A crucial takeaway from this research is the need for sound oral health and how it helps older adults maintain cognitive function.
But first, let's examine the study that links tooth loss with cognitive impairment and dementia.
Researchers Link Tooth Loss to Cognitive Impairment and Dementia
The team at NYU studied tooth loss’s relationship to cognitive impairment via a meta-analysis of 14 studies made up of 34,074 adults. These studies included nearly 4,700 instances of people dealing with worsening cognitive function.
The analysis revealed that adults who lost more teeth were 1.48 times likelier to face cognitive impairment, and 1.28 times likelier to receive a dementia diagnosis.
What’s more, dementia and cognitive impairment risks still exist after controlling for other factors.
Dentures Can Play a Crucial Role in Preventing Cognitive Decline Linked to Tooth Loss
It’s also worth noting how dentures appear to play a role in preventing cognitive impairment; specifically, those without dentures had a 23.8% likelihood of cognitive impairment after losing a tooth compared to those who receive dentures after tooth loss (16.8%).
After even more analysis, the team discovered any links between tooth loss and cognitive impairment were less significant when patients had dentures.
Each Lost Tooth Heightens Cognitive Impairment and Dementia Risks
The NYU team’s research also included a meta-analysis involving 8 studies to determine if there was a “dose-response” relationship between cognitive impairment and tooth loss.
With the above analysis, it was made clear that the more missing teeth there were, the risk for cognitive decline increased. There was a 1.4% boost to cognitive impairment risk for each missing tooth, on top of a 1.1% increased risk of dementia diagnosis.
According to the NYU study, missing teeth leads to problems with chewing, which in turn can cause poor nutrition, which could trigger brain-related changes. Further research shows a connection between gum disease and cognitive decline. This shouldn’t come as much of a surprise since gum disease is a leading cause of tooth loss.
Furthermore, tooth loss could reflect a lifetime’s worth of socioeconomic disadvantages linked to cognitive decline.
What Does This Mean for Dentists?
Can dentists and their teams use this information to provide improved care to their patients?
Any way you can help stave off and prevent these issues can make a massively positive difference in your elderly patient’s quality of life.
So, where should you start?
As per the results of NYU’s research, much of your treatment strategy can revolve around dentures. Even at a glance, it makes sense. Dentures help those who’ve lost teeth chew their food, so they can absorb the nutrients they need to keep their brains functioning effectively.
We’ll then point out that this isn’t the first bit of research highlighting the importance of dentures. Studies from back in 2010 came up with similar results; brain function activity was increased by both the improvement of complete dentures and the wearing of partial dentures. Furthermore, these improvements occurred in patients who were at risk of diminished brain activity.
A proactive approach to dentures might be the answer, or at the very least, vigilance with older patients about receiving their dentures.
You have all the reasons in the world to ensure your patients receive treatment when they lose their teeth.
For one thing, a lost tooth isn’t something to be left alone from the potential for infections to aesthetic reasons.
NYU’s research has given you another reason to help your elderly patients who’ve lost teeth, helping prevent Alzheimer’s and cognitive decline.
You already know the correct type of treatment for missing teeth in elderly patients: dentures.
But you now know how much more urgent it is to ensure you perform the procedures nearly right away. After all, it’s a simple, everyday type of procedure that can make all the difference in the world to someone in need.
Stats from the CDC show that 47.2% of adults 30 and older suffer from periodontal disease. And since periodontal disease worsens with age, a whopping 70.1% of adults 65 and older have periodontal disease.
Although periodontal diseases are common, care providers often have to play a guessing game when it comes to determining the stage and severity of any given case.
With this issue in mind, in 2017, the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) updated the system that classifies the stage and grade of periodontal diseases. The previous classification of periodontal disease was published in 1999.
The AAP and EFP set out to evolve the system through an evidence-based approach that detailed the advancements made in understanding periodontitis and implant-related conditions.
There's no doubt that the revised classification is valuable. It’s a massive step in the right direction.
However, despite these positive changes, it remains difficult to determine the stage and grade of many periodontal diseases.
In Brief Review: What is Staging? What is Grading?
Staging a periodontal disease involves classifying the severity and extent of the patient’s condition. The process includes assessing measurable amounts of tissue that’s been damaged or destroyed by periodontitis. It also examines specific factors that might help with case management over the long term.
At first, clinical attachment loss (CAL) should be used to assess the stage, but it’s not always available. In which case, radiographic bone loss (RBL) is the next most reliable option.
