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Madison, NJ

Children, Airway, Snoring and ADHD

I was at meeting of a group of physicians, dentists, speech and physical therapists, other health care providers and the public that works to educate and provide integrated care for children and adults. The focus of the meeting was airway and how it impacts the health and development of children. “What is airway?” Airway refers to the passage by which air reaches the lungs. The issue is that airway can be affected by anatomical issues like large adenoids and tonsils or a deviated septum, congestion, allergies, asthma and a narrow jaw. All these things contribute to a change from healthy nasal breathing through your nose, to mouth breathing. Mouth breathing is not as efficient because of the way the air flows. “Why is airway important?” Quite simply, your airway and the shape of it or anything that interferes with it, prevents good breathing and the flow of oxygen to the lungs, and therefore, the brain. Many children (and adults) who have problems breathing due to allergies or large tonsils and adenoids may snore at night – a sign that their airway is interrupted. Some even have apnea, a situation where the breathing stops for up to a minute at a time, many times throughout the night. The stops in breathing lead to poor sleep. Consider what happens to a developing child’s brain if there are regular interruptions in oxygen. Snoring in children has been associated with problems in memory, language and poor academic performance. The AmericanAcademyof Pediatrics thinks airway is so important that they have issued new guidelines for screening children and adolescents for snoring at routine visits. “What does any of this have to do with ADHD?” ADHD (attention deficit hyperactivity disorder) in children is characterized by impulsivity, hyperactivity and difficulty focusing. If a child is not sleeping well because of problems with their airway (or any other reason for that matter) they will be tired. A sleepy child acts different than a sleepy adult. Adults who are tired become withdrawn, and quiet and consider taking a nap. Children, on the other hand, try to keep themselves awake! To do this, they try to move around a lot, seem impulsive or talk to themselves to stay awake. Many doctors believe that children are mistakenly diagnosed with ADHD when really they are suffering from sleep apnea and are just tired. “What are the signs that my child may have an issue with their airway?” There are both medical and physical changes that may occur with airway issues. Medical Allergies or asthma Snoring Large adenoids or tonsils Bedwetting Hyperactivity Physical – because breathing uses so many muscles, visible physical changes are common, many related to tooth and jaw position. Narrow upper arch Long, narrow face Poor tongue posture Crossbite Small, poorly developed nostrils Gummy smile Open mouth posture (anterior open bite) Short and turned up upper lip “What do you do to treat airway issues?” Removal of adenoid and tonsils helps resolve about 90% of the issues. Speech and myofunctional therapy that retrain tongue position and encourage nasal breathing. Orthodontic intervention that expands the jaw and the airway. Medication to treat allergies or asthma The most important step in this process is diagnosis. If you suspect airway issues in your child, see their pediatrician, an ear-nose-throat specialist or a dentist who understands airway problems. Remember to be an advocate for your child. You know them better than anyone else so it is your responsibility to find a professional who understands and can help you.  (Oct 19, 2012 | post #1)

