grinding.  Michael Winerip, the author, relates several discussions he had with various dentists and dental professionals in an effort to support his premise that these stressful economic times are causing more tooth grinding; a plausible hypothesis indeed.  But once again, show me the evidence!  Where is the science behind the conclusion that increased stress in causing increased grinding?  Indeed, Mr. Winerip states in his article that “there are no studies about grinding and its relation to the recession.”

 There is no reason to dispute that one dentist in the article made 65% more night guards in 2009 than the year before.  But just because we are living in extremely challenging economic times may not be the only reason the number of night guards made increased.  Nor is polling 3 or 4 dentists a sufficient scientific pool on which to conclude that increased stress is causing more grinding.  The entire subject of tooth wear is extremely complicated; indeed the vast majority of teeth wear occurring not during the night, but during the day.
Our goal as health care providers should be to evaluate our patients concerns, evaluate conditions that exist, and come up with treatment solutions that can address the problems based on scientific evidence, not just the solution “du jour”.  That’s what scientists do.
Just my thoughts, thanks as always, for listening.

RMS

I was listening to Brad Paisley sing “Welcome to the Future” the other day on satellite radio.  He remembers as a child wishing he had a Pac-Man game in his basement and having to get a ride to the arcade- and now having it on his phone.  I’ve spoken before about our need to embrace changing technology and staying relevant in the lives of our patients.  So come 2010 we’re going to use some of the latest technology to help us and our patients stay connected.

For those of you who have been in our office, you know that outstanding patient care is of the utmost importance to us.  It’s a basic building block of our practice foundation.  And while in the past we’ve used the phone and mail to reach out and stay in touch with you, we’re going to be trying something new.  Early in 2010 we will have the ability to communicate and respond more effectively by introducing an advanced, patient-friendly system that allows communication through e-mail and text messages. 

We have noticed that for many of you, texting and e-mail is the primary way you now communicate.  How many of you are still texting and reading e-mails even while sitting in the dental chair?  Lots!  We are hoping our new system will make it easier to alert you of upcoming appointments, find out how you’re feeling after appointments and give you an opportunity to reach us besides using the telephone.  Of course, for those of you who still prefer using the telephone and US mail, we will note your individual preferences and reach out to you in the ways that work best for you.

As we transition into 2010, I’d like to take this opportunity to express my gratitude to all of my patients for the opportunity to help them get healthier and achieve their dental goals.  And to my outstanding team of caring professionals, I thank you for your help in making this happen.

A Happy and Healthy future to all!

As always, thanks for listening.
RMS

For several years I’ve been talking to my patients about a comprehensive integrated approach to dental care that evaluates how comfortable it is to chew and how the “chewing machine” is working. This is the “comfort” part in the Health-Comfort-Beauty” triangle. How nice to see that in the JOHN HOPKINS MEDICAL LETTER “HEALTH AFTER 50”, this same topic is covered in the January 2010 issue.
“Putting Jaw Pain to Rest-Without Surgery” describes the prevalence of temporomandibular disorders in the U.S. and discusses some of the signs, symptoms, and treatment modalities available. Here are some of the more important facts from this article:
1. Up to 10 million Americans suffer from TMD (temporomandibular disorder) which can leave chronic sufferers     unable to sleep well and can interfere with normal speaking and eating.
2. TMD is associated with the complex anatomy of the temporomandibular joint which connects the upper jaw to the lower jaw.
3. Dr. Anthony Tufaro at Johns Hopkins talks about musculoskeletal problems relating to the repeated movements of jaw bones and muscles as one of the most common causes of TMD.  And while misaligned teeth can contribute to this type of pain, for some patients, bite problems have nothing to do with the TMD symptoms they are experiencing.
4. Self care for the TMD may consist of:
• Rest
• Heat
• Medication
• Behavioral counseling
• Jaw appliances (orthotic bite plates/night guards)
• Physical therapy
What is left unsaid in this article is that often times we can see the signs of muscle or bite imbalance by observing teeth that are loose, broken, or worn and /or jaw muscles that are tender to touch. A comprehensive evaluation of all the structures inside and outside the mouth is important to determine not only how healthy we are, but what are the correct steps to take to achieve and maintain a healthy bite and jaw.
Further questions? Call us in the office or drop us an e-mail.
Thanks for listening.
RMS

As I’ve said before, in a world that is changing so rapidly in terms of technology, social interaction and economics, we’re trying hard to remain ahead of the curve.  How do we change and stay in touch with our patients?  How have their dental  concerns about health, comfort and beauty changed over the last 18 tumultuous months and how does that affect the way they perceive what we do?  And how do we remain relevant in their lives?  Do they want us to remain relevant in their lives?

