e - Dentaltown

Transcription

e - Dentaltown

A Statistical Look at the State of Dentistry (see page 106)
Dentaltown Magazine www.dentaltown.com
October 2011 » Volume 12, Issue 10
October 2011 » Volume 12, Issue 10 » Practice Management/Statistics
Howard Speaks:
Howard Goes to Mexico
page 12
Professional Courtesy:
Profile: AMD LASERS
Can Golf Help Your Dental Game?
page 16
Meet the Ironman of Dentistry
page 94
Should You Bother with Long-term Care?
by Dr. Douglas Carlsen, page 62
Periodical Publications Mail Agreement No. 40902037
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contents October 2011
Long-term Care:
insurance feature
Should You Bother?
You can’t be sure if or when you
will need long-term medical care.
Dr. Douglas Carlsen explains how
to approach the insurance issue.
62
106
by Douglas Carlsen, DDS
62
dental statistics
dental statistics
http://www.adea.org/publications/tde/Documents/See%20All%20Predoctor
al%20Dental%20Applicants%20and%20Enrollees%20GraphsLatest.pdf
http://www.adea.org/publications/tde/Documents/Total%20U.S.%20Dent
al%20School%20Graduates%201960-2009.pdf
A statistical look at
the state of dentistry
34.3%
39.4%
I
I
I
Utah
1
Alan Miller, founder of AMD LASERS
I
I
I
I
I
2008-09
I
I
I
I
Number of Dental
School Graduates
Per Year
Source: American Dental Association, Survey of Advanced
Dental Education, 2008-2009
http://www.adea.org/publications/tde/Documents/Total%20U.
S.%20Dental%20School%20Graduates%201960-2009.pdf
Articles
12
16
Howard Speaks:
I Went to Mexico and All I Got Was This
Incredible Experience
Each month, Dr. Howard Farran shares his unique
insights about the dental profession. This month,
Dr. Farran’s message to dentists centers on his recent
mission trip to Mexico, providing dental care to those
in need.
Professional Courtesy:
Better Dentistry Through Golf
Dr. Thomas Giacobbi talks about the connection
between golf and dentistry.
18
Second Opinion:
The Importance of the Generalist-Specialist
Relationship in the New Economy
Dr. Jay Reznick explains that in order to keep the dental profession afloat, general dentists and specialists
must work together.
68
Why You Should Know: W Promote
Dr. Thomas Giacobbi introduces readers to W Promote,
a full-service online marketing firm.
70
Rent-a-Dentist
Dr. Joe Steven Jr. explains the importance of having a
dental community.
I
I
dentaltown.com « October 2011
I
54
October 2011 » dentaltown.com
Statistics
4,796
2000-01
continued on page 80
78
It’s All About
1
West Virginia
Texas
I
I I
%
.3
46
%
.2
47
%
.5
46
%
%
.0
.6
45
46
%
.2
44
1960-61
1
Virginia
Tennessee
I
1
I
%
%
.8
.7
53
52
%
%
.4
53
.3
53
%
%
.9
54
.7
55
3,253
1
4,171
04
10
1970-71
3
Wisconsin
2
Washington
1
3,749
20
20
09
08
20
3
20
03
20
02
01
20
20
00
20
1
1980-81
%
07
.9
43
20
%
05
1
5,256
%
.6
.0
56
%
%
.3
44
.7
43
20
06
2
South Carolina
4
1990-91
%
.1
20
13,742
12,178
4,796
1
Ohio
1
Oregon
2
Oklahoma
2
Pennsylvania
1
Source: American Dental Education Association, U.S. Dental School Applicants and Enrollees, 2009 and 2010 Entering Classes
http://www.adea.org/publications/tde/Documents/Applicants%20by%20Gender,%202000%20to%202009.pdf
36.2%
12,463
4,714
http://www.adea.org/publications/tde/Documents/2010%20Dental%20Schools%20list.pdf
1
4,233
55
56
%
.7
41
%
.4
56
%
.3
40
%
.7
59
Female
46.1%
41.7%
10,731
4,515
2008
Male vs. Female Dental School Applicants
Male
9,433
4,478
2007
Nebraska
1
2006
New Jersey
2
4,350
2005
Applicants
58.9%
57.7%
7,537
8,176 54.3%
4,443
2004
Graduated
53.7%
7,770
4,349
2003
82.6%
7,412
4,367
2002
North Carolina
1
4,171
2001
Missouri
3
4,233 5,123
2000
Mississippi
1
Michigan
2
Maryland
Iowa
Illinois
1
Minnesota
3
Massachusetts
1
Kentucky
1
Louisiana
3
Florida
Arizona
1
Indiana
Alabama
Colorado
1
Georgia
1
District of Columbia
6
Connecticut
2
California
EDUCATION Current Number of Dental Schools by State
1990
Nevada
statistics
Percentage of Dental School Graduates vs. Applicants
New York
about
it’s all
1
79
Check out this
statistical look at the
state of dentistry.
76
Restoration of a Central Incisor with
Tetric EvoCeram
Dr. David Hacmoun discusses the intricate fabric of
enamel in this restorative case presentation.
82
12 Marketing Ideas that Don’t Break the Bank
The marketing budget is often the first area to get cut
during a recession. Dr. Rhonda Savage explains smart
ways to market a practice.
92
Precision in 3D
Dr. Justin Moody discusses the benefits of using CBCT
for implants and implant restorations
94
Office Visit: I Am Ironman
Winner of the Rhode Island Half-Ironman and practicing dentist, David Kahn balances his two passions.
100
Office Visit: Serving Those Who Have Served
Dentists and students at University of Las Vegas volunteer at a charity for veterans to receive needed
dental work.
104
Shared Traits of Highly Successful Practices
Rachel Stutzman identifies five key commonalities
among dental teams that contribute to the success of
the practice.
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continued on page 4
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contents October 2011
continued from page 2
Message Boards
Townie Clinical
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Practice Management:
The Most Important Measure of Dentist Efficiency
Dentists have so many different practice styles and
staff sizes. What is the best metric for comparison?
42
36
Practice Management:
Morning Huddle – Again
Did you give up on the morning huddle? Give it a
second chance.
Hygiene and Prevention
113
114
From Trisha’s Desk:
Creating Your Personal Oral Health Directive
Perio Reports
• Perio Pathogen Linked to Brain Abscess
• Saving Questionable and Hopeless Teeth
• Obesity and Dental Caries in Adolescents,
No Direct Link
• Toothbrush Age and Plaque Removal
• Triple-headed Toothbrush
• Soft vs. Medium Toothbrushes
118
120
124
Hygienetown.com Message Board:
Tongue Stud Damage – A Case Study
126
Hygienetown.com Message Board:
Increase Doctor’s Production
Profile in Oral Health:
Townies Doing Research
Feature: Facing Our Fears
Kathy Beard, RDH, discusses her personal experience
with obsessive-compulsive disorder.
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Cosmetic:
Difficult Veneers
This well-documented case followed all the right
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Product Profiles
80
86
Zest Anchors
Zest Locator Overdenture Attachments
Removable Prosthodontics:
An Overlooked Opportunity
Dr. Frank Lauciello of Ivoclar Vivident tackles the issue
of prosthodontics among the baby-boom generation,
and explains how the need is growing.
In This Issue
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Implant Case – Variations on a Theme
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Variations on a Theme
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continued on page 8
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Krieger Aesthetic &
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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
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Stomapol
Serocka, Wyszkowa, Poland
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Southern California Center for Oral and
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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
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Canyon Dental
North Vancouver, British Columbia, Canada
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howard speaks
I Went to Mexico and All I Got Was
This Incredible Experience
by Howard Farran, DDS, MAGD, MBA, DICOI; Publisher, Dentaltown Magazine
About 20 years ago, I was invited to give a lecture in Lafayette,
Louisiana, by one of the world’s greatest dental implantologists, Dr.
Jerome Smith. When I arrived Jerome began telling me about the
missionary dental clinic he’d set up with Dr. Carl Breaux and the
Rev. Larry Myers of Mexico Ministries in Atoyac de Alvarez,
Guererro, Mexico. It wasn’t really a clinic, seeing as they didn’t have
a proper facility, and at the time they were only set up for extractions. Jerome asked me if I’d consider going on the next trip with
him. I figured it was worth the experience, so I left my brand new
family, practice and the United States and shot down to Mexico.
Now, I’m not the most religious guy in the world, but going on
this trip with Jerome and his crew was one of the very few spiritual
experiences I’d ever had in my life. Like you probably are now, I
was carrying a lot of weight on my shoulders between the stress of
home and raising a family, to the stress of the dental practice and
managing a staff and patients. I was trying to learn endo, perio,
pedo and prostho. I had so much on my mind then, but when I
arrived in Atoyac de Alvarez, and I started working on people who
had no electricity, sewage or running water, everything I was worried about back home melted away. It was one of the most relaxing
environments I’d ever been in. The poverty these people lived in
was hard to imagine, yet everyone there had a smile on their faces.
There were no phones or fax machines or freeways. Nobody was
late for work, nobody was worrying about how much they owed
on their Visa card. Nobody was stressed out – aside from the fact
that they needed medical care. They were the happiest most thankful people I’d ever seen in my life. I bumped my head one time and
20 kids laughed about it for 10 minutes straight. It was so cool.
I came back from that trip more
energized and excited and ready to
work than if I’d gone on a two-week
cruise in the Bahamas. I’m serious.
Jerome Smith is very devoted to
this mission. He’s traveled to this
area in Mexico 35 times in the last
20 years and has sunk a lot of his
own personal money into giving this
severely underserved population medical and dental care. He has attracted a
growing list of volunteer physicians, dentists and nurses, along with
lay people who have given generously of their time and resources to
this “work in progress.” Slowly but surely Jerome and his team have
laid a foundation, built some brick walls and have brought the people of Atoyac de Alvarez a full-fledged clinic for medical, dental and
plastic surgery.
Jerome recently invited me to travel with him to Mexico this
year, and this time I brought two of my four sons with me. We
made the trek with three dental school instructors and seven dental
students from the Arizona School of Dentistry & Oral Health –
A.T. Still University. It was so rewarding for me to watch these
seven dental students go to work. We treated more than 300
patients on this trip. We would work all day and talk about dentistry until midnight every single day. These students entered into
the sacred and sovereign profession of dentistry for all the right reasons – treating their fellow man and doing the right thing every
time. They’re not out to “make a killing,” work two days a week and
drive Beemers and Benzes around. We’d talk all night about stuff
like composites and the aesthetic/health compromise. My boys got
to talking with these dental students and really got turned onto
dentistry – for the first time I can remember! I can’t think of any
other trip I’ve taken my boys on that had such a positive impact on
all of us! I can retire and die in peace after witnessing the next crop
of dentists getting ready to enter the profession with such passion
and drive to do the right thing. They did such great work on this
trip to Mexico. Dentistry is going to be in great hands.
Some time in your careers as dentists, you owe it to yourself to
take a trip like this. There are so many
reasons for it! Yes, you are serving a
needy population of people who are
grateful for your help, and that is by
far one of the greatest rewards of
going on a missionary trip like this.
But there are other, more subtle benefits to you.
I grew up Catholic and Catholics
are big into marriage retreats. When
we were little, once a year, our mom
made us go on these weekend retreats
with the Catholic church. We’d comcontinued on page 14
12
howard speaks
Find us on Facebook
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plain and moan about it for days, but we always returned home better for the experience. It took us out of our routines and opened our
eyes to the world around us. That’s what this trip to Mexico was like
for me and my sons! Guys, you don’t realize how much time you are
spending on e-mail, texting, reading, working and watching 24hour news channels until you’re taken out of your element. What is
great about trips like these is being able to break your routine.
When you leave your home, leave your country and go to a village
that doesn’t have an Internet connection or even a telephone, you
begin to realize how weighted down you are.
In that week I talked to my sons more than I talked to them the
entire summer – and we all live under the same roof! I work, they
work, our social lives rarely intersect, we’re all preoccupied with
e-mail and texting, someone usually has headphones on and if we’re
ever in the same room, one is playing a video game, the other is
watching ESPN and the other one is on the phone. We’re spending
time occupying space, but not spending any quality time together.
But being down there in the jungle for a week we had some of the
deepest discussions we had in months, if not years. It was just an
incredible father and son experience.
Here’s something else you should always remember: We have it
good here in the States. The United States and Great Britain are
two of the richest nations on the planet. When we look at the
almost 200 countries that make up the world, 20 of those countries
Howard Live
Seminars
2011-2012
Howard Farran, DDS, MAGD, MBA, DICOI, 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].
14
10-14-11 ■ Bucks County, Pennsylvania
Eastern Dental Society
[email protected]
www.eastern-dental.org
2-17-12 ■ Tarzana, California
Southern California Oral/Facial
Study Club
[email protected]
www.facebook.com/pages/SoCalOralFacial-Study-Club
818-996-1200
3-2-12 – 3-3-12 ■ Birmingham, UK
The Dentistry Show
www.thedentistryshow.co.uk
have 82 percent of the world’s wealth and the remaining countries
fight over the remaining 18 percent. On Planet Earth today, you
have about seven billion people, and for one billion of those people, it’s a pretty awesome life; for the next four billion, life isn’t
quite so awesome; and for the bottom two billion, life really sucks.
And of that bottom two billion there are thousands of people who
wish they’d never been born. To think that it’s 2011 and the number-one cause of death on the planet is diarrhea from drinking
tainted water is just grotesque.
We drive around in our brand-new, sleek, tricked-out cars
equipped with GPS and satellite radio and Bose surround-sound
systems, and every three seconds some toddler in the third-world
dies from diarrhea. Not to mention the horrific turmoil in places
like Sudan that should outrage every single one of us. Even if we
don’t want to go on trips like this, we should at least throw some
money at people like Jerome and the other volunteers who do!
I’m sure Jerome Smith doesn’t want me to write this but I am
going to write it: The operating budget for his facility in Mexico is
somewhere around $100,000 a year and Jerome, along with Drs.
Russell Romero, Carl Breaux, Tom Mattern and Tom Watson have
run this operation for about 20 years. Jerome has gone down there
35 times. He and a handful of volunteers are this village’s only
health care. Dentaltown Magazine reaches more than 100,000 of
you each month. If each one of you donated a dollar to Jerome
Smith each year, this clinic in Mexico could operate worry free.
Here’s the bottom line: I highly recommend taking yourself out
of your comfort zone and traveling to a far off land to do dentistry
for a population that really needs you. Did you read that? I’ll write
it again. They need you! You need to reconnect to the reason we all
got into this great profession in the first place – to help those in
need. It’s a professional spiritual awakening, I swear. You need to get
away from your morning lattés and e-mail. You need to leave your
cell phone, fax machine, iMac and iPad behind. You need to stop
stressing about your crazy schedule, new patients, broken appointments, overhead, the economy, the debt ceiling and the Republican
debates! Ditch your life for five days. Make this your vacation! Why
sit on the beach like a lump for a week when you can change the
lives of people who need you?
If you don’t want to travel, OK, fine, then how about you open
up your pocketbook and donate some money to a guy like Jerome
Smith. Log on to www.latinworldministries.com, check out the
Web site, and give him $20, or $50 or even $100! Donations can
also be mailed directly to:
Latin World Ministries
2 Whitney Circle
Texarkana, TX 75503
You can afford to skip a steak dinner one night. Instead of the
$75 you’re going to drop at the restaurant one night this week, go
buy some Kraft dinner and some fish sticks and put the rest of that
money to good use. The world will be better for it. ■
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Better Dentistry Through Golf
by Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine
Has a patient ever asked you why dentists like golf so much?
Did you know there is more to the connection between golf and
dentistry than just an old stereotype?
I recently slipped a golf question into Dentaltown.com’s
monthly online poll because I was curious to know if I was
playing as much golf as my colleagues. I was shocked to discover
only 18 percent of respondents play golf more than 15 times per
year. I thought that number would be higher. Another 34
percent surveyed indicated they play less than 15 times per year
for a total of 52 percent who play golf. I thought it would be
helpful to compare dentists to the general population. The best
statistic I found was in the neighborhood of nine percent (which
means there are 28.6 million golfers over the age of six, according to a National Golf Foundation report published in 2009).
Ask a patient why there is such a high percentage of dentists who
play golf, they might say, “Because they are rich and work four
days a week.” I would suggest that the relationship between golf
and dentistry is much stronger than that.
GOLF
DENTISTRY
• Golf is an adjunct to many business meetings because it will reveal
more about the people you are with than a business lunch.
• Put someone in a dental chair and you will learn things about him that
his friends don’t know.
• Golf is filled with highs and lows; you can be playing well and then lose
your composure after you hit an errant shot. Now you must figure out a
way to get back on course.
• Some procedures are completed without complication, but others
present surprises when your patient is “feeling it,” your proximal contact is light, a file is separated, a root tip breaks off, an impression has
a bubble… figure out a solution and get your case back on track.
• Golf will test your patience.
• Patients will test your patience.
• Golf is never the same game twice, even when you play on the
same course.
• Every day in your dental practice is different, even when you see the
same patients from one day to another.
• Putting requires a player to read the contours of the green and make
a decision about the best path and speed for his putt.
• Dentistry requires that a dentist can mimic the existing contours of an
anterior tooth when shaping a composite filling on the adjacent tooth.
• Golf is a game you can play with others, but the end result is yours
alone (your score).
• There are many people in your office who help you do dentistry, but
you are ultimately responsible for the end results.
• Read a golf magazine and you will find endless articles about improving your game and the latest equipment.
• Read a dental magazine and you will find endless articles about
improving your practice and the latest equipment to assist your efforts.
• A small number of golfers are quick to purchase the latest driver or
newest game-enhancing ball.
• A small number of dentists will be the first on their block to own the
latest piece of equipment or newest material.
• Golfers buy new equipment to hit the ball straighter, farther or improve
accuracy.
• Dentists buy new equipment and materials to provide faster, better or
more profitable dentistry.
• No matter how good you are at golf, you want to get better.
• No matter how long you’ve been a dentist, you can always get better.
• The satisfaction from sinking a long putt, hitting a great drive or scoring a birdie brings you back for more.
• Cementing a crown without adjustments, finishing an extensive treatment plan or receiving a letter from your patient; these are moments that
make it possible to come back another day.
Golf Trivia
The golf tee was invented by a dentist. Dr. George Franklin Grant received a
patent for “an improved golf tee” in 1899. There were other methods for teeing
up a ball prior to his patent, but Dr. Grant has been credited as the inventor of
the modern, wooden, peg golf tee by the United States Golf Association.
16
The conclusion is simple, play more golf and your dentistry
will improve. Please post this article on your refrigerator when you
are out at the golf course so your family will know why you went
golfing. If you have a question, or just want to go out for a round
of golf, you can reach me by e-mail: [email protected] ■
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second opinion
The Importance of the GeneralistSpecialist Relationship in the
New Economy
by Jay B. Reznick, DMD, MD
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
Times have changed since I went to dental school.
Back then, dental education was about preparing the student to graduate and go out into the world and practice
general dentistry. We had exposure to the dental specialties, such as endodontics, orthodontics, periodontics and
oral surgery. But our didactic instruction and clinical
experience was limited to the very basics and to simple
cases that could be done easily by the average general dentist once in practice. For oral surgery, it involved a oneweek rotation in the junior and senior years in the school
clinic, plus an additional week rotation at a state veterans’
facility and a public hospital. The cases the students managed were basically periodontally involved teeth with
mostly intact crowns. Anything more complicated, such
as surgical extractions, impacted teeth and soft-tissue procedures, other than a simple biopsy, was a case for the oral
surgery residents. Dental implants were relatively new on
the scene. Dr. Branemark had just introduced the concepts of osseointegration and modern implantology to
the world. Not even the residents were doing implants
then. Only the faculty was allowed to place implants, and
only after completing an official certification course.
Much has changed in dentistry since then. In many
of the specialties, new instruments and materials have
been developed to help make challenging procedures
much easier, safer and more predictable. Most of these
were introduced for use by specialists, but over time,
many of these new endodontic shaping and filling systems, orthodontic brackets, wires and appliances, surgical
instruments and dental implant systems have made their
way into general dental offices. Most of these were used
in offices of general practitioners whose practices were in
more rural and remote areas, as every city, large and small,
had more than its share of specialists who were available
to treat the more complicated cases and patients. In the
90s and early 2000s, there was no financial pressure for
general dentists to perform specialty procedures, since the
economy was doing well and everyone was busy doing
cosmetic and other lucrative elective cases. Why would
anyone want to start doing impacted wisdom teeth,
implant surgery, molar root canals, periodontal surgery,
orthodontic therapy and similar treatment when those
procedures could be difficult and complicated, even in
the hands of experienced specialists? Who needed the
headaches, especially when one could make more money
doing more familiar, less stressful dentistry?
The relationships back then between general practitioners and specialists were very strong. Every GP had
two or three colleagues in every specialty to whom they
referred their patients for braces, root canals, oral surgery, dental implants and periodontal procedures. Every
specialist, in turn, had a list of dozens of “A” and “B”
referrals, as well as a hundred or more “C” referrals who
kept their schedules busy. Lavish holiday gifts, ski trips
and dinners were commonplace for busy specialists to
thank the general dentists who kept the patients and
cash flowing. About 2007, things started to change and
we started hearing about a recession on the horizon, but
few of us paid any attention to it. I remember at the
2008 Townie Meeting hearing the first reports of practices slowing down. But for most of us, things were still
great. Then, in September 2008, the stock market
crashed and Alan Greenspan officially declared the U.S.
economy was in a recession. That was when most of us
started seeing a change in our practices, no matter where
we practiced.
Dental manufacturers saw decreased demand for
many of their products and really started promoting
more orthodontic, endodontic, periodontic, surgical and
dental implant procedures to the general practitioner in
an effort to maintain sales. This started a revolution in
dentistry, in which many general dentists enrolled in
18
second opinion
“What I have become increasingly concerned about is GPs
getting in over their heads and getting their patients and
themselves into trouble.”
continuing education courses in order to increase the
scope of their practices. Overall, this was a good thing
since this increased access to advanced dental treatment
for many patients who were unwilling or unable to travel
to see a specialist.
However, in the last year or so, we have seen a major
change due to significant economic shifts. Patients are
routinely delaying or deferring necessary dental and medical care because of job loss, loss of investments and fear
of what might lie ahead. There are very few dental practices that have not been affected by the current economy.
Fewer patients are calling for appointments, and even
very successful practices are having trouble filling their
chairs. With fewer patients coming in for restorative
dental procedures, many practices are trying to fill those
gaps by keeping procedures in-house that they would
have ordinarily referred. Some practices are doing this by
hiring recent specialty graduates to work in their offices a
couple times per month, and others are simply tackling
cases that they previously would not have bothered to do.
As a result, referrals to dental specialists have dramatically
declined, and many specialty practices are struggling to
survive, especially in more urban settings.
For the record, I have no problem with general dentists doing specialty procedures in their practices. In fact,
one of the things I have done, and still do in my career
is educate GPs in oral surgery and implantology. What I
have become increasingly concerned about is GPs getting in over their heads and getting their patients and
themselves into trouble. I get worried when I see threads
on Dentaltown asking very basic questions about how to
do a surgical procedure. The bottom line is, as much as
we all need to make a living, we are also in a healing profession and always need to do what is best for our
patients, even if it is not what is best for our bottom line.
