New Soldiers in the Digital Revolution

Recent demographic trends are shaping American society in unprecedented ways. With their enormous wealth and education, baby boomers are reinventing the consumer. Thanks to the Internet, nearly half of computer owners research health questions online. When they come to the office, they arrive with knowledge.

Due to these advantages, they have created lifestyles undreamed of by their parents -- lifestyles of luxury goods and designers labels.

Willing to shell out big bucks for lifestyle items, baby boomers can be quite miserly. The Internet allows them to comparison shop. As a result, they often want the cheapest possible price, or, when it comes to health care, as much as possible paid by insurance.

Because they work harder and sleep less, baby boomers are also demanding more value from their time. Businesses are responding by merging with entertainment.

"Goods and services are no longer enough," said James Gilmore, co-author with B. Joseph Pine of The Experience Economy: Work Is Theater & Every Business a Stage. "Customers want experiences that engage them."

Gilmore does not mean theater as metaphor; he means literally. "Whether they know it or not, whether they do it well or not, when one person watches another work, that person is acting," Gilmore said. "They must act in a way that engages each guest with every interaction."

While that might seem like an outrage to health care professionals, some dentists already are incorporating entertainment into their practices -- with enormous success.

With offices in Southgate and Norwalk, Scott Jacks, DDS, is proud of the fact that he entertains his patients, two-thirds of whom are children and teenagers. But the one-third who are adults are treated to movies just like the kids are.

Jacks’ patients enter a video arcade with televisions on the floor, big viewing screens and move-theater-type seating. "I’m just a big kid myself," said Jacks, who has more than 20 dentists in his practice. "I wanted it to be enjoyable for everyone, for adults as well as children. It’s definitely made the practice of dentistry more fun for my patients -- as well as myself."

After treatment, patients often stay to finish watching movies in the waiting room.

"We have patients who come in early and don’t leave right away."

While Jacks is one of the few general dentists using entertainment in his practice, pediatric dentists have been using interactive ideas for decades.

With offices in Camarillo, Oxnard, and Simi, Mark Lisagor, DDS, deliberately chose to play down his own identity to create a theme that would work for the practice -- and any dentist in it. Begun 25 years ago, his spaceship dental office has chrome "woodwork" and doors that open like those on Star Trek. "The automatic doors go ‘whoosh’ when they open," Lisagor said. "And there is a tunnel to the clinical area."

Lisagor carefully chose a look and theme that would appeal to children of all ages, one that 3-year-olds would enjoy but that wouldn’t offend teenagers or their parents. His office also has Nintendo and other games.

While Lisagor admits that the entertainment aspect of his practice has been good for business, he does worry about children expecting to be entertained 24/7. "Parents are taking their kids from one orchestrated activity to another. I’m not sure we’re developing self-reliant adults."

Nonetheless, Lisagor believes that as long as the entertainment promotes good dental habits -- and lessens the fear of the dental experience -- the benefits outweigh the drawbacks.

At the Tustin office of Mike McCartney, DDS, and Warren Brandli, DDS, a robot named Dr. Beap has made as big a name for himself as the dentists by teaching children about brushing and other dental subjects. In fact, children are more apt to pay attention to the television in Dr. Beap’s belly than to an adult.

"The kids are mesmerized by the robot," McCartney said. "They will listen to lessons about hygiene and flossing that they never would from the parent or me."

Specially built nearly 15 years ago, Dr. Beap creates a memorable experience for children and adults alike.

For dentists, creating a positive experience is the real challenge. Wayne Grossman, DDS, is on his third theme office. His first focused on nutrition and had a coffee table of soft-sculptured carrots and over-sized apples.

His second had a railroad with large-gauge trains running through the offices and carriage seats in the waiting room. An event display encouraged people to ride trains and visit train museums. People sent train-related postcards that Grossman displayed.

"It gave us something to talk about with the children other than dentistry," Grossman said. "When the grandparents sat in the seats, their eyes would get misty thinking about the past."

Today’s Gold River office has a national parks theme with a rustic lodge look, waterfalls, and a trout stream.

"People said the trout stream couldn’t be done," Grossman said. Undaunted, Grossman now has two huge tanks of wild fish -- one with trout and one with bass and blue gill -- as well as a stream. Children can watch the fish from the operatory.

Although educational, bringing the outdoors in is very relaxing. "We’re trying to raise the dental I.Q. while creating a generation of people with a better experience."

Dell Richards is the owner of the Sacramento public relations firm Dell Richards Publicity. She specializes in health care clients.

Dental Benefits Still Valued Part of Employee Compensation Offer

A new nationwide poll shows that despite growing concerns with the nation’s health care system, demand for employer-sponsored dental benefits remains high; and most Americans don’t generally associate challenges facing today’s national health care system with dental benefits.

The survey, conducted by Taylor Nelson/Sofres Intersearch for Delta Dental, addresses several aspects of American attitudes regarding dental benefits. For instance, it suggests that most Americans expect dental benefits to be offered, and they do not view the rising cost of medical insurance to employers as a plausible reason for cutbacks in their employer-sponsored dental programs.

"Health care inflation is challenging benefit consultants and their clients to rethink their overall approach to benefits, and in some cases to shift costs to their employees or even eliminate ancillary benefits like dental or vision," said Gary D. Radine, president and CEO of Delta Dental Plan of California. "The survey, however, indicates that dental benefits are not viewed as dispensable by job seekers, and that reducing or eliminating dental is not likely to be appreciated or understood by the workforce."

Radine said the survey also shows widespread agreement with the idea that dental is different with respect to some of the larger challenges faced by the nation’s health care system.

Against a random sample with a margin of error of plus or minus 3 percent, the survey uncovered the following prevailing attitudes regarding dental benefits across the nation:

* 48.3 percent of respondents from a base of 1,025 felt it is "very important," and 30.3 percent felt it is "somewhat important," to have dental insurance provided by a prospective employer.

On a separate question, 635 employed adults responded to how they would react if their employer reduced their dental coverage or increased the employees’ contribution. Of respondents with employer-provided dental coverage:

* 40.6 percent felt this would be a significant loss.

* Only 18.9 percent felt that their employer would have to be forced into such a move in order to reduce expenses, while 37.6 percent either "strongly agreed" or "somewhat agreed" that such a move was probably done "to improve the bottom line."

Dental Disease Poses Significant Health Problem for Santa Clara County Children

An in-depth oral health needs assessment recently released by the Health Trust details devastating results among certain Santa Clara County school-age children and reveals a high correlation between socioeconomic status and ethnicity and the risk of dental disease.

Low-income Hispanic and Asian children are particularly vulnerable to poor oral health and access to care. Especially troubling is the large number of local children with rampant tooth decay -- defined as seven or more decayed teeth -- and those with an urgent need for dental care -- defined as pain or infection originating in their mouth. The research was funded by a grant from the California Endowment.

This is the first study to identify the true state of oral health in local children. More than 1,600 students in Head Start, kindergarten and third-grade in the Santa Clara County public school system participated in the survey. The results clearly identify dental disease as a significant problem for children in Santa Clara County, with one-third of the county’s children having untreated tooth decay. This equates to more than 43,000 public elementary school children with decayed teeth. Ten percent of the county’s children enter kindergarten with dental pain or an abscessed tooth. By the time children are in third grade, 72 percent have a history of decay.

"The results are devastating for certain populations of children and indicative of the magnitude of challenge that remains in Santa Clara County. Much work needs to be done," said David Lees, DDS, director of the Health Trust Dentistry With Heart initiative that targets the dental needs of underserved children.

These are alarming statistics, considering the perceived economic status of Silicon Valley. The study shows that low-income and minority children are more likely to have dental disease. Fifty-one percent of kindergartners eligible for the subsidized or free lunch program enter school with untreated tooth decay and 23 percent of these children already need urgent dental care when they start school. Hispanic children are three times more likely and Asian children twice as likely to have untreated decay when compared to their white non-Hispanic counterparts. One out of every four Hispanic third grade children sits through classes with pain in his or her mouth.

A full copy of the research report, entitled "Oral Health Status of Children in Santa Clara County" is available at www.healthtrust.org.

Researchers Find Clinical Depression May Have a Negative Effect On Periodontal Treatment Outcome

Researchers found depressed patients have twice the odds of suboptimal outcomes from periodontal treatment over one year compared to patients without depression, according to a recent study in the Journal of Periodontology.

"There are many factors that could impact treatment outcomes in clinically depressed periodontal patients," said John Elter, lead author of the study and a dentist and epidemiologist at the University of North Carolina Chapel Hill School of Dentistry. "For example, the patient’s attitude about the treatment process plays a significant role in treatment success. Depressed patients might view a course of periodontal treatment as an overwhelming ordeal, and might be more likely to not comply with all treatment recommendations."

"In addition, depressed persons are more likely to continue to smoke, which has been linked to poor response to periodontal therapy," Elter said. "Most importantly, it is possible that their immune system is impaired, which may slow down the body’s reaction to fight off the infection, but more research needs to be conducted to verify this."

He continued, "Future studies should focus on elucidating a possible mechanism for the negative effect of depression on the immune system and on wound healing."

Dental Problems Boost Pneumonia Risk in Elderly
Better dental care among the institutionalized elderly could reduce incidences of aspiration pneumonia, according to researchers from the University of Michigan and Veterans Administration.

In a study of the records of 402 patients ages 57 to 98, patients were shown to be at higher risk for aspiration pneumonia if they had dental plaque or certain types of mouth bacteria.

Overall, patients who had a stroke, had chronic obstructive pulmonary disease, or needed help eating were at risk.

"We know, as a result of previous studies, that it’s just an area that tends to be overlooked in nursing homes, because it’s very hard and somewhat distasteful, as far as nurse’s aides are concerned, to clean someone else’s mouth," said Margaret Terpenning, of the University of Michigan. "So it’s often left to the residents to clean their mouth, and they just ignore it."

People with dementia or other conditions that impair their mental status, or those who can’t easily move their hands, are especially likely to have dental problems, she said.

The study was supported by a grant from the National Institutes of Health.

Scientists Seek Partner for Tobacco Dental Vaccine
Scientists who have developed a vaccine against tooth decay from genetically modified tobacco plants are looking to start large-scale clinical trials.

Scientists at Guy’s, King’s and St. Thomas’ Dental Institute in London said that the colorless and tasteless topical vaccine was the first derived from a genetically modified plant to go into human clinical trials.

"We drip it onto the teeth, but it could also be added to toothpaste or chewing gum," said Dr. Julian Ma, senior lecturer in the Department of Oral Medicine at King’s College.

The researchers have already carried out intermediate phase II trials in collaboration with Californian biotechnology company Planet Biotechnology, Inc.

Ma said a further partnership with a larger company is now needed for phase III trials involving several hundred patients.

Antiseptic Mouthrinse Effective as Flossing

Data from two six-month clinical trials comparing the effectiveness of rinsing with an antiseptic mouthwash to daily flossing in fighting plaque and gingivitis showed that the antimicrobial action of an antiseptic mouthrinse is "at least as good as" flossing in improving gingival health and plaque reduction, especially in hard-to-reach areas of the mouth.

"These findings support the benefit of adding an antiseptic mouthwash to a daily oral health care routine, especially for those patients who don’t brush and floss properly," noted Sebastian Ciancio, DDS, distinguished service professor and chair of the Department of Periodontics and Endodontics at the University at Buffalo School of Medicine and Dentistry. "The findings, however, do not mean that flossing should be replaced with rinsing. I recommend that dentists and hygienists talk to their patients about what’s best for their oral health care routine, and devise strategies to target difficult to reach areas that are susceptible to plaque accumulation and gingivitis."

In both studies, an antiseptic mouthrinse was clinically comparable to flossing in controlling interproximal gingivitis and better for plaque reduction.