Madison, NJ

12 Rules to Sleep Hygiene

Last week I discussed children and sleep and mentioned something called sleep hygiene. I promised I would give a list of sleep hygiene rules. When speaking about it at the office this week, someone looked at me like I was crazy when I said “sleep hygiene.” So, let me explain: Sleep hygiene is anything that helps you maintain a restful sleep pattern. Sleep is as important as eating and exercise in staying healthy, and many people have developed bad habits over the years that lead to poor sleep. Sleep hygiene “rules” are just guidelines. They are mostly common sense, but like most things in life, we forget or ignore what our mother used to tell us. 12 RULES TO BETTER SLEEP HYGIENE Sleep hygiene is a way to develop healthy sleep habits that lead to consistent, restful, restorative sleep. 1. Sleep as much — at night – as needed to feel refreshed and healthy during the following day. Aim for a standard number of hours of sleep every single night. Excessively long times in bed seem related to fragmented and shallow sleep. 2. Avoid daytime napping. If needed, nap for less than an hour and before 3 p.m. 3. Have a regular wake-up time in the morning. This seems to strengthen circadian cycling and leads to waking up in the morning on your own without the use of an alarm. 4. A steady daily amount of exercise helps deepen sleep in the long run, but occasional one-shot exercise does not directly influence sleep during the following night. 5. Give yourself a wind-down time each day. Use this time to tie up the day’s loose ends and organize tomorrow. It is better to do this when you are awake and alert than to wait until the lights are out and your head has hit the pillow! Anxiety about things you can do nothing about at night interferes with sleep. Give yourself a scheduled, routine 30-60 minutes to do this end-of-the-day. 6. Create a structure to your day (even week-ends) that requires you to do certain things at certain times. Eating and taking medication at the same time helps to maintain your body’s internal clock. 7. You should associate your bed with sleep. Avoid using your bed to watch TV, eat, talk on the phone or work on a laptop. 8. Avoid sleeping pills or use them sparingly. They may be of some benefit, when properly prescribed by your physician, but the constant use of sleeping pills is ineffective at most and detrimental in some insomniacs. It is better to understand why your body is not sleeping, and to correct the root cause. 9. Avoid caffeine and alcohol before bed. Be aware of the many hidden sources of caffeine, ex: Mountain Dew, chocolate. Alcohol does help tense people fall asleep fast, but the ensuing sleep is then fragmented. Alcohol also suppresses REM (dreaming) sleep. 10. If you’re not asleep in 20-30 minutes, get up and do something that will relax you, but definitely with very dim light. 11. Your bedroom should encourage sleep. Everyone has their own image of comfortable – just be sure your bedroom is ideal for you. Regarding temperature, don’t have the room too hot or too cold. 12. Think about light and dark: Get as much exposure to light as you can during the daytime and as much darkness you can during the nighttime. Look at the amount of “extra” light in your bedroom from things like alarm clocks and consider wearing an eye mask to block out all light. Adapted from the 2012 American Academy of Dental Sleep Medicine Annual Meeting  (Jul 10, 2012 | post #1)

Madison, NJ

Children and Sleep

Don’t get too excited – I don’t have the answer for getting a baby to go to sleep. This is part two of my report from the recent American Academy of Dental Sleep Medicine conference. There was actually a lot of interesting discussion on children and teenagers sleep patterns and snoring in children. Here are the interesting things that were reviewed: 1. There are an increasing number of infants, children and teenagers being diagnosed with obstructive sleep apnea (OSA), a disorder where breathing is interrupted during sleep. Many of these children may have been incorrectly diagnosed with ADHD. The reason for the increase in OSA is unclear, but the following things may help identify those who have it: *snoring more than three times a week *allergies, frequent colds or habitual mouth breathing *large tonsils and adenoids *being born prematurely *obesity *long narrow faces and crowding in the front teeth *daytime sleepiness *bedwetting If your child snores, you should discuss the situation with their pediatrician, an ear-nose-throat specialist or a dentist who understands sleep disturbances. Many times a combination of tonsillectomy and adenoid removal along with jaw expansion is successful at eliminating snoring, creating changes in the jaw and face, expanding the nasal passages and reducing daytime sleepiness. 2. There was discussion about teenagers and how their natural sleep patterns vary from adults. The average adolescent requires 10 hours of sleep per night, however, at least two-thirds of those adolescents get less than an average of seven hours of sleep. Many sleep very little during the school week and then make up their lost sleep by sleeping extra hours on the weekend just to get to seven hours. 3. One reason teenagers suffer from sleep disturbances is because their circadian rhythms (their internal clock that regulates sleep) does not coincide with their school pattern. Teenagers are naturally programmed to sleep late in the morning and not go to bed until very late at night. However, when school starts early, it requires teenagers to wake before their final REM phase has completed. This final REM phase is critical because memory consolidation and other important functions occur in it. This constant interruption in sleep can cause issues with school performance, lead to daytime sleepiness and affect growth and development. While many of the signs of lack of sleep like excessive irritability, mood swings and difficulty concentrating can be mistaken for just being a teenager, it is important to be aware of the signs. When the previous signs are coupled with a craving for carbohydrates, sudden shifts in feeling hot and cold, or odd sensations of having things crawling on their skin, you might begin to suspect a sleep disturbance in a teenager. 4. OSA, narcolepsy and delayed sleep pattern are the three most common sleep disorders found in teenagers. As with snoring in children, if you suspect a sleep problem, seek professional help. There are many local sleep centers with specially trained sleep physicians that diagnose and treat sleep issues. 5. The final topic that is worthy of mentioning is sleep hygiene. While it sounds like a strange term, it refers to developing and following healthy sleep habits. Many teenagers, and adults alike, sleep poorly due to overstimulation from TV, phones and computers prior to sleep. For example, the light from computers is a stimulant that wakes you, like mimicking daylight in the morning, so using a computer or texting before bedtime can interfere with the time it takes to fall asleep. Next week I will post 12 Rules for Sleep Hygiene. Remember, if you or a loved one snores or suffers from daytime sleepiness, speak to a professional to determine possible causes and treatment.  (Jul 9, 2012 | post #1)

