Tag Archives: Dentists

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Orofacial pain could become dentistry’s newest specialty

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For starters, let’s define orofacial pain. It will be helpful in understanding how (and whether) it might become dentistry’s newest specialty as recognized by the National Commission for Recognition of Dental Specialties and Certifying Boards’ review committee.

Orofacial pain is a broad term used to describe symptoms of pain and/or dysfunction in the head and neck region. Think headaches, jaw pain and much, much more. According to the American Academy of Orofacial Pain, orofacial pain is evolving and the scope of the field is enlarging.

Currently, orofacial pain encompasses:

  • Temporomandibular joint disorders
  • Masticatory musculoskeletal pain
  • Cervical musculoskeletal pain
  • Neurovascular pain
  • Neuropathic pain
  • Sleep disorders related to orofacial pain
  • Orofacial dystonias
  • Headaches
  • Intraoral, intracranial, extracranial and systemic disorders that cause orofacial pain

In early May, the American Academy of Orofacial Pain submitted an application and request to recognize Orofacial Pain as a dental specialty, which is now under review by the National Commission for Recognition of Dental Specialties and Certifying Boards’ review committee.

According to the National Commission, all documentation in the application is confidential until the review committee has determined that the application is complete. If the application is complete, the National Commission will invite public comment on the applicant’s compliance with the requirements for recognition for a 60-day period.

Specialties currently recognized by the National Commission include Dental Anesthesiology; Dental Public Health; Endodontics; Oral and Maxillofacial Pathology; Oral and Maxillofacial Radiology; and Oral and Maxillofacial Surgery.

The field of orofacial pain is concerned with the prevention, evaluation, diagnosis, treatment and rehabilitation of orofacial pain disorders, according to the AAOP website. Such disorders may have pain and associated symptoms arising from a discrete cause, such as postoperative pain or pain associated with a malignancy, or may be syndromes in which pain constitutes the primary problem.

The National Commission, at its March 11 meeting, revised its policies related to the application process requiring it to publish a notification to its communities of interest when an application has been received.

For more information on the National Commission on Recognition of Dental Specialties and Certifying Boards, visit ADA.org/en/ncrdscb or by calling 1-312-440-2697.

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The mechanism of caries and the anti-caries action of fluoride

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At present, around two-thirds of U.S. households have fluoridated water in their houses. The CDC has made nationwide fluoridation of drinking water a top priority for the prevention of cavities.

In 1945, Grand Rapids, Michigan, became the first U.S. city to implement community fluoridation of the water supply. Fluoride isn’t just found in tap water, of course. It’s also found naturally and fortified in certain foods.

Additionally, fluoride is a common ingredient in tooth varnish or gels, mouthwashes, prophy paste, and toothpaste, with an aim to reverse tooth decay.

How fluoride prevents cavities

We know our mouths house trillions of bacteria, which can form microcolonies on our teeth. When these microcolonies coalesce, it makes a layer of dental plaque.

However, bacteria have a hard time getting into the tooth because of the outer layer of the tooth, called enamel, which is made of a hard substance called hydroxyapatite. Hydroxyapatite is a type of calcium phosphate crystal with the chemical formula Ca10(PO4)6(OH)2.

When bacteria on the tooth surface start to grow, they break down sugar in foods and drinks and release acid as a waste product, which can cause the enamel to break down. Without hydroxyapatite, the tooth enamel can become weak and allow bacteria to enter, causing permanent damage — this is called a cavity.

If left untreated, the bacteria can infect the root of the tooth resulting in pain. This is where fluoride comes in.

Fluoride can replace the OH group in hydroxyapatite to create fluorapatite with the chemical formula Ca10(PO4)6(F)2. In general, fluorapatite is denser and less soluble than hydroxyapatite, so it’s less likely to demineralize. Fluorapatite is found in the strongest animals’ teeth.

Fluoride also accumulates in your teeth over time. So, while fluoride treatments are useful throughout your life, treatments are generally more important during childhood and adolescence. This is why fluoride varnish and gels for children are becoming more popular in recent days.

