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ADRESS: Kestel mahallesi, Sahil Caddesi, No:21 ( Eski Kestel Belediyesi karşısı) Alanya, Antalya 07400 – Türkiye

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Smoking, cancer, heart disease, and the oral-systemic link: Where we are with research


Dr. Richard Nagelberg examines the links between smoking, lung cancer, and heart disease, as well as the types of research and studies that established the strength of their credibility over time. Likewise, he considers where we are today with the link between oral health and overall health as he evaluates the current state of oral-systemic research.

Perhaps the most universally accepted facts in health care are the detrimental effects of tobacco, particularly cigarette smoking, for nearly every part of the body. It is safe to say that no one disputes the direct causal links between cigarette smoking, lung cancer, and heart disease. Listed below are only two statements regarding the state of this knowledge.

✔️The scientific evidence is incontrovertible: inhaling tobacco smoke, particularly from cigarettes, is deadly. Since the first Surgeon General’s Report in 1964, evidence has linked smoking to diseases of nearly all organs of the body. (surgeongeneral.gov. June 21, 2018)
✔️Smoking is by far the biggest preventable cause of cancer. Thanks to years of research, the links between smoking and cancer are now very clear. Smoking accounts for more than 1 in 4 UK cancer deaths, and 3 in 20 cancer cases. (cancerresearchuk.org)[Native Advertisement]
There is a boatload of research supporting this link. However, there has never been one large-scale double-blinded interventional study demonstrating that smoking causes lung cancer and heart disease. The fact that this link exists is based on the cumulative results of numerous smaller studies over a long period of time.
The reasons are the same for the lack of large-scale interventional studies investigating the link between smoking, lung cancer, and heart disease, among others, as well as that between the mouth and the body. These studies are too costly and full of variables that are difficult to control in a study spanning 20 years or more. It is the cumulative results of research that will demonstrate the strength of the link between oral health and overall health, rather than one definitive piece of research.

Keep up with the latest in
oral-systemic research
Click HERE to access all of the articles in 
DentistryIQ’s popular blog, “Making the Oral-Systemic Connection,” by Dr. Richard H. Nagelberg.
Click HERE to write to Dr. Nagelberg about any topics you’ve read about in this blog or to submit items you’d like to see covered here.

While the risks of smoking were being investigated, there were naysayers who doubted the emerging results. In fact, there was substantial skepticism within the medical community about whether the apparent increase in cancer deaths was real or the result of better diagnosis. The study that is credited with the beginning of the stop-smoking movement was published in 1954 by Hammond and Horn. Their paper ended with: “[we are of the opinion that the associations found between regular cigarette smoking and death rates from diseases of the coronary arteries and between regular cigarette smoking and death rates from lung cancer reflect cause and effect relationships.]” (1)
At present, we are in the middle of the oral-systemic research, waiting until a sufficient body of research provides incontrovertible evidence one way or the other.

1. Hammond EC, Horn D, The relationship between human smoking habits and death rates: a follow-up study of 187,766 men. J Am Med Assoc. 1954;155(15):1316-1328.
For more articles about clinical dentistry, click here.

Richard H. Nagelberg, DDS, has practiced general dentistry in suburban Philadelphia for more than 30 years. He is a speaker, advisory board member, consultant, and key opinion leader for several dental companies and organizations. He lectures on a variety of topics centered on understanding the impact dental professionals have beyond the oral cavity. Contact Dr. Nagelberg at gr82th@aol.comsbrufvwavdrvwqwuxdzeuqrxeqetabsadbavrr.
For the most current dental headlines, click here.


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Biolase adds health-care industry veterans to its board of directors


