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    New dental providers may harm the poor and uninsured

    Last updated 3 days ago

     
    Healthcare in America has changed. Even before the passage of the affordable care act (ACA), the role of medical doctors in the assessment and treatment of patients has diminished. Nurses, techs, physician’s assistants, and other“providers” render much of the care performed at the hospital and in medical offices. In recent years, politicians have been pushing this model for dentistry as well. Never mind that most direct care for dental patients is both surgical and irreversible. What matters is that we need more access to dental care for the underserved, regardless of the potential consequences for the patient or the negative impact on the profession of dentistry.
     
    The programs that have caused the most controversy in recent years are the dental health aide therapist (DHAT), the dental therapist (DT) and the advanced dental therapist (ADT) programs. These new “midlevel providers” practice primarily in Alaska and Minnesota, but their impact and reach could spread throughout the country in the near future.
     
    The level of education required for the DHAT, DT and ADT is far less than the education and training a dentist receives, and is roughly comparable to a dental hygienist. The typical training of a dentist requires four years of college with a heavy concentration of basic science, passing an entrance exam, and then four years of dental school with challenging written and clinical board examinations. Many new dental graduates then do at least one year of residency. In recent years, admission to dental school has become extremely difficult. See also http://www.dentalcomfortzone.com/story.php?aid=273
     
    So what can these mid-level providers do? They are essentially able to do most of what a licensed dentist can do, including administering local anesthesia and nitrous oxide, fillings, removing part of the nerve of primary teeth, pulp capping, extracting primary teeth, and “simple” extractions. The problems that these mid-level providers can and will encounter when providing dental treatment to patients are too numerous to list here. When considering oral surgery, problems can occur with fractured roots, damage to the jaw, perforation of the sinus, and excessive bleeding, to name a few. What if there is a medical emergency? Will the mid-level provider know how to handle something as “simple” as a patient fainting or as complicated as chest pain or a heart attack? How will an allergic reaction or aspiration of a foreign body be handled? Even something as routine as administering local anesthesia or nitrous oxide can quickly become a dental emergency. 
     
    In my view, treatment provided by those with insufficient education and training is unethical and wrong. It is an irresponsible approach to treating the poor, underserved, or uninsured. Recently, I was asked to share my views on the subject with a prominent dental journal, Dental Abstracts. My commentary will be published in the September/October issue of this year.
     
    Dr. Jerry Gordon can be reached at (215) 639-0571. Comments, questions, and second opinions are available at The Dental Comfort Zone, 2734 Street Rd. Bensalem, PA 19020 (across from the Giant supermarket). To learn more: www.dentalcomfortzone.com, E-mail: drjdmd@comcast.net

    Doctors play key role in curbing prescription drug abuse

    Last updated 2 months ago

    By Dr. Jerry Gordon, As published in the Buck's County Courier Times

    Monday, June 30, 2014

    Medical doctors, dentists and other licensed practitioners commonly use prescription opioid or narcotic medications to help elevate pain after surgical procedures.  These medications are also used to treat chronic ailments or other conditions that cause people pain.  Despite the importance of these drugs, they are sometimes overprescribed and have led to an alarming and growing epidemic of drug dependency, related criminal activity, overdose, and death.  In 2010, a comprehensive study by the Centers for Disease Control and Prevention revealed that nearly 60 percent of the drug overdose deaths (22,134) involved pharmaceutical drugs and 75% of these deaths involved prescribed opioid painkillers.  A 2013 study from Trust for America’s Health found that here in Pennsylvania, we have the 14th highest rate of drug overdose deaths and most of those deaths involved the use of prescription drugs. Prescription drug related deaths now outnumber those from heroin and cocaine combined.

    Recently Fred Harran, a patient of mine, and the Director of Public Safety for the township of Bensalem invited me to a community meeting aimed at tackling this drug epidemic head on. Local medical doctors, dentists, physician’s assistants, pharmacists, emergency medical technicians and other concerned community leaders attended the meeting that was chaired by Harran.  During the meeting, Harran described the scope of the problem both locally and nationally, and invited comments and written responses from those in attendance. The hope is that the contributions from area practitioners will both raise awareness of this issue and create new ideas to curb the potential for drug abuse and its devastating consequences. The innovative approach was conceived in a mandatory meeting of all Bensalem police employees and approved by both Harran and Bensalem Mayor Joseph DiGirolamo. 

