Treating Obstructive Sleep Apnea in the Dental Setting
Obstructive sleep apnea (OSA), which is a partial or complete blockage of a person’s airway, is a serious medical condition estimated to affect more than 20 million people in the United States alone. The importance of effective treatment is based on how it affects the body and overall health and quality of life. OSA not only degrades healthy restful sleep, it leads to a decrease in the oxygen on which the human body is highly dependent to thrive and survive. The role of the dentist is first and foremost to create awareness. Dentists cannot diagnose OSA—that is currently restricted to medical doctors—but they should be able to recognize the signs and symptoms of OSA, educate patients, and assist them in receiving prescribed treatment, which may include a customized mandibular advancement appliance provided by dentists. The intent of this article is to raise awareness of this issue among dentists and describe steps they can take to offer treatment within a private practice.
Pathways to Gingivitis Control with Stabilized Stannous Fluoride: A Novel Discovery
Gingivitis continues to be prevalent, with nine out of ten adult Americans exhibiting symptoms of mild or greater severity. Its occurrence and severity are influenced by multiple factors, including the bacterial composition of plaque biofilm and the host response. Antimicrobial agents are often recommended for gingivitis patients to reduce the quantity of bacteria in the biofilm and/or inhibit bacterial metabolism. New research has shown stannous fluoride—the only fluoride with antimicrobial properties—also improves gingival health by reducing the toxicity of plaque, even in the gingival sulcus, through interference with the host response. Specifically, stannous fluoride binds to the bacterial endotoxins and prevents their interaction with gingival tissue receptors associated with inflammation. This mechanism is important as it supports the use of stabilized stannous fluoride dentifrice not only in patients with existing gingival bleeding and inflammation, but also in patients who may be susceptible to it.
Intraligamentary Injections in Dentistry
Originally billed as peridental injections in the early 1900s, intraligamentary injections (ILIs), also referred to as periodontal ligament injections, were considered unconventional, and widespread utilization did not occur.1 However, increased use of ILIs began in the late 1970s with the introduction of specialized syringes that allowed the operator to more easily administer anesthetic solution in a high pressure location.2 A second resurgence occurred in the early 2000s with the introduction of computer-controlled local anesthetic delivery devices (C-CLAD) that provide a high-level of injection control. Today, ILIs are “perhaps the most universal of the supplemental injections,” and commonly used when inferior alveolar nerve block techniques are unsuccessful or fail to achieve the desired level of anesthesia.3 In addition, ILIs are indicated for single-tooth anesthesia; when low anesthetic dosage is required; widespread anesthesia is contraindicated; or certain systemic health issues are present.3-4 Continued growth of ILI utilization is expected because patients want less soft tissue anesthesia following dental care and dental providers desire less use of the traditional inferior alveolar nerve block for routine restorative procedures. This article will explore and evaluate the current use of intraligamentary injections in dentistry and the technique’s impact on the dental care experience.
Pain-reducing techniques for delivery of dental anesthesia
Dental anxiety is a major factor in the decision to delay dental procedures. “Dental fear is related to poorer oral health outcomes, and this might be explained by the less frequent dental visiting of many fearful people.”1 Fear of dental injections is frequently cited as the main source of dental anxiety. We, as practitioners, can take simple and easily implemented steps to reduce the fear and pain of dental injections. No special equipment or training is required. Following these techniques may result in more profound anesthesia, less pain on injection, and ultimately a reduction in dental anxiety. A calm and comfortable patient will often result in less stress for both patient and provider.
The Chairside Fabrication of a Provisional Crown for a Single-Tooth Implant (2nd edition)
Whether the intent is a delayed or immediate implant restoration, a dental implant may require a provisional crown. This can be accomplished in the laboratory or chairside. When creating a chairside provisional crown, the practitioner has control over the planned soft tissue growth and therefore the health of the implant and periodontium. This course describes and illustrates the steps needed to fabricate a chairside provisional crown for single-tooth implants.
Is There a Place for Essential Oils in Patient Care? Fact vs. Fiction
A “clean living” lifestyle revolution has taken over the country in recent years, with many people limiting or eliminating chemical-based products from their homes and bodies. Replacement of these products with those from nature has become very popular, especially those containing essential oils. Consumers are looking for acceptance and the cooperation of health-care providers to incorporate essential oils and products containing them into their home care and treatment plan options. By educating themselves on these alternative therapies, providers can better understand the needs and concerns of this patient population, which will promote trust and better compliance.