We’ve tried hard to ask these questions, both in the office and by surveying our patients on line.  My gut feeling has been that we need to remain supportive of what our patients are experiencing and need to be curious about the best ways to help them stay healthy and achieve their dental goals.  I’ve always believed strongly in relationship based and very personalized patient care. 

In the spring of ’09, I was interviewed by a writer for MY BUSINESS Magazine.  I spoke about my belief in patient centered care and how important it is in the world in which we now live where often the Dr-patient relationship has become depersonalized.  You can find some of my comments at http://www.mybusinessmag.com/fullstory.php3?sid=1970

Who’s listening? We are!

I came across this article in the recent edition of the AGD Impact Newsletter.
I thought some might find it interesting.

It’s a common theory that teeth need to be protected from the staining power of red wine. Wine drinkers often opt for white wine to avoid potential stains, but a recent study revealed that white wine simply may be the lesser of two evils.

Researchers discovered that white wine can also contribute to tooth discoloration. The common factor is acid, which is also present in many other beverages.

Researchers found that- no surprise- red wine left the deepest, darkest stains on teeth. However, a more interesting result revealed that the teeth soaked in white wine also showed signs of stains and were significantly more discolored than the set that endured a similar process with water.

Researchers concluded that the acids in wine, white or red, create rough spots and grooves in teeth that allow chemicals in stain- causing beverages, such as coffee, tea, or cola, to penetrate deeper into the tooth.

Acidic erosion isn’t a problem with wines. An abundance of citrus drinks, such as orange and grapefruit juice, lemonade, most sports and energy drinks, as well as sodas, also contain acids. The common threads in acid erosions and dental caries (cavities) are acid and loss of tooth structure. While organic bacterial acids lead to caries (decay), it is the extrinsic acids in foods and beverages and /or intrinsic acids from our stomachs that can lead to erosion. In both cases, early detection and prevention measures can keep an incipient problem from becoming irreversible.

RMS

Several years ago my office team and I spent some time attempting to redefine what we do and how we do it.  We had a general idea of what we felt was important to our patients and to us in terms of the care we deliver but felt we needed to better define our core values and become more focused.

 At the time there was a lot of press related to “cosmetic” dentistry and “spa” dentistry (whatever that is).  In an age of “Extreme Makeover” and almost instantaneous gratification, we chose another path.  I never wanted to be just a “cosmetic” dentist.  I felt our patients were entitled to more than just cosmetic care.  I felt comfortable based on my training and experience providing a more comprehensive kind of experience – one that was patient centered, relationship based, and that fully integrated health, comfort and beauty.

Two articles I read in the last week helped confirm that in a world that is rapidly changing my team and I are on the right track.

In New York Magazine, week of June 1, Beth Landman wrote in her article “Nipped & Tucked” about the changing reality of medical and dental practices that were only recently, cosmetically oriented.  She wrote about “lifestyle” medicine losing some of its allure as the result of changing economic times and the trials and tribulations of doctors who now have to provide more health centered treatment.  I apologize if I appear naïve here, but shouldn’t the health aspects of care have been considered all along? 

As I’ve said before, as dentists we’ve been trained to be scientists, biologists, clinicians, and artists.  But concentrating exclusively on the “cosmetic” aspects of care often times neglects the health and comfort of the patient.  Shouldn’t these clinicians have been addressing health issues all along as part of the “cosmetic work” they were doing?  Now they’re getting back to basics because the revenue stream from these cosmetic procedures has slowed to a trickle.

In the New York Times Business Section, June 7, 2009, Julie Weed wrote an article entitled “If All Doctors Had Time To Listen”.  She talks about changing models of health care delivery; new methodologies that allow physicians to spend more time with their patients, emphasize prevention, and decrease the number of referrals to specialists.   Ms. Weed  states that these “patient centered” practices are popular and growing.  That shouldn’t be a surprise.  Patients are looking to re-establish a more relationship based personalized kind of care where they feel cared about and cared for.

All in all, a good week that made my team and I feel comfortable that we are on the right track, trying to remain relevant in the lives of our patients.

As always, thanks for listening.

RMS

This week I presented a lecture to the Oral Surgery and General Practice Residents at New York-Presbyterian Hospital where I am on staff as a voluntary attending dentist.  I was asked to speak about implants and aesthetic dentistry- certainly an interesting topic. 

