Vital Record » Dentistry Your source for health news from the Texas A&M Health Science Center Fri, 21 Nov 2014 19:22:17 +0000 en-US hourly 1 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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Follow-up oral care: The new normal for childhood cancer survivors Tue, 23 Sep 2014 15:51:18 +0000 Today, because of advances in treatment, more than eight out of 10 children treated for cancer survive at least five years, most into adulthood. However, the same treatments that help these children survive can also cause immediate and late-term health effects, even in the mouth]]>
Follow oral health care is essential for cancer survivors and offers the best chance for long-term, overall health.

Follow oral health care is essential for cancer survivors and offers the best chance for long-term, overall health.

Today, because of advances in treatment, more than eight out of 10 children treated for cancer survive at least five years, most into adulthood. However, the same treatments that help these children survive can also cause immediate and late-term health effects, even in the mouth.

Because childhood cancers tend to be fast growing and cancer therapies — chemotherapy and radiation — target rapidly dividing cells, children usually respond well to treatment. Besides, their bodies are generally better able to recover from higher doses of chemotherapy than adults, so using more intensive treatments gives oncologists a better chance of treating the cancer effectively. However, several parts of the human body including the mouth, hair and stomach are made up of these rapidly dividing cells and can be impacted by the treatment.

“The effects of cancer treatment on a child’s oral cavity depend largely upon the type of cancer treatment, chemotherapy versus radiation, and the timing of treatment,” said Carolyn Kerins, associate professor in pediatric dentistry at Texas A&M University Baylor College of Dentistry. “The effects of chemotherapy vary based on type of drugs used, their doses and frequency. The side effects of radiation will depend on the dose of radiation and location of the radiation beam.”

Oral complications that can occur during cancer therapy include cavities, dry mouth, changes in taste, bleeding, painful swelling and ulcers in the mouth. Although dentists can prescribe medications to manage these conditions, they often improve after treatment is discontinued. However, some complications are persistent or may not show up until months, or even years, after treatment.

“Chemotherapy interferes with the cell division and intracellular metabolism and will cause delayed dental development,” Kerins said. “This may be seen as stunting of tooth roots, absence of one or more teeth, abnormally small teeth or enlarged pulped chambers.”

Once teeth are fully developed, Kerins explained, chemotherapy and radiation has a dramatically reduced affect on them. It’s the teeth that are still forming that are impacted by the treatment, especially radiation, which has far more detrimental effects on the developing permanent teeth by halting their maturation.

“Radiation damage is non-reversible and affects the alveolar bone (the bone that contains the tooth sockets), the periodontal ligament (connective tissues that attach a tooth to the alveolar bone) and the pulp tissue (soft tissue that forms the center of a tooth that contains the nerves and blood vessels),” Kerins said.

It is likely that pediatric patients who have received radiation in the head/neck region may require prosthodontic management later in life. “The more focused the beam, the lesser the field of damage,” she said.

Childhood cancer survivors are also at risk of reduced bone mineral density, which persists into adulthood and may increase bone fracture risk at an older age. Prolonged high doses of radiation can lead to necrosis (death) of the bone.

It is worth noting that good oral health care is important before, during and after cancer treatment “Ideally, each child should have a comprehensive dental exam prior to the initiation of chemotherapy and/or radiation,” Kerins said. “Any decayed teeth should be restored prior to treatment and any teeth requiring extraction should be extracted prior to therapy.”

During chemotherapy, oncology patients should maintain routine dental visits. “As chemotherapy is usually administered in a cyclic nature, it is ideal to see the patient when the blood counts are close to normal, or the day before the next round of chemotherapy is administered,” Kerins said. “As the patient undergoing chemotherapy is immunocompromised, it is advisable to give antibiotic prophylaxis prior to the appointment. Patients should have routine dental cleaning and fluoride therapy every six months.”