How fluoride treatments work

According to a meta-analysis that looked at 20 studies exploring the effects of fluoridation of drinking water on cavities in children, fluoride in the water leads to a 35% reduction of tooth decay in baby teeth and a 26% reduction in tooth decay of permanent teeth.

Another meta-analysis looked at 22 studies exploring the effect of applying a fluoride varnish to children’s teeth every 3 to 6 months at the dentist’s office found a 37% reduction in baby teeth and a 43% reduction in tooth decay in permanent teeth.

A third meta-analysis looked at 25 studies focusing on fluoride gel treatments given at least one time a year at the dentist’s office, generally to children older than 6 years old, which showed a reduction of 28% in tooth decay. A fourth meta-analysis looked at 35 studies that the effect of fluoridated mouth rinses given daily to every other week, and found a 23% reduction in tooth decay.

What the findings mean

If we look at meta-analyses of studies that focus on fluoridated toothpaste, it’s clear that it reduces tooth decay and that the effect is stronger with higher fluoride concentrations in the toothpaste, higher frequency of tooth brushing, and supervised brushing.

This was further supported by another meta-analysis that looked carefully at the amount of fluoride in the toothpaste.

This study showed that brushing with fluoridated toothpaste with a fluoride concentration of at least 0.1% prevents tooth decay in children and adolescents aged 16 years or less. There was a 23% reduction in tooth decay at concentrations of 0.1% to 0.125% fluoride and up to a 33% reduction in concentrations ranging from 0.24% to 0.28% fluoride.

Now, while fluoride can be toxic at doses well above those used for dental hygiene, the main concern with using fluoride has generally been fluorosis. Fluorosis is not a disease, but rather a cosmetic condition caused by overexposure to fluoride. Mild forms of fluorosis are common, with up to 41% of children and adolescents having some form of it.

It usually takes the form of subtle white patches on the teeth that are barely noticeable. In moderate to severe cases, which occur in less than 2-4% of the population, there can be significant mottling of the teeth with brown staining. While fluorosis is not generally a health concern, it can lead to social stigma.

A meta-analysis of 25 studies looked at whether brushing teeth with fluoridated toothpaste is linked to fluorosis and found that brushing the teeth of infants under 1 year old may increase the risk of fluorosis, but that relationship was weak.

There was a stronger relationship for children between the ages of 12 months and 6 years of age. If these children brushed with a toothpaste that was higher than 0.1% fluoride or more, they had a 30% chance of developing mild fluorosis.

This means that the risks of tooth decay, which are decreased over fluoride concentration of 0.1% fluoride or more must be balanced with the risk of fluorosis which increases fluoride concentrations over 0.1% fluoride.

Wrapping up

Tooth decay and dental cavities are leading health concerns around the world. In general, fluoridation of the water supply, and applying fluoride to the teeth via tooth varnishes, gels, mouth rinses, and toothpaste has helped decrease tooth decay.

While fluoride is generally considered safe at the concentrations used in fluoridated products, overexposure can lead to fluorosis. In some cases, risking fluorosis may be preferable to risking tooth decay in children at high-risk for tooth decay. So, it may be beneficial to discuss treatment options with your dentist.

In addition, the American Dental Association recommends preventing overexposure by brushing children’s teeth with only a grain-of-rice-sized smear of fluoridated toothpaste from when the teeth begin to erupt to about 3 years of age, and up to a pea-sized bead of toothpaste for children over 3 years old.

For children that are old enough to brush their own teeth, it’s also a good idea to monitor their brushing to decrease the likelihood that they swallow the toothpaste, which can also lead to overexposure and fluorosis.

The use of fluoride varnish in children could be even better as it may reduce the chance of frequent exposure to fluoride, thus reducing the risk of dental decay more than any other form of treatment.

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AI makes its way to dentistry

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Dentistry is a field that evolves by leaps and bounds, and in other ways, remains fairly unchanged over the course of time. For example, new materials mean fillings last longer, resist decay better and act and feel more like a real tooth. That’s progress.

