I remember growing up hearing people talk about exactly what they were doing the day President Kennedy was shot. It always amazed me that years later, people would so vividly remember where they had been and what they were doing. But that all changed with 9-11. I will never forget where I was or the experiences I had as a result of it.

The morning of September 11th, I was seeing a patient, and as was common at the office, we had the television on in the operatory. By the time we had gotten to work that morning, we’d already heard about the “accidental” plane crash into one of the towers, so we were watching the news to track what was happening. When we saw the second plane crash and realized it wasn’t an “accident”, we cancelled the day and started reaching out to family. My husband went to pick up our children, and I went to the Red Cross. At the time, I was on the Red Cross board and we all thought there would be a need to organize blood drives and emergency medical care. Unfortunately, as we all know, there was little care that could be provided because there were so many more deaths than injuries. We fielded phone calls from people and tried to figure out what needed to be done. I remember we needed to photocopy a lot of papers on the Red Cross’ old copier (although I don’t remember what we were copying). I called up Staples in Madison, asked them if the Red Cross could borrow a better copier and without hesitation, they said yes. When I went to pick it up, they graciously told me we could keep it.
As a member of the NJ Disaster Victim’s Recovery Team, a group of trained forensic dentists that participate in identifying the missing and deceased, I waited with my colleagues hoping our task would be small. However, as the magnitude of the missing became apparent, we were asked to work 12 hour shifts to help with identification. My first shift was about two weeks after the tragedy and I had to work starting at midnight. It was an eerie ride through the Lincoln Tunnel and the quiet city to the Office of Chief Medical Examiner (OCME) on First Avenue. I arrived to barricades and police and was directed to a “room” about the size of a closet that was the dental office. Eventually, we were moved to a trailer parked on the street that was to become our “office” for the next year.

Our group consisted of dentists and dental hygienists who were responsible for organizing all the information that was received by the medical examiner. We had separate files for ante mortem– the dental records that families or dentists gave us about the missing – and post mortem – the information that we collected once a body or a part was brought to the OCME. We worked together in teams to record information. The goal was not on speed, but on precision. Forensic dentistry involves creating a picture of what a person’s mouth looked like when they went missing based on an investigation of their previous dental records and then matching it to a unknown. X-rays don’t always tell the whole picture and sometimes pages of illegible handwriting had to be studied to develop our ante mortem records. The post mortem chart was created in a similar way – precisiely charting all the information that we discovered upon examining a body or a tooth. Then the tedious process of comparing the files begins. Dr. Jim McGivney developed a computer program called WIN-ID that compares similarities between ante and post mortem records and he spent many months at the site helping the team with identification. The program helps to narrow down possibilities and then charts are pulled and again examined with a team approach. The importance of a correct positive ID was more important to us than speed. Most people don’t realize that more of the IDs were accomplished with dental than other methods, although they may have been confirmed by another method like DNA or fingerprint.

The first shift was difficult. The logistics of identification had been rehearsed in training many times, but the emotional impact of what we were doing could never be prepared for. The condition of the bodies was never something I wanted to share with friends or family. I knew some of the missing, as most of us in Madison did, three fathers from St. Vincent’s as well as a patient. I would study their ante mortem charts at the beginning of each shift so their dental “fingerprint” was fresh in my mind as I looked at post mortem records. I found that while I was working a shift I was strong, not letting the horror affect me, only to be distraught when I was at home. I spent a year trying to rediscover priorities in my personal and professional life. It became hard to worry or even care about inconsequential things when compared to what I saw each week.

The Salvation Army was set up in a tent, named “Sal’s”, to supply us with food round the clock. But they provided so much more. I will always remember the Salvation Army workers as a breath of fresh air in a stagnant evening. They profusely thanked us for all we were doing and after a few weeks, the tent was plastered with drawings and cards from children writing to show their support and thanks for our help. Whenever the shift became overwhelming, a cup of coffee and a conversation at Sal’s helped to calm us.

