April is National Facial  Protection Month

With the weather warming up and more folks heading outside for sports activities, April is the perfect time to remind athletes of all ages to protect their mouth from sports injury! Mouthguards may also help to protect against concussion!

Mouthguards

Imagine what it would be like if you suddenly lost one or two of your front teeth. Smiling, talking, eating—everything would suddenly be affected. Knowing how to prevent injuries to your mouth and face is especially important if you participate in organized sports or other recreational activities.

Mouthguards, also called mouth protectors, help cushion a blow to the face, minimizing the risk of broken teeth and injuries to your lips, tongue, face or jaw. They typically cover the upper teeth and are a great way to protect the soft tissues of your tongue, lips and cheek lining. “Your top teeth take the brunt of trauma because they stick out more,” says Dr. Thomas Long, a private practice dentist and team dentist for the Carolina Hurricanes professional hockey team. “Your bottom teeth are a little more protected because they are further back.”

When Should You Wear a Mouthguard?

When it comes to protecting your mouth, a mouthguard is an essential piece of athletic gear that should be part of your standard equipment from an early age.

While collision and contact sports, such as boxing, are higher-risk sports for the mouth, any athlete may experience a dental injury in non-contact activities too, such as gymnastics and skating.

Types of Mouthguards

The best mouthguard is one that has been custom made for your mouth by your dentist. However, if you can’t afford a custom-made mouthguard, you should still wear a stock mouthguard or a boil-and-bite mouthguard from the drugstore. Learn more about each option:

• Custom-made: These are made by your dentist for you personally. They are more expensive than the other versions because they are individually created for fit and comfort.
• Boil and bite: These mouth protectors can be bought at many sporting goods stores and drugstores and may offer a better fit than stock mouth protectors. They are first softened in water (boiled), then inserted and allowed to adapt to the shape of your mouth. Always follow the manufacturers' instructions.  CustMbite MVP and CustMbite Pro are a boil and bite mouthguards that have earned the ADA Seal of Acceptance.
• Stock: These are inexpensive and come pre-formed, ready to wear. Unfortunately, they often don’t fit very well. They can be bulky and can make breathing and talking difficult.

Protecting Your Braces

A properly fitted mouthguard may be especially important for people who wear braces or have fixed bridge work. A blow to the face could damage the brackets or other fixed orthodontic appliances. A mouthguard also provides a barrier between the braces and your cheek or lips, which will help you avoid injuries to your gums and cheeks.

Talk to your dentist or orthodontist about selecting a mouthguard that will provide the right protection. Although some mouthguards only cover the upper teeth, your dentist or orthodontist may suggest that you use a mouthguard on the lower teeth if you have braces on these teeth.

If you have a retainer or other removable appliance, do not wear it during any contact sports.

Mouthguard Care and Replacement

Talk to your dentist about when is the right time to replace your mouthguard, but replace it immediately if it shows sign of wear, is damaged or ill fitting. Teens and children may need to replace their mouthguards more often because their mouths are still growing and changing.

• Between games, it’s important to keep your mouthguard clean and dry. Here are some tips for making sure your mouthguard is always ready to go:
• Rinse before and after each use or brush with a toothbrush and toothpaste.
• Regularly clean the mouthguard in cool, soapy water. Then, rinse it thoroughly.
• During your regular dental checkups, bring your mouthguard for an evaluation. Your dentist may also be able to give it a thorough cleaning.
• Store and transport the mouthguard in a sturdy container that has vents so it can dry and keep bacteria from growing.
• Never leave the mouthguard in the sun or in hot water.
• Check fit and for signs of wear and tear to see if it needs replacing.
• Some mouthguards have fallen victim to family pets, who see them as chew toys. Store your mouthguard and case somewhere your pet cannot get to it.

first published by Mouth Healthy from the ADA

Oral Cancer on the Rise: What to Look For

Preventing oral cancer: Signs, symptoms and preventive care for all ages

When it comes to oral health, most of us are focused on avoiding cavities or banishing bad breath. We don't really think about taking steps to prevent oral cancers. 

But according to Samer Al-Khudari, MD, we should. "Unfortunately, there is relatively low awareness about these cancers—including how to prevent and recognize them," says Al-Khudari, a head and neck surgeon at Rush University Medical Center.

