Category Archives: oral cancer

April Is Oral Cancer Awareness Month. Know The Warning Signs!

Ask most Americans which cancers are the most deadly and you’ll likely hear replies of pancreatic, prostrate or breast cancer. While these cancers are widespread and can be deadly, you rarely hear about oral cancer.

What makes Oral Cancer so deadly is its ability to progress long before symptoms emerge. By the time they do, it becomes a difficult cancer to battle. Treatment is often very disfiguring. Even worse, it is known to be one of the deadliest of all cancers, taking the life of one American every hour of every day.

In the majority of dental offices, regular dental exams include an annual screening for Oral Cancer. However, a 2014 Gallup poll showed that one-third of American adults have not seen a dentist in over a year (http://www.gallup.com/poll/168716/one-third-americans-haven-visited-dentist-past-year.aspx), leaving a significant percentage of adults unchecked. If a key component in catching Oral Cancer before it becomes deadly involves a dental visit, the challenge will continue until more individuals are in a dental chair.

For many individuals, dental fear can be a deterrent to having regular dental care. This is why we offer oral and I.V. sedation. These relaxation options, in addition to providing a gentle touch, have opened the doors for many fearful adults to have regular dental care. Still, there are an estimated 70 percent who have fears or anxiety when it comes to dental visits. Some are so fearful that they avoid dental visits altogether.

Those with the highest risk are adult males, with Black males being the most susceptible. Oral cancer risk also increases with age, especially after age 50. Risk levels generally peak between ages 60 – 70. The highest rates have been noted with males between ages 50 – 59.

Other risk factors (for all ages) includes tobacco and alcohol use. However, a particular factor that is spiking numbers in younger age groups is the sexually transmitted human papillomavirus (HPV).

A National Cancer Institute Survey shows a 15% increase in oral cancer rates over the past three decades. Still, many people assume “if it doesn’t hurt, then nothing’s wrong.” I believe this has lead to such high levels of periodontal (gum) disease and subsequent adult tooth loss. And, as rising Oral Cancer statistics show, the casual attitude toward dental exams can result in far worse than losing teeth.

April is National Oral Cancer Awareness Month. Begin by becoming familiar with the symptoms. Acting on these early warning signs means we can take prompt, appropriate action. These include:

•    A sore, irritation, lump or thick patch in the mouth, lip, or throat
•    White or red patch inside the mouth
•    Feeling something is stuck in the throat
•    Difficulty chewing or swallowing
•    Difficulty moving the jaw or tongue
•    Numbness in the tongue or other areas of the mouth
•    Unexplained swelling of the jaw
•    Pain in an ear without hearing loss

While these symptoms do not always indicate Oral Cancer, anything in the mouth that does not go away on its own in 10-14 days should be examined immediately. Early treatment can mean the difference between resolving the problem simply or disfiguring surgeries, and even death.

Call 586-739-2155 for an examination appointment if you have not had regular dental check-ups. In the meantime, learn more about Oral Cancer at the American Cancer Society’s web site:

http://www.cancer.org/cancer/oralcavityandoropharyngealcancer/detailedguide/oral-cavity-and-oropharyngeal-cancer-key-statistics

Canker Sore Or Cold Sore, Or Worse?

As we enter the holiday season, our risk for illness increases. Perhaps it’s because we’re confined to the indoors with others more often. However, for many of us, the added stressful during this time of year can compromise the immune systems, which can place our resistance at lower levels. christmas-reindeer-head

In spite of getting our flu shot, washing hands often, boosting vitamin C intake and staying active, a couple of irritating and embarrassing oral problems tend to emerge more during stressful times of the year.

During the holidays, we see more individuals who develop canker and cold sores.  With ultra-busy times of year like the holidays, your likelihood of getting a cold or canker sore increases along with the added stress.

The two are often confused, however, with the difference being:

Canker Sores
These are small ulcers that typically have a white or gray base and red border. Unlike cold sores, canker sores appear inside the mouth and are not contagious. The exact cause of canker sores is uncertain but fatigue, stress or allergies can increase the likelihood of a canker sore. Some experts suspect immune system problems, bacteria or viruses can also spurn eruption. A cut caused by biting the tongue or inside of the cheek as well as hot foods or beverages may contribute to canker sore development. Canker sores usually heal on their own in a week or two. Over-the-counter topical anesthetics, steroid preparations,  and antimicrobial mouth rinses can provide temporary relief. As a holistic method, you may try swishing with plain, sugar-free yogurt for a minute or so. This helps to restore a healthy bacteria balance in the mouth while soothing discomfort.

