Vital Record » Dentistry Your source for health news from the Texas A&M Health Science Center Wed, 17 Dec 2014 17:44:12 +0000 en-US hourly 1 Emphasis on personalized care: Calming anxieties benefits dental patients and providers alike Wed, 17 Dec 2014 17:39:18 +0000 An unspoken interaction takes place at the start of nearly every dental appointment. The dental hygienist or assistant brings the patient to the chair, and before it has reclined has already assessed if the patient is feeling talkative, tired or even anxious. In many cases, no words are needed for this exchange]]>

An unspoken interaction takes place at the start of nearly every dental appointment. The dental hygienist or assistant brings the patient to the chair, and before it has reclined has already assessed if the patient is feeling talkative, tired or even anxious. In many cases, no words are needed for this exchange.

“Look. First observe the patient for clues that they are affected: eye movement, breathing and other physiological manifestations,” says Laura Gene Utt, clinical assistant professor in the Caruth School of Dental Hygiene at Texas A&M University Baylor College of Dentistry. “Listen to them closely. Many will tell you they feel anxious. Some will not.”

Laura Gene Utt, clinical assistant professor at TAMBCD's Caruth School of Dental Hygiene, pictured in the college's third-floor general dentistry clinic.

Laura Gene Utt developed her thesis around how Texas dental hygienists manage patients’ dental anxieties.

Recognizing anxieties in patients and learning how to effectively address them is something Utt has fine-tuned during her 35-year dental hygiene career throughout Texas, California and Germany. In December 2014, she completed her thesis on the subject as part of her master’s in dental hygiene education.

Her research, titled “Texas Dental Hygienists’ Use of Behavioral Management Techniques for Patients with Dental Anxieties,” utilized a survey to determine what methods Texas dental hygienists use to recognize and calm dental anxieties in patients. And just as important, it measured how dental hygienists felt about their effectiveness at helping their anxious patients feel comfortable.

Nearly half of the survey respondents stated that up to 20 percent of their patients experience dental anxiety.

In those situations, some of their most commonly used techniques to help patients include:

  • deep breathing;
  • distraction (listening to music, covering up with a blanket, etc.);
  • listening; and
  • talking.

Utt found that dental hygienists who take time to determine the cause of the patient’s anxiety and give them some control over the situation help the patient relax. Empathy for patients is the best approach and decreases negative emotional labor while at work, which could be a factor in retention or attrition within the profession.

She plans to take these techniques with her in January 2015 when she moves to Stuttgart, Germany, where she has plans for teaching, consulting and private practice work.

“Bachelor-level programs in dental hygiene are just now starting in Germany, and the concepts of managing dental anxiety should be considered in the educational programs,” says Utt.

Dental anxieties as a result of personal trauma

Sometimes anxieties are present for reasons not having anything to do with the dental appointment. Previous trauma, such as domestic violence or sexual assault, abuse of the elderly and even combat military experience can present anxieties for patients.

According to statistics cited in a March 2014 article in The Journal of the American Dental Association, “Treating Patients with Traumatic Life Experiences,” the likelihood that an oral health professional will treat patients who have suffered such events is markedly high. Approximately 22 percent of women and four percent of men reported having experienced sexual assault as an adult, and 10 to 20 percent of men and up to 10 percent of women in the U.S. reported having been exposed to combat, whether as service members or immigrants who fled war-ravaged regions.

Routine aspects of a dental appointment, be it impressions, oral cancer screenings and even reclining in the chair, may seem harmless to some — and even convenient for dentists, such as in the case of a mouth prop — but they can incite fear in other patients. Whether it’s from a gag reflex, lack of breath or the fact that a patient cannot close his or her mouth, a feeling of powerlessness sometimes ensues, and with it, panic.

In TAMBCD’s Advanced Education in General Dentistry Residency Program, residents are familiarized with some of the difficulties that can occur as a result of traumatic experiences. One lecture includes a special guest speaker, an assault victim who shares with residents what it’s like to live through the aftermath of such an event, which often includes some degree of post-traumatic stress disorder. At least once during the year, fourth-year dental students also get exposure to patients with anxieties and special needs during a rotation in the AEGD clinic.

“When dentists have a basic understanding of the difficulties that survivors face, they can help to create an environment that feels safe,” says Kirsten Zitzewitz, AEGD clinic coordinator. “As a result, this can help prevent last-minute appointment cancellations as well as help the actual appointment flow in a smooth and productive manner. Most importantly, it can be a positive experience for the survivor that can aid in the survivor’s recovery.”

