blog | NADG

Celebrating Asian Pacific American Heritage Month

North American Dental Group — Mon, 17 May 2021 18:55:24 +0000

At NADG, our company stands united, celebrating our differences and respecting what makes each of us unique. In honor of Asian Pacific American Heritage Month, enjoy getting to know a few members of the NADG family as they share personal insights and what Asian Pacific American Heritage Month means to them.

MEET

Rita Carstens

Office Manager

Sorrento Dental Care

Florida Region 3

Linh Pring

Hygienist

McDonough Center

Family Dentistry

Georgia Region 1

Dr. Jung Lee

NADG Partner & Dentist Stonewalk Family Dentistry Georgia Region 1

What is an interesting hobby or talent that you have that someone might not know?

Rita:

I love boating, fishing, and camping. When I “grow-up” I want to be a camp host and travel the United States. I’d like to live in Colorado during the summer months.

Linh:

During the pandemic, I became a crazy ‘plant mama’.

Dr. Lee:

A new hobby for me – learned how to play piano.

What is the proudest moment in your personal life or career?

Rita:

When I married my best friend and when my children and grandchildren were born. Also, seeing my grown children and spouses accomplishing their career goals.

Linh:

It’s always rewarding when I can put smiles on patient’s faces when they overcome their fear of dentistry and that it’s ok to come to the dentist and not have to worry about pain.

Dr. Lee:

The day I got my dental school acceptance letter, it was a long haul for me.

How has your heritage shaped the person you are today?

Rita:

Rita and her mother.

My Japanese mom raised me to be hard working, dedicated, grateful and appreciate everything that you have. Respect your elders!

Linh:

My heritage has shaped me into the person I am today by being open and understanding of other cultures.

Dr. Lee:

As a 1.5 generation Korean American who immigrated to the U.S. as a child and grew up in the states, my parents never ceased to instill the values of common sense and respecting others. My parents always taught me to treat others as you’d like to be treated, and that hard work always pays off. I try my best to practice that philosophy each day.

Does your family have any traditions that are especially important to you?

Rita:

On New Year’s Day we make and eat mochi which is a Japanese rice cake.

Lihn’s daughters – Chloe (2) and Brooklyn (6)

Linh:

Yes, every year we love to dress up in traditional dresses (ao dai) and pass out red envelopes with money (li xi) on Lunar New Year.

What does Asian Pacific AMERICAN Heritage Month mean to you?

Rita:

Recognizing different heritages that makes this great nation come together as one. It recognizes the contributions and influence of Asian Americans and Pacific Islander Americans to the history, culture and achievements of the United States. My mom came to the United States in 1967 and became a citizen years later so Asian American and Pacific Islander Heritage Month is special to me.

Linh:

I think it’s a great opportunity for people to recognize Asian history and culture.

Dr. Lee:

It’s a time of reflection and gratitude. As a matter of fact, we should all celebrate every ethnic heritage every day of the year, and not just one single month. We should value each of our unique cultural heritage with respect and understanding for others. Mutual respect for one another seems to be lacking lately.

Thanks to these exceptional and generous team members for sharing their personal stories and letting us get to know them a little better.

The post Celebrating Asian Pacific American Heritage Month first appeared on NADG.

COVID-19 Safety: Our Enhanced Safety Measures

North American Dental Group — Wed, 18 Nov 2020 16:52:27 +0000

Hi. I’m Doctor Isbell.

I’d like to share the advanced safety measures that we have put in place to protect your safety and the safety of our team members.

These safety measures go above and beyond the guidelines of the CDC and the American Dental Association and include recommendations from the Professional Dental Alliance, a group of dentists who collaborate to advance patient safety and the quality of care.

Let’s get started…..

Our enhanced safety measures start with advanced Personal Protective Equipment or PPE.

Our practice is adopting PPE standards that exceed the recommendations from the CDC and ADA.

Let me explain what this looks like.

Doctors will wear N95 respirator masks and full arm gowns for aerosol procedures which are those that require the use of high-speed drills or ultrasonic equipment.

Doctors will wear full face shields and other standard PPE for all procedures. Although this enhanced PPE may look intimidating, they are for the safety of our patients and team members.

We will also be providing our patients with PPE which may include eye protection, aprons and surgical masks to wear when you aren’t receiving treatment.

Secondly, we are taking enhanced infection control measures including increasing the frequency of sanitizing all areas of the office and using tools such as rubber dams and high-suction tips. Our team members will also frequently wash their hands.

Our 3^rd key safety measure is comprehensive patient screening including a health questionnaire and temperature checks.

Additionally, we will check temperatures of team members daily.

Lastly, we have made some office visit updates to minimize risk.

They include:

Limiting the # of patients in the office
Implementing a no guest policy. Exceptions will be made for young children and patients who have special needs or require assistance.
Streamlining the check-in and check-out processes by completing as much as possible before or after your visit.
Practicing social distancing by rearranging waiting room seating to be at least 6 ft apart.
Asking patients to wash hands before and after their treatment

The safety of our patients and team members is our #1 priority.

You can have confidence resuming your dental care knowing that we have implemented these enhanced safety measures, many of which go above and beyond provided guidelines.

We’re here to help you smile! See you soon!

The post COVID-19 Safety: Our Enhanced Safety Measures first appeared on NADG.

COVID-19 Safety: What to Expect During Your Visit

North American Dental Group — Wed, 18 Nov 2020 16:51:33 +0000

Hi! I’m Dr. Isbell and I’d like to share some tips about what to expect at your dental appointment as we’ve implemented new measures designed to address your safety and the safety of our team members.

Let’s get started …

When you arrive, our team will complete a comprehensive screening to assess your health. A team member will take your temperature and help you complete a wellness questionnaire.

