Some questions to ask your dentist about sedating your child

family with childrenOn the “Sunday Night with Megyn Kelly” show, which aired July 9, 2017, reporter Kate Snow addressed the risks involved with dentists giving children sedatives. Two families in California were profiled, and their stories were truly heartbreaking. Although most of the time it is perfectly safe, sedation can carry risk no matter what the age. The smaller size of children can make them more vulnerable so becoming more educated on the procedure and its potential impact is a way to help allay your fears.

Please note: We do NOT  use anesthesia or otherwise sedate children In this office!

The American Dental Association, through their consumer website, Mouth Healthy, has put together a list of questions they strongly recommend you review with your dentist and anesthesiologist before, during and after any sedation procedure performed on your child.

Prior to the procedure:

  • Who will provide the preoperative evaluation of my child including their past medical history such as allergies, current prescription medications and previous illnesses and hospitalizations?
  • What is the recommended time that my child should be without food or drink prior to the procedure (with the exception of necessary medications taken with a sip of water)?
  • Will any sedation medication be given to my child at home prior to their coming to the office and,if so, how should they be monitored?
  • What training and experience does the sedation/anesthesia provider have in providing the level of sedation or anesthesia that is planned for the procedure? Does this training and experience meet all of the standards of the ADA Guidelines for the Use of Sedation and General Anesthesia by Dentists?
  • Does the staff assisting in the procedure have current training in emergency resuscitation procedures, such as Basic Life Support for Healthcare Providers, and other advanced resuscitation courses as recommended by the ADA Guidelines? Is this training regularly renewed?
  • Does the state dental board require a special sedation/anesthesia permit or license that allows for the sedation/anesthesia provider to administer this specific level of sedation or anesthesia in the dental office?

During the procedure:

  • In addition to the use of local anesthesia (numbing), what level of sedation or general anesthesia will be given to my child? Is it minimal sedation (relaxed and awake), moderate sedation (sleepy but awake), deep sedation (barely awake) or general anesthesia (unconscious)?
  • How will my child be monitored before, during and after the procedure until the child is released to go home? Are the appropriate emergency medications and equipment immediately available if needed, and does the office have a written emergency response plan for managing medical emergencies?

After the procedure:

  • Will the sedation/anesthesia provider give me instructions and emergency contact information if there are any concerns or complications after returning home?

As always, my staff and I are always available to address any concerns you have about the practice of dentistry and how it impacts you and your family. Don’t hesitate ask us the next time you visit our office Dr. Laurence Stone in Doylestown, PA , or feel free to contact us at 215-230-7667.

Do “Bad Teeth” Run in the Family?

Now that’s a great question! Patients often tell me that their siblings or parents had bad teeth or lost their teeth and they often feel that they’re doomed to a similar fate. Nothing could be further from the truth! Take me for example.My father lost all of his teeth and his father before him (Do bad teeth run in the familymy grandfather) lost all of his teeth. I have all of my teeth and as a dentist I’m going to make sure I keep them.

Yes, there are some complicated hereditary factors that can contribute to poor dental health, but the fact is that poor dental care habits are more likely to be “inherited” and contribute to the demise of one’s dentition. Unhealthy snacking and inadequate oral hygiene practices are much more likely to cause tooth decay and periodontal disease (the number one cause of tooth loss in adults).

Please feel free to to contact me or the staff at my office, Dr. Laurence H. Stone, DDS, any time at 215-230-7667with any specific questions relating to this topic. Everyone’s circumstances differ a little, and we are more than happy to provide customized recommendations for you to help maintain a healthy oral environment.

The Myth of Dental Insurance

Portrait of family keeping their hands one another at home

In my last blog I spoke of the inevitable changes that we will be seeing in dentistry. The dental insurance marketplace is one area that should be included in that discussion, if only because so little has changed, with the exception of how successful they have become in controlling the dental marketplace. I would estimate that 80% of our patients have some form of dental insurance, yet few really understand what this really means for them.

A quick look at the facts:

  1. “Insurance” is intended to help with catastrophic problems (i.e. The current flooding in the Mid-west, Hurricane Katrina, your home is destroyed in a fire, etc.)
  2. There is NO comparable “catastrophic” downside in dentistry!
  3. No dental insurance company has ever lost a nickel on a dental plan. There are so many deductibles , co-pays, and limitations that they can’t lose money! (Have you ever heard of a State Lottery or the Powerball Jackpot losing money?)
  4. In 1975 the annual maximum payout per person in dental plans was about $1,000. Today, 40 years later, it is still only about $1,000. The only thing that has increased are the premiums!
  5. In the average indemnity plan patients only see about 65 cents in return for every dollar in premium paid. The rest goes to the insurance company’s cost of doing business, salaries, profits, etc.
  6. Insurance companies are in the business of making money, not providing dental care. Providing dental care is only incidental to why they exist!

I could go on, but hopefully you get the point. We would be happy to discuss any concerns you have regarding dental insurance and I want you to know that we will do everything possible to maximize any benefits you may have coming to you. For those without dental coverage, I am happy to announce that we now offer our own “in-house” dental program to help control costs. Please ask us for details. If you have any questions in the meantime, you can contact me or the staff at my office, Dr. Laurence Stone in Doylestown, PA.