Biolase, Inc. announced June 19 that it has appointed Todd Norbe and Jess Roper to its board of directors, effective immediately. Roper will become chairman of the audit committee and replace James Talevich, who resigned from the board due to other commitments. The addition of Mr. Norbe increases the size of the board to five directors.
Dr. Jonathan Lord, Biolase’s chairman said, “The addition of Todd and Jess creates a reinvigorated board of directors with direct expertise in new technology adoption, disruptive innovation, and growth,” said. “We have also increased the dental IQ of the company by adding a director with deep experience in the dental industry. Along with welcoming Todd and Jess to the Board, I’d like to thank Jim Talevich for his tireless four and a half years of service to Biolase.”
Norbe, 51, was most recently the president, North America of KaVo Kerr, a subsidiary of the Danaher Corporation, where he held executive leadership positions from 2006 to 2018. He was responsible for the integration of the KaVo and Kerr businesses while leading all aspects of sales, marketing, channel management, group purchasing, customer care, service/warranty, and operations.
Prior to the integration, Norbe served as president of Kerr North America, where he was responsible for integrating three business units into one brand while incorporating a common management structure. Norbe also served as vice president and general manager of Metrex Medical—Sybron Dental Specialties, continuing in that role after it was acquired by Danaher in 2006.
Norbe earned a master of business administration in management from Fairleigh Dickinson University, and a bachelor of science degree in marketing from Bloomsburg University. He served on the board of the Dental Trade Association Foundation and the National Children’s Oral Health Foundation.
Roper, 53, has considerable financial and audit experience in the sectors of medical devices, life sciences, technology, manufacturing, and financial institutions. He joined San Diego-based Dexcom, Inc., in 2005, and he most recently served as its senior vice president and chief financial officer, retiring in April 2017. Dexcom is a developer and marketer of continuous glucose monitoring systems for ambulatory use by patients and by healthcare providers in the hospital.[Native Advertisement]
While at Dexcom, Roper also served as its vice president and chief financial officer and as the director of finance. During his tenure, Dexcom transitioned from a pre-revenue privately-held medical device company to a multi-national, publicly traded entity with 2016 worldwide revenues of $573 million.
Roper previously held financial management positions with two other publicly traded companies and one venture funded company and has extensive capital markets experience. Earlier in his career, Mr. Roper was an auditor with PricewaterhouseCoopers, and a bank and information systems examiner with the Office of the Comptroller of the Currency.
Mr. Roper earned a master of science in corporate accountancy and a bachelor of science in business administration in finance from San Diego State University. He is a certified public accountant in California and a member of the Corporate Directors Forum.
Biolase. Inc., is a medical device company that develops, manufactures, markets, and sells laser systems in dentistry and medicine, and also markets, sells, and distributes dental imaging equipment, including three-dimensional CAD/CAM intra-oral scanners and digital dentistry software. The company’s proprietary laser products incorporate approximately 220 patented and 95 patent-pending technologies. Biolase reports it has sold over 36,200 laser systems to date in over 90 countries around the world.


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BC oral pathology diagnosis 37: The case of the silent lesion


Last month, Dr. Stacey Simmons presented the case of the silent lesion—the 0.5- x 0.5-inch radiopaque mass that had been present in the oral cavity of a 74-year-old patient for at least six years, unbeknownst to the patient. In her complete analysis of this case, Dr. Simmons explains why the lesion will continue to stay silent.
Editor’s note: This article first appeared in Breakthrough Clinical, the clinical specialties newsletter created just for dentists. Browse our newsletter archives to find out more and subscribe here.
This is the COMPLETE ANALYSIS for BC oral pathology case 37

Figure 1:
Panoramic radiograph shows radiopaque mass on left side, just anterior to the angle of the mandible
Presentation and clinical exam
A healthy 74-year-old female presents for a comprehensive exam. A panoramic radiograph is taken. A radiopaque mass measuring approximately 0.5 x 0.5 inches is noted on the left side, just anterior to the angle of the mandible (figure 1). The area is asymptomatic upon palpation. The patient reports no knowledge of the lesion. Access to a previous pan from six years prior is acquired. The same lesion is noted on the radiograph, albeit somewhat less distinctive (figure 2).[Native Advertisement]

Figure 2:
Panoramic radiograph taken six years prior shows the same lesion, although somewhat less distinctive
The location and appearance of the lesion in this case gives it three likely potential differentials, which are discussed below. See schematic illustration (figure 3) for reference. (1)


Figure 3: Calcification schematic
⚫️ Calcified lymph nodes (2)
a. Usually asymptomatic and found in routine radiographic surveys as single round, oval, or linear calcified masses
b. In some cases, an isolated node can be found; in other instances, an entire chain of nodes is observed
c. If superficial, they are palpated as bony, hard round linear masses with variable mobility
d. Calcified lymph nodes do not require treatment; can indicate other diseases in latent stage
⚫️ Tonsilloliths (3)
a. Also known as tonsil stones and are aggregates of cellular and bacterial debris
b. Primarily observed in the tonsillar crypts
c. Differentials can be calcified lymph nodes or sialoliths, granulomas, foreign bodies, etc.
d. In the absences of manifestations, can be difficult to diagnose
e. If not observed clinically, they are often found via routine radiographic examinations; usually asymptomatic, although they produce a fetid odor to the breath
f. Usually no treatment is needed, unless painful or symptomatic
⚫️ Sialolith (2)
a. Radiopaque deposits in the ducts or gland itself of major/minor salivary glands
b. Primarily found in the submandibular gland, followed by the parotid gland
c. When at a critical size, sialoliths can obstruct the duct and are often painful
d. They vary in size, shape, density, contour, and position; can be solitary or multiple
e. If in the parotid gland and present in the anterior two-thirds of Wharton’s duct, they can be palpated intraorally
f. Surgical treatment is recommended if large or within the gland; pain and discomfort will often dictate urgency of treatment
Assessment of potential differentials
As health-care providers, it is in our nature to want to have a definitive diagnosis for potential pathology. In order to do so, however, we must have cooperation from the patient. In this particular case, since the patient was not in pain and the lesion remained relatively unchanged, she was not inclined to have it evaluated further, despite recommendations to do so. In these instances, we must document all conversations and continue to monitor clinically—and, in this case, radiographically—for any variances in the status quo.
1. Carter LC. Soft tissue calcifications and ossifications. Pocket Dentistry website. https://pocketdentistry.com/28-soft-tissue-calcifications-and-ossifications/wfrqzxrvrxsacuauaeayeeusrwyud. Accessed August 8, 2018.
2. Wood NK, Goaz PW. Differential Diagnosis of Oral and Maxillofacial Lesions. 5th ed. St. Louis, MO: Mosby; 1997:471-473, 525-527.
3. Tonsillolith. Wikipedia website. https://en.wikipedia.org/wiki/Tonsillolith. Updated August 2018. Accessed August 8, 2018.

