DT Asia Pacific

Experts discuss future of implantology in Gothenburg / A short interview with Dr Minoru Ueda - Japan / Asia News / Opinion / World News / Business / Word-of-mouth 2.0 / Diagnosis and management of dentine hypersensitivity / The keys to early cancer diagnosis / Testing the bluephase 20i / An interview with Dr Michael Antonio F. Mendoza - the Philippines

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DTAP1009_01-03_TitleNews

04.11.2009

16:17 Uhr

Seite 1

DENTAL TRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition
PUBLISHED IN HONG KONG

www.dental-tribune.asia

NO. 10 VOL. 7

Online reputation

Early cancer diagnosis

Fluoride toothpaste

Dr Lavine on web reviews
and why they are important

The keys to identify
oral mucosal lesions

The search for an effective
utilisation formula

Pages

Experts discuss future of implantology in Gothenburg Medical
First Brånemark Symposium draws over 200 dental professionals to Sweden tourism
slows down,
but could
recover

GOTHENBURG, Sweden/LEIPZIG,
Germany: Professor Per-Ingvar
Brånemark from Sweden has
urged dentist worldwide to refocus on their patients’ needs. Despite the recent developments in
oral and maxillofacial reconstruction, the field should focus on
the development of simple and affordable solutions rather than following commercial interests, he
told Dental Tribune Asia Pacific
during an exclusive interview at
the first P-I Brånemark Symposium in Gothenburg last week.

80-year old Brånemark was
the first clinician to place a modern dental implant back in 1965.
He also discovered the concept of
osseointegration, which had a
huge impact on oral rehabilitation and other clinical disciplines
such as orthopaedics.
The P-I Brånemark Symposium, which is supported by dental
heavyweight Nobel Biocare, is
supposed to be the first in a number of interdisciplinary events focusing on issues like the quality of
life, economics and ethics in regard to oral rehabilitation. The
symposium drew over 250 international scientist and dental ex-

While the economic recession has eroded the growth rate
for medical and dental tourism
by approximately 13.6 per cent
from 2007 to 2009, the economic
recovery may help spur a sustainable 35 per cent annual
growth rate for the medical
tourism industry by 2010, according to a new report released
by the Deloitte Center for Health
Solutions in the US.

Dr Daniel van Steenberghe addressing delegates at the P-I Brånemark Symposium. (DTI/Photo Daniel Zimmermann)

perts, among them doctors from
Australia, China and India, to
Gothenburg in order to met and
discuss the latest concepts and developments in oral and maxillo-facial reconstruction including the
latest advancements in implant
surfaces, bone augmentation, as
well as imaging and CAD/CAMbased prosthetics. New studies revealing promising satisfaction figures among patients that received

treatment with dental implants
were also presented.
“Osseointegration has been
the major breakthrough in 20th
century oral rehabilitation and
brought together clinicians from
different disciplines who otherwise may not have met,” said
Dr Daniel van Steenberghe,
Belgium, Scientific Chairman of
the Symposium. “The purpose of

this meeting is to enhance this
cooperation for the sake of the
patient.”
According to latest industry
figures, the worldwide market
volume for dental implants was
US$700 million in 2008. Industry
experts say that this volume is
expected to increase further due
to lower delivery costs and better
long-term clinical results. DT

Medical tourism has experienced a significant slow down
driven by consumers putting off
elective medical procedures over
the past two years. However, a
better economy and health care
reform in the US will likely propel
growth in the elective outpatient
market, particularly if elective
cosmetic and dental procedures
are not considered basic benefits,
the report states. In 2009, a projected number of 648,000 Americans will travel abroad for outbound medical and dental care. DT
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were recently discussed by the participants of the 6th ESCD Annual Meeting in Paris
INTERNATIONAL NEWS, Page 8
in France. (DTI/Photo Claudia Salwiczek)

China rivals US
in research race

Patients in danger
of zinc overdose

A new report by Thomson
Reuters has found that Chinese
researchers have more than
doubled their output of scientific
papers in recent years and now
rank second after the United
States in terms of volume. In
2008, China published 112,000
papers compared to 340,000 in
the US. DT

The US Consumer Healthcare Products Association has
recently issued a national alert
against the use of denture
creams containing zinc. According to the organisation, exposure
to excess zinc through those
creams can lead to unexplained
weakness, loss of sensation or
other nerve symptoms. DT

A new study from the
Sahlgrenska Academy in Sweden has revealed that substances with high pH values
damage enamel, a condition
usually associated with acid
erosion. The researchers exposed extracted teeth to a number of alkaline substances such
as household degreasers and
found that organic material on
the surface of the tooth dissolves rapidly indicating that
the organic components of
the enamel are also affected,
as the enamel becomes more
porous.
Alkaline degreasers are
mainly used in the food industry, among other things to clean
professional kitchens, but are
also common in the automobile
care industry and to remove
paint from walls and other
surfaces. DT

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[2] => untitled

DTAP1009_01-03_TitleNews

04.11.2009

16:17 Uhr

Seite 2

Asia News

“Oral tissue contains a kind
of powerful stem cell”
A short interview with Dr Minoru Ueda, Japan
Tissue engineering is based on
the concept that the human body
or parts of it can be regenerated
using stem cells. Since the 1980s,
several kinds of tissues and organs
have been generated worldwide
using cultured living cells. Dental
Tribune Asia Pacific in cooperation with FDI’s Worldental Daily
spoke with Dr Minoru Ueda from
Nagoya University in Japan about
key tissue-engineering strategies
and their potential for dentistry.
DTI/WDD: Dr Ueda, tissue
engineering is a relatively new
approach in regenerative medicine. How did it find its way into
dentistry?
Dr Minoru Ueda: The basic
concepts and strategies for tissue
regeneration are general. To regenerate any tissue, we need stem
cells, growth factors and a scaffold.
In the field of dentistry, we have
made much scientific progress in
terms of materials, which gives us
an advantage over other fields of
medicine. We began with developing high-quality materials and then
expanded to using stem cells.
What key tissue-engineering
strategies are currently being
developed for dentistry and how
do they work?
The most important tissue for
dentistry is bone. We are establishing
technologies for bone tissue engineering and apply these clinically
to implant surgery. Secondly, we are
focusing on stem cell science. Oral
tissue contains a kind of powerful
stem cell that can be used to treat systemic diseases, such as brain infarction or heart infarction. The dental
pulp stem cell is one of the most important cells derived from oral tissue.

Which dental conditions will
be the first to be treated or cured
by tissue engineering?
Atrophied alveolar bone and
severe periodontitis.

Dr Minoru Ueda

Is it possible to reconstruct
complex tissue defects made up
of multiple cell types?
Yes, it is. We have succeeded in
reconstructing the structures that
make up periodontal tissues, which
are cementum, bone and periodontal ligament in humans.
There is different legislation
around the world regarding
stem cell research. Could you
please explain how the situation
in Japan differs from other
parts of the world and its effect
on your research?
We can do basic research using
animal cells and human stem cells,
but research using embryonic stem
cells (ES) and induced pluripotent
stem cells (iPS) must be performed
under the control of the ethical committees of each university. In order
to use ES or iPS, we need special
permission from our university and
government. Clinical studies based

on basic research also require approval from our university and government. It is actually very difficult
to gain approval compared to other
countries. So it is easy to conduct
basic research but very difficult to
conduct clinical studies in Japan.
Current debate in the field
of cosmetic dentistry centres on
whether dentists should be allowed to inject osteogenic cells
into patients for non-dental
reasons. What is your opinion on
this matter?
Dentists should not be allowed
to inject any cells by themselves
for non-dental reasons. However,
for cosmetic reasons, dentists can
inject stem cells into the oral and
maxillofacial areas, especially into
the face because cosmetic problems such as wrinkles are not a disease. The surface structures of an
implant are very important, but this
is not a main factor for enhancing
the living cell around the fixture.
What effect will tissue engineering have on the dental
practice during the next 20 to
25 years?
Tissue engineering could provide a new treatment method for
diseases that have not been treatable thus far, such as severe periodontitis and atrophied alveolar
ridges. Also cosmetic therapy using
tissue engineering in the oral and
maxillofacial regions will become
commonplace in the dental practice.
Thank you very much for
the interview. DT
(This interview is published with permission by the FDI World Dental Federation.)

International Imprint
Licensing by Dental Tribune International

Publisher Torsten Oemus

Group Editor/Managing
Editor DT Asia Pacific

Daniel Zimmermann
newsroom@dental-tribune.com
Tel.: +49-341/4 84 74-107

Copy Editors

Sabrina Raaff
Hans Motschmann

Editorial Assistant

Claudia Salwiczek
c.salwiczek@dental-tribune.com

President/CEO

Torsten Oemus

Vice President/Marketing & Sales

Peter Witteczek

Director of Finance & Controlling

Dan Wunderlich

Marketing & Sales Services

Nadine Parczyk

License Inquiries

Jörg Warschat

Accounting

Manuela Hunger

Product Manager

Bernhard Moldenhauer

Executive Producer

Gernot Meyer

Ad Production

Marius Mezger

Designer

Franziska Dachsel

International Editorial Board
Dr Nasser Barghi, Ceramics, USA
Dr Karl Behr, Endodontics, Germany
Dr George Freedman, Esthetics, Canada
Dr Howard Glazer, Cariology, USA
Prof. Dr I. Krejci, Conservative Dentistry, Switzerland
Dr Edward Lynch, Restorative, Ireland
Dr Ziv Mazor, Implantology, Israel
Prof. Dr Georg Meyer, Restorative, Germany
Prof. Dr Rudolph Slavicek, Function, Austria
Dr Marius Steigmann, Implantology, Germany

DENTAL TRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition

Published by Dental Tribune Asia Pacific Ltd.
© 2009, Dental Tribune International GmbH. All rights reserved.
Dental Tribune makes every effort to report clinical information
and manufacturer’s product news accurately, but cannot assume
responsibility for the validity of product claims, or for typographical errors. The publishers also do not assume responsibility
for product names or claims, or statements made by advertisers.
Opinions expressed by authors are their own and may not reflect
those of Dental Tribune International.