Madison, NJ

Are you green?

I had a new patient in yesterday who works at a big pharmaceutical company and is involved with sustainability at their company. It made me think about what, if anything, we do to support sustainability. At first, all I could think of was recycling our paper and plastic, and I was a bit embarrassed. But the more I thought about, I realized that small changes we’ve made over the years have been “green”: • Digital x-rays – I think this is the single biggest change because it is such a win-win for everybody. Using digital allows us to dramatically reduce radiation exposure for patients. Also, the system has a reusable sensor which eliminates the need for film and its lead lining. Finally, no chemicals are needed to develop the film. • Appointment reminders – we decided a few years ago that we wanted to reduce the amount of paper we use at the office, so we switched to an email or text appointment reminder system. We no longer send out postcards which saves paper and printer ink. • Communication – let’s face it, no office will ever completely eliminate paper use, but little changes make an impact. We use email now to communicate with doctors, labs and patients. All referral letters and x-rays are sent over the internet instead of being printed and mailed. The additional plus side is that I’m amazed at how little stationary I need to purchase! • Plastic containers – our sterilizers require distilled water and each week we would go through at least five plastic jugs. Installing an automatic distilled water system in the office has eliminated the waste of plastic (and makes my assistants happy because they don’t have to lug jugs of water around). • Construction – we recently renovated a building for our office and although we made big changes, I tried as much as possible to reuse or maintain building materials. Windows and wood trim could have been replaced, but we chose to keep them. When we purchased things for the building, we looked for sustainable or energy efficient supplies like fluorescent lighting, Energy Star® products, and products made with recycled materials. While I’m sure there are more things we could do at the office, I’m pleased that we’ve done some things to make an impact. I encourage everyone, home and business alike, to spend some time recognizing the changes you’ve already made and considering the additional things you can do to improve sustainability.  (May 29, 2012 | post #1)

Madison, NJ

The Four-Minute Exam That Can Save Your Life

Most people don’t think their family dentist could save their life, but the truth is that they can. This year over 52,000 Americans will be newly diagnosed with oral and throat cancers. When detected in the early stages of disease, these cancers have an 80– 90% chance of survival. However, the reality is that most of the cancers won’t be diagnosed until later stages the person will not live longer than five years after the initial diagnoses. Since April is national Oral Cancer Awareness month, I thought it was important to review the risks and signs of oral cancer. It is important to know the risks for developing oral and throat cancers. The most obvious of risks are smoking and drinking alcohol over a long period of time. Another risk is the HPV-16 virus (human papilloma virus). This is the same virus associated with cervical cancer in women. If you or your partner/spouse has a history of HPV, your risk for developing throat cancer may increase. It is known that men have a three times greater chance of developing throat cancer due to the HPV virus than women. There are a small percentage of people (about 7%) who develop oral and throat cancers with no apparent cause. In these cases it is believed that a genetic predisposition may exist. There is no age discrimination when it comes to oral and throat cancer. These cancers can affect anyone at any age. The following list contains the signs and symptoms that can be associated with oral and throat cancer: - A sore or lesion that does not heal within two weeks - A white or red patch on the gums, tongue, tonsil, floor of the mouth, inside of the cheek - A lump or thickening of the cheek - Difficulty chewing or swallowing - Persistent sore throat, hoarseness, or changes in your voice - Difficulty moving the jaw or tongue - Swelling of the jaw that can cause a denture to fit poorly - Persistent swollen lymph nodes under the chin and along the sides of the neck Each year the death rate for these cancers continues to grow. By raising awareness and knowing your risks for developing the disease we can decrease the death rate and increase the survival rate. Please know your risk for developing oral and throat cancer. Discuss your risks with your dental team and ask your family dentist for a head and neck cancer screening at every visit that may include use of the VELscope, a special non-invasive light that evaluates the cells below the surface. Your dentist should exam your lips, tongue, throat, gums and feel your lymph nodes. It only takes 4 minutes and it could save you life.  (Apr 24, 2012 | post #1)

