Home Oral Care

Key Points

  • Home oral care recommendations from the ADA are based on data from clinical studies.
  • While general recommendations may adequately address the needs for many patients, a dentist may tailor home oral care recommendations to fit the individual patient’s needs and wants.
  • Home oral care is an important contributor to oral health and can help lessen the need for extensive dental intervention in the future.


Spending the right amount of time engaged in appropriate home oral care is undoubtedly essential to helping minimize the risk of caries and periodontal disease.  An individual who visits the dentist twice a year for an oral exam and dental prophylaxis will spend approximately two hours per year in the dental chair.  The time for that same person to brush and clean between his or her teeth each day might be estimated to be around 30 hours per year.  Considering the amount of time that should be devoted to daily oral hygiene, it is important to understand the scientific evidence that supports home oral care recommendations made to patients.

In 2017, the ADA Council on Scientific Affairs identified three aspects of home oral care that dentists should discuss with their patients:

  1. General recommendations that are applicable to most people;
  2. Personalized recommendations specifically targeted to meet the needs of the individual patient, especially patients at increased risk of caries and/or gingivitis; and 
  3. Lifestyle considerations to enhance oral health and wellness.

The general and personalized recommendations were developed in accordance with a rapid evidence assessment methodology,1 meaning that the evidence examined was derived from existing systematic reviews.  Lifestyle considerations comport with current ADA policy.  This Oral Health Topic page is an executive summary of that work and relevant ADA policy.

General Recommendations for the Prevention of Caries and Gingivitis

1) Brush your teeth twice a day with a fluoride toothpaste

While a seemingly simple statement, the guidance for brushing twice daily with a fluoride toothpaste weaves together a number of discrete components.

Toothbrushing frequency
Review of the scientific literature, along with guidance from governmental organizations and professional associations found sufficient evidence to support the contention that twice-daily brushing, when compared with lower frequencies, was optimal for reducing risk of caries,2-4 gingival recession or periodontitis.5-7  It is important to recognize that in these studies, it was the frequency of tooth-brushing with a fluoride toothpaste that was evaluated rather than tooth-brushing alone.

Fluoride toothpaste
Although the measures used to assess the benefit varied, studies examining the effect of over-the-counter (OTC) fluoride dentifrice on caries incidence in children and adolescents found the fraction of caries prevented ranged from 16% per tooth to 31% per surface versus placebo or no dentifrice, and concluded that fluoride-containing toothpaste was effective in caries control.4, 8, 9  In addition, high level evidence shows that 5,000 ppm fluoride (available with a prescription) results in significantly more arrest of root caries lesions than use of OTC levels of fluoride (1,000 – 1,500ppm).10

Toothbrushing duration
Data examining the question of optimal duration of daily tooth-brushing encounters relies on plaque indices which are surrogate measures rather than direct measure of caries or gingivitis.  Understanding that the use of surrogate measures decreases the certainty with which a recommendation can be made, the available systematic reviews found a brushing duration of two minutes was associated with bigger reduction in plaque than brushing for a single minute.11, 12  Two minutes per whole mouth can also be expressed as thirty seconds per quadrant or about four seconds per tooth.

2) Clean between your teeth daily

While cleaning between teeth is important to maintaining oral health, it is a concept that must overcome several barriers to adoption. ” Flossing” is often used as a shorthand, common term for interdental cleaning, which can become problematic in the real world where many report a strong distaste for that activity.13 Some people presume flossing as ineffective or unnecessary, which can also make it harder for them to adopt the daily habit. Flossing is a technique-sensitive intervention14 as exemplified by the disparity in benefit observed when comparing study designs involving self-flossing and professional flossing.15 Where patients do not see positive results from flossing, they may not continue to do so.

Using flossing as shorthand for interdental cleaning can also be problematic in that patients may be unaware of alternative devices that may be more pleasant or effective for them. A meta-review, which included the available devices developed for this purpose (i.e. dental floss, interdental brushes, oral irrigators, and wood sticks), addressed the question “What is the effect of mechanical inter-dental plaque removal in addition to tooth brushing on managing gingivitis in adults?”  The strength of the evidence on the benefit ranged from weak to moderate depending on the device in question.16

Thus, there may not be one “best” interdental cleaning method; rather, the best method for any given patient may be one in which they will regularly perform. A guiding principle which is relevant to  interdental cleaning is: “best care for each patient rests neither in clinician judgment nor scientific evidence but rather in the art of combining the two through interaction with the patient to find the best option for each individual.”17

3) Eat a healthy diet that limits sugary beverages and snacks

While eating a healthy diet is important for overall health and well-being, a review of the literature found little in terms of the effects of micronutrients on the risk of caries or periodontal disease.  However, the conclusion of numerous systematic reviews on the effect of the macronutrient content of the diet, specifically of sugar, is that there is an association between sugar intake and caries.18-20  A review of the evidence supporting nine international guidelines recommending decreased consumption of sugar found consistent recommendations from all the groups while noting that they relied on different data and rationales.18

4) See your dentist regularly for prevention and treatment of oral disease

Viewed through the prism of the primary prevention of caries and/or gingivitis, a systematic review of the literature failed to arrive at consensus regarding optimal recall frequency to minimize either caries21, 22 or periodontal disease risk23 in part due to limited availability of studies addressing this topic.  Nonetheless, in terms of the balance between resource allocation and risk reduction, it can be concluded that there is merit in tailoring a patient’s recall interval to individual need based on assessed risk of disease.21, 24

Previously, the ADA Healthy Smile Tips advised people to “Visit your dentist regularly.”  However, dentists are doctors of oral health, which encompasses both the prevention and treatment of oral disease.  The current recommendation goes a step further than its predecessor in articulating the duality of the dental visits.  Dental care includes actions to reduce disease risk, as well as the formulation and execution of a treatment plan when disease is present.