Dental Tribune International
Holbeinstr. 29, 04229, Leipzig, Germany
Tel.: +49-341/4 84 74-302 Fax: +49-341/4 84 74-173
Internet: www.dental-tribune.com E-mail: info@dental-tribune.com

Regional Offices
Asia Pacific
DT Asia Pacific Ltd.
c/o Yonto Risio Communications Ltd
Room A, 26/F, 389 King’s Road, North Point, Hong Kong
Tel.: +852-3113-6177 Fax: +852-3113-6199
The Americas
Dental Tribune America, LLC
213 West 35th Street, Suite 801, New York, NY 10001, USA
Tel.: +1-212-244-7181 Fax: +1-212-224-7185

[3] => untitled

DTAP1009_01-03_TitleNews

04.11.2009

16:17 Uhr

Seite 3

DENTAL TRIBUNE Asia Pacific Edition

Asia News

India plans to overhaul dental education system
Daniel Zimmermann
DTI

HONG KONG/LEIPZIG, Germany:
The Dental Council of India has
recently announced the introduction of changes to the country’s deficient dental education
system. According to Council
President Dr Anil Kohli, who

spoke to dental graduates of
the Sri Ramakrishna Dental
College and Hospital in Coimbatore in September, the Council will be investigating the
accreditation standards for
graduate and postgraduate dental courses, as well as continuing
dental education and clinical
fellowship programmes. Other
issues such as CE recognition

in India and abroad will also be
reviewed.

dentistry owing to limited career options.

need for a national oral-health
policy.

India has the largest number of dental schools and students in the world but the quality of dental education has deteriorated recently, especially
in economically under-developed areas. In addition, many
graduates are forced to quit

Dr Kohli said that the implementation of the changes will
take several years to complete
and that they are needed to
improve the quality of dentistry
in the country and to attract
more students from foreign
countries. He also stressed the

“Our own figures show that
only four to five per cent of the
population visit a dentist. We’ll
have to look at this aspect as
the next frontier of dental care
in India if we are going to provide fruitful employment to our
fresh graduates,” he added. DT
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Implant
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Daniel Zimmermann
DTI

HONG KONG/LEIPZIG, Germany:
The International Congress of
Oral Implantologists (ICOI) has
recently launched a new website for its members in the Asia
Pacific region. The site, which
offers services in English, Japanese and Chinese, is supposed
to help Asian members of the
ICOI to communicate with their
respective offices in Shenzhen
and Hong Kong, as well as to
complete memberships, Fellowship, Masterships and Diplomate
applications in their native language, the organisation has announced in a press release.
The ICOI currently has
component societies in Korean
and China and affiliate societies
in Australia, Hong Kong, Taiwan, Singapore, India, Thailand,
Japan and The Philippines. Approximately 2,000 implant specialists from Asia are members
of the ICOI.

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The organisation has also announced a new partnership with
the Chinese Stomatological Association to provide better dental
and implant education to dental
professionals in China. Expected
to be finalised at the American
Lifestyles Expo in Hangzhou
later this month, the initiative
titled “Smile and Chewing Technology” was created to promote
how dental care and implant
technology could improve the
quality of life of Chinese people,
according to ICOI officials. It will
be supported by industry giants
like Johnson & Johnson, Nobel
Biocare and Yoshida Dental.
Founded in 1972, the ICOI is
one of the world’s largest organisations for dental implantology.
It also provides continuing dental implant education through
a number of symposiums and
workshops. The organisation
also publishes Implant Dentistry,
a publication designed to keep
members abreast of the latest research and clinical concepts as
well as numerous ICOI activities
and those of their component and
affiliate societies. DT

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[4] => untitled

DTAP1009_04-05_News

04.11.2009

16:19 Uhr

Seite 1

Opinion

DENTAL TRIBUNE Asia Pacific Edition

Dear
reader,

Dental
education
in India

And the battle goes on ...

Daniel Zimmermann
DTI

Ajay Mahal
USA

Lately, I had the opportunity
to visit two major gatherings of
endodontists and implantologists
in Europe. After listening to a
number of lectures and speaking
to experts it became obvious to
me that both specialties are in almost total denial of one another.
This ongoing cease fire is
nothing new to dentistry but it
cannot disguise the fact that one
field is slowly loosing its grip,
and it’s not implantology. Tooth
replacements have seen a remarkable upswing and are expected to gain a significant market volume of US$1 billion in the
years to come. Growth rates have
slowed down recently but this is
due to the fact that more and
more dental companies are jumping on the implant bandwagon
and taking over market shares
from big players like Nobel
Biocare or Straumann. With the
economy recovering in most
parts of the world, people will
also have more money in their
pockets to invest in their smiles.
P-I Branemark’s call to let the
patient decide at the Gothenburg
Symposium last week must be
acknowledged but it goes out to
the wrong group of people. More
and more patients want aesthetic
teeth and they do not care about
what it takes to get there. Latest
studies also reveal that by now
many consider aesthetics to be
more important than function.
It is up to the dentists to decide whether a tooth should be
replaced or not but constantly
improving treatment options
and lower investments will
make the choice an easy one.
On top of that, a growing number
of implant vendors is practicing
more aggressive marketing. It
seems unlikely that many dentists will resist these market calls
in the long-run.
In Gothenburg, a clinical
scan was shown where basically
all teeth had been replaced with
implants. As ridiculous as this
example may be, it does hold
some truth. The future doesn’t
look very bright for the ‘root’. DT
Yours sincerely,
Daniel Zimmermann
Group Editor
Dental Tribune International

Dental Tribune
welcomes comments,
suggestions and
complaints at feedback@
dental-tribune.com

The rapid growth in the
number of dental colleges, mostly
private, over the last several years
is a defining feature of dental education in India. On the one hand,
this development can be considered beneficial as it potentially
helps address a severe shortage of
dental personnel in India. On the
other hand, however, shortages
of teaching staff brought about
by sharp increases in student
strength do not bode well for the
quality of education imparted.

Oral mucosal lesions—
What GP’s need to know
Prof. Stephen Challacombe
UK

It sounds frightening to think
that there are over forty different
types of mouth ulcers. However,
clinically they can be recognised
as only four major presentations.
If ulcers are recurrent, they are
most likely to be of local origin,

local disease and those that indicate systemic diseases. A medical
history of course will often reveal
that other sites are involved but
sometimes mouth ulcers are the
first signs of systemic diseases,
particularly those of the gastrointestinal tract. If other oral signs
are present, such as a depapillated tongue, this may indicate
haematological deficiencies. The
first decision is whether treatment is required at all or whether
referral is needed; thus, the den-

nation, such as palpation of the
lesion and local nodes, will assist
the diagnosis. Speed is of the
essence and a diagnosis cannot
be made from a picture alone
without these other factors. Nevertheless, it is possible that there
will be situations in which referral of the patient may be difficult,
and in these situations the viewing of the image along with discussion with the practitioner
may help to construct a treatment plan for the patient.

Since the mouth can reflect so
many systemic diseases and can
often be the first sign of such a systemic disease, then clearly general practitioners have a responsibility to be able to distinguish
normal from abnormal mucosa
and then decide which lesions
may reflect local oral disease and
which may reflect systemic diseases. The key recommendation
is then to include a thorough
examination of the soft tissues
when seeing dental patients. DT

DCI could direct more careful
attention to two issues. The first
has to do with training dental hygienists and dental chair assistants.
It is disappointing that compared
to nearly 23 thousand seats available for new entrants to dental colleges, there are only 1,700 slots for
dental assistants and hygienist in
India. This reflects a relative neglect of prevention in oral health
and a lack of career opportunities
for the latter. They are also likely
to be cheaper to train than dentists.
The second issue of concern is that
of implementation of DCI guidelines. India has a long history of
well-articulated regulations and
poor follow up. It would be useful
to think about effective monitoring mechanisms and evaluation
of some of these promising initiatives that DCI is embarking on. DT

Contact Info

Prof. Stephen Challacombe is
currently Head of the Mucosal Biology and Disease Research Group, Dental Institute, King’s College, London,
UK. He can be contacted at
stephen.challacombe@kcl.ac.uk.

Ajay Mayal is currently Associate
Professor of International Health
Economics in the Department of
Global Health and Population at
the Harvard School of Public
Health. He can be contacted at
amahal@hsph.harvard.edu.

“The mouth can reflect so many systemic diseases”
what is known as recurrent
aphthous stomatitis (RAS). Ulcers
linked to systemic diseases are
usually persistent (present all
the time) and are usually found
in middle age onwards, although
not invariably so. Single episodes
of ulcers without persistent or
recurrences are usually viral in
origin; we regard a single persistent ulcer as being malignant until proved otherwise. Diagnosis
of oral lesions is made by combination of the medical history
and the clinical appearance, as
well as any investigations.
In general practice, the key
questions are whether the ulcers
or lesions are recurrent or persistent, when they first occurred
and the number, size and site of
the ulcers. The answers to these
five simple questions can render
it easier to distinguish between
ulcers in the mouth that indicate

tist needs to make a decision
based on the severity of the problem. A general rule is that if the
dentist feels that the ulcers reflect
systemic diseases, then they
should all be referred for further
investigation. The majority of
cases of RAS can be treated in
practice and it is perfectly acceptable for practitioners to attempt
therapy and then to refer should
this therapy not be successful.
Oral medicine groups should
have a regular consultation
clinic, during which the consultant can question a patient and
view lesions, or talk to dentists
about cases, advise on treatment
and then make a decision as to
whether referral is necessary.
When a dentist suspects that a lesion may be malignant, then it is
always best to refer the patient,
since other investigations, such
as a biopsy, and clinical exami-

Efforts by the Dental Council
of India (DCI) to enhance the
quality of dental education in
India and imposing stringent
standards on the qualifications of
dentists newly trained abroad are
thus praiseworthy. These include
making recognition of dental
colleges conditional on making
a fifth year of dental training compulsory. The latest rules also introduce a screening test for individuals trained in dental colleges
located outside the US, Australia
and Europe. The increased age
limit for retirement is another
useful mechanism adopted by
the council to enhance the supply
of teaching faculty. DCI promotion of Continuing Medical
Education programmes can help
enhance the quality of dental care
providers and exposing teaching
faculty to the latest in dental
health research and practice. The
overall DCI approach of taking
a long-term view of dental education in India is also encouraging.

