One Reason to Take Care!

Anesthesia Shortages Impact Dentistry

The American Society of Anesthesiologists (ASA) reports that 98% of the respondents in an informal survey of its members said they now regularly experience anesthesia shortages at their institutions, and more than 95% said these shortages affect the way they treat their patients. Dentistry is being affected as well.

“The shortages are forcing anesthesia providers to use alternative sedation drugs,” said Jason R. Flores, DDS, RN, clinic director and director of dental anesthesiology for the University of New Mexico Medical Group’s Ambulatory Surgical Center and assistant professor of the school’s AEGD residency program.

“Some of these alternatives have narrower therapeutic indices, which translates to quicker apneic events, more profound bradycardia, and prolonged sedations in office,” said Flores, who also has Diplomate status with the American Dental Board of Anesthesiology and Fellow status with the American Dental Society of Anesthesiology.

Flores notes that Brevital, which is an alternative to propofol, is a barbiturate that causes quicker, more profound apnea. It is not for the novice provider, he added, calling it “almost too effective in sedation” and “a big sledgehammer for a nail.”

Fentanyl’s alternatives include remifentanil and hydromorphone. Remifentanil has a very quick onset and offset, and it is prone to quicker apneic events and increased incidence of chest wall ridgidity, Flores said.

“Hydromorphone can cause longer periods of obtunded breathing and can lead to more severe cases of apnea,” he added.

Multiple causes have been cited for the shortages, the ASA says, such as pharmaceutical company consolidation and a vulnerable supply chain including Drug Enforcement Agency production limits. Also, key supplies of these drugs are limited to a single manufacturer. The ASA further notes a lack of backup production and reliance on a production facility in Puerto Rico that was damaged during Hurricane Maria.

“Shortages can be artificial, such as a run on fentanyl by the public when they think they are going to run out, or caused purposely by drug companies to artificially inflate the prices,” Flores said. “Or they can be real, such as a true shortage of ingredients, or a disaster that eats up the remaining supply.”

While drug shortages occur cyclically, the current crisis appears to be more significant to the ASA, which has made addressing it a priority. The group aims to use the results of its survey to increase understanding of the issue among regulatory organizations and policymakers.

“ASA spends countless hours working with Congress and leading drug shortage stakeholders as well as collaborating with federal agencies on solutions to combat this important problem,” said ASA president James D. Grant, MD, MBA.

“But we’ve been told by some policymakers that they could use more information and detail about how this is affecting our specialty and the way we care for our patients,” Grant said. “The survey gives real life details to how these shortages are affecting our patients as well as the concerns our patients have about their recovery and postoperative pain.”

In the meanwhile, dentists need to cope with the shortages while ensuring their patients’ care isn’t compromised. Flores encourages sedation providers to become “extremely well versed in a wide range of sedatives and rescue from them.” He also notes that there are institutions and groups such as the American Society of Dentist Anesthesiologists that provide opportunities for clinicians to learn more about dental anesthesia.

“There are residencies, such as dental anesthesiology or oral surgery,” he said. “There are national organizations that hold yearly meetings, and there are training facilities that offer more in-depth courses specifically designed for dentists at all levels.”


We Are Grateful…

…for your sacrifice! Those who served, and their loved ones who also sacrificed that we may live in freedom and liberty. Thank you!0dd57e08-7763-4211-923c-67a32a618adf-original

Maybe We Should Just Let Them Whine

baby-teething-1WASHINGTON — Federal health officials warned parents Wednesday about the dangers of teething remedies that contain a popular numbing ingredient and asked manufacturers to stop selling their products intended for babies and toddlers.

The Food and Drug Administration said that various gels and creams containing the drug benzocaine can cause rare but deadly side effects in children, especially those 2 years and younger.

The agency has been warning about the products for a decade but said reports of illnesses and deaths have continued. Now, it wants teething products off the market, noting there is little evidence they actually work.

“We urge parents, caregivers and retailers who sell them to heed our warnings and not use over-the-counter products containing benzocaine for teething pain,” said FDA Commissioner Scott Gottlieb, in a statement.

The FDA said it will take legal action against companies that don’t voluntarily remove their products for young children. Manufacturers are expected to comply as soon as possible.

Benzocaine is also used in popular over-the-counter products for toothaches and cold sores in adults, including Orajel and Anbesol and generic drugstore brands. Products for adults can remain on the market but the FDA wants companies to add new warnings.

Benzocaine can cause a rare blood condition linked to potentially deadly breathing problems. The pain-relieving ingredient can interfere with an oxygen-carrying protein in the blood. Symptoms include shortness of breath, headache and rapid heart rate.

Teething products with benzocaine include Baby Orajel. The packaging states: “Instant relief for teething pain.”

New Jersey-based manufacturer Church and Dwight Co. Inc. said Wednesday it would discontinue four Orajel teething brands, including Orajel Medicated Teething Swabs.

“We are not discontinuing other Orajel products, which represent the majority of our Orajel offering,” the company said in an emailed statement.

The American Academy of Pediatrics does not recommend teething creams because they usually wash out of the baby’s mouth within minutes. Instead, the group recommends giving babies teething rings or simply massaging their gums to relieve pain.

The FDA issued warnings about the teething products in 2006, 2011 and 2014, but it did not call for their removal from the market. Officials reviewed 119 cases of the blood disorder linked to benzocaine between 2009 and 2017, including four deaths, according to the FDA.

The Associated Press Health & Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

Did you know?

