Handling Pediatric Patients


Pediatric Patients

Even super-heroes should be handled with kid gloves

By now, you may have heard about the potential impacts of the Affordable Care Act (ACA) on dentistry. One interesting likelihood: an influx of pediatric patients, as the ACA provides for dental coverage for children under 19. According to the American Dental Association (ADA), approximately 8.7 million children could gain extensive dental coverage by 2018. This means that more general dentists will have the opportunity to see younger patients. However, there are several things to consider when treating this population.

Chemical Sensitivities

Children aren’t just little adults. Their bodies are still developing, so chemicals that might not have much of an impact on an adult can have a larger impact on a child. A case in point: BPA.

Bisphenol A (BPA), a chemical compound found in everyday plastic products, can also be found in many dental composites and sealants. Unfortunately, BPA acts as an endocrine disrupter, and studies have linked it to a plethora of health maladies in children, including heart and kidney disease, emotional behavioral problems, and even an increased risk of obesity in teenaged girls.

In addition to these generalized health issues, BPA has also become a dental concern: research from France has suggested that BPA exposure in children can adversely affect cells that produce tooth enamel, making it fragile or brittle. This Molar Incisor Hypomineralisation (MIH), which occurs selectively in permanent incisors and first molars, affects about 18% of children between the ages of 6 and 8. Children with MIH are highly prone to dental caries and are very susceptible to tooth sensitivity and pain. Importantly, the age at which children develop their first molars and permanent incisors is the age at which studies show that humans are most sensitive to BPA.

The Asthma Link

Most recently, asthma – one of the most common childhood diseases – has been linked to BPA exposure, according to a recent study at the Columbia Center for Children’s Environment Health at the Mailman School of Public Health (Donohue, 2013). This is important to dental healthcare professionals because another study has linked asthma to an increased risk of dental caries (Alkali, 2013). Asthma medications were shown to reduce the salivary flow rate and buffering capacity in the mouth, leading to a potential for increased caries and gingivitis. Asthmatic children also had higher levels of Strep mutans and Lactobacillus bacteria, compared to healthy children.

Alternatives for Improved Health

Since dental caries is the most prevalent disease in children, it’s important to be on the lookout for increased caries risk factors, like asthma. Fortunately, dental healthcare providers have a number of tools available to help reduce the prevalence of caries in their pediatric patients, without exposing them to additional doses of BPA.

For example, for patients with increased caries risk factors, dentists might want to consider a chlorhexidine varnish. A relatively new product, chlorhexidine varnish addresses the undesirable side effects of chlorhexidine rinses and gels, while still reducing the presence of Strep mutans (Sijjan, 2013).

BPA-free versions of many products are also available. The Venus Pearl and Venus Diamond lines of composites from Heraeus Kulzer are not only BPA-free, but highly durable and well-suited for both anterior and posterior restorations.

Manufacturer Pulpdent produces the BPA-free ACTIVA and Embrace product lines, the majority of which are especially well-suited for pediatric patients as they are hydrophilic (i.e., they work well in a moist environment). These products include the innovative ACTIVA BioACTIVE Restorative and ACTIVA BioACTIVE Base/Liner, as well as the Embrace Wetbond Pit & Fissure Sealant and Embrace Wetbond Resin Cement.

Tips for Chairside Whitening


More Than Cleaning

Incorporate elective services into routine visits

Standardizing and organizing examination protocols creates a framework for recare and restorative visits. Here is an “old school” way to integrate whitening acceptance into your daily routine. The two key pieces of equipment for this tip are: a hand mirror and a shade guide.

Shade GuideOne way to increase whitening business is for assistants and hygienists to make a habit of doing a “color analysis” for each patient. With the patient looking into a mirror, simply say to them, “We know that teeth can change color over time. What I’d like to do now is to determine the current color of your teeth. I’ll need your help with this part.” This immediately gets the patient involved in their care and gives you an opportunity to talk whitening options.

Each operatory (hygiene too) should be equipped with shade guides. Set it up from lightest to darkest; make sure the shade guide also includes newer ‘bleaching’ colors. Hold the shade guide so that your patient can see the colors.

Next, have the patient guide the selection of the shade–this gives them an idea of what their teeth could look like. If your patient has an interest in whitening, he/she will normally take up the issue with you and you will have permission to ask other questions. These might include: “Other than the color shifts, is there anything else that you notice about your smile?”

Thanks to mainstream media, talk shows and magazines, patients are more knowledgeable about tooth discoloration, malodor and the importance of a healthy mouth to overall health. Incorporating something as basic as a shade guide review (at least yearly) is a powerful way to make regular inquiries into all of your aesthetic services.