One of the go-to methods: informal question-and-answer sessions between the oral health professional and patient. Benefits of the initial “meet and greet” are two-fold.

“The AEGD residents learn how to communicate through empathetic listening and speaking skills to build the highest level of rapport with special patients, which does a lot to allay apprehension and raise the pain threshold,” says Dr. Charles Wakefield, professor and director of the AEGD program. At the same time, the dentist gets to know the patient on a personal level.

Regardless of the cause of anxiety, when patients’ fears are addressed in an effective manner, not only are they more likely to return for routine preventive care, but hygienists and dentists are more likely to feel rewarded from the interaction.

“The takeaway message for me is that the benefit is a two-way street,” says Utt. “The oral health care providers who practice these techniques will have a healthier and happier career. And the patients can get over their dental anxiety. When both parties benefit, why wouldn’t you want to do that? You sharpen your skill of observation, that’s so much of it.”

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TAMBCD reducing tooth decay one sealant at a time Thu, 11 Dec 2014 18:02:06 +0000 Dental sealants have been compared to vaccinations because they guard against a common dental culprit known as a cavity. Because the cost of placing dental sealants is much less than treating tooth decay once it develops, Texas A&M University Baylor College of Dentistry provides extensive dental sealant outreach initiatives to ensure children receive this layer of protection]]>
Two TAMBCD dental students perform a dental procedure on young patient in zebra-printed sunglasses.

TAMBCD students place dental sealants on a young patient during sealant day.

Dental sealants have been compared to vaccinations because they, too, provide a preventative measure against a health threat by guarding against a common dental culprit known as a cavity. Because the cost of placing dental sealants is much less than treating tooth decay once it develops, Texas A&M University Baylor College of Dentistry (TAMBCD) provides extensive dental sealant outreach initiatives to ensure children receive this layer of protection.

The Centers for Disease Control and Prevention reports tooth decay is one of the most common chronic conditions among children in the United States. The report finds that by age 15, approximately 60 percent of all adolescents will have experienced tooth decay. According to the report, an estimated 51.7 million school hours are missed annually by school-aged children because of a dental problem or visit and in 2009, the total dental expenses for U.S. children between the ages 5–17 were approximately $20 billion.

Luckily, preventive dental care – including dental sealants – is effective in reducing tooth decay. These thin plastic coatings painted on the chewing surfaces of premolars and molars (back teeth), seal crevices in permanent teeth and act as a physical barrier to prevent bacteria from collecting and creating an environment that allows tooth decay to develop.

It is recommended that children receive sealants on the permanent molars as soon as they erupt through the gum.

“Most children, no matter how well they brush, are unable to reach and clean these areas properly,” said Dr. Stephen Crane, associate professor in public health sciences who oversees TAMBCD’s Dallas County Sealant Initiative. “Sealants provide almost 100 percent protection from dental cavities on the chewing surfaces of teeth, where most dental decay occurs.”

Since 2000, the Seal Mobile — a brightly-painted van — has transported portable dental equipment, dental students and faculty to elementary schools in the Dallas Metroplex and surrounding areas. The van has traveled as far as Sanderson, Texas, 500 miles outside of Dallas, to provide sealants to children.

In 2013 the dental bus, a specially equipped RV, was added to the rotation. The bus has two built-in dental operatories where patients can be seen. With this mobile dental unit now in motion, faculty and students can go out five days a week instead of just four.

Since the sealant initiative’s inception nearly 15 years ago, faculty and dental students have placed sealants on approximately 53,000 teeth – saving patients (and their parents) countless hours of pain and dollars in dental repairs.

In addition to the sealant initiative, TAMBCD dental and dental hygiene students have hosted on-campus sealant events twice a year for the past 16 years. The Asian-American Dental Society Bi-Annual Sealant and Prophy Day is a free, Saturday event which brings together faculty, residents, students, staff and alumni as well as predental students from Austin College, Baylor University, University of Texas at Arlington, University of Texas at Dallas and the University of North Texas.

Parents can bring can bring their children to receive this free service simply by calling to schedule an appointment.

“We have been able to reach so many families because of the unselfish and generous support we receive from TAMBCD, the dental community and our community partners,” said Dr. Loulou Moore, associate professor in restorative sciences and faculty adviser for the Asian-American Dental Society. “Our volunteers sacrifice their weekend to provide a service to children that will offer lasting benefits.”

