Looking for a Few Good Dentists

The list above is the appropriate differential for a localized pigmented lesion in the oral cavity. The first step after recognizing the lesion is to take a radiograph. If small radiopaque “flecks” (as noted in the radiograph above) are noted, this is sufficient for the diagnosis of an amalgam tattoo and no further treatment is necessary. The lack of radiographic evidence of a foreign material (amalgam) would support the recommendation for a biopsy to confirm the diagnosis and rule out melanoma. An amalgam tattoo is due to the implantation of dental amalgam into oral soft or hard tissue. Clinically, the lesions are black, blue or grey in soft tissue tattoos. A blue nevus is most commonly on the hard palatal mucosa and is a melanocytic tumor that usually exhibits slight surface elevation. They are typically less than 1 cm in diameter. An oral melanotic macule is a brown asymptomatic macule produced by focal increases in melanin deposition and are not dependent on sun exposure. The most common site is the vermilion zone of the lower lip (labial melanotic macule). Over 80% are solitary lesions that are less than 7mm is diameter and tend to be well demarcated. There is no malignant transformation potential but these lesions cannot be distinguished clinically from early melanoma. Mucosal melanoma presents at an advanced state and is more aggressive than skin melanomas, making an early diagnosis critical. To distinguish between melanoma and other pigmented lesions (like the benign melanocytic nevus), the ABCDE system has been developed to describe the clinical features of melanoma:

A- Asymmetry B- Border irregularity C- Color variation D- Diameter is greater than 6mm (but they can be smaller) E- Evolving lesions (sudden increase in size)

Works Cited Neville, Damm, Allen, Chi (2016). Oral and Maxillofacial Pathology, 4th Ed. St. Louis: Elsevier.

Bryan Trump, D.D.S, M.S. Associate Professor Oral & Maxillofacial Pathology University of Utah School of Dentistry

ASSOCIATION

LOOKING FOR A FEW GOOD DENTISTS

As part of the responsibilities of the State Board of Dental and Hygiene Licensure, includes the opportunity to help fellow professionals. From time to time, one of your colleagues has a challenge come into their life that compromises their dental licensure. When this occurs, the Utah State Dental Advisory Board (DOPL Board) works to help them regain their opportunity to bring their licensure back to a full privilege level. As part of this process, they need another dentist to supervise/ mentor them on their road to recovery. The DOPL Board is looking for Dentists in every part of the state (but mostly along the Wasatch Front) who would be available and interested in assisting a colleague in this journey.

A supervisor’s responsibilities (many of which can be done online/remotely) are these: meet weekly with your assigned colleague, provide oversight of clinical services/patient treatment, their sobriety, boundaries, ethics, and professional relationships. They would also review monthly 20% of their assigned colleague’s current patient charts (these charts to be chosen randomly by the supervisor). A supervisor would also make regular monthly or quarterly reports to the DOPL board regarding the progress of their supervisee. They would also review their colleague’s prescriptions and drug administration log weekly or monthly. Again, many of these responsibilities can be done online (remotely) so as to take a minimal amount of your time. The DOPL staff will also greatly assist throughout the process.

If you would like to know more about this opportunity to serve your profession as well as your community at large, please contact the UDA office. Your help in this process would be invaluable to a fellow dentist, the State Dental Advisory Board, and your community. Please give the UDA a call at 801-261-5315 or email the UDA office at UDA@uda.org or dotty@uda.org .

Dr Dan Poulson State Board of Dental and Hygiene Licensure (DOPL Board)

PRACTICE

Screening for Prediabetes in Dental Offices

Jeff Hummel, MD, MPH

Medical Director, Informatics Research and Innovation Comagine Health

Although medicine and dentistry usually operate in silos, the human body is unaware of the lack of communication between the two professions. Many dental conditions have an impact on medical disease and vice versa. A common example of this whole person interconnectedness is the complex relationship between periodontal disease and diabetes.

The details about the interaction between diabetes and periodontal disease continue to emerge, but one thing is clear: e elevated blood sugar speeds the progression of periodontal disease and makes it harder to control. The same is true in prediabetes, a condition known in medical parlance as impaired glucose metabolism, in which a person’s blood sugar is elevated, not sufficiently to meet diagnostic criteria for type 2 diabetes but enough to accelerate periodontal disease.