Note that tooth loss caused by periodontitis changes the staging process. Also, when there are one or more complexity factors, the stage could reach a higher level.
Grading is the process in which you rate the periodontitis’s progression in a patient and how it’s responding to therapies and treatments. Moreover, grading deals with the effects that periodontitis can have on overall health.
Initially, the care provider should give a grade of B disease. They’ll then determine whether other factors exist to change the status to an A or C.
What Are the Three Stages Used in Staging and Grading?
Stage 1: Initial Case Overview
This stage includes screening with full mouth-probing depths and radiographs of the whole mouth. You’ll also need to look for missing teeth.
Generally, you’ll find that Stage III or Stage II can be applied to moderate periodontitis. Alternatively, Stage III and Stage IV are appropriate for severe to very severe periodontitis.
Stage 2: Establishing the Stage
Stage I and II periodontitis require that you confirm CAL and rule out causes outside of periodontitis (e.g., cavities, root fractures).
From there, you must determine the maximum CAL or RBL, then confirm potential RBL patterns.
When dealing with Stage III and IV periodontitis, you need to adhere to the above methods. But you also must assess tooth loss due to periodontitis and evaluate complexity factors.
Stage 3: Establishing the Grade
You need to divide the RBL (percentage of root-length multiplied by 100) by age. Then you must assess whether the patient has related risk factors such as smoking or diabetes.
Patient responses to scaling, root planing, and plaque control should be measured while the expected rate of bone loss is assessed.
Conduct a thorough risk assessment and keep medical/systemic inflammatory considerations in mind.
But Wait...The Ground Rules for Assessing Grade of Periodontal Diseases Have Changed
There are new rules for how you should assess the grade of a patient’s periodontitis, as highlighted below.
First and foremost, you’ll define your grade primarily on the observed or inferred rate of periodontitis progression. Heavily weigh the presence (or lack thereof) of control or risk factors that could impact treatment outcomes and further disease progression.
After therapy, the grade can be dropped to a lower level, provided the patient’s risk profile improves enough. Note that these improvements should be sustainable.
Using a B-grade is your go-to when you’re unsure, as it suggests a moderate rate of progression. Afterward, you can make the necessary changes to the grade when the risk profile and its elements make themselves more evident.
Dealing with the Abstract Nature of Periodontitis
Unfortunately, in the world of periodontics, you can’t punch a bunch of numbers in a calculator or type a Google search and get the black-and-white answer you seek.
No, the “right” answer is more abstract when it comes to periodontal disease, existing within an endless number of shades of grey.
Correctly using this upgraded system whenever it’s appropriate will improve your judgement as a periodontist. This way, you can ensure your patients receive the best available care. That notion will hold true even when their current condition is confusing, and you don’t have immediate answers.
Alongside the CDC, both the Canadian and American Dental Associations support the use of face shields to provide more robust protection for dental professionals to combine with their personal masks.
Read on to learn more about the benefits of face shields for dental professionals and how to choose the right one for you.
The Science-Backed Benefits of Wearing a Face Shield
Recently, studies on the efficacy of face shields in reducing the spread of COVID-19 and other viruses were done by researchers from the Iowa City VA Healthcare System and the University of Iowa.
The results showed a 96% reduction to immediate viral exposure when a simulated healthcare worker wore a face shield within 18 inches of a cough. In fact, there was still an 80% protective effect after a half hour. And face shields blocked nearly 70% of small particle aerosols.
Later, the study was repeated. On this occasion, the 6-feet social distancing guideline was adhered to.
The face shields prevented 92% of inhaled virus particles, which almost mirrored distancing on its own. These results reinforce how physical distancing is integral to stopping the spread of viral respiratory infections.
When it comes to containing a sneeze or cough (aka source control), there aren’t yet any studies on the impact of face shields when worn by asymptomatic or symptomatic infected persons.
Still, with 68% to 96% efficacy ranges of a face shield, adding source control would likely improve efficacy. Expect further studies on this matter soon.
Why Face Shields Work So Well for Dentists
Research demonstrates that face shields play a pivotal role in the overall strategy in stopping community spread, and they add substantial protection in high-risk areas. So, how and why do face shields work so well?
The reasons behind these can be summed up as follows: durability, comfort, and communication.
1. Face Shields Have Heightened Durability and Endless Reusability
Face shields have tremendous lasting power, unlike standard medical masks.
All you need is soap, water, and everyday household disinfectants to clean face shields, which can also be reused indefinitely.
The best face shields for dentists, like the Canadian Shield Face Shield, have an all-plastic design that makes it simple to sanitize and reuse.