Tips and Pointers in Selecting Shades

  • For most accurate results, the colors in the room should be neutral as well as the patient’s clothes. Drape the patient with a neutral gray bib or towel when taking a shade. It neutralizes the eyes’ color perception.
  • Female patients: If applicable, remove lipstick.
  • Make sure teeth are not dehydrated.
  • The mouth of the patient should be at eye level.
  • Determine the amber or gray color type of the patient.
  • Determine the base shade of the patient and remove matching shade group (Chromascope).
  • Determine the shade intensity within the shade group.
  • Compare the selected shade once again with the natural tooth.
  • Color Map: Note range of shade, striations, and color banding or mottling. Close examination will reveal a blending of various colors.
  • Collaborative Whitening: All team members can perform color assessments.

In sum, incorporating simple, “old school” basics into your protocols will help your patients understand the full menu of services offered by your practice and can help drive elective procedures such as whitening

Preempting Allergic Reactions

Allergic Reactions to Dental Materials

Be prepared to react quickly to a patient’s adverse reaction

While in the dental chair, a patient can suddenly experience an adverse reaction to a drug, product, or material. Those most susceptible to allergic reactions are patients with asthma, a history of hay fever, or allergies to trees, grasses, animals, dust, molds and certain medications. Tailoring dental products to a patient’s health history is a proactive yet precautionary practice to minimize the occurrence of an adverse reaction. In the event that an adverse reaction does occur, recognizing the symptoms and reacting quickly is critical.

PROBLEM: LATEX

doctor-latex-gloves-stock-gtty

MATERIALS: Latex is most commonly found in gloves. Other dental materials that contain latex include latex dams, gutta-percha, mixing bowls, orthodontic elastics, some suction tips, bite blocks, and amalgam carriers.

SYMPTOMS: Adverse reactions can be classified as allergic contact dermatitis (Type IV hypersensitivity) or true latex allergy (Type I hypersensitivity). Allergic contact dermatitis is a reaction to the chemical additives used in the manufacture of latex gloves (OSAP, 2013). Symptoms take several hours to develop, and include swelling, redness, itching, and blistering/cracking of the skin. Conversely, true latex allergy is a reaction to the latex proteins. These proteins can infiltrate the body through skin and mucosa. If latex lightly powdered gloves are used, aerosolized latex proteins can also enter the respiratory system during gloving and ungloving. Reactions can range from erythema and hives to the most severe reactions characterized by anaphylaxis.

PRECAUTIONS: Patients with true latex allergy (Type I hypersensitivity) require the use of non-latex gloves, such as nitrile, neoprene or vinyl. Patients with allergic contact dermatitis (Type IV hypersensitivity) require the use of vinyl gloves, as nitrile and neoprene gloves contain the same chemical additives found in natural rubber latex.

PROBLEM: LOCAL ANESTHETICS

Local_anesthesiaMATERIALS: Allergic reactions are only caused by ester-type anesthetics, which are used for topical application rather than local injection. Ester-type anesthetics, such as procaine, propoxycaine and chloroprocaine, are more
commonly known by their brand names: Novocain, Ravocaine, Nesacaine and Hurricaine. Amide-type anesthetics, like lidocaine, mepivacaine and prilocaine, can cause reactions resembling allergic reactions, but the anesthesia itself is not a true allergen.

SYMPTOMS: Most patient-reported “allergic” reactions to local anesthetics — namely heightened anxiety and increased heart rate — are really sensitivities to epinephrine. Occasionally, patients might experience a toxicity reaction, which can be attributed to preservatives (methylparaben) or antioxidants (bisulfites) contained in the solution. A toxicity reaction is more common when the anesthetic is used plain (i.e., does not contain a vasoconstrictor), which prevents the anesthetic from leaving the anesthetized site too rapidly.

PRECAUTIONS: Anesthetic cartridges without a vasoconstrictor should be used for patients with epinephrine sensitivity, or when a patient has severe heart disease or recent myocardial infarction. Topical anesthetics should be used sparingly, as excessive amounts or contact with the oral section of the pharynx could intensify a reaction.

PROBLEM: COLOR DYE

food_coloringMATERIALS: Color dyes are typically found in prophy pastes, mouthwashes, fluorides and colored gloves. Red and yellow dyes are the main types of dyes that cause allergic reactions. Red #40, Yellow #5 and Yellow #6 are types of artificial dyes, whereas annatto is a natural coloring substance that comes from seeds of the annatto tree (Yacono, 2011).

SYMPTOMS: Skin irritations, such as eczema or hives, are common symptoms that develop after the ingestion of a particular dye. In rare cases, certain dies can cause anaphylactic shock. The effects of color dyes on behavioral issues—especially in children—are currently being researched.

PRECAUTIONS: Dye-free prophy pastes, fluorides, rinses, etc. are available alternatives and should be used with patients reporting a dye allergy, or as an option for pediatric patients.

Where in the World…

Gray Market Goods: Bad For Business

Are your dental supplies putting your patients at risk?