“The ADS biannual sealant day is a huge success because of their dedication and willingness to give back to the community, especially to our youngest patients.”

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A holiday feast that’s good for your teeth Mon, 24 Nov 2014 21:16:32 +0000 There’s another thing to be grateful for this Thanksgiving: Many elements of the traditional Turkey Day fare nourish your health and smile]]>

tamhsc-thanksgiving-foodsThanksgiving — that tried-and-true American holiday with origins tracing back to autumn 1621 — is unique in that the modern-day version revolves almost entirely around a meal.

Lucky for us, much of the holiday spread has side effects other than causing pants to fit a bit more snugly after enjoying. Turkey, mashed potatoes, cranberries and even pumpkin pie are packed with nutrients ranging from phosphorous to vitamins A and C, translating to stronger tooth enamel, and even prevention of loose teeth and oral cancer.

So go ahead. Celebrate, and dig in — but for the sake of your health be sure to watch portion sizes.


  • Rich in phosphorus
  • Aids in tooth development
  • Rebuilds tooth enamel
  • Helps prevent bone loss


Spinach, kale, brussels sprouts, broccoli

  • Supply vitamins A&C
  • Help prevent bleeding gums, loose teeth and oral cancer



  • Prevent bacteria from sticking to your teeth



  • Full of nutrients, and unlike other starchy foods, they don’t stick to your teeth


Pumpkin pie

  • Good source of vitamin C, iron, niacin and potassium
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Q&A: Navigating the mires of social media Wed, 05 Nov 2014 17:43:46 +0000 Leigh Ann Wyatt watches an interesting transformation take place each fall. In her role as assistant professor and preclinical dental hygiene course director in the Caruth School of Dental Hygiene at Texas A&M University Baylor College of Dentistry, she sees her students grow and change ... ]]>

Leigh Ann Wyatt watches an interesting transformation take place each fall. In her role as assistant professor and preclinical dental hygiene course director in the Caruth School of Dental Hygiene at Texas A&M University Baylor College of Dentistry, she sees her students grow and change throughout the semester. It’s something she refers to as their “becoming dental hygiene professionals before my eyes.”

Leigh Ann Wyatt, assistant professor in dental hygiene at the dental school

Leigh Ann Wyatt, assistant professor in dental hygiene at the dental school

Mentoring is a role Wyatt takes seriously, and it is her approachability that led to a recent career challenge: How would she handle interactions with students on social media, namely, friend requests via Facebook? Could the platform serve as a good mentoring tool or could it cause more harm than good?

The questions came at a fitting time for Wyatt, who, after receiving her bachelor’s in dental hygiene from TAMBCD in 1996 and a master’s in Christian education at Dallas Theological Seminary in 2010, was exploring thesis topics for her second master’s degree, this one in dental hygiene education at TAMBCD.

The research for her thesis, “Attitudes and Experiences of Dental Hygiene Faculty Regarding Interactions with Current Undergraduate Students on Facebook,” wasn’t without difficulty. Wyatt has had to keep a finger on the pulse of a moving target, with privacy controls and terminology that seem to change by the week.

When she commenced her research in 2012, there wasn’t much to be found in dental literature regarding social media. These days, articles on social media and its use in the academic world — dental hygiene education included — continue to surface. Wyatt’s may be added to the mix with submittal of her abstract to the American Dental Education Association for consideration in the educational research poster presentation lineup at the March 2015 annual session.

Now she shares the sensitivities associated with faculty-student Facebook friendships, the heightened need for professionalism in a clinical setting and just where she falls on the spectrum of Facebook users.

The interaction between students and faculty on Facebook is pretty new territory, considering the social media platform launched 10 years ago but only in the past couple years have we seen a considerable surge in users ages 45 to 54. As a faculty member in the higher education and professional school setting, what has been your personal experience with navigating these murky Facebook waters? To friend or not to friend, when it comes to students?

I’m not on Facebook right now. When I was on Facebook, I would accept students’ friend requests after they graduated. This research all started out of a personal dilemma a couple years ago when I accidentally accepted a friend request from a current student. Then as social networking goes, an hour later I had 15 friend requests from current students. I knew I was in uncharted territory. It was at that time point I realized that if I felt uncomfortable interacting with current students on Facebook, other faculty probably did, too.

I felt sometimes that the lines were blurred and that students treated me like they treated their friends. I spent the next year navigating what it’s like to be Facebook friends with current students. Part of my decision to not get back on Facebook has been so I won’t have to deal with that situation.