We are managing our schedule to minimize the total number of people in the office at any one time and asking patients and team members to practice social distancing, maintaining a minimum of six feet distance when possible.

During this time, we have a no guest policy. Anyone who accompanies you will be asked to wait outside the practice. Exceptions will be made for young children and patients who have special needs or require assistance.

We will ask you to wash your hands and rinse your mouth before your treatment.

You will then be provided PPE, or personal protective equipment, including eye protection, an apron and a mask to wear when you aren’t receiving treatment.

You will see that our team will be wearing advanced PPE, which will include N95 masks when necessary and full-face shields. It may seem a little intimidating but know that these advanced measures are for your safety as well as our team members’ safety.

Once your cleaning or treatment is complete, we will ask you to wash your hands again.

Your safety and the safety of our team members is our #1 priority. You can have confidence that our team is prepared to provide a safe environment to provide quality dental care.

We’re here to help you smile! See you soon.

The post COVID-19 Safety: What to Expect During Your Visit first appeared on NADG.

Redefining Dental Safety During COVID-19

North American Dental Group — Wed, 18 Nov 2020 16:46:52 +0000

The post Redefining Dental Safety During COVID-19 first appeared on NADG.

Working in the age of COVID-19: Think like a virus

North American Dental Group — Thu, 12 Nov 2020 17:35:50 +0000

As we return to work and begin to grapple with the new policies, procedures, and—yes—all that added PPE, dental hygienists and the entire dental team must learn to cope within new boundaries that COVID-19 has created for dentistry. To be successful, stay safe, and provide the optimum care for our patients, it is important that dental health-care workers (DHCW) reassess their current way of thinking.

For years, we have rightly based our infection control on what we know to be the most resistant form of life, the bacterial spore.¹ Now we are living in the age of COVID-19. While continuing to follow infection control procedures that are tried and true, we must now add a new dimension to our infection control armamentarium. How can we do this successfully? We must think like a virus! Take what we already know about viruses and add this to our processes.

So what do we know? Well, we understand that viruses are much smaller than bacteria. They are dynamic. They require a susceptible host. They have specificity, and they are infectious.¹ Understanding these simple factors can greatly assist us in combating this new adversary. This just may be our greatest moment! We have the opportunity to begin again. Be innovative by utilizing our knowledge from the past and enhancing it with new protocols to keep our patients and staff better protected.

Mutation

Viruses are dynamic. Viruses are crafty and will mutate to survive.² Therefore, we also need to mutate. Humans are creatures of habit. All too often we get comfortable with what we know, and we fear change. Think like a virus! Due to the minute size of viral microorganisms, our level 3 surgical masks alone are no longer our best line of defense. We recognize that these small particles linger in the aerosols created during our dental procedures. They remain present possibly for up to several hours beyond the time of dental treatment. Therefore, we are beginning to mitigate the virus by adding N95 masks, face shields, long gowns, filtration systems, and more efficient use of the HVE. We have front-desk personnel prescreening patients and taking temperatures at the door. We stagger appointments and work to minimize patient-to-patient contact.³ We are “mutating” to work safely within new boundaries established by COVID-19. If we can “mutate” like a virus, we can better defend ourselves and our patients. Keeping an open mind and consistently striving to adapt and change to new situations will allow DHCWs to thrive successfully in this new and challenging environment. Accept the change. Recognize that change is not an obstacle; it’s a method toward advancement. When we find a new challenge, innovate! Create a way around it.

Specificity

The author in her PPEViruses can only survive in a specific host environment.⁴ Become an unfriendly host! We know that viruses are easy to kill. Soap and water are sufficient. We can mitigate contagion simply by washing our hands and being vigilant with our cleaning and disinfecting within the office. Create an environment that discourages transmission. Think like a virus to make it difficult for the virus to survive. Experiment with new sources of protection such as xylitol nasal sprays and air purification systems.⁵ Be open-minded to investigate new initiatives toward safety.

If we are to think like a virus, then we need specificity. Don’t be afraid to try various types of PPE. There are several types of face shields. Search for one that works well for you. If suitable shields are difficult to obtain right now, don’t be afraid to make your own modifications. Make sure your N95 fits correctly. Take measures to ensure you have the proper PPE to meet your specific needs. One size may not fit all. Every office is different. The location of the practice, size of the office, and the floor plan may impact how guidelines can be properly followed. Create protocols to meet the specific needs of your office and be open to adjusting processes along the way.

Latency

Viruses have an ability to remain dormant within their host cell for up to 25 years or longer before reactivating. A virus will wait years for an opportunity.⁴ If we are to think like a virus, then we need to have patience. We are living and working in difficult times. Don’t allow the stress to distract you from your professional responsibilities. We need to be kind to one another. Understand that all DHCWs are working under tremendous pressure. We need to support one another. Don’t give up. Recognize that although change is difficult, it is necessary. It will make our profession and our world a safer place in the future. Be patient. We will find a new sense of normalcy. Until we reach that point, be proactive, not reactive.

Become infectious!

If we are to think like a virus, then we too must become infectious! Spread dental knowledge. Infect your patients with what you know. Increase oral hygiene instruction. Consider home products that may help patients manage better at home during times when it may be necessary to quarantine. Stress to patients the very real connection between oral health and systemic health. Make patients aware of the importance of maintaining oral health to prevent diseases such as diabetes, heart disease, respiratory illnesses, and other conditions that may increase the risk for COVID-19. Infect your practice with your highly trained skills. Lead by example. Spread your enthusiasm for dental health. Our willingness to implement safety measures within the practice can demonstrate to others the importance of safety. Spread cleanliness. If you are not part of the solution, then you just may be part of the problem. Be infectious!

