First Impressions July 19

For Dental Sales Professionals

Pedodontists Advanced technology, together with experience and a measure of sensitivity, enable pedodontists to provide the best possible care for their young patients.

July 2019

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Editorial Staff Editor Laura Thill lthill@sharemovingmedia.com Managing Editor Graham Garrison ggarrison@sharemovingmedia.com Founder Brian Taylor btaylor@sharemovingmedia.com Senior Director of Business Development Diana Partin dpartin@sharemovingmedia.com Director of Business Development Jamie Falasz, RDH jfalasz@sharemovingmedia.com Art Director Brent Cashman bcashman@sharemovingmedia.com Circulation Wai Bun Cheung wcheung@sharemovingmedia.com Associate Editor Alan Cherry acherry@sharemovingmedia.com

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Pedodontists

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Kid-friendly dentistry

Advanced technology, together with experience and a measure of sensitivity, enable pedodontists to provide the best possible care for their young patients.

Treating young children requires a unique skill set.

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Healthy Reps Health news and notes

Windshield Time Automotive-related news

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Pedodontists Advanced technology, together with experience and a measure of sensitivity, enable pedodontists to provide the best possible care for their young patients.

For pediatric dentists, patient care can be a fine balance between treating a child’s oral health and creating a safe, welcoming environment. The recommended age for a child’s first dental visit has dropped from three years to 12 months in recent years, making it more important than ever before for pedodontists to determine a treatment plan tailored to each patient’s needs.

Indeed, pedodontists must approach their patients with a unique level of clinical experience that enables them to manage each child’s behavior while also assessing his or her growth and development.

“It is important that we meet each child to determine his or her needs for behavioral management, and put together a treatment plan that best suits that child,” says Kim Hansford, DMD, a pediatric dentist at Middletown, KY-based Kid's Dentistree, a Mortenson Dental Partners partner. “We see ourselves as primary care providers, much like pediatricians. Our goal is to provide a dental home for each child.”

The battle against tooth decay Pediatric healthcare can be frustrating, both for parents who wish for immediate results for their children, and clinicians who are always in a position to deliver. “Dental caries is still the most prevalent childhood disease we see, even in our affluent society,” says Hansford. Most people’s diet includes processed foods, with lots of refined carbohydrates, she points out. “Even crackers break down on the teeth into simple sugars, which can cause decay.

“Parents become frustrated,” she continues. They feel they are doing everything they can to protect their child’s teeth, but to no avail, she notes. While good nutrition helps children avoid tooth decay, there often are overlooked culprits that impact oral health. Medications are a prime example, she points out. “A liquid allergy medicine taken every night by a child has sugar in it,” she says. “Gummy vitamins are made with sugar and stick to the teeth.

“It is important that we meet each child to determine his or her needs for behavioral management, and put together a treatment plan that best suits that child.”

– Kim Hansford, DMD, a pediatric dentist at Middletown, KY-based Kid’s Dentistree

“Grazing or snacking – and not letting the mouth have time in between snacks or drinks to normalize – can place children at high risk, due to repeated exposure. It is my job to provide parents with the tools they need to avoid these easy traps, and teach them to care for their child’s teeth at home.

Exceptional technology “Unfortunately, there is no magic bullet for treating children,” says Hansford, noting she makes a point to put herself in these parents’ shoes and be sensitive to their expectations. That said, pedodontists today have some exceptional technology at their disposal for treating patients, she adds.

For many years, nitrous oxide has proved itself invaluable in many dental settings, but particularly in pediatric practices. “Nitrous oxide sedation continues to be the safest and most predictable way to provide an easier experience for most children,” says Hansford.

“We use it for patients of all ages; it can make or break a child's experience under the right circumstances.” She advises dental professionals against using the term sedation too freely. There are a number of options for pediatric patients, and the pedodontist can determine the best method for each patient. “Some children may do great in a pediatric dental setting without any additional medications,” she points out.

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PEDODONTISTS

Equipment such as digital imaging/ radiographs are another must-have for pedodontists. “Developments in digital imaging greatly reduce children's exposure to radiation while delivering excellent clinical X-rays,” she explains. “We make a commitment to image gently in our office.” Without radiographs, pedodontists cannot determine an exact number of cavities, she adds. “Hidden

interproximal decay can be a big surprise to parents!”

Hands-free dental vacuum suction and isolation systems have “totally changed the way I practice pediatric dentistry,” says Hansford. “In the past 20 years, this technology has allowed pedodontists to provide treatment on one whole side of the mouth safely and comfortably, with less local anesthetic than in

“ General public awareness of the importance of early evaluation is key in helping children get established in a dental home and hopefully lowering their risks of oral health issues.”

