Mini Implant Experience!
Transcription
Mini Implant Experience!
Dentaltown Magazine www.dentaltown.com Drs. Gordon Christensen & Paul Child: Is it Time for CAD/CAM to go Mainstream? May 2011 » Volume 12, Issue 5 May 2011 » Volume 12, Issue 5 » Lasers/“Do Good” “Do Good” A Special Report on the Charitable Side of Dentistry, page 98 Laser Dentistry: Are We Being Responsible? page 40 Profile: Ivoclar Vivadent The General DentistEndodontist Relationship by Drs. Kenneth Koch & Dennis Brave, page 88 Does Whitening Help Your Practice... or Hurt It? by Dr. Rod Kurthy, page 74 Periodical Publications Mail Agreement No. 40902037 A Division of Farran Media, LLC www.dentaltown.com . . . 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At Darby, we understand the premium you and your family place on being appreciated. That’s why we created Darby Rewards. NO outrageous spending commitments. NO annual fees. NO complicated rules to follow. Just more value, more selection and more satisfaction, simply for placing your everyday needs with Darby Dental Supply. Select from over 600 best-in-class rewards from the most prestigious brands. Darby makes it easier to buy what you need and get what you want with every order. We wouldn’t settle, so why should you? Expect nothing but the best... Darby Rewards. Don’t waste your purchasing power. Call Darby today. (We’ll even throw in a not-so-lousy t-shirt for spending absolutely NOTHING.) www.darbydentalrewards.com 800.645.2310 800.448.7323 FREE FACTS, circle 20 on card Dr. Ira Newman of Long Island, NY received all these great rewards from the Darby Rewards Program by purchasing contents May 2011 66 Ivoclar Vivadent CEO Robert Ganley Articles 52 98 Do Good Focus page 98 A special focus on the charitable side of dentistry 20 Second Opinion: The Hidden Challenges of Dental Sleep Medicine Dr. Barry Glassman talks about dental sleep medicine and the difficulties that accompany it. 66 Is it Time for In-Office CAD/CAM Milling of Restorations to Go Mainstream? Drs. Gordon Christensen and Paul Child Jr. weigh the upside and downside of in-office technology. 74 Does Whitening Help Your Practice… or Hurt It? Dr. Rod Kurthy discusses the different variables of whitening that affect whether it helps or hurts your practice. 82 Diagnosing Yes – A Patient-centered Approach to Treatment Success Dr. Michael Melkers argues that understanding the patient’s awareness of his or her conditions, helps dentists to better communicate appropriate consequence and offer treatment options. 88 The General Dentist/Endodontist Relationship Drs. Kenneth Koch and Dennis Brave speak about the importance of keeping healthy relationships between specialists and GPs, and explain how working together can improve both parties’ bottom lines. 94 The Use of Oscillation in the Placement of Composite Materials Drs. Robert A. Draughn and Karl F. Leinfelder talk about the difference between using vibration and oscillation devices to increase the flow of composite material. 100 103 106 110 112 114 116 117 Compassion for the Other Man FAQ: Hosting a Free Dental Day Office Visit: Boston Healthcare for the Homeless Three Reasons to Volunteer Profile of National Children’s Oral Health Foundation and Three Affiliates Each of Us Can Play a Role Donating Equipment and Supplies National and State-by-State List of Resources Dentaltown (ISSN 1555-404X) is published monthly on a controlled/complimentary basis by Dentaltown.com, LLC, 9633 S. 48th St., Ste. 200, Phoenix, AZ 85044. Tel. (480) 598-0001. Fax (480) 598-3450. USPS# 023-324 Periodical Postage Paid in Phoenix, Arizona and additional mailing offices. POSTMASTER: Send address changes to: Dentaltown.com, LLC, 9633 S. 48th St., Ste. 200, Phoenix, AZ 85044 ©2011 Dentaltown.com, LLC. All rights reserved. Printed in the USA. Publications Mail Agreement #40902037 Return undeliverable Canadian addresses to Station A, P.O. Box 54, Windsor ON N9A 6J e-mail: [email protected] continued on page 6 4 May 2011 » dentaltown.com Despite tremendous advancements in resin and filler technology, even today’s modern resins can be difficult and time-consuming to place and manipulate...until now. The ET 3000 is the first device to effectively address both stickiness and lack of flow, two of the biggest challenges when working with composite resins. Utilizing a specific frequency and range of oscillating motion, the ET 3000: √ Eliminates the frustrating stickiness and “tug back” of composite resins. √ Increases composite resin flow (by approximately 30%) during use, enhancing your ability to achieve the ideal cavity adaptation and surface anatomy you desire. √ Multiple tip options for every composite placement procedure! Simply put, the ET 3000 can help you better place composite restorations faster, easier, and with much less frustration than is possible with traditional hand instrumentation. Try the ET 3000 in the comfort of your office. To schedule an in-office demonstration, call your Brasseler USA representative or call us toll free at 1-800-841-4522. Introductory Special: Retail Value: $775.00 Special Price $697.50! *Patent Pending FREE FACTS, circle 4 on card contents May 2011 continued from page 4 Townie Clinical 36 Cosmetic: KöR Whitening There are many fine whitening systems on the market and these cases demonstrate some of the universal principles for success. Message Boards 30 Cosmetic: Patient Asks – Does Whitening Damage Your Teeth? Get the scientific explanation behind the simple answer, no whitening doesn’t damage your teeth. 40 Lasers: Are We Being Responsible? Want to start a great discussion? Ask this question in the Laser Forum on Dentaltown.com. 130 Hygiene and Prevention 123 124 128 130 133 134 6 From Trisha’s Desk: Community Education and Prevention Perio Reports: • Toothbrushing Better than Toothette for Intubated Patients • Association Between Perio and Obesity • Lack of Education and Smoking Lead to Perio • Lifestyle Risks for Tooth Loss • Parents with Disease Have Kids with Disease • Smoking and Perio Hygienetown Poll: Ergonomics Profile in Oral Health: Technology in Dental Hygiene Message Board: Acute Lymphocytic Leukemia Message Board: Frozen Shoulder May 2011 » dentaltown.com In This Issue 8 14 18 26 50 58 62 64 129 136 Dentaltown.com Highlights Howard Speaks: Partly Cloudy Professional Courtesy: Make a Permanent Impression on Someone Industry News Dentaltown Research: Technology New Product Profiles Around Town: Innovations on Display at IDS Around Town: Inaugural Scientific Meeting – American Academy for Oral Systemic Health Ad Index Dentally Incorrect Solid Zirconia Crowns & Bridges Replaces full gold crowns and metal occlusals Specifications: • Nearly “chip-proof ”. • Ideal for bruxers and grinders. • An esthetic alternative to posterior metal occlusal PFMs and full-cast crowns. • Prepare as thin as 0.5 mm with feather edge margins, much like you would for cast gold. • 7-year replacement warranty. Regularly Now only... $95 $65 Up to 4 Units BruxZir® is a registered trademark of Glidewell Laboratories all ceramic all you need CAD The strongest esthetic material for single crowns Specifications: • >360 MPa • More translucent than zirconia • No chips, cracks, dark margins • For anterior or posterior single crowns • Can be bonded or cemented Regularly Before Now only... $95 $75 Up to 3 Units Crowns Only After IPS e.max®CAD is a trademark of Ivoclar Vivadent, Inc. 1873 Western Way • Torrance, CA 90501 Authorized Milling Center Vi s i t u s a t : c o n t i n e n t a l d e n t a l . c o m FREE FACTS, circle 46 on card (800) 443-8048 dentaltown.com highlights Case Presentation Wow – Full-mouth Rehab This is a complex case with all the right diagnostics in place from the start. Check this out. Full-mouth Rehab Message Boards Bilateral Parotid Pain Find the Resin… This is a very interesting oral medicine case. Tune in to find out the exciting conclusion. It’s the latest party game. Play with a friend or neighbor. Find the Resin Bilateral Parotid Pain Features + MEDIA CENTER + MONTHLY POLL Videos Equipment Visit the Media Center on Dentaltown.com to view videos of Dr. Howard Farran discussing his current and past Howard Speaks columns, as well as videos from companies like 3M ESPE, Benco Dental, Sleep Group Solutions and more. If you could have one of the following for free to use in your practice, which would you choose? A. CEREC B. E4D C. Lava COS D. Cadent iTero + ONLINE CE Salivary Diagnostics: The Future is Here! – Doug Thompson, DDS This course is designed for the general practitioner and/or their lead hygienist who are serious about advancing the periodontal health of their patients, the health of their team and their practice. A thorough understanding of the oral systemic link, complemented with the use of salivary diagnostics, provides an opportunity for professional and financial growth. continued on page 10 8 May 2011 » dentaltown.com PROVEN PROFITABILITY SINCE 2002 Implant Feature: SPECIAL TIP DESIGN THE 3.0MM I-MINI® IMPLANT Loaded with innovative design features, the I-Mini® has all the functionality and capabilities of a conventional implant. The I-Mini® is also a highly profitable and reliable solution for tight spaces & denture stabilization. • Simple and minimally invasive placement protocol • Over 99% reported success rate for almost a decade • Flexible and easy restorative options • Competitively priced OCO’s OCO’s patent-pending patent-pending bull-nose bull-nose auger auger tip tip locks locks the the apex apex of of the the implant implant bbyy ppulling ulling bone bone up up and and around around tthe he threads threads stimulating stimulating bone bone growth growth FREE FACTS, circle 29 on card (800) 228-0477 | www www.ocobiomedical.com .ocobiomedical.com Designed Designed and and Manufactured Manufactured in in the the USA USA dentaltown.com highlights continued from page 8 Message from the Online Community Manager Update Your Account on Dentaltown.com Whether you’re graduating from dental school or just finishing up your spring cleaning, this is the perfect time to update your Dentaltown.com account information. Visit the My Profile section of the Web site to revise any changes to your password, e-mail address, work address and more under My Account. Make yourself known by modifying your public profile so that fellow Townies can search for your posts and information. Take a minute to adjust your subscriptions, community affiliations and settings to optimize your online membership with Dentaltown.com. Don’t forget to click the update button after any of your changes and remember I’m here to help if you have any questions! If you have questions about the site, call me at 480-445-9696 or e-mail me at [email protected]. See you on the message boards, Kerrie Kruse Online Community Manager Online Features Help Center Video Tutorial Feature of the Month – Looking for someone? You can locate fellow members by their display name, alma mater, city, occupation and more. Just use the Member Search button located in the top menu bar. Would you like to make yourself more identifiable? Update your public profile so Townies can get ahold of you too! How to Update Membership Information – Are you having trouble updating your membership information? Learn how to make changes to your registration information and public profile and update your subscriptions and settings. Go to the Media Center and click on the Tutorial section to watch a short video with step-by-step instructions. Gettag Throughout Dentaltown Magazine, you can scan tag codes to access information directly from your smartphone. To scan these codes, visit http://gettag.mobi/ to download the free barcode reader to your mobile device. You can then scan every code you see in Dentaltown Magazine to access additional information, enter contests, link to message boards, comment on articles and more! 10 May 2011 » dentaltown.com Want to make it easy for new patients to find you? Actual Snap-On Smile Patients Join the Snap-On Smile Dentist Web Locator Service and drive new patients to your practice. Here’s how it works... National TV advertising drives thousands of patients to search for Snap-On Smile online, every day, to be treated by dentists like you. Now you can join the Snap-On Smile Dentist Web Locator Service and make sure that you are one of the dentists that they will find. See for yourself at www.snaponsmile.com. Be 1 of only 3 Dentists Listed! Snap-On Smile® is a non-invasive cosmetic, removable arch Snap-On Smile Dentist Web Locator Service that literally snaps over existing dentition without adhesives... and without impinging on gingival tissue or covering the palate. Hurry! Space is limited to only 3 dentists per zip code! Call 800-445-0345 and sign up your practice today! FREE FACTS, circle 18 on card BEFORE AFTER Easy. Painless. Beautiful! Distributed by ©2011 Den-Mat ® Holdings, LLC. World Rights Reserved. 801298700 04/11CO The DenMat ®, LUMINEERS® and Snap-On Smile ® names and logos are trademarks of Den-Mat ® Holdings, LLC. U.S. Patent No. 7,357,637, and other U.S. and foreign applications pending and granted. dentaltown staff Editorial Advisory Board Editorial Director Thomas Giacobbi, DDS, FAGD • [email protected] Hygienetown Editorial Director Trisha O’Hehir, RDH, MS • [email protected] Editor Benjamin Lund • [email protected] Assistant Editor Marie Leland • [email protected] Copy Editor/Staff Writer Chelsea Patten • [email protected] Creative Director Amanda Culver • [email protected] Rebecca Bockow, DDS Krieger Aesthetic & Reconstructive Dentistry Seattle, WA Kenneth Koch, DMD Real World Endo Wilmington, DE Dennis Brave, DDS Real Word Endo Wilmington, DE Arnold Liebman, DDS Dr. Arnold I. Liebman Brooklyn, NY Doug Carlsen, DDS Golich Carlsen Denver, CO Stan Mcpike, DDS Stan Mcpike, DDS Jonesboro, AR Howard M. Chasolen, DMD Sarasota, FL John Nosti, DMD, FAGD, FACE Advanced Cosmetic and General Dentistry Mays Landing, NJ Mark Fleming, DDS* Mark J. Fleming, DDS, Inc. Sarasota, FL Krzysztof Polanowski, DDS Stomapol Serocka, Wyszkowa, Poland Seth Gibree, DMD, FAGD North Georgia Smiles Cumming, GA Jay Reznick, DMD, MD Southern California Center for Oral and Facial Surgery Tarzana, CA Stephen Glass, DDS, FAGD* Advanced Dentistry of Spring Spring, TX Lloyd Ritchie Jr., DDS Lloyd K. Ritchie Jr., DDS Pensacola, FL Brian Gurinsky, DDS, MS Brian Gurinsky, DDS, MS Denver, CO Donald Roman, DMD, AFAAID Roman Dental Arts Paramus, NJ Eyad Haidar, DMD Weston Dentistry Weston, MA Tom Schoen, DDS Schoen Family Dentistry Wabasha, MN Joshua Halderman, DDS Northstone Dental Group Columbus, OH Timothy Tishler, DDS Northbrook Dental Care, Ltd. Northbrook, IL Glenn Hanf, DMD, FAGD, PC McDowell Mountain Ranch Dentistry Scottsdale, AZ Glenn van As, BSc, DMD Canyon Dental North Vancouver, British Columbia, Canada Graphic Designer Corey Davern • [email protected] Vice President of Sales & Business Development Pete Janicki • [email protected] Regional Sales Managers Mary Lou Botto • [email protected] Steve Kessler • [email protected] Executive Sales Assistant Leah Harris • [email protected] Marketing Director Jerry Kaster • [email protected] Marketing Coordinator Kelly Kunkel • [email protected] Circulation Director Marcie Coutts • [email protected] Circulation Assistant Teri Riggins • [email protected] I.T. Director Ken Scott • [email protected] Internet Application Developers Angie Fletchall • [email protected] Nick Avaneas • [email protected] Electronic Media Production Artist Amy Leal • [email protected] MultiMedia Specialist Devon Kraemer • [email protected] Message Board Manager Howard M. Goldstein, DMD • [email protected] Online Community Manager Kerrie Kruse • [email protected] Publisher Howard Farran, DDS, MBA, MAGD • [email protected] President Lorie Xelowski • [email protected] Controller Stacie Holub • [email protected] Receivables Specialist Kristy Corley • [email protected] Seminar Coordinator Colleen Larkin • [email protected] 12 May 2011 » dentaltown.com *Continuing Education Advisory Board Member William Kisker, DMD, FAGD, MaCCS* Dental Care of Vernon Hills Vernon Hills, IL © 1999–2011 Dentaltown.com, LLC. All rights reserved. Printed in the USA. Copyrights of individual articles appearing in Dentaltown reside with the individual authors. No article appearing in Dentaltown may be reproduced in any manner or format without the express written permission of its author and Dentaltown.com, LLC. Dentaltown.com message board content is owned solely by Dentaltown.com, LLC. Dentaltown.com message boards may not be reproduced in any manner or format without the expressed written consent of Dentaltown.com, LLC. Dentaltown makes every effort to report clinical information and manufacturer’s product news accurately, but cannot assume responsibility for the validity of product claims or typographical errors. Neither do the publishers assume responsibility for product names, claims, or statements made by contributors, in message board posts, or by advertisers. Opinions or interpretations expressed by authors are their own and do not necessarily reflect those of Dentaltown.com, LLC. The Dentaltown.com “Townie Poll” is a voluntary survey and is not scientifically projectable to any other population. Surveys are presented to give Dentaltown participants an opportunity to share their opinions on particular topics of interest. LETTERS: Whether you want to contradict, compliment, confirm or complain about what you have read in our pages, we want to hear from you. Please visit us online at www.dentaltown.com Itt’’s what makes us different. digital family familly y ous ent ng on ust stomer sfaction sf ideas bluchip rew ewa wards the centerpo oint ex experience xp choice reinv nvest stment s success ss painless we web bencoNET bencolab sup sup pp plies lies ess equ uipme uip pme ent partners rt rship p practice coaching big big deals serv rv vice prev eventiive m maintenance boosste errss goals financing op ptions ile customer serrvice rv techno h ology l gy gro row owth wt vision n rust x-ra xray ay suite e value va friendly nco rep office off of ffffice des design es n excellence exc accou untability ty ex 8 DECADES OF LEADERSHIP t 3 GENER RA ATIONS t 1 FA AM MILY As a family-owned company, Benco Dental has spent the last 80 years making responsible, long-ter m choices. Where public companies look at quar ters, we see decades. We’ve succeeded by doing the opposite of what a public company like ours might. We invested millions in a brand new facilittyy during one of the worst economic downturns in histor y because it improved the customer experience.* And it’s a philosophy that works. While our competitors worr y about pleasing Wall Street, we have the luxur y of devoting 100% of our energy to delivering success, smile aftter smile. It’s our mission, our passion. And it works: for the past six years, we’ve been the fastest growing dental distributor in the United States. The reason? Our success is tied directly to the success of others. It’s the Benco Dif fe erence. Follow Us We deliver success smile after smile.® 1.800.GO.BENCO t BENCO.COM *Please come visit CenterPoint, North America’s largest dental equipment showroom. To schedule an appointment, please contact your Friendly Benco Rep. FREE FACTS, circle 34 on card howard speaks Partly Cloudy by Howard Farran, DDS, MAGD, MBA, Publisher, Dentaltown Magazine In the late 1870s, Thomas Edison improved upon the light bulb. Up to that point, the best lighting technology people had was a gas lamp, which was plagued with various drawbacks. Sure gas lamps produced decent illumination, but they left black soot all over the walls and ceiling, sometimes they’d catch fire, and every once in a while gas from a lamp might fill up in a room and explode – logical reasons why the public really liked the idea of electricity. The primary drawback to the electric lamp was it needed electricity to work but, at the time, there was no infrastructure. So, in order to power and capitalize on this new product, there was a great need to develop a cheap, efficient way to generate and distribute electricity. Edison founded the Edison Illuminating Company in the 1880s and started building DC (direct current) power stations that powered street lamps and residences that were close enough to the plant. Edison was convinced this was the way to go, but Nikola Tesla’s AC (alternating current) system was more powerful and could be sent farther by cheaper means. It made much more sense to power a city with one giant power plant than it did to build a power station every few blocks. It’s much easier to tend to the current generated at one station than to maintain dozens upon dozens of power stations strewn throughout the city. With this larger system, companies didn’t need to generate their own power anymore; they just got it from the big power plant. Everyone got the same 120-volt electricity the same way, and nobody had to think about it anymore. Modern micro-computing is heading in the same direction. I might be a little late to the table here, but I recently read The Big Switch by Nicholas Carr, first published in 2008. In this book, Carr conveniently compares modern computing to the power station story above and details the major upheaval the computer industry is facing... which, in my humble opinion, is nothing but positive for dental practices! Why does every single household have to have an IT guy (aka, your tech-savvy nephew who you only invite over when you accidentally download a virus)? Why does every single household have to have a microprocessor? Anti-viral software? Back-ups for its data? It’s asinine. You’ve already seen the commercials and read articles (even in Dentaltown Magazine) about “the cloud,” and soon more and more practices will be running their entire practice management systems on it. Micro-computing made companies like Microsoft and Dell a fortune – primarily because for every dollar you spend on software, you end up spending four or five more dollars to keep it running properly, due to updates or needing an IT guy to come service your equipment. Basically, according to Carr, your current computer system is the equivalent to a direct current power station, and the cloud is the giant power plant. The current micro-computing business model is going to expire because of the cloud, eliminating costly upgrades and repairs to your practice management software. Here’s how: Back-up is Automatic Remember when your brand-new practice management software was installed? Everyone was so excited (or intimidated) to get started. And while you and your team were getting trained you learned one of the major “to-dos” was to back up your servers. Don’t you remember thinking, “Of course! We need to do this every single day, if not multiple times a day. Last thing we need is to lose all of our information. That would be catastrophic!” And then six or seven months later you’d remember to back up your system only after hearing a horror story about the guy down the street whose server crashed and he had to shut down his practice for a week to regain some semblance of practice management normalcy? Backing up your system sucks. You always forget to do it, and it only becomes a priority a second after your server melts down. In the rare chance when you actually remember to do it, it takes all day because of all of the new data you’ve accumulated. On the cloud, everything is automatic – including backing up your information. Oh, and let’s say a batch of servers that houses your information on the cloud goes down. Guess what, there are redundancies in place. If one of massive server farms Google is building exploded, your information would still be safe because it exists in a number of other data farms in other locations around the country (and even the world). Pretty cool, isn’t it? Beats the hell out of backing up your aging software. Which brings me to my next point... The Newest Version All the Time Isn’t it always the case around the time you get settled into the newest iteration of your practice management software, a newer version becomes available? And you can surely relate when a new update presents a glitch that has to be patched up by an IT expert until the new version arrives. It’s eternally frustrating, right? When everyone moves to the cloud, everyone will get the latest and greatest available To hear more of Howard’s thoughts on this topic, go to Dentaltown.com and search: DTV Howard Speaks continued on page 16 14 May 2011 » dentaltown.com FREE FACTS, circle 17 on card howard speaks Find us on Facebook www.facebook.com/dentaltown continued from page 14 No Server Upgrades – or Servers, Period! Sometimes I feel bad for the guys who have CBCT machines in their offices. They’re taking all these amazing scans with this incredible technology, but they’re maxing out their servers every six months because these image files are gigantic. And every time they reach capacity, they have to shell out more money for more server space. Pretty soon, when everything is on the cloud, you can just upload everything and not have to worry about how much space is left on the server. No More Disruptions from the IT Guy Dental practices can be pretty bustling places at times. When your system is in need of a bug fix, chances are the IT guy will show up during the most productive time in your schedule. Try as hard as they might to stay out of everyone’s way, when IT guys are in the office, you can count on countless disruptions. When you’re on the cloud, everything is repaired behind the scenes. Problem with your software? Give your practice management software provider a call or even instant message them and they can get working on the problem from where they sit. There are already companies that exist solely on the cloud. Right now, you can run your entire practice management system on the Internet. You don’t need a server. You don’t need IT. If there are any practice management software companies out there that want to ensure they’re still competing in the next five to 10 years, they need to focus on moving to the cloud. In fact, if their number-one priority isn’t getting their next platform out on the cloud, they might be in trouble. Safe Data and Inexpensive Price Tag On average, how much do you think you’re paying each year on servers, software and for IT guys to come out and repair your crashed computers? $10,000? Maybe $15,000? We all know of colleagues or friends who have had computer crises in their practices. In some cases their systems weren’t ever backed up (or they were improperly backed up), and every single one of these dentists will vouch it was the worst disaster their practice ever faced. Another reason the cloud makes sense: I don’t care what anyone says, we’re still recovering from the recession. The easiest thing you can do to make money during a recession is cut costs. Right now you’re paying one percent of your overhead to your electric bill, and five percent to IT. Why not get your IT down to one percent? I just want some dummy terminals that will run the practice management software for me. Let them worry about data storage. Let them worry about the servers and data back-ups. Is the cloud right for any of us right now? Depends. Are you starting up a new practice or transitioning into one? If you are, it 16 May 2011 » dentaltown.com might not be a bad idea to look into. For most of us, transitioning into the cloud might be impractical. Eventually we might all transition into a hybrid system where everything that lives on our servers might be automatically backed up on the cloud. It’s going to take time. Are there drawbacks to the cloud? Right now, sure, but the Internet infrastructure is ever improving. If your entire system lives on the Internet and your Internet connection goes out, you might have an issue – but how often has your Internet connection gone out in the last five years? If it has gone out more than 10 times, you really ought to check with your current ISP and get a second line installed ASAP. When you went to dental school, how many classes did you take on computer back-up? How many classes did you take on generating electricity? I had one class on electricity in physics and they explained to me in one day how electricity is made and that was the end of it. I don’t want to be responsible for the 120-volt current coming into my office. I don’t want to be responsible for my servers. I’d rather jump on the cloud and take care of my patients, worry free. ■ Howard Live Howard Farran, DDS, MBA, MAGD, is an international speaker who has written dozens of published articles. To schedule Howard to speak to your next national, state or local dental meeting, e-mail [email protected]. Dr. Farran’s next speaking engagement is May 26, 2011, at the Saratoga Dental Congress in Saratoga Springs, New York. For more information, please call Colleen at 480-445-9712. Seminars2011 to them at all times. There’s a glitch in the system? OK, chances are others have already encountered it and have contacted the people that can fix it on the cloud for good. Errors caused by your software won’t have to wait 24 or 48 hours for the IT guy to show up and fix them. May 26 ■ Saratoga Springs, New York Saratoga Dental Congress www.4thdds.org [email protected] Aug. 20 ■ Greater Nashville, Tennessee Tennessee AGD www.tnagd.org Sept. 9 ■ Minneapolis, Minnesota Advanced Practice Management 952-921-3360 [email protected] Oct. 26 ■ Raleigh, North Carolina Nu Image-The Big “3” Dental CE Kim Wolozyn – 919-532-3192 [email protected] these could be yours... imagine the possibilities! YOU can WIN this Lamborghini free extreme practice makeover package FREE FOR THE FIRST 97 TOWNIES g Tra ack Yo ou And Your o Dental Prac a tice To. MOREE NE MORE NEW WP PATIENTS ATIENT TS INCREASED P PRODUCTION RODUCTION IGGER R, BRIGHTER FUTURE A BIGGER, BIGGER Wh hile work o kiing less and makking i signific nificcantlly morre money! mone Name Address _____________________________________________________________ City ________________________________________________________________ Office Phone _________________________________________________________ Fax to o 770.518.7577 Go to www.Lamboand .Lamboand Makeover.com Email NO OBLIGA OBLIGATION. TION. ______________________________________________Zip ______________________________________________ _________________ St______________________________________________ Th The he information you’r’re going to receive is very ry important and verry confidential,l, therefore we will be sending you ou an to arrive. email upon shipment pment so yyo you’ll know when to look for the FedEx FeedEx package p FREE FACTS, circle 10 on card professional courtesy Make a Permanent Impression on Someone by Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine This month we have dedicated a significant portion of our magazine to charitable pursuits within our profession. We hope you find the stories inspirational, as it is our goal to encourage more professionals to get involved in these noble pursuits. Charitable dentistry can take many forms from volunteering in a local free clinic, making a financial contribution to a dental charity or serving on a mission trip to a foreign land. I would like you to consider another option – “charity begins at home.” This oft repeated motto reminds us that we can be charitable right from the comfort of our own home, or in this case, dental office. Each year, many dental offices select a patient from their own population and complete the case at no charge. Many times we have specific criteria for selecting these cases: perhaps the patient is going through a rough time in his or her life and needs to get out of pain, other cases might be someone who has recently lost a loved one and must find a job outside the home or a young child with extensive decay who cannot concentrate in school due to the constant pain. Whatever the reason, the goal is the same – make someone’s life better. In the process, you will be surprised at how much a case like this will tug at the heartstrings of your team, and in many cases, they might agree to work for free as their contribution to this charitable act. There are practical considerations for charitable Charitable dentistry can take cases that should not be forgotten. In spite of the fact that the treatmany forms from volunteering ment is free, the patient should sign all necessary consent forms for treatment. Additionally, you might want the patient to sign a confiin a local free clinic, making a dentiality agreement so they do not share your arrangement with and family, in order to avoid others requesting free treatment. financial contribution to a dental friends If you choose your case carefully, this will not be a problem. Another example of charitable dentistry at home is the offer of charity or serving on a mission free dentistry for a day. There are a number of offices that will open trip to a foreign land. their doors on an off day to provide dental services on a first-come, first-served basis. Most often, this is a Saturday and the staff and doctors volunteer their time for the day. The event can be promoted in local papers or on the radio – most of these outlets will promote charity events at little or no cost. [Editor’s Note: See page 103 for information about hosting a free dental day.] Prior to the event you should prepare the necessary paperwork for patients to complete so you are in compliance with all state and local laws. Consent forms are still necessary and it will be necessary to determine the limits for treatment in advance. As an example: you should allow patients to select one of the following: cleaning, filling or extraction. As a single-day event, your goal should be to help as many people as possible in the limited time. You might elect to repeat this event more than once a year based on the needs of your community. Alternatively, you might refer the patients to a local clinic for follow-up care if such a facility exists in your community. Do you have an idea for volunteer dentistry in your office? Did you recently complete an event? Log on to Dentaltown.com and join the discussions on these topics. Comments and questions can be delivered via e-mail: [email protected]. ■ 18 May 2011 » dentaltown.com Probiotics. They aren’t just for digestion anymore. EvoraPro® supports dental and gingival health and extends the “fresh from the dentist” clean. Each mint contains an extra-strength blend of ProBiora3® probiotics. These beneficial bacteria bind to teeth and go deep under the gingival margin, crowding out harmful bacteria. Introducing EvoraPro® probiotic mints from Oragenics – the first professional-strength probiotics for oral care. EvoraPro PROBIOTIC MINTS AT A GLANCE • Professional-strength probiotics for oral care • Contains ProBiora3 blend of beneficial bacteria • Promotes healthy bacterial balance in mouth • Extends effects of professional cleaning • Does not harm tooth enamel, dental work, or dentures • 100% natural Oragenics probiotic products were developed from basic research begun more than 30 years ago at the Harvardaffiliated Forsyth Institute in Boston. This body of research has shown that a few key naturally-occuring oral bacteria can act as antagonists to harmful oral bacteria. EvoraPro is 100% natural, and will not harm tooth enamel, dental work, bridges, or dentures. 