Reception Room The Slippery Octopus HPV A to Z Periodontal Infection and Pregnant Women
Orthodontics at Any Age 2015 RECEPTION ROOM ISSUE
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contents COVER STORY
10
Orthodontics at Any Age
columns
features
5
President’s Message
6
My Son the Slippery Octopus
31
Off the Cusp
10
Orthodontics at Any Age
14
HPV A to Z and the New Epidemic of Oropharyngeal Cancer
18
Mission of Mercy Event
22
Can a Periodontal Infection in a Pregnant Woman Affect Her Newborn?
24 What Exactly is Florida's Action for Dental Health? 28 Dentists Volunteer to Treat Patients in Need
For information on oral health care, visit: www.mouthhealthy.org.
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Today’s FDA is a member publication of the American Association of Dental Editors and the Florida Magazine Association.
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Today's FDA
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FLORIDA DENTAL ASSOCIATION RECEPTION ROOM 2015 VOL. 27, NO. 2 EDITOR 2015 FLORIDA DENTAL ASSOCIATION
AWARDS THE FLORDIA DENTAL ASSOCIATION RECOGNIZES THE SERVICE AND COMMITTMENT OF THE 2015 FDA AWARD WINNERS. PRESIDENT’S AWARD Richard A. Stevenson, DDS DENTIST OF THE YEAR David Russell, DMD J. LEON SCHWARTZ LIFETIME SERVICE AWARD Donald Clay Erbes, DDS SPECIAL RECOGNITION AWARDS Robert Hayling, DDS Gregory Archambault, DMD Don Ilkka, DDS Charles Llano, DDS Crissy Tallman, CMP, CAE SERVICE AWARDS Suzanne Ebert, DMD Robert Ettleman, DDS John Krueger, DDS James Strawn, DDS LEADERSHIP AWARDS Andrew Brown, DDS, MS Beatriz Terry, DDS Stephen J. Zuknick, DMD
Dr. John Paul, Lakeland, editor
STAFF Jill Runyan, director of communications • Jessica Lauria, publications coordinator Lynne Knight, marketing coordinator
COUNCIL ON COMMUNICATIONS Dr. Thomas Reinhart, Tampa, chair Dr. Roger Robinson Jr., Jacksonville, vice chair Dr. Matt Henry, Vero Beach • Dr. Scott Jackson, Ocala Dr. Marc Anthony Limosani, Miami • Dr. Bill Marchi, Pensacola Dr. Jeannette Hall, Miami, trustee liaison • Dr. John Paul, editor
BOARD OF TRUSTEES Dr. Richard Stevenson, Jacksonville, president Dr. Ralph Attanasi, Delray Beach, president-elect Dr. William D’Aiuto, Longwood, first vice president Dr. Michael D. Eggnatz, Weston, second vice president Dr. Jolene Paramore, Panama City, secretary Dr. Terry Buckenheimer, Tampa, immediate past president Drew Eason, Tallahassee, executive director Dr. James Antoon, Rockledge • Dr. David Boden, Port St. Lucie Dr. Jorge Centurion, Miami • Dr. Robert Churney, Clearwater Dr. Richard Huot, Vero Beach • Dr. Kim Jernigan, Pensacola Dr. Rudy Liddell, Brandon • Dr. Howard Pranikoff, Ormond Beach Dr. Barry Setzer, Jacksonville • Dr. Beatriz Terry, Miami Dr. Ethan Pansick, Delray Beach, speaker of the house Dr. Tim Marshall, Weekiwachee, treasurer • Dr. John Paul, Lakeland, editor
PUBLISHING INFORMATION Today’s FDA (ISSN 1048-5317/USPS 004-666) is published bimonthly, plus one special issue, by the Florida Dental Association, 1111 E. Tennessee St., Tallahassee, Fla. 32308-6914. FDA membership dues include a $10 subscription to Today’s FDA. Non-member subscriptions are $150 per year; foreign, $188. Periodical postage paid at Tallahassee, Fla. and additional entry offices. Copyright 2015 Florida Dental Association. All rights reserved. Today’s FDA is a refereed publication. POSTMASTER: Please send form 3579 for returns and changes of address to Today’s FDA, 1111 E. Tennessee St., Tallahassee, Fla. 32308-6914.
EDITORIAL AND ADVERTISING POLICIES Editorial and advertising copy are carefully reviewed, but publication in this journal does not necessarily imply that the Florida Dental Association endorses any products or services that are advertised, unless the advertisement specifically says so. Similarly, views and conclusions expressed in editorials, commentaries and/or news columns or articles that are published in the journal are those of the authors and not necessarily those of the editors, staff, officials, Board of Trustees or members of the Florida Dental Association.
EDITORIAL CONTACT INFORMATION All Today’s FDA editorial correspondence should be sent to Dr. John Paul, Today’s FDA Editor, Florida Dental Association, 1111 E. Tennessee St., Tallahassee, Fla. 32308-6914. FDA office numbers: 800.877.9922, 850. 681.3629; fax 850.681.0116; email address, fda@floridadental.org; website address, www.floridadental.org.
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PRESIDENT’S MESSAGE RICK STEVENSON, DDS
Your FDA Dentist is Here to Help You
“
Your dentist is committed to helping you maintain and improve your oral health.