Cold Sores
These are also referred to as fever blisters or Herpes simplex and are located around the lips, under the nose or on the chin. Caused by herpes virus type 1, cold sores are very contagious. These are clusters of fluid-filled blisters that often erupt since are they are most commonly found around the edge of the lips. Cold sores are Herpes lesions that may follow a fever, sunburn, skin abrasions or emotional upset. Because cold sore blisters are on the outside of the mouth, they can be embarrassing and uncomfortable. Although they usually heal in a week, over-the-counter topical anesthetics may speed the process while providing some relief. In our office, we can use a laser to hasten healing, often within a 2-3 day period. If occurrences are frequent, ask about prescription drugs that can help reduce the duration of these viral infections.

It is important, however, to pay close attention to any change to oral tissue that does not heal within 10-14 days. When oral tissue does not repair on its own in a week or two, it should be examined immediately! This is a symptom of oral cancer, which kills 1 person every hour of every day.

Oral cancer has one of the worst survival rates of all cancers. Because symptoms can mimic a bite on the inside of your cheek, more obvious symptoms often do not emerge until the cancer has reached advanced stages. Of those who acquire oral cancer, only 57% are estimated to still be alive 5 years later.

Some tissue changes in your mouth are normal and repair on their own in about 10 days. However, it is important to be aware of oral cancer’s symptoms and react quickly to areas that change further or do not go away. Symptoms include:

• white or red patch of tissue
• unusual lesion in the mouth
• difficulty or discomfort when swallowing
• persistent sore throat or feeling something is stuck in the throat
• a lump or mass inside the mouth or neck
• wart-like mass
• numbness in the mouth or face

Lesions or discolorations that are early warning signs are not always visible, particularly in the back portion of the mouth (the oropharynx, the tonsils, and base of tongue), which can be an obstacle to early diagnosis and treatment. This is yet another reason that keeping your regular oral hygiene exam and cleanings is so important. During these times, we look for unusual changes in the mouth that can indicate a problem. However, you should never wait until your scheduled appointment to have anything unusual examined.

While uncomfortable canker or cold sores may not be welcome, they tend to go away in a week or ten days. Again, if an unusual spot or sore is still present after two weeks, call 586-739-2155 immediately for an appointment.

Smoke? Lecture-Free Ways To Keep Your Smile Healthy

If you smoke, the last thing you probably want to hear is a lecture on why you should quit. Chances are, you know a number of reasons why. We understand that smoking is addictive and not easy to quit. As a matter of fact, it’s very difficult.

The Centers For Disease Control & Prevention (CDC) reports that “more people in the United States are addicted to nicotine than to any other drug. Research suggests that nicotine may be as addictive as heroin, cocaine, or alcohol.”

The majority of smokers who try to quit do so without assistance, though only 3 – 6% of attempts to quit without assistance are successful. So, whether you plan to quit or are content with your habit, we want your smile to stay in good condition. And, it can with proper care and regular check-ups.

First, let’s deal with a dire issue. Because smoking (as well as smokeless tobacco) is responsible for nearly 90% of oral cancers (lips, mouth and throat), it is paramount that you have an annual oral cancer exam. We do these as part of your six-month cleaning and exam appointments.

Oral cancer has one of the worst survival rates of all cancers because symptoms rarely emerge until it is at rampant stages. Before symptoms are obvious to you, we may be able to detect signs of oral cancer visually and by touch.

Smoking is drying to oral tissues, which creates an environment where oral bacteria are able to actively thrive and reproduce. Periodontal (gum disease) begins with persistent bad breath, tender gums and gums that bleed easily when brushing.

As gum disease progresses, pus pockets form at the base of teeth. Teeth loosen as oral bacteria attack the bone and tissues that support tooth roots. Eventually, these teeth will require removal.

The bacteria of periodontal disease has been linked to heart disease, high blood pressure, stroke, diabetes, arthritis, preterm babies, some cancers and impotency. This occurs because the potent bacteria can enter the bloodstream through tears in weakened gum tissues, causing inflammatory triggers elsewhere in the body.