Madison, NJ

Diabetes and Gum Disease

For years, dentists have known that oral health and overall systemic health are linked. Now, more and more research recognizes the significant link between diabetes and periodontal (gum) disease. Diabetes is a disease that affects the body’s ability to fight infection and diabetics are more prone to develop gum disease. Inflammation, and the destruction that occurs as a result of it, is a key factor in the development and progression of both diabetes and gum disease. Diabetics may have difficulty controlling their blood sugar levels, even with medication, if they have uncontrolled gum disease. Conversely, patients with gum disease, even those who are undergoing treatment for it, may find their efforts unsuccessful if they lack glycemic control. If you are diabetic, you should see your dentist regularly. You may need to have cleanings done more frequently depending on the condition of your gums. Signs of gum disease: • Red, swollen gums • Gums that pull away from the teeth • Bleeding gums with brushing and flossing • Bad breath • Teeth feel like they don’t fit together properly If you have any of the above signs, regardless of whether or not you are diabetic, you should see your dentist for an evaluation. The good news is that both physicians and dentists are aware of the relationship between these two diseases and will work with one another to co-manage a patient’s care. For more information, please visit our website at www.adamsdentalnj. com or email us at [email protected] .com.  (Feb 28, 2012 | post #1)

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Halloween Isn't All About Candy!

Madison's first, second and third graders received Halloween toothbrushes in preparation for next week's candy. Central Avenue, Torey J. Sabatini, Kings Road and St. Vincent Martyr schools were all visited by Kelly Olsen and Andrea Ceresa of Adams Dental in Madison. They delivered children's toothbrushes with orange handles and black bristles along with instructions on how to brush their teeth. The brushes will be handed out to all first, second and third graders during their Halloween festivities. Kelly Olsen, hygienist, felt it was important to put a different spin on Halloween. She said: "I know that children will eat candy on Halloween and it's not realistic to tell a second grader to turn down a Tootsie Roll. But at least we can encourage good brushing habits afterwards."  (Oct 27, 2011 | post #1)