Cancers of the oral cavity (including the lips, cheeks and tongue) and the oropharynx (including the soft palate, tonsils and throat) can crop up in a variety of ways and are not always easy to spot. "Symptoms vary by the type of cancer," Al-Khudari explains. "Not all patients have pain or irritation. Sometimes the symptoms are barely noticeable in the early stages."

That's a big reason why these cancers often go undiagnosed until the later stages, after they have spread to the lymph nodes.

What you need to know about oral cancer

Here are a few other important things to know about oral cavity cancer and oropharyngeal cancer:

• In general, men are twice as likely to be diagnosed with these cancers as women.
• The number of patients under 50 years old has been steadily increasing; and sometimes, these cancers occur in young adults in their 20s and 30s.
• Patients who survive a first encounter with the disease have a higher risk of developing a second, related cancer. That increased risk can last for five to 10 years.
• Biopsy is the only way to properly diagnose oral and oropharyngeal tumors and lesions.
• Although these various types of cancers can be found in one small area of the body, each type has different causes and treatments.
• Patients on immunosuppression medications—typically those who had an organ transplant—have an increased risk of head and neck cancer.

Keeping your mouth and throat healthy

The good news is that even at the later stages, these cancers are still very treatable.

With current treatment advances, survival rates for oral cancers have improved over even a decade ago. In fact, some oro

pharynx cancers have been found to have to survival rates of 80 to 90 percent at three years.

And many oral cavity and oropharyngeal cancers can be prevented altogether with sensible self-care and healthy lifestyle choices.

Here, Al-Khudari offers five preventive tips:

1. Steer clear of tobacco

The longer you've used tobacco and the more often you use it, the greater your risk of head and neck cancers.

"Both smoking and smokeless tobacco always play a direct role in causing these cancers," Al-Khudari says.

Chewing, smokeless and snuff tobaccos, which are placed directly in the mouth, can create gray-white ulcers called leukoplakia in the mouth that can become cancerous. Smokeless tobacco also contains chemicals known to damage a gene that protects against cancer.

2. Drink alcohol in moderation

As with smoking, the longer you use alcohol and the amount you drink, the more your risk goes up. That's because alcohol plays a role in changing the body's chemistry to break down its defenses against cancer.

People who have more than 3.5 alcoholic drinks per day increase their risk of oral cavity cancers two to three times, according to the National Institutes of Health. "You should definitely avoid excessive drinking," Al-Khudari affirms. "Alcohol dependence and binge drinking increase a person's risk. And excessive drinking and smoking combined has a multiplying effect."

3. See your dentist regularly

Very often, dentists and dental hygienists are the first to notice potentially cancerous growths.

"Typically, they catch things really early during routine dental exams," Al-Khudari says. "They can then refer you to an ear, nose and throat specialist. or a head and neck surgeon like myself. If we can confirm the diagnosis and start treatment right away, there's a good chance we can eliminate the cancer."

In addition to visiting the dentist every six months, be sure to brush and floss twice a day—and after meals—to keep your teeth and mouth healthy.

4. Get vaccinated for HPV

Human papillomavirus (HPV), particularly HPV16, is strongly associated with oropharyngeal cancers, especially those at the back of the mouth.

"Typically, HPV-related cancers are found in men in their late 40s or early 50s," Al-Khudari says. "They tend to have minimal symptoms, like a swelling in their neck that they discover while shaving that doesn't go away."

The best way to prevent HPV is to get vaccinated before you become sexually active. With vaccines now available that protect against two strains of HPV—recommended for 11- to 26-year-olds—there is hope that the number of cases of these cancers will decrease over time as more people are vaccinated.

And because you can get HPV from a single sexual encounter, Al-Khudari also recommends practicing safe sex.

5. Shield your lips from the sun

Lip cancer is directly related to ultraviolet radiation from sunlight, and people who work outdoors and have prolonged exposure to the sun are more likely to develop lip cancer.

"If you have a history of severe sunburns, take extra care with your lips. Just as skin can burn easily, the lips are also sensitive to the sun," Al-Khudari says.