Do you have an interesting oral pathology case you would like to share with
Breakthrough’s readers? If so, submit a clinical radiograph or high-resolution photograph, a patient history, diagnosis, and treatment rendered to

Editor’s note: This article first appeared in Breakthrough Clinical, the clinical specialties newsletter created just for dentists. Browse our newsletter archives to find out more and subscribe here.
For more oral pathology articles, click here.

Stacey L. Simmons, DDS, is in private practice in Hamilton, Montana. She is a graduate of Marquette University School of Dentistry. Dr. Simmons is a guest lecturer at the University of Montana in the Anatomy and Physiology Department. She is the editorial director of PennWell’s clinical dental specialties newsletter, Breakthrough Clinical, and a contributing author for DentistryIQ, Perio-Implant Advisory, and Dental Economics. Dr. Simmons can be reached at ssimmonsdds@gmail.com.
For the most current dental headlines, click here.


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The Me Too Movement and the dental office: Steps dental hygienists can take


“The number one line of defense is clear
communication supported with good body
language to emphasize your distaste with
the offensive behavior and make clear
it is unacceptable.”
By Linda Meeuwenberg, RDH, MA, MA
“In 2006, Tarana Burke founded the ‘me too movement’ to help survivors of sexual violence, particularly young women of color from low wealth communities, find pathways to healing” and “to ensure survivors know they’re not alone in their journey.” According to their website, 17,000 sexual assaults on the job have been reported since 1998 (www.metoomvmt.org).
In October 2017, the hashtag #MeToo was popularized by Alyssa Milano when she encouraged women to tweet about their experiences and “give people a sense of the magnitude of the problem internationally.” The response on Twitter included high-profile posts from several celebrities, including Gwyneth Paltrow, Ashley Judd, Jennifer Lawrence, and Uma Thurman.
Although you may not have experienced a sexual assault on the job in dentistry, I am fairly certain you have experienced an unwelcome advance from an employer and/or patient that made you feel uncomfortable and/or caused your work to suffer. It is rarely something that is discussed in the dental hygiene classroom. When it happens, most are in shock and paralyzed with what to say or do.
Yes, it happened to me on my first job when I was 19 years-old. The dentist followed me into the dark room and shut the door and made a lewd comment. I was frozen. I quit the next week. As it was only a one-day-a-week position, my other employer quickly added another day to my schedule. I never reported the incident and wonder how many others were treated inappropriately in his employment.[Native Advertisement]
Protection from workplace harassment
What constitutes an unlawful act in the workplace? Workplace harassment (including sexual harassment) laws are part of the Civil Rights Act of 1964, Title VII, a set of laws to prevent discrimination. The Equal Employment Opportunity Commission (EEOC) is the federal agency that interprets and enforces discrimination laws. In other words, it is unlawful to create a hostile work environment by federal law and has been since 1964. The law was written for employers with 15 or more employees.
The employer has an obligation to provide a safe, working environment. A hostile environment is defined as unwelcomed serious or pervasive conduct that has the effect of unreasonably interfering with an individual’s work performance or creates an offensive work environment. What constitutes a hostile environment can be different for each individual and thus the ambiguity of the translation of this law. I may find a hug from my employer as an acceptable behavior, whereas many of you may find the hug to be embarrassing and/or unwelcome.
What if you are employed in an office with less than 15 employees? Many hygienists work in a small office environment with a solo dentist business owner, where there is no human resources office. Each individual state handles such claims and often applies them to smaller numbers of employees. Therefore, even if your workplace has fewer than 15 employees, you still may be able to file a claim in state court, with your state’s government agency that enforces anti-discrimination law, or both. You may also consider filing a civil law infraction for recourse. Find an attorney that specializes in these types of cases. Here is a useful site to look up your statedyeywrzvrfdbv.
You can file a claim online in the comfort of your own home. There is a very useful link on the first page titled: “What You Should Know: What to Do if You Believe You Have Been Harassed at Work.”
So, if these state and federal laws have been around since 1964, why aren’t more people reporting these incidents? As we have learned from the #MeToo movement, many of the victims were in a lesser position of power with their accused often an employer or potential employer. The stories I have collected from dental hygienists are troubling and support this notion. Many cite fear, not knowing what to do, and retaliation as a reason for not reporting.
An employer could react with retaliation, terminating your employment, and placing you on a blacklist with other dentists in your area. Many depend on that weekly paycheck to make ends meet in their families—particularly single parents. Somehow these perpetrators sense the vulnerability. I have had reports of women who are divorced indicating that the employer thought it was “OK” to make advances, even though most of them were already married.
A formula for action
Where do you start? The number one line of defense is clear communication supported with good body language to emphasize your distaste with the offensive behavior and make clear it is unacceptable. Hopefully, with good eye contact, upright posture, and an authoritative tone of voice, this will stop the behavior and perhaps illicit an apology. Here is the formula:
Immediately, when an inappropriate behavior occurs, look the person in the eye and state that what he/she just did is unacceptable. Simple as that. Then, tell them what you expect. “I expect that this will stop now.” One of the toughest things to do is remain unemotional as this is an emotionally charged issue. Stay calm. Document completely with time, date, and actions.
If the behavior reoccurs or escalates, you need to repeat number 1 stated above. Document again
If you are in a practice with 15 or more employees, check with your Human Resources representative to discuss their protocol.
Go online to the EEOC office at https://www.eeoc.gov/.
If there are less than 15 employees, go to your state website to determine which branch is in charge of discrimination.
Finally, you may have no recourse but to consult an attorney who can help you resolve the issue. Be prepared to seek other employment opportunities.
Most importantly, be sure that you document everything. Do not be a victim. Take action swiftly. Too often women have allowed the inappropriate behavior to continue for far longer than necessary. We work in close proximity to our patients and often in a small office, making us vulnerable to unwanted behaviors from our employer and/or patients. Make sure you are seated so that your intimate body parts are not coming in contact with your patient.
I am pleased that RDH Under One Roof 2018 is hosting Lil Caperila and myself to discuss this important topic at this year’s conference. The seminar is titled, “Time’s up! Sexual Harassment in the Workplace,dyeywrzvrfdbv” and will be presented on Friday, August 1.
If you have any incidents that you would like to share with me, I welcome your input on this important subject. Please contact me at lindampda@gmail.com.
Linda Meeuwenberg, RDH, MA, MA, is known for her role in education at Ferris State University. As Professor Emeritus and CEO of Professional Development Association, Inc. she has delivered hundreds of seminars, keynote addresses, and enjoyed serving as an emcee in her neighborhood associations. An active volunteer, contributing author in the dental and lay industry, she also serves as a key opinion leader for several dental companies. Her website is: www.lindapda.com.