Many hygienists say they are “hands-on learners.” It doesn’t get any more hands-on than this. We are learning about COVID-19 by living it. Be open to change. Spread enthusiasm for oral health. Be an innovator. If something isn’t working quite right, don’t complain about it. Find a solution. Think like a virus! How can you adjust to your new environment? How will you meet challenges head on? Welcome change, and infect patients with knowledge and safe practices.

Article author: Carolyn Patenaude

Originally published in: DentistryiQ

The post Working in the age of COVID-19: Think like a virus first appeared on NADG.

The Oral Gateway Microbiome: Implications for Systemic Diseases Including COVID-19

North American Dental Group — Mon, 09 Nov 2020 21:16:33 +0000

Today’s Dental News | November 6, 2020

The oral microbiome is considered a gateway to the body that rapidly adjusts to environmental and dietary changes to protect the host and further process the hosts nutritional needs. The host and microbiome evolve in concert, both influencing the development of the other and creating a dependency on each other for survival.

Dysbiosis, or the maladaptation or imbalance of microbiota, of the oral microbiome systematically affects the human host, most seriously impairing the hosts immune response. It also initiates serious pathologic conditions, including hypertension, diabetes, obesity, and cardiovascular disease. Obviously, this list includes the key comorbidity factors associated with COVID-19.

Dental professionals should emphasize home care more strongly, especially after the closure of dental offices on March 16, 2020. This enhanced home care regimen should include the routine use of polyols, such as xylitol and erythritol, to inhibit the oral pathogens associated with oral systemic disease and to possibly hamper the penetration of the SARS-CoV-2 virus into human cells.

Xylitol is used in a number of dental products, including toothpastes, mouth rinses, dental friendly gums, and mints. The Xlear company produces the Spry Dental Defense line of dental products, with the availability of xylitol in many forms.

Review of the Literature

The ideal time to influence the oral microbiome is actually prior to birth. The literature reports positive results with prenatal intervention through supplementing the mother with probiotics and polyols.^1,2Published studies using xylitol that involved the nursing mother and child demonstrate a decrease in the maternal transmission of mutans streptococci.³

The maternal microbiome can also be influenced in numerous ways including diet, exercise, and probiotic supplementation.^4-7Limiting added dietary sugar and the regular addition of polyols can help decrease the prevalence of pathogens before they are passed on to the child.^3,8-10

Erythritol and xylitol are polyols that have been extensively researched and demonstrated to have notable anti-cariogenic and anti-periodontal disease properties.¹¹ In addition, studies demonstrate that xylitol decreases the levels of cariogenic bacteria while having little effect on beneficial bacteria.¹²

Viewing the oral microbiome as a gateway to the body makes sense since the connection between oral health and systemic health is now well established.¹³ Indeed, there is no isolated disease such as periodontal disease. It is simply a symptom of a systemic disease that may best be described as neural arterial gingival simplex (NAGS).¹⁴

Porphyromonas gingivalis has been found to be a causative agent of periodontal disease, arteriosclerosis, and inflammatory Alzheimers.^15-17 Because P gingivalis can be considered the foremost or keystone initiator of periodontal disease, it is reasonable to describe it as a causal agent of NAGS, a single disease with all of its downstream comorbidities.^18,19

P gingivalis has also been called a guerilla for its notable tactics of slowly subverting the hosts defensive mechanisms.²⁰ It does this in three ways:

The hosts immunity is bypassed by the ability of P gingivalis fimbriae to attach to hosts cells, like gingival epithelial cells or endothelial cells, and then invade the cell itself.²¹
P gingivalis has the ability to shift genomes in different strains to specifically target different host cells, making it particularly hostile.²²
The epigenetic influence of P gingivalis allows it to open the tight junctions between cells and to modulate the immune response.²³

All told, P gingivalis undermines a massive host immune response but does not normally overwhelm the host because that would effectively limit the spread of the pathogen. A dead host does not help a pathogen flourish.

With the new concept of P gingivalis infection causing a single disease with multiple symptoms, it is easy to understand the processes involved. The oral component houses the initial infection where the immune system is alerted and subverted, creating an inflammatory environment.

Circulating leukocytes carry P gingivalis and associated lipopolysaccharides, which affect the endothelial cells of arteries, and pass into the neural component. This eventually diminishes the cognitive ability of the host, resulting in reduced oral hygiene and further spreading of the pathogen among all contacts.²⁴

Studies have shown xylitol clearly inhibits the formation of mixed species biofilms, which include P gingivalis in vitro.¹¹Also, evidence shows erythritol suppresses the maturation of gingivitis biofilms and contributes to a more healthy oral ecosystem.²⁵

By inhibiting P gingivalis with xylitol and erythritol, the innate and adaptive immune response of the human host should be more robust.^26,27Also, the possibility of salivary spread of oral pathogens should be reduced, preventing onset of the acute respiratory distress syndrome.

As a result, oral health should be considered an essential service, and never again should dentistry be asked to close its offices and clinics.

Recent Research

Newly published research has demonstrated the antiviral properties of polyols. Xylitol has been reported to reduce the severity of viral infections. The effect of dietary xylitol on hRSV infection was investigated in a mouse model.²⁸ The mice received xylitol for 14?days prior to virus exposure and for a further three?days after virus exposure.

The mice receiving xylitol had significantly reduced viral lung titers than the controls receiving phosphate-buffered saline (PBS). Fewer CD3+ and CD3+CD8+ lymphocytes, whose numbers are indicative of inflammatory status, were recruited in the mice receiving xylitol. These results demonstrate improved hRSV infection outcomes and reduced inflammation-associated immune responses to hRSV infection with dietary xylitol.

