ISSUES IN P E D I AT R I C DENTISTRY
FALL 2019
OUR
NANO HYDROXYAPATITE
STORY THE GUATEMALA CHAPTER
FACING THE FACTS HOW TO IMPROVE YOUR LEAD-GEN APPROACH
YOU’VE JUST BEEN
HACKED
CYBERSECURITY IN THE DENTAL PRACTICE
CASE REPORT
UNIVERSITÉ DE NANTES
29-MONTH FOLLOW-UP OF A PAEDIATRIC ZIRCONIA CROWN
GETTING THROUGH
INSIGHTS ON TREATING PATIENTS WITH AUTISM
BRAIN CHILD MEDIA AND THE ADOLESCENT MIND
CONTENTS FALL ISSUE 2019
12
LETTER FROM THE EDITOR
22 REAL STORIES
Habits and change
Noah’s picture perfect smile
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24 AT WORK
CONTRIBUTORS
Without whom this issue would not have been possible
17 ON THE SCENE Spending good times with friends at all the Sprig-attended events throughout 2019
18 HEALTHY CORNER Power foods for a healthier brain
20
DOCTOR TO DOCTOR
Hear from a colleague how attending Sprig University improved the way she practices
Things that show assistants care
26 CLINICAL CASES Class-3 malocclusions
28 NANO HYDROXYAPTATITE Impact of a non-fluoridated microcrystalline hydroxyapatite dentifrice on enamel caries
38 FACING THE FACTS
How to improve your lead-gen approach
46 A CASE REPORT FROM THE UNIVERSITÉ DE NANTES, 2017
29-month follow-up of a paediatric Zirconia dental crown
NANO HYDROXYAPATITE An alternative that works as good as fluoride?
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46 29 MONTH
Follow-up of a Paediatric Zirconia Dental Crown
Chrystle and Catherine invite you to a
FLOSS PARTY
join the party at
cocoflosspro.com 866-661-4719
CONTENTS FALL ISSUE 2019
52 YOU’VE JUST BEEN HACKED Cybersecurity in the dental practice
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58 BRAIN CHILD
Media and the adolescent mind
64 GETTING THROUGH Insights on treating pediatric patients with autism
71 OUR STORY
The Guatemala chapter
ON THE COVER THE HUMAN BRAIN IS AMAZING — THE CENTER OF ALL DECISIONS AND THE KEY TO CONSCIOUS CHANGE. COVER DESIGN BY JEFFREY P. FISHER, DDS
This issue of Shift magazine features many articles dealing with the habits we form and the decisions we make using our brains. On page 58, Daniel Binus, MD, shares the effect media use (or abuse) has on how our brains process important information.
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Dentistry by Jarod Johnson, DDS Arctic Dental—Muscatine, IA
Restorations by Sprig Oral Health Technologies, Inc. EZCrowns—B4 and I4
Dentistry by Jarod Johnson, DDS Arctic Dental—Muscatine, IA
Restorations by Sprig Oral Health Technologies, Inc. EZCrowns—B4 and I4
LOOKING YOUR BEST Sprig created an entirely new kind of pediatric crown. For an entirely new generation of pediatric patients. Our crowns are unbelievably thin, remarkably strong, and stunningly beautiful. EZCrowns allow children's smiles to look better than you ever imagined. We don’t tell children how to smile, we just give them a reason to.
LETTER
from
THE EDITOR
HABITS
& CHANGE
We are all creatures of habit. As individuals, we validate this statement daily in the way we choose to live our lives. Whether it’s in life’s smaller details like the route we take to work, the parking space we choose each morning, or even the sequence in which we choose to brush our teeth, each one of us proves the point that we humans are creatures of habit. One of my favorite authors put it this way, “The importance of the little things is often underrated because they are small; but they supply much of the actual discipline of life.” When our children were little, my wife and I made a concerted effort to be consistent in teaching them good habits. From a very young age, children begin the process of learning and developing habits that, in many ways, will shape their entire lives. Many of you have heard the famous quote, “Watch your thoughts; they become words. Watch your words; they become deeds. Watch your deeds; they become habits. Watch your habits; they become character. Character is everything.” Forming good habits is a foundational principle in life. It’s also a principle of fundamental importance for developing a successful dental practice. In this issue of Shift magazine, you will read articles stressing the importance of habits. Has your office established the habit of maintaining good cybersecurity? Find out after reading You’ve Just Been Hacked. One of the first adopters of pediatric Zirconia crowns in Europe, Dr. Serena Lopez Cazaux, a professor at the University of Nantes in France, shares a 29-month case study involving her son’s Zirconia crown. Our Healthy Corner feature in this issue highlights habits of choosing power foods for our brains. Getting Through is all about your practice adopting good habits for treating children with autism, while Brain Child addresses the modern phenomena of media use and how habits adopted in childhood affect the developing brains of children. Facing the Facts discusses marketing strategies that can help your practice grow in ways you hadn’t even thought of before. Nano Hydroxyapatite clinically validates that there are alternatives to established habits in dentistry. Finally, Our Story is one colleague’s inspiring challenge to all of us to reach past our habitual daily comfort zone and change the world for the better in some way. Learning new things can be a powerful catalyst for change. Life’s habits are important and powerful building blocks. My hope for all of us is that we choose those blocks carefully to ensure that our habits will assist us in building the best life we possibly can.
Je rey P. Fisher, DDS Editor-in-Chief editor@sprigusa.com 12
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MEET THE
CONTRIBUTORS TO SHIFT MAGAZINE
Daniel Binus, MD Daniel Binus completed his medical training and psychiatry residency at Loma Linda University where he became fascinated by the beauty of the mind. Dr. Binus spent many hours studying the emotional, physical, spiritual, and biological factors that influence mental health. This study made him passionate about treating the cause of mental illness and not just masking the symptoms. Binus serves as clinical director of Beautiful Minds Medical in Auburn, Calif., where he provides outpatient psychiatry and oversees the Intensive Outpatient Program. He’s also serves on the medical staff at Sutter Auburn Faith Hospital, and as a clinical instructor for Loma Linda University.
Mandy Ashley, DMD, MSEd, MS Originally from upstate New York, Dr. Mandy Ashley followed an interesting pathway into pediatric dentistry. After graduating from the University of Pennsylvania in 1999 with a dental degree and master’s degree in education, Dr. Ashley embarked on an 11-year adventure as a general dentist in Barrow, Alaska. She brought dentistry to the villages along the Arctic Ocean and started a dental assisting program for local residents. In 2012, she finished her pediatric dental residency at The Ohio State University and moved to Bowling Green, Kentucky to raise her family and start a private practice. In her spare time, Dr. Ashley plays hockey and travels the world with family, hoping to inspire her kids to enjoy big adventures of their own someday!
Roger D. Gallant, MD Dr. Roger Gallant graduated from the School of Medicine at Loma Linda University in 1994. He currently practices emergency medicine part time at John C. Fremont Healthcare District, a small critical access hospital in Mariposa, Calif. Dr. Gallant is also the medical director of the. NEWSTART Lifestyle Program at Weimar Institute in Northern California. NEWSTART is an 18-day residential lifestyle program where patients are taught lifestyle principles designed to improve their health. NEWSTART is an acronym for Nutrition, Exercise, Water, Sunlight, Temperance, Air, Rest, and Trust in God.
Laura Maly After 10 years in the advertising world working on both agency and client sides (General Motors, Kohl’s Department Stores, Microsoft, and Sony Pictures), Laura took the jump into small business ownership in 2011. Since then she’s been having a ball helping dental practices find their marketing footing and educating her clients. Aside from her love of “dental land,” you might find Laura giving back to the community through Junior League of San Diego and the San Diego County Dental Foundation, practicing yoga, hanging with her four rescue dogs, traveling, or drinking coffee. 14
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Tom Terronez
Amanda Smith, BCBA
Tom Terronez is a hands-on leader in the dental technology industry, committed to helping practices reach their efficiency and IT security potential. Since founding two tech companies in the early 2000’s (Medix Dental and Terrostar Interactive Media,) he has become a nationally respected and increasingly sought-after expert in his field. His mission to help practices mitigate risk, protect patients, and maximize overall success has enabled dentists all over the country to embrace a new type of technology partner.
Amanda Smith received her master's degree in applied behavior analysis in 2010 from National University. She is a Board Certified Behavior Analyst (BCBA) with over a decade of experience working with children with autism spectrum disorders and other developmental issues whether at home, school, or in other community settings. Amanda currently works for a local county office of education as the behaviorist for all county special education programs. She enjoys volunteering for organizations such as Make a Wish Foundation and Global Autism Project that have supported children and their families and helped to improve their quality of life. In 2018, Amanda traveled with the Global Autism Project to Nairobi, Kenya, to work with an autism school as a member of a team of specialists to train staff and promote autism awareness within their community. In her spare time, Amanda loves spending time with her husband, Stephen, and two young boys, Hayden and Ayrton.
Cameron Quayle, DDS
Dr. Quayle grew up in Ogden, Utah and graduated from Weber State University. While there he played tight end for the Wildcats football team. In 1998, he was drafted by the Baltimore Ravens of the NFL and earned the title of “Mr. Irrelevant,” the last person selected in the NFL draft each year. He spent time with the Baltimore Ravens, the Barcelona Dragons (NFL Europe), and the Jacksonville Jaguars. After a neck injury in Jacksonville, he decided to stop playing football and pursue a dental career. Dr. Cam received his DDS degree from Virginia Commonwealth University School of Dentistry. Following dental school, he pursued a two-year pediatric residency at Primary Children’s Hospital in Salt Lake City, Utah, where he continues to oversee the sedation training received by residents. Dr. Cam is married and has two daughters and two sons. He enjoys traveling, mountain biking, snow skiing, and staying active. He, along with his family, recently completed a year-long commitment to provide humanitarian dental care in rural Guatemala. You can follow his family’s adventures and humanitarian efforts at www.masongives.com.
Serena Lopez Cazaux, DDS, PhD
Dr. Serena Lopez Cazaux has been an associate professor in the department of pediatric dentistry at the dental school associated with the Université de Nantes and Centre Hospitalier Universitaire de Nantes, France, since 2010. Her clinical practice is dedicated to children with special needs and children with dental anomalies. Her research focus is digital tools to improve oral health in children with autism. She is author of several national and international publications.
… without whom
THIS ISSUE would not be possible.
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Issues in Pediatric Dentistry Previously published biannually as EZPEDO Magazine 2015—2016.
