18. Ozbek MM, Miyamoto K, Lowe AA, Fleetham JA.
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20. Milleman J, Putt M, Olson M, Master A, Jenkins W,
Schmitt P, Strate J. Comparison of plaque removal by
Sonicare For Kids and a manual toothbrush in children
aged 7–10 years. Int J Ped Dent. 2009;19:s1.
21. Defenbaugh J, Schmitt P, Master A, Jenkins W,
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WINNING THE BATTLE
continued from pg. 60
or noncompliance with at-home products
may factor into recommended treatment
and suggested products. If the patient’s sensitivity is caused by toothbrush abrasion,
recommendations should be given for less
damaging techniques and devices.
As stated before, a combination of products may be indicated for some patients, such
as a take-home product used in conjunction
with an in-office treatment. If making this
recommendation to the patient, the hygienist
must be aware of product compatibility and
any potential contraindications for combining the chemistries of the products.
The manufacturer’s instructions for use
(IFUs) should be the first thing that a hygienist
reviews when selecting a product and prior
to using a product for the first time. IFUs
contain valuable information that will affect
the successful use of a product and improve
outcomes for patients.
Although there are CDT codes for application of desensitizers, as we well know, many
benefit plans do not cover the procedure. The
hygienist and other members of the dental
team must be well versed in presenting treatment options, including the benefit to the
patients and help those patients to value the
treatment and the relief that they may have
from use or application of desensitizing
Yet another factor in determining which
product is best suited for a particular patient
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3. Neville BW, Damm DD, Allen CM, Chi AC. Oral and
Maxillofacial Pathology, 4th Edition. Elsevier 2016.
WAITING TO EXHALE
continued from pg. 56
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8. Halbower AC, McGinley BM, Smith PL. Treatment
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9. Harvard Medical School. Understanding the results.
Apnea: Understanding and Treating Obstructive Sleep
Apnea website. http://healthysleep.med.harvard.edu/
Updated February 11, 2011.
10. Isono S, Shimada A, Utsugi M, Konno A, Nishino
T. Comparison of static mechanical properties of the
passive pharynx between normal children and children
with sleep-disordered breathing. Am J Respir Crit Care
Med. 1998;157( 4 Pt 1):1204-12.
11. Friedman M, Wilson M, Lin HC, Chang HW. Updated
systematic review of tonsillectomy and adenoidectomy
for treatment of pediatric obstructive sleep apnea/
hypopnea syndrome. Presented at: The Annual Meeting
of the American Academy of Otolaryngology–Head
and Neck Surgery; September 21-24, 2008; Chicago,
12. Ahn YM. Treatment of obstructive sleep apnea
in children. Korean J Ped. 2010; 53( 10):872-879.
13. Jureyda S, Shucard DW. Obstructive sleep apnea—
an overview of the disorder and its consequences.
Semin Orthod. 2004; 10( 1): 63-72.
14. Ashok N, Varma NK, Ajith VV, Gopinath S. Effect
of rapid maxillary expansion on sleep characteristics in
children. Contemp Clin Dent. 2014; 5( 4):489-94.
15. Kirjavainen M, Kirjavainen T. Upper airway
dimensions in class II malocclusion. Effects of headgear
treatment. Angle Orthod. 2007; 77( 6):1046–1053.
16. Jena AK, Singh SP, Utreja AK. Sagittal mandibular
development effects on the dimensions of the
awake pharyngeal airway passage. Angle Orthod.
2010; 80( 6):1061-7.
17. Schafer ME. Upper airway obstruction and sleep
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characterized by early atypical melanocytes
called lentigo maligna. These lesions exhibit
atypical melanocytes in the epidermis with
potential to invade the dermis layer. Changes
in size or color, or border irregularity must
be viewed with suspicion. These lesions are
often seen on the faces of older
The possibility of melanoma is always a
concern with any lesion change, whether
the macule is a freckle, melanotic macule,
or a lentigo maligna. Synonyms for melanotic macules are Hutchinson freckle and
ORAL MEDICINE CONSIDERATIONS
Although the oral melanotic macule is a
benign lesion, malignancy has been reported
in rare cases. Malignant melanoma can have
a similar appearance at certain stages. It is
suggested that all pigmented lesions that
have an unknown duration, recent onset, or
have changed in any way be submitted for
biopsy. Excisional biopsy is suggested (
Neville, 2016). Tissue is destroyed when laser or
cryosurgery is used and no biopsy examination would be possible. As a result, any histological examination needs to be performed
prior to laser surgery if removal is being
Certain diseases are known to have mul-
tiple hyperpigmentation areas as a charac-
teristic. The different types of disease-asso-
ciated melanoses listed below are highly
correlated with oral/perioral pigmentation
and are of prime concern in a differential
• Addison’s disease
• Peutz-Jeghers syndrome
• Chronic lichen planus
• Laugier-Hunziker syndrome
• McCune-Albright syndrome
• Kaposi sarcoma
The prognosis for oral melanotic macules
is excellent, and they are followed and mon-
itored after diagnosis through documenta-
tion and photographs/images. Once con-
firmed or diagnosed, no treatment is needed
unless a biopsy is indicated because of
changes or if there is a question regarding
the etiology of the macule. In most instances,
they are removed for esthetic concerns.
As always, continue to ask good questions
and listen to your patients! RDH