I've had the opportunity to associate with a few executives from the American Association of Pediatric Dentistry at a Kellogg School of Business leadership training program. A few years ago, we were at a dinner function with 6 or 7 of us at the table when the subject of bottle-mouth syndrome came up. All the doctors at the table were pediatric dentists except for me. However, with my roots a great portion of my patients have been children. We were all sharing challenges of working with little ones that had bottle mouth syndrome. One of the doctors was a wonderful lady dentist named Patty Lewis.

(Bottle-mouth syndrome is difficult to deal with, as you know. The corrective treatment can be most challenging to the Pediatric Dentist because it often means that the little patient has to be put down on general anesthesia. Certainly, they've lost their smile and it's difficult to regain it completely, even with corrective treatment.)

The men at the table were discussing the subject with some level of understanding and conviction and the consensus was that it was necessary to prevent the syndrome by having mothers keep the bottle away from the children after one year of age. Patty sat quietly and listened at first but then provided a fabulous education (women have brought such a fabulous dimension to dentistry. They see, hear and feel things that many times males may just “gloss” over. Additionally, it’s exciting when these younger dentist giving us older dentists a chance to learn something new and exciting. It reminds us that the torch will keep going up the mountain after we’re gone.) Patty told us that she practices in the Bronx and that she serves a very diverse segment of Americans there. She shared the idea of looking past just the oral cavity. She said something that I'd never thought of before and I think is relevant to every clinician in the world. She discussed how she has patients who wake up crying at 2:00 a.m. like all little ones. In most families, the father and/or mother will wake up to help the little one. Tragically, there are a few families where if the mother can’t calm the baby by placing a bottle in their mouth to stop the screaming, the dad might beat the baby!

We think we've got all of this figured out at times, even as professionals, and then, lo and behold, it turns out there can be more to the picture than what is on the surface. Certainly, we can't separate the oral cavity from the gray matter but more importantly we can't separate it from the family, culture and the like. Patty went on to share that she and others had done quite a bit of research (Patty works part-time at Stony Brook). The research shows that if one can get a high risk patient in the office by one year of age and their teeth are erupted at that time, application of fluoride varnish as often as two times per month can eliminate bottle-mouth syndrome. This is clinically and humanly relevant! This is why the AAPD released their recommendations of up to six treatments a year for the high risk child and the ADA recommends 4 times per year for children starting at one year of age.

It would obviously be next to impossible to get a fluoride tray into a little one-year-old's mouth, and if you did, it would be dangerous. The logic behind the varnish is that it's a higher percentage concentration than the gel, but the volumes used are much lower. Fluoride simply provides a thin film that’s applied against enamel. It prevents the chance of volumes being swallowed. Fluoride varnish facilitates a rapid way to deliver a small quantity, volume-wise, of fluoride, which can remain in the oral cavity for multiple hours and/or days, releasing small quantities over and extended time period. Compare this to the systemic route where the fluoride is dispersed throughout the body, simply to have small percentages of it delivered back through the saliva to the teeth or compare it to when high concentration gels are applied but for only up to 4 minutes and the benefits derived from “duration to exposure” become obvious. Fluoride varnish presents a fabulous opportunity.

The AAPD has taken a position on fluoride varnish. They have made a public announcement and have invited their membership to get their little patients in at one year of age and, where indicated, apply the fluoride varnish. Patty and others of this leadership group shared that they do try to customize the treatment to the needs of the patient. For example, with the more rampant caries such as the bottle-mouth syndrome, they apply fluoride varnish as often as every other month. For the moderate risk patient, application will be quarterly or semi-annually. Otherwise, it should be an annual application.

It's fun when you can see even old ideas, such as fluoride, used in new ways to bring about such important solutions to these kinds of needs. It has become a great enough need in many states that it has been legalized for pediatricians to provide this treatment. Some states are even paying for such treatment through their welfare dentistry program. Certainly, the more we can get ahead of this program and cover the bases as dentists the better. This is “Dentistry” after all. For sure, we must be responsive to the needs of the population we serve.

Dan

I want to share an excerpt from a letter I received from one of our valued employees, Carol Jent.  Carol has worked for Ultradent for 12 years.  She just returned from a humanitarian mission to China.  I share this with you because it exemplifies the type of experience I think we as dentists need at least once in our careers.

“Dr. Fischer, I arrived back in the United States yesterday… a changed person but I think a better person. My trip to China was some of the hardest but most rewarding work I have ever done. I walked around for 5 days with a lump in my throat fighting back the tears - tears of compassion and joy. There was so much poverty and need but so much humility, pride (the good kind) and love. These people pull at your heart strings something fierce - the people that walk or come by a rickshaw-type bike many, many miles in hope of getting help and seeing the American dentists; the desperate parents just begging you to help their child; the elderly who have terrible abscesses and gum disease begging to get out of pain; the orphans that are scared to death and have never seen a Westerner.  The little cleft palate babies are particularly rough.

