The Opiate Crisis and How It Relates To Dentistry

Posted by Chris Raines on Feb 28, 2017 4:46:08 PM

Pennsylvania Guidelines for Dentists Regarding OpioidsDentists are among the leading prescribers of opioid prescriptions. The opiate crisis, which takes lives, destroys families and increases crime, has significantly increased in recent years. New regulations and programs address this issue.

A February 2017 panel discussion that included the Montgomery County Department of Drug and Alcohol, the Sheriff’s office, County Commissioner, Dr. Valerie Arkoosh, a Salvation Army representative, and survivors and advocates, was held to address the 138% increase in Montgomery County drug overdoses in 2016.

Research suggests that abuse of prescribed opioids can open the door to heroin use. Nearly half of young people who inject heroin surveyed in three recent studies reported abusing prescription opioids before they started heroin. Some individuals reported switching to heroin because it is less expensive and easier to obtain than prescription opioids. *

More people are dying from heroin overdose than in the past and authorities say that this is due to Fentanyl, which drug dealers often use to cut heroin. It is 80 to 100 times stronger than morphine.

Chief Deputy Michael Beaty, Montgomery County Sheriff’s Office, reported 237 drug related deaths in 2016 (213 were accidental and 98 involved Fentanyl). He asserted that drug use increases other crimes, such as theft.

Cocaine, methamphetamine, oxycodone and the prescription anti-anxiety medications alprazolam (Xanax) and clonazepam (Klonopin) contribute to overdose deaths.

Drug abuse is not only an urban problem. It occurs all locations, including suburban and, surprisingly, rural areas. A 2015 report from the Center for Rural Pennsylvania showed that overdose deaths from heroin, which sells for as little as $5 per bag on the streets, as well as prescription painkillers and other opioids have increased by 470% compared to the previous 20 years. More Pennsylvanians ages 20 to 44 are dying annually from overdoses than from motor vehicle accidents.

“Because of the uptick in cases, the treatment system is being severely taxed. Treatment centers, like Eagleville Hospital, need more beds.” said Kay McGowan, Montgomery County Deputy Administrator of Drug and Alcohol.

McGowan addressed the issue of relapse by recovering addicts. “So many people relapse when they are prescribed meds by a doctor.” Physicians and dentists must conduct careful screening  to determine if the patient is in recovery. Alternatives, such as Nsaids, should be prescribed.

Benny Mosakowski lived in a tranquil suburban community where he attended Plymouth Whitemarsh High School and played football in the 1980’s.  Prescription opioid medications had been prescribed for a football injury.  Benny states that he became instantly hooked on the prescribed pills. He found that the pills were readily available to him but eventually switched to heroin. Benny never thought that heroin addiction could happen but his life quickly spiraled out of control.  Mr. Mosakowski related, “I needed heroin as much as I needed air. I never learned to be an adult or developed coping skills. At 35, I’d had two marriages and 2 children and was sticking a needle in my arm every day.” It took Benny 10 years to stay clean. Thanks to Eagleville Hospital, as of 2012, he has not had another drug. “This is a disease and not a deficiency. I have seen more people die in the past 1 ½ years than in the previous 15. When you reach a state of willingness, if the help is there, you can quit. The problem starts in the medicine cabinet, but then heroin costs less than pills.” Today, Mr. Mosakowski is a survivor and advocate helping others.

The Journal of the American Medical Association reveals that dentists routinely prescribe opioid analgesics. The first sign of this unexpected source of opioid prescriptions was discovered in 2011. At that time a survey of members from the American Dental Association Survey Center was taken and the findings were surprising. The data shows the following:

  • 85% of dental surgeons said they almost always prescribed an opioid
  • 64% of surgeons said that their opioid prescription of choice was hydrocodone with acetaminophen
  • The average number of hydrocodone with acetaminophen was 20 tablets
  • In 96% of the cases, the only medical instructions provided for taking the pills was "as needed for pain”**

Gary Tuggle, who oversees the DEA’s Philadelphia Division, states, “It is imperative that law enforcement, healthcare and treatment professionals, elected officials, and community groups work together to address the factors impacting availability, use and abuse of these drugs.”

“There are many alternatives to opiates that are quite effective,” adds Valerie Arkoosh MD, Montgomery County Commissioner. “If a physician will not consider giving a non-narcotic medication, get a second opinion.” She emphasized, “Patients can just say no to opiates. Parents should always consider non-opiates.” Arkoosh also briefly discussed the new database that doctors and dentists must check before writing opioid prescriptions.

