Monthly Archives: November 2016

Choosing a Mouth Rinse That’s Right for You

Anti-plaque, anti-gingivitis, alcohol-free — your pharmacy’s oral health section has dozens of mouth rinse products to choose from, all promising to protect your teeth and gums and freshen your breath.

But how can you know which claims are true? And do you really need to use a mouth rinse — or is good brushing and flossing enough?

“There are three major categories [of mouth rinses], from a consumer perspective,” says Michelle Henshaw, DDS, MPH and assistant dean for community partnerships and extramural affairs at Boston University, Henry M. Goldman School of Dental Medicine. These include mouth rinse products that contain fluoride, anti-gingivitis and anti-plaque mouth rinses, and cosmetic mouth rinse products. Some of these mouth rinses are available over-the-counter; others will require a prescription.

Here’s what you should know when shopping for a mouth rinse.

Fluoride-Containing Mouth Rinses

Fluoride helps prevent tooth decay by helping your body strengthen enamel — the white, harder-than-bone substance that covers teeth. But most people will not require fluoride-containing mouth rinses, says Dr. Henshaw. “You pretty much get that from your fluoridated toothpaste,” she says. But, there are some exceptions.

“People with xerostomia (abnormal dryness of the mouth) might use this kind of mouth rinse, and there are other reasons, like dental caries (cavities),” says Henshaw. Severe dry mouth can lead to a change in the bacterial balance of your mouth, while too much bad bacteria can lead to tooth decay. Fluoride mouth rinses can help prevent these problems.

Check with your dentist if you’re not using fluoride toothpaste. In this case, it might be a good idea to supplement your oral health routine with a fluoride mouth rinse.

Mouth Rinse to Freshen Your Breath

Many mouth rinses are available that make your breath smell good, but, they don’t necessarily offer any long-term dental health benefits.

“Cosmetic rinses reduce mouth odors, or halitosis,” Henshaw says. “Some do kill bacteria for a short time, but there is no lasting health impact that you could ascribe to them.” The bacteria killed by these types of mouth rinses will grow back eventually, and while you’ll have fresh and minty breath in the short-term, these rinses don’t actually improve your oral health.

Anti-Plaque or Anti-Gingivitis Mouth Rinses

“For adults, it’s a good idea to include this kind [of mouth rinse] with brushing and flossing,” Henshaw says. Although brushing and flossing are the key components of good oral health, we don’t always do as good a job with these tasks as we should. Anti-plaque and anti-gingivitis mouth rinses can give a boost to your dental care habits by killing potentially damaging bacteria.

“If it has the American Dental Association (ADA) seal of approval that means that the claims made on the bottle have been verified by an independent scientific body,” Henshaw explains. “These rinses work by killing a different spectrum of bacteria than the breath-freshening rinses,” Henshaw says. Oral bacteria can cause gum disease, so using a rinse that eliminates some of these organisms will help your overall oral health.

For people with more serious oral health concerns, dentists can prescribe stronger mouth rinses. “Another level is available by prescription to fight advanced plaque and gingivitis. This will keep inflammation down,” Henshaw says.

Mouth rinses do serve a purpose, whether to freshen your breath or help fight plaque and gingivitis. But, mouth rinses are not a substitute for regular and effective brushing and flossing. Don’t get lazy with your toothbrush and dental floss. And when choosing a mouth rinse product, pick one that has the ADA seal of approval.

FDA’s Warning to Mouthwash Makers

In September 2010, the Food and Drug Administration (FDA) warned a number of mouthwash producers — including Johnson & Johnson, CVS, and Walgreens — that they needed to stop making “unproven” claims in their packaging. The mouth rinses targeted were mainly those containing sodium fluoride, which has found to be an effective cavity-fighter but ieffective at removing plaque or preventing gum disease.

A Guide to Flossing Your Teeth

 Cleaning the spaces between your teeth and along your gums with dental floss is as important to your oral health as cleaning your teeth with a toothbrush. Just like you brush your teeth every day, flossing should be part of your daily routine.

To better understand why flossing is so important, Richard H. Price, DMD, spokesperson for the American Dental Association (ADA) and a former clinical instructor at Boston University Dental School, compares it to cleaning your home: “You cannot effectively vacuum a house with only one attachment,” he says. “You need other attachments to get into the nooks and crannies. That’s what floss does.”