[5] => untitled

DTAP1009_04-05_News

04.11.2009

16:19 Uhr

Seite 2

DENTAL TRIBUNE Asia Pacific Edition

World News

AAE: Issue in implant debate
comes down to saving teeth
Sierra Rendon
DT America

CHICAGO, IL, USA: The
American Association of Endodontists (AAE) has expressed serious concerns over
recent assertions by the American Academy of Implant Dentistry (AAID). According to the
endodontist group, the implantologist group’s position reinforces outdated myths about
root canal treatment.
A press release distributed
by the AAID on 21 September
positioned implants as a better
option than root canal treatment for a variety of reasons,
including higher success rates
and lower financial burdens
—claims that root canal specialists say are inaccurate and
misleading to potential patients.
“Not only has it been proven
that both treatments have
the same success rates,” said
Dr Gerald N. Glickman, president of the AAE, “but several
studies show that root-canal
treated teeth are retained at
about 95 to 97 per cent after
eight years, versus implant
retention of 85 to 90 per cent
during a similar time period.
The AAID chose to ignore the
scientific literature in its news
release.”
Dr Glickman also noted the
inference that diseased teeth
are not worth saving, which he
said does a disservice to both
patients and the dental profession as a whole.

which implants would be a realistic option. He pointed out
that root canal specialists are
ideally qualified to make such
a determination with a patient’s general dentist, and that
all dental professionals are
ethically obligated to inform

patients of all available treatment options. “This whole paradigm is ultimately not about
which treatment modality is
better, but what is best for each
patient. And that is the preservation of the natural dentition,” he said. DT

AEE President Gerald N. Glickman. (DTI/Photo Daniel Zimmermann)
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“Do patients with a broken
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Saving teeth is not so much
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“And arguments that root
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tooth with a root canal rarely
requires follow-up treatment
and generally lasts a lifetime;
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more significant financial
burden.”
Dr Glickman recognises
that there are cases when
a tooth cannot be saved, for

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[6] => untitled

DTAP1009_06-07_News

6

05.11.2009

9:48 Uhr

Seite 1

DENTAL TRIBUNE Asia Pacific Edition

World News

Straumann introduces new implant material
Daniel Zimmermann

DTI

A scanning electron microscope photograph of the porous surface of a
Roxolid implant.(DTI/Photo courtesy
of Institut Straumann AG)

LEIPZIG, Germany: Straumann’s dental implant alloy
Roxolid is now available to
dentists in Europe. Following
the recent launch in North
America, the material was introduced at the 18th Annual
Meeting of the European Association for Osseointegration
(EAO) in Monaco. Roxolid

combines high tensile and fatigue strengths with excellent
osseo-integration, according
to the latest clinical research. It
is designed to increase reliability and confidence, especially
with small diameter implants.
Involving 60 centres and
more than 300 patients, Roxolid has been tested in one of
the largest clinical research
programmes ever undertaken

by a dental implant company
in recent years. Currently, two
other large multi-centre clinical trials are in progress.
Company officials announced that the clinical programme has been extended
to include studies specifically
investigating the need for bone
augmentation and the performance of Roxolid in the front
of the mouth and in narrow

spaces. In addition, preclinical
testing has been broadened to
investigate healing characteristics and to draw direct comparisons with other titanium
alloys.
Roxolid is available in Ø3.3
mm Bone and Soft Tissue Level
implants. DT

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San Francisco, CA, USA: While
the economy is beginning to
show signs of a slow recovery,
many consumers in the US are
struggling with financial challenges, some of which could
affect their health. A survey
released by the American Optometric Association (AOA) has
revealed that 36 per cent of
Americans limited their visits to
doctor because of the recession.
When asked which doctors
they are visiting less, the majority indicated dentist (63 per
cent), followed by primary care
physician (59 per cent) and
optometrist (52 per cent). Only
8 per cent indicated that they
are adhering to their regular
health schedule.
For the fourth year in a row,
the AOA’s American Eye-Q survey found that consumers worry
more about losing their vision
(43 per cent), than their memory
(32 per cent) or their ability to
walk (12 per cent).
“The concept of losing vision
appears very concrete to people,
which may be why people cut
back on other doctor visits first,”
said Minnesota Optometric Association Board of Trustees
member, Dr Jill Hadler (Bright
Eyes Vision Clinic, Otsego).
“We know that many eye and
vision problems have no obvious signs or symptoms, so early
diagnosis and treatment are
critical. We encourage individuals to consider eye and vision
care as an integral part of their
overall health, so cutting back
on any aspect of health care is
not a good idea.”
The fourth annual American
Eye-Q survey was drafted and
commissioned in conjunction
with Penn, Schoen and Berland
Associates (PSB). PSB conducted online interviews between
21 and 24 May 2009 with 1,000
Americans 18 years and older
who were deemed sufficiently
representative of the US population. DT
(Edited by Daniel Zimmermann, DTI)

[7] => untitled

DTAP1009_06-07_News

05.11.2009

9:48 Uhr

Seite 2

DENTAL TRIBUNE Asia Pacific Edition

World News

7

Claims of mercury to cause autism rejected
New study finds similar levels in autistic and normal kids
Reuters

WASHINGTON, DC, USA:
Children with autism have
mercury levels similar to those
of other kids, suggesting the
mysterious disorder is caused
by a range of factors rather
than “a single smoking gun”,
researchers at the University
of California, Davis, said. They
found that children aged 2 to
5 with autism had mercury levels lower than other children
because the autistic kids ate
less fish, the biggest source of
mercury that shows up in the
blood. But when the data were
adjusted for lower fish consumption, blood-mercury concentrations among the autistic
children were roughly similar
to those developing typically.
The children with autism had
mercury levels in line with national norms.
The findings, published online in the journal Environmental Health Perspectives, come
at a time when advocates including parents argue that
mercury found in fish, dental
fillings, vaccines and industrial
emissions are responsible for
autism. The debate became
more vehement recently after
the US Centers for Disease Control and Prevention said autism
was more common than previously thought, affecting one
in 91 children, including about
one in 58 boys.
“It’s time to abandon the
idea that a single smoking gun
will emerge to explain why
so many children are developing autism,” said Irva HertzPicciotto, who led the study.
“Just as autism is complex, with
great variation in severity and
presentation, it is highly likely
that its causes will be found to
be equally complex,” she said in
a statement.

a potential cause of autism,
although many studies and
several reports from the Institute of Medicine have found
no link.
University of California
Davis researchers looked at
452 children, including 249 with
autism, 60 who had other devel-

opmental problems including
Down’s syndrome and 143 children without disorders.
They also examined a variety of mercury sources including fish, nasal sprays, earwax
removal products, vaccinations
and dental fillings made from
a mercury-based amalgam.

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Activists noted that the
University of California study
did not seek to find out whether
mercury might cause autism
because the children’s blood
levels were measured after
autism had been diagnosed.

* Source: Millennium Research Group

Vaccines with mercurycontaining preservative called
thimerosol have also been
blamed by some parents as

“The evidence to date suggests that, without taking account
of both genetic susceptibility
and environmental factors, the
story will remain incomplete,”
Hertz-Picciotto said.“Few studies, however, are taking this kind
of multifaceted approach.” DT

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The research area is due for
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“The results of this study are
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out a link between mercury exposure and autism causation or
severity,” said Sallie Bernard,
executive director of the advocacy group SafeMinds.

Autism researchers are
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household products, medical
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[8] => untitled

DTAP1009_08-09_Business

04.11.2009

16:22 Uhr

Seite 1

DENTAL TRIBUNE Asia Pacific Edition

World News

New York meeting to showcase innovative programmes
Fred Michmershuizen
DTA

NEW YORK, NY, USA: As hosts
of the largest dental meeting in
the USA, the organisers of the
Greater New York Dental Meeting
(GNYDM) feel they have an obligation to the exhibitors and
attendees to excel in presenting
a convention that showcases
the latest products, procedures
and technologies modern dentistry has to offer. To this end,
the 2009 GNYDM, to be held from
27 November to 2 December, will
feature a wide array of new programmes.
In 2008, some 57,854 attendees from 123 countries participated. Pre-registration for 2009
suggests that the number of attendees this year will be even higher.
Dental technology is advancing at an astounding rate. Thus,
the Pride Institute and the GNYDM
are partnering for the first Technology Fair that will run for four
days and take place on the newly
expanded exhibition floor. On
29 and 30 November, the Pride
Institute will also host lectures
designed to showcase the best of
current dental technology.
“Dental technology has always been an important part of
AD

our meeting, so we are very excited to jointly host with the Pride
Institute an annual fair that is
customised to the specific needs
of the rapidly expanding technology sector,” said Executive
Director of the GNYDM Dr Robert
Edwab. “We think it will be a
great time saving for attendees
to have all the technology, education and materials in one place.”
Additionally, the GNYDM
will again partner with Align

Technology to hold its second
educational event InvisalignGNYDM Expo, which will offer
numerous programmes that
will help dental teams learn
the logistics of tooth alignment with Invisalign from some
of the finest clinicians in the
world.
As Invisalign has grown so
rapidly in popularity, the 2009
meeting will feature four days of
Invisalign programmes for the

entire dental team. With such
a diverse range of educational
Invisalign programmes offered,
there is something for everyone
on the team.
All courses will be taught by
Invisalign experts and will take
place in the Invisalign Pavilion
on the exhibition floor. “In 2008,
the Invisalign event attracted
more than 1,200 registrants, and
we are expecting even greater
participation this year,” said

GNYDM General Chairperson
Dr Clifford Salm.
The GNYDM, one of the
largest and most prestigious dental congresses in the USA, is a joint
venture of the New York County
Dental Society and the Second
District Dental Society located
in Brooklyn and Staten Island.
GNYDM provides a broad range
of educational programmes and
hosts over 40,000 health-care
professionals annually. DT

ESCD places focus on patients
Claudia Salwiczek
DTI

PARIS, France/LEIPZIG, Germany:
Members and friends of the European Society of Cosmetic Dentistry
(ESCD) meet in Paris for their
6th annual meeting. Two hundred
attendees from Denmark, Croatia,
Serbia, Germany, Hungary, and
even as far as Australia travelled to
the French capital to learn about
the newest techniques and products, to mingle with colleagues and
to enjoy some of the countless
Parisian attractions.
The noteworthy line-up included 20 international speakers
from India, the UK, Germany,

Austria, the USA, and, of course,
France. Over the course of two
days, scientific sessions and workshops enlightened participants on
diverse topics, such as predictable
bite registration, modern concepts
and risk factors in aesthetic dentistry, aesthetic dilemmas and
solutions, the use of composites,
anterior restorations, and the therapeutic advantages of chairside
CAD/CAM.
Minimally invasive dentistry
and an interdisciplinary approach
to aesthetic dentistry were the focus of most lectures. For instance,
Dr George Kirtley (USA), the creator of the Envision A Smile cosmetic imaging system, highlighted

the importance of an interdisciplinary approach and reminded the
audience that “we treat patients,
not just teeth!” Oftentimes, aesthetic improvements are the collaborative effort of many different
specialists, such as orthodontists,
endodontists and periodontists,
and in some cases also psychologists and nutritionists, he added.
With an impressive case
demonstrating total facial aesthetics, which was certainly a highlight of the meeting and earned
a generous applause from the audience, Dr Kurt Vinzenz (Austria)
opened attendees’ eyes to what
is possible beyond aesthetic dentistry. Sought-after lecturers Prof.