”
The Florida Dental Association (FDA)
This two-day event provides free dental
techniques and technology that is ever-
introduced the Florida’s Action for Dental
services for low- and no-income Florid-
changing and provide the best dental care
Health (FADF) to the Florida Legislature
ians, and was incredibly successful last
for their patients.
in early February. This coincides with
year. The Foundation also supports Project:
the American Dental Association’s Action
Dentists Care and Donated Dental Services,
Your dentist is committed to helping you
for Dental Health, which was introduced
among other programs. These programs are
maintain and improve your oral health. As
nationally. FADF is the result of hard work
designed to help the disadvantaged receive
we know, the oral cavity is the gateway to
by our workforce innovation work group.
much needed dental care. The FDA contin-
overall health. Thank you for choosing to
But that’s only the beginning; now, the work
ually works to improve the quality of dental
visit an FDA-member dentist as your oral
to implement it starts. FADF will allow
care in the state, including advocating for
health care professional.
input from key stakeholders who want to
water fluoridation in all communities.
collaborate with the FDA to ensure that all Floridians have access to quality dental care.
By being a member of organized dentistry, your FDA-member dentist has agreed to
The Florida Dental Association Founda-
abide by the ADA Code of Ethics. They
tion is planning another Mission of Mercy
spend many hours in continuing education
(MOM) event for April 2016 in Jacksonville.
courses to keep up to date on all the current
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Dr. Stevenson is the FDA President.
Reception Room Issue 2015
Today's FDA
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Slippery Octopus
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Today's FDA
Reception Room Issue 2015
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My
Slippery Octopus
Son the
y r e p p i l S Octopus www.floridadental.org
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Slippery Octopus
By Dr. Timothy Wilson
“
Who was it that said brushing had to be in the bathroom? Maybe a change of scenery is in order.
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Today's FDA
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I have two children. My daughter is the eldest and, like older siblings, she always aims to please. She was receptive to brushing her teeth; she wanted to be a big girl. She participated in simple toothbrushing “tell-show-do.” I thought I was the best dentist-dad in the world. My son, however, has sailed down a different path. He is 2 years old, and is the rough-and-tumble dirty type who takes joy in throwing mud at our patio windows. He responds to oral hygiene with the same horror that my wife displays when she sees her just-cleaned windows caked in mud. At toothbrushing time, he can run away from me at the speed of an Olympic sprinter. Once caught, he displays an antibrushing defense mechanism that is best described as the angry flaying of a slippery octopus combined with the high pitched wailing of a sea harpy. This is a problem. Even after I catch him, how do I clean his teeth? How do I convince this young boy to participate in toothbrush time? I do not want to put my fingers near his teeth — I’m scared. You see, my son does not care about cavities, girls, inflation or clean windows. He cares about Thomas the Tank Engine, red rocket ships and dinosaurs. He is turned on by fun and off by necessity. I’ve had to relearn and invent new ways to keep toothbrushing exciting for him. Here are some tips based on my experience.
Banish Fear
If someone sticks a foreign object in your face, you will pull away. The same is true for kids. That’s why it’s important to let your child hold and play with the toothbrush before you begin brushing. I gave the brush
to my son while he was in the tub and an amazing thing happened. My son dunked it in the water and sucked on it. He thought it was a marvelous invention for drinking and didn’t understand why he couldn’t use it at the dinner table. The toothbrush ceased to be scary and now is a fun object.
Use Peer Pressure
Kids love to copy. They have a natural desire to mimic fun activities. This is how our brains learn about society and the world around us. I must not be fun — my son will not copy me. He only wants to copy his big sister. He looks up to her figuratively and literally. I knew this. One particularly stubborn night as the family was brushing their teeth, I left my son’s toothbrush on the counter where he could reach it. I didn’t tell him to pick it up. Instead I got down to my daughter’s level and we began taking turns brushing each other’s teeth. She was having great fun and it showed. Not wanting to be left out, my boy went to the counter, grabbed his brush and budged in front of his sister shouting, “Me too! Me too!”
Count to Five
Having my teeth brushed vigorously by a laughing 6-year-old and a 2-year-old with poor hand-eye coordination taught me another important lesson: When brushing, it’s important to take breaks. Brushing all four quadrants without a break can feel claustrophobic and suffocating to a child. So, every night I brush to five. At five, we stop, close our mouths, swallow, take a breath, open our mouths and brush to five again. To make it fun, sometimes I sing to five, sometimes I count like Arnold Schwar-
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Slippery Octopus
zenegger and sometimes I count in Spanish. But I always stop at five. I don’t want to ruin his trust; it’s fragile. This means I may count to five an average of 10 times a night if that’s how many times it takes to get clean.
Name Your Child’s Teeth
I’ve found that giving each tooth a name is fun. This works at home or in the dental office. For new patient exams, I’ll give each tooth I see a name. “I see Abby and Betsy and Candice and Dorothy. Hello Everett, Freddy and Grayson.” Children find it amazing that so many names could fit in their mouth.
Adopt a Brushing Buddy
Some kids are teachers — they like to lead the group and tell everyone else what to do. For these young scholars, I might suggest a Brushing Buddy. A Brushing Buddy can be a teddy bear, a doll or any similar inanimate object. It should not be your cat, dog or similar living creature. Have your young educator demonstrate good toothbrushing habits to his Brushing Buddy. Maybe even buy your child’s Brushing Buddy its own toothbrush.
Find the Right Toothbrush
Parents always ask me which toothbrush is the best. The best toothbrush is the one your child will allow you to use; the one that helps them want to brush their teeth. Some kids are excited by Barney, some by Cinderella and others by Spiderman. Get the toothbrush that your child accepts and excites them about toothbrushing. Please note that this may mean having multiple tooth brushes for different days or different moods!
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Reward Success
Keeping track of successful toothbrushing sessions is helpful. A calendar stuck to the mirror is fun or a sticker on a chart can be a reward for a job well done. After your child earns a set number of stickers, or at the end of each month, offer your child a prize like a new toothbrush or new toothpaste flavor.
