Mini Implant Experience!

Transcription

Dentaltown Magazine www.dentaltown.com
Drs. Gordon Christensen & Paul Child: Is
it Time for CAD/CAM to go Mainstream?
May 2011 » Volume 12, Issue 5
May 2011 » Volume 12, Issue 5 » Lasers/“Do Good”
“Do Good”
A Special Report on the Charitable Side
of Dentistry, page 98
Laser Dentistry:
Are We Being Responsible? page 40
Profile: Ivoclar Vivadent
The General DentistEndodontist Relationship
by Drs. Kenneth Koch & Dennis Brave, page 88
Does Whitening Help
Your Practice... or Hurt It?
by Dr. Rod Kurthy, page 74
Periodical Publications Mail Agreement No. 40902037
A Division of Farran Media, LLC
www.dentaltown.com
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contents May 2011
66
Ivoclar Vivadent CEO Robert Ganley
Articles
52
98
Do Good Focus page 98
A special focus on the charitable side of dentistry
20
Second Opinion:
The Hidden Challenges of Dental Sleep Medicine
Dr. Barry Glassman talks about dental sleep medicine
and the difficulties that accompany it.
66
Is it Time for In-Office CAD/CAM Milling of
Restorations to Go Mainstream?
Drs. Gordon Christensen and Paul Child Jr. weigh the
upside and downside of in-office technology.
74
Does Whitening Help Your Practice… or Hurt It?
Dr. Rod Kurthy discusses the different variables of whitening that affect whether it helps or hurts your practice.
82
Diagnosing Yes – A Patient-centered Approach to
Treatment Success
Dr. Michael Melkers argues that understanding the
patient’s awareness of his or her conditions, helps dentists to better communicate appropriate consequence
and offer treatment options.
88
The General Dentist/Endodontist Relationship
Drs. Kenneth Koch and Dennis Brave speak about the
importance of keeping healthy relationships between
specialists and GPs, and explain how working together
can improve both parties’ bottom lines.
94
The Use of Oscillation in the Placement of
Composite Materials
Drs. Robert A. Draughn and Karl F. Leinfelder talk about
the difference between using vibration and oscillation
devices to increase the flow of composite material.
100
103
106
110
112
114
116
117
Compassion for the Other Man
FAQ: Hosting a Free Dental Day
Office Visit:
Boston Healthcare for the Homeless
Three Reasons to Volunteer
Profile of National Children’s Oral Health
Foundation and Three Affiliates
Each of Us Can Play a Role
Donating Equipment and Supplies
National and State-by-State List of Resources
Dentaltown (ISSN 1555-404X) is published monthly on a controlled/complimentary basis by Dentaltown.com,
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continued on page 6
4
May 2011 » dentaltown.com
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√ Eliminates the frustrating stickiness and “tug back” of composite resins.
√ Increases composite resin flow (by approximately 30%) during use, enhancing your ability to achieve the ideal cavity
adaptation and surface anatomy you desire.
√ Multiple tip options for every composite placement procedure!
Simply put, the ET 3000 can help you better place composite restorations faster, easier, and with much less
frustration than is possible with traditional hand instrumentation.
Try the ET 3000 in the comfort of your office.
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contents May 2011
continued from page 4
Townie Clinical
36
Cosmetic: KöR Whitening
There are many fine whitening systems on the market
and these cases demonstrate some of the universal
principles for success.
Message Boards
30
Cosmetic: Patient Asks –
Does Whitening Damage Your Teeth?
Get the scientific explanation behind the simple answer,
no whitening doesn’t damage your teeth.
40
Lasers: Are We Being Responsible?
Want to start a great discussion? Ask this question in
the Laser Forum on Dentaltown.com.
130
Hygiene and Prevention
123
124
128
130
133
134
6
From Trisha’s Desk:
Community Education and Prevention
Perio Reports:
• Toothbrushing Better than Toothette for
Intubated Patients
• Association Between Perio and Obesity
• Lack of Education and Smoking Lead to Perio
• Lifestyle Risks for Tooth Loss
• Parents with Disease Have Kids with Disease
• Smoking and Perio
Hygienetown Poll:
Ergonomics
Profile in Oral Health:
Technology in Dental Hygiene
Message Board:
Acute Lymphocytic Leukemia
Message Board:
Frozen Shoulder
In This Issue
8
14
18
26
50
58
62
64
129
136
Dentaltown.com Highlights
Howard Speaks:
Partly Cloudy
Professional Courtesy:
Make a Permanent Impression on Someone
Industry News
Dentaltown Research:
Technology
New Product Profiles
Around Town:
Innovations on Display at IDS
Around Town: Inaugural Scientific Meeting –
American Academy for Oral Systemic Health
Ad Index
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dentaltown.com highlights
Case Presentation
Wow – Full-mouth Rehab
This is a complex case with all the right
diagnostics in place from the start. Check
this out.
Full-mouth Rehab
Message Boards
Bilateral Parotid Pain
Find the Resin…
This is a very interesting oral medicine case. Tune in
to find out the exciting conclusion.
It’s the latest party game. Play with a friend or neighbor.
Find the Resin
Bilateral Parotid Pain
Features
+ MEDIA CENTER
+ MONTHLY POLL
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continued on page 10
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dentaltown staff
Editorial Advisory Board
Editorial Director
Thomas Giacobbi, DDS, FAGD • [email protected]
Hygienetown Editorial Director
Trisha O’Hehir, RDH, MS • [email protected]
Editor
Benjamin Lund • [email protected]
Assistant Editor
Marie Leland • [email protected]
Copy Editor/Staff Writer
Chelsea Patten • [email protected]
Creative Director
Amanda Culver • [email protected]
Rebecca Bockow, DDS
Krieger Aesthetic &
Reconstructive Dentistry
Seattle, WA
Kenneth Koch, DMD
Real World Endo
Wilmington, DE
Dennis Brave, DDS
Real Word Endo
Wilmington, DE
Arnold Liebman, DDS
Dr. Arnold I. Liebman
Brooklyn, NY
Doug Carlsen, DDS
Golich Carlsen
Denver, CO
Stan Mcpike, DDS
Stan Mcpike, DDS
Jonesboro, AR
Howard M. Chasolen, DMD
Sarasota, FL
John Nosti, DMD, FAGD, FACE
Advanced Cosmetic and General Dentistry
Mays Landing, NJ
Mark Fleming, DDS*
Mark J. Fleming, DDS, Inc.
Sarasota, FL
Krzysztof Polanowski, DDS
Stomapol
Serocka, Wyszkowa, Poland
Seth Gibree, DMD, FAGD
North Georgia Smiles
Cumming, GA
Jay Reznick, DMD, MD
Southern California Center for Oral and
Facial Surgery
Tarzana, CA
Stephen Glass, DDS, FAGD*
Advanced Dentistry of Spring
Spring, TX
Lloyd Ritchie Jr., DDS
Lloyd K. Ritchie Jr., DDS
Pensacola, FL
Brian Gurinsky, DDS, MS
Brian Gurinsky, DDS, MS
Denver, CO
Donald Roman, DMD, AFAAID
Roman Dental Arts
Paramus, NJ
Eyad Haidar, DMD
Weston Dentistry
Weston, MA
Tom Schoen, DDS
Schoen Family Dentistry
Wabasha, MN
Joshua Halderman, DDS
Northstone Dental Group
Columbus, OH
Timothy Tishler, DDS
Northbrook Dental Care, Ltd.
Northbrook, IL
Glenn Hanf, DMD, FAGD, PC
McDowell Mountain Ranch Dentistry
Scottsdale, AZ
Glenn van As, BSc, DMD
Canyon Dental
North Vancouver, British Columbia, Canada
Graphic Designer
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Regional Sales Managers
Mary Lou Botto • [email protected]
Steve Kessler • [email protected]
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Marketing Director
Jerry Kaster • [email protected]
Marketing Coordinator
Kelly Kunkel • [email protected]
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Marcie Coutts • [email protected]
Circulation Assistant
Teri Riggins • [email protected]
I.T. Director
Ken Scott • [email protected]
Internet Application Developers
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Nick Avaneas • [email protected]
Electronic Media Production Artist
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MultiMedia Specialist
Devon Kraemer • [email protected]
Message Board Manager
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Online Community Manager
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12
*Continuing Education Advisory Board Member
William Kisker, DMD, FAGD, MaCCS*
Dental Care of Vernon Hills
Vernon Hills, IL
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howard speaks
Partly Cloudy
by Howard Farran, DDS, MAGD, MBA, Publisher, Dentaltown Magazine
In the late 1870s, Thomas Edison improved upon the light
bulb. Up to that point, the best lighting technology people had was
a gas lamp, which was plagued with various drawbacks. Sure gas
lamps produced decent illumination, but they left black soot all over
the walls and ceiling, sometimes they’d catch fire, and every once in
a while gas from a lamp might fill up in a room and explode – logical reasons why the public really liked the idea of electricity. The
primary drawback to the electric lamp was it needed electricity to
work but, at the time, there was no infrastructure. So, in order to
power and capitalize on this new product, there was a great need to
develop a cheap, efficient way to generate and distribute electricity.
Edison founded the Edison Illuminating Company in the
1880s and started building DC (direct current) power stations that
powered street lamps and residences that were close enough to the
plant. Edison was convinced this was the way to go, but Nikola
Tesla’s AC (alternating current) system was more powerful and could
be sent farther by cheaper means. It made much more sense to
power a city with one giant power plant than it did to build a power
station every few blocks. It’s much easier to tend to the current generated at one station than to maintain dozens upon dozens of power
stations strewn throughout the city. With this larger system, companies didn’t need to generate their own power anymore; they just got
it from the big power plant. Everyone got the same 120-volt electricity the same way, and nobody had to think about it anymore.
Modern micro-computing is heading in the same direction. I
might be a little late to the table here, but I recently read The Big
Switch by Nicholas Carr, first published in 2008. In this book, Carr
conveniently compares modern computing to the power station
story above and details the major upheaval the computer industry
is facing... which, in my humble opinion, is nothing but positive
for dental practices! Why does every single household have to have
an IT guy (aka, your tech-savvy nephew who you only invite over
when you accidentally download a virus)? Why does every single
household have to have a microprocessor? Anti-viral software?
Back-ups for its data? It’s asinine. You’ve already seen the commercials and read articles (even in Dentaltown Magazine) about “the
cloud,” and soon more and more practices will be running their
entire practice management systems on it.
Micro-computing made companies like Microsoft and Dell a
fortune – primarily because for every dollar you spend on software,
you end up spending four or five more dollars to keep it running
properly, due to updates or needing an IT guy to come service your
equipment. Basically, according to Carr, your current computer
system is the equivalent to a direct current power station, and the
cloud is the giant power plant. The current micro-computing business model is going to expire because of the cloud, eliminating
costly upgrades and repairs to your practice management software.
Here’s how:
Back-up is Automatic
Remember when your brand-new practice management software was installed? Everyone was so excited (or intimidated) to get
started. And while you and your team were getting trained you
learned one of the major “to-dos” was to back up your servers. Don’t
you remember thinking, “Of course! We need to do this every
single day, if not multiple times a day. Last thing we need is to lose
all of our information. That would be catastrophic!” And then six or
seven months later you’d remember to back up your system only
after hearing a horror story about the guy down the street whose
server crashed and he had to shut down his practice for a week to
regain some semblance of practice management normalcy?
Backing up your system sucks. You always forget to do it, and it
only becomes a priority a second after your server melts down. In
the rare chance when you actually remember to do it, it takes all day
because of all of the new data you’ve accumulated. On the cloud,
everything is automatic – including backing up your information.
Oh, and let’s say a batch of servers that houses your information on
the cloud goes down. Guess what, there are redundancies in place.
If one of massive server farms Google is building exploded, your
information would still be safe because it exists in a number of other
data farms in other locations around the country (and even the
world). Pretty cool, isn’t it? Beats the hell out of backing up your
aging software. Which brings me to my next point...
The Newest Version All the Time
Isn’t it always the case around the time you get settled into the
newest iteration of your practice management software, a newer version becomes available? And you can surely relate when a new update
presents a glitch that has to be patched up by an IT expert until the
new version arrives. It’s eternally frustrating, right? When everyone
moves to the cloud, everyone will get the latest and greatest available
To hear more of Howard’s thoughts on this topic, go to Dentaltown.com and search: DTV Howard Speaks
14
howard speaks
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www.facebook.com/dentaltown
No Server Upgrades – or Servers, Period!
Sometimes I feel bad for the guys who have CBCT machines
in their offices. They’re taking all these amazing scans with this
incredible technology, but they’re maxing out their servers every six
months because these image files are gigantic. And every time they
reach capacity, they have to shell out more money for more server
space. Pretty soon, when everything is on the cloud, you can just
upload everything and not have to worry about how much space is
left on the server.
No More Disruptions from the IT Guy
Dental practices can be pretty bustling places at times. When
your system is in need of a bug fix, chances are the IT guy will show
up during the most productive time in your schedule. Try as hard
as they might to stay out of everyone’s way, when IT guys are in the
office, you can count on countless disruptions. When you’re on the
cloud, everything is repaired behind the scenes. Problem with your
software? Give your practice management software provider a call
or even instant message them and they can get working on the
problem from where they sit.
There are already companies that exist solely on the cloud.
Right now, you can run your entire practice management system
on the Internet. You don’t need a server. You don’t need IT. If there
are any practice management software companies out there that
want to ensure they’re still competing in the next five to 10 years,
they need to focus on moving to the cloud. In fact, if their number-one priority isn’t getting their next platform out on the cloud,
they might be in trouble.
Safe Data and Inexpensive Price Tag
On average, how much do you think you’re paying each year
on servers, software and for IT guys to come out and repair your
crashed computers? $10,000? Maybe $15,000? We all know of colleagues or friends who have had computer crises in their practices.
In some cases their systems weren’t ever backed up (or they were
improperly backed up), and every single one of these dentists will
vouch it was the worst disaster their practice ever faced.
Another reason the cloud makes sense: I don’t care what anyone says, we’re still recovering from the recession. The easiest thing
you can do to make money during a recession is cut costs. Right
now you’re paying one percent of your overhead to your electric
bill, and five percent to IT. Why not get your IT down to one percent? I just want some dummy terminals that will run the practice
management software for me. Let them worry about data storage.
Let them worry about the servers and data back-ups.
Is the cloud right for any of us right now? Depends. Are you
starting up a new practice or transitioning into one? If you are, it
16
might not be a bad idea to look into. For most of us, transitioning
into the cloud might be impractical. Eventually we might all transition into a hybrid system where everything that lives on our
servers might be automatically backed up on the cloud. It’s going
to take time.
Are there drawbacks to the cloud? Right now, sure, but the
Internet infrastructure is ever improving. If your entire system lives
on the Internet and your Internet connection goes out, you might
have an issue – but how often has your Internet connection gone
out in the last five years? If it has gone out more than 10 times, you
really ought to check with your current ISP and get a second line
installed ASAP.
When you went to dental school, how many classes did you
take on computer back-up? How many classes did you take on generating electricity? I had one class on electricity in physics and they
explained to me in one day how electricity is made and that was the
end of it. I don’t want to be responsible for the 120-volt current
coming into my office. I don’t want to be responsible for my
servers. I’d rather jump on the cloud and take care of my patients,
worry free. ■
Howard Live
Howard Farran, DDS, MBA, MAGD, is an international speaker
who has written dozens of published articles. To schedule Howard
to speak to your next national, state or local dental meeting, e-mail
[email protected].
Dr. Farran’s next speaking engagement is May 26, 2011, at the
Saratoga Dental Congress in Saratoga Springs, New York. For
more information, please call Colleen at 480-445-9712.
Seminars2011
to them at all times. There’s a glitch in the system? OK, chances are
others have already encountered it and have contacted the people
that can fix it on the cloud for good. Errors caused by your software won’t have to wait 24 or 48 hours for the IT guy to show up
and fix them.
May 26 ■ Saratoga Springs, New York
Saratoga Dental Congress
www.4thdds.org
[email protected]
Aug. 20 ■ Greater Nashville, Tennessee
Tennessee AGD
www.tnagd.org
Sept. 9 ■ Minneapolis, Minnesota
Advanced Practice Management
952-921-3360
[email protected]
Oct. 26 ■ Raleigh, North Carolina
Nu Image-The Big “3” Dental CE
Kim Wolozyn – 919-532-3192
[email protected]
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Make a Permanent
Impression on Someone
by Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine
This month we have dedicated a significant portion of our magazine to charitable pursuits within our profession. We hope you find the stories inspirational, as it is our goal to
encourage more professionals to get involved in these noble pursuits. Charitable dentistry
can take many forms from volunteering in a local free clinic, making a financial contribution to a dental charity or serving on a mission trip to a foreign land. I would like you to
consider another option – “charity begins at home.”
This oft repeated motto reminds us that we can be charitable right from the comfort of
our own home, or in this case, dental office. Each year, many dental offices select a patient
from their own population and complete the case at no charge. Many times we have specific criteria for selecting these cases: perhaps the patient is going through a rough time in
his or her life and needs to get out of pain, other cases might be someone who has recently
lost a loved one and must find a job outside the home or a young child with extensive decay
who cannot concentrate in school due to the constant pain.
Whatever the reason, the goal is the same – make someone’s life better. In the process, you
will be surprised at how much a case like this will tug at the heartstrings of your team, and
in many cases, they might agree to work for free as their contribution
to this charitable act. There are practical considerations for charitable
Charitable dentistry can take cases that should not be forgotten. In spite of the fact that the treatmany forms from volunteering ment is free, the patient should sign all necessary consent forms for
treatment. Additionally, you might want the patient to sign a confiin a local free clinic, making a dentiality agreement so they do not share your arrangement with
and family, in order to avoid others requesting free treatment.
financial contribution to a dental friends
If you choose your case carefully, this will not be a problem.
Another example of charitable dentistry at home is the offer of
charity or serving on a mission
free dentistry for a day. There are a number of offices that will open
trip to a foreign land. their doors on an off day to provide dental services on a first-come,
first-served basis. Most often, this is a Saturday and the staff and doctors volunteer their time for the day. The event can be promoted in
local papers or on the radio – most of these outlets will promote charity events at little or
no cost. [Editor’s Note: See page 103 for information about hosting a free dental day.]
Prior to the event you should prepare the necessary paperwork for patients to complete
so you are in compliance with all state and local laws. Consent forms are still necessary and
it will be necessary to determine the limits for treatment in advance. As an example: you
should allow patients to select one of the following: cleaning, filling or extraction. As a
single-day event, your goal should be to help as many people as possible in the limited time.
You might elect to repeat this event more than once a year based on the needs of your
community. Alternatively, you might refer the patients to a local clinic for follow-up care if
such a facility exists in your community.
Do you have an idea for volunteer dentistry in your office? Did you recently complete
an event? Log on to Dentaltown.com and join the discussions on these topics. Comments
and questions can be delivered via e-mail: [email protected]. ■
18
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second opinion
The Hidden Challenges
of Dental Sleep Medicine
by Barry Glassman, DMD
Second opinions are common in health care; whether a doctor is sorting out a difficult case or a patient is not sure what to do next. In the context of our magazine, the first opinion will always belong to the reader. This feature will allow fellow dental professionals to share their opinions on various topics, providing you
with a “Second Opinion.” Perhaps some of these observations will change your mind; while others will solidify your position. In the end, our goal is to create
discussion and debate to enrich our profession. –– Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine
I want to bring some reality to the economics of dental sleep
medicine, an area for dentists that is being promoted by many as a
new profit center in the dental practice. There is no question that
adding this service to your armamentarium has the potential not
only to improve the quality of life for many of your patients, but
also provide increased income.
Along with the ability to increase services and income, dental
sleep medicine provides many new challenges to the dentist, which
are often ignored or underestimated. The dentist will only be in a
position to provide a therapy that could be essential to the patient’s
quality of life if the challenges are recognized and conquered.
What is Sleep Medicine?
Sleep medicine is a relatively new specialty of medicine. In a
2005 article, Shepard, et al. stated “the history of the development
of sleep medicine in the United States is relatively short and most
of the individuals involved with its development are still living.”1
They go on to state: “Until 1975 sleep medicine was deemed
‘experimental’ and medical insurance companies routinely denied
reimbursement claims.” In discussing the development of the specialty of sleep medicine, they conclude that “sleep is viewed as a
basic biologic process that affects all individuals and has significant
impact on the function of all organ systems.”
The International Classification of Sleep Disorders is a 400page, stand-alone document that was written in 1990 and revised
in 2005.2 Sleep medicine deals with sleep and arousal disorders
that include all conditions encountered clinically. It deals with
dyssomnias, which are those disorders that involve initiating
and maintaining sleep, as well as with parasomnias, which are
movements and behaviors that occur during sleep.3 Obstructive
sleep disorders are classified as dyssomnias and represent those
disorders resulting from airway obstructions that occur during
sleep. They are relatively common syndromes and by conservative
estimates affect five percent of the Western world,4 but they are
often under-recognized despite having substantial morbidity and
mortality rates associated with them. Treatment for obstructive
sleep disorders ranges from the extremely conservative measures of
weight loss and sleep position training to variations of continuous
positive airway pressure (CPAP), oral appliance therapy and surgery. Many patients prefer the concept of oral appliance therapy
to either the use of CPAP or surgery.5 A dentist should then be
involved with patient evaluation, insertion and appliance maintenance as well as managing post-appliance insertion complications.6 Consequently, one might think that oral appliance therapy
would be a considerable portion of many dentists’ general practices. But this is not the case.
The Carrot of Economic Success
It isn’t unusual to see an advertisement refer to the potential
economic boom that a course will provide for the participant.
Silber states that 30 to 50 percent of the population older than
50 snores.7 This is often interpolated to 40 percent. So, if 40 percent of your adult population snores, and you have a practice with
2,000 active adult patients, 800 of your patients snore. If you treat
only 25 percent of them, and you bundle the workup and appliance fee to a moderate charge of $3,000, then your gross income
should increase by $600,000 the first year.
Unfortunately, that is an unrealistic computation. The literature
ignores the many challenges that face dentistry. Let’s examine some
of those challenges.
The Physician’s Bias
The past few decades have seen the line between dentistry and
medicine continually blur, as dentists have made significant contributions to the care of patients with chronic daily headache,
migraine and facial pain. There was a bias among sleep physicians
against early attempts at oral appliance therapy. Pantino reports
that when he began treating with oral appliances it was not
only considered experimental, but with limited data, research, no
consideration of coverage from the insurance industry and with
limited physician support, he may as well have been “practicing
witchcraft.”8 The 1995 landmark study by Schmidt-Norwara9
opened the door to the need for dentistry and medicine to work
synergistically and pointed out that as health-care providers, we are
20
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second opinion
challenged to acknowledge the necessity for interdisciplinary communication.10 This early bias is complicated by the fact that
obstructive sleep disorders are indeed a medical disorder.
Obstructive disorders are a continuum of disorders that start with
snoring. Therefore, snoring should not be treated without a medical diagnosis, and that diagnosis should be done by a physician.6
In spite of the tremendous improvements in oral appliance therapy,
the fact that oral appliances are usually preferred by patients over
the alternatives of CPAP or surgery, and the fact that the Academy
of Sleep Medicine has mandated by policy that some patients
not only can, but in some cases should, be treated or given oral
appliance therapy, physician bias against oral appliances still exists.
It isn’t enough for dentists to know just the basics of sleep
medicine and oral appliances. Dr. Schmidt-Norwara wrote that
“dentists who offer this service need to become acquainted with the
multifactorial nature of sleep medicine to serve their patients
better and to facilitate their interaction with other sleep medicine
clinicians.”11 A high level of mutual respect and open communication is required for the medical and dental professions to properly
triage and treat patients. In a position paper on practice parameters
by Kushida, et al., it is stated that oral appliances should be
delivered and followed by qualified dental personnel “who have
undertaken serious training in sleep medicine and/or sleep-related
breathing disorders with focused emphasis on the proper protocol
for diagnosis, treatment, and follow up.”6
Challenges Beyond the Science
In order to be successful in incorporating dental sleep medicine
into your practice, understanding the science of sleep medicine and
possessing the ability to insert oral appliances is not enough. The
art of implementing the science requires a different skill set than
was required to develop a general dental practice.
In order to be successful, dentists must have strong communication skills. For the most part, general dentists can work
within their own office walls and choose those specialists with whom
they would like to work. In sleep medicine, dentists must immediately work to develop relationships of trust and mutual respect with
physicians with whom they might have no past relationship and
with whom they have had limited contact. Furthermore, because
many physicians hold the bias discussed earlier in this paper, they
will often have to be educated and motivated to refer patients for
oral appliance therapy.
There is also the matter of “management” and the potential for
failure. The dental model of practice doesn’t usually involve “managing” disease; we treat it and cure it. Obstructive disorders can’t be
“cured,” a concept I have found not readily accepted by some dentists. Dentists need to develop a new mindset and a new definition
of success for the practice of dental sleep medicine. They must learn
that success cannot be determined with an explorer or depend totally
on the polysomnogram results. They must also realize that some
patients will be unable to wear their appliances. Dentists must quell
their disappointment and acknowledge that although they have rendered the best possible care, there are factors beyond their control that
impact the success of oral appliance therapy. This potential for failure
should not dampen their enthusiasm. Fear of failure should not prevent them from helping many other patients. Making this realization
and sharing this information with the patient prior to treatment is a
total change in the model that dentistry routinely utilizes.
There is also the obstacle of post-insertion management. The oral
appliance helps maintain the airway during sleep by creating an external splint, resulting in an increased tonic tone to the relaxing pharyngeal musculature.12 In order to do this, there is a strain placed on the
muscles of mastication, as well as the temporomandibular joint
itself.13 General dentists are not well trained in joint anatomy, physiology or in the treatment of joint dysfunction.14 These common complications will sometimes frustrate the dentist who might not be
trained in the ability to diagnose, treat or manage these adverse effects
on the joints or muscles. This frustration has the potential to cause
the dentist to stop treating with oral appliances. Training in these
areas of treatment is readily available, and will allow the dentist to
manage these complications and make wise risk/benefit decisions
concerning the continued use of the oral appliance.
The most common adverse effect is occlusal changes.13
Dentistry has long emphasized the role of occlusion, and it is difficult for the dentist to make an informed risk/benefit decision if
that role is considered more important than the resolution of the
patient’s obstructive disorder. Ferguson states, “This presents a clinical dilemma when the patient is unconcerned about the occlusal
changes and refuses to abandon the appliance citing that the perceived benefit of treatment outweighs the dentist’s concern with the
altered occlusion.”13 Dental malocclusions created by oral appliance
therapy might have limited or no effect on the patient’s aesthetics
or function, and it might be much more beneficial for the patient
to continue to wear his or her appliance despite the occlusal
changes. It is counterintuitive for the dentist to do anything that
creates a malocclusion, and yet this might be in the patient’s best
interest. This is a difficult concept for dentistry.
Why the Hidden Agenda?
This is, no doubt, an exciting and new field. We are all aware
of today’s economics, and the need for general dentistry to find new
income potential. On the surface, an argument can be made about
how successful dentists can be by adding dental sleep medicine to
their regimen. It is clear that challenges exist, and that we are more
likely to be successful and conquer the challenges if we are aware of
them from the beginning. The rosy picture that is often painted
isn’t real, and many dentists who take their initial course in dental
sleep medicine are soon disenchanted by the unexpected roadblocks to success.
Is the promise of economic gain, then, a conspiracy? The
answer is simple. Yes, it is a conspiracy if there is some implication
that implementing dental sleep medicine is as simple as finding
22
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second opinion
patients in your office who snore and treating them with oral
appliances that you fabricate easily with impressions and bite registrations sent to a lab.
There are real challenges that face dentistry in the field of
dental sleep medicine. These challenges include:
• Becoming a serious student of sleep medicine
• Educating your medical colleagues about the potential service you can provide their patients who might benefit from
oral appliance therapy
• Understanding the need to manage your patients and understanding their role as key players on the treatment team
• Learning how to communicate with local sleep labs and
physicians by keeping them in the loop and referring patients
back to them for post-treatment evaluations
• Establishing reasonable fee structures and understanding the
need to process claims through medical insurance in order to
get the most coverage for your patients
• Learning more about the craniomandibular structures that
you are compromising in order to support a compliant airway
• Carefully reconsidering some of your occlusal concepts that
will prevent your potential bias from keeping patients from
treatment for this serious disorder that is associated with substantial morbidity and mortality rates15
Barsh, in a recent editorial, stated that because of dentistry’s
unique place in our health-care system, it has the responsibility to
screen patients for OSA.16 Ninety percent of OSA remains undiagnosed.17,18 Our patient load would be well served if all dentists had
a better understanding of sleep disorders. Our profession and our
patients would benefit if all dentists were taught the basics of sleep
medicine and consequently screened their patients. But more
intensive study on many levels and a commitment to consider the
model changes discussed are required before the dentist can provide
oral appliance therapy and create another income source in his or
her office.