Vol. 5 No. 2 | Fall 2019
JEFFREY P. FISHER, DDS Editor-in-Chief TIMOTHY SHAMBRA Layout Designer
JAMES R. FISHER, MSPH, PhD Senior Consulting Editor
RICKY QUINTANA Issue Coordinator
STACEY SCHOELLERMAN Graphic Designer
ANN FISHER, MAT, MMus Copy Editor/Proof Reader
Contributing authors Daniel Binus, MD / Mandy Ashley, DMD, MSEd, MS / Amanda Smith, BCBA / Roger D. Gallant, MD / Laura Maly Tom Terronez / Cameron Quayle, DDS/ Serena Lopez Cazaux, DDS, PhD
Contributing photographers Stacey Schoellerman / Timothy Shambra / Garrett Hanes
Special thanks to Victoria L. Dunckley, MD / Sarah Johnson / Jennifer Datwyler, DDS / Kristen (Noah’s mom) Yasmin Kottait, DDS, HDD, MFDS Ed, Dip Hypno, MSc, IBCCES-Autism
SPRIG ORAL HEALTH TECHNOLOGIES, INC. Publisher RICKY QUINTANA Advertising Sales
LYUBA KOLOMIYETS Finance & Accounting
STEPHEN SMITH Advertising Contracts
For editorial enquiries please email: editor@sprigusa.com For advertising enquiries please email: ricky@sprigusa.com Subscriptions are available online by visiting: www.sprigusa.com/magazine For additional enquiries please call: 888 539 7336 / Int. (1) 916 677 1447
SPRIG ORAL HEALTH TECHNOLOGIES, INC. 6140 HORSESHOE BAR ROAD, SUITE L LOOMIS, CALIFORINA 95650
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Shift magazine, a contemporary dental publication highlighting relevant topics of interest for busy practitioners in private practice, publishes scientific articles, case reports, and human-interest stories focusing on current issues in pediatric dentistry. Pediatric and general dentists will learn about new concepts in restorative treatments and the latest innovations in techniques and products, all available in the one magazine that helps them keep pace with rapid changes in pediatric dentistry. © Copyright 2019 Shift magazine, a subsidiary of Sprig Oral Health Technologies, Inc. All Rights Reserved. Sh i f t m ag az in e / Fall 2019
SOCIAL NETWORK
PEOPLE, PLACES AND PARTIES
OUR SPRIG COMMUNITY Familiar faces and new friends! AAPD is always a grand adventure, and we can hardly wait for Nashville!
@SPRIGUSA
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HEALTHY CORNER
POWER F0ODS for a HEALTHIER BRAIN by Roger D. Gallant, MD
Food is crucial to life. We all have our favorite foods, but are they good for us? More specifically, do they optimize our brains. Notice this quote from a book called Counsels on Diet and Foods. “In order to have good health, we must have good blood; for the blood is the current of life. It repairs waste, and nourishes the body. When supplied with the proper food elements and when cleansed and vitalized by contact with pure air, it carries life and vigor to every part of the system. The more perfect the circulation, the better will this work be accomplished.” Don’t forget, our brains rely on the nourishment supplied by what we eat. So, let’s examine some dietary habits that will improve the availability of those nutrients our brains require.
Eat as many whole-plant foods as you can in a rainbow of colors. Whole-plant foods with minimal refinement contain abundant vitamins, minerals, antioxidants, and phytochemicals. These elements of nutrition nourish our bodies and help them to fight off diseases like cancer. Many people are afraid of eating carbohydrates because they fear these “starchy” foods are unhealthy and will make them gain weight. In reality, it is fats and proteins that stimulate one to become overweight. High-carbohydrate foods will not make you overweight unless you also eat high-fat and highprotein sauces, gravies, and other companion foods. Eating a high-carbohydrate diet from natural sources does not typically make one overweight. On the other hand, a high-protein diet is hard on our bodies. A high-protein diet taxes the liver and triggers a loss of calcium from our bones. It also leaves toxic residues which must be eliminated. Before our bodies can eliminate these toxic residues, however, they are often damaged so that they become more susceptible to a variety of diseases, including cancer and arthritis. 18
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Eat blueberries which contain anthocyanins, a group of plant compounds with anti-inflammatory and antioxidant effects. Antioxidants combat both inflammation and oxidative stress, conditions that may contribute to brain aging and neurodegenerative diseases like Alzheimers. Some of the antioxidants found in blueberries may even accumulate in the brain and help improve communication between brain cells. Turmeric (with its active ingredient curcumin) acts as a powerful antioxidant and anti-inflammatory compound. It helps to improve memory, boost serotonin and dopamine levels which assist in fighting depression, and boost brain-derived neurotrophic factor (a type of growth hormone that stimulates brain cells to grow.) Walnuts are a great source of omega-3 fatty acids. This alpha-linolenic acid (ALA) is an essential part of a healthy diet for the brain. A single serving of walnuts (about 14 halves) contains your daily requirement for ALA. Broccoli is a cruciferous vegetable that contains phytochemicals and antioxidants. It's also very high in vitamin K, which is a fat-soluble vitamin that is essential for forming sphingolipids, a type of fat that is concentrated in brain cells. Pumpkin seeds contain powerful antioxidants that protect the brain and body from damage by free radicals. They also contain magnesium which is important for memory and learning, zinc which is an important element for nerve signaling, and copper to help control nerve signaling. Iron is present as well and seems to improve brain function and counteract brain fog. So, remember, if you choose to incorporate a variety of whole-plant foods in your diet, they will literally go to your head!
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SUCCESS
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HemeRx
EZPREP
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DOCTOR-TO-DOCTOR TESTIMONIAL
CONFIDENCE. Why I chose Sprig University
“My first time attending Sprig University was in 2016 when I was just starting my career as a young pediatric dentist. EZCrowns, as the name says, are just that—easy to place, easy to learn, and beautiful to view! Fast forward to 2019. I have now had extensive experience placing many EZCrowns, but I wanted to enhance my clinical practice skills further and do one more course, challenging myself to place these beautiful Zirconia crowns in a much shorter time. I traveled all the way to Boston, USA from Dubai, UAE to attend Sprig U. The experience did not disappoint. I totally recommend it—whether you’re a fresh grad or a dental professional with years of experience.”
Yasmin Kottait, DDS, HDD, MFDS Ed, Dip Hypno, MSc, IBCCES-Autism Dubai Health Care City, UAE
A pediatric dentist by morning and an award-winning tooth fairy by night, Dr. Yasmin’s mission is to spread smiles and encourage healthy habits in children. Her career has been dedicated to providing dentistry to little ones, and she has backed up her master’s degree in pediatric dentistry with three additional dental diplomas. Recently, she received a cognitive-based hypnotherapy diploma from the UK, enabling her to add a much-needed psychological depth to her treatments. In addition, she added an extra certification in dealing with autistic children. After becoming a unicorn in the dental world through her new “hypnodontism,” children and parents alike soon realized she is no normal tooth fairy; she also has magic, kid-whispering powers. Dr. Yasmin currently practices in Dubai, United Arab Emirates. In her spare time, she is a globe trotter who provides aid and relief to impoverished children.
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REAL STORIES | Noah’s Picture Perfect Smile
“I’m so happy my teeth will look this great for picture day!” Noah that Noah’s recovery was so easy. He just rested for a few hours and watched a movie when we got home. Later that evening, Noah was back to his normal, energetic self. The whole process from start to finish couldn’t have run any more smoothly. Noah was thrilled to get his two front teeth fixed just in time for picture day at school. It melted my heart when he smiled in the mirror and saw his teeth. He exclaimed, “I’m so happy my teeth will look this great for picture day!” Noah’s teeth look fantastic, and often I find him smiling into the mirror checking out his front teeth with such pride.
W
hen the dentist told us that Noah would need anesthesia for his upcoming dental work, I immediately started to worry. A few years earlier, we had a bad anesthesia experience with one of our other children who needed anesthesia during a procedure to insert ear tubes required due to his chronic ear infections. Ever since that experience, I had been very leery of anesthesia.
Now, when faced with the thought that we would have to have our little 5-year-old put under for his dental work, I felt a lot of anxiety. The wonderful ladies at Magic Smiles assured me that Noah would be in great hands, and that Dr. Fisher was the best-of-the-best at providing anesthesia. 22
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We couldn’t have been happier with Dr. Fisher’s kindness, attention to detail, and follow-up after Noah’s treatment. We felt extremely blessed to have had such a positive experience with Dr. Fisher and Dr. Datwyler from Magic Smiles.
On the morning of the procedure, I dropped our older two boys off at school and came over to the dental office with Noah. Once I was in the waiting room, a bad case of “nerves” hit me. I could feel a lump rise up in my throat. Dr. Fisher came out to greet Noah, and I was immediately impressed by his calm demeanor and ability to engage Noah in conversation so easily after having just met him for the first time. Dr. Fisher answered the few questions I had with such care and concern that I instantly felt my nervousness melt away. After the procedure, I was expecting to see a groggy and uncomfortable little boy walk out. Instead, Noah was as happy as could be and even asked Dr. Fisher for a hug! I was grateful
Kristen, Noah’s mother
Upper left: Noah proudly posing for his kindergarten picture at school. Above: Dr. Fisher takes a picture of Noah with Dr. Datwyler and his mom, Kristen, during his recovery from anesthesia
EyeSpecial C-III THE DENTAL CAMERA THAT MAKES IT EASY
WATCH NOW! EYESPECIAL C-III
AT WORK
HELPFUL HINTS
THINGS THAT SHOW ASSISTANTS CARE by Sarah Johnson
OFTEN IT IS TRUE IN LIFE THAT THE LITTLE THINGS TEND TO GO UNNOTICED. READ WHAT A FEW RDA’S TRY TO DO FOR THEIR DOCTOR EACH DAY TO MAKE THINGS GO JUST A LITTLE SMOOTHER.
THINK AHEAD
Anticipate your doctor’s next two moves.
LISTEN AND REMEMBER Communication is key. If you’re working as a new assistant or working with a new doctor, ask questions to find out what they prefer. You might find they have different expectations from what you’re used to.
PLAN FOR EFFICIENCY Be prepared. The appointment starts with you. Make sure your room is set up and know who your patient is—their fears, and how their visit went before. Your doctor is only as prepared as you are.
CONTROL THE APPOINTMENT Especially in pediatrics, it’s easy for parents to try and take over the appointment, sometimes without you even knowing it. Set your expectations with the parent in the beginning, so they can be prepared. It sets the tone for the visit.
MANAGE TIME WISELY One of my essential tasks is to keep my doctor on time. It also shows the parent/patient you respect their time too. Always know how much time you have for each procedure.
