E-Prescribing is Here!

A year ago New York State passed a bill requiring that all prescriptions for controlled and non-controlled drugs that are issued by medical and dental practitioners to pharmacies be submitted electronically. Practitioners asked for a delay but now as of March 27, 2016 the New York State requirement has taken effect.  We updated our software last year to include e-prescribing so we have been on-board for a year. I love e-prescribing! It is easy to transmit a prescription electronically with our software and e-prescribing protects the patient.  We can check dosages and history for a given patient – errors are much less likely.

This electronic prescribing requirement is intended to address the misuse of controlled drugs. Electronic prescribing software provides us with a more complete picture of a patient’s prescription history, in addition to options and doses. Prescriptions are transmitted immediately to the patient’s pharmacy to be filled. This will eliminate errors resulting from poor handwriting or a misunderstanding.  Electronic prescriptions are tamper-proof and stolen prescription pads will not be accepted. E-prescribing software improves drug safety by enabling the dentist to automatically check drug dosges, adverse reactions and duplicate drugs. Access to the patient’s medication history is available to us on the spot.  Our e-prescribing software is linked to our Dentrix practice management system. It is seamless.

There are times when electronic transmission is not practical and then paper prescription pads may be used. For example a prescription that will be filled by a patient in a state other than New York will require a paper script.  Another example might be a power or Internet failure.

We are compliant. The future is here!


Last spring a young woman came to our East Setauket office for dental care and – as I always do – I asked about her smoking history.  Smoking is strongly correlated with gum disease, loss of teeth, and oral cancer – so smoking history is a question I always ask.  She answered that she smoked electronic cigarettes.  The electronic cigarette?  What was that? I had never heard of it!

After that incident I read up on the device.  Electronic cigarettes satisfy the nicotine addiction but without inhaling the toxic chemicals that are found in tobacco smoke.  The e-cigarette turns liquid nicotine into a vapor which is inhaled by the individual.  The liquid comes in many flavors, such as mint or bubble gum, pina colada or peach.  But unlike skin patches and nicotine gum, these e-cigarettes have not been evaluated for effectiveness or for safety.  Nevertheless sales of e-cigarettes have been on the increase in the U.S. and in Europe.  European Union regulators are planning to regulate the device with greater vigor, starting in 2016.

E-cigarettes might be safer than inhaling tobacco smoke – a known carcinogen.  But there are still risks.  Nicotine is addictive and there are quality control problems at e-cigarette manufacturers.   There is also the concern among health officials that youngsters may begin with e-cigarettes and then progress to regular cigarettes.  The FDA needs to step up its regulation of e-cigarettes by considering a ban on flavorings that appeal to youngsters and a ban on sales and marketing to minors.   The electronic cigarette manufacturer, Lorillard Technologies, placed an ad in Sports Illustrated with a warning that “these are not a smoking cessation product and have not been evaluated by the Food and Drug Administration, nor are they intended to treat, prevent or cure any disease or condition.”  Another ad stated “WARNING: This product can cause mouth cancer.”

We need studies on the correlation of e-cigarettes and gum disease.  Let’s not replace one unhealthy habit with another.

As many people are now aware, a Tulsa, Oklahoma dentist (not a Port Jefferson dentist!) is being investigated for neglecting to follow appropriate infection control methods and for improper management practices.  Patients of that practice are being tested for HIV.

Please be assured that the safety of the patients in our practice is of paramount concern to us.  We follow the most stringent infection control procedures.  I only delegate procedures to licensed and qualified staff.  All staff scrub their hands before every patient.  We use appropriate protective garb: gloves, eyewear, masks, gowns.  We use new gloves and masks for each patient.  All surfaces in the examining room are cleaned and decontaminated after each patient visit.  Dental instruments that are not disposable are cleaned and sterilized in between patients.  We use an up-to-date autoclave which utilizes steam under pressure.  Disposable sharps, including needles and burs, are placed in special containers for monitored disposal.

Please visit the American Dental Association website: http://www.mouthhealthy.org for more information on infection control, as well as other dental topics of interest.  We are also happy to answer any questions you may have and you are invited to take a tour of our very clean office.

April is National Facial Protection Month.  It is the time for dentists to remind people about using safety devices to protect their face, head, and mouth against injuries.  Mouthguards should be worn while engaging in any sport that could involve injury, such as basketball and volleyball, as well as football and hockey.  Several years ago I treated an adult hockey player who played for a Long Island hockey team. He had all of his front teeth knocked out.  He then recommended me to the rest of his team.  I saw so many dental injuries that could have been prevented with a mouthguard.  Helmets are also crucial to reduce the risk of head and brain injuries.  And don’t forget protective eyewear and face shields when appropriate.  A mouthguard usually covers the upper teeth and can cushion a blow to the mouth, limiting the risk of fractured teeth and soft tissue injuries.  A properly fitted mouthguard stays in place and allows the user to talk an breathe easily.