The conspiracy is on the part of those who might gain economically in the short run by having dentists construct snoring appliances for those patients who snore (even if it means without proper
diagnosis) or by encouraging dentists to take courses because of the
perceived economic gain without recognizing the obstacles to that
end. Furthermore, the conspiracy often encourages the front-end
purchase of equipment that is not required to perform dental sleep
medicine; again, in the long run, this frustrates the general dentist
who is not aware of the obstacles that prevent the successful
implementation of dental sleep medicine in his or her practice.
Many well-done studies have now been completed to demonstrate over and over again the potential of oral appliance therapy to
be successful in mild, moderate and even severe sleep apnea.13
Certainly, oral appliance therapy has been implemented into many
dental practices successfully. Some dentists around the country
have actually limited their practices to dental sleep medicine. The
obstacles can be overcome. But before they can be overcome, they
have to be recognized and acknowledged.
It is essential, then, that the “conspiracy” not result in frustration and the dentist deciding not to pursue dental sleep medicine.
Those who have accepted the challenges and overcome the obstacles have placed themselves in a position to provide a potentially
life-altering and life-saving treatment modality. The diligent dentist
has the opportunity to add not only a new stream of income for his
practice, but also a new quality of life for his or her patients. ■
References:
1. Shepard, J.W., Jr., et al., History of the development of sleep medicine in the United States. J Clin Sleep
Med, 2005. 1(1): p. 61-82.
2. American Sleep Disorders Association, D.C.S.C., ed. International Classification of Sleep Disorders:
Diagnostic and Coding Manual. 2005, American Academy of Sleep Medicine: Westchester, IL.
3. Kryger, M.H., T. Roth, and W.C. Dement, Principles and practice of sleep medicine. 4th ed. 2005,
Philadelphia, PA: Elsevier/Saunders. xxxiii, 1517 p.
4. Young, T., P.E. Peppard, and D.J. Gottlieb, Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med, 2002. 165(9): p. 1217-39.
5. Ferguson, K.A., et al., A randomized crossover study of an oral appliance vs nasal-continuous positive airway
pressure in the treatment of mild-moderate obstructive sleep apnea. Chest, 1996. 109(5): p. 1269-75.
6. Kushida, C.A., Morgenthaler, T.I., Littner, M.R.,etal, Practice Parameters for the treatment of snoring and
obstructive sleep apnea with oral appliances:an update for 2005. SLEEP, 2006. 29(2): p. 240-243.
7. Silber, M.H., Krahn, Lois E., Morgenthaler, Tomothy I., Sleep Medicine in Clinical Practice. 2004, Boca
Raton: Taylor & Francis.
8. Pantino, D.A., Joining Forces. Sleep Review, 2008. 9(3): p. 34-5.
9. Schmidt-Nowara, W., et al., Oral appliances for the treatment of snoring and obstructive sleep apnea: a
review. Sleep,1995. 18(6): p. 501-10.
10. Glassman, B.H., Multidiciplinary Is Not a Dirty Word. Cranio, 2004. 22(2): p. 87-89.
11. Schmidt-Nowara, W., A review of sleep disorders. The history and diagnosis of sleep disorders related to the
dentist. Dent Clin North Am, 2001. 45(4): p. 631-42.
12. Hoekema, A., B. Stegenga, and L.G. De Bont, Efficacy and co-morbidity of oral appliances in the treatment
of obstructive sleep apnea-hypopnea: a systematic review. Crit Rev Oral Biol Med, 2004. 15(3): p. 137-55.
13. Ferguson, K.A., et al., Oral appliances for snoring and obstructive sleep apnea: a review. Sleep, 2006. 29(2):
p. 244-62.
14. Klasser, G.D. and C.S. Greene, Predoctoral teaching of temporomandibular disorders: a survey of U.S. and
Canadian dental schools. J Am Dent Assoc, 2007. 138(2): p. 231-7.
15. Eckert, D.J. and A. Malhotra, Pathophysiology of adult obstructive sleep apnea. Proc Am Thorac Soc, 2008.
5(2): p. 144-53.
16. Barsh, L.I., The recognition and management of sleep-breathing disorders: a mandate for dentistry. Sleep
Breath, 2008.
17. Young, T., et al., Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged
men and women. Sleep,1997. 20(9): p. 705-6.
18. Baumel, M.J., G. Maislin, and A.I. Pack, Population and occupational screening for obstructive sleep apnea:
are we there yet? Am J Respir Crit Care Med, 1997. 155(1): p. 9-14.
Author’s Bio
Barry Glassman, DMD, maintains a private practice in Allentown, Pennsylvania, which is limited to chronic pain management, head and facial pain,
temporomandibular joint dysfunction and dental sleep medicine. He is a diplomate of the American Academy of Craniofacial Pain, a fellow of the
International College of Craniomandibular Orthopedics, a fellow of the Academy of Dentistry International and a diplomate of the American Academy
of Pain Management. He is on staff at the Lehigh Valley Hospital where he serves as a resident instructor of craniomandibular dysfunctions and sleep
disorders. He is a diplomate of the Academy of Dental Sleep Medicine and is board certified in dental sleep medicine. He is on staff at the Sacred
Heart Hospital Sleep Disorder Center. He was recently named Co-Medical Director of the St. Luke’s Hospital Headache Center.
24
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industry news
Dental News in Brief
The Industry News section helps keep you informed and up-to-date about what’s happening in
the dental profession. If there is information you would like to share in this section, please e-mail
your news releases to [email protected]. All material is subject to editing and space availability.
OHA Announces a Three-year, $500,000 Commitment From Ivoclar Vivadent, Inc.
Oral Health America (OHA) is the recipient of a three-year, $500,000 commitment from Ivoclar Vivadent, including a
$100,000 cash contribution in 2010, continuing financial support in 2011 and 2012, and a significant donation of Fluor
Protector fluoride varnish and Helioseal sealant. In addition, Ivoclar Vivadent and OHA will launch a matching gift program
for OHA’s Seal Two Million campaign, which doubles the impact of gifts made by dental professionals to the organization.
Ivoclar Vivadent is OHA’s first Guardian Level Sponsor for the campaign. To find our more, visit www.ivoclarvivadent.com
or www.oralhealthamerica.org.
UIC Oral Health for Homeless Program Receives National Award
The University of Illinois at Chicago College of Dentistry has received the Bud Tarrson Dental School Student Community
Leadership Award for its work treating homeless patients at a student-operated oral health center in Chicago. Sponsored by
the American Dental Association Foundation, the Bud Tarrson Dental School Student Community Leadership Award annually highlights dental student outreach to vulnerable communities. UIC dental students of all levels, from first- to fourth-year,
assist at the clinic, which they operate as if it were their own private practice. A faculty adviser oversees all of the students’
work. For more information about UIC, visit www.uic.edu.
Modern Dental Laboratory USA Named Fastest Growing Private Company and Best Workplace
Modern Dental Laboratory USA (Modern USA), with service centers in Seattle, Los Angeles and Chicago, has been named
one of the 100 Fastest Growing Private Companies and the Best Workplaces in Washington State, as recently awarded by the
Puget Sound Business Journal in the small business category. Modern USA says it has been able to grow into one of the 100
Fastest Growing Private Companies by attracting new dentists and continuing to be a great partner to existing clients through
its dedication to quality. For addition information on Modern USA, visit www.moderndentalusa.com.
Septodont Acquires OraVerse from Novalar
Septodont announces the purchase of OraVerse from Novalar Pharmaceuticals, Inc. OraVerse is an anesthesia reversal agent, used
when dentists or dental patients desire a quick return of sensation to the lip and tongue following a dental procedure in which a
local anesthetic was administered. Under the terms of sale, Septodont will assume full responsibility for OraVerse including sales,
marketing and regulatory activities for the North American and unpartnered international markets. OraVerse will be available
through authorized dental supply dealers. For more information, call 800-872-8305 or visit www.septodontusa.com.
26
©2011 DENTSPLY International. All rights reserved.
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industry news
Dental Wings, 3M ESPE and Straumann Join Forces
Dental Wings, 3M ESPE and Straumann are joining forces to create an open global standard software platform for use across
a range of dental applications. The initiative is expected to offer enhanced flexibility, simplicity and convenience for users,
while saving time, costs and investment risk. To advance industry standardization, 3M ESPE and Straumann have agreed
to adopt Dental Wings’ software platform DWOS as the core operating software in their CAD/CAM solutions. Other companies are encouraged to join the collaboration and to contribute to shaping the platform’s future. Visit www.3mespe.com,
www.straumann.com, or www.dwos.com for additional information.
Congressman Gerlach Met with Premier to Discuss Medical Device Tax
In early February, Congressman Jim Gerlach (RPA) met with employees of Premier Dental and Medical Products to learn
about the impact of the 2.3 percent excise tax on medical devices mentioned in the Health Care and Education Reconciliation
Bill of 2010. The tax could affect Premier’s and other manufacturers’ ability to maintain staffing levels and remain competitive in an increasingly challenging global marketplace. Gerlach told Premier staffers that there will be a number of hearings
held on the issue and that Ways and Means subcommittees will work to develop and introduce smaller, more targeted bills to
replace components within the massive bill.
Officite Selected by the ADA as First Corporate Provider of ADA Online Patient Education
Officite has been selected by the American Dental Association (ADA) as the first corporate provider to offer Web-based ADA
patient education brochures and Toothflix videos. Through the new collaboration, dentists can educate patients with trustworthy and respected, ADA-branded online educational resources through Officite dental Web sites. Now available for the
Web, the ADA’s Toothflix videos and time-tested patient brochures are designed for use by dentists for the promotion of their
dental practices and for the oral health education of their patients. Visit www.officite.com for more information.
Smile Brands, Inc., to Open 30 to 40 New Offices in 2011
Smile Brands, Inc., plans to open at least 30 and as many as 40 new offices this year. By the end of 2011 Smile Brands plans
to have up to 362 affiliated dental offices nationwide operating under the Bright Now Dental, Monarch Dental and Castle
Dental brand names, including other local brands. The first new affiliated dental offices to join Smile Brands’ growing roster
in 2011 include a Castle Dental office in Houston, Texas, and a Bright Now Dental office in Fountain Valley, California. For
more information on Smile Brands, Inc., visit www.smilebrands.com.
Oral Health America’s Gala and Benefit Raised Nearly $500,000
Oral Health America (OHA) raised nearly $500,000 at its 21st annual Gala and Benefit on Wednesday, February 23, at
Chicago’s Field Museum, during the 2011 Chicago Midwinter Meeting. Over 840 guests mixed, mingled and danced under
tempered glass, exotic metal fixtures, grand stone columns, antique light fixtures and an enormous Tyrannosaurus Rex
dinosaur skeleton while participating in an auction and raffle to benefit OHA’s programs which bring healthy mouths to life.
Visit www.oralhealthamerica.org for more information.
28
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cosmetic message board
Patient Asks – Does Whitening
Damage Your Teeth?
Get the scientific explanation behind the simple answer, no whitening doesn’t damage your teeth.
teramdds
Posted: 3/11/2011
Post: 1 of 11
How do you answer your patients’ question “Does whitening damage your
enamel/teeth?”
Are there any studies that show damage to teeth with over usage/beyond recommendations of bleach? Thanks! ■
Just say no. ■ M
marshall_white_dmd
Posted: 3/11/2011 ■ Post: 2 of 11
Rod
Posted: 3/11/2011
Post: 3 of 11
If you like what you’re
reading, check out this
related message board…
Good Information
on the Science of
Bleaching (Whitening)...
Search: Science
of Bleaching
Anyway, regarding damage to the teeth, let me go into it just a little.
What can potentially damage tooth structure chemically? Acid, right?
Early attempts at home whitening involved pre-whitening rinses,
which were acidic. Using those frequently could potentially cause damage.
Hydrogen peroxide (HP) gels have a tendency to become acidic,
even if they start off neutral. As H2O2 breaks down, it will break down to any conceivable combination of oxygen and hydrogen. In school they told you that hydrogen peroxide (HP) breaks down to water and oxygen. That can happen, but what
also happens is that it will break down to superoxide radicals, hydroxyl radicals, perhydroxyl radicals, etc. And these radicals are what are most responsible for whitening. So yippee for radicals!
But the problem is that when HP breaks down to radicals, it also throws off
hydrogen ions into the mix. Remember pH (potential of hydrogen) – hydrogen
ions are acid.
When you place neutral HP on teeth, it can go down to a pH of 3-3.5 in even
20 minutes.
When peroxides are exposed to room temperature, warehouse temperature and
especially freight truck and delivery truck temperatures (that will often range from
125 to 165 degrees Fahrenheit), this causes the peroxide to break down quite a bit
during storage/shipping. Not only is it not nearly as strong, but it has already
become acidic by the time it’s used.
Also, one of the ways that whitening product manufacturers try to avoid the
costs of refrigeration is to add “acidifiers” into the gels to make them more stable.
Of course this makes them more acidic.
So yes, if gels that have acidifiers are used chronically, have been exposed to temperatures, or have no buffering, chronic use could be problematic due to the acid.
This is one of several reasons that I’ve been such a fanatic on refrigeration of gels
for so many years.
Next – damage to the pulp. Well, if the tooth is otherwise healthy, a little transient inflammation here and there won’t be a problem. However, the studies prove
that H2O2 (in its molecular form) can get into the pulp within 15 minutes.
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This could be a problem if it weren’t for Catalase. Catalase is a natural endogenous antioxidant enzyme. The only function of any antioxidant is to force H2O2 to
break down to only water and molecular oxygen. This prevents the formation of
systemic radicals.
So since the Catalase found in the pulp protects the pulp from damage from
radicals, whitening is considered safe for the pulp.
Sorry for the long, drawn-out explanation, but you asked! ■ Rod
dandarnell
Posted: 3/11/2011
Post: 4 of 11
I like Rod’s response. If I get asked, “Does whitening damage your teeth?” I usually just tell them that teeth bleaching is one of the most studied procedures in
dentistry and the American Dental Association has declared teeth whitening with
10 percent carbamide peroxide safe for lifetime use. ■
uscdds95
Posted: 3/12/2011
Post: 6 of 11
I get that same question all the time… I always say no. No permanent damage
to teeth... yet when I get a pregnant patient I won’t do bleaching on them. Does
that make any sense? ■
dandarnell
Posted: 3/12/2011
Post: 7 of 11
When White & Brite came out in 1989 and we were writing the instructions for it,
the question of usage during pregnancy came up. The company that introduced tray
whitening was actually Dunhall Pharmaceuticals – a small division Omni Dental. So
Jim Hatfield, the guy responsible for bringing tray whitening to market and to the dental profession was a pharmaceutical-oriented person. So
he decided to declare tray whitening unsafe for pregnant
women for this reason. No one had done a study on
pregnant women whitening their teeth to see if it would
produce birth defects and no one was ever likely to.
So the no pregnant women bleaching warning was
completely arbitrary. In the past 24 years or so that tray
whitening has been available, countless pregnant women
have whitened their teeth... mainly because they were
already whitening their teeth when they became pregnant and were unaware at the time of the pregnancy.
So the reason you don’t offer bleaching to pregnant
women is that you don’t offer anything that is elective to
pregnant women. ■
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What do I tell
patients? I tell them
that the only chemical that could potentially damage their
teeth is acid. I tell them that there are some whitening
products that produce acid, so to be careful which
products they select over the counter, and to be sure
not to use them chronically long-term.
I tell them that the products that I use in my
practice do not have acid, and they have buffering
Rod
Posted: 3/12/2011
Post: 11 of 11
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systems to make sure that the chemical never becomes acidic – so that active
whitening followed by long-term maintenance is absolutely safe for their teeth
and for their lifetime.
I then throw in that since the system uses alternating whitening with a desensitizer that has fluoride in it, that studies have shown that the teeth will actually get
stronger (increase in surface hardness) with that approach – so there is absolutely
no worry at all.
As far as the pregnancy issue, what has been said is absolutely 100 percent
correct. There is no scientific evidence to even cause us to suspect there could be
any problem. However, when it comes to pregnancy, if something has not been
proven safe we must consider that it might be unsafe and recommend against it.
Personally I’m convinced there would be no problem whitening the teeth of a
pregnant woman. Would I ever do it intentionally? Not on your life! If that baby is
born with a birth defect, or a miscarriage was to occur, the parents’ attorney would
come lookin’ for my butt. ■ Rod
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Does Whitening Damage
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cosmetic townie clinical
KöR Whitening
There are many fine whitening systems on the market and these cases demonstrate some of the universal principles for success.
jboccuzzi
Posted: 7/6/2010
Post: 1 of 28
If you like what you’re
reading, check out these
related message boards…
This is honestly the first time I have ever “blogged.” KöR whitening is a feelgreat product. I have been in the dental industry/community as a hygienist since
1988 and as a DMD since 1995. I have seen, tried and worked with all sorts of
whitening products. I would like to share the stories of two patients – the first, on
whom we tried a different whitening product on September 20, 2007 but had little
results. We made him bleach trays with lifetime bleach. I was not wowed. And the
second patient, who had tetracycline staining. She pointblank didn’t want her teeth
“drilled on” or as she stated, “crap adhered to the outside of her teeth.” We followed
the protocol for KöR whitening and were wowed. So I wanted to share with you!
Much thanks to Dr. Rod Kurthy for his product, guidance, detailed instructions,
DVD and enthusiasm.
Fig. 1
Fig. 3
Fig. 2
Fig. 4
Most Recent KöR Max Case
Search: KoR Max
In-office Bleaching vs.
KöR Bleaching
Search: In-office vs. KoR
Figs. 1-2: Before the KöR whitening procedure.
Figs. 3-4: After the KöR whitening procedure.
Fig. 5
Fig. 7
Fig. 6
Fig. 8
Figs. 5-6: Before the KöR whitening procedure.
Figs. 7-8: After the KöR whitening procedure. ■
36
townie clinical cosmetic
Wow nice! I have the manual, just haven’t been able to sell it to patients yet. Did
you do anything special for the root recession to help with sensitivity? Did you use
Rod’s new protocol or the older one? ■
scandalouslj
Posted: 7/6/2010
Post: 2 of 28
Nice results! I think I will have to give this a try. With this technique how much chairtime, materials and lab fee is involved? ■ Ed
doctored
Posted: 7/6/2010
Post: 3 of 28
Great results!
How did you present the case? I am comfortable with a large fee for an implant
restoration, but not with whitening. It’s just me. Need help here. ■
drjames
Posted: 7/6/2010
Post: 4 of 28
Dr. Boccuzzi, thanks for the remarks, but you deserve the credit.
You took the protocol seriously. After having mastered the training
manual, you had questions on your first case and you took the time to
e-mail me so we could kick it around. You followed the step-by-step
instructions and you hit a home run for your patients.
I’ll try to answer some of the questions so far. For root sensitivity, on the majority of cases just the low-sensitivity gel plus the system desensitizer will take care of
it. If you haven’t received the new manual update, when you do you’ll see that I
go into a lot more detail about sensitivity, the etiology of bleaching sensitivity and
how to handle the unusually sensitive patient that needs even more than the regular desensitizer.
Dr. Boccuzzi was kind enough to send me these photos a couple months ago
with her very nice comments, so I know that this was done with the KöR system.
The new one just came out. Our Dentaltown friend Pav (over in the U.K.) just
finished his first case with the new Hydremide formulation with the KöR deep
bleaching system. I received an e-mail from him today about it and he was going
nuts over the results. He said he’ll post on Dentaltown [see next post].
Ed – With the new Hydremide system, the bleaching chairtime has been cut in
half and the costs for the kits have gone down by about 30 percent. So the actual
time involvement and costs are pretty comparable to other systems out there.
Jim – My guess is that it’s because you’ve never really had something that you
knew was going to make a huge change and that that change could be maintained
forever – even tetracycline. So it’s pretty difficult to imagine charging a patient a
huge amount for whitening if you’ve never had that experience. When you have fabulous results, the patients actually comment frequently that they can’t believe they
achieved that kind of result for only that fee. How many people spend thousands
on 10 to 20 veneers simply for color?
In this economy, the fees for KöR whitening deep bleaching are all over the
board, but the most common range is $600-$750. Some lower and some higher,
but this is the average range. And now that the time has been reduced by about
50 percent and the costs reduced by about 30 percent, we might see that dentists
even lower those fees. We won’t know until dentists have a chance to use the new
products with the system and give us feedback on their fees. ■ Rod
Rod
Posted: 7/7/2010
Post: 5 of 28
dentaltown.com « May 2011
37
cosmetic townie clinical
Pav
Posted: 7/8/2010
Post: 6 of 28
Here’s my first KöR max case using the new protocol and the tri-barrel stuff.
This lady had whitening so many times that she had lost count and it has never
worked. She begged me to do Zoom for her and got quite upset when I told her I
didn’t use Zoom. I did manage to get her interested in KöR. She is ecstatic with
the result! ■
Find it online at
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lasers message board
Are We Being Responsible?
Want to start a great discussion? Ask this question in the Laser Forum on Dentaltown.com.
perioman1
Posted: 6/19/2010
Post: 1 of 65
DinoDMD
Posted: 6/20/2010
Posts: 2 & 3 of 65
I visit Dentaltown’s Laser Dentistry forums on occasion for a brief escape from
reality and comic relief. Every so often, there are some great cases being presented.
Other times, it’s like being hounded in the expo hall on the last day of a dental
convention. The bias is so thick you can cut it with a knife.
Someone please discuss honestly, where are we headed with lasers in dentistry?
Are we doomed to repeat a bunch of case reports and testimonials? Where are the
NIH, the ADA and the AAP? Cowards! If we dentists have a shred of integrity left,
then we must demand the unbiased research. Without it, we are doomed to lose our
credibility with the public and with our peers. Please God, don’t tell me about Ray
Yukna’s paper one more time or I’ll puke! It’s one of the weakest forms of evidence
on the tree of research. It’s not that I don’t appreciate his contribution, but too
many people hold onto it like the last life boat on the Titanic. It might keep you
afloat, but just barely. I don’t even think that Ray believed he would have had the
only credible piece of literature on the histological proof of laser periodontal regeneration three years after publication (positive or negative).
Now this is a topic worthy of discussion for those with some guts! ■
I honestly believe that in the not-so-distant future, lasers will be
viewed as an effective adjunctive tool in treating some forms of periodontal disease. I agree that we need more research, but as we all
know, this requires much time, effort and money. In the meantime, I
will need to rely on what I know and see. I think that the biggest
problem with perio in general is not so much what procedures are available to us
in treating it, as is knowing what we are treating and when to start treating it. All
procedures have limitations. The key to success in treating any form of periodontal disease is diagnosis first, and then knowing which tool/procedure will work
best in the hands of the operator using it.
[Posted: 6/20/2010]
In my opinion a bigger problem than the actual tool/method used is that
nothing is being used. Many practices do not perform full-mouth perio charting
regularly. Out of the practices that do it, not many docs will take responsibility in
ensuring that data obtained by auxiliaries is accurate. How many even know how
to effectively interpret the data so that an accurate diagnosis and effective treatment plan can be formulated?
Are we being responsible? Absolutely not! More than the actual tool/methods
being used, the bigger problem is misdiagnosed and undiagnosed disease. The
bigger problem is specialists unwilling to provide what their referring docs and
patients want and need. The bigger problem is general dentists not taking a
more active role diagnosing and aggressively referring/treating disease regardless
40
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of methods used. The bigger problem is not realizing how serious a condition
periodontal disease really is despite all the research available to us today regarding
the perio-systemic associations.
Bottom line is that we can argue all day over what procedures/methods are
most effective, but realistically speaking, the problem is not so much the procedures we have available to us in treating disease as is how little disease is being
diagnosed and treated at all! In this regard, we as a profession are being completely irresponsible. ■
perioman1
Posted: 6/20/2010
Post: 4 of 65
Check out these message
boards for other conversations
about lasers…
Lasers and Perio Treatment
Search: Lasers and Perio
CO2 Laser for Perio
Search: CO2 Laser
42
DinoDMD, excellent points! It’s often not discussed, but lack of the diagnostic skills and general comfort with the management of periodontal disease is
shameful. I truly believe this stems from a schism in our profession. I call it “the
dentist-doctor problem.”
The dentist within us wants to correct what is wrong or broken. We are more
comfortable with materials which can be molded or manipulated with a specific
set of properties or attributes. These materials might change, but they do so
relatively slowly over time. The level of control we have over these materials in
the short term is very predictable. Most of the infections the dentist deals with
are of the acute type. The acute infection can have fairly narrow treatment with
often rapid results. It’s the rapid result, immediate gratification that the dentist
so enjoys.
The doctor within us is the more demanding aspect of our profession. This
is the questioning and reasoning aspect with which we are so uncomfortable.
Just as you discussed, the emphasis here is the proper diagnosis or differential
diagnosis. Medical professionals will call this the “working diagnosis.” This
assumes that we might have the wrong cause until more information is
available. This is where the dentist gets uncomfortable. It sometimes takes
months or years to reach our final outcome. Routinely we never actually cure
the problem. We simply manage a chronic, long-lasting infection. The modifying factors can be so numerous that our patients always seem to be in a state
of flux between health and disease. We are not comfortable being wrong. We
are even more uncomfortable with the thought of failure. Our cost for failure
might be tooth loss, but it rarely leads to death. The physician is exposed to
extreme consequences and failure. It is constant retrospection, honest deliberation, the pursuit of improvement and the protection of the patient that the
doctor is striving for. This is our weakest area. Most of us get compensated for
procedures and not our time. I find that my colleagues often focus their CE
on money-generating procedures that can be immediately applied for practice
revenue generation and environmental control. With conventional treatment,
periodontal disease can be very frustrating for the dentist to manage. On the
other hand, the doctor is very at home with managing a chronic, system-wide,
behaviorally driven disease.
Laser periodontal disease therapy does my heart well. I have never seen so
much interest in the management of periodontal disease in my life. In the short
run, I see nothing wrong with the blanket use of the current technology for gum
disease management. At the least it is drawing attention to the bigger problem
and in-office identification is improving. Kudos to the LANAPers for providing
a strict set of treatment protocols and diagnostic criteria. Now, I might not
message board lasers
always agree with the application in some cases,
but that I can live with. Our long-term goal is the
focus of this thread. Do we want to be dentists or
doctors? Should we be both? How will this impact
our future practice and education? Will we gain or
lose credibility with our medical colleagues? We
must demand the AAP, the ADA and the NIH
“focus like a laser” (to steal one of Obama’s phrases)
on the applications of lasers on dental and systemic
health. We have an enormous opportunity to save
countless lives! ■
I believe that the
dkimmel
issue at hand is far
Posted: 6/20/2010
more complicated and
Post: 5 of 65
involves more than
just the laser world.
From a research standpoint, our system is and
frankly has always been flawed. Today with even
more limited funds it is even more so. The reality is
that research and so-called peer-reviewed research is
extremely biased and very political. It is far from
being an unbiased and pure science that we all
might believe. As a young, idealistic graduate student this was a hard lesson for me to learn. As I
entered dentistry I was even more discouraged by
these same faults in the system, particularly the lack
of quality of the research. Most would qualify for
the “journal of non-reproducible results.” Today it
is even worse as I believe most in our profession read
no more than the throw-away journals that come
via mail. Beyond the political nature of research
there is the issue of funding. There is no unbiased
funding for basic research. That is a fact of life and
has been so for some time now. The fact is today if
you want to do research you have to take funding
from a corporate interest. I don’t see this changing
any time soon. As far as doctor vs. dentist – one of
my mentors has always stressed that we are first
and foremost physicians of the head and neck and
technicians second! All too often we fall into the
trap of becoming technicians first, looking for
that instant gratification of the quick fix without
doing the basics of proper exam, diagnosis and then
treatment. The fault squarely sits on the shoulders
of the schools of dentistry and our profession as a
whole for requiring training tailored to pass boards
that are more for a tech than a physician. ■
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44
glennvanas
Posted: 6/20/2010
Post: 6 of 65
Perioman, from what I see, a long time ago the discipline of perio
became less interested in “saving” teeth and more interested in CTG
and implants.
The bulk of literature in the discipline of perio seems to focus on
the latter, to be honest. I think that you raise valid points on the fact
that lasers are not so much in the literature for perio. But I will also say that the
AAP doesn’t seem interested in seeing any progress made on the topic.
I do find interesting that now 10 percent of the perio specialists in the U.S. own
a PerioLase.
Maybe there is still hope.