Smoking also gives you an increased risk of bad breath, increased plaque and stained teeth. By keeping oral bacteria in your mouth under control, you can avoid the treatment time and expense for gum disease, cavities and whitening. (Our Zoom WhiteninZoom_Logo copyg system works wonders for our smoking patients, by the way!)

Be aware that smokers have longer healing times following extractions, gum treatment and oral surgery. When healing takes longer, there is a higher risk of bacteria settling into incised tissues. It is a fact that smokers have a higher risk of implant failure.

The best way to avoid many of the problems mentioned above is to keep oral bacteria under control. How do you do that?

First, be very committed to your at-home oral hygiene routine. Brush twice a day for at least two minutes each time. Use a fluoridated toothpaste and soft to medium bristle tooth brush.

Brush your tongue after your teeth. This dislodges a vast amount of bacteria from the tongue. Be sure to get to the back area of the tongue, where most bacteria are embedded. Gently run the brush over the roof of the mouth, under the tongue and inside of the cheeks before rinsing.

If you use a mouthwash, check the label to make sure yours contains no alcohol. Alcohol dries out oral tissues, which makes bacterial growth easier. And, to combat dry mouth, consider using a mouthwash especially formulated to replenish oral moisture. These are available over-the-counter at most drug stores. Be consistent in using these products.

Floss daily. I can’t stress this enough. If flossing seems awkward, ask our hygienists to help you with your technique. We have a flossing video on our web site you may want to check out: http://www.banrbarbatdds.com/videos.php#flossing_tips

You may want to try one of the water or electronic flossers now available. There are also floss holders that make the process easier for some people. Just be sure to avoid ‘popping’ the floss between the teeth onto tender gum tissues. This can cut into the gums, leaving them vulnerable to oral bacteria.

Be sure to keep your 6-month check-ups. These cleanings and exams remove buildup that can occur between visits and help you avoid problems before they occur or catch others while still small.

Drink lots of water — not coffee, tea, colas, sports drinks or energy drinks — most contain caffeine, which is very drying to the mouth.

Limit sugar and carbohydrates. These are oral bacteria super boosters. Instead, opt for crunchy fruits and vegetables, raw nuts and cheese.

We don’t lecture our patients. It is our job to help patients have the very best smile they can regardless of our own preferences and opinions. If you smoke, we care just as much about your smile as our patients who do not. Know that we are here for you regardless of your needs or goals.

If you’re past due for a dental check-up and cleaning, call 586-739-2155. Let’s get you in so you can have a clean slate with your renewed commitment to a healthy smile!

 

How Your Medications Can Impact Your Dental Care

Why does your dentist need to know about the medication you take for high blood pressure?

It is important that your physician(s) and dentist have a current listing of ALL medications you take, including herbal supplements. For example…

Medications such as Heparin or Warfarin lower your risk for stroke and heart disease by helping to reduce your potential to develop blood clots . While these are important medications, your dentist should be made aware due to potential bleeding problems during oral surgery or some procedures involving gum tissues.

PillBottleGrayDry mouth is a common side effect of a wide variety of medications, including those prescribed and over-the-counter. These include antihistamines, decongestants, painkillers, high blood pressure medications, anti-depressants, muscle relaxants, drugs for urinary incontinence and many others. Oral dryness causes the tissues in the mouth to become inflamed, which places you at greater risk for infection. Insufficient saliva flow ups your risk for tooth decay and gum disease.

For those who take medications that help to strengthen bones, these have been associated with a rare but serious condition called osteo-necrosis of the jaw, known as ‘death of the bone.’ These medications, prescribed to help prevent or treat osteoporosis, are Fosamax, Actonel, Atelvia, Didronel and Boniva. Certain versions are administered by injection, including Boniva IV, Reclast and Prolia.

Osteo-necrosis of the jaw commonly occurs after certain dental procedures such as extractions or implant placement. About 90% of those who have experienced osteo-necrosis are those who took the medication in repeated high doses due to cancer or other diseases. However, 10% who experienced osteo-necrosis were taking much lower doses, mostly intended to treat osteoporosis. Those who currently take these medications or have taken them within the past year should reveal this to their dentist.