    Those of us who have the great responsibility of dispensing opioid medications must use these drugs judiciously. When treating patients, we need to balance the legitimate need to help reduce a patient’s pain, while being careful stewards that do not create drug dependency.  Over the years, the drug policy of my dental practice, The Dental Comfort Zone, has been designed to help achieve this balance.  This is what we do:

    • We encourage patients to take over-the-counter pain medication like Advil, Tylenol or Alleve if needed after minor dental procedures including routine dental surgery like uncomplicated extraction of teeth, gum procedures, and biopsies.
    • When more advanced procedures are performed such as surgical dental extractions,root canal or gum surgery, we often recommend prescription strength Ibuprofen like Motrin 800mg for pain.  It is much more effective than most people realize.
    • sWe educate patients that treatment of their condition, such as a root canal orextraction, is the best way to eliminate dental pain, not medication.  In some cases, we use a shot of long acting local anesthesia to reduce pain after a surgical procedure. It works betterthan medication and does not contribute to drug dependency or addiction.
    • We rarely prescribe highly addictive drugs like oxycodone that is found in thedrug Percocet. When an opioid drug is needed, we prescribe less addicting medications like Tylenol with codeine or hydrocodone and limit the quantity to 8, 10, or 12 pills.  No refills.
    • We do not prescribe opioid pain medication to anyone who is not a patient or to any patient who calls the office and has not been seen in more than a year.  These patients are told to come to the office for diagnosis and treatment.
    • We do not prescribe opioid medication to anyone under 21.
    • People who are addicted to opioid medications often “doctor shop” to stockpile medications.  When we suspect this is the case, we ask the pharmacist for a drug profile or list of medications for the patient.  We will not prescribe to anyone who has had opioid medications prescribed recently from other practitioners.
    • We encourage patients to throw away any prescribed opioid medications when they are out of pain.  Pain medications left in the drug cabinet invites the potential of misuse by those who it was given to and for family members.
    • We never prescribe opioid medications to anyone that has a history of drug addiction.  This is a question we ask on our health questionnaire, and also talk to the patient or a family member if addiction is suspected.  This is a sensitive issue and HIPAA privacy laws apply, but the importance of this safeguard is worth the effort.
    • When drug addiction and doctor shopping is suspected, we communicate this concern with any other practitioner that we refer the patient to as long as it is not in violation with HIPAA laws.

    The war on drugs might be over, but in a sense, a new war has taken its place.  We as doctors and other health practitioners can be part of the problem or the solution.  Community leaders and legislators need our help, so reach out to them with what is working for you and your patients.  When you do, powerful forces will come to your aid, like our Director of Public Safety Harran.  When I asked him why he set up the meeting he told me “I’ll try anything within my Legal, Ethical and Moral means to combat this epidemic that is KILLING our country.”

    Dr. Jerry Gordon can be reached at (215) 639-0571. Comments, questions, and second opinions are available at The Dental Comfort Zone, 2734 Street Rd. Bensalem, PA 19020 (across from the Giant supermarket). To learn more: http://www.dentalcomfortzone.com

     

    Ten tips for beating dental fears

    Last updated 2 months ago

     
    Does the sound of the dentist’s drill make you cringe? Does the sight of the needle make you scared and nervous? If so, you’re not alone. Fear of the dentist, or in more severe cases, dental phobia, is the main reason that many people avoid the dentist. The problem with avoiding dental care is that small problems can soon require major dental treatment! Here are some tips that can help you overcome your fear of the dentist.
    Do Some Research. Not all dentists are sensitive to the needs of fearful patients. Ask friends, family members or co-workers about their dentist or if they know of a dentist who has an interest in treating patients who are anxious or fearful of dental treatment.
     
    Check the website. Once you identify a dentist you think is a good fit for you, check the dentist’s website. See if there are testimonials of fearful patients or other information that can help you learn more about the dentist and dental office you are interested in.
     
    Look at reviews. Patients that have had a good experience with a dentist in overcoming their fear will often mention that fact on a review site online. Genuine and heartfelt reviews are usually authentic and can give you a sense of what it would be like to be treated by that dentist.
     
    Send an email. In some cases, it may be helpful to contact your prospective dentist by email. Let him or her know about what experiences you have had in the past that has made you afraid of the dentist. A caring and confident response can go a long way in helping you develop a level of rapport prior to your visit.
     
    Schedule a consultation. Set up a consultation with the dentist. Explain your fears, and listen to what he or she has to say. Meeting the dentist in person can give you a comfort level with the dentist before you begin treatment.
     
    Know what scares you. Before a dentist can help you, he or she has to know what triggers your fear of the dentist. Be open and honest about what scares you so the dentist knows how to approach treatment with you.
     
    Ask for topical. Strong topical gels are available that can numb the gum to a significant degree that you can barely feel the needle.
     
    And buffer too. In the last few years, new technology has made it easy for dentists to add sodium bicarbonate to the anesthetic to buffer the solution. This makes injections more comfortable and the anesthesia work better.
     
    Something to take the edge off. Nitrous oxide gas is very helpful in getting some patients to relax. Highly anxious patients can also benefit from a mild sedative like Xanax prior to treatment.
     
    Squeeze the bear. Don’t laugh, but sometimes I bring out a stuffed animal for a patient to squeeze if they are feeling anxious. The Dental Comfort Zone bear has come in handy over the years in getting patients past their fears.
     
