As Governor Beshear digests information from a state task force, the American Dental Association and national health organizations, restrictions on dental offices around Kentucky are lifting. You are about to see dental offices as you perhaps never imagined.

We are all working with our staffs right now to implement dramatic changes to keep our patients and staff safe. Here is a rundown on what you can expect in the weeks ahead with the phased, gradual reopening of services that the Governor has mentioned in his daily news briefings.

This is a new way to work preliminarily with patients to assess dental problems, educate and counsel in lieu of an immediate visit. While chatting over Facetime, Google Duo or another video conferencing method is no substitution for an in-the-chair visit, it is a sort of triage that helps us figure out what the patient needs and how urgently the patient must be seen.Teledentistry

Waiting Rooms

Say farewell to time by our cozy fireplace and comfortable chairs. Large waiting rooms are becoming a thing of the past. All registrations, dental histories and payments are evolving toward being taken online or over the phone.

This enables patients to come straight from the car to the exam room without interaction with others. In fact, patients will be screened outside the dental office, usually in a car, before they enter the building. Dental personnel will screen patients and passengers for COVID-19 or other Aerosol Transmitting Disease (ATD) and take temperatures.

They will accompany patients to the office and give a wave to our front desk personnel who will now sit behind protective glass and/or wear PPE (personal protective equipment) that will shield them from air-borne viruses and bacteria. The lone waiting room visitors will be parents of pediatric patients, expected to follow the six-feet-apart rule that they now know so well.

In cases where dental offices or patients are not yet ready to process paperwork online, the Commonwealth recommends that pens used by patients and visitors should be considered the property of the user and credit cards will be disinfected before their use by office staff.

The Dental Team
All team members will be screened daily for symptoms and body temperature. These results will be recorded and filed daily. Any ill staff are required to remain at home. Special guidelines have been prepared for dealing with staff who have contracted and recovered from COVID-19.

Sanitization

Of course, an emphasis on handwashing will be even greater than what we experience now, ensuring that our patients, no matter how young, get the royal treatment as will their masked pediatric guardians if they must be present. Hand sanitizer is expected to be plentiful. As for PPE, all dental professionals seek to use the professional-grade N95 masks, known to eliminate 95% of airborne elements. Masks for anyone who enters the office is the new normal. Expect the dental team to wear non-latex gloves and change them between patients.

If you thought our offices were clean before, just wait. We’ll be sanitizing and disinfecting in a greatly enhanced manner, cleaning surfaces in treatment areas between each patient and at the end of the day. We will also place greater emphasis on cleaning entrances, waiting area chairs (the few we may have left), and restrooms.

COVID-19 Positive Patients

These individuals may still need dental care and a long wait for an appointment may not be in their best interest. They will be scheduled as the last patient of the day to reduce contact. The dental team will be ready with gowns, gloves, N95 masks, goggles with side protection, face shields and hair coverings. Dental surfaces will be disinfected both after the patient leaves and then again first thing in the morning.

To reduce airborne viruses spreading, the public may not have heard of the use of treatment boxes that fit over a patient’s head, leaving access to the mouth, UV lights, and various generators that can clean the treatment room atmosphere. Sterilization of equipment is still a vital mainstay.

Our New Normal

We are all adjusting to new paradigms for societal interaction. Dental offices are no exception. While this new normal is an adjustment for all of us, we are willing to do whatever it takes to keep our patients and dental staff as safe as possible.

Dr. Shelley Shearer is a graduate of the University of Louisville Dental School and Founder of Shearer Family and Cosmetic Dentistry in Florence, the largest all-female dental practice in Northern Kentucky.

There are nearly 50,000 new cases of oral cancer in the United States each year, accounting for three percent of all cancer diagnoses. Most are discovered in a dental office.

Oral cancer is caused by the uncontrolled growth and reproduction of cells in some regions of the mouth. It can occur inside the cheeks, under the middle and front of the tongue, or on the tissue lining of the mouth or gum. That’s why it is worthwhile to ensure that people know the symptoms, causes and risk factors.