Some things never change. Like the need for good oral hygiene, for instance. My childhood dentist probably recommended the same hygiene routine — brushing twice a day, flossing daily and two cleanings a year — that is recommended today.

But one advancement is blowing those others out of the water. The field of artificial intelligence (AI) is making its way into the dentistry and may be featured at an office near you in the very near future.

Pearl, a Santa Monica, California-based startup applying AI to dentistry, recently announced that it has raised $11 million in funding, led by Craft Ventures and unnamed strategic dental industry partners.

Pearl’s CEO Ophir Tanz spearheaded the development of AI dental technologies, said the fresh capital will further Pearl’s progress toward creating a holistic oral health platform.

“Pearl will have an immediate positive impact on the dental category,” said Tanz. “It will streamline tedious, repetitive tasks, enhance profitability across dentistry, and, most importantly, it will improve the standard of care by validating diagnoses, removing large elements of uncertainty from the dental equation.”

What’s AI?

Artificial intelligence (AI) makes it possible for machines to learn from experience, adjust to new inputs and perform human-like tasks. Most AI examples that you hear about today — from chess-playing computers to self-driving cars — rely heavily on deep learning and natural language processing.

Using these technologies, computers can be trained to accomplish specific tasks by processing large amounts of data and recognizing patterns in the data.

Cool, right?

How Will AI Help in Dentistry Specifically?

Two ways Tanz predicts AI integration into a dental practice are identifying “dozens” of common pathologies in dental X-rays and creating structured medical records while self-improving from live feedback.

If that goes well, Pearl will incorporate new research to flag early indicators of disease and tie oral health to full-body health (and vice-versa).

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Oral health improving for most Americans, but economic and ethnic disparities still exist

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There’s some good news and some bad news from the Centers for Disease Control regarding the oral health of the nation.

According to a report, there have been significant improvements in oral health for Americans of all ages.

That’s the good news.

More older Americans are keeping their natural teeth. Moderate to severe periodontitis (gum disease) among adults has decreased significantly.

Use of dental sealants in young people ages 6-19 years has increased and tooth decay in school-age children has declined. And children from low-income families appear to be getting more dental treatment.

All great news!

Yet the report, based on data from the CDC’s National Center for Health Statistics (NCHS) — which represents the most comprehensive assessment of oral health data available for the U.S. population to date — reconfirms a hard truth.

Economic and racial/ethnic disparities in oral health persist.

That’s not such good news.

31% of Mexican-American children aged 6-11 years have experienced decay in their permanent teeth compared to 19% of non-Hispanic white children.

12% of children aged 6-11 from families that live below the poverty line had untreated decay, compared to 4% in families with income above the poverty line. The report also records an increase in tooth decay in the primary teeth of children aged 2-5 years, from 24% to 28%.

“This report shows that while we are continuing to make strides in prevention of tooth decay, this disease clearly remains a problem for some racial and ethnic groups, many of whom have more treated and untreated tooth decay compared with other groups,” said Dr. Bruce A. Dye, an NCHS dentist and the report’s lead author.

What can be done?

Beyond education on the importance of oral hygiene and brushing, there are a number of public health steps we can take to address tooth decay in children and adults, too. From addressing dental shortages in underserved communities to advocating for change in public health policies, there are many ways to get involved in making affordable dental care accessible to more Americans.

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Study: Orthodontic treatment doesn’t guarantee future oral health

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Orthodontic treatment can straighten your teeth, but it can’t protect those choppers from developing tooth decay in the future. When polled, many people think that orthodontic treatment will prevent future tooth decay. But new research out of the University of Adelaide in South Australia has found that this is not the case.

Published in the journal Community Dentistry and Oral Epidemiology, the study, conducted by Dr. Esma J. Dogramaci and co-author Professor David Brennan from the University’s Adelaide Dental School, assessed the long-term dental health of 448 people from South Australia.

“The study found that people who had orthodontic treatment did not have better dental health later in life,” says Dr. Dogramaci. “Patients often complain about their crooked teeth and want braces to make their teeth straight so they can avoid problems, like decay, in the future.”