Watch TV
Who was it that said brushing had to be in the bathroom? Maybe a change of scenery is in order. How about the living room while the TV is on? I’m not advocating television as a substitute to personal interaction but let’s be truthful — for some people, TV is a visual narcotic with sedative effects and, depending on the challenges facing each family, this may be a viable option. You also can experiment with iPad apps for brushing, too. We’ve tried “Teeth Timer,” “Monster Mouth,” “Ali’s Teeth Out” and “iBrush,” to name a few.
Try the Tag Team
q Lay your child’s head in your lap while the other adult supports your child’s body in his/her lap. q Have your partner lean forward and hold your child’s arms and legs while you brush the teeth from above. This position will allow for better access and visibility to the operator/brusher. (Note: I feel that using toothpaste in this position can be particularly unpleasant for children because it can run down the back of their throat. Please remember to take breaks and allow your child to swallow or clear his mouth. Better yet, use a dry toothbrush while lying down and toothpaste when in the upright position.) I hope these ideas can help you or someone you know. To keep my son interested in toothbrushing, I need to come up with something new every night. It’s not always successful and it can be frustrating. However, most of our successes are a variation on the ideas in this article.
Of course, there will always be children out there who are destined for the World Wrestling Federation. No amount of coaxing, singing, counting, pleading, begging or stickers is going to convince this little athlete that clean teeth are better than dirty ones. In this situation, I might suggest a two-person brushing technique I call the “Tag Team.”
For many children, routine and familiarity rule the roost, so changing the order in which teeth are brushed or even the song you sing while brushing can cause stress. There is nothing wrong with that. Find what works and sail with it.
This brushing technique can be rough, but consistency and routine will make things better over time. Here’s how it works:
Dr. Wilson has a pediatric and orthodontic practice in Scottsdale, Ariz.
Reprinted with permission from Dentaltown Magazine.
q Find an adult partner and sit knee to knee.
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Orthodontics at Any Age 10
Today's FDA
By Dr. William Layman
Orthodontics is not just for kids and adolescents. Orthodontics is mostly used for correcting the occlusion (bite), but the benefit is that it results in natural looking straight teeth. Orthodontists are trained to predictably intercept major issues in patients under age 10, and using the natural growth pattern during adolescence creates the best and least intrusive result. However, many adults who did not have braces as a child find themselves wanting a natural aesthetic solution to unattractive teeth. Other adults have more comprehensive occlusal (bite) issues that are best treated using orthodontics. Adult cases oftentimes are a team effort between the dentist and orthodontist. Innovations in orthodontics have opened up treatment to many adult patients because it can be completed discreetly.
What causes orthodontic problems? Most orthodontic problems (malocclusions) are inherited. Examples of these genetic problems are crowding, spacing, protrusion, extra or missing teeth, and some jaw growth problems. Other malocclusions are acquired as a result of thumb- or finger-sucking, dental disease, accidents, the early or late loss of baby (primary) teeth, or other causes.
Why is treatment so important? Orthodontic treatment creates a better bite, making teeth fit better and decreases the risk of future and potentially costly dental problems. Crooked and crowded teeth are hard to clean and maintain. A malocclusion (bite problem) can cause tooth enamel to wear abnormally, difficulty in chewing and/or speaking, and excess stress on supporting bone and gum tissue. Without treatment, many problems simply become worse, and are preventable if intercepted with orthodontic therapy.
When should my child see the Orthodontist?
Orthodontics is a tool that patients have access to throughout their life and can benefit from at any age. Whether you are interested in aesthetics or need to save your teeth from destructive bite forces, your local Florida Dental Association member orthodontist is a resource who can address your needs. The following are patients’ most commonly asked questions.
Fig. 2: Child under age 10 with posterior and anterior crossbite requiring interceptive orthodontics. Photo courtesy of the American Association of Orthodontists.
Fig. 1: Adult case showing crossbite and anterior open bite. Photo courtesy of the American Association of Orthodontists.
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The American Association of Orthodontists recommends that your child get a check-up with an orthodontist if you think something doesn’t look right, but no later than age 7. By then, your child has enough permanent teeth for an orthodontist to determine whether an orthodontic problem exists or is developing. Putting off a check-up with an orthodontist until a child has lost all baby teeth could be a disservice. Some orthodontic problems may be easier to correct
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Orthodontics if they are found early. A checkup no later than age 7 gives your orthodontist the opportunity to recommend the appropriate treatment at the appropriate time. If early treatment is in order, the orthodontist may be able to achieve results that may not be possible once the face and jaws have finished growing. Fig. 5: Clear braces as demonstrated on typodont. Photo courtesy of the American Association of Orthodontists.
Signs the Bite’s Not Right It’s not always easy for patients to identify whether there is an orthodontic problem. Even teeth that look straight may be hiding an unhealthy bite. Here are some clues that may indicate the need for orthodontic attention: q difficulty in chewing or biting q early or late loss of baby teeth q breathing through the mouth q headaches q thumb-sucking q crowded, misplaced or blocked-out teeth q jaws that are too far forward or back q biting the cheek or into the roof of the mouth q protruding teeth q upper and lower teeth that don’t meet, or meet in an abnormal way q unbalanced facial appearance q grinding or clenching the teeth
Fig. 4: Adult Class III case that requires surgery. Photo courtesy of the American Association of Orthodontists.
Can adults benefit from orthodontic treatment? Absolutely! Age is not a consideration when it comes to orthodontic treatment. Healthy teeth can be moved at any age. Today, adults account for one in every five orthodontic patients. Thanks to the variety of orthodontic “appliances,” adults may be able to inconspicuously achieve the great smile they want. Advances in today’s orthodontic materials mean patients see the orthodontist only about once every six weeks during active treatment.