877-803-2624 ext. 248 Let us help you maintain your patients’ oral health while enabling them to be more active in their own care. Make EvoraPro a part of your practice. To learn how, call us at 877-803-2624 ext. 248 or visit ForEvoraPro.com. FREE FACTS, circle 14 on card I www.ForEvoraPro.com second opinion The Hidden Challenges of Dental Sleep Medicine by Barry Glassman, DMD Second opinions are common in health care; whether a doctor is sorting out a difficult case or a patient is not sure what to do next. In the context of our magazine, the first opinion will always belong to the reader. This feature will allow fellow dental professionals to share their opinions on various topics, providing you with a “Second Opinion.” Perhaps some of these observations will change your mind; while others will solidify your position. In the end, our goal is to create discussion and debate to enrich our profession. –– Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine I want to bring some reality to the economics of dental sleep medicine, an area for dentists that is being promoted by many as a new profit center in the dental practice. There is no question that adding this service to your armamentarium has the potential not only to improve the quality of life for many of your patients, but also provide increased income. Along with the ability to increase services and income, dental sleep medicine provides many new challenges to the dentist, which are often ignored or underestimated. The dentist will only be in a position to provide a therapy that could be essential to the patient’s quality of life if the challenges are recognized and conquered. What is Sleep Medicine? Sleep medicine is a relatively new specialty of medicine. In a 2005 article, Shepard, et al. stated “the history of the development of sleep medicine in the United States is relatively short and most of the individuals involved with its development are still living.”1 They go on to state: “Until 1975 sleep medicine was deemed ‘experimental’ and medical insurance companies routinely denied reimbursement claims.” In discussing the development of the specialty of sleep medicine, they conclude that “sleep is viewed as a basic biologic process that affects all individuals and has significant impact on the function of all organ systems.” The International Classification of Sleep Disorders is a 400page, stand-alone document that was written in 1990 and revised in 2005.2 Sleep medicine deals with sleep and arousal disorders that include all conditions encountered clinically. It deals with dyssomnias, which are those disorders that involve initiating and maintaining sleep, as well as with parasomnias, which are movements and behaviors that occur during sleep.3 Obstructive sleep disorders are classified as dyssomnias and represent those disorders resulting from airway obstructions that occur during sleep. They are relatively common syndromes and by conservative estimates affect five percent of the Western world,4 but they are often under-recognized despite having substantial morbidity and mortality rates associated with them. Treatment for obstructive sleep disorders ranges from the extremely conservative measures of weight loss and sleep position training to variations of continuous positive airway pressure (CPAP), oral appliance therapy and surgery. Many patients prefer the concept of oral appliance therapy to either the use of CPAP or surgery.5 A dentist should then be involved with patient evaluation, insertion and appliance maintenance as well as managing post-appliance insertion complications.6 Consequently, one might think that oral appliance therapy would be a considerable portion of many dentists’ general practices. But this is not the case. The Carrot of Economic Success It isn’t unusual to see an advertisement refer to the potential economic boom that a course will provide for the participant. Silber states that 30 to 50 percent of the population older than 50 snores.7 This is often interpolated to 40 percent. So, if 40 percent of your adult population snores, and you have a practice with 2,000 active adult patients, 800 of your patients snore. If you treat only 25 percent of them, and you bundle the workup and appliance fee to a moderate charge of $3,000, then your gross income should increase by $600,000 the first year. Unfortunately, that is an unrealistic computation. The literature ignores the many challenges that face dentistry. Let’s examine some of those challenges. The Physician’s Bias The past few decades have seen the line between dentistry and medicine continually blur, as dentists have made significant contributions to the care of patients with chronic daily headache, migraine and facial pain. There was a bias among sleep physicians against early attempts at oral appliance therapy. Pantino reports that when he began treating with oral appliances it was not only considered experimental, but with limited data, research, no consideration of coverage from the insurance industry and with limited physician support, he may as well have been “practicing witchcraft.”8 The 1995 landmark study by Schmidt-Norwara9 opened the door to the need for dentistry and medicine to work synergistically and pointed out that as health-care providers, we are continued on page 22 20 May 2011 » dentaltown.com # ## # #" &# '&% $! $ &#$ '&%$#"! $# $#" ' h4HE SHADE GUIDE IS AMAZING ) HAVE SEARCHED FOR MANY YEARS TOFINDTHEBESTWAYTOCOMMU NICATE SHADING AND TEXTURES TO MYLAB.OW)HAVETHEULTIMATE GUIDE TO DO JUST THAT 4HANK YOUv h$URING YEARS IN PRIVATE PRACTICE)HAVEHADTHEOPPORTU NITY TO WORK WITH MANY DENTAL LABS3HADECOMMUNICATIONHAS ALWAYS PRESENTED A CHALLENGE BUT,UKE+AHNG#$4AND,3+ HAVE SIMPLIFIED THIS TASK AND PRECISELY SO WITH THEIR #HAIRSIDE 3HADE'UIDE»SYSTEM 4HANKS ,UKE AND YOUR TALENTED TEAMOFPROFESSIONALSFORPROVID ING A USEFUL TOOL TO ACHIEVE EXCELLENT ESTHETIC RESULTS TIME AFTERTIMEv h)N THE PAST YEARS ) HAVE USEDTHECUSTOMSHADETABSOF EVERY PORCELAIN COLOR OR TRANSLUCENCY IN A PORCELAIN KIT ABOUT TABS AS A COMMU NICATION TOOL 7ITH THE ,3+ #HAIRSIDE3HADE'UIDE»)HAVE BEENABLETOGETTHERESULTS)VE BEEN LOOKING FOR n ESPECIALLY FOR SHADE MATCHING ANTERIOR TEETH ENAMEL TRANSLUCENCY SURFACE TEXTURE STUMP COLOR TEETH SIZE ALONG WITH ALL THE OTHER ELEMENTS OF TOOTH MORPHOLOGY -Y COMMUNICA TIONISSUESARESOLVEDALMOST AS IF ) HAD A #HAIRSIDE ,AB 4ECHNICIANv #" ' & #&$ &%& " h)LOVETHISGUIDEITTAKESALOTOF THE WORK OUT OF TELLING THE LAB WHAT YOU WANT 7ITH PHOTOS AND THE CODES WE CAN GET AN EXACTMATCHANDINMOSTCASES WEDONTEVENNEEDPHOTOSv 7HATISIT!NUPDATEDANDIMPROVEDVERSIONOFTHEEXTREMELYPOPULAR,3+#HAIR3IDE3HADE3ELECTION'UIDE»FIRSTINTRODUCEDIN)TNOWINCLUDESBOTHA0OSTERIOR ANDAN!NTERIOR2EHABILITATIONSHADINGSYSTEM)NTHENEWLYCREATED0OSTERIOR'UIDEFORBOTHMOLARSANDPREMOLARSBASICCOLORCHOICESHAVEBEENBLENDEDWITHDENTIN ENAMELANDENAMELOVERLAYASWELLASTRANSLUCENCYANDOCCLUSALSTAIN)NADDITION0OSTERIORVIEWSPERSPECTIVEOCCLUSALANDBUCCALOFTHEMAXILLARYANDMANDIBULAR PREMOLARSANDMOLARSAREINCLUDEDFORASIMPLESELECTIONPROCESS4HE!NTERIOR2EHABILITATION'UIDEWITHBLENDEDCOLORSFROMBLEACHINGTO$HASBEENEXPANDEDTO INCLUDETOOTHSHAPEINCISALEDGECORNERSHAPEANDTISSUECOLORSELECTIONFORIMPLANTCASES!LSOPRODUCTSIZEHASBEENSHORTENEDANDTHICKENEDFORABETTERFITINTHE MOUTH%VERYCONSIDERATIONHASBEENGIVENTOCREATINGBETTERDOCTORPATIENTCOMMUNICATIONREGARDINGESTHETICDESIGN (OWTOUSE4WONEWLYCREATEDINSTRUCTIONAL$6$SAREINCLUDEDWITHEACHPACKAGEONEFORANTERIORANDONEFORPOSTERIORTEETH!LLSYSTEMUSAGEISCOVEREDINTHESE$6$S #ALLUSORVISITOURWEBSITEWWWLSKCOM FREE FACTS, circle 41 on card second opinion continued from page 20 challenged to acknowledge the necessity for interdisciplinary communication.10 This early bias is complicated by the fact that obstructive sleep disorders are indeed a medical disorder. Obstructive disorders are a continuum of disorders that start with snoring. Therefore, snoring should not be treated without a medical diagnosis, and that diagnosis should be done by a physician.6 In spite of the tremendous improvements in oral appliance therapy, the fact that oral appliances are usually preferred by patients over the alternatives of CPAP or surgery, and the fact that the Academy of Sleep Medicine has mandated by policy that some patients not only can, but in some cases should, be treated or given oral appliance therapy, physician bias against oral appliances still exists. It isn’t enough for dentists to know just the basics of sleep medicine and oral appliances. Dr. Schmidt-Norwara wrote that “dentists who offer this service need to become acquainted with the multifactorial nature of sleep medicine to serve their patients better and to facilitate their interaction with other sleep medicine clinicians.”11 A high level of mutual respect and open communication is required for the medical and dental professions to properly triage and treat patients. In a position paper on practice parameters by Kushida, et al., it is stated that oral appliances should be delivered and followed by qualified dental personnel “who have undertaken serious training in sleep medicine and/or sleep-related breathing disorders with focused emphasis on the proper protocol for diagnosis, treatment, and follow up.”6 Challenges Beyond the Science In order to be successful in incorporating dental sleep medicine into your practice, understanding the science of sleep medicine and possessing the ability to insert oral appliances is not enough. The art of implementing the science requires a different skill set than was required to develop a general dental practice. In order to be successful, dentists must have strong communication skills. For the most part, general dentists can work within their own office walls and choose those specialists with whom they would like to work. In sleep medicine, dentists must immediately work to develop relationships of trust and mutual respect with physicians with whom they might have no past relationship and with whom they have had limited contact. Furthermore, because many physicians hold the bias discussed earlier in this paper, they will often have to be educated and motivated to refer patients for oral appliance therapy. There is also the matter of “management” and the potential for failure. The dental model of practice doesn’t usually involve “managing” disease; we treat it and cure it. Obstructive disorders can’t be “cured,” a concept I have found not readily accepted by some dentists. Dentists need to develop a new mindset and a new definition of success for the practice of dental sleep medicine. They must learn that success cannot be determined with an explorer or depend totally on the polysomnogram results. They must also realize that some patients will be unable to wear their appliances. Dentists must quell their disappointment and acknowledge that although they have rendered the best possible care, there are factors beyond their control that impact the success of oral appliance therapy. This potential for failure should not dampen their enthusiasm. Fear of failure should not prevent them from helping many other patients. Making this realization and sharing this information with the patient prior to treatment is a total change in the model that dentistry routinely utilizes. There is also the obstacle of post-insertion management. The oral appliance helps maintain the airway during sleep by creating an external splint, resulting in an increased tonic tone to the relaxing pharyngeal musculature.12 In order to do this, there is a strain placed on the muscles of mastication, as well as the temporomandibular joint itself.13 General dentists are not well trained in joint anatomy, physiology or in the treatment of joint dysfunction.14 These common complications will sometimes frustrate the dentist who might not be trained in the ability to diagnose, treat or manage these adverse effects on the joints or muscles. This frustration has the potential to cause the dentist to stop treating with oral appliances. Training in these areas of treatment is readily available, and will allow the dentist to manage these complications and make wise risk/benefit decisions concerning the continued use of the oral appliance. The most common adverse effect is occlusal changes.13 Dentistry has long emphasized the role of occlusion, and it is difficult for the dentist to make an informed risk/benefit decision if that role is considered more important than the resolution of the patient’s obstructive disorder. Ferguson states, “This presents a clinical dilemma when the patient is unconcerned about the occlusal changes and refuses to abandon the appliance citing that the perceived benefit of treatment outweighs the dentist’s concern with the altered occlusion.”13 Dental malocclusions created by oral appliance therapy might have limited or no effect on the patient’s aesthetics or function, and it might be much more beneficial for the patient to continue to wear his or her appliance despite the occlusal changes. It is counterintuitive for the dentist to do anything that creates a malocclusion, and yet this might be in the patient’s best interest. This is a difficult concept for dentistry. Why the Hidden Agenda? This is, no doubt, an exciting and new field. We are all aware of today’s economics, and the need for general dentistry to find new income potential. On the surface, an argument can be made about how successful dentists can be by adding dental sleep medicine to their regimen. It is clear that challenges exist, and that we are more likely to be successful and conquer the challenges if we are aware of them from the beginning. The rosy picture that is often painted isn’t real, and many dentists who take their initial course in dental sleep medicine are soon disenchanted by the unexpected roadblocks to success. Is the promise of economic gain, then, a conspiracy? The answer is simple. Yes, it is a conspiracy if there is some implication that implementing dental sleep medicine is as simple as finding continued on page 24 22 May 2011 » dentaltown.com It’s always a better performance with the right partner. The Prophy Star ® 3 and Titan® Sonic Scaler from StarDental® . The complete hygiene solution that puts your performance in the spotlight. Work efficiently with the lightweight, patient-friendly solution that allows for better movement in the oral cavity and more effective removal of soft and hard deposits. Together, both extend a multitude of conveniences to you, including: UÊÝi`ÊL>VÊi`ÊÀÊÃÜÛiÊ>ÌÌ>V iÌÊ«Ìà UÊ,iÛ>LiÊ>ÕÌV>Û>LiÊiÀ}VÊ}À«Ã UÊÕÀÊVÀV`}ÊV ViÃÊ>iÊ`iÌwÊV>ÌÊi>ÃiÀp>`ÊvÕ UÊ-Ì>ÀiÌ>Ê«>ÌiÌi`ÊÌ«ÃpÃ>viÀÊ>`ÊÀiÊivviVÌÛi >ÊÊÛiÊÜÌ ÊÌ ÃÊ«>ÀÊÌ`>ÞtÊ9Õ½ÊLiiwÊÌÊÀiÊÜ iÊÞÕÊ purchase them together, but you’re welcome to buy them Ãi«>À>ÌiÞÊÌ°ÊÌ iÀÊÜ>Þ]ÊÞÕp>`ÊÞÕÀÊ«>ÌiÌÃp get just what they need. ©2011 DentalEZ ® Inc. All rights reserved. StarDental ®, DentalEZ, Star and Titan are registered trademarks and Hygiene Strong is a trademark of DentalEZ, Inc. To order, please contact your authorized dealer. For more information call toll-free 866.DTE.INFO or visit our Web site: www.dentalez.com FREE FACTS, circle 23 on card LET’S GET HYGIENE STRONG™ Visit www.TheDEZireeShow.com second opinion continued from page 22 patients in your office who snore and treating them with oral appliances that you fabricate easily with impressions and bite registrations sent to a lab. There are real challenges that face dentistry in the field of dental sleep medicine. These challenges include: • Becoming a serious student of sleep medicine • Educating your medical colleagues about the potential service you can provide their patients who might benefit from oral appliance therapy • Understanding the need to manage your patients and understanding their role as key players on the treatment team • Learning how to communicate with local sleep labs and physicians by keeping them in the loop and referring patients back to them for post-treatment evaluations • Establishing reasonable fee structures and understanding the need to process claims through medical insurance in order to get the most coverage for your patients • Learning more about the craniomandibular structures that you are compromising in order to support a compliant airway • Carefully reconsidering some of your occlusal concepts that will prevent your potential bias from keeping patients from treatment for this serious disorder that is associated with substantial morbidity and mortality rates15 Barsh, in a recent editorial, stated that because of dentistry’s unique place in our health-care system, it has the responsibility to screen patients for OSA.16 Ninety percent of OSA remains undiagnosed.17,18 Our patient load would be well served if all dentists had a better understanding of sleep disorders. Our profession and our patients would benefit if all dentists were taught the basics of sleep medicine and consequently screened their patients. But more intensive study on many levels and a commitment to consider the model changes discussed are required before the dentist can provide oral appliance therapy and create another income source in his or her office. The conspiracy is on the part of those who might gain economically in the short run by having dentists construct snoring appliances for those patients who snore (even if it means without proper diagnosis) or by encouraging dentists to take courses because of the perceived economic gain without recognizing the obstacles to that end. Furthermore, the conspiracy often encourages the front-end purchase of equipment that is not required to perform dental sleep medicine; again, in the long run, this frustrates the general dentist who is not aware of the obstacles that prevent the successful implementation of dental sleep medicine in his or her practice. Many well-done studies have now been completed to demonstrate over and over again the potential of oral appliance therapy to be successful in mild, moderate and even severe sleep apnea.13 Certainly, oral appliance therapy has been implemented into many dental practices successfully. Some dentists around the country have actually limited their practices to dental sleep medicine. The obstacles can be overcome. But before they can be overcome, they have to be recognized and acknowledged. It is essential, then, that the “conspiracy” not result in frustration and the dentist deciding not to pursue dental sleep medicine. Those who have accepted the challenges and overcome the obstacles have placed themselves in a position to provide a potentially life-altering and life-saving treatment modality. The diligent dentist has the opportunity to add not only a new stream of income for his practice, but also a new quality of life for his or her patients. ■ References: 1. Shepard, J.W., Jr., et al., History of the development of sleep medicine in the United States. J Clin Sleep Med, 2005. 1(1): p. 61-82. 2. American Sleep Disorders Association, D.C.S.C., ed. International Classification of Sleep Disorders: Diagnostic and Coding Manual. 2005, American Academy of Sleep Medicine: Westchester, IL. 3. Kryger, M.H., T. Roth, and W.C. Dement, Principles and practice of sleep medicine. 4th ed. 2005, Philadelphia, PA: Elsevier/Saunders. xxxiii, 1517 p. 4. Young, T., P.E. Peppard, and D.J. Gottlieb, Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med, 2002. 165(9): p. 1217-39. 5. Ferguson, K.A., et al., A randomized crossover study of an oral appliance vs nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea. Chest, 1996. 109(5): p. 1269-75. 6. Kushida, C.A., Morgenthaler, T.I., Littner, M.R.,etal, Practice Parameters for the treatment of snoring and obstructive sleep apnea with oral appliances:an update for 2005. SLEEP, 2006. 29(2): p. 240-243. 7. Silber, M.H., Krahn, Lois E., Morgenthaler, Tomothy I., Sleep Medicine in Clinical Practice. 2004, Boca Raton: Taylor & Francis. 8. Pantino, D.A., Joining Forces. Sleep Review, 2008. 9(3): p. 34-5. 9. Schmidt-Nowara, W., et al., Oral appliances for the treatment of snoring and obstructive sleep apnea: a review. Sleep,1995. 18(6): p. 501-10. 10. Glassman, B.H., Multidiciplinary Is Not a Dirty Word. Cranio, 2004. 22(2): p. 87-89. 11. Schmidt-Nowara, W., A review of sleep disorders. The history and diagnosis of sleep disorders related to the dentist. Dent Clin North Am, 2001. 45(4): p. 631-42. 12. Hoekema, A., B. Stegenga, and L.G. De Bont, Efficacy and co-morbidity of oral appliances in the treatment of obstructive sleep apnea-hypopnea: a systematic review. Crit Rev Oral Biol Med, 2004. 15(3): p. 137-55. 13. Ferguson, K.A., et al., Oral appliances for snoring and obstructive sleep apnea: a review. Sleep, 2006. 29(2): p. 244-62. 14. Klasser, G.D. and C.S. Greene, Predoctoral teaching of temporomandibular disorders: a survey of U.S. and Canadian dental schools. J Am Dent Assoc, 2007. 138(2): p. 231-7. 15. Eckert, D.J. and A. Malhotra, Pathophysiology of adult obstructive sleep apnea. Proc Am Thorac Soc, 2008. 5(2): p. 144-53. 16. Barsh, L.I., The recognition and management of sleep-breathing disorders: a mandate for dentistry. Sleep Breath, 2008. 17. Young, T., et al., Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep,1997. 20(9): p. 705-6. 18. Baumel, M.J., G. Maislin, and A.I. Pack, Population and occupational screening for obstructive sleep apnea: are we there yet? Am J Respir Crit Care Med, 1997. 155(1): p. 9-14. Author’s Bio Barry Glassman, DMD, maintains a private practice in Allentown, Pennsylvania, which is limited to chronic pain management, head and facial pain, temporomandibular joint dysfunction and dental sleep medicine. He is a diplomate of the American Academy of Craniofacial Pain, a fellow of the International College of Craniomandibular Orthopedics, a fellow of the Academy of Dentistry International and a diplomate of the American Academy of Pain Management. He is on staff at the Lehigh Valley Hospital where he serves as a resident instructor of craniomandibular dysfunctions and sleep disorders. He is a diplomate of the Academy of Dental Sleep Medicine and is board certified in dental sleep medicine. He is on staff at the Sacred Heart Hospital Sleep Disorder Center. He was recently named Co-Medical Director of the St. Luke’s Hospital Headache Center. 24 May 2011 » dentaltown.com NOW5! 5,99 $ FREE FACTS, circle 21 on card industry news Dental News in Brief The Industry News section helps keep you informed and up-to-date about what’s happening in the dental profession. If there is information you would like to share in this section, please e-mail your news releases to [email protected]. All material is subject to editing and space availability. OHA Announces a Three-year, $500,000 Commitment From Ivoclar Vivadent, Inc. Oral Health America (OHA) is the recipient of a three-year, $500,000 commitment from Ivoclar Vivadent, including a $100,000 cash contribution in 2010, continuing financial support in 2011 and 2012, and a significant donation of Fluor Protector fluoride varnish and Helioseal sealant. In addition, Ivoclar Vivadent and OHA will launch a matching gift program for OHA’s Seal Two Million campaign, which doubles the impact of gifts made by dental professionals to the organization. Ivoclar Vivadent is OHA’s first Guardian Level Sponsor for the campaign. To find our more, visit www.ivoclarvivadent.com or www.oralhealthamerica.org. UIC Oral Health for Homeless Program Receives National Award The University of Illinois at Chicago College of Dentistry has received the Bud Tarrson Dental School Student Community Leadership Award for its work treating homeless patients at a student-operated oral health center in Chicago. Sponsored by the American Dental Association Foundation, the Bud Tarrson Dental School Student Community Leadership Award annually highlights dental student outreach to vulnerable communities. UIC dental students of all levels, from first- to fourth-year, assist at the clinic, which they operate as if it were their own private practice. A faculty adviser oversees all of the students’ work. For more information about UIC, visit www.uic.edu. Modern Dental Laboratory USA Named Fastest Growing Private Company and Best Workplace Modern Dental Laboratory USA (Modern USA), with service centers in Seattle, Los Angeles and Chicago, has been named one of the 100 Fastest Growing Private Companies and the Best Workplaces in Washington State, as recently awarded by the Puget Sound Business Journal in the small business category. Modern USA says it has been able to grow into one of the 100 Fastest Growing Private Companies by attracting new dentists and continuing to be a great partner to existing clients through its dedication to quality. For addition information on Modern USA, visit www.moderndentalusa.com. Septodont Acquires OraVerse from Novalar Septodont announces the purchase of OraVerse from Novalar Pharmaceuticals, Inc. OraVerse is an anesthesia reversal agent, used when dentists or dental patients desire a quick return of sensation to the lip and tongue following a dental procedure in which a local anesthetic was administered. Under the terms of sale, Septodont will assume full responsibility for OraVerse including sales, marketing and regulatory activities for the North American and unpartnered international markets. OraVerse will be available through authorized dental supply dealers. For more information, call 800-872-8305 or visit www.septodontusa.com. continued on page 28 26 May 2011 » dentaltown.com ©2011 DENTSPLY International. All rights reserved. STRONGER. Because patients do funny things. NEW! Introducing ChemFil™ Rock. The stronger GI Restorative. Superior fracture and wear resistance. Easier handling. Introducing ChemFil™ Rock Restorative, the new advanced GI restorative from the trusted innovators at DENTSPLY Caulk. With zinc-reinforced glass ionomer technology, ChemFil Rock Restorative is up to 25% stronger than ™ other leading brands. And non-sticky, packable handling makes it easier to place. So if you want the best for patients who live large, reach for The Rock! Talk to your DENTSPLY Caulk representative or visit www.ChemFilRock.com FREE FACTS, circle 39 on card STRONGER. industry news continued from page 26 Dental Wings, 3M ESPE and Straumann Join Forces Dental Wings, 3M ESPE and Straumann are joining forces to create an open global standard software platform for use across a range of dental applications. The initiative is expected to offer enhanced flexibility, simplicity and convenience for users, while saving time, costs and investment risk. To advance industry standardization, 3M ESPE and Straumann have agreed to adopt Dental Wings’ software platform DWOS as the core operating software in their CAD/CAM solutions. Other companies are encouraged to join the collaboration and to contribute to shaping the platform’s future. Visit www.3mespe.com, www.straumann.com, or www.dwos.com for additional information. Congressman Gerlach Met with Premier to Discuss Medical Device Tax In early February, Congressman Jim Gerlach (RPA) met with employees of Premier Dental and Medical Products to learn about the impact of the 2.3 percent excise tax on medical devices mentioned in the Health Care and Education Reconciliation Bill of 2010. The tax could affect Premier’s and other manufacturers’ ability to maintain staffing levels and remain competitive in an increasingly challenging global marketplace. Gerlach told Premier staffers that there will be a number of hearings held on the issue and that Ways and Means subcommittees will work to develop and introduce smaller, more targeted bills to replace components within the massive bill. Officite Selected by the ADA as First Corporate Provider of ADA Online Patient Education Officite has been selected by the American Dental Association (ADA) as the first corporate provider to offer Web-based ADA patient education brochures and Toothflix videos. Through the new collaboration, dentists can educate patients with trustworthy and respected, ADA-branded online educational resources through Officite dental Web sites. Now available for the Web, the ADA’s Toothflix videos and time-tested patient brochures are designed for use by dentists for the promotion of their dental practices and for the oral health education of their patients. Visit www.officite.com for more information. Smile Brands, Inc., to Open 30 to 40 New Offices in 2011 Smile Brands, Inc., plans to open at least 30 and as many as 40 new offices this year. By the end of 2011 Smile Brands plans to have up to 362 affiliated dental offices nationwide operating under the Bright Now Dental, Monarch Dental and Castle Dental brand names, including other local brands. The first new affiliated dental offices to join Smile Brands’ growing roster in 2011 include a Castle Dental office in Houston, Texas, and a Bright Now Dental office in Fountain Valley, California. For more information on Smile Brands, Inc., visit www.smilebrands.com. Oral Health America’s Gala and Benefit Raised Nearly $500,000 Oral Health America (OHA) raised nearly $500,000 at its 21st annual Gala and Benefit on Wednesday, February 23, at Chicago’s Field Museum, during the 2011 Chicago Midwinter Meeting. Over 840 guests mixed, mingled and danced under tempered glass, exotic metal fixtures, grand stone columns, antique light fixtures and an enormous Tyrannosaurus Rex dinosaur skeleton while participating in an auction and raffle to benefit OHA’s programs which bring healthy mouths to life. Visit www.oralhealthamerica.org for more information. 28 May 2011 » dentaltown.com CEREC AC Connect. 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FREE FACTS, circle 31 on card Contact your Patterson representative for more information cosmetic message board Patient Asks – Does Whitening Damage Your Teeth? Get the scientific explanation behind the simple answer, no whitening doesn’t damage your teeth. teramdds Posted: 3/11/2011 Post: 1 of 11 How do you answer your patients’ question “Does whitening damage your enamel/teeth?” Are there any studies that show damage to teeth with over usage/beyond recommendations of bleach? Thanks! ■ Just say no. ■ M marshall_white_dmd Posted: 3/11/2011 ■ Post: 2 of 11 Rod Posted: 3/11/2011 Post: 3 of 11 If you like what you’re reading, check out this related message board… Good Information on the Science of Bleaching (Whitening)... Search: Science of Bleaching Anyway, regarding damage to the teeth, let me go into it just a little. What can potentially damage tooth structure chemically? Acid, right? Early attempts at home whitening involved pre-whitening rinses, which were acidic. Using those frequently could potentially cause damage. Hydrogen peroxide (HP) gels have a tendency to become acidic, even if they start off neutral. As H2O2 breaks down, it will break down to any conceivable combination of oxygen and hydrogen. In school they told you that hydrogen peroxide (HP) breaks down to water and oxygen. That can happen, but what also happens is that it will break down to superoxide radicals, hydroxyl radicals, perhydroxyl radicals, etc. And these radicals are what are most responsible for whitening. So yippee for radicals! But the problem is that when HP breaks down to radicals, it also throws off hydrogen ions into the mix. Remember pH (potential of hydrogen) – hydrogen ions are acid. When you place neutral HP on teeth, it can go down to a pH of 3-3.5 in even 20 minutes. When peroxides are exposed to room temperature, warehouse temperature and especially freight truck and delivery truck temperatures (that will often range from 125 to 165 degrees Fahrenheit), this causes the peroxide to break down quite a bit during storage/shipping. Not only is it not nearly as strong, but it has already become acidic by the time it’s used. Also, one of the ways that whitening product manufacturers try to avoid the costs of refrigeration is to add “acidifiers” into the gels to make them more stable. Of course this makes them more acidic. So yes, if gels that have acidifiers are used chronically, have been exposed to temperatures, or have no buffering, chronic use could be problematic due to the acid. This is one of several reasons that I’ve been such a fanatic on refrigeration of gels for so many years. Next – damage to the pulp. Well, if the tooth is otherwise healthy, a little transient inflammation here and there won’t be a problem. However, the studies prove that H2O2 (in its molecular form) can get into the pulp within 15 minutes. continued on page 32 30 May 2011 » dentaltown.com New Lightweight Nike® Skylon Ace Frame available in Black and Varsity Red. ision VMagnified The ONLY Magnification Custom Manufactured to your measurements (never off the shelf) for TRUE Ergonomics The Lightest LED DayLiteTM Mini Just See It Today with our 45 Day, NO Obligation Trial. 760 Koehler Avenue | Ronkonkoma, NY 11779 | 1.631.585.3300 | 1.800.345.4009 [email protected] | www.DesignsForVision.com Nike and Nike’s Logo are registered trademarks of Nike, Inc. FREE FACTS, circle 43 on card cosmetic message board continued from page 30 This could be a problem if it weren’t for Catalase. Catalase is a natural endogenous antioxidant enzyme. The only function of any antioxidant is to force H2O2 to break down to only water and molecular oxygen. This prevents the formation of systemic radicals. So since the Catalase found in the pulp protects the pulp from damage from radicals, whitening is considered safe for the pulp. Sorry for the long, drawn-out explanation, but you asked! ■ Rod dandarnell Posted: 3/11/2011 Post: 4 of 11 I like Rod’s response. If I get asked, “Does whitening damage your teeth?” I usually just tell them that teeth bleaching is one of the most studied procedures in dentistry and the American Dental Association has declared teeth whitening with 10 percent carbamide peroxide safe for lifetime use. ■ uscdds95 Posted: 3/12/2011 Post: 6 of 11 I get that same question all the time… I always say no. No permanent damage to teeth... yet when I get a pregnant patient I won’t do bleaching on them. Does that make any sense? ■ dandarnell Posted: 3/12/2011 Post: 7 of 11 When White & Brite came out in 1989 and we were writing the instructions for it, the question of usage during pregnancy came up. The company that introduced tray whitening was actually Dunhall Pharmaceuticals – a small division Omni Dental. So Jim Hatfield, the guy responsible for bringing tray whitening to market and to the dental profession was a pharmaceutical-oriented person. So he decided to declare tray whitening unsafe for pregnant women for this reason. No one had done a study on pregnant women whitening their teeth to see if it would produce birth defects and no one was ever likely to. So the no pregnant women bleaching warning was completely arbitrary. In the past 24 years or so that tray whitening has been available, countless pregnant women have whitened their teeth... mainly because they were already whitening their teeth when they became pregnant and were unaware at the time of the pregnancy. So the reason you don’t offer bleaching to pregnant women is that you don’t offer anything that is elective to pregnant women. ■ Negotiating a Lease? Don’t let the landlord take advantage of you. “ I called you because they said you were the best and you are! - Dr. Jaih Jackson, Bradenton, FL ” To level the playing field, simply call toll-free or visit georgevaill.com/dt/ 800-340-2701 What do I tell patients? I tell them that the only chemical that could potentially damage their teeth is acid. I tell them that there are some whitening products that produce acid, so to be careful which products they select over the counter, and to be sure not to use them chronically long-term. I tell them that the products that I use in my practice do not have acid, and they have buffering Rod Posted: 3/12/2011 Post: 11 of 11 continued on page 34 32 May 2011 » dentaltown.com Free Free W Weekly eekly Webinars Webinars F Free ree Patient Patient E Education ducation visit www.curvedental.com www.cur . vedentall..com to to sign signup! up! visit w www.curveed.com ww..curveed.c .co om W We’ll e’ll C Convert onvert Y Your our o Da Data ta at at No No Char Charge!* ge!* Curve Dental before we’ll SSwitch witch tto oC urve D ental bef ore June 30, 2011 and w e’ll cconvert onvert yyour our existing patient data Curve free! Call 888-910-4376.. e xisting pa tient da ta tto oC urve ffor or fr ee! C all 888-910-4376 ee wha whatt we’ve we’ve done with dental al software sofftware and the he Web: Weeb: WOW! WOW! SSee oou’ll never nev evveer have havve upgrade upgrraade 1 YYou’ll hassles.. hassles You o never install nstall sofftwaare. Whenev h er you use thee sofftwaare you’lll be using the latest and greatest. You o ’lll save time and money! Yoou’ll never nevveer worry worr o ry 2 You’ll about abouut backups. backkups u . Eveerry cchange to your data is instantly backed up on multiple servers in multiple locations. No wor orries! Yoou w won’t oon’t spend a 3 You We can can cconvert ca on o veert yyour oour ! We fortune foortune on har hardware. dwaare. data data aatt no char charge.* rgge.* All you need is Internet acccess and a Weeb browser s r. Say “BByebye!” to expensive servers and woorrkkst kstations and save. Whhen you take advvaantage of the Weeb and an switch to Cuurve Dental beffoore June 30, 2011, we’lll conver e t your existing patient data at no charrgge! aalll 888-910-4376 FFree reee Data Data CCall CConversion! oonveersion! visit sitt www.curvedental.com/no-feeconversion www..curveedentall..ccoom/no-ffeeeccon o veersion FREE FACTS, circle 37 on card ©2011 Curve Dental, Inc. *Off ffe er ends end June 30, 2011. Some restrictions apply. Call for details. A-DENTTA ALLTOWN MAY 2011 cosmetic message board continued from page 32 systems to make sure that the chemical never becomes acidic – so that active whitening followed by long-term maintenance is absolutely safe for their teeth and for their lifetime. I then throw in that since the system uses alternating whitening with a desensitizer that has fluoride in it, that studies have shown that the teeth will actually get stronger (increase in surface hardness) with that approach – so there is absolutely no worry at all. As far as the pregnancy issue, what has been said is absolutely 100 percent correct. There is no scientific evidence to even cause us to suspect there could be any problem. However, when it comes to pregnancy, if something has not been proven safe we must consider that it might be unsafe and recommend against it. Personally I’m convinced there would be no problem whitening the teeth of a pregnant woman. Would I ever do it intentionally? Not on your life! If that baby is born with a birth defect, or a miscarriage was to occur, the parents’ attorney would come lookin’ for my butt. ■ Rod Find it online at www.dentaltown.com Does Whitening Damage From Aesthetics to Social Media Find it all on Dentaltownwebcasts.com Check out Dentaltown’s growing collection of Webcasts including: • “Balancing Esthetics & Function of Direct Composite Restorations” – Sponsored by Ivoclar • “Practice Management Tools for Tough Times” Sponsored by easydental Henry Schein Visit Dentaltown.com for the May and June Webcast schedule and to view previous Webcasts in our library. 34 May 2011 » dentaltown.com SAME SUBSTANCE. TRANSFORMED. Gutta-percha. Crosslinked gutta-percha core. GuttaCore obturators are the first to feature a core made of actual gutta-percha that’s been crosslinked. Crosslinked gutta-percha gains a subtle, flexible strength that won’t melt when heated, yet allows you to retreat or create post space with unprecedented ease. Call 1-800-662-1202 for a demo that might change the way you think about obturators. New GuttaCore obturators. Transforming gutta-percha from the inside out. Visit us in booth #1306 at the CDA Anaheim Meeting FREE FACTS, circle 16 on card © 2011 DENTSPLY International, Inc. ADGCCGPCO8/10 DENTSPLY Tulsa Dental Specialties DENTSPLY International, Inc. 5100 E. Skelly Drive, Suite 300 Tulsa, OK 74135 1-800-662-1202 1-800-597-2779 (fax) www.tulsadentalspecialties.com cosmetic townie clinical KöR Whitening There are many fine whitening systems on the market and these cases demonstrate some of the universal principles for success. jboccuzzi Posted: 7/6/2010 Post: 1 of 28 If you like what you’re reading, check out these related message boards… This is honestly the first time I have ever “blogged.” KöR whitening is a feelgreat product. I have been in the dental industry/community as a hygienist since 1988 and as a DMD since 1995. I have seen, tried and worked with all sorts of whitening products. I would like to share the stories of two patients – the first, on whom we tried a different whitening product on September 20, 2007 but had little results. We made him bleach trays with lifetime bleach. I was not wowed. And the second patient, who had tetracycline staining. She pointblank didn’t want her teeth “drilled on” or as she stated, “crap adhered to the outside of her teeth.” We followed the protocol for KöR whitening and were wowed. So I wanted to share with you! Much thanks to Dr. Rod Kurthy for his product, guidance, detailed instructions, DVD and enthusiasm. Fig. 1 Fig. 3 Fig. 2 Fig. 4 Most Recent KöR Max Case Search: KoR Max In-office Bleaching vs. KöR Bleaching Search: In-office vs. KoR Figs. 1-2: Before the KöR whitening procedure. Figs. 3-4: After the KöR whitening procedure. Fig. 5 Fig. 7 Fig. 6 Fig. 8 Figs. 5-6: Before the KöR whitening procedure. Figs. 7-8: After the KöR whitening procedure. ■ 36 May 2011 » dentaltown.com townie clinical cosmetic Wow nice! I have the manual, just haven’t been able to sell it to patients yet. Did you do anything special for the root recession to help with sensitivity? Did you use Rod’s new protocol or the older one? ■ scandalouslj Posted: 7/6/2010 Post: 2 of 28 Nice results! I think I will have to give this a try. With this technique how much chairtime, materials and lab fee is involved? ■ Ed doctored Posted: 7/6/2010 Post: 3 of 28 Great results! How did you present the case? I am comfortable with a large fee for an implant restoration, but not with whitening. It’s just me. Need help here. ■ drjames Posted: 7/6/2010 Post: 4 of 28 Dr. Boccuzzi, thanks for the remarks, but you deserve the credit. You took the protocol seriously. After having mastered the training manual, you had questions on your first case and you took the time to e-mail me so we could kick it around. You followed the step-by-step instructions and you hit a home run for your patients. I’ll try to answer some of the questions so far. For root sensitivity, on the majority of cases just the low-sensitivity gel plus the system desensitizer will take care of it. If you haven’t received the new manual update, when you do you’ll see that I go into a lot more detail about sensitivity, the etiology of bleaching sensitivity and how to handle the unusually sensitive patient that needs even more than the regular desensitizer. Dr. Boccuzzi was kind enough to send me these photos a couple months ago with her very nice comments, so I know that this was done with the KöR system. The new one just came out. Our Dentaltown friend Pav (over in the U.K.) just finished his first case with the new Hydremide formulation with the KöR deep bleaching system. I received an e-mail from him today about it and he was going nuts over the results. He said he’ll post on Dentaltown [see next post]. Ed – With the new Hydremide system, the bleaching chairtime has been cut in half and the costs for the kits have gone down by about 30 percent. So the actual time involvement and costs are pretty comparable to other systems out there. Jim – My guess is that it’s because you’ve never really had something that you knew was going to make a huge change and that that change could be maintained forever – even tetracycline. So it’s pretty difficult to imagine charging a patient a huge amount for whitening if you’ve never had that experience. When you have fabulous results, the patients actually comment frequently that they can’t believe they achieved that kind of result for only that fee. How many people spend thousands on 10 to 20 veneers simply for color? In this economy, the fees for KöR whitening deep bleaching are all over the board, but the most common range is $600-$750. Some lower and some higher, but this is the average range. And now that the time has been reduced by about 50 percent and the costs reduced by about 30 percent, we might see that dentists even lower those fees. We won’t know until dentists have a chance to use the new products with the system and give us feedback on their fees. ■ Rod Rod Posted: 7/7/2010 Post: 5 of 28 continued on page 38 dentaltown.com « May 2011 37 cosmetic townie clinical continued from page 37 Pav Posted: 7/8/2010 Post: 6 of 28 Here’s my first KöR max case using the new protocol and the tri-barrel stuff. This lady had whitening so many times that she had lost count and it has never worked. She begged me to do Zoom for her and got quite upset when I told her I didn’t use Zoom. I did manage to get her interested in KöR. She is ecstatic with the result! ■ Find it online at www.dentaltown.com KoR Whitening Balancing Esthetics and Function of Direct Composite Restorations Webinar - Thursday, May 12 – 7:00 - 8:30 pm EST Join Dr. Jason Olitsky as he shares his philosophy for creating beautiful smiles with one of today’s contemporary direct composite materials. Learn how he balances patient demands for esthetics with the functional requirements of long-lasting, well-performing direct composite restorations. During this technique-centered webinar, Dr. Olitsky will showcase posterior composite placement as well as diastema closure and direct anterior bonding involving multiple teeth. He will share his secrets to making composite materials blend invisibly with surrounding dentition, discuss application techniques and solve post-operative sensitivity issues. C.E. Credits Provided. 