Bernard Touati (France) and Dr
Sasha Jovanovic (USA) concluded
the meeting with their respective
lectures via live web conference
from Los Angeles.
ESCD President Dr Wolfgang
Richter and Congress Chairperson
Dr Jean-Paul Djian concluded the
meeting on a positive note: “We are
very pleased with the meeting, especially considering the difficult
economic times, and look forward
to seeing everyone again in 2010,”
Dr Richter told Dental Tribune.
Next year’s meeting, which will
be held in conjunction with the
AACD, will take place in London
from 23 to 25 September. DT

[9] => untitled

DTAP1009_08-09_Business

04.11.2009

16:22 Uhr

Seite 2

DENTAL TRIBUNE Asia Pacific Edition

Business

9

“We sought to address the increasing needs in the
dental community for comprehensive information”
An interview with Koelmesse’s Michael Dreyer, Vice-President Koelnmesse (Asia Pacific),
and Dr Lewis Lee, President of the Singapore Dental Association, on IDEM Singapore 2010
WDD/DTI: Mr Dreyer,
would you tell us how the
preparations for IDEM Singapore 2010 are coming along?
Michael Dreyer: Even with
the current troubles in the global
economy, IDEM Singapore 2010
is trading on its reputation, and
we already have a full complement of sponsors on board and
bookings for trade-show space
are increasing daily. Now more
than ever, the dental industry
is looking for certainty in these
uncertain times, and the proven
track record of IDEM Singapore
has cemented its place as a pivotal show on the dental calendar.
Why do you think that
IDEM Singapore is doing well
despite the economic downturn?
Combining a well-organised
and widely promoted trade exhibition with a world-class education programme has proven to be
a very successful formula and the
dental industry is looking to capitalise on this. In a slowing economy, the need for manufacturers
and suppliers to both increase
awareness of their products and
transact business is pertinent.
One difference is that our exhibitors are looking to ensure the
maximum return on their investment in order to achieve these
goals and from this perspective,

the dental industry in the region.
IDEM Singapore will benefit
from the extensive knowledge
and experience we have garnered from the previous five
IDEM events and our global
expertise and resources as an
organiser and manager of conferences and exhibitions.

Registration desk at IDEM Singapore 2008.(DTI/Photo courtesy of Koelnmesse Singapore)

IDEM Singapore 2010 offers outstanding value.
We also provide dental practitioners with a convenient and
cost-effective opportunity to gain
exposure to a comprehensive
programme of world-class dental education in a location central
to and easily accessible from
anywhere in the region. This
format of scientific meeting
combined with an extensive
exhibition of new products and
technologies is a very successful
formula.
What can participants expect from IDEM Singapore
in 2010?

ALPRO drives safe and
clean infection control
Daniel Zimmermann
DTI

LEIPZIG, Germany: Germanybased ALPRO is offering a range
of new and proven products
for treatment-water disinfection
and the removal of biofilm from
dental equipment to dentists in
Asia. With BRS Forte, for example, and the independent water
supply system BCS combined
with Alpron and Bilpron, it is possible to provide quality drinking
water for dental units. Hygiene
standards are met with a selection of mild washing liquids and
hand disinfectants, such as the
AlproSept-HDE gel and Cremana derm-protect, which is suitable for the daily care and protection of the hands.
According to the company,
highlights of their product range
are the pressurised spray solutions WL-clean and WL-cid for
manual preparation of dental
transmission instruments. This
system for inner cleaning and disinfection, including cooling water canals and mechanical parts,
was manufactured according to
ISO 15883 standards, and tested
and approved by well-known instrument manufacturers.

With very high material compatibility and proven quick disinfection lines MinutenSpray-classic and PlastiSept (also available
as a high-quality wipe), ALPRO is
able to provide quick efficiency
and excellent cleaning results.
PlastiSept is alcohol free and
intended for sensitive surfaces.
BIB forte is a solution for general
instrument and drill disinfection.
It is economical and intended
to appeal to environmentally
aware and price-conscious practitioners.
ALPRO is a top global specialist in the cleaning, maintenance
and disinfection of instruments
of any kind (including transmission instruments), contaminated
surfaces in practice and dental
aspiration systems with and
without dental amalgam separators. Their AlproJet product line
was the first two-phase system
on the market for the cleaning of
dental aspiration systems. This
was also the first product that
ALPRO marketed 20 years ago.
As a global player, the company
works with over 120 partners
around the world in 45 countries.
Amongst others, local production sites have been set up in
Australia, India and Vietnam. DT

IDEM Singapore will again
provide an excellent opportunity
for manufacturers from around
the world to meet and conduct
trade in a central location in the
Asian region. Since the meeting’s
inception, we have continued to
evolve IDEM to suit the needs of

Dr Lee, what issues did SDA
consider in devising the conference theme for IDEM Singapore 2010?
Dr Lewis Lee: The rapid
growth in popularity of and new
developments in dental implants
and related products, materials
and techniques have dominated
the dental landscape around the
world for some time. In planning the scientific conference for
IDEM Singapore 2010, we sought
to address the increasing needs of
the dental community for comprehensive information on the latest
developments in these areas.

What will conference delegates gain from this scientific
conference?
We have organised a multifaceted programme led by international presenters that will
give delegates access to the latest
research and developments in
the fields of dental aesthetics and
implantology, as well as practical
advice on treatment planning,
operative techniques and postoperative care. We believe delegates will leave the conference
with knowledge that can be
incorporated into daily clinical
practice and a greater understanding of key principles and
philosophies at the leading edge
of dentistry today.
Thank you very much for
the interview. DT
(This interview is published with permission from the FDI World Dental
Federation.)
AD

[10] => untitled

DTAP1009_10-12_Lavine

04.11.2009

16:24 Uhr

Seite 1

DENTAL TRIBUNE Asia Pacific Edition

10 Business

Word-of-mouth 2.0
How leveraging one’s
online reputation can
help attract new patients
Dr Lorne Lavine
USA

It is an undisputed fact
that in the world of dentistry,
no amount of expensive advertising or fancy marketing
can beat the power of wordof-mouth referrals from your
satisfied patients. What your
patients say about you is the
ultimate driver of your business success. Today, consumers increasingly turn to
the Internet to locate and
select a dental practice. Understanding this and using
the right tools will help you
create and maintain the most
relevant, valuable practice
builder you’ll ever have: the
experience and feedback of
your own patients shared
with millions of prospective
patients actively seeking a
new dental practice. It’s up
to you to choose: will your
online reputation consist of
a single thread of random
gossip, or will it become your
most valued asset, carefully
managed and nurtured to
give you the best return on
your investment?
Everyone knows consumers will share a good experience with a few people, but
they’ll make a point of telling
the world about a negative one.
As a service provider, you and
your staff are your brand. You
don’t sell widgets; you sell your
skills, experience, specialties,
personalities, hours and location—and your very existence
and livelihood depend on your
reputation.
We all work hard to ensure
our patients have a good experience and ask that refer us
to friends and family based on
this. Now, take that most valuable scenario, expand it to
hundreds and even thousands
of prospective patients, and
you’ve just moved from the
world of offline word-of-mouth
referrals to the sophisticated new world of online reputation-based marketing—or
word-of-mouth 2.0.
We know that in the growing world of online reviews,
consumers want and expect to
find the local user information
they seek, whether it’s a great
Italian restaurant or a topnotch cosmetic dental practice. As the Internet has come
of age, our universe of availability for goods and services

has exploded. The advent of
local reviews provides a return
to neighbourhood intimacy—
and neighbourhood reputation.
It is highly likely you already have an online reputation, and may not even know it.
Through online web sites, consumers can review and rate
your business. There is no way
to know whether their comments are legitimate. In fact,
these people may have never
seen your dental chair. Like it
or not, these consumers are establishing your online reputation—without your knowledge,

However, even the world’s
leading search engine recognises the extreme power and
relevance of word-of-mouth
feedback. Google recently expanded its offerings to enable
consumers to search for and
compare local businesses online. Try searching for a dentist
in your area by typing in your
postcode followed by the word
dentist in the Google search
box. A map with a listing of

requires time and effort on
your patients’ part, and staff
time to inform patients and
promote the process. Even if
your staff are dedicated to
making your patients aware
of the online review process,
you can only hope patients
remember to follow through
once they get back to their busy
schedules at home and work.
If history is any guide, a passive
approach will result in one or

“It is highly likely you already
have an online reputation, and
may not even know it”
without your control—and there
has been nothing you could
do to manage this exposure,
until now.

Driving patient volumes
As you probably know, the
largest and most powerful
search engine is Google. Today, 67 per cent of all online
searches are conducted using
Google. Google sees 3.2 billion
visits per month. You can optimise your web site to come
up in the free, natural search
results when prospective patients google for a dental practice. If you choose to pay for
exposure, you can subscribe
to Google Adwords (https://adwords.google.com/select/Login), paying for each ‘click’
generated from Google to your
web site. The higher you bid for
a click, the higher your placement in the sponsored section
of Google.
There are many dental
practices that bid more than
£4 for every click, resulting in
thousands of pounds spent
on Adwords each month. One
particular practice I am aware
of spends more than £2,000
a month on Adwords and
claims the cost is “worth every
penny”. As with all advertising,
there are limitations, even beyond expense. Ads are companies promoting themselves,
and today’s savvy consumer
recognises this and filters information accordingly.

ten dental practices will be
displayed above the natural
search results.
To the far right of each listing is a link to reviews. This is
where a consumer can view
what your patients say about
your practice. With this Google
has hit the referral jackpot:
this functionality leverages
consumer relationships and
capitalises on the inherent
credibility of the first-person
testimonial. This is a priceless
intangible—something advertising dollars just can’t buy.