My most memorable experience at the medical examiner’s office was an evening when a Man of Service was brought in. A Man of Service refers to a uniformed officer – police, fire or Port Authority – and while every single person received the ultimate respect, a Man of Service sometimes had more ceremony. The night was long and cold, I had been working with a team in the morgue and we received notification that a fireman had been discovered at the World Trade Center site. The story was pieced together for us – the body was found but not removed from the site until members of the victim’s fire company could get to the site (they were able to see his company number on his jacket) so that they could have the honor of removing him from the rubble. When the body arrived at the OCME, he was draped with an American flag and his company stood on either side while he was silently rolled into the building. As always, the same protocol was followed –visits at personal effects, anthropology, fingerprinting, x-ray and dental. The fire company waited patiently, knowing that identification was not a definite. Just because he had on a jacket with a company number and a name on it, the victim could have picked up someone else’s jacket in the chaos. He deserved the right to a proper identification. After only a few hours, we were able to make a positive ID, mostly because we had the name on the jacket to guide us. As the flag draped body was removed from the building, his company again flanked him, together for a final walk to a secure tent across from the OCME. There was no music, no speech, no fanfare, just a group of men committed to one another in life and death.

I spent almost a year in the trailer at the medical examiner’s office working 12 hours shift about two to four times a month. I was joined by almost 300 dental professionals from across the country who committed their time and knowledge to a unified goal – identification of as many victims as possible so that their families could have closure. I remember driving home one morning from the city, depressed and tired from a fruitless night, and suddenly, I noticed the ubiquitous flags that had appeared on cars and buildings after the attack. As sad as I was, I was proud of my country and proud of myself. I felt as though we were making a difference.

Before 9-11, I often had colleagues question why I “wasted my time” learning about forensics since it wasn’t something that would be profitable for me. It’s true, there was no financial gain from my involvement with World Trade, but the knowledge that I helped our country and my neighbors during a horrible time in our history will forever be remembered and is priceless to me.

Dry mouth can’t be solved by having a drink of water and there are a lot of problems that may result from having it.  The main cause of dry mouth is taking a medication that interferes with the normal production of saliva.  Saliva is critical to the overall health of a person’s mouth.  Saliva does something fancy called “buffering” that regulates or modifies the pH in your mouth.  Think back to high school chemistry.  pH deals with acids and bases.  The bacteria in your mouth thrive in an acid environment and the enamel on your teeth break down the more acid the conditions.  With less saliva present, this leads to erosion, cavities, and sensitivity – all bad stuff.  Additionally, saliva helps to lubricate your mouth when you eat so crusty Italian bread doesn’t scrape your cheek.

So – what causes dry mouth? And is there a way to reduce it?

Causes of dry mouth

1. Medications are the primary cause of dry mouth and considering that a Google search I did reported that Americans filled 11.5 prescriptions per capita and spent over $291 billion on prescription medications, it is safe to say that this is a big problem for the public.
2. Systemic conditions are the next thing that cause dry mouth.  Systemic means it affects your whole body and in certain diseases, the mouth is also affected.  Sjogren’s syndrome, Alzheimer’s disease, diabetes, rheumatoid arthritis, and high blood pressure have all been linked to dry mouth.
3. Aging and hormonal changes.
4. Damage to the salivary glands – this happens primarily due to head and neck radiation and chemotherapy from cancer treatment.

I’ve included an abridged list of some medications and their uses that cause dry mouth.

Anti-anxiety – Ativan, Valium, Vistaril, Xanax

Anti-convulsant – Lamictal, Neurontin, Tegretol

Anti-depressant – Celexa, Effexor, Paxil, Prozac, Tofranil, Wellbutrin, Zoloft

Anti-histamine – Allegra, Benadryl, Claritin, Vistaril, Zyrtec

High blood pressure – Accupril, Altace, Cardura, Coreg, Lopressor, Norvasc, Tenormin

Anti-inflammatory – Dolobid, Motrin, Naprosyn

Cholesterol reducting – Lipitor

Diuretic – Diuril, Dyazide, Lasix

How to treat dry mouth and prevent problems that result from dry mouth

As previously mentioned, just rinsing with or drinking water is not enough to solve dry mouth.  While there are medications you can take to help stimulate saliva production, simpler methods include:

1. Toothpastes or rinses specifically for dry mouth.  Biotene or Oasis are great products that help lubricate the mouth.
2. Using lozenges like Salese with Xylitol.  These are placed in your cheek and allowed to dissolve creating lubrication in your mouth, especially helpful when used 20-30 minutes prior to eating.
3. Using a fluoride toothpaste or rinse at home to protect and strengthen at risk enamel.
4. Have fluoride treatments when you visit the dentist.
5. Using sugar free mints and gums.
6. Drinking water or sugar-free drinks – this is a short term fix, but it helps, especially when you are eating.
7. Decrease alcohol and caffeine consumption.
8. Avoid salty, spicy, hard foods.