2. High-Level Comfort Combined with Optimal Protection
Face shields offer comfort, and they prevent viral entry at every portal.
Since they stop you from touching your face, face shields also decrease the chances of spreading dangerous germs to yourself.
3. Face Shields Don’t Disrupt Communication
Medical masks often muffle up a wearer’s words while talking, leading to removing the PPE. Whereas face shields don’t have this problem, leading to seamless verbal communication while keeping on the protective equipment.
Furthermore, face shields provide a cue to remain distanced for you, your staff, and your patients while maintaining visibility of lip movements for speech perception and facial expressions.
Choosing the Best Face Shield for Dentists & Dental Hygienists
Reusable plastic face shields for dentists come in a range of unique shapes, sizes, and overall levels of quality.
With that said, if you want a good, reliable face shield, here’s what to look for:
Shields should anteriorly extend below the chin and laterally to the ears.
No exposed gaps should exist between the shield’s headpiece and your forehead. This design helps stop you from touching your face.
Since face shields must be worn for extended periods, you need to prioritize comfort. The most cutting-edge products on the market are made using medical-grade PETG. This material brings with it high-end durability and lightweight convenience, making it ideal for all-day wear.
Sable Industries is proud to provide the Canadian Shield Face Shield, designed to be both comfortable and compatible with other PPE including N95’s and safety goggles. The Canadian Shield is manufactured in Ontario, Canada and made with materials sourced from Canadian and US suppliers.
To learn more about face shields for dentists, or to inquire about bulk ordering for your practice, contact us today and we will be happy to assist you!
More specifically, it was found that patient saliva wasn’t a significant source of aerosol microbes created during dental procedures.
In this article, we will explore these new studies and the issue surrounding dental aerosols and COVID-19 transmission in more detail.
Sources of SARS-CoV-2 and Other Microorganisms in Dental Aerosols
The study involved 28 patients receiving the following procedures at Ohio State’s College of Dentistry between May 4 and July 10, 2020:
Restorations with high-speed drills
Ultrasonic scaling procedures
These procedures have one thing in common: they produce a large amount of dental aerosols.
From there, samples of saliva and irrigant (i.e. water-based cleaning solutions for flushing out the mouth) were collected before each procedure. Then, 30 minutes after the procedure was complete, researchers collected condensate (i.e. aerosol remnants) from the dentist’s face shield, patient’s bib, and an area six feet away from the chair.
This study focused on identifying what types of microorganisms were created by the procedures, and determining how much saliva was a factor.
Researchers gathered these samples from personnel, equipment, and other relevant surfaces that aerosols could reach during these various procedures.
Previously, it was found that aerosols landed on a dentist’s face and their patient’s chest, travelling up to 11 feet. At first, this seemed dangerous in the context of a world dealing with COVID-19. But those previous studies only concluded that bacteria existed on people and equipment, never classifying the organisms.
In addition, it was unable to identify their origin. Saliva being the source of most dental aerosols had always been an unproven presumption.
The results of the Ohio University research painted a clear picture: irrigants caused almost 80% of the organisms found in dental aerosols. Saliva, if present, was responsible for just 0.1% to 1.2% of the microbes spread throughout the room.
The main source of organisms in aerosols was the water from the ultrasonic equipment, not saliva. This result was consistent regardless of where the moisture landed.
There were only 8 cases where saliva was found in the condensate, and of those instances, 5 patients failed to use mouth rinse before their procedure.
Also, while 19 patients possessed the SARS-CoV-2 virus in their saliva, it couldn’t be detected in their aerosols.
Further Takeaways From the Research
Purnima Kumar, D.D.S., Ph.D., a professor of periodontology at Ohio State, believes that the research findings add up.
She explains that there’s an estimated 20-to-200-fold diluting effect that irrigant has on saliva.
Offering this information to your patients will help you put their minds at ease about visiting your practice and receiving much-needed dental care.
The Need for Vigilance Remains
As fantastic as this news is for dental professionals and their patients, more research is still needed regarding the risk of microbial transmission in oral healthcare settings.
Furthermore, these results don’t change the fact that COVID-19 spreads through aerosols. Therefore, sneezing, coughing, and speaking in a dental office can still lead to disease transmissions, meaning vigilance is still necessary for preventing the spread.
Dr. Manu Dua opened a private dentistry clinic in Calgary, Alberta, in 2016.
In 2020, following a cancer diagnosis, Dr. Dua made the difficult decision to sell his clinic to concentrate on his health.