Personalized Recommendations for the Prevention of Caries and Gingivitis

While generalized recommendations for home oral care may be appropriate to help optimize oral wellness for many patients, those found to be at elevated risk of caries and/or gingivitis, may ask their dentists to provide guidance on additional action steps that they can take to reduce their risk of oral disease.25  To help address this reality, the Council on Scientific Affairs recommends that dentists: 

  • Design a home care regimen with specific recommendations for oral hygiene. This may involve consideration of not only the person’s individual oral disease risk, but the needs and wants of the patient.
  • Offer direction concerning lifestyle changes.  This is addressed in the next section, entitled “Lifestyle Considerations.”  
  • Provide guidance on dental products and mechanical devices. This includes detailed suggestions that can help patients make decisions about dental hygiene practices and products.  Patients may look to their dentists for guidance and recommendations to help discern among the plethora of home oral care products and mechanical devices that lay claim to oral health benefit.  Dentists and patients can look to the ADA Seal of Acceptance program as a source of validated information regarding the safety and efficacy of many home oral care products.

After careful review of the available evidence, the Council on Scientific Affairs provides the following rationale to inform decision-making between dentists and patients on products and mechanical devices that can be considered as adjunct therapies and modalities for the prevention of caries and/or gingivitis:

1) Antimicrobials
For individuals with increased risk for gingivitis or periodontal disease, there is evidence that over-the-counter oral care products containing specific antimicrobial active ingredients can decrease risk of gingivitis.  Systematic reviews found that mouth rinses containing an antimicrobial effective amount of essential oil(s) (with or without alcohol) or cetylpyrdinium chloride,26-28 and toothpastes containing triclosan or stannous fluoride,29-31 were associated with decreased risk of supragingival plaque and gingivitis.

2) Fluoride Mouth rinses
With regards to caries risk reduction, there is strong evidence supporting the use of fluoride-containing mouth rinses by children at elevated caries risk;32 and low level evidence on the benefit of adults using fluoride mouth rinse to decrease their risk of root caries.10

3) Power Toothbrushes
Powered toothbrushes provide effective removal of dental plaque and reduction in gingival inflammation.11, 33 Though there may be statistically significant improvement in dental plaque removal or gingival inflammation when comparing use of a powered toothbrush with a manual toothbrush, the difference may not be clinically meaningful.33 However, when brushing technique is a concern such as for patients with special needs, those who require the help of a caregiver for activities of daily living, or those with manual dexterity deficit, the use of a powered toothbrush has been found to provide substantive benefit in plaque reduction.34-38

4) Interdental Cleaning Devices
Recent analysis using NHANES data found that adults who more frequently reported using floss or other devices to clean between their teeth were found less likely to have periodontitis.39  Because of the barriers to interdental cleaning, it may not be effective to tell patients that they must floss and expect it to become a regular part of their oral home care routine. Instead, dentists can support effective home oral care by gauging their patient’s level of understanding, learning about their motivation, and then serving as a “coach” by communicating and promoting daily cleaning between their teeth.40 Discussing the various interdental cleaning devices can help educate patients on available options and provide them with some of the skills necessary to be effective stewards of their own oral health.

Lifestyle Considerations for the Prevention of Caries and Gingivitis

Dentists can provide, promote or direct patients to information about lifestyle behaviors and/or services that can aid in reducing their risk.

Beyond the general and personalized recommendations above, there are three specific ADA policies regarding aspects that fall under the rubric of lifestyle considerations with roles to help prevent caries and gingivitis:

1) Consumption of Fluoridated Water
Much of the literature evaluated in systematic reviews examining the association between consumption of fluoridated water and reduced levels of caries in primary and permanent dentition derives from studies conducted before the 1980’s.41  One experiment, in which a Canadian community discontinued its community water fluoridation to allow for the comparison of caries rates within a socioeconomically similar, adjacent community which maintained its water fluoridation demonstrated a significant increase in primary tooth decay and an increasing trend for increased decay in permanent dentition 2.5 – 3 years post cessation among residents who reported usually drinking tap water.42  In 2016, the U.S. Surgeon General expressed the view that community water fluoridation was an important component for developing a culture of disease prevention and helping to ensure health equity for all.43

2) Use of Tobacco Products
While the various forms of tobacco have a variety of health consequences, the oral consequences of cigarette smoking44 and smokeless tobacco products45 can include adverse effects on gingival health, enamel discoloration and erosion, and oral cancer.  For these reasons, the ADA has long advocated for smoking and tobacco cessation initiatives both at the policy and practice levels.

3) Oral Piercings
The literature on the oral consequences of oral piercings show tooth fracture, tooth wear and gingival recession among the commonly reported adverse events,46 and the ADA established policy discouraging oral piercing in 1998.

This information was prepared & provided by the ADA Science Institute’s Center for Scientific Information. The ADA Council on Scientific Affairs reviewed and approved the content of this page.

Last Updated: January 18, 2018


Massage: Get in touch with its many benefits

Massage: Get in touch with its many benefits

Massage can be a powerful tool to help you take charge of your health and well-being. See if it’s right for you.

Massage is no longer available only through luxury spas and upscale health clubs. Today, massage therapy is offered in businesses, clinics, hospitals and even airports. If you’ve never tried massage, learn about its possible health benefits and what to expect during a massage therapy session.

What is massage?

Massage is a general term for pressing, rubbing and manipulating your skin, muscles, tendons and ligaments. Massage may range from light stroking to deep pressure. There are many different types of massage, including these common types:

  • Swedish massage.This is a gentle form of massage that uses long strokes, kneading, deep circular movements, vibration and tapping to help relax and energize you.
  • Deep massage.This massage technique uses slower, more-forceful strokes to target the deeper layers of muscle and connective tissue, commonly to help with muscle damage from injuries.
  • Sports massage.This is similar to Swedish massage, but it’s geared toward people involved in sport activities to help prevent or treat injuries.
  • Trigger point massage.This massage focuses on areas of tight muscle fibers that can form in your muscles after injuries or overuse.

Benefits of massage

Massage is generally considered part of complementary and alternative medicine. It’s increasingly being offered along with standard treatment for a wide range of medical conditions and situations.

Studies of the benefits of massage demonstrate that it is an effective treatment for reducing stress, pain and muscle tension.

While more research is needed to confirm the benefits of massage, some studies have found massage may also be helpful for:

  • Anxiety
  • Digestive disorders
  • Fibromyalgia
  • Headaches
  • Insomnia related to stress
  • Myofascial pain syndrome
  • Soft tissue strains or injuries
  • Sports injuries
  • Temporomandibular joint pain

Beyond the benefits for specific conditions or diseases, some people enjoy massage because it often produces feelings of caring, comfort and connection.

Despite its benefits, massage isn’t meant as a replacement for regular medical care. Let your doctor know you’re trying massage and be sure to follow any standard treatment plans you have.