Build your reputation
So how do you, as a dentist,
take advantage of this new tool
to guide and shape your online
reputation? It is important
to remember that this is not
a practice snapshot in time, but
rather a reputation built and
sustained over time. Your best
chance of securing and maintaining a ‘top-ten’ placement
is to be amongst the first to
populate your Google profile—
and to keep a steady stream of
relevant reviews and quality
practice information flowing
in to Google. You can do this
one of two ways: passively or
actively.
The passive approach: you
can hope the patients who
visit your practice have the
wherewithal to create a Google
account, find your Google profile, and submit a review. This

two reviews posted over the
course of several months.
The proactive approach:
today, the only integrated
approach to proactively managing your online reputation
on Google is through companies such as Demandforce
(http://demandforce.com/), an
online patient-communication
company. They recently announced a data integration
agreement with Google that
enables dental practices to
populate their Google profiles
easily, including posting reviews directly from data originating from their communication systems.
With Demandforce, each
patient is automatically sent
a thank-you e-mail message
after each appointment. As
part of the thank-you, they can
choose to submit a confidential
survey of their visit, as well as
a public review. You can read
the reviews of your practice
and post a response or ask for
a review to be removed if
it does not meet standard posting requirements. After seven
days, the data is automatically
sent to Google to populate your
profile.
This proactive approach
results in dozens of reviews
being posted to your profile
every month. In addition to
Google review management,
Demandforce will optimise

your profile by submitting additional information such as
specialties, languages spoken,
insurance accepted, hours of
operation and affiliations. You
can also choose to integrate
online scheduling directly
into your profile. The new
Google review functionality is
included at no additional cost
with a standard monthly subscription.
Whether you opt to take a
passive approach or a proactive approach to building your
online reputation, I highly recommend you take charge to ensure it accurately reflects and
therefore benefits your practice. Your online reputation is
your business and those practices that realise this early on
will have a significant head
start over their peers.
Solicited or not, online reviews are here to stay. Our
patients’ satisfaction and their
resulting word-of-mouth referrals will always be our bread
and butter; only the serving
plate has changed. What are
you doing to shape your online
reputation? Have you googled
your practice or your competitors lately? DT

Contact Info

Dr Lorne Lavine is founder and
president of Dental Technology
Consultants, a company that
aims to address the specialised
technological needs of the dental community. He can be contacted at DrLavine@TheDigital
Dentist.com.

[11] => untitled

DTAP1009_10-12_Lavine

04.11.2009

16:24 Uhr

Seite 2

DENTAL TRIBUNE Asia Pacific Edition

Trends & Applications 11

Diagnosis and management of
dentine hypersensitivity
Dr David G. Gillam
UK

The aim of this review is to
update dental professionals
on this troublesome clinical
condition that is not fully
appreciated by many dental
practitioners and as such is
often under-diagnosed in
dental practice.

Diagnosis and
differential diagnosis
Before considering a treatment strategy for the management of the condition, it is
important to note from the
published literature that there
are a number of individuals
who may be at risk from
dentine hypersensitivity (DH),
for example1 overenthusiastic
brushers, periodontally treated patients, bulimics, people
with xerostomia, high-acid
food/drink consumers, older
people exhibiting gingival
recession, and people who
chew ‘smokeless’ or ‘snuff’
tobacco.

History-taking, oral
examination and diagnosis
One of the difficulties facing
the dental professional when
confronted with a patient complaining of tooth pain is that
there are a number of clinical
conditions that may elicit the
same clinical symptoms as DH,
and they have to be eliminated
before a correct diagnosis of
DH can be made. It is also important to acknowledge that
patients who have been suffering from various types of
orofacial pain in the form of
toothache or tooth sensitivity

may suffer various physical or
emotional symptoms that can
be very upsetting and disturbing to them. For example, they
may experience a feeling of despair or helplessness, and frustration of not being able to cope
and relying on a dental professional to resolve their problem.2 This in turn may make
recording a satisfactory history
of the condition difficult and
the dental professional will
need all his or her skills in obtaining the correct diagnosis,
which will lead to a successful
conclusion in his or her treatment strategy. In a busy dental
practice, this may take time
and the dental professional
needs to be a good listener,
sympathetic and patient in order to elicit the necessary information from the patient.
However, it is important to remember that no irreversible
treatment procedure should
be performed until a definite
diagnosis is made; in other
words, no diagnosis, no treatment.3
No doubt dental professionals may remember various acronyms from Dental
School such as ‘LOCATE’ and
‘SOCRATES’ in order to aid
them in obtaining sufficient information about the character,
site, onset, duration, periodicity and severity of the problem
that the patient may have when
they come to see the dental
professional (the reason for
attending). Further questions
as to what makes the problem
better or worse, as well as asking the patient to describe the
pain he or she is experiencing

(use of word descriptors such
as in the McGill Pain Questionnaire may also be useful) may
give the dental professional
more information to aid his or
her search for the correct diagnosis. A useful question in relation to the severity of the pain is
asking the patient to estimate
his or her pain on a 0 to 10 vi-

tests, relevant to the oral examination may be taken and these
should be able to confirm the
clinical diagnosis based on
a thorough history. Identification of localised areas of exposed buccal or facial aspects
of dentine may be investigated
by using an explorer probe and
gently drawing it across the

(DTI/Photo Tjerrie Smit)

sual analogue scale (no pain
to very severe pain) or simply
relate it as a 0 to 10 numerical
score. It is important for the
dental professional to conduct
this part of the diagnostic
process in a systematic manner. Once the history-taking
has been completed the patient
should be examined, in order
to diagnose the presenting
problem that patient may have.
This will include all extra-oral
and intra-oral tissues (including palpation) in a thorough
and systematic manner. Various investigational aids, such
as radiographs and vitality

dentine surface. This procedure may elicit a response from
the patient, although it is generally accepted that a blast of
cold air from a dental air syringe is more likely to record
a response from the patient if
his or her problem is due to DH.
A practical tip the dental professional can use in the diagnostic process is to apply a varnish such as Duraphat on the
affected area and then retest
using a cold air blast. If the
patient’s response indicates
a reduction in his or her discomfort this may indicate that
the problem is due to DH. This

however should not exclude
the dental professional from
identifying and relieving any
aetiological and predisposing
factors in his or her management strategy.
It is important to note that
diagnosis may not be simple, as
there are a number of conditions that may cause similar
symptoms, of which the dental professional needs to be
aware. These may include conditions such as cracked tooth
syndrome, dental caries, reversible and irreversible pulpitis, fractured teeth or restorations, post-operative sensitivity (from restorative, periodontal and bleaching procedures)
and atypical facial pain (see also
Table 1, page 12). These may
well require a prolonged clinical examination using various
diagnostic tests (such as vitality: pulp tester, ethyl chloride,
ice stick; percussion; and radiographs). A useful tip in diagnosing cracked tooth syndrome, for example, is the use
of a diagnostic local infiltration
or inferior dental block3 or
the use of a tooth sleuth.4 The
importance of the definition as
suggested by Addy et al.5 and
evident from the Canadian
consensus document6 is that it
provides a very useful clinical
description of the condition
and suggests the need to exclude other forms of tooth pain
or sensitivity.

Counselling and prevention
This aspect of the diagnostic and management process is
 DT page 12
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[12] => untitled

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16:24 Uhr

Seite 3

DENTAL TRIBUNE Asia Pacific Edition

12 Trends & Applications
Aetiology

Pain character and timing

Pain intensity

Provoking factors

Relieving factors

Associated features

Dentine hypersensitivity

Sharp, stabbing,
stimulation evoked

Mild to moderate

Thermal, evaporative,
tactile, chemical, osmotic

Removal of the stimulus

Attrition, erosion,
abrasion, abfraction

Reversible pulpitis

Sharp,
stimulation evoked

Mild to moderate

Hot, cold, sweet

Removal of the stimulus

Caries, restorations

Irreversible pulpitis

Sharp, throbbing,
intermittent/continuous

Severe

Hot, chewing, lying flat

Cold in the late stages

Deep caries

Cracked tooth syndrome

Sharp, intermittent

Moderate to severe

Biting, ‘rebound pain’

Peri-apical periodontitis

Deep, continuous boring

Moderate to severe

Biting

Lateral periodontal abscess

Deep, continuous aching

Moderate to severe

Biting

Peri-coronitis

Continuous

Moderate to severe

Biting

Dry socket
(acute alveolar osteitis)

Continuous
4–5 days post-extraction

Moderate to severe

Trauma, para-function
Removal of trauma

Peri-apical redness, swelling,
mobility
Deep pockets redness
and swelling

Removal of trauma

Fever, malaise,
imprint of upper tooth

Irrigation

Loss of clot,
exposed bone

Table 1: Differential diagnosis of dental pain (adapted from Aghabeigi4).
 DT Page 11

often forgotten. It is not acceptable practice to simply treat
DH by providing a toothpaste,

restoration or gingival graft
without due consideration of
the aetiological and predisposing factors that gave rise to the
problem initially. The use of

AD

Jet

diet history sheets to help both
the patient and the dental professional identify the various
erosive elements in the form
of food and drinks is a valid tool
in this process. Advice should
therefore be based on the findings from the completed diet
sheet particularly in identifying the various erosive elements in the patient’s diet.
The dental professional can be
instrumental in educating the
patient by providing information (by demonstration, professional literature etc.) on correct brushing procedures (and
type of brush) in order to prevent/minimise further damage
to the exposed root surface.
The importance of counselling
the patient concerning his or
her intake (especially frequency) of acidic fruits and
beverages with low pH, particularly in relation to when the
teeth are brushed, should not
be underestimated. For exam-

START

ple, brushing with desensitising or fluoride toothpaste prior
to drinking fruit juice may help
to reduce any erosive effects on
the tooth surface, or avoiding
sucking a portion of grapefruit
in the anterior part of the
mouth to prevent loss or dissolution of tooth substance.