The ADA has more information on mouthguards at http://ada.org/2970.aspx including discussion of dental emergencies and the advantages and disadvantages of stock, boil-and-bite, and custom fitted mouthguards.  Also look at my blog entry about mouthguards.



Athletic Mouthguard

We were about to take xrays on a patient today when she asked if we had heard about the recent Dr. Oz show in which he spoke about the increase in thyroid cancer among women.  No, we hadn’t heard about it.   Apparently Dr. Oz linked thyroid cancer to dental xrays and mammograms.  I haven’t been able to find any serious studies linking dental xrays to thyroid cancer, but that is beside the point.  The patient understood the importance of the dental xrays we were about to take, but she wanted to know if we used a thyroid guard (thyroid collar).  Yes, we assured her that we do use a thyroid guard (collar).  We placed the guard, just as we always do to assure maximum protection for our patients.  The American Dental Association recommends that a thyroid guard be placed for all dental xrays.

There are lots of ways that tooth enamel can become worn.  Abrasion and erosion are two ways.  But I just learned two new terms: “fruit mulling” and “soda Swishing.”

Fruit mulling refers to excessive chewing of fruit.  That is, keeping the fruit in your mouth for minutes at a time.  The acid in the fruit eats away at the dental enamel.  Soda swishing refers to excessive swishing of soda – keeping soda in the mouth for minutes at a time.  One victim of soda swishing was apparently trying to cut down on his habit of drinking 9 bottles of Coke a day, so he hoped that by swishing, he would reduce his consumption of the drink.  It may have reduced his consumption, but he was keeping his teeth bathed in the sweet liquid and it destroyed his enamel.

Hasn’t everyone done the experiment of placing a baby tooth in a glass of coke to watch it dissolve?   I guess he didn’t learn this lesson.  So avoid swishing and mulling.

Harmful bacteria from a parent’s mouth can be passed to a baby’s mouth, putting the child at increased risk for dental decay.  Most American caregivers don’t realize that they can pass dental disease to their babies.   Streptocccus mutans bacteria is transferred when items contaminated with saliva enter the child’s mouth.  This can occur through shared food or eating utensils or through cleaning a baby’s pacifier in one’s mouth.  Americans often share utensils with their children but this passing of bacteria can lead to dental decay.

Babies are born without any harmful bacteria in their mouths but once bacteria colonize in their mouth, the child may be prone to decay.  If the parent has a history of poor dental health, he/she is more likely to pass these harmful germs.  So practice good oral hygiene and keep your children’s teeth healthy!

Remember the cold metal chain placed around the back of your neck before a dental procedure?  Well this chain that clips onto a patient’s paper bib to hold it in place has recently been under attack.

The dental chain can harbor potentially harmful germs.  A study at the University of North Carolina School of Dentistry found that one out of 5 bib chains that they tested were contaminated with bacteria.  The bacteria stems from saliva and dental plaque.  Cross-contamination is the spreading of bacteria and viruses from one surface to another – for example from the patient’s mouth through aerosols in the air to the dental bib chain.

We haven’t used the dental chain for several years.  Instead we use a disposable bib holder – safer for the patient and more comfortable as well.

Is your swimming pool safe for your teeth?  Did you know that if your pool chlorination level is not properly maintained it can cause erosion of dental enamel.  Proper pool chlorine and pH levels need to be monitored weekly.  If the pH of the pool water ranges between 2.7 and 7, the teeth enamel can erode due to contact with the water.

A recent clinical report by professors at NYU is based on a patient who presented with sensitive teeth, dark stains and rapid enamel loss.  The researchers concluded that the condition was a result of his 1 1/2 hour daily swim.  The patient did not use a professional pool maintenance service but maintained his own pool.

The Center for Disease Control and several dental journals have noted cases of enamel erosion due to excess swimming pool chlorination but this is an issue of which the public is largely unaware.  So check out your pool and save your enamel.

In my last dental blog post I spoke about the importance of the American Dental Association (ADA) Seal of Acceptance.  This Seal helps patients make informed decisions about choosing safe and effective consumer dental products.  In order to facilitate this process, the ADA has launched a new website www.ada.org/seal.  The website gives detailed information on all ADA Accepted products and it compares product attributes.  The website includes product information sheets as well as comparison pages that can be printed out for reference.

The ADA Seal program dates to 1931 when the first product was awarded its Seal.  In that year the ADA adopted guidelines that would enable it to evaluate dental products for safety and effectiveness.

While participation by oral care companies is voluntary, more than 300 dental products including toothbrushes, toothpaste, mouthwashes and dental floss carry the Seal today.  Dental professionals hold the Seal in high regard.  So visit this new website and compare oral products to be sure that you know what you are buying.