The Benefits of Flossing to Your Oral Health

There are many benefits to regularly flossing your teeth. Dental floss can help clear food debris and plaque from the spaces between your teeth, where your toothbrush can’t reach. As a result, flossing helps prevent gum or periodontal diseases, tooth decay, and bad breath.

There are certain things to keep in mind to get the most out of flossing:

  • Use dental floss or an interdental cleaner every day.
  • Floss at least once a day.
  • Be gentle when using dental floss so you avoid damaging gum tissue.
  • If long threads of regular dental floss are too hard for you to hold, use a floss holder.

A Variety of Dental Cleaning Products

Drugstores offer a mindboggling variety of dental cleaning tools. These include:

  • Waxed dental floss
  • Unwaxed dental floss
  • Interdental cleaning aids, including picks and special sticks
  • Oral irrigators, which use water to remove plaque caught between teeth
  • Mouth rinses

Both waxed and unwaxed dental floss work well to clean the spaces between your teeth. If the spaces are tight, waxed floss may glide more easily between them. The bottom line, says Price, is that flossing every day is more important to your oral health than which floss you choose.

“Any floss that slips easily between teeth without hurting and damaging the gums is the floss for you,” says Price. “Ask you dentist for a recommendation. Some have samples you can try. Waxed, unwaxed, high-tech teflon types, nylon types? Just use it!”

A floss holder or other interdental cleaning tool may be helpful if you have trouble handling long pieces of floss due to arthritis, vision difficulties, or discomfort, but you must follow instructions or ask your dentist how to use them properly so you don’t hurt your gums.

Oral irrigators can help remove food caught between your teeth, too; but they shouldn’t replace dental floss and toothbrushing. Likewise, most mouthwashes won’t do an effective job of keeping your mouth healthy on their own. Many are used simply to cover up breath odor, although some over-the-counter fluoride mouth rinses approved by the ADA can help prevent decay, and some anti-gingivitis or anti-plaque mouth rinses can help fight periodontal diseases.

Offering ‘rock and roll’ dentistry to time-poor patients

 With a prestigious London postcode and situated only a stone’s throw away from the world famous music studio, Abbey Road Dental has a location and name that’s world renowned.

The clinic is small but perfectly formed and sits above a café and bar in the road made famous by the Beatles. Whilst respecting the privacy of any rock star clients – ‘we do see the occasional celebrity who uses the recording studios down the road, but our lips remain sealed’, says practice principal Diana Spencer – the bijou practice is anything but anonymous when it comes to its approach to patient care.

‘We are small, but very special,’ Diana says of the practice that opened its doors in June 2011. ‘We offer everything that could be asked for in a modern practice but, because of our size, we are a close-knit and mutually supportive group. We know all our patients by name and they are part of our family. No one is an anonymous face – neither staff nor patients – and I pretty well know all of the patients, whether I treat them or not.’

Preventative care

Abbey Road Dental is a clinic that places preventative care at its heart, while offering complementary cosmetic dentistry and Diana is proud of its ability to combine aesthetic treatments with a more nurturing and holistic approach to dental health.

She says: ‘We are in a wonderful period of development in medicine and dentistry. It is hard to believe that, only a few generations ago, extractions with no anaesthetic were the solution to dental disease. Prevention of disease is key for a healthy and fulfilled life – and not only in dentistry.

‘The technological advances of the last few decades have revolutionised the practice of dentistry. These days, minimally invasive dentistry is the song we dentists sing. The high tech approach – with intraoral cameras and computer-aided technology and so on – not only allows us to achieve fabulous results without pain, but also educates and empowers patients.’

High expectations

The practice has a mixed patient base and attracts a large number of patients from across the Home Counties as well as a number of American families who live in the area due to the proximity of the American School in London. Diana explains: ‘They love the kind of practice we have – preventative orientated and child friendly. We also see a high number of young professionals who work in central London but live locally.’

With this comes a multitude of challenges, not least of which is the cohort of professionals in the early stages of their career who work hard, play hard but with their dental health sometimes taking the brunt.

Diana says: ‘We have quite a high proportion of patients who are time poor but with high expectations. It is paramount to us we keep our promises to patients to be able to offer late-night openings and to understand the problems involved with working in high stress environments while trying to fit in some time to take care of health needs.’