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The importance of dental and medical screenings


There’s much discussion regarding the relationship between TMD and airway disorders. Many dentists look for TMJ issues or problems with a patient’s bite, but often the cause of a patient’s issues is related to airway and breathing complications. Dr. DeWitt Wilkerson outlines the case of a dentist-patient, explaining the signs and symptoms to evaluate through dental and medical screenings that lead to the best course of treatment.
Editor’s note: This article first appeared in Breakthrough Clinical, the clinical specialties newsletter created just for dentists. Browse our newsletter archives to find out more and subscribe here.
There’s a lot of discussion going on regarding the relationship between temporomandibular disorders (TMD) and airway disorders. Many dentists look for TMJ issues or problems with a patient’s bite, but oftentimes the cause of a patient’s issues may be related to airway and breathing complications. Therefore, signs and symptoms must be evaluated and identified through AIRWAY AND MEDICAL SCREENINGS.
For example, allergies, deviated septum, upper airway inflammation and infection, and deformation can all cause airway obstruction and difficulty in nasal breathing. Strong evidence shows these obstructions can convert normal nasal breathing to mouth breathing.
Mouth breathing bypasses a person’s normal physiologic filtration system through the nose. Breathing dirty air through the mouth can be a source of inflammation and infection in the posterior throat and tonsil area. It can result in swollen tonsils and difficulty breathing through both the nose and mouth, and it can induce problematic ventilation during sleep. In turn, it can lead to both upper airway resistance syndrome (UARS) and, in more severe cases, obstructive sleep apnea (OSA).[Native Advertisement]
With such potentially serious medical issues and complications, it is very important for all dentists to screen every patient for breathing and airway concerns.
Signs and symptoms during medical screenings
A few months ago, a dentist named Danny traveled from Sydney, Australia, to St. Petersburg, Florida, to attend one of The Dawson Academy’s courses. Danny was only in town for a few days, but he was experiencing some problems that he thought I could help solve. I agreed to see him as a patient, so we met to discuss his issues, take photographs, and complete a new-patient exam, which includes airway and medical screenings (figure 1).

Figure 1:
Danny shared that he’d been experiencing problems that he felt might require a bite adjustment or possibly orthodontic correction.
His chief complaints were:
• Frequent morning headaches
• Clenching both day and night
• Chronically sore jaw and neck muscles
• Joint clicking on the left side
• Bite relationship feels off
• Teeth crowding
• Slight wear on the anterior teeth
• Chronic use of nasal decongestants
Another dental office might have identified Danny as a classic patient with TMJ and bite issues. However, many of these symptoms—such as frequent headaches, clenching, sore jaw, and crowded teeth—are also common indicators of airway issues. Through screens for airway and breathing disorders, we were able to identify these signs and symptoms as red flags for airway issues (figures 2–4).


