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Here is an article written by Joushua Bernstien and appeared in Dental Economics.

At a recent dental meeting, a famous panel of dentists and consultants fielded questions about how to improve our practices. Leadership, teamwork, vision, communication, strategic planning, focus, and many other great buzz-word ideas were discussed. When the dust settled after the discussion, I realized that we are completely out of touch with our cosmetic dentistry patients.

As we evolve and behave like business owners, we sometimes forget that the patients are still thinking the same old thing-they “hate the dentist!” While we are excited about various occlusion philosophies, new materials, and high technology, the patients are still “afraid of the shot!” While we are dinking around refining the perfect crown margin, the patients “hate the sound of the drill!” While we are concerned about diagnosis and treatment, the patients are worried about gagging, drowning, smelly tooth dust, pain, “germs,” scary noises, sharp x-ray films, scolding hygienists, sweaty palms, dentists with halitosis, and getting the heck out of the chair! Dentists want to work on more teeth, but patients want to be comfortable!

Dentists deserve a lot of credit for inventing local anesthetic, high-speed hand-pieces, and so many other techniques, materials and equipment. But our reputation runs deep in the minds of the public. Movies, TV, jokes, and popular culture depict dentists as sadistic, painful, and altogether dreadful. “As bad as a root canal” and “like pulling teeth” are obvious similes. Every day, new patients come into our offices and say, “Nothing personal, Doctor, but I hate the dentist.”

We should be taking this personally–and seriously. 50% of the public does not see a dentist even if they have dental insurance. It is up to us as a profession to work hard to earn a better reputation. All of us should be learning everything we can to make a dental visit completely comfortable so that patients will get the care that they need. We now know that this is not just about saving teeth.All the latest research shows that dental health reflects conditions throughout the body, so it is really a matter of public health.

Complacency would be easy. After all, most of us think we are doing a pretty good job in the comfort area; and it would be so hard to change our reputation when we could just keep laughing about it in good-hearted, self-deprecating humor. However, we could learn from the Japanese. After World War II, the words “Made in Japan” were branded to mean poor quality. Now, the Japanese have turned quality into a science and everyone knows that Japanese products set the standard for reliability. Dentists can similarly change reputations by proving ourselves anew.

I have seen many dentists in my life, all of them conscientious and some of them famous. I am certain that they all thought they were comfortable and painless, but only two of them really were. Some of the experiences were downright unpleasant. I’ve had blocks that hurt like a tetanus shot. I’ve been gagged by impressions. I’ve had anesthetic wear off then “reassured” that “we’re almost done.” I’ve weathered a two-hour crown prep. I’ve had a root canal without being completely numb. I’ve had repairs done with no anesthetic at all. I’ve had my tongue nicked, my lips bruised, and my throat jabbed! The interesting thing is that I am not a dental phobic and I don’t “hate the dentist.” I just want to have the pleasant, comfortable experience that I know is possible-after all, I’ve experienced comfortable dentistry in the past. My wife, Allison, wisely says that it doesn’t matter how great the dentistry is if we hurt the patient, because the pain is the only thing they will remember. She’s absolutely right.

Each of us owes it to our patients to do everything we can to make each visit completely comfortable. If a patient is genuinely phobic or simply prefers to be sedated, we should be trained in oral conscious sedation. But for the vast majority of procedures, we should carefully begin earning the reputation of being painless and comfortable. There is so much we can do. It starts with genuine compassion. We can be on time. We can use a great topical and allow time to let it work. We can revisit our “painless” injection technique and do it every time with The Wand. We can be gentle in our manner. We can be comforting in our communication. We can provide our patients with pillows, blankets and video glasses. We can teach our team to be friendly in interactions, comfortable in assisting, and gentle in hygiene techniques. We can buy equipment and materials that make the experience comfortable. Microultrasonics and lasers reduce the need for scaling and for perio surgery that patients despise. Digital x-rays sensors are now rounded for comfort. New implant techniques eliminate flap surgery. Rubber dams and Isolites provide comfort and relaxation, while reducing gagging and drowning. Intraosseous anesthetic guarantees profound numbness in difficult situations. Rotary endo techniques are quick and painless. New bonding protocols reduce sensitivity. And so do new whitening products. Proper medication eliminates post op pain. The list is endless.

Comfort is the new frontier in dentistry. As dentists, we think we have overcome this hurdle but we have not. Luckily there are materials, equipment, and techniques to make our patients completely comfortable. All we have to do is make a commitment to improve, invest appropriately in our practices, and avail ourselves of the education to provide our patients with consistently comfortable experiences. It’s time for us to surprise our patients with comfort. Imagine how fabulous it would be if dentistry was universally known as the most comfortable area of health care. It can be. The reputation of our profession depends on each of us-every day.

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Children with a migraine headache are more likely to have sleep disorders, such as obstructive sleep apnea  and lack of sleep, than children without a migraine.

For this study, presented on June 10 at SLEEP 2008, the 22nd Annual Meeting of the Associated Professional Sleep Societies (APSS), 90 children with headache and sleep problems underwent a polysomnogram, a sleep test that monitors the brain, eye movements, muscle activity, heart rhythm, and breathing. Of the participants, 60 had a migraine, 11 had a chronic daily headache, six had a tension headache and 13 had a non-specific headache.