The same researchers previously reported positive effects of xylitol on mice with influenza A virus infection (H1N1) also with a decrease in recruitment of inflammatory lymphocytes.²⁹ It has been reported that a decrease in CD3+CD8+ lymphocytes is a predictor of mortality for COVID-19 patients. The anti-inflammatory and antiviral properties of D-xylose/xylitol in respiratory conditions are subject of a patent application (number WO1999048361A1) filed in 1998 in the United States.³⁰ Subsequently, xylitol is a main active ingredient in nasal spray products, such as Xlear Sinus Care.

For another study, the BioCryo Laboratory at Northwestern University received Vero 76 cells that were exposed to SARS-CoV-2 virus for 15- and 40-minute time intervals in a media with either xylitol or grape fruit seed extract added. The samples were prepared at the Institute for antiviral research at Utah State University by Dr. Jonna Westover.

STEM images obtained at high magnification by Dr. Reiner Bleher demonstrated the SARS-CoV-2 virus contained in inclusion bodies outside the cell wall. A very recently published article correlated d-xylose and xylitol to the severity and morbidity related factors in COVID-19. ³¹

D-xylose is the initiating element for sulfated glycosaminoglycans (GAG) that attach to the core protein. It can be derived from xylitol by d-xylose reductase action replenishing this carbohydrate, which is targeted by the SARS-CoV-2 virus. If the virus attaches to the d-xylose position on the GAG, such as heparin sulfate, the virus can then contact the ACE2 receptor.

Additionally, xylitol serves as a decoy target for the virus, preventing it from successfully reaching the ACE2 receptor. Further research into the mechanism that xylitol initiates with cells to prevent viral penetration and replication is essential and should be prioritized.

Conclusion

Xylitol has a long history of being safe and beneficial in preventing bacterial pathogen infections. It is considered a prebiotic due to its positive effect on the microbiome, reducing pathogenic proliferation. The use of xylitol in oral health to prevent dental caries and periodontal disease has been well documented as safe and effective.

Xylitol products should be included in all dental preventive programs, as it works synergistically with fluoride. Plus, it improves the patients systemic health.

Current research indicates that xylitol may also be useful in curbing viral respiratory infections, including COVID-19, by both reducing the viral load and by an anti-penetration of the cell wall mechanism that has very recently been hypothesized.³¹ Therefore, the use of xylitol nasal and oral rinses may prove valuable in reducing the rapid spread of viral pandemics.

With the current surge in new cases, and a vaccine still not available, time is of short supply and the need for validating clinical research using safe and available xylitol is crucial.

References

Baldassarre ME, Palladino V, Amoruso A, et al. Rationale of probiotic supplementation during pregnancy and neonatal period. Nutrients. 2018;10:1693.
Luoto R, Laitinen K, Nermes M, et al. Impact of maternal probiotic-supplemented dietary counselling on pregnancy outcome and prenatal and postnatal growth: a double-blind, placebo-controlled study. Br J Nutr. 2010;103:1792-1799.
Söderling E, Isokangas P, Pienihäkkinen K, et al. Influence of maternal xylitol consumption on mother-child transmission of mutans streptococci: 6-year follow-up. Caries Res. 2001;35:173-177.
Nørrisgaard PE, Haubek D, Kühnisch J, et al. Association of high-dose vitamin D supplementation during pregnancy with the risk of enamel defects in offspring: a 6-year follow-up of a randomized clinical trial. JAMA Pediatr. 2019;173:924-930.
Ley RE, Turnbaugh PJ, Klein S, et al. Microbial ecology: human gut microbes associated with obesity. Nature. 2006;444:1022-1023.
Brown K, DeCoffe D, Molcan E, et al. Diet-induced dysbiosis of the intestinal microbiota and the effects on immunity and disease. Nutrients. 2012;4:1095-1119.
Clarke SF, Murphy EF, OSullivan O, et al. Exercise and associated dietary extremes impact on gut microbial diversity. Gut. 2014;63:1913-1920.
Caufield PW, Cutter GR, Dasanayake AP. Initial acquisition of mutans streptococci by infants: evidence for a discrete window of infectivity. J Dent Res. 1993;72:37-45.
Isokangas P, Söderling E, Pienihäkkinen K, et al. Occurrence of dental decay in children after maternal consumption of xylitol chewing gum, a follow-up from 0 to 5 years of age. J Dent Res. 2000;79:1885-1889.
Loesche WJ, Grossman NS, Earnest R, et al. The effect of chewing xylitol gum on the plaque and saliva levels of Streptococcus mutans. J Am Dent Assoc. 1984;108:587-592.
Janakiram C, Deepan Kumar CV, Joseph J. Xylitol in preventing dental caries: a systematic review and meta-analyses. J Nat Sci Biol Med. 2017;8:16-21.
Bahador A, Lesan S, Kashi N. Effect of xylitol on cariogenic and beneficial oral streptococci: a randomized, double-blind crossover trial. Iran J Microbiol. 2012;4:75-81.
Kim J, Amar S. Periodontal disease and systemic conditions: a bidirectional relationship. Odontology. 2006;94:10-21.
Dominy SS, Lynch C, Ermini F, et al. Porphyromonas gingivalis in Alzheimers disease brains: evidence for disease causation and treatment with small-molecule inhibitors. Sci Adv. 2019;5:eaau3333.
Kim HJ, Cha GS, Kim HJ, et al. Porphyromonas gingivalis accelerates atherosclerosis through oxidation of high-density lipoprotein. J Periodontal Implant Sci. 2018;48:60-68.
Bale BF, Doneen AL, Vigerust DJ. High-risk periodontal pathogens contribute to the pathogenesis of atherosclerosis. Postgrad Med J. 2017;93:215-220.
Hussain M, Stover CM, Dupont A. P. gingivalis in periodontal disease and atherosclerosisscenes of action for antimicrobial peptides and complement. Front Immunol. 2015;6:45.
Cannon ML, Peldyak JN. The prevention and treatment of neural arterial gingival simplex. Dental Research and Management. 2019;3:32-37.
Hajishengallis G, Darveau RP, Curtis MA. The keystone-pathogen hypothesis. Nat Rev Microbiol. 2012;10:717-725.
Hajishengallis G. Porphyromonas gingivalis-host interactions: open war or intelligent guerilla tactics? Microbes Infect. 2009;11(6-7):637-645.
Moreno S, Contreras A. Functional differences of Porphyromonas gingivalis Fimbriae in determining periodontal disease pathogenesis: a literature review. Colomb Med (Cali). 2013;44:48-56.
Tribble GD, Kerr JE, Wang BY. Genetic diversity in the oral pathogen Porphyromonas gingivalis: molecular mechanisms and biological consequences. Future Microbiol. 2013;8:607-620.
Guo W, Wang P, Liu ZH, et al. Analysis of differential expression of tight junction proteins in cultured oral epithelial cells altered by Porphyromonas gingivalis, Porphyromonas gingivalis lipopolysaccharide, and extracellular adenosine triphosphate. Int J Oral Sci. 2018;10:e8.
Hajishengallis G. Periodontitis: from microbial immune subversion to systemic inflammation. Nat Rev Immunol. 2015;15:30-44.
Sánchez MC, Romero-Lastra P, Ribeiro-Vidal H, et al. Comparative gene expression analysis of planktonic Porphyromonas gingivalis ATCC 33277 in the presence of a growing biofilm versus planktonic cells. BMC Microbiol. 2019;19:58.
Ferreira AS, Silva-Paes-Leme AF, Raposo NRB, et al. By passing microbial resistance: xylitol controls microorganisms growth by means of its anti-adherence property. Curr Pharm Biotechnol. 2015;16:35-42.
Ghezelbash GR, Nahvi I, Rabbani M. Comparative inhibitory effect of xylitol and erythritol on the growth and biofilm formation of oral Streptococci. African Journal of Microbiology Research. 2012;6:4404-4408.
Xu ML, Wi GR, Kim HJ, et al. Ameliorating effect of dietary xylitol on human respiratory syncytial virus (hRSV) infection. Biol Pharm Bull. 2016;39:540-546.
Yin SY, Kim HJ, Kim HJ. Protective effect of dietary xylitol on influenza A virus infection. PLoS One. 2014;9:e84633.
Jones AH, inventor. Xylitol compositions for treating upper respiratory conditions. World Intellectual Property Organization. International Publication Number: WO 99/48361. September 30, 1999.
Cheudjeu A. Correlation of D-xylose with severity and morbidity-related factors of COVID-19 and possible therapeutic use of D-xylose and antibiotics for COVID-19. Life sciences. 2020; 260, 118335. Advance online publication. https://doi.org/10.1016/j.lfs.2020.118335.