Many people believe that if pain relievers are prescribed by a doctor or dentist, then they are safe.  However, if these medications are taken in larger amounts, more often than prescribed, or for unintended reasons, they can cause severe adverse effects including addiction, overdose, and death. Prescribed medications should never be taken by someone other than the one for whom they were prescribed. Opioid medications should never be combined with alcohol or other drugs.

In light of the current opiate epidemic, dentists must ask themselves how they can effectively help to reduce the problem.  They must learn how to identify patients who have an addiction problem.

Pennsylvania Programs at PA.Gov

What should a dentist do if they suspect that one of their patients has an addiction problem?

New Pennsylvania Department of Health Prescription Drug Monitoring Program (PA PDMP) requirements took effect in January 2017.  Dentists must check the PA PDMP database each time they prescribe an opioid medication.

Governor Wolf said, “By reducing the pattern of over-prescribing painkillers that have such a high risk for abuse, we are fighting back against opioid abuse and heroin use before those habits even begin.”

Providers have a responsibility to diagnose and treat pain using informed clinical judgement that minimizes serious adverse effects. Consideration for the patient’s past and current history of opioid use and abuse must be included when determining which pain medications should be prescribed. The patient’s substance use history should be documented.

Ask open-ended questions to learn about the patient’s drug use. It is as difficult as it is essential. Broaching the subject feels awkward and intrusive.

Unless contraindicated, non-steroidal anti-inflammatory medications (NSAIDS) should be considered. In many cases, NSAIDs have proven to be more effective in treating dental pain than opioids. Pain therapy can be initiated immediately prior to the surgical procedure and continued on a scheduled basis following completion of the procedure.

Patients reporting unexpectedly prolonged pain, particularly those who do not show evidence of ongoing pathology, should not be prescribed opioids. They can instead be referred to a chronic pain specialist.

Relevant information should be provided so patients are well informed about the various options available for pain management. Good physician/patient communication is essential.***

Patients whose behavior indicates the presence of a substance use disorder, should be encouraged to seek evaluation for treatment through their primary medical care provider.

Pennsylvania Medication Take-Back Program ContainerPatients should be instructed in safe disposal of unused medications, to ensure that these meds will not be misused. Through the Pennsylvania Prescription Drug Take-Back Program, Med Return Collection Boxes are available for safe disposal of unused medications, including opioids. This program has placed 492 boxes across Pennsylvania. The total amount of drugs taken back and destroyed in 2015 was 56,252 pounds.

Prosthodontist, Dr. Glenn Wolfinger states, “The staff of Pi Dental Center and I have been very aware of the issues regarding opioid use and have been very careful throughout the years in how these medications were prescribed. Non-steroidal anti-inflammatory pain medications have worked well for Pi Dental Center patients.”

In light of the severity of the opioid crisis, it is obligatory that dentists and physicians follow the new Pennsylvania guidelines to identify at-risk patients and to ensure patients are prescribed safe medications.

Contact Pi Dental Center for information about dental treatment and surgical procedures and pain medications.

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Learn More about the opiate crisis and how it relates to dentistry:

Pennsylvania Department Of Health Prescription Drug Monitoring Program

Link to Portal

Mapping Pennsylvania’s Worsening Heroin Crisis

DEA: Drug overdose deaths up sharply in Pennsylvania By Michael Goldberg


Info about Gary Tuggle

*** Improving the management of post-operative acute pain Meissner et al.

Tags: dentist, dentistry, opiate crisis and how it relates to dentistry

Can’t Fool Santa or the Dentist

Posted by Chris Raines on Dec 20, 2016 4:18:41 PM

naughty-nice.jpgHe's making a list,
He's checking it twice,
He's gonna find out who's naughty or nice
Santa Claus is coming to town

He sees you when you're sleeping
And he knows when you're awake
He knows if you've been bad or good
So be good for goodness sake

We’ve all heard the Christmas song, “Santa Claus Is Coming to Town,” written by John Frederick Coots and Haven Gillespi.  This Christmas classic, first sung on Eddie Cantor's radio show in November 1934, cautions children to behave because Santa can magically perceive whether they are naughty or nice.

20161220_100703 copy.jpgSome people try to hide their dental habits from the dentist.  They try to hide their irregular and haphazard oral hygiene by brushing their teeth vigorously right before their dental appointment.  Oral hygiene habits cannot be concealed. Built up stain and food impaction are visible tell-tale signs of poor dental hygiene.  Poor dental hygiene will eventually result in tooth decay, cavities, gum disease tooth loss and can even affect overall physical health.

