Cybermouth: A Closer Look

This week I decided to explore the Web for sources that are relevant to my blog’s emphasis in dentistry. In the course of my search, I found ten sites, which have been posted in my link roll to the left, that may be valuable to those who share an interest in my field of study. As a tool for those browsing my blog, I have critiqued the websites according to the Webby Awards criteria, and have offered a few comments as to how these sites may be improved in order to make a viewer’s experience more enjoyable.

The first and foremost significant aspect of a credible website is having trustworthy text, visual, and musical content. The American Association of Orthodontics offers educational videos, detailed advice for patients, and updated press releases. These areas of interest are easy to navigate, structurally appealing, and engaging. I found my overall experience at this particular site to be excellent, as it functioned well and provided a wide variety of topics that could be valuable to dentists and patients.

Since cosmetic dentistry involves meticulous attention to detail, it is no surprise that the American Academy of Cosmetic Dentistry appropriately contains superb visuals and audio. The Kaplan Test Prep and Admissions suitably offers exceptional material for students with intentions of pursuing a career in dental medicine. From personal experience, I can ensure that it contains easily accessible links that can offer a student all the necessary advice to properly prepare for the DAT. The American Dental Association also offers suggestions for the DAT exam, in addition to a variety of subject matter concerning oral health. It arranges all of its topics in alphabetical order, which makes browsing the page more efficient.

The American Association of Women Dentists is an appealing site because more and more women are entering the field of dentistry and need power for networking and representation. The site also offers easy access to affiliate organizations. The content is intriguing, however the way the material is presented needs to be done so more creatively. Web Dentistry encounters a similar problem. Although it contains high-quality, frequently updated content relevant to current issues in dentistry, the structure of the site is very repetitive and boring. For these sites, it may be beneficial to add supplements that are visually pleasing to the viewer, like video clips, audio, and photos.

With new breakthroughs in medicine and health care everyday, it is important for professionals and patients to be able to share experiences and thoughts on the web. Oral Health America actively portrays to the public the importance of the mouth on general health, and encourages viewers to donate to charities and sign up for news letters. Dental Fear Central allows patients to easily and promptly discuss their fears involved with seeing the dentist. There is abundant opportunity for students to interact within the American Student Dental Association. It encourages student dentists to obtain a membership, make a profile, and to participate in discussion forums. Although ADS Practice Transitions Made Perfect offers interactivity for those professionals with questions about their practices and questions about dental economics, it is unfortunately not very functional. It is slow to load its blog page, which may drive away browsers. It is crucial that websites not only have easy access to areas within the page, but it must allow viewers to retrieve information in a timely manner.

Although these websites do need some corrections and updates, they do contain very useful information that may be beneficial to patients, practitioners, and students. I hope my critiques may be valuable to others when exploring these links.

The Good Dentist: Accommodating all Patients

Visiting the dentist on a regular basis is not always easy for a majority of people. For some it is too costly, others do not have time, many fear going to the dentist all together, and some are simply unreliable. As I get closer and closer to entering my profession as a dentist, I have realized that it is not only important to be technically proficient and knowledgeable about multiple disease states, but it is also imperative to acquire a knack in order to cater to a broad spectrum of patients. After entering the blogosphere for the first time, it was refreshing to see that several dentists and organizations are now attempting to accommodate all of their patients through a variety of ways. Richmond Dental Implants was the first blog I came across, and I examined the post, “Sedation Dentistry in Richmond,” published by Dr. Scott Gore D.D.S. He is a graduate of the Medical College of Virginia, School of Dentistry, and is a proud advocate of sedation dentistry. Sedation dentistry (see picture to right) appears to allow the busy patient to receive the type of treatment they need in a time efficient manner, and may make a visit more pleasant for patients with dental phobia. The other post that interested me was found within a blog written by a USC student, Melody Chiu. Her entry entitled, “USC School of Dentistry Students Check Local Children’s Oral Hygiene,” discusses how USC is assisting patients and families with low incomes by providing them with a trip to the dentist and exposure to proper oral hygiene, as seen in the picture below. I have offered my comments on both posts below and directly on the authors’ blog page.

Comment (Sedation Dentistry in Richmond):
It seems to me that whenever I mention my aspirations of becoming a dentist to those who ask about my future career plans, the majority cringe. At least at some point in your career, I am sure you have also experienced family, friends, and even patients telling you, “I hate going to the dentist!” or something along those lines. As you mention in your post, people avoid the dentist for a number of reasons: some are too busy to get to the dentist regularly, others get physically sick, some people have severe back and neck pain that make sitting in a chair uncomfortable, and several get claustrophobic or anxious, to name a few. Although my father is not a dentist, he is a very successful gynecologist, and has demonstrated to me over the years how very important it is to find a way to accommodate all types of patients. What is intriguing to me about your article is that sedation dentistry seems to be a technique that can help patients who dread a trip to the dentist for a variety of reasons. Being naïve in the field of dentistry at this point, I have very little knowledge about sedation dentistry. You do mention it involves taking pills, that the patient is not asleep, and that it promotes relaxation. Having an interest in medicine as well, and to ensure a patient’s well being, I would like to know more about the composition of these pills, side effects, and who specifically may or may not benefit from this new technique. As you have probably experienced in your practice, children especially tend to have a difficult time at the dentist. With this in mind, I am interested in knowing if sedation dentistry is safe for the younger patient, and if this technique may affect them differently than it would affect adults. Finally, you mention it allows you to do several procedures in one sitting and may shorten recovery time for the patient. Fewer trips to the dentist and a less painful and shorter recovery time are aspects of sedation dentistry that would clearly be appealing to all people. With the significance of being able to accommodate a wide variety of patients, do you feel that sedation dentistry may be the way of the future in dental medicine for everyone? Thank you for your time.

Comment (USC School of Dentistry Student’s Check Local Children’s Hygiene):
Recently, I published a post that discusses how the mouth may be used as a diagnostic tool for diagnosing other systemic diseases. When I came across your post, I found it quite interesting that the number one reason why kids from the Los Angeles Unified School District are missing school is because of tooth-related problems that ultimately affect the rest of the body. It was fulfilling to find facts within your post that relate to a previous post of mine. However, what truly caught my attention within your entry was the idea of USC dental school students taking action to help less fortunate children from low income families solve these tooth-related problems. As you probably can agree, a necessary ingredient to becoming a successful practitioner is being capable of accommodating a variety of patients and their needs. You mention that a lot of kids end up with infections because their parents cannot afford to take them to the dentist. It is very uplifting to see, through exposure to proper oral hygiene, that USC students are helping children get the treatment they need while eliminating some of the expenses. I think it is great that USC is teaming up with the American Dental Association to provide basic screenings and required sealants for children, but I believe disease prevention and reduction of tooth decay starts with knowing how to eat and brush properly. With intentions of becoming an orthodontist, I completely agree with Dr. Holtzman when she states in your post that, “Teeth are very important in the way we feel about ourselves.” To be able to enhance a patient’s confidence by providing them with appropriate care and a beautiful smile will be very rewarding. Accommodating my patients’ needs, whether it be cutting costs, or making their experience more pleasant, while providing care at the same time will be even more rewarding. Your post was very engaging. Thanks for your time.

The Mouth: A Diagnostic Tool

It is no surprise that certain systemic diseases, like cancer, osteoporosis, coronary artery disease and certain viral infections are becoming more prevalent amongst the general population. Whether this is due to unhealthy diet, genetics, age, or environmental factors like smoke and pollution, more are being diagnosed with these and other lethal infections. Regardless of the source, many individuals are reluctant to see their doctors on a regular basis, which may not only prevent diseases, but allow them to be treated in an earlier and more curable stage. People are failing to turn to their physicians, so perhaps a visit to the dentist could be an alternative. Recent evidence shows that there may be new screening technology for the oral cavity that could possibly predict which patients are at risk for developing these diseases. Minimally invasive, inexpensive, and painless screening techniques, that are currently demonstrating promising results in clinical studies, may be the diagnostic tool of the future.