In addition to limiting sun exposure during the peak hours of 10 a.m. and 2 p.m., always wear a protective lip balm with SPF when you're outside, and reapply it after you eat or drink, or whenever you reapply sunscreen. Also, wear hats that shield your face from the sun.

Symptoms of oral cancer

In general, warning signs of mouth and throat cancers include the following:

• Sores in the mouth that don't heal
  
• Bleeding in the mouth that lasts more than a week
• Slow-growing lumps in the mouth or neck
• Pain in your mouth lasting more than two weeks
• Dramatic voice changes, especially in smokers
• Persistent earaches in both ears
• Numbness of the lower lip and chin

If you experience any of these symptoms, Al-Khudari says, visit your primary care doctor as soon as possible. "If it is cancer, the earlier it's diagnosed, the better the chance we can successfully treat it."

This article provided by: Rush University Medical Center, April, 6, 2021

April is National Facial Protection Month

 

Take Five: Sports Safety Tips for National Facial Protection Month Calling all MVPs, team captains, full roster players, practice squads, coaches, teachers and parents/caregivers. Five of the nation’ s top dental associations want to remind everyone to play it safe during recreational and organized sports to help prevent serious, painful facial injuries that can take the fun out of the game. Take five, and take in these five simple safety tips. Mouth Guards are a Must. Mouth guards are significantly less expensive than the cost to repair an injury, and dentists and dental specialists can make customized mouth guards that hold teeth in place and allow for normal speech and breathing.   Helmets are always Helpful.  Helmets absorb the energy of an impact and help prevent damage to the head.   Have 20/20 Vision with Protective Eyewear.  Eyes are extremely vulnerable to damage, especially when playing sports. Face Shields Save Skin…and more.  Hockey pucks, footballs and racquetballs can cause severe facial damage at any age. Cheer and Shout Out Your Support for Mandatory Protective Gear.  Athletes who participate in football, hockey and boxing are required to wear mouth guards. If mouth guards have been proven to significantly decrease the risk of oral injuries, why is it not mandatory in every sport for kids to wear them?  Whether your child is playing a contact sport or just monkeying around on the monkey bars, accidents happen. A recently published study by the University of Alabama at Birmingham analyzed data from the National Electronic Injury Surveillance System (NEISS), a database of injuries treated at hospital emergency departments, for the period 2001-2008. Researchers found the five most common causes of childhood injuries were, in order of frequency, basketball, football, bicycling, playgrounds and soccer. 1 An estimated 12 million people ages of 5 and 22 years suffer a sport-related injury annually, which leads to 20 million lost days of school2 and approximately $33 billion in healthcare costs.3 Yet, some of these injuries could be prevented with protective gear. “A properly fitted mouth guard is an essential piece of any athlete's protective equipment,” says Dr. Paul Nativi, DMD, FASD, and past president of the Academy for Sports Dentistry. “Talk with your dentist about what kinds of activities your family enjoys and ask about ways to make sure their teeth and face stay protected.” Every April, National Facial Protection Month strives to raise public awareness and remind parents/caregivers, coaches and athletes to play it safe while playing sports. The Academy for Sports Dentistry (ASD), American Academy of Pediatric Dentistry (AAPD), American Association of Oral and Maxillofacial Surgeons (AAOMS), American Association of Orthodontists (AAO), and the American Dental Association (ADA) are collaborating to promote the 2015 April is National Facial Protection Month observance to help people learn more about how simple it can be to take five and make a play for better safety that protects not only your mouth and face, but also your peace of mind.  References: 1. http://www.sciencedaily.com/releases/2014/10/141013152656.htm. 2. National Athletic Trainers’ Association. (unpublished media review). 3. Ferguson RW. Safe Kids Worldwide Analysis of Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System (NEISS) data, 2013.  About National Facial Protection Month National Facial Protection Month is sponsored annually during the month of April by the Academy for Sports Dentistry (http://www.academyforsportsdentistry.org), American Academy of Pediatric Dentistry (http://www.aapd.org), American Association of Oral and Maxillofacial Surgeons (http://www.MyOMS.org), American Association of Orthodontists (http://www.mylifemysmile.org), and the American Dental Association (http://www.mouthhealthy.org). Visit their Web sites for more information and helpful materials.

Periodontal Disease and Hypertension-Are They Linked?