Risks of massage

Most people can benefit from massage. However, massage may not be appropriate if you have:

  • Bleeding disorders or take blood-thinning medication
  • Burns or healing wounds
  • Deep vein thrombosis
  • Fractures
  • Severe osteoporosis
  • Severe thrombocytopenia

Discuss the pros and cons of massage with your doctor, especially if you are pregnant or you have cancer or unexplained pain.

Some forms of massage can leave you feeling a bit sore the next day. But massage shouldn’t ordinarily be painful or uncomfortable. If any part of your massage doesn’t feel right or is painful, speak up right away. Most serious problems come from too much pressure during massage.

What you can expect during a massage

You don’t need any special preparation for massage. Before a massage therapy session starts, your massage therapist should ask you about any symptoms, your medical history and what you’re hoping to get out of massage. Your massage therapist should explain the kind of massage and techniques he or she will use.

In a typical massage therapy session, you undress or wear loose-fitting clothing. Undress only to the point that you’re comfortable. You generally lie on a table and cover yourself with a sheet. You can also have a massage while sitting in a chair, fully clothed. Your massage therapist should perform an evaluation through touch to locate painful or tense areas and to determine how much pressure to apply.

Depending on preference, your massage therapist may use oil or lotion to reduce friction on your skin. Tell your massage therapist if you might be allergic to any ingredients.

A massage session may last from 10 to 90 minutes, depending on the type of massage and how much time you have. No matter what kind of massage you choose, you should feel calm and relaxed during and after your massage.

If a massage therapist is pushing too hard, ask for lighter pressure. Occasionally you may have a sensitive spot in a muscle that feels like a knot. It’s likely to be uncomfortable while your massage therapist works it out. But if it becomes painful, speak up.

McGlone Dental Care has Massage Therapist on Staff

Michelle Stefun, LMT

Michelle’s philosophy – ‘Massage’ means many things to many people. Some massage is comparable to getting your nails done—full of treatments and pampering. Some forms mimic physical therapy involving a significant amount of pain and effort on your part. And others are basically your daily rub-down of moisturizer—honestly, your toddler could do that. There’s nothing wrong with these forms of massage, but I’ve chosen a starkly different course for my work. I am, first and foremost, a healer. Patients get my full attention in each session. I’ve found that the body heals best in a state of rest. Therefore, my work is a blend of medical treatment and relaxation. 

​Similar to the human body, trees require a degree of flexibility and balance. They are flexible enough not to snap with every wind gust. Their branches spread over them for balance. And finally, trees pour back into their environment. They provide oxygen, habitats for wildlife, and food for many. In the same way, massage therapy should enable you to be more active in your world—whatever that world looks like. I make no claims to ‘fix’ anything, yet I’ve seen this treatment provide dramatic improvement for my patients. I am a facilitator to each individual’s journey toward healing.

The take-home message about massage

Brush aside any thoughts that massage is only a feel-good way to indulge or pamper yourself. To the contrary, massage can be a powerful tool to help you take charge of your health and well-being, whether you have a specific health condition or are just looking for another stress reliever. You can even learn how to do self-massage or how to engage in massage with a partner at home.

Article provided by The Mayo Clinic Newsletter

Use it or Lose it!

Dental Insurance Use It or Lose ItDo you have money left on your annual Dental Insurance Plan? Have you checked it lately? If not, you can check, or you can have us check for you. Most insurance plans are run on a calendar year and if you don’t use all your benefit each year you lose those funds.

So, what does that mean for you? It means that it’s a great time to maximize your dental insurance benefits and make sure that you use your yearly maximum amount allowed according to your plan. If whatever dental work you need to have done is completed before 12/31/17 and billed on or before that date, that work will be applied to this year’s maximum amount that is allowed according to your plan. Most insurance plans cover 2 cleanings per year and cover 100% of any preventative work. You should make sure that you get your full value out of the benefits that you work hard and pay for.

We have openings in our schedule for the rest of the year and are even open three days the week of Christmas. If you have dental work that you need to have done or just want to have your teeth cleaned before the end of the year, give us a call. We will do our best to make sure that your dental insurance coverage is maximized for you and you are able to get the full amount of your plan for the year.

We are also having a Whitening Special in December. Insurance won’t pay for teeth whitening, but if you’d like to have a brighter smile for the holidays, come in and take advantage of this great special. For $150 (normally $200) you will get custom whitening trays and a tube of whitening gel (for up to 6 whitening treatments) to take home. You can whiten your teeth in an hour at your own time and in the privacy of your own home. This special is good until 12/31/17.

Call for an appointment today before we are all booked up through the end of the year: 303-759-0731.

Happy Holidays from the McGlone Dental Team!

Smoking and Your Oral Health

Smoking and Your Oral HealthWhile most people are aware of the impact tobacco use has on their overall health, some might not consider its effects on oral health, including:

  • 50 percent of smoking adults have gum (periodontal) disease.
  • Smokers are about twice as likely to lose their teeth as non-smokers.
  • Cigarette smokers are nearly twice as likely to need root canal treatment.
  • Smoking leads to reduced effectiveness of treatment for gum disease.
  • Smoking increases risk of mouth pain, cavities and gum recession (which can lead to tooth loss).
  • Tobacco reduces the body’s ability to fight infection, including in the mouth and gums. Smoking also limits the growth of blood vessels, slowing the healing of gum tissue after oral surgery or from injury.
  • Smokeless tobacco (snuff or chewing tobacco) is associated with cancers of the cheek, gums and lining of the lips. Users of smokeless tobacco are 50 times more likely to develop these cancers than non-users.
  • Cigars, chewing tobacco, snuff and unprocessed tobacco leaves (used as cigar wrappers) contain tiny particles that are abrasive to teeth. When mixed with saliva and chewed, an abrasive paste is created that wears down teeth over time.
Tobacco Use and Children 

All parents, even those who do not use tobacco, should educate their children about the dangers of smoking:

  • 3,000 children and teens become regular users each day (including chewing tobacco).
  • Nearly one-quarter of all high school students smoke.
  • Some tobacco companies target children with cherry-flavored chewing tobacco sold in colorful containers.
  • Children exposed to tobacco smoke may have delays in the formation of their permanent teeth.
  • Women who smoke may be more likely to have children born with an oral cleft (cleft lip or cleft palate).
What You Can Do

If you are a smoker or a parent with a child or teen who you suspect may be using tobacco, you can start by understanding that tobacco dependence is a nicotine addiction disorder.