Dr. Cannon is expert in preventive pediatric dentistry, especially in the use of xylitol. He received his DDS at the University of Nebraska and then attended Northwestern University for his masters degree in pediatric dentistry. He completed his residency at Childrens Memorial Hospital and received Diplomate status from the American Board of Pediatric Dentistry. He later served as a member of the faculty at the Northwestern University Dental School and is now a professor with the Feinberg School of Medicine Department of Otolaryngology Division of Dentistry. He is the research coordinator for the Pediatric Dental Program at the Ann and Robert Lurie Childrens Hospital of Chicago as well. He is a past president of the Illinois Society of Dentistry for Children and a member of the International Association of Pediatric Dentistry. He has lectured both nationally and internationally. He is the senior partner of Associated Dental Specialists of Long Grove, Illinois, founding the practice in 1981. He has been involved in microbiome and hologenome research. And, he is a consultant for Alexion Pharmaceuticals, Bisco, Garrison Dental, GC, Probiora, and Xlear as well.

The post The Oral Gateway Microbiome: Implications for Systemic Diseases Including COVID-19 first appeared on NADG.

Ambassadors: Ways To Market A Dental Practice Internally And Externally

North American Dental Group — Mon, 02 Nov 2020 19:49:51 +0000

Today’s RDH | October 21, 2020

Image is everything, and everyone wants to look and feel their best. People are accomplishing this through personal trainers, expensive diets, and even seeking out plastic surgery. However, many people avoid both necessary and elective treatment when it comes to dentistry because of fear, anxiety, previous bad experiences, costs, and impatience with the process. They simply do not trust the clinician.

Dental professionals need to properly educate patients and the community about the importance of a healthy mouth and its effects on the body. We have to help patients understand what treatment they need, why they need it, and make patients feel comfortable during the treatment process to help them look and feel their best.

Hygienist to Patient Relationship

The hygienist to patient relationship is very important to the success of the patients health and dental practice success. Hygienists see patients more frequently and for longer appointment times than the dentist. Whether they are seen for a routine six-month recall visit or are on a more frequent three-month periodontal maintenance program, the patient develops a rapport with the hygienist.

During these appointment times, the hygienist gets to know and understand the patient better, resulting in a more profound patient-clinician relationship. Patients feel more comfortable with the hygienist, and a relationship built on trust is created. How many times has a patient asked the hygienist after a doctors exam, Do I really need that restoration? Is the doctors work any good? What do you think I should do first?

These questions are not a bad problem to have. Actually, it is a good thing because the patient respects the hygienists opinions. This allows the hygienist the opportunity to effectively communicate with patients about the doctors credentials and achievements such as, for example:

Participating in free dental community service events
Published articles
Involved with local or national dental boards and associations
Extensive training on a particular restoration or form of treatment

It also shows the patient that the hygienist is a supportive team player and on the same page as the dentist for the recommended treatment.

Understanding and adapting to your patients verbal and nonverbal communication styles is going to have a great impact on your current and future treatment outcomes. Well-respected author and speaker Steven R. Covey once stated in The 7 Habits of Highly Effective People, When the trust account is high, communication is easy, instant, and effective.

When Printed Materials Are Not Enough

Every dental team member supports the doctors treatment recommendations and provides education via treatment brochures and before-and-after photos. Photos can help market and show the quality of work you have completed over time. However, seeing the work up close and personal has a greater impact on a patients decision to move forward with treatment.

One particular underused marketing strategy is Promoting Your Staffs Smiles. The dental staffs smiles add value to the practice. Ultimately, smiles are the image of the dentists business. As a business owner, a dentist should want his or her team to have good oral health. How can a dentist ensure that happens? The doctor does the dental work on staff members. When staff feels appreciated and valued by their employer, their loyalty to the practice increases.

I have worked in both private and group dentistry organizations where the philosophies are totally different regarding patient care. However, regardless of the setting I was in, it was important for me to treat the person and not just the disease. I learned that taking the time to listen to the patient made them feel respected and part of the treatment plan process.

For example, a woman in her early 30s presented to our office for a cleaning and complained of pain on her lower right posterior teeth. We took the necessary diagnostic radiographs and intraoral pictures. During that time, I learned that the patient had not seen a dentist since adolescence when she had a bad experience. I acknowledged her fear and explained to her that it was not an uncommon topic of discussion in our practice, and we have been able to improve patients perceptions and ease their anxiety due to the expertise and overall office quality of care.

Next, I proceeded to discuss my findings and alert her to the possibility of a crown recommendation. Since the patient had already picked up several restoration brochures in the lobby, she seemed confused and alarmed by the picture diagrams. When the doctor entered the operatory, I provided the patients background details and updated him on the patients concerns regarding a possible crown restoration.

After the doctor reviewed the diagnostics and completed the exam, he agreed with the need for a crown and explained the process to the patient. She still seemed apprehensive afterward. To help ease the patient and help with the conversation, since I was so confident in my doctors work, I proceeded to show off the new crown he had just placed for me a few months prior.

You could immediately see the patient become more comfortable, and she decided to schedule the crown prep procedure. After all the time we spent speaking with her about the crown, the funny thing was that she was more impressed with how white my teeth were. So she wanted to get that done too.

Due to our teamwork approach and patient interaction level, the patient complied with the treatment recommendations and completed the teeth whitening she really wanted within the month. That experience was a true win-win situation for both the practice and the patient. During the seven years I practiced in that office, I am happy to say that we developed a great hygienist-patient relationship over that time.

Dentists schedules are driven by hygiene patients. The more we continue to advocate for each other, the more increased treatment acceptance, better patient retention, more patient referrals, and an increase in practice profitability.

Ambassadors

Dentists should use their hygienists and other staff members as a live walking and talking photo album. They are the ambassadors of the practice. Whether inside or outside, when a staff member can proudly show off the treatment their dentist has done for them, it will greatly benefit the entire practice.

Inside the practice, they can share their personal treatment experience with patients, and the dentists can answer any questions or concerns the patient may have. Utilizing this new team approach will ease patient fear, increase their confidence in your practice, and ultimately lead to the recommended treatment acceptance.

Outside the practice, people will notice how nice your teeth are and inquire about it. This can be a great referral source and an additional way to market your practice.

The post Ambassadors: Ways To Market A Dental Practice Internally And Externally first appeared on NADG.

COVID-19: Can Dentistry Be Part of the Solution?

North American Dental Group — Mon, 02 Nov 2020 19:47:25 +0000

Dental Products Report | October 14, 2020

When the American Dental Association asked dental offices to temporarily close, except for emergencies, on March 16, 2020, little was known about the relationship between oral hygiene and the severity of COVID-19 infections. Since that time, new research is showing that poor oral hygiene can directly affect how patients are able to fight off the disease. The short-term lack of access to preventative dental care, especially in minority populations, now underscores the risk factors that can accompany poor oral hygiene, including diabetes, hypertension, obesity and cardiovascular disease.

A recent article published in the British Dental Journal in June 2020 reflects that relationship in a very relevant and urgent way. It concludes that poor oral hygiene may be connected to serious COVID-19 complications due to high levels of harmful oral bacteria.¹The authors explored the connection between high bacterial load in the mouth and post-viral complications, and how improving oral health may reduce the risk of complications from COVID-19. They concluded that the development, severity, and risk of complications following a COVID-19 infection depend on a number of host and viral infections.

The four main co-morbidities related to COVID-19 are also associated with altered oral biofilms and periodontal disease. In addition, an article published in Dental Research and Management detailed the close relationship between a number of systemic conditions that are all most likely initiated by one single oral pathogen strain.² The prevention of these prevalent systemic illnesses needs to be started at the earliest possible point, with intervention starting with good Oral Maternal-Fetal health.³

COVID-19 affects people in different ways, with patients exhibiting a range of symptoms and severity. So why do some people suffer more severely? Its become clear that bacterial superinfections are common in patients suffering from a severe case of COVID-19. Over 80% of COVID-19 patients in ICUs exhibited an exceptionally high bacterial load, with more than 50% of deaths exhibiting bacterial superinfections.

While COVID-19 has a viral origin, its suspected that in severe cases, complications such as pneumonia and acute respiratory distress (ARDS) may be caused by bacterial superinfections. And those bacteria may originate in the mouth. In addition, SAR-CoV-2 has a significant salivary level, providing for testing with salivary sampling. The oral cavity, via saliva and plaque, is strongly felt to be significant in the modes of transmission with COVID-19.