In your research you found that 68 percent of dental hygiene faculty surveyed felt a blurring of lines occurs when professors are Facebook friends with undergraduate students. What are some situations that surface as a consequence?

One concern is possible grading bias in the clinical setting. Another is that if faculty and students are friends on Facebook, faculty see what the students are doing. That puts the faculty member in an awkward position with behavior that didn’t happen at school that may be negative: Here’s a student who’s representing the school, representing the profession of dental hygiene and is advertising unprofessional behavior.

Do the same implications apply to professors at four-year undergraduate institutions?

An undergrad professor may only have a student one semester, and then they’re done; here we work closely with students the whole time, and that can be a little difficult. There’s something very special and sensitive about the fact that we’re not only grading students in the classroom, but we’re also in the clinic where there’s a lot of one-on-one, and it feels more subjective. The stakes seem to be a little higher at an institution like this, where there’s not just didactic knowledge, but there’s professionalism you’re trying to muddle through.

Where do we go from here? Is there a happy medium that can be reached with the help of institutional guidelines?

I do think there’s a middle ground. Approximately 54 percent of faculty I surveyed felt that if faculty were going to interact with students that they should have a separate professional and personal page. That was not a new idea — in 2010, the American Medical Association recommended a separate page for Facebook interactions to protect the physician-patient relationship.

I think by and large how it’s being used in programs is to track alumni job placement, which CODA may ask about when they make a site visit, and maybe to advertise special events for the school, like continuing education courses, but few faculty are using it for academic purposes. (Only 12.5 percent responded that they were friends with students on Facebook.)

That’s one of the takeaways. Faculty in general do not feel like Facebook interactions with students are a good idea. It goes along with a quote that came in through my survey: “Facebook is for social interaction, and education is not a social event.”

Another takeaway is that the faculty-student relationship is one built on mutual trust and respect. As educators, how can we work to ensure that there are healthy boundaries in social media interactions with students to minimize harm and maximize the benefits of interaction?

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Restoration in progress Tue, 04 Nov 2014 20:40:38 +0000 Eyes, ears, noses, even faces: Texas A&M University Baylor College of Dentistry center restores what’s missing]]>
Mary Turner practices attaching her new prosthesis.

Mary Turner gets a glimpse of her appearance as she practices attaching her new prosthesis.

Mary Turner nearly fainted when her doctor told her she had carcinoma in her right eye. “It just floored me,” she says.

Treating the cancer required surgery to remove her eye and surrounding tissues. The desire to restore her appearance through a prosthesis anchored to craniofacial implants led to her referral to the Center for Maxillofacial Prosthodontics at Texas A&M University Baylor College of Dentistry.

By the time she completed her care, her silicone prosthesis was hardly detectable during an on-camera interview by the news crew of Univision Dallas, a Spanish-language television station that covered the center’s work in a two-part series.

“Oh my goodness,” Turner exclaimed when she first saw her prosthesis in place. She looked up from the hand mirror and beamed at her son and the gathered faculty and staff.

The center, one of just a few multidisciplinary ones in the U.S. and Canada that include an anaplastologist – a specialist in restoring a malformed or missing part of the human body through artificial means – is the only one of its type housed within a dental school.

Ongoing collaboration with faculty members of TAMBCD’s Department of Oral and Maxillofacial Surgery, including Turner’s implant surgeon Dr. Marianela Gonzalez, assistant professor, promotes advanced presurgical planning and navigational surgery: cutting-edge techniques transforming care.

“It is imperative to have a thorough preoperative plan to make sure the craniofacial implants are placed into an area with good bone quantity, and in a location that will provide a good prosthetic result,” says Suzanne Verma, assistant professor and anaplastologist. “We precisely plan the implant locations for patients based on their CT scans, enabling us to go straight into the operating room with the digital plan.

“Our surgeries use navigational technology, otherwise explained as ‘GPS in the OR.’ When our instruments touch a patient in surgery, we can see where we are in the CT scan and our digital plan in real time.”

Verma can manipulate the same radiographic data to create a physical model of the missing anatomy.


Anaplastologist Suzanne Verma

Four to six months following surgery, after the implants are fully integrated with the bone and the soft tissue is healed, the patient returns for a series of appointments with Verma, who uses a combination of art, science and digital technology to create a prototype and mold for the patient’s silicone prosthesis.

She still spends up to a week in the clinic and lab – longer for more complex cases – creating the perfect prosthesis by pigmenting silicone to perfectly match the patient’s skin tone, vascularization and unique characteristics. This process often requires as many as 16 different colors painted into the mold layer by layer.