I don’t own a PerioLase, but do own quite a few diodes and erbiums and if
I had a dollar for every wayward comment, snicker or quizzical idle look, I would
be quite wealthy by now. ■ Glenn
still learning
Posted: 6/20/2010
Post: 9 of 65
I remember having a conversation one time with a cardiovascular surgeon
about preventive cardiac care (i.e., healthy diet and exercise) versus waiting for
disease to develop and surgery. He said, “You can’t change people... people want
pills and procedures, not lifestyle changes. Until someone invents the ‘exercise and
healthy diet’ pill, I will keep cutting people open.” It is no mystery that eating
healthy (low fat, low sodium, low carbs, etc.) and regular exercise will improve your
heart, but many people choose to ignore this every day to their own detriment. I
have been through enough marriage counseling to know that you can’t just
“change” someone. If I do not have the ability to “change” the habits of the woman
I have been married to for nine years, how will I change the habits of my patients?
Perhaps people today are more interested in quick fixes that require little
change in their own behavior. In our society I believe more people would rather
have the “instant” gratification of an implant, than the “inconvenience” of changing their habits (i.e., take the time to floss), or three-month perio recalls for the rest
of their life.
I think most people would choose a quick fix with moderate results over
a lengthy treatment that requires a lot of personal change that would give excellent results. ■
glennvanas
Posted: 6/21/2010
Post: 11 of 65
Still Learning: an excellent post with some good points.
My thoughts are that perio is more interested in CTG and implants
for their predictability and for the financial gain as well. I think if there
was a predictable solution for moderate to advanced perio then more
would utilize it.
I do agree that it is hard to change a person’s habits, but the results I see in many
cases posted by PerioLase users show remarkable improvements despite these habits.
Oh well, time will tell... need those 20-year double-blinded, randomized trials
to come out, I guess. ■ Glenn
zendentist
Posted: 7/9/2010
Post: 13 of 65
Where are we headed with lasers in dentistry? Let me paraphrase Einstein:
“For every brilliant idea, there are a million mediocre minds. And many of them
are dentists.” Where we are headed is like every other aspect of dentistry that does
message board lasers
not receive approval or blessings of the specialistoriented political machinations. There are dentists
who use and embrace lasers and for every one of
those, statistically, there are 20 more who don’t know
enough about lasers to fill a paragraph, much less use
them to any extent and understand and appreciate
what can and cannot be done with them. Like a
cult, the “evidence-basers” don’t want anyone to do
anything that isn’t blessed by the “Holy Grail of
double-blinded university-based unbiased research.”
The trouble is that nothing of the sort exists. Nearly
every study or researcher has a bias or axe to grind,
and as far as interpreting the results of “lies” and
statistics, the results of studies are crunched in manners that seem to follow quantum mechanics more
than logic. While this is an admitted and humorous
overstatement, I like to think of evidence-based
followers as sort of research socialist/fascists who
don’t think the great unwashed practioners can make
good treatment decisions for their patients unless in
comes from a “great study.” The day I have to practice and be forced to put my clinical judgment and
knowledge of the patient behind an “approved
approach” is the day I’ll quit this profession.
There are three types of dentists – those that
embrace new technology, those that reject it and
those that criticize it. We are going to the place with
lasers that our profession has gone with amalgam,
periodontal disease, implants and radiography. The
smart, patient-centered practioners know what
works for them and their patients. Activist practioners don’t have enough of their own patients and they
feel the overwhelming urge to dictate how everyone
else practices.
But the real question here is why do you care
where we are headed with lasers? The more important question is where you, yourself, are headed with
lasers and why? If you’re so hot for some unbiased
research then open your wallet, close your practice
and do it yourself. It is in the works, but as we all
know – to design research that would meet the
demands you place on it takes a lot of time, a lot of
money and a lot of commitment. The people with
most of those qualities are currently involved in trying to meet these requests, but I guarantee, in the
end no matter how well designed the study, no
matter how convincing the evidence, Charlie Cobb
will fail to mention it in his next review of the topic.
And on it will go.
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45
If you’re looking for a sweeping kumbaya of the profession around lasers,
it’s not going to happen. Smart people will continue to embrace the technology
and use it well. These are the practioners who have taken the time to learn the
topic for themselves so that they can make their own decisions instead of
waiting for someone else to make them – sort of intellectual capitalism, if you
will. Most others will mill around or be afraid to step outside of the narrow
trickle of the mainstream. They’re dangerous and will cut down on the referrals
to my periodontal practice where I’m more interested in extracting teeth and
placing implants than I am in possibly saving them with laser-assisted therapies.
Or any other therapies that allow GPs a viable method of treating their patients,
for that matter. ■
Lasers have changed my practice, my patients’ lives and my life for the past
15 years. I have used many wavelengths and see virtues in all of them. I am not
an evidence-based guy. Never was, never will be. I know what I am doing with
lasers and would rather be a pioneer than a 10-year follower and say I should
have started 10 years ago (I am not asking anyone to agree with me on this). I
have successes and failures with lasers (mostly successes) like every other aspect of
dentistry. I have perio success with diode, Nd:YAG and erbium with little
failures. I use lasers in endo, operative,
“Lasers have changed my practice, my crown and bridge, oral surgery and implant
dentistry. I own a Waterlase, Wateralse MD,
patients’ lives and my life for the past 15 years. Powerlase, Picasso, Picasso Lite, Ezlaze, etc.
I have used many wavelengths and see virtues I am even testing some newer wavelengths
in all of them. I am not an evidence-based guy. for some companies. I do this all with consent, logic and experience. The laser is only
Never was, never will be. I know what I am part of the equation. You need someone
doing with lasers and would rather be a that knows what they are doing. I am quite
content that many skeptics still exists. It
pioneer than a 10-year follower and say I
makes it better for guys like me and you and
should have started 10 years ago.” the rest of the prudent early adopters, many
of which lurk here.
It’s up to dentists to embrace what is there or not. While the Picasso has
changed the face of soft tissue laser dentistry, people still question if it is a good
or bad laser. Why? Because that’s what dentists do. Even for $2,500 they will try
to find reasons to criticize. Hard tissue laser companies like Biolase and Lares have
dropped prices substantially to generate sales, but many still teeter on if a laser will
be good for their practice despite so many dentists that say lasers change lives. But
that is what I love about this profession. I always say in my lectures, “If you do
not believe this technology is right for you, you are right. If you believe much of
what I have shared with you, you are right.” I am just enjoying the ride and hope
it does not end. ■
whitertth
Posted: 7/10/2010
Post: 17 of 65
Find it online at
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dentaltown research
Dentaltown Research: Technology
Dentaltown is digging a little deeper. Based on the monthly poll on Dentaltown.com we’re determining explanations for each poll result.
Included with the poll statistics are the most popular write-in answers as well as small fun facts and recaps of the Townie Choice Award
winning categories that coincide with our research topic. Don’t forget to participate in the poll on Dentaltown.com each month. The more
opinions you can provide us, the more information and statistics we can supply to you. The following poll was conducted from March 7, 2011
to April 4, 2011 on Dentaltown.com.
Do you own a smartphone (iPhone, Android or Blackberry, etc.)?
402 total votes
399 total votes
59%
41%
71%
29%
Yes
Yes
No
No
July
March
2010:
2011:
Will you buy a tablet computer
(iPad, etc.) in 2011?
33%
Yes
37% No
30%
Already own one
When do you think cloud-based
practice management software
will be standard?
275 total votes
68%
513 total votes
Are you using paperless
(computer-based) forms
in your practice?
45%
Yes
55%
No
397 total votes
50
12%
4%
One
year
or less
Two
years
16%
Three
years
More
than
four
years
dentaltown research
What price range do most of the LED curing
lights that you have purchased fall into?
389 total votes
20%
$500-$750
Townies were asked to name
one piece of technology they
could not live without. Here
are the top three answers:
1. Computers
2. Digital radiography
3. Cell phone
“A solid majority of technology
experts and stakeholders participating in the fourth Future of the
Internet survey expect that by 2020
most people will access software
applications online and share and
access information through the use
of remote server networks, rather
than depending primarily on tools
and information housed on their
individual, personal computers.”
Source:
http://pewinternet.org/Reports/2010/
The-future-of-cloud-computing/Overview.aspx
23%
More than
$1,000
$750-$1,000
Which of the following features would be most important
in a new LED curing light?
12%
48%
Battery life
Cordless
40% Light output at or above 1000mw/Cm
368 total votes
How did you acquire your current curing light?
11%
In the Cloud
33%
24%
$400-$500
Free with purchase of another item
50% Special price offered on curing light
39%
Purchased unit at regular price
367 total votes
What is the expected time of service before a curing
light will require replacement in your office?
365 total votes
14%
One to
two years
47%
Three to
four years
39%
More than
five years
Curing Lights: 2010 Townie
Choice Award Winners Recap
Curing Lights – LED:
Demi LED Light Curing System
– Kerr Corporation
Curing Lights – Non-LED:
Demetron LC
– Kerr Corporation
Which of the following features would be most important
in a new LED curing light?
62% Rapid curing of cordless light in 30 seconds or less
23%
15%
Price under $500
Warranty longer than one year
367 total votes
51
ivoclar vivadent corporate profile
Ivoclar Vivadent is a true citizen of the world. The company’s
headquarters and primary location of research and development is
located in Schaan, Liechtenstein, while other R&D and manufacturing facilities are located in Austria, Italy, France, the
Philippines, Canada and the United States. Traveling between and
running it all is CEO Robert Ganley. Ganley started his career
with Ivoclar Vivadent in 1980 after spending four years with
KPMG. In 1990 Ganley was promoted to President of Ivoclar
Vivadent North America, and in 2003 he was named CEO of
Ivoclar Vivadent Worldwide. Dentaltown Magazine recently sat
down with Ganley to discuss the reach of Ivoclar Vivadent’s
impact on dentistry around the world, the one product it is most
known for – e.max – and the charitable side of the company.
How do you divide your time between locations?
Ganley: As CEO of Ivoclar Vivadent, my office is in Schaan,
Liechtenstein. I travel throughout the global dental markets frequently. I also maintain an office in Amherst, New York, and can be
there twice per month. I realize that this is a lot of travel but it is
very effective. I look at it this way – I am in the two largest dental
markets in the world every month visiting customers and employees. I enjoy it and the business benefits.
Tell me about your new manufacturing facility in
the United States.
Ganley: Our newest manufacturing facility is in Somerset,
New Jersey. It is a full Ivoclar Vivadent manufacturing facility
dedicated only to ceramics. This will give us ceramic manufacturing both in Europe and in North America.
How is your company expressing the mission
statement “Passion – Vision – Innovation” in 2011?
Ganley: We try to have a clear view of how the market is
developing. There are a lot of factors involved, but mainly we just
talk to dentists and labs and try to understand their needs. This
vision provides the map, which we follow. We build our company
on a foundation of innovation. We believe innovation has value
when it provides opportunities for our customers. Finally, it is the
passion of our people that provides the energy for success. We only
succeed because we have an enthusiastic, dedicated and talented
workforce behind us; people who pursue trailblazing solutions and
continually broaden their horizons and those in our industry.
Dentists are sometimes afraid to try new
products. How does Ivoclar Vivadent manage
these trepidations?
Ganley: I think fear is a natural reaction to the unknown.
We try to add clarity and understanding to the dimensions of
change so that the customer sees the whole picture. We do this
with education and training tools but mainly by getting a clear
understanding of what the customer wants and needs.
Furthermore, we stay with the dentist or technician to help
them through the learning process.
What also helps ease fears and apprehensions is the fact that
many of our developments are geared toward the needs of dental professionals and their patients, resulting specifically from
the interplay between treatment and market relevance, technical
feasibility and experience. Our goal is to turn these innovations
into tomorrow’s standards.
Three of Ivoclar Vivadent’s newest IPS e.max innovations include IPS e.max Press Multi, IPS e.max CAD-On and IPS e.max Press Implant Solutions.
These products are expected to be on the market later this year.
52
corporate profile ivoclar vivadent
Ivoclar Vivadent CEO Robert Ganley
53
IPS e.max has taken off like a rocket. Why is this
material so special?
Ganley: When we launched IPS e.max in 2005 we did so
with the message, “All Ceramic, All You Need.” The material
delivers increased productivity, improved performance and great
aesthetics. The unique combination of high strength and high
aesthetics make it very reliable and naturally beautiful. Probably
the best answer to your question is that dentists and labs like IPS
e.max because it is reliable, aesthetic and they are successful with
it. This is the best marketing.
Additionally, it’s a fact that clinically proven materials like IPS
e.max require a network of knowledgeable users and other innovators to reach saturation among those who stand to benefit most
from their application. Dentists are using IPS e.max. Labs are
using IPS e.max. Patients are even asking for IPS e.max.
Universities and independent testing facilities are evaluating it and
confirming that it truly is on the forefront of innovation. Today,
IPS e.max is the standard care that dental professionals depend on.
Universities and independent
testing facilities are evaluating
IPS e.max and confirming that
it truly is on the forefront of
innovation. Today, IPS e.max is
the standard care that dental
professionals depend on.
How could IPS e.max be even better? What new
developments are you working on?
Ganley: At the IDS in Cologne we launched three new parts of
the IPS e.max System. The first is a multi-layer (polychromatic)
ingot for pressing. It is a unique technology which allows the lab to
press a multi-layered crown. The second is a two-part bridge system
called CAD-On. The third is an IPS e.max Press Ingot that is used
to make a customized ceramic abutment. It is our plan to continue
to introduce IPS e.max innovations.
One of your core businesses is
the production of alloys used in
the dental lab. Have you seen
a change in the volume of this
business with the explosion of
all-ceramic options?
Tetric EvoCeram restoration
Ganley: The precious alloy business
over the years has been affected by the rapid growth of the allceramic products. Now the extreme increase in precious metal prices
has added a new catalyst to the move from metal to all ceramic.
Composite materials continue to get more
sophisticated each year. Tell us about your latest
innovations with Tetric EvoCeram.
Ganley: Tetric EvoCeram is an excellent restorative material.
At the IDS we introduced the new Tetric EvoCeram featuring
the new bulk cure material. This is a unique material with managed working times and a catalyst that allows it to be placed up
to 4mm, sculpted and cured without the need for a finish coat.
What are your thoughts on the future for dental
laboratories? Is it necessary for them to have a
CAD/CAM solution or partner?
Tetric EvoCeram
Ganley: By using enhanced digital dental systems, dental
professionals are streamlining processes and becoming more
efficient. Our “blue block” (IPS e.max CAD) is gaining traction in the dental laboratory business every day. It is a proven
solution for chairside CAD/CAM systems and many of our
laboratory partners.
Your company manufactures products and
materials for nearly every phase of dentistry.
What are some categories you would like to add
in the future?
Ganley: We are actively entering the aesthetic implant
abutment market. Our first product, the IPS e.max Abutment
was launched recently in Europe in cooperation with
Straumann. Our new IPS e.max Hybrid Abutment is a modular system, which allows the lab to customize an abutment
54
HAND
LIN
G
Evo
Evo
E
ESTH
TIC
S
OV
C L I N I C A L LY P R
EN
New & Improved
Impr
Te
etric EvoCera
Evo
a
A unique chemisstry offering the perfect balancee of handling esthetics and durrability
Evo
ATISF
T ACTION
100% CUSTOMER SA
GUARANTEED!
ivoclarvivadent.com
Call us toll free at 1-800-533-6825 in the U.S., 1-800-263-8182 in Canada.
© 2011 Ivoclar Vivadent,
dent, Inc. Tetric
e
EvoCeram is a registered trademark of Ivoclar Vivadent.
with lithium disilicate in the lab in a pressing operation. It is
very productive, reliable and delivers the aesthetics needed in
anterior cases.
Charitable giving is an important component of
your company. Describe some of the programs
that you are passionate about.
Ganley: Charitable giving comes in two ways. The first is
the planned program, which targets a specific area of need. At
the Chicago Midwinter Meeting this year we announced a
$500,000 gift to Oral Health America. This money will be
directed to organizations in support of children’s preventive
and restorative dentistry. We are also very concerned about
access to dentistry by the geriatric population. Many older
people simply cannot get to a dentist. Even those who are
edentulous often have a denture but do not have a dentist. We
are developing programs with OHA to assist in helping these
older Americans. We are very proud to be part of this initiative.
They do a wonderful job educating and serving those who
need dental care. I truly believe that as a profession, we need to
stand up and take action. It’s our responsibility to help those in
need of dental services.
What is Ivoclar Vivadent’s single greatest
advantage?
Ganley: We believe that we have a clear vision of the market. This is a path that we are following and we build strategies
accordingly. Our innovation capacity in the areas of dental
materials is excellent and we focus on innovation that creates
opportunities for our customers. We believe that our people
have a passion for their jobs which gives them energy and a commitment that our customers feel. Finally, we are a family-owned
company. We plan in the long term. We believe that we are large
We are a family-owned
company. We plan in the
long term. We believe
that we are large
enough to compete
with anyone but still
small enough to
know our customers.
56
enough to compete with anyone but still small enough to know
our customers.
What does the global landscape for dentistry
look like? Where are the hot beds? Where are
the struggles?
Ganley: The global dental market is healthy and growing.
Around the world it is different and yet in some ways the same
– all want and need dental health. Sometimes this is at the
minimum level due to geography and economics, but also
high-level dentistry is found in nearly every corner of the
world. A mother in Mumbai and a mother in Boston want the
best for their children. They will try to provide the best that is
available and affordable.
The developed markets are the most advanced for dentistry
and it is in these markets where you will find advanced equipment sales and a larger ratio of dentists per capita. Since the penetration is high, the growth potential as a percentage is lower
than in the developing markets. If you look at the BRIC countries (Brazil, Russia, India, China) you will see high growth rates
and high potential. In these countries you will also see increased
investments from the leading dental companies.
As far as struggles, we are often confronted with natural, economic or political disasters. These situations are devastating for
the people in a country or region. The affect on dental care
access is obvious. Ivoclar Vivadent like other leading companies
tries to assist in these situations through donations of money
and products. These are struggles of man against natural and
human opponents. We must continue to assist when and where
we can, both as dental companies and as caring people.
To learn more about Ivoclar Vivadent, call 800533-6825 or visit www.ivoclarvivadent.com. n
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new product profiles
You are invited to visit Dentaltown.com to ask questions or post comments about the following New Product Profiles. If you would like to submit a
new product for consideration to appear in this section, please send your press releases to Assistant Editor Marie Leland at [email protected].
Royal Alliant Chair and Unit Line
Reflection Advanced Whitening Take-Home Kits
The Royal Alliant Chair and Unit Line’s design provides
ergonomic features including a chair base that places the seat
of the chair at 13.5 inches from the floor at its lowest position.
The Alliant unit line by Proma has all-new styling as well as
the piston valve control system that carries a lifetime warranty.
The new handpiece water spray system introduces a new precision adjustment feature. Visit www.royaldentalgroup.com
for additional details.
The Reflection Advanced Tooth Whitening Take-Home Kits
contain everything patients need to safely whiten their teeth at
home. The kit includes two bulk 5ml syringes of mint-flavored
22% carbamide peroxide solution, two reusable, universal
trays that require no heating, a shade guide and complete
patient instructions. Available in several designs or create
your own custom design – all personalized with your practice
name and information. To learn more and view the complete
assortment, visit www.smartpractice.com/whitening.
Royal Alliant Chair
Reflection Whitening Kits
Silver Recovery X-Ray Fixer Machine
Store-A-Tooth
The Silver Recovery X-Ray Fixer removes hazardous silver
from X-ray and photo processing wastes on site. Due to the
long life and the hazardous nature of silver in these waste
solutions, the untreated solution cannot be simply poured
down the drain. This system eliminates this hazard and
potential liability on site and allows the practice to avoid
resorting to a hazardous waste carrier. For more information,
visit www.medicalinnovationsinc.com.
Store-A-Tooth is a service that allows patients to store the
stem cells associated with healthy deciduous teeth or adult
teeth that are exfoliating or are being extracted. The StoreA-Tooth system provides the materials, education, training
and support. Patients register directly with Store-A-Tooth for
the service and administrative compensation is available for
timely recovery of healthy tissue. For additional details, call
877-867-5753 or visit www.store-a-tooth.com.
Silver Recovery Machine
58
Store-A-Tooth
PreXion3D Elite
The PreXion3D Elite with CLEARimage Scanning Technology incorporates PreXion’s proprietary CLEARimage
technology that produces high quality, high-definition
images while reducing radiation exposure by up to 53 percent
in a fast 8.6-second scan. In addition to reductions in radiation exposure and faster scanning times, this new system
offers a wide range of innovations
including four new scanning
modes, Rapid, High-def,
High-res and Ultra highdef. Visit www.prexion.com
for more information on the
PreXion3D Elite.
PreXion 3D Elite
eBiteplus Intraoral Suction and Lighting System
The eBiteplus Intraoral Suction and Lighting System is a
multi-functioning device that combines full illumination
of the workspace as well as suction, tongue retraction, and
bite block tools in a single unit. eBiteplus features three
levels of light intensity, a fully autoclavable handpiece, fits
into any standard delivery unit and provides continuous
aspiration without interruption of treatment. For more
information, visit www.greatlakesortho.com.
eBiteplus Intraoral System
59
Einstein DL
Gluma Desensitizer PowerGel
Einstein DL diode laser is specially designed to perform soft
tissue procedures in a least invasive and less traumatic
manner. The Einstein DL helps reduce healing time while
providing simultaneous hemostasis; all while achieving
minimal charring of the tissue. The 980nm wavelength
takes advantage of the 70 percent water content of the
tissue which allows the high absorption of its radiant light
energy into the tissue.
Visit www.dcinter.com
for more information.
Gluma Desensitizer PowerGel is a one-step gel formula desensitizer that allows for accurate control and placement to reduce
or eliminate dentinal hypersensitivity. The new Gluma
Desensitizer PowerGel delivers the same level of desensitization
as Gluma liquid but also offers better handling, easier control,
and greater accuracy, due to both its unique gel consistency and
green-color indication which allows the practitioner to see
where the material is being placed. For more information on
Gluma Desensitizer PowerGel, visit www.heraeus-kulzer.com.
Gluma Desensitizer PowerGel
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around town
Innovations on Display at IDS
Biorepair
3Shape TRIOS
PAD Plus
62
I have just returned from the 34th International Dental
Symposium (IDS) in Cologne, Germany. Not only is it the
largest dental meeting in the world, it is one of the best.
This is an opportunity to take the temperature of the worldwide dental industry and to peek into the future of dentistry
in the United States. Two stand-out topics were implants
and CAD/CAM. These topics are already big news in the
U.S., but the sheer number of CAD/CAM companies for
both lab and office applications were mind boggling. On the
implant side, there was a surgical suite in one of the booths
where they performed live implant placement surgery during
the show.
Aside from the sheer size of the show crowds, it is interesting to note the differences in exhibit size at IDS. Many of the well-known suppliers in the U.S. have a major presence in Europe: 3M ESPE, Heraeus, Ivoclar
Vivadent and Sirona to name a few. Their exhibit spaces are filled with every product available, demonstration spaces, lounges, meeting rooms and often a bar serving drinks! This is not about getting drunk, it is part of the culture to have a space
where people can meet and have a conversation while conducting their business.
There are many reasons why products are slow to arrive in the U.S. There are
regulatory hurdles and distribution agreements to complete. Some products require
additional testing. I thought it would be fun to share a few of the new items on display at IDS, which are not yet available in the United States.
BioRepair: This product is best described as a synthetic hydroxyapetitie which
will repair the microscopic damage in tooth enamel, prevent plaque accumulation
due to the smoother surface and reduce sensitivity by occluding exposed dentin
tubules. Certainly there are other products already available in the U.S. that claim
one or more of these benefits. This product earns a mention because it is a novel
technology and was recently well-received at the IADR meeting. If you would like
more information, visit: www.biorepair.co.uk.
3Shape TRIOS: A new intraoral digital impression scanner from a company
that is very familiar to dental labs, 3Shape. This device adds to its existing line of
products that run the gamut of the CAD/CAM process. This scanner was also spotted at the Heraeus booth with the product name of Cara. Pricing appears to be
equivalent to other digital impression technologies currently available in the U.S.,
but no specific numbers will be available until this unit makes an appearance on
American soil. You can learn more about this technology and the company at
www.3shapedental.com.
PAD Plus: PAD is an acronym for Photo Activated Disinfection. This novel
tabletop device utilizes a specific wavelength of light to kill bacteria in periodontal pockets, root canals and deep carious lesions. The technique includes use of a
around town
medical-grade solution of tolonium chloride which is used to selectively tag all
bacteria, and when the tagged bacteria are exposed to the PAD light, a singlet of
oxygen is released and it will rupture the cell membrane of the bacteria. The
process is said to be pain free and without side effects. If you would like to learn
more about this technology, visit www.denfotex.com.
ANALGE-JECT: Ronvig Dental Manufacturing in Denmark has launched this
microprocessor controlled injection system which uses existing needles and carpules
and does not require any additional supplies. There are multiple, pre-programmed
injection rates and the device is activated by a separate foot control or it can be integrated into your dental unit foot control. The advantages of uniform injection rate
are well known in the U.S. and this new device will no doubt join others in this growing space. For more information, visit www.ronvig.com.
VirTeaSy: Complicated name for a simple product – virtual reality meets
dental training. The simulator provides dentists and students the ability to perform implant surgery with a handheld haptic device and stereoscopic glasses
which provide a 3D view of the surgical field. You can use images from your
actual patient case to populate the instructional material in the program. This
workstation is designed to work best in an implant training institute with students at the workstations and an instructor workstation that provides data on
student performance. As the company expands their offerings, this is the ideal
device to train dental students of the future. Visit www.didhaptic.com for
more information.
pa_on: Yes, that was the name used for this unique device. Unfortunately, I
was unable to find a Web site for this new product, so the details will be limited
to the information provided at the booth. This is a portable, electronic periodontal probe. Once a simple calibration is completed, the dentist or hygienist begins
probing the pockets according to the programmed sequence. Once finished, the
device is returned to the small docking station that is connected to the workstation, and the periodontal data is automatically transferred to the practice management software. This device can also be used to record bleeding points,
suppuration and attachment loss. There is no indication if/when this might be
available in the U.S., so stay tuned. n
ANALGE-JECT
VirTeaSy
Pa_on
IDS by the Numbers
Attendees
Exhibitors
Expo Area
IDS
Chicago Midwinter
115,000
30,000
1,956
600
1,560,767 sq. ft. 460,000 sq. ft.
Next IDS March 12-16, 2013 in Cologne, Germany
63
around town
Inaugural Scientific Meeting –
American Academy for
Oral Systemic Health
The American Academy for Oral Systemic Health (AAOSH) is hosting its first
annual scientific meeting in Chicago, June 24-25, 2011. This meeting will bring
together leading cardiology and dental authorities to address the oral-systemic connection. Acting on its mission to improve inter-disciplinary health care by changing public
and professional awareness of the mouth-body health links, meetings and exhibits have
this theme in mind.
Registration
Academy and registration information are available online at www.aaosh.org; also
watch the video invitation.
Tuition
AAOSH Member Doctors: $399*/$499
Non-Member Doctors: $449*/$549
AAOSH Member Team: $199*/$239 each
Non-Member Team: $239*/$279 each
*early registration by May 31
Accommodations
The Westin O’Hare
6100 North River Road, Rosemont, Illinois
Book by calling 800-937-8461 or visiting www.aaosh.org
Special rate for accommodations: $119 per night (use code: “Oral Systemic”)
Exhibit Hall
Sponsors and exhibitors include: OralDNA Labs, Perio Protect, My DentalETC,
CloSYS, Zellies, Young Innovations, Oragenics, LED Dental/VELscope, AIM Dental
Marketing, Philips and many more.
Program
Friday June 24, 8 a.m.-5 p.m.
• Scientific Session Welcome – Chris Kammer DDS, AAOSH President
• Preventive Cardiology & Oral Inflammation – Lloyd Rudy MD
• The Oral/Systemic Connection: Working Together to Prevent Heart Attacks and
Ischemic Strokes – Bradley Bale MD, Amy Doneen ARNP, Tom Nabors DDS
Saturday, June 25, 8 a.m.-5 p.m.
• Diabetology in 21st Century Dentistry – Casey Hein BSDH, MBA
• Oral Pathogen Management in the Oral-Systemic Link – Duane Keller DMD
• Inter-disciplinary Care & Building Physician Referral Networks – Lee Ostler DDS
• The New Business of Wellness OralSysteMix - Robert Maccario MBA
For more information, visit www.aaosh.org. n
64
From equipment specs
to member-only promotions
Find it all on Dentaltown.com’s Marketshare pages
• Easy access to information direct from manufacturers
• Exclusive promotions only for Townies
• Just a click away from your favorite message boards
cad/cam feature
by Gordon J. Christensen DDS, MSD, PhD
and Paul L. Child Jr. DMD, CDT
Twenty-five years have passed since the CEREC system from
Sirona was in its initial developmental stages (Fig. 1). Many similar ideas and devices have come and gone before and after
CEREC came onto the scene. Only one, other than CEREC,
has been successful enough to still be on the market, the E4D
Dentist Chairside CAD/CAM System from D4D Technologies
(Fig. 2). In the United States, Patterson has the sales and service
responsibility for the CEREC, and Henry Schein has the sales
and service responsibility for the E4D.