I have been teaching this message for many years in
my continuing education courses on Dentaltown,
OnlineOralSurgery and at the Scottsdale Center for
Dentistry. If you would like to incorporate oral surgery
and implant procedures in your practices, take the time
to educate yourself in the proper way to do so. There are
plenty of educational opportunities out there. Learn the
right way to do surgery, how to avoid complications, how
to manage complications and how to recognize the limits of your own comfort zone. Just because you have the
20
time open in your chair does not mean that you should
treat every patient. Everything you do in your practice
should help to build your practice. Subjecting a patient
to undergo a surgical procedure that is difficult, uncomfortable and prolonged will do just the opposite. There
are procedures in oral and maxillofacial surgery that I
refer to my colleagues because I do not do them often
enough to be comfortable doing them. Can I do them?
Yes. Can I fit them in my schedule? Yes. But, I elect to do
what is best for the patient. I was told in residency that
they could teach a monkey to do surgery, but what makes
a surgeon is the ability to know when not to operate. We
were also taught we should never do a procedure for
which we could not anticipate and handle all of the
possible complications. This comes from education and
experience. If you choose to refer fewer patients to your
specialists and treat them in your own practices, please
make the investment in yourself to become more proficient at those procedures first. We all know how little specialty training we actually got in dental school and that
most of what we see in practice is more complicated than
what we did in school.
One of the benefits of continuing education in the
dental specialties is the ability to recognize the limits of
your training. No matter how many root canal, impaction,
grafting and implant procedures you do, there will always
be some that are best managed by a specialist who has
many more years of training and experience. That is why
it is important, even in these changing economic times, to
maintain a good relationship with a core of dental specialists to whom you can refer, ask for advice and get help.
Most of us understand the pressures GPs are under and are
very willing to help out in a sticky situation. However, that
willingness might waiver if all specialists get from some
are your complications. We need you. And, you need us.
You do not need to treat every patient by yourself who
comes in to your practice, even if times are slow. Learn to
recognize which cases are within your comfort zone and
which ones are beyond your expertise. Maybe, even take
your specialists to lunch and talk to them about what is
going on in your practice. We are all in this together and
will make it through by working with each other. Try to
always follow the principle of “do no harm” and refer your
patients where appropriate. Your patients will be happier,
and you will sleep better at night. ■
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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.
AvaDent Digital Dentures Bring Removable Prosthetics into the Digital Age
Global Dental Science (GDS), LLC, announces the introduction of AvaDent Digital Dentures. AvaDent’s breakthrough digital
technology brings the precision, aesthetics, speed and profitability of CAD/CAM technology to removable dentistry. A series of
half-day seminars are currently being offered throughout the U.S. to dentists who would like to learn more about AvaDent Digital
Dentures. October 7/8: Buffalo; October 21/22: Dallas, Denver, Orlando; October 28/29: Tampa and Cincinnati; November
4/5: Vegas and Philadelphia; November 11/12: Scottsdale and Atlanta; November 18/19: Houston and Chicago; December 2/3:
Miami and Los Angeles and December 9/10: Seattle and Kansas City. See page 50 for a write-up of the AvaDent Digital Dentures
product. To learn more about AvaDent Digital Dentures call 855-AVADENT (282-3368) or go to www.avadent.com.
Doctors Can Now Capture X-rays Directly to the Cloud with Curve Dental
Curve Dental announced the completion of new digital imaging features, which allow doctors and staff to capture X-ray
and intra-oral images directly to the cloud. Using the cloud to capture and store patient images eliminates the need for a
server, affords unlimited storage and a proven backup and business continuity solution, and provides the dentist with access
to the data from any computer with Internet access at any time. Currently the software is compatible with the Schick, Suni,
Gendex, Eva and Owandy digital X-ray sensors, and will soon be compatible with the Kodak sensor. Call 888-910-4376 or
visit www.curvedental.com for more information.
Glidewell Laboratories Launches the Glidewell International Technology Center
The Glidewell International Technology Center, a 2,800-square-foot training, education and technology demonstration
center located on the Glidewell Laboratories campus in Irvine, California is now open. The center houses a fully functional
operatory and surgical suite equipped with state-of-the-art dental equipment and technology, including a CBCT scanner
and will offer live video demonstrations to a 40-seat interactive classroom auditorium. Experienced clinicians and technicians will provide comprehensive and affordable professional development and continuing education programs covering all
aspects of modern implant and restorative dentistry. For more information or to register for upcoming courses, visit
www.glidewellce.com or call 800-854-0970.
Comlite Systems Releases the LAN4000
Comlite Systems has released the LAN4000 light signaling intra-office communication software. It easily installs on existing
Windows networks and requires no additional wiring. The software allows dental offices to customize system layouts, button
colors and labeling and has multiple chime options. Screen display sizing options and minimization help keep communications
confidential. A free 15-day trial download is available from www.comliteinfo.com, or call 800-426-5271.
22
industry news
Sesame Communications Named to Inc. 500|5000 List of Fastest-Growing Private Companies
Sesame Communications has been named to the fifth annual lnc. 500|5000, an exclusive ranking of the nation's fastestgrowing private companies. In its debut year on the list, Sesame is ranked an impressive #2024 for its 125 percent growth
over three years and $9.2 million in revenue in 2010. The companies on this year’s list report having created 350,000 jobs
in the past three years, and aggregate revenue among the honorees reached $366 billion, up 14 percent from last year.
Sesame’s ranking can be found at www.inc.com/inc5000/profile/sesame-communications and for more information regarding Sesame, visit www.sesamecommunications.com.
DENTSPLY International Completes Acquisition of Astra Tech
DENTSPLY International, Inc., has completed the previously announced acquisition of Astra Tech AB, a leading provider of dental implants, customized implant abutments, and urology and surgery products, from AstraZeneca. DENTSPLY anticipates this
transaction will add approximately $200 million to the company’s net sales in 2011, and $600 million on an annualized basis.
DENTSPLY also expects the transaction will be neutral to slightly accretive to adjusted earnings per diluted share in 2011. For
more information, visit www.dentsply.com.
Smile Reminder Evolves Into Solutionreach
Smile Reminder has changed its name to Solutionreach. Smile Reminder recognizes its evolution from patient-to-practice communication to a comprehensive engagement platform with the new Solutionreach brand identity. Having serviced the health-care
industry for more than a decade, the newly branded Solutionreach is looking forward to making its full suite of engagement tools
available to businesses in a variety of markets in health care and beyond. For more information, please visit www.solutionreach.com.
BIOMET 3i Has An App For That
BIOMET 3i invites dental professionals worldwide to download the free BIOMET 3i App for the iPad and iPhone, Android
and Blackberry smartphones. The BIOMET 3i Solutions App consists of two portals, one for the clinician and one for the
patient. The Clinician Portal provides immediate access to BIOMET 3i Product and Service Solutions for clinicians. The
Patient Portal is an interactive version of the BIOMET 3i Patient Education Brochure with easy-to-understand animated
information tailored to the patient. The BIOMET 3i Solutions app is free and available to download and install directly
from www.apps.biomet3i.com.
Sterngold Dental, LLC, Announces the 2011 Three-Day Hands-On Attachment Courses
The Sterngold Dental three-day hands-on attachment course is designed for both dentists and technicians. This intensive
three-day program will leave you confident in your ability to design, prescribe and fabricate attachment-retained prostheses.
Attachment courses will be held September 23-25 in Los Angeles, California at Los Angeles City College, and November
10-12 at Sterngold Headquarters in Attleboro, Massachusetts. Each course is limited to 15 participants. To register, and for
more information, call 800-243-9942 or visit www.sterngold.com/sterngold/events/training for a printable registration form.
24
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The Most Important Measure of
Dentist Efficiency
Dentists have so many different practice styles and staff sizes. What is the best metric for comparison?
Linc
Posted: 8/9/2011
Post: 1 of 105
Often here, we have discussion about different practice styles.
Low overhead.
High grossing.
Complex procedures.
Bread and butter.
One dentist, three hygienists.
One dentist, one hygienist.
But from a business point of view, your bottom line is all that really matters. So
how can you compare all these different practice styles? What is a common way to
compare the efficiency of different styles of practice? ■ Linc
Kevin Tighe
Posted: 8/9/2011
Post: 3 of 105
Take your average monthly production or collections and divide
that number by the number of staff you have. That will give you a
baseline to start from. Then implement an effective staff training program. The baseline should steadily increase. You can apply this to any
practice model. ■
Linc
Posted: 8/9/2011
Post: 5 of 105
That’s not a bad method. How do you compare a single dentist
niche practice that only does short-term ortho with a large hygiene
practice? Even though the niche practice might be much more efficient
per staff member, the take-home pay might be less for the same hours
worked. So in effect, the dentist in the hygiene-based practice might
be using all those staff to make himself personally more efficient. ■ Linc
Broken Dentist
Posted: 8/9/2011
Post: 10 of 105
Production per hour depends on your fees and your insurance participation.
So even if you can do efficient dentistry, production per hour can be low if
your fees are low. ■
gregholm
Posted: 8/10/2011
Post: 15 of 105
I probably wouldn’t care what practice type (GP everyday work
vs. implant, etc.) or about much else, as long as I am able to net in
the same hourly timeframe, in that $500K area. After that, it just
wouldn’t matter. ■
browndawg
Posted: 8/10/2011 ■ Post: 16 of 105
I bet most Townies would change their “style” to net in the $550K area.
This can’t be the norm or I really missed the boat on this tooth fixing stuff. ■
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gregholm
Posted: 8/10/2011
Post: 18 of 105
I really didn’t mean for that to be the point. The only point I was
trying to make was who really cares how they do it – whatever it is.
If they do care, they need to make a change. If they don’t, fine.
There are all kinds out there, doing pretty much the same on a financial level. You will have extremes in just about everything. That doesn’t
mean anyone or everyone could or should be doing things in that same way. ■
skuzma2dds
Posted: 8/10/2011
Post: 19 of 105
From what I can tell... there are many practices with one full-time dentist, two
assistants, two to three full-time hygienists and two full-time front desk staff that
do $1-1.2 million with 50-60 percent overhead ($500K range).
This type seems to be the most predictable method for a dentist to net $400550K. There’s a handful of dentists on here who do more than $2 million with 55
percent overhead or so... netting about $1 million. Not many, but a few. ■
gregholm
Posted: 8/10/2011
Post: 23 of 105
If there is a procedure or a patient I really don’t want to take on –
I don’t do it. I’m a single tooth kind of guy. I don’t like the stress I feel
when doing the full mouth or the big cosmetic cases. On the right person, with the right circumstances I might do the case, but I refer far
more than I complete myself.
The odd thing is by doing this; neither my production efficiency/overhead efficiency nor net efficiency has ever suffered.
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Some of these people just don’t have enough money, in my opinion. In fact, I
would say that is a big component for my efficiency. I’ve learned when to hold ‘em
and when to fold ‘em, as the saying goes.
I think the stress factor becomes a larger and larger multiple as time goes on. ■
ut-bill
Posted: 8/10/2011
Post: 25 of 105
Funny, I remember an article that Mike DiTolla wrote on this. He made a
point that the most profitable were three or less units on a fixed case. After this,
the cases became more complicated and the actual net profit was lower. Of course
he backed it up with more numbers, but that was the gist of the article. ■
rscrawfo
Posted: 8/10/2011
Post: 26 of 105
Good thread, Linc! Predictability is also important. It’s always nice
to have a predictable monthly income rather than a feast or famine type
practice. Many hygiene-based practices seem to have a very steady production level, and downturns in the economy seem to affect them less.
They will never have the extreme high months, but they also never get
the low months. The more hygiene patients you see, the more stable production
seems to be.
I think profit per hour worked is an excellent measure, but you must include
all hours worked, including lab work, paying bills, etc. Many of the small efficient
offices have low overhead because the dentist is doing all the extracurricular work
(lab work, paying bills, ordering supplies, repairing equipment, doing up deposits,
keeping the books, etc.). This could double the hours
spent working. Many of the larger hygiene-based
practices might have higher overhead, but the dentist
spends much less time working. Personally, I do very
little in my practice and the extra overhead it costs me
is money well spent. ■
Linc, My answer to
your question would
be hourly production
average for the dentist.
We keep this on hygienists as well. It is amazing to watch a practice with
two or three hygienists, once we start measuring this
on Dental Dashboard. All of them increase and it
really keeps them on their toes. It’s a great stat.
Remember you better collect what you produce! I’m
not impressed by high production without the collections being right there with it.
It also gets interesting with two or more dentists
in the same practice. ■
Sandy Pardue
Posted: 8/10/2011
Post: 27 of 105
browndawg
Posted: 8/10/2011
Post: 31 of 105
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Check out these other
Dentaltown.com message
boards for ways dentists
can become more efficient.
Overhead Percentages 2011
Search: Overhead Percentages 2011
My Production Stinks Today but
My Schedule is Full
Search: My Production Stinks
lievably hard through the 80s and 90s. Now we have massive competition and bad
economic times and the game has changed. Fees are so much higher than they
were. I can read in our charts where Dad was taking out all four impacted thirds
for $375. Crowns were $250. Occlusals $40 and he managed to earn $200K a
year at those fees. He came home, crashed on the couch and woke up to eat dinner. Rarely ate lunch.
I do much better than he did working a lot less with less stress simply due to
implementing systems, adding implant therapy and controlling costs.
We have three docs now. Some months I feel rather pathetic doing four crowns
with open holes in the schedule and producing $30K. Crowns are now $1,050
here. The key that I have noticed over time is that our overhead is much lower and
we are doing so much less dentistry. Most of this must be due to fee increases over
the years.
But since we built the practice based on hygiene, it not only out produces, but
out collects each of the individual doctors.
I can’t imagine having it any other way. Working on four to six patients a day
and collecting half of my net from hygiene profits with the phone rarely ringing
on a weekend and having the time with the wife and kids. This has become a
blessing – we never knew what we were blindly creating.
And as Greg says, who cares how you get it if it is low stress and you enjoy
the ride. ■
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Linc
Posted: 8/11/2011
Post: 42 of 105
Generally when I take on a new procedure, I use the following method
to get proficient.
1. Accept that it won’t be a money maker for a year or more.
2. Do some free cases to get going. Usually I make this a charity
thing as well, so I get marketing mileage out of it.
3. Accept that my first few cases will not be as good as those I do in 10 years’
time. This is a big problem. I don’t advocate being a hack. However I do
understand that a lecturer who has done 1,000 sinus lifts over five years is
probably going to be better than me. You cannot be good without practice,
and you cannot do any practice if you expect to be perfect your first time.
The difficulty is that there are a lot of armchair experts on Dentaltown who
will criticize the tiniest imperfection of other people’s cases, but then when
they show their own, they will explain why it was appropriate to cut a few
corners (normally because the patient was informed and declined. Don’t let
armchair perfectionism cripple your attempts at new procedures.
4. I begin marketing new procedures as soon as, or shortly after I’m trained in
them so that I get enough to be proficient.
5. Yes, taking more CE is great, but no amount of CE will make you proficient.
Only practice will do that.
6. You will get failures. Suck it up and learn from them. I had my first sea-o-pus
implant the other day.
What I meant by the statement that you shouldn’t do procedures that you don’t
do often enough is that sometimes people learn a new procedure and for whatever
reason, they don’t do it often. Like implants – there are a lot of dentists out there
that only do 10 a year. The first implants you do, you don’t know which drill to use
and you drill slowly and tentatively. It takes forever. If you are doing one a month,
it’s like you are always doing your first implant.
I didn’t make much out of rehabs when I first started them. Now they are very
profitable because they proceed smoothly and efficiently, and prepping 10 crowns
is always more profitable than one. I also get very few fractures now, although I did
get a lot in my earlier days. Hope that helps. ■ Linc
CoachDDS
Posted: 8/18/2011
Post: 84 of 105
This is something I’ve really learned first-hand in the last few months of
owning a practice. There’s a counterpart of efficiency that a lot of practice management experts don’t seem to grasp. There comes a time when one is so efficient that
your head starts to spin... you make more mistakes, you get burnt out faster and
your long-term overall efficiency is lower.
My favorite days are with a nice easy flow. A crown in the morning, some
fillings here and there, eight or nine hygiene patients in between and maybe an
emergency or two. All adds up to a $3-4K day and I get to leave the office without
feeling drained. Granted I can do those rollerskate $10K days just fine but they tax
me. Doing that day in and day out would kill me and I’m young.
I say the biggest measure of efficiency is how much your practice allows you to
live the life you want to live. ■
Find it online at
www.dentaltown.com
34
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Morning Huddle – Again
Did you give up on morning huddles? Give it a second chance.
Steven Polevoy
Posted: 7/7/2011
Post: 1 of 43
I just about lost it – again – during our pathetic, ridiculous, unproductive, disgusting excuse for a huddle.
I never really get angry in the office, but the huddle thing just kills me.
Charts are supposed to be prepped, hygiene is supposed to verify X-rays are upto-date, perio charting, see if there’s any outstanding treatments that need to be discussed with the patients, medical history updates, etc.
Assistants are supposed to do the same.
The front desk is supposed to go over yesterday, discuss any needed follow-ups
and the whole thing is supposed to follow a YT2 (yesterday, today, tomorrow) format.
Does it?
No!
And it never did.
Does anyone have a productive huddle in the morning?
How do you do it? ■ Steve
Jamie Nicole White, CDA, RDH, BSDH
Posted: 7/7/2011
Post: 2 of 43
Steven, I have attached a clinical assessment form that I have made up for the
offices I consult in. It’s unfortunate but I have found that some hygienists tend to be
lazy and not hold up their end of patient care assessment, which helps the dentist to
stay consistent and proficient day in and day out.
I hope this helps to organize your patient assessments in hygiene!
[Editor’s note: Visit the message board online to view the attached clinical assessment form.] ■
davidpalmer
Posted: 7/7/2011
Post: 6 of 43
Forget the morning huddle... Fire someone not doing their job and watch
what happens.
I tried a morning huddle for about a week a long time ago. Waste of time in my
opinion. If after being trained and working for six months, my staff doesn’t know
what to do, how to do it, etc. to make the office run smoothly and make my life easier, a morning huddle won’t help. ■
Tyler R. Twiss, DMD, MBA
twisster
Posted: 7/7/2011
Post: 8 of 43
Steven, Is any of this written down? It sounds like it is time for a checklist. I’m
assuming there is currently no accountability for this long list of “supposed-tos.” If it is
written down, they have something visual to see, and know that it is expected. This is
a lot more effective than a routine that takes place out of tradition. ■
jbdent
Posted: 7/7/2011
Post: 9 of 43
I think the morning huddle is a bunch of BS. I have a big staff that come in anywhere from 6:30 a.m. to 7:30 a.m. so we couldn’t do one anyway. Our review is at
the end of the day for the next day and doesn’t require everyone knowing everyone’s
36
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business. The staff members coordinate what they need to with the appropriate
people. We don’t stand around in a circle singing Kumbaya. ■
Mike Scoles, DMD
drscoles
Posted: 7/7/2011
Post: 11 of 43
I think if you are having this meeting and it’s not effective, you need to look in
the mirror. You are not leading well. We spend seven to eight minutes going over the
schedule and I think it is beneficial.
It keeps you from getting blindsided on things like “Hey Mrs. Smith, How’s your
husband doing?” And Mr. Smith died a month ago.
Or Suzy Soccer mom’s kid got a scholarship in synchronized underwater basket
weaving and she’s very proud of it and you can congratulate her and you look like a
rock star.
Or Mr. Jones needs an FMX and you have that NTI seat at the same time, can
someone in the front come back and push the button for me so we get it done
faster... and stay on time?
Or Bill has that fractured cusp on #3 and he knows he needs a crown but he’s
been out of work for a year and he wants to keep an eye on it. Bill gets pissed when
you keep overstating the obvious. Bill thinks you are a cool dude when you ask him
how the job prospects are going and that we’ll keep watching that tooth and we can
put a band aid on it to get him by if necessary.
Depends on what type of office you want to have or are comfortable with. Do
you want a bunch of independents running around, or do you want a cohesive teamoriented vibe? ■
Negotiating a Lease?
Don’t let the landlord
take advantage of you.
“
Thanks sincerely
for your determination
to do right
by your clients.
“
- Dr. Joel Gonzales
Gloucester, MA
When you have good
systems you don’t have to
micromanage anything.
Huddles should last no
longer than 10 minutes.
Staff comes prepared with data. The doctor doesn’t
have to do anything. The staff report to the doctor.
If they don’t come with the data, they go get it and
come right back while the huddle continues. ■
Sandy Pardue
Posted: 7/7/2011
Post: 13 of 43
We have four hygienists, four
assistants, three front office and two
docs (one is my wife).
Our huddle is a little long in the
tooth. 15 minutes easy.
Yes, hygiene drags their feet but every day we discover some way to head off trouble, reroute the schedule, perform same day treatment and sing Kumbaya. ■
madmike
Posted: 7/7/2011
Post: 14 of 43
To level the playing field, simply call
toll-free or visit georgevaill.com/dt/
saldoc
Posted: 7/7/2011
Post: 16 of 43
800-340-2701
We’ve had a huddle
every morning for about
six years. I think we got the
format idea from Sandy
and Dr. Westerman.
38
▼
Want to read more about
morning huddles? Then check
out these other message boards
on Dentaltown.com.
How is Your Morning Huddle?
Search: How is Your Huddle
Need Help with Morning Meetings
Search: Morning Meetings
David Kimmel, DMD
dkimmel
Posted: 7/7/2011
Post: 17 of 43
Find it online at
www.dentaltown.com
40
Front office goes first and reports: yesterday’s production, yesterday’s collection, today’s scheduled production, lists any new patients coming in and relevant
info about them, where they intend to place any emergencies that call (I find this
very important and might offer my suggestions) and anyone coming in with large
account balances.
Back office reports premeds and allergies (latex), confirms all lab cases are in
and addresses any inconsistencies in the schedule that do not match what is listed
in the chart.
Hygiene (two hygienists) lists teeth we are monitoring for crowns on each
patient (these are teeth they are supposed to show with the intra-oral camera), note
any FMXs needed, premeds, allergies, etc.
Sterilization tech (who now acts as my second assistant) announces all the
hygiene patients who need probe readings; she will help hygiene with those readings
(we alternate between probes and X-rays every six months).
And that’s it. I generally sit there nodding and saying that sounds good.
I don’t want a lot of adlibbing or going off script. The whole thing usually lasts
about five or six minutes. On rare occasion, I’ve had an employee announce at the
huddle that they did not have time to prepare their report. I’ll gently remind them
afterward that it is not acceptable to be unprepared for the huddle, and it usually
doesn’t happen twice.
It’s nothing too revolutionary, but it at least ensures the staff pays a minimum
amount of attention to the day ahead. ■ Sal
This is our 21st year with morning huddles. I could not imagine a
day without one. One of the first things that comes to mind, are you
giving your staff time to pull all of this information together? We have
admin time set aside every day for chart review for the hygienist and
the assistants, as well as for the front desk to get reports together to
present each morning. No meeting can be productive without proper preparation.
The other thought is you must inspect what you expect and give feedback as
needed. The first time a staff member comes unprepared for a meeting, I would
specifically let he/she know what I needed from him/her. I would ask if there is
anything I could do to help he/she be prepared and then I would ask about being
prepared for the next meeting. In your case, I would do this as a group. I’ve never
had to go beyond this step. If I ever had to, it would result in writing the person
up. If he/she continued to not perform, the staff member would be let go.
Bottom line it’s your party and you are paying the bill. The key is to catch these
problems before you get angry. My wife calls it being confrontational dysfunctional.