There is still uncertainty as to whether treating periodontal disease in people with prediabetes actually prevents or slows progression to diabetes, but once a person has diabetes, successful treatment of periodontal disease makes it easier to keep a person’s blood sugar in a safe range.

W What does all this mean for dentists? There are many of people with impaired glucose metabolism who are unaware they have prediabetes, and many of them see their dentist more frequently than they see a primary care physician. This means that dentists are in an ideal position to help identify people who may have prediabetes without realizing it. This is important because there are proven interventions to slow progression from prediabetes to type 2 diabetes or stop it altogether. The most effective treatment for prediabetes is a major life-style change involving exercise and diet, so this is not something a dentist would be expected to manage. However, d dental offices are a perfect place to identify people at high risk for prediabetes and refer them to a medical office or community resource where they can receive guidance in lifestyle changes that will keep them and their periodontium healthy in the long run.

The National Diabetes Prevention Program (National DPP) is a public-private partnership comprised of federal and state agencies, employers and health care professionals, and works with a wide array of partners, including dental practices. The program supports participants in improving their nutrition and increasing physical activity. P Participants have been shown to reduce their risk of developing type 2 diabetes by 58% — up to 71% for people 60 and older. In Utah, the partnership includes public health districts, private medical groups and community partners.

I If you would like to learn more or get involved, a list of Utah organizations offering the National DPP can be found here.

Your partnership is appreciated.

For additional information, contact:

Trei Herd, Consumer Engagement Manager Comagine Health therd@comagine.org | 503-515-5359

Jeff Hummel, MD, MPH

Jeff Hummel is a general internist with 35 years of medical experience and advanced training in health services. He is currently Comagine Health’s medical director for health care informatics, a position in which he provides leadership for practice coaches working in population health consulting, clinical outcomes reporting and integration of behavioral health and oral health into primary care.

About Comagine Health

Comagine Health is a national, nonprofit, health care consulting firm. We work collaboratively with patients, providers, payers and other stakeholders to reimagine, redesign and implement sustainable improvements in the health care system.

This material was supported by the Grant or Cooperative Agreement Number, NU58DP006369-01, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

ARE YOU NETFLIX OR BLOCKBUSTER?

There’s a city in Oregon called Bend. Known for craft breweries, natural scenery and the Deschutes River that runs through the heart of the city. Bend is a shining example of a Pacific Northwest city and the air is clean and crisp. Home to more than 130 dentists, Bend also is unique in that on a semibusy street sits the lone remaining Blockbuster Video store in the world. I’ve visited the store and there’s mostly just people taking selfies out front or walking the aisles wondering who still uses a VCR.

Blockbuster Video at one time had more than 9,000 locations around the world and 60,000 employees. Renting movies and DVDs was a lucrative business with more than $5 billion in revenue at its peak. Blockbuster was the leader in its space. Yet in less than 10 years, Blockbuster went from the top of the mountain to laying in a crumbed heap at the bottom to eventually becoming a novelty with one remaining store on the planet (which is now also offering limited Air B&B rentals). This article is not about Blockbuster though, it’s about the inevitable aspect of all things that Blockbuster refused to embrace. Evolution. Everything changes, but not everything evolves. Blockbuster, Nokia, Kodak – these are just some of the names of large companies that were at the top of their industries, done in by ignoring the world around them, being unprepared to evolve and falling prey to their own conceit.

We all know things change. Trends emerge. Technology advances. Consumer expectations evolve. Are you ready to meet them? Is your practice embracing change? Or resisting it? Are you evolving to meeting your patients’ wants and needs? Or do you still require people to pay by mailing in a check? (Side note: I switched dentists solely based on the fact my previous one only took checks mailed in an envelope – in 2020!)

What’s your practice worth?

Since 1968

Request a FREE MARKET VALUE ANALYSIS www.AFTCO.net | 800.232.3826 While we never know for sure where the future will lead us or what unexpected events will affect your practice (like a complete shutdown!) we can be assured that teeth will need to be cleaned, fixed, built and more. Alignment will be wanted and reconstruction will be needed. The mission to help people have healthy, beautiful smiles will always remain. The methods, though, will evolve.

