So when Levi returned to Charlotte Pediatric Dentistry in January to get two more teeth pulled, dental hygienist Barb Kucera had a surprise for him: a friendly yellow Labrador retriever named Atkins.

“Would you like Atkins to lie on your lap?” she asked.

Levi nodded, and Kucera helped Atkins hop into the dental chair and rest her head on a pillow on Levi’s chest. As Levi stroked the soft fur on Atkins’ ears, the dentist numbed Levi’s mouth and eased out two of his teeth.

“The dog made me feel happy and calm,” Levi said.

Across the country, a growing number of dentists are bringing in four-legged staff members to reduce stress for both children and adults — typically at no additional cost to patients. Dental patients at a practice in Green Bay, Wisconsin, can cuddle with a cockapoo named Charlie, for instance, while those at a practice in Nashville, Tennessee, visit with PeeWee, a French bulldog. In Cornelius, North Carolina, Whalen Dentistry advertises that a goldendoodle named Beamer will “make any appointment a little less…RUFF!”

Yet the proliferation of dental dogs highlights a surprising lack of regulation. In most states, nothing prevents a dentist from bringing in an untrained pet and calling it a comfort or therapy dog, possibly putting patients at risk for an infection or a dog attack. Patients with allergies or a fear of dogs might also have concerns.

In North Carolina, complaints from patients concerned about sanitation and safety prompted state regulators to approve a rule allowing only certain types of highly trained dogs in dental exam rooms. It took effect in June 2021 and is thought to be the first regulation of its kind nationwide.

experience dental anxiety and fear. For them, a visit to the dentist can be terrifying, and research indicates dogs can help. A published in the journal Animals found that patients with a fear of the dentist who had a dog lie on their laps during treatment experienced a decrease in their stress and blood pressure levels.

Other research shows animals in health care facilities can reduce the perception of pain and boost patients’ moods.

The Americans with Disabilities Act allows people with disabilities to bring a service dog into health care facilities, including dental clinics. Such animals do not pose a significant risk of transmitting infection in a dentist’s office, according to the .

The North Carolina State Board of Dental Examiners published an initial rule that would have allowed only service dogs for patients with disabilities in dental exam rooms, effectively banning “rehabilitative facility dogs” like Atkins. In response, dog lovers and dental patients flooded the board with emails, said Bobby White, the board’s CEO and legal counsel.

The board then proposed also allowing facility dogs in dental offices.

Facility dogs get the same intense training as service dogs but learn tasks to help many people, rather than just one, said Kyria Henry Whisenhunt. She’s the executive director and founder of , the North Carolina-based nonprofit that trained Atkins and three other dental dogs in the state.

Facility dogs are trained to work in specific professional environments, Whisenhunt said. For instance, Atkins had to be desensitized to sounds such as the screech of the dentist’s drill. The dog also had to practice laying her head on a patient’s lap and staying still while a dentist works.

Other facility dogs work with professionals in special education, physical and occupational therapy, and mental health care.

The new North Carolina regulation defines a “certified facility dog” as one trained in a program accredited by an organization that promotes training standards for assistance dogs, such as or . It also requires the dog’s handler to be trained and certified.

“Our whole goal was to make sure the dogs are safe,” White said. “There’s a lot of difference between a facility dog that has special training and a person who goes on the internet, buys a vest, and puts it on a Chihuahua.”

The Animal Legal and Historical Center at Michigan State searched laws and regulations in all 50 states for KHN and found that only Virginia, New Jersey, and Georgia specifically prohibit animals (except for service animals) in dental facilities. Center attorney Rebecca Wisch found no other guidelines related to dogs in a dental office. “I think the NC regulation is unique,” she said in an email.

Dr. James Sparks, an Oklahoma dentist who is president of the , said he wasn’t aware of any similar laws. He added that he personally would never bring an animal into his practice. “I can’t take the chance of a dog jumping up while I do work,” he said.