Figures 2 and 3:
Crowding of the lower anterior teeth and scalloping of the tongue. These are common findings with airway and breathing disorders.

Figure 4:
Maxillary and mandibular retrusion.
Systematic approach to evaluating airway issues
It is helpful for time-savings and accuracy to have a systematic approach for evaluating patients who may present with symptoms of potentially overlapping disorders. As we evaluated Danny’s complex presentation, we used the Integrative Dental Medicine (IDM) checklist as a guide (figure 5). This checklist evaluates three aspects of the patient: infection/inflammation, airway/breathing, and TMD/occlusion. These three areas are evaluated through a history of signs and symptoms, evaluation of clinical signs, and, finally, screening and testing.

Figure 5:
Checklist to evaluate overlapping disorders
Following the checklist, we began to determine Danny’s history of signs and symptoms, which revealed the following.
Positive signs/symptoms for airway and breathing (figures 6–9):
• Mouth breathing
• Snoring
• Poor sleep quality
• Nasal congestion
• Forward head posture
• Tongue-tie
• Deviated septum

Figure 6:
Extremely enlarged tonsillar tissue obstructing the posterior airway

Figure 7:
Ankyloglossia—75% tongue-tie constriction

Figure 8:
Deviated nasal septum and narrowed airway

Figure 9:
95% obstructed posterior airway due to extremely enlarged tonsils
Positive signs/symptoms for TMD and occlusal issues:
• Joint discomfort
• Popping/clicking
• Sore muscles
• Bruxism
• Poor bite
• Clenching
• Worn teeth
• Crooked teeth
• Limited opening
After we reviewed Danny’s history of signs and symptoms, we began to evaluate the clinical signs for the three areas, which indicated the following.
Clinical signs for infection and inflammation:
• Swollen tonsils
Clinical signs for airway and breathing:
• Mallampati score greater than two
• Scalloped tongue
• 75% tongue restriction

Clinical signs for TMD and occlusion:

• Muscle palpation/tenderness
• Occlusal slide from centric relation to maximum intercuspation position with inadequate anterior guidance
Screening, testing, and findings
After identifying Danny’s history and evaluating the clinical signs, we moved to screening and testing. We recommended a home sleep test for his airway and breathing problems, as well as a Doppler auscultation and CBCT imaging for the TMD and occlusal issues.
The Doppler auscultation revealed reciprocal click on the left temporomandibular joint. The CBCT revealed normal joint anatomy, nasal airway obstruction with a slight deviated septum, and approximately 95% tonsillar obstruction in the posterior throat region. These findings led us to the conclusion of a positive airway/breathing disorder, with a Piper Stage I right temporomandibular joint and Piper Stage IIIa left temporomandibular joint.
We began to develop medical priorities based on the information gathered through the history of signs and symptoms, evaluation of clinical signs, and screening and testing. In Danny’s case, the priorities are medical evaluation for allergies and an ear, nose, and throat (ENT) specialist’s evaluation of his upper airway, posterior airway, and tongue-tie.
It is possible that allergies and airway obstruction could be the driving forces behind most of Danny’s signs and symptoms. It is important to address these medical concerns first, and use the process of elimination before we return to the dental considerations.
After we concluded our evaluation and determined the priorities, we discussed our findings and recommendations for medical evaluations to reestablish an open airway for Danny. The treatments will also help reestablish normal tongue posture, swallowing function, and cervical neck posturing. After that, we can assess temporomandibular and occlusal concerns to complete our clinical care.
By carefully evaluating both the associated medical as well as dental and joint concerns, we have thoroughly addressed all aspects of Danny’s signs and symptoms, ensuring the best possible course of treatment for him.
Editor’s note: This article first appeared in Breakthrough Clinical, the clinical specialties newsletter created just for dentists. Browse our newsletter archives to find out more and subscribe here.
For more articles about clinical dentistry, click here.

DeWitt Wilkerson, DMD, is a senior faculty member at The Dawson Academy, where he leads many of The Dawson Academy courses. He joined Dr. Peter Dawson’s private practice in 1982, and he now co-owns DuPont & Wilkerson Dentistry in St. Petersburg, Florida, with fellow senior faculty member Dr. Glenn DuPont. Dr. Wilkerson is a recognized leader in researching and educating on dentistry’s role in the diagnosis and medical management of what is now described as “disordered breathing.” Dr. Wilkerson launched The Dawson Academy’s annual Airways Symposium in 2017, and he has lectured on integrative dental medicine, whole-health dental treatments, and airway/dental sleep medicine all over the world.
For the most current dental headlines, click here.