RESEARCH NEW PRODUCTS One of the things our o ce prides itself in is new technology. I try to keep up with research about new products that help our team be more e cient. It’s important to say relevant.
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When people need treatment now, they also appreciate options now.
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option that lets your patients choose the
Call 800-859-9975, option 1, then 6.
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CLINICAL CASES
CLASS-3 MALOCCLUSIONS
CAN I TREAT PATIENTS WITH CLASS-THREE MALOCCLUSIONS USING PREFABRICATED ZIRCONIA CROWNS
Class-thee occlusions can be challenging, but with a little planning, you can restore your patients’ teeth to their natural appearance, even in cases where patients still continue to exhibit a crossbite.
?
Clinical case by Jennifer R. Datwyler, DMD
Patients with class-three malocclusions commonly present some of the most challenging cases we see. Often their occlusions also are complicated by deep underbites or crossbites leading to frequent fractures in restorative materials such as composite crowns when they are used as part of the treatment. Due to Zirconia’s strength and superior esthetics, Zirconia crowns are often the best and most reliable choice to use in restoring these challenging cases. The first thing to consider when planning treatment to restore an anterior tooth in a patient with crossbite is whether the case is a dental or skeletal class-three malocclusion. This determination will dictate the course of treatment. Let me explain. If you are treating a true skeletal class-three case, you will want to prepare the tooth mostly on the facial surface. This will allow the crown to seat far enough lingually for it to clear the lower incisors when the child bites into maximum intercuspation. If, however, the patient has a mildly trapped dental class-thee occlusion and you feel you might be able to correct the situation by crowning the anterior incisors, you will want to prepare the tooth mostly from the lingual side. This will allow you to flair the crown labially when seating. Often it proves helpful to adjust the incisal edges of the lower incisors, in many cases thus allowing for the anterior upper and lower teeth to meet end to end. 26
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Restorations with EZCrowns–D, E, F, G.
“
Evie returned to my office for her post-op visit two weeks later. She and her mother were thrilled with the results. Evie hopped right up in the chair and showed me her “new” teeth. It has now been over six weeks since her restorations were placed, and Evie’s mother says, ‘My daughter is so proud of her teeth and shows them off every chance she gets! We are all so amazed with Evelyn's results, especially Evelyn! She is constantly showing everyone how great her teeth look and how proud she is.’
Dr. Jen Datwyler
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Laura Maly: Co-Founder at Wonderist Agency, a full-service marketing agency for dentists.
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Facing the
Facts HOW TO IMPROVE YOUR LEAD-GEN APPROACH by Laura Maly
When applied to dental marketing, Lead Generation is a buzz word that specifically means just one thing—filling dental seats with kids. But accomplishing that can be a little more complicated than simply uttering a two-word phrase. If attracting new patients was that easy, everyone would be successful, and you’d have no reason to read this article. Yet here we are. Your first instinct when attempting to get the word out about your practice is likely to recruit a top-notch marketing agency to design a beautiful, kid-friendly logo and build a responsive website chock-full of original, keyword-rich content. Maybe you’ll look into pay-per-click campaigns. Perhaps you’ll also encourage your team to post on social media platforms three times a week. Your efforts wouldn’t be wrong.
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“
As the co founder of Wonderist Agency, Iʼve seen first hand the direct impact a well thought out marketing strategy can have on a doctorʼs practice, especially for a pediatric dentist. But Iʼm not here to plug my own business, Iʼm here to help you with yours.
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Marketing tactics aside, there’s a simple, effective method doctors can adopt that will make the right impression on parents and get more kiddos through the doors of their offices. What is this technique? Be your authentic self. I don’t mean this in a cheesy, Pinterestaffirmation sort of way. I mean that the best way to market your business—to influence moms and dads to choose you out of all other dentists—is to market yourself. As the practice owner, you are the business. If there’s anything my husband Michael and I have learned over the last seven years, it’s the importance of authenticity. So how do you showcase who you really are while making your best first impression? Here are a few things I’ve learned while being a business owner myself.
If your face fits, put it out there. I can’t stress enough the value of using video. My team can attest to this. When Michael is giving feedback on a website and he’s out of the office, he records a video and sends it to the team. If our team has the opportunity to do a client call via video, you can bet we take it. Almost all of our sales calls are conducted via a video chat. And there is one critical reason why this is so imperative to our team. It humanizes us. During sales calls specifically, we show potential clients our office, our team, and how we work. We want them to see how the sausage is made because we want our relationships to be built on trust. We want to attract clients who will trust our recommendations, who will trust that we have their best interests at heart, and who will trust us enough to work with us for the long-haul. When you are able to see the people who are actually working so hard to help you achieve your dreams, sticking with them becomes a rather natural choice. The same thing holds true for parents when they are choosing a doctor for their child. The main thing a parent looks for is someone they can trust.
This page: Joanna Wong, Wonderist Agency account manager sitting in a weekly status meeting with Ms. Maly.
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Similar logic can be applied to your choice of photographic images to include on your website. When a parent is browsing the Web in search of a new dentist for their kid, which of the two doctors described below do you think they’ll choose? 1. The doctor with a fresh, responsive website filled with beautiful photos of their fun office and friendly team 2. The doctor whose website displays a bunch of stock photos Capturing people’s interest is not that complicated. Parents and their kids want to see you and your team and get a sense of the experience they’ll have when they come to your practice. High-resolution head shots of people 42
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and action photos of your practice go a long way in garnering trust and making you the obvious choice in a sea of otherwise run-of-the-mill options. The amazing thing about using photos and video nowadays is that technology is making it easier than ever to take these shots yourself. Of course, we always prefer that clients take advantage of the services of professional photographers and videographers who can edit, cut, adjust for lighting, and provide all the digital files you’ll ever need, not to mention give creative direction that will help make your team shine. Despite the sticker shock you might experience when hiring these professionals, their expertise will be well worth the cost.
These pages: Suite of Wonderist Agency's work for their long-standing client, Buckwalter Dental Care.
Creating a sense of community means putting yourself out there, showing the world what youʼre all about. occasional post. Using social media allows you to accomplish two things: 1. Create a sense of community 2. Take control of your message Let’s consider first the idea of creating community. Imagine if a place existed where half your patients were just hanging out every day looking for content and information to absorb. Well, that place already exists! With over 169 million users in the United States, more than half the population of our country is on Facebook. Instagram, at 107 million users nationwide, is steadily increasing their user base year after year. And it’s not just parents using these platforms anymore. Minors as young as 13 years old are found on both of these platforms, and they are just as active as their parents, if not more so.
In the meantime, with the launch of the iPhone 11 Pro (I know you pre-ordered!) with its advanced camera capabilities, there’s no reason you can’t tackle taking photos on your own. Get a friend with a well-curated Instagram feed to help you out and start snapping your own photos. Speaking of Instagram …
Make social your new best friend. Most people see social media as a collection of fun platforms to browse through while we’re waiting in line for coffee, enduring a boring meeting, or watching our significant other’s favorite TV show. But it’s so much more than that. Social media goes far beyond collecting followers by making an
Social media platforms like Facebook or Instagram are so commonplace now that it only makes sense to make use of them in promoting your business. But using them effectively doesn’t mean simply pushing treatment options or promoting your own agenda. Creating a sense of community means putting yourself out there, showing the world what you’re all about, and letting people get onboard—on their own terms. Social media communities are places where authenticity is honored with loyalty and where people quickly stop following sites that appear fake or phony. The second point noted above, taking control of your message, goes beyond using traditional platforms. Have you ever googled yourself? How about checking out a date online? Have you ever researched an establishment on the Internet before you committed to it? Of course, you have. That’s the whole point of the Internet. Parents do the same thing with doctors. They want to know what they and their child are getting themselves into before they commit. www. sp r ig u sa.co m / Fa l l 2 01 9
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Marketing tactics and strategies As a doctor and as a practice owner, you have the right and responsibility to take control of your online will only presence and the message you are sending to moms and dads. take you so Keep in mind that you are a brand. You own a dental practice; you are the face of that business and you are far. You what parents are buying into. Your brand is who you are, so let that one-of-a-kind personality shine. It’s have to get way too exhausting trying to portray yourself as someone else. out into the Get out of community the office. and make Nothing beats boots-on-the-ground marketing. Whether sure people you sign up for a booth at your neighborhood farmer’s market, EREH SE Odrop GoffDbrochures A at other local businesses, offer know who your service as a guest speaker at the grade school down the street, or partner with other dentists—the more you get your name and face out there, the more success you you are… will experience.
Social Media Layout Buckwalter Dental Care
Remember what I said about the face? It humanizes you. When people see your logo and name on mailers and collateral marketing materials, it’s one thing. But to meet you in-person at a local event, to see you active and engaged in your community, that’s a game-changer. Marketing tactics and strategies will only take you so far. You have to get out into the community and make sure people know who you are. Owning a business is not for the meek or faint of heart. If you’re shy, get over it. If you think people won’t like you, go to therapy and get over it. I can assure you of one thing—this is what will not happen …. You won’t set up shop and immediately have 100 new patients showing up every month until you decide to retire. You’ll have to build a reputation that parents and kids can count on. The good news, however, is this—to ensure success all you have to do is work hard and be your spectacular self.
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You’ve just been
HACKED Cybersecurity in the Dental Practice. by Tom Terronez
Beep.
Beep. BEep.
Beep. BEep. BEEp.
Beep. BEep. BEEp. BEEP!
BEEP! BEEP! BEEP! BEEP! BEEP! Your alarm clock sounds. Initially it rings intermittently and gently, gradually working its way to the five-beep, get-out-of-bed-now sound needed to finally grab your attention. Your day is beginning like every other day.
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Backup PROTECTION
1 in 3
practices lack adequate backup protection in cybersecurity assessments.
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Y
our shower is hot. Your coffee is hot; and as always, you lack the patience to let it fully cool before taking that first sip … ouch! Your commute is as normal as it has ever been.
The parking spot you always park in is open (let’s be honest, we’re all creatures of habit!), and your day serving patients is about to begin. Everything is unfolding just as it should. Now, fast forward 12 minutes, since that’s the amount of time you need to begin your work process. You jiggle your mouse to wake your sleeping computer, still smiling while exchanging morning pleasantries with your office staff. One glance back to your monitor, and … Boom! Your computer is down. No programs load. Everything is locked up. You hear your coworkers outside your door echoing the same thing you just mumbled in your head, “My computer won’t work; something’s wrong!” It’s like a scene from a bad movie. Your worst imagined fears suddenly realized. As you contact your IT vendor in an attempt to bring your system and network back to life, the clock is ticking. Patients are arriving for appointments scheduled months in advance.