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After F.I.R.S.T.® Learn Rewarding Techniques for You & Your Patients Experience a renewed enthusiasm for dentistry by increasing your income & enhancing the quality of your patients’ lives! 2011 Training Courses: Niagara Falls Buffalo July 16th September 16th Orlando Caribbean Cruise August 12th & 13th November 12th-19th Visit www.ShatkinFIRST.com/dentaltown FREE FACTS, circle 42 on card Ergonomics "Drive-Lock" Technology lasers message board Are We Being Responsible? Want to start a great discussion? Ask this question in the Laser Forum on Dentaltown.com. perioman1 Posted: 6/19/2010 Post: 1 of 65 DinoDMD Posted: 6/20/2010 Posts: 2 & 3 of 65 I visit Dentaltown’s Laser Dentistry forums on occasion for a brief escape from reality and comic relief. Every so often, there are some great cases being presented. Other times, it’s like being hounded in the expo hall on the last day of a dental convention. The bias is so thick you can cut it with a knife. Someone please discuss honestly, where are we headed with lasers in dentistry? Are we doomed to repeat a bunch of case reports and testimonials? Where are the NIH, the ADA and the AAP? Cowards! If we dentists have a shred of integrity left, then we must demand the unbiased research. Without it, we are doomed to lose our credibility with the public and with our peers. Please God, don’t tell me about Ray Yukna’s paper one more time or I’ll puke! It’s one of the weakest forms of evidence on the tree of research. It’s not that I don’t appreciate his contribution, but too many people hold onto it like the last life boat on the Titanic. It might keep you afloat, but just barely. I don’t even think that Ray believed he would have had the only credible piece of literature on the histological proof of laser periodontal regeneration three years after publication (positive or negative). Now this is a topic worthy of discussion for those with some guts! ■ I honestly believe that in the not-so-distant future, lasers will be viewed as an effective adjunctive tool in treating some forms of periodontal disease. I agree that we need more research, but as we all know, this requires much time, effort and money. In the meantime, I will need to rely on what I know and see. I think that the biggest problem with perio in general is not so much what procedures are available to us in treating it, as is knowing what we are treating and when to start treating it. All procedures have limitations. The key to success in treating any form of periodontal disease is diagnosis first, and then knowing which tool/procedure will work best in the hands of the operator using it. [Posted: 6/20/2010] In my opinion a bigger problem than the actual tool/method used is that nothing is being used. Many practices do not perform full-mouth perio charting regularly. Out of the practices that do it, not many docs will take responsibility in ensuring that data obtained by auxiliaries is accurate. How many even know how to effectively interpret the data so that an accurate diagnosis and effective treatment plan can be formulated? Are we being responsible? Absolutely not! More than the actual tool/methods being used, the bigger problem is misdiagnosed and undiagnosed disease. The bigger problem is specialists unwilling to provide what their referring docs and patients want and need. The bigger problem is general dentists not taking a more active role diagnosing and aggressively referring/treating disease regardless continued on page 42 40 May 2011 » dentaltown.com You are the gatekeeper of your patients’ total body health and well-being OralDNA® Labs Advancing Patient Wellness Through Salivary Diagnostics Helping patients fight the battle against existing disease is a noble cause, but imagine if you could help them win the fight even before disease has a chance to take hold. With salivary diagnostic tests from OralDNA® Labs, you now have the ability to learn more about your patients’ oral health even before clinical signs and symptoms appear. Our tests are based on a wellness model that strives to keep patients healthy by allowing you to detect disease earlier, determine who is at risk, and put them on a path toward a lifetime of overall health and wellness. It’s amazing what we can find out from a few drops of saliva. It’s even more amazing what you can do to help patients with that knowledge. Learn more about OralDNA® Labs and salivary diagnostics Visit us at: • Townie Meeting, May 5-7, 2011 Booth #326 • CDA South, May 12-14, 2011 Booth #2155 • AACD, May 18-20, 2011 Booth #2520 FREE FACTS, circle 24 on card © 2011 OralDNA® Labs Inc. All Rights Reserved. OralDNA® Labs is a subsidiary of Quest Diagnostics® Inc. www.OralDNA.com/professionals 877.577.9055 lasers message board continued from page 40 of methods used. The bigger problem is not realizing how serious a condition periodontal disease really is despite all the research available to us today regarding the perio-systemic associations. Bottom line is that we can argue all day over what procedures/methods are most effective, but realistically speaking, the problem is not so much the procedures we have available to us in treating disease as is how little disease is being diagnosed and treated at all! In this regard, we as a profession are being completely irresponsible. ■ perioman1 Posted: 6/20/2010 Post: 4 of 65 Check out these message boards for other conversations about lasers… Lasers and Perio Treatment Search: Lasers and Perio CO2 Laser for Perio Search: CO2 Laser 42 DinoDMD, excellent points! It’s often not discussed, but lack of the diagnostic skills and general comfort with the management of periodontal disease is shameful. I truly believe this stems from a schism in our profession. I call it “the dentist-doctor problem.” The dentist within us wants to correct what is wrong or broken. We are more comfortable with materials which can be molded or manipulated with a specific set of properties or attributes. These materials might change, but they do so relatively slowly over time. The level of control we have over these materials in the short term is very predictable. Most of the infections the dentist deals with are of the acute type. The acute infection can have fairly narrow treatment with often rapid results. It’s the rapid result, immediate gratification that the dentist so enjoys. The doctor within us is the more demanding aspect of our profession. This is the questioning and reasoning aspect with which we are so uncomfortable. Just as you discussed, the emphasis here is the proper diagnosis or differential diagnosis. Medical professionals will call this the “working diagnosis.” This assumes that we might have the wrong cause until more information is available. This is where the dentist gets uncomfortable. It sometimes takes months or years to reach our final outcome. Routinely we never actually cure the problem. We simply manage a chronic, long-lasting infection. The modifying factors can be so numerous that our patients always seem to be in a state of flux between health and disease. We are not comfortable being wrong. We are even more uncomfortable with the thought of failure. Our cost for failure might be tooth loss, but it rarely leads to death. The physician is exposed to extreme consequences and failure. It is constant retrospection, honest deliberation, the pursuit of improvement and the protection of the patient that the doctor is striving for. This is our weakest area. Most of us get compensated for procedures and not our time. I find that my colleagues often focus their CE on money-generating procedures that can be immediately applied for practice revenue generation and environmental control. With conventional treatment, periodontal disease can be very frustrating for the dentist to manage. On the other hand, the doctor is very at home with managing a chronic, system-wide, behaviorally driven disease. Laser periodontal disease therapy does my heart well. I have never seen so much interest in the management of periodontal disease in my life. In the short run, I see nothing wrong with the blanket use of the current technology for gum disease management. At the least it is drawing attention to the bigger problem and in-office identification is improving. Kudos to the LANAPers for providing a strict set of treatment protocols and diagnostic criteria. Now, I might not May 2011 » dentaltown.com message board lasers always agree with the application in some cases, but that I can live with. Our long-term goal is the focus of this thread. Do we want to be dentists or doctors? Should we be both? How will this impact our future practice and education? Will we gain or lose credibility with our medical colleagues? We must demand the AAP, the ADA and the NIH “focus like a laser” (to steal one of Obama’s phrases) on the applications of lasers on dental and systemic health. We have an enormous opportunity to save countless lives! ■ I believe that the dkimmel issue at hand is far Posted: 6/20/2010 more complicated and Post: 5 of 65 involves more than just the laser world. From a research standpoint, our system is and frankly has always been flawed. Today with even more limited funds it is even more so. The reality is that research and so-called peer-reviewed research is extremely biased and very political. It is far from being an unbiased and pure science that we all might believe. As a young, idealistic graduate student this was a hard lesson for me to learn. As I entered dentistry I was even more discouraged by these same faults in the system, particularly the lack of quality of the research. Most would qualify for the “journal of non-reproducible results.” Today it is even worse as I believe most in our profession read no more than the throw-away journals that come via mail. Beyond the political nature of research there is the issue of funding. There is no unbiased funding for basic research. That is a fact of life and has been so for some time now. The fact is today if you want to do research you have to take funding from a corporate interest. I don’t see this changing any time soon. As far as doctor vs. dentist – one of my mentors has always stressed that we are first and foremost physicians of the head and neck and technicians second! All too often we fall into the trap of becoming technicians first, looking for that instant gratification of the quick fix without doing the basics of proper exam, diagnosis and then treatment. The fault squarely sits on the shoulders of the schools of dentistry and our profession as a whole for requiring training tailored to pass boards that are more for a tech than a physician. ■ Visit us at: Townie Meeting, May 5-7, 2011 CDA South, May 12-14, 2011 AACD, May 18-20, 2011 Booth #326 Booth #2155 Booth #2520 MyPerioPath & MyPerioID PST ® ® ® salivary diagnostic tests 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. MyPerioID® PST® Salivary DNA test that determines who is at increased risk for severe periodontal infections The MyPerioID® PST® test identifies individual genetic susceptibility to periodontal disease and enables you to establish which patients are at increased risk for more severe periodontal infections due to an exaggerated immune response. To order MyPerioPath® & MyPerioID® PST® testing supplies, contact your Henry Schein® representative at 800.372.4346 For more information, www.OralDNA.com/professionals 877.577.9055 1 Exclusively Distributed by © 2011 OralDNA® Labs Inc. All Rights Reserved. OralDNA® Labs is a subsidiary of Quest Diagnostics® Inc. FREE FACTS, circle 25 on card continued on page 44 dentaltown.com « May 2011 43 lasers message board continued from page 43 44 glennvanas Posted: 6/20/2010 Post: 6 of 65 Perioman, from what I see, a long time ago the discipline of perio became less interested in “saving” teeth and more interested in CTG and implants. The bulk of literature in the discipline of perio seems to focus on the latter, to be honest. I think that you raise valid points on the fact that lasers are not so much in the literature for perio. But I will also say that the AAP doesn’t seem interested in seeing any progress made on the topic. I do find interesting that now 10 percent of the perio specialists in the U.S. own a PerioLase. Maybe there is still hope. I don’t own a PerioLase, but do own quite a few diodes and erbiums and if I had a dollar for every wayward comment, snicker or quizzical idle look, I would be quite wealthy by now. ■ Glenn still learning Posted: 6/20/2010 Post: 9 of 65 I remember having a conversation one time with a cardiovascular surgeon about preventive cardiac care (i.e., healthy diet and exercise) versus waiting for disease to develop and surgery. He said, “You can’t change people... people want pills and procedures, not lifestyle changes. Until someone invents the ‘exercise and healthy diet’ pill, I will keep cutting people open.” It is no mystery that eating healthy (low fat, low sodium, low carbs, etc.) and regular exercise will improve your heart, but many people choose to ignore this every day to their own detriment. I have been through enough marriage counseling to know that you can’t just “change” someone. If I do not have the ability to “change” the habits of the woman I have been married to for nine years, how will I change the habits of my patients? Perhaps people today are more interested in quick fixes that require little change in their own behavior. In our society I believe more people would rather have the “instant” gratification of an implant, than the “inconvenience” of changing their habits (i.e., take the time to floss), or three-month perio recalls for the rest of their life. I think most people would choose a quick fix with moderate results over a lengthy treatment that requires a lot of personal change that would give excellent results. ■ glennvanas Posted: 6/21/2010 Post: 11 of 65 Still Learning: an excellent post with some good points. My thoughts are that perio is more interested in CTG and implants for their predictability and for the financial gain as well. I think if there was a predictable solution for moderate to advanced perio then more would utilize it. I do agree that it is hard to change a person’s habits, but the results I see in many cases posted by PerioLase users show remarkable improvements despite these habits. Oh well, time will tell... need those 20-year double-blinded, randomized trials to come out, I guess. ■ Glenn zendentist Posted: 7/9/2010 Post: 13 of 65 Where are we headed with lasers in dentistry? Let me paraphrase Einstein: “For every brilliant idea, there are a million mediocre minds. And many of them are dentists.” Where we are headed is like every other aspect of dentistry that does May 2011 » dentaltown.com message board lasers not receive approval or blessings of the specialistoriented political machinations. There are dentists who use and embrace lasers and for every one of those, statistically, there are 20 more who don’t know enough about lasers to fill a paragraph, much less use them to any extent and understand and appreciate what can and cannot be done with them. Like a cult, the “evidence-basers” don’t want anyone to do anything that isn’t blessed by the “Holy Grail of double-blinded university-based unbiased research.” The trouble is that nothing of the sort exists. Nearly every study or researcher has a bias or axe to grind, and as far as interpreting the results of “lies” and statistics, the results of studies are crunched in manners that seem to follow quantum mechanics more than logic. While this is an admitted and humorous overstatement, I like to think of evidence-based followers as sort of research socialist/fascists who don’t think the great unwashed practioners can make good treatment decisions for their patients unless in comes from a “great study.” The day I have to practice and be forced to put my clinical judgment and knowledge of the patient behind an “approved approach” is the day I’ll quit this profession. There are three types of dentists – those that embrace new technology, those that reject it and those that criticize it. We are going to the place with lasers that our profession has gone with amalgam, periodontal disease, implants and radiography. The smart, patient-centered practioners know what works for them and their patients. Activist practioners don’t have enough of their own patients and they feel the overwhelming urge to dictate how everyone else practices. But the real question here is why do you care where we are headed with lasers? The more important question is where you, yourself, are headed with lasers and why? If you’re so hot for some unbiased research then open your wallet, close your practice and do it yourself. It is in the works, but as we all know – to design research that would meet the demands you place on it takes a lot of time, a lot of money and a lot of commitment. The people with most of those qualities are currently involved in trying to meet these requests, but I guarantee, in the end no matter how well designed the study, no matter how convincing the evidence, Charlie Cobb will fail to mention it in his next review of the topic. And on it will go. Visit us at: Townie Meeting, May 5-7, 2011 CDA South, May 12-14, 2011 Booth #326 Booth #2155 Booth #2520 AACD, May 18-20, 2011 OraRisk HPV ® salivary diagnostic test The OraRisk® HPV test determines who is at increased risk for oral HPV-related oral cancers. Advancing Patient Wellness Through Salivary Diagnostics 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. For more information, www.OralDNA.com/professionals 877.577.9055 Exclusively Distributed by © 2011 OralDNA® Labs Inc. All Rights Reserved. OralDNA® Labs is a subsidiary of Quest Diagnostics® Inc. FREE FACTS, circle 26 on card continued on page 46 dentaltown.com « May 2011 45 lasers message board continued from page 45 If you’re looking for a sweeping kumbaya of the profession around lasers, it’s not going to happen. Smart people will continue to embrace the technology and use it well. These are the practioners who have taken the time to learn the topic for themselves so that they can make their own decisions instead of waiting for someone else to make them – sort of intellectual capitalism, if you will. Most others will mill around or be afraid to step outside of the narrow trickle of the mainstream. They’re dangerous and will cut down on the referrals to my periodontal practice where I’m more interested in extracting teeth and placing implants than I am in possibly saving them with laser-assisted therapies. Or any other therapies that allow GPs a viable method of treating their patients, for that matter. ■ Lasers have changed my practice, my patients’ lives and my life for the past 15 years. I have used many wavelengths and see virtues in all of them. I am not an evidence-based guy. Never was, never will be. I know what I am doing with lasers and would rather be a pioneer than a 10-year follower and say I should have started 10 years ago (I am not asking anyone to agree with me on this). I have successes and failures with lasers (mostly successes) like every other aspect of dentistry. I have perio success with diode, Nd:YAG and erbium with little failures. I use lasers in endo, operative, “Lasers have changed my practice, my crown and bridge, oral surgery and implant dentistry. I own a Waterlase, Wateralse MD, patients’ lives and my life for the past 15 years. Powerlase, Picasso, Picasso Lite, Ezlaze, etc. I have used many wavelengths and see virtues I am even testing some newer wavelengths in all of them. I am not an evidence-based guy. for some companies. I do this all with consent, logic and experience. The laser is only Never was, never will be. I know what I am part of the equation. You need someone doing with lasers and would rather be a that knows what they are doing. I am quite content that many skeptics still exists. It pioneer than a 10-year follower and say I makes it better for guys like me and you and should have started 10 years ago.” the rest of the prudent early adopters, many of which lurk here. It’s up to dentists to embrace what is there or not. While the Picasso has changed the face of soft tissue laser dentistry, people still question if it is a good or bad laser. Why? Because that’s what dentists do. Even for $2,500 they will try to find reasons to criticize. Hard tissue laser companies like Biolase and Lares have dropped prices substantially to generate sales, but many still teeter on if a laser will be good for their practice despite so many dentists that say lasers change lives. But that is what I love about this profession. I always say in my lectures, “If you do not believe this technology is right for you, you are right. If you believe much of what I have shared with you, you are right.” I am just enjoying the ride and hope it does not end. ■ whitertth Posted: 7/10/2010 Post: 17 of 65 Find it online at www.dentaltown.com 46 May 2011 » dentaltown.com Being Responsible NBC CERTIFIED | FDA APPROVED MATERIALS | NADL MEMBER 1200 MPa of flexural strength Porcelain overlay 100% clinical grade Zirconia The strength you need. 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Our Ultralite CX Highspeed Handpieces offer: • Lube-free ceramic bearing technology • MULTIflex** compatible quick disconnect fiber optic 360 degree swivel • Triple port water spray (757 model) • Superior accessibility and visibility (557 model) • Outstanding cutting power and smooth operation Our lube-free ceramic bearing technology is available for all our highspeed models, including 5 hole fiber optic and 4 hole non-optic. Try Lares Risk Free With Our 30-Day Money-Back Satisfaction Guarantee Call 1-888-333-8440 Ext. 1 Today Or order online at www.laresdental.com Handpiece Shown Actual Size *Not good in combination with any other offer. For new customers only. Offer ends soon! Call today! **MULTIflex is a trademark of Kavo FREE FACTS, circle 36 on card LD-TWN0511 Ten Ways To Increase Practice Income and Efficiency With LightWalker® All Tissue Lasers LightWalker All Tissue Laser users enjoy substantial increases in practice income and efficiency performing these ten minimally invasive procedures, and so can you. We’ll provide you with the world-class hands on training you need to be successful! 1: 2: Anesthetic Free Cavity Preps- treat multiple quadrants in the same visit and save setup costs and time. Wow your patients for more referrals. Gingivectomy for Class V Subgingival Caries- gain access without bleeding. 3: 4: Frenectomy- quick, easy and 7: Biopsy- save the patient from 8: Implant Recovery- quick, 9: Gingivectomy For Braces/ Drug Induced Hyperplasia- Crown Troughing- no need to pack cord. Save time and get perfect impressions. Closed Flap Osseous Crown Lengthening- its easy and profitable additional income. referral and keep the income in your practice. easy, painless and won’t damage the implant. no bleeding and little to no post-op pain. profitable to get the perfect biological width. 5: 6: 10: Laser Endo- PIPS™ (patent pending) is so fast, easy and predictable, you’ll treat ALL your patients’ root canals- anterior and posterior- in your own practice. Laser Perio- WPT™ eliminates scalpels and sutures and makes treating perio a pleasure right in your general practice. Models starting at $39,995 Affordable Financing Available ST-E model shown 1-888-333-8440 Ext. 2050 www.laresdental.com ® Er:YAG All Tissue Laser dentaltown research Dentaltown Research: Technology Dentaltown is digging a little deeper. Based on the monthly poll on Dentaltown.com we’re determining explanations for each poll result. Included with the poll statistics are the most popular write-in answers as well as small fun facts and recaps of the Townie Choice Award winning categories that coincide with our research topic. Don’t forget to participate in the poll on Dentaltown.com each month. The more opinions you can provide us, the more information and statistics we can supply to you. The following poll was conducted from March 7, 2011 to April 4, 2011 on Dentaltown.com. Do you own a smartphone (iPhone, Android or Blackberry, etc.)? 402 total votes 399 total votes 59% 41% 71% 29% Yes Yes No No July March 2010: 2011: Will you buy a tablet computer (iPad, etc.) in 2011? 33% Yes 37% No 30% Already own one When do you think cloud-based practice management software will be standard? 275 total votes 68% 513 total votes Are you using paperless (computer-based) forms in your practice? 45% Yes 55% No 397 total votes 50 May 2011 » dentaltown.com 12% 4% One year or less Two years 16% Three years More than four years dentaltown research What price range do most of the LED curing lights that you have purchased fall into? 389 total votes 20% $500-$750 Townies were asked to name one piece of technology they could not live without. Here are the top three answers: 1. Computers 2. Digital radiography 3. Cell phone “A solid majority of technology experts and stakeholders participating in the fourth Future of the Internet survey expect that by 2020 most people will access software applications online and share and access information through the use of remote server networks, rather than depending primarily on tools and information housed on their individual, personal computers.” Source: http://pewinternet.org/Reports/2010/ The-future-of-cloud-computing/Overview.aspx 23% More than $1,000 $750-$1,000 Which of the following features would be most important in a new LED curing light? 12% 48% Battery life Cordless 40% Light output at or above 1000mw/Cm 368 total votes How did you acquire your current curing light? 11% In the Cloud 33% 24% $400-$500 Free with purchase of another item 50% Special price offered on curing light 39% Purchased unit at regular price 367 total votes What is the expected time of service before a curing light will require replacement in your office? 365 total votes 14% One to two years 47% Three to four years 39% More than five years Curing Lights: 2010 Townie Choice Award Winners Recap Curing Lights – LED: Demi LED Light Curing System – Kerr Corporation Curing Lights – Non-LED: Demetron LC – Kerr Corporation Which of the following features would be most important in a new LED curing light? 62% Rapid curing of cordless light in 30 seconds or less 23% 15% Price under $500 Warranty longer than one year 367 total votes dentaltown.com « May 2011 51 ivoclar vivadent corporate profile Ivoclar Vivadent is a true citizen of the world. The company’s headquarters and primary location of research and development is located in Schaan, Liechtenstein, while other R&D and manufacturing facilities are located in Austria, Italy, France, the Philippines, Canada and the United States. Traveling between and running it all is CEO Robert Ganley. Ganley started his career with Ivoclar Vivadent in 1980 after spending four years with KPMG. In 1990 Ganley was promoted to President of Ivoclar Vivadent North America, and in 2003 he was named CEO of Ivoclar Vivadent Worldwide. Dentaltown Magazine recently sat down with Ganley to discuss the reach of Ivoclar Vivadent’s impact on dentistry around the world, the one product it is most known for – e.max – and the charitable side of the company. How do you divide your time between locations? Ganley: As CEO of Ivoclar Vivadent, my office is in Schaan, Liechtenstein. I travel throughout the global dental markets frequently. I also maintain an office in Amherst, New York, and can be there twice per month. I realize that this is a lot of travel but it is very effective. I look at it this way – I am in the two largest dental markets in the world every month visiting customers and employees. I enjoy it and the business benefits. Tell me about your new manufacturing facility in the United States. Ganley: Our newest manufacturing facility is in Somerset, New Jersey. It is a full Ivoclar Vivadent manufacturing facility dedicated only to ceramics. This will give us ceramic manufacturing both in Europe and in North America. How is your company expressing the mission statement “Passion – Vision – Innovation” in 2011? Ganley: We try to have a clear view of how the market is developing. There are a lot of factors involved, but mainly we just talk to dentists and labs and try to understand their needs. This vision provides the map, which we follow. We build our company on a foundation of innovation. We believe innovation has value when it provides opportunities for our customers. Finally, it is the passion of our people that provides the energy for success. We only succeed because we have an enthusiastic, dedicated and talented workforce behind us; people who pursue trailblazing solutions and continually broaden their horizons and those in our industry. Dentists are sometimes afraid to try new products. How does Ivoclar Vivadent manage these trepidations? Ganley: I think fear is a natural reaction to the unknown. We try to add clarity and understanding to the dimensions of change so that the customer sees the whole picture. We do this with education and training tools but mainly by getting a clear understanding of what the customer wants and needs. Furthermore, we stay with the dentist or technician to help them through the learning process. What also helps ease fears and apprehensions is the fact that many of our developments are geared toward the needs of dental professionals and their patients, resulting specifically from the interplay between treatment and market relevance, technical feasibility and experience. Our goal is to turn these innovations into tomorrow’s standards. Three of Ivoclar Vivadent’s newest IPS e.max innovations include IPS e.max Press Multi, IPS e.max CAD-On and IPS e.max Press Implant Solutions. These products are expected to be on the market later this year. 52 May 2011 » dentaltown.com corporate profile ivoclar vivadent by Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine Ivoclar Vivadent CEO Robert Ganley continued on page 54 dentaltown.com « May 2011 53 ivoclar vivadent corporate profile continued from page 53 IPS e.max has taken off like a rocket. Why is this material so special? Ganley: When we launched IPS e.max in 2005 we did so with the message, “All Ceramic, All You Need.” The material delivers increased productivity, improved performance and great aesthetics. The unique combination of high strength and high aesthetics make it very reliable and naturally beautiful. Probably the best answer to your question is that dentists and labs like IPS e.max because it is reliable, aesthetic and they are successful with it. This is the best marketing. Additionally, it’s a fact that clinically proven materials like IPS e.max require a network of knowledgeable users and other innovators to reach saturation among those who stand to benefit most from their application. Dentists are using IPS e.max. Labs are using IPS e.max. Patients are even asking for IPS e.max. Universities and independent testing facilities are evaluating it and confirming that it truly is on the forefront of innovation. Today, IPS e.max is the standard care that dental professionals depend on. Universities and independent testing facilities are evaluating IPS e.max and confirming that it truly is on the forefront of innovation. Today, IPS e.max is the standard care that dental professionals depend on. How could IPS e.max be even better? What new developments are you working on? Ganley: At the IDS in Cologne we launched three new parts of the IPS e.max System. The first is a multi-layer (polychromatic) ingot for pressing. It is a unique technology which allows the lab to press a multi-layered crown. The second is a two-part bridge system called CAD-On. The third is an IPS e.max Press Ingot that is used to make a customized ceramic abutment. It is our plan to continue to introduce IPS e.max innovations. One of your core businesses is the production of alloys used in the dental lab. Have you seen a change in the volume of this business with the explosion of all-ceramic options? Tetric EvoCeram restoration Ganley: The precious alloy business over the years has been affected by the rapid growth of the allceramic products. Now the extreme increase in precious metal prices has added a new catalyst to the move from metal to all ceramic. Composite materials continue to get more sophisticated each year. Tell us about your latest innovations with Tetric EvoCeram. Ganley: Tetric EvoCeram is an excellent restorative material. At the IDS we introduced the new Tetric EvoCeram featuring the new bulk cure material. This is a unique material with managed working times and a catalyst that allows it to be placed up to 4mm, sculpted and cured without the need for a finish coat. What are your thoughts on the future for dental laboratories? Is it necessary for them to have a CAD/CAM solution or partner? Tetric EvoCeram Ganley: By using enhanced digital dental systems, dental professionals are streamlining processes and becoming more efficient. Our “blue block” (IPS e.max CAD) is gaining traction in the dental laboratory business every day. It is a proven solution for chairside CAD/CAM systems and many of our laboratory partners. Your company manufactures products and materials for nearly every phase of dentistry. What are some categories you would like to add in the future? Ganley: We are actively entering the aesthetic implant abutment market. Our first product, the IPS e.max Abutment was launched recently in Europe in cooperation with Straumann. Our new IPS e.max Hybrid Abutment is a modular system, which allows the lab to customize an abutment continued on page 56 54 May 2011 » dentaltown.com HAND LIN G Evo Evo E ESTH TIC S OV C L I N I C A L LY P R EN New & Improved Impr Te etric EvoCera Evo a A unique chemisstry offering the perfect balancee of handling esthetics and durrability Evo ATISF T ACTION 100% CUSTOMER SA GUARANTEED! ivoclarvivadent.com Call us toll free at 1-800-533-6825 in the U.S., 1-800-263-8182 in Canada. © 2011 Ivoclar Vivadent, dent, Inc. Tetric e EvoCeram is a registered trademark of Ivoclar Vivadent. FREE FACTS, circle 5 on card ivoclar vivadent corporate profile continued from page 54 with lithium disilicate in the lab in a pressing operation. It is very productive, reliable and delivers the aesthetics needed in anterior cases. Charitable giving is an important component of your company. Describe some of the programs that you are passionate about. Ganley: Charitable giving comes in two ways. The first is the planned program, which targets a specific area of need. At the Chicago Midwinter Meeting this year we announced a $500,000 gift to Oral Health America. This money will be directed to organizations in support of children’s preventive and restorative dentistry. We are also very concerned about access to dentistry by the geriatric population. Many older people simply cannot get to a dentist. Even those who are edentulous often have a denture but do not have a dentist. We are developing programs with OHA to assist in helping these older Americans. We are very proud to be part of this initiative. They do a wonderful job educating and serving those who need dental care. I truly believe that as a profession, we need to stand up and take action. It’s our responsibility to help those in need of dental services. What is Ivoclar Vivadent’s single greatest advantage? Ganley: We believe that we have a clear vision of the market. This is a path that we are following and we build strategies accordingly. Our innovation capacity in the areas of dental materials is excellent and we focus on innovation that creates opportunities for our customers. We believe that our people have a passion for their jobs which gives them energy and a commitment that our customers feel. Finally, we are a family-owned company. We plan in the long term. We believe that we are large We are a family-owned company. We plan in the long term. We believe that we are large enough to compete with anyone but still small enough to know our customers. 