Fig. 1
Fig. 2
Fig. 1: CEREC. This device from Sirona and marketed by Patterson in the U.S. has
evolved through several generations over nearly 26 years. It was the first to succeed
in real-world practice from many potential ones 25 to 30 years ago.
Fig. 2: E4D. This E4D device from D4DTechnologies initiated in 2003 has evolved
into a viable competition for the CEREC device.
When the air turbine handpiece came into the profession in
the late 1950s, almost all restorative dentists purchased them
within a few years of their introduction. Similarly, when rootform implants were proven, almost all oral surgeons and later
some periodontists, prosthodontists and general dentists implemented them into practice. It appears that the in-office milling
concept is similar in its potential to facilitate restorative dentistry. Why has it not had the same acceptance and growth as
other concepts?
It is estimated that about 12,000 in-office milling devices
have been sold to dentists in the U.S. from the two companies,
the major share of which are the CEREC, primarily due to their
head start. There are about 140,000 general dentists and
prosthodontists in the U.S., which indicates that less than 10
percent of the potential restorative dentists have chairside
CAD/CAM devices. Are all of those dentists using their
CERECs or E4Ds? That is impossible to determine. A few inoffice design and milling systems can be found for sale on the
Internet for unknown reasons. Some are older models of
CEREC that are probably being replaced with newer technology. However, it has been our observation that a few dentists do
not find the concept compatible with their practices.
The frustrating fact to both of us is that we know from both
research and practice experience that the in-office CAD/CAM
concept works well, and that it can be financially feasible in a
busy restorative or prosthodontic practice. After significant
experience, the concept can be used for quadrants and even fullarch and implant restorations. Many studies have supported the
use of chairside design and milling systems. The references in
the following list contain articles supporting the concept and
show positive research on the devices.1-15 Implementation of the
system takes time, planning, teamwork, willingness and patience
to learn.
66
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cad/cam feature
The purpose of this article is to identify and discuss the
potential reasons that have impeded the in-office milling concept from being incorporated into more practices and to make
suggestions for practitioners, distributors and manufacturers to
make the concept more desirable and useful for dentists.
CAD/CAM Negative Characteristics
and Needed Changes as Identified
by Practitioners
The apparent negative points will be presented in the following
manner. Each concept will state the identified item followed by
potential solutions to that complaint.
Challenge – Cost
Currently, both systems and accessories require an initial
outlay of about $130,000. This amount is a significant impediment for dentists, in spite of financing and the assurance that
increased revenue will come into their practices. Before the
recession, the initial cost was not as formidable as it has been
during the last two years, but numerous surveys have shown that
many dentists have refrained from such large capital expenditures during the “great recession.” Each of the companies selling
in-office milling systems requires a payment of about $2,600 per
month. Obviously, that payment is present in spite of the practitioner’s potential health challenges, vacations, a down economy or a scarcity of patients. This amount is not much less than
the annual net revenue of a typical general dentist. However, the
dentist has greatly reduced laboratory fees, and the financial
needs can be met with an average amount of restorative treatment in a typical practice.
Potential solution: Cost has been a major impediment for
many dentists. This is a challenge only solvable by the manufacturers and the distributors of the devices. The companies have
put enormous amounts of money into developing CAD/CAM
technology for in-office milling. That investment must be recovered. That goal has undoubtedly been accomplished by the original device (CEREC), but time will probably be required for
the newcomer (E4D) to do so. Additionally, there is ongoing
research needed for each company to update and modify software and hardware as the concept continues to evolve. The distributors who sell and service the devices need to make a profit
also. Only the respective companies can know when it will be
possible to reduce the cost of the devices.
One potential for reduction is to put the same concept into
a simplified and less expensive delivery systems to lower cost,
which we will discuss later. However, it is well-known that, in
spite of relatively palatable lease payments, the overall investment required to introduce this concept into practice causes
concern for most typical practitioners. The real solution to this
challenge appears to be to reduce the manufacturing cost of the
systems and pass those savings on to clinicians. Other similar
“expensive” technologies are experiencing rapid growth due to
decreased cost, such as diode lasers and cone beam CT imaging.
Challenge – Fear of the Unknown
In spite of some devout in-office milling users, key opinion
leaders and sales representatives assuring potential customers
about the usefulness of the concept, many dentists are fearful of
the unknown challenges they will face. There are numerous factors contributing to that fear. Included are: anxiety about how
the concept will fit into their practices, the chance of unpredictable ill health and lack of income, age and the thought of
retirement, the extreme debt (upward of $200,000) of young
graduates, the real possibility of further and prolonged economic recession, various family challenges requiring more financial resources, inability to determine the real increased revenue
that the concept will build into practice, and the knowledge that
the monthly payment continues in spite of the potential
described problems.
Potential solution: If fear is an impediment for you, might
we suggest you meet with a user of in-office CAD/CAM to
observe a clinical demonstration and a testimonial of how this
concept is working in his or her practice? The Henry Schein or
Patterson dealers will be pleased to provide names of users for
you to contact and observe. When contacting these users ask
in-depth questions to determine if the concept will fit into
your practice environment. Distributors will often bring a system into your office for a demonstration to allow you to see
how it works in your practice. In our observation, satisfaction
with the concept ranges from extremely positive acceptance to
dissatisfaction and selling the devices on the Internet. Only
you can see if this concept meets your needs and desires for
your specific practice.
Challenge – Negative Comments from Some Peers
The majority of in-office milling unit owners really like their
devices and enjoy having them in their practices. But some disgruntled purchasers and non-users who are satisfied with their
conventional methods loudly proclaim that the concept did not
or will not fit their practice needs and that they will not use inoffice milling. These few negative practitioners often make
potential owners wary and afraid to purchase the devices.
Potential solution: Do you include all of the new technologies or materials into your practice, and do you like all of the
concepts you have elected to put into your practice? Quite obviously, you do not do so. Similarly, not all purchasers of in-office
CAD/CAM love their devices. Because they cost so much, their
68
cad/cam feature
resentment is voiced more actively. As already suggested, please
connect with someone who had the concept fit well into their
practice. Take the time to see how they made the transition from
conventional dentistry to use of in-office design and milling systems. Identify whether you have similar characteristics present
in your practice that ensure success with the concept, such as
high restorative need, competent computer ability, etc.
Challenge – The Relatively Small Number of
Purchasers to Date
Potential buyers become discouraged when looking at the
number of devices sold to date compared to the general population of dentists... thinking that it would have sold better if it
were any good. However, the market penetration is quite good
when one considers that many practices with more than one
dentist have only one device, that the concept is expensive and
that it is relatively new technology.
Potential solution: This challenge has no real solution other
than to have all of the potential solutions stated in this article
implemented by manufacturers, distributors and practitioners.
The implementation of all of them would undoubtedly make
the concept more desirable to practitioners and lead to more
sales. It is well known that any new concept starts out as an
unknown and grows into a commonly used object. Examples are
automobiles, PCs, radios, TV, etc. The concepts must become
faster, easier, better and less expensive to become commonly
used. Additionally some dentists do not have interest in any
dental laboratory work and reject the concept on that basis.
CEREC MC XL milling unit.
E4D Dentist milling unit.
Challenge – The Necessity to Change Long-stable
Practice Modes
Challenge – The Size of the Image-capturing Device
and the Milling Machine
When a practice is organized, running smoothly and producing adequate revenue, there is a tendency among some dentists to reject anything that would decrease the stability of the
practice routine. Change is difficult, but change can be stimulating and will bring a level of self-confidence and new enthusiasm for dentistry. Incorporating in-office milling into a practice
usually involves educating dentists to delegate some of the procedure to qualified staff members.
Potential solution: If this concept sounds interesting to you,
and you have investigated it thoroughly, changing your practice
routine will be exciting and refreshing to you. We have seen
mature practitioners who were relatively “burned out” with
practice become excited about dentistry again. Changing a practice routine is a formidable thought until you determine that
you will “re-invent” yourself again. We do not mean to downplay the needed organization and thought that must go into this
scheduling change. It will take some time to do so, but the result
will be satisfying to you and your staff.
As expressed to us from potential purchasers, there is some
frustration that both companies have large-wheeled, cart-type
devices that contain the necessary computer, the monitor, the
imaging handpiece, as well as other necessary devices. Many
offices, especially the older ones, do not have adequate space
to house the wheeled carts without compromising their
already crowded operatories. Additionally, significant space
must be found to locate the milling device, which is also very
large and heavy.
Potential solution: Their size can certainly be disagreeable
and obtrusive in small offices. There are too many large objects
already in treatment rooms. We have talked with the representatives of the two companies about this challenge. In our opinion,
the large size problem must be overcome to make the concept
more acceptable to practitioners. Changing the cameras to smaller
sizes, changing the “cart” concept to a simple laptop or other
small package, and making the milling devices smaller and lighter
weight would greatly facilitate their acceptance into typical
70
feature cad/cam
restorative/prosthodontic practices. However, the above suggestions pose significant technical and manufacturing challenges.
Challenge – Lack of Desire to Delegate
Clinical Procedures
Some dentists do not delegate many clinical procedures.
They do almost all of the clinical procedures themselves.
Average practices have two assistants. One of the best ways to
make the in-office milling concept financially acceptable is to
delegate a significant portion of the procedure to other qualified staff persons. Such dentists must change their overall staff
delegation policies to facilitate more staff delegation or they
must raise their fees allowing them to spend a longer time
making the restorations.
A well-organized office in which staff delegation is accomplished can make the in-office milling concept very effective and
efficient. A practitioner that rarely delegates must change his or
her delegation of procedures for optimum efficiency and acceptable revenue production. Programs are available to train staff
persons to use the systems and to gain proficiency.
Potential solution: Do you delegate some or many clinical
responsibilities to staff? If so, the incorporation of in-office
milling will be a pleasure for you. If you do not delegate many
clinical tasks to staff, you will find a significant change in your
practice routine to have staff persons accomplish some of the inoffice digital impression procedures, design and milling. If you
elect to do all of the imaging and milling yourself, the concept
is not as financially acceptable as when you delegate much of the
imaging and milling tasks to staff, while you concentrate primarily on tooth preparation and seating the restorations.
Delegating to dental assistants, dental hygienists or other staff
persons builds a sense of responsibility, self-esteem, trust and
teamwork. When they take on these new responsibilities they
appreciate your trust in them and they appreciate the opportunity to expand their value to the practice.
Challenge – Relationship with Previous Dental
Laboratories
Some technicians and ceramists are concerned that the
dentist’s total number of indirect restorations will no longer be
coming to the laboratory. But when laboratory technicians
and ceramists learn that only some of the indirect restorations
will be milled using an in-office milling device, and that some
of them might have data sent to the lab for milling, they are
less frustrated.
Potential solution: Most dentists using in-office milling
make primarily posterior crowns and onlays. Some progress on
to more complicated and less frequently needed restorations.
Therefore, there is still need for laboratory technicians and this
will always be so. Additionally, some practices actually grow
the amount of both their conventional and CAD/CAM
restorative dentistry when incorporating CAD/CAM. Frankly,
as the concept continues to grow in popularity, the growth will
be slow and steady, not fast, thereby allowing your technicians
to accommodate the needed change. Many dentists become
more interested in the laboratory concepts in dentistry as they
use the devices.
Challenge – Concern about Quality and Longevity
of Restorations
In the U.S., most patients want and/or demand tooth-colored restorations. Although many dentists favor metal restorations, because of their proven longevity, these are not done with
the in-office milling devices currently in the U.S. Therefore,
dentists going into CAD/CAM milling in their offices feel compelled to use tooth-colored ceramic or polymer restorations, the
most popular of which are currently the ceramic IPS e.max
CAD, lithium disilicate or VITA Mark II Blocs. This orientation is uncomfortable for some dentists. Many worry about the
all-ceramic restorations produced by the in-office milling
machines regarding their quality and the amount of time they
will last.
Potential solution: Clinicians Report (previously CRA) staff
have been working with this concept for about 23 years. The
ceramic and polymer restorations made with in-office milling
have served in this time period as well as or better than laboratory restorations made with similar materials. However, it is well
known and reported in the scientific literature that cast gold
alloy restorations have the longest service potential of all restorations. You know well that very few patients want to display
metal in their mouths in spite of the known greater longevity to
be expected. In-office milled tooth-colored restorations placed
properly are serving very well.
Summary and Conclusions
It has been proven that in-office milling systems for dental
restorations are highly useful, functional and financially feasible
for many practices. The restorations made with the CEREC and
E4D devices are serving as well as or better than restorations
made by conventional laboratory procedures. There are numerous reasons why these systems have not made more market penetration – which have been detailed and discussed above. It is
our hope that manufacturers, distributors and practitioners will
work together to find ways to further implement this technology into the mainstream of restorative practice. n
References
1. Fasbinder DJ. Clinical performance of Chairside CAD/CAM restorations. J Am Dent
Assoc 2006 Sep; 137 Suppl: 22S-31S.
71
cad/cam feature
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Isenberg BP, Essig ME, Leinfelder KF. Three-year clinical evaluation of CAD/CAM restorations. J of Esth and Rest Dent 1992. 4 (5): 173-176.
Reich S, Wichmann M, Nkenke E, Proeschel P. Clinical fit of all-ceramic three-unit fixed
partial dentures, generated with three different CAD/CAM systems. Eur J Oral Sci. 2005
Apr; 113 (2): 174-9.
Bindl A. Mormann WH. Marginal and internal fit of all-ceramic CAD/CAM crown-copings on chamfer preparations. J Oral Rehabil 2005 June; 32 (6): 441-7.
Nakamura T, Tanaka H, Kinuta S, Akao T, Okamoto K, Wakabayashi K, Yatani H. In
vitro study on marginal and internal fit of CAD/CAM all-ceramic crowns. Dent Mater J
2005 Sep: 24 (3): 456-9.
Tsitrou EA, Northeast SE, van Noort R. Evaluation of the marginal fit of three margin
designs of resin composite crowns using CAD/CAM. J Dent 2007 Jan; 35 (1): 68-73. Epub
2006 Jun 15.
Christensen GJ. In-office CAD/CAM milling of restorations – the future? J Am Dent Assoc
2008; 139 (1): 83-5.
Clinicians Report. Performance evaluation of chairside CAD/CAM milling units.
Oct 2009.
Clinicians Report. Making in-office CAD/CAM work for your practice. June 2009.
Christensen GJ. Successful use of in-office CAD/CAM in a typical practice. J Am Dent
Assoc. 2008 Sep; 139 (9) 1257-60.
CHRISTENSEN GJ. Is now the time to purchase an in-office CAD/CAM device? J Am
Dent Assoc 2006; 137: 235-8.
CHRISTENSEN, G.J. The Future Significance of CAD/CAM for Dentistry. State of the
Art of CAD/CAM Restorations – 20 Years of CEREC. Werner H. Mormann, Quintessenz
pg 19-28. May 2006.
Thompson VP, Rekow ED, Wolff M, Silva N RFA. CEREC vs E4D Mouth-motion Fatigue
Evaluation. http://www.e4d.com/resources/pdf/NYUCADCAMFatiqueReport.pdf
Thompson VP, Rekow ED, Wolff M, Silva N RFA. CEREC vs E4D Film Thickness
Evaluation. http://www.e4d.com/resources/pdf/NYUCADCAMFilmThickness.pdf
Rekow ED, Wolff MS. Report: In Vivo Operational Assessment of the D4D System.
Bluestone Center for Clinical Research. http://www.e4d.com/resources/pdf/NYUClinical.pdf
Author Bios
Dr. Paul Child is the CEO of CR Foundation, a nonprofit
educational and research institute (formerly CRA). He conducts extensive research in all areas of dentistry and
directs the publication of the Gordon J. Christensen
Clinicians Report, and their other publications. Dr. Child is
a prosthodontist, a certified dental technician and maintains a private
practice at the CR Dental Health Clinic in Provo, Utah. Dr. Child lectures nationally and co-presents the “Dentistry Update” course with
Drs. Gordon and Rella Christensen. He lectures on all areas of dentistry, with an emphasis on new and emerging technologies. He
maintains membership in many professional associations and academies. Further information is available at www.cliniciansreport.org.
Dr. Gordon J. Christensen is founder and director of
Practical Clinical Courses (PCC) in Utah. This group is an
international continuing education organization providing
courses and videos for all dental professionals. He is also
co-founder of the nonprofit Gordon J. Christensen
Clinicians Report (previously CRA), as well as an adjunct
professor for Brigham Young University and University of Utah. He is
a diplomate with the American Board of Prosthodontics. Dr.
Christensen has presented more than 45,000 hours of continuing
education throughout the world and has published many articles and
books. Further information is available at www.pccdental.com.
72
Dentist Funded Dental Product Research
esives • Anesthesia • CAD/CAM • Cements • Ceramics • Esthetics • Handpieces • Implants • Impressions • Intraoral Cameras • Lasers • Office Management Tips • Periodonti
ventive Dentistry • Prosthodontics: Fixed and Removable • Radiology • Resin Curing Lights • Restoratives • Surgery • Adhesives • Anesthesia • CAD/CAM • Cements • Cerami
etics • Handpieces • Implants • Impressions • Intraoral Cameras • Lasers • Office Management Tips • Periodontics • Preventive Dentistry • Prosthodontics: Fixed and Remova
adiology • Resin Curing Lights • Restoratives • Surgery • Adhesives • Anesthesia • CAD/CAM • Cements • Ceramics • Esthetics • Handpieces • Implants • Impressions • Intra
meras • Lasers • Office Management Tips • Periodontics • Preventive Dentistry • Prosthodontics: Fixed and Removable • Radiology • Resin Curing Lights • Restoratives • Surg
dhesives • Anesthesia • CAD/CAM • Cements • Ceramics • Esthetics • Handpieces • Implants • Impressions • Intraoral Cameras • Lasers • Office Management Tips • Periodon
eventive Dentistry • Prosthodontics: Fixed and Removable • Radiology • Resin Curing Lights • Restoratives • Surgery • Adhesives • Anesthesia • CAD/CAM • Cements • Ceram
thetics • Handpieces • Implants • Impressions • Intraoral Cameras • Lasers • Office Management Tips • Periodontics • Preventive Dentistry • Prosthodontics: Fixed and Remova
adiology • Resin Curing Lights • Restoratives • Surgery • Adhesives • Anesthesia • CAD/CAM • Cements • Ceramics • Esthetics • Handpieces • Implants • Impressions • Intra
Independent
Unbiased
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Agenda
meras • Lasers • Office Management Tips • Periodontics • Preventive Dentistry • Prosthodontics: Fixed and Removable • Radiology • Resin Curing Lights • Restoratives • Surg
dhesives • Anesthesia • CAD/CAM • Cements • Ceramics • Esthetics • Handpieces • Implants • Impressions • Intraoral Cameras • Lasers • Office Management Tips • Periodon
eventive Dentistry • Prosthodontics: Fixed and Removable • Radiology • Resin Curing Lights • Restoratives • Surgery • Adhesives • Anesthesia • CAD/CAM • Cements • Ceram
No Hype
thetics • Handpieces • Implants • Impressions • Intraoral Cameras • Lasers • Office Management Tips • Periodontics • Preventive Dentistry • Prosthodontics: Fixed and Remova
adiology • Resin Curing Lights • Restoratives • Surgery • Anesthesia • CAD/CAM • Cements • Ceramics • Esthetics • Handpieces • Implants • Impressions • Intraoral Camer
ers • Office Management Tips • Periodontics • Preventive Dentistry • Prosthodontics: Fixed and Removable • Radiology • Resin Curing Lights • Restoratives • Surgery • Anesthe
AD/CAM • Cements • Ceramics • Esthetics • Handpieces • Implants • Impressions • Intraoral Cameras • Lasers • Office Management Tips • Periodontics • Preventive Dentist
Thank you to all you TOWNIES
who support CR in our non-profit mission to identify outstanding products
and techniques to make dentistry the best for the patients we serve!
• 35 Years: The original and only non-profit, independent review of dental
product, technologies, concepts, and techniques
• Concise, quick, bottom-line reviews each month that you can implement
immediately
• Real-world testing by real-world dentists
• Funded by dentists, written by dentists—all for dentists to best serve
their patients
801-226-2121
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Gordon J. Christensen
DDS, MSD, PhD
Paul L. Child Jr.
DMD, CDT, CEO
Clinical Success is the Final Test • Serving Dentistry since 1976
cosmetic dentistry feature
by Rod Kurthy, DMD
W
hitening is a very misunderstood concept among dentists. First,
the low cost or free offer of whitening to attract new patients is
often gone about in the wrong way, and second, the promise of
whitening as a gateway to more cosmetic treatment is often falsely assumed.
Whitening to Attract New Patients
You spend a lot of money for each patient you get into your practice. These new
patients are of no benefit if they never return and pay for necessary or optional treatment. So why is it that so many dentists virtually push these new patients out of their
offices after working so hard and spending so much to get them in the first place?
Let’s say you offer free whitening to attract new patients. You look for the fastest,
least expensive method of whitening to offer – because of course, since you’re giving
it away for free, you can’t afford to spend much time or money on the whitening.
74
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You spent all this money to market to hundreds, if not thousands of potential
patients, but just a tiny percentage of them respond to your marketing. That makes
each one of these patients very, very valuable. So why are you buying the cheap
stuff? These are the very few who said, “OK, I’ll give you a chance. Show me what
you can do!” Better not drop the ball, or they’ll drop you.
If the patient does not follow your recommendations, book treatment, pay for
treatment and refer others, then your marketing money is a total waste. When that
new patient walks in your door, they have not committed to be your patient.
They’re simply giving you a try. You still have to instill confidence in them or
they’re gone.
You’ve spent a ton of money to get that patient there, but then you’re afraid to
spend a little more money and time to keep them? What’s wrong with this picture?
The patient comes to you because of an offer of free whitening. Even though
you give it away at a low cost or for free, they still expect it to work. When you use
a quickie protocol and the cheapest products you can find, your results probably
aren’t very impressive. That means you’ve just disappointed this new patient you’ve
worked so hard and paid so much money to get into your practice; you’ve proven
to them that you don’t deserve their confidence. Do you really think they’ll have
you do their veneers if you can’t even get their teeth white? Do you think they’ll
trust you to do any treatment on them or their families?
They might not say a word, but they just never come back,
You’ve spent a ton and you scratch your head wondering why these patients never
follow through. It must be because paid advertising doesn’t
of money to get that patient bring in “referral quality patients,” right? Wrong!
If you’re offering inexpensive or free whitening, get them
there, but then you’re afraid to
white. Impress them! It will pay off in spades. Once you
spend a little more money and impress them, they’re much more inclined to follow your
time to keep them? What’s treatment recommendations and certainly more inclined to
refer others to you.
wrong with this picture?
Whitening gels are unstable chemicals. That is precisely
why they can break down quickly when placed in the mouth.
The downside is that because of this instability, they start breaking down immediately upon manufacture unless stabilizers are used in the formula or continuous
refrigeration is provided.
Stabilizers – like anhydrous base and acidifiers – add stability to whitening
gels. But when you want them to break down in the mouth, they’re not going
to break down as well and will be less effective. Also these stabilizers result in a
much higher osmolarity and often acidic pH, both of which cause more whitening sensitivity.
Even when these stabilizers are used, the gels still break down at room temperature and especially during storage in hot warehouses and in freight trucks that
average 125-165 degrees Fahrenheit. The cheaper the whitening gel, the less that
whitening company can spend on their overhead, and the larger their batches are
when they manufacture. By the time you receive them, they have often been unrefrigerated and overheated for significant periods of time. Combine that with the
stabilizers, and you have a much less effective whitening gel.
What if you take a bit more time and spend just a few more dollars to provide
the most effective whitening system available? If you did it for cheap or even free,
you’re a hero; the “best dentist I’ve ever gone to.” They take your recommendations
76
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for other cosmetic or restorative dentistry. They tell their friends that you gave them
this great white smile and it didn’t even cost much or was free. Think those friends
will be asking for your name? Of course they will.
This is the big payoff. Don’t step over the dollars to pick up the pennies.
Impress those new patients and make them yours!
Fig. 1a
Fig. 1b
Fig. 2a
Fig. 2b
Figs. 1 & 2: Effective KöR Whitening results.
The False Promise
You’ve heard it all before, “Buy our whitening products and whiten your patients’
teeth. Once their teeth are white, they’ll be asking you for more cosmetic treatment.”
Most dentists have not found this to be true. It is a false promise that whitening is
a gateway to more cosmetic treatment.
The bottom line is that most whitening results are not that spectacular. Maybe
your patient is happy her teeth are a little whiter, but others don’t even notice, and
Fig. 3a
Fig. 3b
Fig. 4a
Fig. 4b
Figs. 3 & 4: Effective KöR Whitening results.
78
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Fig. 5a
Fig. 5b
Fig. 5c
Figs. 5: 78-year-old patient with 19 shade improvement
(from C4 to bleaching shade 020) with KöR Whitening.
Patient had crowns 3, 4, 6, 12, 13, 14, 19 and bridge
28x30 replaced to match color.
they’re not white enough for her to obsess over, so she really doesn’t give it much
thought. End of story.
What if you could actually give your patient a whitening result that knocks
her socks off (Figs. 3 & 4)? Every time she sees herself in the mirror she’ll be
shocked. She’ll spend time studying her smile. Her new white smile looks great…
until she sees that darker PFM crown on a lower left bicuspid or molar. “I’m
going to ask Dr. Johnson if we can replace those crowns with whiter ones” or,
“Wow, my teeth look great, but I never realized how crooked and chipped my
teeth are, or how ugly the gaps between my teeth are. Maybe Dr. Johnson can fix
that for me” [with veneers].
This happens all the time, but only when the patient is truly impressed by the
whiteness, amazed by all the comments from friends and spends time looking at
her smile. Then she’ll see all those imperfections and obsess over them until you
fix them.
Here’s an amazing example: This patient was 78 years old (Fig. 5). She started
out with a solid C4 color. After whitening, her teeth were 19 shades lighter – a
bleaching shade 020 (three shades lighter than a B1). At a family reunion her family went wild. Three relatives drove more than an hour and a half to have their
teeth whitened. And over the following nine months this patient paid to have me
replace crowns 3, 4, 6, 12, 13, 14, 19 and bridge 28X30 because she wanted to
match the rest of her teeth.
Many 78-year-olds wouldn’t replace them even if they had recurrent caries – they’d
simply say, “I’m old. Just leave them alone.” So if true whitening can get a 78-year-old
to react this way, just imagine how your middle-age and younger patients will react.
But what if all this costs too much? Make sure you offer your patients a great
financing option. I’ve used CareCredit successfully in my practice for about 25
years (even before they were called CareCredit). All this treatment is high profit, so
you can easily pay just a little of that to CareCredit or another financing company
for extended payments at no interest and still make a great profit. Remember,
it’s not what it costs, but how affordable you make it for patients (easy monthly
payments with no-interest financing).
What about referrals? If you used a super-effective whitening system, her friends
will notice her beautiful white teeth immediately and then they’ll ask about you.
However, this referral system only works if you were able to get that patient’s teeth
truly white. Effective whitening can be a tremendous boost to your practice – or
done poorly, it can actually help sink your ship. ■
Author’s Bio
Dr. Rod Kurthy practices in Mission Viejo, California. He graduated with highest honors from Fairleigh Dickinson University School of
Dentistry in 1978, and completed a GP residency at Newark Beth Israel Medical Center.
Kurthy’s 35 years of research and development includes laser and surgical periodontal bone regeneration; endodontic surgery,
including bone regeneration and repair of resorptive lesions; teeth whitening; teeth sensitivity; and development of several cosmetic
techniques and impression techniques. His first participation in periodontal research was in 1976, and teeth whitening in 1977.
Kurthy is an international lecturer and author of five popular clinical and dental marketing books. Most recently Kurthy is widely known for his KöR Whitening
Deep Bleaching System.
You may contact Dr. Kurthy at [email protected] or by calling 866-763-7753.
80
KNOWLEDGE
|
EDUCATION
|
RESEARCH
|
NETWORKING
|
IMPACT
EVER CONSIDERED A KNOWLEDGE
The ITI operates on the basis of sound scientific knowledge. Become a member of
the leading professional network for implant dentistry. ITI Members receive free
publications, access to ITI Study Clubs and benefit from reduced entry fees to ITI
events and courses. Meet the experts. Share knowledge with colleagues from all
over the world.