 

Periodontitis poses heart risks for healthy patients

March 29, 2021

The new study adds to the growing body of evidence indicating a causal link between periodontitis and hypertension. The findings suggest that periodontal bacteria trigger an inflammatory response that contributes to the development of hypertension, noted corresponding author Dr. Francesco D'Aiuto, PhD, head of periodontology at the University College London (UCL) Eastman Dental Institute.

"This would mean that the link between gum disease and elevated blood pressure occurs well before a patient develops high blood pressure," D'Aiuto stated in a press release.

The case-control study was a collaboration between UCL and International University of Catalonia in Barcelona, Spain. It recruited 250 adults with generalized, severe periodontitis and 250 controls without gum disease who were matched by gender, body mass index, and age.

All study participants were healthy and free of diagnosed chronic health conditions, including cardiovascular disease and hypertension. The median age of the cohort was just 35.

Participants with severe periodontitis were twice as likely to have high systolic blood pressure (140 mmHg). They also had 50% greater odds of having high diastolic blood pressure, and higher blood pressure readings were tied to worse periodontitis severity.

After the authors adjusted for common cardiovascular risk factors, a diagnosis of periodontitis was still associated with higher odds of hypertension and higher mean systolic and diastolic blood pressure readings. People with periodontitis also had higher levels of white blood cells and high-sensitivity C-reactive protein (hsCRP), which are markers of increased inflammation.

Markers of systemic health in people with and without periodontitis
Health marker	Participants with periodontitis	Participants without periodontitis	p-value
Systolic blood pressure, mmHg	124.07	120.70	0.007
Diastolic blood pressure, mmHg	78.10	75.94	0.027
Glucose, mmol/L	1.6	1.2	< 0.001
hsCRP, mg/L	1.86	1.38	0.008
White blood cell count, 1000/µL	6.36	5.58	< 0.001

Worryingly, many of the study participants didn't realize they had high blood pressure readings. Overall, 17% of cases and 14% of controls qualified for hypertension based on the European definition. That percentage shot up to 50% and 42%, respectively, when the U.S. definition of hypertension was used (130/80 mmHg).

"Elevated blood pressure is usually asymptomatic, and many individuals may be unaware that they are at increased risk of cardiovascular complications," stated lead author Dr. Eva Muñoz Aguilera, a senior researcher at UCL Eastman Dental Institute.

Based on their findings, the authors advised researchers to conduct larger randomized clinical trials to test the effects of periodontal treatment on blood pressure. They also recommended that dental professionals screen for high blood pressure and medical professionals look for periodontal disease.

"Integration of hypertension screening by dental professionals with referrals to primary care professionals and periodontal disease screening by medical professionals with referrals to periodontists could improve detection and treatment of both conditions to improve oral health and reduce the burden of hypertension and its complications," D'Aiuto stated.

By Theresa Pablos, DrBicuspid.com editor in chief

Is it safe to go to the dentist now? 5 reasons to feel confident in seeing your dentist!

Is it safe to go to the dentist now?

Regular dental appointments are important since oral health is related to overall health. While it’s tempting to postpone your regular checkups during the Covid-19 pandemic, this is not advisable. That’s because routine appointments give dentists and hygienists the opportunity to check and monitor a number of oral health conditions. When conditions such as tooth decay are identified early, they can be easier and less expensive to treat. When dental disease is left untreated it can become more difficult, painful, and expensive to address.

5 Reasons why you should feel safe

Dentists, hygienists and dental assistants have years of training in infection control and prevention

Dentists, hygienists and dental assistants have followed comprehensive infection control standards for years to protect themselves, their teams, and most importantly their patients from exposure to infectious diseases. In addition to wearing eye protection, masks, and gloves to decrease their risk of exposure, dental professionals have stepped up their standard protocols even further during the pandemic by adding surgical gowns, face shields and higher-level masks (e.g. N95s).

Effective patient screening protocols 

Dental offices now screen each patient prior to the visit. Typically, a series of questions is asked to identify possible risk factors and exposure. Patients are often asked to wait outside rather than in waiting rooms, wear face masks, and not bring additional people to their appointment. When patients arrive at the office, they are greeted by a masked dental team member, a few additional questions, a temperature check and alcohol-based hand sanitizer.