Although it wasn’t an easy decision for him ‒ having worked tirelessly to build his practice from scratch and make it a success ‒ Dr. Dua soon found himself relishing in his new life and wondering why he had not made the move earlier.
“At this point, you’d think that I would’ve been deeply upset about the sense of loss and purpose,” he wrote in a heartfelt piece for DentalTown magazine. “In this regard you would be incorrect.”
Because truth be told, Dr. Dua had been thinking about leaving dentistry long before his diagnosis.
“I gave my heart and soul to the profession and yet I found it hollow and unfulfilling, despite that superficially I had achieved most levels of success in terms of a steady happy patient pool, a wonderful loyal staff and a beautiful new clinic,” wrote Dr. Dua. “Deep inside, though, I felt empty: a former shell of that once bright, excited young man who was overjoyed at opening his acceptance letter to dental school.”
When he left the dentistry profession behind, Dr. Dua gradually began to feel that spark of passion return.
“I felt such a deep sense of relief and release of tension—as if a great weight had been lifted off my shoulders. Over time, people around me noticed a great change in my personality. I felt more relaxed, calmer, just a better person overall.”
Dr. Manu Dua sadly passed away on March 14, 2021. Yet it is heartening to see how he made the most of the time remaining to him, and many in the dentistry profession will be touched by what he expressed so poignantly.
Leaving the Dentistry Profession Behind
The fact is, for every dentist who loves what they do, there are those who can't wait until they retire.
Few will admit it, because no one wants to acknowledge they spent eight years in school and accumulated thousands in student loan debt just to be unhappy.
But even the most passionate young dentists can find that their passion slowly fades, along with their patience and sense of fulfillment, as years go by.
There are many reasons for this. For one thing, practicing dentistry is a lot harder than dental school, especially practice owners like Dr. Dua. Starting a dental practice means you’re suddenly thrust into the position of the CEO, CFO, HR director, benefits coordinator, payroll specialist, office manager...the list goes on.
Plus, dentists often feel underappreciated. It’s frustrating when patients do not attend follow-up appointments, decline treatment because of cost, or do not follow your instructions day after day.
“I put on a brave face and gave [patients] the best of me even as they lied to me about their oral hygiene habits, while I smiled and nodded, completely “ignoring” the can of Mountain Dew they brought to their appointment,” wrote Dr. Dua.
Furthermore, dentistry is physically demanding. Despite your best efforts to sit up straight and maintain good posture, your profession requires you to be all over the place. The positions you have to assume just to get a good look at the oral cavity can have you feeling like a contortionist!
Whatever the reason, there may come a time when you feel like you're done with dentistry. Everyone has a bad day at work from time to time, but if you find yourself feeling physically, mentally and emotionally drained on a daily basis, it may be time to do some soul-searching.
For some, like Dr. Dua, the revelation comes early ‒ he had graduated from dental school in 2012 and left the profession in 2020.
Others make the decision much later on. For Dr. John Kennedy, that day came at age 57 after a long, tiring day at the office.
“I realized that there were other things I wanted to do while I was still in good health and relatively young,” he wrote in a piece for Dental Economics.
Life After Leaving Dentistry
Nearly everyone who made the move at one point found leaving dentistry unthinkable.
After you've devoted so much time, energy and money to a single profession, it can feel like there’s no way you could ever do anything else. Changing your career can be a long and circuitous process.
“A small number of dentists, perhaps, work until they drop for their own mental well-being,” wrote Dr. Kennedy. “Some, through lack of planning or financial catastrophes beyond their control, have no choice but to continue working. Others - those who are financially secure - have a choice.”
Besides the daunting task of finding a new calling, one of the things dentists worry most about is how their colleagues will react to their departure. Will they judge me? Try to talk me out of it? Feel rejected?
Laura Brenner, a former dentist and career coach, writes about this subject at length in her blog. While some dentists are judgemental, she writes, “The majority are supportive and actually find leaving the career courageous because it is so hard to do.”
“The judgmental, smug dentists that do care are like our patients: most are wonderful, but 1 or 2 are not. Somehow, these are the ones that get under our skin and make the most noise. But they’re not in the majority.”
Everyone's life after dentistry is different, but there is one thing many former dentists have in common when discussing the topic: they don't regret making the choice.
“As I transition into a new life devoid of handpieces and hygiene checks, I find myself excited to explore all that is around me and engage the sense of self that died a long time ago as I was forced to put on a mask and pretend to be someone that I wasn’t,” wrote Dr. Dua.