On another note, we end our day with a quick wrap up. Each staff member
just talks about one positive thing that happened during the day. Takes very little
time and well worth the effort. ■
Morning Huddle Again
cosmetic townie clinical
Difficult Veneers
This well-documented case followed all the right steps, and the feedback is priceless. Learn from this case!
Henry FCD
Posted: 7/28/2011
Post: 1 of 9
Case is posted for critics and what could have been done better.
Fig. 1
Fig. 2
Fig. 4
Fig. 3
Fig. 5
▼
In these similar message boards
Townies provide suggestions and
constructive criticism when it
comes to veneers.
Below: Perio treatment is done.
Conclusion: Healthy perio tissues
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Veneers on Tetracycline
Teeth - Help!
Search: Veneers on
Tetracycline Teeth
Veneers, I Just Don't Get It
Search: I Just Don't Get It
Below: Preps and veneers
Fig. 12
Fig. 13
42
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Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
Fig. 19
Conclusion: “The professional man has no right to be other than a continuous
student.” G. V. Black ■
I will be the first to make some suggestions here.
1) I think the preparations should have been carried through the
interproximal areas. This would allow it to drop the contact points further toward the gingival area and potentially allow the interdental
papilla to regenerate and close up the black triangles.
John R. Nosti, DMD, FAGD, FACE
John Nosti
Posted: 7/28/2011
Post: 2 of 9
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2) Maybe it was a seating issue, but the lengths of the centrals are off.
3) The axial inclinations could be improved on the laterals... again this would
have been done with preparations that correct axial inclinations. It is hard for
ceramists to correct this sometimes when the preps don’t correct it.
4) Do people like their front six teeth six shades whiter than their premolars? I
never understand why people recommend the social six. If the person couldn’t
afford to do 10 veneers, composite bonding on these teeth will improve his look.
Check out Jason Olitsky’s CE course on Dentaltown.com, Balancing Esthetics and
Function of Direct Composite Restorations.
5) Is that a picture of him “in occlusion” in the post-op picture? ■
Henry FCD
Posted: 7/28/2011
Post: 3 of 9
John, I appreciate your suggestions.
1) I thought about carrying through the interproximal areas but with the recession I thought that can be cutting too much.
2) I had to compromise aesthetics to close the gap. I agree extending the prep
could have been the best way to do it.
3) Is there anything that you can help me with when it comes to improving the
axial inclinations? Photos? Something to read?
4) Will do. I’ll check out the course.
5) Yes, it is in occlusion.
I would love that you do not stop. The reason I am posting is that they are not
the best veneers I have done. ■
Andrew Z. Green DDS
umazg
Posted: 7/28/2011 ■ Post: 4 of 9
Is this patient perio stable? It doesn’t look like he had even a cleaning in a while
let alone perio treatment. If the goal was toilet bowl white, mission accomplished.
This is a tough case. ■
Henry FCD
Posted: 7/28/2011 Post: 5 of 9
Yes, it is no BOP or deep pockets, stains from very heavy smoking.
I wanted to go with A2 giving a natural look but was declined by patient. ■
■
John R. Nosti, DMD, FAGD, FACE
John Nosti
Posted: 7/28/2011
Post: 6 of 9
First I want to backtrack a little bit and say that I want to congratulate you for having the confidence to come onto Dentaltown and post
a case that you feel isn’t your best work... and to ask for criticism on
top of it. That is very hard to do. I want to also say that I hope I did
not come off sounding like a jerk with my last post, because as hard as
it is to ask for criticism... it is very challenging offering criticism without having
people think you are being
condescending, or a knowit-all, etc.
You can easily correct the
centrals being two different
lengths with a disc or porcelain polishing cup, etc. That
is an easy fix.
Here is a smile design
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the axial inclinations of the teeth start slanting toward the mesial as you go posterior.
When the inclinations slant distal the teeth look flared and goofy. If they are too
upright they look artificial.
Take notice of the gingival zeniths and contact points (blue diamonds in the
center and going toward the right side of the photo). You can literally spend 20
minutes or more discussing this photo and all the aspects of smile design.
I offered my opinions that there are still black triangles but I neglected to ask
you if this patient was concerned about them and whether the two of you discussed
the case requiring more aggressive preps in order to attempt to correct it. Maybe he
was fine with it, and in this case I would have prepped as you did.
If he wanted the black triangles closed I would have prepped with slice preps
and broken contacts. In all honesty, I don’t think this type of prep is really that
much more aggressive from the preps you showed in your picture. The decision
between the two isn’t deciding between prepping enamel only vs. dentin – either
way you are on dentin.
The after picture of him in occlusion looks a little off. Either his occlusion is
compromised or he wasn’t closed down all the way. I am leading to believe he
wasn’t closed down all the way or hit closed in a slightly protrusive position from
his CO point. Did you deprogram and restore to CR with anterior guidance?
I hope this post came off less offensive than my first. I am not trying to be a
harsh guy here... just trying to provide the constructive criticism you requested...
which again I commend you for! ■
Henry FCD
Posted: 8/1/2011
Post: 7 of 9
John, Sorry for not getting back earlier. I appreciate you taking the time to
answer my post.
I think next time I will be going to fully break contacts for better aesthetic.
By the way, I am not offended by any of your posts; I really believe this is the
only way to learn. ■
rovster
Posted: 8/9/2011
Post: 8 of 9
I agree with John’s first post, and second as well. First thing that
jumped out was the preps. Although conserving a sliver of tooth structure, a full slice prep would have not only helped with the emergence contours, but also helped to establish more hygienic contours in the
interproximal area that are more easily cleansable by the patient. The
transition between restorative and these types of preps with such large spaces are funky
at best, and tend to collect debris. I also agree the lab work, although not horrible,
could definitely have been better. Did you make a temp and have the patient approve
it before proceeding? Did you do a wax-up? Overall, not bad but there are lots of areas
where little tweaks here and there could have led to a much better cosmetic result.
Also, realize when you blow up your pictures on the computer screen, your imperfections really jump out and humble you. Kudos for posting. I’m sure at a “social distance” the case probably looks decent. ■
Find it online at
www.dentaltown.com
48
Difficult Veneers
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53
amd lasers corporate profile
Alan Miller & AMD LASERS Go Global in Their Next Move to Ensure a Laser in Every Operatory
Alan Miller, AMD LASERS’ founder and president, and his
team have been hard at work since the company was acquired by
DENTSPLY International earlier this year. Miller’s whirlwind,
round-the-world tour to DENTSPLY’s worldwide locations will
lead to the Picasso laser line introduction in many new geographic markets, greatly expanding the number of dentists
around the globe who will offer improved patient care with this
innovative laser technology.
Before Miller left on his trip, Dentaltown Magazine sat
down with him to discuss the future of AMD LASERS and
laser dentistry.
I think back to the time we first met. I believe it
was in 2005. Your company back then was
National Laser Technology which serviced and
refurbished lasers. How did that experience
influence the formation of AMD LASERS?
Miller: It was a great experience from several standpoints.
First, I got a good understanding of what dentists were looking
for; they wanted laser technology – but they wanted it at an
affordable price. The second thing it did was allow me to look
at all the different laser platforms,
both hard and soft tissue, and
really figure out what dentists
wanted most. They wanted reliable
lasers. They wanted easy-to-use lasers.
It was apparent that there was a real
need for an affordable
soft-tissue laser.
When you told your
family that your plan
was to start selling
lasers in a market that
54
already had a number of players, did they meet
your dream with skepticism?
Miller: I think most people thought I was crazy. It was a
great motivator for me. I’m one of those guys who if you tell
me I can’t do it, I’m going to try 10 times harder to prove you
wrong. No one around the world had taken this approach
toward laser technology, which I knew would work. One of the
strategies we implemented was a model the automotive industry has used for years: a single platform, then buying the internal components in high volume and assembling with as few
touches as possible. This allowed AMD LASERS to drive
down the price.
Would it be fair to call you a serial entrepreneur?
Miller: Yes. I have always enjoyed helping companies with
projects, introducing technology. I grew up a nerd. I think I’m
still one of those nerdy guys. I love technology. Through my
dental career I have helped a number of companies take ideas or
products that were in the beginning stages and ask: How do we
get these products into mainstream dentistry? How do we package it? How do we make it affordable? How do we make it a
desirable product? I really enjoy that.
Did you set out to grow a company that would
be the target of an acquisition?
Miller: Yes, that was always my strategy. When you start a
company the odds are stacked against you. You are better off
going to Las Vegas and betting everything on red or black,
frankly. In the business world, to get a company to $10 million
is a small miracle. That was my goal. I bootstrapped the whole
thing. To do it out of pocket and reinvest the earnings of the
company to grow it is extremely difficult. But I knew at some
point AMD LASERS would be bigger than I could personally
manage. To really realize the dream of putting a laser in every
corporate profile amd lasers
operatory, I knew at some point we would need
some help. We were going to need to scale it up.
Do you have any business heroes?
Miller: I admire Steve Jobs. I really like Apple. From the
packaging standpoint, we try to treat our products much like
Apple looks at packaging its products. The out-of-box-experience is unparalleled with Apple products. When our customers
open up a Picasso laser, I want them to feel like they are opening
up this little jewel. The product itself is unlike any other laser in
the world. When I was developing it, I wanted the packaging to
be an experience, too. It’s not just about the product for me.
You made an expensive product affordable while
maintaining features and quality that rivaled your
competitors. Are you a hero and a villain?
Miller: I am basically a businessman who listened to dentists
and provided a product that met their needs as they cared for
their patients.
We were talking about Apple and Steve Jobs.
You are one of the first companies I’ve seen that
has integrated the iPad into your products. What
was the reaction from your customers?
Miller: They said, “Thank you!” and, “It makes total sense.”
Education in general has gone through a huge transformation
over the last 20 years. Before, we would take educational material which would usually be on a VCR tape or a DVD or even
online. We built a very intuitive iPad app for laser dentistry and
put it at their fingertips; it was something no one has ever
done. I saw it as a long-term solution to an age-old problem
– how do you educate dentists on technology and
have it there ready at their fingertips when they
need it?
55
Looking around the world and getting this worldwide adoption of lasers, what do you think are
the biggest obstacles?
“Will AMD LASERS lose its identity as an innovator when it is part of such a large company?”
What are your thoughts?
Miller: I’ve been asked that question a lot. It is a very good
question. The biggest obstacle of laser dentistry is not education. Dentists have been educated on laser dentistry for the last
15 years. As consumers, we are surrounded by lasers every single day. Dentistry has been exposed to lasers for a long time.
The laser companies that have been out there have done a great
job with educating dentists on why they need laser technology.
The biggest obstacle has been price. Lasers like the Picasso
should be viewed by the dental public as an affordable necessity. They should be accessible. I think that’s better for dentistry as a whole. Make laser technology affordable, make it
attractive and make it available to dentists so they can help
their patients.
Miller: From the top down, DENTSPLY is a fantastic company with strong leadership and a commitment to innovation. At
the end of the day, DENTSPLY focuses on providing solutions
for better dentistry. While acquisitions serve as a growth strategy,
the company looks for successful businesses with profitable operating models. Its businesses are enabled and empowered to build
on their prior success by enjoying all the benefits a global corporation can offer. To illustrate that point, I am still president of
AMD LASERS and we still have the same vision of putting a
laser in every operatory. DENTSPLY has already started working
with us to make that vision a reality.
You have had notable success in a number of
foreign markets. Two examples would be India
and Turkey. How did you make it happen?
Miller: I can truly say that the global success of AMD
LASERS is thanks to our network of opinion leaders and passionate customers. We are surrounded by some of the best and
brightest dentists from around the world. They really believe
in what we are doing with laser technology. They travel and
lecture around the world to introduce AMD to the local dental community. I’m excited to be working with DENTSPLY,
which has a solid international reputation for quality and
service. DENTSPLY understands our goal to make lasers
affordable around the world. They’re going to make it reality.
DENTSPLY International acquired AMD LASERS
on June 1 this year and my first thought was,
During the process leading up to the acquisition,
did you have any hesitation? What scared you
the most about making this step?
Miller: I was never scared. It really came down to whom
did we want to be in line with? It has been my job to figure out
the best course of action for AMD. That is why I wanted to
work with DENTSPLY. For me, the company has always been
the gold standard. If you want to sell a company, as an entrepreneur you can’t get much better than DENTSPLY. With the
vision of putting a laser in every operatory, DENTSPLY was
the best solution.
For the AMD customers who are already owners, are there any changes with this acquisition?
Miller: Nothing is changing. We still offer that outstanding
AMD LASERS experience. You are still going to get great customer service. We are still open from 8 a.m. to 8 p.m. EST five
days a week. It’s how I wanted to build a company. I love the fact
56
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that our customers love treating with the product and they refer
other people to come to us. With the DENTSPLY acquisition,
if anything, our current clients will say, “Wow! This is fantastic!” To illustrate that point, we’ve already received a lot of
great feedback from customers. There is a certain sense of security when a leading company partners with you. You know
you’re going to be around for a while.
It’s a vote of confidence in the business and
that’s a good thing. Discus Dental purchased
Zap Lasers a few years ago and quickly dropped
the name. Was that a good move? What is the
plan for the AMD name and Picasso brand?
Miller: I’m not sure it was a good move for them. I think it’s
always good to stay true to yourself. That’s what AMD is doing.
We built a strong brand with Picasso and with AMD, there is
really no reason to change something that’s not broken.
Can we expect to see dentists doing a lot more
with lasers in the future? I hear about cutting
frenums and soft tissue and doing laser
troughing but, beyond those things, I don’t hear
a lot of other treatments being mainstream.
Miller: I’ve been asked that before – why don’t you talk
about the other 50 uses of lasers? I keep coming back to my job
and my responsibility which is to introduce laser technology and
get dentists walking with lasers before we get them running. I
think that is why we’re successful. We talk about basic uses. I
want dentists and hygienists in their offices to put down the
scalpel, to put down the electric cautery, to stop referring
patients out for simple things they can do comfortably in their
own offices. That’s where a soft-tissue laser really excels – the fact
that it does replace a basic technology.
Once laser dentistry gets to a comfort level, that’s when we
will really start exploring what you can do with lasers.
Whether it’s perio treatment or endodontic treatment, surgery or low level laser therapy, which is very strong in the
European market yet not here in the United States. We’ll get
to those things. We’ve got to walk before we run.
Your analogy of teaching dentists
to walk before they run is
a good one. Are there new
products in development?
Is a hard-tissue laser in
the cards?
Miller: We have been working on a
number of different laser wavelengths.
We have been working on a hard-tissue
laser for some time. With DENTSPLY and
58
AMD LASERS together, we’re going to have some fantastic
products coming out in the future.
Millennium has done a good job of promoting
very specific use of the laser in conjunction with
periodontal treatment. When are we going to
see a deeper penetration of laser use in periodontal treatment? What is it going to take?
Miller: I think it’s a combination of things. We have a number of university clinical studies either underway or in planning
stages. I really like Millennium. I applaud what they’ve done to
date; they are a good company. The laser industry is a small one,
and I like to see all of us do well. I’m really looking forward to
getting lasers mainstream for periodontal treatment. It’s got to
be a combination of scientific research and affordable technology. No matter how well the clinical evidence shows that lasers
have a place in periodontal treatment, it’s never going to mainstream if the technology is not affordable.
What does the future hold for Al Miller? Have you
thought about starting another company?
Miller: No. I want to see my vision and my dream come to
fruition. I plan to be with AMD and DENTSPLY for many
years to come. We’re working to make the Picasso line globally
accessible. I enjoy it though. It’s a dream come true of mine. I
love dentistry.
Thank you for taking time out of your busy
schedule to visit with our community. To view
this interview in its entirety, please visit:
http://www.dentaltown.com/profileamd
For more information about AMD LASERS, visit
www.amdlasers.com ■
Your patients need to know that Oral Healthcare Can’t Wait
®
This FREE Brochure Gets The Message Across
LOUD AND CLEAR
Oral health is not something to be merely pushed aside, saved for a better economy,
a better mood, or better weather. You know this. But your patients don’t always. Don’t let
them give you, or their oral health, the brush-off.
Download and print this persuasive patient education brochure, available in English and
Spanish, and display it prominently in your waiting room. It’s also a good idea to mail it to
patients who break their appointments or have become habitual no-shows.
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© 2011 Dental Trade Alliance.
Oral Healthcare Can’t Wait and Visit Your Dentist Now are registered trademarks of Dental Trade Alliance.
Dental Trade Alliance
Follow us on
,
and
dentaltown research
Dentaltown Research: Endodontics
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 August 5,
2011 to August 31, 2011 on Dentaltown.com.
Do you do the majority of your endo in one visit?
542 total votes
What percentage of the time
do you refer your root canals
to an endodontist?
44% Less than five percent
27%
14%
6%
9%
65%
35%
Six to 30 percent
31-60 percent
61-80 percent
More than 80 percent
Yes
No
474 total votes
A similar question was asked in July 2006
What percentage of root canal treatments
do you refer to a specialist?
14%
None, I perform all RCT in my office
53% One to 20 percent
16%
10%
7%
21-55 percent
56-80 percent
81-100 percent
How long have you been using your current
file system?
1054 total votes
471 total votes
13%
Less than
one year
60
27%
One to
three
years
38%
More than
five years
22%
Three to
five years
dentaltown research
What type of posts do you use?
43% Metal
40%
7%
10%
Non-metal
Custom cast
I don’t use posts
466 total votes
Free Facts
Endodontists
According to the AAE there are
approximately 4,000 active endodontists
in the United States.
How often do you replace enginedriven files?
446 total votes
Source: www.aae.org/rootcanalspecialists/dentalprofessionalsandstudents/factsheet/
2%
5,099,090
Annual estimate of molar endodontic
therapy procedures (D3330) completed
by general practitioners.
When
they
break
30%
When they
seem
worn out
36%
Every
other
case
32%
Every
case
Source: American Dental Association, Survey Center, 2005-06 Survey of Dental
Services Rendered.
Endodontics –
The ENDO Files Forum Statistics
Total number of threads: 11,023
Total number of posts: 171,306
Do you use warm gutta
percha backfill?
473 total votes
33%
Yes
67%
No
Endodontics: 2010 Townie Choice Award
Winners Recap
Canal Treatment – Lubricants & Cleaners:
Premier Dental – RC-Prep
Canal Treatment – Medicaments:
Pulpdent Corporation – Calcium Hydroxide
Endodontic Hand Instruments:
DENTSPLY Tulsa Dental – Endo Access Kit
Files/Reamers – Engine-Driven Files:
DENTSPLY Tulsa Dental – GT Series X, ProTaper Universal & ProFile Vortex
Files/Reamers – Hand Files:
SybronEndo – K-Flex Files
Gutta Percha Points:
DENTSPLY Tulsa Dental – GT Series X, ProTaper & Lexicon
Obturation Devices & Systems:
DENTSPLY Tulsa Dental – GT & Thermafil Obturators
Sealers & Cements:
DENTSPLY Maillefer – AH Plus Jet Root Canal Sealer
61
insurance feature
by Douglas Carlsen, DDS
62
insurance feature
Dr. Bill and his wife, Carrie, always said their lives were
blessed. Bill created a beautiful practice in the Pacific Northwest
with both a long-term staff and loyal patients. In 2000, Bill
retired at age 62. He and Carrie frequently hiked, fished and
golfed. Bill worked part-time as a volunteer for the Forest Service
while Carrie worked at a local hospital. They both dabbled in
watercolors with the local art colony.
The couple was told they had more than enough money to
enjoy an easy retirement. Bill retired right at the peak of the tech
and stock market boom, and immediately turned to more conservative investments. Again, he felt blessed. Bill and Carrie had
a great PPO medical plan through Carrie’s job at the hospital, a
financial portfolio that was safe from risk and a solid estate plan.
In 2002, Carrie began to have mild forgetfulness, having a
little trouble with names and remembering recent activities.
She and Bill attributed this to age-related memory change.
Over the next year, the symptoms worsened to include forgetting how to accomplish simple tasks like brushing her hair and
teeth. Carrie had Alzheimer’s disease and needed full-time care.
At first, Bill was optimistic, knowing that Carrie would be
afforded the best possible care. Her health plan did pay well for
doctor visits and medications.
Soon, the dark side of retirement appeared.
Bill had thought about, but never purchased a long-term
care policy. This lack of action eventually proved costly.
Bill’s health policy, like most, provided partial benefits for 90
days of skilled nursing care and 20 days of mental health inpatient care per year. However, by 2003, Carrie needed full-time
skilled nursing care. Carrie’s nursing home costs rose to well
over $70,000 by 2005, even with assistance from their health
insurance policy. These changes meant severe curtailing of personal expenses.
Many of us worry about another market decline like in 2008.
What most of us don’t realize is that a more ominous potential
disaster lurks ahead. It is the coming crisis of longer lives and
nursing home fees that could devour a lifetime’s savings in less
than 10 years.
Traditionally, Americans cared for the elderly at home. This
still occurs, but at a significantly reduced rate than even 30 years
ago. Advances in longevity and disease control have created a
more sophisticated system that obviates the possibility in most
cases that the elderly can be assisted and housed without professional care. This burden on our health-care system, our finances
and our domestic lifestyle will only increase as we advance in age.
Table 1 shows some frightening statistics about care in the
U.S. Genworth Financial also has a 2011 update with similar
figures to MetLife’s, yet with state-by-state rates.2
Using a rate of $230 per day for nursing home care, three
years of care would cost $251,850, and 10 years would cost
$839,500. No wonder Dr. Bill has a financial problem.
What is the government’s role? Medicare pays for a limited
number of days of skilled nursing care after hospitalization. It
does not offer long-term custodial care. And there is no
Medicare supplemental policy to cover custodial care. State
Medicaid plans do cover custodial care for the impoverished,
but only after most assets are gone, and in facilities where you
would least want to be.
Traditional health-care plans don’t offer long-term care policies.
Long-Term Care Insurance
When to buy: Analyze at age 60 or before, as many patients
need care before age 65.
Levels of care: A policy should cover non-skilled, skilled
and custodial care, either in your home, an assisted-living facility, adult day care center or nursing home. Make sure you have
the home care option, even if it costs more.
Elimination period: 90 days is normal.
Benefit amount: At least $250 per day, $7,500 per month
or $90,000 per year. As noted, rates are rising quite quickly –
boomers born in 1950 will have $270,000 per year in nursing
home fees at age 89 (see Table 2 on page 66).
Length of benefit: The average benefit payment is for 2.4
years, yet Alzheimer’s patients often require assistance for more
than a decade. Policies offer varying lengths, yet I would recommend five years minimum.
Inflation protection: Get compound inflation protection,
not simple inflation protection. Rates are rising rapidly, like any
medical insurance. Consider a “guaranteed purchase option”
also. This allows the later purchase of more insurance without a
medical exam.
Spousal discounts: Domestic partners might qualify in
some states. Ask about “survivor waiver of premium.” This
Table 1: Care in the United States1
$83,585
$229
$19
70%
40%
Average annual cost of nursing home care in a major city
Average daily rate for a private room in a nursing home
Average hourly rate for non-skilled home health aids provided by a home health-care agency
Percentage of boomers who will need long-term care after age 65.
Percentage of long-term care recipients under age 65.
64
They’ve always been there for you. Now it’s your turn.