Some medications can sores in the mouth, inflammation or discoloration of gum tissues. Oral sores or discolorations may arise from taking medications for blood pressure, oral contraceptives and chemotherapy agents. Because some spots and discolorations can be symptoms of oral cancer, keeping your dentist aware that you take these drugs helps he or she to monitor these areas closely and appropriately. When your dentist is aware of all your medications, you can be adequately monitored without being treated for problems that mimic symptoms of something else.

Because most supplements do not require a prescription, they may seem safe or not connected to your oral health. However, a number of these can actually affect your care more than you realize. It is important for your dentist to know if you take…
 • Ginkgo Biloba and Evening Primrose – Can reduce your ability to clot, possibly leading to excessive bleeding during and/or after a dental procedure.
 • St. John’s Wort – Often taken to reduce anxiety, this herb can interfere with the metabolism of other medications, including sedatives, antibiotics and anti-inflammatory drugs. When combined with St. John’s Wort, these drugs can be less effective. On the other hand, narcotics such as codeine, Vicodin and oxycodone can become more potent when taken with St. John’s Wort, leading to sleepiness, lethargy and dizziness.
• Valerian – Has mild sedative effects. If your dentist prescribes drugs for anxiety or painkillers containing codeine, the effects of both together are greatly accentuated. This can lead to severe sleepiness, lethargy and dizziness that can last into the next day.
• Calcium and Magnesium – Combining these supplements with certain antibiotics can interfere with the absorption of the antibiotics. This can compromise your ability to fight off infection.

Your oral health is an important part of your overall health as “the window to your body.” Keep your dentist up-to-date on all medications and supplements you take to avoid undue complications.

Not All Mouthwashes Are Good For You

Mouthwash is a common component of many oral hygiene routines at home. For many patients, we recommend certain mouthwashes for their ability to kill oral bacteria, add fluoride, and treat particular mouth sores. Too, some mouthwashes are advised following extraction of teeth to curtail bacteria in areas where brushing must be postponed.

While many people assume mouthwash is a beneficial conclusion to proper brushing and flossing, not all are recommended by our office. Some mouthwashes contain alcohol, which dries out oral tissues. Even though alcohol kills oral bacteria, it also serves as a drying agent. This actually increases your potential for cavities and bad breath since alcohol decreases saliva flow.

Saliva is your mouth’s natural cleanser, keeping oral tissues moist and moving bacteria (and food particles that cause bacterial growth) out of the mouth. Some medications, smoking and drinking alcoholic beverages can also lead to dry mouth.

Additionally, it is suspected that regular use of mouthwash containing alcohol can lead to dental erosion.

Mouthwashes that contain alcohol have also come under fire for increasing one’s risk for oral cancer. Although there is no scientific consensus on these findings, it is suspected that the alcohol becomes a carcinogen in the mouth, which is a cancer causing agent. Researchers have found that oral cancer risk is five times higher for those using alcohol-containing mouthwashes, even if they are non-smokers.

Like any product, read the label of mouthwash before purchasing. Look for alcohol-free types and those with fluoride additives. Use after brushing and flossing and practice a gargling action to get the mouthwash to the back of your mouth. Since the back of your tongue harbors more oral bacteria than the front, consider using a tongue scraper prior to mouthwash. This loosens oral bacteria that are embedded in the tongue’s surface. You can also brush your tongue with your toothbrush following teeth brushing.

Remember, any mouthwash use is an addition to brushing and flossing. It should never be used as a replacement. However, certain mouthwashes can help keep your breath fresher, decrease your risk for cavities and support your oral health overall. Swish away!

If you have questions about which mouthwashes are recommended, call us toll free 1-866-9-Smiles.

Pay Special Attention To Mouth Sores

Because of the devastating statistics associated with oral cancer, any sore or unusual spot in the mouth should be monitored carefully. However, some sores that occur inside the mouth may be canker sores. (A sore outside the mouth, such as bordering the lips, is typically a ‘cold sore’).

A canker sore is a painful spot that can appear on the tongue, inside of the cheek or on the soft palate (the back portion of the roof of the mouth). Canker sores are white or gray circles outlined in red. You may have a tingling or burning sensation before the sore appears.

Stress or an injury to oral tissue is often suspected to be the reason canker sores emerge, however, their exact cause is unknown. Tissue can be damaged from wearing braces, biting the inside of the cheek or a tooth that cuts into tender oral tissue, for example. Citrus or acidic foods can also be a possible trigger for canker sores. A compromised immune system, B vitamin or iron deficiency, or diseases such as Crohn’s disease can be causes.

