Dr. Larry J. Sangrik, D.D.S. Printer Friendly Version

Medical Emergencies in Dentistry - We're All Small Town Dentists Now
Larry J. Sangrik, D.D.S.
Director of Medical Emergency Preparedness
Raven Maria Blanco Foundation, Inc.

Over 32 years ago I returned to my birthplace, a small town in northeast Ohio, and established a general dental practice. Practicing in an environment where “everybody knows everybody” has its quirks. One lesson that I learned early on was the importance of a reputation. Relieve the pain of an abscess with a root canal and you are a hero. Break a root tip on a third molar extraction and spend time retrieving it, well, everyone knows that too.

Much has changed during the course of my career, both within dentistry and beyond it.  Everyone acknowledges that dentistry offers more complex treatment alternatives than it did a generation ago. Additionally, attitudes about dental marketing are different. The internet now exists, and social media is prevalent. Dental patients are less healthy.

Patients are less healthy? Yes. Just as I am grayer than I was when I started practicing, so are my patients. The 2010 U.S. Census clearly documents that mean and median ages have increased since the last census and will continue to do so. The earliest members of the baby boomer generation recently filed for Social Security.

Secondly, diseases of an aging population: obesity, coronary artery disease and type-II diabetes, have now reached epidemic proportions.

Finally, the successes of medicine mean that many people with serious medical conditions now enjoy a high quality of life, including pursuing oral health through routine dental care. Many individuals such as these were either home-bound (or therefore not part of the dental population) or dead, only a generation ago. The combination of offering more complex surgical and anesthesia-related services within dentistry coupled with a more medically-complex patient base means the dental profession needs to be “extra vigilant” about the need to prepare their office for a medical emergency.

Sadly, few dentists comprehensively prepare their office for a crisis. In part, until recently, it has been difficult to know if your office was truly prepared to face a medical event. In 2007, an 8 year-old Virginia girl was taken by her father to the dentist for a routine check-up and cleaning. When respiratory arrest unexpectedly occurred, the dentist was unable to resuscitate her successfully. Sadly, events like this are not rare.  Six dental office deaths occurred nationally in the 14 month period leading up to the writing of this article. How many other, non-fatal emergencies occurred has not been researched and is not known.

To honor her life, the parents and family of this child established a non-profit foundation which bears her name, the Raven Maria Blanco Foundation, Inc. (RMBF). Central to the mission of RMBF is the goal of calling the dental profession’s attention to the need to prepare for medical emergencies in dental offices.  

Beyond merely calling attention to the problem, RMBF partnered with the Institute of Medical Emergency Preparedness and adopted The Six Links of Survival™, a set of timeless principals emphasizing how to prepare a dental office for a medical emergency.  These principals include:  dentist training, staff training, holding mock drills, having a written emergency plan, stocking the appropriate medications and maintaining the necessary equipment.

No one can debate that preparing for a medical emergency is the ethical thing for dentists to do. Statistically, it is the right scientific thing to do. However, it is now also the right business thing to do.

The advent of social media has made all of us “small-town” dentists. Your reputation is far more public and easily accessible to a wider audience than it ever was. When I started in practice, a difficult extraction might be known throughout my small town while my dental school classmates could “bury” that event in a large metropolitan patient base. No more. Now all of us face the fact that events within our practices can (and are) being shared by our patients.

How well would your office be able to stand up to the public scrutiny of a major medical emergency occurring during treatment?  Would your office be seen as one that was a highly skilled, well-prepared healthcare facility?  Or would it be viewed as “something less?” The days have long past when spending time, money and energy in medical emergency preparedness were a wasted investment.  Today, they are a business necessity.

Larry J. Sangrik, DDS is the Director of Medical Emergency Preparedness for RMBF. In addition to maintaining a full-time general dental practice in Chardon, Ohio, he lectures on medical emergencies and other subjects. 

He has been a featured speaker at the ADA, the Hinman Meeting, the Chicago Midwinter Meeting and the Yankee Dental Congress. He will be returning to the ADA Annual Session this autumn. He may be contacted at (440) 286-7138.

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Dr. Ryan Swain Printer Friendly Version

The Disease of "Crooked Teeth"
By Ryan Swain DMD

There’s a common myth in the dental world that says cosmetic dental procedures are the first ones to decline in a recession. The opposite is actually true. As dental professionals, we know that the following topics of conversation become more difficult when money is tight:

1. “This molar has some cracks in it and really should have a crown.”
2. “This tooth has a spot on the x-ray and the root canal needs to be re-treated.”
3. “Your wisdom teeth are impacted and really should be taken out.”

We’ve all seen the blank stares and heard the giant sighs that sometimes happen after we inform patients about these dental needs. The tough part for us is that as the economy continues to falter, our ability to influence and persuade people to take action with their teeth is increasingly challenged as people tend to hold onto their dollars with a firmer grip.

Human DNA is much more influential in driving behavior than even the most verbally skilled dental professional. Whether we like it or not, humans love symmetry and beauty. We’re just wired that way. We are attracted to things and people that exhibit symmetry and harmony. These things make us feel good. To some it may seem shallow, but it is a truth that we can either tap into or ignore - to our detriment. Mal-positioned teeth are not esthetically pleasing. In other words, crooked teeth are UGLY. Please forgive me for being blunt, but let’s cut to the chase. Adults who are living with the “disease” we call crooked teeth know how it affects their life and their self-image. Laughter is oftentimes less joyous. An interaction with a new person can be less successful. Every photograph taken is a potential disaster. Every smile is restrained. Take a minute to think about how much a completely new smile would be worth to these people. How valuable is it to receive a new smile that looks attractive, is confidence boosting, and that will positively affect every day of the rest of your life? What is the value associated with “curing the disease of crooked teeth?”

About four years ago I treated a patient named Linda.  The first time I saw Linda she was grumpy and a bit confrontational. She told me that she hated her crooked teeth and hated the way they made her feel about herself.  Like most adults, Linda didn’t consider traditional orthodontics a viable option because of the lengthy treatment times and metal braces typically associated with the procedure. However, Linda had found out that I provided Short-Term Orthodontics and came to my office because she was excited to learn more.

Linda was a great candidate for Short-Term Orthodontic treatment and we were able to straighten her teeth in just six months. The process is simple and general dentists are able to straighten teeth safely and predictably in an average of six months. With unique clear orthodontic brackets and a slight shift in treatment goals, adults are able to say goodbye to their crooked teeth and have an attractive new smile in a reasonable amount of time. The goals of treatment are similar to those of veneers: to dramatically improve the appearance of the smile without completely revamping the occlusal scheme.

Linda’s treatment was routine. She was in and out of braces quickly and we watched her blossom into a new person. She was friendlier, warmer and exuded a newfound confidence that she had never experienced before. Linda had lived 55 years with crooked teeth, but now she was cured. There was no need to explain to Linda that getting a beautiful symmetrical smile was a good investment. Her DNA had already convinced her. When she came in for a final check, she gave me a big bear hug and told me something I’ll never forget. She said, “Dr. Swain, when I die and they lower me into my coffin, I don’t care what my hair looks like or what clothes I have on… as long as they prop my mouth open so that everyone can see my beautiful smile!”

Linda’s Before and After photos. Linda had lived for 55 years with crooked teeth. She was treated with the Six Month Smiles Short-Term Orthodontic System.

Dr. Ryan Swain is a graduate of the University of Florida College of Dentistry. He practices in Rochester, NY and focuses on Short Term Ortho and other conservative cosmetic dental procedures. He is president and chief clinical instructor for Six Month Smiles. Dr. Swain is a pioneer in the field of Short Term Ortho and constantly on the forefront of GP orthodontics. He has trained dentists internationally. 

Dr. Swain can be reached at Drswain@thedentistsnetwork.net

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Louis Malcmacher DDS MAGD Printer Friendly Version

Veneers Are Against The Law!
By Dr. Louis Malcmacher DDS MAGD

Well, I say the title of this article probably got your attention. You may be surprised to learn that it may not be that far off.  As President of The American Academy of Facial Esthetics, we have been working with many state dental boards in the area of facial esthetics in dentistry. This would include, but is not limited to, the use of Botox and dermal fillers as well as a number of other dental therapeutic and esthetic uses of facial injectables, both extra-orally and intra-orally. 

So what does this have to do with veneers being illegal? Let’s look together at this common definition of dentistry that appears in many state dental practice acts: “The practice of the profession of dentistry is defined as diagnosing, treating, operating, or prescribing for any disease, pain, injury, deformity, or physical condition of the oral and maxillofacial area related to restoring or maintaining dental health.”  What do veneers treat? If porcelain veneers are purely done for esthetic reasons, which they are most of the time, how does that fit into the definition of dentistry according to most states? Is an esthetic deficiency, which may or may not be in the eye of the beholder and the dentist, really a “deformity or physical condition” that would require treatment?  Are most veneers involved in “restoring or maintaining dental health?” Let’s be honest - not at all. This would technically place porcelain veneers and other procedures like surgical crown lengthening (when done for purely esthetic reasons) outside of the scope of dental practice.

Obviously, porcelain veneers and surgical crown lengthening for purely esthetic reasons which most likely involve destruction of virgin teeth, healthy gingiva and bone, have become accepted dental practice and is a large part of general dentistry, even when it is not done for “restoring or maintaining dental health.”

Now, let’s turn to the oral and maxillofacial tissues and/or adjacent structures, as those words are commonly used in dental practice acts across the country. Use of Botox and dermal fillers for esthetic reasons is simply soft tissue esthetics in and around the oral and maxillofacial structures, which is clearly designated as being within the practice of dentistry per the definition above. For some strange reason, there are some in dentistry that want to limit purely esthetic procedures only to oral surgeons. This would mean that only oral surgeons can do crown lengthening procedures and porcelain veneers - what a world that would be. 

Oral surgeons are extremely talented and very knowledgeable professionals, but I am sure you would agree that we would not want them doing our porcelain veneers, because that is not what they do. Yet, according to some state dental boards’ opinions, an oral surgeon is the only dental professional that can deliver porcelain veneers the way they interpret their dental practice acts. 

Do not fault your state dental boards. As I have previously stated in articles, the state dental board members are very dedicated and pretty much as limited by the state dental practice act as we all are. However, as explained above, it is illogical to say that hard tissue dental esthetics is allowed while soft tissue dental esthetics with the use of Botox and dermal fillers is not allowed, when it fits into the dental practice act. It is impossible to tell a dental professional they can inject Botox as a therapeutic agent for facial pain in the forehead, between the eyes and around the eyes, but they can’t inject Botox for esthetic uses in the exact same areas. This is especially unreasonable when the nurse or medical esthetician (who has very little actual medical training) is injecting Botox in patients down the street.

As of now, close to 20% of the dental profession has been trained and has been performing Botox and dermal filler procedures. Botox is another tool for treating patients, just like porcelain veneers. To ban Botox, you would also have to ban dentists from using porcelain veneers. 

I hope that this column does generate some discussion. I ask only one thing - let’s have an intelligent professional discussion among those who have been trained in Botox and dermal fillers. So many times I will get a dentist who wants to ban Botox and dermal fillers when they don’t even know what the procedures are, how or what the mechanism of action is for Botox and dermal fillers, and how they are used for esthetic or therapeutic uses. 

Botox has been well documented in muscle therapy by reducing the intensity of contractions which will directly reduce the pain involved with TMJ, bruxism and facial pain cases. Botox has recently been FDA approved for the primary treatment of chronic migraines and facial pain.  Botulinum toxin can also help with orthodontic retention by relaxing the mentalis muscle, denture retention with those patients who have a hyperactive masseter and buccinator muscle, and we are now finding a myriad of other uses that can be accomplished therapeutically with the muscles of the head and neck. 

Dermal fillers such as hyaluronic acids are essentially volumizers, which also can have a number of therapeutic uses. These would include angular cheilitis, lip deficiencies, reducing maxillary vertical excess (gummy smile), filling up black triangles, and resorbed pontic areas.

It is our ethical duty to give patients all of the available options for treatment. As I have demonstrated through articles in Dental Economics as well as other journals, there are many dental conditions where Botox and dermal fillers are an excellent viable alternative and sometimes even the best treatment option to accomplish dental therapeutics and esthetics. Facial injectables are a tool like anything else we use - get trained and learn what they are and how they can help your patients.

Louis Malcmacher DDS MAGD is a practicing general dentist and an internationally known lecturer, author, and dental consultant. An evaluator emeritus for Clinicians Reports, Dr. Malcmacher is president of the American Academy of Facial Esthetics. 

Interested in knowing more about how to truly enjoy dentistry? Click here.

Interested in having Dr. Malcmacher speak to your dental society or study club? Click here. To reach Dr. Malcmacher, email him at DrMalcmacher@thedentistsnetwork.net or call 1.800.952.0521.

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