Welcome to the team: www.iti.org
practice management feature
You
just finished your polished presentation to your patient. You had all of the
records – the groomed study casts, the digital photos, the radiographs, cone beam
images and diagnostic mock-ups. The treatment plan was crisply printed on your
letterhead and neatly packaged in the monogrammed folder with your business card
and financial options. Everything was there. All of your verbal skills honed over the
years intertwined with your commitment to technical excellence in treatment planning.
You finished your case “performance” for the patient and sat back waiting for the
patient’s favorable reaction and commitment to treatment. And you waited... and the
patient looked over the materials... and you waited... while the patient glanced around
at the desk... and the walls and the floor. And you waited...
Then, the patient thoughtfully replied, “Doc, I am going to need to think about
it.” Nine simple words that are uttered in every language, in every country, in every
dental practice around the world. Nine simple words that crush us, frustrate us and in
the end lead to the patient never scheduling treatment. We wonder what they “need to
think about.” Did we not give them enough information? Perhaps we should have
included more pamphlets on periodontal disease and comprehensive care, or the tooth
drawing with the nerve and dentin drawn out in red and blue pencil. What was it that
we were missing? What a waste of time.
82
Townie
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(kits are not included - expires with wax up Rx’s received by 5.31.11 and restorative cases received by 12.31.11)
You entrust your dental laboratory to manifest your vision and make it a reality. It requires confidence in the
fabrication process, and an understanding about what is important to you and most importantly the talent to
deliver. Every case you seat is a reflection of your personal integrity and skills. At Gold Dust, we get it. Which
is why our commitment is to delivering uncommon predictability in fit, occlusion, aesthetics, and function for
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The patient walks out of our office, overwhelmed and frustrated. “What was that
doctor thinking? Didn’t he know what I came to see him for? What was all of that
garbage that he wanted me to do? What a waste of time.”
As doctors, we want to help our patients. In some way, shape or form it is why we
chose the profession that we did. First, Hippocrates implored us to first do no harm.
Following that, it was the natural progression that we committed ourselves to our
patients’ well-being. Patients seek us out to help them achieve their health goals. They
seek, we provide. It seems like the perfect arrangement, yet we still encounter the “Nos,”
“maybes” and the “I will think about its.” Where and how does this disconnect occur?
When we consider the opening scenario between the patient and the doctor, there
is a tangible frustration that stems from unmet expectations. The doctor expected for
the patient to understand, appreciate and accept the treatment recommendations. The
patient had an expectation that the doctor would provide treatment options to choose
from that would address his concerns and goals. Each had invested time, money and
effort into the process, yet no one was happy with the end result.
Expectations can be better understood and achieved by breaking down the process
of offering dental care options.
We as
practitioners
must seek to
understand the
patients’ level
of awareness
regarding their
dental health
conditions.
Awareness
The first step in meeting expectations is awareness. We as practitioners must seek
to understand the patients’ level of awareness regarding their dental health conditions.
Assumptions of their level of awareness can lead to offering “solutions” that have little
or no level of value or relevance for a patient. Steven Covey wrote, “First seek to understand, then seek to be understood.” This commitment is a foundation for meeting
expectations but also for a successful and continued patient-doctor relationship. Once
we have put forth that effort, we can share our additional observations and do our best
to raise patients’ level of awareness.
Awareness should also be considered when it comes to patient goals. Without
awareness of their conditions, they might not have the same goals that we do.
Considering their level of awareness, are we ready to present appropriate treatment
options? Mind you, awareness of conditions does not mean that the patient has any
desire or urgency to address the condition.
Consequence
Consequence is the “information” that might or might not motivate a patient to
treatment. Once we have established a co-awareness of the conditions between the
patient and the doctor, we can begin the educational process of discussing benefits of
treatment as well as the consequences of inaction or delayed treatment. If the benefit or consequence is great enough for the patient, and appropriate as a motivator, he
or she will seek treatment. However, if the benefit is not of interest or the consequence is not a concern, then he or she might just “think about it.”
As a simple example, we all frequently see cracked yet intact and asymptomatic
premolars or molars. The patient likely might have been unaware of the condition
until we pointed it out. Even then, they might seem completely unmotivated to do
any treatment. Why should they? There is no consequence.
By referring to a third party – like your other patient who had his tooth crack and
it was too late to salvage – you might be able to get the message across. In the absence
of our own awareness of the patient’s concerns, we were able to communicate
through third-person analogy, the classic consequences of inaction to the patient.
These consequences are common motivators that inspire patients to seek and accept
treatment recommendations.
84
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FREE FACTS,
circle 33 on card
Pain
Some patients come to us in pain, looking for relief. Others might come to us hoping to avoid the onset of pain. Patients might even decline treatment due to the perceived
pain involved with the procedure. They might balance tolerating their existing pain to
avoid what they feel will be a greater pain.
Money
Like pain, money can be a motivator or barrier. Patients can be inspired to seek treatment before treatment fees escalate. They can also feel a financial barrier to treatment if
payment options or phasing is not available. Money can be a barrier to patients when they
consider prognosis, longevity and re-treatment costs. I recall a patient reacting quite
strongly to the financial aspect of root canal therapy, but following up by asking for an
extraction and implant restoration. Her concern, while financial, was not with spending
the money. Her concern was with the longevity of initial treatment, future treatments
and ending up with an implant restoration anyway. The better we understand patients’
financial concerns, the better we are equipped to discuss them.
Aesthetics and Social Embarrassment
As I imagine we have all experienced how aesthetics can be the chief motivator for
some. Trying to communicate the benefits of treatment from an aesthetic standpoint to
a patient who doesn’t have concerns about aesthetics is not only ineffective but could
also be perceived as insulting. If a patient seeks a beautiful new smile but is only focused
on her two front teeth, she might need to be counseled on how her desired treatment
might not actually help her achieve her goals. In fact, we could communicate how
limited treatment could have the consequence of making her smile worse.
Function
What do the patients want from treatment? Do they want their dentures to stay in
their mouth while they eat? Or is their goal to be able to eat corn on the cob and steak
when they are 70? Are the patients’ treatment decisions consistent with their goals? Do
we communicate the consequences associated with their choices?
Once we are able to better understand a patient’s awareness of his or her conditions, we can better communicate the consequences of denying treatment
and offering appropriate and affordable treatment options. All of our technical know-how and continuing education is of little value to us or our
patients if we are unable to apply it and step beyond Hippocrates’
charge. When we can look the patient in the eye at the treatment
consultation appointment or at the exam and say with confidence
“Based on your goals, as I understand them, what I would recommend is...” we can feel that we have taken that step. It is then
that we can move beyond diagnosing conditions and toward
diagnosing “yes” and treatment success. ■
Author’s Bio
Dr. Michael Melkers maintains a private practice with his wife, Dr. Jeanine
McDonald, in Spokane, Washington. Their practice focuses on comprehensive
and restorative care. Dr. Melkers is the founder and author of the Nuts & Bolts
Occlusion programs & DVD series and visiting faculty at The Spear Institute. He
can be contacted at [email protected].
86
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H I G H E R S TA N D A R D S . H I G H E R L I V I N G .
endodontics feature
by Drs. Kenneth Koch and Dennis Brave
Cases You Might Refer
Anatomy Related
• Calcified or ledged canals
• Severe curvatures
• Retreatment cases
Not Specific to Tooth Anatomy
• Elderly or medically compromised patients
• Difficult patients
• Phobic patients
• Difficult to diagnose cases
We have had the privilege over the past 10 years to write more than 100 articles on different aspects of endodontics. Topics have ranged from the latest techniques and technology, to debunking some of the myths surrounding endodontics.
However, we have never specifically written about the special relationship that
exists between the general dentist and the endodontic specialist. Consequently, we
believe the time has come to evaluate this relationship and we would like to discuss
it from a few different perspectives.
The first perspective, and perhaps the most significant one, is the need for the
general dentist to work within a comfort zone. This is a zone that obviously varies
from one clinician to another. However, it makes little sense to attempt a root canal
in cases that are beyond your skill and experience level. Don’t try to be a hero.
These cases will ramp up your anxiety level, generally require extended time and
energy and often prove to be non-profitable. In the long run the majority of these
difficult cases wind up being referred anyway, so be honest with yourself and do
what is in the patient’s best interest from the outset.
Previously, we have recommended the AAE Case Difficulty Assessment Form
(www.aae.org) and it is a good place to start. The Assessment Form ranks the various cases in terms of difficulty and will give you a heads-up for specific cases. Some
of the warning signs noted are calcified and ledged canals, severe curvatures and
retreatment cases. These are all good cases to refer but there are additional cases
(not addressed in the form) that might be troublesome and, in fact, are not related
to the specific anatomy of a tooth.
The first of these are elderly patients (or medically compromised individuals)
who cannot sit in one position for any significant period of time. These cases
require speed in addition to skill, and we believe they are best served through the
referral process.
Another group that frequently merits referral is difficult patients. The old bromide that says, “bad things happen to bad patients” is too often true. As endodontists, we frequently see floor perforations that have occurred as the result of a
dentist trying to get into the pulp chamber (of an endodontic tooth) on a difficult
patient. Furthermore, difficult patients are many times best treated in one appointment, which helps to minimize the experience for both the patient and the doctor.
Another patient group that warrants consideration for referral is anxious or
phobic patients, where one can appreciate that the treatment itself might very well
be comprised because of the level of anxiety of the patient. Root canal treatment
88
.EW0ATIENTS!RE9OUR&UTURE
endodontics feature
There is a wonderful
old axiom in endodontics that states, ‘When
you are lost, stop and
take an X-ray.’ This
can be extrapolated
to a new axiom that
states, ‘If you cannot
reproduce the chief
complaint, stop and
refer it to a specialist.’
can be difficult under the best of circumstances, so to compound the technical
challenges with emotional ones makes no sense. Identifying your own comfort
zone is equally important in making the decision to refer. The best time to refer a
difficult case is before you start it. This is why it is so important to get an angled
X-ray (or image) of the tooth before you begin the case. Take your cone head and
move it about 15 degrees to the mesial. Moving the cone head in such a manner
will allow you to separate the roots of the tooth in question. Additionally, a good
angled X-ray will help identify the periodontal ligaments that surround the multiple roots. It will also help identify bifurcations and apical delta formations. In particular, this is a great way to identify deep furcations in mandibular premolars. A
deeply bifurcated premolar is perhaps the most difficult endodontic case and it is
one usually best referred to a specialist.
Another example where a referral to a specialist is indicated but might not be so
obvious is the difficult diagnosis case. The most difficult part of endodontics is not
a curved canal. It is diagnosis. Furthermore, it is not the typical run-of-the-mill
cases. When a patient presents in pain and the diagnosis is not apparent, rather than
have the patient return to your office multiple times, refer them to your endodontist. It is very important that you have a working relationship with your specialist
that includes his or her willingness to see your emergencies immediately. This does
not mean the next day or the next week. We have no tolerance for endodontists who
will not see emergencies in a timely manner… and nor should you.
There is a wonderful old axiom in endodontics that states, “When you are lost,
stop and take an X-ray.” This can be extrapolated to a new axiom that states, “If
you cannot reproduce the chief complaint, stop and refer it to a specialist.” This
will make your life a whole lot easier and your patient will appreciate it.
Another aspect of the general dentist-endodontist relationship and one that
receives little attention is the ability to perform appropriate emergency treatment.
Once you have proper anesthesia, you can handle emergencies. Seeing emergency
patients and treating them in the proper manner can be a huge help in establishing
your practice and enhancing your relationship with your specialist. The key is to
deliver the appropriate treatment for vital and non-vital teeth. Consequently, the
first thing you need to determine with your patient is whether you are dealing with
a vital or non-vital tooth. As a general rule, vital teeth can be handled with a pulpotomy while non-vital teeth require a pulpectomy. Let’s take a closer look.
Vital teeth: In these cases a pulpotomy will work, although in molars we also
recommend removing the inflamed tissue from the largest canal (such as the palatal
or distal) in conjunction with the pulpotomy. Do not put files down into each of
the canals, unless you plan on removing all the tissue. If you put a file into an
inflamed canal you have just committed yourself to a pulpectomy.
Non-vital teeth: If the tooth is necrotic, you really need to do a pulpectomy. A
great benefit of rotary instrumentation is that a pulpectomy can be accomplished
quickly and efficiently. You need to remove as much of this necrotic material as
possible at this initial visit. However, even a partial pulpectomy accomplished with
one or two rotary instruments will often suffice. Following the pulpectomy, we recommend filling the canal with calcium hydroxide, a cotton pellet and an appropriate temporary dressing. Also, do not forget to adjust the tooth.
The final perspective is communication with your endodontist. This is important for both parties. The specialty of endodontics is referral-based and the
endodontist should be willing to reach out to his or her referring doctors. The doctor should be approachable and willing to share his or her experience. Your
90
endodontics feature
endodontic specialist should be an education resource to you, his or her referring
doctor. While it might seem obvious, the lack of communication between general
For the general dentist and specialist can often have unforeseen consequences.
For the general practitioner, part of creating a good relationship with the spepractitioner, part of
cialist is not to just send them cases when something goes wrong, such as perforacreating a good tions or broken instruments. It really does help to refer these difficult cases before
relationship with the you start definitive treatment. It is also wise to be honest. As we like to say, “Don’t
deceive your attorney and don’t try to deceive your specialist.” If you break an
specialist is not to just instrument or think you might have ledged a canal, inform them in advance. It
send them cases when makes it easier for endodontists if they know what’s going on when they initiate
treatment and they are going to discover the truth during the course of treatment
something goes wrong. anyway. Being up front and honest accomplishes a better relationship between
both parties based on trust. The establishment of trust is the foundation on which
all referrals are based.
The relationship between the general practitioner and the endodontist is
indeed special and to summarize this, we asked Dr. Jerry Cymerman, an endodontist with more than 25 years of experience, to comment:
The general practitioner and the endodontist must realize that they are on the
same team. The endodontist really must be seen as an educational resource, not just
as a clinician, and it can be very constructive if the specialist can help the general dentist do the straight-forward cases in the best manner possible. I also believe that the
endodontist needs to be on the same frequency as his referring doctor, when it comes
to restorative needs. In fact, I have a referring doctor who wants me to do all the necessary things required, so that when the case is returned to him, it is (in his words)
‘ready to go.’ I cannot recommend strongly enough that
Author Bios
the general dentist needs to communicate their restorative
needs to the specialist, before the root canal is initiated.
Dr. Dennis Brave is a diplomate of the American Board of
As has been previously stated, endodontic diagnosis can
Endodontics, and a member of the College of Diplomates. Dr.
be a real challenge for even the most experienced dentists.
Brave received his DDS degree from the Baltimore College of
I also recommend the AAE Case Difficulty Assessment
Dental Surgery, University of Maryland and his certificate in
endodontics from the University of Pennsylvania. He is an
Form as a guide in case selection for the general dentist.
Omicron Kappa Upsilon Scholastic Award Winner and a Gorgas
This form, as well as other information on endodontics, is
Odontologic Honor Society Member. In endodontic practice for more than 25
available on the American Association of Endodontists
years, he has lectured extensively throughout the world and holds multiple
Web site (www.aae.org). When the case is beyond the scope
patents, including the VisiFrame. Formerly an associate clinical professor at the
of general practitioners, the endodontist has the experience
University of Pennsylvania, Dr. Brave currently holds a staff position at The
and technology to provide exceptional treatment. We use
Johns Hopkins Hospital. Along with having authored numerous articles on
cone beam computer tomography in our office to aid in
endodontics, Dr. Brave is a co-founder of Real World Endo.
diagnosis and treatment. This technology is extremely useDr. Kenneth Koch received both his DMD and certificate in endodontics from
ful in the diagnosis of lesions not apparent on two-dimenthe University of Pennsylvania School of Dental Medicine. He is the founder and
sional radiographs, in evaluating traumatic injuries, root
past director of the new program in postdoctoral endodontics at the Harvard
resorption, root fractures, previously treated cases and
School of Dental Medicine. Prior to his endodontic career, Dr. Koch spent 10
patients scheduled for periapical surgery. Our goal is to
years in the Air Force and held, among various positions, that of Chief of
preserve the natural dentition and to assist the general denProsthodontics at Osan AFB and Chief of Prosthodontics at McGuire AFB. In
tist in treatment planning.
addition to having maintained a private practice, limited to endodontics, Dr.
Koch has lectured extensively in both the United States and abroad. He is also
The general dentist-endodontist relationship is a
the author of numerous articles on endodontics. Dr. Koch is a co-founder of Real
relationship based completely on trust and the knowlWorld Endo.
edge that the ultimate goal is the same for each party –
superb treatment of the patient. n
92
Beautify Easily, Quickly
E xc l u s ive ly D i s t ri b u t e d by
restorative feature
by Robert A. Draughn, DSc and Karl F. Leinfelder, DDS, MS
Since composite resin restorative materials were first introduced, many improvements have been made in filler technology
and handling properties. Still, today the typical composite
restorative material has a stiff viscosity1 which, while desirable
when molding and sculpting, makes it difficult to fully contact
all of the cavity walls in cases where there is an acute line angle.
This has been addressed to some degree by the creation of flowable composites, which exhibit excellent flow and wetting
properties, but at a sacrifice of some of the performance characteristics of traditional filled resins.
In addition to flow/cavity adaptation challenges, all modern
composite resins exhibit some degree of stickiness,2 resulting in
a frustrating phenomenon commonly referred to as “pull-back.”
In an attempt to overcome this, many practitioners utilize
instruments designed to be “non-sticky” or, to the potential
detriment of the restoration, dip their composite instrument in
unfilled resin in order to make it “slippery.”
Over the years, several vibrational devices have been tried in an
effort to increase the flow of composite material3-7 and to reduce
stickiness/pull-back, all with little to no success. An oscillation
device (ET 3000, Brasseler USA, patent pending) has recently
been developed and has been found to significantly increase the
flow of composite materials while eliminating composite stickiness/pull-back. The development of the device is based on laboratory research aimed at quantification of the effects of oscillation on
the properties of composites before and after polymerization.
The success of the oscillating composite placement device
is due to the basic difference between vibration and oscillation. Vibration is a trembling, shaking or quivering motion which
is usually uncontrolled and might be in several directions.
Oscillation is a steady or regular back-and-forth movement in a
predictable and regular pattern. Our research has found that the
most desirable limit for the back-and-forth action (amplitude) is
in the general vicinity of 1.5mm with a speed (frequency) of
65Hz. It is this high-speed, definite back-and-forth action to the
composite material that immediately reduces its viscosity, allowing it to flow much more freely. Also, because the oscillating
placement blade strikes the material and withdraws so quickly, the
material does not have time to adhere to the placement blade and
therefore does not stick – thus pull-back is eliminated.
In these experiments, we used a model oscillating instrument
with amplitude of 1.5mm and a frequency of 65Hz. A schematic
of an instrument is shown in figure 1. Attached to the oscillation
instrument was a “beaver tail” placement tip. The same tip was
used with a non-oscillating manual procedure. Several widely
used composite materials were tested. After oscillation, polymerized specimens of the composites were compared to the polymerized specimens of the non-oscillated (traditionally placed)
composites. The results of the measurements are:
• Flow Properties: Among the oscillated composites, there
was an increase in the amount of flow up to 30 percent
more than the non-oscillated composites.
• Microhardness: Oscillating force caused no difference in
the hardness.
• Tensile Strength: The strengths of the composite materials
were not affected by oscillation.
94
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DN0511
restorative feature
• Density: No difference in density was detected between
oscillated and non-oscillated specimens.
• Microstructure: There were no differences in the spatial distributions of reinforcing particles in the oscillated and the
non-oscillated specimens and no differences between the
thickness of polymer rich regions at the surface of the oscillated and non-oscillated specimens. In addition, differences
were not observed in the amount or size of porosity.
• Bond Strength to Dentin: With the oscillated and nonoscillated samples, there was no significant difference in
the bond strength to dentin.
• Adherence of the Composite to the Oscillating Placement
Instrument: Contrary to the “stickiness” common to the
non-oscillating composite (regular) placement tip, there
was no measurable sticking/pull-back with the oscillating
composite placement tip; i.e., composites do not stick to
an oscillating composite placement instrument.
Imposition of oscillation to appropriately designed placement tips can allow practitioners to use the device in a variety of
clinical procedures. For example:
• Operative Dentistry – Classes I-V
• Placing of composite resins in all cases can be made
more efficient. In multi-layer posterior restorations,
voids and lamination gaps between layers can be more
easily avoided.
• The need to place a flowable composite in some situations is potentially reduced.
• A greater degree of restoration shaping and contouring can be accomplished pre-cure, reducing time
consuming post-cure shaping and finishing.
• Direct Veneers
• Due to the increase in flow and no pull-back, this technique can greatly decrease the time spent in shaping
the body and interproximal of the veneer.
• Placement of Sealants
• More highly filled resins can potentially be used as
oscillation enhances flow into pits and fissures, and
could decrease the presence of bubbles and voids
within the placed sealant.
Fig.1: Schematic of the oscillatory instrument
used in this study. Internal mechanism is shown.
• Core Build-ups
• Heavy, viscous composites can be encouraged to more
readily flow into all areas of the core preparation.
• Splinting
• Flow of composite material more thoroughly between
teeth (and into a mesh if necessary) is enhanced.
Conclusions
It was found that an oscillating (not vibrating) composite
placement tip can increase the flow of composite more than 30
percent. The research also showed that composite materials do
not stick to an oscillating placement instrument and the use of
oscillation does not affect the properties of polymerized composites. The improvements in handling properties have the
potential to significantly facilitate clinical procedures using
composite materials. n
Acknowledgements: Original research funded in part by Brasseler USA.
Original research funded in part by Dentsply International.
References
1. Lee IB, Son HH, Um CM. Rheologic properties of flowable, conventional hybrid, and condensable composite resins. Dent. Mat. 2003, 19: 298-307.
2. Al-Sharaa KA, Watts DC. Stickiness prior to setting of some light cured resin composites.
Dent. Mat. 2003, 19:182-187.
3. Oliveira JF, Ishikiriama A, Vieira DF, Mondelli J. Influence of pressure and vibration during cementation. J Prosthet Dent 1979, 41:173 177.
4. Koyano E, Iwaku M, Fusayama T. Pressuring technique and cement thickness for cast
restorations. J Prosthet Dent 1978; 40: 544 548.
5. Judge RB, Wilson PR. The effects of oscillatory forces upon the flow of dental cements.
J.Oral Rehabil. 1999; 26: 892-899.
6. Kaburagi K. Effect of vibration for the rheology of some luting cements. Shika Zairyo Kikai
1989; 8: 436 454.
7. Walmsley AD, Lumley PJ. Applying composite luting agent ultrasonically: A successful
alternative. J Amer Dent Assoc 1995; 126: 1125-1129.
Author Bios
Dr. Karl F. Leinfelder earned both his Doctor of Dental Surgery and Master of Science (dental materials) degrees from Marquette
University. In 1983, he joined the School of Dentistry at the University of Alabama and is the recipient of the Joseph Volker Chair. He also
served as Chairman of the Department of Biomaterials until 1994. Presently he holds positions at both universities; adjunct professor at
University of North Carolina and Professor Emeritus at the University of Alabama. Dr. Leinfelder has published more than 275 papers on
restorative materials, authored more than 150 scientific presentations, two textbooks on restorative systems and has lectured nationally
and internationally on clinical biomaterials.
Dr. Robert A. Draughn is Emeritus Professor in the College of Dental Medicine of the Medical University of South Carolina. He earned the Doctor of
Science in Materials Science from the University of Virginia and has more than 35 years of experience in dental materials teaching and research.
96
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“do good” focus
98
focus “do good”
Go into the world and do well.
But more importantly, go into the world and do good.
– Minor Myers Jr. (1942-2003)
It’s easy to stay in our own pockets of the world. To wake up, go to work or
church or school, go about our own business, on our own time, attending only to
those closest to us.
But there is a world just outside many of our immediate neighborhoods
where people live a very different existence. They live paycheck to paycheck,
many working two or more jobs, and with the exception of Medicaid, most do
not have the luxury of health or dental insurance.
Minor Myers, an author, scholar and composer said, “Go into the world and
do well. But more importantly, go into the world and do good.” Graduating with
a dental degree does not burden you with the responsibility of helping others; it
does however grant you the opportunity and privilege to do so.
Maybe serving the underprivileged is something you’ve not yet thought about,
or perhaps you have but aren’t sure where to start. Dentaltown Magazine has put
together resources for you – to be inspired and to get involved. We’ve talked to
experts and doctors who have already taken the steps into charitable dentistry.
We’ve collected contact information. We’ve asked hundreds of questions. And
whether you want to adopt a few cases a year in your practice (see pg 16), dedicate a day to free dentistry (see pg 118) or – at the most extreme – drop everything and work the rest of your career in a homeless clinic (pg 110), we
have the information you seek. And with Dentaltown.com available 24/7,
you have a forum for ongoing discussion and support.
… by the world’s definition, you have done well. Now we hope
you’ll go into the world and do good.
Articles in Section:
Compassion for the Other Man – Terry Dickinson of Missions of Mercy. . . . . . . . . . . . . . . . 100
FAQ: Hosting a Free Dental Day. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Office Visit: Boston Healthcare for the Homeless . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Three Reasons to Volunteer – Kris Volcheck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
National Children’s Oral Health Foundation and Three Affiliates . . . . . . . . . . . . . . . . . . . . . . 112
Each of Us Can Play a Role – Kenton Johnson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Donating Equipment and Supplies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
National and State-by-State List of Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Also focusing on charitable dentistry, see:
Professional Courtesy: Make a Permanent Impression on Someone . . . . . . . . . . . . . . . . . . . 18
From Trisha’s Desk: Volunteering by RDHs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
99
“do good” feature
An interview with Terry Dickinson – lifetime dentist, founder
of Missions of Mercy, winner of the 2010 ADA Humanitarian
Award, and regular do-gooder.
by Chelsea Patten, staff writer, Dentaltown Magazine
Dr. Terry Dickinson treating a patient at Middle
Peninsula MOM, assisted by VCU student John Reynolds.
100
“I’m sure people worried about my sanity,” chuckles Dr. Terry Dickinson, executive director of the Virginia Dental Association, in response to a question about
his big move from Texas to Virginia in 1999. He left his comfortable home, successful practice and the city-life of Houston, Texas, in search of a missing piece he
felt so strongly about finding. What that missing piece was though, he wouldn’t
find out until he was knee-deep in Missions of Mercy (MOM), an organization he
built from the ground up.
Dickinson graduated from University of Texas Dental Branch in Houston in
1967. He spent two years in the Air Force during Vietnam, performing dental
physicals on soldiers prior to their deployment and then went on to own a private
practice in which he practiced for 30 years.
During the last five of those 30 dedicated years, he caught the career version of
the seven-year itch. He loved dentistry and had a booming practice in a city he
knew and loved, so he questioned the “annoying” restlessness of something missing. Sleuthing for his higher purpose, he says, “was a difficult journey.”
It was in this period of time when he received a call from two friends asking
him to consider the position of executive director of the VDA. He was hesitant and
vacillated over interviewing and eventually living somewhere unfamiliar. “When
things are good and predictable, it’s easy to stay,” he says. “But here I am 11-anda-half years later without any regrets.”
Soon after assuming the position of executive director, Dickinson sewed
together the infrastructure of Missions of Mercy (MOM), a not-for-profit means
of providing dental care to the underserved working poor populations of Virginia.
Although it originated in the state, 20 states now have a model of the program and
it stimulated the formation of the America’s Dentists Care Foundation.
Dickinson says the MOM events border on chaos. “It’s organized chaos
though,” he says. Trucks pull up next to a facility – whether it is a high school gym,
feature “do good”
fairgrounds or a convention center – full of portable equipment and supplies.
Volunteers help to unload and quickly set up. A 50-chair clinic is typical. “It’s quite
impressive to watch” says Dickinson about the set-up process and of the 500 to
1,000 people they are able to serve during one- or two-day clinics. To operate a 50chair clinic, he estimates the volunteer count to be around 250 dental professionals; and upward of 400 volunteers counting the additional locals who help with
registration, patient interviews and triage, food service, security and parking.
I asked him about the challenges that conducting a program like this entails.
He named resources as one challenge typical of most charities, but he did not dwell
on hardship. MOM gets the majority of its funding via foundations and grants, as
well as through large dental companies like Henry Schein and Delta Dental. He
admits seeking funding is an ongoing process. “The good news is we leverage each
dollar into about $32 of patient care,” he says.
“One of the problems we’ve never faced is having enough patients,” Dickinson
says as he recalls a story of once hosting a clinic up in the mountains. He worried
that patients might not make the trip and expressed anxiety to the Sister in charge
about the volunteer dentists not having enough to do. “The first morning of the
clinic it was very foggy. We got about a mile out and traffic was at a dead stop. We
had to walk the rest of the way in.” The team had to turn a thousand people away
that day. “The Sister came up to me and asked ‘is that enough?’ I’ve never worried
about patients since then,” he laughs, now maintaining a “build-it-and-they-willcome” mentality. At MOM’s last big project, patients traveled from 15 different
states (including Virginia).