The scope of technological advancements in Verma’s field is far-reaching. She is involved on an international level with a multidisciplinary group called Advanced Digital Technology in Head and Neck Reconstruction, which she serves as a member of its scientific advisory board.

“We meet every three years, and it’s amazing to hear how interdisciplinary craniofacial teams around the world are applying new technology to patient care,” Verma says.

In addition to department faculty, Verma collaborates on navigational surgery with medical and dental professionals at numerous hospitals in North Texas and receives referrals from around the U.S. and South America.

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Chords of healing Fri, 31 Oct 2014 21:01:49 +0000 When Ashley Smith, a third-year dental student at Texas A&M University Baylor College of Dentistry, isn't treating patients in the clinic, she can be found at the Baylor Sammons Cancer Center next door to the college, playing piano for patients and their families as part of the hospital's Healing Arts Program]]>

As a third-year dental student at Texas A&M University Baylor College of Dentistry, most of Ashley Smith’s days are spent treating patients in the clinic. On the rare occasion Smith is gifted with a bit of spare time, she knows exactly what to do: Stride down the hall of the college’s first floor to where TAMBCD and Baylor University Medical Center intersect. Take the hospital elevator to the second floor, and breeze through the sky bridge to the Baylor Charles A. Sammons Cancer Center. Grab the keys hanging in the mezzanine-level office, and descend the stairs to the lobby. Sit at the bench, and crack open the baby grand.


Third-year dental student Ashley Smith at the Baylor Charles A. Sammons Cancer Center in Dallas

When Smith’s hands glide across the keys, the number of listeners can swell to nearly 2,000 throughout the duration of any given performance, according to Benny Barrett, volunteer coordinator for the hospital’s Healing Arts Program, in which music is brought to cancer patients and their families in open-air, informal settings.

“If you sit down by Ashley when she is on the piano, and you look up, people will be shoulder to shoulder on the balcony above,” Barrett says. “On chemo day, patients can walk around with their pumps. You’ll literally see 14 to 30 people with their pumps, leaning over, looking.”

Smith — who has played classical piano since she was 5 — parlayed her affinity toward the Sammons Center’s calming environment into a volunteer music gig in spring 2014. She was eating lunch at the center’s cafe when the sound of the piano on auto-play caught her attention. She asked around, discovered Barrett’s name and inquired if the program needed another volunteer musician.

“I said, ‘That’s great, can you play?’” recalls Barrett, who suggested an impromptu audition at the chapel piano downstairs. “Eight bars into it, I was ready to put her on the schedule.”

Volunteers play for two-hour sets, and Smith signs up for those slots when summer breaks permit. Clinic and dental school coursework consume most of her time, so she and Barrett have a new agreement: Whenever Smith has time, whether it’s for 10 minutes or 45, all she needs to do is take the keys from his office, unlock the piano and play.

The time is as valuable to Smith as it is to the patients and their families.

“With dentistry, we’re working with our hands doing these skills we have never done before,” Smith says. “When I play piano, it reminds me I am in control of my hands. It makes me remember I can do this. I take that feeling back to the clinic, back to the lab. I feel like it trains my hands to do what my brain wants it to do. It helps my hands build the manual dexterity needed for dental work.”

The foundations for Smith’s love of piano were laid during her childhood in Pine Bluff, Ark. Her mother, the choir director at their church, encouraged Smith to play and signed her up for lessons. Soon enough, Smith was teaching classmates and performing during children’s mass at her school. By the time high school rolled around, she played piano during Sunday services.

These days, Smith branches out from her classical environs and gravitates toward modern music including ballads, inspirational pieces and songs with religious undertones.

“My focus is to give cancer patients hope and relaxation, to give them a break from what they may be going through,” says Smith. “I could only imagine having to wait for those appointments. Waiting to hopefully get good news. It’s kind of scary, with what to expect, and to have to sometimes wait hours for that kind of an appointment.”

Back in the dental clinic, a refurbished iPod, some headphones and a Spotify app allow Smith to introduce the calming effects of music during appointments. Her patients can listen to their preferred genre throughout their care.

She may be on to something.

The Healing Arts program at Baylor University Medical Center — also home to medical students as part of the Texas A&M Health Science Center Dallas campus — is one of several success stories nationwide. Inspired from established music therapy models at the Cleveland Clinic and New York’s Memorial Sloan Kettering Cancer Center, the Sammons program includes bedside music performance for inpatients, provided by a certified staff musician when the treating physician prescribes.