Finally, your IT person shows up. You’re saved! Well, actually there’s bad news. After attempting to get your computer system back in operational mode, your IT professional informs you, “You’ve been hacked, and those data backups you’ve been running? Yeah, well they haven’t been working! However, there is an option to access your data.” “At last!” you say. “Some good news on this already horrid Monday. What is it?” “There’s an option,” your IT pro responds, “to pay a ransom to decrypt and access your data, and the fee will likely be just a bit over $10,000 … but the process will take at least a week.” Now, if your IT specialists are worth their salt, they’d also know an instance like this one requires paying another seasoned professional to conduct a forensic analysis to assess if an actual breach occurred. But just as you’ve heard on those late-night infomercials, “But wait, there’s more!” Yes, in fact, there’s much, much more. The financial impact from this incident stretches far beyond the the ransom and breach analysis. Expenses resulting from downtime and lost production may be far bigger burdens. According to an IBM-commissioned report, 54
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the average cost to recover from a breach is $380 per patient. So, for a 2,000-patient practice, that’s $760,000. Cyberattacks happen very regularly. In fact, over the course of the last three years, the frequency has increased exponentially. Just how frequent are they? One occurs every 39 seconds to be exact. So, by the time you have finished reading the next few paragraphs, another cyberattack will have been executed. So, the big questions are these: • •
What can you do to prevent such attacks? How does your practice function during the recovery process?
And the bigger—and immensely tougher—question: •
What do you tell your patients?
Light at the end of this tunnel Believe it or not, there is some good news that can come from a situation like this. The best news? It was completely preventable.
Security breach
COSTS The average cost to recover from a security breach is
$380 = per patient
$760,000
for a 2,000-patient practice
In this case, a properly configured secure network would have decreased by tenfold the likelihood of this incident happening. Having the proper security measures in place to thwart would-be attackers takes care of the vast majority of attacks. On the off-chance an attack was successful despite your existing defense system, an off-site, monitored backup or disaster-recovery system would have allowed for the restoration of all of your data based on a snapshot taken just before the attack occurred. Let’s say your last backup was successfully completed on a Sunday morning at 2:00 am, and the attack was made at 11:00 pm Sunday night. Everything that was saved during that 2:00 am backup would be stored in the off-site backup location, and this process would ensure total recovery of everything up to that point.
You’re not o the hook While multiple types of IT failure may create an environment which results in significant disruption that impacts your office routine, the responsibility and downtime are yours. It’s your name on the practice. The patients are your patients. It’s your duty to own whatever mistakes occurred.
While it’s a bitter pill to swallow, accepting responsibility for the disruptive issues and being 100 percent transparent with your patients is imperative. Not only does this allow your patients to be clued in to what has happened, but it also helps you maintain the credibility you’ve worked so hard to build up to this point. One of the most effective ways to rebuild the patientpractice trust is by communicating your plan to correct the issue which caused the situation. Your first corrective step should be to find a more reliable and effective IT vendor that has expertise in working with dental practices.
Don’t be a victim— Correct common IT issues Let’s face it. You’re a practice owner not an IT professional. You’re not expected to be privy to all of the intricacies of the IT world. However, you are expected to—and absolutely must—know the basics in order to make an informed decision regarding the IT vendor best suited to protect your practice.
The Unfortunate TRUTH Percent of offices with liabilities
backups
59%
Backup drives or devices lacking encryption
firewalls
58%
Inadequate or no firewall
endpoints Inadequate endpoint protection (either no or insufficient antivirus software)
updates Operating systems missing critical and security updates
47%
42%
These four liabilities can create damaged or compromised data, resulting in unnecessary lost time, damage to your reputation, and significant costs for regulatory fines and related expenses.
Here is a list of items to include on a cheat sheet to help you avoid IT disruptions to your practice:
Frequent backups As we outlined earlier, backups can be lifesavers, or, in this instance, data savers. Having a regularly scheduled backup system in place is an essential tool in keeping yourself protected. It doesn’t stop there, though. Knowing (and having a say in) what data is being backed up, where the data is being backed up to, and how long it will take to be restored are the crucial pieces of information you need to know. Think of a backup as being your practice treasure. You wouldn’t want to bury your practice treasure somewhere without knowing where to find the X which marks the spot you can recover it.
Windows updates Security vulnerabilities are being discovered all the time. This means if you’re not keeping your operating system up-to-date, you’re harboring big-time risks. Current security updates must be installed on all workstations and servers. Taking this precaution is critical. Side note: For any of you still running Windows 7 and/ or Windows Server 2008, your hourglass is quickly emptying. Come January 2020, support for these systems will be discontinued, and no further patches or security updates will be released. Your practice will be non-compliant.
Antivirus/antimalware No free solutions exist to combat these threats. Plain and simple. Enterprise-grade antivirus and antimalware software programs are the only acceptable way to equip your practice for best protection. Find a reputable enterprise-grade provider that runs at least daily updates. The normal antivirus applications designed for home use that you’re likely accustomed to are unacceptable options for use in protecting your practice. Choosing one of these options is basically like arming your practice with Swiss cheese—there are just too many holes.
Sta
training
Having the peace of mind that your employees—you know, the people who are using your network on a daily basis—are properly educated in keeping your systems safe is invaluable. Cybersecurity training should be given annually at a minimum, but the ideal
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timeframe is quarterly. Keeping up with new threats, trends, and techniques goes a long way in helping protect your practice. Two big pieces of advice I always give to practices I assist are:
1.
Don’t get click happy; slow down when browsing anything online and do not click without reading. 2. Don’t open email attachments unless you are 100 percent certain of who the sender is, AND that you’re expecting an attachment from them.
Don’t open email attachments unless you are 100 percent certain of who the sender is, AND that you’re expecting an attachment from them. Secure firewalls Having a firewall is your first line of defense against internet malice. However, don’t be fooled. Your practice needs much more than just a firewall, but a firewall is equally important as antivirus/antimalware protection. A practice without a firewall would be like playing chess without pawns acting as the initial barrier, blocking access to your royalty. You may be thinking, “Managing each of those bigticket solutions sounds great, but how can I accomplish all of them?” That’s a perfect question to ask, and the answer has several components. But it starts by understanding the importance of this short and simple quip, “Not all IT is created equal.” Just as in the dental profession, specialties exist in IT. One company that’s great at solving problems may not have a security focus or may not have experience in that field at all. In many cases, general IT companies are far less equipped to protect your practice than a dental-specific IT company.
Even then, just because a company identifies as a “dental-specific” IT vendor, it doesn’t automatically mean they’re experts in the security field. Identifying a dental-specific IT vendor that is a known expert in practice security is essential. They’re like a rare four-leaf clover, and you’re lucky when you find one. While their fees may be more than those of the run-ofthe-mill local general IT company, there’s a reason— the expertise and quality they provide. Protecting your practice means protecting your patients. Patients who have placed their undivided trust in you deserve the best protection possible. Being proactive rather than reactive in protecting your practice and patient data can save you more than just the thousands of dollars in recovery costs and fines. Doing so will also save you unneeded stress, headache, and—maybe most importantly—your reputation. Having premier IT support should not be looked at as an expense, but rather as an investment … and even as insurance to an extent. Find an IT partner who sees themselves as an extension of your practice, not just a vendor who sees you as “just another number” on their bottom line. When it comes to finding the IT vendor that is the best fit for your practice, always keep in mind these words, spoken by the brilliant Benjamin Franklin, “An ounce of prevention is worth a pound of cure.”
TAKEAWAY Always keep in mind these words, spoken by the brilliant Benjamin Franklin, “An ounce of prevention is worth a pound of cure.”
For additional information regarding cybersecurity specific to dental o ces, you can contact Medixdental through their website: medixdental.com or contact them by phone at 877.885.1010
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BRAIN CHILD MEDIA AND THE ADOLESCENT MIND
W
e see the impact of media everywhere in our society. Most of us interact with some sort of electronic devices throughout most of our waking hours. The Nielsen report from 2018 reports that adults in the United States now engage in media use for more than 11 hours per day. This is an increase from 10.5 hours in 2017. Teens use media an average of 9 hours per day, and this excludes time spent using media for school or homework! The typical American spends more than 4 hours per day watching TV, which is equivalent to more than one 24-hour day in a week. By age 75, most of us will have spent more than 15.5 years in front of the TV.1 So how does this affect our brain, relationships, and overall mental health? Specifically, how does this impact the developing minds of our young people? As a psychiatrist, these are questions that I have often pondered, especially as I have seen the rise of mental-health problems in the adolescent population. As a result, I have taken significant time to look at the
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by Daniel Binus, MD
impact of media on our mental health. The results have been concerning, to say the least, and have led me to suggest frequent interventions for media-related, mental-health issues. The first thing I would like to emphasize is that media and electronic devices are not inherently bad. Every day I use a computer, my smart phone, the Internet, and different ways of communicating electronically to improve the quality of my life and the positive impact I can have on others. Media is powerful and can have a tremendous influence for good. However, like any other powerful tool, you can also easily cause harm if you use media devices inappropriately. In this article I will focus on three main areas: 1) the impact of media on our mental health, 2) the link between media and violence, and 3) the effect of media on relationships. I will then end with a few practical strategies to manage media use in the home.