– Kim Hansford, DMD, a pediatric dentist at Middletown, KY-based Kid’s Dentistree.

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the past when we relied more on rubber dam isolation.

“Dental materials have also come far, allowing pedodontists to provide more esthetic options, in more instances than in the past. Glass ionomer restorations in children provide fluoride release, good esthetics and are more tolerant in moist environments, where perfect isolation may not be achieved.

“General public awareness of the importance of early evaluation is key in helping children get established in a dental home and hopefully lowering their risks of oral health issues,” Hansford continues. Children may always have caries, she adds. But, with new treatments like silver diamine fluoride as an adjunct therapy to delay treatment, or decrease need in times where it may not be practical due to the patient’s medical status or very young age, pediatric dental practices should have greater opportunity to take a preventive stance to oral healthcare.

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PEDODONTISTS

Kid-friendly dentistry Treating young children requires a unique skill set.

A few generations back, the general consensus was that children should be seen but not heard. Fortunately, by today’s standards, not only should children be seen and heard, they should be afforded the best possible healthcare, including oral care. Indeed, the recent drive to educate families on the importance of early oral care and the need to make treatment more accessible has paid off, both for pediatric patients and the pedodontists treating them. Overall, this is great news for dental professionals. At the same time, many dental owners are challenged with making their waiting rooms more child-friendly, investing in newer technology and providing their teams with more and better training.

Outreach and education Rolando Mia, vice president of customer success at Zyris, has seen a definite rise in pediatric dental visits among the company’s pedodontist customers. “We believe the increasing population of children in the United States is helping fuel growth among our pediatric customers, many who are expanding – adding operatories, personnel and even offices,” he says. “We also hear that more families are realizing the importance of bringing their children to the dentists’ office; This is reinforced by our pediatric and community health center customers via addi-

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tional and ongoing educational programs, as well as dental education outreach in their local communities. For instance, many dentists today offer on-site visits to schools and provide free dental packs (e.g., toothbrushes, toothpaste, floss, etc.) for the children.

“It appears that more children and their families are taking advantage of insurance coverage, as well as special pediatric-focused dental outreach programs for preventative dental care, (e.g., the American Dental Foundation’s Give Kids a Smile, America’s Tooth Fairy, etc.),” he continues. “It’s been especially helpful as

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dental associations have come together to develop a successful ad council awareness campaign promoting the importance of managing children’s oral hygiene (e.g., 2 Min – 2X/Day, which involves brushing one’s teeth for 2 minutes, twice daily). As a result, more children are receiving higher quality oral healthcare today.”

Addressing the need As more and more children are scheduled for dental visits, pedodontists and general dentists who perform basic pediatric care (e.g., checkups and cleaning, preventive care, caries treatment, sealants, education, etc.) are tasked with adopting new technology, remodeling their waiting rooms and offering reward programs to motivate their younger patients.

“We’ve observed that many of our customers recognize the need to make their offices an inviting, fun and safe place for children to visit,” Mia points out, noting it is common for dentists to rely on themes to make their offices less intimidating.

So, for instance, the office may feature a beach theme or a tropical, jungle, ocean or zoo theme. It’s also becoming more common to have digital or board games available in the waiting room, children’s programming playing on a television and interactive iPads available in waiting rooms, operatories and recovery rooms.

Some practices have begun sponsoring special events, such as field trips to the dental office to give children the opportunity to use the instruments, see the operatories and learn about dentistry, he adds.

“We also see different engagement and reward systems for children who are successfully performing preventative oral care,

such as the Brush DJ app, a no-cavity club or movie passes, awards or toys,” says Mia. Not surprisingly, with an increase in patient visits comes a handful of administrative responsibilities, including recruiting qualified doctors and staff, managing the business and working with parents and caregivers – some who can be overbearing! “Pediatric dentists must be effective in consistently managing issues related to profitability, staffing, expense control, maintaining a high quality of care and managing the team,” says Mia. And, it’s not always easy to secure qualified or experienced dentists, he adds. Many dental school graduates are opting to join DSOs over solo practices. “In addition, we’ve learned from working with our pediatric customers there is a special patience and focus required to work with children,” he points out. “There is a level of communication and patience required to be effective with children, and not all doctors and clinicians have the capacity or talent to do so.