The study found the children with a migraine were twice as likely as the other children in the study to have OSA. A sleep-related breathing disorder (SRBD) was found in 56 percent of the children with a migraine versus 30 percent of the children with a non-migraine headache. A severe migraine was also associated with shorter total sleep time, longer total time to fall asleep, and shorter REM sleep.

“Sleeping problems can exacerbate the problems a migraine causes on a child’s health and may hinder a child’s performance at school,” said Sanjeev Kothare, MD, senior author of the study. “Parents and doctors need to be aware of the strong likelihood of sleep disorders in children with a migraine and seek appropriate preventions and treatments.”

The study also found that 50 percent of children with tension headache grind their teeth at night, compared to 2.4 percent of children with a non-tension headache. In addition, an SRBD was also frequent in children with a non-specific headache and in children who were overweight.

The study was conducted at St. Christopher Hospital for Children, Drexel University, in Philadelphia, Pennsylvania. Dr. Kothare is currently at Harvard Medical School, Children’s Hospital in Boston.

OSA is an SRBD that causes your body to stop breathing during sleep. OSA occurs when the tissue in the back of the throat collapses and blocks the airway. This keeps air from getting into the lungs. OSA occurs in about two percent of young children. It can develop in children at any age, but it is most common in pre-schoolers. OSA often occurs between the ages of three and six years when the tonsils and adenoids are large compared to the throat. OSA appears to occur at the same rate in young boys and girls. OSA also is common in children who are obese, and is more likely to occur in a child who has a family member with OSA.

Sleep-related bruxism involves the grinding or clenching of teeth during sleep. It is common for the jaw to contract while you sleep. When these contractions are too strong, they produce the sound of tooth grinding. This can cause dental damage by wearing the teeth down. In most severe cases, hundreds of events can occur during the night. In milder cases, the grinding may vary from night to night.

The rate of bruxism seems to be highest in children. About 14 to 17 percent of children have it. It can begin as soon as a child’s upper and lower teeth have come through the gums. Around one third of children with bruxism will still have it when they are adults.

This material is adapted from material in the American Academy of Sleep Medicine

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New guidelines developed by the American Academy of Neurology confirm that the drug botulinum toxin is safe and effective for treating cervical dystonia, a condition of involuntary head tilt or neck movement, spasticity and other forms of muscle overactivity that interfere with movement in adults and children with an upper motor neuron syndrome, and excessive sweating of the armpits and hands. Botulinum toxin may also be used in hemifacial spasm, blepharospasm, some voice disorders , focal limb dystonias, essential tremor and some forms of spastic bladder disorders.

This guidelines project was chaired by David M. Simpson, MD. To develop the guidelines, the authors reviewed and analyzed systematically all available scientific studies on the topic.

Since its introduction 28 years ago, botulinum toxin has become the most effective treatment for numerous movement disorders associated with increased muscle contraction. The drug is injected into affected muscles.

A surprising finding was that botulinum toxin is probably not effective in the treatment of migraine or chronic tension-type headache. “Based on currently available data, botulinum toxin injections should not be offered to patients with episodic migraine and chronic tension-type headaches,” said pain guidelines author Markus Naumann, MD, Professor of Neurology, Head of the Department of Neurology at Augsburg Hospital in Germany, and member of the American Academy of Neurology. “It is no better than placebo injections for these types of headache.”

“We found that botulinum toxin is possibly effective in relieving low back pain and therefore may be considered as a treatment option,” said Naumann. “However, our recommendation is based on data from only one study in a small number of patients. More research is needed to define the place of botulinum toxin in treating this condition, in comparison to other treatment options.”

If you are consisdering using botulinum toxin there are reports that it can damage parts of the body far away from the injection site and can cause nerve damage. Please be careful if considering this treatment.

The guidelines appeared in the May 6, 2008, issue of Neurology®, the medical journal of the American Academy of Neurology.

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Hey guys, I just wanted to share a quick update of how this website has been fairing as far as people visiting go. It has gradually been increasing each month through my promotion and SEO efforts. Hopefully I can keep the trend going throughout the summer. I have a few more ideas in mind to increase visibility in primarily Google as I do not rank as well in Google as I do in MSN and Yahoo. However, Google makes up the most of the people who find my site.

Here is a chart to help illustrate the site’s growth. Thanks to everyone for visiting!

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I wanted to talk briefly about the reader email i have been receiving. Thank you all for sending me email. I appreciate it and I wish you all well in your health.

A common theme that appears is people emailing me saying something along the lines of “I wish I would have found your site before…”. I am aware that many people often will go and have their wisdom teeth removed and not think hard and long about the quality of life that could be diminished and impacted after the procedure. People may fail to do research online, or not do as much research as they should, or fail to find my site.

I have been promoting my site hard through the use of SEO techniques and have been reading up heavily on blogs such as Winning the Web and John Chow. It is hard when Google works against you and tries to manually put you out of the search. It is also hard to compete against other websites for the top keywords such as “wisdom teeth removal” and “wisdom teeth”. It is my hope that you who are thinking about wisdom teeth removal can find this site before the decision. Please let your friends and family know as well.

I wish you all well in your health and hope the U.S. does something to stop removing healthy impacted wisdom teeth when it is more dangerous than beneficial.

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