How bacteria travel from the mouth to the lungs

The oral microbiome is considered a gateway microbiome. Our human-specific oral microbial species have all evolved with the host to help protect the host and to also process the nutritional intake of the host. The oral bacteria, yeasts, viruses, archaea number in the thousands of strains, and rapidly adapt to dietary influences, allowing for homo sapiens to change and survive. Significant dietary changes in our developmental history, with the massive increase in carbohydrates, encouraged the expansion of pathogenic strains that injure the human host, even suppressing the hosts immune responses. Maintenance of a healthy oral microbiome is therefore essential.

Micro-organisms that colonize the mouth propagate via the saliva. The pathogenic bacteria or viruses within the saliva can then be aspirated into the lower respiratory tract and cause or aggravate an infection. Periodontitis and decay are the two most common oral diseases associated with an imbalance of pathological bacteria in the mouth. This imbalance is a Dysbiosis, whereas the increase in pathogens follows the decrease in competing probiotic bacteria and the strain shifting of commensals into co-pathogens. This illustration from the British Dental Journal shows how that works.

Image by British Dental Journal

Oral health probiotics

Oral care probiotics seem to be relatively new to the dental industry and are often confused with traditional probiotics, which are designed to improve gut health. However, oral-care probiotic research is more than 35 years old and the best products have been around for more than 10 years. There are scientific distinctions that can help dentists prescribe and consumers choose the best product for their patients. Those that support throat health only provide minimal support to the health of teeth and gums, while those oral-care probiotics that use gum and tooth specific strains provide the best overall support and benefits to both periodontal and tooth health and have the longest research behind them.

Generally speaking, oral care probiotics are live bacteria that are identical to the beneficial microorganisms found naturally in the oral biome. The addition of oral care probiotics to an oral care regimen can restore the natural balance of the oral biome by repopulating beneficial bacteria, which can be depleted by diet, stress, medication, illness, or other factors.

Specifically, only oral care probiotics that include bacteria Streptococcus oralis KJ3, Streptococcus uberis KJ2, and Streptococcus rattus H145, support teeth and gums, the inherent source of these strains. These products can be seen as a first line defense against pathogens coming into the mouth. While all patients will see benefits, for those with periodontal disease, caries, and other oral care concerns, oral care probiotics are an effective adjunct to extend treatment benefits.

One key takeaway from this article is that, with COVID-19 and other viral diseases, inadequate oral hygiene can increase the risk of inter-bacterial exchanges between the lungs and the mouth, increasing the risk of respiratory infections and potentially post-viral bacterial complications.⁴

Good oral hygiene has been recognized as a means to prevent airway infections in patients, especially in those over the age of 70. In fact, studies show that improved oral care can significantly reduce the incidence of ventilator-associated pneumonia in ICU patients.

The other key takeaway from the articles authors is that improved oral hygiene may play a part in reducing the risk of complications. The authors write, We recommend that oral hygiene be maintained, if not improved, during a SARS-CoV-2 infection in order to reduce the bacterial load in the mouth and the potential risk of a bacterial superinfection.¹

In addition to diligent home care, adding oral care probiotics to the daily regime can also help reduce harmful bacteria in the mouth. According to my recent peer-reviewed study in the Journal of Clinical Pediatric Dentistry, (oral care) probiotics significantly reduced the caries rate of high caries prone pediatric subjects without any reported side effects.⁵ The article continues, Indeed, probiotics simply reduce the pathogens that modern, high sugar diets, feed. While the study was conducted on children over a three-year time period, the findings can be extrapolated to adults, who may also benefit from taking oral care probiotics to reduce the bacterial load in the mouth.

Preventive care continues to be a problem during the pandemic, as patients may be fearful of returning to their dentists. Home care has never been so important. Our patient protocol includes testing, treating, and repopulating the beneficial bacteria in the mouth, says Lora Hooper, BS, RDH, FDA Dental Hygiene, part of the oral care team at the Heart Attack and Stroke Prevention Center of Central Ohio. I have seen a dramatic improvement in oral health in patients using oral care probiotics. The practice is run jointly by a dentist and cardiologist, who unify oral and systemic care for all patients.

As the search for COVID-19 treatments and vaccines continues, dentists and hygienists can help patients stay healthy with good communication and education. Oral health is a key factor in helping fight the pandemic. Were all in this together.

The post COVID-19: Can Dentistry Be Part of the Solution? first appeared on NADG.

Hygienists On The Frontline: How We Are Navigating COVID-19

North American Dental Group — Mon, 02 Nov 2020 19:39:23 +0000

Todays Dental News | October 27, 2020

There is no question that the COVID-19 pandemic has dramatically changed the dental industry. We are seeing the biggest shift in how we operate and care for patients in decades. Our personal protective equipment (PPE) looks different. Our workflow has changed. Our appointments include new patient risk assessments and procedures.

Its only natural that dental hygienists would have some trepidation about returning to the frontlines of their practices. To be honest, we did. Its no secret that hygienists face a higher risk of exposure to COVID-19 because of our close contact with patients and the generation of aerosols during treatment. In fact, US Department of Labor data indicates hygienists are at greater risk than dental assistants, dentists, and respiratory therapists.

So, how are we continuing to manage the increased risk on the frontlines and make our hygienists feel safe during these uncertain times? At North American Dental Group (NADG), I think there are three critical steps we took to help us better navigate this pandemic.

Giving Hygienists a Voice and Listening

First, NADG gave hygienists a seat at the table and ensured we had a voice in creating the safety measures and guidelines that are now in place at all our affiliated practices. So often in our industry, hygienists do not get heard.

The relationship between the doctor and dental hygienists should be one in which they work together as partners. From the beginning of the COVID-19 outbreak, hygienists had a seat on NADGs Dental Advisory Board, which is led by the organizations dentist-led Professional Dental Alliance. We were able to express our concerns and discuss things that could impact our company and our care.