Join Oral Health America (OHA) and Ivoclar Vivadent as we elevate the oral health of vulnerable older
Americans through the Wisdom Tooth Project® – an initiative dedicated to the well-being of older
adults. Over 10,000 Americans reach retirement age every day, and many will go without the oral
healthcare they need. But they can’t be healthy without good oral health!
HOW
CAN YOU
HELP
?
Multiply your impact. Donate to OHA between now and December 31st,
and Ivoclar Vivadent will match 50 cents on every dollar to promote healthy
mouths throughout the journey of life.
Want to know more? Watch the video. Simply log onto www.oralhealthamerica.org/wisdomtoothvideo/
or scan the QR code with your smart phone.
To make a donation that changes lives, visit oralhealthamerica.org or call (312) 836-9900
and ask for Emma.
© 2011 Oral Health America
insurance feature
Table 2:
The Rising Costs of Long-term Care
Year
1975
2005
2015
2039
Cost
$7,2001
$74,0002
$106,0003
$270,0003
1. United Equitable Insurance Company, 1977.
2. MetLife Market Survey on Nursing Home
and Home Care Costs 2005 Mature Market
Institute, MetLife, September 2005.
3. “Facts About Long-Term Care,” American
Council of Life Insurers, 2009.
on $107,240 (76.6 percent of $140,000).3 The couple’s incomeneed thus jumps to $192,240 ($85,000 + $107,240). If five
years of care is needed, the extra living amount for two is
$52,240 times five, or $261,200. For two people for five years,
the need is $522,400.
The average doctor I encounter needs around $2 million for
retirement, not including their home or long-term care insurance. Therefore, to self-insure, couples might need an extra halfmillion dollars or more.
waives premiums for a surviving spouse if premiums have been
paid for more than 10 years.
Care coordinators: Make sure this is offered in your policy.
These professionals are a must in many instances, especially with
family members living a distance away. The cost should be
included in the benefits.
International coverage: If you plan to retire outside the
U.S., definitely purchase this coverage.
Non-forfeiture benefit: If the insurance company raises
premiums and you cannot afford to continue paying, you still
might retain some benefit from the policy.
Cost: For the best information and a meaningful quote, go
to the AARP Web site. Genworth Financial offers good plans at
AARP and you can receive a quote without talking to an agent
by visiting: longtermcare.genworth.com/SimpleEngine/private/
loginAARP.do.
A quote at Genworth for a 60-year-old with all the bells and
whistles mentioned above for $250/day coverage is approximately $4,000 per person per year, $8,000 per couple. A 50year-old couple can expect premiums of about 65 percent of a
60 year-old. A 70-year-old couple can expect rates about 65 percent higher than age 50, or about $13,000 per year.
Insurer: You will want to purchase coverage from a large
company that has shown stability for the long term. Genworth
Financial, through AARP, is the only company I recommend
in 2011.
Combined Life and Long-term Care Policies
According to Terry Savage, financial columnist for the
Chicago Sun-Times, “These policies are funded by a large, single-premium deposit into a life insurance policy. Typically the
money comes from savings that you don’t plan to use in your lifetime, but would otherwise leave to your heirs. If only some of the
death benefit is used for care, the balance goes to your heirs.
“Buying one of these combo policies gives you leverage to
get more long-term care coverage than simply self-insuring by
keeping the money in savings.”3
I’m normally not a fan of any life insurance policy that isn’t
term life. This is an appropriate exception.
OneAmerica, Lincoln National and Genworth all have good
policies to investigate.
Self-funding
The average retired dental couple I talk to lives on an
income of around $140,000 per year. If one needs nursing care
that costs $85,000 per year, the other person can normally live
References:
Final Thoughts
During the heyday of our professional lives, we concentrate
our finances on homes, autos, travel, clothing, college for children and savings. In retirement, health issues not only occupy a
large slice of time, but can also eat up most of our budgets.
There isn’t a happy ending for Dr. Bill, only the knowledge that
his children now will help out both Carrie and Bill financially.
Terry Savage provides a meaningful discussion of longterm care in her new book, The Savage Truth on Money, found
at any bookseller. ■
1. Market Survey of Long-Term Care Costs, MetLife, October 2010
2. http://www.genworth.com/content/products/long_term_care/long_term_care/cost_of_care.html
3. Terry Savage, “Combined life, long-term care policies,” Chicago Sun-Times, downloaded Feb.
5, 2011 at www.suntimes.com/business/savage/3445374-452/care-insurance-policies-moneyterm.html
Author’s Bio
Douglas Carlsen, DDS, owner of Golich Carlsen, retired at age 53 from private practice and clinical lecturing at UCLA School of
Dentistry. He writes and lectures nationally on financial topics from the point of view of one that was able to retire early on his own
terms. Carlsen consults with dentists, CPAs, and planners on business systems, personal finance and retirement scenarios. Visit his Web
site: www.golichcarlsen.com; call 760-535-1621 or e-mail at [email protected].
66
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you should know
Why You Should Kno
68
You Should Know_Layout 1 10/19/11 10:09 AM Page 69
o w:
you should know
Wpromote
Meet Mike Mothner, the founder and CEO of Wpromote, a full-service online marketing firm that
serves about 2,000 clients across the world but mostly in the U.S., ranging from small local
businesses all the way to Fortune 500 companies.
Who was your first client?
Mothner: Our first client that we helped with SEO and
online marketing was a fingerprinting company, for people
who need to get security clearance.
How did you come up with the name
Wpromote?
Mothner: I was really into computers at the age of 15.
I wrote a piece of software and I started buying domain
names and helping people launch their Web sites in the late
90s. I came up with the concept of the service and I needed
to think of a name. I happened to look down my list of dot
com names that I owned and I saw Wpromote. I thought
that is kind of short and easy to remember and W is kind
of from World Wide Web. I wish I had a better, more
romanticized answer.
Search engine optimization (SEO) is the core
of your business. How would you say this
has become more sophisticated?
Mothner: The core is organic search engine optimization. Helping Web sites have better content, more authority; and then search engine marketing and pay per click is
the active advertising. That probably composes about half
to two-thirds of our business now. In the past decade the
SEO industry has gone from where you just needed to
show up with text on your Web site to now where we are
in a competitive, mature industry with a lot going on.
There has been a lot of talk lately about
Google’s decision to discontinue posting
third-party reviews on its Places pages.
What are your thoughts on that?
Mothner: At the end of the day Google wants to be the
source. Their thinking is it is a less “spammy” environment
if they control the content. They got people involved in the
beginning when they didn’t really have any reviews. There
are definitely positive and negatives to it. I personally
believe Google does care about the user and the honesty
and integrity of the reviews.
What I would consider the three main search
engines are Google, Bing and Yahoo. How
would you characterize those three?
Mothner: I think it is very easy to fall into the trap of,
“I only use Google.” The bottom line is that the combination of Yahoo and Bing basically are all powered by Bing. It
is three properties but you are only dealing with two venues
in which to focus SEO efforts as well as search efforts. If you
have a relatively limited budget and you’re not going to have
enough to cover everything, your first dollars are going to be
better spent in Bing or Yahoo.
How frequently does a dental office need to
add fresh content to its Web site, Facebook
page, etc.?
Mothner: In the realm of a dentist office there is not
much that changes. I have my services, I have my bio, I have
the relevant information and it is not like that changes very
often so it can be a challenge. From an SEO perspective we
are adding content for Google not necessarily for the user so
if you are a client of ours and we are adding five pages of
content a month and we are picking key words and creating
the content, etc. That has a quality benefit. It should be
ongoing – that’s the key. The better way to have a more natural growth of content on the site is to have a blog on your
site. You don’t have to really think about it from an SEO
perspective, you just have to be routine about it. I can post
a link to another article. I can post something about the
happenings in the local town or schools. It can be more
about updates for patients on things to do in the community. It doesn’t always have to be about teeth.
For more information, visit www.wpromote.com. n
69
practice management feature
RENT-a-
DENTIST
by Joe Steven Jr., DDS
I
have to admit that I kind of felt sorry for that doctor after our
phone conversation! An out-of-state dentist called me at home
to talk about some clinical concerns he had. We visited for
about an hour, and before we said goodbye, he said, “Joe,
thanks for talking to me tonight! I can’t remember the last time
I talked to another dentist. It’s been years!”
70
I thought about how often Mark Troilo and I talk with
each other since graduating together 33 years ago. We talked
nearly every night about the clinical and management side of
dentistry because we love talking dentistry!
I realize that there is more to life than dentistry, and all
dentists will have different levels of passion about our profession. This article is about what those conversations can do for
a dentist. Because we talked dentistry all the time over the
years, our practices grew very successful simultaneously. Our
practices mirror each other very closely when it comes to the
size, team, philosophies and production numbers.
Is this just coincidental? I don’t think so. I believe it is a
direct result of the fact that we discuss dentistry whenever we
can. We learn from each other. We take turns trying out new
products and systems, and then share our results. Over the last
four years, we’ve had many discussions on incorporating associates. We discuss things that we learn at different seminars
and work together to implement them into our practices.
We even go so far as to
joke about that if you don’t
have a friend who is
a dentist, go rent one!
At our seminars Mark and I talk about how important it is
to have a good friend who is a dentist whom you can talk with
on a regular basis. We even go so far as to joke about that if
you don’t have a friend who is a dentist, go rent one! We think
it is that important.
Mark and I have been very lucky to be best friends since
dental school, so yes that makes it easy for us. But, what do
you do if you don’t have a close dental friend? There are
several things you can do. The easiest is to join some of the
dental e-mail network groups. Dr. Howard Farran said it best
when he started Dentaltown.com with the tagline, “Never
practice alone again!” What a great way to learn from other
dentists while building friendships. Dr. Mike Maroon and his
friends started the ACE e-mail network, which accomplishes
the same learning experiences. We started one with KISCO
that you can join easily by going to our Web site. I’ve picked
up many good ideas from these groups. Because of these networks, my daughter, Dr. Jasmin Rupp is doing Six Months
Smiles, which has been great for our practice. So, if you don’t
belong to any of these groups, what are you waiting for? They
don’t cost anything. And please, don’t be afraid to share your
input with others also.
Joining a study club is another great resource. You can also
start your own. Contact some of your colleagues in your area
72
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PRODUCTS
PRODUCTS 2011
2011
and visit with them about starting your own club. I belong to
one here in Wichita, and we meet every three to four months.
We discuss different dental topics and also dental politics. Our
group has been very proactive in state politics and has made
positive changes for the profession in our state. You can do the
same. Along the way you just might pick up a close friend or
two who you can call late at night to tell them that you broke
another NiTi reamer in a patient’s tooth!
If you practice in a medical or dental building with several
other dentists, try to get all the dentists to go to lunch once a
month or every other month. If you practice alone, call several
dentists within a radius of a couple of miles, and invite them
to do the same. While building good relationships with some
colleagues, another advantage is that you might find good connections for covering each other’s office emergencies when
those situations arise.
And then of course, there are plenty of personal consulting
programs out there that you can bring on board to help manage your practice. These programs are ideal for getting doctors
more involved in the business side of their practice because
now they have to talk dentistry on a regular basis with someone who is trying to help them. Too many times dentists are
just so busy practicing dentistry and raising a family that they
don’t have time to really implement and improve systems in
their office.
Can you become successful without any of the above? Sure
you can, but the large majority cannot. It just makes sense that it
is much easier to improve your practice if you have a friend, a
colleague or a coach to help you through your dental business
journey. Plus, it’s good to have someone you can call to vent
some of your frustrations and problems. Better yet, it’s great to
have someone you can share your clinical dental successes. All
around, it is a much more beneficial way to practice dentistry! ■■
Author’s Bio
Dr. Joe Steven graduated from Creighton Dental
School in 1978 and has been in solo practice in
Wichita, Kansas, up until June, 2007 at which time his
daughter, Dr. Jasmin Rupp joined him. He is president
of KISCO, a dental products marketing company,
providing “new ideas for dentistry,” and is the editor of the KISCO
Perspective Newsletter. Dr. Steven, along with Dr. Mark Troilo,
presents the “Team Dynamics” seminar. Dr. Steven also presents
three other seminars: “Efficient-dentistry,” “Efficient-prosthetics”
and “Efficient-endo.” Dr. Steven also provides the KISCO Select
Consulting Program to dentists in the form of a monthly audio CD
recording. He also offers a coaching consulting program called
the KISCO’s 21 Club. Contact info: [email protected];
800-325-8649; www.kiscodental.com.
74
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restorative feature
by Dr. David Hacmoun
76
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restorative feature
Fig. 1: Pre-operative view: fractured central incisor
Fig. 2: Considerable loss of dental enamel; fracture
line near the pulp
Fig. 3: Mock-up made of composite resin (A4) for the
palatal silicone matrix
Fig. 4: Preparation of a featheredge under rubber dam
isolation
78
A very close inspection of dental enamel reveals its intricate fabric. Having to
reproduce these fine structures and shade nuances seems a daunting task. Due to
the research and development efforts of dental composite manufacturers over the
past few years, materials are now available to facilitate the placement of restorations.
Nevertheless, the appearance of composite resin restorations is often marred by a
grayish shimmer. The following clinical case shows a way to avoid this problem and
realize the natural-looking results envisioned by the patient.
An 11-year-old male patient presented for surgery with a fractured central incisor (Fig. 1). The clinical examination revealed that the tooth was sensitive to temperature and percussion. A fracture close to the pulp was diagnosed (Fig. 2).
Clinical evidence of a periodontal trauma was not found. I recommended the tooth
be reconstructed by layering composite resin using a minimally invasive and conservative restorative technique.
Shade Selection
I determined the shade in daylight at the beginning of the treatment before
the teeth were dried. I used the shade guide of the composite resin, which I subsequently used during the restorative procedure (Tetric EvoCeram). In order to
check the selected tooth color, I applied a composite layer to a tooth and polymerized it. For the cervical area, I chose dentin shade A2 and for the incisal area
enamel A1.
The Mock-Up
The treatment area was locally anaesthetized and the tooth was reconstructed
free-handedly using a composite resin (deviating from the tooth color), without
preparation or the application of an adhesive. I decided to use an easily recognizable shade; in this case A4 (Fig. 3). After polymerization, the shape and exact position of the margin and the occlusion were refined. Finally, a silicone matrix of the
palatal surface and the margin was fabricated with a putty impression material.
This matrix would facilitate the subsequent layering procedure. After the fabrication of the silicone matrix, the provisional restoration (mock-up) was removed.
Later a composite resin in the desired tooth color would be placed.
The Cementation Protocol
When the adhesive was applied on the restoration, it was important to ensure
that the tooth surface was not too wet. The placement of a rubber dam with ligatures is standard procedure. The rubber dam provides an unobstructed view of
the treatment field and increases the safety and comfort of the practitioner and
the patient.
The tooth substance was prepared with a featheredge in the labial enamel. This
preparation design ensures tight sealing and forms the basis for an unobtrusive
transition between the natural tooth structure and the composite resin (Fig. 4).
The enamel and dentin were cleaned with a mixture of pumice and pure chlorhexidine (Paroex) at 0.2 percent. Next, Telio CS Desensitizer was applied.
Due to the wide enamel edge, the total-etch technique was used. That is, the
tooth was etched with phosphoric acid before the adhesive was applied. Therefore,
the enamel was etched for 30 seconds and the dentin for 15 seconds with total
etch. This etching gel contains 37 percent phosphoric acid. The surfaces were
rinsed for 20 seconds and then carefully dried according to the “wet-bonding”
principle (adhesion on moist surfaces). As a result, the enamel was dry, while the
feature restorative
dentin remained somewhat moist. This drying step requires utmost care when this
type of adhesive is used. If the moisture content within the dentin tubules is too
high or if the collagen fibers collapse due to excessive drying, the penetration of
the adhesive, and therefore the bond strength, is reduced.
The single-component adhesive ExciTE was applied to the enamel and dentin
and allowed to react for 10 seconds. An indirect stream of air was used to evaporate the solvent contained in the adhesive. In the process, the air spray was applied
on a mirror in the mouth, which was held at an angle to the prepared tooth surface. As soon as the surface was lustrous, the adhesive was further polymerized for
10 seconds (low power mode of the bluephase G2 LED curing light).
Layering of the Composite Resin
First, the composite resin was applied to the palatal areas. The enamel material A1 was applied in the silicone matrix. In order to avoid the formation of
bubbles, the composite resin was distributed very carefully. The matrix was
placed in the patient’s mouth and positioned on the palatal surface with light
pressure. The composite resin was polymerized for 15 seconds using the soft
start mode (Fig. 5). Small lobes of dentin material (A2) were subsequently
applied. The position of these lobes was individually determined. The aesthetic
results were based on the contralateral teeth, which served as a comparison. In
this case, the mamelons were clearly separated. They ended below the incisal
edge (Fig. 6). By observing the existing anatomical features, a natural-looking
and aesthetic outcome was achieved.
The composite resin was applied in small amounts, which were periodically
cured with a bluephase curing light in the soft start mode. The dentin material was
applied and light-cured. Next, the incisal edge of the tooth, that is, the outermost
part of the restoration, was reconstructed. Small portions of the translucent incisal
material were placed between the dentin mamelons. A probe came in useful in
these narrow areas. Finally, the entire labial surface was coated with Tetric
EvoCeram Bleach 1, making sure both the dentin lobes and the incisal edge were
completely covered. The bleach shade made the tooth appear lighter. The dentin
material imparted the composite resin restoration with a tooth-like appearance.
The shade was responsible for the tooth’s natural-looking brightness.
Surface Finishing
The aesthetic outcome is largely based on the successful re-creation of the surface texture. The imitation of the shape and surface details is just as important as
that of the fine color nuances. In the treatment of a child’s tooth in particular, it is
important to take the micro- and macro-anatomical structure into consideration.
The surface was finished with finishing diamonds (first red, then yellow). Spray was
not used. Work was done using a surgical microscope. The restoration was finally
polished with the Astropol system (using water spray). In contrast to polishing
discs, these rubber tips do not harm the surface structure.
Conclusion
The fabrication of natural-looking, highly aesthetic restorations is a rewarding
task with Tetric EvoCeram materials and the increment technique. The bleach
shade on the tooth surface brightens the restoration. This approach is extremely
helpful in the restoration of children’s teeth. With the help of this adhesive technique, teeth can be restored in a minimally invasive way (Figs. 7a, b). ■
Fig. 5: Build-up of the palatal surface with enamel
material (A1). The precision of the morphology is
already impressive at this stage.
Fig. 6: Lobes are created with dentin material (A2).
The translucent material is placed between these
mamelons.
Figs. 7a, b: A comparison: before and after: The shade
on the surface of the restoration imparts the tooth with
the necessary brightness.
Author’s Bio
Dr. David Hacmoun practices
in France. He can be reached at
[email protected].
79
product profile
Zest Anchors
Zest Locator Overdenture Attachments
Locator Root Attachment
Locator Implant Attachment
Locator Bar Attachment
80
For 40 years Zest Anchors has been in the design and manufacturing of overdenture attachments. Zest pioneered self-aligning attachments to combat the
damage done by the improper seating of overdentures.
Zest’s Locator Attachment is designed with the primary benefits of ease of
insertion and removal, customizable levels of retention, low vertical profile and
exceptional durability. Its most critical design feature is its innovative ability to
pivot, which increases the Locator’s resiliency and tolerance for the high mastication forces an attachment must withstand and allows it to compensate for the path
of insertion even with up to 40 degrees of divergence between implants.
During seating, while the Locator male pivots inside the denture cap, the system’s
self-aligning design centers the male on the attachment before engagement. These
two actions in concert allow the Locator to self-align into place, enabling patients to easily seat
their overdenture without the need for accurate alignment and without causing damage to the
attachment components. This self-aligning feature also increases the durability of the Locator
Attachment. Once seated, the male remains in static contact with the attachment while the denture cap, which is processed into the overdenture, has a full range of rotational movement over
the male for a genuine resilient connection of the prosthesis without any loss of retention.
The Locator System offers both Locator males and extended range males, which provide
clinicians with a variety of retention level options to suit their patients’ needs and enables clinicians to accommodate various paths of insertion depending on implant positions. Locator
males allow for insertion of the overdenture with up to 20 degrees of divergence between
implants and are available with one and a half, three or five pounds of retention forces.
Extended range males allow for insertion of the overdenture with up to an extensive 40
degrees of divergence between implants and are available with zero, one, two or four pounds
of retention forces.
With the Locator Attachment’s unique design, the overall restorative height of the overdenture is significantly reduced on all brands of endosseous implants. With a total attachment height
of only 3.17mm (male plus 1mm cuff height) for an externally hexed implant, the Locator saves
a minimum of 1.68mm of interocclusal space compared to other overdenture attachments. The
Locator Attachment also has twice the amount of retention surface area compared to other overdenture attachments available. Its unique dual-retention feature, which includes inside and outside retention, ensures long lasting performance and predictable durability.
Zest offers three Locator Attachments for the various types of overdenture treatments.
The Locator Implant Attachment is the premier attachment for implant-retained, tissuesupported overdentures and is available for virtually every implant system. When a treatment
plan calls for an overdenture bar, the Locator Bar Attachment provides the same self-aligning feature, superb retention, a low-profile design and long-lasting durability. It is also offered
in three options for the fabrication of a resilient attachment on an implant-supported cast
alloy or milled titanium bar. The Locator Root Attachment is a supra-radicular design with
a choice of a straight post and 10- or 20-degree angled posts to accommodate divergent roots.
A special cast-to version is also available.
Locator has become the overdenture attachment that is embraced by clinicians worldwide. It is currently available for more than 350 different implants produced by more than
70 manufacturers, meaning that almost any implant platform has a compatible Locator
Attachment to fit. Now, patients all over the world are enjoying a better quality of life, without the worry of ill-fitting dentures.
For more information, call 800-262-2310 or visit www.thepivotingdifference.com. ■
1972
ZEST Anchor
Aachment
®
2012
ZAAG
Aachment
ZEST LOCATOR
Aachment System
(Implant, Bar &
Root Aachments)
(Implant, Bar &
Root Aachments)
®
®
SATURNO
Pivoting O-Ring
Aachment
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The Next Generation
of Overdenture
Aachments
Leading four decades of overdenture aachment system innovations.
For forty years, we’ve been raising the bar in overdenture aachment innovations. From pioneering
pivoting, self-aligning aachments to exciting breakthroughs on the horizon, ZEST continues to
define the overdenture aachment market. It’s why over 70 implant manufacturers have partnered
with us to customize our third generation aachment, LOCATOR, and made it compatible with over
350 different implant products. It’s also why millions of patients are now enjoying a beer quality
of life every single day. We’re proud of what we’ve accomplished, but we’re not standing still... in the
coming year, watch for exciting new product introductions designed to once again provide your
practice with increased revenue opportunities and even more satisfied patients.
For more information download a QR app to scan this code, visit
our new microsite at www.thepivotingdifference.com/DTOWN,
or please call 1.800.262.2310.
©2011 ZEST Anchors LLC. All rights reserved. ZEST®, LOCATOR®, ZAAG® and ZEST® Anchor are registered trademarks and SATURNO™ is a trademark
of ZEST IP Holdings, LLC.
marketing feature
by Rhonda R. Savage, DDS
Elmer Wheeler, a selling genius from the 1940s, said: “Don’t
sell the steak, sell the sizzle.” But, you can’t sell the sizzle if the
patient doesn’t trust you.
Think about the “steak” as your basic dental services. The
“sizzle” is above and beyond. The sizzle can be those little things
that increase your bottom line: adult fluoride, night guards,
sealants, cosmetic whitening, nitrous oxide or referrals of new
patients by existing patients. Also, the “sizzle” can be big things
like cosmetic dentistry, implant restorations, orthodontic treatment or laser-assisted periodontal treatment.