She explains: ‘We insist on a full-hour assessment with the hygienist and another hour with the dentist for all new patients, so we can investigate fully – and at leisure – the current state of health of the patient, as well as their needs and desires. The aesthetics of a smile is very important to all of us – but oral hygiene is first and foremost and a beautiful smile can only be achieved once that is perfected.

‘I believe there is nothing better than a natural tooth, so invasion into that tooth is always kept to the absolute minimum.’

The home care toolkit she recommends to all her patients is always evidence based and up to date, taking in any developments in dental technology and research.

She explains: ‘We always recommend power brushes to all our patients, including children. The latest models are brilliant at motivation and preventing over-brushing as well as making the patient aware of the need to brush all surfaces of the teeth, not just the visible areas. When our patients return for follow-up care, they are usually amazed at the change in the appearance and feel of clean healthy teeth and gums – and we can show them the pictures to prove it!

‘We always recommend the Oral-B Genius powerbrush, Satin tape and the Pro-Expert toothpaste. The powerbrush is good for assisting in patient compliance and the patients see the results very quickly.’

Children’s dentistry

Abbey Road Dental also has a special interest in children’s dentistry, the source of which lies in Diana’s own childhood.

She explains: ‘I had awful dental experiences as a child – Sherbet Dip Dabs were my downfall – and, consequently, needed fillings every dental visit and it always hurt, even when they said it wouldn’t.

‘I want children to see the dentist as a friend and teacher who have their best interests at heart and is fun to be with and always keeps her promises, whatever happens. A visit to the dentist should be easy and relaxed and just a normal part of life, not a crisis.’

And this translates across all age groups, too. Diana says: ‘We endeavour to create a calm, relaxed and friendly practice so that all our patients are able to just slow down and have some “me” time and know that they will be cared for professionally.’

The most common lies dentists tell themselves

 As humans, we tend to believe things that may not necessarily be true because they fit our view of the world. These “lies,” or innocent self-deceptions, may seem harmless, but can in fact be very costly to a professional practice in terms of time, money, and satisfaction. As advisors to dentists, we have found the following to be the most common “lies” dentists tell themselves:

1. I am a doctor, not a business owner. Success is guaranteed.
Many dentists struggle with the challenges of owning a business. Some will proudly tell you that they didn’t become a dentist to make a profit, but rather to help people by treating dental diseases. Being a financially successful dentist and being a good doctor are not mutually exclusive. In fact, in order to be there to treat your patients, you or your employer must make a profit. In today’s world you must devote time to the business side of your practice.

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2. Budgets are a waste of time. I just check whether I’m doing better than last year.
Just the sound of the word “budget” sounds confining and restrictive. We all want the freedom to spend as we please. Ironically, when budgeting is proactive, the process “frees
up” money that tends to get wasted. Budgets provide the dentist three significant benefits:

  • Budgets set revenue and expense goals. Studies have shown that people are more likely to accomplish goals that are written compared to those that are not.
  • Budgets ensure the efficient use of resources. Setting and reaching revenue goals ensures that cash is available to meet all obligations. Expenditure goals ensure that resources are directed toward those activities that will move the practice forward toward a well-defined goal. Finally, a dentist is less likely to impulse buy because expenditures have been determined in advance.
  • The budgeting process helps the dentist internalize the practice goals, resulting in better practice management decisions.

Simply depending upon last year’s numbers to manage one’s practice is like driving a car by looking in the rearview mirror. Start budgeting and experience the freedom.

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3. Scheduling for production is all about money.
One of the most dramatic improvements you can bring to your practice is to learn to schedule for productivity. Often, practices confuse being busy with being productive. Scheduling for productivity is about time management. A good scheduling system maximizes the efficient use of both doctor and staff time. Done well, scheduling can reduce stress of patients and staff, improve patient satisfaction and reduce the time a patient will need to spend in your chair. A few dollars spent with a qualified consultant can pay big dividends.

“One of the important lessons doctors must learn is that each and every one of their staff contributes to their success or failure. […] Being appreciated is one of the top reasons employees continue to work for a  particular employer.”

4. I have more important things to do than plan my equipment purchases. I can wait until it wears out and then buy what’s currently “hot” at the dental convention.
Planning equipment purchases seems like a mundane task. However, the money saved by doing this planning can be pretty exciting. Most practitioners finance the purchase of dental equipment if the amounts are significant. However, by planning ahead and saving rather than borrowing, the results are positive and dramatic. If a dentist expects to acquire $50,000 of dental equipment in three years, simply setting aside the funds in an equipment reserve account can save $8,200 (assumptions are 5% rate of return, 40% tax bracket, 7.5% interest rate, 60-month repayment term for equipment loan). Money-saving ideas occur when the dentist develops and works a good business plan in partnership with an accountant that understands the dental industry.