Management of
dentine hypersensitivity
It is important that the dental professional not simply rely
on previous success strategies
but address the specific aetiological and predisposing factors relevant to the patient.7
The choice and suitability of
a particular treatment procedure or product should be
based on a sound understanding of evidence-based dentistry rather than on product
literature alone. A problem in
evaluating results from the
various studies in the published literature is that there

is a very strong placebo effect
present when assessing patients with pain in the form of
DH. As emphasised in this article, any treatment strategy
(over-the-counter [OTC] or
in-office) in a patient suffering
from DH should be based on a
correct diagnosis of the condition by the dental professional
who should be aware of other
clinical conditions that are
similar in their presenting
features.5
Management should be
based on the severity of the
condition. For example, for
isolated problems, therapy is
largely professionally delivered in the form of in-office
treatment using adhesives,
resins, cervical restorations
(glass-ionomer cements) and
varnishes that may provide
effective treatment of DH over
 DT page 14

No

Patient complains of transient dentinal pain in response to
stimulation (Note 1)

No treatment required

Yes
Yes

Differential diagnosis: is there an identifiable cause for the
dentinal pain? (Note 2)

Diagnose and treat as
appropriate.

No
Confirm diagnosis of DH
Treat with consideration for convenience and costeffectiveness (Note 3)
1. Preventive advice
2. ‘At-home’ treatment (e.g. desensitizing dentifrice)

No pain relief (Note 5)

Review
(2-4 weeks)
Note 4)

AlproJet-W

Pain relief

Continue with
Preventive advice and
Desensitizing dentifrice

AlproJet-DD

‘In-office’ treatment:
1. Topical agents (e.g. fluorides,
oxalates)
2. Adhesive materials

No further treatment;
Reinforce preventive advice;
continue to review.

Pain relief
Review
(Note 4)

Pain persists
Review diagnosis of DH
DH confirmed

DH not confirmed
Orchardson & Gillam (2006)

Fig. 1: Flowchart for the clinical management of dentine hypersensitivity (adapted with permission of George Warman
Publications [UK] Ltd.).11,22
Note 1: Pain evoked by thermal, evaporative (jet of air), probe, osmotic or chemical stimuli as part of the clinical examination of the patient.
Note 2: Alternative causes of tooth pain include caries, chipped teeth, cracked tooth syndrome, fractured or leaking restorations, gingivitis, palato-gingival grooves, post-restoration sensitivity or pulpitis.
Note 3: Treatment may be delivered in a stratified manner, as follows: with localised or severe dentine hypersensitivity,
dental professionals may prefer to treat the patient directly, using an in-office procedure.
Note 4: Some form of follow-up is recommended. However, the follow-up interval may vary, depending on patient or
dental professional’s preference and circumstances.
Note 5: If mild dentine hypersensitivity persists after the initial follow-up appointment,the dental professional may continue with
preventive and at-home therapies. If the sensitivity is more severe, some form of in-office treatment may be appropriate.

[13] => untitled

A3-out.pdf

C

M

Y

CM

MY

CY

CMY

K

4/14/09

5:16:05 PM

[14] => untitled

DTAP1009_10-12_Lavine

04.11.2009

16:24 Uhr

Seite 4

DENTAL TRIBUNE Asia Pacific Edition

14 Trends & Applications
 DT Page 12

one to three months; although in some situations
pulpal extirpation or extraction of the offending tooth may
be the treatment of choice.
Laser technology has been reported to relieve DH through
creating an altered surface
layer on the root physically
occluding the tubules (smear
layer creation). According to
West, 7 clinical results from
these studies are somewhat
equivocal; therefore, it may be
prudent for more research to
be undertaken before this
technique can be recognised
as an acceptable treatment for
this condition.
8

Guided tissue regeneration
and flap procedures to treat
DH associated with localised
gingival recession have also
been recommended.9 However,
these should not necessarily be
the first treatment option for resolving the problem and, as indicated in this article, providing
a treatment procedure without
identifying and modifying the
aetiological and predisposing
features responsible may not
AD

“The importance of implementing preventative and management
strategies in identifying and eliminating predisposing factors in
particularly erosive factors (such as dietary acids) cannot be ignored...”
resolve the problem in the long
term. Post-operative pain following periodontal procedures
such as scaling, root surface
debridement and periodontal
surgery may also be problematic in the short term and palliative procedures, such as the
application of varnishes (for
example, Duraphat), resins
etc., as well as the adjunctive
use of a desensitising mouthwash, may also be recommended. The use of desensitising toothpastes prior to, during
and following tooth-whitening
procedures has also been recommended and this is particularly important for patients
with a known history of DH who
may be undergoing such procedures.10
Over the last decade a number of new product innovations
have come on to the market,
for example the combination of

casein phosphopeptides (CPP)
and amorphous calcium phosphate (ACP) Recaldent (CPPACP; GC America, Inc.) has
been claimed to reduce DH.
ACP has also been used in
bleaching trays to reduce DH
during the bleaching process.
Products have been developed
from bioactive and bio-compatible glasses that are known
to induce osteogenesis in
physiological systems and may
offer suitable materials for
surface reactivity that could
theoretically occlude tubules.
NovaMin (calcium sodium
phosphosilicate) is a new product formulation found in a variety of dental products for sensitive teeth, such as NuCare
Prophy Paste (Sunstar Butler)
and Oralief Therapy (NovaMin
Technology, Inc.).11
According to Gillam,1 technology based on a combination

of an amino acid arginine and
an insoluble calcium carbonate
compound (Pro-Argin) has recently been developed as a desensitising paste for use in the
dental surgery and as an OTC
toothpaste product (8 per cent
arginine, calcium carbonate,
and 1,450 ppm fluoride as sodium monofluorophosphate).
This technology appears to have
been based on previous work
by Kleinberg12 and it has previously been suggested that at
physiological pH the positively
charged arginine in the combination binds to the negatively charged dentine surface,
thereby encouraging a calciumrich mineral layer into the open
(exposed) dentine tubule, acting as an effective plug or tubular occlude. Initial laboratory
(in vitro) evidence appears to
support this in that the product
does occlude the dentinal
tubules and effectively block
fluid flow and is resistant to an
acid challenge. 13 Evidence
from subsequent clinical studies appears to support its efficacy as a desensitiser.14–17
For generalised sensitivity
involving several teeth, OTC
toothpastes containing potassium (nitrate, chloride and
citrate) and strontium-based
products (strontium/strontium
acetate/fluoride) have been
shown to be clinically effective
in well-controlled clinical
studies, and are readily available to the consumer. According to Orchardson and
Gillam, 18 formulations containing potassium salts (in
toothpaste, gels, solutions and
mouthwashes) have been
widely used for treating DH;
however, the effectiveness of
these formulations (in toothpaste form) in reducing DH has
been questioned.19
It would also be appropriate
for the dental professional to
recommend an OTC product
for the patient to use for two to
four weeks and then review the
situation if the pain has not resolved sufficiently for the patient to enjoy some ‘quality of
life’. Subsequent treatment
could be in the form of a more
invasive therapy, such as
restorations. The advantages,
however, of using an OTC
product readily available for
the treatment of DH by the consumer compared to attending a
dentist for treatment include
ease of access and expense.
One disadvantage is that OTC
desensitising products may
take up to two to four weeks to
relieve symptoms, whereas in
theory a dental professionalapplied therapy ideally may
provide immediate relief of
discomfort.

products in the form of prophylaxis pastes that can be used
by the dental professional in the
dental office and supplemented
by a selected desensitising
product for home use. For the
dental professional who wishes
to be successful in treating the
condition it is important to realise that there is no ‘one size fit’
panacea for the treatment of
this condition but rather a selected armamentarium of products and procedures. It is important therefore for the dental
professional to have a management strategy that is based on
a thorough history and examination, leading to a definitive
diagnosis that involves not
only the removal of any aetiological and predisposing factors, but also careful monitoring of the condition following
initial treatment. To this end,
a number of treatment paradigms have been suggested
by researchers (Fig. 1, page
12).5,6,20–22 However, it is important that the management of
the condition fits in with the
day-to-day running of the individual practice rather than
cause an unnecessary burden
on both the dental professional
and patient.

Conclusion
From reviewing the available literature on the condition
it is apparent that the availability of a vast array of treatments
would indicate either that
there is no one effective desensitising agent for completely
resolving the discomfort or
that the condition, owing to its
highly subjective nature, is difficult to treat irrespective of the
available treatment options.
The importance of implementing preventative and management strategies in identifying
and eliminating predisposing
factors in particularly erosive
factors (such as dietary acids)
cannot be ignored if the dental
professional is to treat this
troublesome clinical condition
successfully. DT
Editorial note: A complete list of references is available from the publisher.

Contact Info

© Gabor & Barbara 2009

One of the interesting observations that may be relevant
in the treatment of DH is the
introduction of desensitising

Dr David G. Gillam can be contacted at d.g.gillam@qmul.ac.uk.

[15] => untitled

Anschnitt_DIN A3

19.10.2009

16:11 Uhr

Seite 1

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[16] => untitled

DTAP1009_16-18_Gordon

04.11.2009

16:26 Uhr

Seite 1

DENTAL TRIBUNE Asia Pacific Edition

16 Trends & Applications

The keys to early cancer diagnosis
Dr Sara Gordon
USA

The young man was just
19 when he came in to see
his dentist after Halloween
because of a sore on the side of
his tongue. A non-smoker and
non-drinker, he did not seem to
be at risk for cancer, so his dentist decided to re-check the lesion before Christmas. By then
the lesion was bigger. When he
finally had a biopsy in January,
the lesion proved to be an invasive squamous cell carcinoma.
Oropharyngeal cancer continues to claim the life of about one
American every hour, accounting for 7,590 deaths in 2008,
according to the American
Cancer Society. Oral cancer
takes a terrible toll if it is not
detected early, as it can rob its
survivors of the ability to eat,
speak and taste.
Dentists often fail to detect
oral cancer until it has invaded
deeply because it can mimic
common traumatic, infectious
or immune diseases. When oral
cancer is detected early enough,
it can be cured; recognised in its
precursor stages, it can even
sometimes be prevented.
The cancer-screening examination includes examining
and palpating the neck, scalp
and face, as well as the mouth
and oropharynx. About twothirds of oral cancers arise in
the lateral/ventral tongue and
the floor of the mouth, but other

common sites include the retromolar pad, the tonsillar pillars,
the soft palate and the oropharynx.
The dentist should thoroughly
examine the lateral tongue by
gently pulling it forward with
gauze, and check the floor of the
mouth when the patient rolls the
tongue back against the palate.

rough because the proliferating
epithelium piles up on the surface and the thickened epithelium hides the red colour of the
underlying blood vessels.
Malignancies of surface tissues, as seen in Figure 2, are often
red and enlarged; unexplained

that persist for more than ten days
should be biopsied.

metal, in susceptible patients
(Fig. 3), and for other reasons.