“The thing that struck me right away is what people are willing to do to get
dental care,” referring to the line of patients outside the first MOM project. People
are willing to stand in line for hours. Many spend the night in their cars or in tents;
in cold weather; sometimes even in snow storms. “They are so desperate to get the
needed dental care. It really reshapes and helps to rethink what kind of life they
must live,” says Dickinson.
Most of the patients treated at MOM projects do not have insurance. In
Virginia, there is a limited adult benefit Medicaid program, but the state has one
of the best children’s programs. For this reason, 95 to 97 percent of the people
treated are adults.
Dickinson and his teams of volunteers are deeply impacted by patients’ life stories. In fact, he claims they are the most rewarding part of the work he does. “If you
don’t listen to their stories, you don’t have any idea of the struggles they have.” One
middle-aged man came to one of the MOM projects with a severe cleft palate. He
was hard to understand but Dr. Dickinson could understand he needed a denture.
Unfortunately a denture couldn’t be fabricated on-site for lack of lab facilities.
Dickinson decided he would find help for the patient outside the MOM clinic and
“I always walk away feeling more blessed
than the people who had the dental work
done, because I was able to be a part
of giving something back.”
Youngest Wise County MOM patient happily poses with
Dr. Terry Dickinson and dental hygienists following her
cleaning. The stuffed animal made the day!
Dr. Terry Dickinson triages Southwest Virginia patient
for needed treatment.
Dr. Andrew “Bud” Zimmer, Dr. Terry Dickinson, and
Dr. Ralph Howell display picture of Governor Tim Kaine
presenting Dr. Dickinson with the National Governors'
Association Private Citizen Distinguished Service to State
Government Award.
Governor Tim Kaine presents Dr. Terry Dickinson with
the Virginia Health Care Foundations NETworthy
Award (2006).
101
Dr. Terry Dickinson exams Wise MOM patient and
determines necessary care.
he spoke with a prosthodontist with whom he was acquainted. The doctor was
a kind man, but a bit reluctant about doing the work as he already does a fair
amount of pro bono work in his practice. Reluctant that is, until he heard the
patient’s story.
The patient had dropped out of school in the third grade since his classmates
ridiculed him incessantly because of his deformity. His lack of education gave him
few choices for work but a job in the coal mines of Virginia. With a debilitating
injury in the mines, he had little hope left. This story not only left the prosthodontist changed, but changed the practice dynamic of his staff as well. The doctor now
runs the prosthetics department for Missions of Mercy. As for the patient, he said
of the denture: “It made me feel like a man again.” The circle was complete.
“It wakes you up to what is going on out there,” explains Dickinson “There are
hundreds of stories for what [programs like this] do in people’s lives. It’s not just getting teeth out or doing fillings.” The mission really helps to sustain hope in patients.
Dickinson testifies many of the people who visit the clinics suffer not only from
poverty of money, but oftentimes, poverty of hope. Performing dentistry helps to
provide hope for their future. “It changes lives… on both sides of the equation.”
Because the program has had an impact across the board, it’s not hard to see
why Dr. Dickinson was nominated (without his knowledge) for the 2010 ADA
Humanitarian Award. Dickinson received the award and certainly deserves praises
for the work he does, but he is a humble man who does good for the sake of the
greater good, and that’s enough for him... n
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102
Townies on the message boards have asked many-a-question about hosting a free dental
day in their practices. We have decided to clear up some of the confusion. We spoke with
Lindsey Nickel de-la-O, communications director, and Brian Carlsen, chief operations officer
of Dentistry from the Heart (DFTH) to answer your questions.
What are the steps to host a free dental
day through your organization?
For a nominal donation, doctors can register to host a
Dentistry from the Heart event on our Web site. The donation
made by the volunteer doctor provides the practice with membership in our 501(c)(3) Public Charity. This allows a given practice to solicit and receive tax-deductible donations and support
from interested parties both private and corporate. Donors who
offset the practice’s initial donation are offered honorable
mention in press releases, event banners, etc. Our doctors also
have access to our marketing and public relations materials.
Event materials are also provided (i.e. customized T-shirts and an
event banner). This approach lifts a huge burden off of a practice
allowing them to focus on dentistry, which is their strong suit.
What are the steps to host a free dental
day independently?
A doctor needs to be prepared to manage the following:
1. Marketing the event and building community awareness.
2. Soliciting support.
3. Coordinating the event logistics from patient registration,
capacity, services, staff, volunteers, sponsors and more.
4. Insurance, both event insurance for dentists who rent their
office space property and any additional patient liability.
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To-do List Not sure where to begin?
Here’s a checklist of items to help you plan your own charity day from Townies Rick and Nancy Hammel.
One Year Before
Reserve a day. Get your team excited about it.
Have a team meeting to begin planning and answer to following questions:
• Will you see children?
• What services will you perform?
• Will you see patients who have insurance?
• Will you pay your team?
• Will you need to have more volunteer dentists and/or hygienists for
your capacity?
• How will you get past the “what if” questions and doubts?
• Will you need security?
• What will you do in inclement weather?
Six Months Before
Decide Basic Logistics.
Appointments vs. First-come First-served
We chose to have an early morning greeter who arrived at 5 a.m. He had
two sets of alpha-numeric cards. Patients who wanted to see the dentist
got a yellow card with D-1, D-2, etc. Patients wanting hygiene services
got a white card with H-1, H-2. We estimated each patient would be in
our office about a half-hour and the greeter could tell patients approximately what time to return so that we didn’t have people just hanging out
all day long.
Waiting, Shelter and Bathrooms
We are fortunate that we have a large yard and we got a couple of large
canopy-type tents and the city parks department brought in benches, trash
cans and tables. Fortunately, we also have a patient who owns a portable
toilet business and brings in a toilet so that we don’t have to have people
coming into our office bathrooms.
Traffic Flow of Patients and Triage
Determine the traffic flow pattern to avoid hallway bottlenecks.
Consider asking other dentists or hygienists to do your triage and administer anesthetic as well as any pre-medication needed. And, if you have
extra treatment rooms ask them if they want to serve by seeing patients.
Be sure if you are bringing in providers from out of state that they can
practice legally in your state.
Dental Work
Because we wanted to see as many patients as possible we decided that
patients would only be able to have about a half-hour of the dentist’s
time, (i.e., no quadrant dentistry). The person doing the triage determines
the patient’s one or two most critical needs, enters treatment into the
computer and anesthetizes.
Hygienist vs. Dentist
Our patients are told they can choose to see either one or the other. If they
want to get their teeth cleaned in addition to seeing the dentist they have
to get another ticket.
Patient Information and Consent Forms
We designed a one-page form that contains pertinent information and
release that is on Dentaltown.com (see “Downloads” Section)
We chose not to use any treatment specific consent forms but every
office should consider carefully their own environment. Just because the
dentistry is free doesn’t mean you aren’t still liable if someone would
choose to sue.
Give-aways/Food
Thanks to donations provided by our dental supply vendors we were able
to give away items such as toothbrushes, toothpaste and floss. We also
provided packs of acetaminophen and ibuprofen to give to those patients
for post-operative discomfort.
104
Also, because people are waiting for many hours and because we have
a very generous small community, volunteers serve a free lunch as well
as donated bottled water and coffee and cookies both mid-morning and
mid-afternoon. We contacted our local grocery store and asked them to
furnish hot dogs, buns and chips. Our next-door neighbor assisted living
facility donated coffee and cookies.
Marketing
We had a graphic artist design our logo and the company who maintains
and designs our Web site set up a Web page for our mission – www.claycenterdentalmission.com. We also chose to have all volunteers wear a
bright colored T-shirt with our logo and date. This serves as a way to
identify the volunteers.
Printed Materials
We used extraction and how to treat dry socket informational sheets.
Security
If you believe you'll have a lot of people spending the night in your yard
or parking lot see about hiring some sort of security to be there to protect your property and the patients as a safety measure.
Volunteers and Donations
People in our community got really excited about becoming a part of this
day of mission dentistry and said it was the “biggest high” to be a part of
it. We had volunteers help with gatekeeping, trash collection, greeting and
ministering, serving food, taking photos, Tweeting and running errands.
Begin conversations with your vendors about donations. Tell all your vendors about your day and solicit their help. Our very own dental supply rep
will be spending his second charity day with us. Our experience shows
that most local vendors are very generous because of the relationship
built with an office over time. Most dental supply reps have stashes of
supplies to give away for events like this.
Two to Three Months Before
• Contact local charitable organizations, churches and pastors.
• Offer community businesses an opportunity to participate by sending
them letters about sponsorship, i.e., furnishing lunch, T-shirts, etc.
• Order T-shirts and additional dental supplies.
• Hire a volunteer photographer to upkeep social media outlets.
One Month Before
• Order food, if applicable.
• Confirm Porta-Potty, if needed.
• Contact radio and TV stations; send news releases to local newspapers.
• Print patient “tickets” if doing first-come, first-served event.
• Have a team meeting to review the day’s logistics.
• Write up an instruction manual, including job descriptions, for volunteers.
• Touch base with donors.
One Week Before
• Confirm all orders.
• Confirm all volunteers and review duties and job descriptions.
Author’s Bio
Dr. Rick Hammel and Nancy Hammel have built Clay Center Family
Dental Care in Clay Center in Kansas. They have hosted two successful
charitable dental days. They can be contacted at: [email protected]
Out-of-the-Box Advice
...from Jeff Dalin, Co-founder of Give Kids a Smile
• To find kids, ask school nurses. They know exactly who is in
need of dental care.
• To find supplies, ask local sales reps about products that have
been opened or returned or are getting close to expiration dates.
• To find volunteers, offer CE credit or host a study club contest.
This is a great way for recent graduates to network with established dentists.
Is it tax-deductible?
Dentistry From The Heart donations and events are tax deductible to the degree allowable under the auspices of a 501(c)(3).
Operating without a charitable status does reduce the amount of
donations or practice expenditures that might be deducted. I would
recommend speaking to a tax accountant about this.
What are the liabilities?
Charitable events which are held with the status of a 501 (c)(3)
enjoy sovereign immunity from prosecution for services rendered.
Events run outside of a charitable status must rely upon their
own insurance and legal resources to deal with treatment issues
that might arise.
How much would it cost a dentist?
That depends on many factors including the size of the staff
and the number of people to be treated. Many doctors receive
donations from their vendors and additional sponsors that help
offset the cost of hosting the event. On average, a typical practice will treat about 90 patients in one day. Material expenses
might run up to about $5,000. If the staff volunteers their time
as well, a practice might be able to narrow its event costs down
to a minimal financial impact.
What services should a dentist offer?
We recommend that dentists offer free fillings, cleanings
and extractions. These are the most universal services needed.
To attempt to do more than these procedures will impact the
number of people that might be treated while increasing the likelihood of more complex procedures involving complications.
What are the benefits of hosting a free
dental day through a charity like DFTH
versus doing it independently?
It just ends up being a lot more affordable for the dentist
because we provide them with so many marketing and logistic
services. The average dental practice is very good at being a
dental practice, but oftentimes lacks the internal resources to
take on the media, logistics and financial aspects in offering
free dentistry. To attempt this with a staff that is very good at
running a practice but not a charity event can evolve into a
costly endeavor. We have designed our services around the
simple notion of making it easier for a practice to reach out to
those in need.
What are other charity resources
besides DFTH which help dentists host
free dental days?
There are organizations like Give Kids a Smile and the
Missions of Mercy organization. The enemy of tooth decay is
our friend. In other words, we all have virtually the same mission: to bring care to those who are in need. As we are one of
the fastest growing charities, we must be doing something
right. For every member that we have, there are three more
considering membership.
The profession of dentistry is composed of giving and
caring people. It is supremely gratifying to work with dentists
and their staff in pulling these events together. The enthusiasm
and the humanity that our members exude is truly touching
to see.
“People who don’t have insurance or can’t afford
dental work don’t have many low cost or free
care options available to them… Our passion is
to work with dental practices across North
America in encouraging them to volunteer their
time and give back to their communities by
hosting a Dentist from the Heart event.”
– Dr. Vincent Monticciolo, founder of DFTH
■
Dentistry from the Heart is a nonprofit 501(c)(3) Public Charity.
For more information, visit www.dentistryfromtheheart.org, e-mail
[email protected] or call 727-849-2002.
How should a dentist market the event?
We recommend dentists use public relations to promote
their event. We also recommend they use whatever advertising
sources they are currently using to promote their practice.
How should dentists screen patients?
Patient screening is up to the independent practice. We do
not screen patients, we only ask that they be 18 or older, or have
a signature of a parent or guardian to receive services.
105
“do good” office visit
Serving Boston’s Underserved
An interview with Dr. Colleen Anderson of the Boston Health Care for the Homeless Program
by Chelsea Patten, staff writer, Dentaltown Magazine
South of the Massachusetts Turnpike, surrounded by urban sprawl, across the street from Boston Medical Center sits Jean
Yawkey Place. Nestled in the heart of Boston, this building and the staff who walk its halls strive to care for the city’s homeless population. Boston Health Care for the Homeless Program (BHCHP) started with limited funding and a coalition of
health-care professionals with a vision. Since its founding in 1985, BHCHP has worked to assuage the burden of homelessness by providing health care and dental care to the city’s underserved.
Dr. Colleen Anderson, a University of Michigan School of Dentistry graduate, is one of the many selfless individuals
employed by BHCHP, and a woman with both the vision and skills to make a difference. Here, in an interview with Dentaltown
Magazine, she shares her inspiration for getting involved and the heartwarming stories that keep her in the nonprofit sector.
106
office visit “do good”
What inspired you to apply to work at BHCHP?
Dr. Anderson with Alan Filzer, DDS,
director of the BHCHP dental clinic.
Anderson: I decided before even starting dental school that I wanted to work in public
health. I wanted to provide care to the patients who need it most, and have the hardest time
accessing it. When it came time to look for work, BHCHP was a natural fit. They provide
service to some of the city’s most vulnerable people, in a setting that demands the highest
quality of care and a focus on the integration of primary, behavioral and dental care. Another
attractive aspect was the level of commitment from the other providers. Employees here
really care about their work and fulfilling their mission.
Did you volunteer in a charitable clinic before deciding to look for a
job like the one at BHCHP?
Anderson: Yes, when I was in dental school I had externships in several nonprofit clinics. I completed my general practice residency at the Brigham and Women’s Hospital/
Harvard Extension program. I spent time in northern Michigan at both a community health
center and at a mobile dental clinic set up to serve migrant workers and their families. I also
spent a month in rural Maine, at a regional health center.
How can dentists find similar programs?
Anderson: I found the job listing through the National Health Service Corps, which,
among other things, serves to match clinics throughout the country with providers interested
in working in public health. They also provide loan repayment and scholarship programs (of
which I was a recipient). There are Health Care for the Homeless Programs in many cities, and
dentists should seek out their local program to find out about work or volunteer opportunities.
What is BHCHP’s philosophy?
Anderson: The program’s mission is to provide homeless individuals and families with
access to the highest quality health care. The homeless population faces a particular set of
health hazards as well as obstacles and barriers to health care that make management of
chronic illnesses very difficult. We try to address their medical complexity in the context of
their need for food, shelter and clothing.
What makes this practice different than the typical dental office?
How is practicing charitable dentistry different than practicing noncharitable dentistry?
Photography by Michele McDonald
Name: Colleen Anderson, DDS
Graduate from: University of Michigan School of Dentistry
Practice Name: Boston Health Care for the Homeless Program
Practice Location: Boston, Massachusetts
Web site: www.bhchp.org
107
“do good” office visit
Dr. Anderson evaluates an emergency patient.
Anderson: Having only worked in nonprofit settings, I can
only speak to that. Here, we really try to focus on providing
treatment that will serve that patient best in their current situation. Our goals are very basic: treating disease, improving function, improving aesthetics; but the outcomes can have major
impacts on the patients’ lives: overall better health, improved
nutrition and employment opportunities.
Describe a typical day in the office.
Anderson: Our first appointments begin at 7:30 a.m. Our
clinic has three dentists, two full-time and one part-time. In
addition to seeing our own patients, we instruct fourth-year
dental student externs from Harvard University and Boston
University. We schedule all appointment types every day, as well
as see emergency patients and we are typically very busy.
The dental clinic is located in the same building as our outpatient medical clinic and our respite care facility, which provides short-term medical and recuperative services for those
who are too ill to stay in shelters but not sick enough to stay in
a hospital. One records system is used by all the services, and
we are in frequent communication with our patients’ primary
care providers.
What is the most common dental/health problem among the homeless? How about the most
common procedure performed?
Anderson: Many of our patients have multiple health issues,
many of which are complicated by or exacerbate oral diseases.
Many of them, when they first see us, lack the ability to pay
attention to oral hygiene day-to-day. Disease management is our
first priority, and corrective services are very important for many
of our patients.
108
What sort of challenges do you and your colleagues face in working each day?
Anderson: We face the consequences of the challenges our
patients face. While many of them struggle financially, they also
commonly experience an extreme disorganization in their lives
that makes keeping appointments, transportation, and taking
medications, among other tasks, very difficult. Daily oral
hygiene is not achievable for some of our patients. Many of
them are struggling with substance abuse. Our challenge is to
educate and work with our patients to find treatments that
accommodate their particular situations.
Describe your most successful or rewarding
experience.
Anderson: Rewarding experiences abound here. I am very fortunate to often encounter patients when they are making positive
changes in their lives, and therefore get to take part in what can be
an amazing transformation. Success can mean seeing patients
through full-mouth extractions into complete dentures, but also
seeing them mark sobriety, control diabetes, control hypertension
or start HIV therapy. Often, several of these things are happening
at the same time. I can think of many special patients, but one in
particular is a young man who had cancer, and stayed in our
respite care facility during treatment. I started dental treatment
with him, and completed extractions, extensive restorative care
and a partial denture. He’s now in remission; he’s sober; he’s working; and he and his girlfriend are expecting a baby. It’s incredibly
rewarding to be part of that process; to have contributed to his
self-confidence, health and overall stability. You can’t beat that.
How about a disappointing experience or failure?
Anderson: Not every treatment plan is completed of course, and
office visit “do good”
Indira Goranovich and Bessy Wrights.
some patients are not able to follow through, chronic illnesses
worsen or other circumstances intervene. While it can be disappointing, we will be here to try again if and when the patient is able.
What are your primary funding resources?
Anderson: Most of our patients (around 75 percent) are
insured, many through the state MassHealth program. We also
receive funding through grants and donations. Like all other
community health centers, we are affected by state cuts to dental benefits. However, BHCHP is very committed to providing
oral health care, and we work hard to keep all of our services
available. To that end, patients are not billed for treatment.
How do you get the word out to patients about
services?
Anderson: Many of our patients are referred through their
BHCHP medical providers, or through one of the more than 80
programs we work with in the city that provide services to the
homeless. Some patients hear about us through word of mouth.
We also do oral health screenings at several organizations that
provide aid to the homeless, and those patients often then come
to our clinic.
How do you deal with language barriers?
Literacy problems? Transportation issues?
Abuse of free services (if any)?
Anderson: We are fortunate to have members of the dental team who speak multiple languages, so most of the time
we have someone who can communicate with the patient.
We also can call on other employees throughout the program
to translate for us, which covers almost every language we
have encountered.
Back, from left: Bessy Wrights, Indira Goranovich, Maria Alves and Cam Nguyen.
Front, from left: Colleen Anderson and Alan Filzer.
Transportation can be a problem for many of our patients.
We are accessible by public transportation, and that is the
method used by the vast majority of our patients. We are able to
provide bus and subway passes for many patients.
Evaluating abuse of services is difficult. Our patients face
many challenges that other groups do not, including misplacing
belongings or having those stolen, hospitalizations and frequent
moves, which put them at greater risk of losing prostheses. We
try to evaluate and accommodate those situations on a case-bycase basis.
Who are some of your mentors?
Anderson: I had terrific teachers at the University of
Michigan, and while I no longer see those instructors, it seems
like I’m reviewing their lessons every day. In particular, Dr. Ron
Heys and Dr. Phil Richards taught me so much about treatment
planning, about standards and about patient interactions.
How do you see the homeless program growing
and changing in the next few years?
Anderson: It seems that we’re always growing and expanding. The demand for service is high, and our dental clinic is considering the possibility of adding staff and extending hours.
With that, we might be able to expand our services as well. The
challenge of achieving our mission drives us to continually evaluate the needs of the homeless population, and evolve as an
organization and as individual providers to meet those needs.
Dr. Anderson, thank you for sharing your experiences with our readers. You, along with the
others who dedicate themselves to programs
like BHCHP are truly inspiring. n
109
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by Kris Volcheck, DDS, MBA, founder of the CASS Clinic
Can you guess the number-one reason why people volunteer? To do good?
A nice sentiment... but no. To help people? Nope. When the CASS Clinic first
started in January of 2001, we didn’t know the motivating reasons for dentists
to get involved. I had been a dentist in private practice and I didn’t know what
it took for a successful volunteer program. Check out the list below to find out
what I learned to be the top three reasons people volunteer. Whatever your reason, get involved in some sort of pro bono work – it’s good for you and the people you help.
#3 Reason: To Learn from Peers
We have many dental, hygiene and dental assisting students with us.
Volunteer dentists like to come and interact with the students, teach the students, and learn about all the new techniques and technology happening in dental school. Since we do every aspect of dentistry from hygiene to implants and
cosmetics to plastic surgery, we have specialists in every area of dentistry. If one
of our dentists wants to learn how to place implants… he can come in and learn
from one of our surgeons. If another wants to learn the newest techniques in
endo, she can come in and observe the endodontist. It’s a constant exchange of
techniques and ideas, all based around the common cause of helping others.
110
#2 Reason: To Do Good
We use the tag line “Do good… but just a little.” This sounds funny but we
don’t want our volunteers to burn out because we need them! Oddly our
patients are actually the second priority. If we accommodate and satisfy our volunteers, they will then satisfy our patients.
At the beginning, I didn’t have a clear idea of what characteristics I wanted
in my volunteers. I just wanted them to be licensed, competent dentists and
hygienists. They have turned out to be not only licensed and competent, but
also empathetic, resourceful, energetic members of my family, who happen to
want to help the homeless. This quality of clinician has become the norm.
When the clinic first began, volunteers had to be more flexible with the time
they volunteered. Now with so much help, we can usually accommodate clinicians’ request for certain hours or procedures – whether they want to work once
a month for a day, once a quarter for an hour or once a year doing only extractions, root canals or everything that comes up. They have infinite options; they
just have to want to help.
Same goes for dental labs. We started with 20 volunteer labs
and grew to more than 100 volunteer labs in 15 states. We
applied the same principle of “Do good… but just a little” to our
labs. We want to make sure we only solicit help at a rate that is
comfortable and affordable for labs and volunteers.
Volunteers also have the choice of receiving a schedule ahead of
time, or getting a phone call every three or six months to see if they
would like to volunteer. Generally our female volunteers prefer to be
scheduled but many of our male volunteers like the “non-commitment” of not having a schedule, so we call them at certain intervals.
#1 Reason: To Socialize with Peers
The number-one reason to volunteer is to socialize with peers.
We got lucky when the CASS Clinic first began because even
though I didn’t know the factors that motivate dentists to volunteer I happen to really like to socialize and we hired people who
liked to socialize. The volunteers liked the friendly, warm, but
productive and professional environment so much that we went
from 20 volunteers in 2001 to 400 volunteer dentists, hygienists,
students and assistants in 2011.
I didn’t realize until many years into our program why it
was so successful. Once we had so many volunteers, I was asked
to speak in many other cities about the success of our program
and in my research, the number-one reason to volunteer stuck
out – to socialize. At the beginnings of our clinic, we had no
idea of its importance.
Even if this is your main reason for volunteering, do it. Other
professionals have the same needs for social interaction.
We don’t necessarily “recruit” volunteers but we always need
new blood to keep things energized and growing and keep
expanding our care for the homeless. We can never meet the
needs of our population.
Whatever your reason for getting involved, you’ll get just as
much benefit from helping, socializing and learning as the underserved who receive the dental care. n
CASS Dental Clinic Update
Remember the November 2009 Office Visit that featured the CASS
Clinic in Phoenix, Arizona? Well, it has expanded since then. Here’s
an update:
• They are continuing the expansion of care for the Homeless
United States Veterans. The clinic sees virtually every homeless
U.S. vet in Maricopa County.
• The Midwestern College of Dental Medicine will start sending
their senior students in June 2011. They will join the students
from the Arizona School of Dentistry and Oral Health, who have
been with CASS for six years now.
• They are in the final licensing process to open a dental assisting
school at CASS Dental Clinic. This will help the community at
large, assist the selected homeless clients in getting a career
and bring in revenue to the clinic.
• CASS opened the Murphy Kids Dental Clinic in June 2010. This
clinic is fully portable and serves the four schools in the impoverished Murphy Elementary School District in south Phoenix. A
full dental clinic with comprehensive services is set up inside
each school and treats every child in that school, whether they
are insured or not.
111
“do good” profile
National Children’s Oral Health Foundation (NCOHF) is an organization we’ve
all heard of in some way or another – probably through its most endearing persona
America’s Toothfairy. You might donate. You might read about it in the news. You
might even participate in some of its programs.
NCOHF supports a national affiliate network of community-based oral health programs located everywhere from Washington, DC, to the small rural towns of Washington
State. NCOHF affiliates work to eliminate pediatric dental disease by providing comprehensive care to local underserved children. Affiliate models uniquely represent the communities they serve and range from mobile units and universities, to foundations and
clinics. Here are just a few successful examples.
KinderSmile Foundation
“We cannot forget those who
are less fortunate and need us
as health-care providers.
I personally feel obligated as a
human being to serve anyone
who is less fortunate.”
– Nicole M. McGrath, DDS;
KinderSmile Founder, President and
Executive Director
“Every child and his or her family is
extremely appreciative of the generosity and kindness from NCOHF
and the work that we provide.
- Brent Lin, DMD; Director, UCSF
Pre-Doctoral Pediatric Dentistry Program
112
Location: Montclair, New Jersey
Web Site: www.kindersmile.org
KinderSmile Oral Health Program (KSOHP)
Volunteers visit preschools, daycares, Head Start, Early Head Start and middle
schools, providing on-site preventive exams, cleanings and fluoride varnish, as well
as presenting age-appropriate oral health education workshops for caregivers and
teachers. If participating children are not insured, KSOHP directs them to local
offices that offer services pro bono.
Pre-/Post-natal Oral Education Program
Volunteers provide education, nutritional workshops and a dental “home” to atrisk, pregnant mothers by collaborating with Early Head Start programs and United
Way/WIC programs. These programs help women to understand the connection
between their oral health and their developing fetus.
University of California at San Francisco
Web Site: www.dentistry.ucsf.edu
UCSF Clinic
Named the NCOHF Affiliate of the Year for the remarkable impact the
UCSF Clinic is having on their community, UCSF faculty and supervised student dentists provide comprehensive oral health services based upon the unique
dental needs of each pediatric patient. With support from NCOHF, UCSF has
expanded vital educational and preventive programs offered both in-clinic and
profile “do good”
during various outreach initiatives conducted throughout the school year, reaching children in the Bay Area’s most underserved communities.
Students United for America’s Toothfairy (SUAT): UCSF Chapter
A student-action group dedicated to increasing local awareness of pediatric dental
disease. Students in the UCSF Chapter of the SUAT improve community oral health
literacy and raise critical funds to suppport vital preventive services in their community.
Run by a board of students and assisted by Dr. Brent Lin, the group started a
tooth-brushing program throughout Bay Area low-income preschools to encourage
mid-day brushing and adoption of healthy habits. They also take part in oral health
fairs, provide oral hygiene education and teacher training.
United Methodist Mexican American Ministries
Location: Garden City and Dodge City, Kansas
Web Site: www.ummam.org/dental.html
UMMAM Clinic
With NCOHF support, UMMAM provides a full range of preventive treatment and restorative treatment services on a sliding fee scale basis according to
household income. UMMAM accepts all dental insurances, but most patients
qualify for the minimum service fee.
Lifetime Smiles Program
Clinicians provide preventive and educational services in area daycares, Head
Start, preschools, and public and private schools. The program gives oral health supplies to those in need, helps families understand and use available dental insurance,
arranges treatments at the dental clinic and other dental clinics, educates patients on
oral health topics and provides pre-natal information.
Inspiring, isn’t it? Here’s how you can get involved:
Tomorrow’s Smiles works with volunteer practitioners to provide pro bono restorative and aesthetic dental services to promising at-risk teens, renewing their self-esteem
and encouraging them to take responsibility for their own oral health. Recipients also
participate in a “Pay It Forward” program to teach younger children lessons on how to
break the cycle of pediatric dental disease.