Volunteer musicians like Smith help fill in the gaps to create a healing environment within the entire building. The music helps boost coping skills, relaxation, and distraction from pain while reducing anxiety. Patients and family members alike can benefit from the sweet strains and melodies, whether they are at the center for treatment or diagnostic services.

Barrett witnesses the program’s impact every day.

“Walking off that elevator, people are just in a daze,” Barrett says. “They’ll sit down and just dissolve into tears or get that thousand-yard stare. Thirty minutes later, they’re essentially kissing the feet of the performers, thanking them for getting them through that first initial period.”

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Dark chocolate: subtle trick or ideal treat? Thu, 30 Oct 2014 21:45:19 +0000 This Halloween, a little dark chocolate might not be frightful when coupled with moderation and good oral hygiene. ]]>

Halloween is fraught with the perils of cavity-inducing candies and tempting treats. Lip-smacking sour gummies, ooey gooey caramel and the lingering indulgence of hard candies and fruit chews can get to the best of us, but these sugar-laden delights wreak havoc on our oral health. Even after candy is swallowed, the traces of sugar coupled with bacteria in the mouth create enamel-eroding acid. Yet there is a glimmer of semi-good news for the cavity conscious: dark chocolate.

04features-halloweenDark chocolate — which contains at least 60 percent cocoa solids and little-to-no added sugar — offers a bevy of health benefits when consumed in moderation. As rich in flavor as it is in flavonoids, which act as antioxidants, dark chocolate is associated with improvement in mood, cognitive performance, and blood flow to the heart and arteries. Conversely, it has been shown to have the potential to reduce blood pressure, cholesterol and the risk of blood clots.

It also contains theobromine, a naturally-occurring compound that studies have shown may strengthen tooth enamel. But does this mean that we should make a beeline for dark chocolate in the interest of stronger pearly whites?

“I think the potential oral health benefit is really minimal,” says Dr. Carolyn Wilson, ’77, ’81, a retired professor in pediatric dentistry at Texas A&M University Baylor College of Dentistry, now in full-time private practice. “If you think you’re going to eat dark chocolate and be doing your teeth good I don’t think that’s true. If you’re going to eat candy, chocolate would be the best option. But I wouldn’t eat dark chocolate to try to make my teeth stronger.”

Plus, she adds, kids don’t readily spring for the somewhat-sweet, slightly-bitter treat. They gravitate instead toward the milk chocolate variety, which lacks health benefits but is not as damaging to the teeth as other Halloween candy out there.

“Chocolate is probably the best option because it melts quickly and doesn’t stick to the teeth like caramels, Jolly Ranchers and Skittles,” Wilson says. “Chocolate dissolves and clears out of the mouth pretty quickly. Anything sticky is going to be much worse.”

That includes dark or milk chocolate brimming with nougat, caramel or ganache. Fillings cancel out potential benefits.

“Solid chocolate is better than chocolate with anything inside of it,” says Wilson. “Then it’s all downhill from there.”

To minimize the eroding effects of sugar, Wilson recommends that parents let their kids have candy as a dessert right after mealtime as opposed to snacking on it intermittently throughout the evening. The quicker they can brush or at least rinse with water, the better.

This Oct. 31, Wilson plans to pass out crayons to her trick-or-treaters, but she readily shares the name of a favorite candy bar of her own, and it’s not the solid chocolate variety.

“I do buy Halloween candy, and I do eat it,” Wilson says. “Everybody deserves a treat now and then. You can have a treat; just practice good oral hygiene afterward.”

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Addressing disease hazards in the dental setting Thu, 09 Oct 2014 21:42:07 +0000 There are myriad factors dentists take into consideration in order to create a safe and sterile environment for patients, from the cleanliness of office surface areas to the water used for rinsing and the methods of instrument cleaning]]>

Time spent at a medical office, where illness is expected, can create a fair amount of apprehension. One person’s persistent sneezing causes another to reach for an extra dollop of hand sanitizer. A patient’s wracking cough makes those in the vicinity think twice before taking a deep breath.

Visiting the dentist’s office doesn’t necessarily prompt that reaction, but the risk of contracting a serious infectious disease is just as real as catching a minor cough or cold. There are myriad factors dentists take into consideration in order to create a safe and sterile environment for patients, from the cleanliness of office surface areas to the water used for rinsing and the methods of instrument cleaning.

tamhsc-cc-2Safeguarding dental instruments

While in recent decades a handful of global pandemics have spread through air and contact — like tuberculosis, H1N1 and severe acute respiratory syndrome (SARS) — serious infectious diseases such as HIV, AIDs and hepatitis are actually simpler to prevent than airborne illnesses, says Dr. Raghunath Puttaiah, an associate professor at Texas A&M University Baylor College of Dentistry.