Fig. 6: Clear tray aligners as demonstrated with patient inserting. Photo courtesy of the American Association of Orthodontists.
Can I get braces that can’t be seen?
Fig. 3: Severe overbite and Class II in adolescent. Photo courtesy of the American Association of Orthodontists.
As mentioned above, there are several “appliances,” such as clear brackets, brackets behind the teeth and clear removable aligners, which allow inconspicuous orthodontic treatment to create a gorgeous, natural smile. Many of today’s treatment options are designed to minimize the appearance of the appliance and better fit an adult lifestyle. Ask your orthodontist about treatment options that are appropriate for you. Dr. Layman is an orthodontist with a practice in Clearwater.
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Fig. 7: Lingual braces as demonstrated on typodont. Photo courtesy 3M Unitek.
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Tips for Keeping Mouths Healthy While Eating Sweets The American Dental Association (ADA) and Florida Dental Association (FDA) offer these tips to help kids (and parents) keep their mouths healthy while still enjoying treats. 1. Avoid snacking on candy, as well as drinking sugary beverages, throughout the day. Instead, enjoy these treats after mealtimes, as increased saliva production from a meal will help prevent tooth decay. 2. Be wary of chewy candies like taffy, which stick to your teeth longer than chocolate, and hard candies that take longer to consume. The longer a sugary food is in your mouth, the higher the risk for tooth decay. 3. Choose sugarless gum as a candy alternative, as chewing sugarless gum after meals helps reduce tooth decay by increasing saliva flow that helps wash out food and dental plaque bacteria. 4. Balance out the increase of sugary candies by avoiding sugary beverages such as sodas and sports drinks. Instead, drink fluoridated water, which can help reduce cavities by 20 to 40 percent. 5. Eating foods that are calcium-rich (such as leafy greens, cheese and almonds) and protein-rich (such as meat, eggs, fish and beans) can help rebuild tooth enamel and bone. And of course, continue to practice ongoing oral health care including flossing daily, brushing teeth twice a day and visiting your FDA-member dentist regularly!
As the state’s premier professional organization representing Florida-licensed dentists, the Florida Dental Association (FDA) serves as Florida’s advocate for oral health. A constituent society of the American Dental Association, the FDA was established in 1884 to ensure patients receive the highest quality of care from dental professionals. The FDA is the leading expert and advocate on issues affecting Florida dentists and the oral health of Floridians. To learn more, visit www.floridadental.org or call 850.681.3629.
HPV A to Z and the ... 14
1b.
1a.
1c.
2.
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HPV/Cancer
New Epidemic
of
Oropharyngeal Cancer
By Dr. Don Cohen
America, we have a problem! There is a dramatic increase in the occurrence of throat cancer in males, and cervical cancer in females, due to the human papilloma virus (HPV). Believe it or not, HPV infects almost all men and women at some time during their lives! There are more than 150 types that affect the skin, oral cavity and other mucous membranes. These different viruses are divided into high- and low-risk types, which refers to their risk of causing cancer. Even though HPV is present in most people, the infection usually is silent and does not make people visibly ill. In fact, most patients who are infected are unaware of their infection. In order to infect a person, the virus must invade the skin; in most cases, through a sore or break in the skin. However, it may be possible for the virus to enter through the tonsils’ thin tissue without any trauma or sores. Medical professionals believe the high rate of throat cancer is due to the virus’ ability to infect the tonsil tissue without any trauma.
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Most often the infection with HPV disappears without a trace or the virus takes over the cell’s apparatus and starts reproducing and produces benign things like papillomas and warts. However, if it gets into your cell’s DNA, it can transform the cell and cause the formation of a malignancy. HPV can be present as a silent infection without any signs or symptoms. In one study in Europe, patients who developed throat cancer had antibodies to the virus present for one to 13 years, indicating the virus can remain silent for a very long time. It also can become active and eventually produce benign, potentially malignant or outright malignant lesions. It is important to note that infections and many lesions caused by HPV can disappear by themselves without any treatment. HPV is the most common sexually transmitted disease (STD), and there are approximately 5.5 million new cases in the United States every year. This makes up almost 40 percent of STDs in the United States. It’s important to note that about twothirds of people who have sexual contact with an HPV-infected person also will become infected. Because of this and other factors, such as the population’s increased sexual activity, more than 85 percent of Please see HPV, 16
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The major problem with high-risk HPV is the tremendous increase in head and neck cancer.