56 May 2011 » dentaltown.com enough to compete with anyone but still small enough to know our customers. What does the global landscape for dentistry look like? Where are the hot beds? Where are the struggles? Ganley: The global dental market is healthy and growing. Around the world it is different and yet in some ways the same – all want and need dental health. Sometimes this is at the minimum level due to geography and economics, but also high-level dentistry is found in nearly every corner of the world. A mother in Mumbai and a mother in Boston want the best for their children. They will try to provide the best that is available and affordable. The developed markets are the most advanced for dentistry and it is in these markets where you will find advanced equipment sales and a larger ratio of dentists per capita. Since the penetration is high, the growth potential as a percentage is lower than in the developing markets. If you look at the BRIC countries (Brazil, Russia, India, China) you will see high growth rates and high potential. In these countries you will also see increased investments from the leading dental companies. As far as struggles, we are often confronted with natural, economic or political disasters. These situations are devastating for the people in a country or region. The affect on dental care access is obvious. Ivoclar Vivadent like other leading companies tries to assist in these situations through donations of money and products. These are struggles of man against natural and human opponents. We must continue to assist when and where we can, both as dental companies and as caring people. To learn more about Ivoclar Vivadent, call 800533-6825 or visit www.ivoclarvivadent.com. n Are You Fed Up With Not Making The Income You Deserve? Learn The Secrets To A Multi-Million-Dollar Practice “We went from doing $100,000 per month to $180,000 the very next month!” Dr. Mark Davis Tulsa, OK “Even in this down economy, our office production and collections have steadily increased, something that I am positive would not have happened without their coaching.” Dr. Andy Shumway Chandler, AZ “My numbers were up over 20% after only 2 months with Quantum Leap.” Dr. Avis Broussard Southfield, MI "So many times dentists find something that works but are unwilling to share their success with colleagues. You are willing to tell anyone who will listen how to be successful in dentistry. I admit that I was a skeptic at first, but this is the best decision I have ever made for my practice, staff and family." Dr. David Boyd Portageville, Missouri “Quantum Leap has allowed me to increase my revenue by 15% in the last 4 months when all the other dentists in my area are down by 15%. You don’t have to be a victim of this economy. With what Dr. Kesner teaches I have a thriving practice that continues to grow each month, even though the area I practice in is economically depressed.” Dr. George Lunn Durango, CO Dr. Mike Kesner founder of Quantum Leap Success in Dentistry and author of Multi-Million-Dollar Dental Practice. How to NET $1 million per year. Call for your free consultation to find out how you can… • • • • • • Produce $200,000 per month in four months...like I did in a new practice, starting from zero. Get patients to say “yes” to the treatment you recommend. Bring in 100-200 new patients every month with a 50% referral rate. Earn an extra 30% of your production each month from your hygiene department. The bonus system your staff will love that will make you rich. Get wealthy in dentistry and reduce your stress at the same time. Why are we offering a FREE consultation? We need 27 new clients to fill the remaining slots for our 2011 program. If you are serious about taking your practice to the next level, and enjoying the wealth you should be making in dentistry, then call 480-282-8989 and see if Quantum Leap Success In Dentistry Program is right for you. Our graduate dentists average a 32% revenue increase in the first 6 months. Our program is fully GUARANTEED, in writing: your increased revenue will at least double your membership fees, or it is free! Call Today To Schedule Your FREE Phone Consultation! 480-282-8989 FREE FACTS, circle 9 on card www.QLSuccess.com new product profiles You are invited to visit Dentaltown.com to ask questions or post comments about the following New Product Profiles. If you would like to submit a new product for consideration to appear in this section, please send your press releases to Assistant Editor Marie Leland at [email protected]. Royal Alliant Chair and Unit Line Reflection Advanced Whitening Take-Home Kits The Royal Alliant Chair and Unit Line’s design provides ergonomic features including a chair base that places the seat of the chair at 13.5 inches from the floor at its lowest position. The Alliant unit line by Proma has all-new styling as well as the piston valve control system that carries a lifetime warranty. The new handpiece water spray system introduces a new precision adjustment feature. Visit www.royaldentalgroup.com for additional details. The Reflection Advanced Tooth Whitening Take-Home Kits contain everything patients need to safely whiten their teeth at home. The kit includes two bulk 5ml syringes of mint-flavored 22% carbamide peroxide solution, two reusable, universal trays that require no heating, a shade guide and complete patient instructions. Available in several designs or create your own custom design – all personalized with your practice name and information. To learn more and view the complete assortment, visit www.smartpractice.com/whitening. Royal Alliant Chair FREE FACTS, circle 54 on card Reflection Whitening Kits FREE FACTS, circle 55 on card Silver Recovery X-Ray Fixer Machine Store-A-Tooth The Silver Recovery X-Ray Fixer removes hazardous silver from X-ray and photo processing wastes on site. Due to the long life and the hazardous nature of silver in these waste solutions, the untreated solution cannot be simply poured down the drain. This system eliminates this hazard and potential liability on site and allows the practice to avoid resorting to a hazardous waste carrier. For more information, visit www.medicalinnovationsinc.com. Store-A-Tooth is a service that allows patients to store the stem cells associated with healthy deciduous teeth or adult teeth that are exfoliating or are being extracted. The StoreA-Tooth system provides the materials, education, training and support. Patients register directly with Store-A-Tooth for the service and administrative compensation is available for timely recovery of healthy tissue. For additional details, call 877-867-5753 or visit www.store-a-tooth.com. Silver Recovery Machine 58 May 2011 » dentaltown.com FREE FACTS, circle 56 on card Store-A-Tooth FREE FACTS, circle 57 on card new product profiles PreXion3D Elite The PreXion3D Elite with CLEARimage Scanning Technology incorporates PreXion’s proprietary CLEARimage technology that produces high quality, high-definition images while reducing radiation exposure by up to 53 percent in a fast 8.6-second scan. In addition to reductions in radiation exposure and faster scanning times, this new system offers a wide range of innovations including four new scanning modes, Rapid, High-def, High-res and Ultra highdef. Visit www.prexion.com for more information on the PreXion3D Elite. PreXion 3D Elite FREE FACTS, circle 58 on card eBiteplus Intraoral Suction and Lighting System The eBiteplus Intraoral Suction and Lighting System is a multi-functioning device that combines full illumination of the workspace as well as suction, tongue retraction, and bite block tools in a single unit. eBiteplus features three levels of light intensity, a fully autoclavable handpiece, fits into any standard delivery unit and provides continuous aspiration without interruption of treatment. For more information, visit www.greatlakesortho.com. eBiteplus Intraoral System FREE FACTS, circle 59 on card FREE FACTS, circle 44 on card continued on page 60 dentaltown.com « May 2011 59 new product profiles continued from page 59 Einstein DL Gluma Desensitizer PowerGel Einstein DL diode laser is specially designed to perform soft tissue procedures in a least invasive and less traumatic manner. The Einstein DL helps reduce healing time while providing simultaneous hemostasis; all while achieving minimal charring of the tissue. The 980nm wavelength takes advantage of the 70 percent water content of the tissue which allows the high absorption of its radiant light energy into the tissue. Visit www.dcinter.com for more information. Gluma Desensitizer PowerGel is a one-step gel formula desensitizer that allows for accurate control and placement to reduce or eliminate dentinal hypersensitivity. The new Gluma Desensitizer PowerGel delivers the same level of desensitization as Gluma liquid but also offers better handling, easier control, and greater accuracy, due to both its unique gel consistency and green-color indication which allows the practitioner to see where the material is being placed. For more information on Gluma Desensitizer PowerGel, visit www.heraeus-kulzer.com. Gluma Desensitizer PowerGel FREE FACTS, circle 61 on card Einstein DL FREE FACTS, circle 60 on card ® The #1 Botox and dermal filler training course in dentistry! ® BOTOX & DERMAL FILLER THERAPY For Every Dental Practice AMERICAN ACADEMY of FACIAL ESTHETICS TM TM Join the AAFE today and save an extra $200 on tuition Featuring: Dr. Louis Malcmacher, Dr. Anthony Feck, and the faculty of the American Academy of Facial Esthetics Limited Attendance! Sign up before June 1 - save up to $500 plus bring a team member for free! 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FREE FACTS, circle 28 on card 60 May 2011 » dentaltown.com 40,000 new patients have seen the light. Since summer 2010, Zoom in-office whitening has drawn more than 40,000 new patients into dental practices like yours. In fact, 95% of dentistry-related Groupon.com promotions have focused on Zoom to drive foot traffic – with tens of thousands of patients downloading the offer*. It’s clear that the #1 in-office whitening system in the world is also #1 among your patients. • Full suite of marketing materials to support practice growth • Clinically proven to whiten an average of 8 shades in 45 minutes† • 85% of patients want whiter teeth* FREE FACTS, circle 50 on card * Data on file. † Excluding preparation time. © 2011 Discus Dental LLC. All rights reserved. Groupon is a registered trademark of Groupon, Inc. To be dispensed by a dental professional only. ADV-3286 031011 Get Zoom and get going. Call (800) 422-9448 to learn more! around town Innovations on Display at IDS by Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine Biorepair 3Shape TRIOS PAD Plus 62 May 2011 » dentaltown.com I have just returned from the 34th International Dental Symposium (IDS) in Cologne, Germany. Not only is it the largest dental meeting in the world, it is one of the best. This is an opportunity to take the temperature of the worldwide dental industry and to peek into the future of dentistry in the United States. Two stand-out topics were implants and CAD/CAM. These topics are already big news in the U.S., but the sheer number of CAD/CAM companies for both lab and office applications were mind boggling. On the implant side, there was a surgical suite in one of the booths where they performed live implant placement surgery during the show. Aside from the sheer size of the show crowds, it is interesting to note the differences in exhibit size at IDS. Many of the well-known suppliers in the U.S. have a major presence in Europe: 3M ESPE, Heraeus, Ivoclar Vivadent and Sirona to name a few. Their exhibit spaces are filled with every product available, demonstration spaces, lounges, meeting rooms and often a bar serving drinks! This is not about getting drunk, it is part of the culture to have a space where people can meet and have a conversation while conducting their business. There are many reasons why products are slow to arrive in the U.S. There are regulatory hurdles and distribution agreements to complete. Some products require additional testing. I thought it would be fun to share a few of the new items on display at IDS, which are not yet available in the United States. BioRepair: This product is best described as a synthetic hydroxyapetitie which will repair the microscopic damage in tooth enamel, prevent plaque accumulation due to the smoother surface and reduce sensitivity by occluding exposed dentin tubules. Certainly there are other products already available in the U.S. that claim one or more of these benefits. This product earns a mention because it is a novel technology and was recently well-received at the IADR meeting. If you would like more information, visit: www.biorepair.co.uk. 3Shape TRIOS: A new intraoral digital impression scanner from a company that is very familiar to dental labs, 3Shape. This device adds to its existing line of products that run the gamut of the CAD/CAM process. This scanner was also spotted at the Heraeus booth with the product name of Cara. Pricing appears to be equivalent to other digital impression technologies currently available in the U.S., but no specific numbers will be available until this unit makes an appearance on American soil. You can learn more about this technology and the company at www.3shapedental.com. PAD Plus: PAD is an acronym for Photo Activated Disinfection. This novel tabletop device utilizes a specific wavelength of light to kill bacteria in periodontal pockets, root canals and deep carious lesions. The technique includes use of a around town medical-grade solution of tolonium chloride which is used to selectively tag all bacteria, and when the tagged bacteria are exposed to the PAD light, a singlet of oxygen is released and it will rupture the cell membrane of the bacteria. The process is said to be pain free and without side effects. If you would like to learn more about this technology, visit www.denfotex.com. ANALGE-JECT: Ronvig Dental Manufacturing in Denmark has launched this microprocessor controlled injection system which uses existing needles and carpules and does not require any additional supplies. There are multiple, pre-programmed injection rates and the device is activated by a separate foot control or it can be integrated into your dental unit foot control. The advantages of uniform injection rate are well known in the U.S. and this new device will no doubt join others in this growing space. For more information, visit www.ronvig.com. VirTeaSy: Complicated name for a simple product – virtual reality meets dental training. The simulator provides dentists and students the ability to perform implant surgery with a handheld haptic device and stereoscopic glasses which provide a 3D view of the surgical field. You can use images from your actual patient case to populate the instructional material in the program. This workstation is designed to work best in an implant training institute with students at the workstations and an instructor workstation that provides data on student performance. As the company expands their offerings, this is the ideal device to train dental students of the future. Visit www.didhaptic.com for more information. pa_on: Yes, that was the name used for this unique device. Unfortunately, I was unable to find a Web site for this new product, so the details will be limited to the information provided at the booth. This is a portable, electronic periodontal probe. Once a simple calibration is completed, the dentist or hygienist begins probing the pockets according to the programmed sequence. Once finished, the device is returned to the small docking station that is connected to the workstation, and the periodontal data is automatically transferred to the practice management software. This device can also be used to record bleeding points, suppuration and attachment loss. There is no indication if/when this might be available in the U.S., so stay tuned. n ANALGE-JECT VirTeaSy Pa_on IDS by the Numbers Attendees Exhibitors Expo Area IDS Chicago Midwinter 115,000 30,000 1,956 600 1,560,767 sq. ft. 460,000 sq. ft. Next IDS March 12-16, 2013 in Cologne, Germany dentaltown.com « May 2011 63 around town Inaugural Scientific Meeting – American Academy for Oral Systemic Health The American Academy for Oral Systemic Health (AAOSH) is hosting its first annual scientific meeting in Chicago, June 24-25, 2011. This meeting will bring together leading cardiology and dental authorities to address the oral-systemic connection. Acting on its mission to improve inter-disciplinary health care by changing public and professional awareness of the mouth-body health links, meetings and exhibits have this theme in mind. Registration Academy and registration information are available online at www.aaosh.org; also watch the video invitation. Tuition AAOSH Member Doctors: $399*/$499 Non-Member Doctors: $449*/$549 AAOSH Member Team: $199*/$239 each Non-Member Team: $239*/$279 each *early registration by May 31 Accommodations The Westin O’Hare 6100 North River Road, Rosemont, Illinois Book by calling 800-937-8461 or visiting www.aaosh.org Special rate for accommodations: $119 per night (use code: “Oral Systemic”) Exhibit Hall Sponsors and exhibitors include: OralDNA Labs, Perio Protect, My DentalETC, CloSYS, Zellies, Young Innovations, Oragenics, LED Dental/VELscope, AIM Dental Marketing, Philips and many more. Program Friday June 24, 8 a.m.-5 p.m. • Scientific Session Welcome – Chris Kammer DDS, AAOSH President • Preventive Cardiology & Oral Inflammation – Lloyd Rudy MD • The Oral/Systemic Connection: Working Together to Prevent Heart Attacks and Ischemic Strokes – Bradley Bale MD, Amy Doneen ARNP, Tom Nabors DDS Saturday, June 25, 8 a.m.-5 p.m. • Diabetology in 21st Century Dentistry – Casey Hein BSDH, MBA • Oral Pathogen Management in the Oral-Systemic Link – Duane Keller DMD • Inter-disciplinary Care & Building Physician Referral Networks – Lee Ostler DDS • The New Business of Wellness OralSysteMix - Robert Maccario MBA For more information, visit www.aaosh.org. n 64 May 2011 » dentaltown.com From equipment specs to member-only promotions Find it all on Dentaltown.com’s Marketshare pages • Easy access to information direct from manufacturers • Exclusive promotions only for Townies • Just a click away from your favorite message boards cad/cam feature by Gordon J. Christensen DDS, MSD, PhD and Paul L. Child Jr. DMD, CDT Twenty-five years have passed since the CEREC system from Sirona was in its initial developmental stages (Fig. 1). Many similar ideas and devices have come and gone before and after CEREC came onto the scene. Only one, other than CEREC, has been successful enough to still be on the market, the E4D Dentist Chairside CAD/CAM System from D4D Technologies (Fig. 2). In the United States, Patterson has the sales and service responsibility for the CEREC, and Henry Schein has the sales and service responsibility for the E4D. Fig. 1 Fig. 2 Fig. 1: CEREC. This device from Sirona and marketed by Patterson in the U.S. has evolved through several generations over nearly 26 years. It was the first to succeed in real-world practice from many potential ones 25 to 30 years ago. Fig. 2: E4D. This E4D device from D4DTechnologies initiated in 2003 has evolved into a viable competition for the CEREC device. When the air turbine handpiece came into the profession in the late 1950s, almost all restorative dentists purchased them within a few years of their introduction. Similarly, when rootform implants were proven, almost all oral surgeons and later some periodontists, prosthodontists and general dentists implemented them into practice. It appears that the in-office milling concept is similar in its potential to facilitate restorative dentistry. Why has it not had the same acceptance and growth as other concepts? It is estimated that about 12,000 in-office milling devices have been sold to dentists in the U.S. from the two companies, the major share of which are the CEREC, primarily due to their head start. There are about 140,000 general dentists and prosthodontists in the U.S., which indicates that less than 10 percent of the potential restorative dentists have chairside CAD/CAM devices. Are all of those dentists using their CERECs or E4Ds? That is impossible to determine. A few inoffice design and milling systems can be found for sale on the Internet for unknown reasons. Some are older models of CEREC that are probably being replaced with newer technology. However, it has been our observation that a few dentists do not find the concept compatible with their practices. The frustrating fact to both of us is that we know from both research and practice experience that the in-office CAD/CAM concept works well, and that it can be financially feasible in a busy restorative or prosthodontic practice. After significant experience, the concept can be used for quadrants and even fullarch and implant restorations. Many studies have supported the use of chairside design and milling systems. The references in the following list contain articles supporting the concept and show positive research on the devices.1-15 Implementation of the system takes time, planning, teamwork, willingness and patience to learn. continued on page 68 66 May 2011 » dentaltown.com The Sapphire Portable Diode Laser… Built To Perform, Wherever You Need It ® Actual size: 6.5” x 4.75” x 7.5” Actual weight: 2.33 lbs. Actual price: Just $ 2,495! The Sapphire Portable Diode Laser brings the benefits of laser surgery to your patients while providing you the portability you need to move easily between operatories. Made in the USA Supported by the same innovative engineering that went into the Sapphire® Plus Plasma Arc Curing Light, the Sapphire Portable Diode Laser gives you unbeatable performance and value…to go. 800.445.0345 www.denmat.com FREE FACTS, circle 19 on card ® ©2011 Den-Mat Holdings, LLC. World Rights Reserved. 801299000 04/11 KJ Call DenMat today at and discover just how affordable laser technology can be. cad/cam feature continued from page 66 The purpose of this article is to identify and discuss the potential reasons that have impeded the in-office milling concept from being incorporated into more practices and to make suggestions for practitioners, distributors and manufacturers to make the concept more desirable and useful for dentists. CAD/CAM Negative Characteristics and Needed Changes as Identified by Practitioners The apparent negative points will be presented in the following manner. Each concept will state the identified item followed by potential solutions to that complaint. Challenge – Cost Currently, both systems and accessories require an initial outlay of about $130,000. This amount is a significant impediment for dentists, in spite of financing and the assurance that increased revenue will come into their practices. Before the recession, the initial cost was not as formidable as it has been during the last two years, but numerous surveys have shown that many dentists have refrained from such large capital expenditures during the “great recession.” Each of the companies selling in-office milling systems requires a payment of about $2,600 per month. Obviously, that payment is present in spite of the practitioner’s potential health challenges, vacations, a down economy or a scarcity of patients. This amount is not much less than the annual net revenue of a typical general dentist. However, the dentist has greatly reduced laboratory fees, and the financial needs can be met with an average amount of restorative treatment in a typical practice. Potential solution: Cost has been a major impediment for many dentists. This is a challenge only solvable by the manufacturers and the distributors of the devices. The companies have put enormous amounts of money into developing CAD/CAM technology for in-office milling. That investment must be recovered. That goal has undoubtedly been accomplished by the original device (CEREC), but time will probably be required for the newcomer (E4D) to do so. Additionally, there is ongoing research needed for each company to update and modify software and hardware as the concept continues to evolve. The distributors who sell and service the devices need to make a profit also. Only the respective companies can know when it will be possible to reduce the cost of the devices. One potential for reduction is to put the same concept into a simplified and less expensive delivery systems to lower cost, which we will discuss later. However, it is well-known that, in spite of relatively palatable lease payments, the overall investment required to introduce this concept into practice causes concern for most typical practitioners. The real solution to this challenge appears to be to reduce the manufacturing cost of the systems and pass those savings on to clinicians. Other similar “expensive” technologies are experiencing rapid growth due to decreased cost, such as diode lasers and cone beam CT imaging. Challenge – Fear of the Unknown In spite of some devout in-office milling users, key opinion leaders and sales representatives assuring potential customers about the usefulness of the concept, many dentists are fearful of the unknown challenges they will face. There are numerous factors contributing to that fear. Included are: anxiety about how the concept will fit into their practices, the chance of unpredictable ill health and lack of income, age and the thought of retirement, the extreme debt (upward of $200,000) of young graduates, the real possibility of further and prolonged economic recession, various family challenges requiring more financial resources, inability to determine the real increased revenue that the concept will build into practice, and the knowledge that the monthly payment continues in spite of the potential described problems. Potential solution: If fear is an impediment for you, might we suggest you meet with a user of in-office CAD/CAM to observe a clinical demonstration and a testimonial of how this concept is working in his or her practice? The Henry Schein or Patterson dealers will be pleased to provide names of users for you to contact and observe. When contacting these users ask in-depth questions to determine if the concept will fit into your practice environment. Distributors will often bring a system into your office for a demonstration to allow you to see how it works in your practice. In our observation, satisfaction with the concept ranges from extremely positive acceptance to dissatisfaction and selling the devices on the Internet. Only you can see if this concept meets your needs and desires for your specific practice. Challenge – Negative Comments from Some Peers The majority of in-office milling unit owners really like their devices and enjoy having them in their practices. But some disgruntled purchasers and non-users who are satisfied with their conventional methods loudly proclaim that the concept did not or will not fit their practice needs and that they will not use inoffice milling. These few negative practitioners often make potential owners wary and afraid to purchase the devices. Potential solution: Do you include all of the new technologies or materials into your practice, and do you like all of the concepts you have elected to put into your practice? Quite obviously, you do not do so. Similarly, not all purchasers of in-office CAD/CAM love their devices. Because they cost so much, their continued on page 70 68 May 2011 » dentaltown.com FREE FACTS, circle 35 on card cad/cam feature continued from page 68 resentment is voiced more actively. As already suggested, please connect with someone who had the concept fit well into their practice. Take the time to see how they made the transition from conventional dentistry to use of in-office design and milling systems. Identify whether you have similar characteristics present in your practice that ensure success with the concept, such as high restorative need, competent computer ability, etc. Challenge – The Relatively Small Number of Purchasers to Date Potential buyers become discouraged when looking at the number of devices sold to date compared to the general population of dentists... thinking that it would have sold better if it were any good. However, the market penetration is quite good when one considers that many practices with more than one dentist have only one device, that the concept is expensive and that it is relatively new technology. Potential solution: This challenge has no real solution other than to have all of the potential solutions stated in this article implemented by manufacturers, distributors and practitioners. The implementation of all of them would undoubtedly make the concept more desirable to practitioners and lead to more sales. It is well known that any new concept starts out as an unknown and grows into a commonly used object. Examples are automobiles, PCs, radios, TV, etc. The concepts must become faster, easier, better and less expensive to become commonly used. Additionally some dentists do not have interest in any dental laboratory work and reject the concept on that basis. CEREC MC XL milling unit. E4D Dentist milling unit. Challenge – The Necessity to Change Long-stable Practice Modes Challenge – The Size of the Image-capturing Device and the Milling Machine When a practice is organized, running smoothly and producing adequate revenue, there is a tendency among some dentists to reject anything that would decrease the stability of the practice routine. Change is difficult, but change can be stimulating and will bring a level of self-confidence and new enthusiasm for dentistry. Incorporating in-office milling into a practice usually involves educating dentists to delegate some of the procedure to qualified staff members. Potential solution: If this concept sounds interesting to you, and you have investigated it thoroughly, changing your practice routine will be exciting and refreshing to you. We have seen mature practitioners who were relatively “burned out” with practice become excited about dentistry again. Changing a practice routine is a formidable thought until you determine that you will “re-invent” yourself again. We do not mean to downplay the needed organization and thought that must go into this scheduling change. It will take some time to do so, but the result will be satisfying to you and your staff. As expressed to us from potential purchasers, there is some frustration that both companies have large-wheeled, cart-type devices that contain the necessary computer, the monitor, the imaging handpiece, as well as other necessary devices. Many offices, especially the older ones, do not have adequate space to house the wheeled carts without compromising their already crowded operatories. Additionally, significant space must be found to locate the milling device, which is also very large and heavy. Potential solution: Their size can certainly be disagreeable and obtrusive in small offices. There are too many large objects already in treatment rooms. We have talked with the representatives of the two companies about this challenge. In our opinion, the large size problem must be overcome to make the concept more acceptable to practitioners. Changing the cameras to smaller sizes, changing the “cart” concept to a simple laptop or other small package, and making the milling devices smaller and lighter weight would greatly facilitate their acceptance into typical 70 May 2011 » dentaltown.com feature cad/cam restorative/prosthodontic practices. However, the above suggestions pose significant technical and manufacturing challenges. Challenge – Lack of Desire to Delegate Clinical Procedures Some dentists do not delegate many clinical procedures. They do almost all of the clinical procedures themselves. Average practices have two assistants. One of the best ways to make the in-office milling concept financially acceptable is to delegate a significant portion of the procedure to other qualified staff persons. Such dentists must change their overall staff delegation policies to facilitate more staff delegation or they must raise their fees allowing them to spend a longer time making the restorations. A well-organized office in which staff delegation is accomplished can make the in-office milling concept very effective and efficient. A practitioner that rarely delegates must change his or her delegation of procedures for optimum efficiency and acceptable revenue production. Programs are available to train staff persons to use the systems and to gain proficiency. Potential solution: Do you delegate some or many clinical responsibilities to staff? If so, the incorporation of in-office milling will be a pleasure for you. If you do not delegate many clinical tasks to staff, you will find a significant change in your practice routine to have staff persons accomplish some of the inoffice digital impression procedures, design and milling. If you elect to do all of the imaging and milling yourself, the concept is not as financially acceptable as when you delegate much of the imaging and milling tasks to staff, while you concentrate primarily on tooth preparation and seating the restorations. Delegating to dental assistants, dental hygienists or other staff persons builds a sense of responsibility, self-esteem, trust and teamwork. When they take on these new responsibilities they appreciate your trust in them and they appreciate the opportunity to expand their value to the practice. Challenge – Relationship with Previous Dental Laboratories Some technicians and ceramists are concerned that the dentist’s total number of indirect restorations will no longer be coming to the laboratory. But when laboratory technicians and ceramists learn that only some of the indirect restorations will be milled using an in-office milling device, and that some of them might have data sent to the lab for milling, they are less frustrated. Potential solution: Most dentists using in-office milling make primarily posterior crowns and onlays. Some progress on to more complicated and less frequently needed restorations. Therefore, there is still need for laboratory technicians and this will always be so. Additionally, some practices actually grow the amount of both their conventional and CAD/CAM restorative dentistry when incorporating CAD/CAM. Frankly, as the concept continues to grow in popularity, the growth will be slow and steady, not fast, thereby allowing your technicians to accommodate the needed change. Many dentists become more interested in the laboratory concepts in dentistry as they use the devices. Challenge – Concern about Quality and Longevity of Restorations In the U.S., most patients want and/or demand tooth-colored restorations. Although many dentists favor metal restorations, because of their proven longevity, these are not done with the in-office milling devices currently in the U.S. Therefore, dentists going into CAD/CAM milling in their offices feel compelled to use tooth-colored ceramic or polymer restorations, the most popular of which are currently the ceramic IPS e.max CAD, lithium disilicate or VITA Mark II Blocs. This orientation is uncomfortable for some dentists. Many worry about the all-ceramic restorations produced by the in-office milling machines regarding their quality and the amount of time they will last. Potential solution: Clinicians Report (previously CRA) staff have been working with this concept for about 23 years. The ceramic and polymer restorations made with in-office milling have served in this time period as well as or better than laboratory restorations made with similar materials. However, it is well known and reported in the scientific literature that cast gold alloy restorations have the longest service potential of all restorations. You know well that very few patients want to display metal in their mouths in spite of the known greater longevity to be expected. In-office milled tooth-colored restorations placed properly are serving very well. Summary and Conclusions It has been proven that in-office milling systems for dental restorations are highly useful, functional and financially feasible for many practices. The restorations made with the CEREC and E4D devices are serving as well as or better than restorations made by conventional laboratory procedures. There are numerous reasons why these systems have not made more market penetration – which have been detailed and discussed above. It is our hope that manufacturers, distributors and practitioners will work together to find ways to further implement this technology into the mainstream of restorative practice. n References 1. Fasbinder DJ. Clinical performance of Chairside CAD/CAM restorations. J Am Dent Assoc 2006 Sep; 137 Suppl: 22S-31S. continued on page 72 dentaltown.com « May 2011 71 cad/cam feature continued from page 71 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Isenberg BP, Essig ME, Leinfelder KF. Three-year clinical evaluation of CAD/CAM restorations. J of Esth and Rest Dent 1992. 4 (5): 173-176. Reich S, Wichmann M, Nkenke E, Proeschel P. Clinical fit of all-ceramic three-unit fixed partial dentures, generated with three different CAD/CAM systems. Eur J Oral Sci. 2005 Apr; 113 (2): 174-9. Bindl A. Mormann WH. Marginal and internal fit of all-ceramic CAD/CAM crown-copings on chamfer preparations. J Oral Rehabil 2005 June; 32 (6): 441-7. Nakamura T, Tanaka H, Kinuta S, Akao T, Okamoto K, Wakabayashi K, Yatani H. In vitro study on marginal and internal fit of CAD/CAM all-ceramic crowns. Dent Mater J 2005 Sep: 24 (3): 456-9. Tsitrou EA, Northeast SE, van Noort R. Evaluation of the marginal fit of three margin designs of resin composite crowns using CAD/CAM. J Dent 2007 Jan; 35 (1): 68-73. Epub 2006 Jun 15. Christensen GJ. In-office CAD/CAM milling of restorations – the future? J Am Dent Assoc 2008; 139 (1): 83-5. Clinicians Report. Performance evaluation of chairside CAD/CAM milling units. Oct 2009. Clinicians Report. Making in-office CAD/CAM work for your practice. June 2009. Christensen GJ. Successful use of in-office CAD/CAM in a typical practice. J Am Dent Assoc. 