“Infections spread through saliva and blood are easier to control, because there are so many adequate precautions,” says Puttaiah, who teaches infection control and occupational safety at the dental school and trains dentists internationally on the subject.

Chief among those measures at Texas A&M Baylor College of Dentistry is a centralized system for instrument sterilization. Because dental instruments come into direct contact with saliva and blood, they present the potential for conditions such as herpes, hepatitis and HIV. To mitigate this risk, instruments go through a stringent cleaning and steam heat sterilization process, which when used and monitored correctly, destroys all known bacteria.

After dental instruments are cleaned in washers, they are sealed into sterilization packs and placed into one of three large autoclaves, or pressurized chambers. Heat-sensitive tape on the packs indicates that the autoclave has reached the required temperature: 270 degrees.

In private practice, many dental offices use the same method, just on a smaller scale.

“Most dental practices do not have the volume of equipment that a school setting has; therefore, their needs are usually met through the use of a small autoclave such as a ‘Lisa,’” says Vickie Thompson, director of dispensing operations at the dental school. The college utilizes these smaller autoclaves — comparable in size to toaster ovens — in several of its dispensaries.

Monitoring water lines

Water goes hand in hand with a trip to the dental office. It is used to flush debris and polish from teeth during routine cleanings, and it acts as a coolant during lengthy procedures. But when water lines aren’t properly monitored and maintained, tiny microbes can form, leading to allergies or reactions in patients with compromised immune systems. Also at risk, Puttaiah says, are older patients and very young children.

Myra Spurgin is an infection control officer at the college and oversees water line maintenance and cleaning. Texas A&M Baylor College of Dentistry, like most dental schools, operates on a closed water system. Instead of running city water to each operatory, a water bottle is attached to every dental chair. Once filled, a preservative tablet is added, and water lines are cleaned only with products approved by the U.S. Food and Drug Administration and Environmental Protection Agency.

“You can regulate water lines better when you have a closed system,” Spurgin says. “Private practices may be hooked up directly to municipal water supplies, but they may only have three or four operatories.” Texas A&M Baylor College of Dentistry, by comparison, has 314 dental chairs.

Using protective equipment and common sense

Just as important for dentists, dental hygienists and assistants, Thompson says, is personal protective equipment, including gloves, a mask, and protective eyewear and apparel.

Avoiding common hazards in the dental environment begins with a shift in mindset, she says.

“Just because it’s not bloody doesn’t mean it’s not there,” Thompson says. “You have just as many infections in saliva and spray from your handpiece.”

Airborne diseases with the potential to spread at a rampant pace can be best prevented through basic tenants of infection control as well as common sense, says Puttaiah. Every dental practice is required to have a manual with occupational safety standards, which call for frequent hand washing and intermediate-level, hospital-grade disinfectants for cleaning equipment and work surfaces.

Don’t underestimate the importance of a phone call, he adds.

“We let the patients know that if they are not feeling well, it’s best not to come,” Puttaiah says. “If they have symptoms of not feeling good or feeling listless, we ask them to stay home. The same thing applies to staff.

“Constantly keep your ears open, eyes open and follow the fundamental principles of infection control.”

Puttaiah’s words mirror a unifying mindset in dental schools and dental practices nationwide: that infection control doesn’t just begin the moment the patient reclines in the dental chair. It’s an ongoing process of implementing, maintaining and refining with one priority in mind — the safety and comfort of patients.

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Q&A: Unraveling the mysteries of salivary dysfunction Tue, 07 Oct 2014 18:54:00 +0000 Patients often suffer a long time before coming to see Dr. Ibtisam Al-Hashimi, director of the Salivary Dysfunction Clinic at Texas A&M University Baylor College of Dentistry. The clinic is uniquely positioned as a hub to treat patients with salivary dysfunction and by default, Sjögren’s syndrome, a little-understood but extremely prevalent autoimmune condition. ]]>

Dr. Ibtisam Al-Hashimi directs the Salivary Dysfunction Clinic at TAMBCD.