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D.C.-based humanitarian program wins 3rd annual Schein Cares gold medal


Henry Schein, Inc. announced that Mary’s Center for Maternal and Child Care, Inc., a Washington, DC-based humanitarian organization, was awarded the gold medal in the oral health category of the third annual Henry Schein Cares Medal program.  [Native Advertisement]
Mary’s Center was recognized for its delivery of health care, education, and social services. According to a press statement, the organization “fulfills this mission by embracing culturally diverse communities and providing them with the highest quality of care regardless of ability to pay.”
The Henry Schein Cares program honors organizations from the fields of oral health, animal health, and medicine that “demonstrate excellence in expanding access to care for the underserved.” In June, Stanley Bergman, Henry Schein’s chairman of the board and chief executive officer, presented Mary’s Center with the gold medal at Henry Schein Dental’s national sales meeting in Orlando, Florida.

Beginning in 2010 in a converted storage room with five full-time employees, Mary’s Center’s dental program has since evolved into a fully integrated, six-day-a-week clinic with 55 full-time employees. The program’s team of general dentists, dental hygienists, and dental assistants provide a range of oral health services, including specialty care, to children, adults, and the elderly who are underinsured or uninsured.
Patient education and prevention are key components of Mary’s Center’s dental program, and each patient’s care is staged in a customized treatment plan. This ensures that providers are focused on diagnosing and delivering care and patients stay informed and engaged throughout their treatment cycle. The dental program is a key component of Mary’s Center’s unique model of behavioral change.
“Since 1988, our work has been guided by a social change model driven by holistic, whole-patient care, and our dental program is a crucial factor in setting our clients on the path to healthier, happier lives,” said David Tatro, chief operating officer of Mary’s Center. “The impacts that our fellow medalists have had on their communities has been incredible to learn about and have served to inspire our own work in meaningful ways. We thank Team Schein and the Henry Schein Cares Foundation for this award and for recognizing organizations like ours, and we look forward to expanding our impact with their support.”
An independent panel of judges selected Mary’s Center as this year’s gold medalist from a field that also included silver medalist My Community Dental Centers, Inc. (Boyne City, Michigan) and bronze medalist Community Treatment, Inc. (Festus, Missouri). Each medalist receives a cash award in the following amounts: $15,000 for gold, $10,000 for silver, and $5,000 for bronze through the support of the Henry Schein Cares Foundation. In addition to the cash awards, each medalist will receive $10,000 worth of product from Henry Schein.
Bergman said, “Mary’s Center’s commitment to incorporating the delivery of dental care into its patient-centric health care model pairs well with our company’s belief in the importance of oral health to overall health and is integral to its mission to help create stronger people, families, and communities. We are pleased to present Mary’s Center with the Henry Schein Cares Gold Medal in recognition of its unceasing devotion to the people it serves, and for demonstrating the true power of collaboration, care, and compassion.”
The company created the Henry Schein Cares Medal in 2015 to honor community organizations that shared the company’s commitment to serving society and whose work has been especially effective in bringing care to people and animals in need.
More information about Mary’s Center and its Henry Schein Cares Gold Medal can be found by watching a video interviewvbybzuwzebdrxbaburrvxwfdbwruee with Jennifer Kim Field, executive director of the Henry Schein Cares Foundation, and Dr. Joseph Rizk, Mary’s Center’s dental director.


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Fighting the epidemic: My experience with an opioid-free practice


Dr. Desirée Walker still remembers the reactions from the group of dentists, physicians, and health-care providers, who were all gathered to discuss substance abuse, when she said, “I have a narcotic-/opioid-free practice.” Silence. And then: Can you repeat that, please? She explains the protocol that has worked well in her practice for two years. And yes, she still provides the same surgical procedures, but without prescribing opioids.
Editor’s note: This article first appeared in Breakthrough Clinical, the clinical specialties newsletter created just for dentists. Browse our newsletter archivesssszufwytryzvwszefsex to find out more and subscribe here.

I remember the moment when jaws dropped and eyes widened. What followed was silence from those participating in the discussion as they processed the words I had just said. I was asked to repeat my statement to the group of physicians, dentists, and other health-care providers who had gathered to discuss substance abuse in my rural community.


