Mary Ellen Cagnassola

Tooth pulling was often used as a punishment in Medieval England.

Dentists today rarely, if ever, worry about killing, disfiguring or poisoning their patients. People often verbalize their fear or hatred of visiting the dentist, much to the chagrin of many a DDS, but if only they knew how good they have it here in the 21st century, they might change their tune. From the first recorded “dentists” of ancient Egypt to turn-of-the-century butchers, patients of the past would gladly trade their experiences for the excellent care available today. Hang on to your probes 

 these past dental care practices will shock you.

This civilization may have the earliest records of tooth pain, but sadly for its members, there was not even a semblance of dental medicine. Sumerians, according to the 

, literally relied on a hope and a prayer for relief from “tooth worms.” Worshiping deities such as Shamash, Anu and Ea was the common (and only) practice for treating oral issues.

Dramatic patients may act like you are murdering them in the chair, but in ancient China, dentists did kill people. Arsenic, which is known to cause abdominal pain, vomiting, brain damage and diarrhea when ingested, was often administered for tooth pain. To be fair, most patients no longer felt pain after this treatment 

Romans, after conquering the Etruscans, who invented dental bridges, had some wits about them when they originated gold crowns and artificial teeth. Gargling urine, however, was not their brightest moment. This was a common treatment recommended by physicians specializing in dentistry at the time, and while a brave few still swear by urine therapy, there is no real evidence that it helps gum disease or tooth pain, never mind the fact that it is repulsive.

Brace yourself for this one (no pun intended, orthodontists) 

 the Middle Ages are also referred to as The Dark Ages for a reason. This era was regressive in several capacities and perhaps the most dangerous for anyone who dared to find treatment for oral health issues. While bloodletting originated in ancient Greece, the practice was used as a solution for pretty much every ailment during Medieval times, including “tooth worms.” There never has been any such thing, but that did not stop physicians from draining patients of their blood, covering them in leeches, blistering their skin, inducing diarrhea, shoving garlic cloves their ear canals or taking a hot iron or acid to dental nerves. It is no wonder that thousands of patients died during procedures or afterwards from infection.

There still were no regulations during this time of industrialization, leaving plenty of opportunity for frauds to rob people of their money and cause them excruciating pain in the process. In England, one could become a dentist without any training whatsoever, and for some ungodly reason, arsenic made a comeback in the U.S. for the first-ever root canals. The toxin was applied to kill the root of an ailing tooth and then scooped out, usually without any numbing — that is until the medical community adopted cocaine as a cure-all and local anesthetic.

Fillings during this time resembled what dentists use today, but early adopters of this new method of treating decay did not know that incorrectly mixing mercury with silver causes leakage and leads to insanity, tremors, muscle atrophy and a whole host of debilitating symptoms. To add insult to injury, the fillings were applied at 200 degrees Fahrenheit.

The roaring 20s made Americans hyper-aware of their appearances. Enter cosmetic dentistry, which back then made teeth more unsightly in the long run. Bleach and Tartaroff, a whitening agent with hydrochloric acid, not only whitened teeth, but stripped enamel from them and destroyed gums.

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Medical science has come a long way in the past 100 years, dentistry included. But prior to regulations, laws and, well, actual peer-reviewed knowledge, what physicians and dentists did to their patients was nothing short of absurd by today's standards. In fact, a visit to the dentist in bygone eras could often do more harm than good. Continue below to see how dentistry has advanced. 

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Futuredontics' survey of dental patients reveals what matters most to your patient base.

When it comes to attracting and retaining patients, there are many unknowns. What causes patients to switch dentists? How do they chose providers? Futuredontics, a dental marketing services and software provider, created an online survey of more than 3,000 participants to answer your most pressing questions.

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Here are the top factors that influence patients’ dental health care decisions and what you can do to satisfy them.

