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Newsletter – 2nd Quarter 2001

This Issue:

  • Dental Activism – an introduction to this issue
  • An Antiseptic Tool for Gum Disease Management – an introduction to At-Home Cleaning & Debriding
  • At-Home Cleaning & Debriding in your practice
  • Periodontal Dangers – gum disease can have serious consequences
  • Miller Speaks – on the future of tooth whitening
  • The Crisis/Opportunity of Whitening Trends
  • Tongue Cleaner – The toothbrush should not stand alone
  • Community Service Whitening – It’s good business to give back to your community

DENTAL ACTIVISM
Activists are those who take direct,
vigorous action in support of a doctrine
or practice which they vehemently champion.
This makes a Dental Activist a great label for
today’s c aring, driven, dental professional.
You have an extremely compelling and
consequential message and mission.

The public-at-large needs to hear your message and benefit from your dental activism. Even though they sometimes don’t seem to be listening, you have the most receptive audience ever. Consider these points regarding periodontal disease:

1. Approximately eighty percent of all adults have some form of periodontal disease. They need you!
2. Periodontal disease has been linked to cardiac arrests, blood clots, strokes, respiratory ailments, premature births, hip replacement infections, and other serious ailments. It is no longer considered just a localized infection; it has quick and easy access to the entire blood stream.
3. Most periodontal disease goes either under-diagnosed or untreated. Patients may not see their dentists concerning periodontal problems; instead, they may limit dental concerns to tooth and cosmetic issues.
4. The mouth is a breeding ground for bacteria and infections. Most infections are introduced orally.
5. More patients are adopting a preventive and holistic health approach. With the immune system being at the core of this approach, how can a strong immune system be built upon a foundation of periodontal disease?
6. Preventive oral health care is not a concept that is widely accepted beyond brushing and flossing. Such care in many other health fields has been a growing trend for years. A heightened focus on preventive oral care would not only help patients change their attitudes about new preventive measures, but would boost support of basic brushing and flossing.
7. We should not underestimate the positive influence of Dental Activism. There are more subtle consequences of periodontal disease that can affect your patients’ quality of life. Such thi ngs can be as small as bad moods due to low-level infections or as big as lost productivity — and even lost wages — from illnesses contracted as a result of weakened immune systems.

The Whitener applauds you, Dental Activists, who are making a difference in the fight against periodontal disease. In this issue, we cover a number of related subjects in support of your good work, including:

* At-Home Cleaning & Debriding – Carbamide peroxide was first used as an oral antiseptic to treat periodontal disease. The valuable, re-emerging treatment tool, At-Home Cleaning and Debriding, is covered in a se ries of two articles. First, Victoria DaCosta, RDH outlines the modality model for using 10% carbamide peroxide in an At-Home Whitening, Cleaning, and Debriding stent. Next, Dr. Rodney Ogrin covers the opportunities and practicalities of implementing At-Home Cleaning & Debriding in your practice.
* Health Risks of Periodontal Disease – Gum disease can have serious consequences! Review a list of health risks associated with untreated periodontal disease to help you communicate its seriousness to your patients.
* Whitening – The article, The Crisis/Opportunity of Whitening Trends, shares a perspective on how to convert recent trends in professional tooth whitening into opportunities to get more patients in your door and lead them from cosmetic to broader dental solutions.
* Tongue Cleaning – Review the benefits of tongue cleaners and how your practice can use them to help patients improve overall oral health and fight halit osis.
* rong>Community Service – Dental activism is a community affair. Learn about a program to receive F REE whitening material to be used for community service.

An Antiseptic Tool for
GUM DISEASE MANAGEMENT
An introduction to At-Home Cleaning & Debriding
by Victoria DaCosta, RDH

In my work as the President of GumAerobics Management Systems, I see so many practices that need to have structured systems in place to best treat the sometimes overwhelming demand for periodontal services. It is all too easy to focus on “just doing” prophy uo;s as “perio recalls,” allowing patients to pass through our offices as “watches” and stay a part of the over 80% adult popula tion having some form o f un treated periodontal disease. Scaling/root planing and antibiotic tools can be effective st rategies. However, these treatment options have limitations. Some states don’t permit hygienists to place subgingival antimicrobials. What about patients who are special cases or need more? There is a clear demand for alternative solutions and tools to manage gum disease. The GumAerobics Management Systems focus on the win-win side of the formula to help practices improve patient care and increase revenue. This is done by empowering the hygienist with tools to manage periodontal disease — as a separate, viable business — all the while healing the patients. In this article, I’d like to highlight an up-and-coming treatment that offers an antimicrobial breakthrough in periodontal prevention, care, and treatment.