The study, which followed people from the age of 13 until they were 30, recorded patients’ dental health behaviors and the number of decayed, missing or filled teeth over that period of time.

The cost of orthodontic treatment, in which crooked teeth are realigned using braces worn over several years, varies according to the severity of the problem and whether braces are placed on one arch or both and what materials are used.

The average price tag in America for braces? Anywhere from $3,000 to $7,000, according to the American Association of Orthodontics, depending on the factors named above.

Braces have typically been a teenage rite of passage. But they are becoming increasingly popular in the adult population, with one in five patients being adults. The global orthodontics market is predicted to be worth more than $6 billion by 2023.

“Evidence from the research clearly shows that people cannot avoid regularly brushing their teeth, good oral hygiene and regular dental check-ups to prevent decay in later life,” says Dr. Dogramaci. “Having your teeth straightened does not prevent tooth decay in later life.”

The research was carried out by the Adelaide Dental School, and the Australian Research Centre for Population Oral Health (ARCOPH), the University of Adelaide.

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Anesthesiology recognized as 10th dental specialty

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About 175 years ago, a dentist in Hartford, Connecticut, extracted one of his own third molars to test the analgesic properties of nitrous oxide. It was risky. But it paid off.

That’s a commitment to science right there.

It was Dr. Horace Wells’ introduction of nitrous oxide, and the demonstration of anesthetic properties of ether by Dr. William Morton, a student of Dr. Wells, that gave the gift of anesthesia to medicine and dentistry. Thanks, doctors!

And now, in 2019, dental anesthesiology has become the 10th dental specialty as recognized by the National Commission on Recognition of Dental Specialties and Certifying Boards. The recognition is a result of the National Commission adopting a resolution earlier this year based on an application from the American Society of Dentist Anesthesiologists to recognize dental anesthesiology as a dental specialty.

“This historic vote by the National Commission certainly reflects the ADA’s ongoing efforts towards improved patient care and safety in the areas of dental sedation, dental anesthesiology and access for those with special health care needs,” said Dr. James Tom, president of the American Society of Dentist Anesthesiologists.

Dental anesthesiology joins the following dental specialties: dental public health; endodontics; oral and maxillofacial pathology; oral and maxillofacial radiology; oral and maxillofacial surgery; orthodontics and dentofacial orthopedics; pediatric dentistry; periodontics; and prosthodontics.

Dental specialties are recognized and selected “to protect the public, nurture the art and science of dentistry and improve the quality of care,” according to the National Commission website.

A sponsoring organization seeking specialty recognition for a discipline of dentistry must document that the discipline satisfies six requirements, as outlined in the “Requirements for Recognition of Dental Specialties.”

Additionally, the sponsoring organization of the proposed specialty must provide documentation to show that it is a distinct and well-defined field that requires unique knowledge and skills beyond those commonly possessed by dental school graduates; that it requires advanced knowledge and skills; and that it scientifically contributes new knowledge, education and research in both the field, and the profession.

Check, check and check. Welcome to the family, dental anesthesiologists.

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World Oral Health Day spotlights awareness about good oral hygiene

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Move over, St. Paddy. It’s time for World Oral Health Day, which is celebrated globally every year on March 20. It may not come with green beer and four-leafed clover cookies, but the day is organized by the FDI World Dental Federation and is the most extensive global awareness campaign on oral health.

The observance spreads the word about the importance of good oral hygiene practices to adults and children alike and demonstrates the importance of optimal oral health in maintaining general health and well-being.

Every year, World Oral Health Day chooses a specific theme and reaches out to the public, oral health professionals and health-related policymakers who all have a role to play in helping reduce the burden of oral disease.

The official theme of the 2019 campaign is “Say Ahh: Act on Mouth Health.”

World Oral Health Day first became a thing in 2007 and was originally celebrated on Sept. 12 — which is the birth date of FDI founder Dr. Charles Godon. The campaign was not fully activated until 2013, and at that time, the date was changed to March 20 in order to avoid conflict with the FDI World Dental Congress, which traditionally takes place in the late summer/early fall.

Resources and tips on how to celebrate World Oral Health Day are available at worldoralhealthday.org/resources.

FDI World Dental Federation is the largest membership-based dental organization in the world. It is the principal representative body for over one million dentists worldwide. FDI’s membership comprises approximately 200 national member dental associations, including the ADA, and specialist groups in some 130 countries.

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Funding available for overseas dental care efforts

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It was Martin Luther King, Jr. who once wisely said, “There is nothing greater than to do something for others.” If you’re a dentist or dental professional who embraces this mindset, get ready for some great news!

If you’re involved with a U.S.-based nonprofit organization working to improve access to oral health care in underserved communities outside the U.S., funding is available for your work. You have until April 26 to apply for the American Dental Association (ADA) Foundation Grant for International Dental Volunteer Projects.

The most successful dentists stay dedicated to the profession by exploring other opportunities in the field. Volunteering your time, skills, and services for the betterment of others is one way to revitalize, strengthen, and sustain enthusiasm in your career.

The grants available through the ADA are up to $5,000 and are designed to support dental outreach programs.

Five organizations were selected to receive these grants in 2018. The recipients were the Colonial Presbyterian Church in Kansas City for its work in Guatemala; Global Dental Relief in Denver for its work in Nepal; Medical Eye Dental International Care Organization (MEDICO) in Northlake, Illinois, for its work in Honduras; Open Wide Foundation in Scottsdale, Arizona, for its work in Guatemala; and Strong Villages in Agoura Hills, California, for its work in Belize, Ecuador and India.

Who Can Get Involved?

As a dentist or dental hygienist, your unique skill set is quite portable. With the help of some basic equipment and instruments, a rudimentary dental clinic can be set up anywhere just about in the world.

Although international medical volunteers are statistically practitioners in their middle years or close to retirement, those in the early years of practice, teaching, or even those still in dental school can gain a lifetime of satisfaction by getting involved.

International colleagues in many developing countries are eager to learn from their U.S. counterparts as well as share their own techniques.

Learn more about the grant at ADAFoundation.org/en/how-to-apply/access-to-care#IntlGrant.

For those interested in volunteering internationally, visit the ADA Foundation’s international volunteer website, ADAFoundation.org/internationalvolunteer.

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Upcoming webinar shows how to handle awkward patient situations successfully

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If you’ve ever wondered if there were resources out there for dentists and practice administrators who find themselves sideways with a patient for one reason or another, wonder no more!

A March 12 American Dental Association webinar will offer dentists and dental practice team members real-life solutions for managing…umm…let’s say delicate patient situations. Things like addressing cancellations and no-shows, tips for fielding phone calls from prospective patients and even guidance on the right way to dismiss patients from the practice will be covered.

The free ADA webinar is called “GPS Managing Patients Webinar: You Want Me to Say WHAT to a Patient?! How to Resolve Delicate Patient Situations with Tact and Diplomacy.” It will be held from 12 to 1 p.m. Central time. The educational program is sponsored by the ADA Council on Dental Practice.

“Every practice can benefit from a refresher course on handling the types of conversations that no one wants to have,” said Dr. Nima Aflatooni, chair of the council’s Practice Management Subcommittee. “Shifting the focus of these discussions so they’re patient-centric can be a real game-changer.”

Goals of the one-hour course include helping practitioners to:

  • Create and foster a practice culture that’s authentic and patient-driven.
  • Manage uncomfortable conversations with patients with sensitivity and professionalism.
  • Develop business and communications protocols that enhance production.

ADA member dentists can register here. And don’t forget to ask about eligibility for one hour of continuing education credit through the ADA Continuing Education Recognition Program.

The program will be presented by Denise Ciardello, past president of the Academy of Dental Management Consultants, and an entrepreneur, professional speaker, published author and co-founder of Global Team Solutions (GTS), a practice management-consulting firm; and Dr. Pamela Porembski, director of the ADA Council on Dental Practice in the Practice Institute.

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When healthcare and politics intersect

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Healthcare consumers and providers may not always speak of politics and healthcare in the same breath; however, these two powerful cultural and societal forces are often inextricably linked in multifaceted ways.

For healthcare providers who want to have an impact in this regard, understanding politics and the political nature of medicine and patient care is paramount.

The Obvious Political Healthcare Footballs

When we consider the cross-pollination of healthcare and politics, we need look no further than the ongoing arguments, disagreements, and activism related to the Affordable Care Act (ACA). Created under the administration of President Barack Obama, the ACA continues to be a lightning rod on both sides of the political aisle.

While persistently overt attempts to eradicate or undermine the ACA have mostly gone underground since the 2018 political sea change in the U.S. Congress, many can attest that the current administration has continued to work covertly in this regard. Whether you agree with the reality of the ACA or not, its place in American society remains firm, especially for those who love it or loathe it.

Medicare, Medicaid, Social Security, and other programs related to the health and well-being of Americans are frequently under some form of threat when the political winds shift direction. How we as a country respond to such rancor depends upon our relative positions regarding these so-called “entitlements.”

Healthcare Professionals in the Political Arena

A large swath of Americans may not be aware of the fact that many healthcare providers serve in local, state, and federal governments in a variety of positions.

According to Advisory.com, 17 nurses and physicians were elected to Congress in the 2018 mid-term election cycle. Nurse Lauren Underwood, for example, is the first African-American woman to represent Illinois’ Chicago-based 14th District, and Jeff Van Drew is a dentist newly representing New Jersey’s 2nd District.

Other more well-known members of Congress include Bernice Johnson (a former psychiatric nurse), Karen Bass (yet another nurse turned politician), and Raul Ruiz, a California-based ED physician. These and others bring their training and knowledge to the table, not to mention an insider’s understanding of the larger healthcare system and its intrinsic challenges and successes.

As far as local and state politics, there’s little doubt that medical professionals sit on city councils, school boards, electoral commissions, and in state houses around the country. They are likely also accompanied by numerous colleagues who are teachers, ranchers, attorneys, social workers, business owners, and all manner of professionals who choose to serve their communities in this particular way.

There is indeed precedence for healthcare workers to run for office, and our communities benefit from these individuals and the multifaceted expertise they proffer.

Healthcare Provider Activism

Those who do not care to run for office can still have an impact when it comes to chiming in on issues salient to the health and well-being of their fellow citizens. The ways in which healthcare workers can use their voice and the power of the pen to influence legislation and decision-making include, but are not limited to:

  • Letters to the editor
  • Contacting, local, state, and federal lawmakers
  • Writing articles for newspapers, journals, websites, and magazines
  • Becoming a published author of books related to healthcare delivery, quality, etc.
  • Learning how to read, understand, and respond to pending legislation
  • Launching blogs, websites, or podcasts pertaining to these types of issues
  • Becoming a social media influencer in the space where healthcare and policy intersect

Healthcare provider activism need not be limited to marching in the streets or protesting, although nonviolent civil disobedience is a cornerstone of the political freedoms enjoyed in the United States and other countries where speech and assembly are generally protected. Any healthcare worker who feels the call to action can engage on whatever level is comfortable and appropriate.

Politics, Healthcare, and Beyond

There is no rulebook instructing medical providers on how, why, where, and when to engage in political discourse. Although some employers may discourage open political debate or their staff members appearing on the news or in blogs, podcasts, or articles that may be construed as opinionated or partisan, many healthcare providers do indeed engage in such activities.

Politics and healthcare are permanently entwined, despite some who may turn a blind eye to this fact. Whereas our society can at times appear heavily divided into silos, these two powerful and influential silos certainly overlap in profound ways.

No matter how a nurse, physical therapist, social worker, or dietitian may feel about the political landscape, there is always room for those who wish to speak their peace on salient and timely conversations of great import to citizens, communities, states, the nation, and the world at large.

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