The dentists at Pi Dental Center recommend brushing after every meal, cleaning between the teeth with dental floss, water flosser or Proxabrush and scheduling oral hygiene cleanings and examination at least twice a year.  Oral hygiene instruction can help patients improve their oral hygiene techniques.

Pi Dental Center’s dentists and hygienists are your partners in dental health, helping you to make sure that your teeth are as healthy and attractive as they can be. Call to schedule your dental hygiene visit.

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Related Subjects:
Tooth Extraction
Bone Remodeling
Maintaining Dental Investment

Tags: dentist, oral hygiene, dental health, dental hygiene

When Looking For Dental Implants, How Does The Dentist Measure Up?

Posted by Chris Raines on Oct 11, 2016 12:04:50 PM

Drs. Balshi and Wolfinger lecturing to students and dentistsEach morning, the Pi Dental Center mailbox receives a new batch of emails from people looking for the best dental implant specialist. The other day, we received an email asking if our doctors were as good as Doctor So-and-So in Las Vegas.  

Before responding, I did a little research to learn about So-and-So. I learned that Dr. So-and-So had almost nothing to back up his glitzy persona.

I’ve had the pleasure of working at Pi Dental Center for 29 ½ years for Drs. Thomas Balshi and Glenn Wolfinger! One of my tasks is to document every research article on our website. I document every book they write, every course they teach, every lecture they give, every poster-presentation they produce and every award they receive.  Documenting their distinguished careers is almost a full time job.

Drs. Balshi and Wolfinger are both board certified prosthodontists. Prosthodontists are dentists who specialize in diagnosis, planning, rehabilitation, and maintenance of the teeth and mouth with special emphasis on the patient’s oral comfort, facial appearance, and dental health. Prosthodontists treat patients with congenital conditions, missing teeth and complex dental problems. Prosthodontists receive two or three years of additional training following dental school through an accredited American Dental Association program.

To become board certified, prosthodontists must successfully pass a rigorous examination conducted by the American Board of Prosthodontics. These specialists are subjected to recertification every eight years to insure their clear understanding of current practices that affect the specialty.

Teeth In A Day Course presented by Drs. Balshi and Wolfinger in 2016

Drs. Balshi and Wolfinger’s 118 research articles are available online.

A quick way to learn doctor’s accomplishments is to look at their Curriculum Vitaes. Here is the link to Dr. Balshi’s lengthy Curriculum Vitae  and Dr. Wolfinger’s comprehensiveCurriculum Vitae.

Dr. Balshi has been America’s Top Dentist and International Congress of Oral Implantologists Diplomate. He’s been awarded for 40 continuous years of service by the American College of Prosthodontists, received the Temple University Kornberg School of Dentistry Gallery of Success Award and the American College of Prosthodontics Founders Award. He was named Top Prosthodontist by the Consumers’ Research Council of America. Dr. Balshi earned the United States Army Medal of Commendation, a Freedom Foundation George Washington Medal of Honor, and has been recognized in the Congressional Record of the United States of America.

Both Drs. Balshi and Wolfinger have been at the forefront of dental implant research and development since the 1980’s. Their research has helped to take the journey to fixed teeth from a difficult year-long ordeal that involved many steps to a relatively pain-free one-day procedure.

Drs. Balshi and Wolfinger trained graduate and postdoctoral students from Harvard, Tufts, Loma Linda, Nova Southeastern, Temple, University of Connecticut, University of Maryland and other dental schools and lectured worldwide on surgical and restorative aspects of dental implant treatment.

Pi Dental Center’s prosthodontists successfully provided dental implants to patients with countless complicated problems from diabetes, Cleidocranial Dysplasia, Ectodermal Dysplasia, advanced periodontal disease, congenitally missing teeth, and traumatic injury. 

Some of Drs. Balshi and Wolfinger’s Scientific Accomplishments:

Patients have willingly and readily provided positive reviews for Drs. Balshi and Wolfinger.  The whole team has been commended for their professionalism, caring friendly manner and beautiful result.

Drs. Balshi and Wolfinger are the real deal. Dr. So-and-So — not so much.

If you are looking for a dentist or have questions about dental treatment please feel free to contact us.  We look forward to helping you regain your magnificent and healthy smile.

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Chris Raines
Web Site Administrator
Information Systems Manager



Tags: dental implants, dentist, choosing a dentist

Why Pi? Our restorative dental care is both skilled and heartfelt

Posted by Joanne Balshi on Feb 19, 2016 5:11:41 PM


Patients who come to Pi for restorative dental care often write us “love letters” expressing their sheer wonderment at how profoundly we prioritize each individual.  Though many come for the  advanced cosmetic techniques available in today’s prosthodontic practices, most still come with serious dental issues that affect function, create pain, and diminish overall health.  Those patients are anxious, have fears and need questions comprehensively answered.  From the first phone call to our reception staff to the delivery of a custom restoration, our eyes, ears and even arms are open to give first class personal service to every human being.