There are four aspects to nicotine addiction: physical, sensory, psychological and behavioral. All aspects of nicotine addiction need to be addressed in order to break the habit. This difficulty can mean that tobacco users may need to try several times before they are able to successfully kick the habit.

*Content provided by Delta Dental

No Dental Insurance? We Have the Solution!

No Dental Insurance? We Have the Solution! mcglone dental denverAt McGlone Dental Care, the customer always comes first – and we know that many of our friends and neighbors don’t have dental insurance. We also know that not having dental insurance makes dental care decisions more stressful – How much is a filling going to cost? Can I afford getting a new crown?

We understand, and we want to help. For our friends and neighbors who don’t have dental insurance, we are offering a simplified way to think about dental care – and to help make those tough decisions a little easier – a flat fee of $300 per hour for ALL routine dental work, including fillings, crowns, bridges, periodontal deep-cleanings, extractions and complete and partial dentures.

To put it in perspective, we can usually complete 2 to 3 fillings in ONE HOUR, using highly rated materials and careful techniques.

Of course, some procedures simply take more time – crowns, bridges and full or partial dentures require help from an outside lab.  Together, we will choose the appropriate lab and proper material to be used. We will work with you to establish an accurate cost estimate, and the lab fee will be charged with zero mark-up.

Your dental health is as important as any other health decision you make. And we believe it should be available to ALL our friends and neighbors.

Call us today to find out how simple and affordable your dental care can really be – without all the stress and unknowns. We’re here for you and look forward to visiting with you soon.

Oral Piercing

Key Points

  • Oral piercing of the tongue, lip, cheek, or other soft tissues is a form of body art and self-expression. Oral piercings are more typically seen in adolescents and young adults, and the tongue is considered the most common site for oral-piercing placement.
  • Complications associated with oral piercing include: swelling, bleeding, infection, chipped or damaged teeth, gingival recession, lacerations/scarring, embedded oral jewelry (requiring surgical removal), airway obstruction, hypersalivation, palatal erythema, keloid formation, and purulent or unusual or discharge from the pierced region.
  • Tongue splitting is a less common form of body modification within the oral cavity. By definition, the tongue-splitting process is one in which an individual’s tongue is severed into two pieces using various techniques. The procedure is inherently invasive and dangerous, with significant risks of severe bleeding, infection, inflammation, lingual nerve damage or other complications.
  • The ADA advises against the practices of cosmetic intraoral/perioral piercing and tongue splitting, and views these as invasive procedures with negative health sequelae that outweigh any potential benefit.


Oral piercing is an ancient practice of body modification and self-expression that is also common in modern society.1, 2 Oral piercings may be placed intraorally (most commonly on the tongue) or periorally on the lips, cheeks or a combination of sites.3-5 Oral piercings are more typically seen in adolescents and young adults, and the tongue is considered the most common site for oral-piercing placement.1 There are two primary forms of oral piercing: the term intraoral piercing describes a piercing in which both ends of the oral jewelry (device or apparatus) reside in the oral cavity, as seen with tongue piercings. Similarly, the term perioral piercing describes a piercing in which one end resides in the oral cavity and the other end penetrates the skin surface in the perioral region (e.g., the cheek, upper or lower lip, chin or associated tissues).

Common forms of oral jewelry include studs, barbells, rings and hoops, which are fabricated using a variety of metals, such as stainless steel, gold, titanium and various alloys or synthetic materials.

While some individuals may consider oral piercings to be popular or trendy, numerous studies and case reports have shown that oral piercings can lead to a wide range of oral and systemic complications, including chipped teeth, gingival recession, embedding or aspiration of jewelry and other potentially severe infections, such as Ludwig’s angina6 or infective endocarditis.7

Tongue splitting is another, less common, form of body modification that literally splits, or bifurcates, an individual’s tongue from front to back, creating a “forked” appearance down the anterior midline. Tongue splitting is an invasive and dangerous procedure that directly compromises the intact physical barrier of the tongue surface, rendering it susceptible to severe bleeding and pain, bacterial infection, lingual nerve damage and other adverse effects.8

Complications of Oral Piercing

As with any puncture wound or incision, oral piercings can cause pain,5, 9, 10 swelling,4, 5, 9-11 and infection.9, 10, 12 Other complications of intraoral and perioral piercings include increased salivary flow;10, 13gingival injury or recession;2, 9, 11, 14, 15 damage to teeth, restorations or fixed prostheses;2-4, 10, 11, 15, 16 lingual abscess;17 interference with speech, mastication or deglutition;3, 5, 9 scar tissue and keloid formation;13, 18 and allergic contact dermatitis.19, 20 Because of the tongue’s vascular nature, prolonged bleeding can result if vessels are punctured during the piercing procedure.21 Purulent, unusual and/or colored discharges from oral piercings have also been reported.22

The technique for inserting tongue jewelry may abrade or fracture anterior dentition,3, 4, 10, 16 and digital manipulation of the jewelry can significantly increase the potential for infection.9, 11, 12 Airway obstruction due to pronounced edema4 or aspiration of jewelry poses another risk, and aspirated or ingested jewelry could present a hazard to respiratory or digestive organs.5, 11 Oral jewelry can compromise dental diagnosis by obscuring anatomy and defects in radiographs. There are also reports of the jewelry becoming embedded in surrounding oral tissues, requiring surgical removal.2, 11, 23 Studies have also shown that lip or tongue piercings can harbor periodontopathogenic bacteria,24, 25 and that piercing jewelry made of synthetic materials (e.g., polytetrafluoroethylene or polypropylene), rather than steel or titanium, have lower levels of bacterial colonization.26

Oral piercing complications are relatively common. According to one systematic review, gingival recessions were identified in up to 50% of individuals with lip piercing and in 44% of those with tongue piercing; tooth damage was also seen in 26% of individuals with tongue piercings.27 Complications can arise either during the oral-piercing procedure, immediately after its completion, or over the long term (after initial placement).2

Several case reports in the published literature have described severe or life-threatening complications related to oral piercing.6, 28 In one case, a 25-year-old British woman developed Ludwig’s angina, a rapidly spreading cellulitis involving the submandibular, sublingual and submental fascial spaces bilaterally, four days after receiving a tongue piercing.6 Intubation was necessary to secure the woman’s airway, and when antibiotic therapy failed to resolve the condition, surgical intervention was required to remove the barbell-shaped jewelry and decompress the swelling in the floor of the mouth.