Keeping dental appointments to monitor the effects of dry mouth is important.  It is amazing how quickly deterioration of enamel can happen in an acidic, dry environment.  Meticulous home care and regular dental checkups and cleanings will allow you and your dentist to keep track of your dry mouth and the effects it may be having on your dental health.

If you have any additional questions about dry mouth, please contact me at drallison@adamsdentalnj.com or visit the American Dental Association’s website at: http://ada.org/3014.aspx?currentTab=1.

Yea!  Summer is here!  No homework, visits to the beach, hanging out at the pool and going to camp.  It all sounds fantastic.  But as my son likes to tell me, I’m a “fun sucker”, because I also think about the cotton candy, sugary ice pops, unlimited snacks, soda and lemonade that can cause problems with your teeth.  How do you balance the good with the bad and not feel as though you’re depriving yourself or your kids the “fun” foods of summer?  How do you ensure that your children are really brushing their teeth when they go to a friend’s for a sleepover or are away at camp?

Here are a few ideas that might make summer tooth care easy:

• So, you’ve just visited the Madison Farmer’s Market and you couldn’t resist the kettle corn (few are capable of escaping its sweet and salty temptation).  Once you’ve finished the bag, why not at least rinse your mouth with some water and then have a piece of sugarless gum.  It helps to remove some of the debris that is stuck in your teeth.  This is a great habit to teach your children – if you’ve eaten and it’s going to be a while before you can brush, have sugarless gum.
• Sugary foods and drinks should be consumed with meals.  Because saliva production increases during meals and helps neutralize acid production, it’s best to combine sugary treats with a meal.
• Who doesn’t love a lemonade stand?  But your teeth don’t need all the sugar.  Consider watering down the lemonade so you only get half the amount of sugar.  Or why not just surprise a child by giving them 50 cents and not even taking the lemonade!
• Limit between-meal snacks.  Each time you eat, acid is produced in your mouth that helps to feed the bacteria that causes cavities.  It’s better to eat a bag of M&Ms all at once instead of having a few M&Ms every hour.  For more information on the dangers of snacking click here.
• Think fruits and vegetables!  This is one of the best things about summer.  There’s nothing better than a Jersey tomato with a little salt and pepper.  I’d take a handful of blueberries over cotton candy any day.  Make your own ice pops with crushed watermelon or trying freezing grapes for a quick refreshing summer treat.

Getting your kids to brush regularly is like hoping my curly hair will have “good day” when I’m going out – easy to talk about, impossible to predict and no amount of products can ensure that it happens.  Some children are eager to please and can appreciate why taking care of their teeth is worthwhile.   However, most children are harder to convince.  The importance of maintaining their teeth for when they’re older is lost on them.

• Forget scaring them with horror stories of losing teeth or having big cavities.  Instead, I find that appearance factors more in their decision making.  While talking about healthy teeth, bring up bright, white, beautiful teeth.  Mention bad breath and what their friends might say if they smell bad.  You’d be surprised how even six year old children want to look their best.
• While no amount of products will guarantee that they brush, I encourage you to find products that they like and want to use.  Some children are very sensitive to flavors and may love Tom’s of Maine’s Silly Strawberry toothpaste but want nothing to do with the Orange-Mango paste.  Buy small tubes for them to try before you plunk down $4 for a tube that will sit unused on the counter.
• Think electric.  Children want power because they are  surrounded with iPods and Game Boys.  Let them choose an electric toothbrush with fancy colors and characters to make brushing more fun.  If they’re going away to camp, consider an inexpensive version like the Crest Spinbrush My Way that they can customize for under $10.  To keep at home, try the Sonicare for Kids.
• Encourage them to be a leader when they’re at a friend’s house or away at camp by being the one to get the group to brush their teeth.
• Check up on them every now and then and make sure their teeth look clean.  Most adult I know are bad at brushing, so why do we expect our eight year olds to be amazing at it?  If it looks like there is a spot they’re missing when brushing, show them in the mirror.  Don’t yell, just talk about the germs that are bad for their teeth.
• Make a game out of brushing.  School’s out and there’s a little more time in the day for fun.  Have your child make a brushing calendar and agree before hand on some rewards after they’ve brushed twice a day for a week.