Life-Like, Dr. Rodney Ogrin, and I have been working with a procedure we call At-Home Cleaning & Debriding — using 10% carbamide peroxide. This gives patients a powerful antiseptic option for gum disease prevention and a tool for effective periodontal treat- ment. I think of it as Neosporin-on-a-Band-Aide for the gums.

The At-Home Cleaning & Debriding procedure roots back to the pre-history of tooth whitening. ProxigelTM was used as early as 1972 in a tray as a n antiseptic to treat patients who had inflammation or poor oral hygiene. Similar use of Gly-Oxide, another 10% carbamide peroxide product, predates 1968. In 1986, Dr. John Munro began the practice of using 10% carbamide peroxide to control bacterial growth after periodontal root planing. These procedures not only improved the health of soft tissue, but also were found to whiten teeth. Unfortunately, the antiseptic value of 10% C.P. quickly became overlooked — in favor of the more visible cosmetic side effect.

* The practice of using a 10% carbamide peroxide gel as a periodontal debriding treatment offers extensive advantages:
* Effective – Ten percent carbamide peroxide gel is an effective a ntiseptic. When held in place by a stent:
* It releases H2O2 for sustained antiseptic and oxygen-cleansing action. The anhydrous glycerol and gelling agent protects the peroxide molecule delaying its breakdown. It also holds the carbamide peroxide plus peroxide foam in close contact with the teeth and tissue.
* It elimin  ates su  pragingival aerobic bacteria and at least, reduces subgingival anaerobic bacteria via hydrostatic pressure from the debriding tray.
* It gently removes unhealthy tissues as well as cleans and soothes minor wounds and inflammations, so natural healing can occur.
* It foams and flushes out food particles most patients miss.
* With ongoing use, it guards against the risk of gum infections.
* It discourages plaque formation, decreases calculus, and reduces bleeding. This creates greater visual access to subgingival accretions.

Easy Implementation – The procedure is an easy addition to your practice. It requires making only a slightly modified whitening stent. Only a few extra minutes are required to make an At-Home Cleaning & Debriding stent using the same stone model used for making a whitening stent.

Patient Compliance – Patients are quick to accept the procedure since it is easy and can be adopted as a habit before and/or after the cosmetic inducement of tooth whitening. Also, patients stick with it because it requires brief treatment times with no negative side effects.

 

The procedure is as follows:
Stent: Make a .040 EVA stent as though you were making a whitening stent with one exception (see the Q1 2001 Whitener article “How to Make an Optimal Stent”). The difference is in how the stent is trimmed. An At-Home Cleaning & Debriding stent (using .040 EVA) is trimmed to extend onto attached gingiva by 2-3 millimeters.

Regimen: 12-Wks, recall in 90 days.
Dosage: Use .5cc per application of bottled 10% carbamide peroxide.
Treatment Time: Use the table below to establish the treatment time.

Treatment time for patients with moderate to severe periodontitis or halitosis should be up to thirty minutes for the first seven to fourteen days.

To learn more about how to implement an At-Home Cleaning & Debriding program and maximize your periodontal service and revenue, call Life-Like at 800-543-3545, visit www.gumaerobics.com, or call me at 877-373-4000.

The Role of
AT-HOME CLEANING AND DEBRIDING
in your practice
By Rodney Ogrin, DDS

A statistic can sometimes be a rousing call to action. Consider that up to 9 out of 10 adults have some form of periodontal disease and think how that relates to the health risks of periodontal disease listed on Page 7. This statistic strikes at our professional duty and poses a challenging opportunity for our practices. Our profession needs to do more to attack these numbers. Take a look at Victoria DaCosta’s article on Page 3 and review these practical tips. Learn more about how to use 10% carbamide peroxide, a history proven debriding agent, for an At-Home Cleaning & Debriding program in your practice. Scenarios for implementing At-Home Cleaning & Debriding in your practice include:

1. Whitening, Cleaning, & Debriding Whitening is a great way to bring new patients to your practice. Now, you can extend your whitening services one step further. For an additional fee, you can take the same stone impression and make the patient a Cleaning & Debriding stent. Recall the patients at the end of the whitening regimen. Using hygienist/auxiliary staff and limited chair time, you can give them stent, material, and instructions. The whitening treatments help patients become accustomed to the regular use of carbamide peroxide treatments. This ongoing routine will then fit into one of the following other scenarios depending on the patient’s needs.
2. Periodontal Prevention – If the pat  ient has had a history of gingivitis, an ongoing preventive At-Home Cleaning & Debriding program is prudent. Let the patient know that not only is the program going to help maintain healthy gums, but will benefit whitening maintenance also. The patient should maintain two to three treatments a week for just two to five minutes each (see the treatment table also on Page 3).
3. Pre-Surgical Periodontal Treatment – When surgical periodontal treatment appears to be the next step for a patient, an At-Home Cleaning & Debriding program is a good idea. It will help get the patient in the best possible condition for additional treatment. It will help identify what will heal and what won’t. It can even help avoid a surgical solution. In the case of a referral, the Periodontist will appreciate receiving the patient who has been undergoing this antiseptic therapy. If the patient postpones the Periodontal referral, the at-home treatments will help control the damage of the disease.
4. Post-Periodontal Treatment – At-Home Cleaning & Debriding treatments by the patient after periodontal treatment will help the patient heal faster. Following root planing or scaling, this program is the best way to make the most of the in-office visit. Depending on the severity of the disease, have the patient maintain 1  to 2 treatments daily for 7 to 15 minutes each (see the table on Page 3).
5. Special Periodontal Cases – Having At-Home Cleaning & Debriding also provides you with a tool that fits many special cases. Consider it as a non-surgical option for geriatric cases, and patients with diabetes mellitus, chronic fatigue, and immune related disorders.

Ten percent bottled carbamide peroxide fits the economic and practical requirements of the At-Home Cleaning & Debriding program. It is effective, yet mild on the soft tissue. Learn more about this useful antiseptic tool against gum disease by calling 800-543-3545.

PERIODONTAL DANGERS


Heart disease, stroke, premature births, respiratory ailments, hip replacement infections: these are just some of the serious conditions that have been tied to periodontal disease.

Some of these links include:

* Heart Disease & Stroke – Several studies have indicated that patients with periodontitis are 1.5 to 2.0 times more at risk of fatal cardiovascular disease. According to the American Heart Association, 1 in 5 Americans suffers from cardiovascular disease, which is the leading cause of death in the United States. Bacteria from oral infections have easy access to the bloodstream. Researchers have noted that bacterial endotoxins and inflammatory cytokines can result from periodontal disease. These can either initiate or exacerbate atherosclerosis (which include myocardial disease and stroke) and thromboembolic occurrences. Chronic inflammation of the gums from plaque can also ultimately lead to the build up of plaque in the arteries. Additionally, periodontal disease has been linked to higher levels of fibrinogen and white cell counts which correlate with cardiovascular risk factors.
* Diabetes Mellitus – According to the Journal of Periodontology, those with non-insulin-dependent diabetes mellitus are three times more likely to develop destructive periodontal disease. High glucose levels may encourage the growth of bacteria in the mouth, causing gum disease. Additionally, diabetes can cause blood vessels to thicken which slows the flow of nutrients and the removal of harmful wastes.
* Premature Births – Pregnant women with periodontal disease are at least six times as likely to deliver a premature baby, based on an ongoing study on 2,000 pregnant women by the University of Alabama at Birmingham School of Dentistry. Also, a preliminary study done by the International Association for Dental Research on 800 pregnant women indicated a higher number of premature births from mothers with severe periodontal disease. The chance of a preterm birth increased as the severity of periodontitis increased.
* Respiratory Ailments – According to the Journal of Periodontology, periodontal disease may promote chronic obstructive pulmonary disease which is a respiratory disorder and the sixth leading cause of death in the United States. Researchers have discovered that the bacteria found in the oral cavity can be aspirated into the lung to cause respiratory diseases such as pneumonia, especially in people with periodontal disease. The teeth may also serve as a container for respiratory pathogen colonization.1
* Hip Replacement Infections – An article posted on the Alberta Dental Association web page examined the possible link between hip replacement infections and dental procedures. The records of 2,973 patients after total hip arthroplasty (THA) were reviewed. The article concluded that infections of a THA after dental procedures are more common than previously suspected.

References:
1. “Exploring the Association Between Gum Disease and Preterm Births and Osteoporosis” (June, 2000), www.ada.org
New Survey Shows “Oral Health May Mirror Overall Health” (October, 1999) www.ada.org.
“Diabetes and Periodontal Disease, What is the Link Between Diabetes and Periodontal Disease?” www.nidcr.nih.gov.
Scannapieco, Frank A. “The Role of Oral Bacteria in Respiratory Infection” The Journal of Periodontology. July 1999; 20:793-802.
LaPorte D.M., Waldman B.J., Mont M.A., Hungerford D.S., “Some hip replacement infections linked to dental procedures” Alberta Dental Assoc., www.abda.ab.ca.
“Can Gum Disease Kill You?” www.gumaerobics.com.