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HPV/Cancer
HPV from 15
women and most likely men will have HPV genital infections by age 50. HPV causes a whole range of lesions. The most common benign lesions are squamous papillomas, or wart-like growths (Fig. 1a); verruca vulgaris, or common warts (Fig. 1b); and condylomas, or venereal warts (Fig. 1c). Papillomas are extremely common in the mouth. Verruca are much more common on the skin and rarely occur in the mouth. These growths are white and bumpy, and appear wart- or cauliflower-like (Fig. 1a). Common sites for papillomas are the back of the roof of the mouth and the tongue. For warts, any place on the skin — especially the fingers — is typical. Venereal warts are a prevalent STD; the same viruses (HPV 6 and 11) cause them as well as oral papillomas. Venereal warts usually are larger and can be in a cluster, whereas papillomas are small (less than half an inch) and solitary. Venereal warts represent 20 percent of all sexually transmitted diseases in the U.S. The incidence of venereal warts and other HPV-related diseases is increasing rapidly. Venereal warts infect thin tissue that is warm and moist, and they tend to cluster together. They usually occur about one to three months after contact but may take more than one year to develop. Venereal warts are primarily found on the genitals, but they also can be found in the mouth due to oral-genital contact. The major problem with high-risk HPV is the tremendous increase in head and neck cancer. While mouth cancers caused by smoking and drinking have decreased by 50 percent, throat cancer will double in the
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next 10 years. In fact, throat cancer now is more common than oral cancer. This rapid increase in throat cancer probably is due to the large, and increasing, number of people who carry the virus both genitally and orally. Roughly 4 percent of females and 10 percent of males harbor oral HPV at any one time. Oral HPV infections usually are acquired by oral-genital contact, deep kissing or are self-spread (autoinoculation). Interestingly, a peak incidence for oral HPV is in the 60-64-year-old age group, where about 11.5 percent of the patients have this virus. Since these patients probably are not as sexually active as the younger age groups, this possibly is due to the latent virus reactivating. Approximately 1 percent, or 2.13 million people, in the U.S. population has HPV 16, which has the highest risk factor. HPV 16 causes more than 90 percent of cervical and throat cancers. On an encouraging note, about 90 percent of HPV infections will clear within two years, so even an HPV 16 infection does not mean that cancer or lesions will develop. Patients with oral cancer differ from those with throat cancer in many aspects. Throat cancer patients usually do not have the typical risk factors, such as smoking and drinking that are found with oral cancer patients. They tend to be younger (by five years) and also tend to be wealthier. Obviously, since HPV is an STD, they are sexually active. The risk increases with each additional partner. The reason we think that our population is experiencing this throat cancer epidemic is not only due to having more sex partners, but the individual partners being more sexually active as well. For instance, in the 1950s Kinsey Report on
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Human Sexuality, only 10 percent of single males and 20 percent of single females engaged in oral sex. A similar survey done in the 2000s showed that 90 percent of single males and 90 percent of single females had engaged in oral sex. Basically, having sex with partners who have had multiple sex partners is more likely to spread disease than having sex with partners who have not experienced oral sex. There is a multiplier effect. The signs and symptoms of oropharyngeal or throat cancer (Fig. 2) usually are a sore throat, change in voice, a lump in the neck, feeling a mass in the throat or difficulty swallowing. These lesions can be difficult to diagnose early on and often present as a lump in the neck after they have spread from the throat. It’s important to note that throat cancer is much more curable than typical intraoral cancer. The three-year survival rate for throat cancer is approximately 95 percent, but is as low as 25 percent in HPV-negative patients who smoke and drink. Basically, people with HPV-driven throat cancer have as much as an 80 percent reduced risk of death from their cancer. Therefore, this disease is curable and most importantly, also preventable! Most people believe that oropharyngeal cancer is almost entirely preventable by administering a vaccination to preteen males and females. It’s important to vaccinate these patients before they become sexually active; the prime time appears to be 9-11 years old. GARDASIL® is the only HPV vaccine that helps protect against four types of HPV: types 6 and 11, which cause most venereal warts; and types 16
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HPV/Cancer
and 18, which cause the vast majority of cervical and throat cancers. The Food and Drug Administration has recently approved GARDASIL® 9, which not only protects against HPV 16 and 18, but also five other cancer-causing HPV types. It is expected that this new vaccine will prevent more than 90 percent of throat and cervical cancers if taken in time. Initially, GARDASIL® was only offered to women as it was solely intended to prevent cervical cancer. With the realization that more than 70 percent of throat cancer is caused by HPV, it is important to vaccinate both males and females. While obviously only females can get cervical cancer, males outnumber females by 3:1 in terms of throat cancer. Males also should be vaccinated between 9 and 11 years old to prevent throat cancer and stop this epidemic. The vaccination requires three shots to be administered over six months. The vaccine protects not only against cancer but also venereal warts — the most common STD in America. Unfortunately, as of 2009, only 27 percent of adolescent females in the U.S. had received all three doses of the vaccine. If they haven’t previously been vaccinated, catch-up vaccination can be done in males or females between 13 and 18 years old; but once again, the protection drops off dramatically if they have become sexually active. When given to young patients, the vaccine is approximately 90 percent effective in preventing cancer from HPV 16 and 18. If the vaccination is given to females over 15 years old, it protects only 35 percent of the patients; if given to females older than 18, it drops to only 20 percent. Therefore, it’s essential to vaccinate earlier rather than later. It’s important to note that an increase
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in sexual activity has not been attributed to vaccination. In recent studies comparing the sexual activity in vaccinated and unvaccinated adolescents, there was absolutely no difference found. Another concern for the vaccine is the side effects. However, the No. 1 side effect — fainting — is not caused by the vaccine, but rather the fact that a 1½ in. 22 gauge needle is used. Arm soreness and headache has mainly been associated with the vaccination, but compared to cancer, obviously there is a tremendous benefit to getting vaccinated. The vaccine’s cost is approximately $130-160 per dose, with three required doses. Most insurance companies now cover the vaccine for both males and females. The bottom line is: Let’s get all children vaccinated and stamp out this throat cancer epidemic.