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Impact on Brain/ Mental Health When we first engage in a media-related activity such as watching television, gaming, using our smartphones, going online, or watching a movie, what Pavlov described as the orienting response is triggered. This simply means that media are made to grab our attention and keep our attention.2,3,4,5 This response activates the dopamine reward pathway in our brains and gives us a feeling of anticipation and reward. It also leads to increased activity in the limbic system, our emotional part of the brain, and under activity in the frontal lobe, our reasoning and self-control part of the brain.3,4,5,6,7,8,9 When one watches television, for example, brain waves in the frontal lobe switch predominantly to alpha waves within about 30 seconds of turning on the TV. This indicates a more passive, relaxed state in which the critical thinking and reasoning skills are largely dormant.7,8,9 Researchers state that television “effortlessly transmits huge amounts of information not thought about at the time of exposure.”7,9 Interestingly, while people watching TV feel more relaxed, their mood worsens afterwards, and they feel energy depleted, passive, and struggle to remain focused.10
Media and Mental Illness Over the years, the evidence for a link between mental illness and television, gaming, and other forms of media has become increasingly strong. For example, as early as the 1990s, the American Academy of Pediatrics has reported that early TV exposure is associated with the development of attention problems such as ADHD.11 Many people have been misled to believe that interactive screen time (such as gaming or using social media) is better than passive screen time (such as watching TV). This is simply not true. Interactive screen time is often worse for the user, especially in adolescence, as it causes dysregulation of the nervous system with hyper-arousal which can lead to emotional outbursts, meltdowns, irritability, and distractibility.12 Gaming, for example, can lead one to sacrifice real life relationships and forego other past-time activities. Furthermore, it can result in decreased sleep, problems at work, academic failure, lack of attention and verbal memory, aggression and hostility, dysfunctional coping, low wellbeing, and high levels of loneliness.13 Researchers see Internet overuse as being similar to self-medication with alcohol or other psychoactive 60
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drugs. Sleep deprivation, academic underachievement, failure to exercise and engage in face-to-face social activities, negative mood states, suicidal ideation, substance abuse, and decreased ability to concentrate are some of the known consequences of Internet overuse.14,15,16 Individuals identified as having social-media addiction were discovered to be at high risk of developing abnormal general mental health, somatic symptoms, anxiety, insomnia, social dysfunction, and severe depression.14,15 Smart phone use increases the likelihood of insomnia; in adolescence, it is also related to later bedtimes. This, in turn, contributes to academic problems and depressive symptoms.17,18 Moreover, sexually explicit material is now indiscriminately available to youth, and pornography viewing is shown to have significant negative mental and physical health effects.19 Television exposure and total media exposure in adolescence are associated with increased odds of depressive symptoms in young adulthood. Both TV viewing and mobile phone use contribute to the development of depressive symptoms. In logistic regression models, each additional hour per day spent watching television or screen viewing was associated with greater odds (1.64 and 1.58 respectively) of prevalent depression in young adulthood, and doseresponse relationships were indicated.20,21,22,23 This can become a self-perpetuating cycle. Although heavy use of the Internet and video games is associated with an increased risk of depression, increased depression also predicts greater use of these media as well as withdrawal from sports participation and club activities.24 Using the Internet, even for social media purposes, or gaming throughout the day, can actually increase social anxiety. Online, you can create your own self-image, whereas in real social situations, you actually have to be yourself.25
Media and Violence The impact of media and violence is controversial and has frequently been downplayed. A meta-analytic review reported that “the evidence strongly suggests that exposure to violent video games is a causal risk factor for increased aggressive behavior, aggressive cognition, aggressive affect, and for decreased empathy and prosocial behavior.”26 In a 2009 policy statement on media violence, the American Academy of Pediatrics said, “extensive research evidence indicates that media violence can contribute to aggressive behavior, desensitization to violence, nightmares, and fear of being harmed.”27
Resources The Media Violence Commission of the International Society for Research on Aggression (ISRA) in its 2012 report on media violence said, “Over the past 50 years, a large number of studies conducted around the world have shown that watching violent television, watching violent films, or playing violent video games increases the likelihood for aggressive behavior.” According to the commission, more than 15 meta-analyses have been published examining the links between media violence and aggression.28 This violent link is often minimized because of people’s concept of aggression. Often times, media use triggers forms of indirect aggression instead of actual physical violence. For example, the likelihood of a child becoming a bully between ages 6 and 11 has been linked to how much television this child watched at four years of age. Often times excessive media use leads to confrontational body language and verbal aggression instead of physical violence. Internet and social media sites now make it easier for a student to bully a peer, and adolescents represent the majority of cyber bullying victims.28
Media and Relationships Media is changing relationships. Recent research from UCLA shows that when teens learned that their own pictures supposedly received a lot of “likes,” they showed significantly greater activation in their brain’s reward circuitry—the same circuitry activated by seeing pictures of a person one loves.28 Adolescence is a particularly important time for social learning. During this time the brain becomes primed for certain rewards. If we program our brains to be rewarded by media messages, we tend to start valuing real-life experiences much less.28 This programming can also impact our ability to read facial expressions and connect in healthy ways within relationships. Researchers surveyed college students between 1938 and 2007 and high school students between 1951 and 2002. They discovered an astounding 500 percent increase in mental-health problems during these time intervals. The researchers concluded that the results best fit a model which incorporates “a cultural shift toward extrinsic goals, such as materialism and status and away from intrinsic goals, such as community, meaning in life, and affiliation.”30 It appears that the media is driving us apart and creating an emptiness in our hearts that no electronic device can fill.
At Beautiful Minds we choose life and all that word encompasses. We work closely with each person to understand the root cause of his/her condition and treat it in combination with proven lifestyle principles in the areas of nutrition, exercise, connection, and hope.
AUBURN, CALIFORINA beautifulmindsmedical.com (530) 889-8780
American Academy of Pediatrics:
“Approximately three decades ago, teachers of young children at all socioeconomic levels began to report troubling changes in their students, mainly centering on decreasing abilities to listen, pay attention, and to engage in independent problem solving … perhaps it is indeed time to consider that pediatricians may have yet one more job to do in early parent education about placing limits on screen time.” 29 www. sp r ig u sa.co m / Fa l l 2 01 9
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Conclusion and Resources So, what can we do to address this media-driven, mental-health crisis? First of all, adults—especially parents—need to provide better examples. While 72 percent of parents say their teens are sometimes or often distracted by their phone while having real-life conversations, 51 percent of teens say the same about their parents.31 We also need to start talking about screen time before it becomes a problem. This strategy also includes getting primary caregivers on the same page and having conversations between parents and children. Clear parameters need to be set and agreed upon regarding approved amounts of screen time and appropriate content. Parents also need to watch for telltale signs of media overuse/addiction such as increasing irritability, failing grades, decreased interest in activities, and appearing disconnected or distracted. Psychiatrist Victoria Dunckley has had tremendous results utilizing a "brain reset" program for individuals who have some of these
Quality Time: Taking the time to read a book with your child not only builds memories but builds bonds that last forever—there is no app to replace a parent’s lap.
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evidences of media addiction. Amazing mental-health results are often seen within a couple weeks of restricting media intake. Finally, children need to be offered positive alternatives to media use. These include such healthy activities as music opportunities, games, puzzles, reading, family meal times, time in nature, exercise, spiritual engagement, and community outreach activities. As parents we want the very best for our children. Often times, when children start to hit adolescence, they all of a sudden seem to make a drastic change. I have heard parents say, “I don’t know what happened. My child just overnight became this defiant, confrontational person.” While behavior changes are common at this age, often times what parents are experiencing is just the inevitable consequences of the behavior and habits that have been formed over the past decade of their child’s life. These changes may have taken place suddenly, but the root causes have likely been years in the making. In fact, the only thing that has changed, in many respects, is that the presenting behavior that used to be cute when the child was four or five is no longer cute. My
Resources advice to parents of children of all ages, but especially to the parents of younger children living in this age of constant technology overload, is to start early with a plan. Realize that how you raise your 3-year-old will directly affect how your 16-year-old will act.
Victoria L. Dunckley, MD
My challenge to all parents is to consciously make the effort to spend more quality time with your children and control the use of technology in your home. This disciplined approach from a young age will prove very valuable for your family unit down the road. Like many other areas in life, the more work you put into something in the beginning, the greater the reward down the road. And the reward of a happy, loving, and healthy family is priceless at any age.
Resource in Print: Victoria L. Dunckley, M.D., is an integrative child, adolescent and adult psychiatrist with 12 years’ clinical experience in both the public and private sectors. An active blogger for Psychology Today and speaker to both parents’ groups and clinicians, she emphasizes the impact of lifestyle factors on mental health, particularly the e ects of overstimulating electronic screen media on mood, cognition, and behavior. You can also read her blog on Psychology Today at www.psychologytoday.com /blog/mental-wealth
"Screen time acts like a stimulant, putting the nervous system into a chronic state of fight-or-f light. It alters brain chemistry, reward pathways, stress hormones, the body clock, and brain blood f low, and thus can have potent effects on mood, focus, sleep and behavior. Parents don't realize that even moderate amounts of screen time can result in a child who's moody, anxious, disorganized, defiant, or even explosive. The good news is that these effects are largely reversible, by methodically giving the brain the sustained break it needs to 'reset' itself."
References: 1. Nielson Report, 2014. 2. Kuss DJ. Internet gaming addiction: current perspectives. Psychol Res Behav Manag. 2013;6:125–37. doi:10.2147/PRBM.S39476. 3. Matsuda G, Hiraki K. Sustained decrease in oxygenated hemoglobin during video games in the dorsal prefrontal cortex: a NIRS study of children. Neuroimage. 2006;1;29(3):706–11. 4. Sigman, A. Remotely Controlled: How Television is Damaging Our Lives. Ebury Press, 2007. 5. Lang A, et al. The effects of edits on arousal, attention, and memory for television messages. J Broadcast Electron Media. 2000;44(1):94–109. 6. Goldberg I, et al. When the brain loses its self: prefrontal inactivation during sensorimotor processing. Neuron, 2006;50:329–39. 7. Krugman H. Brain wave measures of media involvement. Journal of Advertising Research. 1971;11(1):3–9. 8. Kubey R, Csikszentmihalyi M. Television addiction. Scientific American—Special Addition. 2004;14(1):48–55. 9. Koepp M, et al. Evidence for striatal dopamine release during a video game. Nature. 1998;393:266–68. 10. Sigman, A. Remotely Controlled: How Television is Damaging Our Lives. Ebury Press, 2007. 11. American Academy of Pediatrics, Committee on Public Education. Pediatrics. 1999;104:341–43. 12. Dunckley, V. Reset Your Child’s Brain. 1st ed. Canada: New World Liberty, 2015. 13. Kuss DJ. Internet gaming addiction: current perspectives. Psychol Res Behav Manag. 2013;6:125–37. doi:10.2147/PRBM.S39476. 14. Hanprathet N, et al. Facebook addiction and its relationship with mental health among Thai high school students. J Med Assoc Thai. 2015 Apr;98(Suppl3):S81–90. 15. Li W, et al. Characteristics of internet addiction/pathological internet use in U.S. university students: a qualitative-method investigation. PLoS ONE. 2015 Feb 3;10(2). doi: 10.1371. 16. Ibid. 17. Lemola S, et al. Adolescents’ electronic media use at night, sleep disturbance, and depressive symptoms in the smartphone age. J Youth Adolescence. 2015;44:405–18. https://doi.org/10.1007/s10964-014-0176-x. 18. Hysing M, et al. Sleep and use of electronic devices in adolescence: results
from a large population-based study. BMJ Open 2015;5: e006748. doi:10.1136/ bmjopen-2014-006748. 19. Bailin A, et al. Health implications of new age technologies for adolescents: a review of the research. Curr Opin Pediatr. 2014 Oct;26(5):605–19. 20. Bulletin of Educational Psychology. 2008;39(3):355–76. 21. Primack BA, et al. Association between media use in adolescence and depression in young adulthood: a longitudinal study. Arch Gen Psychiatry. 2009;66(2):181–88. doi: 10.1001/archgenpsychiatry.2008.532. 22. Bickham DS, et al. Media use and depression: exposure, household rules, and symptoms among young adolescents in the USA. Int J Public Health. 2015;60(2):147–55. 23. Grøntved A, et al. A prospective study of screen time in adolescence and depression symptoms in young adulthood. Prev Med. 2015 Dec;81:108–13. doi: 10.1016/j.ypmed. 2015.08.009. 24. Romer D, et al. Older versus newer media and the well-being of United States youth: results from a national longitudinal panel. J. Adolesc. Health. 2013 May;52(5):613–19. doi: 10.1016/j.jadohealth.2012.11.012. 25. Tonioni F, et al. Internet addiction: hours spent online, behaviors and psychological symptoms. Gen Hosp Psychiatry. 2012 Jan-Feb;34(1):80–87. doi: 10.1016/j.genhosppsych. 2011.09.013. 26. Anderson CA, et al. Violent video game effects on aggression, empathy, and prosocial behavior in eastern and western countries: a meta-analytic review. Psychol Bull. 2010 Mar;136(2):151–73. doi: 10.1037/a0018251. 27. Kaplan, A. Violence in the media: what effects on behavior? Psychiatric Times. 2012;29(10). http://www.psychiatrictimes.com/child-adolescent-psychiatry/violencemedia-what-effects-behavior. 28. East S. Teens: This is how social media affects your brain. Updated August 1, 2016. https://www.cnn.com/2016/07/12/health/social-media-brain/index.html. 29. Healy J. Early television exposure and subsequent attention problems in children. Pediatrics. 2004;113(4):917–18. 30. Twenge J. Increases in depressive symptoms, suicide-related outcomes, and suicide rates among U.S. adolescents after 2010 and links to increased new media screen time. Clin. Psychol. Sci. 2018;6:3–17. doi:10.1177/2167702617723376. 31. Anderson J. Even teens are worried they spend too much time on their phones. Published August 23, 2018. https://qz.com/1367506/Pew-research-teens-worried-theyspend-too-much-time-onphones.