Reality Magazine’s
MILLER SPEAKS OUT
on the Future of Tooth Whitening

Michael Miller, DDS of Reality Magazine has spoken out about the future of whitening. When lecturing on five-star products, research and evaluation at the Las Vegas Cosmetic Dentistry 2001 conference, February 8 and 9, 2001, Dr. Miller discussed whitening’s future in the context of his ratings of the various bleaching materials and techniques.

During his evaluations he stated that Dr. Ogrin (owner of Life-Like Cosmetics Solutions) had introduced a new at-home 30% carbamide peroxide. Dr. Miller said, “I have to give him a lot of appreciation because a lot of us stick our heads in the sand and we don’t look at different concepts when we should, and I’m the same way. We get real busy, and when I first thought of somebody doing home bleaching with a 30% carbamide peroxide, I said, ‘You’re out of your mind. This’ll never work, it’ll blow out teeth, they’ll be sensitive, it’ll be this, it’ll do that.’ Well, I can tell you, it doesn’t do that.”

Dr. Miller went on to explain, “And, what’s very nice about this product is that you can have patients wear the tray twice a day for 20 minutes and you can go from a C3 to a C1 in one week — in one week, 20 minutes a day — driving to and from work. So this 30% carbamide peroxide, as long as they keep the wear time down to a minimum and you don’t cover any of the gums, so you scallop the trays very nicely, I am firmly convinced that this is the way that home bleaching is going to go.”

THE CRISIS/OPPORTUNITY
of Whitening Trends
Prospering from increased competition and economic uncertainty
How many times lately have you seen professional tooth whitening “just like you can get from your dentist” being offered directly to the consumer? Such TV ads and infomercials abound, countless newspaper and magazine ads are everywhere, the numbers of on-line offers are multiplying, mall kiosks are popping up, and now the Crest WhitestripsTM are moving onto your local drug store shelves. Add this to the news from the financial page of fluctuating consumer confidence/spending and you’ve got one potentially scary picture for the prospects of your tooth whitening services.
Yes, these are shifting times for professional tooth whitening, but these trends can be cast as crisis — or point to opportunity:

TREND: Crest WhitestripsTM are now available as a mass-marketed, low cost OTC whitener.
CRISIS: Any patient can opt to whiten for a fraction of the cost of professional tooth whitening.
OPPORTUNITY: Proctor and Gamble will help continue the trend toward tooth whitening and will bring whitening to hundreds of thousands of people who may not otherwise be able to afford tooth whitening. More people will whiten their teeth and many of them will be driven to professional tooth whitening once they see the limited results they get with the strips. The strips are small, cumbersome, and bunch up on the teeth. There is a potential to get the “horse mouth” effect, where the front teeth are whitened while very visible back teeth are left untreated. Additionally, patients who have caps and veneers will use the strips without realizing they will create a mismatch of shades to their smile. They will, again, need to see their dentist to resolve such mistakes. The strips will also usher in a hierarchy of tooth whitening; there will be those who have to deal with horse mouth, slow whitening, and mixed results. On the other hand, professional tooth whitening offers a comprehensive oral care program, fast whitening, and dentist-supervised results.

TREND: Professional Tooth Whitening materials are becoming available over the internet, through TV campaigns, and in consumer ads in newspapers and magazines.
CRISIS: Carbamide peroxide percentages of 10%, 15%, and even 20% are being sold directly to consumers using one-size-fits-all or boil-and-bite trays. They are to some extent undermining the current professional dental market.
OPPORTUNITY: Professional whitening has critically key advantages starting with speed, safety, and effectiveness. It takes only one big mistake to put professional fees into perspective. When dealing with something as important as one’s teeth and oral health, why would someone want to gamble? That is why Life-Like will absolutely not sell products directly to consumers and turns away calls and internet requests daily.

* Fast 30% carbamide peroxide bleach clearly distinguishes your whitening services from the lower concentration professional gels being sold directly to consumers. Which would you rather use, 10% that takes 10-28 days per arch for a total of up to 56 days, or fast 30% that supports dual arch whitening to be completed in just 7 days? And, with fast 30%, you can bleach during your bathroom routines (two 20-30 minute treatments) as opposed to hours or overnight with the lower concentrations.
* The 30% is proven to be safe, causes less sensitivity, requires the least amount of wear time, and produces the fastest and most predictable results. Once you’ve tried it and proven to yourself this is true, you’ll never want to use anything else. Your patients are no different.
* It isn’t less expensive if the patient isn’t compliant and is therefore unsuccessful. Patient compliance tends to fall after 7 to 10 days. Long wear time also promotes sensitivity. What is the likelihood of patient compliance when the process takes from 20 to 56 days requiring hours of stent time a day using the lower concentrations? When your patients use fast 30% bleach, they see dramatic results quickly and have to stick with it for only 7 days. Your patients’ time counts!
* You won’t ever see 30% being sold directly to consumers. A custom, properly-trimmed stent is absolutely required along with some patient screening and proper instruction. Fast 30% bleach is truly the future — the At-Home professional product of the third millennium.