Atkins, who is 6 years old, received 600 hours of training from Paws4people. She and Kucera then trained together for an additional 50 hours. There was no charge for Kucera to get Atkins, but she had to commit to raise $10,000 for the foundation. Although Atkins lives with Kucera, she is owned by Paws4people.

On the days Atkins works at Charlotte Pediatric Dentistry, a sign in the reception area alerts patients that a dog is on duty. If someone has allergies or a fear of dogs, the staff puts Atkins in her kennel in a back room.

For the youngest patients, Atkins jumps into the dental chair and models behavior. She gets her own clip-on napkin and holds her mouth open while Kucera checks her teeth with a mirror.

When patients want Atkins in their laps, Kucera uses a disposable drape to create a barrier between the patient’s clothing and the dog so the patient doesn’t go home covered with dog hair. She said that she’s never had a problem with Atkins disturbing a dentist’s work and that many families request the pooch for every appointment.

Levi said that’s his plan, too. “It’s just really helpful,” he said. “Everyone should have one.”

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

“I can’t drill. I can’t pull teeth,” said Geiselhofer, whose mobile clinic is called . “I’d recommend they see a dentist, but that was often out of the question because of mobility challenges. So visit after visit, I would come back and there would be more decay.”

But now Geiselhofer has a weapon to obliterate a cavity with a few brushstrokes.

Silver diamine fluoride is a liquid that can be painted on teeth to stop decay. Fast, low-cost and pain-free, the treatment is rapidly gaining momentum nationwide as the cavity treatment of choice for patients who can’t easily get a filling, such as the very young or the very old.

“It has been life-changing for my patients,” said Geiselhofer, who has been using the treatment for about 18 months.

Geiselhofer has not been able to go into nursing homes during the COVID-19 pandemic, but she uses the liquid on the older adults she visits in private homes. She also uses it to treat the cavities of patients in homeless shelters, jails and Head Start programs ― now wearing greater protective gear, including gloves, a surgical mask, an N95 mask and a face shield.

The topical medication is an especially good option for seniors, dental industry experts say, because dental care has remained a major gap in health insurance coverage despite poor dental hygiene being linked to heart disease and other health problems like diabetes and pneumonia. Medicare doesn’t cover most dental care, and patients on a fixed income often can’t afford treatment. But because of the effectiveness and low cost of silver diamine fluoride, more state Medicaid programs now cover it — and older adults who pay out-of-pocket can afford it outright.

Silver diamine fluoride has been used in other countries for decades, and studies have proved it safe. Its biggest downside is that it permanently turns the decayed area black — a turnoff, in particular, for people with decay on a front tooth.

Dental providers say the black spots can be covered by tooth-colored material for an extra cost. For older adults, Geiselhofer said, a dark spot is a small price to pay for a treatment that stops cavities quickly, with no drilling, needle prick or trip to the dentist required.

Oral Care a Problem for Older Adults

Silver diamine fluoride was approved by the Food and Drug Administration in 2014 for reducing tooth sensitivity. But its off-label use to treat cavities was quickly adopted. It made headlines as a trauma-free treatment for tooth decay in children under age 5.

Pediatric dentists have embraced it as a solution for kids who can’t sit still for treatment and whose parents want to avoid general anesthesia. In 2018, the then-president of the American Academy of Pediatric Dentistry, , said that, aside from fluoridated water, the topical cavity fighter “may be the in pediatric dental health in the last century.”

But today, with more older Americans keeping their natural teeth than in decades past, the treatment is also serving as a boon for a different generation. Because of insurance gaps and the prohibitive cost of most dental treatments, many seniors miss out on preventive care to stave off dental decay, putting them at risk for dental disease that can trigger serious health problems. About 27% of Americans age 65 and older have untreated cavities, .

Residents in long-term care facilities are at especially high risk, . Medications cause their mouths to dry, promoting decay. They also may have cognitive issues that make it difficult to practice good oral care. And many are either too frail for traditional dental treatment or too weak to be transported.