To share a small part of a huge experience… there was a "grandma and grandpa" that brought their 2 month-old severely cleft grandchild to the clinic every day in hope the doctor could help the poor little girl’s deformed face/mouth.  She needed help so she could breathe and eat better. We couldn't do anything at the time (at this particular clinic, anyway) because the baby was so young. The grandparents cried (I cried). The grandparents took the baby in when the mom abandoned it for being a "freak". They love that baby so much. When they left the building (or anytime they were out in public) they had to cover the little girl's face to keep others from taunting them. We promised the family we would be back next year to help the baby.  The upside?  We were able to help seven others with cleft deformities.

That is one of the sad stories but we have many happy ones too. Like the many times we gave orphans an OH kit (brush. paste, floss, instruction sheet in Chinese) and a toy.  They were so excited! I swear, you'd think we had just handed them the crown jewels. One 15 year-old boy had a Class IV that abscessed a long time ago which had decayed up into the canal.  We decided to take heroic measures.  I walked Dr. Woolsey through the AET system and we managed to clean and seal it the best we could.  We begged the orphanage to let him come back the next day to restore it. Finally, we bribed the orphanage teacher/driver with 2 toothbrushes and toothpaste so he brought the boy back the following day.  We placed a post, used Amelogen Plus with Vit-L IrB and it looked great!  The kid didn't understand what we were doing the entire time until I handed him a mirror. His eyes popped out of his head and if he said "sank you" once, he said it a million times!

Needless to say the oral hygiene in this region was non-existent. Young children with black stain and tartar like you might see in the US on a 40+ year old who had never seen a dentist... or worse. Amazing.  Once it was removed, the tissue looked like hamburger. We did give out OH kits with pictures and instruction written in Chinese. Sometimes you can cheat yourself out of this experience and ask yourself “why bother.”  But I would tell myself, even if this is the only time many of these patients EVER have their teeth cleaned or restored, this one time may give them an extra year or two of having teeth and a better quality of life.  True, they won’t necessarily know it was because of this care they received but I will.

The dentists that were part of our group were an amazing collection of humanitarian hearts!  All in all, we worked long days and saw well over 500 patients the week we were there. You may be hearing many, many thanks from them for the supplies Ultradent donated.  We experienced many late evenings some of which were spent training local dentists.

I worked as a hygienist, assistant, nurse, office manager, supply clerk, lecturer. I can never thank you enough for this experience. I hope to have the opportunity to do it again and feel it has greatly furthered and reinforced Ultradent's mission to improve oral healthcare  – globally!  Attached are some photos of patients and the cases I mentioned above (some are a bit graphic). I hope you enjoy them and can put up with my mind set for a while.  I will probably be bringing up various experiences in conversation for a long, long time… I apologize in advance J!”

Carol Jent, RDH, BA

At the end of the day, we (as dentists, hygienists, dental assistants) have a humanitarian obligation.  We’ve been gifted with the means to improve the oral care of other humans.  It makes no sense to reserve opportunities to provide care for only those we’re blessed to call our patients.

Dan

Ultradent recently launched a new campaign with its new orthodontic division, “Opal Orthodontics”. Both the Ultradent and Opal Orthodontics management team with the suggestion of Jeff Smith, suggested that we partner with the Susan G. Komen for the Cure foundation. The partnership entails donating a significant percentage of earnings from Opal Orthodontic’s adhesive line to the foundation.

The more I learn about this organization, the more I’m impressed. The promise and commitment of the surviving sister, Nancy G. Brinker is exemplary. Nancy has dramatically shown that “ONE PERSON CAN MAKE A DIFFERENCE”! And ok, hundreds of thousands have rallied to help her cause but Nancy was the spark, the drive and the follow through - the human with the vision and the passion to make it all come together. It’s amazing! Between the commitment Nancy made to her sister Susan who later died of cancer in 1982 until the present, the organization has raised one BILLION dollars for the cause. I toast Nancy, her family/parents who instilled values, ethics and care in their children so that when the opportunity arose, there was a virtual automatic shift in human care, courage, integrity and work ethic inside to blast from the launch pad and hence generate this herculean effort!! Nancy, Susan and their family created the tipping point to help make it a better world!! One person. . . one family, can make a difference!

Good stuff,

Dan

We’re saddened by the tragedy of the Midwest floods and we realize how difficult this time must be for those who have been affected. Nature has chosen a path with difficult consequences. The devastation of the flood has extended throughout several counties destroying the homes and businesses of many of our colleagues.

Ultradent would like to offer support to those with dental practices that have been damaged to help begin the path towards recovery. If your dental practice has been impacted by this tragedy, we’d like to help by offering a discount on the supplies required to help you reestablish a functional practice.

For information on how to redeem the flood relief discount, please call us at 1-888-230-1420 and press #1. Our customer support staff is available and prepared to meet your immediate needs from 6:00 am to 6:00 pm, Mountain Time. Please share this information with any others who may need our assistance.

While we’re certain it will take time for life to return to normal, we’re reassured by the collective support of the community. We hope to do our part by helping those affected rebuild their practices.

The families in the Midwest will be in our thoughts and prayers.