Typically, a canker sore doesn’t last long with discomfort subsiding in just a few days. They generally heal completely in less than two weeks. To speed healing, a prescription mouth rinse or ointment can be provided. Discomfort can also be eased by some over-the-counter medications.

When canker sores are reoccurring, citrus, spicy or acidic foods should be avoided. Using a soft-bristled tooth brush is also advised to avoid worsening any existing tissue damage. A dentist should be contacted when canker sores seem unusually large, are multiplying or last longer than two weeks. Also, see a dentist when canker sore pain becomes extreme or is accompanied by a high fever. Call toll free 1-866-9-Smiles promptly.

Does A Shrinking Jaw Bone Occur From Missing Teeth?

Natural teeth are held into your jawbones by their tooth roots, which are embedded in the bone. Throughout the day, actions such as biting and chewing create physical stimulation to the jaw by each root. The tooth roots stimulate the bone so it maintains a healthy mass.

Once natural teeth are removed, the lower and upper jaw bone structures begin to shrink (or ‘resorb’) due to the lack of stimulation. While conditions such as osteoporosis, gum disease and oral cancer can attack healthy bone structure, the leading cause of bone loss (‘resorption’) is missing tooth roots.

Although dentures and partial dentures provide low cost replacement of teeth, they actually accelerate this rate of bone loss. These rest on top of gum tissue, placing pressure on the jaw bone ridge whiling providing no direct stimulation to the bone.

Custom bridges, a popular treatment for replacing missing teeth, are no help, either. The bone underlying the span of missing teeth will experience resorption since no bone stimulation is provided.

There are many repercussions to bone resorption. Facial changes can be seen at early stages by removing dentures or partials and looking in the mirror. Once bone loss is underway, you’ll notice your mouth seems to collapse into the face, the chin becomes more pointed, and deep wrinkles form around the mouth. Eventually, jowls form from the detachment of facial muscles from the jaws.

Profile comparison of healthy jaw bone and one with severe resorption.
Profile comparison of healthy jaw bone and one with severe resorption.

Other signs of bone loss are: Periodic changes in the way your denture fits; Sore spots on gum tissues; Food becoming trapped between the gums and denture; and, Difficulty chewing even with the help of denture adhesives and pastes.

Because they are secured by the jaw bone, Dental Implants recreate the stimulation of the natural tooth roots you once had. This halts the rate of bone loss and preserves bone mass.  For those who have already experienced severe bone loss, bone rebuilding procedures can be performed to restore adequate bone structure.

Let’s discuss a confident, secure and dependable smile during a free consultation appointment. Call toll free 1-866-9-Smiles to schedule.

Caution On Rx Meds That Can Contribute To Tooth Loss

If you take antihistamines, aspirin, asthma medications and syrups, you may be taking one that makes you more vulnerable to tooth loss. It is estimated that about 40% of Americans take at least one type of medicine that can cause damage to their teeth.

These medications include prescription drugs and over-the-counter preparations and can contribute to gum tissue problems such as inflammation, bleeding or ulcers. Additionally, diseased gum tissue can lead to other dental problems, including tooth loss.

Some medications with damaging side effects to teeth include:
• Antihistamines – can cause dry mouth, and an increased risk of gum problems.
• Antihypertensives – can lead to an increased risk of gum problems.
• Aspirin – chewing aspirin can directly damage the tooth enamel, as aspirin is acidic. Always take aspirin strictly as directed.
• Asthma medications – some asthma drugs are highly acidic and can dissolve tooth enamel if used regularly over a long period of time.
• Chemotherapy drugs – can cause a dry mouth and lead to an increased risk of gum problems.
• Immunosuppressive drugs – can lead to an increased risk of gum problems.
• Oral contraceptives – can lead to an increased risk of gum problems.
• Syrups – medicated syrups that contain sugar can increase the risk of tooth decay if teeth are not brushed after these syrups are taken.

To check the level of tooth loss on a long list of prescription medications, use the link below. This shows drugs such as Stelara with only 1 case of tooth loss but Prednisone having 436 cases and Zometa a whopping 1,571.

http://www.ehealthme.com/symptom/tooth+loss

At each appointment, it is important that you keep us updated on medications you take. We want to help you avoid tooth loss. Knowing your medical and dental history and list of medications (including herbal supplements) can help us be more proactive on your behalf.