“I miss some of the people, and I miss doing some of the procedures,” Dr. Kennedy writes. “But I practiced dentistry for 30 years and, as wonderful as it was for me, that was enough. I certainly don’t miss any of the paperwork or hassles.”
As for Laura Brenner, she wrote, “With another Thanksgiving and the 1-year anniversary of my split with dentistry behind me, I am once again reminded of my gratitude for being able to break free from something that had me feeling so trapped for so long.”
Leaving Isn’t the Only Option
It’s important to acknowledge that leaving dentistry isn’t the only option when you feel you’re at the end of your rope.
Dental burnout is a real problem, but there are steps you can take to avoid and overcome it. You may find that you can reignite your passion for dentistry by seeking support and learning opportunities outside of your clinic.
“I did this by taking dental continuing education – workshops, seminars and more,” wrote Dr. Jeff Lineberry in a piece for Spear Education. “Not only did I learn, but I got out of my isolated “box” at the dental office and got to interact with other dental professionals who were just like me: trying to be the best they can be, take better care of their patients, and be a better leader and practice owner.”
One of the most important things you can do is not keep your problems to yourself. When you feel like quitting dentistry, you should reach out to mentors, colleagues, and family members for support.
“More importantly, I had some great support from family members as well as from fellow dental professionals who helped guide and direct me to the path of focusing on making myself better – better for myself, my patients and my family,” Dr. Lineberry wrote. “Ultimately, that guidance helped me become more resistant to what many call “burn out,” and to be simply happier with myself and my chosen profession.”
Alternative Careers for Dentists
Plus, while some choose to pursue a completely different career after dentistry practice, it’s not the only option. Many others successfully pursue roles that involve their dentistry skills and knowledge in a non-clinical setting.
The ADA Center for Professional Success offers resources to assist you in making an informed decision about alternative dental careers, such as public health, academia, research, insurance, and the dental products industry.
Temporomandibular disorders (TMD) and sleep bruxism (SB) can both take a toll on a patient’s quality of life. And it’s not hard to imagine the two could be linked ‒ it’s long been speculated that grinding or gnashing one’s teeth could cause or contribute to temporomandibular joint pain.
Yet, until recently, the connection between the two conditions hadn’t been thoroughly investigated.
A new study published in Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology provides greater insight into the connection between SB and TMD, shedding light on how dentists and other oral health specialists can help patients suffering from these two mandibular ailments.
Before diving into the results of the study below, you’ll find a brief overview on sleep bruxism and TMD.
TMD, Sleep Bruxism, and the Relationship Between Them
Found on both sides of the head and in front of the ears, the temporomandibular joint (TMJ) connects the jaw and temporal bone. It works alongside ligaments and muscles, aiding in yawning, chewing, swallowing, and speaking.
Pain or tenderness in the jaw muscles/joints, face, temples, and around the ears
Issues when opening or closing the mouth
Popping, grinding, clicking, or crunching sounds while chewing, yawning, or opening the mouth
Neck pain and headaches.
Historically, TMDs result from jaw injuries, joint diseases (e.g., arthritis), or a combination of the two. Dental experts have long speculated that sleep bruxism (clenching/grinding the teeth) worsens TMD symptoms.
Despite the apparent connection between the two conditions, the science behind the link remains unclear.
In short, these were intensive studies meant to draw insightful, accurate results, which brings us to the next section:
What Were the Results of UTSD’s Study?
Many dental professionals wouldn’t be surprised with the results of UTSD’s study, which were as follows:
Compared to patients who only had TMD, patients with a combination of TMD and SB experience more oral behaviours (e.g., clenching, grinding) during sleep and waking hours.
Moreover, patients with both conditions chewed gum for extended periods (or had similar habits) more often than those with only TMD.
Patients with both conditions tended to have more TMD-related headache symptoms than those who only had TMD.
By the end of the study, UTSD’s team reached these conclusions:
There is clinical evidence that dentists must diagnose and treat patients with TMD and SB.
Dentists also need to weigh the chances of SB being present when diagnosing patients suffering from temporal headaches caused by TMD.
Always Consider the Relationship between SB and TMD
As a dental professional, you want to do everything to improve your patients’ oral health and overall quality of life.
Anybody coming into your practice with TMD-related issues is going through discomfort that you can help soothe. Unfortunately, by neglecting the possibility that sleep bruxism is a factor, you might not solve their problem.
While the two conditions hadn’t been directly connected before, UTSD’s study should give dental professionals a nudge in the right direction. Treating someone’s sleep bruxism might get to the root of their TMD, relieving their symptoms for good.