Lichen planus, or lichenoid
mucositis, has generated heated
debate about its pre-malignant
potential for years. It is now
recognised that there are several
conditions that can share the

There are many reports in
the literature of cancer arising in
a patient previously diagnosed
with lichen planus, but some
retrospective analyses have confirmed that the original clinical

The gagging dental patient is
a perennial problem, but it is
more important than ever to
make the effort to inspect this difficult region. The dentist should
routinely depress the tongue and
examine the soft palate and
oropharynx while the patient
says ‘aaah’. Even the act of gagging presents a momentary opportunity to glimpse the oropharynx and soft palate.
There has been a recent increase in Human Papillomavirus
(HPV)-associated squamous cell
carcinoma of the base of the
tongue and tonsils in young patients, a change that is attributed
to a rise in high-risk HPV infection in the oral cavities of sexually active young adults. Nevertheless, the most common risk
factors for oral cancer remain
tobacco and alcohol use.
About 90 per cent of oropharyngeal malignancies are
squamous cell carcinoma of the
surface mucosa. Precancerous
mucosal lesions are often white
and may appear slightly rough;
unexplained white lesions are often termed Leukoplakia. Lesions
such as shown in Figure 1 look

Fig. 1:This rough white lesion was diagnosed on biopsy as moderate epithelial dysplasia.—Fig. 2:This large red mass was
a squamous cell carcinoma. The lateral tongue is the most common site for oral cancer.

red lesions are often termed
Erythroplakia. Unexplained red
lesions are more likely to be
diagnosed as malignancies than
white lesions when they are biopsied because the expanding malignancy causes inflammation
and secretes molecules that stimulate the formation of new blood
vessels. However, both red and
white lesions are capable of representing malignancy. Malignancies may cause spontaneous pain
or paraesthesia. The general rule
of thumb is that unexplained red,
white and/or ulcerated lesions

clinical appearance of lacy white
lines on a red background and
also the microscopic feature of
a dense T-lymphocyte infiltrate
along the basement membrane.
Lichenoid conditions are probably not all equally likely to generate squamous cell carcinoma.
A lichenoid drug reaction,
for example, is a reaction to a
systemic medication that disappears when the medication is
withdrawn. Lichenoid reactions
can also result from contact with
an allergenic material, such as a

or even microscopic diagnosis
of lichen planus was incorrect.
Apparent malignant transformation of oral lichen planus (OLP)
may represent “red and white
lesions that were dysplastic from
their inception but that mimic
OLP both clinically and histologically.” Figures 4 and 5 demonstrate this concept.
Warty-looking verrucous conditions also may confuse dentists. Many diseases in this group
DT page 18

Fig. 3: This lesion looks much like lichen planus, but it arose when the orthodontic brackets were placed and disappeared when they were removed. Lesions such as this are termed lichenoid mucositis.—
Fig. 4: This rough white lesion was initially thought to be lichen planus, but on biopsy it proved to be a micro-invasive squamous cell carcinoma.—Fig. 5: This photomicrograph of squamous cell carcinoma
demonstrates an area in which lymphocytes are attacking the overlying dysplastic epithelium, giving a microscopic appearance that is similar to lichen planus. Such an inflammatory reaction to dysplasia
may explain why some cases are initially misdiagnosed as lichen planus and later prove to be squamous cell carcinoma.

Fig. 6: Verruca vulgaris, the common wart, is a benign discrete warty lesion that is usually self-limiting. It is caused by some types of HPV. It is more familiar on the skin, and may spread to the mouth by direct
contact.—Fig. 7: Condylomata (genital warts) are also caused by HPV and may be florid in immunosuppressed patients such as this. They are benign.—Fig. 8: Biopsy specimens should be of adequate size (3 mm
or larger) and should be taken from a representative area of the lesion. The dentist should place them in formalin fixative immediately, and then transport them to the oral pathologist for microscopic diagnosis.

[17] => untitled

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[18] => untitled

DTAP1009_16-18_Gordon

04.11.2009

16:26 Uhr

Seite 2

DENTAL TRIBUNE Asia Pacific Edition

18 Trends & Applications
 DT Page 16

are caused by HPV. Benign members of this group include verruca vulgaris, the common wart
(Fig. 6), which is self-limiting in
most patients, and condylomata,
genital warts (Fig. 7), which can
be widespread in the immunosuppressed patient.
There are also pre-malignancies and malignancies in this
group. Proliferative verrucous
leukoplakia (PVL) is a multifocal
verrucous disease that eventu-

ally turns into carcinoma in a
substantial proportion of cases.
Figure 1 may represent a case
of PVL. Verrucous carcinoma is
a large warty malignancy that is
slow to invade but can degenerate into squamous cell carcinoma.

Technique

Example of common brand name

How it works

Toluidine blue vital dye

Orascan

Dyes proliferating tissues blue

Tissue reflectance

Vizilite

Enhances the appearance of white areas

Tissue autofluorescence

Velscope

Abnormal tissue loses normal green autofluorescence, appears black

Brush test

Oral CDx

Superficial epithelial sample is classified as positive, negative or atypical

Table 1: Commercial techniques intended to aid oral cancer detection.

Several commercial chairside applications, such as toluidine blue staining, tissue reflectance, fluorescence imaging
and brush tests, have appeared
on the market in the past decade,
which are intended to help the

dentist with early cancer detection. Despite their attractive
marketing and convenience,
they have not been proven by rigorous Cochrane analysis to either help or hinder early cancer

detection in the general population. Even visual screening programmes have not been proven
to help reduce oral cancer
deaths, and more study is needed
in this field. Table 1 summarises

AD

the currently available adjunctive technologies.
This leaves the dentist with
a very powerful tool: the biopsy,
which is still the only technique
that definitively diagnoses oral
cancer. When combined with a
detailed patient history, as well as
a thorough head and neck examination, it can allow the dentist
to diagnose oral lesions with as
much confidence as possible.
A biopsy is simply the removal
of tissue from a living patient
for the purposes of diagnosis.
Whether the dentist uses a scalpel,
surgical scissors or a surgical
punch, the aim is to retrieve
a piece of tissue that is representative of the entire lesion and preserve it en route to the oral pathology laboratory (Fig. 8). At the laboratory, the specimen is processed
on a glass slide and diagnosed microscopically. Usually it takes a
week or less for the oral pathologist to finalise the biopsy report.

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General pathologists will also accept biopsies from dentists; however, it should be considered that
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By routinely examining every
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Editorial note: A complete list of references is available from the publisher.

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[19] => untitled

Anschnitt_DIN A3

28.01.2009

12:19 Uhr

Seite 1

GC Asia Dental Pte Ltd
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[20] => untitled

DTAP1009_20-23_Ivoclar

04.11.2009

16:29 Uhr

Seite 1

DENTAL TRIBUNE Asia Pacific Edition

20 Trends & Applications

Testing the bluephase 20i
A user report on the new bluephase 20i LED light
Dr Niklas Bartling
Switzerland

We have been using a firstgeneration bluephase LED
light for more than two years
in our dental practice. This
curing light offers a light intensity of 1.200 mW/cm2 and
achieves a wavelength range
similar to the spectrum of
halogen lights, owing to its
poly-wave LED technology.
There was therefore no need
to purchase a new light unit.
Nonetheless, I let myself be
persuaded into testing the
bluephase 20i for three weeks
in my practice, focusing on
assessing the light’s performance in the Turbo programme when used at a
maximum light intensity of
2.000 mW/cm2.
In the past, several suppliers offered curing lights that
were claimed to provide high
light intensities and short
polymerisation times. Unfortunately, most of these lights
failed to live up to these claims
when they were evaluated in
field tests. Against such a background, the employees in my
practice were less than enthusiastic about conducting the
trial. To overcome their resistance, they were first shown
how to operate the four programmes of the bluephase 20i
light. In addition, we drew up
a table of all the materials that
would be used in the trial and
their respective curing times in
conjunction with the Turbo
programme (Fig. 1). Normally,
we select the curing programme individually at each
step in the treatment together
with the dental assistant. It
transpired that the well-known
bluephase programmes—High,
Low and Soft modes—were
used whilst the Turbo programme of the bluephase 20i
was studiously avoided.

Reclaiming trust
The objective of our field
test was to identify the limitations of the new LED light.
Given the reservations of the
team members, we decided to
establish first the depth of cure
achieved using the Turbo programme of the bluephase 20i.
It was hoped that this would
dispel the objections of the
team members. The Heliotest
kit, which used to be available for the fabricating of
custom-made shade samples,
is no longer manufactured. We
therefore created our own test
samples by cutting an approximately 1 cm-long piece from a
straw. Next, we pressed a small
amount of low-viscosity silicone into one side of this piece
of straw and allowed the material to set. Then, we inserted
the piece of straw into an empty
composite syringe and filled
the syringe with composite.

Material

Curing time in conjunction
with the Turbo program

Tetric EvoCeram /
Tetric EvoFlow /
IPS Empress Direct

Compoglass F /

2x5s

Compoglass Flow
Variolink II *,
Variolink Veneer *

5 s per mm ceramic
and per segment

Multilink Automix **
Heliosit Orthodontic

5 s per segment
2x5s

* applies to base paste only; ** applies to dual-curing

Fig. 1: Curing times in conjunction with the Turbo programme of the bluephase 20i
for the materials used in the trial.

Fig. 2: A typical case treated during the trial phase: replacement of defective
fillings on teeth 11 and 12.

If a light probe is placed on the
composite and the material is
polymerised, the depth of cure
can be established as an alternative test method.
As it is not always possible
to place the light probe directly
onto the tooth in dental applications, I increased the distance to the material with a matrix in the course of conducting
my tests. The results were unambiguous: the bluephase 20i
successfully passed all test series conducted with the Turbo
programme in conjunction
with the composites used in
our practice.
I repeated the tests in front
of the practice team with good
effect and all reservations regarding the Turbo programme
and its short curing time of five
seconds suddenly vanished.
From then onwards, nothing
hindered the Turbo programme being used routinely.
On the contrary, this programme became very popular
amongst the team members
and they used it frequently. The
usual waiting times associated
with the layering technique
decreased drastically and swift
working during light-curing
was soon established. All team
members repeatedly commented on the substantial
amount of time that can be
saved by reducing the polymerisation time from twenty to
five seconds.

