Monthly Archives: December 2014

Keeping Fear Out of the Holiday Cheer

by Implantadmin Posted on December 23, 2014

Keeping Fear Out of the Holiday Cheer
Avoiding End-of-Year Dental Emergencies
Arun K. Garg, DMD

Ask any doctor what’s the deadliest time of year and chances are they’ll have the same answer: Thanksgiving to New Years.

Theories for the seasonal uptick are as varied as the aliments doctors treat. But whether it’s increased stress, shoveling snow, increased fat and salt intake, alcohol overindulgence, ignoring seemingly benign-but-deadly symptoms like chest pain, or reduced (or fewer senior staff) at national hospitals and trauma centers, the fact of the matter remains that despite the holiday cheer, the end of the year has the greatest risk of loss of life. According to one study, December 25, is statistically the deadliest day of the year.

If that doesn’t take the twinkle out of your Christmas star, then I’m not sure what will. Unfortunately, dentists – and their patients – aren’t immune to these effects either. Not surprisingly, with all the delectable desserts served this time of year and unchecked in-school and in-office snacking running rampant, our collective sugar intake goes into hyperdrive. Mind you, this increase is already baked into a decades’ long trend of increasing sugar intake, about 30 percent above US norms in the 1970s.

That means that for many of us, our teeth are under assault. Bacteria in our mouth literally live off the sweet goodness coating our pearly whites. As they consume the sugar they also consume our teeth enamel. Given enough time a nuisance toothache can become a medical emergency, or at least an excruciatingly painful experience.

And time is the real enemy during the holidays. How easy is it for a parent to dismiss their child’s complaints as a trip to the dentist will interfere with travel plans? Or what if a parent heeds those concerns only to find their family dentist is taking a two-week vacation? As a practicing dental surgeon and owner of multiple practices, I can tell you these scenarios happen every year. Adults too experience problems during the holidays as they may be consuming foods like nuts and other crunchy treats (even chewing on ice cubes in those extra drinks) that can chip natural teeth or cause dentures and veneers to fail.

But keeping fear out of the holiday cheer shouldn’t be difficult. Often, this is where your dental practice’s marketing tactics can be put to good use. While the end of year is always a great time to reach out to patients thanking them for their continued business and for your accounting department to set up payment plans and phone call follow-ups, it’s also a great time to remind patients about some of the above health risks. Simply reading a friendly but cautionary email or tweet about sugar’s teeth-damaging effects might prevent a consumption pattern – before it starts.

Likewise, it might be a good idea to remind patients of the reduced holiday staff and to be transparent about who will be in the office, when, and the expected turnaround time for office phone calls. Referring patients to colleagues in an effort to cross cover also reduces their stress levels if in the event an appointment cannot be delayed.

Efforts like this will help your dental practice remain in good standing with your patients and just might lead to an uptick in post-holiday appointments. This year, as we all head off to our holiday parties and enjoy that sweet goodness, lets stay healthy in the process and reverse some of those troubling national trends. The holiday season is supposed to be “the most wonderful time of the year.” Not the deadliest.

Elderly Patients and the Ongoing Dental Dilemma: A Labor Day Reminder

by Implantadmin Posted on December 22, 2014

Elderly Patients and the Ongoing Dental Dilemma: A Labor Day Reminder

By: Dr. Arun K. Garg

One hundred and twenty years ago this Monday Americans celebrated the first national Labor Day. At the state level, the movement for such a day of appreciation of American workers had been building for years and some 23 states had already enacted legislation to that effect. Thinking about that date, 1894, it occurred to me that some of our oldest citizens were born near that time, or immediately following it. (The oldest American, Gertrude Weaver, is 116, born in 1898.)

As Americans gather for their last outdoor romp at the unofficial end of summer, it’s important to remember our workers, yes, but especially our older workers who helped build the modern labor movement.

One way to honor them is by addressing an ongoing dental dilemma. For millions of older Americans, visiting the dentist is not as easy as it sounds. A new report in the American Journal of Health Behavior finds that 60 percent of senior citizen survey participants sited financial constraints for not making a follow-up dental appointment after an initial checkup. Nearly one-third said transportation was difficult and 20 percent required assistance in scheduling the appointment.

Unfortunately, without private health insurance (which may or may not include dental care) the government-subsidized landscape is full of pitfalls. Medicare, the country’s senior citizen healthcare assistance program generally does not cover dental care, though there are exceptions – especially if dental work relates to a larger, more life-threatening illness and its associated surgery. Medicaid, America’s low-income program, provides universal child dental care, but leaves adult coverage up to the states. The result is a patchwork of shifting eligibility and the runaround typical of any large bureaucracy.

Despite dentistry’s century-plus mainstream acceptance, too often dental care is condemned to second-tier status. That’s true even as a wealth of data confirms that tooth decay remains a pressing national and global challenge. In fact, 92 percent of adults 20 to 64 have had at least one cavity in their lives. In the same age range, adults have an average of 3.28 decayed or missing permanent teeth.