This time, there was no misunderstanding. My colleagues were dumbfounded by what they had just heard me say, and they were in awe of the bold direction I had taken in this action-driven stance.[Native Advertisement]
Processing my words was the catalyst to many questions. What if a patient demands a medication? What if a patient gets upset and threatens to leave your practice? What if you get labeled as being insensitive to patients’ needs? You could quickly see the fear in the eyes of some of the other providers who said they did not believe it was possible to achieve this.
I have had a narcotic-/opioid-free practice for more than two years. I still provide the same surgical procedures (e.g., extractions, bone grafts, ridge preservation, etc.), but I have stopped prescribing Tylenol III, Vicodin, and a myriad of other opioids based on research guidelines. To be clear, my decision is based on published evidence and personal experience.
According to Moore et al. (2018), the NSAIDs are more effective for severe oral pain and present the least risk of long-term harm. (1) Furthermore, the combination of acetaminophen and NSAIDs may be an even better option to treat acute oral pain. (2) The American Dental Association also has a great resource guide on its website for helping combat opioid abuse. (3)
So, how is this approach conducted at my practice, Lumber River Dental? Following is a list of considerations I have found that work well. Keep in mind that some of these might need to be tweaked depending on the practice and location.
The do’s and don’ts
I have found this combination to be effective: 400 mg to 600 mg of ibuprofen with 1000 mg of acetaminophen every eight hours—with heavy emphasis on the recommended maximum ibuprofen (2400 mg to 3200 mg) and acetaminophen (3000 mg). However, you need to have a strategy to set yourself up for success. This approach will likely not work well if you are cavalier in how you deliver the message. For example, I do not say, “I extracted your tooth, and you might have some pain. I suggest taking some ibuprofen and acetaminophen if this happens.” This approach is not likely to be well-received by patients. Effective communication is key.
Write an Rx
I know what you may be thinking—you can get ibuprofen and acetaminophen over-the-counter, so why is it necessary to write a prescription? In my experience, writing a prescription helps with patient compliance, because it lists details of the medication protocol. The written prescription also allows patients to leave with something tangible in hand. At that point, it is irrelevant that the prescription is only for over-the-counter medication. Leaving with a prescription has a powerful psychological effect and can offer financial savings for patients as well.
Patient education, verbal and written instructions
Every patient in my practice who receives this protocol also receives verbal and written instructions about how to take the medication. In my experience, verbal and written instructions as a combination work better than verbal instructions alone. Taking time to verbally explain the protocol to the patient allows for a little more doctor-patient face time, which helps establish a trusting relationship. We refer to the combination of ibuprofen and acetaminophen as a medication sandwich to drive home the importance of combining the two medications. The verbal message may sound similar to the following: (Please note the “Dr. Walker” would be replaced with “I” if I were giving the instructions rather than my dental assistant.)
For your comfort during the healing process, it is important that you take the medication just as Dr. Walker has prescribed. It is a medication sandwich of ibuprofen and acetaminophen. Dr. Walker has prescribed your specific dose of ibuprofen, which you will get filled at the pharmacy. You will take it with [specific dose which includes the number of tablets and total milligrams] of Tylenol. You will take it x times a day and approximately x hours apart. Remember, it is important that you follow these directions specifically for the medication to work as effectively as possible. What questions do you have?
Then, we provide the patient with the written prescription and instructions that restate the medication sandwich combination, specific dosages, time intervals, and number of tablets (for acetaminophen). We also list the practice phone number and my personal cell phone number in case the patient has questions or after-hours concerns. If a patient calls or texts, which is rare, we email or text the patient these instructions again.
On follow-up calls, I specifically ask patients how well they have tolerated the medication sandwich and how they have been taking the medications. Asking them to repeat the medication sandwich instructions allows me to assess how well they have complied with the protocol. It also allows me to assess if they have had any adverse reactions.
Lumber River Dental results
You might be wondering how all of this has worked out for me and my practice. Did the fears of my colleagues at the substance-abuse meeting come to light? Did patients become raving mad, issue threats, and call me nonstop on my cell phone? In short, no. Since implementing this protocol, I have had four patients to date ask for stronger medication. I gently informed them that the medication sandwich is the strongest and most effective for their dental pain and is supported by research. Additionally, I also let them know that this protocol is the best for their body and overall health.
For patients who have ibuprofen contraindications, pain control may be acetaminophen only. For those receiving pain management care from a physician, I coordinate medication therapy with the patient’s physician on a case-by-case basis.
One of my biggest and welcomed surprises was that my patients have received no adverse reactions with this protocol. Although I provide my patients with my personal cell phone number, I rarely get calls from patients needing my help. I also have not received texts or calls from patients saying they have experienced side effects from narcotic/opioid medications. I cannot emphasize this enough: The ibuprofen and acetaminophen protocol has significantly decreased my post-op and still-in-pain emergency visits. Overall, this a big win for the patient, dentist, and practice.
Do not let fear of what-ifs keep you from taking a similar approach. This protocol has served my patients well and eliminated an average of four calls per month due to side effects of narcotic/opioid prescriptions. I also take comfort in knowing I am helping to fight the epidemic of narcotic/opioid abuse in my community. My hope is that my story will inspire you to examine the narcotic/opioid prescription protocols in your practice.
1. Prescription opioid abuse. American Dental Association website. https://www.ada.org/en/advocacy/advocacy-issues/prescription-opioid-abuse?utm_medium=VanityUrlssszufwytryzvwszefsex. Updated August 9, 2018.
2. Moore PA, Hersh EV. Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions: translating clinical research to dental practice. J Am Dent Assoc. 2013;144(8):898-908.
3. Moore PA, Ziegler KM, Lipman RD, Aminoshariae A, Carrasco-Labra A, Mariotti A. Benefits and harms associated with analgesic medications used in the management of acute dental pain: an overview of systematic reviews. J Am Dent Assoc. 2018;149(4):256-265.e3. doi: 10.1016/j.adaj.2018.02.012.
Editor’s note: This article first appeared in Breakthrough Clinical, the clinical specialties newsletter created just for dentists. Browse our newsletter archives to find out more and subscribe here.
For more articles about clinical dentistry, click here.