2008 Sep; 139 (9) 1257-60. CHRISTENSEN GJ. Is now the time to purchase an in-office CAD/CAM device? J Am Dent Assoc 2006; 137: 235-8. CHRISTENSEN, G.J. The Future Significance of CAD/CAM for Dentistry. State of the Art of CAD/CAM Restorations – 20 Years of CEREC. Werner H. Mormann, Quintessenz pg 19-28. May 2006. Thompson VP, Rekow ED, Wolff M, Silva N RFA. CEREC vs E4D Mouth-motion Fatigue Evaluation. http://www.e4d.com/resources/pdf/NYUCADCAMFatiqueReport.pdf Thompson VP, Rekow ED, Wolff M, Silva N RFA. CEREC vs E4D Film Thickness Evaluation. http://www.e4d.com/resources/pdf/NYUCADCAMFilmThickness.pdf Rekow ED, Wolff MS. Report: In Vivo Operational Assessment of the D4D System. Bluestone Center for Clinical Research. http://www.e4d.com/resources/pdf/NYUClinical.pdf Author Bios Dr. Paul Child is the CEO of CR Foundation, a nonprofit educational and research institute (formerly CRA). He conducts extensive research in all areas of dentistry and directs the publication of the Gordon J. Christensen Clinicians Report, and their other publications. Dr. Child is a prosthodontist, a certified dental technician and maintains a private practice at the CR Dental Health Clinic in Provo, Utah. Dr. Child lectures nationally and co-presents the “Dentistry Update” course with Drs. Gordon and Rella Christensen. He lectures on all areas of dentistry, with an emphasis on new and emerging technologies. He maintains membership in many professional associations and academies. Further information is available at www.cliniciansreport.org. Dr. Gordon J. Christensen is founder and director of Practical Clinical Courses (PCC) in Utah. This group is an international continuing education organization providing courses and videos for all dental professionals. He is also co-founder of the nonprofit Gordon J. Christensen Clinicians Report (previously CRA), as well as an adjunct professor for Brigham Young University and University of Utah. He is a diplomate with the American Board of Prosthodontics. Dr. Christensen has presented more than 45,000 hours of continuing education throughout the world and has published many articles and books. Further information is available at www.pccdental.com. FREE FACTS, circle 27 on card 72 May 2011 » dentaltown.com Dentist Funded Dental Product Research esives • Anesthesia • CAD/CAM • Cements • Ceramics • Esthetics • Handpieces • Implants • Impressions • Intraoral Cameras • Lasers • Office Management Tips • Periodonti ventive Dentistry • Prosthodontics: Fixed and Removable • Radiology • Resin Curing Lights • Restoratives • Surgery • Adhesives • Anesthesia • CAD/CAM • Cements • Cerami etics • Handpieces • Implants • Impressions • Intraoral Cameras • Lasers • Office Management Tips • Periodontics • Preventive Dentistry • Prosthodontics: Fixed and Remova adiology • Resin Curing Lights • Restoratives • Surgery • Adhesives • Anesthesia • CAD/CAM • Cements • Ceramics • Esthetics • Handpieces • Implants • Impressions • Intra meras • Lasers • Office Management Tips • Periodontics • Preventive Dentistry • Prosthodontics: Fixed and Removable • Radiology • Resin Curing Lights • Restoratives • Surg dhesives • Anesthesia • CAD/CAM • Cements • Ceramics • Esthetics • Handpieces • Implants • Impressions • Intraoral Cameras • Lasers • Office Management Tips • Periodon eventive Dentistry • Prosthodontics: Fixed and Removable • Radiology • Resin Curing Lights • Restoratives • Surgery • Adhesives • Anesthesia • CAD/CAM • Cements • Ceram thetics • Handpieces • Implants • Impressions • Intraoral Cameras • Lasers • Office Management Tips • Periodontics • Preventive Dentistry • Prosthodontics: Fixed and Remova adiology • Resin Curing Lights • Restoratives • Surgery • Adhesives • Anesthesia • CAD/CAM • Cements • Ceramics • Esthetics • Handpieces • Implants • Impressions • Intra Independent Unbiased No Ads No Hidden The Bottom Line Agenda meras • Lasers • Office Management Tips • Periodontics • Preventive Dentistry • Prosthodontics: Fixed and Removable • Radiology • Resin Curing Lights • Restoratives • Surg dhesives • Anesthesia • CAD/CAM • Cements • Ceramics • Esthetics • Handpieces • Implants • Impressions • Intraoral Cameras • Lasers • Office Management Tips • Periodon eventive Dentistry • Prosthodontics: Fixed and Removable • Radiology • Resin Curing Lights • Restoratives • Surgery • Adhesives • Anesthesia • CAD/CAM • Cements • Ceram No Hype thetics • Handpieces • Implants • Impressions • Intraoral Cameras • Lasers • Office Management Tips • Periodontics • Preventive Dentistry • Prosthodontics: Fixed and Remova adiology • Resin Curing Lights • Restoratives • Surgery • Anesthesia • CAD/CAM • Cements • Ceramics • Esthetics • Handpieces • Implants • Impressions • Intraoral Camer ers • Office Management Tips • Periodontics • Preventive Dentistry • Prosthodontics: Fixed and Removable • Radiology • Resin Curing Lights • Restoratives • Surgery • Anesthe AD/CAM • Cements • Ceramics • Esthetics • Handpieces • Implants • Impressions • Intraoral Cameras • Lasers • Office Management Tips • Periodontics • Preventive Dentist Thank you to all you TOWNIES who support CR in our non-profit mission to identify outstanding products and techniques to make dentistry the best for the patients we serve! • 35 Years: The original and only non-profit, independent review of dental product, technologies, concepts, and techniques • Concise, quick, bottom-line reviews each month that you can implement immediately • Real-world testing by real-world dentists • Funded by dentists, written by dentists—all for dentists to best serve their patients 801-226-2121 www.cliniciansreport.org Gordon J. Christensen DDS, MSD, PhD Paul L. Child Jr. DMD, CDT, CEO Clinical Success is the Final Test • Serving Dentistry since 1976 FREE FACTS, circle 15 on card cosmetic dentistry feature by Rod Kurthy, DMD W hitening is a very misunderstood concept among dentists. First, the low cost or free offer of whitening to attract new patients is often gone about in the wrong way, and second, the promise of whitening as a gateway to more cosmetic treatment is often falsely assumed. Whitening to Attract New Patients You spend a lot of money for each patient you get into your practice. These new patients are of no benefit if they never return and pay for necessary or optional treatment. So why is it that so many dentists virtually push these new patients out of their offices after working so hard and spending so much to get them in the first place? Let’s say you offer free whitening to attract new patients. You look for the fastest, least expensive method of whitening to offer – because of course, since you’re giving it away for free, you can’t afford to spend much time or money on the whitening. continued on page 76 74 May 2011 » dentaltown.com From Portland, Maine to Portland, Oregon We list what you need Harness the power of ADS through the Classified Ads on Dentaltown.com. Click on the Classified Ads section and search for Dental Practice for Sale. And don’t worry, all of the other classified ad categories you currently use are still there for your convenience. www.dentaltown.com/classifieds cosmetic dentistry feature continued from page 74 You spent all this money to market to hundreds, if not thousands of potential patients, but just a tiny percentage of them respond to your marketing. That makes each one of these patients very, very valuable. So why are you buying the cheap stuff? These are the very few who said, “OK, I’ll give you a chance. Show me what you can do!” Better not drop the ball, or they’ll drop you. If the patient does not follow your recommendations, book treatment, pay for treatment and refer others, then your marketing money is a total waste. When that new patient walks in your door, they have not committed to be your patient. They’re simply giving you a try. You still have to instill confidence in them or they’re gone. You’ve spent a ton of money to get that patient there, but then you’re afraid to spend a little more money and time to keep them? What’s wrong with this picture? The patient comes to you because of an offer of free whitening. Even though you give it away at a low cost or for free, they still expect it to work. When you use a quickie protocol and the cheapest products you can find, your results probably aren’t very impressive. That means you’ve just disappointed this new patient you’ve worked so hard and paid so much money to get into your practice; you’ve proven to them that you don’t deserve their confidence. Do you really think they’ll have you do their veneers if you can’t even get their teeth white? Do you think they’ll trust you to do any treatment on them or their families? They might not say a word, but they just never come back, You’ve spent a ton and you scratch your head wondering why these patients never follow through. It must be because paid advertising doesn’t of money to get that patient bring in “referral quality patients,” right? Wrong! If you’re offering inexpensive or free whitening, get them there, but then you’re afraid to white. Impress them! It will pay off in spades. Once you spend a little more money and impress them, they’re much more inclined to follow your time to keep them? What’s treatment recommendations and certainly more inclined to refer others to you. wrong with this picture? Whitening gels are unstable chemicals. That is precisely why they can break down quickly when placed in the mouth. The downside is that because of this instability, they start breaking down immediately upon manufacture unless stabilizers are used in the formula or continuous refrigeration is provided. Stabilizers – like anhydrous base and acidifiers – add stability to whitening gels. But when you want them to break down in the mouth, they’re not going to break down as well and will be less effective. Also these stabilizers result in a much higher osmolarity and often acidic pH, both of which cause more whitening sensitivity. Even when these stabilizers are used, the gels still break down at room temperature and especially during storage in hot warehouses and in freight trucks that average 125-165 degrees Fahrenheit. The cheaper the whitening gel, the less that whitening company can spend on their overhead, and the larger their batches are when they manufacture. By the time you receive them, they have often been unrefrigerated and overheated for significant periods of time. Combine that with the stabilizers, and you have a much less effective whitening gel. What if you take a bit more time and spend just a few more dollars to provide the most effective whitening system available? If you did it for cheap or even free, you’re a hero; the “best dentist I’ve ever gone to.” They take your recommendations continued on page 78 76 May 2011 » dentaltown.com Powerful prescriptions for snoring and sleep apnea Silent Nite® SL $99* t Our No. 1 prescribed snoring appliance is also indicated for sleep apnea t Interchangeable connectors by the patient aveoTSD® $139 ‡ t A brilliantly simple treatment for snoring t Suctions gently on tongue to keep airway open t Requires no impressions or adjustments t Free six-month replacement warranty $189* EMA® TAP ® 3 TL $340* t Appliance for snoring or sleep apnea t Appliance for snoring and sleep apnea t Interchangeable elastic straps by the patient t Patient-adjustable protrusive gauge t Elastic strap strength matched to the musculature of the patient t Smaller hardware compared to original TAP, which provides more tongue space ‡ Price does not include shipping. aveoTSD volume pricing/ unit: (1– 4) $139; (5 – 9) $129; (10 –19) $119; (20+) $115. *Price does not include $14 round-trip overnight shipping. tt www.glidewelldental.com FREE FACTS, circle 38 on card aveoTSD is a registered trademark of Innovative Health Technologies (NZ) Limited. EMA is a registered trademark of Frantz Design Inc. TAP is a registered trademark of Airway Management Inc. GLIDEWELL LABORATORIES Premium Products - Outstanding Value cosmetic dentistry feature continued from page 76 for other cosmetic or restorative dentistry. They tell their friends that you gave them this great white smile and it didn’t even cost much or was free. Think those friends will be asking for your name? Of course they will. This is the big payoff. Don’t step over the dollars to pick up the pennies. Impress those new patients and make them yours! Fig. 1a Fig. 1b Fig. 2a Fig. 2b Figs. 1 & 2: Effective KöR Whitening results. The False Promise You’ve heard it all before, “Buy our whitening products and whiten your patients’ teeth. Once their teeth are white, they’ll be asking you for more cosmetic treatment.” Most dentists have not found this to be true. It is a false promise that whitening is a gateway to more cosmetic treatment. The bottom line is that most whitening results are not that spectacular. Maybe your patient is happy her teeth are a little whiter, but others don’t even notice, and Fig. 3a Fig. 3b Fig. 4a Fig. 4b Figs. 3 & 4: Effective KöR Whitening results. continued on page 80 78 May 2011 » dentaltown.com Be Deep Be Level Be Adaptable Be Sure Only SureFil® SDR® flow bulk fills to 4mm, self-levels and adapts completely. SureFil® SDR® flow bulk fills up to 4mm, thanks to our revolutionary SDR™ Technology, which reduces polymerization stress up to 60 percent. But to be really Sure, we added self-leveling handling and excellent cavity adaptation. And now, a two-year clinical study has proven it: we earned our name. SureFil® SDR® flow . Now you can be Sure, too. Sample the most successful bulk fill flowable1 at www.surefilsdrflow.com FREE FACTS, circle 40 on card cosmetic dentistry feature continued from page 78 Fig. 5a Fig. 5b Fig. 5c Figs. 5: 78-year-old patient with 19 shade improvement (from C4 to bleaching shade 020) with KöR Whitening. Patient had crowns 3, 4, 6, 12, 13, 14, 19 and bridge 28x30 replaced to match color. they’re not white enough for her to obsess over, so she really doesn’t give it much thought. End of story. What if you could actually give your patient a whitening result that knocks her socks off (Figs. 3 & 4)? Every time she sees herself in the mirror she’ll be shocked. She’ll spend time studying her smile. Her new white smile looks great… until she sees that darker PFM crown on a lower left bicuspid or molar. “I’m going to ask Dr. Johnson if we can replace those crowns with whiter ones” or, “Wow, my teeth look great, but I never realized how crooked and chipped my teeth are, or how ugly the gaps between my teeth are. Maybe Dr. Johnson can fix that for me” [with veneers]. This happens all the time, but only when the patient is truly impressed by the whiteness, amazed by all the comments from friends and spends time looking at her smile. Then she’ll see all those imperfections and obsess over them until you fix them. Here’s an amazing example: This patient was 78 years old (Fig. 5). She started out with a solid C4 color. After whitening, her teeth were 19 shades lighter – a bleaching shade 020 (three shades lighter than a B1). At a family reunion her family went wild. Three relatives drove more than an hour and a half to have their teeth whitened. And over the following nine months this patient paid to have me replace crowns 3, 4, 6, 12, 13, 14, 19 and bridge 28X30 because she wanted to match the rest of her teeth. Many 78-year-olds wouldn’t replace them even if they had recurrent caries – they’d simply say, “I’m old. Just leave them alone.” So if true whitening can get a 78-year-old to react this way, just imagine how your middle-age and younger patients will react. But what if all this costs too much? Make sure you offer your patients a great financing option. I’ve used CareCredit successfully in my practice for about 25 years (even before they were called CareCredit). All this treatment is high profit, so you can easily pay just a little of that to CareCredit or another financing company for extended payments at no interest and still make a great profit. Remember, it’s not what it costs, but how affordable you make it for patients (easy monthly payments with no-interest financing). What about referrals? If you used a super-effective whitening system, her friends will notice her beautiful white teeth immediately and then they’ll ask about you. However, this referral system only works if you were able to get that patient’s teeth truly white. Effective whitening can be a tremendous boost to your practice – or done poorly, it can actually help sink your ship. ■ Author’s Bio Dr. Rod Kurthy practices in Mission Viejo, California. He graduated with highest honors from Fairleigh Dickinson University School of Dentistry in 1978, and completed a GP residency at Newark Beth Israel Medical Center. Kurthy’s 35 years of research and development includes laser and surgical periodontal bone regeneration; endodontic surgery, including bone regeneration and repair of resorptive lesions; teeth whitening; teeth sensitivity; and development of several cosmetic techniques and impression techniques. His first participation in periodontal research was in 1976, and teeth whitening in 1977. Kurthy is an international lecturer and author of five popular clinical and dental marketing books. Most recently Kurthy is widely known for his KöR Whitening Deep Bleaching System. You may contact Dr. Kurthy at [email protected] or by calling 866-763-7753. 80 May 2011 » dentaltown.com KNOWLEDGE | EDUCATION | RESEARCH | NETWORKING | IMPACT EVER CONSIDERED A KNOWLEDGE The ITI operates on the basis of sound scientific knowledge. Become a member of the leading professional network for implant dentistry. ITI Members receive free publications, access to ITI Study Clubs and benefit from reduced entry fees to ITI events and courses. Meet the experts. Share knowledge with colleagues from all over the world. Welcome to the team: www.iti.org practice management feature You just finished your polished presentation to your patient. You had all of the records – the groomed study casts, the digital photos, the radiographs, cone beam images and diagnostic mock-ups. The treatment plan was crisply printed on your letterhead and neatly packaged in the monogrammed folder with your business card and financial options. Everything was there. All of your verbal skills honed over the years intertwined with your commitment to technical excellence in treatment planning. You finished your case “performance” for the patient and sat back waiting for the patient’s favorable reaction and commitment to treatment. And you waited... and the patient looked over the materials... and you waited... while the patient glanced around at the desk... and the walls and the floor. And you waited... Then, the patient thoughtfully replied, “Doc, I am going to need to think about it.” Nine simple words that are uttered in every language, in every country, in every dental practice around the world. Nine simple words that crush us, frustrate us and in the end lead to the patient never scheduling treatment. We wonder what they “need to think about.” Did we not give them enough information? Perhaps we should have included more pamphlets on periodontal disease and comprehensive care, or the tooth drawing with the nerve and dentin drawn out in red and blue pencil. What was it that we were missing? What a waste of time. continued on page 84 82 May 2011 » dentaltown.com Townie T ownie Special Off Offer: fe er : Free Diagnostic Wa Wax a Ups in Month of May M All Diagnostic Waax Up prrescriptions sent s in the month of Maay that iincludes a note “I’m a Townie” will reeceive a crredit for o the diagnostic dia wax up when the restorative case is received. (kits are not included - expires with wax up Rx’s received by 5.31.11 and restorative cases received by 12.31.11) You entrust your dental laboratory to manifest your vision and make it a reality. It requires confidence in the fabrication process, and an understanding about what is important to you and most importantly the talent to deliver. Every case you seat is a reflection of your personal integrity and skills. At Gold Dust, we get it. Which is why our commitment is to delivering uncommon predictability in fit, occlusion, aesthetics, and function for every patient. When your patient is happy, we know you are too. For more incredibly happy patients, Call 800.513.6131 today or visit us online www.golddustdental.com FREE FACTS, circle 47 on card practice management feature continued from page 82 The patient walks out of our office, overwhelmed and frustrated. “What was that doctor thinking? Didn’t he know what I came to see him for? What was all of that garbage that he wanted me to do? What a waste of time.” As doctors, we want to help our patients. In some way, shape or form it is why we chose the profession that we did. First, Hippocrates implored us to first do no harm. Following that, it was the natural progression that we committed ourselves to our patients’ well-being. Patients seek us out to help them achieve their health goals. They seek, we provide. It seems like the perfect arrangement, yet we still encounter the “Nos,” “maybes” and the “I will think about its.” Where and how does this disconnect occur? When we consider the opening scenario between the patient and the doctor, there is a tangible frustration that stems from unmet expectations. The doctor expected for the patient to understand, appreciate and accept the treatment recommendations. The patient had an expectation that the doctor would provide treatment options to choose from that would address his concerns and goals. Each had invested time, money and effort into the process, yet no one was happy with the end result. Expectations can be better understood and achieved by breaking down the process of offering dental care options. We as practitioners must seek to understand the patients’ level of awareness regarding their dental health conditions. Awareness The first step in meeting expectations is awareness. We as practitioners must seek to understand the patients’ level of awareness regarding their dental health conditions. Assumptions of their level of awareness can lead to offering “solutions” that have little or no level of value or relevance for a patient. Steven Covey wrote, “First seek to understand, then seek to be understood.” This commitment is a foundation for meeting expectations but also for a successful and continued patient-doctor relationship. Once we have put forth that effort, we can share our additional observations and do our best to raise patients’ level of awareness. Awareness should also be considered when it comes to patient goals. Without awareness of their conditions, they might not have the same goals that we do. Considering their level of awareness, are we ready to present appropriate treatment options? Mind you, awareness of conditions does not mean that the patient has any desire or urgency to address the condition. Consequence Consequence is the “information” that might or might not motivate a patient to treatment. Once we have established a co-awareness of the conditions between the patient and the doctor, we can begin the educational process of discussing benefits of treatment as well as the consequences of inaction or delayed treatment. If the benefit or consequence is great enough for the patient, and appropriate as a motivator, he or she will seek treatment. However, if the benefit is not of interest or the consequence is not a concern, then he or she might just “think about it.” As a simple example, we all frequently see cracked yet intact and asymptomatic premolars or molars. The patient likely might have been unaware of the condition until we pointed it out. Even then, they might seem completely unmotivated to do any treatment. Why should they? There is no consequence. By referring to a third party – like your other patient who had his tooth crack and it was too late to salvage – you might be able to get the message across. In the absence of our own awareness of the patient’s concerns, we were able to communicate through third-person analogy, the classic consequences of inaction to the patient. These consequences are common motivators that inspire patients to seek and accept treatment recommendations. continued on page 86 84 May 2011 » dentaltown.com .-,+*)(+* * * '&% **$(#)+"#"!** (-+"!+ 9 )+*'&% )+*'&% ++*'&% ++*'&% -,1,11$751'713-4+41$71*4+1$7+4 1 1 1 1 1 1 1 1 '-7214$15+7$721,*1*/1/# 1 1 1 1 1 4177122,+,4*51!"1.-,+7*,*)1'71357716,,+1#,(-+"!+ 1 1 1 1 1 1 1 1 * * * * * 710/18$#1,'+4$1 1 1 1 1 $2,'1,++57+4*1 1 1 * * * * * 5 1/4 1 551$7'7,6711'435,7*+$/177+-1.-,+7*,*)1(, 1 1 1 1 1 1 5+4$1$4)$1 1 1 ,+-1/4 1 $14$27$#1 7*+,4*1$441427181-7*1/4 1 1 1 1 1 1 1 1'55# 1 -7177+-1.-,+7*,*)1(, 1 1 1 5+4$1$4)$157+1/4 1 1 1 11*21/4 1 $13+,7*+1771 1 1 1 -41,*)1+-7,$1+77+-1,5515441,+-1!"1$7 1 1 1 1 1 1 1 1 5+# * * * * * * * 1 1 1 1 1 1 1 * * * * *"+-,*!--")++ "+-,*!--")++ * * * * !"1.-,+7*,*)18773157'-,*) 1 1 1 11)7+1+77+-1+-7,$1045 1 1 1 +71-,+7+1767$/1+,7 1 1 1 ) $*+772#1+1541+-71/+71/4 1 1 1 1 1 671-7$2104 1 1 +1+-+1,)*,'*+5/1-,+7*1551 1 1 1 1 1 +77+-1*41++7$1-+1-271+-7/1$71+4107),*1,+-1*21*41++7$1-+1' 1 1 1 1 1 1 1 1 1 1 1 1 1 1 721+-7 1 2,'454$+,4*1)714,*)14421*210767$)71+,*1767*1+7+$'/'5,*71+,*# 1 1 1 1 1 1 1 1 1 !"12471,+1551*21,+1247141,+-11-,)-5/177'+,671*+,7*,+,6,+/133$4'-1*21 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 4$ 5+,4*#1-7107+1/1+41075,7671,+1,1+41+$/1,+#1$27$11+$+7$1,+1+42/#14 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 *21/4 1 $13+,7*+,551071+-$,55721,+-1+-71$7 1 1 1 1 1 1 5+###11 $+*!--")++*#) * * * * * * * * * * * * * * *+*#"-)#"*-"*)*+* * * * * * * ** ,#+"+ FREE FACTS, circle 33 on card practice management feature continued from page 84 Pain Some patients come to us in pain, looking for relief. Others might come to us hoping to avoid the onset of pain. Patients might even decline treatment due to the perceived pain involved with the procedure. They might balance tolerating their existing pain to avoid what they feel will be a greater pain. Money Like pain, money can be a motivator or barrier. Patients can be inspired to seek treatment before treatment fees escalate. They can also feel a financial barrier to treatment if payment options or phasing is not available. Money can be a barrier to patients when they consider prognosis, longevity and re-treatment costs. I recall a patient reacting quite strongly to the financial aspect of root canal therapy, but following up by asking for an extraction and implant restoration. Her concern, while financial, was not with spending the money. Her concern was with the longevity of initial treatment, future treatments and ending up with an implant restoration anyway. The better we understand patients’ financial concerns, the better we are equipped to discuss them. Aesthetics and Social Embarrassment As I imagine we have all experienced how aesthetics can be the chief motivator for some. Trying to communicate the benefits of treatment from an aesthetic standpoint to a patient who doesn’t have concerns about aesthetics is not only ineffective but could also be perceived as insulting. If a patient seeks a beautiful new smile but is only focused on her two front teeth, she might need to be counseled on how her desired treatment might not actually help her achieve her goals. In fact, we could communicate how limited treatment could have the consequence of making her smile worse. Function What do the patients want from treatment? Do they want their dentures to stay in their mouth while they eat? Or is their goal to be able to eat corn on the cob and steak when they are 70? Are the patients’ treatment decisions consistent with their goals? Do we communicate the consequences associated with their choices? Once we are able to better understand a patient’s awareness of his or her conditions, we can better communicate the consequences of denying treatment and offering appropriate and affordable treatment options. All of our technical know-how and continuing education is of little value to us or our patients if we are unable to apply it and step beyond Hippocrates’ charge. When we can look the patient in the eye at the treatment consultation appointment or at the exam and say with confidence “Based on your goals, as I understand them, what I would recommend is...” we can feel that we have taken that step. It is then that we can move beyond diagnosing conditions and toward diagnosing “yes” and treatment success. ■ Author’s Bio Dr. Michael Melkers maintains a private practice with his wife, Dr. Jeanine McDonald, in Spokane, Washington. Their practice focuses on comprehensive and restorative care. Dr. Melkers is the founder and author of the Nuts & Bolts Occlusion programs & DVD series and visiting faculty at The Spear Institute. He can be contacted at [email protected]. 86 May 2011 » dentaltown.com DENTAL TOWNIES SAVE $400 USE PROMO CODE: DENTALTOWN2011 Scan this code with your smartphone to hear Dr. Grantham’s full story, and hear other PDA client success stories. 800.757.6077 “Like” PDA on Facebook www.ProductiveDentist.com H I G H E R S TA N D A R D S . H I G H E R L I V I N G . FREE FACTS, circle 49 on card endodontics feature by Drs. Kenneth Koch and Dennis Brave Cases You Might Refer Anatomy Related • Calcified or ledged canals • Severe curvatures • Retreatment cases Not Specific to Tooth Anatomy • Elderly or medically compromised patients • Difficult patients • Phobic patients • Difficult to diagnose cases We have had the privilege over the past 10 years to write more than 100 articles on different aspects of endodontics. Topics have ranged from the latest techniques and technology, to debunking some of the myths surrounding endodontics. However, we have never specifically written about the special relationship that exists between the general dentist and the endodontic specialist. Consequently, we believe the time has come to evaluate this relationship and we would like to discuss it from a few different perspectives. The first perspective, and perhaps the most significant one, is the need for the general dentist to work within a comfort zone. This is a zone that obviously varies from one clinician to another. However, it makes little sense to attempt a root canal in cases that are beyond your skill and experience level. Don’t try to be a hero. These cases will ramp up your anxiety level, generally require extended time and energy and often prove to be non-profitable. In the long run the majority of these difficult cases wind up being referred anyway, so be honest with yourself and do what is in the patient’s best interest from the outset. Previously, we have recommended the AAE Case Difficulty Assessment Form (www.aae.org) and it is a good place to start. The Assessment Form ranks the various cases in terms of difficulty and will give you a heads-up for specific cases. Some of the warning signs noted are calcified and ledged canals, severe curvatures and retreatment cases. These are all good cases to refer but there are additional cases (not addressed in the form) that might be troublesome and, in fact, are not related to the specific anatomy of a tooth. The first of these are elderly patients (or medically compromised individuals) who cannot sit in one position for any significant period of time. These cases require speed in addition to skill, and we believe they are best served through the referral process. Another group that frequently merits referral is difficult patients. The old bromide that says, “bad things happen to bad patients” is too often true. As endodontists, we frequently see floor perforations that have occurred as the result of a dentist trying to get into the pulp chamber (of an endodontic tooth) on a difficult patient. Furthermore, difficult patients are many times best treated in one appointment, which helps to minimize the experience for both the patient and the doctor. Another patient group that warrants consideration for referral is anxious or phobic patients, where one can appreciate that the treatment itself might very well be comprised because of the level of anxiety of the patient. Root canal treatment continued on page 90 88 May 2011 » dentaltown.com .EW0ATIENTS!RE9OUR&UTURE FREE FACTS, circle 45 on card endodontics feature continued from page 88 There is a wonderful old axiom in endodontics that states, ‘When you are lost, stop and take an X-ray.’ This can be extrapolated to a new axiom that states, ‘If you cannot reproduce the chief complaint, stop and refer it to a specialist.’ can be difficult under the best of circumstances, so to compound the technical challenges with emotional ones makes no sense. Identifying your own comfort zone is equally important in making the decision to refer. The best time to refer a difficult case is before you start it. This is why it is so important to get an angled X-ray (or image) of the tooth before you begin the case. Take your cone head and move it about 15 degrees to the mesial. Moving the cone head in such a manner will allow you to separate the roots of the tooth in question. Additionally, a good angled X-ray will help identify the periodontal ligaments that surround the multiple roots. It will also help identify bifurcations and apical delta formations. In particular, this is a great way to identify deep furcations in mandibular premolars. A deeply bifurcated premolar is perhaps the most difficult endodontic case and it is one usually best referred to a specialist. Another example where a referral to a specialist is indicated but might not be so obvious is the difficult diagnosis case. The most difficult part of endodontics is not a curved canal. It is diagnosis. Furthermore, it is not the typical run-of-the-mill cases. When a patient presents in pain and the diagnosis is not apparent, rather than have the patient return to your office multiple times, refer them to your endodontist. It is very important that you have a working relationship with your specialist that includes his or her willingness to see your emergencies immediately. This does not mean the next day or the next week. We have no tolerance for endodontists who will not see emergencies in a timely manner… and nor should you. There is a wonderful old axiom in endodontics that states, “When you are lost, stop and take an X-ray.” This can be extrapolated to a new axiom that states, “If you cannot reproduce the chief complaint, stop and refer it to a specialist.” This will make your life a whole lot easier and your patient will appreciate it. Another aspect of the general dentist-endodontist relationship and one that receives little attention is the ability to perform appropriate emergency treatment. Once you have proper anesthesia, you can handle emergencies. Seeing emergency patients and treating them in the proper manner can be a huge help in establishing your practice and enhancing your relationship with your specialist. The key is to deliver the appropriate treatment for vital and non-vital teeth. Consequently, the first thing you need to determine with your patient is whether you are dealing with a vital or non-vital tooth. As a general rule, vital teeth can be handled with a pulpotomy while non-vital teeth require a pulpectomy. Let’s take a closer look. Vital teeth: In these cases a pulpotomy will work, although in molars we also recommend removing the inflamed tissue from the largest canal (such as the palatal or distal) in conjunction with the pulpotomy. Do not put files down into each of the canals, unless you plan on removing all the tissue. If you put a file into an inflamed canal you have just committed yourself to a pulpectomy. Non-vital teeth: If the tooth is necrotic, you really need to do a pulpectomy. A great benefit of rotary instrumentation is that a pulpectomy can be accomplished quickly and efficiently. You need to remove as much of this necrotic material as possible at this initial visit. However, even a partial pulpectomy accomplished with one or two rotary instruments will often suffice. Following the pulpectomy, we recommend filling the canal with calcium hydroxide, a cotton pellet and an appropriate temporary dressing. Also, do not forget to adjust the tooth. The final perspective is communication with your endodontist. This is important for both parties. The specialty of endodontics is referral-based and the endodontist should be willing to reach out to his or her referring doctors. The doctor should be approachable and willing to share his or her experience. Your continued on page 92 90 May 2011 » dentaltown.com FREE FACTS, circle 7 on card endodontics feature continued from page 90 endodontic specialist should be an education resource to you, his or her referring doctor. While it might seem obvious, the lack of communication between general For the general dentist and specialist can often have unforeseen consequences. For the general practitioner, part of creating a good relationship with the spepractitioner, part of cialist is not to just send them cases when something goes wrong, such as perforacreating a good tions or broken instruments. It really does help to refer these difficult cases before relationship with the you start definitive treatment. It is also wise to be honest. As we like to say, “Don’t deceive your attorney and don’t try to deceive your specialist.” If you break an specialist is not to just instrument or think you might have ledged a canal, inform them in advance. It send them cases when makes it easier for endodontists if they know what’s going on when they initiate treatment and they are going to discover the truth during the course of treatment something goes wrong. anyway. Being up front and honest accomplishes a better relationship between both parties based on trust. The establishment of trust is the foundation on which all referrals are based. The relationship between the general practitioner and the endodontist is indeed special and to summarize this, we asked Dr. Jerry Cymerman, an endodontist with more than 25 years of experience, to comment: The general practitioner and the endodontist must realize that they are on the same team. The endodontist really must be seen as an educational resource, not just as a clinician, and it can be very constructive if the specialist can help the general dentist do the straight-forward cases in the best manner possible. I also believe that the endodontist needs to be on the same frequency as his referring doctor, when it comes to restorative needs. In fact, I have a referring doctor who wants me to do all the necessary things required, so that when the case is returned to him, it is (in his words) ‘ready to go.’ I cannot recommend strongly enough that Author Bios the general dentist needs to communicate their restorative needs to the specialist, before the root canal is initiated. Dr. Dennis Brave is a diplomate of the American Board of As has been previously stated, endodontic diagnosis can Endodontics, and a member of the College of Diplomates. Dr. be a real challenge for even the most experienced dentists. Brave received his DDS degree from the Baltimore College of I also recommend the AAE Case Difficulty Assessment Dental Surgery, University of Maryland and his certificate in endodontics from the University of Pennsylvania. He is an Form as a guide in case selection for the general dentist. Omicron Kappa Upsilon Scholastic Award Winner and a Gorgas This form, as well as other information on endodontics, is Odontologic Honor Society Member. In endodontic practice for more than 25 available on the American Association of Endodontists years, he has lectured extensively throughout the world and holds multiple Web site (www.aae.org). When the case is beyond the scope patents, including the VisiFrame. Formerly an associate clinical professor at the of general practitioners, the endodontist has the experience University of Pennsylvania, Dr. Brave currently holds a staff position at The and technology to provide exceptional treatment. We use Johns Hopkins Hospital. Along with having authored numerous articles on cone beam computer tomography in our office to aid in endodontics, Dr. Brave is a co-founder of Real World Endo. diagnosis and treatment. This technology is extremely useDr. Kenneth Koch received both his DMD and certificate in endodontics from ful in the diagnosis of lesions not apparent on two-dimenthe University of Pennsylvania School of Dental Medicine. He is the founder and sional radiographs, in evaluating traumatic injuries, root past director of the new program in postdoctoral endodontics at the Harvard resorption, root fractures, previously treated cases and School of Dental Medicine. Prior to his endodontic career, Dr. Koch spent 10 patients scheduled for periapical surgery. Our goal is to years in the Air Force and held, among various positions, that of Chief of preserve the natural dentition and to assist the general denProsthodontics at Osan AFB and Chief of Prosthodontics at McGuire AFB. In tist in treatment planning. addition to having maintained a private practice, limited to endodontics, Dr. Koch has lectured extensively in both the United States and abroad. He is also The general dentist-endodontist relationship is a the author of numerous articles on endodontics. Dr. Koch is a co-founder of Real relationship based completely on trust and the knowlWorld Endo. edge that the ultimate goal is the same for each party – superb treatment of the patient. n 92 May 2011 » dentaltown.com Beautify Easily, Quickly E xc l u s ive ly D i s t ri b u t e d by FREE FACTS, circle 22 on card restorative feature by Robert A. Draughn, DSc and Karl F. Leinfelder, DDS, MS Since composite resin restorative materials were first introduced, many improvements have been made in filler technology and handling properties. Still, today the typical composite restorative material has a stiff viscosity1 which, while desirable when molding and sculpting, makes it difficult to fully contact all of the cavity walls in cases where there is an acute line angle. This has been addressed to some degree by the creation of flowable composites, which exhibit excellent flow and wetting properties, but at a sacrifice of some of the performance characteristics of traditional filled resins. In addition to flow/cavity adaptation challenges, all modern composite resins exhibit some degree of stickiness,2 resulting in a frustrating phenomenon commonly referred to as “pull-back.” In an attempt to overcome this, many practitioners utilize instruments designed to be “non-sticky” or, to the potential detriment of the restoration, dip their composite instrument in unfilled resin in order to make it “slippery.” Over the years, several vibrational devices have been tried in an effort to increase the flow of composite material3-7 and to reduce stickiness/pull-back, all with little to no success. An oscillation device (ET 3000, Brasseler USA, patent pending) has recently been developed and has been found to significantly increase the flow of composite materials while eliminating composite stickiness/pull-back. The development of the device is based on laboratory research aimed at quantification of the effects of oscillation on the properties of composites before and after polymerization. The success of the oscillating composite placement device is due to the basic difference between vibration and oscillation. Vibration is a trembling, shaking or quivering motion which is usually uncontrolled and might be in several directions. Oscillation is a steady or regular back-and-forth movement in a predictable and regular pattern. Our research has found that the most desirable limit for the back-and-forth action (amplitude) is in the general vicinity of 1.5mm with a speed (frequency) of 65Hz. It is this high-speed, definite back-and-forth action to the composite material that immediately reduces its viscosity, allowing it to flow much more freely. Also, because the oscillating placement blade strikes the material and withdraws so quickly, the material does not have time to adhere to the placement blade and therefore does not stick – thus pull-back is eliminated. In these experiments, we used a model oscillating instrument with amplitude of 1.5mm and a frequency of 65Hz. A schematic of an instrument is shown in figure 1. Attached to the oscillation instrument was a “beaver tail” placement tip. The same tip was used with a non-oscillating manual procedure. Several widely used composite materials were tested. After oscillation, polymerized specimens of the composites were compared to the polymerized specimens of the non-oscillated (traditionally placed) composites. The results of the measurements are: • Flow Properties: Among the oscillated composites, there was an increase in the amount of flow up to 30 percent more than the non-oscillated composites. • Microhardness: Oscillating force caused no difference in the hardness. • Tensile Strength: The strengths of the composite materials were not affected by oscillation. continued on page 96 94 May 2011 » dentaltown.com Financing as advanced as the care you provide. “There were no surprises, so I can keep on smiling.” Your patients won’t be left guessing with clear and simple monthly payment plans from ChaseHealthAdvance. Patients choose a monthly plan and their payments remain the same from the first payment to the last. No surprises. ǦȜȝƽȜȣȝȟ Ǧ ǦȖȠƽțțț Ǧʬ ȓȝȝȢ ǀ Give your patients a trusted payment option to start their care: ǀǠ ȜǂȣȣȣǂȞȣȣǂȢȡȞȞ FREE FACTS, circle 1 on card Information above is for providers and not for patient distribution. ©2011 JPMorgan Chase & Co. All rights reserved. DN0511 restorative feature continued from page 94 • Density: No difference in density was detected between oscillated and non-oscillated specimens. • Microstructure: There were no differences in the spatial distributions of reinforcing particles in the oscillated and the non-oscillated specimens and no differences between the thickness of polymer rich regions at the surface of the oscillated and non-oscillated specimens. In addition, differences were not observed in the amount or size of porosity. • Bond Strength to Dentin: With the oscillated and nonoscillated samples, there was no significant difference in the bond strength to dentin. • Adherence of the Composite to the Oscillating Placement Instrument: Contrary to the “stickiness” common to the non-oscillating composite (regular) placement tip, there was no measurable sticking/pull-back with the oscillating composite placement tip; i.e., composites do not stick to an oscillating composite placement instrument. Imposition of oscillation to appropriately designed placement tips can allow practitioners to use the device in a variety of clinical procedures. For example: • Operative Dentistry – Classes I-V • Placing of composite resins in all cases can be made more efficient. In multi-layer posterior restorations, voids and lamination gaps between layers can be more easily avoided. • The need to place a flowable composite in some situations is potentially reduced. • A greater degree of restoration shaping and contouring can be accomplished pre-cure, reducing time consuming post-cure shaping and finishing. • Direct Veneers • Due to the increase in flow and no pull-back, this technique can greatly decrease the time spent in shaping the body and interproximal of the veneer. • Placement of Sealants • More highly filled resins can potentially be used as oscillation enhances flow into pits and fissures, and could decrease the presence of bubbles and voids within the placed sealant. Fig.1: Schematic of the oscillatory instrument used in this study. Internal mechanism is shown. • Core Build-ups • Heavy, viscous composites can be encouraged to more readily flow into all areas of the core preparation. • Splinting • Flow of composite material more thoroughly between teeth (and into a mesh if necessary) is enhanced. Conclusions It was found that an oscillating (not vibrating) composite placement tip can increase the flow of composite more than 30 percent. The research also showed that composite materials do not stick to an oscillating placement instrument and the use of oscillation does not affect the properties of polymerized composites. The improvements in handling properties have the potential to significantly facilitate clinical procedures using composite materials. n Acknowledgements: Original research funded in part by Brasseler USA. Original research funded in part by Dentsply International. References 1. Lee IB, Son HH, Um CM. Rheologic properties of flowable, conventional hybrid, and condensable composite resins. Dent. Mat. 2003, 19: 298-307. 2. Al-Sharaa KA, Watts DC. Stickiness prior to setting of some light cured resin composites. Dent. Mat. 2003, 19:182-187. 3. Oliveira JF, Ishikiriama A, Vieira DF, Mondelli J. Influence of pressure and vibration during cementation. J Prosthet Dent 1979, 41:173 177. 4. Koyano E, Iwaku M, Fusayama T. Pressuring technique and cement thickness for cast restorations. J Prosthet Dent 1978; 40: 544 548. 5. Judge RB, Wilson PR. The effects of oscillatory forces upon the flow of dental cements. J.Oral Rehabil. 1999; 26: 892-899. 6. Kaburagi K. Effect of vibration for the rheology of some luting cements. Shika Zairyo Kikai 1989; 8: 436 454. 7. Walmsley AD, Lumley PJ. Applying composite luting agent ultrasonically: A successful alternative. J Amer Dent Assoc 1995; 126: 1125-1129. Author Bios Dr. Karl F. Leinfelder earned both his Doctor of Dental Surgery and Master of Science (dental materials) degrees from Marquette University. In 1983, he joined the School of Dentistry at the University of Alabama and is the recipient of the Joseph Volker Chair. He also served as Chairman of the Department of Biomaterials until 1994. Presently he holds positions at both universities; adjunct professor at University of North Carolina and Professor Emeritus at the University of Alabama. Dr. Leinfelder has published more than 275 papers on restorative materials, authored more than 150 scientific presentations, two textbooks on restorative systems and has lectured nationally and internationally on clinical biomaterials. Dr. Robert A. Draughn is Emeritus Professor in the College of Dental Medicine of the Medical University of South Carolina. He earned the Doctor of Science in Materials Science from the University of Virginia and has more than 35 years of experience in dental materials teaching and research. 96 May 2011 » dentaltown.com From Articulators to Ultrasonics Find it all in Dentaltown.com’s free classifieds • Buy and sell equipment • Check out practices for sale • Find a job or your next superstar team member “do good” focus 98 May 2011 » dentaltown.com focus “do good” Go into the world and do well. But more importantly, go into the world and do good. – Minor Myers Jr. (1942-2003) It’s easy to stay in our own pockets of the world. To wake up, go to work or church or school, go about our own business, on our own time, attending only to those closest to us. But there is a world just outside many of our immediate neighborhoods where people live a very different existence. They live paycheck to paycheck, many working two or more jobs, and with the exception of Medicaid, most do not have the luxury of health or dental insurance. Minor Myers, an author, scholar and composer said, “Go into the world and do well. But more importantly, go into the world and do good.” Graduating with a dental degree does not burden you with the responsibility of helping others; it does however grant you the opportunity and privilege to do so. Maybe serving the underprivileged is something you’ve not yet thought about, or perhaps you have but aren’t sure where to start. Dentaltown Magazine has put together resources for you – to be inspired and to get involved. We’ve talked to experts and doctors who have already taken the steps into charitable dentistry. We’ve collected contact information. We’ve asked hundreds of questions. And whether you want to adopt a few cases a year in your practice (see pg 16), dedicate a day to free dentistry (see pg 118) or – at the most extreme – drop everything and work the rest of your career in a homeless clinic (pg 110), we have the information you seek. And with Dentaltown.com available 24/7, you have a forum for ongoing discussion and support. … by the world’s definition, you have done well. Now we hope you’ll go into the world and do good. Articles in Section: Compassion for the Other Man – Terry Dickinson of Missions of Mercy. . . . . . . . . . . . . . . . 100 FAQ: Hosting a Free Dental Day. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Office Visit: Boston Healthcare for the Homeless . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Three Reasons to Volunteer – Kris Volcheck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 National Children’s Oral Health Foundation and Three Affiliates . . . . . . . . . . . . . . . . . . . . . . 112 Each of Us Can Play a Role – Kenton Johnson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Donating Equipment and Supplies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 National and State-by-State List of Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Also focusing on charitable dentistry, see: Professional Courtesy: Make a Permanent Impression on Someone . . . . . . . . . . . . . . . . . . . 18 From Trisha’s Desk: Volunteering by RDHs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 dentaltown.com « May 2011 99 “do good” feature An interview with Terry Dickinson – lifetime dentist, founder of Missions of Mercy, winner of the 2010 ADA Humanitarian Award, and regular do-gooder. by Chelsea Patten, staff writer, Dentaltown Magazine Dr. Terry Dickinson treating a patient at Middle Peninsula MOM, assisted by VCU student John Reynolds. 100 May 2011 » dentaltown.com “I’m sure people worried about my sanity,” chuckles Dr. Terry Dickinson, executive director of the Virginia Dental Association, in response to a question about his big move from Texas to Virginia in 1999. He left his comfortable home, successful practice and the city-life of Houston, Texas, in search of a missing piece he felt so strongly about finding. What that missing piece was though, he wouldn’t find out until he was knee-deep in Missions of Mercy (MOM), an organization he built from the ground up. Dickinson graduated from University of Texas Dental Branch in Houston in 1967. He spent two years in the Air Force during Vietnam, performing dental physicals on soldiers prior to their deployment and then went on to own a private practice in which he practiced for 30 years. During the last five of those 30 dedicated years, he caught the career version of the seven-year itch. He loved dentistry and had a booming practice in a city he knew and loved, so he questioned the “annoying” restlessness of something missing. Sleuthing for his higher purpose, he says, “was a difficult journey.” It was in this period of time when he received a call from two friends asking him to consider the position of executive director of the VDA. He was hesitant and vacillated over interviewing and eventually living somewhere unfamiliar. “When things are good and predictable, it’s easy to stay,” he says. “But here I am 11-anda-half years later without any regrets.” Soon after assuming the position of executive director, Dickinson sewed together the infrastructure of Missions of Mercy (MOM), a not-for-profit means of providing dental care to the underserved working poor populations of Virginia. Although it originated in the state, 20 states now have a model of the program and it stimulated the formation of the America’s Dentists Care Foundation. Dickinson says the MOM events border on chaos. “It’s organized chaos though,” he says. Trucks pull up next to a facility – whether it is a high school gym, feature “do good” fairgrounds or a convention center – full of portable equipment and supplies. Volunteers help to unload and quickly set up. A 50-chair clinic is typical. “It’s quite impressive to watch” says Dickinson about the set-up process and of the 500 to 1,000 people they are able to serve during one- or two-day clinics. To operate a 50chair clinic, he estimates the volunteer count to be around 250 dental professionals; and upward of 400 volunteers counting the additional locals who help with registration, patient interviews and triage, food service, security and parking. I asked him about the challenges that conducting a program like this entails. He named resources as one challenge typical of most charities, but he did not dwell on hardship. MOM gets the majority of its funding via foundations and grants, as well as through large dental companies like Henry Schein and Delta Dental. He admits seeking funding is an ongoing process. “The good news is we leverage each dollar into about $32 of patient care,” he says. “One of the problems we’ve never faced is having enough patients,” Dickinson says as he recalls a story of once hosting a clinic up in the mountains. He worried that patients might not make the trip and expressed anxiety to the Sister in charge about the volunteer dentists not having enough to do. “The first morning of the clinic it was very foggy. We got about a mile out and traffic was at a dead stop. We had to walk the rest of the way in.” The team had to turn a thousand people away that day. “The Sister came up to me and asked ‘is that enough?’ I’ve never worried about patients since then,” he laughs, now maintaining a “build-it-and-they-willcome” mentality. At MOM’s last big project, patients traveled from 15 different states (including Virginia). “The thing that struck me right away is what people are willing to do to get dental care,” referring to the line of patients outside the first MOM project. People are willing to stand in line for hours. Many spend the night in their cars or in tents; in cold weather; sometimes even in snow storms. “They are so desperate to get the needed dental care. It really reshapes and helps to rethink what kind of life they must live,” says Dickinson. Most of the patients treated at MOM projects do not have insurance. In Virginia, there is a limited adult benefit Medicaid program, but the state has one of the best children’s programs. For this reason, 95 to 97 percent of the people treated are adults. Dickinson and his teams of volunteers are deeply impacted by patients’ life stories. In fact, he claims they are the most rewarding part of the work he does. “If you don’t listen to their stories, you don’t have any idea of the struggles they have.” One middle-aged man came to one of the MOM projects with a severe cleft palate. He was hard to understand but Dr. Dickinson could understand he needed a denture. Unfortunately a denture couldn’t be fabricated on-site for lack of lab facilities. Dickinson decided he would find help for the patient outside the MOM clinic and “I always walk away feeling more blessed than the people who had the dental work done, because I was able to be a part of giving something back.” Youngest Wise County MOM patient happily poses with Dr. Terry Dickinson and dental hygienists following her cleaning. The stuffed animal made the day! Dr. Terry Dickinson triages Southwest Virginia patient for needed treatment. Dr. Andrew “Bud” Zimmer, Dr. Terry Dickinson, and Dr. Ralph Howell display picture of Governor Tim Kaine presenting Dr. Dickinson with the National Governors' Association Private Citizen Distinguished Service to State Government Award. Governor Tim Kaine presents Dr. Terry Dickinson with the Virginia Health Care Foundations NETworthy Award (2006). continued on page 102 dentaltown.com « May 2011 101 “do good” feature continued from page 101 Dr. Terry Dickinson exams Wise MOM patient and determines necessary care. he spoke with a prosthodontist with whom he was acquainted. The doctor was a kind man, but a bit reluctant about doing the work as he already does a fair amount of pro bono work in his practice. Reluctant that is, until he heard the patient’s story. The patient had dropped out of school in the third grade since his classmates ridiculed him incessantly because of his deformity. His lack of education gave him few choices for work but a job in the coal mines of Virginia. With a debilitating injury in the mines, he had little hope left. This story not only left the prosthodontist changed, but changed the practice dynamic of his staff as well. The doctor now runs the prosthetics department for Missions of Mercy. As for the patient, he said of the denture: “It made me feel like a man again.” The circle was complete. “It wakes you up to what is going on out there,” explains Dickinson “There are hundreds of stories for what [programs like this] do in people’s lives. It’s not just getting teeth out or doing fillings.” The mission really helps to sustain hope in patients. Dickinson testifies many of the people who visit the clinics suffer not only from poverty of money, but oftentimes, poverty of hope. Performing dentistry helps to provide hope for their future. “It changes lives… on both sides of the equation.” Because the program has had an impact across the board, it’s not hard to see why Dr. Dickinson was nominated (without his knowledge) for the 2010 ADA Humanitarian Award. Dickinson received the award and certainly deserves praises for the work he does, but he is a humble man who does good for the sake of the greater good, and that’s enough for him... n A New Standard For Dental Isolation Now with Two Solutions! Both the original Isolite™ with 5 levels of brilliant intra-oral lighting and the new lightless IsodryTi™ systems provide continuous adjustable suction, tongue and cheek retraction, throat protection, and a comfort bite block. Professionals using this award-winning isolation technology are experiencing: 30% Faster Procedures U Improved Patient Comfort Reduced Ergonomic Strain Superior intra-oral lighting Lightless but brilliant! To Learn More about Isolite, Call 800-560-6066 OR VISIT I S O L I T E S Y S T E M S . C O M DT2011 FREE FACTS, circle 13 on card 102 May 2011 » dentaltown.com feature “do good” Townies on the message boards have asked many-a-question about hosting a free dental day in their practices. We have decided to clear up some of the confusion. We spoke with Lindsey Nickel de-la-O, communications director, and Brian Carlsen, chief operations officer of Dentistry from the Heart (DFTH) to answer your questions. What are the steps to host a free dental day through your organization? For a nominal donation, doctors can register to host a Dentistry from the Heart event on our Web site. The donation made by the volunteer doctor provides the practice with membership in our 501(c)(3) Public Charity. This allows a given practice to solicit and receive tax-deductible donations and support from interested parties both private and corporate. Donors who offset the practice’s initial donation are offered honorable mention in press releases, event banners, etc. Our doctors also have access to our marketing and public relations materials. Event materials are also provided (i.e. customized T-shirts and an event banner). This approach lifts a huge burden off of a practice allowing them to focus on dentistry, which is their strong suit. What are the steps to host a free dental day independently? A doctor needs to be prepared to manage the following: 1. Marketing the event and building community awareness. 2. Soliciting support. 3. Coordinating the event logistics from patient registration, capacity, services, staff, volunteers, sponsors and more. 4. Insurance, both event insurance for dentists who rent their office space property and any additional patient liability. continued on page 104 dentaltown.com « May 2011 103 “do good” feature continued from page 103 To-do List Not sure where to begin? Here’s a checklist of items to help you plan your own charity day from Townies Rick and Nancy Hammel. One Year Before Reserve a day. Get your team excited about it. Have a team meeting to begin planning and answer to following questions: • Will you see children? • What services will you perform? • Will you see patients who have insurance? • Will you pay your team? • Will you need to have more volunteer dentists and/or hygienists for your capacity? • How will you get past the “what if” questions and doubts? • Will you need security? • What will you do in inclement weather? Six Months Before Decide Basic Logistics. Appointments vs. First-come First-served We chose to have an early morning greeter who arrived at 5 a.m. He had two sets of alpha-numeric cards. Patients who wanted to see the dentist got a yellow card with D-1, D-2, etc. Patients wanting hygiene services got a white card with H-1, H-2. We estimated each patient would be in our office about a half-hour and the greeter could tell patients approximately what time to return so that we didn’t have people just hanging out all day long. Waiting, Shelter and Bathrooms We are fortunate that we have a large yard and we got a couple of large canopy-type tents and the city parks department brought in benches, trash cans and tables. Fortunately, we also have a patient who owns a portable toilet business and brings in a toilet so that we don’t have to have people coming into our office bathrooms. Traffic Flow of Patients and Triage Determine the traffic flow pattern to avoid hallway bottlenecks. Consider asking other dentists or hygienists to do your triage and administer anesthetic as well as any pre-medication needed. And, if you have extra treatment rooms ask them if they want to serve by seeing patients. Be sure if you are bringing in providers from out of state that they can practice legally in your state. Dental Work Because we wanted to see as many patients as possible we decided that patients would only be able to have about a half-hour of the dentist’s time, (i.e., no quadrant dentistry). The person doing the triage determines the patient’s one or two most critical needs, enters treatment into the computer and anesthetizes. Hygienist vs. Dentist Our patients are told they can choose to see either one or the other. If they want to get their teeth cleaned in addition to seeing the dentist they have to get another ticket. Patient Information and Consent Forms We designed a one-page form that contains pertinent information and release that is on Dentaltown.com (see “Downloads” Section) We chose not to use any treatment specific consent forms but every office should consider carefully their own environment. Just because the dentistry is free doesn’t mean you aren’t still liable if someone would choose to sue. Give-aways/Food Thanks to donations provided by our dental supply vendors we were able to give away items such as toothbrushes, toothpaste and floss. We also provided packs of acetaminophen and ibuprofen to give to those patients for post-operative discomfort. 104 May 2011 » dentaltown.com Also, because people are waiting for many hours and because we have a very generous small community, volunteers serve a free lunch as well as donated bottled water and coffee and cookies both mid-morning and mid-afternoon. We contacted our local grocery store and asked them to furnish hot dogs, buns and chips. Our next-door neighbor assisted living facility donated coffee and cookies. Marketing We had a graphic artist design our logo and the company who maintains and designs our Web site set up a Web page for our mission – www.claycenterdentalmission.com. We also chose to have all volunteers wear a bright colored T-shirt with our logo and date. This serves as a way to identify the volunteers. Printed Materials We used extraction and how to treat dry socket informational sheets. Security If you believe you'll have a lot of people spending the night in your yard or parking lot see about hiring some sort of security to be there to protect your property and the patients as a safety measure. Volunteers and Donations People in our community got really excited about becoming a part of this day of mission dentistry and said it was the “biggest high” to be a part of it. We had volunteers help with gatekeeping, trash collection, greeting and ministering, serving food, taking photos, Tweeting and running errands. Begin conversations with your vendors about donations. Tell all your vendors about your day and solicit their help. Our very own dental supply rep will be spending his second charity day with us. Our experience shows that most local vendors are very generous because of the relationship built with an office over time. Most dental supply reps have stashes of supplies to give away for events like this. Two to Three Months Before • Contact local charitable organizations, churches and pastors. • Offer community businesses an opportunity to participate by sending them letters about sponsorship, i.e., furnishing lunch, T-shirts, etc. • Order T-shirts and additional dental supplies. • Hire a volunteer photographer to upkeep social media outlets. One Month Before • Order food, if applicable. • Confirm Porta-Potty, if needed. • Contact radio and TV stations; send news releases to local newspapers. • Print patient “tickets” if doing first-come, first-served event. • Have a team meeting to review the day’s logistics. • Write up an instruction manual, including job descriptions, for volunteers. • Touch base with donors. One Week Before • Confirm all orders. • Confirm all volunteers and review duties and job descriptions. Author’s Bio Dr. Rick Hammel and Nancy Hammel have built Clay Center Family Dental Care in Clay Center in Kansas. They have hosted two successful charitable dental days. They can be contacted at: [email protected] feature “do good” Out-of-the-Box Advice ...from Jeff Dalin, Co-founder of Give Kids a Smile • To find kids, ask school nurses. They know exactly who is in need of dental care. • To find supplies, ask local sales reps about products that have been opened or returned or are getting close to expiration dates. • To find volunteers, offer CE credit or host a study club contest. This is a great way for recent graduates to network with established dentists. Is it tax-deductible? Dentistry From The Heart donations and events are tax deductible to the degree allowable under the auspices of a 501(c)(3). Operating without a charitable status does reduce the amount of donations or practice expenditures that might be deducted. I would recommend speaking to a tax accountant about this. What are the liabilities? Charitable events which are held with the status of a 501 (c)(3) enjoy sovereign immunity from prosecution for services rendered. Events run outside of a charitable status must rely upon their own insurance and legal resources to deal with treatment issues that might arise. How much would it cost a dentist? That depends on many factors including the size of the staff and the number of people to be treated. Many doctors receive donations from their vendors and additional sponsors that help offset the cost of hosting the event. On average, a typical practice will treat about 90 patients in one day. Material expenses might run up to about $5,000. If the staff volunteers their time as well, a practice might be able to narrow its event costs down to a minimal financial impact. What services should a dentist offer? We recommend that dentists offer free fillings, cleanings and extractions. These are the most universal services needed. To attempt to do more than these procedures will impact the number of people that might be treated while increasing the likelihood of more complex procedures involving complications. What are the benefits of hosting a free dental day through a charity like DFTH versus doing it independently? It just ends up being a lot more affordable for the dentist because we provide them with so many marketing and logistic services. The average dental practice is very good at being a dental practice, but oftentimes lacks the internal resources to take on the media, logistics and financial aspects in offering free dentistry. To attempt this with a staff that is very good at running a practice but not a charity event can evolve into a costly endeavor. We have designed our services around the simple notion of making it easier for a practice to reach out to those in need. What are other charity resources besides DFTH which help dentists host free dental days? There are organizations like Give Kids a Smile and the Missions of Mercy organization. The enemy of tooth decay is our friend. In other words, we all have virtually the same mission: to bring care to those who are in need. As we are one of the fastest growing charities, we must be doing something right. For every member that we have, there are three more considering membership. The profession of dentistry is composed of giving and caring people. It is supremely gratifying to work with dentists and their staff in pulling these events together. The enthusiasm and the humanity that our members exude is truly touching to see. “People who don’t have insurance or can’t afford dental work don’t have many low cost or free care options available to them… Our passion is to work with dental practices across North America in encouraging them to volunteer their time and give back to their communities by hosting a Dentist from the Heart event.” – Dr. Vincent Monticciolo, founder of DFTH ■ Dentistry from the Heart is a nonprofit 501(c)(3) Public Charity. For more information, visit www.dentistryfromtheheart.org, e-mail [email protected] or call 727-849-2002. How should a dentist market the event? We recommend dentists use public relations to promote their event. We also recommend they use whatever advertising sources they are currently using to promote their practice. How should dentists screen patients? Patient screening is up to the independent practice. We do not screen patients, we only ask that they be 18 or older, or have a signature of a parent or guardian to receive services. dentaltown.com « May 2011 105 “do good” office visit Serving Boston’s Underserved An interview with Dr. Colleen Anderson of the Boston Health Care for the Homeless Program by Chelsea Patten, staff writer, Dentaltown Magazine South of the Massachusetts Turnpike, surrounded by urban sprawl, across the street from Boston Medical Center sits Jean Yawkey Place. Nestled in the heart of Boston, this building and the staff who walk its halls strive to care for the city’s homeless population. Boston Health Care for the Homeless Program (BHCHP) started with limited funding and a coalition of health-care professionals with a vision. Since its founding in 1985, BHCHP has worked to assuage the burden of homelessness by providing health care and dental care to the city’s underserved. Dr. Colleen Anderson, a University of Michigan School of Dentistry graduate, is one of the many selfless individuals employed by BHCHP, and a woman with both the vision and skills to make a difference. Here, in an interview with Dentaltown Magazine, she shares her inspiration for getting involved and the heartwarming stories that keep her in the nonprofit sector. 106 May 2011 » dentaltown.com office visit “do good” What inspired you to apply to work at BHCHP? Dr. Anderson with Alan Filzer, DDS, director of the BHCHP dental clinic. Anderson: I decided before even starting dental school that I wanted to work in public health. I wanted to provide care to the patients who need it most, and have the hardest time accessing it. When it came time to look for work, BHCHP was a natural fit. They provide service to some of the city’s most vulnerable people, in a setting that demands the highest quality of care and a focus on the integration of primary, behavioral and dental care. Another attractive aspect was the level of commitment from the other providers. Employees here really care about their work and fulfilling their mission. Did you volunteer in a charitable clinic before deciding to look for a job like the one at BHCHP? Anderson: Yes, when I was in dental school I had externships in several nonprofit clinics. I completed my general practice residency at the Brigham and Women’s Hospital/ Harvard Extension program. I spent time in northern Michigan at both a community health center and at a mobile dental clinic set up to serve migrant workers and their families. I also spent a month in rural Maine, at a regional health center. How can dentists find similar programs? Anderson: I found the job listing through the National Health Service Corps, which, among other things, serves to match clinics throughout the country with providers interested in working in public health. They also provide loan repayment and scholarship programs (of which I was a recipient). There are Health Care for the Homeless Programs in many cities, and dentists should seek out their local program to find out about work or volunteer opportunities. What is BHCHP’s philosophy? Anderson: The program’s mission is to provide homeless individuals and families with access to the highest quality health care. The homeless population faces a particular set of health hazards as well as obstacles and barriers to health care that make management of chronic illnesses very difficult. We try to address their medical complexity in the context of their need for food, shelter and clothing. What makes this practice different than the typical dental office? How is practicing charitable dentistry different than practicing noncharitable dentistry? continued on page 108 Photography by Michele McDonald Name: Colleen Anderson, DDS Graduate from: University of Michigan School of Dentistry Practice Name: Boston Health Care for the Homeless Program Practice Location: Boston, Massachusetts Web site: www.bhchp.org dentaltown.com « May 2011 107 “do good” office visit continued from page 107 Dr. Anderson evaluates an emergency patient. Anderson: Having only worked in nonprofit settings, I can only speak to that. Here, we really try to focus on providing treatment that will serve that patient best in their current situation. Our goals are very basic: treating disease, improving function, improving aesthetics; but the outcomes can have major impacts on the patients’ lives: overall better health, improved nutrition and employment opportunities. Describe a typical day in the office. Anderson: Our first appointments begin at 7:30 a.m. Our clinic has three dentists, two full-time and one part-time. In addition to seeing our own patients, we instruct fourth-year dental student externs from Harvard University and Boston University. We schedule all appointment types every day, as well as see emergency patients and we are typically very busy. The dental clinic is located in the same building as our outpatient medical clinic and our respite care facility, which provides short-term medical and recuperative services for those who are too ill to stay in shelters but not sick enough to stay in a hospital. One records system is used by all the services, and we are in frequent communication with our patients’ primary care providers. What is the most common dental/health problem among the homeless? How about the most common procedure performed? Anderson: Many of our patients have multiple health issues, many of which are complicated by or exacerbate oral diseases. Many of them, when they first see us, lack the ability to pay attention to oral hygiene day-to-day. Disease management is our first priority, and corrective services are very important for many of our patients. 