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Disrupting the Biofilm

Disrupting the biofilm – sounds like a great name for a ‘90s punk rock band, huh? Unfortunately, it’s not really that exciting or glamorous. Biofilm is actually the new description for the plaque in your mouth. Read on and see why it’s so important. A little technical, but this is a great definition of biofilm that I recently found: “Bacteria living in a biofilm can have significantly different properties from free-floating bacteria, as the dense and protected environment of the film allows them to cooperate and interact in various ways. One benefit of this environment is increased resistance to detergents and antibiotics, as the dense extracellular matrix and the outer layer of cells protect the interior of the community.”* Read the definition again and you’ll be impressed by what it says – loose, single bacteria are like the kid who is trying to be tough, but doesn’t have any muscle. So, what does he do? He joins the local gang (other bacteria) and now by sheer numbers and support creates a protective environment that gives him not just the illusion, but real, power. When it comes to your mouth, we used to think that plaque was made up of single bacteria that could be brushed and flossed away. The more we learn, the more we discover that plaque is really a collection of a variety of both dangerous and benign bacteria that create a “matrix” that they live in. The longer the bacteria are present, the stronger and more dangerous they become. That’s why dentists annoy you about brushing and flossing daily. The bacteria present on day one is not good for your teeth and gums, but if you don’t floss and the bacteria is left undisturbed, it becomes more virulent, with the ability to lead to gum disease, bone loss and tooth loss. After a few days, it becomes harder and harder to floss away the bacteria. Some of it attaches to teeth and some actually begins to invade gum tissue. That’s why the topic of “disrupting the biofilm” is so important. Okay, so you get the picture – you need to get the “gang” of bacteria out of your mouth before it does damage, primarily gum disease that leads to tooth loss. What do you do? How do you disrupt the biofilm? It’s all about who wins the fight. Bacteria are forming a complex matrix that is impermeable to antibiotics and rinses. You have to get it BEFORE it is in the matrix, the “gang”. Regular brushing (and I mean twice a day, two minutes each time) with an electric, sonic toothbrush (Sonicare**),daily flossing and a rinse like Listerine or The Natural Dentist (based here in Madison on Cook Avenue www.stopbleedingna turally.com/rinses are a no-brainer. Additionally, regular dental cleanings are a necessity. Regular in this instance is a personal thing between you and your dentist. Some people have light plaque, no bleeding, and great home care – they can go six months between cleanings. Other people build up plaque like crazy, bleed when you look at their gums and haven’t flossed in a year – they might need cleanings every three months. The hardest situation is the people who do everything they’re supposed to at home with brushing and flossing and still have bleeding – they are a special group that have an exaggerated immune response to plaque (a blog for a different day…), but they might also need cleanings every 3 months. Cleanings for people with lots of bleeding should include the use of ultrasonics to help disrupt the bacteria under the gumline. The key is to overwhelm the bacteria with all the tools in your arsenal. Microbiologists talk about “bacterial burden”, basically, how much bacteria is hanging out in the street corner of your mouth. You have to bring all your guns to the fight so you can beat the bacterial gang. Hope you win the war! If you have any questions about plaque, biofilm, or how it impacts your overall health, contact me at [email protected] talnj.com. *www.bionewsonline .com/n/what_is_bio film.htm **www.usa.philips. com/c/electric-too thbrushes/139863/c at/en/  (Oct 7, 2011 | post #1)

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My Memories of 9-11

Here is the link to my blog about identifying the victims of 9-11 through dental records. http://www.adamsde ntalnj.com/?p=1139  (Sep 9, 2011 | post #1)

Madison, NJ

Xerostomia – a fancy name for “my mouth is really dry”