Desirée Walker, DDS, is a general dentist and owner of Lumber River Dental in Lumberton, North Carolina. She graduated from the University of North Carolina at Chapel Hill School of Dentistry in 2008. Outside of her practice and training for her next appearance on American Ninja Warrior, she does yoga and gymnastics outdoors with her two cats, Lu and Jones. She can be contacted at drwalker@lumbertondental.com.
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Study pinpoints genetic connections to perio and coronary artery disease in addition to lifestyle factors


Results of a meta-analysis to be presented at EuroPerio9 reported that periodontal disease and coronary artery disease (CAD) share a common genetic basis, involving the VAMP8 function (1).
“Knowledge of the shared genetic basis helps to understand the molecular mechanisms that underlie and predispose to the disease,” explained lead author, Dr. Arne S Schäfer, a professor at the department of periodontology and synoptic dentistry based at Charité University Medicine in Berlin, Germany. “This knowledge will guide strategies for therapy but also allow the identification of risk groups for preventive care, before the disease manifests itself.”
Strong evidence of association between CAD and periodontal disease (PD) has already been established. Both are among the most common diseases: CAD affects 110 million people worldwide and is the first cause of death, while PD affects 538 million people.(2) Both diseases are frequently diagnosed together and have common risk factors, such as smoking and diabetes. Both are characterised by a chronic inflammatory process but, independent of those shared risk factors, previous studies(3,4) had suggested a few shared genetic variants.
Dr. Schäfer said, “Our aim in undertaking this study was to further explore the joint genetic basis of CAD and PD. The identification of the shared genetic susceptibility factors will pinpoint relevant molecular pathways for the disease. This knowledge will yield very specific therapeutical targets for precision medicine. We believed that, given the localized nature of periodontitis which is confined to the oral cavity, there would be a small variety of different pathways that had the potential to contribute to both diseases.”
He added that the 10-year study examined every common variant in the entire DNA sequence. “These are alternative building blocks called alleles, which are in the millions. We counted if a variant was more common in both CAD and periodontitis cases, compared to healthy controls,” he said. To rule out chance findings, which can be caused by random differences of natural variation, we counted all these variants in all patients of CAD and periodontitis that were available to us. This high number of analyzed individuals and a replication of the results in an independent sample of cases and controls, allows to generalize our findings.”[Native Advertisement]
He said the discovery stage used a German sample with aggressive periodontitis (717 cases vs 4,213 controls) and the CARDIoGRAMplusC4D CAD meta-analysis dataset, which included 60,801 cases and 123,504 controls. Replication was performed in an independent genome-wide association study (GWAS) meta-analysis dataset consisting of patients with either aggressive periodontitis or with chronic periodontitis from Germany, Austria, The Netherlands, and the United States (4,423 cases vs 6,219 controls).
Researchers identified a variant in the promoter region of the gene VAMP8 (a promoter regulates the activity of a gene in response to other stimuli) to be significantly more frequent in CAD and periodontitis cases than in healthy controls, indicating the involvement of this gene in the aetiology of both diseases.
“VAMP8 is of special interest, because it is involved in the import and export of molecules and other substances into and out of the cells (acting as a sort of door),” Dr. Schäfer said. “It is strongly expressed in the epidermis of cellular interfaces of barrier organs of the gastrointestinal tract, which includes the gingiva. We are now looking in detail at which direction the transport is affected in the disease processes and what substances are involved, for example microbial substances that get in or antimicrobial substances that get out of the gut.”
Two single nucleotide polymorphisms (SNPs) at the known CAD risk loci ADAMTS7 (rs4468572) and VAMP8 (rs7568458) passed the pre-assigned selection criteria (PAgP-Ger<0.05; PCAD<5x10-8; PMetaReferences: 

1. EuroPerio9 Abstract O017, Genome wide association meta-analysis of coronary artery disease and periodontitis reveals a novel shared risk locus. Presentation at the Biomarkers session on 21 June 2018, at 14:00.
2. “Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015”. Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6.
3. Identification of a shared genetic susceptibility locus for coronary heart disease and periodontitis. Arne S Schaefer et al. PLoS Genet 2009 Feb 13;5(2):e1000378. Epub 2009 Feb 13.
4. The large non-coding RNA ANRIL, which is associated with atherosclerosis, periodontitis and several forms of cancer, regulates ADIPOR1, VAMP3 and C11ORF10. Gregor Bochenek et al. Hum Mol Genet 2013 Nov 27; 22(22):4516-27. Epub 2013 Jun 27.


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