You can’t offer the steak or the sizzle unless you get new
patients in the door and you keep them in your practice. You
won’t attract word-of-mouth referrals from your existing patient
base if your patients don’t trust you.
Step into your patient’s shoes. Would you choose your
dentist or physician if he or she were totally about self-respon-
82
sibility? How about if he had the reputation of placing your
needs above his? “My dentist makes recommendations based on
what’s right for me, not on what’s best for him!”
As a privately practicing dentist, former dental assistant and
front office person, I look at the business of dentistry from the
inside out. Who do you stack up against, from a competition
standpoint? As a consultant and a dentist, I can say that my
products are a head and shoulders above the competition. Can
you say the same about yours?
People are willing to pay a premium for these qualities. You’ll
attract more new patients if this is your reputation. People shop
up if they have the opportunity. Price is only an issue in the
absence of value.
What’s holding your practice back from creating value? Is it
training or refining your team’s talents? There are five areas of
critical training that exist in dentistry.
feature marketing
Visit us at ADA, October 10-12, 2011
Clinical and motivational verbal skills
Financial presentation skills
Communication systems within the office
Leadership skills for the doctors
Effective business systems
You’ll need to personally examine your practice and consider how you fare with your “steak and sizzle” in each of these
categories. It doesn’t make sense to spend your precious time
and money on marketing if you don’t engender trust in your
patients. This is true whether you’re a fee-for-service practice, a
participating provider or a Medicaid-based practice.
Marketing is one step; keeping the patients is another. First,
you need a defined goal.
In order for your practice to grow, you should be seeing
between 25-40 new patients a month per doctor. As an established practice, you need 10-20 new patients a month. If you
have an associate, I recommend your goal be 50 new patients
per month. Your need for new patients depends upon your
demographics, practice style and number of years you’ve been
in practice. As an established practice, if you have less than 10
new patients per month, your practice is declining.
A growing practice should have a marketing allowance of
two to six percent of collections. Consider spending twothirds of your budget on internal marketing and one-third on
external marketing.
I’ve worked with some rapidly growing scratch practices
who see a high number of PPO patients, primarily obtained by
billboard marketing, magazine and newspaper ads and neighborhood mailers. If you consider the PPO adjustment as a
marketing tool, how much of your gross production could be
technically considered “marketing”?
Your team members need to understand that PPO participation can be considered one way to build a practice. Be careful, however, that you work to keep those hard-earned patients.
If you get too many new patients, don’t have an adequate staff
and there’s no effort to recall or reactivate, you’ll be a revolvingdoor-type of practice.
Here are 12 strategies to market
your practice:
1. Stay Connected
One very powerful marketing tool is a confidential patient
survey (Smile Reminder is one company offering a great electronic survey). Or, you can choose to do an in-office survey; a
mail-in survey will obtain more information because the
patient can choose to be anonymous. E-mail me if you’d like a
copy of our in-house survey. Have your front desk team let the
patient know you’re asking all of your patients for their help.
Give them a self-addressed, stamped envelope and inform them
that the survey can be anonymous or signed.
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who is at increased risk for oral
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Advancing Patient Wellness Through
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Studies reveal that the human papillomavirus, particularly HPV-16,
has been definitively implicated in oral cancers.1,2 In fact, over 50% of
oropharyngeal tumors contain the HPV genome (DNA).2 Early detection
of oral HPV is a fundamental element of a patient’s overall wellness plan.
The OraRisk® HPV salivary diagnostic test is a non-invasive, easy-to-use
screening tool to identify the type(s) of oral HPV, a mucosal viral infection
that could potentially lead to oral cancer. The test enables clinicians to
establish increased risk for oral cancer and determine appropriate
referral and monitoring conditions.
To order OraRisk® HPV testing supplies,
contact your Henry Schein® representative at
800.372.4346
References:
1. Ragin CC, Modugno F, Gollin SM. The epidemiology and risk factors of head and neck cancer:
a focus on human papillomavirus. J Dent Res. 2007 Feb;86(2):104-14.
2. Fakhry C, Gillison ML. Clinical implications of human papillomavirus in head and neck cancers.
J Clin Oncol. 2006 Jun 10;24(17):2606-11.
PRODUCTS 2011
For more information,
www.OralDNA.com/professionals
877.577.9055
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OralDNA® Labs is a subsidiary of Quest Diagnostics® Inc.
83
marketing feature
Recall and reactivation is truly the best form of internal marketing. What is your percentage of effectiveness in getting your
patients back in the door?
Stay in touch with your patient base with a newsletter. The
least costly is a electronic version (Smile Reminder, Demand
Force and TeleVox are some companies to research). Make it 50
percent non-dental, fun and interesting! Also, send birthday
cards, anniversary cards, sympathy cards and daily thank you
cards to patients.
2. Call Patients Post-treatment
Are you calling patients post-treatment to see how well
they’re doing? Your patients will be very impressed that the doctor is calling them! You should call after major treatment.
Patients love it! Also, your hygienists should call after any scaling
and root planing, within 24 hours post-treatment.
3. Call New Incoming Patients
Within one to two days of scheduling, call new patients to
greet them and welcome them to the practice. This will certainly set you apart from other dentists and decrease new
patient failures! Ninety-five percent of the time, you’ll be leaving a message. This is what I say: “Hi, I’m Dr. Rhonda Savage.
I understand you’ve made a new patient appointment with
my practice. I wanted to call and let you know we’re looking
forward to having you in our practice. If you have any questions, feel free to call me at 555-1212.”
4. Evaluate Facility Appearance
One significant part of marketing is the appearance of the
facility. Is cleanliness an issue? Hold your cleaning company
accountable. I recommend an outside cleaning company; if you
must use internal help, the cleaning person needs to be held at
the same level of accountability as an outside cleaning company.
In order to see what the patients see, set aside 20 minutes at
your next team meeting for a patients’ perspective exercise (PPE).
Everyone walks in silently from the outside and looks at all the
spaces. Each staff member should make notes on a pad of paper.
Then meet and combine the notes and ideas into three categories:
ideas that cost nothing, ones that cost a little, and those that cost
a lot. You will be amazed at what a little “spring cleaning” can do!
I always recommend that all spaces be “patient ready” at all times.
Does your facility project warmth in color and décor? You
don’t need to spend a lot of money to create a warm look with
paint, carpet and décor.
The entire team needs to be involved in cleaning their personal space or have an assigned operatory. They should be cleaning
their operatory from top to bottom quarterly. This is not the job
of a cleaning crew. Doctor, does your desk need cleaning?
Dusting? Your space should be kept as neat and clean as the rest
of the office. Cleaning the blinds is the duty of the cleaning crew.
They should be cleaned quarterly or at least semi-annually.
84
Make certain the front entrance area is kept clean on a daily
basis. Have a well-lit exterior, with colorful flowers if possible.
Consider the use of small, decorative white lights to illuminate
trees and create interest at nighttime.
5. Consider Professional Image
If you’re interested in presenting a higher level of care, you
might consider professional dress. The front desk needs closedtoed shoes and a professional top with little or no cleavage visible. Even in warm areas, I recommend the team avoid capris and
sandals. If someone appears at work with cleavage, they should
be sent home to change. Everyone should reflect the image that
you want your office to be known for! Consider the image as part
of your PPE discussion.
6. Adding Services
An addition of new services within your practice will help
make your practice stand out from others. One company to consider is OralDNA. Ask your hygiene department to research its
products. Also, have your staff wear one of many magnetized
buttons that say, “Ask me about Six Month Smiles!” or “Ask me
about Cosmetic Whitening.” Check out RLM Dental Marketing
for these buttons; place them in a basket and have everyone grab
one each morning at your morning huddle.
7. Personal Marketing Outside the Practice
The doctor needs to be active personally in the community.
All team members need to actively refer when out in the community. Give your team $25 per new patient referral from outside
sources (personal family members do not count).
8. Keep an Up-to-date Web Site
Do you need to increase the search engine visibility of your
Web site? Do a local search to check your placement. Also, review
the image of your site. Does it draw patients in within the first
few seconds? Blog, blog, blog on your Web site. You need video,
rave reviews and Facebook on your opening page. Look into the
QR code! Have rotational promotions on your site.
9. Consider Patient Financing
Look into alternate patient financing as part of your marketing program. I personally have worked with CareCredit all my
years in private practice. If the patient doesn’t qualify for
CareCredit or ChaseHealthAdvance, consider ComprehensiveFinance.com.
10. Evaluate Patient Services
What’s in the patients’ best interest? What can you offer them?
Consider X-rays every year for the majority of your patients.
Unless the patient is a clean, healthy adult, you cannot diagnose
what you don’t see. Sometimes, even those that appear clean and
healthy can surprise you!
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11. Front Desk Organization
The front desk needs to be prepared for everything. Examples
include: checking insurance benefits ahead of time, knowing
whether a patient is covered for X-rays. Prior preparation says,
“We’re professional and you can trust us!” It is a marketing tool!
Also, look into On Hold Messaging as a form of advertising.
Customer service is reflected in your recare/reactivation
efforts. This is a front desk responsibility. Keep your front desk
accountable for preparedness and organized systems.
Consider a white board to greet new patients and welcome
back returning patients. Or place a picture board in the reception area to create instant connections.
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12. Show Thanks
Step up your “thank you” program versus a flat $25 credit to their account/new patient. Have an internal raffle semiannually. Put the patient’s name in a fish bowl when they
refer a new patient or “like” you on your Facebook Fan Page.
Have a great non-dental prize like an iPad as a first prize, then
in-office whitening as a second prize, then a kid’s Sonicare
toothbrush as third.
A downturn in the economy is when you need to count on
creativity and innovation the most. You can utilize the talents
of the team to accomplish the majority of these efforts. It takes
the entire team to offer and perfect your “steak and sizzle.”
So… pull out the barbeque and have a team meeting this week
to review your current marketing efforts! ■
Advancing Patient Wellness Through
Salivary Diagnostics
MyPerioPath®
Salivary DNA test that determines the cause of periodontal infections
The MyPerioPath® test will reveal what pathogenic bacteria are responsible
for the infection, which is valuable information you need to treat patients
more effectively and with more predictable outcomes. MyPerioPath® test
results also serve to establish a baseline reading, so you can monitor
treatment effectiveness over time.
Author’s Bio
Dr. Rhonda Savage began her career in dentistry as a
dental assistant in 1976. After four years of chairside
assisting, she took over front office duties for the next two
years. She loved working with patients and decided to
become a dentist. Savage graduated with a BS in biology, cum
laude, from Seattle University in 1985; she then attended the
University of Washington School of Dentistry, graduating in 1989
with multiple honors. Savage went on active duty as a dental officer in the U.S. Navy during Desert Shield/Desert Storm and was
awarded the Navy Achievement Medal, the National Defense Medal
and an Expert Pistol Medal. While in private practice for 16 years,
Savage authored many peer-reviewed articles and lectured internationally. She is active in organized dentistry and has represented the State of Washington as president of the Washington State
Dental Association. Savage is the CEO for Miles Global, formerly
Linda L. Miles and Associates, known internationally for dental
management and consulting services. She is a noted speaker who
lectures on practice management, women’s health issues, periodontal disease, communication and marketing and zoo dentistry.
To speak with Dr. Savage about your practice concerns or to schedule her to speak at your dental society or study club, please e-mail
[email protected], or call 877-343-0909.
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To order MyPerioPath® & MyPerioID® PST® testing
supplies, contact your Henry Schein® representative at
800.372.4346
PRODUCTS 2011
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85
product profile
by Frank Lauciello, DDS
According to a 2002 estimate based on data from the national
epidemiologic survey, edentulism has declined 10 percent each
year.1 Yet, due to the growth of the U.S. population aged 50, which
is estimated to increase in the next 10 years by 79 percent,1 the
number of adults predicted to need complete dentures is expected
to increase from 53.8 million in 1991 to 61 million in 2020.2
Dentures are and will continue to be essential in dentistry
for the aging population. However, there is hesitation by many
clinicians to treat the edentulous patient, which can be
extremely challenging due to the subjectivity of the treatment.
Everything from the proper selection of teeth, where to position the teeth, how to communicate to the lab and judging
variability of vertical and centric jaw positions, among many
other aspects, are difficult to control and predict. Therefore
success is often compromised leaving the clinician feeling not
in control of the outcome and consequently removable treatment is perceived as a liability rather than a profitable, enjoyable part of practice.
With the successful introduction of implant dentistry the
edentulous state can be remarkably improved which has inspired
a renewed interest for the edentulous patient to seek retreatment. Depending on the number of implants placed, there are a
variety of restorative options that can now be considered. If
properly diagnosed and efficiently treated, these restorations
represent a tremendous financial incentive for the clinician and
dental lab. Unfortunately denture techniques and materials of
IV Bracket Implant
86
the past offer limited solutions. Today’s clinicians are less apt to
engage in time-consuming chairside removable procedures and
have become more reliant on laboratory support.
This, of course, requires accurate communication with the
dental lab.
A Systematic and Simplified Approach
The challenge for the professional team is to seek out a denture system that will enable accurate impressions and patient
records, tooth selection that is patient specific and aesthetic,
communication of essential patient information to the lab and
special attention to the accurate and hygienic processing of the
denture base material.
Having the opportunity to work with a multitude of dental
laboratories, clinicians and academics has given me the opportunity to evaluate many suggested systems of treatment for the
edentulous patient. I consider the Ivoclar Vivadent removable
system presented in this article as a composite of ideas, techniques and materials that is a logical solution to minimize the
subjective variables of removable treatment that cause time consuming miscommunications and ultimately less than desirable
outcomes. This system has been taught in our educational programs for several years and has provided clinicians and dental
labs with a successful framework to increase profitability and
success. I have grouped the discussion into four categories:
impressions and patient records, tooth selection, communication and denture base processing. This article is not meant to be
totally comprehensive, so each of these categories will be outlined and lightly addressed.
Impressions and Patient Records
Understanding the anatomy and physiology of the edentulous mouth is critical in developing an accurate impressioning
technique. Knowledgeable border molding is particularly
important for the mandibular arch which has the major complication of having the tongue as a major determinant of retention
and stability. For the mandibular arch, the choice of impression
materials is not nearly as critical as the impressioning technique.
On the other hand, the stability and retention of the maxillary
denture is more a product of adhesion and cohesion and is best
product profile
impressioned using a technique and material that captures the
tissues in a rested mucostatic condition. Briefly stated, the
mandibular impression requires a preliminary impression, custom tray, border molding and final wash. The maxillary impression can be a single entry irreversible hydrocolloid impression
which if done carefully can be considered the final impression
relatively routinely. The AccuDent System 1 is an excellent system of material and tray design and is the choice for single entry
final impression systems.
Making a provisional centric jaw record can provide a significant form of communication to the dental lab. The centric tray
is a tool that provides a platform to retain impression putty
material to record a tentative intra-oral relationship. This will
allow the casts to be mounted early in the procedure for diagnostic purposes and it also allows the laboratory an option to
assemble a bite-recorder.
I have always been an advocate for bite-recorder devices to
facilitate vertical and centric jaw registrations. Unfortunately
they have a history of being intimidating and therefore rather
unpopular. A little-known device called the Gnathometer M is a
unique instrumentation that not only provides the bite-recorder
option but can also be used to simplify the mandibular final
impression procedure. Having the casts mounted using the centric tray record greatly facilitates the assembling of the
Gnathometer M by the dental lab. As we all know, border molding the mandibular impression can be extremely challenging.
This device allows the patient to be in a stable closed-mouth
position. Once the mandibular impression is made, the white
Accudent
Centric Tray
bite tabs can be removed and the bite-recorder elements
attached allowing vertical dimension to be accessed and provides
a stable tracing pin to stabilize the bases while the centric record
is made. In selected circumstances an intra-oral Gothic arch
tracing can also be performed. These techniques greatly improve
and simplify the challenging procedures of mandibular final
impressioning and jaw registration. Chairtime is reduced since
the laboratory provides support.
Denture Tooth Selection
Often times this responsibility is delegated to the dental laboratory. Although most laboratory technicians can provide assistance, it is a bit unfair since they do not have the advantage of
seeing the patient. Denture tooth selection systems of the past
(square, tapering, ovoid) have focused on criteria that are inaccurate and impossible to effectively practice. The BlueLine denture tooth system was the first to break from these old systems
and reclassify their maxillary anterior teeth by size – small,
medium, large – and individual characteristics of soft and bold.
This concept has been further advanced with the PHONARES
new line of denture teeth, which also classifies the teeth to age.
These are logical criteria that are teachable and have made tooth
selection simplified and more accurate for the clinician. Both
systems provide individual FormSelectors, including a facial
meter, which measures the interala distance and helps to determine an appropriate size for the anterior tooth selection.9
The selection of denture tooth material is dependent on
optics, wear and toughness. The BlueLine is representative of
Gnathometer
87
product profile
the premium, double cross-linked polymethylmethacrylate (DCLPMMA) and the PHONARES represent a nano-hybrid composite
(NHC) resin chemistry. Cross-linked PMMA chemistry has been
the standard in the industry for many years and has acceptable aesthetics, wear and exceptional toughness. The composite resin
chemistry has improved optical qualities due to the opalescence of
composite resin materials. Wear is also significantly enhanced
which is an advantage for implant restorations which tend to show
premature wear with conventional PMMA. However in situations
where there is minimal restorative space, the PMMA-based denture tooth might have the advantage since it has more “toughness”
and less chance for fracture when it is ground thin.
Posterior denture tooth occlusion choices are primarily classic semi-anatomic, lingualized and non-anatomic (monoplane).
If aesthetics of the premolar area are important, the semianatomic choice has better aesthetics in this area because the
buccal cusps of the maxillary premolars are functional and set
similar to natural dentition. If function or prevention of cheek
biting is most important, lingualized occlusion has an advantage
since the maxillary buccal cusps are tipped upward accentuating
the penetrating quality of the maxillary palatal cusp. In addition,
the tipped maxillary buccal cusps protect the cheek tissues from
being “bit” during function. Non-anatomic teeth set monoplane
are thought to be the least challenging tooth form to set, however aesthetics and function are compromised.
FormSelector
DCL material
Vivodent DCL
NHC material
Phonares NHC
Tools of
Communication
Lingual
88
Tools of Communication
There are many tools that help gather patient information
and communicate to the dental laboratory. The centric tray,
Gnathomether M and FormSelector have previously been mentioned. The Papillameter is used to measure maxillary lip length
to determine the necessary amount of incisal display.9 Denture
gauge measures the incisal length of the patient’s existing denture. Both these devices help to communicate the appropriate
incisal length of the maxillary wax rim or denture teeth; otherwise the lab must use average values. The biteplane is an invaluable tool for evaluating the horizontal plane and occlusal plane of
the maxillary wax rim. The flat set up table is used to mount the
maxillary cast with wax rim. This orientation transfers the hori-
Papillometer
product profile
zontal plane and occlusal plane to the Stratos Articulator. The
table also serves to provide a template for setting the maxillary
anterior denture teeth and assures that they will be the same
length and horizontal plane as the maxillary wax rim. The Stratos
Articulation System is very user-friendly and is the favorite of
many dental laboratories. It has an extremely accurate and
durable calibration so there is never need to send the articulator
in the mail since the casts will fit accurately on the laboratory
Stratos. The structure of the instrument is also very durable and
easy to maintain. The wide assortment of components allows
many options for mounting and setup templates. In addition the
articulator is very presentable in appearance.
Each step of the communication process is managed by a comprehensive case planning software called Intercom. Developed by
Ivoclar Vivadent, Intercom, improves communication between the
dentist and dental laboratory, and virtually guides the user through
each step of a fixed or removable restoration. Each step is accompanied by treatment-related literature, videos and similar tools
helping to specify the appropriate process parameters. Upon case
completion the software produces a detailed prescription, which
can be e-mailed or sent as hardcopy to a designated lab partner.
Denture Base Processing
Once approval is received to fabricate the definitive denture
prosthesis, a precision injection molding process eliminates the inaccuracies in fit and function that could otherwise be caused by poly-
Dental gauge
Bite plane
merization shrinkage. Traditional denture materials are hand measured, leaving room for inconsistencies and mixing errors, and standard trial packing is predisposed to warpage and shrinkage.
However, the SR Ivocap system combines controlled heat and pressure polymerization, so denture bases consistently demonstrate an
accurate fit, a high degree of polymerization and high polishability.10
Ivocap compensates for acrylic shrinkage by continuously
flowing the exact amount of material needed into the flask during the entire polymerization curing cycle.10,11 The material is
distributed in pre-measured capsules, requiring no measuring
which eliminates human error and also prevents direct material
contact with the skin minimizing the risk of irritation.10
And although the features and benefits of the SR Ivocap
injection system seem immediately beneficial to the laboratory
technicians, their significance to dentists and to their patients
cannot be overstated. The accuracy of injection processing
improves denture base stability and retention which assures the
patient the best possible fit and minimizes the necessity for postinsertion adjustment. In addition this system results in a denture
surface that is more dense and therefore more polishable and
resistant to plaque accumulation, which helps to ensure proper
oral hygiene after delivery of the prosthesis.10,12
Conclusion
According to recent projections, the edentulous population
will increase for at least the next 10 years, along with demand
Stratos
Conventional denture
Ivocap denture
Intercom
89
product profile
for removable prosthodontic care. To meet this demand, more
dentists must provide this service, but their ability to do so is
predicated on the availability of systematic and easily integrated
denture solutions. Although edentulous cases might be intricate,
they also present an opportunity for the dentist and laboratory
technician to collaborate to ensure outstanding rehabilitation
results for the patient.13,14 Ivoclar Vivadent’s removable denture
systems provide viable solutions to the clinical challenges of
edentulism and denture fabrication. Eliminating the complexities of denture fabrication with methodical steps and reliable
laboratory techniques, dental professionals can improve the
quality of life for edentulous populations using simplified and
highly accurate techniques. ■
References
1. Douglass, CW, Shih A, Ostry L. Will there be a need for complete dentures in the United States
in 2020? J Prosthet Dent. 2002 Jan;87(1):5-8.
2. Waldman BH, Perlman SP, Ling Xu. Should the teaching of full denture prosthetics be maintained in schools of dentistry? J Dent Ed. 2007 Apr;71(4):463-466.
3. Vogel RC. Implant overdentures: a new standard of care for edentulous patients – current concepts
and techniques. Inside Dentistry. 2007;1(Suppl 2):30-36.
4. Henry K. Q&A on the future of implants. Dental Equipment and Materials. September/October 2006.
5. Rossein KD. Alternative treatment plans: implant supported mandibular dentures. Inside
Dentistry. July/August 2006.
6. Glantz PO. Biomaterial considerations for the optimized therapy for the edentulous predicament.
J Prosthet Dent. 1998;79(1):90-2.
7. Komiyama O, Kawara M. Stress relaxation of heat-activated acrylic denture base resin in the
mold after processing. J Prosthet Dent. 1998;79(2):175-81.
8. Radford DR, Callacombe SJ, Walter JD. Denture plaque and adherence of Candida albicans to
9.
10.
11.
12.
13.
14.
denture-base materials in vivo and in vitro. Crit Rev Oral Biol Med. 1999;10(1):99-116.
Kreyer Robert. Dentures using a coordinated system for removable prosthetics. Information supplied by Ivoclar Vivadent. Dent Prod Report.2006 Apr:1-2.