Risks Associated with Tongue Splitting

Like oral piercing, tongue splitting is an invasive, albeit uncommon, procedure with inherent risks of severe bleeding, pain, infection and nerve damage.8 Reports describing the morbidity and mortality associated with tongue splitting are relatively sparse in the research literature, but the risk of complications secondary to surgical procedures (including pain, swelling and infection) is well known.

As a matter of ADA policy, the Association advises against the practices of oral piercing and tongue splitting. The latter practice may be performed using a variety of techniques, which are typically provided in a non-sterile setting (e.g., body-piercing parlor or similar establishment). The practice of tongue splitting entails the deliberate alteration of an individual’s tongue for nonmedical purposes, often without the presence of health professionals and without standard infection control practices, proper sterilization or the provision of safe, appropriate after-care.29 The tongue’s anatomic location, high vascularity and proximity to diverse oral microflora and biofilms present significant potential risks for viral infection or transmission of pathogenic organisms.

Dental Considerations for Patients with Oral Piercing

In the U.S., dentists commonly encounter and treat patients, particularly younger adults, with various forms of oral piercing or oral jewelry (e.g., studs, rings, hoops, barbells) in the intraoral/perioral region. Piercings of the tongue and other oral sites are associated with increased risk of orodental trauma, gingival recession and potentially traumatic lacerations.5 Pierced individuals are also at increased risk of infection due to vast number of bacterial species in the oral cavity.

Individuals who receive oral piercings can expect pain and swelling within the first few days after the procedure.2 Use of an alcohol-free mouthrinse is advised for use after oral piercing to cleanse the mouth and site of the oral piercing.30 After the swelling subsides, the piercee will need to visit their piercer after the piercing procedure to replace the original, longer piece of jewelry with a shorter piece, which should help minimize damage or irritation to oral tissues.31

To reduce risks of oral infection after piercing procedures, pierced individuals should be advised to maintain a standard oral hygiene regimen that includes: twice-daily tooth-brushing using fluoride-containing toothpaste and a soft-bristle toothbrush; regular use of floss or another interdental cleaner; and use of alcohol-free mouthrinse during and after the healing period.30

Dental patients with an oral piercing or split tongue should be advised to keep their piercing site clean, avoid playing with oral-piercing jewelry and monitor their oral cavity for signs of infection, including swelling, pain, tenderness or unusual discharges (particularly those with an offensive odor).30, 32  All forms of intraoral or perioral jewelry (e.g., tongue barbell, lip ring or stud, etc.) should be removed before participating in athletic and other physical activities, particularly contact and collision sports.33

Prepared by: Center for Scientific Information, ADA Science Institute
Reviewed by: Scientific Information Subcommittee, ADA Council on Scientific Affairs
Last Updated: September 18, 2017

Disclaimer: Content on ADA.org is for informational purposes only, is neither intended to and does not establish a standard of care, and is not a substitute for professional judgment, advice, diagnosis, or treatment. ADA is not responsible for information on external websites linked to this website.

Maximize Your Annual Dental Insurance Benefits

This is our favorite time of the year in Colorado.  The temperature is cooler and you can sleep with your windows open.  The leaves are changing colors and are beautiful with gold and red hues.  It also means that year end is fast approaching and benefits will be resetting come January.

That brings us to the point of this post.  It’s a great time to maximize your benefits and make sure that you use your yearly maximum amount allowed according to your plan.  If whatever dental work you need to have done is completed before 12/31/17 and billed on or before that date, that work will be applied to this year’s maximum amount that is allowed according to your plan.  Most insurance plans cover 2 cleanings per year and cover 100% of any preventative work.  You should make sure that you get your full value out of the benefits that you work hard and pay for.

We have openings over the next few months, so give us a call and we’ll be happy to get you scheduled and take great care of you!

Information about Mouthguards

Key points:

  • TMJ disorder dentist DenverMouthguard use has been shown to reduce the risk of sport-related dental injuries
  • An ANSI/ADA standard exists for Athletic Mouth Protectors and Materials
  • The ADA Council on Access, Prevention and Interprofessional Relations and the ADA Council on Scientific Affairs encourage patient education about the benefit of mouthguard use.
  • A product earns the ADA Seal of Acceptance by providing scientific evidence that demonstrates safety and efficacy, which the ADA Council on Scientific Affairs carefully evaluates according to objective requirements.


The ADA has taken an active stance since the mid-1990s recognizing the preventive value of orofacial protectors, endorsing their use by those who engage in recreational and sports activities; and encouraging widespread use of orofacial protectors with proper fit, including mouthguards.1

Both the ADA Council of Scientific Affairs and the Council on Access, Prevention and Interprofessional Relations recognize that dental injuries are common in collision or contact sports and recreational activities.2 Numerous surveys of sports-related dental injuries have documented that participants of all ages, genders and skill levels are at risk of sustaining dental injuries in sporting activities, including organized and unorganized sports at both recreational and competitive levels. While collision and contact sports, such as boxing, have inherent injury risks, dental injuries are also prevalent in non-contact activities and exercises, such as gymnastics and skating.3-5

The Councils promote the importance of safety in maintaining oral health and the use of a properly fitted mouthguard as the best available protective device for reducing the incidence and severity of sports-related dental injuries. The Councils are committed to oral health promotion and injury prevention for sports participants.


It is necessary that mouthguards actually perform as required, i.e. to keep teeth safe.  An important step was therefore the work of the ADA with ANSI in developing a standard for Athletic Mouth Protectors and Materials.  However, as recently as 2009, a study of commercially available products found none that met current ANSI and ADA standards for impact attenuation.6


It is important for mouthguards to be safe however to be effective, they also have to be used.  Reasons given for why mouthguards are not used include awareness, cost, and lack of requirement for their use.7

Raising Awareness

There have been several “Patient Pages” in JADA to be used by dentists to help engage patients in conversation about mouthguards, facilitating discussion to encourage their use.  Each underscores the importance of mouthguard use and informs consumers about the 3 types that are available – ready-made, boil and bite, and custom made.8-12 

Recent trends to increase ‘realism’ in video games has resulted their incorporating more actual player behaviors including what they do with their mouthguards while at the free throw line.13  While perhaps not the most desirable behavior, it raises the profile and awareness of mouthguards. Further, by having a sport idol model their use, it serves to increase their ‘coolness’ factor.