“Children are especially difficult to treat due to their decreased understanding of the procedure, short attention span and smaller mouth,” he continues. “Pediatric dentists have a small window of opportunity to treat a child before the patient becomes tired, distracted or simply upset during the procedure.” Sometimes, it’s a matter of working with a difficult parent or caregiver, he notes. “We continually hear that parents can make or break a dental procedure visit. When parents do not cooperate, or they feel compelled to question everything a clinician is doing, we’ve been told this can upset the child and compromise the clinician’s ability to effectively treat the patient. In addition, children key off their parents/ caregivers during a procedure. If a parent is nervous, impatient, fearful, etc., the effect on the child can be negative.

“As technology and materials continue to improve, procedures are easier and quicker to perform,” says Mia. That said, incorporating and using new technology, equipment and materials can be challenging, he adds. “We’ve been told the proliferation of computer and digital systems is especially daunting.

The challenge is to find clinicians, hygienists and dental assistants with the skills and ability to operate and use these systems once they are trained.”

Examples of newer pediatric technology includes silver diamine fluoride (SDF) for caries prevention and treatment, digital

there’s a learning curve involved and it takes time for clinicians to become comfortable using new technology. The dental team must also keep up with software updates and on-going training and support. “It requires a dedicated effort, and when technology is set aside and forgotten, it’s a wasted investment.”

Training and education Even as dental care becomes more accessible to many children, some community health clinics continue to face a huge patient backlog, notes Mia. “According to one community health clinic

“ It appears that more children and their families are taking advantage of insurance coverage, as well as special pediatric-focused dental outreach programs for preventative dental care.”

– Rolando Mia, vice president of customer success at Zyris

X-rays, digital and laser cavity detection devices and aids, hard and soft tissue laser designed to painlessly treat cavities and decay, CAD/CAM impression technology, painless injection systems and improved isolation and retraction devices, such as the Isolite System. At the same time, pediatric dentists today must be comfortable with sedation dentistry, which is now used more routinely.

“We’ve heard a number of concerns from our dental customers regarding these newer technologies,” says Mia. For one, there’s an ongoing cost involved in adopting new technology, some of which may quickly become obsolete as next generation systems become available. “Our customers also tell us that new technology can be disruptive to clinicians,” he says. Naturally,

we work with, some pediatric patients have wait times of one to two years to be seen by a clinician,” he says. “The majority of recent dental school graduates are trained to perform procedures primarily on adults,” he explains. “They often have limited education or expertise when it comes to working with younger children.

“Pedodontists must participate in a graduate education program that is focused specifically on treating and managing younger children,” says Mia, noting this requires a much different skill set from working with adult patients. “When a child is experiencing more complex oral health issues or severe conditions, it is imperative that he or she is treated by a specialist – one that is specifically educated and experienced in treating young children and special needs patients.”

https://www.childstats.gov/americaschildren/tables/pop1.asp, https://www.childtrends.org/indicators/number-of-children

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HEALTHY REPS

Health news and notes How much screen time?

How much screen time – smartphones, videos, online games – should little kids have? The World Health Organization says that kids in their first year of life should have ZERO time in front of a screen, and very little in year 2. Those aged 2 to 4 should spend no more than an hour a day in front of a screen, says WHO. The international health agency drew on emerging – but as yet unsettled

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– science about the risks screens pose to the development of young minds, reports The Washington Post. Experts in child development say the acquisition of language and social skills, typically by interacting with parents and others, are among the most important cognitive tasks of childhood. But there is disagreement about how screen time interferes with that. “The more guidelines we give, it just seems like there’s going to

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be more of a mismatch between what experts say … and what it feels like to be a parent in the real world every day,” said University of Michigan pediatrician Jenny Radesky, author of 2016 screentime guidelines for the American Academy of Pediatrics.

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can safely forego immediate treatment of their eye condition as long as they are closely monitored, and treatment begins promptly if vision worsens, according to clinical trial results. The findings were published in the Journal of the American Medical Association. Diabetic macular edema is the most common cause of vision loss among people with diabetic eye disease in the United States. Diabetes can result in the development of leaky blood vessels in the retina – the light-sensing tissue at the back of eye.

Diabetic macular edema is the result of fluid build-up in the central area of the retina, called the macula, which is important for sharp vision. Swelling of the macula can distort vision required for reading and driving.

Lightning strikes Just as lightning can strike the same target more than once in a given storm, hip fractures can and do happen again to the same person, according to New York Times health writer Jane Brody.