This may seem like a no-brainer, but according to the survey, insurance is the no.1 consideration for 59 percent of patients when choosing a provider. Even if a patient enjoys your practice’s services, staff and location, if you cannot accept their insurance, most have no choice but to head elsewhere.

Try the following to score points in patient satisfaction:

 and consider adding insurance plans to acquire and retain new patients.

about the distinctions between health and dental coverage.

 that give patients what they need, regardless of their coverage.

 and explicit about the options you have available.

Survey says that patients, especially those between 35 and 54 years old, will not go out of their way to patronize your practice. Location is everything when it comes to business, so if you’re looking to save money by purchasing real estate in an isolated area, you could be hurting your finances. Beyond distance, availability of online appointments, extended workweek hours, weekend hours and a sleek website are of utmost importance.

Try the following to increase convenience: 

 Pay close attention to parking availability, proximity to public transit, street visibility and ease of access.

 at least one day out of the week and offer weekend appointments.

 This includes having a social media presence and online bookings.

While online reviews do not always offer truthful reflections of a business, it is true that what people say about you online can determine whether a patient choses you. A 

 from DMD asserts that Google searches can make or break a practice. If you want to know exactly how influential these reviews are, consider that most people search a business before booking an appointment and place search results over experience, service offerings and where a dentist went to school.

Try the following to improve your search results:

Claim your dental practice on all social media

. This means Facebook, Yelp, Google Places and more. The more platforms the better, and the same goes for your activity on them. This may sound daunting, but think of it as free advertising that allows you to be creative while promoting your business.

 and review your practice with signs in the waiting and exam rooms.

, but do not be too pushy. Automatic ratings, like the ones you get after using services like Lyft, and custom emails are excellent strategies.

. There is no set formula to the Internet, and so you will always need to continue learning to keep up.

Incorporating new technology is not just fun for you — it is important to patients. Busy schedules necessitate the use of advanced devices to save time, reduce discomfort and make dental visits easier overall. In fact, according to Futuredontics, patients say they would discontinue their patronage of a practice if it does not offer the latest technology.

Try following to fit your practice with the latest gadgetry:

		Clinical writing turns patients off, so 

 in a way that the average person can understand.

 in your marketing, web page and social media.

 and how they can make patients more comfortable.

Some things remain the same, and referrals from friends and family are one of them. While practices should not rely on word-of-mouth entirely, recommendations from patients with positive experiences of your services will always put bodies in the chair.

 Much like word-of-mouth referrals, direct communication is valued, and many patients will be happy to oblige.

, but be careful. Instead of calling it an incentive, “thank” your patients with reward plans such as discounts or product samples. Futuredontics advises checking with your local board about state regulations to avoid violations.

. By showing your patients how much you appreciate them the old-fashioned way, you create an emotional connection to your practice. Thank you notes are a cheap and effective way to accomplish this.

Dentists used to rely on local papers and publications to get their brands out to the community. In the digital era, this is no longer effective for getting eyes on your practice. Insurance lists, online directories, review sites, online dental referral companies and social media all have a bigger draw than any of the few print sources left.

Try the following to increase your visibility.

, as well as social media. The digital era is a visual one, so give some thought to aesthetics.

Retaining patients is a huge piece of the pie when it comes to the success of your practice. If you cannot build patient loyalty, you may find yourself in trouble. Luckily, the factors that influence a patient’s decision to stay or leave for another provider are within your control.

Try the following to keep patients coming back:

. Your team should have the best training, chairside manner and passion possible.

 by maximizing comfort and making patients feel special.

. While that new laser machine may have a hefty price tag, it does not compare to the cost of losing patients down the road.

Discover more Dentist’s Money Digest® news here

Understanding what motivates consumers in the competitive dental industry is a top concern for practice owners, who rely on new and returning patients to survive. With all the options available in states like California, Texas and New York, practicing dentists in areas with high concentrations of dental care providers would be wise to practice some active listening. Continue below to find out how to be the perfect dentist in the eyes of patients. 

The 7 Things Patients Want in a Dentist

Dentists across the country are employed in a number of fields, not just dental practices. 

According to the U.S. Bureau of Labor Statistics (BLS), there were more than 105,000 practicing dentists in 2016, a number expected to grow by about 21,000 over the next seven years. With providers earning an average of $76.81 per hour, dentistry is looking as stable as ever. Let's take a look at a few of the areas we think will be most interesting to you.

Each area of dental care is as important as the next. But when it comes to salary, specialists are unsurprisingly the highest earners. Still, even the lowest earners (prosthodontists) bring home 84 percent more than the median U.S. household income, which is nothing to balk at.

BLS provides three areas of industry-specific data: industries with the highest level of employment, industries with the highest concentration of employment and top-paying industries for dentists. Dental practices make the list across the board, but the other places dentists are working may be surprising. Outpatient care centers, physician offices, state government and hospitals have both the highest levels and the highest concentration of employment in dentistry. Dentists working in residential facilities that treat substance abuse, intellectual disabilities and mental health earn the most on

Residential Intellectual and Developmental Disability, Mental Health, and

Employment of dentists is strong, particularly in large states like Texas and California. However, the states with the highest concentration of jobs and location quotients in dentistry differ. New Mexico, Michigan, California, Massachusetts and Arizona boast the highest number of jobs relative to population size. Employment per thousand jobs for these states stands at .97, .95, .94, .93 and .93, respectively.

The U.S. Bureau of Labor Statistics released the latest data on annual salaries for dental health care providers. We cut through all the numbers to provide you with what you want, and need to know. Continue below to find out which specialists make the most, where dentists are needed, top-paying industries, and more. 

Everything You Need to Know About the Latest Salary Numbers for Dentists

, namely addiction and lack of access to medical care, 

are creating a generation of abysmally poor oral health.

Appalachia is often the butt of jokes about missing teeth, but few truly understand the grim reality that the region, and many others across the U.S., live with. According to the Center for Oral Health Research in Appalachia (COHRA), the population of this rural landscape bears the brunt of the nation’s oral health problems with the largest per capita rate of disease, infection and decay.

Like any isolated area with high rates of poverty, discrepancies in general and oral health abound. COHRA, a continuing research project at West Virginia University and the University of Pittsburgh, is one of the only programs attempting to understand the multiple causes of oral health disparities in Northern Appalachian populations. Now in its second phase, researchers follow women during pregnancy and beyond after its phase-one findings indicated that caries begin in early childhood.

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Dr. Dan McNeil, principal investigator for COHRA at WVU, says on top of having some of the poorest oral health, his state boasts the highest rate of overdose deaths in the U.S. West Virginia’s environmental and economic issues have drastically changed the fabric of the state, leaving many unable to provide for themselves or secure adequate health care. The state’s large senior population, according to McNeil, is also a propellant of general health problems like chronic pain. Availability of opiate medications as the solution for pain has helped pave the way for the staggering overdose death rates.

“We have a unique population and a unique set of environmental and economic circumstances right now. Unfortunately, all that is coming together to make the opioid crisis as bad as it is in our state,” McNeil said.

The painful and unsightly tooth decay that plagues the region often begins in children as young as one, and nearly half of Appalachia’s most high-risk population is completely toothless before the age of 70. Children suffer the most physical and emotional pain from inflamed gums, cavities and rot. School absences are a common side effect, as is dental fear associated with excruciating visits to address early childhood oral ailments. These factors, combined with lack of Medicaid coverage for adults up to 55, establish a pattern of avoiding dental care.

“If you have missing dentition, it’s a huge social issue. We have also done with work with orthodontics, and one of the problems we’ve seen is that children who get care through Medicaid have an increased rate of not completing that care,” McNeil added. “That leaves [young patients] with less-than-functional and less-than-aesthetic dentition, which has social and employment implications later in life.”

With no dental insurance or even a dentist nearby, many are left with no choice but to pull out their own teeth using pliers or other make-shift tools. West Virginia in particular has a lower rate of insured patients, thus decreasing dental utilization. McNeil said this lack of comprehensive oral health care creates huge problems, as people are dealt with on an emergent basis rather than a preventative one.

“It was probably six to seven years ago they really just started breaking off — some of them even below the gum line. Worst pain of my life,” Bobby Horn, a Grundy, Virginia, resident, told PBS Newshour in 2011.

Social and general health is hurt by these realities. People with visible extractions are less employable, further perpetuating stereotyping and misunderstanding of the Appalachian population. While West Virginians do face serious problems with addiction and oral health, McNeil says there are many positives about the state and its people that often go ignored in favor of stigmatization.

“There is a strong sense of self-reliance. People want to stand on their own two feet and get themselves out of problems,” McNeil said. “There is a strong sense of patriotism and sense of devotion to community, and unfortunately, that is one of the things the opioid crisis has caused problems for. There is also a real devotion to young people and to the future. They want life to be better for their kids than it was for them in terms of health issues, including oral health.”

While oral ailments have persisted in Appalachia for decades, comprehensive efforts to reveal their causes and remedy them have only been underway since 2000. Most families residing in Northern Appalachia rely on well water, which Mary Marazita, principal COHRA investigator at PITT, says contains little to no fluoride.

“Like much of Appalachia, the counties are fairly mountainous, remote and struggle economically,” Marazita told the National Institute of Dental and Craniofacial Research. “A lot of people still live out of town on farms or family land. We ask our participants to bring in water samples from their homes, and that allows us to test fluoride levels.”

But lack of fluoride is hardly the primary cause of decay, periodontal disease and the array of other oral conditions impacting the Appalachian region. Given the generational endurance of these issues, considering patients within the context of their family situations is crucial, as is education on oral health for new parents.

“One of our most striking findings to date is that the oral health disparity begins very early in life,” Marazita continued. “The overall increase in decay that is seen in our study population, compared to the rest of the nation, typically remains steady throughout childhood into adulthood.”

Educating these rural communities, however, is not as simple as reminding them to brush and floss twice a day. In places where families struggle to provide the basics and often suffer from more life-threatening issues like addiction, heart disease and lung cancer, oral hygiene is low priority. Other illnesses, especially addiction to meth and opioids, join forces with poor diet and sugary drinks to accelerate the already nightmarish levels of decay and disease.

Lack of access to dentists, along with the U.S. health care system’s treatment of dental health as non-essential, further exacerbates these disparities. And it does not end with Appalachia.

In an increasingly divided nation that struggles to provide basic health care to the poor, having a full set of healthy teeth is a privilege few can afford. Though an ailing mouth affects the rest of the body 

 potentially leading to heart disease, diabetes and even cancer — 

 writer Anna Sanford reports that in the eyes of insurers and even government-subsidized programs, dental benefits are optional.

Across the U.S., Sanford writes, more than 50 million people live in Dental Health Professional Shortage Areas and are forced to go to emergency rooms for treatment. New federal requirements are improving coverage for children, but individuals over 19 often go years without receiving dental care.

“Emergency room visits for dental-related issues among adults over 65 rose from 1 million in 199-2000 to 2.3 million in 2009-2010,” the Center for Medicare Advocacy (CMA) reports. “As overall health care system reforms aim to emphasize primary and preventive care and deter costly emergency care, dental care remains neglected by policymakers at a time when the need for attention is greater than ever.”

Combatting the lack of dental care on this scale 

 in this era of mounting public health crises and uncertainty about the future of Medicaid, Medicare and the Affordable Care Act 

 is no easy feat. But according to CMA’s report, solutions are available.

Advocating specifically for policy changes to improve public health, the group encourages strengthening community education and outreach, as well as addressing provider payment and shortage issues. COHRA’s research in their target area can be applied on a larger scale to educate affected communities with consideration to income levels, literacy and recruitment of families and dental professionals.

“Access to dental care is another community issue that can contribute to the disparity.  It can be extremely difficult for rural communities to recruit dentist,” Marazita said.  “Without a dentist in town, people must go out of their way to find treatment.”

McNeil, who specializes in psychology, emphasized the importance of a strong inter-disciplinary approach that allows dentists, hygienists, physicians, psychologists and pharmacists to work together.

“We need to ensure that [oral health] is brought to the table as an issue. We need to impact both national and state policies, even local community policies and school system policies [to promote] tooth brushing and things like that in their curriculum,” he said.

The economic factors in place, however, stand as one of the most profound causes of health disparities, and states must work to provide incentives and opportunities for young people. Increased outflow from places like West Virginia and Northern Pennsylvania, which relied primarily on the coal and oil industries, is creating a deficit of wage-earning people.

“That leaves greater problems for the state budget, but at the same time the state continues to maintain a program to provide tuition for students going to college in the state,” McNeil continued. “Part of the effort is to keep young people in the state so they will hopefully settle here, become tax payers and contribute to the well-being of the state.”

There is no doubt that drug addiction, particularly addiction to opiates, is a public health crisis that crosses regional, racial and class boundaries in the United States today. While it is expected that less-urgent matters take a backseat as doctors, researchers, police and governments on every level scramble to address sky-rocketing overdose deaths, less trendy issues, both new and old, are becoming worse. In Appalachia, long-neglected dental health affects people of all ages, and while the region may be infamous for its poor oral hygiene, it is hardly the only one suffering from this health care emergency.

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When you hear this, you probably say to yourself, “Yeah, well the dentist hates you back, but thanks for reminding me how unpopular I am.” This is the most common utterance from patients, who are remarkably oblivious to the fact that they’re being rude.

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Just like any other doctor, dentists have busy patient schedules. So, when a patient flakes out or is tardy for not one, not two, but pretty much every appointment, the aggravation can be enough to want to banish that person from your practice.  

Ironically enough, both dentists and patients complain about this one. Can’t everyone just agree to be quiet?

Oh, the dentist on the other side of town only charged you mother-in-law X dollars for the same procedure? Go see them, then.

No one likes a patient who forgoes seeing a dentist for a decade and then shows up at a practice’s doorstep to get a rotting tooth yanked out. To prevent agonizing pain, patients should schedule regular dental checkups and take care of their teeth.

The patient is screaming, but you haven’t even touched them yet. Should be a fun appointment.

Seriously, does a patient really need to be texting the entire time the dentists’ hand is in their mouth?

Yes, you really do need to brush and floss every day, avoid foods that cause tooth decay, and come in for routine visits. If a patient does not follow these simple tips for a healthy mouth and then complains about the consequences, it is hard to have sympathy.

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Working in the medical industry is a rewarding and meaningful opportunity to help others. But sometimes, patients can be whiny, inconsiderate nightmares that make doctors question why they even bother. With dental fear being one of the most common medical phobias, dentists deal with this perhaps more than any other health care provider. DMD put together a comprehensive list of top complaints from dentists, so scroll below to see if any of your pet peeves made the cut.

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The ADA plans to provide resources for dentists with questions about compliance with the EPA new regulation

 worked for several years to reach what they call 

a “fair and reasonable” approach to dental amalgam waste

Oral pathologists, oral and maxillofacial radiologists, oral and maxillofacial surgeons, orthodontists, periodontists 

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 prohibit providers from flushing waste amalgam down drains and 

 prohibit the use of bleach or chlorine-containing cleaners that may lead to the dissolution of solid mercury when cleaning chair-side traps and vacuum lines.

 varies greatly from office to office, according to our sources from the ADA. It depends on the size or number of units needed, any reworking of plumbing or equipment and other factors. However, because a separator may extend the life of other equipment, actual overall costs for some dental offices may be less.

·“Although less than one percent of mercury released to the environment from man-made sources comes from dentistry, dentists are committed to protecting the environment,” our sources said. “By adding separators, dentists have much greater control in their efforts to ensure a healthier environment for everyone. The use of a separator is the only effective way to capture the waste amalgam so it can be recycled.”

·“The ADA supports this national regulation because it is a fair and reasonable approach to the management of dental amalgam waste,” the ADA representative continued. “It is far better for dentists than a patchwork of inconsistent regulations that vary between states and localities. The ADA worked with the EPA for several years on the final rule and it closely follows the ADA's best management practices.”

After being withdrawn in January, the EPA has reinstated a new rule requiring U.S. dental offices to install amalgam separators, effective July 14. Working in collaboration with the ADA to create a sensible approach to dental amalgam waste management, both organizations hope to phase in the new regulations over the next three years. Read on to find out what your practice will need to do to comply. 

What You Need to Know About the New EPA Regulation for Amalgam Waste

The Michigan native is not only a partner at Completely Smiles, she is also a recipient of the Academy of General Dentistry’s Fellowship Award for going above and beyond her patients’ oral health. DeLacy speaks publicly about double standards in her field and discusses the obstacles she faces as a female dentist. Her blog post “I Am a Female Dentist” caught the attention of her peers, revealing the ways advertisers in the dental industry objectify and alienate their female audience.

“I have a higher standard for my profession than what I see in the grocery store aisle reading selection,” DeLacy said in her blog post.

Check out Dr. DeLacy at @CompletelySmiles.

Dr. Austin may just be dentistry’s very own media darling. With multiple TV appearances on “The Today Show,” the Discovery Health Channel and more, this seasoned dentist wears many hats. Aside from author, entrepreneur and public speaker, Austin boasts the title of national dental consumer brand spokeswoman and expert for Colgate Total. In her practice, which was the first in the nation to offer HIV testing, Austin strives to bring awareness to the connection between dental health and diabetes.

Check out Dr. Austin at @DrCatriseAustin.

As one of New Jersey’s top dentists for the past six years, Dr. Adams is guided by a philosophy that demands radical thinking, extraordinary patient care and an ability to look beyond teeth. In addition to leading an all-female team at 

, Adams strives to incorporate whole body solutions in her original practice and her new Integrative Dental Center. At the center, patients with orthodontic needs, sleep apnea, breathing issues and oral motor disorders can find creative treatments that fit their unique needs.

Hunter is hardly your run-of-the-mill dental assistant. When she’s not busy tending to her responsibilities as vice president of the American Dental Assistants Association, the CDA and writer manages the office of Dr. Eric Hurtte and directs Dental Careers Institute’s six schools. She takes a hands-on approach in her position as director, going the distance to educate dental students with her own classes. Thanks to a fierce sense of determination and careful research, Hunter has been able to locate communities with a need for dental education, create continuing education courses and bring new schools to fruition.

On the business end of the dental industry, Valplast International’s senior vice president, Carmen Alatzas, is breaking barriers and seeking results. In her roles leading Valplast’s innovations department and overseeing operations and marketing, Alatzas finds gratification in helping dentists grow their practices and touch the lives of their patients. Growing up with challenges experienced by many first-generation Americans, Alatzas has used adversity to commit herself to every element of Valplats’ marketing, from exhibit displays to individual shipments.

Discover more Dentist’s Money Digest® news here.

In the male-dominated medical industry, women have long struggled to gain both access to education and recognition for their accomplishments. Dentistry is no exception, as of 2004, the American Dental Association reported that only 19 percent of U.S. dentists were women compared to 30 percent of physicians. Armed with periodontal probes and passion for patient care, the following women are helping to raise that percentage and re-define what it means to be a dental professional. 