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1 in 37 BOYS develop autism
An estimated one-third of people with autism are nonverbal.
As many as one-third of people with autism have epilepsy.
Boys are four times more likely to be diagnosed with autism than girls.
Minority groups tend to be diagnosed later and less often.
In 2018
Early intervention can improve learning, communication and social skills.
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Children born to older parents are at a higher risk for having autism.
There is no medical detection for autism.
the CDC determined that approximately 1 in 59 children is diagnosed with an autism spectrum disorder (ASD).
https://www.autismspeaks.org/autism-facts-and-figures
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Most children are still being diagnosed after age 4, though autism can be reliably diagnosed as early as age 2.
Autism affects all ethnic and socioeconomic groups.
Nearly half of those with autism wander or bolt from safety.
1 in 1 GIR 51 LS
dev elo
pa
utis
m
GETTING
THROUGH INSIGHTS ON TREATING PEDIATRIC PATIENTS WITH AUTISM. A Shift interview with Amanda Smith, BCBA, and Mandy Ashley, DMD, MSEd, MS
All parents want to feel assured their children will be accepted, treated kindly, and regarded with understanding. But let’s face it, children are complicated! For parents nurturing a developing child, life may seem like riding a rollercoaster—an emotional journey with many twists and turns. We’re all acquainted with toddler tantrums, hormonal tweens, and embarrassed teenagers. Now what happens when we throw some autism into the mix? In this issue, Shift magazine’s editor sits down with Amanda Smith, a board-certified behavior analyst, and Dr. Mandy Ashley, a pediatric dentist, to discuss therapeutic approaches to helping pediatric patients with autism spectrum disorder. They also provide supportive suggestions for parents of autistic children to help them overcome the anxiety associated with medical and dental appointments. In addition, they bring awareness to the community that treatment needs to be given with understanding and inclusion.
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HIFT INTERVIEWS AMANDA SMITH, BCBA
SHIFT: Where are you currently employed and what is your role?
AS: I currently work for a local county Office of Education where I am the sole Board Certified Behavior Analyst (BCBA) overseeing approximately 24 separate county programs consisting of autism classrooms, adult programs, preschools, and day classes for moderate/severe special needs individuals. I prefer to train the trainers on behavior management so they can confidently manage behavioral crises without hesitation and then they, too, can educate and train their staff. SHIFT: Please explain briefly for us what autism is and how it affects children. AS: Autism is a spectrum disorder characterized by social and communication deficits as well as behavioral excesses, including sensory processing and dysregulation. A child with autism is often misunderstood as a disobedient child or one that just “needs a little discipline.” However, the brain is just so much more complex than that. A neurotypical individual accepts information into their brain constantly (think of your five senses) and interprets that information in ways that are generally socially appropriate. For individuals with autism, however, information that enters their brains is often interpreted in a way that comes off as socially “inappropriate.” For example, if an autistic child hears an emergency siren at a distance, they may begin to scream loudly. When neurotypical individuals observe this behavior, they do not understand why this child is screaming, and perhaps they can’t even hear the siren themselves. Individuals with autism often benefit from modified sensory input—whether physical touch or tactile, noise levels, lights, etc.—increasing or decreasing the amount of stimuli to help them feel more regulated. SHIFT: Do you have any current statistics on the number of children with autism? Is the frequency of the disorder on the rise, and is it true that autism is more common in boys than in girls? AS: According to the Centers for Disease Control (CDC), autism is on the rise. In 2000, one in 150 children were diagnosed as autistic, rising to one in 69 in 2012. Currently, one in 59 children are diagnosed with an autism spectrum disorder. Autism is reportedly four times more prevalent in boys than girls.
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SHIFT: When speaking with parents of children with autism, what have you found to be the biggest challenges that these parents face on a day-to-day basis, especially when they have a medical or dental appointment scheduled? AS: Children on the autism spectrum can’t always communicate their wants or needs appropriately and will often use another means to communicate. Screaming, crying, flopping, thrashing their body, eloping, and aggression are just a few of the behaviors that I’ve been asked to help parents manage when in public settings. The amount of physical, emotional, and mental energy it requires for parents to get through a shopping trip with an autistic child (not to mention the stares or judgmental comments they may receive from bystanders) can be so exhausting that they just don’t want to do it anymore. When arranging medical and dental appointments, most parents have reported long waits, required advanced scheduling, difficulty with rescheduling, or cancelling of appointments. They also report difficulties when facing an emergency or an unexpected event. Parents have often cited the need to leave appointments early due to challenging behaviors in the lobby. SHIFT: When dealing with stressful situations, what are some of the most common behaviors that children with autism exhibit? AS: “Tantrum” behaviors are common. These look very different from child to child, but may include yelling, screaming, crying, flailing, and flopping to the ground. Aggression is also very common—hitting, pulling hair and clothing, kicking, and biting. Children may curse loudly or say other inappropriate things in an effort to escape the situation. Self-injurious behaviors (SIB) are very common. These can range from mild to severe head banging (with hands or against a hard surface), biting, scratching, or pulling their hair out. Elopement from the situation, often by running through the parking lot or out of the building, is also quite common.
I ENCOURAGE ROLE PLAYING SO THE CHILD CAN GET AS MUCH EXPOSURE AS POSSIBLE TO A NEW SITUATION.
Parents often give in to these escape-maintained behaviors due to safety concerns, feeling embarrassed, or being judged by others. SHIFT: In pediatric dentistry, we often use the “tell, show, do” approach to help desensitize children to the dental environment. Does this approach work well with the autistic patient, or are there modifications to this approach that would work better for autistic children, especially those with sensory issues? AS: I encourage role playing so the child can get as much exposure as possible to a new situation. Children with autism may have difficulty generalizing concepts; however, if a child can visit a new facility (outside of an appointment), this is ideal. Desensitizing them to the sounds, smells, noise, etc. is very important. Even if the experience is not “perfect” (because it never is), it gives parents peace of mind that at least an attempt was made to avoid troublesome outcomes, and then they can predict more of their child’s response. Using social stories is also a common strategy used to help children understand what behaviors will be expected and what the outcomes will be in specific situations. SHIFT: When working with an autistic patient, what are three or four different techniques that would be helpful to use in managing behavioral difficulties in clinical situations? AS: Know the child’s likes/dislikes prior to his/her visit. The child may prefer noise-cancelling headphones, dim lighting, soft music, access to fidget tools (like squishy balls, spikey balls, pin-impression toys, light-up toys, etc.), access to movement breaks (like jumping, running, or spinning in the doctor’s chair), pillows/bean bags, or weighted blankets. Know how much pressure or physical touch the child likes. SHIFT: Many offices will separate children from their parents if cooperation is becoming a problem, especially when the parent’s response tends to escalate the child’s behavior. How important is it when treating autistic children to involve their parents, and is there ever a good reason to separate autistic children from their parents? AS: I would always suggest a parent be with their child. It is hard enough on the child to be in an unpredictable setting, but taking the only familiar person away from them creates the possibility of increased behavioral challenges. Parents can learn a lot from the doctors, especially if they will help make the experience more individualized to their child’s needs, giving them the space and time they may require and taking a genuine and compassionate approach to treatment
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HIFT INTERVIEWS Mandy Ashley, DMD, MSEd, MS
SHIFT: You are such a high-energy person and so passionate about dentistry. What was the catalyst that created your passion, and why do you have such an interest in the underserved, autistic, and special needs communities? MA: I definitely feel that I have been lucky enough in my life to have gone this far with my education. It’s been a great privilege to have become a pediatric dentist, and that privilege comes with a challenge. My challenge is to always make sure I am helping people who have traditionally faced obstacles to receiving adequate dental care. The special needs community also consists of amazing parents and caregivers. Their unselfish devotion to their children’s health inspires me to break down, wherever possible, the barriers to healthcare access so that their life might be, in some small way, a little easier because going to the dentist is a fun and comfortable experience. SHIFT: Knowing that the prevalence of autism is increasing rapidly, what were some of the things you did when building your new offices in anticipation of this fact? MA: Creating a special dark, starry room helped differentiate my office. I wanted to let the special needs community know my practice was designed with every child in mind. While I was still in the design and planning process for my first office, I met with our local center serving children on the autism spectrum. I discussed how I could create a dental treatment environment that mimicked a sensory room and provided autistic kids with a way to become more relaxed during a dental exam and cleaning. The sensory rooms that I created in my offices have starlighted ceilings and dark calming walls with quieting acoustic tiles. We use the Midwest cordless prophy handpiece for cleanings and a lighted Dent-light style mirror for the exams. This minimally invasive technique has helped us avoid OR visits every six
Developmental regression, or loss of skills, such as language and social interests, affects around one in five children who will go on to be diagnosed with autism. This typically occurs between ages 1 and 3.
months for even severely autistic children and helped hundreds of kids in our area get desensitized to their dental visits to the point where they are no longer coded as a special patient in our system because they have “graduated” to scheduling regular dental visits in a regular dental chair.