References 1) Ang KK and Sturgis EM. Seminars in Radiation Oncology 2012; 22(2) 128-142A. 2) Begum S et al. Clinical Cancer Research 2005; Aug 15, 11(16):5694 3) CDC MMWR HPV Epidemiology 2010; 59(32) 1018-1023 4) Chaturvedi A. Head and Neck July 2012; July6 Suppl 1: S 16-24 5) Chaturvedi A et al. European Latency Study JCO 2011; 29:4294-4301 6) Gillison M et al. JAMA 2012, Feb 15,307(7):693-703 7) Giuliano AR et al. J Infectious Diseases 2007; 196(8):1146-1152 8) Giuliano AR et al. Cancer Epidemiology Bio Markers Prev 2008; 17(8):2036-2043 9) Herrero R et al. PLOS One 2013, July 17, 8(7) e68329 10) Mahmud SM et al. J Clinical Oncology 2014(32)6
Photos: Fig. 1a: Papilloma on the tongue with leaflike projections, lesion resembling cauliflower. Fig. 1b: Verruca vulgaris (common wart); most common in children and most often found on the fingers. These lesions are contagious and can be spread to the mouth. Fig. 1c: Condyloma acuminatum (venereal wart); most common on external genitalia but can occur in the mouth, and are the result of oral-genital contact. Fig. 2: Oropharyngeal cancer located in the back of the throat. This type of HPV-driven cancer is now the most common type of oral cancer. Dr. Don Cohen is a professor at the University of Florida College of Dentistry, and provide insight and feedback on common, important, new and challenging oral diseases. The dental professors operate a large, multistate biopsy service. They write a column titled “Diagnostic Discussion” for Today’s FDA that includes case studies that originate from the more than 10,000 specimens the service receives every year from all over the United States.
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MOM Event
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MOM Event
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It is clearly evident that FDA members are committed to giving back to their communities to help solve the access-tocare challenges in Florida.
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y c r e t M Even Please see MOM, 21
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Donations from your dentist and the public support these FDA Foundation programs: Florida Mission of Mercy Project: Dentists Care Oral health education programs Scholarships Disaster aid For more information, or to volunteer: 800.877.9922 foundation@floridadental.org www.floridadental.org/foundation
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MOM Event MOM from 19 By Drs. Nolan W. Allen and Leo R. Cullinan
In March 2014, the first Florida Mission of Mercy (FLA-MOM) event was held and it was a huge success! The 2014 FLA-MOM event was a 110-chair dental clinic set up in the 40,000 sq. ft. Florida State Fairgrounds Special Events Pavilion in Tampa. There were 1,500 volunteers, including more than 400 dentists and dental hygienists, who treated 1,661 patients on a first-come, first-served basis. This free two-day event for low- and no-income Floridians touched many lives directly, and continues to have a positive effect on these patients, our profession, our communities and our legislators across the state. The 2016 FLA-MOM already is in the planning stages for April 22-23 in Jacksonville, and the Florida Dental Association (FDA), with the support of the Florida Dental Association Foundation, is aiming to produce a MOM event on an annual basis in other cities around our state. Many lives were touched during our MOM event, and Duane Wagner’s story is no exception. He had an initial dental examination at a Clearwater dental office prior to the MOM event, where it was determined that he needed all of his remaining teeth extracted, with the exception of six lower teeth. Additionally, a complete upper denture and a removable lower partial denture would be necessary. We discussed the upcoming MOM event; Duane said he wanted to volunteer to set up the clinic the day before seeing patients, and he would like to be the first patient seen the next day. He previously saw Dr. Renaldo Claudio, an oral and maxillofacial surgeon in Clearwater, who also volunteered to work on the first day of the event. Dr. Claudio agreed to perform Duane’s extractions the first morning of MOM, so we took the necessary impressions to create the oral appliances that would be placed immediately after the extractions. We contacted the owner of a dental lab in Clearwater who agreed to create Duane’s dentures at no cost so they would be ready for delivery at the event. And lastly, we asked Dr. Gordon Krueger, a St. Petersburg prosthodontist, to fit Duane’s upper denture and lower partial denture following his teeth extractions. All of these dental professionals played a vital role in making Duane’s dream of a new smile come true, and he showed his gratitude by being our hardest worker during clinic setup — an absolute whirlwind of activity all day. He was the first person there in the morning and the last to leave that night. Duane was the first patient seen the next morning, and his case proceeded like clockwork. He left the clinic showing off his beautiful new smile to everyone in his path while saying, “I feel great!” Duane received post-operative follow-up dental care at the Clearwater dental office he previously went to as he continues his ongoing quest for optimal dental health. In a subsequent interview that asked Duane how he felt about his FLA-MOM experience, he stated that it has given him a second chance at life. It was important to him that he could volunteer on setup day and work before he was a patient the next day. He also stated that he will go anywhere, anytime to assist for the next FLA-MOM — just tell him when and where the next event will take place! He further stated that he physically feels so much better now, and is able to sleep through the night and not wake up with a migraine from toothaches. He said, “People don’t look at me funny now,” and “People include me in their activities and invite me to social events again.” Duane also has been able to get and keep a full-time job again, which he states, “Means the world to me.”
www.floridadental.org
While the FDA and the FDA Foundation are committed to sponsoring MOM events annually beginning next year, Project: Dentists Care (PDC) is the dental access-to-care program that has been ongoing since 1993 in Florida. PDC consists of numerous organizations in Florida that provide a safety net of preventive and restorative dental care to those in greatest need. Many FDA members volunteer their time and talents with these organizations to provide oral health care to the underserved. These dentists treat those low-income individuals who don’t qualify for public assistance but have the greatest unmet needs. PDC clinics around the state donate more than $11 million in dental care annually in addition to the Give Kids a Smile event that donates an estimated $1 million in dental care. In closing, it is clearly evident that FDA members are committed to giving back to their communities to help solve the accessto-care challenges in Florida. Additionally, the FDA announced Florida’s Action for Dental Health, which is a comprehensive effort developed to improve the oral health and resulting overall health of all Floridians — from infants to the elderly. As then-FDA President Dr. Terry Buckenheimer stated at the conclusion of the FLA-MOM: “It has been said that small dreams don’t stir the souls of men. As highly trained dental professionals, we have a rare gift to share with people in need — and most do so in many small and often unseen ways. But there also is an occasion for showing compassion on a large scale, for attempting to do something together that could never be done alone. That’s the beauty of FLA-MOM. That powerful philosophy is the essence and backbone of membership in the Florida Dental Association.” Drs. Allen and Cullinan were the 2014 FLA-MOM co-chairs.