108 May 2011 » dentaltown.com What sort of challenges do you and your colleagues face in working each day? Anderson: We face the consequences of the challenges our patients face. While many of them struggle financially, they also commonly experience an extreme disorganization in their lives that makes keeping appointments, transportation, and taking medications, among other tasks, very difficult. Daily oral hygiene is not achievable for some of our patients. Many of them are struggling with substance abuse. Our challenge is to educate and work with our patients to find treatments that accommodate their particular situations. Describe your most successful or rewarding experience. Anderson: Rewarding experiences abound here. I am very fortunate to often encounter patients when they are making positive changes in their lives, and therefore get to take part in what can be an amazing transformation. Success can mean seeing patients through full-mouth extractions into complete dentures, but also seeing them mark sobriety, control diabetes, control hypertension or start HIV therapy. Often, several of these things are happening at the same time. I can think of many special patients, but one in particular is a young man who had cancer, and stayed in our respite care facility during treatment. I started dental treatment with him, and completed extractions, extensive restorative care and a partial denture. He’s now in remission; he’s sober; he’s working; and he and his girlfriend are expecting a baby. It’s incredibly rewarding to be part of that process; to have contributed to his self-confidence, health and overall stability. You can’t beat that. How about a disappointing experience or failure? Anderson: Not every treatment plan is completed of course, and office visit “do good” Indira Goranovich and Bessy Wrights. some patients are not able to follow through, chronic illnesses worsen or other circumstances intervene. While it can be disappointing, we will be here to try again if and when the patient is able. What are your primary funding resources? Anderson: Most of our patients (around 75 percent) are insured, many through the state MassHealth program. We also receive funding through grants and donations. Like all other community health centers, we are affected by state cuts to dental benefits. However, BHCHP is very committed to providing oral health care, and we work hard to keep all of our services available. To that end, patients are not billed for treatment. How do you get the word out to patients about services? Anderson: Many of our patients are referred through their BHCHP medical providers, or through one of the more than 80 programs we work with in the city that provide services to the homeless. Some patients hear about us through word of mouth. We also do oral health screenings at several organizations that provide aid to the homeless, and those patients often then come to our clinic. How do you deal with language barriers? Literacy problems? Transportation issues? Abuse of free services (if any)? Anderson: We are fortunate to have members of the dental team who speak multiple languages, so most of the time we have someone who can communicate with the patient. We also can call on other employees throughout the program to translate for us, which covers almost every language we have encountered. Back, from left: Bessy Wrights, Indira Goranovich, Maria Alves and Cam Nguyen. Front, from left: Colleen Anderson and Alan Filzer. Transportation can be a problem for many of our patients. We are accessible by public transportation, and that is the method used by the vast majority of our patients. We are able to provide bus and subway passes for many patients. Evaluating abuse of services is difficult. Our patients face many challenges that other groups do not, including misplacing belongings or having those stolen, hospitalizations and frequent moves, which put them at greater risk of losing prostheses. We try to evaluate and accommodate those situations on a case-bycase basis. Who are some of your mentors? Anderson: I had terrific teachers at the University of Michigan, and while I no longer see those instructors, it seems like I’m reviewing their lessons every day. In particular, Dr. Ron Heys and Dr. Phil Richards taught me so much about treatment planning, about standards and about patient interactions. How do you see the homeless program growing and changing in the next few years? Anderson: It seems that we’re always growing and expanding. The demand for service is high, and our dental clinic is considering the possibility of adding staff and extending hours. With that, we might be able to expand our services as well. The challenge of achieving our mission drives us to continually evaluate the needs of the homeless population, and evolve as an organization and as individual providers to meet those needs. Dr. Anderson, thank you for sharing your experiences with our readers. You, along with the others who dedicate themselves to programs like BHCHP are truly inspiring. n dentaltown.com « May 2011 109 “do good” feature e for th c i n i l c ? g at a ting factor n i r e e volunt your motiva r e d i s is on Ever c ved? What ser under by Kris Volcheck, DDS, MBA, founder of the CASS Clinic Can you guess the number-one reason why people volunteer? To do good? A nice sentiment... but no. To help people? Nope. When the CASS Clinic first started in January of 2001, we didn’t know the motivating reasons for dentists to get involved. I had been a dentist in private practice and I didn’t know what it took for a successful volunteer program. Check out the list below to find out what I learned to be the top three reasons people volunteer. Whatever your reason, get involved in some sort of pro bono work – it’s good for you and the people you help. #3 Reason: To Learn from Peers We have many dental, hygiene and dental assisting students with us. Volunteer dentists like to come and interact with the students, teach the students, and learn about all the new techniques and technology happening in dental school. Since we do every aspect of dentistry from hygiene to implants and cosmetics to plastic surgery, we have specialists in every area of dentistry. If one of our dentists wants to learn how to place implants… he can come in and learn from one of our surgeons. If another wants to learn the newest techniques in endo, she can come in and observe the endodontist. It’s a constant exchange of techniques and ideas, all based around the common cause of helping others. 110 May 2011 » dentaltown.com feature “do good” #2 Reason: To Do Good We use the tag line “Do good… but just a little.” This sounds funny but we don’t want our volunteers to burn out because we need them! Oddly our patients are actually the second priority. If we accommodate and satisfy our volunteers, they will then satisfy our patients. At the beginning, I didn’t have a clear idea of what characteristics I wanted in my volunteers. I just wanted them to be licensed, competent dentists and hygienists. They have turned out to be not only licensed and competent, but also empathetic, resourceful, energetic members of my family, who happen to want to help the homeless. This quality of clinician has become the norm. When the clinic first began, volunteers had to be more flexible with the time they volunteered. Now with so much help, we can usually accommodate clinicians’ request for certain hours or procedures – whether they want to work once a month for a day, once a quarter for an hour or once a year doing only extractions, root canals or everything that comes up. They have infinite options; they just have to want to help. Same goes for dental labs. We started with 20 volunteer labs and grew to more than 100 volunteer labs in 15 states. We applied the same principle of “Do good… but just a little” to our labs. We want to make sure we only solicit help at a rate that is comfortable and affordable for labs and volunteers. Volunteers also have the choice of receiving a schedule ahead of time, or getting a phone call every three or six months to see if they would like to volunteer. Generally our female volunteers prefer to be scheduled but many of our male volunteers like the “non-commitment” of not having a schedule, so we call them at certain intervals. #1 Reason: To Socialize with Peers The number-one reason to volunteer is to socialize with peers. We got lucky when the CASS Clinic first began because even though I didn’t know the factors that motivate dentists to volunteer I happen to really like to socialize and we hired people who liked to socialize. The volunteers liked the friendly, warm, but productive and professional environment so much that we went from 20 volunteers in 2001 to 400 volunteer dentists, hygienists, students and assistants in 2011. I didn’t realize until many years into our program why it was so successful. Once we had so many volunteers, I was asked to speak in many other cities about the success of our program and in my research, the number-one reason to volunteer stuck out – to socialize. At the beginnings of our clinic, we had no idea of its importance. Even if this is your main reason for volunteering, do it. Other professionals have the same needs for social interaction. We don’t necessarily “recruit” volunteers but we always need new blood to keep things energized and growing and keep expanding our care for the homeless. We can never meet the needs of our population. Whatever your reason for getting involved, you’ll get just as much benefit from helping, socializing and learning as the underserved who receive the dental care. n CASS Dental Clinic Update Remember the November 2009 Office Visit that featured the CASS Clinic in Phoenix, Arizona? Well, it has expanded since then. Here’s an update: • They are continuing the expansion of care for the Homeless United States Veterans. The clinic sees virtually every homeless U.S. vet in Maricopa County. • The Midwestern College of Dental Medicine will start sending their senior students in June 2011. They will join the students from the Arizona School of Dentistry and Oral Health, who have been with CASS for six years now. • They are in the final licensing process to open a dental assisting school at CASS Dental Clinic. This will help the community at large, assist the selected homeless clients in getting a career and bring in revenue to the clinic. • CASS opened the Murphy Kids Dental Clinic in June 2010. This clinic is fully portable and serves the four schools in the impoverished Murphy Elementary School District in south Phoenix. A full dental clinic with comprehensive services is set up inside each school and treats every child in that school, whether they are insured or not. dentaltown.com « May 2011 111 “do good” profile National Children’s Oral Health Foundation (NCOHF) is an organization we’ve all heard of in some way or another – probably through its most endearing persona America’s Toothfairy. You might donate. You might read about it in the news. You might even participate in some of its programs. NCOHF supports a national affiliate network of community-based oral health programs located everywhere from Washington, DC, to the small rural towns of Washington State. NCOHF affiliates work to eliminate pediatric dental disease by providing comprehensive care to local underserved children. Affiliate models uniquely represent the communities they serve and range from mobile units and universities, to foundations and clinics. Here are just a few successful examples. KinderSmile Foundation “We cannot forget those who are less fortunate and need us as health-care providers. I personally feel obligated as a human being to serve anyone who is less fortunate.” – Nicole M. McGrath, DDS; KinderSmile Founder, President and Executive Director “Every child and his or her family is extremely appreciative of the generosity and kindness from NCOHF and the work that we provide. - Brent Lin, DMD; Director, UCSF Pre-Doctoral Pediatric Dentistry Program 112 May 2011 » dentaltown.com Location: Montclair, New Jersey Web Site: www.kindersmile.org KinderSmile Oral Health Program (KSOHP) Volunteers visit preschools, daycares, Head Start, Early Head Start and middle schools, providing on-site preventive exams, cleanings and fluoride varnish, as well as presenting age-appropriate oral health education workshops for caregivers and teachers. If participating children are not insured, KSOHP directs them to local offices that offer services pro bono. Pre-/Post-natal Oral Education Program Volunteers provide education, nutritional workshops and a dental “home” to atrisk, pregnant mothers by collaborating with Early Head Start programs and United Way/WIC programs. These programs help women to understand the connection between their oral health and their developing fetus. University of California at San Francisco Web Site: www.dentistry.ucsf.edu UCSF Clinic Named the NCOHF Affiliate of the Year for the remarkable impact the UCSF Clinic is having on their community, UCSF faculty and supervised student dentists provide comprehensive oral health services based upon the unique dental needs of each pediatric patient. With support from NCOHF, UCSF has expanded vital educational and preventive programs offered both in-clinic and profile “do good” during various outreach initiatives conducted throughout the school year, reaching children in the Bay Area’s most underserved communities. Students United for America’s Toothfairy (SUAT): UCSF Chapter A student-action group dedicated to increasing local awareness of pediatric dental disease. Students in the UCSF Chapter of the SUAT improve community oral health literacy and raise critical funds to suppport vital preventive services in their community. Run by a board of students and assisted by Dr. Brent Lin, the group started a tooth-brushing program throughout Bay Area low-income preschools to encourage mid-day brushing and adoption of healthy habits. They also take part in oral health fairs, provide oral hygiene education and teacher training. United Methodist Mexican American Ministries Location: Garden City and Dodge City, Kansas Web Site: www.ummam.org/dental.html UMMAM Clinic With NCOHF support, UMMAM provides a full range of preventive treatment and restorative treatment services on a sliding fee scale basis according to household income. UMMAM accepts all dental insurances, but most patients qualify for the minimum service fee. Lifetime Smiles Program Clinicians provide preventive and educational services in area daycares, Head Start, preschools, and public and private schools. The program gives oral health supplies to those in need, helps families understand and use available dental insurance, arranges treatments at the dental clinic and other dental clinics, educates patients on oral health topics and provides pre-natal information. Inspiring, isn’t it? Here’s how you can get involved: Tomorrow’s Smiles works with volunteer practitioners to provide pro bono restorative and aesthetic dental services to promising at-risk teens, renewing their self-esteem and encouraging them to take responsibility for their own oral health. Recipients also participate in a “Pay It Forward” program to teach younger children lessons on how to break the cycle of pediatric dental disease. The America’s Toothfairy Dental Home Program gives caring dental professionals the opportunity to provide underserved youth with ongoing comprehensive pro bono dental services in a compassionate health-care environment. Through national partnerships with Boys & Girls Clubs of America and National Association of School Nurses, NCOHF will match practitioners with pre-screened local students in need of dental services. Go to www.americastoothfairy.org and click “Contact” to volunteer or register a child. Student’s United for America’s Toothfairy (SUAT): SUAT is a student action group comprised of dental, pre-dental, hygiene and nursing students who are dedicated to increasing local awareness of pediatric dental disease. SUAT groups educate local families about maintaining good oral health and providing vital tools for a lifetime of proper care. Upon acceptance into the SUAT program, each chapter receives a comprehensive toolkit filled with templates and information and a one-time stipend of $500 to ensure your SUAT group quickly becomes a valuable asset for the health of your community. Request a SUAT application by e-mailing [email protected]. Visit www.ncohf.org for more information. n “It is very fulfilling to see a need in the community, secure funding and start offering a much-needed service. Our patients are very grateful to us as most of them would not be able to seek care because of the financial barrier.” – Marcie Strine, CFO, United Methodist Mexican American Ministries “The earlier we can reach out to these kids and create good oral hygiene habits, the more successful we will be. The children we work with are just so precious, and when we make it fun for them, they really grow to love the dentist.” – Kaitlin Jennison, Dental Student at UCSF and SUAT President dentaltown.com « May 2011 113 “do good” feature by Kenton Johnson, DDS, MS The unmet need for dental care is all around us, from urban to suburban areas, as well as in rural areas. This is true even in many communities that are growing and prosperous. Where I live in the Twin Cities we like to boast about our quality of life and rankings in those “best places to live” reports. But there are many residents of our metropolitan area who do not have insurance or the financial means to access dental care. One reason is that most dentists nationwide don’t accept Medicaid patients, and even those who do might cap the number of Medicaid enrollees that they will see. A report last year by the Government Accountability Office revealed that there were 25 states in which fewer than half of all dentists treated a single Medicaid patient (http://www.gao.gov/htext/d1196.html). That’s why it is so critical for organized dentistry to expand its volunteer efforts to provide care to low-income, underserved 114 May 2011 » dentaltown.com populations. In my home state, I am proud to say that the Minnesota Dental Association is committed to this objective. During the first weekend of February, more than 3,000 dental professionals and interpreters in Minnesota volunteered at hundreds of locations around the state to offer dental care. This was accomplished through the “Give Kids a Smile” program, which is sponsored by the Minnesota Dental Association. These dentists were able to treat thousands of kids, many of whom haven’t seen a dentist in years. Since 2003, San Joaquin County in California has operated one of the most impressive volunteer dental programs. First and foremost, it is a year-round program. One of the clinics provides free dental care to low-income kids three days a week. That’s 150 days of free dentistry at one location; what a wonderful opportunity for the children and volunteers alike! feature “do good” Making that kind of impact is possible because the program is drawing on the voluntarism of more than 30 dentists. In other words, the actual reach of these volunteer programs depends on the number of dentists who lend their services. We are the only people who can fill the blanks on the schedule. Dentists all have an excuse not to volunteer, but once they participate they are overwhelmed by the experience. They can’t wait until the next opportunity. Unlike the California program, many of the free dental programs across the country operate only for a few days or for one month – often, they occur in February for Dental Health Month. It would be ideal to see this change – for more states and communities to offer care for longer periods of the year. Dentists who are not yet involved in volunteer care efforts should consider contacting their state dental associations. Generally, these associations have existing programs through which they seek to connect dentists with communities in need. [Editor’s note: Check out our extensive list of resources beginning on page 117.] If you are a dentist who already participates in these volunteer projects, consider talking to other dentists about these activities and encourage them to join you in getting involved. It could make a difference in attracting more of your peers to join these activities. The research appears to show the importance of dentist-to-dentist dialogue. In fact, a 2008 study of a volunteer dental program in Israel found that 68 percent of participating dentists had heard about the program from another dentist. I had an opportunity to introduce three dentists and their staff to “Give Kids a Smile” in February. They felt that helping the underserved not only made them appreciate their work, it helped the teams work better together. There is a nationwide mobile dentistry program I have worked with called Christina's Smile. If a PGA tournament comes through your city, chances are the semi-truck with a tooth and golf club come too. The program focuses on the needs of the underserved and parks in front an elementary school in St. Paul. The kids can walk to the facility during the three-day stay! There are many unique programs that communities have designed to fit their needs. These programs can only thrive if volunteers commit to a shift or two a year. Together we can make a difference in the lives of people who cannot seek regular dental care – it is up to each of us. ■ Attention: Dental Students Establish a Dental Pipeline Program at Your School by Donna Lewis Johnson Closing the gap in oral health was the mission of the nine-year demonstration project supported by the Robert Wood Johnson Foundation and held at 23 dental schools across the country. Dental Pipeline set out in 2001 to respond to access disparities by increasing student diversity at America’s dental schools and increasing the length of time that all senior dental students spend in community-based dental clinics. The community experience had an immediate effect on increasing care for underserved patients. The program also influenced dental school graduates to work in community sites or treat more underserved patients in their private practices. In 2008, students from University of Illinois at Chicago (UIC) College of Dentistry teamed up to expand dental services at a clinic serving homeless adults. Under faculty supervision, UIC dental students staffed the clinic, performing root canals, extractions, and restorations. The rotations continue with current senior students. “The Pipeline program is dear to my heart,” says Esther Lopez, DDS, an alumna of the program. “Increasing the number of minority professionals in dentistry is so important. When you understand people’s struggles, challenges and culture, you are able to better serve them.” Currently, Lopez spends upward of 15 hours a week at the community clinic while operating her private practice in suburban Chicago that also treats vulnerable populations. Replicating the Dental Pipeline program would require dental schools to partner with grantmaking institutions in a collaborative effort. Read the program’s final report, www.jdentaled.org/content/ vol74/10_suppl, for guidance on how to establish successful community-based dental education programs and underrepresented dental student enrollment programs. Author’s Bio Kenton M. Johnson, DDS, MS, has been a general dentist in Roseville, Minnesota, with Metro Dentalcare since 1994. Dr. Johnson is currently active with the MDA’s Elderly and Special Needs Adults Committee. He can be contacted at: [email protected] dentaltown.com « May 2011 115 “do good” message board Donating Equipment and Supplies Throughout the message boards of Dentaltown, many Townies have asked the question “Where do I donate equipment and supplies?” Here is a compilation of advice from Townies picked from various message boards about donating equipment. phoney Posted: 6/7/2003 I donated most of my old equipment to an interfaith clinic. Since I was buying new equipment, my supply company was more than happy to deliver the units. ■ ricklin Posted: 5/23/2006 Check with local church groups. ■ Buck L. Margin Posted: 1/19/2007 Check the classified advertisement in Dentaltown under “equipment wanted.” ■ ericyuan007 Posted: 4/20/2007 I would donate the equipment to DentalVolunteer (Web site is dental volunteer.org). They connect volunteers with dental volunteering opportunities. ■ DRGLEE Posted: 8/17/2007 I saw an ad in The Dental Trader from Knightsbridge International (501c3 nonprofit organization) requesting supplies and equipment donations for worldwide distribution to humanitarian mission organizations. Your donation is tax-deductible and they provide pick-up. Call 818-372-6902 or e-mail them at [email protected]. ■ We donate samples of paste, floss and brushes to the homeless shelter. ■ needardh 1/25/2008 Donald J. Greco Posted: 11/5/2008 Most dental hygiene and assisting schools are happy to take older equipment. ■ fliegenfischen Posted: 1/24/2009 I donate things to local schools – like toothbrushes and sample toothpaste. ■ Donate to a local school or college. ■ Tim Lott, CPA, CVA 6/19/2009 116 FortHillDMD Posted: 2/22/2010 Maybe try posting and looking in the classifieds for your state and local states’ dental association classifieds. ■ techguru Posted: 1/26/2011 You also might contact your local chapter of the ADA to see if they know of someone to whom you can donate. ■ May 2011 » dentaltown.com resources “do good” Nationwide Resources Interested in helping? Here’s a head start. Contact these for opportunities to donate time, money or equipment. 1-800-Volunteer.org www.1-800-volunteer.org Academy of General Dentistry (AGD) Foundation www.agd.org/agdf [email protected] ADA Foundation www.ada.org/adafoundation.aspx [email protected] • 312-440-2547 Americorps www.americorps.gov The American Academy of Cosmetic Dentistry Charitable Foundation – Give Back a Smile Domestic Violence Victims www.givebackasmile.com 800-773-4227 America’s Dentists Care Foundation - Missions of Mercy www.adcfmom.org 316-260-5056 Children’s Dental Health Project www.cdhp.org Center for Oral Health www.centerfororalhealth.org/index-new.html 510-663-3727 Children’s Healthy Smile Project www.childrenssmileproject.org/home [email protected] Community Dental Foundation www.cdental.org [email protected] Delta Dental www.deltadental.com The Foundation of the American Academy of Pediatric Dentistry – Healthy Smiles, Healthy Children www.aapd.org/foundation [email protected] • 312-337-2169 Give Kids a Smile www.givekidsasmile.org 636-397-6453 The Grottoes of North America Humanitarian Foundation The Dental Care for Children with Special Needs Program www.hfgrotto.org [email protected] National Children’s Oral Health Foundation www.ncohf.org 800-559-9838 National Dental Association Foundation www.ndaonline.org [email protected] National Dental Hygienists’ Association www.ndhaonline.org [email protected] National Foundation of Dentistry for the Handicapped Donated Dental Services www.nfdh.org 303-534-5360 National Health Service Corps www.nhsc.hrsa.gov Oral Health America’s National Sealant Alliance www.oralhealthamerica.org RAM (Remote Area Medical) Foundation www.ramusa.org 877-5RAMUSA Dental Jobs www.dentaljobs.net/volunteer.asp Special Olympics – Special Smiles www.specialolympics.org/volunteer_with_healthy_athletes.aspx [email protected] • 202-628-3630 Dentistry from the Heart www.dentistryfromtheheart.org [email protected] • 727-849-2002 Volunteers in Medicine www.volunteersinmedicine.org [email protected] continued on page 118 dentaltown.com « May 2011 117 “do good” resources continued from page 117 State-by-State Resources Sonrisas Community Dental Center www.sonrisasdental.org [email protected] • 650-726-2144 Alabama Arkansas University of Alabama School of Dentistry at UAB www.dental.uab.edu Arkansas State Dental Association www.arkansasdentistry.org [email protected] Alabama Dental Association www.aldaonline.org [email protected] Harmony Health Clinic www.harmonyclinicar.org/en/volunteers [email protected] University of Colorado Denver School of Dental Medicine www.uchsc.edu/sod Sarrell Dental Center www.sarrelldental.org [email protected] California Colorado Dental Association www.cdaonline.org [email protected] Alaska Herman Ostrow School of Dentistry of USC www.usc.edu/hsc/dental Colorado Alaska Dental Association www.akdental.org [email protected] Anchorage Neighborhood Health Center www.anhc.org 907-257-4600 Loma Linda University School of Dentistry www.llu.edu/llu/dentistry University of California at Los Angeles School of Dentistry www.dent.ucla.edu Arizona Western University of Health Sciences College of Dental Medicine www.westernu.edu/xp/edu/dentistry/about.xml Midwestern University College of Dental Medicine – Arizona www.midwestern.edu/Programs_and_ Admission/AZ_Dental_Medicine.html University of California at San Francisco School of Dentistry www.dentistry.ucsf.edu A.T. Still University Arizona School of Dentistry and Oral Health www.atsu.edu/asdoh University of the Pacific Arthur A. Dugoni School of Dentistry www.dental.pacific.edu Arizona Dental Association www.azda.org California Dental Association www.cda.org [email protected] Arizona Dental Foundation www.azdentalfoundation.org ACT Kids Health Fair www.actkidshealthfair.org [email protected] • 602-370-7049 CASS Dental Clinic www.cass-az.org/dental.html 602-256-6945 x 3020 Dave Pratt Dental Clinic www.bgcmp.org/dental.htm 602-271-9961 Berkeley Free Clinic www.berkeleyfreeclinic.org/pages/dental [email protected] • 510-548-2570 Homeless Not Toothless www.homelessnottoothless.org 310-820-0123 The Modern House Call for Women www.themodernhousecall.com [email protected] 877-490-9284 Virginia G. Piper Medical and Dental Clinic www.stvincentdepaul.net/PS-VirginiaGPiper.htm 602-261-6886 The Children’s Dental Center of Greater Los Angeles www.tcdc.org 310-419-3000 El Rio Community Health Center www.elrio.org 520-792-9890 Dreams Are Possible www.dreamsarepossible.org/?page_id=1724 [email protected] 118 May 2011 » dentaltown.com Kids in Need of Dentistry www.kindsmiles.org/kind/en/volunteers/how tovolunteer/ [email protected] • 303-733-3710 x 17 Inner City Health Center www.innercityhealth.com/clinical [email protected] Dental Aid www.dentalaid.org [email protected]. Connecticut University of Connecticut School of Dental Medicine www.sdm.uchc.edu Connecticut State Dental Association www.csda.com [email protected] Connecticut State Dental Foundation www.csdf.us [email protected] • 860-378-1800 Delaware Delaware State Dental Society www.delawarestatedentalsocieity.org [email protected] Delaware Technical & Community College Dental Health Center www.dtcc.edu/sw/dhc 302-657-5176 District of Columbia Howard University College of Dentistry www.dentistry.howard.edu District of Columbia Dental Society www.dcdental.org [email protected] resources “do good” Mary’s Center www.maryscenter.org [email protected] Catholic Charities of the Archdiocese of Washington www.catholiccharitiesdc.org/page.aspx?pid=413 [email protected] 202-772-4300 Florida Nova Southeastern University College of Dental Medicine www.dental.nova.edu University of Florida College of Dentistry www.dental.ufl.edu Florida Dental Association www.floridadental.org [email protected] Project: Dentists Care www.smileflorida.org/access/pdc.html Florida Dental Health Foundation www.floridadental.org/foundation Central Florida Dental Outreach www.centralfloridadentaloutreach.com Georgia Medical College of Georgia School of Dentistry www.mcg.edu/SOD Georgia Dental Association www.gadental.org [email protected] Ben Massell Dental Clinic www.benmasselldentalclinic.com 404-881-1858 Macon Volunteer Clinic www.maconvolunteerclinic.com [email protected] Hawaii Hawaii Dental Association www.hawaiidentalassociation.net [email protected] Aloha Medical Mission www.alohamedicalmission.org/volunteerhawaii-programs 808-847-3400 Mobile Care Health Project www.catholichawaii.org/social_ministry/mob ilecare [email protected] • 808-935-3050 Idaho Idaho State Dental Association www.isdaweb.org [email protected] Terry Reilly Health Services www.trhs.org 208-467-4431 Boise School District Health Services www.sd01.k12.id.us/health/index.html [email protected] • 208-854-6627 Garden City Community Clinic www.genesisworldmission.org/getlocal.htm [email protected] Illinois Southern Illinois University Edwardsville School of Dental Medicine www.siue.edu/dentalmedicine Trinity Free Clinic www.trinityfreeclinic.org/volunteer [email protected] • 317-819-0772 Gennesaret Free Clinic www.gennesaret.org 317-639-5645 Iowa University of Iowa College of Dentistry www.dentistry.uiowa.edu Iowa Dental Association www.iowadental.org [email protected] Iowa City Free Medical & Dental Clinic www.freemedicalclinic.org [email protected] Community Health Free Clinic www.communityhfc.org [email protected] Kansas Illinois State Dental Society www.isds.org [email protected] Kansas Dental Association www.ksdental.org [email protected] University of Illinois at Chicago College of Dentistry www.dentistry.uic.edu Kansas School Oral Health Screening Initiative www.kdheks.gov/ohi [email protected] Midwestern University College of Dental Medicine – Illinois www.midwestern.edu/Programs_and_Admiss ion/IL_Dental_Medicine.html Chicago Dental Society www.cds.org/for_your_practice/clinic_volunteering.html Chicago Dental Society Foundation www.chicagodentalsocietyfoundation.org 312-836-7301 CommunityHealth www.communityhealth.org [email protected] • 773-969-5923 Indiana Marian Clinic www.marianclinic.org [email protected] 785-233-9780 x 330 Kentucky University of Kentucky College of Dentistry www.mc.uky.edu/Dentistry University of Louisville School of Dentistry www.dental.louisville.edu/dental Kentucky Dental Association www.kyda.org [email protected] Indiana University School of Dentistry www.iusd.iupui.edu Kentucky Dental Foundation www.kyda.org/kdf.html Indiana Dental Association www.indental.org [email protected] White House Clinics www.whitehouseclinics.com/howyoucanhelp.htm 859-626-7700 x 4044 continued on page 120 dentaltown.com « May 2011 119 “do good” resources continued from page 119 HealthPoint Family Care www.healthpointfc.org [email protected] • 859-655-6157 Massachusetts Boston University Henry M. Goldman School of Dental Medicine www.dentalschool.bu.edu Louisiana Doorstep Healthcare Services www.doorstephealthcare.org/mobile 763-541-6000 Helping Hand Dental Clinic www.westsidechs.org [email protected] Louisiana State University School of Dentistry www.lsusd.lsuhsc.edu Harvard University School of Dental Medicine www.hsdm.harvard.edu Louisiana Dental Association www.ladental.org [email protected] Tufts University School of Dental Medicine www.tufts.edu/dental Migrant Health Service, Inc. www.migranthealthservice.org/en/dental 800-842-8693 Louisiana Seals Smiles www.dhh.louisiana.gov/offices/?ID=376 [email protected] • 225-342-7804 Massachusetts Dental Society www.massdental.org [email protected] Mississippi Greater Baton Rouge Community Clinic www.gbrcc.org [email protected] • 225-769-3377 The Sharewood Project www.sharewood.info [email protected] All Saints Dental Clinic www.foodbankofcovington.org 985-871-3939 Community Health Center of Cape Cod www.chcofcapecod.org 508-477-7090 Michigan Maine Maine Dental Association www.medental.org [email protected] Maine Dental Health Out-Reach www.mdho.org [email protected] • 207-377-7003 Waldo Community Action Partners www.waldocap.org [email protected] • 207-338-6809 x 107 Knox County Health Clinic www.knoxclinic.org/dental.html [email protected] • 207-594-6996 Maryland University of Maryland Baltimore College of Dental Surgery www.dental.umaryland.edu Maryland State Dental Association www.msda.com [email protected] Mission of Mercy www.amissionofmercy.org/marylandpennsylvania/getinvolved/volunteer.asp [email protected] 410-340-3791 Health Care for the Homeless www.hchmd.org/dental.shtml [email protected] 120 May 2011 » dentaltown.com University of Michigan School of Dentistry www.dent.umich.edu University of Detroit Mercy School of Dentistry www.dental.udmercy.edu Michigan Dental Association www.smilemichigan.com [email protected] CareFree Dental Clinic www.carefreemedical.com/dental.htm [email protected] 517-887-5922 x 8 DePaul Dental Clinic www.svdpdet.org/volunteer.html [email protected] • 313-393-2936 Tri-County Dental Health www.dentalhealthcouncil.org [email protected] • 248-559-7767 Medical Teams (MI) www.medicalteams.org [email protected] • (503) 624.1000 Minnesota University of Minnesota School of Dentistry www.dentistry.umn.edu Minnesota Dental Association www.mnental.org [email protected] University of Mississippi Medical Center School of Dentistry www.dentistry.umc.edu Mississippi Dental Association www.msdental.org Mission First Dental Clinic www.missionfirst.org/medicaldentalclinic [email protected] • 601-608-0050 Missouri University of Missouri – Kansas City School of Dentistry www.umkc.edu/dentistry Missouri Dental Association www.modental.org [email protected] Kansas City Free Health Clinic www.kcfree.org/services/dental.html 816-777-2761 The Kitchen Dental Clinic www.thekitcheninc.org/clinic.php [email protected] • 417-837-1504 Miles for Smiles Mobile Dental Unit www.citizensmemorial.com/community/milessmiles.html 417-328-6334 Montana Montana Dental Association www.mtdental.com [email protected] Montana State University Oral Health Screening Program http://healthinfo.montana.edu/dental.html [email protected] 406-994-5627 resources “do good” Nebraska University of Nebraska Medical Center College of Dentistry www.unmc.edu/dentistry Creighton University School of Dentistry www.creighton.edu/dentalschool/ Nebraska Dental Association www.nedental.org [email protected] Council Bluffs Community Health Center www.cbchc.com 712-256-9151 Nevada University of Nevada, Las Vegas School of Dental Medicine www.dentalschool.unlv.edu Nevada Dental Association www.nvda.org [email protected] Northern Nevada Dental Health Program www.nndental.org/default.php?p=Hp [email protected] • 775-770-6609 Albuquerque IHS Dental Clinic www.ihs.gov/AIDC New Mexico Dental Hygienists Association www.nmdha.org [email protected] San Juan College – Dental Hygiene Program [email protected] 505-566-3642 New York University at Buffalo The State University of New York School of Dental Medicine www.sdm.buffalo.edu Columbia University College of Dental Medicine www.dental.columbia.edu New York University College of Dentistry www.nyu.edu/dental State University of New York Stony Brook School of Dental Medicine www.stonybrookmedicalcenter.org/dental New York State Dental Association www.nysdental.org [email protected] Southern Nevada Dental Society www.sndsonline.org 702-733-8700 New York State Dental Foundation www.nysdentalfoundation.org [email protected] • 518-465-0044 New Hampshire North Carolina New Hampshire Dental Society www.nhds.org [email protected] University of North Carolina School of Dentistry www.dentistry.unc.edu Lamprey Health Care’s School-Based Dental Program www.lampreyhealth.org/index.php/patientservices/community_health_outreach _page/ [email protected] East Carolina University School of Dental Medicine (Opening August 2011) www.ecu.edu/dentistry/index.cfm New Jersey North Carolina Dental Society www.ncdental.org [email protected] University of Medicine & Dentistry of New Jersey – New Jersey Dental School www.dentalschool.umdnj.edu Blue Ridge Free Dental Clinic www.blueridgefreedentalclinic.org [email protected] New Jersey Dental Association www.njda.org [email protected] North Dakota New Mexico New Mexico Dental Association www.nmdental.org [email protected] Ohio Case Western Reserve University School of Dental Medicine www.dental.case.edu The Ohio State University College of Dentistry www.dent.ohio-state.edu Ohio Dental Association www.oda.org [email protected] Ohio State Dental Board – Ohio Association of Free Clinics www.dental.ohio.gov 614-466-258 Oklahoma University of Oklahoma College of Dentistry www.dentistry.ouhsc.edu Oklahoma Dental Foundation www.okdf.org [email protected] • 405-241-1299 Oregon Oregon Health and Science University School of Dentistry www.ohsu.edu/sod Oregon Dental Association www.oregondental.org [email protected] The Dental Foundation of Oregon www.smileonoregon.org [email protected] Medical Teams (OR) www.medicalteams.org [email protected] • 503-624-1000 Pennsylvania Temple University The Maurice H. Kornberg School of Dentistry www.temple.edu/dentistry University of Pennsylvania School of Dental Medicine www.dental.upenn.edu North Dakota Dental Association www.nddental.com [email protected] University of Pittsburgh School of Dental Medicine www.dental.pitt.edu Migrant Health Service, Inc. www.migranthealthservice.org/en/dental 800-842-8693 Pennsylvania Dental Association www.padental.org [email protected] continued on page 122 dentaltown.com « May 2011 121 “do good” resources continued from page 121 Community Volunteers in Medicine www.cvim.org/volunteers.aspx [email protected] • 610-836-5990 x 107 University of Texas Health Science