Hope you can make maintaining healthy teeth an easy part of your summer.  If you any questions about anything in this posting, please email me at drallison@adamsdentalnj.com.

Andrea receiving her Extra Mile Award

I’m always hearing people in business say they have a hard time finding good employees.  Apparently, dedicated, productive, proactive team members are hard to find.  I hear complaints about employees wanting to leave early, not wanting to go beyond their job description, not bringing ideas to the workplace and solely thinking about how to advance their own careers without supporting the business as a whole.

I am lucky to say that I don’t have that problem.  In fact, the Madison Chamber of Commerce reintroduced the Extra Mile Award, a special award given to a Madison employee who exemplifies extraordinary service.   I’m so proud to report that my office manager, Andrea Ceresa, received the award, along with two other chamber members from Tons of Toys and Downtown Salon.

The award was presented at the Chamber’s year end party at Hamilton Park and was expertly organized by Karen Meyer, Executive Director of the Chamber.  As Karen read some of the nominations that were received for Andrea, I secretly smiled, because I felt that she was getting public recognition for what I have known for years.  She is a team member (not just an employee), who goes out of her way to support the practice and its patients.  She is the face and voice of Adams Dental who welcomes patients to the practice and then continues to serve their needs.  Nominations from patients included comments like:

• “She goes the extra mile by saying your name.”
• “What makes Andrea remarkable is her always upbeat and energetic demeanor and the way she puts a patient at ease and makes them feel as though they are not just important and special, but among friends.”
• “She is patient and kind – makes you want to get to the dentist!”
• “She and her staff run one of the finest organizations. Her sense of service is unmatched and her joy is infectious. I was startled last week when I had left a message on the answering machine late Friday and received a return call on Saturday morning. The office manager is a pivotal position in any organization. He or she sets the tone and the expectations for the entire office and business. I have seen none better than Andrea Ceresa.”
• “Andrea was my first point of contact in the office. She was both friendly and especially knowledgeable regarding all aspects of my insurance.  Over the years my admiration for her has increased as well as my appreciation of her humor. Her professionalism and genuine concern for the patients in Dr. Adams’ office is unparalleled.”
• “She knows every single patient’s name and remembers everything about them. When she sees patients out in public, which is quite often, she always stops and speaks with them as if they were friends and not a customer.”
• “She has a genuine heart and sincerely cares for her patients and staff”

I sometimes wonder how I’m so lucky to have such excellent staff and I think it boils down to the old adage: “Hire for attitude, train for skill”.  Certainly, for every position, there are skills that are necessary, but before looking to see if someone can use Excel, why not explore what makes them tick.  I like to find out about the person’s personal vision for themselves and see what their overall attitude is.  I can teach anyone to answer the phone, but I can’t teach everyone to do it with warmth and passion.  If you’re looking for an employee, I suggest looking beyond their education and their past work experience; instead, look for a person who can support your vision with the same energy, passion and commitment that you have.  If you look for the right things, you may end up with someone like Andrea, who, as a patient remarked to me recently “makes you look good!”