    Dr. Jerry Gordon can be reached at (215) 639-0571. Comments, questions, and second opinions are available at The Dental Comfort Zone, 2734 Street Rd. Bensalem, PA 19020 (across from the Giant supermarket). To learn more: www.dentalcomfortzone.com E-mail: drjdmd@comcast.net

    Step up and be a mentor

    Last updated 4 months ago

    As published in the Buck's County Courier Times

    Climbing the ladder of life is not an easy process.  Many obstacles get in our way, and at times it seems like no one is around to help us.  Just about anyone who has achieved success in any aspect of life has had the help of family, friends, teachers, coaches or civic-minded community leaders.  Successful individuals can have a tremendous positive influence on young people by lending their support and value of their life experiences. One area where the help of others is especially needed is in education and career planning.  A great thing professionals in healthcare, the sciences, law, accounting, teaching, and business can do is to step up and be a mentor to young people in their communities.

    Why is being a mentor so important?  The reason is that young people need to have some foundation of what they would like to do before they invest years in college and graduate school.  In my profession of dentistry, you need to go to college for four years (in most cases), take rigorous courses, admission examinations, and then do not start treating patients in dental school until your third year.  So you will not know if you like what you are planning to do for the rest of your career until your seventh year of study.  Wouldn’t it be helpful to have an idea of what it will be like beforehand? 

    At the Dental Comfort Zone, we have actively mentored high school, college and even graduate students who want to enter the profession of dentistry for many years. We also allow area dental assisting schools to have their student’s intern at our office as part of their training.  Most of the people we mentor are truly grateful for our help, and the experience is also satisfying for us, especially when they send us letters like this:

     "The internship at the Dental Comfort Zone with Dr. Gordon was a great experience. There was a lot of clinical experience, following Dr. Gordon around and seeing the actual procedures being done, which was a very practical way to learn about the field. By the end of the internship, I became very familiar with dentistry my interest in the field grew exponentially. Dr. Gordon never held back in sharing his knowledge and expertise in his field, and his personal advice was always helpful. For any people interested in dentistry and learning what it is all about, I would really recommend becoming an intern at the Dental Comfort Zone." - Kyusun Cha

    Becoming a mentor is easy to do if you are open and accessible to your patients, clients, students or customers.  Let your local high schools, trade schools, colleges and graduate schools know that you are interested in sharing your expertise.  Put this information on your website.  You can make a huge difference in your community.

    New technology can troubleshoot root canal problems

    Last updated 5 months ago

    As published in the Buck's County Courier Times on Monday, March 31, 2014.


    Root canal is still one of the most feared dental procedures. There are also those who have a negative view of root canal due to a bad experience, result or the cost of the procedure. Once the pulp of a tooth becomes infected, a root canal is the only way to save the tooth. In most cases, a root canal is the best option, but there are many factors that go into that decision. Although an experienced dentist can usually perform a root canal with minimal discomfort and with a high degree of success, problems can and do occur. In some cases, new technology used by some general dentists and endodontists (root canal specialists) called cone-beam computed tomography (CBCT) could help diagnosis root canal problems.

    The root canal procedure involves the dentist making a small hole in the tooth and then removing the tiny infected nerves and blood vessels within the tooth’s root(s). The roots are then shaped, disinfected, and filled with an inert material. The procedure is usually successful about ninety percent of the time when properly performed. When a tooth with root canal is successful, a person will have no pain or other signs or symptoms of infection. Of course, this also means that about ten percent of the time, a root canal will become re-infected or"fail", and continue to cause problems for the person.

    A root canal that is failing will usually continue to cause pain or discomfort, especially when biting down. In some cases, a failing root canal will cause swelling, also known as an abscess. There are several reasons why a tooth that has root canal can fail. A root canal can fail if some of the infected nerves and blood vessels are left inside the roots, the inert filling does not completely seal off the roots from bacteria, the tooth is damaged during the procedure (perforation), or the tooth fractures between or within the roots. A root canal is more likely to fail if a permanent filling or crown (cap) is not placed to protect the tooth. A root canal can fail within days, weeks, months or even many years after the procedure has been completed.

    In some cases, it is difficult to diagnose the reason a root canal fails. It your dentist cannot discover the reason the root canal has failed with conventional x-rays and clinical tests, referral to a root canal specialist with CBCT technology should be considered. CBCT can give a three dimensional view of the tooth that will be better able to show missed roots or nerves, fractures inside the tooth, and difficult anatomy within the tooth. In most cases, a failing root canal can be retreated, or a procedure called an apicoectomy (removal of the root tip) can be performed to save the tooth. If these measures are unsuccessful or deemed unlikely to succeed, the tooth will usually need to be extracted.

    Dr. Jerry Gordon can be reached at (215) 639-0571. Comments, questions, and second opinions are available at The Dental Comfort Zone, 2734 Street Rd. Bensalem, PA 19020 (across from the Giant supermarket). To learn more: http://www.dentalcomfortzone.com

     

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