Dental Hygienists Lead the Way

Take 87-year-old Ron Hanscom, for example. A patient of Geiselhofer’s, he has been in a Denver nursing home since he had a stroke six years ago, and needs a mechanical lift to get into and out of his wheelchair.

On a visit to Hanscom’s nursing home earlier this year, before the pandemic, Geiselhofer spotted a cavity under one of his crowns. After checking in with his dentist, she used a small brush to paint on the silver treatment.

“It’s a good thing she had the silver, because I couldn’t get to a dentist’s office — no way,” Hanscom said. “She did it right in my room.”

Across the country, dental hygienists provide much of the care to patients like Hanscom who otherwise might never see a dentist. They also see patients in homeless shelters, schools, jails and low-cost medical clinics. Since the pandemic hit, Geiselhofer said she has received a flood of requests for in-home care from seniors who are too nervous to go into a dentist’s office, but she has turned them down because she is too busy caring for underserved populations.

Many states allow hygienists to work directly with patients in public health settings without a dentist’s supervision, and Colorado is one of a few that allows them to set up a completely independent practice.

Because the silver treatment is relatively new in this country and can leave a stain, the Colorado state legislature passed a law in 2018 that says hygienists must have an agreement with a supervising dentist to apply it. The law also requires them to get special training on how to use the liquid, which at least 700 hygienists from across the state have completed.

Other states, including Maryland and Virginia, have no special requirements for applying the cavity treatment but require some supervision by a dentist, said Matt Crespin, president of the . In those places, hygienists apply it under the same rules that govern the application of other fluoride products.

Preventing New Cavities, Too

silver diamine fluoride stops decay in 60% to 70% of cases with one application. A second application six months later boosts the treatment’s long-term effectiveness to more than 90%.

In addition to killing cavity-causing bacteria, the treatment hardens tooth structure, desensitizes the tooth and even stops new cavities from forming. Applying the liquid on the exposed root surfaces of older adults once a year is “a simple, inexpensive, and effective way” to prevent cavities, concluded.

One of the most important benefits of the application on older patients is that the liquid can reach decay that forms under existing dental work such as crowns and bridges, said dental hygienist Michelle Vacha, founder of , which runs clinics in Colorado Springs and Pueblo, Colorado.

Previously, a dentist would have had to remove the crown, drill out the cavity and make a new crown — a traumatic, time-consuming procedure with a typical cost of $1,000 or more, Vacha said. Unable to afford the cost, many patients would instead have the tooth pulled.

The paint-on liquid is significantly cheaper than traditional treatment. Estimates vary, but a private dentist may charge $10 to $75 for one application, compared with $150 to $200 for a filling. Hygienists often have lower fees. At Vacha’s community clinics, the cost is $10 a tooth.

About half of state Medicaid programs now reimburse for the treatment, said Steve Pardue, scientific officer of that distributes Advantage Arrest, the main brand of the topical medication used nationally. Reimbursement rates range from $5 to $75 per application.

More private insurers — about 20% to 30% of them — have also started covering it, Pardue said.

Coming Soon to a Dentist Near You?

A small but growing number of mainstream dentists have begun to offer the treatment to all patients, not just the youngest and oldest.

It’s a good option for those who have anxiety about dental work or concerns about cost, said Dr. Janet Yellowitz, director of geriatric and special care dentistry at the University of Maryland School of Dentistry.

by the American Dental Association found that almost 8 in 10 dentists had never used the treatment. The ADA doesn’t have more recent statistics, but ADA spokesperson Matthew Messina said anecdotal reports indicate usage is increasing dramatically.

Yellowitz noted that dentists still have a financial incentive to drill and fill. She has made presentations highlighting the benefits of the silver solution at national conferences.

“We’re trying to get everyone to use it,” she said. “It’s a slow process because we’re asking dentists who have been trained for their whole careers to do things one way to completely change their mentality. It’s like asking them to go to another country and drive on the other side of the road.”

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .