Pharmacology Declassified

Excited to announce that Synapse Dental is hosting a live, continuing education webinar featuring yours truly, Tom Viola, and the talented Dr. Graham Garber! 🎉

Dental anesthesia is key to keeping our patients comfortable, but many people still avoid the dentist due to fears about pain and needles. With new ADA guidelines tightening the use of invasive pharmacologic pain management for pediatric patients, it’s more important than ever to explore alternative solutions.

Join us for an in-depth discussion on how electronic dental anesthesia is revolutionizing patient care. We’ll dive into how this needle-free, drug-free method is making dental visits more comfortable and effective for everyone—patients and practices alike.

Don’t miss out on this complimentary session and earn 1 CE credit while you’re at it! Register now and see how innovation in dental anesthesia can benefit you and your patients. 🌟

For more info visit: https://us06web.zoom.us/webinar/register/3217202112068/WN_PuxMyoGmTTSmkHuvylcE4g?fbclid=IwY2xjawEQ5_lleHRuA2FlbQIxMQABHQd1NQw-woupM48Meub6AycSAAoQv9AjCFSVbmCaB0kZwHbQanLQy6ijCA_aem_wOmiBprv3YZeX2gstN2sxw #/registration

Missed our live session? No worries! Dive into our RDH Solutions Lab on-demand webinar to explore groundbreaking solutions for xerostomia, available anytime for your convenience.

About the Webinar:
Discover the revolutionary lipid-based technology designed to offer long-lasting relief for dry mouth sufferers. This cutting-edge approach not only mimics the natural protective layer of saliva but also locks in moisture more effectively than traditional treatments.

Why You Should Watch:
- Understand the persistent discomfort of xerostomia affecting diverse age groups and backgrounds, often exacerbated by medications, medical conditions, and lifestyle choices like va**ng or ma*****na use.
- Dive into the statistics and impact of xerostomia on oral health, including increased risks of cavities, gum disease, and difficulties in speaking and swallowing.
- Compare traditional water-based solutions with innovative lipid-based formulations through an evidence-based lens to empower informed decisions in managing dry mouth.

What You’ll Gain:
- Insightful reviews of how different product formulations interact with saliva.
- Knowledge to choose the right treatment option based on solid scientific backing.

👉 Learn more and sign up here: https://www.rdhmag.com/rdh-solutions-lab/webinar/14302753/why-dry-mouth-patients-continue-to-suffer-new-lipid-based-technology-that-lasts

It’s been a fantastic journey speaking and educating about dental pharmacology! Each stop was a chance to dive into the world of medication management and connect with amazing professionals.

A big thank you to everyone who attended and contributed to these sessions. I’m excited for more opportunities to share and learn together!

Academy of General Dentistry RDH magazine

Join me on Dec 7th, 2024, for a crucial seminar titled "It’s All About The Medical History!” tailored specifically for us busy dental professionals. Let's uncover the hidden complications in our patients' medical histories that could influence our dental therapy.

📚 What We’ll Learn:

- An overview of dental implications of common medications, supplements, and substances of abuse.
- Effective management of acute dental pain using both non-opioid and opioid analgesics.
- A deep dive into the pharmacology and therapeutics of local anesthetic agents.

📍 Hershey Country Club, 1000 East Derry Road, Hershey, PA 17033.

🕘 Schedule:
- Registration & Continental Breakfast: 7:45 - 8:30 AM
- Seminar: 8:30 AM - 5:00 PM (Lunch included at 12:30 PM)
- Earn 8 CE Hours across Basic Science and Opioid Prescribing

📅 Mark your calendar and join me by Dec 7th, 2024! Learn more at: https://www.concordseminars.com/seminars/its-all-about-the-medical-history-essential-pharmacology-for-busy-dental-professionals-3/

In case you missed it: Did you know the health of your mouth can reflect deeper health issues, including Alzheimer’s disease? As we continue to dive deeper into dental hygiene, it's essential to recognize the impactful role it plays in overall health, particularly in managing conditions like Alzheimer's.

Alzheimer's Disease Overview:
Alzheimer's is a neurodegenerative disorder marked by memory loss, behavioral changes, and cognitive decline, profoundly impacting life quality and social interactions.

Why It Matters to Dental Professionals:
Patients with Alzheimer’s often suffer from oral health issues like dry mouth, periodontal disease, and more due to their decreased ability to manage personal care. This makes frequent dental check-ups crucial.

Treatment Insight:
There's no cure yet, but medications like cholinesterase inhibitors and memantine help manage symptoms by enhancing neurotransmission and protecting neurons, respectively. Additionally, the innovative treatment Lecanemab shows promise in reducing brain amyloid plaques, potentially slowing the disease's progression.

Dental Care Adaptations:
For those suffering from Alzheimer’s, dental treatments need thoughtful adjustments. This includes shorter, more frequent visits and proactive care to minimize oral health deterioration.

The Role of Dental Hygienists:
Dental hygienists are pivotal in providing tailored care to Alzheimer’s patients, ensuring they receive gentle, empathetic treatment that acknowledges their unique needs.

As we continue to explore the connections between systemic health and oral care, it becomes clear that every dental visit counts, especially for those battling complex diseases like Alzheimer’s.

It's almost that time!

I am thrilled to take the stage at , July 17-20 in Minneapolis, to discuss the following courses.

- "Hurts So... Swell! Management of Acute Dental Pain and Appropriate Opioid Prescribing"
- "Waiting to Inhale: The Rise of Cannabis, Cannabinoids and Terpenes"
- "It's (Medically) Complicated! Essential Pharmacology for Treating Medically Complex Dental Patients"
- "Phantom of the Opera-tory: An Update in Pharmacology For The Entire Dental Team"

I hope to see you there! Register today at agd2024.org.

In case you missed it! In the ever-evolving world of medicine, innovations like acetaminophen gummy bites for kids are making waves. However, this new approach also brings challenges.

Recent developments have sparked concerns about potential overdose risks. Acetaminophen overdoses cause 50,000 hospitalizations annually and are a leading cause of liver failure. Children may mistake these gummies for harmless treats, unaware of the potent medication they contain. Adding to the complexity, acetaminophen is widely found in various over-the-counter meds, heightening overdose risks.

To ensure safety, it's crucial to tailor dosages to a child's weight and strictly follow recommended limits. Scrutinizing product labels is key, as some labeled as Tylenol may lack acetaminophen, while others, like Advil Dual Action and Motrin Dual Action, combine ibuprofen and acetaminophen.

In dentistry, where acetaminophen is common, awareness is vital to prevent accidental overdose. Thorough understanding, precise dosage calculations, and detailed medical histories are paramount for safe and effective usage.

Stay informed, stay vigilant, and prioritize safety above all else.

🎆 Happy 4th of July! 🇺🇸

As we celebrate the land of the free and the home of the brave, let's remember the importance of unity and gratitude. Wishing everyone a day filled with joy, laughter, and fireworks! Stay safe, enjoy the celebrations, and cherish the moments with loved ones.

Happy Independence Day!

🌟 Thank you for your incredible feedback! 🌟

🦷✨ Effective pain management in dental care goes beyond the procedure—it's about ensuring lasting comfort and success for patients. Here's what I've learned:

- It all starts with precise local anesthesia delivery, keeping patients comfortable throughout their dental hygiene sessions.

- Local anesthetics block nerve signals, temporarily numbing pain without affecting consciousness. Choosing the right one depends on each patient's medical needs.

Key Anesthetics:

- Lidocaine: The go-to for its quick action and effectiveness in various dental procedures, but careful dosage is crucial.

- Articaine: Known for its potency and long-lasting effects, proper administration is key to minimizing risks.

- Mepivacaine: Rapid onset and suitable for moderate procedures, with formulations for sensitive patients.

- Considerations: Allergic reactions are rare but possible; patient assessment is vital for safe anesthesia selection.

Proper techniques and dosage ensure patient safety and comfort throughout their dental care journey. Beyond the chair, effective pain management leads to optimal therapeutic outcomes.

Receiving a letter from your pharmacist can feel like a gesture of care—a reminder to remain vigilant about the potential adverse effects of medications, especially in older patients. This collaboration between healthcare professionals complements your expertise as a clinician.

In case you missed it, take Dr. Pam, for example. She recently received a letter from her pharmacist regarding a prescription for TMJ pain. Flexeril was prescribed short-term while the patient awaited their night guard, with photobiomodulation (PBM) therapy added for pain relief. The pharmacist's insights on potential risks for older patients were eye-opening.

So, why is this letter a game-changer? It highlights the power of open communication between healthcare providers. The pharmacist's note prompted Dr. Pam to reconsider the prescription's appropriateness, focusing on adverse effects and patient safety. It reaffirmed the value of a multi-disciplinary approach to patient care, ensuring optimal outcomes.

While Flexeril seemed suitable based on the patient's history, weighing potential risks—especially for older individuals—is crucial. This underscores the importance of informed decision-making and constant collaboration among healthcare professionals.

What's the takeaway? This letter isn't just paper; it's a testament to teamwork and continuous learning in healthcare. By working together, we can optimize patient care and ensure safer, more effective treatment options.

In conclusion, I appreciate this valuable insight from my pharmacist and look forward to fostering collaborative relationships in patient care. Here's to teamwork, innovation, and solving medical mysteries together!

Acknowledging the pharmacist's input fosters a culture of teamwork, potentially leading to fruitful professional relationships. As we delve into Medical History Mysteries, it serves as a reminder of the importance of continuous education and open communication in healthcare. Each interaction presents an opportunity to learn and grow, ultimately benefiting patient outcomes.

Check out DentistryIQ.com for the full Medical History Mysteries, including "Dentists and pharmacists: Why getting a letter from a pharmacist can be a good thing." 📚💊

**Septocaine for Mandibular Blocks: What’s the Verdict?**

When I first started discussing Septocaine for mandibular blocks, I still had hair! Whether it was the debates or just time passing, who knows? But here’s the bottom line: we need to talk about articaine in its generic form, as several companies produce it. Can we use articaine in mandibular blocks? The answer is both yes and no – we simply don’t know yet.

It’s not just about articaine. Prilocaine, another 4% anesthetic, also comes into play. Research from 2010 indicated a high probability that using a 4% anesthetic, either articaine or prilocaine, in a mandibular block could lead to paresthesia. While I don’t dispute this, I am skeptical. After nearly 1,500 lectures on anesthesia, I’ve found only a small fraction of practitioners report issues with paresthesia, suggesting the problem is rare.

We must consider other causes of paresthesia beyond using a 4% anesthetic. Third molar extractions and needle trauma are significant factors. For instance, during my own third molar removal, the oral surgeon cautioned about potential paresthesia due to the nerve’s position. In these cases, the specific anesthetic doesn’t matter – paresthesia could still occur.

Based on the data and my experiences, I believe the most likely cause is the effect of a 4% anesthetic on the mandibular nerve, but the exact reason remains unclear. Until we have more clarity and professional guidelines from the ADA and AGD, it’s best to avoid using articaine or prilocaine in mandibular blocks. We need official guidance and clinical standards to ensure patient safety.

🦷✨ "The Phantom of the Opera-tory": An Overview and Update in Pharmacology for the Entire Dental Team! ✨🦷

I’m thrilled to invite you to join the New Jersey Dental Association for this essential Series. Designed to make your mandated continuing education courses convenient and affordable, each course is offered VIRTUALLY three times in 2024, from April through September, on different days and times to fit your busy schedule.

📌 Course Description:
As a clinician, you need to navigate the medical considerations of dental agents and the dental considerations of systemic medications. This program offers a comprehensive overview of dental pharmacology, with a special emphasis on medications used in dentistry and systemic treatments that impact dental therapy.

📚 Learning Objectives:

Understand the pharmacology of common dental medications: Analgesics, Antibiotics, Local anesthetics, Anxiolytics.
Discuss the pharmacology of internal medicine medications, including drug interactions and contraindications.
Learn appropriate prescribing practices and strategies to combat prescription drug abuse, including the role of the NJPMP.
Master best practices for taking complete and accurate medical histories.
📅 Dates:

Tuesday, August 6th at 6:00 PM - 9:00 PM
Wednesday, September 5th at 6:00 PM - 9:00 PM
👨‍🏫 Speaker: Tom Viola, RPh, CCP (That’s me!)

I’m looking forward to enhancing your pharmacology knowledge and helping you fulfill your continuing education requirements!

Learn more and register at: njda.org

When treating patients taking Ozempic, dental professionals must consider several important factors to ensure optimal care.

Firstly, significant weight loss associated with Ozempic may require adjustments in local anesthetic, antibacterial, and analgesic dosages to maintain efficacy. Understanding whether the patient is taking Ozempic for diabetes management or weight loss can help address specific health concerns.

Patients using Ozempic for weight loss may be at risk of hypoglycemia, especially during stressful situations like dental appointments. Additionally, it's crucial to monitor for signs of pancreatitis, such as abdominal discomfort, given the drug's potential impact on the pancreas.

Originally designed for diabetes treatment, Ozempic carries a risk of thyroid cell tumors, similar to Victoza. Regular thyroid examinations and monitoring can aid in early detection and appropriate medical intervention if necessary. Dentists should also be aware of potential interactions between Ozempic and other medications the patient may be taking. For example, if a patient is on medications that cause dry mouth, there is an increased risk of oral health issues such as dental caries and periodontal disease.

Educating patients about maintaining good oral hygiene practices, including regular brushing, flossing, and dental check-ups, is essential to mitigate any adverse effects of Ozempic on oral health. Collaboration with other healthcare providers, such as endocrinologists and primary care physicians, is vital to ensure comprehensive care and optimal health outcomes for patients taking Ozempic.

By staying informed about the potential dental implications of Ozempic and taking proactive measures, dental professionals can play a crucial role in promoting the overall health and well-being of their patients.

Happy Father's Day to all the amazing dads out there!

Effective pain management in dental care isn't limited to procedures—it extends to ensuring patients' comfort and success beyond the chair. Here's what I've learned over the years:

Pain Management Essentials:

- Proper Delivery of Local Anesthesia: Ensures patients remain comfortable throughout dental hygiene procedures.
- Function of Local Anesthetics: These agents block nerve conduction, numbing pain without affecting consciousness. Choice of anesthetic depends on each patient’s medical needs.

Key Anesthetics:
- Lidocaine: The gold standard with a fast onset, suitable for various procedures. Proper dosage is crucial to avoid complications.
- Articaine: Known for rapid onset and long duration, it’s favored for potency. Proper administration minimizes risks.
- Mepivacaine: Ideal for moderate-length procedures with a rapid onset and intermediate duration. Formulations without epinephrine are available for patients with sensitivities.

Patient Considerations:
- Allergic Reactions: Rare but possible. Always assess for allergies and individual factors before selecting an anesthetic.
- Technique and Dosage: Proper techniques and accurate dosage calculation are essential to minimize risks and ensure patient safety and comfort.

Pain management in dental hygiene extends beyond the chair. By carefully selecting and administering anesthetic agents, dental hygienists can optimize patient comfort and therapeutic success.

Join me at the RDH Under One Roof conference from July 18-20, 2024, in Denver, Colorado!

I'll be presenting a must-attend session: "(Are You Just) Waiting To Inhale? Do You Know Enough About Ma*****na (Cannabis) To Have THAT Conversation With Your Patient?"

Course Highlights:

- History & Legal Status: Learn about the evolution and various types of cannabis, and its legal status.
- Pharmacology: Dive into the pharmacology of cannabis, including its mechanism of action, routes of administration, and available formulations.
- Organ Systems: Understand the effects of cannabis on major organ systems.
- Clinical Considerations: Explore clinical considerations, including adverse reactions, drug interactions, and contraindications.

Cannabis is often seen as having no accepted medical use by the DEA, making it illegal to possess. Yet, nearly every state has moved towards legalizing or decriminalizing cannabis for medical or recreational use. Despite this growing acceptance, there are significant public health concerns, particularly among dental hygienists due to the primary routes of administration involving the oral cavity. This program will provide an in-depth look at cannabis pharmacology, dosage forms, routes of administration, and adverse effects. Emphasis will be placed on the implications of cannabis use on oral health, dental hygiene treatment, and its potential use chairside for managing patient anxiety and pain.

About the event:
This three-day event is packed with high-quality dental hygiene education. Learn from industry-leading speakers and explore the latest dental hygiene products and equipment on the exhibit floor.

🗓️ Save the date and don't miss out on this incredible opportunity to expand your knowledge and skills! Learn more at: https://www.rdhunderoneroof.com/rdhuor2024

We learned in school to take blood pressure on all our patients, but not every dentist does it before administering local anesthetic. What happens if you don't, and something goes wrong?

Vitals are vital for a reason. They help us understand the patient's suitability for treatment and are crucial from a litigious standpoint. If something goes wrong, the first question will be, "What was their blood pressure and pulse prior to the incident?" If you didn’t take it, you'll have to say, "I don't know." This is bad from a legal perspective and shows you didn't consider the patient's best interest.

You must take their blood pressure and pulse beforehand to assess their suitability for treatment and to know if other actions are needed. Sometimes, a patient might need a medical consult. Without these vitals, you’re practicing in the dark.

I know some clinicians think there's no time to take vitals, but it doesn't have to be you. Train your staff. If your state allows it, delegate it to someone else. We should find a way to take blood pressure and pulse on every patient. Blood pressures are essential, but so are pulses because they give a quick view of the patient's cardiovascular fitness.

We have access to charts indicating normal, high-normal, high, and critical blood pressure. If a patient says, "That's normal for me," or "I'm just nervous," what do you do? There’s a gray area, but you still have clinical decisions to make.

Ask patients what’s normal for them. If someone’s normal blood pressure is 90 over 70 and it's 150 over 100 at your office, that’s extreme hypertension for them. Knowing this in advance helps you decide if they need a consult.

Clinicians often say they'd have no patients if they sent everyone with high blood pressure home. Dental visits are stressful, but not enough to drastically elevate vitals. If you never take the blood pressure and pulse, you wouldn’t know.

Discuss this topic in team meetings to decide what's acceptable and what your protocol will be. Everyone should do the same thing!

In case you missed it... Mark your calendars for July 17-20 and join me in Minneapolis, MN, for the 2024 Academy of General Dentistry Conference! This is the premier event for general dentistry, where you can network with colleagues, students, and dental team members.

The AGD annual scientific session is renowned for its top-tier dental continuing education. With a mix of advanced hands-on training and insightful lectures in an innovative one-hour format, all CE credits earned can be applied towards AGD Fellowship and Mastership awards.

📚 I'll be presenting on these exciting topics:

- Hurts So... Swell! Management of Acute Dental Pain and Appropriate Opioid Prescribing
- Waiting to Inhale: The Rise of Cannabis, Cannabinoids, and Terpenes
- It's (Medically) Complicated! Essential Pharmacology for Treating Medically Complex Dental Patients
- Phantom of the Opera-tory: An Update in Pharmacology for The Entire Dental Team

Don't miss this opportunity for professional growth and to stay updated with the latest trends in disease state management. See you there for a transformative weekend of learning and networking!

Dental hygienists play a crucial role in promoting good oral and systemic health. Recent research has deepened our understanding of the connection between oral health and Alzheimer’s disease. It's essential to be aware of the dental implications of Alzheimer's and our role in providing care for these patients.

What is Alzheimer’s Disease?
Alzheimer’s is a neurodegenerative disorder characterized by memory loss, language difficulties, and behavioral changes. It progresses over time, with symptoms ranging from mild memory loss in early stages to severe cognitive and functional impairment in later stages.

Causes and Clinical Effects
The exact cause of Alzheimer’s is unknown, but it involves loss of neurons and the formation of beta-amyloid plaques and neurofibrillary tangles, leading to decreased neurotransmitters crucial for cognition and memory. This results in significant cognitive deficits and behavioral issues, impacting the quality of life.

Dental Implications
Alzheimer’s patients often experience oral health issues like xerostomia, candidiasis, periodontal disease, and root caries. They may also suffer from oral injuries due to impaired chewing and increased risk of aspiration pneumonia due to swallowing difficulties. Regular dental check-ups, fluoride applications, and oral hygiene education are vital for these patients.

Treatment Challenges
Patients with advanced dementia may become anxious or uncooperative, making dental treatments challenging. Early intervention is crucial, focusing on restoring oral health and then shifting to preventive care and maintenance with shorter, more manageable appointments.

The Role of Dental Hygienists
Dental Hygienists must promote good oral hygiene, provide prophylaxis, and ensure prompt treatment. Communicating effectively with Alzheimer’s patients and their families is key. Use simple, clear language and maintain a positive, empathetic attitude to help them understand and follow oral health instructions.

Read the full article on RDH Magazine for more in-depth information and insights: https://www.rdhmag.com/patient-care/article/14305948/not-total-recall-what-dental-hygienists-need-to-know-about-alzheimers-disease-and-its-treatment

**Are Multivitamins Beneficial? A Deep Dive on "Medical History Mysteries"**

In case you missed it, our recent "Medical History Mysteries. episode explores whether multivitamins are truly beneficial.