Active steps to reduce aerosols 

Dentists and hygienists are taking additional precautions to reduce the creation of aerosols, which can carry viral particles through the air. These can include pre-procedural antiviral oral rinses, the use of high-evacuation suction whenever possible, using water only (no spray) to rinse during procedures.

Increased cleaning protocols

Dental offices have always operated with strict cleaning procedures before, during, and after patient visits to prevent cross-contamination. Now in addition to normal cleaning protocols, offices are specifically using disinfectants known to kill the COVID-19 virus, removing high-touch items like magazines and toys from waiting rooms, frequently cleaning or replacing items like pens and clipboards and providing multiple hand sanitizer dispensers.

Fewer patients per day 

Dental offices are seeing fewer patients in the office each day so people can stay farther apart in clinics and waiting rooms. This additional time also allows for the thorough cleaning described above and vigilance of the dental team to utilize personal protective equipment to help keep everyone safe.

Additional information you may find valuable

CDC / Healthcare Workers - Guidance for Dental Settings            https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html 

Yes, it’s safe to go to the dentist                                                                        https://www.insider.com/its-safe-to-go-the-dentist-during-the-coronavirus-pandemic-2020-9 

Is it safe to visit the dentist?                                                                                https://dental.washington.edu/is-it-safe-to-visit-the-dentist/ 

The Dentist Will See You Now. But Should You Go?                                            https://www.npr.org/setions/health-shots/2020/07/06/886456835/the-dentist-will-see-you-now-but-should-you-go

COVID-19 AND IT''S LINK TO VAPING/SMOKING

 

Vaping and It's Link to Covid-19 Cases and Their Severity

Smoking, vaping, and the connection to COVID-19 severity is yet another developing link, adding to the dangers that e-cigarette users face. The vaping epidemic that dominated the news for a time has since resulted in severe lung injury and death for many users nationwide. However, while the vaping issue still exists, it has recently taken a back seat to other news stories. Studies and warnings are now emerging about the increased risk of severe COVID-19 reactions in individuals who vape or use traditional cigarettes. 

A newly released study from the Stanford School of Medicine, published on August 11, 2020, makes the connection between vaping and the likelihood of contracting COVID-19.1 Results reveal a startling increase in the odds of smokers contracting COVID-19 with more severe onset of symptoms. The study included 4,351 participants, ranging in age from 13 to 24, with all 50 states represented. A notable statistic is that individuals who had ever used e-cigarettes had a greater risk (by five times) of contracting COVID-19 than their nonsmoking counterparts. Further, those who smoked in the previous 30 days were 6.8 times more likely to contract the disease.1

Lead researcher Shivani Mathur Gaiha, PhD, states: “This study tells us pretty clearly that youth who are using vapes or are dual-using [e-cigarettes and cigarettes] are at elevated risk, and it is not just a small increase in risk; it’s a big one.”1

It has also been determined that vaping or smoking can increase the risk of disease severity if an individual contracts SARS-CoV-2. Multiple studies, including research from the University of Rochester Medical Center, confirm that, on average, COVID-19 affects all smokers worse than the general population.2 Irfan Rahman, who runs the lab at the university, goes on to state that use of tobacco and vaping products increases the receptors on cells in the lungs for an enzyme called ACE2. More receptors allow for a higher viral load exposure, which can lead to a more severe infection.2 This was also reiterated by Jason Sheltzer, a scientist at Cold Spring Harbor Laboratory, who has been studying the role of ACE2 enzymes as a correlation in disease progression.2

New York-Presbyterian is one of many hospitals that have issued warnings and statements that point to smoking and vaping as factors that increase the risk of complications from a COVID-19 infection.3 Notably, use of these products can lead to a malfunction of the immune system within the lungs.3 While the World Health Organization has yet to confirm this, it is well known that inhaling tobacco and vaping substances into the lungs causes inflammation, which can increase one’s susceptibility to disease.

Looking back over the past few years when vaping became widely popular, especially among teens and young adults, the boiling point came in 2019 when many began to fall seriously ill for reasons unknown at the time. To date, nearly 3,000 people have been hospitalized. The Centers for Disease Control and Prevention (CDC) stopped tracking cases of e-cigarette or vaping-associated lung injury (EVALI) in February 2020, as cases had drastically dropped off from their peak in September 2019.4

One contributor to the decrease in cases was identification of vitamin E acetate that had been added to tetrahydrocannabinol (THC)-containing e-cigarettes.4 We are still seeing a rise in vape users, but consumers are a little more aware of what is in the vaping e-liquids.