The pandemic has been a turbulent ride for the dental industry.
Practices across Canada and the United States faced new challenges, and as a result, dental professionals adapted to meet the demands of a society dealing with the pandemic.
Dentists, registered dental hygienists, and other practice staff kept their eyes and ears wide open as ever-changing policies dictated how and when dental care could be provided.
Naturally, there were stumbling blocks along the way. But dental professionals took these difficulties and turned them into learning opportunities. And the industry has come out the other side of COVID-19 more knowledgeable and passionate than before.
With vaccine rollouts promising greener pastures, it’s the perfect time to take stock of the lessons dental practice owners have learned over the course of the pandemic.
It was an understandable concern shared by clients and practitioners alike. Aerosols are inevitable when you’re working with high-speed equipment and saliva, blood, or plaque. For all we knew, everyone and everything could have been contagious.
Yet, as a dentist, you’ve always taken steps to prevent the spread of infectious diseases in your practice. You’ve been trained from day one at dental school about PPE and other necessary precautions.
Gowns, caps, gloves, and N95/KN95 masks saved the day. It won't be easy to take them for granted again.
2. Leaning into Technology
During the initial shutdown in spring 2020, 25% of dentists relied on teledentistry. Those who invested in teledentistry tools before the crisis gave themselves a leg up once restrictions took hold.
Of course, there was no predicting a pandemic. But these types of technologies keep you prepared for worst-case scenarios so that patients can continue to receive care, no matter what.
Dentists have learned to continue embracing teledentistry. Furthermore, they’ve discovered the value of staying informed about technology trends throughout the industry.
Who knows what the future holds and what type of tech you’ll need? You can't be prepared unless you stay informed.
3. The Industry Needs Strong Leaders
The pandemic was a scary time for everyone, including dental practice owners. But as a leader, you have a responsibility to be empathetic, honest, and available to your team.
Everybody working at the office was going through their own challenges and facing their own fears. Strong dental leaders always kept that in mind, prioritizing the health and wellbeing of their teams.
Moreover, a trustworthy dental leader knows their duty to the community, keeping them safe along with employees. Such leadership shined while setting up COVID-19 protocols and maintaining a safe working space.
“As a new practice owner, I had the challenge of gaining the trust of my team members as well as my patients during COVID,” she said. “We’ve all shown patience and understanding toward each other during this time because we recognize that we’re all in this together.”
It is clear that the pandemic has reminded practice owners of the importance of transparency and empathy in leadership.
4. Emphasizing Wellness
A core principle of wellness is the mind-body connection.
Emotions often lead to physical symptoms, some of which can be oral. For instance, nearly half of dentists have seen an increase in bruxism and fractured teeth since the end of lockdowns.
Dentists are often the first healthcare providers to find and identify signs of stress, and as such, wellness initiatives should be part of every practice in a post-COVID world.
This will offer patients a more three-dimensional approach to their well-being, improving their overall quality of life.
“Some patients mentioned that our office was the first public place they had been to since shelter-in-place,” said Zoey Huang, DDS, speaking to the CDA. “In our conversations with our patients, I realized that it’s more imperative than ever to understand proper self-care and stick to healthy daily routines, healthy eating, ergonomics, healthy emotions and mental health.”
5. A Unified Dental Industry is a Stronger Dental Industry
There are many unsung heroes of the pandemic. Among them are the Canadian and American Dental Associations.
As the COVID-19 guidelines changed throughout the first year of the pandemic, both the CDA and ADA offered important guidance to dentists across both nations.
By April 2020, the ADA had already formed an Advisory Task Force on Dental Practice Recovery. Soon after, a toolkit was released to help dentists get their practices up and running during the pandemic while protecting patients, staff, and themselves.
As the pandemic persisted, more resources were made available by the CDA and ADA. These efforts kept dentists informed and safe.
The constant updates, lobbying, and advocacy led to the dental industry growing stronger, more unified, and able to thrive despite COVID-related boundaries.
COVID-19 restrictions will steadily be lifted with vaccines rolling out, and dental practices will enjoy the related benefits. However, dentists won’t forget the lessons they learned along the way.
After all, if there’s one final lesson the pandemic taught you, it’s to take nothing for granted. So, being ready to adapt will remain a top priority.
When you're just starting out, it's hard to envision where your business will be in a few years. But while your lease might seem like an afterthought now, it can carry a lot of weight if you ever decide to move, sell, or shut down your practice!