Stop the Violence...Exploring Domestic Violence (2nd edition)
Oral health-care professionals can have an enormous impact on the identification of patients suffering from domestic violence (DV). Physical violence injuries frequently occur on the head and neck, which can be identified through routine extra/intraoral screenings in the dental office. This course will discuss the prevalence, signs, symptoms, and effects of intimate partner violence (IPV) in the United States. IPV is a public health concern for lawmakers with total national costs of 8.3 billion dollars.1 One in three women and men will experience IPV in their lifetimes.2 Dental providers have legal and moral obligations to the public, and as such are an integral component to IPV and providing resources for families. Barriers to clinician intervention and tools to break down those barriers will be presented, thus increasing the clinician’s confidence in implementing intervention protocols for their patients.
Identifying and Managing Dental Impression Problems
Fixed restorative dentistry requires an impression of the teeth and area to be restored for the laboratory to fabricate the desired restorations. Traditional impressions are still utilized the majority of the time to capture the needed information. Selection of the correct viscosity will vary depending on what prosthesis is to be fabricated, which tray is being used and whether the preparations are on natural teeth or implants. Problems can arise during impression taking that can compromise the ability of the lab to fabricate the restoration or affect the accuracy and fit of the finished prosthesis. Identifying impression problems is part of the process, but how to manage these to improve the quality and accuracy of our impressions is critical to fixed prosthetics.
Puff, Not the Magic Dragon…The Cost of America’s Tobacco and Marijuana Abuse (2nd edition)
Tobacco use in America remains the single largest preventable cause of death in the United States, accounting for more than 480,000 (1:5) deaths annually.1,2,3 Even with the increased cost for tobacco products, increased anti-tobacco media campaigns, and smoke-free laws for workplaces and public places, 15% of Americans still continue to smoke cigarettes.3 The newer nicotine products on the US market, such as electronic cigarettes and snus, along with the legalization of marijuana, are systematically changing the dynamics of American culture. Dental professionals are in an ideal position to directly influence nicotine and marijuana use among their patients. This course will present current statistics of nicotine and marijuana use, and also the pharmacokinetics as it relates to addiction, dependence, and cessation.
The Hard and Soft Chairside Denture Reline (2nd edition)
Complete and partial removable dentures can become ill-fitting. This can be due to alveolar ridge resorption, wear and damage to the denture base, among other reasons. Chairside denture relining or repairing broken areas can correct many of these problems. Chairside procedures provide immediate resolution, avoiding the edentulous period of time accompanying laboratory relines. This course will demonstrate the evaluation, treatment planning, and implementation of chairside denture relining in a variety of scenarios.
A Cursory Review of Forensic Dentistry
Forensic Dentistry/Odontology is not an official specialty as defined by the American Dental Association. It is an enhancement of the Dental Profession that uses knowledge, experience and judgement to collaborate with legal systems. Within this field, dental professionals, including, dentists, dental hygienists and dental assistants play vital roles in several areas of the field. They will often be affiliated with coroners, medical examiners and law enforcement agencies in the United States and worldwide. The roles Forensic Dental professionals play involve work in human identification, human abuse, expert witness testimony, bite mark analysis, age estimation and recently contributing to the creation of forensic dental standards.
The Missing Link in Today's Periodontal Therapy Program
The association between periodontal disease and systemic health is becoming increasingly clear and is the benchmark of innovative healthcare delivery. Periodontal disease is the most common chronic inflammatory disease known to mankind. Long running, ongoing chronic disease such as periodontal disease tips the body’s balance towards chronic inflammation.
Are we still treating periodontal disease as an infection when leading authorities have redefined periodontitis as an inflammatory disease? The most current evidence-based clinical practice guideline on the non-surgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts was published in July 2015 in the Journal of the American Dental Association (JADA). Upon evaluation of all evidence, the strongest recommendation involved addressing the inflammatory component of periodontal disease; specifically host response.
Effective risk assessment and risk management are the cornerstone of patient centered treatment planning. Therapeutic interventions focused on bacterial reduction both chairside and self-care comprise the mechanical aspect of periodontal therapy. The host response, often recognized as an essential determinant, is not routinely addressed. Host modulation through a pharmaceutical approach is the missing link in today’s periodontal therapy programs and one of the most predictive components of therapeutic outcome.
Super Pulsed Dental Lasers
There are many methods available to perform minor oral soft tissue surgery and procedures. Those that provide a minimally invasive methodology with rapid healing are ideal and are today’s gold standard in all aspects of dental care. The dental laser is a device that meets these goals and should be considered in the treatment of cases when weighed against other options. This course will provide information on dental lasers, specifically the newer class of super pulsed diode lasers.