Fig. 3: The defective restorations were removed…

Fig. 4: …the cavities were filled with Tetric EvoCeram…

Fig. 5: …and the composite was polymerised with the Turbo programme of the bluephase 20i light. A common situation:
the light probe cannot always be placed in an optimal position. With the Turbo light probe (10 > 8 mm), the curing time only
has to be doubled if the distance to the material is 8 mm or more.—Fig. 6: Completed Tetric EvoCeram composite restoration.

Field test in the
dental practice
Several patient cases treated during the trial phase of
bluephase 20i are described
below to provide examples of
how the new light unit may
work.

Fig. 7: Another test case: a gap between two anterior teeth had to be closed. Veneers made of IPS Empress Esthetic were
selected for this purpose.—Fig. 8: When ceramic veneers and Variolink II are polymerised using the Turbo programme
(five seconds per mm of ceramic), it is advisable to protect the margins with Liquid Strip.

In the first case, two defective restorations had to be replaced, one on the distal side of
tooth 11 and the other on the
mesial side of tooth 12 (Fig. 2).
The defective fillings were removed and the cavities filled
with EvoCeram (Figs. 3 & 4).
Next, the restorative material
was polymerised using the
Turbo programme of the bluephase 20i (Figs. 5 & 6). As can
be seen on the pictures, the
DT page 22

Fig. 9: The time-saving was clearly noticeable when the six veneers were placed.—Fig. 10: The result: six IPS Empress
Esthetic veneers placed on teeth 13 to 23 and bleaching of the mandibular teeth.

[21] => untitled

Stand_Satzspiegel_DIN A3

05.10.2009

13:39 Uhr

Seite 1

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[22] => untitled

DTAP1009_20-23_Ivoclar

04.11.2009

16:29 Uhr

Seite 2

DENTAL TRIBUNE Asia Pacific Edition

22 Trends & Applications
DT page 20

light probe cannot always be
positioned directly onto the
tooth. It is therefore essential
to use a high-performance
polymerisation light to ensure
a complete depth of cure in
every situation. The polymerisation time only has to be doubled if the distance between
the composite and the light
emission window is larger
than 8 mm if a Turbo light
probe (10 > 8 mm) is used.
AD

Furthermore, the bluephase 20i provides a clear
advantage when treating children. In such cases, swift working is of paramount importance to prevent the treatment
from turning into a struggle.
Reducing the polymerisation
time to twice five seconds in
conjunction with Compoglass
F is very helpful in these circumstances.

Light-curing through ceramic
Ceramic restorations are
usually more opaque than

“None of the patients complained about pain
when cervical restorations
were cured with the bluephase 20i”
composite ones. If a luting composite is light-cured through
an all-ceramic restoration, the
polymerisation time has to be
increased to ensure complete
polymerisation. In this case,
we had to close a gap between
two anterior teeth, as the
patient was unhappy with the

appearance of his teeth (Fig. 7).
The patient did not desire
orthodontic treatment. As an
alternative, we decided to insert IPS Empress Esthetic veneers. If the Turbo programme
of the bluephase 20i light is
used, a polymerisation time of
five seconds for each millime-

tre of ceramic and for each
segment is required (Fig. 8).
The built-in fan presents a real
advantage in these situations.
Curing lights without integrated cooling tend to overheat
after a short time when used in
continuous operation and, as
a result, have to be switched off
repeatedly to allow them to
cool down for a few minutes.
This situation can be avoided
with the bluephase 20i light.
The restorations can be placed
swiftly. In this case, six veneers
had to be placed in the upper
jaw and the gain in time was
clearly noticeable (Fig. 9). The
time-saving is particularly
substantial when placing extensive multiple restorations
(Fig. 10).
Given the high power of this
curing light, a few glimpses of
doubt emerged at times. In particular, concerns around heat
development during polymerisation were voiced. We asked
ourselves if the gingival tissues
might suffer thermal damage
during polymerisation. To
clarify this issue, I tested the
curing light on myself by having various sites on my tooth
necks irradiated with the light
strength of the Turbo programme for five seconds. I then
took the light probe and placed
it directly onto my gingiva
without help. During all these
cycles of irradiation I did not
feel the slightest heat-induced
pain. Similarly, none of the patients complained about pain
when cervical restorations
were cured with the bluephase
20i, even when the restorations
were inserted without anaesthetic.

Conclusion
Although I had a few reservations at the beginning of the
trial, I was satisfied with the
bluephase 20i in every aspect.
All composites can be reliably
cured, as this curing light emits
light in a similar spectrum as
halogen lights. In addition,
the Turbo programme offers
substantial time-saving when
treating patients. DT

Contact Info

Dr Niklas Bartling can be contacted at zahnarzt@bartling.ch

[23] => untitled

DTAP1009_20-23_Ivoclar

04.11.2009

16:29 Uhr

Seite 3

DENTAL TRIBUNE Asia Pacific Edition

The search for an effective
fluoride toothpaste
utilisation formula
An interview with Dr Michael Antonio F. Mendoza,
the Philippines
ride source for most barangays.
Therefore, we selected a peripheral barangay and a central
barangay in the city of Malolos,
which is located 45 km north of
Manila.
Household health managers
were interviewed on their
knowledge, attitudes and practices regarding oral health,

Oral examination in Malolos. (DTI/Photo Dr Michael Antonio F. Mendoza)

lisation of fluoride toothpaste
in the country. Dental Tribune
Group Editor Daniel Zimmermann spoke with Dr Michael
Antonio F. Mendoza, Assistant
Professor at the College of Dentistry of the University of the
Philippines in Manila, about
the study and the challenges
of making the use of fluoride
toothpaste more effective.
Daniel Zimmermann: Dr
Mendoza, is tooth brushing
with fluoride toothpaste common routine in the Philippines?
Dr Michael Antonio F.
Mendoza: Toothpastes available
in the Philippines are generally
fluoridated and most people use
such toothpaste when they brush
their teeth. However, it is not uncommon in certain parts of the
population to clean teeth without
toothpaste. A toothbrush, washcloth or even a twig is used
with or without alternatives to
dentifrice, such as salt, sand, ash
or just water.
A study was conducted on
the use of fluoride toothpaste
in two Filipino barangays
(villages). What were the objectives of the study and what
were its findings?
With an initial objective to
present oral-health policy options to the local government,
baseline data on fluoride utilisation patterns was first required.
Toothpaste is the primary fluo-

particularly fluoride use. We also
questioned them on the amount
of toothpaste dispensed, the
frequency of use and whether
rinsing was done after brushing.
All interviewed health managers who are dentate brush with
fluoride toothpaste. A hot dogsized amount was used twice to
three times a day, followed by
rinsing with water. We also found
that the use of kiddie toothpaste
was not an established practice.
What effect does the rinsing
habit have on the benefits of
fluoride toothpaste?
Almost all respondents and
their family members rinsed
with water after brushing with
toothpaste. Therefore, the effects
of fluoride were not optimised, as
was evident from an observed
trend of increasing DMFT score
with increasing age.
Were there any differences
with regard to age and gender?
Three out of four respondents
were female, as mothers are
usually considered to be the
household health managers. All
claimed to use fluoride toothpaste regardless of gender.
DMFT scores were higher in the
peripheral barangay. However,
there was only a significant difference in the age group 35 to
44, for which the peripheral
barangay had a high caries level
compared to the moderate level
of the central barangay.

The study was conducted in
early 2008. What has been done
in the last 12 to 16 months to
address the problem?
Workshops were held in
collaboration with the Youth
Council and the mother leaders
to increase their knowledge
of oral health and, hopefully,
their capacity to communicate
the knowledge gained to other
members of the community.
The results of the study were
discussed with the communities
who participated in the study and
members of the City Council involved in the planning and implementation of the research.
However, no specific oral-health
programmes have been established since.

Matrix

Inserts as a
wedge

Convex Contact
Point Maker

Tight Cervical
Marginal Adaptation
avoids overhangs

Flexible wing exerts
pressure for maintained
separation and cervical
adaption

In your opinion, what are
the main challenges of increasing the effectiveness of
brushing with fluoride toothpaste in countries like the
Philippines?
As I mentioned before, Filipinos generally use fluoridated
toothpastes but improper brushing techniques and poor awareness of its benefits negate the
preventive potential of fluoride.
Re-education of patients and reorientation of dental professionals on the optimal use of fluoride,
particularly fluoride toothpastes,
is required.
Only seven per cent of the
population in the Philippines
receives fluoridated drinking
water. Could increased levels
of fluoride in water be of any
help to the problem?
The National Oral Health
Survey of 2006 found a very
low, naturally occurring fluoride
content in drinking water, which
was also evident in tests of water
samples from Malolos.
Although literature indicates
that it would be the most costeffective in terms of prevention,
infrastructure costs and watersystem modification for water
fluoridation would be too prohibitive.
Most countries in the Asia
Pacific region have conditions similar to those in the
Philippines. What are your
recommendations in this regard?
We need to investigate more
practical and cost-effective preventive measures. The proper
use of fluoride toothpastes needs
to be practised and steps to make
fluoride toothpastes more affordable, as the WHO advocates,
should be taken.
Thank you very much for
the interview. DT

The effective use of fluoride for
the prevention of dental caries
is advocated by organisations
like the WHO and the FDI. In
most Asian countries, fluoride
toothpaste is often the only
affordable source of fluoride
for the general population. In
early 2008, a cross-sectional
study was conducted in the
Philippines to evaluate the uti-

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[24] => untitled

Projekt1

08.10.2009

9:54 Uhr

Seite 1

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[cover] => DT Asia Pacific

[toc] => Array ( [0] => Array ( [title] => Experts discuss future of implantology in Gothenburg [page] => 01 ) [1] => Array ( [title] => A short interview with Dr Minoru Ueda - Japan [page] => 02 ) [2] => Array ( [title] => Asia News [page] => 03 ) [3] => Array ( [title] => Opinion [page] => 04 ) [4] => Array ( [title] => World News [page] => 05 ) [5] => Array ( [title] => Business [page] => 09 ) [6] => Array ( [title] => Word-of-mouth 2.0 [page] => 10 ) [7] => Array ( [title] => Diagnosis and management of dentine hypersensitivity [page] => 11 ) [8] => Array ( [title] => The keys to early cancer diagnosis [page] => 16 ) [9] => Array ( [title] => Testing the bluephase 20i [page] => 20 ) [10] => Array ( [title] => An interview with Dr Michael Antonio F. Mendoza - the Philippines [page] => 23 ) ) [toc_html] =>

Table of contents

[toc_titles] =>

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