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Pregnancy
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Pregnancy By Dr. David Campbell
Can a newborn’s health be affected if the mother has an oral infection? This is an interesting question. Through most of our training as health care providers, we were taught that problems within the mouth were separate from the rest of the body. Within the past 15 years, new research has discovered correlations with oral infections (like gum disease) and health issues, such as heart attack, stroke, upper respiratory infections, some cancer (kidney, pancreatic and blood cancer) and interestingly, premature low birth weight babies. Periodontal (gum) disease is an infection that affects the teeth’s supporting structures. This infection is a silent disease in most individuals — meaning that it doesn’t hurt until it’s too late — however, signs might include bleeding or puffy gums. Prevalence of periodontal disease in the United States’ adult population approaches 50 percent in the 2009 and 2010 National Health and Nutrition Examination Survey (NHANES) cycle. It’s important to note that any infection during pregnancy is a cause for concern. Recent studies have discovered that pregnant women who have periodontal disease may be seven times more likely to have a baby that is born too early and too small. How could this be? How could an infection in a pregnant woman’s mouth cause her baby to be born too early? The likely culprit is a chemical found in dental plaque called prostaglandin. Prostaglandin is a labor-inducing chemical found in high levels in women with severe cases of periodontal disease.
These recent studies indicate that the more of the mouth affected with periodontal disease, the more likely a woman is to prematurely deliver a low birth weight baby. Although the study finds a definite correlation between the severity of periodontal disease and premature low birth weight babies, premature deliveries were observed in women with as few as two infected gum pocket sites. About one in nine babies in the United States is born prematurely. Babies that are born before 37 weeks of pregnancy are considered premature. Most women that I know are miserable the last few weeks during pregnancy and would love to deliver early, but there are certain issues with premature birth. What health conditions can premature birth cause for newborns? In addition to low birth weight, respiratory distress syndrome, brain bleeding, a heart problem called patent ductus arteriosus (PDA) or a problem in a baby’s intestines called necrotizing enterocolitis (NEC) are health conditions that can affect premature babies. Diabetes, heart disease and high blood pressure are health conditions that can affect premature babies later in life. The longer hospital stays at birth, as well as the short- and long-term health conditions associated with premature babies, also adds a large financial burden. Our best recommendation is to have a full dental and periodontal screening prior to becoming pregnant. If any type of infection is found at that screening, it’s a great time to get your oral health under control. However, if you are already pregnant, do not shy away from dental treatment. Most OB/GYNs recommend the second trimester as the best time to have dental procedures performed, due to minimal risk. Dr. Campbell is a periodontist in Lakeland.
tal Infection in a ffect Her Newborn? www.floridadental.org
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FADH
What Exactly is F Action for
“ ” The FDA cares about the citizens of Florida — from infants to the elderly.
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By Dr. Jolene Paramore FDA SECRETARY
The Florida Dental Association (FDA) is pleased to share Florida’s Action for Dental Health (FADH) with you, a multi-year plan that outlines programs and initiatives focused on improving the oral health and resulting overall health of all Floridians! You may be wondering, “Why should I care about Florida’s Action for Dental Health?” Since you’re reading this in your dentist’s office, you’re already on your way to oral health. Good question — and the answer is simple: FDA-member dentists are the advocates for oral health in Florida; it is our ethical responsibility to stand up for those who have no or minimal voice in “the system.” We care about the citizens of Florida — from infants to the elderly — and we have a hunch you do, too. FADH will implement proactive measures to reduce the pain and suffering from dental disease that many Floridians experience daily. FADH has three objectives: v Promote attainable dental care for the uninsured and underserved in Florida.
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? FADH
Florida’s r Dental Health v Collaborate to maximize use and capacity of the current dental workforce to optimally serve Floridians with preventive and therapeutic dental care. v Expand opportunities for public health dentistry to serve Floridians. Look for our strategies to achieve these objectives on www.floridadental.org. FADH is a guideline to develop innovative and practical solutions that remove the challenges to obtaining and providing quality dental care in Florida. For years, we’ve known preventive care works. Community water fluoridation, oral health education and preventive dental care are easy and inexpensive compared to treatment. In 2012, Florida had more than 139,000 emergency room visits for preventable dental problems, costing more than $141 million. We are seeking solutions to this overwhelming problem and financial burden that the lack of preventive care creates.
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We understand that this will not happen overnight. There are many pre-existing programs and projects already implemented in Florida. This initiative is an opportunity to expand those programs statewide and open the door for more innovative ways to approach dental care. The FDA welcomes your input and any ideas you would like us to consider. Please feel free to think “out of the box.” You may have a great idea that helps your fellow Floridians! The FDA and its member dentists believe it is important to address the problem on a large scale and come up with real solutions that will impact the lives of all Floridians. Please contact the FDA at 850.224.1089 or gao@floridadental.org with your suggestions. Dr. Paramore is the FDA Secretary. She is a periodontist in Panama City.
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mouthhealthy.org Find an ADA Seal product Age-related information Nutrition Symptom Checker Dental Care Concerns ACA Checklist for Dental Plans Dental Emergencies And, much more!