Between 30 and 40% of adults have xerostomia or dry mouth. Its prevalence increases with age and is caused mostly by medications or systemic disease. Dry mouth can’t be solved by having a drink of water and there are a lot of problems that may result from having it. The main cause of dry mouth is taking a medication that interferes with the normal production of saliva. Saliva is critical to the overall health of a person’s mouth. Saliva does something fancy called “buffering” that regulates or modifies the pH in your mouth. Think back to high school chemistry. pH deals with acids and bases. The bacteria in your mouth thrive in an acid environment and the enamel on your teeth break down the more acid the conditions. With less saliva present, this leads to erosion, cavities, and sensitivity – all bad stuff. Additionally, saliva helps to lubricate your mouth when you eat so crusty Italian bread doesn’t scrape your cheek. So – what causes dry mouth? And is there a way to reduce it? Causes of dry mouth 1. Medications are the primary cause of dry mouth and considering that a Google search I did reported that Americans filled 11.5 prescriptions per capita and spent over $291 billion on prescription medications, it is safe to say that this is a big problem for the public. 2. Systemic conditions are the next thing that cause dry mouth. Systemic means it affects your whole body and in certain diseases, the mouth is also affected. Sjogren’s syndrome, Alzheimer’s disease, diabetes, rheumatoid arthritis, and high blood pressure have all been linked to dry mouth. 3. Aging and hormonal changes. 4. Damage to the salivary glands – this happens primarily due to head and neck radiation and chemotherapy from cancer treatment. I’ve included an abridged list of some medications and their uses that cause dry mouth. Anti-anxiety – Ativan, Valium, Vistaril, Xanax Anti-convulsant – Lamictal, Neurontin, Tegretol Anti-depressant – Celexa, Effexor, Paxil, Prozac, Tofranil, Wellbutrin, Zoloft Anti-histamine – Allegra, Benadryl, Claritin, Vistaril, Zyrtec High blood pressure – Accupril, Altace, Cardura, Coreg, Lopressor, Norvasc, Tenormin Anti-inflammatory – Dolobid, Motrin, Naprosyn Cholesterol reducting – Lipitor Diuretic – Diuril, Dyazide, Lasix How to treat dry mouth and prevent problems that result from dry mouth As previously mentioned, just rinsing with or drinking water is not enough to solve dry mouth. While there are medications you can take to help stimulate saliva production, simpler methods include: 1. Toothpastes or rinses specifically for dry mouth. Biotene or Oasis are great products that help lubricate the mouth. 2. Using lozenges like Salese with Xylitol. These are placed in your cheek and allowed to dissolve creating lubrication in your mouth, especially helpful when used 20-30 minutes prior to eating. 3. Using a fluoride toothpaste or rinse at home to protect and strengthen at risk enamel. 4. Have fluoride treatments when you visit the dentist. 5. Using sugar free mints and gums. 6. Drinking water or sugar-free drinks – this is a short term fix, but it helps, especially when you are eating. 7. Decrease alcohol and caffeine consumption. 8. Avoid salty, spicy, hard foods. Keeping dental appointments to monitor the effects of dry mouth is important. It is amazing how quickly deterioration of enamel can happen in an acidic, dry environment. Meticulous home care and regular dental checkups and cleanings will allow you and your dentist to keep track of your dry mouth and the effects it may be having on your dental health. If you have any additional questions about dry mouth, please contact me at [email protected] talnj.com or visit the American Dental Association’s website at: http://ada.org/301 4.aspx?currentTab= 1.  (Aug 1, 2011 | post #1)

Madison, NJ

Taking Care of Teeth over the Summer

Summer is here! No homework, visits to the beach, hanging out at the pool and going to camp. It all sounds fantastic. But as my son likes to tell me, I’m a “fun sucker”, because I also think about the cotton candy, sugary ice pops, unlimited snacks, soda and lemonade that can cause problems with your teeth. How do you balance the good with the bad and not feel as though you’re depriving yourself or your kids the “fun” foods of summer? How do you ensure that your children are really brushing their teeth when they go to a friend’s for a sleepover or are away at camp? Here are a few ideas that might make summer tooth care easy: Sugary foods and drinks should be consumed with meals. Because saliva production increases during meals and helps neutralize acid production, it’s best to combine sugary treats with a meal. Who doesn’t love a lemonade stand? But your teeth don’t need all the sugar. Consider watering down the lemonade so you only get half the amount of sugar. Or why not just surprise a child by giving them 50 cents and not even taking the lemonade! Limit between-meal snacks. Each time you eat, acid is produced in your mouth that helps to feed the bacteria that causes cavities. It’s better to eat a bag of M&Ms all at once instead of having a few M&Ms every hour. Think fruits and vegetables! This is one of the best things about summer. There’s nothing better than a Jersey tomato with a little salt and pepper. I’d take a handful of blueberries over cotton candy any day. Make your own ice pops with crushed watermelon or trying freezing grapes for a quick refreshing summer treat. Getting your kids to brush regularly is like hoping my curly hair will have “good day” when I’m going out – easy to talk about, impossible to predict and no amount of products can ensure that it happens. Some children are eager to please and can appreciate why taking care of their teeth is worthwhile. However, most children are harder to convince. The importance of maintaining their teeth for when they’re older is lost on them. Forget scaring them with horror stories of losing teeth or having big cavities. Instead, I find that appearance factors more in their decision making. While talking about healthy teeth, bring up bright, white, beautiful teeth. Mention bad breath and what their friends might say if they smell bad. You’d be surprised how even six year old children want to look their best. While no amount of products will guarantee that they brush, I encourage you to find products that they like and want to use. Some children are very sensitive to flavors and may love Tom’s of Maine’s Silly Strawberry toothpaste but want nothing to do with the Orange-Mango paste. Buy small tubes for them to try before you plunk down $4 for a tube that will sit unused on the counter. Think electric. Children want power because they are surrounded with iPods and Game Boys. Let them choose an electric toothbrush with fancy colors and characters to make brushing more fun. If they’re going away to camp, consider an inexpensive version like the Crest Spinbrush My Way that they can customize for under $10. To keep at home, try the Sonicare for Kids. Encourage them to be a leader when they’re at a friend’s house or away at camp by being the one to get the group to brush their teeth. Check up on them every now and then and make sure their teeth look clean. Most adult I know are bad at brushing, so why do we expect our eight year olds to be amazing at it? If it looks like there is a spot they’re missing when brushing, show them in the mirror. Don’t yell, just talk about the germs that are bad for their teeth. Make a game out of brushing. School’s out and there’s a little more time in the day for fun. Have your child make a brushing calendar and agree before hand on some rewards after they’ve brushed twice a day for a week. Hope you can make maintaining healthy teeth an easy part of your summer.For more information visit our website at www.adamsdentalnj. com.  (Jul 7, 2011 | post #1)