• Eat well – study after study shows that reducing fats and sugars, eating more fruits and vegetables and increasing fiber is beneficial to your health.  Why not try to make simple changes, without going on a diet.  Substitute a soda with a glass of water, have an apple instead of apple juice or ask the waitress to wrap half of your meal instead of eating the whole thing.
• Exercise – the more you move, the easier it is to move.  We can all benefit from exercise, but I think you need to find something you enjoy doing or you’ll never stick with it.  Personally, I can’t stand using exercise machines – they make me feel like a hamster on a wheel.  But I love yoga and the way I feel afterwards.  Find something you like (maybe with a friend) and it is easier to stick with it.
• Floss – you knew I was going to throw this in my list.  Seriously, I can’t impress upon you enough the impact flossing makes.  Regular flossers have healthier gums.  Healthier gums mean a healthier person.  So many studies are now revealing the link between oral and systemic health.  It is amazing how that little piece of string makes such a difference.
• Be social – make a point of cultivating and maintaining friendships.   Everyone’s different – personally, I need a few good friends and my family around me; other people enjoy having many friends.  Whatever your preference, think about how great you feel after going out to dinner with a friend or laughing on the phone about a ridiculous joke.  Maybe try to contact one person whom you haven’t spoken to in a long time.  I just had my 30^th high school reunion and had a wonderful time catching up with old friends.
• Take some time for yourself – we all need a little “me” time to recharge.  Curl up and read a book, work in the garden (once the rain stops), go fishing, take the dog for a walk, get a massage – whatever you need for yourself, do it.
• Enjoy each day – I know this sounds all kumbaya-like, but really – I think it’s important to see the good in each day.  Sure, there are some days that everything goes wrong and you wish you had stayed in bed, but within each day, look for small moments of joy and focus on them.  Don’t be upset about the traffic on the way home, because when you get there, at least you’ll see your kids.  Ignore the 15 minute wait at Starbucks, and savor the latte instead.  Tolerate the rain we’ve had and think of how great your grass looks.

I’m glad the world’s not over (not that I was really worried about it), because I have a lot of living left to do.  Enjoy (and floss!).

For those of you who know me well, you know that food – the preparation, consumption and whole experience surrounding it – means a lot to me. I wanted to read Chef Achatz’s book because I’m fascinated by restaurants and how chefs come up with their ideas for different dishes. (Let’s face it, they’re not creating new ingredients, just new ways to work with them.) Life, On the Line provided so much more than a discussion of food. My takeaways from the book:
Leadership is about setting an example, not preaching about what to do. Chef Achatz started his career with Thomas Keller, a world class chef who is known for French Laundry in Napa and Per Se in New York City. Throughout the book, Chef Keller stands out as an inspiring example of a leader – someone who isn’t afraid to sweep a floor even though he owns a multimillion dollar restaurant, someone who encourages his team to achieve more than they expect from themselves and someone who is profoundly humble about his success, instead crediting his team for his successes.

Food is so much more than food. The dishes that Chef Achatz describes as part of his 16 course tasting menu are almost incomprehensible. Recognizing the limitations of “regular” plates, he commissions plates and bowls to complement his food. One dish he describes is a simple shrimp dish that is served inside a larger bowl. The larger bowl has flowers in it and when presented to the diner, hot water is poured on the flowers so the aroma of the flowers mingles with the taste of the shrimp.

Anything less than perfect is not good enough. This mantra was one that Chef Achatz and his team believed sincerely and it is one that I believe my staff and I try to achieve. We are not always perfect, but we should strive for it each day.

It is my responsibility as a general dentist to find oral cancer. Chef Achatz complained for three years prior to his diagnosis to his dentist about a spot on his tongue. Instead of the horrifying treatment he had to endure, I believe an early diagnosis would have improved the quality of his treatment dramatically.

I encourage you to read this story about Chef Achatz, his struggles for perfection, his mind-blowing food and his battle with oral cancer.

http://search.barnesandnoble.com/Life-on-the-Line/Grant-Achatz/e/9781592406012/?itm=1&USRI=life%2C+on+the+line

http://www.health.com/health/library/topic/0,,sig258649spec_tp21158,00.html7

Let’s face it, we all remember the thrill of trick-or-treating and collecting more candy than your friends, so the last thing you want to do is make the day miserable for your children by denying them some treats.  However, it is a great opportunity to speak with them about healthy choices not only for their teeth, but for their overall growth. Remind children about moderation and brushing after snacking.  Also, speak with them about the different candy options that are out there.  If they really want a piece of candy, a small piece of chocolate that melts away quickly is much better for their teeth than a sticky, sweet candy that will stick in the grooves of their teeth.

The same goes for the adults – when you see the candy bowls on people’s desks at the office, veer away from the sticky, sweet candies (you know the ones that pulled out your co-worker’s cap last Halloween?) or hard candies that will stay in your mouth for a long time.  Instead, treat yourself occasionally with a piece of chocolate and then at least rinse with water if you can’t brush.  Better yet, why not have an apple with peanut butter or a yogurt sprinkled with nuts – they will satisfy your need to snack and  provide you with protein instead of a sugar high.

I would love to hear what you are choosing for healthy snacks instead of candy.  Leave me a comment….