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Going the distance to help you save. Now that’s Progressive. Progressive Casualty Ins. Co. & affiliates, Mayfield Village, Ohio, and in Texas by Progressive County Mutual Ins. Co. Do not attempt.
Dental Lifeline
Dentists Volunteer to Treat Patients in Need “The DDS program made a tremendous difference in our lives and we will be forever grateful for what you have done for us.” — Cynthia, a Florida DDS patient
Left to right, Dr. Z, Dorothy, Cynthia and Dr. L
A mother and daughter with serious medical problems and painful dental disease lived together in Apopka, unable to afford the extensive dental care they needed. While Cynthia, age 53, was in treatment for ovarian cancer, her mother, Dorothy, age 87, had cardiac problems including an 11-year-old heart stent.
vices (DDS), a program of Dental Lifeline Network • Florida. General dentist Dr. L donated Cynthia’s crown and restorations and a volunteer endodontist completed the root canal she needed. Dr. Z, in practice with Dr. L, contributed Dorothy’s new lower partial. A volunteer oral surgeon extracted root tips for both patients.
The lives of both were dramatically transformed through extensive treatment generously donated by four volunteer dentists and two labs through Donated Dental Ser-
“The DDS program made a tremendous difference in our lives and we will be forever grateful for what you have done for us,” said Cynthia.
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Cynthia and Dorothy are among thousands of vulnerable Florida residents with disabilities or who are elderly or medically fragile and have no access to dental care that they desperately need. The four dentists who volunteered to help mother and daughter are part of a network of 397 Florida DDS volunteer dentists. Two hundred dental laboratories also volunteer for the program. Through Florida DDS, 1,351 patients have received more than $4.9 million in donated treatment since Dental Lifeline Network • Florida was founded in 1997 in conjunction with the South Florida District Dental Association (SFDDA). A full-time DDS Coordinator is funded with help from the Florida Dental Association Foundation. Dental Lifeline Network • Florida is part of the national Dental Lifeline Network organization, a charitable affiliate of the American Dental Association. Dental Lifeline Network serves patients in all 50 states and the District of Columbia through more than 15,000 volunteer dentists and 3,800 laboratories.
www.floridadental.org
Dental Lifeline
How to Apply for Treatment through the Donated Dental Services (DDS) Program Eligibility Applicants must lack adequate income to pay for dental care and: n Have a permanent disability, or n Be age 65 or older, or n Qualify as medically fragile Patients who qualify as medically fragile are those who need a clean bill of oral health to receive chemotherapy for cancer or autoimmune diseases, an organ transplant, dialysis, cardiac surgery or those who have crippling arthritis and need a joint replacement.
To Apply Contact the DDS Coordinator for an application or go to http://dentallifeline.org/florida/ to download an application.
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It was a happy day when Dorothy and Cynthia came in. The staff was excited to see them. — Dr. Z, a DDS volunteer
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Megan Manor, DDS Coordinator n 850.577.1466 n mmanor@DentalLifeline.org n 850.577.1467 (Fax) All applications must be submitted through the DDS Coordinator.
Services
n DDS volunteer dentists provide comprehensive treatment to eligible patients. n Volunteers do not provide emergency services.
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The Plaqster, Den and Buck are sure having fun! You can join in. Can you find 25 differences between the two pictures?
2014 American Dental Association
OFF THE CUSP JOHN PAUL, DMD, EDITOR
That Strange Language Your Dentist Speaks Patients often come to my office embarrassed. They are convinced that what’s in their mouth is the most awful looking thing I’ve ever seen and I will make judgments about them because of it. Now, no patient should have to experience dental school, but I did, and I can pretty much guarantee that you are not bringing me the worst thing I’ve ever seen. Many people have dental problems— not always from their own fault — and anyone would be foolish to make judgments about a person just from the condition of their teeth. Everything that goes on in a dentist’s office is weird if it’s the first time you’ve experienced it. It smells funny, there are scary sounds and the doctor speaks a language you don’t understand. We get excited when we’re talking about the things we know and start the Latin jibber-jabber that only another dentist can understand (no, really, our team doesn’t understand either). Most of the time, we are speaking plainly, especially when we are asking questions. There are no trick questions, we are seeking simple answers. It amazes me the number of times I ask a patient if something hurts and they start their answer with, “Ummm …” or “Well …” “Does it hurt?” simply requires a
yes or no answer. It may only hurt a little bit or it may just be annoying, but if you want the feeling to quit, “Yes” is your best answer. “Where does it hurt?” This is one that doesn’t even need a verbal answer; it’s A-OK to point, even if you have to put your finger inside your mouth. It’s also OK to say the pain isn’t in just one tooth, but is in a general area. This is common and actually helps us diagnose what is causing the pain. “How long has it hurt?” This is when folks often tell me the entire history of their experience with dentistry. It’s good to be thorough, but simple is best here, too. Just be honest whether it’s hurt for two years or only two days (remembering that “hurt” is the word for any feeling you wish would go away).
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Everything that goes on in a dentist’s office is weird if it’s the first time you’ve experienced it.
It’s also OK to tell your doctor, “I’ve been thinking about this treatment,” or “There is no way that treatment would be something I’d consider.” There is no single “best” treatment. There are solutions that are most appropriate for you. Your dentist’s job is to find out about you and your dental condition, and explain to you what treatments can help you have the oral health you want.
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Dr. Paul is the editor of Today’s FDA. www.floridadental.org
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THE SIGN OF A PROFESSIONAL! Member dentists of the American Dental Association and Florida Dental Association are committed to a code of ethics and professional conduct that puts patients first.