Not all prosthodontics involves teeth, though, and on this gray February day in Fort Washington, a small glow came from the operating room where a most heartwarming procedure was taking place. One of our youngest patients is a charming young African American soccer enthusiast who came to Pi, not for dental implants, but for implants to give him back a nose! Having been viciously attacked by a wild hyena when only six years old, Sisay lost the entire center of his face and was substantially disfigured until the Pi team came up with a prosthetic replacement, especially designed to be altered when a growing boy required a new look.

Today, another young boy, nearly the same size as Sisay, volunteered to have an impression of his nose taken to help our team create Sisay’s next nose.  The procedure was painless and simple, but the concept was really no different than the concept of a living organ donor.  A child was using his own body to enhance the physical existence of another. Surrounded by our Pi team of doctors, two dental assistants and our bio-medical engineer, the appropriate model was taken and the production of a nose-to-grow-with is now underway.

Why Pi?  This simple project was unrushed.  The people involved were keenly compassionate and sensitive to both children, aware of the value of the gift in the development of an invaluable medical solution.  It was not simply a process; it was a fulfillment.  Alongside creative, cutting edge technology was the unmistakable impact of a tender and lingering human touch, something rarely reported in 2016 healthcare.

Everything went so smoothly that the appointment took less time than expected—another hallmark of dental care at Pi Dental Center.  When the doctors were finished, Martha and Julie remained with the boys, gave both of their faces a little spa treatment, and most importantly, engaged in conversation that was right in their young zone.

This little excerpt from a Wednesday at Pi is a small taste of the big picture.  Why Pi?
Because when people are hurting, our job is not just nuts and bolts and know-how.  It’s the CARE part of healthcare and we challenge ourselves to do it better than anyone else around.

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Photos of Sisay at Pi Dental Center in Fort Washington, Pennsylvania.


Tags: dental implants, dentist, dentures, dental patient satisfaction, dental health, skilled dental care, restorative dental care

Prosthodontics Awareness Week a la Pi Dental Center

Posted by Thomas Balshi, DDS FACP on Apr 11, 2011 2:40:00 PM

Prosthodontics Awareness Week a la Pi Dental Center - April 4-9, 2011

Pi Team At Open House

When the American College of Prosthodontists announced their first designation of a Prosthodontics Awareness Week, the Pi team embraced the idea with gusto.  Here was an opportunity to showcase all that distinguishes a prosthodontic practice from a neighborhood dental office. 

Drs. Thomas Balshi and Glenn Wolfinger

We started with a simple question: Do YOU have a prosthodontist?  We threw it out there on the internet, in the local newspapers, and in banks and restaurants and supermarkets.  Then we elected to answer the question comprehensively by opening our doors to the community. 

The Pi Dental Center invited prospective patients and all of our patient family to Open House.  We provided tours, question and answer sessions, refreshments, and a rolling slide show of dental trivia, before and after photos, and most importantly, bold statements that defined what a prosthodontist really is. Astoundingly one of the most successful parts of the event turned out to be the conversations between treated patients and those contemplating a whole new smile. The articulated enthusiasm and spirit of “go for it” were overwhelming.  Giveaway bags and a raffle rounded out the day.

Andrea Smiles at Pi Dental Center Open House

Throughout the week, silver trays of decorated cookies in the shape of toothbrushes and toothpaste tubes graced our reception area.  In early March our staff were invited to suggest a clever tag line to write on the cookies.  Twenty-five staff actually submitted forty-six entries.  The judges chose:  Prosthodontics is for smart cookies!

Everyone from the mailman to the last patient on Friday afternoon took home a brush and a tube.

So what does make a prosthodontist different?  Besides his superior training (at least two years of specialty education beyond regular dental school), a prosthodontist has extraordinary vision. A prosthodontist blends science and esthetics, engineering and spatial relations to create natural looking teeth, custom designed for each individual patient, that function with precision and radiate health and beauty. Open House Refreshments

It does not matter whether it is one single tooth or an entire upper and lower dentition; a prosthodontist’s eye is geared toward perfection.  He/she is not simply maintaining teeth but rather is building or rebuilding one of humanity’s most powerful assets. A prosthodontist has a sense of pride in smiles that is born of passion and education second to none in the dental profession. When one is contemplating the reconstruction of a smile, the prosthodontist is the specialist that will best manage the delivery of care and provide an outcome that will exceed expectations.  