Overcoming Barriers with the ADA Seal of Acceptance

While still being able to highlight the benefit of custom fit mouthguards, dentists can also recommend the use of over-the-counter mouthguards with the ADA Seal of Acceptance.  Look for the ADA Seal—your assurance that the product has been objectively evaluated for safety and efficacy by an independent body of scientific experts, the ADA Council on Scientific Affairs.  A product earns the ADA Seal for athletic mouthguards by providing scientific evidence, which is evaluated according to objective requirements, demonstrating the safety and efficacy of ready-to-use and mouth-formed (boil-and-bite) mouthguards.

To qualify for the Seal of Acceptance, the company must provide evidence that:

  • The product components are safe for use in the mouth and do not harm or irritate oral soft tissues.
  • Mouth-formed appliances can be prepared by the average person with low risk of injury to oral hard or soft tissues, or damage of orthodontic appliances.
  • The mouthguard is free of sharp or jagged edges.
  • The mouthguard passes tests outlined by the American National Standards Institute/American Dental Association for hardness, ability to resist tearing and withstand impact; as well as a measurement of the amount of water absorbed.14

Comparison finds custom mouthguards made by dentists to perform best;15 having an over-the-counter option that meets ANSI/ADA standards helps with the cost barrier to engagement while still affording the consumer with a safe method of protecting their teeth.


Dentists are encouraged to ask patients if they participate in team sports or other activities with risks of injury to the teeth, jaw and oral soft tissues (mouth, lip, tongue, or inner lining of the cheeks). The Councils recommend that people of all ages use a properly fitted mouthguard in any sporting or recreational activity that may pose a risk of injury. The Councils also recommend educating patients about mouthguards and orofacial injury risks, including appropriate guidance on mouthguard types, their protective properties, costs and benefits. The key educational message is that the best mouthguard is one that is utilized during sport activities.


  1. American Dental Association, Policy Statement on Orofacial Protectors. Transactions; 1995. p. 613.
  2. ADA Council on Access, Prevention and Interprofessional Relations; Council on Scientific Affairs. Using mouthguards to reduce the incidence and severity of sports-related oral injuries. J Am Dent Assoc 2006;137(12):1712-20; quiz 31.
  3. Fasciglione D, Persic R, Pohl Y, Filippi A. Dental injuries in inline skating – level of information and prevention. Dent Traumatol 2007;23(3):143-8.
  4. Knapik JJ, Marshall SW, Lee RB, et al. Mouthguards in sport activities : history, physical properties and injury prevention effectiveness. Sports Med 2007;37(2):117-44.
  5. Kumamoto DP, Maeda Y. A literature review of sports-related orofacial trauma. Gen Dent 2004;52(3):270-80; quiz 81.
  6. Gould TE, Piland SG, Shin J, Hoyle CE, Nazarenko S. Characterization of mouthguard materials: physical and mechanical properties of commercialized products. Dent Mater 2009;25(6):771-80.
  7. O’Malley M, Evans DS, Hewson A, Owens J. Mouthguard use and dental injury in sport: a questionnaire study of national school children in the west of Ireland. J Ir Dent Assoc 2012;58(4):205-11.
  8. For the dental patient. Do you need a mouthguard? J Am Dent Assoc 2001;132(7):1066.
  9. Mouthguards lower dental injuries. J Am Dent Assoc 2002;133(3):278.
  10. For the dental patient. The importance of using mouthguards. Tips for keeping your smile safe. J Am Dent Assoc 2004;135(7):1061.
  11. For the dental patient. Keep sports safe–wear a mouthguard. J Am Dent Assoc 2012;143(3):312.
  12. For the dental patient. Protecting teeth with mouthguards. J Am Dent Assoc 2006;137(12):1772.
  13. Stephen Curry’s mouth guard routine gets video game treatment.  2015.
  14. ANSI/ADA Standard No.99-2001(R2013) Athletic mouth protectors and materials. Chicago: American Dental Association.
  15. DeYoung AK, Robinson E, Godwin WC. Comparing comfort and wearability: custom-made vs. self-adapted mouthguards. J Am Dent Assoc 1994;125(8):1112-8.

ADA Resources

Other Resources

Prepared by: Center for Scientific Information, ADA Science Institute
Reviewed by: ADA Council on Access, Prevention and Interprofessional Relations
Last Updated: October 25, 2016


Content on ADA.org is for informational purposes only, is neither intended to and does not establish a standard of care, and is not a substitute for professional judgment, advice, diagnosis, or treatment. ADA is not responsible for information on external websites linked to this website.

Aging and Dental Health

Key Points

  • The demographic of older adults (i.e., 65 years of age and older) is growing and likely will be an increasingly large part of dental practice in the coming years.
  • Although better than in years past, the typical aging patient’s baseline health state can be complicated by comorbid conditions (e.g., hypertension, diabetes mellitus) and physiologic changes associated with aging.
  • Older adults may regularly use several prescription and/or over-the-counter medications, making them vulnerable to medication errors, drug interactions or adverse drug reactions.
  • Potential physical, sensory, and cognitive impairments associated with aging may make oral health self-care and patient education/communications challenging. 
  • Dental conditions associated with aging include dry mouth (xerostomia), root and coronal caries, and periodontitis; patients may show increased sensitivity to drugs used in dentistry, including local anesthetics and analgesics.

The Federal Interagency Forum on Aging-Related Statistics projects that by the year 2030, the number of U.S. adults 65 years or older will reach 72 million, representing nearly 20% of the total U.S. population; this is an approximate doubling in number as compared to the year 2000.1 Older adults are, therefore, a growing patient demographic for dental practices. Increased numbers of older adults are retaining their natural teeth compared with previous cohorts.2 According to a 1999-2004 National Health and Nutrition Examination Survey (NHANES), approximately 18% of adults aged 65 years or older with retained natural teeth have untreated caries3 while a 2009-2012 NHANES found that 68% of these patients have periodontitis.4 Consideration of the overall clinical and oral health context of aging patients is important in order to provide optimum dental care.