Recent studies, like the COSMOS Trial, suggest that multivitamins might help slow memory loss and cognitive decline in adults over 60. While there are some benefits, they may not be significant enough to recommend daily multivitamin use for everyone.

Multivitamins can be large and hard to swallow, though alternatives like gummies and liquids exist. However, not all multivitamins are created equal. They can vary widely in formulation and may interact with medications, potentially causing harm.

Before starting any supplement, it's essential to consult with your healthcare provider to ensure it won't interfere with your medications. Dietary supplements are not standardized or regulated by the FDA, so making an informed decision is crucial.

To watch the full episode, check out Dentistryiq.com!

This Memorial Day, we honor and remember the brave men and women who have made the ultimate sacrifice for our country. Their courage, dedication, and selflessness are the foundation of our freedom.

As we gather with family and friends, let's take a moment to reflect on the true meaning of this day and express our deepest gratitude to those who have served and continue to serve.

Wishing everyone a peaceful and respectful Memorial Day. 🇺🇸

Dental professionals must frequently draw upon their knowledge of pharmacology for optimal care of today’s medically complex dental patients; however, many dental professionals simply cannot keep up with the latest trends in disease state management. Join me July 17-20 in Minneapolis, MN for the 2024 Academy of General Dentistry Conference!

Network with colleagues, students, and dental team members at the premier meeting for general dentistry. AGD’s annual scientific session has earned a reputation for having some of the finest dental continuing education in the world. From advanced hands-on education to clinical and practice management lectures in an innovative one-hour lecture format, all of the CE earned at an AGD meeting can be applied to the AGD Fellowship and Mastership awards.

I'll be covering the following topics:

-Hurts So... Swell! Management of Acute Dental Pain and Appropriate Opioid Prescribing
-Waiting to Inhale: The Rise of Cannabis, Cannabinoids and Terpenes
-It's (Medically) Complicated! Essential Pharmacology for Treating Medically Complex Dental Patients
-Phantom of the Opera-tory: An Update in Pharmacology for The Entire Dental Team

See you there for a weekend of learning and growth!

Learn more at: https://agd2024.eventscribe.net/

Is dry mouth an issue for you or a loved one?

Check out the recent webinar with Confessions of a Reluctant Caregiver to uncover the link between dry mouth and health issues like nutritional deficiencies and social isolation. You can find out simple things like using a lipid-based spray to help.

Session Overview:

• Overview of the significance of dental health in preventing future medical issues
• Discussion on the interconnection between dental health and overall well-being
• Challenges of xerostomia and its impact on quality of life and dental health
• Identification of diseases and treatments that have significant dry mouth challenges – Sjogren’s; Oral, Head and Neck, Thyroid Cancer and radiation treatments (short intro to be followed up by dental oncologist in next session); medications
• Guidelines for maintaining dental health to prevent future medical problems
• Importance of regular dental examinations and screenings
• Practical strategies for promoting overall health through effective dental hygiene practices

Plus more! Watch the webinar at:

Introduction to Dental Health and Its Role in Preventing Medical Complications Presenter: Tom Viola, RPhSession Overview:• Overview of the significance of dental health in preventing future medical issues• Discussion on the interconnect...

Don't miss out on the latest episode of the Dental Sound Bites Podcast by the American Dental Association! We're tackling one of the hottest topics: GLP-1 medications for weight loss. Learn how to navigate the unique challenges these drugs may present when treating your patients, from chairside chats to expert intel.

In this episode, we cover:

- The origins and mechanics of GLP-1 medications, including why Gila monsters play a surprising role.

- Why dentists should care about these drugs and their systemic effects on overall and oral health.

- Key considerations for dental professionals when treating patients on these medications.

- The importance of asking the right questions during medical history assessments: 'What do you take? Why do you take it? And, did you take it today?'

- Strategies for initiating crucial conversations about GLP-1 medications and their side effects.

- Top three recommendations to help dentists better prepare for treating patients using GLP-1 medications.

Listen to the full episode at the ADA website:

Weight Loss Drugs and what dentists need to know - S4E01 In this episode of the Dental Sound Bites Podcast, GLP-1 medications for weight loss, and what dentists need to know.