1. Navigating the Make-Good Clause in a Dental Lease
A make-good provision lays out how the landlord expects the property to be when the lease is over. If you don’t leave the space in the condition you agreed to, you’ll pay for it!
Examples of common make-good clauses include:
The tenant returns the building in its initial condition
The tenant strips the building down
A make-good clause can be bad news if your practice space is a fixer-upper and you plan to undertake major renovations. Years down the road, when it comes time for you to move on, you could be on the hook for the expenses of stripping the property or returning it to its original state.
Fortunately, there are ways to navigate this costly sticking point. Sometimes, all you need is to ask. Your best chance is if the landlord is eager to bring on a tenant long-term and you have leverage.
Of course, it won’t always be that straightforward, in which case, you’ll need to take other steps to offset those expenses.
Below is a list of actions you can take to stave off the potential pitfalls of a make-good clause if your landlord doesn’t get rid of it:
Agree to a maximum total expenditure so that you’re only paying a certain amount.
Don’t agree to undo any work you didn’t do. Make sure it’s written in the contract that you only have to pay to return the space in its original condition, not to make any additions or strip it bare.
Get a document called a “condition report” before moving in. This will document damage or changes that already exist before your tenancy begins. This way, you won’t have to pay anything that wasn’t your doing.
Be sure you're not paying your make-good provision fees months after your lease ends. Ask your landlord at the end of your term if there’s work they want you to do. Provided they answer “no,” ask them to release you from the clause.
2. Know the Difference Between Sublets and Assignments
Sublets involve transferring your lease’s rights and responsibilities to a third party (i.e., the right to access space and the responsibility to pay rent every month) without changing your original contract with your landlord. You’re responsible for any of the new tenant’s actions (e.g., if they miss rent, you’re stuck with the bill).
This option's a bit risky, but it's a whole lot easier to negotiate than an assignment. Sublets are ideal for sharing your practice space with another dentist or professional part-time, or on a temporary basis.
An assignment, on the other hand, entirely releases you from your obligations as a tenant and transfers those obligations to the new tenant. This option makes sense when you’re selling your practice or trying to move to a different location before the end of your lease. However, since you need the landlord's permission to assign your lease, you must talk to your landlord before making this arrangement with another professional.
To avoid any confusion, your lease should clearly state which scenarios allow an assignment to occur.
For example, your landlord might agree to get rid of the make-good clause because you sign a longer lease. Or, they might even end up paying for some of the improvements you make to the space.
Before signing a long lease, consider the following:
Are you confident in your practice and its long-term success?
How long do you plan on running your practice?
Does the lease require a personal guarantee?
Remember that a long lease can be rigid, so you should be 100% sure that the benefits outweigh the commitment!
Finally, know that the end of your lease doesn’t always spell the end of your business at that location. If you have a good deal on a great space, talk to your landlord about renewing the lease before the end of its term. However, renewal clauses should not be a substitute for negotiating good make-good and assignment clauses up front.
Securing a great lease from day one will help get your practice off on the right foot! Understanding these factors gives you a better idea of what to look for in a dental practice lease before you shake hands and start doing business.
Why Mouthwash Has the Potential to Reduce COVID-19 Transmissions
When people think mouthwash, they think of fresh breath and plaque removal. They don’t really think about the broader health benefits of swishing a mouthful of the minty, slightly-burning liquid.
However, the results of recent laboratory testing suggest that there are at least two types of mouthwash that could stop COVID-19 from replicating in a human cell.
The two types of mouthwash in question are Listerine and chlorhexidine. Listerine contains the active ingredients Eucalyptol (0.092%), Menthol (0.042%), Methyl salicylate (0.06%), and Thymol (0.064%). The latter, chlorhexidine, is only available in Canada and the United States by prescription.
According to the lab results, both mouthwashes only took a few seconds to disrupt the virus, even after they were diluted to resemble functional use.
Questions remain about the real-life efficacy of these findings. The study only replicated conditions found in the mouth, applying concentrations of the mouthwash and measuring the time it took to contact tissues. Real-world scenarios have yet to be tested.
For this reason, more studies are needed before anything is set in stone. However, the findings suggest a simple, straightforward method that people could use to protect themselves.
Other Mouthwashes Show Promise for Preventing COVID-19 Transmissions
Another mouthwash has the potential to help in the fight against COVID-19, that being Betadine. But unlike Listerine and chlorhexidine, this product couldn’t disrupt the virus without impacting the skin cells in the mouth, which offer a layer of protection.
Betadine contains Peroxyl and povidone-iodine, which are not found in the other two mouthwash products tested by researchers.