The health status of adults older than age 65 years can be quite variable, ranging from functional independence to frail or cognitively impaired.5-8 According to the U.S. Administration on Aging, over 40% of noninstitutionalized adults aged 65 years or older assessed their health as excellent or very good (compared to 55% for persons aged 45 to 64 years).9 Most older persons have at least one chronic condition and many have multiple conditions.9 In the time period up to and including 2013, the most frequently occurring conditions among older persons were: hypertension (71%), arthritis (49%), heart disease (31%), any cancer (25%), and diabetes (21%).9 A 2015 report by the World Health Organization listed conditions common to older age, including hearing loss, cataracts and refractive errors, back and neck pain and osteoarthritis, chronic obstructive pulmonary disease, diabetes, depression, and dementia.10, 11

Physiologic changes that are age related include changes to cellular homeostasis, including regulation of body temperature and blood and extracellular fluid volumes; decreases in organ mass; and decline in or loss of body system functional reserves.5, 12 Changes to the gastrointestinal system include decreases in intestinal blood flow and gastric motility and increased gastric pH. Renal, cardiovascular, respiratory, central nervous, and/or immune systems may show decreased function (e.g., decreases in glomerular filtration, cardiac output, lung capacity, sympathetic response, cell-mediated immunity).12 These changes may have an effect on medication absorption and metabolism or an individual’s sensitivity to certain medications (See “Medication Considerations”).13

Physical changes associated with aging include decreased bone and muscle mass.12 Osteoarthritis may result in limitations in mobility.14Visual changes may include age-related macular degeneration, presbyopia, cataracts, glaucoma, or diabetic retinopathy.5, 14 Patients may experience age-related hearing loss, which may affect their ability to communicate.5, 14 Postural reflexes can become dampened, and falls become more common in elderly individuals.5, 12, 13 

Older adults may also demonstrate a spectrum of cognitive acuity, ranging from not at all affected to mild cognitive impairment to frank dementia.5 Dementia is a syndrome characterized by progressive deterioration in multiple cognitive domains, severe enough to interfere with daily functioning.5, 14 Older patients with poor cognitive health will have difficulty managing medications, medical conditions, or other self-care, including dental hygiene.14

According to data from NHANES, 39% of people aged 65 years and older reported using 5 or more prescription drugs (“polypharmacy”) in the prior 30 days during the year 2011 through 2012.15 Ninety percent of people 65 years of age and older reported using any prescription drug in the prior 30 days.15 The high prevalence of polypharmacy among older adults may lead to inappropriate drug use, medication errors, drug interactions or adverse drug reactions.5, 13 The average older adult takes 4 or 5 prescription drugs; in addition, these individuals may also be taking 2 or 3 over-the-counter (OTC) medications.13 A review of older dental patients’ medical history and current medications, both prescription and OTC medications/supplements,16, 17 should be done regularly.5, 13

Drugs most commonly prescribed in elderly patients include “statin” drugs for hypercholesterolemia; antihypertensive agents; analgesics; drugs for endocrine dysfunction, including thyroid and diabetes medications; antiplatelet agents or anticoagulants; drugs for respiratory conditions (e.g., salbutamol); antidepressants; antibiotics; and drugs for gastroesophageal reflux disease and acid reflux.13 The most frequently taken OTC medications by older adults include analgesics, laxatives, vitamins, and minerals.13

Older adults frequently show an exaggerated response to central nervous system drugs, partly resulting from an age-related decline in central nervous system function and partly resulting from increased sensitivity to certain benzodiazepines, general anesthetics, and opioids.13, 18 The American Geriatrics Society has published a 2015 update to the Beers Criteria for potentially inappropriate medication use in older adults.19 Beers Criteria potentially inappropriate medications have been found to be associated with poor health outcomes, including confusion, falls, and mortality. One change of note to the 2015 Beers Criteria includes the addition of opioids to the category of central nervous system medications that should be avoided in individuals with a history of falls or fractures.19


Xerostomia affects 30% of patients older than 65 years and up to 40% of patients older than 80 years; this is primarily an adverse effect of medication(s), although it can also result from comorbid conditions such as diabetes, Alzheimer’s disease, or Parkinson’s disease.5, 8, 20Xerostomia, while common among older patients, is more likely to occur in those with an intake of more than 4 daily prescription medications.5 Dry mouth can lead to mucositis, caries, cracked lips, and fissured tongue.8 Recommendations for individuals with dry mouth include drinking or at least sipping regular water throughout the day5, 8and limiting alcoholic beverages and beverages high in sugar or caffeine, such as juices, sodas, teas or coffee (especially sweetened).8 

Older adults are at increased risk for root caries because of both increased gingival recession that exposes root surfaces and increased use of medications that produce xerostomia; approximately 50% of persons aged older than 75 years of age have root caries affecting at least one tooth.2, 21, 22 Ten percent of patients 75 to 84 years of age are affected by secondary coronal caries; this is likely related to the prevalence of restorations in the older population.20 Adoption of good oral hygiene, which includes use of rotating/oscillating toothbrushes, and the use of topical fluoride (i.e., daily mouth rinses, high fluoride toothpaste and regular fluoride varnish application), as well as attention to dietary intake have been recommended in the literature.8, 20, 22

Because cardiovascular disease is common among older individuals, it has been suggested by Ouanounou and Haas that the dose of epinephrine contained in anesthetics should be limited to a maximum of 0.04 mg.13 The authors13 recommend that even without a history of overt cardiovascular disease, the use of epinephrine in older adult patients should be minimized because of the expected effect of aging on the heart. They recommend monitoring blood pressure and heart rate when considering multiple administrations of epinephrine-containing local anesthetic in the older adult population.13

Cognitive Limitations Affecting Dental Care and Self-Care

Patients with severe cognitive impairment, including dementia, are at increased risk for caries, periodontal disease, and oral infection because of decreased ability to engage in self-care.14 Education of the caregiver, as well as the patient, is an important part of the prevention and disease management phase of dental care.5, 14

Communication during the dental appointment may be challenging when the older adult has cognitive impairments. It is recommended that the number of people, distractions, and noise in the operatory be minimized when providing care to a patient with dementia, although a trusted caregiver in the room may provide reassurance to the patient.23 Patients should be approached from the front at eye level and use of nonverbal communication, such as smiling and eye contact, is important.23 The dentist should begin the conversation by introducing himself or herself. Because a patient with cognitive limitations may become overloaded with information easily, instructions should be simple and sentences short, such as, “Please open your mouth.”23