Early detection and treatment of oral cancer can help prevent the cancer from developing further or spreading to other areas. Be sure to tell your dentist is you have experienced any of the following for more than two weeks:

• difficulty chewing or swallowing
• a lump or sore area in the mouth, throat or on the lips
• a white or red patch in the mouth
• difficulty moving the tongue or jaw
• unexpected weight loss
• a sore or ulcer that does not heal or bleeds
• tenderness, pain, or lumps anywhere in the mouth or on the lips.

These are not always definitive signs of oral cancer and may be caused by other conditions, such as an allergy or an infection. But it’s better to check out these occurrences before it’s too late.

Patients often ask what causes oral cancer so they can try to avoid it. Here are some of the main causes and risk factors:

• Tobacco and alcohol use: Any form of tobacco use involves carcinogenic substances entering the mouth, which significantly increases the risk for oral cancer. Excessive alcohol use can also increase the risk.
• Age: The risk of oral cancer increases with age, with the average age of diagnosis at 62 years old.
• Human papillomavirus (HPV): This is a  sexually transmitted infection that has strong associations with several forms of oral cancer.
• Sun exposure: The sun emits rays that can burn the lips and trigger the development of oral cancer.
• Gender: Males are more than twice as likely to develop oral cancer than women. Researchers have yet to discover a reason why.

As with most other cancers, it is not always possible to prevent oral cancer. Some risk factors for oral cancer, such as being male or aging, are not preventable. However, consider some lifestyle factors that can reduce the risk of oral cancer such as:

• avoiding tobacco
• consuming alcohol in moderation
• maintaining a healthy diet
• using screen around the mouth and a lip balm on the lips when exposed to the sun
• exercising regularly
• maintaining good oral hygiene by brushing and flossing twice a day
• regularly visiting a dentist for check-ups.

Conduct Your Own Self-Check

Just as women take time for a monthly breast self-exam, those with oral cancer risk factors should conduct their own self-check.

First, look at and feel your head and neck in a mirror. Do the left and right sides of the face have the same shape? Are there any lumps, bumps, or swellings that are only on one side of your face? Also view the skin on your face for changes in color or size, sores, moles or growths. To check the neck, press along the sides and front of the neck for tenderness or lumps.

Lips and cheeks can reveal much as well. Pull your lower lip down and check for sores or color changes. Then use your thumb and forefinger to feel the lip for lumps, bumps, or changes in texture. Repeat this on your upper lip. Examine your inner cheek for red, white, or dark patches. Put your index finger on the inside of your cheek and your thumb on the outside. Gently squeeze and roll your both sides of your cheeks between your fingers to check for any lumps or areas of tenderness.

Often the roof of the mouth is an indicator that something is off. Tilt your head back and open your mouth wide to look for any lumps and see if the color is different than usual. Touch the roof of your mouth to feel for lumps. Extend your tongue and look at the top surface, sides and underneath for lumps, swelling or changes in color and texture.

Tell your dentist if you suspect anything unusual in your mouth. Catching oral cancer early can save time, money and most importantly, your life.

Dr. Shelley Shearer is a graduate of the University of Louisville Dental School and Founder of Shearer Family and Cosmetic Dentistry in Florence, the largest all-female dental practice in Northern Kentucky.

Did you know that the stress of the holidays can contribute to the dental problem of Bruxism?

Bruxism is a condition in which you grind, gnash or clench your teeth. Those with the problem may unconsciously clench their teeth when they’re awake (called, fittingly, awake bruxism) or when asleep (sleep bruxism).

These people are more likely to have other sleep disorders such as snoring and sleep apnea.

While this sounds solely like an adult condition, it’s not. Research indicates that approximately 8% of adults experience bruxism. Recent studies show that an estimated one-third of parents report symptoms of Bruxism in their children. While most kids outgrow it, some continue to grind their teeth during deep sleep or when they are under stress.

Mild Bruxism may not require dental treatment. For others, it may be frequent enough to cause facial or jaw pain; tension-type headaches; damage to teeth, restorations, crowns or jaw; or disorders that occur in the temporomandibular joints (TMJ) located just in front of the ears. It can sound like a clicking sound when you open and close your mouth.