Your Smile – An Added Reason To Quit Smoking

Smokers already know they are taking health risks. However, many are unaware of the negative oral health issues when it comes to tobacco use.

For example, research shows that smokers lose more teeth than nonsmokers. According to the Centers for Disease Control & Prevention, about 20% of people over age 65 who have never smoked are toothless, while over 41% of daily smokers over age 65 are toothless.

It’s no surprise to dentists that following gum treatment or any type of oral surgery (including implant placement), patients who smoke typically have longer healing times with less predictable treatment outcomes. Other oral problems include a heightened risk for oral cancer, bad breath, stained teeth, loss of taste, gum recession, mouth sores, tooth loss and deep wrinkling around the mouth.

As a smoker, you also have a far greater increase for periodontal disease. Smoking increases your susceptibility to calculus, which is the plaque that hardens on teeth and can only be removed through a professional cleaning.

When calculus is not removed, the bacteria it harbors can destroy gum tissue and cause gums to pull away from teeth. As a result, teeth look longer and are more vulnerable to bacteria. As bacteria growth develops into periodontal disease, sore pockets form between teeth and fill with bacteria, destroying tissues and supporting bone. Eventually, the teeth become loose and require removal.

Cigarette smoke contains more than 7,000 chemicals and harms nearly every organ of the body. Nearly 50% of those who don’t quit smoking will die of smoking-related problems.

Quitting is not easy but the benefits are almost immediate. Your circulation improves, your blood pressure starts to return to normal and breathing becomes easier. You’ll also have a healthier mouth and avoid many oral problems.

A new year is an ideal time to kick the habit. The American Cancer Society’s web site, www.cancer.org, is an excellent resource for smokers who are trying to quit. If you are a smoker and past due for your 6-month dental exam and cleaning, call us toll free 1-866-9-Smiles. We are always happy to welcome new patients.

How Problems Start In The Mouth & How To Avoid Them

Want to save yourself from costly and time-consuming tooth and gum problems? Read on to know where most of the problems begin, and how to avoid them.

Plaque is a sticky substance in the mouth that results from chemical reactions when bacteria, carbohydrates, food particles, and saliva combine. When food particles and saliva mix in your mouth and aren’t properly removed, this results in a build up on teeth that creates oral bacteria. Plaque accumulation on teeth leads to an attack on enamel, causes bad breath, yellow teeth, cavities and oral decay. Brushing and flossing twice a day is the best way to remove plaque and keep your teeth, gums and breath in good condition.

The beginning of plaque formation occurs as you chew carbohydrates, which are components of most of the foods we eat. As the carbohydrates combine with the natural bacteria in the mouth, an acid is created. This acid can eat at tooth enamel and triggers the production of oral bacteria. When the acid and saliva mix with rotting food particles in the mouth, the accumulation of oral bacteria becomes sticky and attaches to teeth.

Once plaque forms on teeth, you have a limited amount of time to remove it before it hardens. Most plaque hardens within 48 hours, becoming so hard within days that removal can only occur with special tools used by your dentist or dental hygienist. It cannot be brushed or flossed away.

Plaque can be prevented or controlled by maintaining a low carbohydrate diet. Although it’s not possible to avoid all carbohydrates, limiting sweets, bread, cereal, potatoes and sugary drinks will help greatly.

Additionally, it is important that you brush and floss twice a day. Brushing removes plaque build up on teeth and leftover food particles that contribute to bacteria build up. Brush for a minimum of two minutes each time and be sure to brush the top, front and back of all teeth. Daily flossing removes food particles and debris from between teeth, further decreasing the potential for plaque to form in the first place.

Remember, if plaque has formed on your teeth but hasn’t hardened into tartar, thorough brushing and flossing in a timely manner can remove it. If, however, tartar has formed on teeth, you’ll need a dental cleaning to have this bacteria-filled attachment removed from teeth. Call toll free 1-866-9-Smiles to schedule an appointment before tartar can cause costly damage to your teeth and gums.

Also, if flossing is a challenge for you, check out this easy-to-follow video! In just a few minutes, it can have you flossing effectively and easily!

http://www.banrbarbatdds.com/dental_care.php