Because cognitive impairment or dementia can affect a patient’s ability to follow instructions following oral surgery, it is recommended that practitioners ensure local hemostasis (i.e., sutures, local hemostatics, socket preservation techniques) prior to dismissal from the dental practice.14

Dentate patients with cognitive limitations should be encouraged to brush their teeth two or more times daily; use of an electric or battery-operated toothbrush should be considered.14 The same oral care routine should be followed consistently, as possible.14 In patients with removable prosthetic devices, the device(s) should be removed, inspected, and cleaned before bed and returned to the mouth in the morning.14

Physical and Sensory Limitations Affecting Dental Care and Self-Care

Patients with Hearing Loss:  Dental care providers should speak slowly, clearly, and loudly when talking with older patients to enhance hearing and understanding.23 It is important to make sure that speaking loudly and slowly does not introduce a patronizing or condescending tone of voice.23 Yellowitz in The ADA Practical Guide to Patients with Medical Conditions14 advises the following in communicating with patients with hearing loss and/or hearing aids:

  • In patients who read lips, face the patient while speaking, speak clearly and naturally; and make sure your lips are visible (remove mask). Be at the same level as the patient.
  • Gain the patient’s attention with a light touch or signal before beginning to speak. Be sure the patient is looking at you when you are speaking and avoid technical terms. Use written instructions and facial expressions.
  • Inform the patient before starting to use dental equipment or when equipment is changed, resulting in an altered experience, e.g., vibrations from a low-speed versus a high-speed handpiece. 
  • In patients with hearing aids, minimize background noise when speaking. Avoid sudden noises and putting your hands close to the hearing aid(s). Patients may want to adjust or turn off the hearing aid(s) during treatment.
  • Written and illustrated materials and websites can be used to help explain dental information, procedures, and postoperative instructions

Patients with Visual Loss:  Age-related visual impairment, such as cataracts, glaucoma or presbyopia, can diminish a person’s ability to process nonverbal conversational cues that frequently are communicated visually.23 Ensure the patient can clearly see demonstrations and read written materials, including appointment cards and instructions.14 The following tools and strategies14 can assist visually impaired older adults in the dental office:

  • Large-print magazines in the waiting room
  • Good lighting throughout the office; add spot/task lighting in areas used for completing forms
  • Large print on prescription bottles
  • Install blinds or shades to reduce glare
  • Use contrasting colors on door handles, towel racks, and stair markers

Patients with Physical Limitations/Loss of Mobility:  Osteoarthritis or rheumatoid arthritis in the hand, fingers, elbow, shoulder, and/or neck can affect a person’s ability to maintain good quality oral health self-care.14 Modification of manual toothbrush handles (e.g., with Velcro® straps or attaching a bicycle handlebar grip) or use of an electronic toothbrush with a wide, grippable handle can help accommodate for lost mobility.14 Floss holders or interdental cleaners/brushes can aid in cleaning between teeth.14Increasing the frequency of dental cleanings and examinations can help promote optimal maintenance of oral hygiene.

Prepared by: Center for Scientific Information, ADA Science Institute
Last Update: June 14, 2017

Provided by ADA.org – Content on ADA.org is for informational purposes only, is neither intended to and does not establish a standard of care, and is not a substitute for professional judgment, advice, diagnosis, or treatment. ADA is not responsible for information on external websites linked to this website.

New Artist in Residence Program at McGlone Dental Care

By Meg Benjamin

We moved into our new location in June and the aesthetic of the building is very hip with an open, industrial, modern vibe.  As we started thinking about how we wanted the building to look and were shopping for décor that would match the great vibe we’ve created , we decided instead of purchasing stock art for the walls, we would reach out to local artists to see if we could get any interested in displaying local art on a rotating basis.  That’s how our “Artist in Residence Program” was born!

The response from local artists, after just one post on a local community site, was amazing!  We got more artists interested than we have months left to display art this year.  We are currently booked with artists to display their art on the walls of McGlone Dental Care through October of next year. 

All the artist’s work that is displayed here is for sale.  We have a price list and description of each piece that is hung on our walls.  If a piece sells we only ask that the artist donate 10% of their profit to an animal non-profit organization in Denver.  We really like the Denver Dumb Friend’s League, but if an artist has their own non-profit they like to give to, that’s ok too.

In June when we started the “Artist in Residence Program”, our first artist Brett Cremeens partnered with us to display his art here.  Brett uses acrylic’s, pencil, oil, White Out (Yes! White out that you are used to using for corrections), among other things on all types of surfaces.  He creates art on paper, canvas, exterior and interior walls, denim jackets, and even doors.  Brett painted the tooth logo that is painted prominently on the back of our building.  He has also painted a beautiful, colorful sea turtle on the inside back door of our office.  We have used bright colors mixed with neutrals to make the art pop on our walls. We also have several exposed brick walls that make a great back drop for any art.

July brings us a new artist, Elizabeth Erickson.  She is a photographer that prints her art on metal and standard print material.  Most of her images that are hung in our building are nature inspired.  She doesn’t specialize in one type of photography. She photographs, stills, nature, families, family events, weddings, Bar/Bat Mitzvah’s and more.  Her pieces are currently on display and are all for sale. If you’d like to stop in to take a peek, please do.

Here is our upcoming schedule of artists who will be displaying their art through the rest of the year at McGlone Dental Care:

September & October we will be featuring Jamie Lollback’s art.  She specializes in product, art and portrait photography.  We are excited to see what she comes up with to hang on our walls this fall.  If you’d like a preview click here (link – www.jamiejolollback.com).

November & December we are excited to have Tom Lybeck share his art with us and our patients.  Tom uses oils to paint beautiful, vibrant paintings.  The categories he paints are landscapes, birds, animals, western scenes, predators (the animal kind) and gospel type paintings.  He also produces prints and cards from his art.  For a sneak peek at Tom’s style and art click here http://www.doublevisionart-design.com.

As of now, we have November and December of 2018 open for a local artist to display their art.  If you or someone you know may be interested in partnering with McGlone Dental Care, please give Meg a call at 303-759-0731.  We hope our Artist in Residence Program will be a big hit and a win-win for everyone!