Special dark, starry-sky treatment rooms mimick sensory environment and provide autistic kids with a way to become more relaxed during a dental exam and cleaning.
SHIFT: What protocol have you adopted, or do you have any procedures in place to streamline your appointments with special needs patients? MA: Because I designed my newest office myself, I had the freedom to create whatever I wanted. I designed it to accommodate a “Roll Up, Call Up” appointment system. Parents of children with special healthcare needs that may be disturbed by a busy waiting room, or children needing to limit their exposure to others because of their immunocompromised condition, can park in the back of the office in one of three designated “Roll Up, Call Up” parking spots. Once there, the parent calls the number on the posted sign and a SKY team member will bring out any necessary paperwork if they have not already filled it out online using our secure patient portal. The SKY team member will have the child’s exam or treatment room ready and will escort the family through a private entry directly into their treatment room, skipping the lobby entirely. Our families with severely autistic children, children in wheelchairs, and children undergoing chemotherapy or immunocompromised status love this option of skipping past the front desk and having a conciergelike experience at the dentist. We have had so many parents thank us profusely and say that this is what they would love to see across all of their healthcare experiences. Simply having the “Roll Up, Call Up” system in place has enabled me to treat kids and adults that might pose a danger to themselves or others in the waiting room. SHIFT: Providing this type of concierge service—the private entrances, the additional support—is very impressive. What is your motivation for providing this type of specialized care? MA: This is something we wanted to do because we wanted to respect our patient families. This system allows us to see both kids and adults, because some adults with behavioral issues cannot handle the waiting room either. It just takes that worry completely off of the parents’ and caregivers’ minds, knowing they will be ushered directly into a comfortable treatment area right away. 68
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SHIFT: How important is repetition and consistency when scheduling appointments with patients with autism? Do you always schedule the same assistant, room, etc.? MA: If a child has done exceptionally well with a particular assistant or hygienist, we will note that in our record and try to have the same person with the child for the next appointment. But the vast majority of our patients with autism are comfortable with interchangeable staff because the flow of the appointment is the same. The flow of the appointment becomes the consistent part. SHIFT: Do you have any advice for dentists that are not sure how and when to schedule their patients? What are some of the protocols you have put into place that make scheduling treatment easier for your staff, patients, and caregivers? MA: Initially you could block an hour of hygiene time for kids with special healthcare needs. Start your appointments 15–20 minutes early to allow the child to arrive and “settle in.” Like most young kids, behavior can deteriorate during the day, so you might want to initially block off your last appointments of the day. As your staff gets comfortable and kids see less “deer in the headlights” fear in your staff members’ eyes, you can open appointments later in the day for children with special healthcare needs. We have also found that many preschool children may not have a diagnosis yet, but are already exhibiting challenging behaviors. We ask the parents, “Are there any behavioral concerns you have about your child’s first dental visit?” It’s been very helpful to know if a child is being evaluated for autism before the first visit. Parents may be more willing to disclose their concerns when asked directly, especially if they have not yet received an official diagnosis. Before we started asking this question, we were presented with more than a few surprises with difficult behaviors in our more open areas. Now we are able to start appointments for kids with behavioral concerns in a more private area, right from the start.
I wanted to let the special needs community know my practice was designed with every child in mind. We don’t have any restriction on the time or day that parents are allowed to book an appointment, but we do highlight their special healthcare needs status in our Dentrix schedule. After the practice had been open for a couple years, we were getting so many new families with kids on the autism spectrum that we had one morning with eight new severely autistic children, and that did create a slight amount of mayhem with my staff and me trying to get all of the autistic children and our other patients seen in the most timely, comfortable, and accommodating manner possible. After that special morning, we created a system where records of patients with special healthcare needs requiring additional doctor time are flagged with a purple color in our patient management system. Our staff knows to stagger these purple appointments throughout the day so that we can continue to flow with all of our appointments in a timely manner and increase the comfort level of all patients. SHIFT: When treating a patient with autism, what are some techniques you use to manage behavioral outburst, and are there any times when you cancel patients or reschedule them because of these behaviors? What do these interventions look like in your practice, and is there ever a time when it is best not to have a caregiver present? MA: I like parents or caregivers to be present whenever possible. The only times I have parents stay out of the room when treating autistic children is when the parent has requested it. Now that my
practice is seven years old, we are seeing teenage autistic patients who have been coming to us from the beginning, and we have some families who use our appointments to help build confidence and independence skills. The parents trust that continued positive dental visits will help foster more independence and confidence in their child. Sometimes kids are just having a bad day. We try to coach parents to not stack other appointments on top of a first dental visit. But it happens sometimes anyway. If a child is screaming and fighting their parent coming in the door and we see the Band-Aids from recent shots, we do offer to reschedule, providing the option of a different day and an appointment earlier in the morning when we have a fresh start behaviorally. Our practice referral area is about a 100-mile radius, so we have some families that want us to just push on and complete the visit despite a deterioration in behavior. We can pivot from a more traditional dental cleaning in a dental chair to a stand-up, cordless prophy in a “starry room” if parents prefer. I try to minimize the number of times we are exposing our children with special needs to general anesthesia experiences so we also offer immobilization if parents are present in the room and want to proceed in that way. SHIFT: Do you modify your “tell, show, do” desensitizing protocol for children with autism or sensory disorders? MA: Yes, we even have appointments on days with no provider present so that kids can essentially model their dental visit without ever having someone look in their mouths. It’s like a dry run or mock visit. These are scheduled on days I’m out of the office or working in the hospital. The whole office and even the parking lot is very quiet and low-key since there are no other patients. The child is able to have their mock X-ray taken, and they walk around the office finding animals hidden on the walls. We call it our Smile Safari. After completing the safari, the patients receive a prize, even if they only find one animal. The Smile Safari is a way for us to standardize the experience, especially for our staff, and it helps harmonize the experience for the patients. www. sp r ig u sa.co m / Fa l l 2 01 9
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SHIFT: Do you train your staff specifically on how to prepare for appointments with autistic patients and other special needs children? MA: We have an orientation, basically providing our staff with a check sheet that outlines a step-by-step plan on how to accommodate special needs kids and lead them through a Smile Safari. Our staff are trained how to do everything step-by-step. SHIFT: What items do you have in your office that can help prevent a behavioral outburst? MA: I feel like timing is everything when it comes to preventing outbursts. If we can get kids settled back in their room before they have time to become upset, we are starting off ahead of the game. We also have a lot of items like the Herman Miller rotating chair and Gaim bounce balls that help kids let off steam if they need to during their dental appointment. SHIFT: Would you please comment on the concept— some call it a “grandfathered tradition”—that you can only see autistic patients on certain days because special needs patients require longer appointments? MA: A lot of associates are told by an older dentist, “You know, it’s just not possible to see severely autistic kids, kids with wheelchairs, kids with Tourette’s syndrome, or kids with severe medical issues on the same day as “regular patients.” However, I have found that it is completely possible. We see so many kids with all of these healthcare needs, especially kids on the autism spectrum. They don’t take any longer— except maybe on the first visit. This mindset that you can only see special needs patients on certain days needs to go away. The trend is toward integration rather than some kind of “quarantine” that compartmentalizes these kids and assigns them a special time that they can be seen. People with special health needs need to be integrated into a regular schedule with the same access to healthcare as the general population. SHIFT: What advice would you give pediatric dental residents on treating autistic patients when they get into private practice, and what challenge would you give your colleagues in private practice on how to treat this unique and growing population? MA: I think residents should get all the experience they can during their programs. And don’t let your attending handle all of the communication with the parents. As a resident, you need to be able to directly communicate with families and learn what problems they have with accessing dental care. Ask the moms 70
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how it went with parking, getting to the dental clinic, getting through the door to the operatory, etc. You need to get a good idea of all the challenges these families are facing before you give them advice on better brushing techniques.
My challenge for newly minted pediatric dentists is this. Look at the practice you are joining or creating and define one way you can increase access for kids with special healthcare needs. It might be as simple as creating a way for families to wait in the car until their room is ready, or converting a “consultation room” to a “sensory room” to allow for a more relaxing nontraditional treatment environment. Become the healthcare provider that anchors the family of special needs kids to good experiences with easy access to care. On average, care of an autistic child costs an estimated $60,000 a year through childhood, with the bulk of the costs in special services and lost wages related to increased demands on one or both parents. Costs increase with the occurrence of intellectual disability.
OUR STORY The Guatemala Chapter by Cameron Quayle, DDS
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Above: Dr. Cam and his assistant Juanito taking digital radiographs for an orphan at Eagle’s Nest Orphanage in Solola, Guatemala.
It
all started quite innocently. While sitting in bed one night reading, I asked my wife a simple question while she brushed her teeth. “What do you think about moving our family to a developing country and doing humanitarian work for a year?” She looked at me, turned off her Sonicare, eyed me some more, and said, “OK!” She turned her toothbrush back on and kept brushing her teeth. As simply as that, our dream started to unfold.
OUR VISION
network of vans and buses which travel between towns. We wanted to solve this access issue by bringing our clinic to the people. With our mobile clinic we would be able to set up a comprehensive dental clinic anywhere we had a power outlet. Schools, orphanages, churches, or even open yards would serve as temporary clinic locations. We could provide radiographs using our laptop, a Dexis intraoral sensor and software, and a Nomad X-ray gun. Our portable dental units were equipped with highand low-speed handpieces, air/water syringes, as well as high-volume and low-volume suction.
We had travelled to Guatemala several times previously with different organizations providing dental services. During our previous visits, we had observed several different models of care, all of them helpful to the people they served, but very different in their vision and delivery. Some organizations chose to provide oral exams and fluoride but no additional treatment. Other groups would only treat patients with the worst teeth. While another group would extract the worst two or three teeth on each patient.
Even in remote areas, we would be able to sterilize our instruments by utilizing Statim autoclave devices. Thus, with the exception of not having nitrous and TV screens on the ceiling for the kids to watch, we would be able to provide the same level of treatment to patients in rural Guatemala as we had done in our modern offices in the United States.