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Tags: dentist, Pi Dental Center, restorative dentistry

A Cost Effective Approach for Rehabilitation with Dental Implants

Posted by Pi Dental Center on Feb 8, 2011 2:26:00 PM

Facial Rehabilitation Using The All-On-4 Mandibular Prosthesis

Robert, a 49-year-old journalist came to Pi for an opinion on his smile.  His profession required frequent face-to-face interviews.

His chief complaints were the embarrassment he experienced when smiling, painful chewing, very poor aesthetics and highly mobile teeth. He wrote in his medical history, “It would be nice to smile again”.  Robert was in a severe automobile accident in 1980, which left him with a chronic painful condition in his neck, his back and his jaws.    

Robert’s initial clinical examination noted multiple fractured teeth, extensive dental decay, several abscesses, and extruded teeth, which created a severe malocclusion.  There was a heavy plaque and calculus accumulation, which combined with smoking, contributed to advanced periodontal disease. 

At his initial visit, he smoked one pack of cigarettes a day, but wished to stop. Robert was advised of the effects of smoking, not only for his general health, but also for his dental condition.  He was strongly advised to quit smoking immediately.  Robert did admit he was “a very bad dental patient” due to his high level of anxiety.

Historically, extensive periodontal therapy followed by prosthodontic treatment may have been indicated to maintain and restore Robert’s natural dentition.  However, with all the clinical findings and the current condition of the patient’s teeth, traditional dental treatment had a poor prognosis.  With his advanced periodontal disease and his poor compliance, orthodontics to improve the dental malocclusion was not a viable option.  

Robert was presented with a treatment plan addressing all his concerns in an expedient manner. Cost was a consideration for the full mouth reconstruction.  Some doctors would recommend less expensive prosthetic treatment using an implant overdenture.  At Pi Dental Center we have found that patients are rarely satisfied with the removable implant overdenture as they are with fixed implant prostheses. At Pi Dental Center, we have found that there are many additional visits, as well as added costs associated with maintenance of the overdentures.  Recent studies have collaborated our findings.

The philosophy at Pi Dental Center is to provide patients with the most effective and efficient approach to solving their dental problems.  The Teeth In A Day® dental implant procedure is an excellent alternative for patients with a failing teeth who need to make the transition to an implant-supported prosthesis.  Historically, it would take several months or even years to see the benefits of implant treatment.  Fifteen years of research, pioneered at Pi Dental Center, has enabled patients to enjoy the benefits of immediately loading the implant-supported teeth on the same day that their decayed teeth are removed and the implants installed.  This accelerates the entire clinical process.

The early research for Teeth In A Day® was accomplished in patients where larger numbers of implants were placed to provide a very predictable solution for prosthesis stability.  Recently, studies have been published that show comparable predictability using fewer implants.  The latter may prove to be a more cost effective treatment approach for patients in need of implant-reconstruction.  

For Robert’s treatment all the periodontally compromised teeth were extracted, six implants were placed in the maxillary arch, four implants were placed in the mandibular arch and prostheses for both arches were put into immediate function following the Teeth In A Day® protocol.  While the patient was encouraged to adhere to a soft diet for the first three months, the temporary teeth proved to be much stronger than Robert’s natural teeth.  The aesthetic improvements were immediate.  Three months after the surgery the bone healing had stabilized and the  final implant reconstructions were delivered.

The patient went through a complete makeover to improve his overall aesthetics.  Dr. George Zavitsanos, a board certified plastic surgeon, provided improved facial aesthetics by surgically correcting the deviation in Robert’s nose in conjunction with multiple soft tissue enhancements.  Following facial surgery healing and the Teeth In A Day® treatment, Robert agreed to a style makeover and experienced his first hair cut since 1969.  A new prescription for corrective lenses offered yet another cosmetic improvement with his stylish new glasses.  Robert’s satisfaction with the Teeth In A Day® procedure is extremely high.  He has noticed a dramatic improvement in his psychological well-being and has found it easy to smile and be more outgoing.  As a news journalist for a Washington, DC newspaper, he feels more comfortable at press conferences in the highly political public eye.

From a dental standpoint, the periodontal disease has been eliminated and the patient now has a completely healthy, functional, stable and aesthetically pleasing reconstruction.

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Tags: tooth replacement, dental implants, dental implant treatment, dentist, cost effective dental treatment, board certified prosthodontist