The America’s Toothfairy Dental Home Program gives caring dental professionals the opportunity to provide underserved youth with ongoing comprehensive pro
bono dental services in a compassionate health-care environment.
Through national partnerships with Boys & Girls Clubs of America and National
Association of School Nurses, NCOHF will match practitioners with pre-screened local
students in need of dental services.
Go to www.americastoothfairy.org and click “Contact” to volunteer or register a child.
Student’s United for America’s Toothfairy (SUAT): SUAT is a student action group
comprised of dental, pre-dental, hygiene and nursing students who are dedicated to
increasing local awareness of pediatric dental disease. SUAT groups educate local families about maintaining good oral health and providing vital tools for a lifetime of
proper care. Upon acceptance into the SUAT program, each chapter receives a comprehensive toolkit filled with templates and information and a one-time stipend of
$500 to ensure your SUAT group quickly becomes a valuable asset for the health of
your community.
Request a SUAT application by e-mailing [email protected].
Visit www.ncohf.org for more information. n
“It is very fulfilling to see a
need in the community, secure
funding and start offering a
much-needed service. Our
patients are very grateful to us
as most of them would not be
able to seek care because of
the financial barrier.”
– Marcie Strine, CFO, United Methodist
Mexican American Ministries
“The earlier we can reach out
to these kids and create good
oral hygiene habits, the more
successful we will be. The
children we work with are
just so precious, and when we
make it fun for them, they
really grow to love the dentist.”
– Kaitlin Jennison, Dental Student
at UCSF and SUAT President
113
by Kenton Johnson, DDS, MS
The unmet need for dental care is all around us, from urban
to suburban areas, as well as in rural areas. This is true even in
many communities that are growing and prosperous.
Where I live in the Twin Cities we like to boast about our
quality of life and rankings in those “best places to live” reports.
But there are many residents of our metropolitan area who do
not have insurance or the financial means to access dental care.
One reason is that most dentists nationwide don’t accept
Medicaid patients, and even those who do might cap the number of Medicaid enrollees that they will see. A report last year by
the Government Accountability Office revealed that there were
25 states in which fewer than half of all dentists treated a single
Medicaid patient (http://www.gao.gov/htext/d1196.html).
That’s why it is so critical for organized dentistry to expand
its volunteer efforts to provide care to low-income, underserved
114
populations. In my home state, I am proud to say that the
Minnesota Dental Association is committed to this objective.
During the first weekend of February, more than 3,000 dental professionals and interpreters in Minnesota volunteered at
hundreds of locations around the state to offer dental care. This
was accomplished through the “Give Kids a Smile” program,
which is sponsored by the Minnesota Dental Association. These
dentists were able to treat thousands of kids, many of whom
haven’t seen a dentist in years.
Since 2003, San Joaquin County in California has operated
one of the most impressive volunteer dental programs. First
and foremost, it is a year-round program. One of the clinics
provides free dental care to low-income kids three days a week.
That’s 150 days of free dentistry at one location; what a wonderful opportunity for the children and volunteers alike!
Making that kind of impact is possible because the program is drawing on the voluntarism of more than 30 dentists.
In other words, the actual reach of these volunteer programs
depends on the number of dentists who lend their services. We
are the only people who can fill the blanks on the schedule.
Dentists all have an excuse not to volunteer, but once they participate they are overwhelmed by the experience. They can’t
wait until the next opportunity.
Unlike the California program, many of the free dental programs across the country operate only for a few days or for one
month – often, they occur in February for Dental Health
Month. It would be ideal to see this change – for more states and
communities to offer care for longer periods of the year.
Dentists who are not yet involved in volunteer care efforts
should consider contacting their state dental associations.
Generally, these associations have existing programs through
which they seek to connect dentists with communities in need.
[Editor’s note: Check out our extensive list of resources beginning on
page 117.]
If you are a dentist who already participates in these volunteer projects, consider talking to other dentists about these activities and encourage them to join you in getting involved. It
could make a difference in attracting more of your peers to join
these activities. The research appears to show the importance of
dentist-to-dentist dialogue. In fact, a 2008 study of a volunteer
dental program in Israel found that 68 percent of participating
dentists had heard about the program from another dentist.
I had an opportunity to introduce three dentists and their
staff to “Give Kids a Smile” in February. They felt that helping
the underserved not only made them appreciate their work, it
helped the teams work better together. There is a nationwide
mobile dentistry program I have worked with called Christina's
Smile. If a PGA tournament comes through your city, chances
are the semi-truck with a tooth and golf club come too. The program focuses on the needs of the underserved and parks in front
an elementary school in St. Paul. The kids can walk to the facility during the three-day stay!
There are many unique programs that communities have
designed to fit their needs. These programs can only thrive if
volunteers commit to a shift or two a year. Together we can make
a difference in the lives of people who cannot seek regular dental
care – it is up to each of us. ■
Attention: Dental Students
Establish a Dental Pipeline Program at Your School
by Donna Lewis Johnson
Closing the gap in oral health was the mission of the nine-year
demonstration project supported by the Robert Wood Johnson
Foundation and held at 23 dental schools across the country.
Dental Pipeline set out in 2001 to respond to access disparities
by increasing student diversity at America’s dental schools and
increasing the length of time that all senior dental students
spend in community-based dental clinics.
The community experience had an immediate effect on
increasing care for underserved patients. The program also
influenced dental school graduates to work in community sites
or treat more underserved patients in their private practices.
In 2008, students from University of Illinois at Chicago (UIC)
College of Dentistry teamed up to expand dental services at a
clinic serving homeless adults. Under faculty supervision, UIC
dental students staffed the clinic, performing root canals,
extractions, and restorations. The rotations continue with current senior students.
“The Pipeline program is dear to my heart,” says Esther Lopez,
DDS, an alumna of the program. “Increasing the number of
minority professionals in dentistry is so important. When you
understand people’s struggles, challenges and culture, you are
able to better serve them.”
Currently, Lopez spends upward of 15 hours a week at the community clinic while operating her private practice in suburban
Chicago that also treats vulnerable populations.
Replicating the Dental Pipeline program would require dental
schools to partner with grantmaking institutions in a collaborative
effort. Read the program’s final report, www.jdentaled.org/content/
vol74/10_suppl, for guidance on how to establish successful community-based dental education programs and underrepresented
dental student enrollment programs.
Author’s Bio
Kenton M. Johnson, DDS, MS, has been a general dentist in Roseville, Minnesota, with Metro Dentalcare since 1994. Dr.
Johnson is currently active with the MDA’s Elderly and Special Needs Adults Committee. He can be contacted at:
[email protected]
115
“do good” message board
Donating Equipment and Supplies
Throughout the message boards of Dentaltown, many Townies have asked the question “Where do I donate equipment and supplies?”
Here is a compilation of advice from Townies picked from various message boards about donating equipment.
phoney
Posted: 6/7/2003
I donated most of my old equipment to an interfaith clinic. Since I was buying
new equipment, my supply company was more than happy to deliver the units. ■
ricklin
Posted: 5/23/2006
Check with local church groups. ■
Buck L. Margin
Posted: 1/19/2007
Check the classified advertisement in Dentaltown under “equipment wanted.” ■
ericyuan007
Posted: 4/20/2007
I would donate the equipment to DentalVolunteer (Web site is dental
volunteer.org). They connect volunteers with dental volunteering opportunities. ■
DRGLEE
Posted: 8/17/2007
I saw an ad in The Dental Trader from Knightsbridge International (501c3 nonprofit organization) requesting supplies and equipment donations for worldwide distribution to humanitarian mission organizations. Your donation is tax-deductible and
they provide pick-up. Call 818-372-6902 or e-mail them at [email protected]. ■
We donate samples of paste, floss and brushes to the homeless shelter. ■
needardh
1/25/2008
Donald J. Greco
Posted: 11/5/2008
Most dental hygiene and assisting schools are happy to take older equipment. ■
fliegenfischen
Posted: 1/24/2009
I donate things to local schools – like toothbrushes and sample toothpaste. ■
Donate to a local school or college. ■
Tim Lott, CPA, CVA
6/19/2009
116
FortHillDMD
Posted: 2/22/2010
Maybe try posting and looking in the classifieds for your state and local states’
dental association classifieds. ■
techguru
Posted: 1/26/2011
You also might contact your local chapter of the ADA to see if they know of someone to whom you can donate. ■
resources “do good”
Nationwide Resources
Interested in helping? Here’s a head start. Contact these for opportunities to donate time, money or equipment.
1-800-Volunteer.org
www.1-800-volunteer.org
Academy of General Dentistry (AGD) Foundation
www.agd.org/agdf
[email protected]
ADA Foundation
www.ada.org/adafoundation.aspx
[email protected] • 312-440-2547
Americorps
www.americorps.gov
The American Academy of Cosmetic Dentistry
Charitable Foundation – Give Back a Smile
Domestic Violence Victims
www.givebackasmile.com
800-773-4227
America’s Dentists Care Foundation - Missions of Mercy
www.adcfmom.org
316-260-5056
Children’s Dental Health Project
www.cdhp.org
Center for Oral Health
www.centerfororalhealth.org/index-new.html
510-663-3727
Children’s Healthy Smile Project
www.childrenssmileproject.org/home
[email protected]
Community Dental Foundation
www.cdental.org
[email protected]
Delta Dental
www.deltadental.com
The Foundation of the American Academy of Pediatric
Dentistry – Healthy Smiles, Healthy Children
www.aapd.org/foundation
Give Kids a Smile
www.givekidsasmile.org
636-397-6453
The Grottoes of North America Humanitarian Foundation
The Dental Care for Children with Special Needs Program
www.hfgrotto.org
[email protected]
National Children’s Oral Health Foundation
www.ncohf.org
800-559-9838
National Dental Association Foundation
www.ndaonline.org
[email protected]
National Dental Hygienists’ Association
www.ndhaonline.org
[email protected]
National Foundation of Dentistry for the Handicapped Donated Dental Services
www.nfdh.org
303-534-5360
National Health Service Corps
www.nhsc.hrsa.gov
Oral Health America’s National Sealant Alliance
www.oralhealthamerica.org
RAM (Remote Area Medical) Foundation
www.ramusa.org
877-5RAMUSA
Dental Jobs
www.dentaljobs.net/volunteer.asp
Special Olympics – Special Smiles
www.specialolympics.org/volunteer_with_healthy_athletes.aspx
Dentistry from the Heart
www.dentistryfromtheheart.org
Volunteers in Medicine
www.volunteersinmedicine.org
[email protected]
117
“do good” resources
State-by-State Resources
Sonrisas Community Dental Center
www.sonrisasdental.org
Alabama
Arkansas
University of Alabama School of Dentistry
at UAB
www.dental.uab.edu
Arkansas State Dental Association
www.arkansasdentistry.org
[email protected]
Alabama Dental Association
www.aldaonline.org
[email protected]
Harmony Health Clinic
www.harmonyclinicar.org/en/volunteers
[email protected]
University of Colorado Denver School of
Dental Medicine
www.uchsc.edu/sod
Sarrell Dental Center
www.sarrelldental.org
[email protected]
California
Colorado Dental Association
www.cdaonline.org
[email protected]
Alaska
Herman Ostrow School of Dentistry of USC
www.usc.edu/hsc/dental
Colorado
Alaska Dental Association
www.akdental.org
[email protected]
Anchorage Neighborhood Health Center
www.anhc.org
907-257-4600
Loma Linda University School of Dentistry
www.llu.edu/llu/dentistry
University of California at Los Angeles
School of Dentistry
www.dent.ucla.edu
Arizona
Western University of Health Sciences
College of Dental Medicine
www.westernu.edu/xp/edu/dentistry/about.xml
Midwestern University College of Dental
Medicine – Arizona
www.midwestern.edu/Programs_and_
Admission/AZ_Dental_Medicine.html
University of California at San Francisco
School of Dentistry
www.dentistry.ucsf.edu
A.T. Still University Arizona School of
Dentistry and Oral Health
www.atsu.edu/asdoh
University of the Pacific Arthur A. Dugoni
School of Dentistry
www.dental.pacific.edu
Arizona Dental Association
www.azda.org
California Dental Association
www.cda.org
[email protected]
Arizona Dental Foundation
www.azdentalfoundation.org
ACT Kids Health Fair
www.actkidshealthfair.org
CASS Dental Clinic
www.cass-az.org/dental.html
602-256-6945 x 3020
Dave Pratt Dental Clinic
www.bgcmp.org/dental.htm
602-271-9961
Berkeley Free Clinic
www.berkeleyfreeclinic.org/pages/dental
Homeless Not Toothless
www.homelessnottoothless.org
310-820-0123
The Modern House Call for Women
www.themodernhousecall.com
[email protected]
877-490-9284
Virginia G. Piper Medical and Dental Clinic
www.stvincentdepaul.net/PS-VirginiaGPiper.htm
602-261-6886
The Children’s Dental Center of
Greater Los Angeles
www.tcdc.org
310-419-3000
El Rio Community Health Center
www.elrio.org
520-792-9890
Dreams Are Possible
www.dreamsarepossible.org/?page_id=1724
[email protected]
118
Kids in Need of Dentistry
www.kindsmiles.org/kind/en/volunteers/how
tovolunteer/
[email protected] • 303-733-3710 x 17
Inner City Health Center
www.innercityhealth.com/clinical
[email protected]
Dental Aid
www.dentalaid.org
[email protected].
Connecticut
University of Connecticut School of
Dental Medicine
www.sdm.uchc.edu
Connecticut State Dental Association
www.csda.com
[email protected]
Connecticut State Dental Foundation
www.csdf.us
Delaware
Delaware State Dental Society
www.delawarestatedentalsocieity.org
[email protected]
Delaware Technical & Community College
Dental Health Center
www.dtcc.edu/sw/dhc
302-657-5176
District of Columbia
Howard University College of Dentistry
www.dentistry.howard.edu
District of Columbia Dental Society
www.dcdental.org
[email protected]
Mary’s Center
www.maryscenter.org
[email protected]
Catholic Charities of the Archdiocese
of Washington
www.catholiccharitiesdc.org/page.aspx?pid=413
[email protected]
202-772-4300
Florida
Nova Southeastern University College of
Dental Medicine
www.dental.nova.edu
University of Florida College of Dentistry
www.dental.ufl.edu
Florida Dental Association
www.floridadental.org
[email protected]
Project: Dentists Care
www.smileflorida.org/access/pdc.html
Florida Dental Health Foundation
www.floridadental.org/foundation
Central Florida Dental Outreach
www.centralfloridadentaloutreach.com
Georgia
Medical College of Georgia School
of Dentistry
www.mcg.edu/SOD
Georgia Dental Association
www.gadental.org
[email protected]
Ben Massell Dental Clinic
www.benmasselldentalclinic.com
404-881-1858
Macon Volunteer Clinic
www.maconvolunteerclinic.com
[email protected]
Hawaii
Hawaii Dental Association
www.hawaiidentalassociation.net
[email protected]
Aloha Medical Mission
www.alohamedicalmission.org/volunteerhawaii-programs
808-847-3400
Mobile Care Health Project
www.catholichawaii.org/social_ministry/mob
ilecare
Idaho
Idaho State Dental Association
www.isdaweb.org
[email protected]
Terry Reilly Health Services
www.trhs.org
208-467-4431
Boise School District Health Services
www.sd01.k12.id.us/health/index.html
Garden City Community Clinic
www.genesisworldmission.org/getlocal.htm
[email protected]
Illinois
Southern Illinois University Edwardsville
School of Dental Medicine
www.siue.edu/dentalmedicine
Trinity Free Clinic
www.trinityfreeclinic.org/volunteer
Gennesaret Free Clinic
www.gennesaret.org
317-639-5645
Iowa
University of Iowa College of Dentistry
www.dentistry.uiowa.edu
Iowa Dental Association
www.iowadental.org
[email protected]
Iowa City Free Medical & Dental Clinic
www.freemedicalclinic.org
[email protected]
Community Health Free Clinic
www.communityhfc.org
[email protected]
Kansas
Illinois State Dental Society
www.isds.org
[email protected]
Kansas Dental Association
www.ksdental.org
[email protected]
University of Illinois at Chicago College
of Dentistry
www.dentistry.uic.edu
Kansas School Oral Health Screening Initiative
www.kdheks.gov/ohi
[email protected]
Midwestern University College of Dental
Medicine – Illinois
www.midwestern.edu/Programs_and_Admiss
ion/IL_Dental_Medicine.html
Chicago Dental Society
www.cds.org/for_your_practice/clinic_volunteering.html
Chicago Dental Society Foundation
www.chicagodentalsocietyfoundation.org
312-836-7301
CommunityHealth
www.communityhealth.org
Indiana
Marian Clinic
www.marianclinic.org
[email protected]
785-233-9780 x 330
Kentucky
University of Kentucky College of Dentistry
www.mc.uky.edu/Dentistry
University of Louisville School of Dentistry
www.dental.louisville.edu/dental
Kentucky Dental Association
www.kyda.org
[email protected]
Indiana University School of Dentistry
www.iusd.iupui.edu
Kentucky Dental Foundation
www.kyda.org/kdf.html
Indiana Dental Association
www.indental.org
[email protected]
White House Clinics
www.whitehouseclinics.com/howyoucanhelp.htm
859-626-7700 x 4044
119
HealthPoint Family Care
www.healthpointfc.org
Massachusetts
Boston University Henry M. Goldman
www.dentalschool.bu.edu
Louisiana
Doorstep Healthcare Services
www.doorstephealthcare.org/mobile
763-541-6000
Helping Hand Dental Clinic
www.westsidechs.org
[email protected]
Louisiana State University School of Dentistry
www.lsusd.lsuhsc.edu
Harvard University School of
Dental Medicine
www.hsdm.harvard.edu
Louisiana Dental Association
www.ladental.org
[email protected]
Tufts University School of Dental Medicine
www.tufts.edu/dental
Migrant Health Service, Inc.
www.migranthealthservice.org/en/dental
800-842-8693
Louisiana Seals Smiles
www.dhh.louisiana.gov/offices/?ID=376
Massachusetts Dental Society
www.massdental.org
[email protected]
Mississippi
Greater Baton Rouge Community Clinic
www.gbrcc.org
The Sharewood Project
www.sharewood.info
[email protected]
All Saints Dental Clinic
www.foodbankofcovington.org
985-871-3939
Community Health Center of Cape Cod
www.chcofcapecod.org
508-477-7090
Michigan
Maine
Maine Dental Association
www.medental.org
[email protected]
Maine Dental Health Out-Reach
www.mdho.org
Waldo Community Action Partners
www.waldocap.org
Knox County Health Clinic
www.knoxclinic.org/dental.html
Maryland
University of Maryland Baltimore College
of Dental Surgery
www.dental.umaryland.edu
Maryland State Dental Association
www.msda.com
[email protected]
Mission of Mercy
www.amissionofmercy.org/marylandpennsylvania/getinvolved/volunteer.asp
[email protected]
410-340-3791
Health Care for the Homeless
www.hchmd.org/dental.shtml
[email protected]
120
University of Michigan School of Dentistry
www.dent.umich.edu
University of Detroit Mercy School
of Dentistry
www.dental.udmercy.edu
Michigan Dental Association
www.smilemichigan.com
[email protected]
CareFree Dental Clinic
www.carefreemedical.com/dental.htm
[email protected]
517-887-5922 x 8
DePaul Dental Clinic
www.svdpdet.org/volunteer.html
Tri-County Dental Health
www.dentalhealthcouncil.org
Medical Teams (MI)
www.medicalteams.org
[email protected] • (503) 624.1000
Minnesota
University of Minnesota School of Dentistry
www.dentistry.umn.edu
Minnesota Dental Association
www.mnental.org
[email protected]
University of Mississippi Medical Center
School of Dentistry
www.dentistry.umc.edu
Mississippi Dental Association
www.msdental.org
Mission First Dental Clinic
www.missionfirst.org/medicaldentalclinic
Missouri
University of Missouri – Kansas City
School of Dentistry
www.umkc.edu/dentistry
Missouri Dental Association
www.modental.org
[email protected]
Kansas City Free Health Clinic
www.kcfree.org/services/dental.html
816-777-2761
The Kitchen Dental Clinic
www.thekitcheninc.org/clinic.php
Miles for Smiles Mobile Dental Unit
www.citizensmemorial.com/community/milessmiles.html
417-328-6334
Montana
Montana Dental Association
www.mtdental.com
[email protected]
Montana State University Oral Health
Screening Program
http://healthinfo.montana.edu/dental.html
[email protected]
406-994-5627
Nebraska
University of Nebraska Medical Center
College of Dentistry
www.unmc.edu/dentistry
Creighton University School of Dentistry
www.creighton.edu/dentalschool/
Nebraska Dental Association
www.nedental.org
[email protected]
Council Bluffs Community Health Center
www.cbchc.com
712-256-9151
Nevada
University of Nevada, Las Vegas School of
Dental Medicine
www.dentalschool.unlv.edu
Nevada Dental Association
www.nvda.org
[email protected]
Northern Nevada Dental Health Program
www.nndental.org/default.php?p=Hp
Albuquerque IHS Dental Clinic
www.ihs.gov/AIDC
New Mexico Dental Hygienists Association
www.nmdha.org
[email protected]
San Juan College – Dental Hygiene Program
[email protected]
505-566-3642
New York
University at Buffalo The State University
of New York School of Dental Medicine
www.sdm.buffalo.edu
Columbia University College of
Dental Medicine
www.dental.columbia.edu
New York University College of Dentistry
www.nyu.edu/dental
State University of New York Stony Brook
www.stonybrookmedicalcenter.org/dental
New York State Dental Association
www.nysdental.org
[email protected]
Southern Nevada Dental Society
www.sndsonline.org
702-733-8700
New York State Dental Foundation
www.nysdentalfoundation.org
New Hampshire
North Carolina
New Hampshire Dental Society
www.nhds.org
[email protected]
University of North Carolina School
of Dentistry
www.dentistry.unc.edu
Lamprey Health Care’s School-Based
Dental Program
www.lampreyhealth.org/index.php/patientservices/community_health_outreach _page/
[email protected]
East Carolina University School of Dental
Medicine (Opening August 2011)
www.ecu.edu/dentistry/index.cfm
New Jersey
North Carolina Dental Society
www.ncdental.org
[email protected]
University of Medicine & Dentistry of New
Jersey – New Jersey Dental School
www.dentalschool.umdnj.edu
Blue Ridge Free Dental Clinic
www.blueridgefreedentalclinic.org
[email protected]
New Jersey Dental Association
www.njda.org
[email protected]
North Dakota
New Mexico
New Mexico Dental Association
www.nmdental.org
[email protected]
Ohio
Case Western Reserve University School of
Dental Medicine
www.dental.case.edu
The Ohio State University College of Dentistry
www.dent.ohio-state.edu
Ohio Dental Association
www.oda.org
[email protected]
Ohio State Dental Board – Ohio
Association of Free Clinics
www.dental.ohio.gov
614-466-258
Oklahoma
University of Oklahoma College of Dentistry
www.dentistry.ouhsc.edu
Oklahoma Dental Foundation
www.okdf.org
Oregon
Oregon Health and Science University
School of Dentistry
www.ohsu.edu/sod
Oregon Dental Association
www.oregondental.org
[email protected]
The Dental Foundation of Oregon
www.smileonoregon.org
[email protected]
Medical Teams (OR)
Pennsylvania
Temple University The Maurice H.
Kornberg School of Dentistry
www.temple.edu/dentistry
University of Pennsylvania School of
Dental Medicine
www.dental.upenn.edu
North Dakota Dental Association
www.nddental.com
[email protected]
University of Pittsburgh School of
Dental Medicine
www.dental.pitt.edu
Migrant Health Service, Inc.
www.migranthealthservice.org/en/dental
800-842-8693
Pennsylvania Dental Association
www.padental.org
[email protected]
121
Community Volunteers in Medicine
www.cvim.org/volunteers.aspx
University of Texas Health Science
Center – San Antonio Dental School
www.dental.uthscsa.edu
Charlottesville Free Clinic
www.cvillefreeclinic.org/index.html
Puerto Rico
Texas Dental Association
www.tda.org
[email protected]
Washington
University of Puerto Rico School of
Dental Medicine
www.dental.rcm.upr.edu
Colegio de Cirujanos Dentistas de Puerto Rico
www.ccdpr.org
[email protected]
South Carolina
Medical University of South Carolina James
B. Edwards College of Dental Medicine
www.musc.edu/dentistry
South Carolina Dental Association
www.scda.org
[email protected]
Anderson Free Clinic
www.andersonfreeclinic.org
South Dakota
South Dakota Dental Association
www.sddental.org
[email protected]
Tennessee
Tennessee Dental Association
www.tenndental.org
[email protected]
The University of Tennessee Health Science
Center College of Dentistry
www.uthsc.edu/dentistry
Meharry Medical College School of Dentistry
www.mmc.edu/education/dentistry
Interfaith Dental Clinic
www.interfaithdentalclinic.com/vols.aspx
[email protected]
615-329-4790
San Antonio Christian Dental Clinic, Inc.
www.sachristiandental.org
210-226-8041
HOPE Clinic
www.hope-clinic.org
Utah
Utah Dental Association
www.uda.org
[email protected]
Utah Department of Health
www.health.utah.gov/oralhealth/volunteer
opportunities.htm
Baylor College of Dentistry Component
of Texas A & M Health Science Center
www.tambcd.edu
University of Texas Health Science
Center – Houston Dental Branch
www.db.uth.tmc.edu
122
Washington State Dental Association
www.wada.org
[email protected]
Medical Teams (WA)
West Virginia
West Virginia University School of Dentistry
www.hsc.wvu.edu/sod
West Virginia Dental Association
www.wvdental.org
[email protected]
Utah Dental Alliance
www.uda.org
Change, Inc.
www.changeinc.org
Vermont
Wisconsin
Vermont State Dental Society
www.vsds.org
[email protected]
Rutland Free Clinic – Medical and
Dental Clinics
www.vccu.net/rfc.htm
Red Logan Dental Clinic
www.vccu.net/rldc.htm
www.goodneighborhealthclinic.org/volunteers
[email protected].
Marquette University School of Dentistry
www.dental.mu.edu
Wisconsin Dental Association
www.wda.org
[email protected]
Fowler Memorial Free Dental Clinic
www.fowlerclinic.org/index.aspx
608-328-9404
Wyoming
Wyoming Dental Association
www.wyda.org
[email protected]
Virgin Islands
Virgin Islands Dental Association
340-777-6612
Virginia
Texas
University of Washington School
of Dentistry
www.dental.washington.edu
Virginia Commonwealth University School
of Dentistry
www.dentistry.vcu.edu
Virginia Dental Association
(includes Missions of Mercy)
www.vadental.org
[email protected]
Community Action of Laramie County,
Inc. – Cheyenne
www.calc.net
To get even more specific, you can search for
local dental associations and societies here:
www.ada.org/localorganizations.aspx n
from trisha’s desk hygiene & prevention
Volunteering by RDHs
by Trisha E. O’Hehir, RDH, MS, Hygienetown Editorial Director
Many Townies participate in volunteer programs
at home and around the world. Hygienetown
Townies have traveled to Honduras, Peru, Ecuador,
the Galapagos Islands, Romania, India and Mexico as
volunteers providing everything from local anesthesia
to oral hygiene instructions. They pay their own way
on these trips and bring their own instruments and
supplies. The overwhelming response from all who
have participated in volunteer trips overseas is the
sense of receiving much more from those who they
met and treated than they gave in their time and
expertise as dental professionals. The sense of appreciation by those they treated was amazing.
Closer to home, many more Townies volunteer at
local community free clinics, providing a half day
here and there, or some find time to volunteer on a
weekly or monthly basis. Clinics close to home need
your volunteer services as much as those far away. The
dental needs found in third-world countries are also
found in our own neighborhoods. Dental hygiene
and dental students often learn about local free clinics through rotations in these clinics. Several Townies
have participated in large community-based RAM or
Remote Area Medical clinics. First designed to bring
medical and dental care to rural areas, RAM also provides 10-day clinics in cities like Los Angeles, with
hundreds of dental volunteers. Others are part of an
entire dental team that opens the office one day each
year to provide free dental care to those in need as
their own community service or through a state or
national program like Give Kids A Smile.
Townies are also generous with their time, taking
the prevention message to daycare centers, schools
and senior centers. They teach preschoolers what to
expect when visiting the dental hygienist for the first
time, complete with gloves for them to wear. Others
use puppets to teach grade-school children oral
hygiene and to bring in nutrition, they build a pizza
using healthy foods. Education is fundamental to prevention and Townies teach teenagers about the dangers of sour, tart, tangy, acid candies, gums, mints,
sports drinks and fruit-flavored waters. To senior centers, Townies bring the news of xylitol, a sweet way to
reduce bacterial biofilm in the mouth. The messages
are adapted to the age of the audience bringing information and fun to the experience.