5. Staff are all overpaid and don’t appreciate their job – or me.
One of the most important lessons doctors must learn is that each and every one of their staff contributes to their success or failure. Studies have shown that 68% of patients that leave your practice do so because of something your staff has done. You need to create a culture where everyone works towards the practice success. Being appreciated is one of the top reasons employees continue to work for a particular employer.

6. Leadership training doesn’t apply to our practice. We’re all professionals and know what we’re doing.
How would you feel if you were boarding a flight to London and overheard the pilot say, “We don’t need a flight plan today; we can just ‘wing’ it?” Most people would feel nervous and uncomfortable because they want the pilot to know the best course, be aware of bad weather, and anticipate air traffic conflicts so they arrive at their destination safely and on time. Likewise, patients and staff want the dentist to have a clear idea of where the practice is going and to assume a leadership role. When everyone is pulling in the same direction, astounding results occur. If each person on your dental team cannot clearly articulate and enthusiastically support the practice goals, then the practice has a leadership vacuum. You are the person responsible to fill that vacuum. Improve your leadership skills and your practice performance will soar.

“Waiting even five years [to plan for your retirement] can cost you a large amount of money, and putting off funding retirement indefinitely will most assuredly put your ability to retire at all in jeopardy.”

7. Staff meetings are a waste of time and money.
One of the symptoms we see when a practice is struggling is the lack of communication between the doctor and staff. Well-run practices understand the value of staff meetings. Staff meetings take several forms. Each day should start with a morning huddle to review the day about to take place. At least monthly, the practice should set aside a couple of hours for a full staff meeting. The staff meeting is a great opportunity for training, problem solving, review of systems, and holding team members accountable.

8. Our practice is not experiencing any problems. We can afford to coast.
After working hard to build a practice, a dentist must guard against complacency. Little thoughts creep into one’s mind, “Everything is going well. I think I’ll coast for a while. I deserve it.” In times past, people manufactured horse drawn carriages, steam locomotives, slide rules, and typewriters. Today all of those once-useful products are obsolete. We sometimes forget that the world is constantly changing, and if we are not constantly changing, our dental practices become obsolete. If your practice looks the same as it did three years ago, is likely a red flag warning you to innovate, upgrade, and improve. A dynamic business plan will include innovation and improvements. Create or update your plan, and use it as a daily guide.

9. Our practice will never be embezzled. My bookkeeper has worked in our office for 20 years and is totally trustworthy.
Of course we trust our employees; we would never hire a person that we don’t trust. Trust is crucial to running a successful business. As prudent business owners, we always insist on honesty and ethical behavior. Despite the best of intentions, a substantial number of dental practices (15% to 20% by most estimates) unfortunately experience fraud or embezzlement. In order to protect business assets while simultaneously maintaining high employee morale through mutual trust and support, a dentist must implement and maintain “internal controls.” Internal controls are simply self-checking systems that constantly alert the owner whether business assets are being handled in a responsible manner. Internal controls can include a record like a day sheet, a procedure such as checking daily production totals against the schedule, or a policy such as “checks must always be signed by the dentist.” If you are unsure whether your internal controls are protecting you, contact your dental CPA.

10. I can wait until later to start funding my retirement.
We believe the first day a dentist should begin planning for his or her retirement is the first day of practice. Developing the discipline to save for retirement early is the best way to meet your retirement goals. Consider five different dentists who each contribute $25,000 per year towards retirement but started at different ages (35, 40, 45, 50 and 55) and earn a rate of return of 6%. The dentist who starts at age 35 contributes a total of $750,000 and accumulates $1,976,455. The dentist who waits until age 40 only accumulates $1,371,613. Waiting to start at age 45 only allows the dentist to accumulate $919,640. Waiting until age 50 results in accumulating only $581,899, and $329,520 if you wait until age 55. Waiting even five years can cost you a large amount of money, and putting off funding retirement indefinitely will most assuredly put your ability to retire at all in jeopardy. There are many qualified plan choices for dentists today that provide flexibility and tax advantages. Your dental CPA can help you choose the best plan for you to meet your retirement planning goals.