Vitamin E acetate additives were not the exclusive cause of EVALI, however. According to the CDC, tobacco is the leading cause of preventable disease and death in the US, with nearly 40 million Americans using cigarettes and nearly 4.7 million teens using at least one form of tobacco.4 Every day approximately 1,600 youths smoke for the first time, starting a potentially deadly habit.5

EVALI symptoms often mirror COVID-19–related symptoms. With a worldwide focus on the COVID-19 pandemic, multiple sources state that testing and reporting of vaping-associated lung disease have taken a back seat. Symptoms that both COVID-19 and EVALI may share include nausea, vomiting, shortness of breath, cough, headache, and dizziness.6

Side effects of e-cigarettes can lead to more than just acute or chronic lung injury. It has been well documented that vaping increases the risk of periodontal disease, similar to traditional smoking. Periodontal disease has been shown to have a correlation between multiple detrimental health concerns, including cardiovascular disease, chronic kidney disease, diabetes, insulin resistance, and, most recently, an association in the brains of Alzheimer’s patients.8

A large case study of more than 18,000 participants was conducted to assess the risk factor of e-cigarette use associated with periodontal disease diagnosis to reflect the national population.9 Study findings revealed an increased risk of periodontal disease associated with vaping, even when accounting for the use of tobacco and other confounding variables.9 Notably, in vitro studies have shown “e-cigarette vapor can lead to inflammation of gingival epithelial cells similar to that observed in cells exposed to conventional cigarette smoke.”9

The oral effects of vaping may also include stomatitis or evidence of burns, which is not surprising when you realize that the heat necessary to vaporize the liquid can reach up to 420 degrees Fahrenheit.10 The liquid does cool some before passing over the tongue and oral cavity, but high temperatures may explain why some e-cigarette users complain of a sore or burning tongue sensation. Xerostomia caused by smoking or vaping may also contribute to the oral irritation.

Did you know that the use of vaping products increases caries risk and decreases enamel hardness by 27%?11 In addition to the increased caries risk, one study states that “certain e-liquid ingredients interact with hard tissues of the oral cavity in such a way that resembles high-sucrose candies and acidic drinks.”11 The e-liquids made with propylene glycol and glycerin increase attachment and provide additional food sources for bacteria, including Streptococcus mutans.

E-cigarette users show an increase in biofilm formation over those who do not use e-cigarettes, and vaping is noted to increase the microbial adhesion by four times.11 Combined with less-than-stellar home care, this combination can create an atmosphere primed for decay, along with an expensive restorative bill for the patient.

January 2020 brought a new national ban on flavored refillable cartridges and raised the minimum age of those who can purchase tobacco from 18 to 21.12 However, that did little to curb the way teens were still getting the attractive flavored devices. Going from the popular replaceable cartridges like JUUL, teens turned toward disposable cigarettes like Puff Bar that could still be sold in various flavors. This continued until July 20, 2020, when the FDA issued a warning letter to remove flavored disposable e-cigarettes and e-liquids from the market for illegal marketing.13