There’s a case study Dr. Ibtisam Al-Hashimi likes to share with dental students. In it, the patient’s chief complaints are all over the place: seasonal allergies, asthma-like symptoms, sore mouth, reflux, irritable bowels, and aches and pains. Everything in the lab work comes back perfect, but the patient is miserable. The symptoms are seemingly unrelated, but if you look closer, there’s one commonality. The answer lies in the exocrine system, which includes the salivary glands.

Patients often suffer a long time before coming to see Al-Hashimi, professor in periodontics and director of the Salivary Dysfunction Clinic at Texas A&M University Baylor College of Dentistry. The clinic — formed in 1991, just after Al-Hashimi’s arrival at the college — is uniquely positioned as a hub to treat patients with salivary dysfunction and by default, Sjögren’s syndrome, a little-understood but extremely prevalent autoimmune condition. Almost immediately, patients with Sjögren’s, which causes the body’s white blood cells to attack moisture-producing glands, flocked to the clinic for its diagnostic services.

Because TAMBCD has one of the only noncommercial labs in the country dedicated to patient salivary analysis as a diagnostic tool, the opportunities for interprofessional collaboration and research are plentiful. A recent collaboration with the University of Toledo and its hospital in Ohio resulted in the publication of a study examining the type of comorbidities associated with Sjögren’s syndrome. An article currently in press examines a new diagnostic tool based on genetic markers, and a contribution to the August issue of The Journal of the American Dental Association details management of dry mouth and underactive salivary glands.

Now Al-Hashimi talks a bit more about what enticed her to devote her career to the study of saliva, just how important it is to our well-being and how salivary gland problems are invariably a manifestation of exocrine dysfunction.

Your education traces back to the University of Baghdad, where you received your bachelor’s degree in dental surgery and diploma in oral surgery, and to State University of New York at Buffalo, where you received a master’s in oral sciences and a doctoral degree in oral biology. What was it that enticed you to study saliva?

In Buffalo I ended up working in a lab that focused on salivary biochemistry. I came from a clinical background, and I wanted to see what happens when people have trouble with their saliva.

It really became a passion for me the more I got into this clinical practice and started seeing the issues that come along with it. I became more interested in understanding problems with salivary glands, and before I knew it, we started seeing a lot of patients with dryness that wasn’t limited to their mouths but also occurred in their eyes — a symptom of Sjögren’s. When I came here and started the salivary dysfunction clinic, before I knew it, it had become a referral center for Sjögren’s, which started as a consortium with UT Southwestern, Baylor University Medical Center and Texas Health Presbyterian Hospital Dallas and now includes several more physicians throughout the metroplex.

When you first joined the TAMBCD faculty in 1991, you re-energized the Dallas chapter of the Sjögren’s Syndrome Foundation Support Group. In that time period, what successes have you seen in terms of how people cope with the condition?

When I came to Dallas, I reactivated the support group, and we started having meetings and symposia. The school still hosts the quarterly meeting.

One really good resource for patients has been to talk with people who have exactly the same thing; not that everybody cries on everybody’s shoulder, but that they increase awareness and education. The benefit of the meetings is the educational programs where professionals come to educate the patients and make them knowledgeable of their condition and how to avoid potential complications. A lot of pulmonary and gastrointestinal problems come along with Sjögren’s syndrome. Not many people are aware of how easily you can prevent the complications that come with impaired exocrine dysfunction just by knowing what to do and how to take care of it.

In what ways can salivary dysfunction research and treatment stand to grow?

My dream is that one day we will have a specialty in the exocrine system just like the endocrine system. Medicine is expanding so much, and there are specialists for an organ and a disease, but there is no specialist for the exocrine glands, which are distributed throughout the body, including the respiratory system, starting from the nose, sinuses, and through the lungs; and the entire digestive system, gallbladder, digestive enzymes, liver, pancreas, and the genitourinary tract. Problems and dysfunction within the exocrine system have a wide range of impact on those systems and the entire body, however, neither medical nor dental education addresses this system as one entity. Considering the abundance and accessibility of the salivary glands in the mouth, I believe dentists can play a significant role in better understanding the underlying causes of exocrine dysfunction.

There are some interesting nicknames attributed to you — Spit Doctor, Spit Lady, Dr. Spit — to name a few. Where did these offbeat monikers originate?

I initiated it. Whichever one you want me to be, that’s me. I always award myself those titles. People think so little about saliva, but here we really know how valuable it is. Just ask a patient with dry mouth, and then one can appreciate the significance and systemic implications of salivary and exocrine dysfunction. It is not just saliva; it is the entire exocrine system.

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