You must be ready and willing to evolve. You should be giving a portion of your time to researching innovative technologies, techniques and products, attending conferences (virtual or in person), networking with peers, talking with vendors and suppliers about what’s happening in research and development and getting involved with the association to help you stay in the know.

Blockbuster was at the top of its industry and even had a chance to buy the very company that would eventually be its demise. At one point, Netflix was in talks with Blockbuster to be acquired and Blockbuster executives laughed Netflix out of the boardroom. Blockbuster’s leaders said they didn’t’ think a DVD delivery system had longevity. What they didn’t know was that Netflix agreed and was already working on the next evolution: streaming. Netflix as a company has always looked to the future. While the company delivers for customers in the present, there’s also an eye toward the future. In its short life, Netflix evolved from a delivery service to a streaming service to a content creator/studio. Who knows what its next play will be?

So, the question is: Are you more like Netflix or Blockbuster? Are you keeping an eye on the future to know what’s coming? Or are you resting on your past successes and fighting against evolution of any sort? If you’re the latter … be wary. Chances are, you’ll be left behind. Work hard not to become a practice where someone will caption their selfie with your sign and say, “remember when?”

Judson Laipply Today’s FDA

A NEW DRUG TARGET FOR TREATING TOOTHACHES

An international team of scientists has figured out how teeth sense the cold and has pinpointed the molecular and cellular players involved. The team led by David Clapham, MD, PhD, vice president and chief scientific officer of the Howard Hughes Medical Institute, reported that tooth cells called odontoblasts contain cold-sensitive proteins that detect temperature drops in both mice and humans. Signals from these cells can ultimately trigger a jolt of pain to the brain. The study was published in the journal Science Advances in March.

The work offers an explanation for how one age-old home remedy eases toothaches. The main ingredient in clove oil, which has been used for centuries in dentistry, contains a chemical that blocks the “cold sensor” protein, said electrophysiologist Katharina Zimmermann, PhD, who led the work at FriedrichAlexander University Erlangen-Nürnberg in Germany.

Developing drugs that target this sensor even more specifically could potentially eliminate tooth sensitivity to cold, Dr. Zimmermann said. “Once you have a molecule to target, there is a possibility of treatment.”

About 15 years ago, the research team discovered that an ion channel called TRPC5 was highly sensitive to the cold. But the team didn’t know where in the body TRPC5’s cold-sensing ability came into play. It wasn’t the skin, they found. Mice that lacked the ion channel could still sense the cold, the team reported in 2011 in the journal Proceedings of the National Academy of Sciences.

But TRPC5 does reside in teeth and more so in teeth with caries, as study co-author Jochen Lennerz, MD, PhD, a pathologist from Massachusetts General Hospital, discovered after examining specimens from human adults. A novel experimental set up in mice convinced the researchers that TRPC5 indeed functions as a cold sensor. Instead of cracking a tooth open and solely examining its cells in a dish, Dr. Zimmermann’s team looked at the whole system: jawbone, teeth and tooth nerves. The team recorded neural activity as an ice-cold solution touched the tooth. In normal mice, this frigid dip sparked nerve activity, indicating the tooth was sensing the cold. This was not so in mice lacking TRPC5 or in teeth treated with a chemical that blocked the ion channel. That was a key clue that the ion channel could detect cold. One other ion channel the team studied, TRPA1, also seemed to play a role.

The team traced TRPC5’s location to a specific cell type, the odontoblast, that resides between the pulp and the dentin. When someone with a dentin-exposed tooth bites down on a frozen pop, for example, those TRPC5-packed cells pick up on the cold sensation and an “ow!” signal speeds to the brain. Read more of this study in Science Advances (2021); dx.doi. org/10.1126/ sciadv.abf5567.

CDA June 2021

Text to: 801 -261 -5315

1. Include your First and Last Name 2. Your interests to get involved:

a) House of Delegates - Governance b) UDA Action Committee - Publications c) UDPAC Committee – Legislation d) I know my legislators – Name them & connection e) I’d be willing to be a Collaborative Dentist