I had an opportunity to speak to them about the changes I’ve seen in implant dentistry over a 25 year time frame as the result of scientific frontiers that have been continually pushed outward.  But just as importantly, I had the opportunity to speak to them about what I call, “The Psychology of Beauty”.

We live in a society where more of us than ever before want to look good and feel good.  And for many, feeling good about themselves is tied in to feeling good about the way they look. We live in a society where baby boomers want to look better than their parents did at a similar age and where, right or wrong, it takes but 15 seconds for an observer to make decisions about who we are based on visual images (note the Susan Boyle phenomenon).  I tried to educate the residents about the psyche of the patients they are treating; about their expectations based on what they see on TV and in the media, and how their self esteem can be affected by our results.

 We spoke about the origins of plastic surgery and the first documented procedures in 600BC; the evolution of plastic surgery from an art and science dedicated to making disfigured patients fit into their society to one trying to make patients look better than others in society.  I spoke about the phenomenon of TV shows like “Extreme Makeover” and how programs showing significant improvement in body image impact on the self-image of the individual.  And I discussed with them how this evolution, indeed revolution, in technique and social thinking impacts on their successful delivery of aesthetic implant procedures. 

Studies by  Ellen Berscheid, at the University of Minnesota, and books such as “Survival of the Prettiest”  by Nancy Etcoff, PhD  cite the importance our society places on “good looks” and the “raison d’être” of the beauty industry.  After all, the eyes and smile are the first two features someone looks at when they meet you for the first time.  And many have come to realize the importance of a pleasing smile in both their personal and professional lives.

Of course I also addressed dental technique and process, and aesthetic and diagnostic criteria so essential to being successful.  But I think the idea of presenting information on “the psychology of beauty” and how this affects our patient’s expectations is another important consideration in the learning experience.

As always, thanks for listening.

RMS

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In December of last year, Thomas Friedman wrote an Op-Ed article for the New York Times entitled “While Detroit Slept”  In it he says  “ I can’t help but reflect on what, in my view, is the most important rule of business in today’s integrated and digitized global market, where knowledge and innovation tools are so widely distributed. It’s this: Whatever can be done, will be done. The only question is will it be done by you or to you. Just don’t think it won’t be done.”

I’ve spent a lot of time thinking about this because if I have a choice, I’d prefer it to be done “by me” instead of “to me”. How does this apply to dentistry, how does this apply to my patients, how does this apply to me?

 As dentists, we wear many hats; we are scientists, biologists, clinicians, psychologists, and artists.  And yes, as small business professionals we are also entrepreneurs.  I’m trying to better understand how we can continue to maintain outstanding patient service and customer care, as well as provide our patients a comprehensive approach to dental health that fully integrates health, comfort and beauty.  And how do we do this in a world that is changing so rapidly in terms of social interaction, economic turmoil and technological change? 

What got my attention today (May 25, 2009) is a posting in the New York Times entitled “Webcast your Brain Surgery?  Hospitals See Marketing Tool” by Pam Belluck.  It addresses new ways health care providers are using social networking to get the message out about what they do and how they are doing it. In the article, the author writes about a patient at Methodist University Hospital who allowed the webcast of her brain surgery from the operating room.  It seems as if education was not the only goal of the webcast.  Evidently the concept of webcasting the operation, even though it was done on tape and played later, was also used as an advertising and promotional tool by the hospital; the hospital monitoring how many watched the operation, how many YouTube hits the webcast got and how many people called for an appointment.  The competition is so great hospitals are trying unconventional methods to attract perspective patients to their facilities.

In other hospitals individuals are Tweeting directly from the operating room to describe what’s happening.  According to Ed Bennett, Web strategy director for the University of Maryland Medical System, more than 250 hospitals now use YouTube, Facebook, Twitter or blogs in an effort to reach a wider audience (patient population).

According to Ms. Belluck while some ethicists and physicians raise questions about privacy issues and hospitals painting an overly positive picture, the hospitals feel they must use unconventional, even audacious methods in order to connect directly with the public. 

In a world that is changing so rapidly in terms of how we connect to patients, the question I have is this-is the utilization of the new social interactive technology like Twitter, webcasting, and YouTubing in the patients’ best interest or the providers best interest?  For sure, if the new avenues of social interaction work to educate and comfort patients, they are wonderful new tools to demystify medical and dental procedures.   But if they are utilized solely for advertising and self-promotional reasons, then maybe they need to be rethought.  Maybe the best way to answer the question is to ask.  That’s something my team and I intend to do.

As always, thanks for listening.

Robert Sorin