We decided to develop a plan that would hopefully give us the opportunity to positively impact our patients’ lives for the long term. In addition to providing urgent dental care, our primary goal would be to educate patients how to prevent future decay. We wanted to treat our patients comprehensively, so we created a plan to utilize portable dental units and develop a mobile, fully equipped dental clinic.
VALUABLE PARTNERS
OVERCOMING OBSTACLES For the people of rural Guatemala, two major obstacles stand in the way of their receiving quality dental services. Affordability issues If individuals find work in rural Guatemala, they typically do manual labor, earning just $7–8 (US) per day. Such meager incomes must be used to provide necessities like food, housing, firewood, clothing, and clean drinking water. When your daily earnings are so sparse, dental services are considered an extravagance. However, because our proposed plan was to provide all of our dental care at no charge, this affordability dilemma would be solved. Access to care Many towns and villages in rural Guatemala do not have a dentist. When patients need acute care, they typically have to travel to the nearest town to find a dentist. Most people do not have their own vehicles, and their only choice is to hire a driver or pay to use a
When we arrived in Guatemala, no one was providing the type of dental care we were proposing, and we were confident the people would benefit from this new model of care.
In addition to adopting our comprehensive service model, we wanted to provide our patients with the best products in the world. We partnered with Sprig to provide anterior pediatric Zirconia crowns to some of the poorest children in the world. The results are spectacular! Happy, smiling kids with beautiful Sprig smiles. Other dental suppliers also helped us assemble our portable dental units, complete with portable dental chairs and other essential dental equipment, instruments, and materials. Even though for a few weeks we have had large groups of people assisting us in providing care, our typical team is small. Our regular dental team consists of myself, my wife, our four children (ages 14, 11, 9, and 5,) and two Guatemalans we trained as dental assistants.
“With the exception of not having nitrous and TV screens on the ceiling, we would be able to provide the same level of treatment to patients in rural Guatemala as we had done in our modern offices in the United States.” www. sp r ig u sa.co m / Fa l l 2 01 9
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Photo#1: Doctor Luz, Guatemalan anesthesiologist, and Dr. Cam in the OR in Monte Mercedes, Guatemala. Photo #2: Charly, our 11-year-old daughter, playing with an orphan while she waits for treatment. Photo #3: Dr Cam extracting a tooth while Jack, our 9-year-old son, assists. Photo #4: Dr. Cam and Mandee working on two crowns while an orphan scrolls through Mandee’s photos.
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#3 each week. We want to show them that the world is a big, exciting place, and each of us has the ability to change it for the better in some way.
HOW WE PREPARED Photo #5: A little boy in Santa Lucia, Guatemala, excited to get his oral hygiene kit at one of “Mason Gives” community screenings. Photo #6: Charly, our 11-year-old daughter, finishing up a prophy with some flossing. Photo #7: Dr. Cam, Juanito (our Guatemalan assistant), and Shelby (an assistant from our o ce in the U.S.) working in the OR in Monte Mercedes, Guatemala. Photo #8: Dr. Cam screening patients at ADISA, a specialneeds school in Santiago Atitlan, Guatemala.
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WHY WE DO IT You may be asking why we choose to do this? Excellent question. Why would we choose to leave our busy practices, the amazing recreation available in our home state, and our stable lives to jump into the unknown? It’s all about the story. We teach our kids that we are the authors of our own stories. We can choose to write something common, predictable, and safe, or we can choose to w r i t e s o m e t h i n g exc i t i n g, n e w, a n d adventurous in the chapters of our lives. It is up to us what we write. We want to lead our children by example and show them that mom and dad want more from life than working in a dental practice
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Mason Gives (a non-profit, fund-raising organization) started unassumingly with a friend setting up the legal entity and another friend donating his time to build our website— w w w. m a s o n g i v e s . c o m . Initially, we reached out to dental companies whose products we used on a daily basis. After explaining to them our purpose and goals, we gladly accepted donations of equipment and supplies offered to us by large and small dental suppliers across the country. These donations provided the crucial core of required dental equipment that has helped turn our
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Photo #9: Dr. Cam practicing his intubation technique in Panajachel, Guatemala. Photo #10: Dr. Cam posses with some of the women from the community in Panajachel, Guatemala. Photo #11: Charly and Jack watching their Dad, Dr. Cam, extract teeth on a local woman in Choquec, Guatemala. Photo #12: Juanito and Dr. Cam with a patient in Solola, Guatemala. Photo #13: Mandee showing an orphan what her new crowns look like at Eagle’s Nest Orphanage.
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In November, prior to our departure, we started a campaign targeting our followers on social media, hoping to raise $10,000 to help cover general anesthesia expenses for the young children we would be caring for. The response during “Mason Gives Month of Thanksgiving,” as we called it, was miraculous. By the end of the month, we had raised over $18,000 from our supporters. With individual donations ranging from $5 to $5,000, we had raised the necessary resources, allowing us to treat the young children who would be coming to our clinics.
“We wanted to show our kids by example that each one of us has the ability to change the world for the better in some way.”
DAY-TO-DAY LIFE One of our favorite things resulting from adopting a portable clinic model is being able to experience www. sp r ig u sa.co m / Fa l l 2 01 9
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something new and different each day. Every town has a different feel to it. Each school, orphanage, or church has different resources. Some days my daughter sets up trays on a table. Other days she sets them up on the floor. Some clinics are held in classrooms; others are conducted outdoors. The local children are always curious about what we are doing. They stare through the windows and watch our every move as we X-ray and examine their friends. Many of them wear their best clothes on the day of their appointments. To them, experiencing the clinic is a big deal.
FACING CHALLENGES Our experience is not always easy. Nor is it always fun. Yet, we have never felt unsafe during our time in Guatemala—never. The residents in the rural towns in the Guatemalan highlands are simple people. They are also kind. We have shared moments that frightened us but never made us doubt our choice to come here. In the first few months after our arrival, our kids had to adjust to a new way of life. Some nights we heard them crying themselves to sleep because they missed their grandparents and their friends. At one time or another, we have had to deal with a blood infection, outrageous amounts of bug bites, or UTI infections from dirty water that kept our daughter out of commission for days. Another time, I had to carry my daughter to the nearby free clinic at 1:30 am because she was experiencing severe abdominal pain. Fortunately, a doctor was available at the clinic which is open 24 hours a day. Furthermore, the roads in our area are anything but smooth or straight. Gallon-sized Ziploc bags are regularly included as part of our standard packing list whenever we leave town because we know our kids will be throwing up from motion sickness. As hard as each of these trials has been for our family, they are a small price to pay for the privilege of experiencing the greatest thing we have ever done.
REAPING REWARDS It’s extremely difficult to sum up the rewards we have received as a family. Occasionally, a mother might bring us fresh mangoes as thanks for the surgery performed on her son the day before. Other times, grateful parents will invite us into their homes to share dinner with their family. Countless parents express enormous amounts of gratitude for the care we provide for their children. As rewarding as these expressions of thanks may be, they are not my favorite memories. The moments that
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mean the most to me are those spent simply sitting and doing exams at our portable clinics. These times give me an opportunity to observe my wife and 14-year old daughter taking X-rays of children’s teeth while my 11year old daughter sits at my side charting and my boys play Matchbox cars with the children waiting their turn for treatment. During moments like these, I realize we are doing more than just practicing dentistry. We are actively and positively involved in shaping our children’s minds, perceptions, and futures. They will never look at the world the same again. I can’t think of anything more rewarding than coming to this realization.
LIFE-CHANGING IMPACT We are exposed to situations almost daily that are new, uncomfortable, and yet exhilarating. We come in contact with countless people who are deciding to write a better story for themselves and their families. As you are exposed to these kinds of rewarding experiences and to these kinds of appreciative people, you start to look at life differently. You quickly realize that a big, exciting world exists out there. This world constantly surrounds us, but sometimes we need to step out of the mainstream in order to alter our perspective and prepare ourselves to respond to the needs of disadvantaged people in our world in a creative, caring manner.
WRITING A BETTER STORY When we take such action, we often face critically important questions. What kind of persons will we choose to be? Will we be honest, ethical, and compassionate? Will we follow the masses on the path of discontent and complacency, or will we choose to write something more invigorating, inspiring, and fulfilling? You’ll notice that we’ve mentioned “our story” several times in this article. At the end of the day or at the end of our lives, “our story” is all that really matters. For a year we’ve been committed to providing dental services to some of the poorest people on the planet. Hopefully, this Guatemalan chapter is just the beginning of writing a better, more meaningful story for our family. From the words of Donald Miller found in his book, A Million Miles in a Thousand Years, we learn this valuable lesson. “The truth is, if what we choose to do with our lives won't make a story meaningful, it won’t make a life meaningful either.”
#MASONG I VE S
A PERSONAL MESSAGE FROM DR. CAM This article may not describe your vision. But the question is worth asking. What is your vision? Are you pursuing it? We fully understand that living in a small town in the developing world providing dental services for some of the poorest people on the planet may not be your thing. That’s cool. But it is our thing. Now the question is, what is your thing? Have you thought about that? Have you defined it? Are you pursuing it? Are you putting it off because you’re too busy, your kids are too young, or you’re just not ready? We were scared to take the leap of faith and follow our hearts down a tiny unknown path. Nearly a year before we left for Guatemala, I convinced Mandee, my wife, we needed to postpone our departure date a few months while I prepared a few things at our practices. She agreed to move back our departure date, but then she said something that will stay with me forever. “If we postpone this opportunity and it never happens, I will be broken-hearted.” That’s certainly not the story we wanted to write. Thankfully, we decided instead to go for it!
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$500 Off an STA Unit Plus One Box of Each Needle Size Handpiece 27 Gauge with 1¼˝ Needle • 30 Gauge with 1˝ Needle • 30 Gauge with ½˝ Needle
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FO R A D D I T I O N A L I N FO R M AT I O N please visit: theWand.com or call: 800-862-1125 email: jfreeman@milestonescientific.com
ML-0266-013A
A LOOK BEHIND THE SCENE True leaders create their own content and that’s exactly what we do at Sprig. So remember, the beautiful pictures of smiling children in our ads are not stock photos, they’re all special because they’re all patients wearing EZCrowns.
SEE YOU IN
LAS VEGAS NOVEMBER 13–15, 2020
Bond with your entire team in Las Vegas, Nevada at our three-day CE event designed specifically for you! With the option to get your PALS recertification.
Sprig Oral Health Technologies, Inc. Nationally Approved PACE Program Provider for FAGD/MAGD credit. Approval does not imply acceptance by any regulatory authority or AGD endorsement. 5/1/2018 to 4/30/2022 Provider ID# 358727
Learn more at sprigusa.com/spriglive