For example, when hygienists expressed concern about how they were going to be able to complete all the additional safety procedures and stay on schedule, we were comfortably assured that safety was the top priority. As a result, we extended appointment times so our hygienists could get comfortable with the new protocols.

Making Safety the Top Priority

Second, NADG has been very deliberate in creating safety protocols to keep our team members and patients safe. That thoughtfulness and attention to identifying best practices has tremendously helped ease any fear or anxiety our hygienists had.

When the COVID-19 pandemic first began, NADG developed and integrated an innovative Essential-Treatment Only model that helped team members and dentists in its practices make decisions about which procedures to postpone to a future date and which to maintain on schedule. Providing clear guidelines on essential and non-essential care empowered us to make educated, thoughtful decisions that are in the best interest of our patients.

NADGs Dental Advisory Board developed advanced infection control procedures and protocols to help dental practices ensure the health and safety of their team members and patients. NADG also developed guides and tools to help dentists across the industry treat patients safely during the pandemic.

In addition, the organization also conducted briefings for other dental service organizations (DSO) and dental industry leaders in the United States and across the globe to share its perspective on how to operate responsibly in this unprecedented environment, including relevant regulatory/legislative information, employee relations strategies, patient engagement approaches, office operational plans, and more.

NADG-affiliated dental practices have also implemented additional safety procedures, including the use of company-issued N95 or KN95 masks for all staff, screening patients prior to their dental appointments, and sanitizing equipment and evaluation rooms after each patient visit.

All these added layers of precaution helped reassure us that we were returning to the safest environment possible.

Communication, Engagement, and Training

Third, NADG stayed connected to its dental practices and teams, even when their offices were closed. They regularly communicated with us and scheduled education and training opportunities to keep us engaged, learning, and energized.

We had weekly calls on Thursday that included state-of-the-union updates. Throughout the pandemic, NADG leaders have been very transparent about what was happening in the business. That was a great comfort to many of us because we had a clear picture of NADGs vision for reopening our practices and we saw that they generally cared about every one of us.

To help make the most of our time away from our practices, NADG held webinars for CE credits and knowledge. During the time our practices were closed, we held 64 webinars and offered 72 continuing education credits. In all, nearly 5,400 team members attended.

There was never a moment during the weeks our practices were closed that team members did not have an accurate picture of the business. They also saw firsthand NADGs commitment to protecting its employees and patients and minimizing the risk of exposure. As a result, when we finally did return to work, we knew the safety processes and procedures and had received extensive training, which made it easier to transition back to seeing patients.

With COVID-19 cases rising again in many states, we dont know what will happen next with the pandemic. But what we do know is that hygienists at NADG-affiliated dental practices and beyond are here on the frontlines providing our patients with the essential dental care they need in the safest matter possible. And, we will continue to do so as the world navigates these uncertain times.

Ms. Louthain is director of clinical operations at North American Dental Group, a leading US DSO that supports 432 doctors at more than 230 dental practices in 15 states.

Ms. Casada is regional director of clinical operations at NADG.

The post Hygienists On The Frontline: How We Are Navigating COVID-19 first appeared on NADG.

5 Reasons to Visit An Emergency Dentist

North American Dental Group — Sun, 03 May 2020 15:49:47 +0000

Dental emergencies can be scary, painful, and confusing, and in some cases, it can be hard to decide if you need to make an emergency appointment. This brief guide is designed to help you decide whether or not you need to contact an emergency dentists. If you are experiencing any of the following situations, you should call the dentist as soon as possible.

Knocked Out Tooth

Sports injuries, car accidents, and similar types of trauma can cause one of your teeth to get knocked out. If this happens, rinse the tooth and try to replace it in the socket. If that is not possible, place the tooth in a small container of water or saliva and contact the emergency dentist for an appointment immediately. When handling the tooth, try to only touch the crown or top of the tooth. Handling the root can lead to damage.

Broken or Chipped Tooth

A broken or chipped tooth is not as serious as a knocked out tooth, but depending on the extent of the damage, you should still contact an emergency dentist. Again, if you place the chipped off piece in water or saliva, the dentist may be able to reattach it to your tooth. When you call your dentist, they will let you know if you need to come in immediately or if you can wait until the next day.

Lacerations or Cuts

When you have received trauma to the mouth, you may experience cuts or lacerations in the soft tissues of your mouth. An emergency dentist can help by stitching wounds as needed, prescribing antibiotics to help your body fight infections, and examining your mouth for additional damage. You can contact an emergency dentist, but you may also go directly to a hospital emergency room.

Dental Abscess

A dental abscess is a pocket of infection around your tooth. Signs you have an infection include swelling, pus, rotten odors, and a fever. You need to contact an emergency dentist as soon as possible if this is happening. Do not ignore these signals. The infection from an abscessed tooth can spread to the rest of your body and cause serious damage. To control the pain, take an over the counter pain reliever and place an ice pack on that side of your face.

Toothache

In some cases, you can get intense toothaches that are not related to a dental abscess. Instead, the pain stems from a cavity that is not infected yet. This situation is not as dire as an abscessed tooth, but if ignored, the tooth may become abscessed. You do not necessarily need to see a dentist immediately for a toothache, but you should contact the emergency dentist, talk with them about your pain levels, and make an appointment for the next morning or as soon as possible the following day.

If you are experiencing jaw pain, swollen gums, or any other dental issues, make sure to contact your dentist. They can let you know if you should schedule a regular appointment or contact an emergency dentist.

Article author: Professional Dental Alliance

Originally published in: Healthy Smile Connections

The post 5 Reasons to Visit An Emergency Dentist first appeared on NADG.