SR Ivocap.The successful technique. [Brochure]. Amherst, NY: Ivoclar Vivadent;2009.
Salim S, Sadamori S, Hamada T. The dimensional accuracy of rectangular acrylic resin specimens
cured by three denture base processing methods. J Prosthet Dent. 1992;67(6):879-81.
Richmond R, Macfarlane TV, McCord JF. An evaluation of the surface changes in pmma biomaterial formulations as a result of toothbrush/dentifrice abrasion. Dent Mater. 2004;20(2):124-32.
Strong SM. Adolescent dentistry: multidisciplinary treatment for the cleft lip/palate patient. Pract
Proced Aesthet Dent. 2002;14(4):333-8; quiz 340, 342.
Rudd RW, Rudd KD. A review of 243 errors possible during the fabrication of a removable partial denture: part i. J Prosthet Dent. 2001;86(3):251-6.
Author’s Bio
Dr. Frank Lauciello graduated from the State University of New York at
Buffalo (SUNY), School of Dental Medicine in 1969 and completed his
Prosthodontic training at the Buffalo VA Medical Center. He is a Clinical
Associate Professor in the Restorative Department at SUNY
at Buffalo and was director of the Veterans Administration Advanced
Prosthodontic Program from 1973-1998 and Chief of the Dental Service
from 1996-1998. He is presently Director of Removable
Prosthodontics Research, Development, & Education for Ivoclar
Vivadent, Amherst, NY and Director of the Implant Esthetic Center of
Excellence in Sarasota, Florida.
Dr. Lauciello is a Diplomat of the American Board of
Prosthodontics and has authored 25+ articles including several
chapters of textbooks. He is actively involved in dental research and
new product development.
620 PATIENTS SCREENED.*
28 LESIONS UNDISCOVERED WITH THE NAKED EYE.
5 DYSPLASIAS. VELSCOPE DIDN’T MISS ANY.
When it comes to oral cancer, it’s what you can’t see that can be most troubling. A recent study of routine patients by the
University of Washington highlighted the potential benefits of complementing standard oral-soft-tissue-examination with
a fluorescence visualization device. The VELscope Vx system is used in combination with traditional head and neck
exams to detect abnormal mucosal areas including oral cancer and premalignant dysplasia. It’s an easy-to-use,
affordable and effective screening tool that involves no messy dyes. Give yourself the added help of VELscope Vx and
know for sure that you’re doing everything in your power to care for the health—and the life—of your patients.
* Edmond L. Truelove et al, General Dentistry, July/August 2011, 281-289.
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90
around town
The 2011 Greater New York
Dental Meeting
The Greater New York Dental Meeting is hosting its 87th meeting this
fall! Join thousands of other dental and health professionals in the Big
Apple. Take CE courses, learn about new products in dentistry, meet up
with colleagues and go see a Broadway musical, all in a single day.
Registration
Registration is available online and free of charge until the start of the
meeting on November 25. Attendees can also register on-site for $30.
Scientific Session
Friday, November 25 – Wednesday, November 30
Invisalign Expo
Sunday, November 27 – Wednesday, November 30
SomnoMed Sleep Appliance Expo
Exhibit Hall Hours
9:30 a.m.-5:30 p.m. (closes at 5 p.m. on Nov. 30)
The exhibit hall is located at the Jacob K. Javits Convention Center at 655 West
34th Street, New York City.
Continuing Education
Full-day and half-day seminars, “lunch & learns,” table demonstrations and
live-patient demonstrations all contribute to the CE program available through the
GNYDM. Highly regarded educators tackle dental topics from A to Z. Proof of
attendance is required to claim credit. To view the 2011 speaker schedule click the
“Courses and Events 2011” tab on the left sidebar menu.
Special Events
Dinner Dance
Saturday, November 26 • 7-11 p.m.
Price: $125
Marriot Marquis – Broadway Ballroom – Sixth Floor
Celebrity Luncheon with George Stephanopoulos
Monday, November 28 • 12-2 p.m.
Price: $75
Special Events Hall – Level 1
Wednesday Night Happening
Come for dancing, fun, food and a cash bar
Wednesday, November 30 • 6:30-9:30 p.m.
Price: Free (for those registered)
Marriot Marquis – Westside Ballroom – Fifth Floor
For more information about the dental meeting, including accommodations
and directions, visit www.gnydm.com. For more information about travel and
activities in New York City, visit www.nycgo.com. ■
91
digital imaging feature
Planning dental treatment can be complicated, especially in
the case of exacting procedures such as implants and their
restorations. Knowledge of available space between teeth, measurements of bone and root angulations can change the course of
treatment, and in some cases even preclude the need for surgery.
To gain the detailed information needed to treatment plan and
execute these procedures, practitioners are turning to cone beam
3D imaging instead of 2D radiography methods.
I research all that I can about implants and value my
colleagues’ opinions on CBCT. I find that we share a common
view of the benefits of CBCT. “The cone beam scan is very significant in uncovering anatomical conditions that would not
be apparent on a 2D X-ray,” said Steven Guttenberg, DDS,
MD. “CBCT technology provides detailed, precise data in a
3D format that can be rotated 360 degrees, enlarged and sliced
in any direction.”
Like Dr. Guttenberg, I have experienced inherent differences
between planning in 2D and 3D. John Russo, DDS, MHS,
offers, “3D imaging provides safety for my patients and confidence that I am formulating a good diagnosis before developing
a surgical treatment plan.”
Utilizing cone beam scans in 3D imaging software can alert
the clinician to potential complications prior to surgery, such as
undercuts in the mandible or the need for grafts. As CBCT
imaging becomes a part of more dental procedures, new treatment tools within software applications are being developed to
make the processes even safer and more efficient. For example,
using a program that provides the tools for complete treatment
Fig. 1: 2D view of implant sites offering only a flattened, buccal-to-lingual perspective.
Fig. 2
Fig. 2: 3D cross sections showing the clear need for
sinus augmentation and an undercut in the mandible
along with precise measurements that aid in planning
for these conditions.
Fig. 1
Fig. 3: Multiple and helpful views offered when planning implants in 3D imaging software.
Fig. 4: Progressive 3D planning of implants and
restorations.
Credit: CBCT images taken with i-CAT Precise scan
in Tx Studio, Imaging Sciences.
Fig. 4
Fig. 3
92
feature digital imaging
by Justin Moody, DDS
planning for both the placement and restoration of implants,
including abutments and crowns, creates precision throughout
the entire procedure.
Dr. Guttenberg notes having the right software is important,
because of “the opportunity for integrating the scan with guided
surgical techniques and other state-of-the-art applications.” For
one particularly difficult case, he sent his 3D scan to a third-party
software firm that produced a stereolithic model of the patient’s
jaw so he could simulate surgery before working on the patient.
All these options are made possible by 3D CBCT technology.
As with any technology, it’s not just about choosing a
method; there are decisions to be made regarding equipment. In
the case of cone beam modality, selecting a CBCT machine with
flexibility in image size and lowered radiation exposure gives
dentists the clinical control to respond to individual patient’s
needs while complying with ALARA (as low as reasonable
achievable). Machines which offer low-dose scans while delivering a great amount of anatomical information are especially
helpful maintaining this control. In many of my 3D imaging
cases, such as follow-up scans where I want to monitor the
healing of grafts, I can avoid over-exposing the patient by
reducing the height of the scan to cover just the area needed.
While 3D imaging allows implant cases to be quicker and
easier, more importantly, it aids in patient understanding and
helps build relationships with other dentists. I can plan most
cases in a few minutes, from when I take the scan to when I
start going over options with the patients. As I go through the
software with them, they can see their own mouth in 3D and
really understand why I suggested a particular type of treatment. CBCT’s reliability is instrumental for case referrals. My
colleagues send patients to me because they know I will use
the 3D scan to place the implant as precisely and least invasively as possible.
When placing implants, making the right decisions on size
and placement is a matter of precision. The added dimension
provided by CBCT offers the information needed to guide the
dentist to a successful outcome. With cone beam technology,
the dentist gains clinical control, efficiency, accuracy and confidence. Patients gain much more – an implant experience that
they can understand and trust. ■
Author’s Bio
Dr. Justin Moody is a graduate of the University of Oklahoma College of Dentistry. As a supporter of organized dentistry and continuing education,
he is a member of the American Academy of Implant Dentistry, International College of Oral Implantologists, Academy of Osseointegration as well as
the ADA, state and local societies. He is a diplomate in the American Board of Oral Implantology/Implant Dentistry and the ICOI, associate fellow and
fellow of the AAID and holds mastership and fellow status at the Misch International Implant Institute. Dr. Moody lectures throughout the country on
implant dentistry and is in private practice in Crawford, Nebraska. He can be reached at [email protected].
93
office visit
by Chelsea Patten, staff writer, Dentaltown Magazine
David Kahn, a graduate of University of Pennsylvania
School of Dental Medicine, doesn’t live the average
life of a recent grad. Not only is he up to his elbows
at St. Charles Hospital for his general practice residency, he also took home the win for the Rhode
Island Half-Ironman in July (that’s 70.3 miles swimming, biking and running!) and was one of 40 participants invited to the World Championships in
September. Herein, Kahn gives his two cents about
life right after graduation and discusses how he balances his two passions.
What made you choose dentistry?
David Kahn: Growing up I always wanted to go into
sports medicine. I swam all through high school and college, so I had a strong background in sports.
I come from a family of dentists. My father and two
of his brothers joined practices in 1980 and my grandfather has been the practice manager since 1990. After my
94
third year of undergrad, I decided I wanted to continue
the family tradition.
I get my dose of sports by training for triathlons.
Describe a typical day for you.
Kahn: I am in a one-year general practice residency
at St. Charles Hospital in Port Jefferson, New York.
Completing a residency is part of New York State’s licensing requirements. However, I would choose to do a hospital residency regardless because of the clinical experience I
could gain before going on to private practice.
My day-to-day schedule varies. There are two other
co-residents, and we trade off mornings observing and
assisting the OR, pre-surgical testing and the dental
clinic. In the afternoons all three of us are in the dental
clinic. We then have rotation in the ER until 7 p.m. One
of us is on call every three weeks. [Editor’s Note: At press
time, the three residents will have finished their rotations
and will be spending most of their time in the clinic.]
office visit
Photograph by Karl Rivenburgh
95
office visit
I train before and after work. My coach writes
my workouts, and it’s different every day.
Sometimes I finish a day at the hospital – for
instance this week I had two four-hour workouts
after working 11-hour days at the hospital.
Sometimes it can be pretty difficult.
What is your favorite procedure
to perform?
Kahn: Going through dental school all the procedures I performed were dictated by curriculum and
requirements. With residency, I have the opportunity
to treat cases that interest me. I try to keep an open
mind and experience a little of everything. Maybe I’ll
get a better idea of what procedures I’m partial to by
the time I start private practice.
What sparked your interest in athletics?
Kahn: I have swum my whole life. I was seven-time New York
State High School Champion and New York State Swimmer of
the Year. I went to University of Texas, which has a great sports
program. I lived and breathed swimming for years.
After I stopped swimming, I was looking for something else.
I didn’t want to put on weight like a lot of people do after they
stop swimming. While I was out on a jog, I came across someone who used to be a swim coach. He had a triathlon team and
encouraged me to check it out. That’s how I got into it.
Can you give us a mini lesson on what an
Ironman is?
Kahn: Sure. I compete in Half-Ironman (HI) competitions
which are 70.3 miles – a 1.2-mile swim, a 56-mile bike ride and
a 13.1-mile run. A Full-Ironman (FI) would be double that distance – 140.6 miles. The problem with the FI competitions is
that you need to be able to put in four- to five-hour blocks of
training at least three times a week. This just won’t work with
my schedule right now.
There are four distances for triathlons (sprint, Olympic, halfIronman and Ironman). World Triathlon Corporation (WTC) is
a company that puts on the Ironman races. The term “Ironman”
has become synonymous with the distance.
I race on the Ironman circuit because it is the best established
company. They have races, year round, all over the world. Since
I’m busy, my race schedule has to line up perfectly with my dental schedule. They seem to have the right locations at the right
time. Plus, they’re organized. They know how to put on races.
What goes into preparing for such a feat –
training, diet, etc.?
Kahn: My workouts vary from week to week. It’s difficult to
write a training program and then when you throw in working
eight to 12 hours a day, it makes it more complicated. I have a
great coach named Siri Lindley who writes my training programs. She is a two-time world champion and runs a coaching
program called Sirius Athletes. She held the number-one ranking in the world for the Olympic distance when she retired and
went into coaching.
Training schedules vary at different points in the year. Base
training is building up fitness – long, slow stuff. As races get
closer, I increase the intensity of the work – higher effort, higher
heart rate stuff. Some days I just run. Some days I might swim
and bike. It’s all different. I train anywhere from two to seven
hours per day. Those longer ones are on weekends. During the
week they’re shorter. I put in around 18 to 23 hours of training
per week.
I just try to eat healthy, avoid the sweets the best I can. I’m
not on a regimented diet though. My trouble foods are bagels
and muffins. I just try to stay away from them.
Had you done a Half-Ironman prior to your
Rhode Island win?
Kahn: I’ve raced for four years. I’ve probably done close to
20 WTC races, but 30 races overall. When I first started out, I
just wanted to finish one. Now, I will compete in up to eight HI
in a year. This year I’ve done five so far. It takes discipline, but I
love the challenge.
Who are your mentors?
Kahn: From dental school, Dr. Raul Figueroa, Keith
Dunoff, Mary Sidawi and Alan Rauch influenced my clinical
education significantly.
My father and uncles are great dental resources, and I discuss
with them frequently. My parents were, and still are, such a support system, not just with school but with sports as well.
96
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office visit
Also, when it comes to sports, John
DeMarie, Eddie Reese, Kris Kubik and
my current coach Siri Lindley have each
had a tremendous impact on not only
my athletic career but my discipline and
perseverance.
How do you balance work
and life?
Kahn: Balance is hard. I have to make
sacrifices and decisions and sometimes I
miss out on things I want to do. That
comes with the territory. I have chosen
two things – dentistry and Ironman competitions – that take a ton of dedication…
but I’m passionate about both. It’s a commitment and it’s important to not get
upset when those things that I have to
give up come along. When it gets overwhelming (like days with
a 12-hour day at the hospital and a four-hour workout) I just
have to remind myself that it will get better. It always eventually does and I become a better dentist and a better triathlete
because of it.
98
What do you want to do after
your residency?
Kahn: After my residency I plan to go
into the family practice. I want to maintain the practice’s quality, which my family has built over the last 30 years. I’ve had
the opportunity to learn quite a bit in residency and I want to continue to expand
on those abilities and my education
throughout my career as a practitioner.
If you weren’t a dentist, what
do you think you’d be doing
right now?
Kahn: I would be a professional
triathlete. I have a pro license but at this
point in my life, I’m not using the sport
as a main source of income. But if I wasn’t a dentist I would do it full time. I
could also use my sports training for teaching or coaching.
I suppose we should all be so lucky to have
more than one life passion. Thanks so much for
chatting with us. ■
veterans clinic
SERVING
THOSE WHO HAVE
SERVED
by Chelsea Patten, staff writer, Dentaltown Magazine
Sergeant Clint Ferrin was killed by a roadside bomb on a dusty
street in Baghdad in 2004. There was a memorial service, a 21-gun
salute and the awarding of well-deserved posthumous medals… but
John Ferrin had a different and less conventional idea to keep his
brother’s legacy alive.
The dedicated soldier and family man had lost an anterior tooth
during combat training. He went two years before receiving a temporary prosthodontic appliance and never received a permanent prosthesis. John combined the frustration regarding the lack of affordable and
available dental care with the appreciation and honor he had for his personal hero and he ran with it. His vision: a free dental clinic to serve
those like his brother who put mission before all else.
The men and women of the Armed Forces often neglect their oral
and general health care in order to focus on the mission at hand. Dental
work requires taking time off from duties and fronting out-of-pocket
expenses. Since John knew there was a large population of underserved
veterans in his immediate area, he and other like-minded people began
the Sergeant Clint Ferrin Dental Clinic to provide accessible and
affordable dental care.
The kernel for the idea started in 2007 when John first entered
dental school at University of Nevada, Las Vegas School of Dental
Medicine (UNLV-SDM). It developed quickly into a brick-and-motar,
100
veterans clinic
John Ferrin (above), founder of clinic and brother of Sgt. Clint Ferrin (above left).
Group photo, from left: Jeff Roberts, Mike Uffens, Dan Salus, John Ferrin, Jeremy Manuele,
Chad Aitken, Jesse Falk, John Quinn, Nadim Guirguis and Brian Hirsbrunner.
101
veterans clinic
fully functioning clinic by July 2008. Students use the clinic as
a way to gain experience with dental procedures all while helping vets who need care.
Michael Lloyd, fundraising chair member for the clinic,
says, “Saturday is the heart and soul of the Sergeant Clint Ferrin
Dental Clinic.” Held one Saturday every month and lasting for
about four hours, the university provides clinic space, dental
materials and staff for the operation. Currently, UNLV-SMD is
the only dental school which operates a clinic for veterans.
An average of 35 veterans are treated by dental students each
Saturday the clinic is open. The students are supervised by
licensed dentists, all of whom volunteer their time. From simple
restorations to full-mouth extractions, the clinic aids in treating
the overwhelming number of veterans in need.
The majority of veterans do not qualify for free dental treatment through the Department of Veterans Affairs (VA), says
Lloyd. The VA has strict guidelines to determine whether a veteran is eligible. Lloyd uses a current patient as an example:
Sam* served three tours of duty in Iraq and Afghanistan as
an Army scout. During his last tour he was injured by a grenade
that went off near his face, sending shrapnel into
his jaw. The injury resulted in him being medically
1.
discharged from the military. Unfortunately, the
VA would not cover any of his dental care because
he is not 100 percent disabled and because the
injury to his face was written up as a jaw injury
instead of as an injury to his teeth (even though
two of his teeth were extracted due to the injury).
Unfortunately this is only one of many situations returnee
soldiers face. Veterans are often put in the predicament of needing, but not being able to afford quality care. The clinic tries to
provide care to anyone who meets the criteria, but with the
demand reaching more than 100 applications per month, they
have to set some guidelines. In order to qualify for care at the
clinic, the recipient must be a U.S. Veteran, must have an
income of less than $25,000 per year and must not have dental
insurance (and have the documentation to prove all three).
From there, priority is based on need and wartime experience. Veterans from WWII, Korean War, Vietnam, Desert
Storm, Operation Enduring Freedom and/or Operation Iraqi
Freedom qualify for eligibility. Another group served in the
clinic is members of the National Guard. Unlike active duty
troops, National Guard troops do not get full dental coverage
and have often joined the National Guard to aid in their struggling budgets. “Our mission is to serve those who have served,”
says John.
The clinic is recognized as a 501(c)(3) nonprofit organization and therefore is funded from donations and grants. Their
2.
3.
4.
2. George Bitar, class of 2013, with oral surgery patient.
3. Dr. Daniel Orr, UNLV surgeon.
1. Jesse Falk (left), 2011 graduate.
4. Sarah Kitchen, class of 2012 and Colby Meeder, class of 2014
with oral surgery patient.
102
veterans clinic
sponsors include: Henry Schein, Veterans of Foreign Wars,
Veterans for Freedom, American Legion, Anthem Periodontics
and Dental Implants, Mvestor Media, Ballard Spahr (community partner), Acrylic Works, Astratech Dental, Performance
Dental Lab, Two Ocean Dental Lab, CloudPeak Dental Lab
and Sunstone Dental Care, just to name a few of the generous
philanthropists which believe in the clinic’s mission. The
American Dental Association is also a subsidiary. Additional
funding comes from National Guard screenings. The National
Guard will pay the clinic to come out to their various facilities
and perform screenings on soldiers.
Saturday clinics are funded by the UNLV-SDM, which provides the materials to complete most of the procedures. The
clinic itself has to pay for the prosthodontic materials.
Fortunately, many gracious labs in the area donate units.
The clinic may be “officially” open on only one Saturday per
month, but students are constantly working on veteran patients
during UNLV-SDM’s normal business hours. The students are
able to get needed experience and the veterans are able to receive
needed dental care. It’s a win-win situation. “Most of the veterans who we treat have not seen a dentist for years, if not decades,
due to their financial constraints,” says Lloyd.
Sergeant Clint Ferrin served in the U.S. Army 82nd
Airborne division and left the legacy of his hard work and service to the country. Now, thanks to his hero-like persona and his
brother who thought of him as just that, his legacy lives on in
more than name alone.
If you would like more information about the Sergeant Clint
Ferrin Dental Clinic, visit www.veteransdentistry.org. The site
also houses the volunteer application, patient application and a
portal to donate funds. ■
*Names of patients have been changed
5.
6.
5. John Ferrin, left, and
Todd Davis, right.
7. Marlow Rillera, class
of 2014, patient coordinator with patient.
8. Dr. Adam Gatan,
UNLV endodontist with
patient.
8.
7.
6. UNLV faculty that help
with the clinic, back row
from left: Dr. William
Leavitt, Dr. Richard Walker,
Dr. Gerald Fox and Dr.
Douglas Ashman. Front row
from left: Dr. Andrew Ingle,
Dr. Richard Hamilton, Dr.
Wendy Woodall and Dr.
Daniel Orr.
9. Saliem Tsighe, left, class
of 2012, with Dr. Richard
Walker.
9.
10.
10. Top row, from left: Nadim Guergis (class of 2011 went on to
ortho at UOP), Chris Capua (class of 2013), Broc Hammon (class of
2014), John Ferrin (founder, class of 2011), Spencer Armuth (class of
2014), Zac Soard (Class of 2014) and Chad Hanson (class of 2014).
Bottom row: Cody Besso (class of 2014), Todd Davis (class of 2013),
Austin Burnett (class of 2013), Heather O’Dell (Class of 2013),
Benjamin Brown (class of 2014), Marlowe Rillera (class of 2014)
and Jeremy Manuele (class of 2012).
103
by Rachael Stutzman
What makes a practice successful? Is it the location or its
systems and processes? Is it the exceptional patient experience it
consistently delivers? Or is it the doctor’s leadership and the
team’s attitude? Recently, my team of more than 100 practice
development managers shared what they have identified as key
commonalities, or “best practices,” among dental teams that
contribute to the success of the practice. Their insight came
from visiting thousands of dental teams. Interestingly, many of
the attributes my team of practice development managers identified are the same factors for success that were cited in a recent
Dentaltown online poll.
1. Successful practices make marketing
a priority.
In a struggling economy, many practices immediately reduce
or eliminate marketing to save money. Practices that are seemingly least impacted by the current economy budget for, and
consistently invest in, marketing. We hear that, on average, these
practices set aside about three percent of production to do both
patient retention communications and also to increase new
patient flow. This is consistent with the June 2011 Townie poll
which found 28 percent of Townies believe consistent marketing
has the biggest impact on success. One area of focus is online marketing, including having an up-to-date Web site and a Web site
optimized for smartphones, a Google keywords campaign and
using patient e-mails to maintain consistent communication.
2. Successful practices invest in
themselves.
In highly successful practices, patient communications are
not left to chance. Each team member is provided communication skills training, usually thorough scripts and role playing, to
104
ensure patients hear a consistent and positive message. From
how the initial phone call is handled through to how treatment
fees and payment options are discussed, the doctor and team
pre-determine how each patient interaction should be conducted, a system is created and then scripts and training are provided to ensure consistency. In the Townie poll, 20 percent
chose “scripting for presenting treatment plans” as having the
greatest impact on their practice. In addition to investing in the
team, dentists in top practices also invest in themselves through
CE and practice management courses.