Interproximal plaque accumulation was reduced by 37.5 percent and 20.0 percent (p<0.001) respectively, in patients who rinsed twice a day. In comparison, those patients who flossed daily showed a 2.1 percent (p = 0.305) and 3.4 percent (p = 0.134) reduction in interproximal plaque accumulation. Both the mouthrinse and flossing groups included brushing with regular fluoride-containing toothpaste and were compared with a negative control treatment group that brushed and rinsed with a placebo rinse.

In addition to site-specific plaque reduction, patients who rinsed twice a day with showed a 7.9 percent and 11.1% (p<0.001) reduction in interproximal gingivitis versus an 8.3% (p<0.001) and 4.3 percent (p=0.006) reduction in those who flossed daily.

The two, six-month, randomized, evaluator-blinded, controlled, parallel group studies were presented at the International Association of Dental Research annual meeting.

Honors

Richard C. Burns, DDS, of San Mateo, Calif., received the Edgar D. Coolidge Award from the American Association of Endodontists. The award, the association’s most prestigious honor, is given to an individual who has displayed leadership and exemplary dedication to dentistry and endodontics.

Angelle M. Casagrande, DDS, MD, of Antioch, Calif., was appointed assistant program director of the University of the Pacific’s Oral and Maxillofacial Surgery Residency Program with the Alameda County Medical Center, Highland Hospital.

The International College of Dentists’ 13th district honored Arthur A. Dugoni, DDS, of San Francisco, dean of the University of the Pacific School of Dentistry, with the Award of Excellence in Dentistry during the annual ICD/American College of Dentists spring dinner and awards ceremony April 5.

Paul Glassman, DDS, MA, MBA, of San Francisco, professor and associate dean at the University of the Pacific School of Dentistry, was elected president of Special Care Dentistry on March 21 in Chicago. Glassman will lead this national organization, consisting of more than 1,100 members, that is dedicated to improving the oral health of people with special needs. Its component organizations include the American Association of Hospital Dentists, the Academy of Dentistry for Persons with Disabilities, and the American Society for Geriatric Dentistry.

The Pierre Fauchard Academy, Southern California Section, presented the Honor Award to Richard Kahn, DDS, of Encino, Calif. In making this award, the academy cited Kahn’s 37 years of exemplary service to the dental community.

Peter K. Moy, DDS, Calif., of Los Angeles, has been elected a member of the Board of Directors of the Academy of Osseointegration.

Richard K. Rounsavelle, DDS, of Torrance, Calif., has been elected secretary of the Academy of Osseointegration’s Board of Directors.

Mahmoud Torabinejad, DMD, MSD, PhD, of Loma Linda, Calif., has been elected president-elect of the American Association of Endodontists. He is currently the director of graduate endodontics and a professor of endodontics at Loma Linda University School of Dentistry.

Upcoming Meetings

2002

July 4-7 Academy of General Dentistry Annual Meeting, Honolulu, (888) 243-3368, Ext. 4339, www.agd.org.

July 19-21 Second Annual Dental Materials and Technology Update 2002, Universal City, Calif., (818) 716-1791, www.estheticprofessionals.com.

Aug. 16-23 Fun in the Sun, Costa Rica, (818) 716-1791, www.estheticprofessionals.com.

Sept. 25-28 Academy of Periodontology’s 8th Annual Meeting, New Orleans, www.perio.org.

Sept. 26-28 American Society for Dental Aesthetics, 26th International Conference on Aesthetic Dentistry, Las Vegas, (813) 264-2772, www.asdatoday.com.

Sept. 27-29 CDA Scientific Session, San Francisco, (916) 443-3382, Ext. 4470.

Oct. 11-13 National Association of Filipino Dentists in America Annual Meeting, San Francisco, (818) 988-3910.

Oct. 19-23 ADA Annual Session, New Orleans, (312) 440-2500.

Nov. 3-9 United States Dental Tennis Association Annual Meeting, Palm Desert, Calif., (800) 445-2524.

Nov. 7-9, Excellence in Dentistry, Las Vegas, (800) 337-8467.

To have a meeting included on this list, please send the information to Upcoming Meetings, CDA Journal, P.O. Box 13749, Sacramento, CA 95853 or fax the information to (916) 443-2943.