Yet, more often than not, people who fracture a hip do not get follow-up treatment that could prevent another fracture. Anyone who breaks a hip, unless from a severe trauma like a car accident, is considered at high risk for further fractures, including breaking the other hip. To reduce the risk, orthopedic experts recommend that following a fracture, patients should have a bone density test, evaluation of calcium and vitamin D levels and, in nearly all cases, medication to protect against further bone loss. Writing in JAMA Geriatrics last year, University of California San Francisco internist Dr. Douglas Bauer wrote about “really depressing, hocking data” revealing that only a small – and steadily declining – fraction of hip fracture patients are being treated with medication that might forestall future broken bones.

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HPV vaccine has impact Cervical cancer is the most common human papillomavirus (HPV)-associated cancer in women, and high-grade cervical lesions (CIN2+) have been used to monitor HPV vaccine impact, reports the CDC. During 2008–2016, CIN2+ rates in a population-based surveillance system declined in women aged 18–24 years, the agency reported. The estimated numbers of U.S. CIN2+ cases were 216,000 (2008) and 196,000 (2016), with an estimated 76% attributable to 9-valent HPV vaccine types.

“The reduction in CIN2+ attributable to vaccine types in young women demonstrates impact of the HPV vaccination program,” says CDC. “Continued efforts to increase coverage and encourage vaccination at the routine ages (11–12 years) can increase vaccine impact on cervical disease in the United States.”

hypertension, organ failure, and far too often, early death.

How valuable are vitamins?

More than half of U.S. adults take dietary supplements, according to Dr. Francis Collins, director of the National Institutes of Health. But does popping all of those vitamins, minerals, and other substances really lead to a longer, healthier life? A nationwide study published in the Annals of Internal Medicine suggests it doesn’t. Based on an analysis of survey data gathered from more than 27,000 people over a six-year period, an NIHfunded study found that individuals who reported taking dietary supplements had about the same risk of dying as those who got their nutrients through food.

What’s more, the mortality benefits associated with adequate intake of vitamin A, vitamin K, magnesium, zinc, and copper were limited to food consumption.

Sickle cell therapy is tested An experimental gene therapy being tested at the National Institutes of Health Clinical Center in Bethesda, Maryland, has shown some positive results in eliminating sickle cell disease (SCD).

The approach involves using gene editing to increase levels of fetal hemoglobin (HbF) in the red blood cells of people with SCD. Significant quantities of HbF have been found to provide protection against sickling. Sickle cell disease is caused by a specific point mutation in a gene that codes for the beta chain of hemoglobin.

People with just one copy of this mutation have sickle cell trait and are generally healthy. But those who inherit two mutant copies of this gene suffer lifelong consequences of the presence of this abnormal protein. Their red blood cells – normally flexible and donut-shaped – assume the sickled shape that gives SCD its name.

The sickled cells clump together and stick in small blood vessels, resulting in severe pain, anemia, stroke, pulmonary

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Sensor for diabetic foot ulcers Somerville, Massachusetts-based Podimetrics is tackling the problem of diabetic foot ulcers through a smart sensor mat that is designed to be placed in a patient’s home and can analyze foot temperature variations to predict and prevent the occurrence of a potential ulcer, according to MedCity News. Podimetrics users stand on the mat for about 20 seconds, and the data gets analyzed and sent to the Podimetrics care team, which examines and triages the data and works with the patient’s physician on preventative treatments and coaching. A study published in Diabetes Care found that the company’s technology could detect 97 percent of developing foot ulcers an average of five weeks before they could be detected otherwise. Podimetrics has reportedly raised around $16 million in funding since its founding in 2011.

WINDSHIELD TIME

Chances are you spend a lot of time in your car. Here’s some automotive-related news that might help you appreciate your home-away-from-home a little more.

Automotive-related news Entry-level crossover One of the toughest decisions by product planners working on the Hyundai Venue was to engineer the subcompact crossover with front-wheel drive only – forgoing claims as an occasional offroad vehicle capable of spinning all four wheels in mud or snow, reports Automotive News. But what the planners gave up in all-wheel-drive grip, they gained in carving out a niche of their own, ac-

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cording to the editors. “The Venue is built from the ground up as a stylish urban crossover for the U.S. at the price of a ho-hum economy car – a play that could even convert some used-car shoppers into new-vehicle buyers and bring them into the Hyundai fold.” At its size, it's the first of its kind, but not likely the last, Michael O'Brien, vice president for product, corporate and digital planning at Hyundai Motor America, told the magazine.

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Customizing electric cars’ performance Hyundai Motor Group has developed new technology that will allow drivers of electric cars to customize the vehicle’s performance using a smartphone application, reports TradeArabia. The industry-first innovation can adjust seven performance features, including the maximum torque output of the motor, ignition, acceleration and deceleration abilities, regenerative

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braking capacity, maximum speed limit, responsiveness, and energy use on climate control. As well as customizing for individual drivers, the application can optimize the settings for specific journeys.