According to the American Cancer Society, the second leading cause of death among American women today is breast cancer. In order to detect cysts, calcifications and tumors within the breast, typically women over the age of 35 make a trip to their OBGYN to receive a yearly mammogram. However, Chyke A. Doubeni, M.D., M.P.H., of the University of Massachusetts Medical Center claims that, "Despite their [women] significant risk for development of a new breast tumor, even women who comply with a recommended yearly mammogram gradually fall by the wayside over the years." On the other hand, in a recent experiment at the University of Texas, Dr. Charles F. Streckfus D.D.S., may have discovered an alternative method for diagnosis. He simply examined a swab of saliva for salivary protein levels, which he claims have the potential to assist in diagnosis of breast cancer, and the ability to monitor tumor response during treatment. The study revealed that breast cancer patients tend to have higher levels of salivary proteins than healthy patients, that ultimately decrease once chemotherapy is initiated. Though this method has not yet been approved by the FDA, it is still an easier process for the patient and the practitioner. Until this new technology receives approval, in collaboration with mammography and blood work, salivary protein analysis may enhance the diagnostic acumen of the medical provider.

An analysis of the saliva may eventually help gynecologists to also detect other disease states. A study conducted at the University of Buffalo concluded that the prevalence of gum-disease causing oral bacteria has been linked to oral bone loss. In a controlled setting, postmenopausal women that were part of a larger investigation involving risk factors for osteoporosis and oral bone loss (see picture to left), were examined for specific periodontal pathogens, mainly P. gigivalis and T. forsynthesis. These two pathogens were found to infect 15.1 percent and 37.9 percent of these women. In addition, two other pathogens, P. intermedia and C. rectus, were found in 43.4 percent and 17.4 percent of women. If indeed these oral pathogens are related to bone loss in the mouth, it is conceivable that this may prove to be an easy, reasonably priced, and risk free test that may help in the diagnosis of systemic osteoporosis. It is well known that obese women compared to women with normal BMIs have a lower risk of developing osteoporosis due to effects of estrogen and weight bearing on bone preservation. However, this study also found that the greatest risk for oral bone loss was found in overweight women, supported by a three-fold increase. These seemingly contradicting discoveries only support the fact that further research needs to be done to elucidate the seemingly conflicting results. Since the cost of the current bone density test used by gynecologists is so significant, if further investigation of this new diagnostic tool could prove to help predict systemic osteoporosis, health care costs could be decreased dramatically.

Salivary analysis could also help infectious disease specialists diagnose viral infections. Although typically these viruses are found through examination of blood samples, Farmer, Clewley, Griffiths, and Johnson of the U.S. National Institute of Health claim that, "The sensitivity of the saliva Murex GACELISA is the same as the routine serum testing assay." For example, salivary IgA levels tend to decline as an HIV patient becomes symptomatic. Therefore, it may be that the detection of IgA antibody to HIV (see picture to right) in saliva may indicate the progression of the HIV infection. Similar studies have used saliva samples as a successful tool for diagnosis of hepatitis A and hepatitis B, based on the levels of IgM antibodies in saliva. In particular, it has been found that low levels of IgM are associated with vaccine-induced immunity. Just as the comparison of serum and saliva levels of antibody to HIV have been directly correlated, so have the levels of antibody for hepatitis (sensitivity = 98.7% and specificity = 99.6%). Since it has been discovered that in certain cases saliva and serum analysis are equally effective in the diagnoses of some diseases, this new technique may be advantageous. This needle-less method of analysis is not only simple and cost effective, but it is also beneficial to those patients, like hemophiliacs and drug users, who have difficulty in accessing peripheral blood.

Saliva samples are also being used to predict and monitor drug and hormone levels, certain autoimmune diseases, and hereditary diseases like cystic fibrosis. Still, many physicians are hesitant to believe that it could ever truly be considered a valid method for accurately predicting systemic diseases. For instance, Irwin Mandel, a professor emeritus of Columbia University, believes that, "Saliva doesn't have the drama of blood and the salivary glands are only lowly excretory organs." Although plenty of further research is necessary to make this new diagnostic tool legitimate, it is still very encouraging to believe that in the very near future, health care providers may have a painless, efficient, and cost effective way for detecting several of today’s most common diseases. After all, swabs of certain body surfaces that were at one point thought to be unreliable have proven to save lives, and the classic example is George Papanicolaou’s Pap Smear.