If the patient develops swelling and ulcers in the mouth during treatment, mucosal coating agents or topical anesthetics may be prescribed.

According to Kerins, patients occasionally develop a secondary intraoral infection such as candida or herpes while undergoing chemotherapy. She said the pediatric dentist can prescribe the appropriate antifungal medication to treat the candida infection. To prevent herpes infection, cancer patients routinely take anti-viral drugs.

Although the side effects of cancer therapy can be frustrating, they are the result of life-saving treatment. It’s important to realize that follow-up care is essential and offers the best chance for long-term, overall health.

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Partnership provides care to uninsured in Irving, cuts down on dental-related emergency room visits Wed, 17 Sep 2014 18:21:06 +0000 A new partnership between Texas A&M University Baylor College of Dentistry and Baylor Health Care System is shifting patients out of the emergency room for dental-related pain and into the care of fourth-year dental students. On Aug. 18, TAMBCD dental students began seeing patients at the ... ]]>

A new partnership between Texas A&M University Baylor College of Dentistry and Baylor Health Care System is shifting patients out of the emergency room for dental-related pain and into the care of fourth-year dental students.

On Aug. 18, TAMBCD dental students began seeing patients at the Irving Community Clinic, across the street from Baylor Medical Center at Irving.


Photo: Irving Healthcare Foundation

Two students rotate through the clinic for a week at a time, providing cleanings, X-rays, extractions and fillings with the help of two dental assistants.

Plans are in the works to add more dental chairs and treatment options, such as endodontics and fixed prosthodontics procedures.

The partnership is part of a plan to cut down on the 1,500 dental-related emergency room visits at the Irving hospital every year. That figure mirrors national numbers from the American Dental Association, which reports that there are 2 million visits every year to hospital emergency rooms for dental pain. Since most hospitals do not have dentists on staff, patients are prescribed painkillers and antibiotics. It’s a temporary fix: 39 percent of these patients make return trips to the emergency room for recurring symptoms.

So far, numbers from the Irving initiative are encouraging.

Dr. Vanessa Williams, clinical assistant professor in public health sciences, supervises TAMBCD students at the Irving clinic. She began seeing patients there in mid-July, and by the end of August, she and students had treated more than 180 individuals. It’s nearly as many as the 250 dental patients seen in all of 2013 at the same location, which began years ago as the all-volunteer Irving Interfaith Clinic.

Because the dental clinic’s hours were previously on a volunteer-only basis, Williams says, many patients would have lengthy wait times between appointments.

“This in turn, would leave them with no other choice but to seek emergency treatment through the ER due to financial constraints,” says Williams. “Many of the patients have expressed their gratitude in having TAMBCD fulfill such a tremendous need.”

02connections-icc-2Cheryl Keith, director of operations with HealthTexas Provider Network, an affiliate of Baylor Health Care System, oversees the Baylor community care clinics and says 2,500 dental patients are anticipated to be seen at the Irving location this year alone.

For several years, HealthTexas has been involved with placing full-time physicians at the clinic, which is also dedicated to patients in need of medical care, most of whom suffer from chronic conditions such as diabetes and hypertension. Efforts began in early 2014 to expand the dental clinic’s reach beyond a volunteer capacity.

“Sustainability is a big buzz word — being able to sustain this service for this population of patients and having the ability to integrate different services that really affect each other,” Keith says. “Having the dental clinic sitting right inside the medical clinic, and having a physician full time, it’s just a great service. If there’s a medical issue with a patient in a dental suite, we’re able to take care of that, too.”

Thanks to Irving Healthcare Foundation, the primary fundraising organization for the Irving Community Clinic, care provided to uninsured residents in need doesn’t cost taxpayers a dime.

“Baylor employee giving, special events, annual giving memberships and grants are expected to make up most of the $170,000 needed this year to support the needs of the clinic,” says Kim Hanna Hollwedel, major gifts officer at the foundation.