TREND: The recent downturns for Wall Street and other economic indicators have been gnawing at consumer confidence.

CRISIS: The uncertainty in consumer spending could translate into a lower demand for cosmetic dentistry procedures such as whitening.
OPPORTUNITY: The fact is, people still want whiter teeth and the trend toward whitening continues to grow. So it becomes a matter of timing — of when people want to make the investment. Here are some points to keep in mind:

* Whitening isn’t like a new car – requiring a long-term commitment of payments.
* Whitening is a small use of discretionary dollars that results in extremely visible and tangible results.
* Whitening can affect patients’ self-esteem, social lives, and career prospects — making it a very good investment during all economic times.
* Those who market as though there is no economic slowing should step forward as the leaders – and grab vulnerable market share. To lead, update your marketing materials. Add the next marketing tool to your mix (visit www.life-like.com/marketing or call (800) 543-3545 and ask about our latest marketing materials).
* At-Home Whitening, Cleaning, & Debriding can be a component of a larger treatment plan and can fall under some insurance categories.
* Whitening is often used by some practices as a loss leader to bring in more cosmetic and restorative patients. This is a good time for such a strategy to help boost overall business.
* When consumers tighten their belts, it’s a good time to emphasize the value per dollar spent for your services. Professional whitening is a better all-around value than other whitening options, since it is safer, faster, and more predictable. It is a better value, especially when packaged with other dental services.

TONGUE CLEANER
The Toothbrush should not stand alone

Virtually all bad breath comes from bacteria living in your mouth and should be overcome using proper oral health solutions – elimination of bacteria producing volatile sulphur compounds. Of course there’s tooth decay and gum disease to be handled in the dental office. Then there’s brushing, flossing, and At-Home Cleaning & Debriding to be performed at home. The tongue cleaner is a home oral health aid destined to work alongside the toothbrush.

Tongue cleaning scrapes away the bacteria that breeds in the nooks and crannies of the tongue. It can remove up to an additional 60% of bacteria in the mouth on top of tooth brushing. It reduces plaque formation on the teeth and helps prevent passing bacteria back to the teeth and gums from the tongue after brushing and flossing.

Tongue cleaning is not new, but is growing in popularity. It dates back to the Roman Empire and was well practiced in China and other Asian cultures. The practice has been becoming more popular in recent years and is recommended by a growing number of dentists.

Tongue cleaners offer your patients better overall oral health and have other significant benefits. Approximately 80% to 90% of all bad breath comes from the rancid waste of bacteria in the mouth. A good tongue cleaner acts like a squeegee to remove the coating of plaque  and bacteria on the tongue. A tongue cleaner is more effective at reducing halitosis than even brushing. Unlike a toothbrush, it avoids causing the gagging reflex. Additionally, tongue cleaning offers your patients a cleaner palate to better taste, enjoy, and appreciate food.

Life-Like has introduced a new high quality, high value tongue cleaner for distribution exclusively through dental offices. This stiff, thick, yet flexible U-shaped cleaner is professional grade and designed to clean the surface of the tongue with the least amount of abrasion to the tissue. Your patients will love its reusable strength, gentle yet highly effective scraping edge, and ease of cleaning and storing. A great value, the professional wholesale price is just $.65 each and comes in packs of 12. Call Life-Like at 800-543-3545 and ask about a FREE SAMPLE and the introductory offer.

COMMUNITY SERVICE WHITENING
It’s good business to give back to your community

Making the world and our communities a better place is everyone’s business. Life-Like Cosmetic Solutions is running a program to help you give something back to your community. And, it’s good business.

For a limited time, Life-Like will give you up to 15 FREE 10% Carbamide Peroxide Whitening Kits a month to be used exclusively for charitable promotion.

Run an ad or distribute a flyer promoting a program where you donate your full whitening fee to a local or national charity (501c3 non-profit organization) of your choice. Life-Like will provide the whitening kits free of charge. It is best if you submit a press release to your local newspaper, radio, and television media a month in advance. The program is a great way to reach out and contribute to your community, gain important exposure for your practice, and attract new patients.