We’re always here to help.

Polypharmacy – Are you at risk for prescribing cascade with your medications?

Pills_polypharmacy_DrLarryStone

As the population in the United States ages, so does the population of dental patients that are typically seen each day. One of the most noted characteristics of this group is the sheer number of prescription medications they take. The average 65 year old is taking five or more medications for a variety of reasons. One of the most serious side effects of many medications is drug-induced xerostomia (dry mouth), which can be devastating to one’s oral health!  (See my prior blog on Xerostomia.)

Another aspect of this “polypharmacy” is that patients taking five or more drugs are at risk of experiencing “prescribing cascade”, which occurs when unrecognized side effects of an existing drug prompts physicians to prescribe a new drug to then treat these new symptoms! The elderly and persons with disabilities are especially prone to prescribing cascade. The Beers list, developed by an expert panel to assess inappropriate drug prescribing, consists of a list of medications that are particularly prone to adverse effects in the elderly.

Please consult with your personal physician should you have any questions regarding this issue. And please let us know if you are experiencing “dry mouth”. Be sure to ask us at your next visit how you can best treat dry mouth. You can contact me or the staff at my office, Dr. Laurence Stone in Doylestown, PA to discuss any concerns you may have and to schedule an appointment.

Fifty Shades of Gray – A Reminiscence on Central High School

LStone_CentralHigh2

Before I found out what the movie “Fifty Shades of Gray” was all about (obviously I did not read the book!), I thought they were talking about me. After all, this year I will be celebrating my 50th high school reunion–a very sobering thought. Gray or not, I’m just happy to still have hair!

I went to Central High School in Philadelphia, back when it was still an all-boys school. I am very proud to have had the privilege of attending Central and still carry that pride today. Although I was not one of them, the year I graduated we led the nation in Merit Scholarship Finalists (45). I did in fact receive a Bachelor of Arts Degree from Central, one of the only high schools in the country legally permitted to grant that degree. Only four of my classmates became dentists, while there were over 130 attorneys and probably as many or more physicians.

About twenty years ago my only sister needed to have some gynecological surgery. A now retired classmate of mine, Dr. Larry Seidman, performed the procedure at Rolling Hill Hospital. During the surgery he found a lymphoma on my sister’s colon incidental to the procedure. He removed it and thus saved her life. I hope to see Larry and thank him again at our upcoming reunion.

Please feel free to talk with me at your next visit about the reunion. I will be happy to share my experience. Be sure to contact me or the staff at my office, Dr. Laurence Stone in Doylestown, PA to schedule your next visit

15 Prescription Drugs That Can Lead to Dry Mouth (Xerostomia) – and why you should be worried

pills

Xerostomia (dry mouth), is a serious dental problem affecting millions of people.
Saliva has antibacterial properties and when we don’t have enough of it we can suffer
from increased tooth decay and  gum disease. Additionally,  dry mouth makes it difficult for denture wearers to tolerate their appliances and affects our ability to taste the foods we enjoy.

According to a study by Clinical Research Associates, of the top 20 most prescribed drugs in the U. S. in 2010, the following 15 have been associated  with Xerostomia:

  1. Hydrocodone/Acetaminophen – a narcotic
  2. Lisinopril (Prinivil,Zestril) – an antihypertensive
  3. Simvastatin (Zocor) – an antiperlipidemic to fight cholesterol
  4. Amlodipine (Norvasc) – an antihypertensive
  5. Alprazolam (Xanax) – an anti-anxiety medication
  6. Hydrochlorothiazide – a diuretic
  7. Omeprazole (Prilosec) – an anti-ulcer agent
  8. Atorvastatin calcium (Lipitor)– an antihyperlipidemic to fight cholesterol
  9. Furosemide (Lasix) – a diuretic
  10. Metoprolol Tartrate (Lopressor) – an antihypertensive
  11. Sertraline HCL (Zoloft) – an antidepressant
  12. Metoprolol Succinate (Toprol) – an antihypertensive
  13. Zolpidem (Ambien) – a sedative/hypnotic
  14. Oxycodone/Acetaminophen (Percocet) – a narcotic
  15. Citalopram Hydrobromide (Celexa) – an antidepressant

The average 60-year-old in this country is taking at least three prescription medications daily. If you believe you suffer from drug-induced Xerostomia or just feel like you have a dry mouth in general, ask us about it. There are many treatments available to help with this  potentially serious problem.

Any questions? Don’t hesitate to contact me or the office, Dr. Laurence Stone in Doylestown, PA, today to schedule your next appointment and we can talk more about this. See you soon!

Obstructive Sleep Apnea – Can You Pass This Simple Test?

STOP-BANG Quetionnaire

Obstructive sleep apnea (OSA) is one of the most under-diagnosed and potentially most serious of all medical conditions. If untreated, it can lead to high blood pressure, stroke, and premature death.