Mouthwashes Could Help Keep Dental Professionals Safe from COVID-19
Part of fending off COVID-19 is keeping yourself safe from the virus. While PPE and other safety standards help, they aren’t impenetrable. After all, your job revolves around being up close to your clients’ mouths day after day. Every added bit of protection is welcome.
By giving a patient (who has unknowingly caught the virus) Listerine or chlorhexidine, there’s now proof it might lessen the viral load and help offset the chances of you transmitting COVID-19.
And in keeping yourself safe, you keep your patients, staff, and surrounding community safe.
The hope is that people using these mouthwashes a few times per day would lessen transmissions. However, mouthwash alone cannot stop anyone from catching or transmitting the virus.
While other research had been performed to test other antiseptic mouthwashes’ abilities to disrupt COVID-19, these findings are unique. Previous studies only examined temporary transmission prevention, whereas the new study also examined antiseptic rinse concentrations, time of contact, and skin-cell killing traits that mirrored oral conditions.
Although Listerine and chlorhexidine aren't 100% proven to prevent transmission, it wouldn't hurt to encourage patients to use them.
As a dental professional, there’s nothing you want more than for your patients to feel at ease. A comfortable patient is a happy patient ‒ not to mention easier to work with and less likely to skip cleanings or check-ups.
Unfortunately, studies show that around half of all adults have a fear of the dentist, and up to 12% suffer from extreme dental anxiety (also known as dental phobia, odontophobia, dentophobia, or dental fear.)
This is a two-pronged problem. First, patients with dental anxiety are less likely to visit the dentist as often, missing out on important dental and overall health benefits. Not only does that harm their own oral health, but it adversely impacts your practice’s financial health!
Second, anxious patients who do attend regular check-ups tend to have negative experiences. Often, anxious patients are more worried that their dentist might try to trick them, won't take their fears seriously, or will recommend unnecessary work. An anxious patient may offer less cooperation than others, which means more resources and time are required to treat them.
Plus, having someone on edge in the dental chair can make you feel like you’re not in control.
In the end, the appointment is a negative and stressful experience for both the patient and dentist, hygienist, or dental assistant. The more you can help patients reduce their anxiety level, the better the experience will be for everyone.
Cranial electrotherapy stimulation involves administering pulsed, low-intensity current to the patient’s earlobes or scalp to activate specific groups of nerve cells in the brain.
Essentially, by altering the chemical and electrical activity of these cells, the current serves to boost activity in some areas of the brain and decrease activity in others. Devices like the Alpha-Stim harness this effect to induce feelings of calmness, relaxation, and mental sharpness, reducing stress, calming agitation, and stabilising mood.
The device itself is small and unintimidating, resembling a smartphone.
Researchers have studied the effectiveness of this technology in calming patients who experience dental anxiety. One study, conducted in Niagara, sought to compare the efficacy of CES to relaxation therapy and to a combination of both CES and relaxation therapy.
While all three approaches drastically reduced patients’ dental anxiety levels, researchers found that CES (delivered via the Alpha-Stim device) was more efficient and easier than relaxation therapy.
Years earlier, Colette had suffered a traumatic experience during a dental procedure that left her very anxious, to the point of tears, whenever she needed to see a dentist. She required sedation to get through even simple treatments like fillings, as well as somebody to distract her throughout the procedure.
These solutions were not ideal. Adding pharmaceuticals to the equation creates an array of potential complications. Throw distractions into the mix and you’ve got one stressful dental appointment.
After skipping out on necessary dental treatments for years, Colette finally sought out a new dentist, who introduced her to the Alpha-Stim. The results were immediate. No more appointments missed.
On her first experience with CES, Colette writes: “I couldn’t believe it at first; I thought the nurse was tricking me. But when she adjusted the level of microcurrents I could feel myself adjusting to my situation and actually relaxing. I wasn’t as conscious of what was going on.”
Many dentists in the UK and Ireland, as well as parts of Canada and the U.S., are embracing this technology with great enthusiasm. While there are numerous other strategies to help patients cope with anxiety, most involve factors that are out of your control: not everyone responds the same way to sedatives, and relaxation therapy takes time to learn.
CES, on the other hand, is a direct approach that appears to provide immediate, consistent results.
Running a dental practice is a blend of technical expertise, business savvy, and customer service. In this day and age, where people value the customer experience more than ever, the ability to provide a fear-free dental practice is a huge competitive edge.
And when patients aren’t anxious, neither are hygienists or dentists. Technologies like the Alpha-Stim could truly be game-changing devices for your practice.