From the Mayo Clinic Staff – Oral health: A window to your overall health Your oral health is more important than you might realize. Get the facts about how the health of your mouth, teeth and gums can affect your general health. By Mayo Clinic Staff Did you know that your oral health offers clues about your overall health — or that problems in your mouth can affect the rest of your body? Protect yourself by learning more about the connection between your oral health and overall health. What’s the connection between oral health and overall health? Like many areas of the body, your mouth is teeming with bacteria — most of them harmless. Normally the body’s natural defenses and good oral health care, such as daily brushing and flossing, can keep these bacteria under control. However, without proper oral hygiene, bacteria can reach levels that might lead to oral infections, such as tooth decay and gum disease. In addition, certain medications — such as decongestants, antihistamines, painkillers, diuretics and antidepressants — can reduce saliva flow. Saliva washes away food and neutralizes acids produced by bacteria in the mouth, helping to protect you from microbial invasion or overgrowth that might lead to disease. Studies also suggest that oral bacteria and the inflammation associated with periodontitis — a severe form of gum disease — might play a role in some diseases. In addition, certain diseases, such as diabetes and HIV/AIDS, can lower the body’s resistance to infection, making oral health problems more severe. What conditions may be linked to oral health? Your oral health might contribute to various diseases and conditions, including: Endocarditis. Endocarditis is an infection of the inner lining of your heart (endocardium). Endocarditis typically occurs when bacteria or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart. Cardiovascular disease. Some research suggests that heart disease, clogged arteries and stroke might be linked to the inflammation and infections that oral bacteria can cause. Pregnancy and birth. Periodontitis has been linked to premature birth and low birth weight. Certain conditions also might affect your oral health, including: Diabetes. Diabetes reduces the body’s resistance to infection — putting the gums at risk. Gum disease appears to be more frequent and severe among people who have diabetes. Research shows that people who have gum disease have a harder time controlling their blood sugar levels, and that regular periodontal care can improve diabetes control. HIV/AIDS. Oral problems, such as painful mucosal lesions, are common in people who have HIV/AIDS. Osteoporosis. Osteoporosis — which causes bones to become weak and brittle — might be linked with periodontal bone loss and tooth loss. Drugs used to treat osteoporosis carry a small risk of damage to the bones of the jaw. Alzheimer’s disease. Worsening oral health is seen as Alzheimer’s disease progresses. Other conditions that might be linked to oral health include eating disorders, rheumatoid arthritis, head and neck cancers, and Sjogren’s syndrome — an immune system disorder that causes dry mouth. Because of these potential links, tell your dentist if you’re taking any medications or have had any changes in your overall health — especially if you’ve had any recent illnesses or you have a chronic condition, such as diabetes. How can I protect my oral health? To protect your oral health, practice good oral hygiene every day. For example: Brush your teeth at least twice a day with fluoride toothpaste. Floss daily. Eat a healthy diet and limit between-meal snacks. Replace your toothbrush every three to four months or sooner if bristles are frayed. Schedule regular dental checkups and cleanings. Avoid tobacco use. Also, contact your dentist as soon as an oral health problem arises. Taking care of your oral health is an investment in your overall health.

Thinking first about what you might be considering, is a good idea!


Hi Kevin. You can quote me anywhere you want with this.

Bob Wartell (DDS)

One Visit Crowns and Onlays
I have purchased the CEREC CAD-CAM crown machine, and attempted to use it for my patients. My goal was to save patients from having to come in for a second appointment, and to lower my laboratory cost for providing crowns. After several months of taking seminars and learning to use the CEREC, I came to the realization that the CEREC single-visit crowns I was able to make were not as strong, did not fit as well, and did not look as natural as those that a good laboratory technician is able to provide for my patients. I was very disappointed by this, and thought that if I learned more about using the CEREC system, the results would be satisfactory.
To improve my skill at making CEREC crowns, I attended even more seminars. At one of these, a 2 day, hands-on training, the instructors told me I was the I was better at designing crowns using the CEREC software than any other dentist they had taught. I even spent a day observing at the office of a dentist in Arizona who told me he had made 6,500 CEREC restorations for patients. During that day he confided to me that if he were making a crown for his wife, and it was in an area that was visible in her smile, he would have it made at a custom laboratory using traditional techniques. But the CEREC crowns were good enough for his ordinary patients. I do not have two classes of patients. Every patient in my office deserves what I would do for my wife, and CEREC is not good enough for her.
Since then, I have seen many CEREC restorations in the teeth of patients new to my practice. Most of them are totally unacceptable. If they were made by a dental school student, instructors would not permit them to be placed in the mouth. My supposition is that the dentists who made these restorations did not have the time to make them fit properly, and under time pressure, elected to cement them onto the teeth.
I can offer crowns made of all materials – all ceramic with no metal, ceramic supported by metal, and all gold. The choice will be made by what is best for each patient, for a combination of health, esthetics, and durability, as well as patient desire. The crowns are made by excellent technicians, using the highest quality materials. There are no shortcuts and no compromises. You will receive what my wife would receive, the best that I am able to do.
We enjoy answering your questions. For more information,
please call us at 505-474-4644
Center For Dental Medicine
2019 Galisteo St. Suite A
Santa Fe, NM 87505

We Are the Artisans

Second Nature Dental Arts is your one source for the professional artisan service uniquely equipped to sculpt your new smile. We are the artisans who match the shade and sculpt the porcelain or wax into the natural shape matching your own teeth.