It’s hard to pass up a good bargain when you see it. However, there is more than meets the eye when it comes to dental products offered at deeply discounted pricing. These goods may actually be “gray market” goods — those intended for international sale, but which are rerouted back to distributors in the US and made available to dentists at very low prices. They can seem like a good deal, but there are risks associated with the gray market:

  • Products are often sold “as is” with no returns or warranties
  • Safety recalls are often not communicated to the end-user
  • Products may be counterfeit or altered to fit foreign specifications
  • Products might be expired or stored in improper conditions
  • Legal liability is held solely with the purchaser, not the manufacturer

Each of these conditions puts both the dentist and the patient at risk, so it’s important to know where your dental products are coming from. There are four distinct red flags for identifying a gray market product: 

1. LOW PRICE

If a product is selling at a significantly lower price that seems too good to be true, it probably is. Low price is the most obvious red flag of gray market goods.

2. UNAUTHORIZED DISTRIBUTOR

There are many reputable dental distributors out there that only carry products they are authorized to sell. However, a number of internet-based dental dealers have recently emerged in the industry. Some are unauthorized dealers that will redirect goods intended for foreign sale back to the US, and then re-sell them on their website. If ordering from a web-only supplier, pay special attention to the product prices. If you find they are substantially lower than other distributors’ pricing, you may have encountered a gray market site.

3. ALTERED OR UNUSUAL PACKAGINGNonUSsticker

Because gray market products are intended for a market outside the United States, they are manufactured with different specifications and usually with different labels. If you check your stock and see a product that doesn’t look quite right, ask yourself these questions:

  • Is the language on the package something other than English?
  • Is the packaging smeared, uneven, or of lesser quality than you have previously seen with products of the same brand?
  • Is the product name current or a previous name from an earlier version of the product?
  • Is the bar code or any aspect of the product description blocked out?
  • Is the product marked “For export only” or “Not registered for sale in the United States?”

4. EXPIRATION DATE

Has the product expired? Does it appear that the expiration date has been changed? If you notice a package that meets any of these criteria, don’t hesitate to reach out to the manufacturer of that brand or product. When it comes down to it, although discounted dental products are available, the cost of overcoming the potential problems for patients caused by gray market products can be far greater than the amount saved.

At PureLife, providing quality products to our customers is our top priority, which is why we offer money-back guarantees on all purchases. Also, we only purchase products from authorized manufacturers. We couldn’t live up to these promises with gray market products, so we simply don’t buy them!

PureLife is proud to be an authorized distributor of these great brands

PureLife is proud to be an authorized distributor of these great brands

The Best Tax Code Ever

Reap the Benefits of the 2013 Section 179 Tax Deduction

Purchase equipment for your practice before maximum write-off amounts are reduced in 2014

With the end of the year fast approaching, many dental practices are stocking up on supplies before the 2013 tax declaration deadline. Section 179 of the IRS tax code provides some real relief to dental practice owners purchasing equipment in 2013. If you are even thinking about purchasing equipment for your practice, now is the time to do it.  Starting next year, the current benefits of Section 179 are scheduled to be drastically reduced. The 2013 deduction limit of $500,000 will be reduced to $25,000 in 2014, and the equipment purchase limit of $2 million will be cut to $200,000.

SECTION 179 BASICS

While Section 179 doesn’t increase the total amount you can deduct in a single year, it allows you to benefit from the deduction all at once. In other words, rather than having to deduct an asset’s value over the course of several years, Section 179 allows businesses to get the entire depreciation deduction in a single year, a practice known as first-year expensing.

“Many business owners prefer to write off entire equipment purchases the year they buy it. In years past, many companies avoided purchasing new equipment because they’d have to wait several years to realize the tax write-off in its entirety” – Ryan Goodrich, Business News Daily contributor

According to regular depreciation rules, if  you were to purchase all-new high-speed handpieces for each of your operatories, you’d be obligated to deduct a portion of each handpiece’s cost over multiple years. For the next five years, you’d only be able to deduct a fraction of the overall expense. With the Section 179 tax code, however, you are allowed to immediately deduct the entire expense of the handpieces in a single year instead of having to track their depreciation over time.

ELIGIBILITY AND QUALIFICATIONS

Up to $500 in dental equipment can be written off via Section 179

Up to $500,000 in dental equipment can be written off in 2013 via Section 179

All new and used equipment is eligible for deduction up to $500,000 for 2013. All companies that lease, finance or purchase equipment with a total value of less than $2,000,000 still qualify for the Section 179 deduction. Expenses over that maximum amount begin to decrease on a dollar-for-dollar deduction scale, effectively gearing this tax code toward small and medium-sized businesses.

Large businesses that exceed the $2 million threshold in capital expenditure can take a Bonus Depreciation of 50% on the amount that exceeds the limit. Also, businesses with a net loss in 2013 qualify to deduct some of the cost of new equipment and carry-forward the loss.

Most tangible goods qualify for the Section 179 Deduction. For basic guidelines on what equipment is covered under the Section 179 tax code, refer to this list of qualifying equipment. Note: To qualify for the Section 179 Deduction, the equipment and/or software purchased or financed must be placed into service between January 1, 2013 and December 31, 2013.

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Check out an example of Section 179 at work:

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 SOURCE: Section179.org