The nonprofit was willing to support the project, Hanna says, because access to dental care ranks among the top needs of indigent Irving residents, alongside access to medical care and programs to battle obesity. Since 2008, the foundation has granted more than $1 million to these causes.

Paul Hoffmann, TAMBCD administrative director for extramural clinics, says the common mission and long-term mindset of all parties involved served as a springboard for the initiative.

“The needs for dental care among the underserved are so dramatic,” says Hoffmann. “We’re looking for partners who recognize that need but who also will help us with sustainability in the long term.

“This is a unique partnership. You have a large hospital system, physician network, health care foundation, community medical clinic and dental school involved in offering comprehensive dental care for the dentally underserved in Irving.”

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Adventurous dental students seek training opportunities in rural — and sometimes forbidding — locations Mon, 08 Sep 2014 22:13:53 +0000 From the Southwest to the Far North, students from Texas A&M University Baylor College of Dentistry serve Native American patient groups through a public health externship. ]]>

No roads lead into Barrow, Alaska, the northernmost city in the U.S., an outpost on the frozen tundra that clings to the edge of the Arctic Ocean. By Labor Day 2014, residents had already seen the lightest dusting of snow — which typically blankets the dirt roads from October through June.

Dr. Jonathan Oudin '11 with one pediatric patient

Dr. Jonathan Oudin ’11 with one pediatric patient

And yet, the Indian Health Service welcomes hardy dental students seeking an extern opportunity the likes of which they would not experience in any other clime. While remote, cold places with limited Internet and cell phone coverage are a distinct possibility, even more so are the rewards of providing oral health care for the region’s residents, say Drs. Jonathan Oudin ’11 and Kim Self ’09, who devoted three years as public health dentists with the Indian Health Service in Barrow. It all traces back to summer 2008, when Self completed the externship before her final year of dental school — and then promptly returned that December in the dark of the Alaskan winter.

The summer months in Alaska are more hospitable. That’s when fourth-year dental student Josh Morales traveled to Bethel and Hooper Bay, spending several weeks as an extern with the Indian Health Service in July 2014. He worked with a team of 10 rotating dentists and several dental students from the University of Colorado School of Dental Medicine.

Bethel, with a population that barely skirts 6,400, is the only city of its size for hundreds of miles. It’s large compared to Hooper Bay. Getting there requires a one-hour jaunt on a single-engine propeller plane. The village has no restaurants, a general store and one facility with running water. With no Wi-Fi and 19 hours of daylight, Morales had plenty of time to fish, kayak and brush up on card-playing skills when he wasn’t working at the clinics.

It was exciting to get up each morning, and not just because the sun had already hovered over the horizon for hours.

“I did more dentistry in that month than I did in all of third year,” says Morales, who wants to pursue pediatric dentistry. He treated approximately 12 children a day as opposed to two patients at the dental school.


Fourth-year dental student Josh Morales, en route to treat patients in Hooper Bay, Alaska

The experience exposed Morales to the cultural nuances of Native Alaskan Yup’ik culture in tandem with increasing his hand skills.

“The children won’t verbally answer you when you ask a question. Instead, they’ll raise their eyebrows,” Morales says. “You’ll put the sunglasses on them and ask them if something hurts; you’ll look for the normal body signs, but they’ll just raise their eyebrows. You have to learn to look out of your loops, to see if the sunglasses bob up and down.”

Training opportunities with the Indian Health Service aren’t limited to the Last Frontier.


Fourth-year TAMBCD student Abrefi Asare

Back in the Lower 48, four senior students from Texas A&M University Baylor College of Dentistry spent time at IHS clinics this summer. Britni Batisse and Abrefi Asare worked at the dental clinic in Clinton, Okla., and Christina Dawson and Lindsay Tilger at the Claremore, Okla., location. The students’ trips were arranged through the college’s preceptorship program, so theirs were abbreviated one-week versions of the IHS externships, which can last from a few weeks to several months.

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