No matter when tooth decay begins or when permanent teeth fall out, edentulism is associated with numerous comorbidities. Difficulty chewing and articulating are two of the most obvious. But a lack of self-esteem could cause some edentulous seniors to withdraw from social and professional situations, augmenting an increasing sense of isolation and even depression. All because preventative oral care wasn’t maintained.

Whether Medicare undergoes a significant overhaul, permitting basic dental care, or dental insurance programs pool risk more effectively and lower per-person costs, the ongoing senior citizen dental dilemma must be solved. As we spend the weekend celebrating all that our older workers have done, lets work together to help give them the dental care they deserve. After 120 Labor Days, they’ve certainly earned it.

Toothpaste with Fluoride a Plus for Pediatric Patients

By: Dr. Arun K. Garg


With a new school year already underway in the South and the academic calendar only days away up North, the American Academy of Pediatrics released new recommendations on when young children should begin brushing their teeth with fluoride toothpaste.

Like a homework assignment for children’s mouths, fluoride-enhanced brushing should begin as soon as deciduous teeth (baby teeth) come into place. Over-the-counter fluoride treatments, however, are not recommended for children younger than six. That’s because of lingering fears younger children will swallow too much of the fluoride mineral – a natural substance that in proper doses strengthens tooth enamel, reducing the risk of cavities. Too much consumed fluoride can lead to a teeth-discoloring condition known as fluorosis.

The findings were published earlier this week online in the journal Pediatrics.

Considering that tooth decay is one of the most common chronic diseases in children – some 17 million children in the U.S. don’t visit the dentist for annual checkups resulting in the loss of more than 51 million school hours – the start of a new school year is an excellent time to lay down some new oral health family rules.

As a dentist with clinics throughout South Florida, it’s disturbing enough to see adults and the elderly with tooth decay and edentulous gaps in their upper and lower jaws. But it’s particularly disturbing when I see patients in their most formative years coming into my office with the same problems. For children, the ability to visit the dentist is beyond their control. And without proper at-home guidance from parents or guardians, their between-visit dental care will suffer too.

The United States, by many measures one of the world’s wealthiest nations, with the highest standards of living, should not be in the throws of such a pediatric oral crisis. Admittedly, national generalizations mask a problem with deep roots. Nearly half of Americans lack dental insurance, including 20 million children. For millions of Americans having to choose between a dental checkup and food on their table, the decision is obvious.

But even if underprivileged children can’t visit the dentist with the frequency clinicians recommend, they can at least be encouraged to do a better job brushing at home. I applaud the AAP for its latest recommendations and hope parents use the new information as a springboard to get their children’s school year off right!

How Long Will the Saline Solution Shortage Leave Dental Patients and Practitioners Parched?

by Implantadmin Posted on

How Long Will the Saline Solution Shortage Leave Dental Patients and Practitioners Parched?
Arun K. Garg, DMD

While not exactly blowing up email inboxes around the country, if you’re a doctor – or a patient – the saline solution shortage is a big deal.
That’s because it’s a mounting problem that’s already a year in the making and has caused some dentists to reschedule their oral surgery appointments or cancel them entirely. Considering that saline solution, also known as .9% sodium chloride injection or “normal saline,” is one of medicine’s most basic supportive therapies and that supportive therapies like fluid replenishment/maintenance are key to many hospital procedures and patients, I’m surprised the saline shortage hasn’t received more attention.
The latest Food and Drug Administration update is a case of good news-bad news. Earlier this fall the FDA announced that B. Braun Medical Inc. of Bethlehem, Pa., a producer of the solution, will taps its German manufacturing site to temporarily augment US supply. That statement follows similar announcements going back nearly a year (January 2014) of other pharmaceutical companies relying on their European manufacturing sites as well, including Spain and Norway.
But the bad news is obvious. The shortage remains and if it continues, it may become more difficult for local saline solution suppliers to meet the needs of hospitals and dental clinics. There’s also the risk of price hikes or price volatility. For while the cost of a single saline solution IV bag (which has about two teaspoons of salt in the aqueous mixture) ranges from 44 cents to around one dollar, transportation costs remain high and stringent sterilization procedures add to the total bill. Throw in a little medical bureaucracy to the mix and six liters of saline solution could end up costing much more.
Actual cost aside, saline solution is foundational to modern medicine. In addition to fluid replenishment and combating dehydration, saline solution has been used for hundreds of years to flush out wounds and irrigate clogged nasal passages. In the dental office, saline solution helps cleanse oral surgical sites and reduces the risk of infection – especially in more complicated (and possibly bloodier) dental implant cases.
But when a product this critical to modern medicine isn’t produced in sufficient quantities for nearly a year (more than a billion units are used in the US annually) you have to ask why. To date, the FDA and others have offered up what sounds more like excuses than reasons. Many cite last winter’s harsh conditions as an early catalyst. Frigid cold and relentless snow meant more injuries and hospital admittance. Meanwhile, staying cooped up in poorly ventilated buildings increases the risk of airborne infection. Under these conditions influenza spreads like wild fire, straining medical resources like saline. Others within the medical profession have faulted the FDA itself, blaming the shortage on overly strict saline solution production guidelines.
As a result of the ongoing shortage –regardless of its ultimate cause – some dentists, like Scott Manhart, DDS, of Billings, Montana, said he’s never experienced a saline shortage in his entire career. Failing to resupply his saline stock (a practice which he does about every six weeks) Dr. Manhart had to reduce the number of oral surgeries performed, hurting his practice’s revenue. I’m sure Dr. Manhart is far from the only dentist experiencing such problems.
While I applaud the latest FDA announcement regarding additional European-manufactured saline supply, it’s time we end this entirely man-made drought. No more excuses. No more belated explanations. As an owner of dental practices in South Florida, I know that the buck stops with me. Sometimes, I’m the only one capable of resolving inter-office challenges. The FDA must take a similarly leadership role and assist the world’s top saline solution providers in getting back up to speed. Something this basic to modern medicine shouldn’t hang in the balance. The world cannot wait another year for this problem to be resolved.