Center – San Antonio Dental School www.dental.uthscsa.edu Charlottesville Free Clinic www.cvillefreeclinic.org/index.html [email protected] • 434-296-5525 Puerto Rico Texas Dental Association www.tda.org [email protected] Washington University of Puerto Rico School of Dental Medicine www.dental.rcm.upr.edu Colegio de Cirujanos Dentistas de Puerto Rico www.ccdpr.org [email protected] South Carolina Medical University of South Carolina James B. Edwards College of Dental Medicine www.musc.edu/dentistry South Carolina Dental Association www.scda.org [email protected] Anderson Free Clinic www.andersonfreeclinic.org [email protected] • 864-226-1294 South Dakota South Dakota Dental Association www.sddental.org [email protected] Tennessee Tennessee Dental Association www.tenndental.org [email protected] The University of Tennessee Health Science Center College of Dentistry www.uthsc.edu/dentistry Meharry Medical College School of Dentistry www.mmc.edu/education/dentistry Interfaith Dental Clinic www.interfaithdentalclinic.com/vols.aspx [email protected] 615-329-4790 San Antonio Christian Dental Clinic, Inc. www.sachristiandental.org 210-226-8041 HOPE Clinic www.hope-clinic.org [email protected] • 281-331-3288 Utah Utah Dental Association www.uda.org [email protected] Utah Department of Health www.health.utah.gov/oralhealth/volunteer opportunities.htm Baylor College of Dentistry Component of Texas A & M Health Science Center www.tambcd.edu University of Texas Health Science Center – Houston Dental Branch www.db.uth.tmc.edu 122 May 2011 » dentaltown.com Washington State Dental Association www.wada.org [email protected] Medical Teams (WA) www.medicalteams.org [email protected] • 503-624-1000 West Virginia West Virginia University School of Dentistry www.hsc.wvu.edu/sod West Virginia Dental Association www.wvdental.org [email protected] Utah Dental Alliance www.uda.org Change, Inc. www.changeinc.org [email protected] • 304-797-7733 Vermont Wisconsin Vermont State Dental Society www.vsds.org [email protected] Rutland Free Clinic – Medical and Dental Clinics www.vccu.net/rfc.htm [email protected] • 802-775-1360 Red Logan Dental Clinic www.vccu.net/rldc.htm www.goodneighborhealthclinic.org/volunteers [email protected]. Marquette University School of Dentistry www.dental.mu.edu Wisconsin Dental Association www.wda.org [email protected] Fowler Memorial Free Dental Clinic www.fowlerclinic.org/index.aspx 608-328-9404 Wyoming Wyoming Dental Association www.wyda.org [email protected] Virgin Islands Virgin Islands Dental Association 340-777-6612 Virginia Texas University of Washington School of Dentistry www.dental.washington.edu Virginia Commonwealth University School of Dentistry www.dentistry.vcu.edu Virginia Dental Association (includes Missions of Mercy) www.vadental.org [email protected] Community Action of Laramie County, Inc. – Cheyenne www.calc.net [email protected] • 307-635-9291 To get even more specific, you can search for local dental associations and societies here: www.ada.org/localorganizations.aspx n from trisha’s desk hygiene & prevention Volunteering by RDHs by Trisha E. O’Hehir, RDH, MS, Hygienetown Editorial Director Many Townies participate in volunteer programs at home and around the world. Hygienetown Townies have traveled to Honduras, Peru, Ecuador, the Galapagos Islands, Romania, India and Mexico as volunteers providing everything from local anesthesia to oral hygiene instructions. They pay their own way on these trips and bring their own instruments and supplies. The overwhelming response from all who have participated in volunteer trips overseas is the sense of receiving much more from those who they met and treated than they gave in their time and expertise as dental professionals. The sense of appreciation by those they treated was amazing. Closer to home, many more Townies volunteer at local community free clinics, providing a half day here and there, or some find time to volunteer on a weekly or monthly basis. Clinics close to home need your volunteer services as much as those far away. The dental needs found in third-world countries are also found in our own neighborhoods. Dental hygiene and dental students often learn about local free clinics through rotations in these clinics. Several Townies have participated in large community-based RAM or Remote Area Medical clinics. First designed to bring medical and dental care to rural areas, RAM also provides 10-day clinics in cities like Los Angeles, with hundreds of dental volunteers. Others are part of an entire dental team that opens the office one day each year to provide free dental care to those in need as their own community service or through a state or national program like Give Kids A Smile. Townies are also generous with their time, taking the prevention message to daycare centers, schools and senior centers. They teach preschoolers what to expect when visiting the dental hygienist for the first time, complete with gloves for them to wear. Others use puppets to teach grade-school children oral hygiene and to bring in nutrition, they build a pizza using healthy foods. Education is fundamental to prevention and Townies teach teenagers about the dangers of sour, tart, tangy, acid candies, gums, mints, sports drinks and fruit-flavored waters. To senior centers, Townies bring the news of xylitol, a sweet way to reduce bacterial biofilm in the mouth. The messages are adapted to the age of the audience bringing information and fun to the experience. Personally I donate time, money and services to AD World Health, a foundation begun by my stepson and daughter-in-law. I serve on the board of directors as the secretary and have traveled to India to perform dental screenings and teach the children and adults basic oral hygiene at the Manjushree orphanage in Tawang, India on the India/China border at 10,000 feet. AD World Health, located in Los Angeles, California, is currently building a medicaldental clinic locally to provide care to underserved people in the Los Angeles area. AD World Health provides needed medical and dental care at the same time as providing an educational experience for medical, dental and dental hygiene students. We are blessed to be in the dental profession, able to help others and provide for ourselves and our families. You might give back with your time, clinical services, equipment and supply donations or monetarily. However you decide to give back, your donations are sincerely appreciated and make a difference in the lives of others. Thank you for your generosity and caring. We have much to be thankful for in our lives. Giving back is second nature to dental professionals, and it turns out, you don’t have to go far from your own front door to find somewhere to help. n In This Section 124 Perio Reports 128 Townie Poll: Fresh Breath 130 Profile in Oral Health: Sitting Doesn’t Have to be a Pain in the Butt 133 Message Board: Acute Lymphocytic Leukemia 134 Message Board: Frozen Shoulder Look for additional content in the Hygienetown Magazine digital edition. dentaltown.com « May 2011 123 hygiene & prevention perio reports Perio Reports Vol. 23 No. 5 Perio Reports provides easy-to-read research summaries on topics of specific interest to clinicians. Perio Reports research summaries will be included in each issue to keep you on the cutting edge of dental hygiene science. Toothbrush Better Than Sponge for Intubated Patients Patients in intensive care units that have been intubated are at risk for ventilator-associated pneumonia (VAP), a lifethreatening condition. The incidence varies between nine and 45 percent of those intubated, with a mortality rate of 50 percent. Risk factors for VAP include underlying medical conditions, immunosuppression, brain injury, factors related to airway and ventilator management, presence of naso- or orogastric tubes and medication. Another risk factor is aspiration of oral bacterial biofilm in saliva. Although low levels of respiratory pathogens are found in oral plaque, oral pathogens are detected in the lungs preceding the development of VAP. Researchers at University College London compared power toothbrushing to the use of a sponge toothette for plaque control for intubated patients recently admitted to the National Hospital for Neurology and Neurosurgery in London, U.K. Colgate Actibrush was compared to a sponge toothette. Both treatments were provided by the nursing staff every six hours for two minutes. Chlorindioxide was used on the brush and the sponge each time. Plaque levels and bacterial counts were gathered on day one before the first oral hygiene intervention and again on days three and five. More plaque was removed by the Actibrush than by the sponge. A distinction was made by the authors between decontamination with chlorhexidine and plaque removal with either the Actibrush or sponge. Mechanical disruption of the plaque with the power toothbrush is considered more effective than antimicrobial chemicals to control oral biofilm and prevent VAP. Clinical Implications: Toothbrushing is more effective in reducing oral biofilm than wiping with a sponge toothette. Needleman, I., Hirsch, N., et. al.: Randomized Controlled Trial of Toothbrushing to Reduce Ventilator-Associated Pneumonia Pathogens and Dental Plaque in a Critical Care Unit. J Clin Perio 38: 246-252, 2011. n 124 May 2011 » dentaltown.com Soft Bristle Toothbrushes Best Oral bacterial biofilm is the primary etiologic factor in both caries and periodontal disease. Mechanical disruption using a toothbrush is the best way to remove biofilm from facial and lingual surfaces of the teeth. Researchers at Witten/Herdecke University in Witten, Germany compared similar manual toothbrushes with different bristle stiffness to determine effects on plaque removal, gingival bleeding and tissue damage. Dr. Best toothbrushes from GlaxoSmithKline were used for the study creating three groups: soft, medium and hard. A total of 120 healthy volunteers participated in this eight-week study. Subjects were instructed to brush twice daily for two minutes each time. At four weeks and eight weeks, plaque levels were reduced for all groups, with plaque levels reduced slightly more for the hard-bristle toothbrush group. Bleeding was reduced significantly more for those in the soft toothbrush group and increased from baseline levels in the hard toothbrush group. The medium toothbrush fell between the soft and hard bristle toothbrushes. The soft bristles might reach subgingivally more comfortably to remove subgingival plaque, thus explaining lower bleeding scores for the soft toothbrush users. Evaluation of gingival abrasion revealed an average of 20 lesions in the hard toothbrush group, six in the medium toothbrush group and only two in the soft toothbrush group. Clinical Implications: Hard bristle toothbrushes will remove more plaque from smooth surfaces, but they will also cause tissue trauma compared to soft bristle toothbrushes and lead to higher bleeding scores. Zimmer, S., Öztürk, M., Barthel, C., Bizhang, M., Jordan, R.: Cleaning Efficacy and Soft Tissue Trauma After Use of Manual Toothbrushes with Different Bristle Stiffness. J Perio 82: 267-271, 2011. n perio reports hygiene & prevention Like Father, Like Son – Like Mother, Like Daughter Intergenerational studies show associations between the parents and offspring for cardiovascular disease, diabetes, metabolic syndrome, cancer, asthma, obesity, smoking, alcohol use and drug abuse. Many studies have evaluated the familial role played in aggressive periodontitis, but few studies are available evaluating the intergenerational effect of chronic periodontitis. Researchers at Otago University in Dunedin, New Zealand wanted to know if family history of periodontal disease was a risk factor for future disease in the offspring. Study subjects were part of the Dunedin Multidisciplinary Health and Development Study (DMHDS). During the age32 assessments, a total of 913 subjects received a complete periodontal examination. Parents of these subjects participated in interviews about their periodontal health, being asked if they were ever told they had periodontal disease, were ever treated for periodontal disease or if they lost teeth due to periodontal disease. One or both parents were interviewed for 849 subjects and both parents were interviewed for 625 subjects. Parents were divided into two groups – high risk and low risk. Subjects whose parents were in the high risk group were more likely to show early signs of pocketing and attachment loss. Not surprising, those who smoked and had higher plaque scores also had deeper pockets and more attachment loss. Identifying high-risk individuals early might lead to earlier preventive intervention and thus prevent the disease and the associated cost involved with treatment later. Clinical Implications: Parents share not only their genes and their saliva; they also share environmental and oral hygiene habits, leading to similar periodontal health between parents and offspring. Shearer, D., Thomson, M., Caspi, A., Moffitt, T., Broadbent, J., Poulton, R.: Inter-Generational Continuity in Periodontal Health: Finding from the Dunedin Family History Study. J Clin Perio 38: 301-309, 2011. n Risk for Tooth Loss After Therapy Aggressive periodontitis (AgP) also called “early onset periodontitis” or “localized juvenile periodontitis” is a rare disease that is characterized by rapid attachment loss and bone loss. It affects young people and can lead to edentulism early in life. AgP runs in families and affects less than one percent of the population. Treatment is similar to that provided for chronic periodontitis, non-surgical, surgical and oral hygiene. Researchers at the University of Heidleberg in Germany wanted to know the risk for tooth loss after treatment for AgP. They invited patients who had been treated at the University Hospital Periodontology Clinic between 1992 and 2005 to participate in the study. A total of 84 patients agreed to be re-examined. A full periodontal examination was done and past records were evaluated to determine the supportive periodontal therapy (SPT) intervals and if any teeth had been lost. Less than half of the subjects lost teeth during the ensuing years of SPT and only a few lost more than three teeth. A total of 133 teeth were lost following therapy, or 0.6 percent. Those with only a high school education experienced more tooth loss than those with a college education. Smoking also increased risk of tooth loss. Those who routinely kept their SPT appointment were less likely to experience tooth loss. Those with generalized disease compared to localized disease also experienced more tooth loss. Recurrence of the disease was evident in 24 percent of those evaluated. Clinical Implications: Following treatment for AgP, patients should abstain from smoking and follow the recommended perio maintenance interval to avoid the risk of tooth loss. Bäumer, A., Sayed, N., Reitmeir, P., Eickholz, P., Pretzl, B.: Patient-Related Risk Factors for Tooth Loss in Aggressive Periodontitis After Active Periodontal Therapy. J Clin Perio 38: 347-354, 2011. n continued on page 126 dentaltown.com « May 2011 125 hygiene & prevention perio reports continued from page 125 Review of Black Stain Black stain, also known as brown stain, black line stain or pigmented dental plaque, has been investigated for more than a century and the exact cause still remains unknown. Researchers agree it is most likely caused by specific chromogenic bacteria and perhaps metabolism by the bacteria of iron molecules. The stain might be a thin line or unconnected dots on the enamel along the gingival margin. Examination of the black stain finds high levels of calcium, phosphate and an insoluble ferric salt. Black stain is found in children and disappears before age 20. Prevalence is reported to be from one to 20 percent, depending on the subjects evaluated and the criteria used for identifying black stain. Tobacco use is a significant risk factor for many diseases, including periOver the years several chromogenic odontitis. Many governments have set smoking cessation goals and guidelines bacteria have been suggested as the to encourage professionals to provide the services necessary for smokers to quit. cause of black stain, primarily Prevotella Dental hygienists are in the perfect position to question and counsel smokers melaninogenica and Actinomycetes species. who are ready to quit, but several studies show the number of dental hygiene Salivary levels don’t differ between those clinicians offering smoking cessation counseling to patients is low. with and without the stain, but the pH is Researchers at Kings College London Dental Institute at Guys Hospital in elevated and higher levels of calcium and the U.K. evaluated hygienists’ attitudes and participation in smoking cessation phosphate minerals are found in the saliva activities using a questionnaire. There are approximately 4,000 dental hygienof those with black stain. ists in the U.K. Surveys were sent to 671 hygienists in the east of England, an Black stain is not easily removed with toothbrushing, instead requiring profesarea called the Home Counties. The return rate was 61 percent, with 412 sursional dental hygiene care to remove it veys returned. with instrumentation and polishing. When asked if hygienists should set a good example by not smoking, Removal reveals intact, healthy enamel 97.4 percent agreed. Also, 93.5 percent of respondents felt it was important with no demineralization. Not in all, but to ask patients about smoking habits. Although hygienists were optimistic in many studies, caries rates are reported about offering smoking cessation, 62.8 percent think most people will not lower for children with black stain comgive up tobacco due to the nicotine addition, even if their hygienist tells pared to children without the stain. them they should. The unusual nature of black stain Based on other studies, hygienists who don’t offer smoking cessation counand the likelihood that specific bacteria seling and activities lack the knowledge, training, time, educational materials are responsible for black stain and lower and confidence to achieve success with smoking cessation. caries rates presents a model for the oral probiotic replacement of missing oral Clinical Implications: Hygienists with positive attitudes about the effecmicroorganisms. tiveness of smoking cessation are more likely to initiate smoking cessation counseling and activities for their patients. Clinical Implications: Black stain occurs most often in children and is linked to Pau, A., Olley, R., Murray, S., Chana, B., Gallagher, J.: Dental Hygienists’ Selfslightly lower caries rates and higher Reported Performance of Tobacco Cessation Activities. Oral Health Prev Dent 9: oral pH levels. 29-36, 2011. n Smoking Cessation in the Hands of Hygienists Ronay, V., Attin, T.: Black Stain - A Review. Oral Health Prev Dent 9: 37-45, 2011. n 126 May 2011 » dentaltown.com FREE FACTS, circle 6 on card hygiene & prevention poll Hygienists’ Opinions About Fresh Breath Check out what your peers do in their offices in relation to their patients’ breath in this poll conducted from February 14, 2011 to March 11, 2011. Don’t forget to visit Hygienetown.com and participate in the current online poll. Do you offer a fresh breath program in your practice? Do you recommend a specific tongue cleaner to patients? 26% Yes 74% No 207 total votes 176 total votes 89% 11% No Yes Do you recommend tongue cleaning to your patients? 96% Yes 4% No 172 total votes Do you provide tongue cleaning for your patients? 23% Yes 77% No 176 total votes Do patients ask you for fresh breath advice? 78% Yes 22% No Do you recommend specific products for fresh breath? 58% Yes 42% No 175 total votes 177 total votes Do you tell patients when they have bad breath? Do you tell the dentist when he or she has bad breath? 44% Yes 56% No 178 total votes 27% Yes 73% No 176 total votes Have you seen tonsil stones or tonsoliths in any of your patients? 177 total votes 60% Yes 12% Don’t know what they are 28% No 128 May 2011 » dentaltown.com -- ad index Our advertisers make it possible for us to bring Dentaltown to Advertiser Page # Circle # you each month free of charge. 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IFC 12 Discus Dental, Inc. 25 21 Xlear, Inc. IBC 30 AMD Lasers, LLC Brasseler USA Darby Dental Supply DDS Lab OCO Biomedical, Inc. dentaltown.com « May 2011 129 hygiene & prevention profile in oral health As a society and specifically as a dental community, we sit a lot. Whether in our car, at a computer, on the sofa, or on a dental stool, our spine is sadly at increased risk of injury due to the excessive amount of sitting we endure most of our day. Numerous epidemiological studies have shown that clinicians, as well as professional office workers, who are in a seated position, have an increased chance of suffering from back trouble. The reference list is endless – but you know firsthand, your own back pain is evidence enough. The bottom line is this: sitting can be helpful instead of hurtful. Firstly, to better appreciate why sitting can be so damaging, it is helpful to understand the curvature of the spine and even some history regarding the evolution of chairs. The spine has three natural curves: the cervical, thoracic and lumbar. Every body has different spinal configurations and degrees of curvature. For example, female gymnasts commonly exemplify a large degree of lumbar curvature, termed lordosis, and conversely, a retired senior dentist who hunched over his patients for numerous years, might show a severe thoracic curvature called a kyphosis. The spine has a natural gentle lumbar slope at the base of the spine; however, when we sit, this natural curve is lost and the amount of pressure on each intervertebral disc is doubled when compared to the normal lumbar curve when it is not violated.1 Preventing this loss of curvature is incumbent when sitting on a chair or dental stool; however, most dental stool manufacturers have left out this vitally important aspect of stool mechanics. It has only been very recently that a “lumbar support” has been added to dental stools, but this simple addition is not enough. Problems arise when the pelvis, which intricately attaches to the lower part of the spine at the sacrum, is asked to perform a function it was not designed to do. It is analogous to the patient who uses anterior teeth to gnash food when some of the posterior teeth are missing. Over time, inevitable damage occurs. Chair Changes and Stool Alterations The earliest chairs were an article of state and dignity as well as an emblem of authority (e.g., a king or queen’s throne).2 These chairs were often made of hard wood, ebony by Juli Kagan, RDH, MEd 130 May 2011 » dentaltown.com profile in oral health hygiene & prevention Fig. 1 Fig. 2 or ivory. In Europe, thanks to the Renaissance period, chairs ceased to be a privilege and became a standard item of furniture, but only for those who could afford them. Ergonomics was certainly not part of chair design. Around the early part of the industrial revolution the divide between upper and lower class became more distinct. The poor working class stood all day. Up until this time, dental clinicians also stood; however, some dentists wanted to sit in order to elevate their status and earn greater respect in their profession. In the mid-early-1800s Sir John Tomes of Britain was the first dentist to have a stool in his operatory and perhaps the first person to Fig. 1: Due to an unsupported back, the operator perches forward and cranes her neck in order to get closer sit down and perform dentistry. The chair was to the patient. “overstuffed,” and by 1870 dental stools were Fig. 2: A combined back support and tilted seat pan allows for a healthy lumbar curve and anteversion of commercially available to dentists. Despite the pelvis. Note the hip opening to approximately 130 degrees. the growing market for stools, by the end of blood to the lower extremities. Lastly, the lower back, which the century, dentists still did not feel justified in sitting down.3 In 1909, William Reynolds patented the first dental stool.4 must compensate for the head being held down and forward, is It was not until 1958 that John Naughton, founder of the jeopardized. Imagine a bowling ball hanging from your neck Comfra Lounge Chair Company, had a meeting with two den- while leaning over a patient and you can understand that your tists at a convention to create a dental chair. Even at this time, a tail must overcompensate and round under to counterbalance dental stool for the clinician was not part of the overall design the weight of the head, which can be more than 10 pounds. along with the patient chair. But after observing the clinicians at More significantly, the head weight is doubled for every inch it work, Naughton was convinced that the dentist needed to work progresses forward. It is simple physics: what happens at one end affects the opposite end. from a seated position to preserve energy.5 Up until about 2004, most stool manufacturers used male In the medical arena, stools were originally used in the mid1960s when doctors wanted to sit down to evaluate their dimensions to create a stool, and it was often made to “match” patients. These stools employed a round seat pan and a sort of the décor of the patient dental chair, with little attention to “one-size-fits-all” phenomenon for quick examinations. Trying operator ergonomics. Currently, with the number of female to borrow from the medical profession, doctor stools were sim- dentists increasing every year, the advent of a more personalply ineffective for dentists who needed to sit for longer periods ized and customized chair, designed for women in particular, seems paramount. of time. Unfortunately, most seat pans in the industry are too deep for Dental Stools the average woman.5 When a woman sits on a stool with a seat Today, practicing dentistry or dental hygiene requires the cli- pan that is too large, she often has to perch on the edge of the nician to often sit in a prolonged position. Even while seated the chair in order to work and view the mouth. While seated in this practitioner works between two positions: active and passive. Up very precarious position, the back is unsupported and the body until recently, most stool manufacturers only crafted stools to must compensate with sophisticated maneuvers to get closer to work in the passive position. That is, there was no mechanism the patient. The end result is that the back ultimately gives out. that allowed the chair to tilt forward. When there is no forward tilt mechanism the clinician is Back to Ergonomics There has been tremendous progression of positioning forced to work from the body instead of the support of the chair. Working in this compromised position, the upper- and mid- theories over a very short period of time. It was only in 1988 back rounds and becomes kyphotic to get closer to the patient. that ANSI, the American National Standards Institute, In addition, significant pressure is forced onto the hamstring leg emphasized the 90-degree sitting upright posture as the best muscles, which bear the brunt of the lean, causing restriction of posture. This position is difficult to maintain, especially continued on page 132 dentaltown.com « May 2011 131 hygiene & prevention profile in oral health continued from page 131 when a clinician needs to get close to a position. This allows the clinician to sit softly or almost stand while working. patient, and due to the forward lean, Assembling all the beneficial features most people do not sit back far enough noted above into an effective stool/chair to get back support in that posture. was the brainchild of Le Mans racecar Currently it is believed that opening the winner and owner of Crown Seating, Steve hip angle (formed between the top of Knight. The new innovative chair called the thighs and the abdomen while the Virtù was unveiled at the recent seated) should approximate 130 degrees. Chicago Midwinter Meeting. It has a Even in the forward tilt position, patented ZenWave motion that provides unless the back is supported by the backmild support while in a forward tilt posirest, stress is put on the spine. Ideally, a tion (which opens the hips to approxislight backward tilt would be the most mately 130 degrees), allows the pelvis to comfortable and perfect position, howrotate forward in a natural position (which ever, this is impossible in dentistry unless permits the pelvis to be more anteverted) we can get a patient dental chair to be susand aligns the spine (keeping it neutral pended from the ceiling and work under it and unstressed) thereby protecting the like a car mechanic works on a lift. For now only a handful of dedicated The revolutionary Virtú stool/chair with a spine from further injury. The best comchair manufacturers take judicious time to ZenWave seat pan has a unique free-floating ponent is that the backrest moves with the engineer stools that are ergonomically backrest that aligns the spine, massages the back operator in both the active and passive sound. More often, stools that “come with muscles and improves blood flow to the vulnera- positions, which massages the vulnerable a patient chair” are often not customized, ble lumbar region. lumbar region, promoting blood flow and nor ergonomically sound. nutrients to the lower back muscles and Personalized stools come in a variety of styles each as intervertebral discs. This chair/stool collectively puts all the unique as the user. For example, Crown Seating sculpts out the important and vital components of stool ergonomics together. area in the back of the seat pan to relieve pressure on the tailWe have come a long way from wooden chairs and overbone and rounds the front sides of the pan to relieve pressure stuffed stools. Today, the operator demands more comfort and under the thighs which increases blood flow to the lower legs function while working. But, choosing a stool can be as com(it’s shaped like a bicycle seat) and especially beneficial for plex as the spine itself; every body is different. What might women users. RPG Dental allows for a forward tilt waterfall work for one body might not work for another. When in the design, thereby allowing the clinician to maintain a healthy market, try different types of stools for a period of time. See amount of natural lordosis in the lower back. And as another what works for you. n example, Orascoptic was one of the first to utilize armrests to References aid in neck and shoulder relief. 1. Nachemson, A.The lumbar spine, an orthopaedic challenge. Spine 1976; 1(1):59-71. Many clinicians are starting to prefer a small, but extra 2. Retrieved from en.wikipedia.org/wiki/History_of_the_chair. February 23, 2011. thick lumbar backrest, which provides a proprioceptive qual- 3. Wynbrandt, J.The Excruciating History of Dentistry. St. Martin’s Press; New York, NY; 1998: pp 202-205. ity, allowing continuous feedback to the spine, both in the active as well as the passive position. Conversely, many female 4. Official Gazette of the United States Patent Office. Jan. 12, 1909: Volume 138; pp. 292-293. clinicians are favoring the saddle-type stool with no backrest 5. Knight, Steven R. The Art of Humaneering: Designing a Better Stool for Women. because it aids in moving the pelvis into a more anteriorverted Sullivan Schein Sidekick, Summer, 2006. Author’s Bio Juli Kagan, RDH, MEd: Devoted to wellness, and passionate about physical and mental fitness, as well as proper posture, Juli is a certified Pilates instructor, yoga teacher and professor of health education. With an energy and enthusiasm that transforms knowledge into practice, Juli wrote Mind Your Body: Pilates for the Seated Professional and has created numerous free videos on her Web site. For more information, visit www.julikagan.com. 132 May 2011 » dentaltown.com townie clinical hygiene & prevention Acute Lymphocytic Leukemia Sometimes clinical signs suggest a serious systemic condition rather than the typical periodontal infection. A female patient in her late 50s was referred by her general dentist to evaluate her gingival hyperplasia. The clinical picture suggested a systemic etiology and a provisional diagnosis of leukemia was made. She was referred to her physician for a consultation and work up. Fig. 1 periosupport Posted: 1/28/2011 Post: 1 of 13 Fig. 2 Fig. 1: Note the atypical gingival hyperplasia on the right side. I did not probe the patient. Fig. 2: Maxillary left gingival hyperplasia A diagnosis of acute lymphocytic leukemia was made. She passed away about six months later. ■ Thanks for sharing this with us. How sad! Are those large ulcers in the buccal sulcus also? ■ lindadouglas Posted: 1/29/2011 Post: 3 of 13 Very often it is the dental professional that makes the tentative diagnosis from the clinical presentation. Yes, absolutely sad and her husband was a patient of mine as well. [Posted: 1/29/2011] Yes, there is some ulceration evident in the vestibules – a red flag! ■ periosupport Posted: 1/29/2011 Posts: 4 & 5 of 13 Leukemia Find it online at www.hygienetown.com dentaltown.com « May 2011 133 hygiene & prevention message board Frozen Shoulder One of the risks of clinical work is a frozen shoulder or adhesive capsulitis, which causes pain and stiffness in the shoulder leading to limited range of motion. mmmrdh Posted: 3/15/2011 Post: 1 of 11 134 I have been having a lot of pain in my right shoulder, wrist, elbow and now fingers for the past month. Have been using NSAIDs and icing it, but it has been getting worse. Went to see the MD yesterday and she said I have a frozen shoulder. No patients for two weeks and physical therapy for a month. Has anyone else had this? Did it go away with physical therapy? Will it affect my clinical abilities in the future? The research I did said it doesn’t seem to be indicative of any one profession or industry, but I wonder. ■ jelrdh Posted: 3/25/2011 Post: 5 of 11 Had frozen shoulder months after mastectomy and it took a year to get it back to no pain. Pain did not usually bother me at work. Good luck. Not all physical therapists are equal. Hope you find a good one. ■ jlj2595 Posted: 3/25/2011 Post: 6 of 11 Does this involve your neck as well? I have had (for years) multiple episodes of frozen neck and shoulder with radiating numbness to my non-dominant hand. I have been a clinical RDH since 1989 and finally found relief with a combination of chiropractic care and exercise. I found acupuncture to be helpful as well. NSAIDS, massage and icing were not enough. Physical therapy alone was minimally helpful and my primary care physician had suggested cortisone injections (this is when I decided to try chiropractic treatment). I believe a “frozen shoulder” is also known as thoracic outlet syndrome and rotator cuff tendinitis. I also found wearing magnification loupes very helpful to improve my ergonomics. Poor patient operator positioning is a key cause of these disorders. Making certain to position your patient supine (patient heels even with the chin) is critical to better clinician alignment and will work especially well with loupes. Also, keep your “wings” in to prevent the strain on the shoulders. It might take many months to undo years of wear, so be patient. I hope you find relief soon! ■ periopeak Posted: 3/25/2011 Post: 7 of 11 I have a sister who carries heavy trays for a living with her right arm and shoulder; she ended up with this condition. I urged her to see a chiropractor with a good familiarity with this condition and of the “proadjuster” method (computer scan method) of chiropractic. She waited and waited (very skeptical about chiropractors) and was in severe chronic pain for months. She finally went to a chiropractor because she couldn’t handle the pain anymore. Long story short, she is all better after this care and has had no recurrence for over a year now. No surgery or other things required; a full recovery it seems. You can go online to find a “pro-adjuster” doctor near you. ■ May 2011 » dentaltown.com message board hygiene & prevention I have very similar pain! I am currently in pain management and going through lidocaine IV fusion therapy. I just started and it seems to be working. I know people that have gone through this therapy and have been pain-free for more than two years. I got some relief from Voltaren cream. The treatment that helps the most is stretching and watching my ergonomics. I would also consult an orthopedic surgeon. ■ KeriRDH Posted: 3/26/2011 Post: 8 of 11 I currently am being treated for frozen shoulder by an orthopedic surgeon. My treatment has consisted of three cortisone shots two months apart with some physical therapy. He said it’s common in peri-menopausal women and that, if we do nothing, it will go away on its own in a couple of years. Fortunately for me, I do not practice clinically. I was working three hours a week clinically, but gave that up when this started. My full-time job is teaching and there are some things I can’t do, like turn on my overhead projector to get a PowerPoint presentation going. My students help. Also writing on the white board is difficult if I go too high. Being on the computer is not good. Did you have an X-ray or an MRI? It’s important to get a correct diagnosis. I struggled for a few months with an incorrect diagnosis of rotator cuff tendonitis because my internist did not refer me to an orthopedist soon enough. I went through painful physical therapy for the wrong condition! I say that to spare you the suffering. Get an X-ray and see a specialist! ■ AnnieB25 Posted: 3/27/2011 Post: 9 of 11 Though this might seem too simple to really work – I have a close friend who has been in massage therapy for many years. She has spent huge amounts of money to further her knowledge in neuromuscular therapy (NMT). This woman works miracles on muscle problems. If you can track down a therapist who is skilled at NMT you might save yourself months of pain and a lot of money or even surgery. The NMT is fast, too. Start calling around to the local massage schools or tap into the massage network in your area to find that person with the hands of gold. ■ shazammer1 Posted: 3/27/2011 Post: 10 of 11 I have had some physical therapy and am definitely showing improvement in range of motion and level of pain. Not 100 percent yet, but definitely better than I was two weeks ago (and able to back off a bit on the NSAIDS). The physical therapist has been using a combo of heat, ultrasound, massage, exercises and cold. I am following up at home with heat, exercise and cold before I turn in at night. When I start seeing patients again she is going to come in and evaluate my posture, etc. I will also probably contact our ergonomics department for an evaluation. She also suggested I start getting regular massages. Tomorrow I have an appointment with someone in our integrative medicine department that was recommended by another hygienist. ■ mmmrdh Posted: 3/28/2011 Post: 11 of 11 Frozen Shoulder Find it online at www.hygienetown.com dentaltown.com « May 2011 135 dentally incorrect mother was walking with her four-year-old daughter one day when the daughter picked up something off the ground and started to put it into her mouth. The mother stopped her and said she shouldn’t do that. 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