Personally I donate time, money and services to
AD World Health, a foundation begun by my stepson and daughter-in-law. I serve on the board of
directors as the secretary and have traveled to India to
perform dental screenings and teach the children and
adults basic oral hygiene at the Manjushree orphanage in Tawang, India on the India/China border at
10,000 feet. AD World Health, located in Los
Angeles, California, is currently building a medicaldental clinic locally to provide care to underserved
people in the Los Angeles area. AD World Health
provides needed medical and dental care at the same
time as providing an educational experience for medical, dental and dental hygiene students.
We are blessed to be in the dental profession, able
to help others and provide for ourselves and our families. You might give back with your time, clinical
services, equipment and supply donations or monetarily. However you decide to give back, your donations are sincerely appreciated and make a difference
in the lives of others. Thank you for your generosity
and caring. We have much to be thankful for in our
lives. Giving back is second nature to dental professionals, and it turns out, you don’t have to go far from
your own front door to find somewhere to help. n
In This Section
124 Perio Reports
128 Townie Poll: Fresh Breath
130 Profile in Oral Health:
Sitting Doesn’t Have to be a Pain in the Butt
133 Message Board: Acute Lymphocytic Leukemia
134 Message Board: Frozen Shoulder
Look for additional content in the Hygienetown Magazine digital edition.
123
hygiene & prevention perio reports
Perio Reports
Vol. 23 No. 5
Perio Reports provides easy-to-read research summaries on topics of specific interest to clinicians.
Perio Reports research summaries will be included in each issue to keep you on the cutting edge of dental hygiene science.
Toothbrush Better Than Sponge
for Intubated Patients
Patients in intensive care units that have been intubated
are at risk for ventilator-associated pneumonia (VAP), a lifethreatening condition. The incidence varies between nine and
45 percent of those intubated, with a mortality rate of 50 percent. Risk factors for VAP include underlying medical conditions, immunosuppression, brain injury, factors related to
airway and ventilator management, presence of naso- or orogastric tubes and medication. Another risk factor is aspiration
of oral bacterial biofilm in saliva. Although low levels of respiratory pathogens are found in oral plaque, oral pathogens are
detected in the lungs preceding the development of VAP.
Researchers at University College London compared
power toothbrushing to the use of a sponge toothette for
plaque control for intubated patients recently admitted to
the National Hospital for Neurology and Neurosurgery in
London, U.K. Colgate Actibrush was compared to a sponge
toothette. Both treatments were provided by the nursing staff
every six hours for two minutes. Chlorindioxide was used on
the brush and the sponge each time.
Plaque levels and bacterial counts were gathered on day
one before the first oral hygiene intervention and again on
days three and five. More plaque was removed by the
Actibrush than by the sponge. A distinction was made by the
authors between decontamination with chlorhexidine and
plaque removal with either the Actibrush or sponge.
Mechanical disruption of the plaque with the power toothbrush is considered more effective than antimicrobial chemicals to control oral biofilm and prevent VAP.
Clinical Implications: Toothbrushing is more effective in
reducing oral biofilm than wiping with a sponge toothette.
Needleman, I., Hirsch, N., et. al.: Randomized Controlled Trial
of Toothbrushing to Reduce Ventilator-Associated Pneumonia
Pathogens and Dental Plaque in a Critical Care Unit. J Clin
Perio 38: 246-252, 2011. n
124
Soft Bristle Toothbrushes Best
Oral bacterial biofilm is
the primary etiologic factor
in both caries and periodontal disease. Mechanical disruption using a toothbrush
is the best way to remove
biofilm from facial and lingual surfaces of the teeth.
Researchers at Witten/Herdecke University in Witten,
Germany compared similar manual toothbrushes with
different bristle stiffness to determine effects on plaque
removal, gingival bleeding and tissue damage.
Dr. Best toothbrushes from GlaxoSmithKline were
used for the study creating three groups: soft, medium and
hard. A total of 120 healthy volunteers participated in this
eight-week study. Subjects were instructed to brush twice
daily for two minutes each time.
At four weeks and eight weeks, plaque levels were
reduced for all groups, with plaque levels reduced slightly
more for the hard-bristle toothbrush group. Bleeding was
reduced significantly more for those in the soft toothbrush
group and increased from baseline levels in the hard toothbrush group. The medium toothbrush fell between the
soft and hard bristle toothbrushes. The soft bristles might
reach subgingivally more comfortably to remove subgingival plaque, thus explaining lower bleeding scores for the
soft toothbrush users.
Evaluation of gingival abrasion revealed an average
of 20 lesions in the hard toothbrush group, six in the
medium toothbrush group and only two in the soft toothbrush group.
Clinical Implications: Hard bristle toothbrushes will
remove more plaque from smooth surfaces, but they
will also cause tissue trauma compared to soft bristle
toothbrushes and lead to higher bleeding scores.
Zimmer, S., Öztürk, M., Barthel, C., Bizhang, M., Jordan,
R.: Cleaning Efficacy and Soft Tissue Trauma After Use of
Manual Toothbrushes with Different Bristle Stiffness. J Perio
82: 267-271, 2011. n
perio reports hygiene & prevention
Like Father, Like Son – Like Mother, Like Daughter
Intergenerational studies show associations between the
parents and offspring for cardiovascular disease, diabetes,
metabolic syndrome, cancer, asthma, obesity, smoking, alcohol use and drug abuse. Many studies have evaluated the
familial role played in aggressive periodontitis, but few studies are available evaluating the intergenerational effect of
chronic periodontitis.
Researchers at Otago University in Dunedin, New
Zealand wanted to know if family history of periodontal disease was a risk factor for future disease in the offspring.
Study subjects were part of the Dunedin Multidisciplinary
Health and Development Study (DMHDS). During the age32 assessments, a total of 913 subjects received a complete
periodontal examination. Parents of these subjects participated
in interviews about their periodontal health, being asked if
they were ever told they had periodontal disease, were ever
treated for periodontal disease or if they lost teeth due to periodontal disease. One or both parents were interviewed for 849
subjects and both parents were interviewed for 625 subjects.
Parents were divided into two groups – high risk and
low risk. Subjects whose parents were in the high risk group
were more likely to show early signs of pocketing and
attachment loss. Not surprising, those who smoked and had
higher plaque scores also had deeper pockets and more
attachment loss.
Identifying high-risk individuals early might lead to earlier preventive intervention and thus prevent the disease and
the associated cost involved with treatment later.
Clinical Implications: Parents share not only their genes
and their saliva; they also share environmental and oral
hygiene habits, leading to similar periodontal health
between parents and offspring.
Shearer, D., Thomson, M., Caspi, A., Moffitt, T., Broadbent, J.,
Poulton, R.: Inter-Generational Continuity in Periodontal
Health: Finding from the Dunedin Family History Study. J Clin
Perio 38: 301-309, 2011. n
Risk for Tooth Loss After Therapy
Aggressive periodontitis (AgP) also called “early onset periodontitis” or “localized juvenile periodontitis” is a rare disease
that is characterized by rapid attachment loss and bone loss. It
affects young people and can lead to edentulism early in life. AgP runs in families and
affects less than one percent of the population. Treatment is similar to that provided for
chronic periodontitis, non-surgical, surgical
and oral hygiene.
Researchers at the University of Heidleberg
in Germany wanted to know the risk for tooth
loss after treatment for AgP. They invited
patients who had been treated at the University Hospital
Periodontology Clinic between 1992 and 2005 to participate in
the study. A total of 84 patients agreed to be re-examined. A full
periodontal examination was done and past records were evaluated
to determine the supportive periodontal therapy (SPT) intervals
and if any teeth had been lost.
Less than half of the subjects lost teeth during the ensuing
years of SPT and only a few lost more than three teeth. A total
of 133 teeth were lost following therapy, or 0.6 percent. Those
with only a high school education experienced more tooth loss
than those with a college education. Smoking also increased
risk of tooth loss. Those who routinely kept
their SPT appointment were less likely to
experience tooth loss. Those with generalized
disease compared to localized disease also
experienced more tooth loss. Recurrence of
the disease was evident in 24 percent of
those evaluated.
Clinical Implications: Following treatment
for AgP, patients should abstain from smoking and follow
the recommended perio maintenance interval to avoid the
risk of tooth loss.
Bäumer, A., Sayed, N., Reitmeir, P., Eickholz, P., Pretzl, B.:
Patient-Related Risk Factors for Tooth Loss in Aggressive
Periodontitis After Active Periodontal Therapy. J Clin Perio 38:
347-354, 2011. n
125
hygiene & prevention perio reports
Review of Black Stain
Black stain, also known as brown stain, black line stain or pigmented
dental plaque, has been investigated for more than a century and the
exact cause still remains unknown. Researchers agree it is most likely
caused by specific chromogenic bacteria and perhaps metabolism by the
bacteria of iron molecules. The stain might be a thin line or unconnected
dots on the enamel along the gingival margin. Examination of the black
stain finds high levels of calcium, phosphate and an insoluble ferric salt.
Black stain is found in children and
disappears before age 20. Prevalence is
reported to be from one to 20 percent,
depending on the subjects evaluated
and the criteria used for identifying
black stain.
Tobacco use is a significant risk factor for many diseases, including periOver the years several chromogenic
odontitis. Many governments have set smoking cessation goals and guidelines
bacteria have been suggested as the
to encourage professionals to provide the services necessary for smokers to quit.
cause of black stain, primarily Prevotella
Dental hygienists are in the perfect position to question and counsel smokers
melaninogenica and Actinomycetes species.
who are ready to quit, but several studies show the number of dental hygiene
Salivary levels don’t differ between those
clinicians offering smoking cessation counseling to patients is low.
with and without the stain, but the pH is
Researchers at Kings College London Dental Institute at Guys Hospital in
elevated and higher levels of calcium and
the U.K. evaluated hygienists’ attitudes and participation in smoking cessation
phosphate minerals are found in the saliva
activities using a questionnaire. There are approximately 4,000 dental hygienof those with black stain.
ists in the U.K. Surveys were sent to 671 hygienists in the east of England, an
Black stain is not easily removed with
toothbrushing, instead requiring profesarea called the Home Counties. The return rate was 61 percent, with 412 sursional dental hygiene care to remove it
veys returned.
with instrumentation and polishing.
When asked if hygienists should set a good example by not smoking,
Removal reveals intact, healthy enamel
97.4 percent agreed. Also, 93.5 percent of respondents felt it was important
with no demineralization. Not in all, but
to ask patients about smoking habits. Although hygienists were optimistic
in many studies, caries rates are reported
about offering smoking cessation, 62.8 percent think most people will not
lower for children with black stain comgive up tobacco due to the nicotine addition, even if their hygienist tells
pared to children without the stain.
them they should.
The unusual nature of black stain
Based on other studies, hygienists who don’t offer smoking cessation counand the likelihood that specific bacteria
seling and activities lack the knowledge, training, time, educational materials
are responsible for black stain and lower
and confidence to achieve success with smoking cessation.
caries rates presents a model for the oral
probiotic replacement of missing oral
Clinical Implications: Hygienists with positive attitudes about the effecmicroorganisms.
tiveness of smoking cessation are more likely to initiate smoking cessation
counseling and activities for their patients.
Clinical Implications: Black stain occurs
most often in children and is linked to
Pau, A., Olley, R., Murray, S., Chana, B., Gallagher, J.: Dental Hygienists’ Selfslightly lower caries rates and higher
Reported Performance of Tobacco Cessation Activities. Oral Health Prev Dent 9:
oral pH levels.
29-36, 2011. n
Smoking Cessation in the Hands
of Hygienists
Ronay, V., Attin, T.: Black Stain - A Review.
Oral Health Prev Dent 9: 37-45, 2011. n
126
hygiene & prevention poll
Hygienists’ Opinions About
Fresh Breath
Check out what your peers do in their offices in relation to their patients’ breath in this poll
conducted from February 14, 2011 to March 11, 2011. Don’t forget to visit Hygienetown.com
and participate in the current online poll.
Do you offer a fresh breath program
in your practice?
Do you recommend a specific
tongue cleaner to patients?
26%
Yes
74% No
207 total votes
176 total votes
89%
11%
No
Yes
Do you recommend tongue
cleaning to your patients?
96% Yes
4%
No
172 total votes
Do you provide tongue cleaning
for your patients?
23%
Yes
77% No
176 total votes
Do patients ask you for fresh
breath advice?
78% Yes
22%
No
Do you recommend specific
products for fresh breath?
58% Yes
42%
No
175 total votes
177 total votes
Do you tell patients when
they have bad breath?
Do you tell the dentist when
he or she has bad breath?
44%
Yes
56% No
178 total votes
27%
Yes
73% No
176 total votes
Have you seen tonsil
stones or tonsoliths
in any of your patients?
177 total votes
60%
Yes
12%
Don’t know what
they are
28%
No
128
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129
hygiene & prevention profile in oral health
As a society and specifically as a dental community, we sit
a lot. Whether in our car, at a computer, on the sofa, or on a
dental stool, our spine is sadly at increased risk of injury due
to the excessive amount of sitting we endure most of our day.
Numerous epidemiological studies have shown that clinicians,
as well as professional office workers, who are in a seated position, have an increased chance of suffering from back trouble.
The reference list is endless – but you know firsthand, your
own back pain is evidence enough. The bottom line is this: sitting can be helpful instead of hurtful.
Firstly, to better appreciate why sitting can be so damaging,
it is helpful to understand the curvature of the spine and even
some history regarding the evolution of chairs. The spine has
three natural curves: the cervical, thoracic and lumbar. Every
body has different spinal configurations and degrees of curvature. For example, female gymnasts commonly exemplify a
large degree of lumbar curvature, termed lordosis, and conversely, a retired senior dentist who hunched
over his patients for numerous years,
might show a severe thoracic curvature called a kyphosis.
The spine has a natural gentle lumbar slope at the base of
the spine; however, when we sit, this natural curve is lost and
the amount of pressure on each intervertebral disc is doubled
when compared to the normal lumbar curve when it is not
violated.1 Preventing this loss of curvature is incumbent when
sitting on a chair or dental stool; however, most dental stool
manufacturers have left out this vitally important aspect of
stool mechanics. It has only been very recently that a “lumbar
support” has been added to dental stools, but this simple addition is not enough.
Problems arise when the pelvis, which intricately attaches
to the lower part of the spine at the sacrum, is asked to perform a function it was not designed to do. It is analogous to
the patient who uses anterior teeth to gnash food when some
of the posterior teeth are missing. Over time, inevitable damage occurs.
Chair Changes and Stool Alterations
The earliest chairs were an article of state and dignity as
well as an emblem of authority (e.g., a king or queen’s
throne).2 These chairs were often made of hard wood, ebony
by Juli Kagan, RDH, MEd
130
profile in oral health hygiene & prevention
Fig. 1
Fig. 2
or ivory. In Europe, thanks to the Renaissance
period, chairs ceased to be a privilege and
became a standard item of furniture, but only
for those who could afford them. Ergonomics
was certainly not part of chair design.
Around the early part of the industrial revolution the divide between upper and lower
class became more distinct. The poor working
class stood all day. Up until this time, dental
clinicians also stood; however, some dentists
wanted to sit in order to elevate their status
and earn greater respect in their profession.
In the mid-early-1800s Sir John Tomes of
Britain was the first dentist to have a stool in
his operatory and perhaps the first person to Fig. 1: Due to an unsupported back, the operator perches forward and cranes her neck in order to get closer
sit down and perform dentistry. The chair was to the patient.
“overstuffed,” and by 1870 dental stools were Fig. 2: A combined back support and tilted seat pan allows for a healthy lumbar curve and anteversion of
commercially available to dentists. Despite the pelvis. Note the hip opening to approximately 130 degrees.
the growing market for stools, by the end of
blood to the lower extremities. Lastly, the lower back, which
the century, dentists still did not feel justified in sitting down.3
In 1909, William Reynolds patented the first dental stool.4 must compensate for the head being held down and forward, is
It was not until 1958 that John Naughton, founder of the jeopardized. Imagine a bowling ball hanging from your neck
Comfra Lounge Chair Company, had a meeting with two den- while leaning over a patient and you can understand that your
tists at a convention to create a dental chair. Even at this time, a tail must overcompensate and round under to counterbalance
dental stool for the clinician was not part of the overall design the weight of the head, which can be more than 10 pounds.
along with the patient chair. But after observing the clinicians at More significantly, the head weight is doubled for every inch it
work, Naughton was convinced that the dentist needed to work progresses forward. It is simple physics: what happens at one end
affects the opposite end.
from a seated position to preserve energy.5
Up until about 2004, most stool manufacturers used male
In the medical arena, stools were originally used in the mid1960s when doctors wanted to sit down to evaluate their dimensions to create a stool, and it was often made to “match”
patients. These stools employed a round seat pan and a sort of the décor of the patient dental chair, with little attention to
“one-size-fits-all” phenomenon for quick examinations. Trying operator ergonomics. Currently, with the number of female
to borrow from the medical profession, doctor stools were sim- dentists increasing every year, the advent of a more personalply ineffective for dentists who needed to sit for longer periods ized and customized chair, designed for women in particular,
seems paramount.
of time.
Unfortunately, most seat pans in the industry are too deep for
Dental Stools
the average woman.5 When a woman sits on a stool with a seat
Today, practicing dentistry or dental hygiene requires the cli- pan that is too large, she often has to perch on the edge of the
nician to often sit in a prolonged position. Even while seated the chair in order to work and view the mouth. While seated in this
practitioner works between two positions: active and passive. Up very precarious position, the back is unsupported and the body
until recently, most stool manufacturers only crafted stools to must compensate with sophisticated maneuvers to get closer to
work in the passive position. That is, there was no mechanism the patient. The end result is that the back ultimately gives out.
that allowed the chair to tilt forward.
When there is no forward tilt mechanism the clinician is Back to Ergonomics
There has been tremendous progression of positioning
forced to work from the body instead of the support of the chair.
Working in this compromised position, the upper- and mid- theories over a very short period of time. It was only in 1988
back rounds and becomes kyphotic to get closer to the patient. that ANSI, the American National Standards Institute,
In addition, significant pressure is forced onto the hamstring leg emphasized the 90-degree sitting upright posture as the best
muscles, which bear the brunt of the lean, causing restriction of posture. This position is difficult to maintain, especially
131
hygiene & prevention profile in oral health
when a clinician needs to get close to a
position. This allows the clinician to sit
softly or almost stand while working.
patient, and due to the forward lean,
Assembling all the beneficial features
most people do not sit back far enough
noted above into an effective stool/chair
to get back support in that posture.
was the brainchild of Le Mans racecar
Currently it is believed that opening the
winner and owner of Crown Seating, Steve
hip angle (formed between the top of
Knight. The new innovative chair called
the thighs and the abdomen while
the Virtù was unveiled at the recent
seated) should approximate 130 degrees.
Chicago Midwinter Meeting. It has a
Even in the forward tilt position,
patented ZenWave motion that provides
unless the back is supported by the backmild support while in a forward tilt posirest, stress is put on the spine. Ideally, a
tion (which opens the hips to approxislight backward tilt would be the most
mately 130 degrees), allows the pelvis to
comfortable and perfect position, howrotate forward in a natural position (which
ever, this is impossible in dentistry unless
permits the pelvis to be more anteverted)
we can get a patient dental chair to be susand aligns the spine (keeping it neutral
pended from the ceiling and work under it
and unstressed) thereby protecting the
like a car mechanic works on a lift.
For now only a handful of dedicated The revolutionary Virtú stool/chair with a spine from further injury. The best comchair manufacturers take judicious time to ZenWave seat pan has a unique free-floating ponent is that the backrest moves with the
engineer stools that are ergonomically backrest that aligns the spine, massages the back operator in both the active and passive
sound. More often, stools that “come with muscles and improves blood flow to the vulnera- positions, which massages the vulnerable
a patient chair” are often not customized, ble lumbar region.
lumbar region, promoting blood flow and
nor ergonomically sound.
nutrients to the lower back muscles and
Personalized stools come in a variety of styles each as intervertebral discs. This chair/stool collectively puts all the
unique as the user. For example, Crown Seating sculpts out the important and vital components of stool ergonomics together.
area in the back of the seat pan to relieve pressure on the tailWe have come a long way from wooden chairs and overbone and rounds the front sides of the pan to relieve pressure stuffed stools. Today, the operator demands more comfort and
under the thighs which increases blood flow to the lower legs function while working. But, choosing a stool can be as com(it’s shaped like a bicycle seat) and especially beneficial for plex as the spine itself; every body is different. What might
women users. RPG Dental allows for a forward tilt waterfall work for one body might not work for another. When in the
design, thereby allowing the clinician to maintain a healthy market, try different types of stools for a period of time. See
amount of natural lordosis in the lower back. And as another what works for you. n
example, Orascoptic was one of the first to utilize armrests to
References
aid in neck and shoulder relief.
1. Nachemson, A.The lumbar spine, an orthopaedic challenge. Spine 1976; 1(1):59-71.
Many clinicians are starting to prefer a small, but extra 2. Retrieved from en.wikipedia.org/wiki/History_of_the_chair. February 23, 2011.
thick lumbar backrest, which provides a proprioceptive qual- 3. Wynbrandt, J.The Excruciating History of Dentistry. St. Martin’s Press; New York, NY;
1998: pp 202-205.
ity, allowing continuous feedback to the spine, both in the
active as well as the passive position. Conversely, many female 4. Official Gazette of the United States Patent Office. Jan. 12, 1909: Volume 138; pp.
292-293.
clinicians are favoring the saddle-type stool with no backrest 5. Knight, Steven R. The Art of Humaneering: Designing a Better Stool for Women.
because it aids in moving the pelvis into a more anteriorverted
Sullivan Schein Sidekick, Summer, 2006.
Author’s Bio
Juli Kagan, RDH, MEd: Devoted to wellness, and passionate about physical and mental fitness, as well as proper posture, Juli is
a certified Pilates instructor, yoga teacher and professor of health education. With an energy and enthusiasm that transforms
knowledge into practice, Juli wrote Mind Your Body: Pilates for the Seated Professional and has created numerous free videos on
her Web site. For more information, visit www.julikagan.com.
132
townie clinical hygiene & prevention
Acute Lymphocytic Leukemia
Sometimes clinical signs suggest a serious systemic condition rather than the typical periodontal infection.
A female patient in her late 50s was referred by her general dentist to evaluate
her gingival hyperplasia. The clinical picture suggested a systemic etiology and a
provisional diagnosis of leukemia was made. She was referred to her physician for a
consultation and work up.
Fig. 1
periosupport
Posted: 1/28/2011
Post: 1 of 13
Fig. 2
Fig. 1: Note the atypical gingival hyperplasia on the right side. I did not probe
the patient.
Fig. 2: Maxillary left gingival hyperplasia
A diagnosis of acute lymphocytic leukemia was made. She passed away about six
months later. ■
Thanks for sharing this with us. How sad! Are those large ulcers in
the buccal sulcus also? ■
lindadouglas
Posted: 1/29/2011
Post: 3 of 13
Very often it is the dental professional that makes the tentative diagnosis from the clinical presentation. Yes, absolutely sad and her husband
was a patient of mine as well.
[Posted: 1/29/2011]
Yes, there is some ulceration evident in the vestibules – a red flag! ■
periosupport
Posted: 1/29/2011
Posts: 4 & 5 of 13
Leukemia
Find it online at
www.hygienetown.com
133
hygiene & prevention message board
Frozen Shoulder
One of the risks of clinical work is a frozen shoulder or adhesive capsulitis, which causes pain and stiffness in the shoulder leading to limited
range of motion.
mmmrdh
Posted: 3/15/2011
Post: 1 of 11
134
I have been having a lot of pain in my right shoulder, wrist, elbow and now
fingers for the past month. Have been using NSAIDs and icing it, but it has been
getting worse. Went to see the MD yesterday and she said I have a frozen shoulder.
No patients for two weeks and physical therapy for a month.
Has anyone else had this? Did it go away with physical therapy? Will it affect my
clinical abilities in the future? The research I did said it doesn’t seem to be indicative
of any one profession or industry, but I wonder. ■
jelrdh
Posted: 3/25/2011
Post: 5 of 11
Had frozen shoulder months after mastectomy and it took a year to get it back
to no pain. Pain did not usually bother me at work. Good luck. Not all physical
therapists are equal. Hope you find a good one. ■
jlj2595
Posted: 3/25/2011
Post: 6 of 11
Does this involve your neck as well? I have had (for years) multiple episodes of
frozen neck and shoulder with radiating numbness to my non-dominant hand. I
have been a clinical RDH since 1989 and finally found relief with a combination
of chiropractic care and exercise. I found acupuncture to be helpful as well.
NSAIDS, massage and icing were not enough. Physical therapy alone was minimally helpful and my primary care physician had suggested cortisone injections
(this is when I decided to try chiropractic treatment).
I believe a “frozen shoulder” is also known as thoracic outlet syndrome and rotator cuff tendinitis.
I also found wearing magnification loupes very helpful to improve my
ergonomics. Poor patient operator positioning is a key cause of these disorders.
Making certain to position your patient supine (patient heels even with the chin) is
critical to better clinician alignment and will work especially well with loupes. Also,
keep your “wings” in to prevent the strain on the shoulders. It might take many
months to undo years of wear, so be patient. I hope you find relief soon! ■
periopeak
Posted: 3/25/2011
Post: 7 of 11
I have a sister who carries heavy trays for a living with her right arm
and shoulder; she ended up with this condition. I urged her to see a chiropractor with a good familiarity with this condition and of the “proadjuster” method (computer scan method) of chiropractic. She waited and
waited (very skeptical about chiropractors) and was in severe chronic pain
for months. She finally went to a chiropractor because she couldn’t handle the pain
anymore. Long story short, she is all better after this care and has had no recurrence
for over a year now. No surgery or other things required; a full recovery it seems. You
can go online to find a “pro-adjuster” doctor near you. ■
message board hygiene & prevention
I have very similar pain! I am currently in pain management and going through
lidocaine IV fusion therapy. I just started and it seems to be working. I know people
that have gone through this therapy and have been pain-free for more than two years.
I got some relief from Voltaren cream. The treatment that helps the most is stretching and watching my ergonomics. I would also consult an orthopedic surgeon. ■
KeriRDH
Posted: 3/26/2011
Post: 8 of 11
I currently am being treated for frozen shoulder by an orthopedic surgeon. My
treatment has consisted of three cortisone shots two months apart with some physical therapy. He said it’s common in peri-menopausal women and that, if we do nothing, it will go away on its own in a couple of years. Fortunately for me, I do not
practice clinically. I was working three hours a week clinically, but gave that up when
this started. My full-time job is teaching and there are some things I can’t do, like turn
on my overhead projector to get a PowerPoint presentation going. My students help.
Also writing on the white board is difficult if I go too high. Being on the computer is
not good.
Did you have an X-ray or an MRI? It’s important to get a correct diagnosis. I
struggled for a few months with an incorrect diagnosis of rotator cuff tendonitis
because my internist did not refer me to an orthopedist soon enough. I went through
painful physical therapy for the wrong condition! I say that to spare you the suffering.
Get an X-ray and see a specialist! ■
AnnieB25
Posted: 3/27/2011
Post: 9 of 11
Though this might seem too simple to really work – I have a close
friend who has been in massage therapy for many years. She has spent
huge amounts of money to further her knowledge in neuromuscular therapy (NMT). This woman works miracles on muscle problems. If you
can track down a therapist who is skilled at NMT you might save yourself months of pain and a lot of money or even surgery. The NMT is fast, too. Start
calling around to the local massage schools or tap into the massage network in your
area to find that person with the hands of gold. ■
shazammer1
Posted: 3/27/2011
Post: 10 of 11
I have had some physical therapy and am definitely showing improvement in
range of motion and level of pain. Not 100 percent yet, but definitely better than I
was two weeks ago (and able to back off a bit on the NSAIDS).
The physical therapist has been using a combo of heat, ultrasound, massage, exercises and cold. I am following up at home with heat, exercise and cold before I turn
in at night. When I start seeing patients again she is going to come in and evaluate
my posture, etc. I will also probably contact our ergonomics department for an evaluation. She also suggested I start getting regular massages. Tomorrow I have an
appointment with someone in our integrative medicine department that was recommended by another hygienist. ■
mmmrdh
Posted: 3/28/2011
Post: 11 of 11
Frozen Shoulder
Find it online at
www.hygienetown.com
135
dentally incorrect
mother was walking
with her four-year-old
daughter one day when
the daughter picked up something off the ground and started
to put it into her mouth. The
mother stopped her and said
she shouldn’t do that.
A
“Why,” asked the little girl.
“Because it’s dirty. It’s been
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The little girl looked up at her
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Transcription

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