3. Successful practices have a plan.
My team of practice development managers consistently
find top performing practices have goals that they write down
and share with the entire team. Then together they create a plan
to achieve them. These practices don’t “wish” the economy
would get better, or “wish” that they had more patients; they
work together to figure out how to reach their practice goals in
a way that benefits patients, the practice and each of them as
individuals. The larger practice goals are broken down into
monthly and daily goals as well as team and individual goals.
These goals determine how the team schedules patients and staff
for the day. There is nothing more powerful than a team working together to achieve a shared vision. In fact, the Townie poll
also found this to be consistent with the findings of the practice
development team, with 22 percent of responding Townies citing setting measureable goals as the second-most impactful tool
for success.
4. Successful practices have confidence
in their patients.
Other attributes shared among practices that have strong
feature practice management
production and strong patient relationships are the unwavering
conviction that their patients deserve and desire to have a beautifully healthy smile. This conviction gives the team the confidence to recommend and present complete dentistry in a way
that clearly communicates to patients the value of the treatment.
We all know that patients do not accept dentistry that has never
been recommended to them. And they don’t accept dentistry if
it’s presented as an “option” rather than a recommendation that
will enable them to meet their oral health or aesthetic goals. Of
course, patients might choose to move forward with care that
only meets their immediate needs, but it’s important to plant the
seed so they are aware of the care recommended and can plan for
it in the future.
5. Successful practices provide
financial options.
Experienced dental teams know the two primary barriers
to treatment acceptance are still cost and fear. Of the two, fear
might be the most difficult to address because solving cost
concerns is as simple as providing a range of payment options
including cash, major credit cards and a health-care credit
card. Of those responding to the Townie poll, about 20 percent found offering financing to be the biggest contributor to
their success. In addition, thriving practices consistently let
patients know – even before the clinical examination – all the
payment options available so patients can choose what’s best
for them and their financial situation. They don’t wait until
the patient has expressed concerns with cost because that
means the patient has already moved into a “no” mindset and
the barrier to treatment acceptance has been set.
The most compelling shared behavior among dentists and
teams who seem to continue to perform through any economic climate is an attitude of service and a commitment to
patients. When patients can hear, see and “feel” that their
dentist and his or her team is on their side and want what’s
best for them and their oral health, the foundation of a longterm relationship is laid. And ultimately, having happy
patients who routinely come in for care and refer their friends
and family is the single-most critical component for longterm success. ■
Author’s Bio
Rachael Stutzman is Vice President of Practice Development at
CareCredit. For more information about CareCredit, call 800-8599975 or visit www.carecredit.com.
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105
dental statistics
about
it’s all
statistics
A statistical look at
the state of dentistry
1
1
Missouri
2
Minnesota
1
Michigan
3
Maryland
1
Massachusetts
2
Louisiana
1
Kentucky
3
Illinois
1
Indiana
1
Iowa
3
Florida
1
Georgia
1
1
Connecticut
Alabama
6
Colorado
2
Arizona
1
California
EDUCATION Current Number of Dental Schools by State
04
20
03
20
10
20
09
20
20
08
07
20
06
20
05
%
.9
%
%
.3
43
44
.7
%
%
20
0%
.
56
%
.6
55
1%
.
56
43
%
.4
56
.3
.7
41
7%
.
59
40
Female
20
20
20
Male
02
01
00
Male vs. Female Dental School Applicants
7%
.
53
8%
3%
4%
.
52
.
53
.
53
%
.3
46
%
.2
47
%
.5
46
0%
6%
.
45
%
.2
.
46
%
.9
54
%
.7
55
44
Source: American Dental Education Association, U.S. Dental School Applicants and Enrollees, 2009 and 2010 Entering Classes
http://www.adea.org/publications/tde/Documents/Applicants%20by%20Gender,%202000%20to%202009.pdf
106
dental statistics
http://www.adea.org/publications/tde/Documents/See%20All%20Predoctor
al%20Dental%20Applicants%20and%20Enrollees%20GraphsLatest.pdf
http://www.adea.org/publications/tde/Documents/Total%20U.S.%20Dent
al%20School%20Graduates%201960-2009.pdf
Percentage of Dental School Graduates vs. Applicants
1990
4,233 5,123
2000
4,171
2001
4,367
2002
4,349
2003
82.6%
53.7%
7,770
58.9%
57.7%
7,537
8,176 54.3%
4,350
2005
4,478
2006
4,515
2007
4,714
2008
4,796
Applicants
7,412
4,443
2004
Graduated
9,433
46.1%
10,731 41.7%
36.2%
12,463
13,742
12,178
34.3%
39.4%
2
1
1
4
2
1
1
3
1
2
3
1
1
1
North Carolina
Nebraska
New Jersey
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
South Carolina
Tennessee
Texas
Utah
Virginia
Washington
4,233
1990-91
1980-81
I
I
I
I
I
I
I
I
I
Number of Dental
School Graduates
Per Year
Source: American Dental Association, Survey of Advanced
Dental Education, 2008-2009
http://www.adea.org/publications/tde/Documents/Total%20U.
S.%20Dental%20School%20Graduates%201960-2009.pdf
I
I
I
1960-61
2000-01
2008-09
I
3,253
I
I
I
I I
I
3,749
1970-71
I
1
4,796
4,171
5,256
1
West Virginia
2
Wisconsin
1
Mississippi
http://www.adea.org/publications/tde/Documents/2010%20Dental%20Schools%20list.pdf
107
dental statistics
%
81.1
DENTISTS 116,372
Total Number of
132,835
General Dentists
of independent
dentists are in
solo practice
1993
Source: ADA; 2009 Survey of Dental Practice “Characteristics of dentists”
2000
in U.S.
Source: ADA Distribution of Dentists publications - ADA Health Policy Resources Center
*Provided by ADA Department of Membership,
Marketing and Tripartite Relations
10,375
146,675
7,184
6,134
4,953
5,252
3,343
2009
1
150,043*
2
3
4
5
6
Total Number of Specialists in
the United States
2010
1. Oral and Maxillofacial Surgeons
2. Endodontists
3. Orthodontists & Dentofacial Orthopedics
4. Pedodontists
5. Periodontists
6. Prosthodontists
Source: American Dental Association, Survey Center, 2009 Distribution of Dentists in the United
States by Region and State
Dentists to Population Ratio by State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
1:3,064
1:1,683
1:2,422
1:2,982
1:1,569
1:1,955
1:1,774
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
1:2,674
1:2,404
1:2,411
1:2,259
1:2,690
1:2,545
1:1,809
Sources: American Dental Associaton, Survey Center, 2009 Distribution of Dentists in the United States by Region and State.
http://www.census.gov/schools/facts/
2009 Data for States
with More Than 20,000
People Without a Dentist
ARKANSAS
75
4
22,086
COLORADO
NEBRASKA
93
20
35,905
NORTH DAKOTA
53
17
53,386
64
9
28,217
GEORGIA
ILLINOIS
159
24
211,479
102
12
29,960
Total # of counties
Total # of counties without a dentist
Total of county population without a dentist
KANSAS
105
12
31,015
MISSISSIPPI
82
4
31,246
SOUTH DAKOTA
66
16
53,205
VIRGINIA
136
5
30,000
* Data for Alaska, California, Florida, Indiana, Minnesota, New Jersey, New Mexico, Utah, Vermont and Wyoming not provided. http://apps.nccd.cdc.gov/synopses/ProgramDataV.asp?ProgramID=20
108
dental statistics
According to the ADA Department
of Membership, Marketing and
Tripartite Relations, in 2010, of the total
active licensed dentists
(all specialties) in the United States…
187,898
60.2%
Approximately
are
Caucasian
9.2%
are
Asian
4.0%
are
Hispanic
3.5%
are
African American
Approximately
Approximately
Approximately
0.3%
Less than
Source: ADA Department of Membership, Marketing
and Tripartite Relations, 2010
1998
2006
2009
are
American Indian
Male: 140,000
Female: 23,513
Male: 140,000
Female: 35,444
Male vs. Female
Professionally-active
Male: 144,775
Female: 41,309
General Dentists
Source: ADA; 2009 Survey of Dental Practice “Characteristics of dentists”
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
1:2,792
1:1,183
1:2,452
1:2,912
1:1,520
1:2,023
1:1,893
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
1:1,991
1:2,036
1:3,098
1:2,623
1:2,023
1:2,065
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
1:2,441
1:2,113
1:1,587
1:2,731
1:1,645
1:2,789
1:2,302
Ohio
Oklahoma
Oregon
1:2,382
1:2,485
1:1,812
Pennsylvania
Rhode Island
South Carolina
1:2,067
1:2,405
1:1,666
Dental Health Professional
Shortage Areas [HPSAs]
As of April 5, 2011
1:2,790
South Dakota
Tennessee
Texas
Utah
1:2,362
1:2,616
1:2,770
1:1,919
Vermont
Virginia
Washington
1:2,245
1:2,120
1:1,805
West Virginia
Wisconsin
Wyoming
1:2,596
1:2,140
1:2,258
http://ersrs.hrsa.gov/ReportServer?/HGDW_Reports/BCD_
HPSA/BCD_HPSA_SCR50_Smry&rs:Format=HTML3.2
33,444,731
Estimated Underserved Population
51,475,776
Population of Designated HPSAs
9,968
Practitioners Needed to
Achieve Target Ratios
109
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DENTALTOWN
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Source: Publisher’s data
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dental statistics
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As of August 24, 2011
If you took all
Total number of registered
users on Dentaltown.com: 140,455
154
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continuing education courses
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board topics: 161,391
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Total number of Dentaltown.com
CE course views: 367,034
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059 Dental Trade Alliance
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128 Ribbond, Inc.
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071 Shatkin F.I.R.S.T., LLC
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031 Six Month Smiles
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074 New Patients, Inc.
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013 Keller Laboratories, Inc.
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BC Procter & Gamble
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035 Temrex Corporation
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077 Townie Meeting, LLC
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023 Tuff Kids Crowns, LLC
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053 US Bank
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099 Park Dental Research Corporation
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IFC VOCO America, Inc.
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030 Practice Café
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123 Xlear, Inc.
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117 Procter & Gamble
81 Zest Anchors, Inc
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from trisha’s desk hygiene & prevention
Creating Your Personal
Oral Health Directive
by Trisha E. O’Hehir, RDH, MS, Hygienetown Editorial Director
No one wants to think about it, but you could
end up in a nursing home one day due to either an
accident or complex medical issues requiring others
to care for you. Lawyers urge people to have a signed
advanced health-care directive, consisting of two
forms. One is a living will, specifying what healthcare actions be taken if through illness or injury you
become unable to make those decisions yourself.
The other form is a power of attorney or health-care
proxy specifying who will make your health-care
decisions if you can’t.
Missing from these directives is a specific oral
health-care directive. In the five wishes document, a
comprehensive living will from the Aging with
Dignity Organization, oral health falls under general
grooming, not health. But since oral health is so
important and needs to be addressed every day
through both oral hygiene and diet, a specific oral
health directive should be in place as well. What specific directions would you like caregivers to follow to
maintain your oral health? Or, as some Townies on
Dentaltown suggested for nursing home patients,
would you opt for full-mouth extractions? They
weren’t suggesting it for themselves, but did for
nursing home residents. What if one day you
become a nursing home resident? Do you think
those Townies would still want full-mouth extractions for themselves?
In 1993, this became a reality for Irene Woodall,
RDH, PhD, a leader and visionary in the dental
hygiene profession. While skiing in Colorado she
suffered an aneurysm. With speedy medical care, she
was rushed to the hospital and underwent brain surgery that prevented a more intense stroke that would
have taken her life. Instead, she suffered severe brain
damage taking away her short-term memory and
severely affecting her cognitive and physical abilities.
Irene is now confined to a wheelchair and requires
care around the clock.
In the midst of all the medical care needed to
deal with the stroke and rehabilitation, her dental
care was overlooked. Her daughters are overseeing
her care at a long-term care facility in the Chicago
area and were shocked to find that their mother, a
consummate dental hygienist, now has severe dental
disease! To cover the extensive dental costs ahead,
they created the Irene R. Woodall Special Needs
Trust from which donations will be used for Irene’s
oral health-care needs.
Had Irene had an oral health-care directive in
place when she suffered the stroke and subsequently
was moved to a long-term care facility, her oral
health and diet would have been addressed the way
she wanted, not overlooked because of other issues.
Oral health will impact general health, so it
shouldn’t be overlooked in any situation.
What would you want done for your oral health
on a daily basis if you suffered a stroke and were confined to wheelchair and unable to perform your own
oral hygiene? I know what I would want – five exposures to xylitol every day, MI Paste morning and
evening, twice-daily brushing with the 30 Second
Smile toothbrush using baking soda to keep the
pH of my saliva up, tongue scraping, interdental
cleaning with either the Sunstar Soft Picks or flossing with water. I’d also specify the diet I want.
Write out your own oral health directive today
just in case something unforeseen happens one day
and write your directive with the hope that it will
never be needed. ■
In This Section
114
118
120
124
126
Perio Reports
Message Board: Tongue Stud Damage – A Case Study
Profile in Oral Health: Townies Doing Research
OCD Feature: Facing Our Fears
Message Board: Increase Doctor’s Production
113
hygiene & prevention perio reports
Perio Reports
Vol. 23 No. 10
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.
Perio Pathogen Linked to
Brain Abscess
Periodontitis is a bacterial infection that contributes to the
overall inflammatory burden on the body. Periodontal
pathogens are linked with several systemic diseases, including
infectious bowel diseases, atherosclerosis, coronary heart diseases, stroke, diabetes and rheumatoid arthritis. Aggregatibacter
actinomycetemcomitans (Aa) is a major periodontal pathogen,
found most often in association with endocarditis.
A man, age 42, with a history of heavy smoking and alcohol
abuse was admitted to a hospital in Leeuwarden, the
Netherlands, complaining of confusion and reduced consciousness over the previous three days. Lab tests revealed an elevated
white blood cell count and a moderately elevated C-reactive protein level. His oral health was poor. A CT scan of the brain
revealed four lesions. No other lesions were found elsewhere in
the body.
The patient was treated with dexamethasone and a followup CT scan showed no changes. Biopsy confirmed inflammation and abscess formation. Aa was the primary microorganism
detected. IV antibiotics were begun. Nine days later, the
patient’s condition worsened, yet a new CT scan showed no
change in the abscesses. It was decided to drain the abscesses and
an oral surgeon extracted five teeth with advanced periodontitis.
Antibiotics were continued for six weeks. At one year follow-up,
he was doing fine.
Several other published case reports confirm the presence of
Aa in a variety of infections in non-oral areas of the body.
Clinical Implications: Poor oral health can impact more
than the teeth and gingiva, when oral pathogens travel to
other parts of the body. Good oral health is necessary for
good general health.
Rahamat-Langendoen, J., van Vonderen, M., Engström, L.,
Manson, W., van Winkelhoff, A., Mooi-Kokenberg, E.: Brain
Abscess Associated with Aggregatibacter Actinomycetemcomitans:
Case Report and Review of Literature. J Clin Perio 38: 702706, 2011. ■
114
Saving Questionable
and Hopeless Teeth
The primary goals of periodontal therapy are to stop
disease progression and save teeth. Treatment planning
aggressive and chronic periodontal cases includes identifying teeth that are questionable or hopeless. Researchers
have shown that with healthy gingiva (no gingivitis) the
tooth survival rate is 99.5 percent. In the presence of gingivitis (gingival index score of 3) survival rate drops to
63.4 percent.
Researchers at the University of Greifswald in
Greifswals, Germany, looked back at dental school charts
for periodontal patients who had been treated and monitored with supportive periodontal therapy (SPT) for 15
years. Those who showed signs of bone loss (on at least
two teeth) before age 34 were diagnosed with aggressive
periodontitis (AgP). Those with bone loss (on at least
two teeth) appearing after age 40 were diagnosed with
chronic periodontitis (CP). Each group had 34 patients.
Periodontal therapy consisted of scaling and root planing
and in some cases, access flaps were needed to reach all
subgingival deposits. Antibiotics were used only rarely.
SPT intervals were individualized for each patient
ranging from three to 12 months.
Teeth considered hopeless were those with 50 to 70
percent bone loss. Hopeless teeth were those with more
than 70 percent bone loss. In the AgP group there were
262 questionable teeth and 63 hopeless teeth. After 15
years, 88 percent of questionable teeth and 60 percent of
hopeless teeth survived. Tooth survival rates were similar
for both the AgP and CP groups.
Clinical Implications: Many questionable and hopeless teeth can be saved with effective supportive periodontal therapy and good patient compliance.
Graetz, C., Dörfer, C., Kahl, M., Kocher, T., El-Sayed,
K., Wiebe, J., Gomer, K., Rühling, A.: Retention of
Questionable and Hopeless Teeth in Compliant Patients
Treated for Aggressive Periodontitis. J Clin Perio 38: 707714, 2011. ■
perio reports hygiene & prevention
Obesity and Dental Caries in Adolescents, No Direct Link
Dental caries and childhood obesity are growing problems
worldwide. Changes in diet and lifestyle are impacting the
health and nutritional status of many populations. Decreased
fruit and vegetable consumption, decreased physical activity
and increased snacking on highly processed foods contribute
to these declining health levels globally.
Researchers at the University of Copenhagen in
Copenhagen, Denmark wanted to know if there was a link
between dental caries and childhood obesity or if there were
lifestyle factors shared by both. The researchers evaluated 385
adolescents from eight municipalities in Denmark. The teens
were all 15 years of age. Dental records were available and written questionnaires were mailed to the teens and their parents.
The questionnaires provided basic demographic data and information on eating breakfast, daily fruit consumption, physical
activity, smoking and alcohol consumption. BMI was calculated for each student from weight and height measurements.
There was no direct correlation between obesity and den-
tal caries in this group. Sixteen percent of the group was classified as obese and 62 percent of the group had no decayed,
missing or filled teeth (DMFT). The average DMFT for the
group was two. However, those who had no decay reported
more healthful habits: eating breakfast, eating fruit, exercising
and no smoking or drinking. Teenagers who did not eat
breakfast were more likely to smoke and drink alcohol.
Bad habits begun as children are likely to follow these
teenagers into adulthood, leading to more significant health
problems. More must be done to address both obesity and
dental caries earlier.
Clinical Implications: Dentists and physicians should
work together to manage both obesity and dental caries.
Cinar, A., Christensen, L., Hede, B.: Clustering of Obesity and
Dental Caries with Lifestyle Factors Among Danish Adolescents.
Oral Health Prev Dent 9: 123-130, 2011. ■
Toothbrush Age and Plaque Removal
Many studies are published measuring plaque removal
effects of both manual and power toothbrushes, but few are
published on the impact of toothbrush wear on plaque removal.
One reason might be the lack of a standard way to measure
toothbrush wear. Toothbrush wear varies
considerably between people and many use
their toothbrushes for much longer than
the recommended three months.
Researchers at Ponta Grossa State
University in Brazil devised a method to
determine toothbrush wear by measuring
bristle splay from the brush head. They
were able to categorize toothbrush wear
into three categories: low, moderate and
high wear. A total of 110 undergraduate, non-dental students
were recruited from the university for this four-month study.
Subjects were randomly assigned to one of four groups, having
plaque and toothbrush wear measured at four weeks, eight
weeks, 12 weeks and 16 weeks.
The students were all given a new manual toothbrush, plastic toothbrush cover, Colgate toothpaste and instructed to brush
and floss three times daily. Baseline plaque and gingivitis scores
were recorded. Subjects returned at their assigned time.
No statistical difference in gingivitis scores was measured
at any time point. There was more gingivitis on lingual surfaces than on facial surfaces. Plaque scores
remained similar throughout the study,
with more plaque found on lingual surfaces than on facial surfaces. Toothbrush
wear increased over the 16-week study, but
this wear didn’t impact plaque or gingivitis scores.
Clinical Implications: Toothbrush age
or wear might not be an important factor in effectively removing plaque. The toothbrushing
method used and the time spent on lingual surfaces might
be more important.
Pochapski, M., Canever, T., Wambier, D., Pilatti, G., Santos, F.:
The Influence of Toothbrush Age on Plaque Control and Gingivitis.
Oral Health Prev Dent 9:167-175, 2011. ■
115
hygiene & prevention perio reports
Triple-headed Toothbrush
Children under the age of 10 usually need their parent’s help to effectively brush
their teeth. Children do not effectively remove bacterial biofilm due to lack of motivation and poor manual dexterity.
A triple-headed, manual toothbrush is available
from DenTrust in Newport, Rhode Island and is
designed to clean facial, lingual and occlusal surfaces
with one motion. This design does not rely on manual dexterity to effectively reach all surfaces.
Researchers at the University of Sao Paulo in
Brazil compared the triple-headed toothbrush to a
Researchers at Franciscan University in Santa Maria, Brazil
conventional manual toothbrush. They asked two
wanted to know the difference between medium and soft toothquestions. First, was the new brush better at plaque
brushes for plaque removal and soft-tissue abrasion. A total of 25
removal and second, did it matter if the mother or
undergraduate students participated in the study, all free of gingivitis.
the dentist did the toothbrushing. Four-year-old
At baseline, the students were asked to refrain from all oral hygiene
children were selected from two kindergarten classes
for 96 hours, to allow plaque to accumulate. Using disclosing solufor the study.
tion, plaque scores for all facial surfaces were measured except central
In this cross-over study, each child received
incisors and third molars.
toothbrushing with both brushes at different visFor the experiment, students were randomly assigned to brush
its, one week apart. Disclosing solution was used
two contra-lateral quadrants with the medium brush and the other
to measure plaque scores both before and after
two quadrants with the soft toothbrush. This way, both right and left
brushing with the assigned toothbrush. The mothsides of the mouth were brushed with both the soft and medium
ers and the dentist were instructed in the use of
brushes. The lower quadrants were brushed with Colgate Triple
both toothbrushes and they practiced on a
Action toothpaste and the upper quadrants were brushed without
typodont until proficient.
toothpaste. Upper quadrants were brushed first, before lower quadThe mothers were more efficient in removing
rants. Each quadrant was brushed for 30 seconds.
plaque with the triple-headed toothbrush than with
Both medium and soft toothbrushes removed significant
the conventional toothbrush. The dentist was more
amounts of plaque. There was no difference in plaque removal
efficient with the manual brush than with the triplebetween brushing with or without toothpaste for the soft toothbrush.
headed toothbrush. Overall, the dentist removed 76
The medium toothbrush with toothpaste removed more plaque than
percent of plaque compared to 53 percent removed
without toothpaste. Both brushes removed more plaque from facial
by the mothers.
surfaces than from proximal surfaces. The medium toothbrush
removed more plaque than the soft toothbrush in the premolar area.
Clinical Implications: The triple-headed toothBoth brushes removed more plaque in premolar areas than molar or
brush might be an option for parents who are not
anterior areas.
The medium toothbrush caused more cervical abrasions than the
effectively removing all plaque from their chilsoft toothbrush and the medium toothbrush with toothpaste resulted
dren’s teeth with a conventional brush.
in more tissue abrasion than without toothpaste.
Oliveira, L., Zardetto, C., Rocha, R., Rodrigues, C.,
Clinical Implications: Soft toothbrushes with or without toothWanderly, M.: Effectiveness of Triple-Headed
paste should be recommended.