Dentists have often discussed the possible causes for Bruxism, but there is no definitive consensus. It may be due to a combination of physical, psychological and genetic factors:

Stress and Anxiety-New situations, a feeling of losing control, anger and frustration can lead to teeth grinding.

Age-Bruxism is most common in children. They typically grow out of it before too much damage is done.

Personality-Those who are highly competitive, aggressive or suffer from Attention Deficit Disorder have a higher risk of developing bruxism.

Medications and Substances-Bruxism is known to be a side effect of some medications such as antidepressants. Risk also rises for those who smoke, drink alcohol or caffeinated beverages, or use recreational drugs.

Heredity-Sleep bruxism seems to often pass to the next generation. It’s a good question to ask parents and grandparents.

Various Disorders-Unfortunately, bruxism is often associated with medical conditions: Parkinson’s disease, dementia, gastroesophageal reflux disorder, epilepsy, night terrors, sleep disorders and ADHD.

Awake Bruxism has been linked to emotions such as anxiety, stress, anger, frustration or tension. Some believe it may be a coping strategy or merely a habit.

Sleep Bruxism may be a sleep-related chewing activity associated with various dream visions during sleep. Children may grind their teeth because the top and bottom teeth are not properly aligned. It may also be a response to pain, possibly from teething or earaches. For some, the grinding is a way to soothe the pain, like rubbing a sore muscle.

Then there is the lingering question of stress. The Bruxism in kids may stem from worry about an upcoming test or a change in their routine such as discord in the family, a new baby in the house, a new teacher or if they believe they have not behaved well enough for Santa to visit.

We dentists are not psychologists, but most of us have around enough to know how to probe for stress in children. We ask questions such as, “Are you worried about anything at school or home? How do you feel before you go to bed? What do you do right before bed? Are you angry with anyone?”

This gives us information to asses whether the child (or adult) has a physical condition or a psychological cause for the bruxism.

The best thing patients and parents can do is to be on the lookout for these various symptoms of Bruxism:

• Teeth that are flattened, fractured, chipped or loose
• Increased temperature sensitivity
• Headaches that start in the temples
• Jaw, neck or face pain soreness
• Damage from chewing on the inside of the cheek
• Sleep disruption and waking others
• Worn tooth enamel
• Increased pain or sensitivity
• Tired or tight jaw muscles, or a locked jaw that won’t open or close completely.

Visit your dentist if you or your child have any of these symptoms. If gone undetected, the disorder can lead to more complicated problems that can affect one’s smile, ability to chew and severe jaw problems and misalignment. Most of all, enjoy the holiday season and try to keep your environment as stress-free as possible.

Dr. Shelley Shearer is a graduate of the University of Louisville Dental School and founder of Shearer Family and Cosmetic Dentistry in Florence, the largest all-female dental practice in Northern Kentucky.

Active-duty U.S. military personnel and veterans are invited to receive free dental care at Shearer Family & Cosmetic Dentistry in Florence on Monday, November 11 in honor of Veteran’s Day.

“As a large dental practice committed to giving back to the community, we’ve wanted to assist veterans in some capacity for a while,” says founder Shelley Shearer, D.M.D.

“We figured the best way to honor them for their service is to turn the tables and serve them with our professional capabilities.”

The Florence dental practice is the largest all-female dental office in Northern Kentucky with four dentists and almost two dozen professional staff members.

Some of their community efforts have included free dental care for first responders, scholarships and assistance with local non-profits.

Shearer will offer veterans free dental services until the November 11 schedule is filled.

For an appointment phone (859) 647-7068.

This year, before your Baby Sharks, Stranger Things characters and Fionas are ready to rush out the door the second Trick or Treating starts, establish some ground rules. Since every parent knows their kids are going to sneakily pop candy in their mouths while they run door to door, have some prior agreement.

Here are 13 quick tips for maintaining teeth despite the proliferation of Halloween candy:

1. Beware of Bacteria

The true news is that it’s really not the candy itself that causes tooth decay. It’s the bacteria that develops due to the sugar. Bacteria enjoys sugar as much as your child adores candy. Unfortunately, the bacteria produces the erosive acids that cause tooth decay, cavities and gum disease. When kids know this, they tend to be a bit more cautious.

2. Hide the Candy

Parents should have some control over when the candy is consumed to prevent dental disasters, over consumption and mouths full of bacteria. When the goodies are out of sight, you help limit temptation.

3. Have a Plan

Some families have started a tradition of donating candy. They select their favorite treats from Halloween night to keep at home and donate the rest to a charity, orphanage or other non-profit that deals with kids. It’s a win for everyone; your kids learn valuable lessons in sharing, they consume less sugar and those who are needy may have a Halloween to remember.

4. Agree on the Best Time to Consume Candy

Let’s face it: we all stockpiled candy when we were kids. We’d hide in the basement or behind the garage and indulge in our stash. We didn’t even think about at least washing the sugar away with some gulps of water. How about negotiating with the kids the best times to eat their candy haul?

Some families allow kids to pick out two items for their lunch box and additional pieces for after-dinner dessert. There’s a good reason to eat candy after a meal. Since saliva production increases during meals, it helps eliminate the acids produced by bacteria in the mouth and rinse away food particles.

 5. Maintain a Healthy Diet

As tempting as it may be, eating candy is no substitution for a meal. The nutrients from a balanced diet help keep the body, gums and teeth strong. Parents can make a deal; kids eat portions of vegetables and other nutritious food offerings, and Halloween candy can be their dessert. The worst thing you can do is swipe a Snickers from a candy bowl for a mid-day snack and let the sugar linger in your mouth until tooth brushing time. Try to avoid those sweet snacks.

6. Drink Lots of Water

We always want to be hydrated to have a healthy body. Water is also a Halloween necessity. When you are hydrated you have plenty of saliva to wash away all that harmful bacteria lingering in your mouth from the sugar. The best way to deal with Halloween candy sugar is to drink water, rinse and repeat. Maybe you can even sing it as a jingle with the kids. If “Baby Shark, doo, doo, doo doo” can become a hit, why not “drink, rinse, repeat…”

7. Stay Away from Sugary Beverages

This includes soda, sports drinks and flavored waters. When teeth come in frequent contact with beverages that contain sugar, the risk of tooth decay is increased.

8. Crack Down on Hard Candy

Avoid candy that stays in your mouth for a long time. The length of time it stays in your mouth plays a role in tooth decay. Also, biting down on hard candy can lead to a disaster such as a cracked tooth.

9. Avoid Sticky Situations

Be picky if it’s sticky! Sticky candies cling to your teeth. The stickier candies, like taffy, caramel and gummy bears, take longer to get washed away by saliva, increasing the risk for tooth decay.

10. Praise Chocolate

Chocolate is probably your best dental-friendly treat, which is helpful since it’s also one of the most popular kinds of candy handed out on Halloween. Chocolate is one of the better candies because it washes off your teeth easier than other types of treats. Dark chocolate also has less sugar than milk chocolate.

11. Chew Gum

According to the American Dental Association chewing sugarless gum for 20 minutes after meals helps reduce tooth decay, because increased saliva flow helps wash out food and neutralize the acid produced by bacteria. You might even want to think about giving sugarless gum out as a treat instead of candy.

12. Brush Twice a Day

Dentists can’t say this enough. Brush your teeth twice a day for two minutes with a  fluoride toothpaste. Remember, replace your toothbrush every three or four months, or sooner if the bristles are frayed. A worn toothbrush won’t do a good job of cleaning your teeth.

13. Clean Between Your Teeth

You knew this one was coming. Floss your teeth once a day. Decay-causing bacteria get between teeth where toothbrush bristles can’t reach. Flossing helps remove plaque and food particles from between the teeth and under the gum line.

Wishing all Northern Kentucky families a safe and tooth-healthy Halloween.

Dr. Shelley Shearer is a graduate of the University of Louisville Dental School and Founder of Shearer Family and Cosmetic Dentistry in Florence, the largest all-female dental practice in Northern Kentucky.