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Say “Hey Google,” and the Assistant can control vehicle features as well as answer questions. electricity than high-pressure sodium street lights. The project will replace 270,000, or 85 percent, of Chicago’s streetlights with LED fixtures, and includes creation of a citywide lighting management system. When it becomes operational, the system will alert the city when lights need service.

Chicago lights up The city of Chicago announced it would install an additional 40,000 new LED lights on residential streets, alleys and viaducts as part of its four-year project to modernize its lighting system. The city estimates it will save $100 million over the next 10 years due to the energy efficiency of the new lights, which consume 50% to 75% less

Current Customers

A dashboard-centric operating system Google is opening up Android Automotive OS – the dashboard-centric version of its mobile platform – to third-party media apps.

Android Auto has long allowed phones to project a customized version of their interface onto vehicle infotainment systems,

offering access to navigation, multimedia, calls, messaging, and the Assistant, reports Slash Gear. But Android Automotive OS is said to go deeper. Control is via an 11-inch portrait orientation touchscreen in the center console, which resembles a propped-up Android tablet. It has a modular user interface, with different panes for multimedia, communication, navigation, and managing the vehicle’s drivetrain.

Say “Hey Google,” and the Assistant can control vehicle features as well as answer questions. Android Automotive OS is scheduled to launch first on the Polestar 2 EV, the all-electric car from the new Volvo and Geely-backed Swedish automaker.

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QUICK BYTES

Editor’s Note: Technology is playing an increasing role in the day-to-day business of sales reps. In this department, First Impressions will profile the latest developments in software and gadgets that reps can use for work and play.

Technology News Something new: An affordable smartphone

Alexa speaks Spanish Americans will soon be able to speak to Alexa in Spanish. Amazon launched a new voice model that will let developers build skills for Spanish-speaking users, reports Engadget. The addition to the Alexa Skills Kit for developers comes months before Amazon plans to bring full Spanish-language support to all Alexa devices later this year. With a total of 48.6 million speakers, the U.S. is said to have the second largest concentration of Spanish speakers in the world next to Mexico.

Braille-enabled controller for Xbox Microsoft has been leaning into accessibility in gaming lately, most visibly with its Adaptive Controller, and a new patent suggests another way the company may be accommodating disabled gamers, reports TechCrunch: an Xbox controller with a built-in Braille display. It is already quite hard for a visually impaired gamer to play some games, and although that difficulty can’t be entirely alleviated, there are

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Microsoft has been leaning into accessibility in gaming lately, most visibly with its Adaptive Controller, and a new patent suggests another way the company may be accommodating disabled gamers, reports TechCrunch: an Xbox controller with a built-in Braille display. definitely things worth doing. In many circumstances a screen reader is what a visually impaired person would use to interact with this kind of data, but often that text is relayed to them in audio form, which is far less appealing an option when you’re in-game. There are already some Braille display accessories for this kind of thing, but there’s nothing like having support direct from your console’s designer, and that’s what Microsoft has demonstrated with its patent for a Braille-enabled controller, according to the newsletter.

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Smartphones today can cost more than $1,000. Samsung’s Galaxy Fold is going for twice that. Now Google has introduced the Pixel 3A, a new version of its Pixel smartphone, for about $400 – half the price of its high-end phone. The New York Times tech editor recently wrote: “The Pixel 3A lacks some frills you may find in premium devices, like wireless charging and water resistance. But based on my tests, it is a great value. It’s fast and capable with a very good camera and a nice-looking screen – and, yes, especially for this price. I wouldn’t hesitate to recommend this phone to those who don’t mind going without some cutting-edge features.

In fact, the Pixel 3A is so satisfying that at this point, I might hesitate to recommend its $800 counterpart, the Pixel 3, to people other than gear heads and tech enthusiasts. While I rated the Pixel 3 an excellent Android phone last fall, it is not two-timesthe-cost better than the Pixel 3A.”

Foldable PC Lenovo announced it will introduce a foldable PC – the newest addition to its flagship ThinkPad X1 family – sometime in 2020, reports Channel Futures. The foldable will run Microsoft Windows and will run on an Intel-based platform. Some specs: The device has a 13.3-inch folding OLED, 2K display with a 4:3 ratio, and weighs less than 2 pounds. Details regarding other specs, such as memory and storage, are still being worked out. Lenovo is targeting all-day battery life, or “workday” battery life. A company spokesman couldn’t provide more specifics.

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