Toothbrushes and the Influence of the Person who
Performs the Toothbrushing on Biofilm Removal. Oral
Zanatta, F., Bergoli, A., Werle, S., Antoniazzi, R.: Biofilm Removal and
Health Prev Dent 9: 137-141, 2011. ■
Gingival Abrasion with Medium and Soft Toothbrushes. Oral Health
Prev Dent 9: 177-183, 2011. ■
Soft vs. Medium Toothbrushes
116
P&G and Crest Oral-B are proud to partner with
the National Breast Cancer Foundation, Inc.®—for
every Give Hope PinkPack sold, Crest Oral-B
will donate 3% to the National Breast Cancer
Foundation to help in its mission to educate women about the importance
of detecting breast cancer early.
To learn more about what you can do to support this program, visit
facebook.com/professionalcrestoralb or call Customer Service at 1-800-543-2577.
Together, we can make a difference
© P&G
hygiene & prevention message board
This thread comes from the message boards of Hygienetown.com.
Tongue Stud Damage A Case Study
Oral piercings are becoming more common and so are the problems they create. Remind patients of the dangers of oral piercings.
periopeak
Posted: 7/16/2011
Post: 1 of 49
This female patient in her early 50s had a tongue
stud for 10 years. Check out the damage it caused.
Class I mobility on 24 and 25, both are non-vital.
Her periodontist recommended extraction of 24 and
25. Notice lack of attached gingiva. Endo was performed, then regenerative periodontal endoscopy
(RPE) the same day with Emdogain. Limiting factor
here will be the attached gingiva on the lingual. Buccal
is all WNL with beautiful tissues.
Patient was prescribed metronidazole 500mg BID for eight days. DNA test
revealed high level of T. denticola. She is PST negative, smokes half a pack daily and
eats very well. Periogain was recommended, two caps twice daily for host modulated
therapy. Do you think she has a chance of keeping these teeth? ■
lindadouglas
Posted: 7/16/2011
Post: 2 of 49
Judging by those periapical lesions I would have said the prognosis
was hopeless, especially because she is a smoker, but I have seen your
work before, so I would love to see the outcome after you work on this
patient. I usually see tongue piercings on the young and foolish, but not
on the middle-aged! I once read about someone who got a brain abscess
after a tongue piercing. ■
Unbelievable the damage she was doing and didn’t even know it! ■
JERSEY DEVIL
Posted: 7/17/2011
Post: 6 of 49
JGonzalesRDH
Posted: 7/17/2011
Post: 7 of 49
118
Absolutely savable! Expensive, but she could have these teeth for
another 10 years I bet. If mobility remains after RPE, what are they considering for restorative options? Did they take #24/25 out of occlusion?
Would be interesting to see a full arch photo as well if you have one...
doesn’t look like she has a lot of incisal wear, which is good. Great case
study! Thanks for sharing. ■
message board hygiene & prevention
Just for your general drtoast
information, when consid- Posted: 8/3/2011
ering treating this area with Post: 43 of 49
a CT graft I am mostly
looking for the following:
Is there adequate depth to the floor of the mouth?
Does the remaining gingiva have some thickness to it
so when I reflect it back I won’t wind up perforating
through the tissue? (When this happens, you are in
really bad shape, and you have now most likely made
things worse than they were before.) Will the
patient’s tongue allow me adequate access to do the
surgery? And lastly, am I dealing with a highly compliant patient?
I know that recession on the lingual aspect of
lower anterior teeth is an extremely prevalent problem,
and many of these patients would benefit significantly
if they could have soft tissue augmentation procedures.
I am definitely very careful and cautious when I decide
to treat one of these problems. I think a very appropriate area to treat is when a patient has only his lower six
anterior teeth present and there is significant recession
on the lingual of a canine, which happens so often
as the lingual bar of the partial has settled. This can
be a very nice service to a patient, helping her so she
doesn’t lose either the canine or worse still, the lower
partial. (I am still a big believer in trying to preserve
our own natural teeth where possible.) ■
periopeak
Posted: 8/4/2011
Post: 44 of 49
Here are some threeweek post-op photos;
nice tight tissue. ■
Find it online at www.hygienetown.com
Tongue Stud Damage
119
hygiene & prevention profile in oral health
Townies
Doing
Research
by Trisha E. O’Hehir, RDH, MS
Do you ever feel like a detective searching for the
answers to clinical mysteries? Why can’t patients effectively brush their
teeth? Why don’t pockets heal after they’ve been treated? If only you were
a clinical researcher, you could answer those questions and solve those mysteries! As an active Townie, you can now become a Townie Researcher and
participate in clinical research, gathering data to answer those questions.
Hygienetown and Dentaltown now offer Townies the opportunity to
test new products in their own clinical practices. These are not randomized, controlled clinical trials. There is no calibration between clinicians.
Extensive data collection is not needed. On the other hand, these studies
are not simply product evaluations. These are real-life pilot studies to
determine just how new products work in the hands of regular clinicians
with regular patients. These studies bridge the gap between randomized,
blinded, controlled, clinical trials and personal experience.
Top Townies, those who are active on the site, are invited to participate
in the studies. If a particular project fits their schedule and their interest,
they agree. Dentist and dental hygienist teams are invited to participate.
The two most recent projects were directed toward hygienists, but since
they work in practices owned by dentists, the dentist was informed about
the study and agreed to the project as outlined.
The goal of Townie Research projects is to add something new to clinical practice that interests both patients and clinicians. Patients are
impressed that their dentist/dental hygienists are researchers and they are
excited to be part of studies testing new products that are already on the
market. Data collection involves the usual clinical and photographic data
already being collected in practice today. We want to know how these
products work if you simply buy them and start using them. The indices
used are plaque scores, probing depths and bleeding upon probing. Our
120
profile in oral health hygiene & prevention
goal is not to add time to already busy appointments, but to make gathering the data useful in measuring the effectiveness of a new product.
Townie Researchers receive a copy of the complete research protocol
explaining what the product is, what the research question to be answered
is and step-by-step instructions on how to gather data, instruct or treat the
patient and what follow-up data is needed. Test products are sent directly
to the practice from the manufacturer. Telephone conference calls with the
researchers on a particular project help answer questions, revise the protocol if we find an easier way to treat the patients and give the Townie
Researchers an opportunity to compare notes with each other.
Reports from the latest two research projects are presented here. The
Townie Researchers who participated enjoyed the experience and provided
valuable information on the products they tested. Join them on the Townie
Research message board to find out more about the studies and about
becoming a Townie Researcher yourself!
Patient 1: Before: 58 percent
Effects of the 30 Second Smile Power
Toothbrush on Plaque Removal
A Clinical Practice Study
People brush an average of 38 seconds and brush in an erratic pattern
that doesn’t allow for equal brushing throughout the mouth. To overcome
those difficulties, the 30 Second Smile power toothbrush was designed by
Hydrabrush, Inc., located in Escondido, California, with a unique brush
head that contacts maxillary, mandibular, facial, lingual and occlusal surfaces at one time, simply by biting into the brush and moving it gently
around the arch. The 30 seconds that people now brush will reach all tooth
surfaces equally.
Townie Researchers selected patients in their practices who showed
high plaque levels despite repeated instructions in oral hygiene. Townie
Researchers provided the 30 Second Smile power toothbrush to a total of
12 patients. Data collection included baseline plaque scores and intra-oral
photographs. Plaque scores were repeated approximately two weeks later,
and in some cases further follow-up visits were scheduled. Both children
and adults were included in the study.
Before and after photos of the study reveal high baseline plaque levels.
After using the 30 Second Smile toothbrush for two weeks, plaque levels
were reduced. Plaque scores dropped from 58 percent to 25 percent
(patient 1).
Patient 2 began with a plaque score of 82 percent and returned two
weeks later with a 21 percent plaque score.
A null hypothesis was proposed for this study stating that no changes
in plaque scores would be seen with the use of the 30 Second Smile toothbrush compared to previous brushing. Results demonstrated that a majority of patients in this study showed lower plaque scores after two weeks
or more of using the new brush. Some showed no difference and none
showed increased plaque scores using the 30 Second Smile toothbrush.
Thus, the null hypothesis was disproved in this study.
Based on these findings, the 30 Second Smile power toothbrush provides better plaque removal when used instead of a manual toothbrush for
Patient 1: After: 25 percent
Patient 2: Before: 82 percent
Patient 2: After: 21 percent
121
hygiene & prevention profile in oral health
These are
real-life pilot studies
to determine just how
new products work in
the hands of regular
clinicians with regular
patients. These studies
bridge the gap between
randomized, blinded,
controlled, clinical
trials and personal
experience.
Millimeters
Mean Pocket Depth Reduction
1.8
1.6
1.4
1.2
1
0.8
0.6
0.4
0.2
0
1.56
1.3
0.47
0.33
RDH-1
122
RDH-2
RDH-3
RDH-4
those who are ineffective with daily plaque removal. For patients who are
not effectively removing plaque with a manual or power toothbrush, the
30 Second Smile brush promises to provide an effective alternative. The
unique design and ability to reach all areas without depending on the manual dexterity of the user makes the 30 Second Smile ideal for those who
need a new way to effectively clean their teeth.
A Clinical Practice Observation of the Effects
of HybenX
Instrumentation on Non-Responding Periodontal Sites
by Dental Hygienists in the European Union
Non-responding areas are common after completion of non-surgical
periodontal therapy, due to remaining bacterial biofilm. These areas
continue to show signs of disease with probing depths of 5mm or greater
and bleeding upon probing. Bacterial biofilm is attached to root surfaces,
floating within subgingival pockets and found within root surface calculus
deposits. This subgingival bacterial biofilm can be disrupted with mechanical action or chemical desiccation causing the biofilm matrix to denature,
precipitate and coagulate. This detaches the biofilm and allows it to be
rinsed away.
HybenX Plaque Biofilm Remover is a concentrated sulfate solution
that causes desiccation by absorbing water, making it an effective solution
for breaking down bacterial biofilm. It is both selective and self-limiting,
making it a safe plaque removal agent for subgingival areas. HybenX is
made by Epien Medical in St. Paul, Minnesota, makers of Debacterol.
HybenX is not yet available in the U.S., but is available in many countries
outside the United States.
HybenX solution comes in pre-filled syringes for subgingival delivery
prior to instrumentation. The HybenX will desiccate the bacterial biofilm
and allow for effective subgingival calculus removal, resulting in reduced
bleeding and reduced probing depths.
Four Townie Researchers were recruited, each active international
Hygienetown members, from England (2), Scotland (1) and Italy (1). All
Townie Researchers received a copy of the research protocol and the
HybenX product. Each hygienist agreed to treat five patients with subgingival instrumentation plus the application of HybenX.
Data collection included baseline probing depths and bleeding scores
on areas that did not respond to previous instrumentation (see chart).
Probing depth reductions were seen in 10 of the 13 patients treated.
Three patients showed no reduction in probing depth after treatment.
Comparing Townie Researchers, the mean probing depth reductions were
1.56mm for RDH-1, 0.4mm for RDH-2, 1.3mm for RDH-3 and
0.33mm for RDH-4. The overall mean reduction was 0.92mm.
Based on these preliminary findings, the use of HybenX in combination with subgingival instrumentation in sites that did not respond to initial scaling and root planing provided a benefit. Findings thus disproved
the null hypothesis that no changes in probing depths and bleeding would
be seen. Future studies will need to compare sites treated with instrumentation alone and sites treated with both instrumentation and HybenX to
determine the impact of HybenX Plaque Biofilm Remover. ■
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hygiene & prevention ocd feature
by Kathy L. Beard, RDH, BSDH
We are all aware of the common adage that experience is the
best teacher. I would qualify this motto by adding… if we use that
experience for good.
Communication is one of the most powerful instruments we
utilize within our armamentarium. Words and their inflection,
as well as actions can encompass both positive and negative consequences. We must ask ourselves, how are we being received?
The answer to this question is somewhat contingent on whom
might be the recipient of our dealings. What cannot be contested is that everyone needs care and understanding.
We all lead complicated lives and it is wise to remember this
consideration while communicating with fellow staff members,
other professionals and our patients. These principles have been
profoundly illustrated to me during my personal struggle with
obsessive compulsive disorder (OCD), and by the examples set
by those caregivers who have encouraged me to face both my
professional and personal fears. If it were not for the joint
efforts of my physician, psychiatrist and clinical psychologist, I
would not be where I am today. Everyone should have such personal care! I am also grateful for the skill and teamwork which
I encountered at the Anxiety & Stress Reduction Center of
Seattle (ASRC).1
124
My primary objective in sharing this struggle is to provide
hope for those who are openly or silently suffering with OCD,
an anxiety disorder affecting 2.2 million Americans of both genders at the same rate.2 OCD frequently becomes apparent during
the teen and young adult years, and typically progresses slowly.3
In retrospect, I can see where this was true in my life as well, but
it was not until 2006, that I began noticing my life spinning out
of control after an emotional encounter. I was placed on Zoloft
by my physician, but found it did not agree with me. I began
seeing a social worker/counselor from May 2006 to October
2007. By May 2008, I realized that I could not continue in clinical hygiene. I was experiencing severe obsessions and compulsions which became very apparent to my employer as well as my
fellow employees. I was the first person in the office in the morning, and the last one to leave at night, often returning home after
10 p.m. or so. I was fearful I would make a mistake and inadvertently hurt a patient somehow. I would continually question
whether the operatory was clean enough, and wonder if I cleaned
the tray of instruments properly. Were my chart notes understandable? Did they clearly represent the treatment I had rendered? When I would return home, I would shower for one to
two hours, often using a full bar of soap each shower session.
ocd feature hygiene & prevention
These worries spilled over into my personal, everyday activities as with OCD, and take medication, but it will never take over my
well. I could no longer cook meals, and it became extremely dif- life again!
I have learned many lessons which I will bring back with me
ficult to touch our dirty laundry.
These illustrations introduce examples of the most frequent to the dental setting, such as the benefits of taking time to
varieties of OCD. The debilitating trepidation that someone understand the individual in my chair. What works for one permight be harmed by carelessness combined with the “rituals” sonality, might not work for another. Some might not know
why they react in a certain way – I did
performed trying to ease those fears for
not understand where my fears came
one, and “checking” items over and
Some might not know why
from! They just might need to know
over again being another. The obsessive
portion of OCD fears the worst, while
they react in a certain way – that someone genuinely cares.
Providentially, experiences of these
the compulsive measures temporarily
I did not understand where
past few weeks have added to this
relieve those fears.4
As I saw my clinical future slipjourney. As I contemplate these events,
my fears came from!
ping, I tried to find other avenues
I realize they will be extremely helpful
They just might need to
to stay in the career I loved. I
in caring for future patients. A family
member recently had surgery which
became founder/president of Premiere
know that someone
went awry. There was much confusion
Hygiene Study Club from 2008genuinely
cares.
and miscommunication between all of
2009. I also earned my Bachelor of
the different entities. It left me wonderScience degree in Dental Hygiene from
Eastern Washington University’s Dental Hygiene Degree ing, are we sending our patients home understanding services
Completion Program at Pierce College in 2009. Thankfully, rendered? Are they confused about what treatment they are
scheduled for, or how to care for a surgical site? Are we attenthere was no clinical component to this schooling.
In May 2010, I began the process of healing. I was referred tive, loving and kind? Do they feel cared for? There is much to
to a psychiatrist who placed me on Prozac. I was referred to a ponder as we try and use our experiences for good. ■
clinical psychologist from the Anxiety & Stress Reduction
Center of Seattle (ASRC). I was impressed by their confidence References
1. Anxiety & stress reduction center of Seattle (ASRC). (2010). Retrieved December 10,
in evidence-based treatment:
2010, from EBTCS Web site: http://asrcseattle.com/
“Both evidence-based medicine (EBM) and evidence-based 2. Facts & statistics: Anxiety disorders association of America, ADAA. (2010). Retrieved
practice (EBP) assert that making clinical decisions based on
January 31, 2011, from Anxiety Disorders Association of America Web site:
http://www.adaa.org/about-adaa/press-room/facts-statistics
best evidence, either from the research literature or clinical
3. Obsessive compulsive disorder. (2010). ASRC of Seattle: Obsessive compulsive disorder.
expertise, improves quality of care and quality of life. EBP is
Retrieved December 10, 2010, from EBTCS Web site: http://asrcseattle.com/
unique because it includes the preferences and values of the
ocdisorder.html
client and family in the process.”5
4. Baer, L., Ph.D. (1992). Getting control: Overcoming your obsessions and compulsions.
New York, NY: Plume.
My psychologist employed a method known as cognitive
5. What is evidence based treatment? (2011). ASRC of Seattle – Evidence-based treatment.
behavioral therapy (CBT), which assists individuals in recogRetrieved January 27, 2011, from EBTCS Web site: http://www.asrcseattle.com/ebt.html
nizing actions which need to be modified.6 An example of this 6. What is cognitive behavioral therapy (CBT)? (2010). ASRC of Seattle: Cognitive
method used in my case is known as exposure and response prebehavioral therapy. Retrieved December 10, 2010, from EBTCS Web site: http://asrcseattle.com/cbt.html
vention.3 “The following statements illustrate this principle…
7. Foa, E. B., Ph.D., & Wilson, R., Ph.D. (2001). Stop obsessing!: How to overcome your
1. You cannot always control your thoughts.
obsessions and compulsions (Rev. ed.). New York, NY: Bantam Books.
2. You cannot always control your feelings.
3. But you can always control your behavior.
4. As you change your behavior, your thoughts and feelings
Author’s Bio
will also change.”4
Kathy Beard, RDH, BSDH, has enjoyed the dynamics of a
Also, two books were recommended to me and gave me
dental hygiene career for more than 25 years. Her duties
comfort as I went through the “recovery” process. They were
as past president of Premiere Hygiene Study Club, as well
Getting Control: Overcoming Your Obsessions and Compulsions by
as her responsibilities in implementing a safety program,
L. Baer4 and Stop Obsessing! How to Overcome Your Obsessions
have enriched her understanding of the importance of
and Compulsions by E.B. Foa.7
continued communication. She resides in Washington State with her
In less than three months, and in approximately 13 seshusband, and has one daughter.
sions, I was done with treatment. I will always have to contend
125
hygiene & prevention message board
This thread comes from the message boards of Hygienetown.com.
Increase Doctor’s Production
Whether you’re new in practice or just experiencing a slump in your schedule, there are many ways to increase production.
cln2th
Posted: 5/13/2010
Post: 1 of 36
126
Greetings all! I hope that you might have some suggestions for me. I work
with a new, young dentist who purchased this established 30-year practice in a
small, rural community. I worked with the previous dentist for 22 years. My
schedule has remained full, even as much as being booked solid a month in
advance. The issue is that the doctor’s schedule has vacancies. How can I assist in
increasing his production? Honestly, a majority of our patients do not need
restorative care when they are examined during their care in my operatory. What
should I be recommending? ■
timothyives
Posted: 5/13/2010
Post: 2 of 36
I admire your loyalty to your employer. It sounds like he’s a real
preventive dentist with a minimal intervention approach. Has your
dentist explored other avenues such as Invisalign? Tooth whitening is
also a great way to bring in patients and is minimally invasive.
I am just beginning to realize the power of clinical photography.
I’m finding that simply taking clinical photos, discussing them with patients and
letting the patient have a copy has had a positive effect. These patients are starting
to ask about orthodontics and aesthetic work, just by being presented with a photo
– subtle marketing. ■
skr RDH
Posted: 5/13/2010
Post: 3 of 36
Be sure that the previously treatment-planned items are discussed at
each subsequent visit if it is not booked yet. There are also plenty of
courses and tools to introduce to the practice to boost treatment acceptance and production. ■
shazammer1
Posted: 5/13/2010
Post: 8 of 36
I like the idea of “before and after” photos hanging on the reception
area walls. It gives patients something to ponder while waiting. Or a big
photo album of before and after photos. I ask every patient if he or she
has ever considered whitening. Not that they need it, but that they
would have spectacular results if they decided to because of the beige
undertone of their teeth. Once whitening is done, many patients are eager to continue with more treatment. Make sure every staff member has gorgeous dentistry in
their own mouths for show and tell to the patient.
I make it a habit to talk over the patient. If I think some treatment would be
good, say a crown or some cosmetic stuff, I will start to talk to the doc during the
exam. Something like “George is not ready at this time to go ahead with that anterior crown on that discolored tooth, but when he is, what kind of time frame would
he need for the appointment?” The doc and I discuss this without George so much
as throwing in two words, but he is hearing it. ■
message board hygiene & prevention
I own a laser company so that is obviously what I would suggest.
You sound like an excellent hygienist and I’m sure you can spot all the
things that your doctor could be doing with a little diode i.e., frenectomies, fibroma removal, operculectomies (tons of those to do), treating ulcers and of course, perio (decontamination and sulcular
debridement)... just to name a few. ■ Jim
jimking
Posted: 9/6/2010
Post: 11 of 36
We’re getting a laser in a week or so, and have many patients waiting
for frenectomies already (our associate is trained and uses it elsewhere).
Main reason we’re getting it is for relieving tissue/hemostasis for crown
impressions, minor crown lengthening and to have another technology
to brag about on the Web site. ■
skr RDH
Posted: 9/6/2010
Post: 12 of 36
My office has struggled a bit with this also. Our patient population is a younger
demographic, so their restorative needs are generally not extensive. We are currently
working with a consulting firm. It’s too soon to evaluate the outcome, but what I’ve
learned so far is that having someone who is objective to look at things will bring
many missed opportunities to light.
Hiring a consultant, of course, is a financial investment, but many have some
type of guarantee. In other words, if they don’t help you increase your profit by X
amount they will refund the fees you paid. ■
squirlsgirl
Posted: 9/18/2010
Post: 16 of 36
I am also reminded of the fact that a regularly seen population of
patients who have been in the practice for more than 30 years will not
be providing you with opportunity for rehabs or even much more than
naturally occurring repair work. You might need to start a program
designed to bring in the new patients who are lingering out there and
have not been seen by anyone for years or a lifetime. Ads touting laughing gas, sedation dentistry, comfort or painless anesthetic can fire up your phone calls. ■
shazammer1
Posted: 9/21/2010
Post: 18 of 36
My best advice is to use protocols and systems that you follow for consistency and
thoroughness. Going over risk factors makes sure nothing is overlooked. This covers
everything from gums, teeth, TMJ, smile characteristics and medical precautions. I
feel good that I am being thorough and providing service that the patients need. ■
toothbat2000
Posted: 9/24/2010
Post: 30 of 36
End-of-the-year letters can be sent out to patients who have unfinished treatment encouraging them to use their benefits. We typically do
ours in the fall and they always generate a good response. ■
dentmom
Posted: 9/24/2010
Post: 31 of 36
Dr’s Production
Find it online at
www.hygienetown.com
127
dentally incorrect
If you find a town which looks deserted,
it’s probably for a reason. Take the hint
and stay away!
Do not search the basement, especially
if the power has just gone out.
If household appliances start operating
by themselves, move out.
Never read a book of demon summoning
aloud, even as a joke.
If you’re running from the monster,
expect to trip or fall down at least
twice. Also note, despite the fact that
you are running and the monster is
merely shambling along, it’s still moving
fast enough to catch up with you.
Don’t fool with recombinant DNA
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If your children speak to you in Latin
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their own, run! ■

e - Dentaltown

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