Excerpts of Article published in RDH magazine Nov 4, 2020 

By Jamie Collins, BS, RDH, EA

References

1. Digitale E. Vaping linked to COVID-19 risk in teens and young adults. Stanford School of Medicine. August 11, 2020. https://med.stanford.edu/news/all-news/2020/08/vaping-linked-to-covid-19-risk-in-teens-and-young-adults.html
2. Dahlberg B. Researchers uncover links between COVID-19 and smoking, vaping. WBFO NPR. June 30, 2020. https://news.wbfo.org/post/researchers-uncover-links-between-covid-19-and-smoking-vaping
3. Vaping and COVID-19: Can vaping increase complications? New York-Presbyterian Health Matters. https://healthmatters.nyp.org/vaping-and-covid-19-can-vaping-increase-complications/
4. Outbreak of lung injury associated with the use of e-cigarette, or vaping, products. Centers for Disease Control and Prevention. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion. Updated February 25, 2020. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
5. Youth and tobacco use. Centers for Disease Control and Prevention. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion. Updated September 9, 2020. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm
6. Armatas C, Heinzerling A, Wilken JA. Notes from the field: e-cigarette, or vaping, product use—associated lung injury cases during the COVID-19 response—California, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(25):801-802. doi:10.15585/mmwr.mm6925a5
7. Betsaida A. A new sign of COVID-19: a rash in the mouth. News Medical. July 21, 2020. Accessed September 10, 2020. https://www.news-medical.net/news/20200721/A-new-sign-of-COVID-19-a-rash-in-the-mouth.aspx
8. .Kim J, Amar S. Periodontal disease and systemic conditions: a bidirectional relationship. Odontology. 2006;94(1):10-21. doi:10.1007/s10266-006-0060-6
9. Atuegwu NC, Perez MF, Oncken C, Thacker S, Mead EL, Mortensen EM. Association between regular electronic nicotine product use and self-reported periodontal disease status: population assessment of tobacco and health survey. Int J Environ Res Public Health. 2019;16(7):1263. doi:10.3390/ijerph16071263
10. Construction of electronic cigarettes. Wikipedia. Accessed September 10, 2020. https://en.wikipedia.org/wiki/Construction_of_electronic_cigarettes
11. Kim SA, Smith S, Beauchamp C, et al. Cariogenic potential of sweet flavors in electronic-cigarette liquids. PLoS ONE. 2018;13(9):e0203717. doi:10.1371/journal.pone.0203717
12. FDA finalizes enforcement policy on unauthorized flavored cartridge-based e-cigarettes that appeal to children, including fruit and mint. US Food and Drug Administration. January 2, 2020. https://www.fda.gov/news-events/press-announcements/fda-finalizes-enforcement-policy-unauthorized-flavored-cartridge-based-e-cigarettes-appeal-children
13. FDA notifies companies, including Puff Bar, to remove flavored disposable e-cigarettes and youth-appealing e-liquids from market for not having required authorization. US Food and Drug Administration. July 20, 2020. https://www.fda.gov/news-events/press-announcements/fda-notifies-companies-including-puff-bar-remove-flavored-disposable-e-cigarettes-and-youth

JAMIE COLLINS, RDH-EA, is a practicing clinical hygienist in Idaho and Washington states. She has been in the dental field for nearly 20 years, both as an assistant and hygienist. With a passion for patient care, especially for those with higher risk factors, she enjoys sharing the tips and tricks of the dental profession through speaking and writing. In addition to being in clinical practice, Collins is also an educator, has contributed to multiple textbooks and curriculum development, and is a key opinion leader. She can be contacted at jamiecollins.rdh@gmail.com.

Dear valued patients:

Our office is committed to maintaining your oral health while safeguarding our community from the effects of the Corona Virus (COVID-19) pandemic. We want to provide direction to you regarding your ongoing care, and advise you of the steps we are taking to ensure the safety and well-being of our patients and staff.

•       We are following directives from the Centers for Disease Control and Prevention (CDC) as well as the American Dental Association (ADA) to limit patient and staff exposure to this virus. We are also monitoring information from our state dental board and other regulatory bodies regarding safe practice procedures.

•       Federal and state guidelines are changing daily.. We will try to keep you posted on our website as well,  www.stlouisdentalimplants.com

•       Patients will be seen only to address emergency dental needs.

•       We will contact you as soon as reasonable to reschedule routine hygiene, maintenance, and elective procedures.

•       If you are already scheduled for an urgent issue, we will contact you the day before your appointment to discuss your health status, confirm whether you should be seen, and explain our current patient safety protocol. Please contact us as soon as possible if you believe you have a dental emergency.

•       Please continue to follow the home care regimen that has been established for you.

Your health remains our primary concern. We will continue to monitor the status of COVID-19 in our community and notify you when it is safe to return to business as usual in our office.

	If you have any questions or concerns, please call my cell 314-795-5557 or email georgeduello@gmail.com We will respond as soon as we can. Please take care of yourself and your loved ones during this health crisis, and we look forward to a return to good health and normalcy for all.

Be well,

Dr. Duello