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Can you get good help?

I’m always hearing people in business say they have a hard time finding good employees. Apparently, dedicated, productive, proactive team members are hard to find. I hear complaints about employees wanting to leave early, not wanting to go beyond their job description, not bringing ideas to the workplace and solely thinking about how to advance their own careers without supporting the business as a whole. I am lucky to say that I don’t have that problem. In fact, the Madison Chamber of Commerce reintroduced the Extra Mile Award, a special award given to a Madison employee who exemplifies extraordinary service. I’m so proud to report that my office manager, Andrea Ceresa, received the award, along with two other chamber members from Tons of Toys and Downtown Salon. The award was presented at the Chamber’s year end party at Hamilton Park and was expertly organized by Karen Meyer, Executive Director of the Chamber. As Karen read some of the nominations that were received for Andrea, I secretly smiled, because I felt that she was getting public recognition for what I have known for years. She is a team member (not just an employee), who goes out of her way to support the practice and its patients. She is the face and voice of Adams Dental who welcomes patients to the practice and then continues to serve their needs. Nominations from patients included comments like:  “She goes the extra mile by saying your name.”  “What makes Andrea remarkable is her always upbeat and energetic demeanor and the way she puts a patient at ease and makes them feel as though they are not just important and special, but among friends.”  “She is patient and kind – makes you want to get to the dentist!”  “She and her staff run one of the finest organizations. Her sense of service is unmatched and her joy is infectious. I was startled last week when I had left a message on the answering machine late Friday and received a return call on Saturday morning. The office manager is a pivotal position in any organization. He or she sets the tone and the expectations for the entire office and business. I have seen none better than Andrea Ceresa.”  “Andrea was my first point of contact in the office. She was both friendly and especially knowledgeable regarding all aspects of my insurance. Over the years my admiration for her has increased as well as my appreciation of her humor. Her professionalism and genuine concern for the patients in Dr. Adams’ office is unparalleled.”  “She knows every single patient's name and remembers everything about them. When she sees patients out in public, which is quite often, she always stops and speaks with them as if they were friends and not a customer.”  “She has a genuine heart and sincerely cares for her patients and staff” I sometimes wonder how I’m so lucky to have such excellent staff and I think it boils down to the old adage: “Hire for attitude, train for skill”. Certainly, for every position, there are skills that are necessary, but before looking to see if someone can use Excel, why not explore what makes them tick. I like to find out about the person’s personal vision for themselves and see what their overall attitude is. I can teach anyone to answer the phone, but I can’t teach everyone to do it with warmth and passion. If you’re looking for an employee, I suggest looking beyond their education and their past work experience; instead, look for a person who can support your vision with the same energy, passion and commitment that you have. If you look for the right things, you may end up with someone like Andrea, who, as a patient remarked to me recently “makes you look good!" For more information about Adams Dental, visit our website at www.adamsdentalnj. com.  (Jun 23, 2011 | post #1)