By taking this simple test below (the “STOP-BANG” questionnaire) you can determine if you are at risk for OSA. If so, speak with your physician or call us for a referral to a medical sleep specialist. Any questions? Don’t hesitate to contact me or the office, Dr. Laurence Stone in Doylestown, PA, today to schedule your next appointment and we can talk more about this. See you soon!

STOP-BANG Questionnaire
To Assess Risk for an Obstructed Sleep Airway (OSA)

  1. Do you Snore loudly (louder than talking or loud enough to be heard through closed doors ?   O Yes O No
  2. Do you often feel Tired, fatigued, or sleepy during daytime?  O Yes O No
  3. Has anyone Observed you stop breathing during your sleep? O Yes O No
  4. Do you have or are you being treated for high blood pressure? O Yes O No
  5. Body Mass Index (BMI) more than 35 (use the formula to calculate your BMI)?
    O Yes O No
    BMIFormula
  6. Age over 50 yr old?  O Yes O No
  7. Neck circumference greater than 40 cm?  O Yes O No
  8. Gender male?  O Yes O No

Scoring: Answering “yes” to three or more of the 8 questions indicates that you are at High Risk for OSA. Answering “yes” to less than three questions indicates that you are at Low Risk for OSA. If you scored in the High Risk for OSA category, a sleep study or an evaluation by a sleep specialist may be warranted.

 

Fluoridated water – why all the fuss?

Fluoridated Water

When I read this morning that the city of Dallas, Texas was considering discontinuing fluoridating its public water supply I couldn’t believe my eyes! But it’s true! The city fathers want to save money ($1.8 million for a 3 year contract) by discontinuing the practice after nearly 50 years. Dallas would be the largest city in the country to do this. Approximately 210 million people in the U.S. receive the benefits of drinking fluoridated water-20 million people in Texas alone!

 So why all the fuss? Several reasons:

  • Firstly, the Centers for Disease Control (CDC) has stated that fluoridation of public water supplies is one of the top 10 public health advancements in the last century! No one can seriously argue that drinking fluoridated water helps prevent tooth decay by strengthening the enamel of children’s teeth while they are forming.
  • Secondly, the move by the industrial food chain in America to a corn-based and processed food diet has wrought havoc on the decay rate in children in particular. Decay rates that were initially lowered with the help of fluoridation are now climbing again thanks to foods and drinks sweetened with high fructose corn syrup. (As a reference consider reading The Omnivore’s Dilemma by Michael Pollan.)
  • And finally, in the end, the cost of treating dental disease would be much higher than the investment needed to prevent it. In this case an ounce of prevention really is worth a pound of cure!

Any questions? Don’t hesitate to contact me or the office, Dr. Laurence Stone in Doylestown, PA, today to schedule your next appointment and we can talk more about this. See you soon!

 

Mobs, saints and dentistry – dentistry’s patron saint

Patronsaint

As we think of those who have fought for our cause this Memorial Day weekend, I thought you might be interested to learn that dentistry has a patron saint. Few are aware of this fact today, but in fact, St. Apollonia is the Patron Saint of Dentistry and the Roman Catholic Church celebrates the feast day of St. Apollonia every year on February 9th. Legend has it that during the Alexandria uprising of 248, and angered by the prophecy of an impending calamity, mobs committed bloody atrocities on Christians whom they blamed for such catastrophes.

Apollonia, an esteemed Christian deaconess at the time, was seized and tortured, having all of her teeth broken or forcibly removed. Gaining a brief moment of freedom, she willingly threw herself into a raging fire to die a martyr rather than commit a blasphemy against Christ.

The legend was thus born and Apollonia became the Patron Saint of Dentistry. The faithful prayed to her for centuries, long before the advent of modern dentistry, to relieve them of toothache pain.

So now you know. Next time you visit with us, don’t feel shy about saying a prayer to this brave woman. Maybe her sacrifice can help you endure your next dental appointment! Don’t hesitate to contact me with any questions or suggestions you may have or contact Dr. Laurence Stone in Doylestown, PA today to schedule your next appointment and we can talk more about this. See you soon!

 

Safe dental restoration materials – What’s in Your Mouth?

Dental Restorations Fabricated in the U.S.

Most people assume that whatever a dentist places in their mouth, i.e. crowns, filling materials, dentures, etc. are safe. But how do you know? Many of the products we use in daily life come from abroad and many dentists, in an effort to cut costs, are sending dental work offshore.

Today it is estimated that 15% of all dental materials are either counterfeit or “gray market” materials. In addition, approximately 25% of domestic dental laboratory sales and 38% of actual restorations are manufactured overseas.

Why does this matter? Because only restorations that are fabricated in the United States can be guaranteed to be made with materials that are FDA approved and made in an environment that conforms to ISO 9001 – an internationally recognized sign of quality.

I guarantee that we use only premium FDA approved materials and only use dental laboratories In the United States. The next time you are in the office don’t be shy about asking us for details about your dental restorations. You deserve it!

Don’t hesitate to contact me with any questions or suggestions you may have or contact Dr. Laurence Stone in Doylestown, PA today to schedule your next appointment and we can talk more about this. See you soon!