How Knowledge is the Ultimate Career Currency

by Implantadmin Posted on

Continuing Education Continues Demonstrating its Worth

How Knowledge is the Ultimate Career Currency

By: Arun K. Garg, DMD


Earlier this fall Coursera, the increasingly popular free online continuing education company, made news again. This time it wasn’t about new lectures, or the number of enrollees. It was about the company’s expansion into Latin America. Thanks to a partnership with Brazil’s University of Sao Paulo and the State University of Campinas, Coursera is about to start offering Portuguese courses.

Since its founding in 2012 Coursera has garnered mostly positive press underscoring the growing importance of continuing education and the need for adults to brush up on existing skills or learn new ones. Even for recent higher education graduates (five years or less) the pace of workplace change has grown so swift that employers resist the time and expense required for on-the-job training.

But Coursera isn’t the first company to promote the value of continuing education. The medical profession, with its numerous oversight boards and credentialing agencies in the U.S. and abroad, has a decades’ long head start. In fact, the Institute of Medicine, a non-profit affiliated with the National Academy of Sciences defines what it considers continuing education:

“Continuing education is the process by which health professionals keep up to date with the latest knowledge and advances in health care.”

The Enhanced Value of Credentialed Continuing Education

While the above is a perfectly accurate definition I would add an important addendum. For continuing education – or dental health education specifically – to truly maximize its potential, the knowledge acquired must include some type of credentialing accreditation. Just as employers consider the quality of a new employee’s university education as a proxy of future performance, doctors (and their patients) are eager to have their continuing education efforts recognized by reputable sources. Doing so helps doctors take pride in the quality of their education and put patients at ease.

Credentialed, paid-for continuing education is also a way to separate serious learners from those dabbling in the experience – individuals who may not complete a given course. This is perhaps Coursera’s greatest criticism. While the company boasts some 9 million users and over 400 programs, it struggles with a 5 percent course completion rate.

Of course, continuing education is about more than hanging a certificate on the wall or framing a diploma. As with other disciplines, medical knowledge and the technology used to diagnose and treatment plan patients is changing rapidly. Even the way doctors input and share patient data has changed radically in the last few years, evolving from paper charts and manila folders, to integrated software and tablet computers.

Ray Caprio, the former vice president for continuing education at Rutgers University in New Jersey sums up the need for continuing education best. “Every day we know less and less about more and more,” he said in an interview with the New York Times.

Beating Back Brain Drain

Therefore, continuing education super charges your mind and reinvigorates one’s career. After all, remaining relevant and a contributing member to society as we age is of paramount importance. And when we lose that sense of self-worth, especially as men and women in the healing profession, a host of additional challenges manifest including career burnout, declining quality of service (and the risk of lawsuits) and ultimately depression. Learning, it seems, really does keep you young.

Increasingly, a growing body of evidence supports continuing education’s cognitive worth. A recent University of Texas study found that adult memory improved over a three month period when a group of adults 60-90 were exposed to new tasks (like learning digital photography and knitting) that took them out of their knowledge comfort zones. Additionally, a 2011 study published in The Journal of Neuropsychiatry found that reading books and crafting – the non-medical equivalent of a hands-on experience like a live patient program or work with a cadaver – reduced the risk of developing mild cognitive impairment by up to 50%, a condition which affects up to 20% of adults 65 and over. Already nearly half of all U.S. physicians (42 percent) are 55 and over and nearly a quarter (21 percent) are over 65. For this age group, remaining sharp isn’t only a matter of professional satisfaction. It’s about maintaining their quality of life and their patients’ safety.

As a national lecturer on implant dentistry whose dental health education courses are approved by the Academy of General Dentistry, I can personally attest to the fact that credentialed American dental education in a continuing education format, can be a life-changing, brain-boosting experience. The bottom line: Henry Ford was right when he said, “anyone who stops learning is old, whether at twenty or eighty.”

Credentialed continuing education and ongoing dental health education doesn’t come in a pill and it can’t be injected. Thus, dentists who seek new knowledge must take the time necessary to investigate what courses work for them and which locations fit their busy schedules. Ongoing knowledge truly is the ultimate career currency and it’s vital doctors of all ages cash in and sign up for a course at their earliest convenience. Their brains – and their patients – will thank them in the years ahead.