DT Middle East and Africa

Ajman University Organized a Joint Accredited Dental Conference / Botox and dermal fillers for every dental practice (part1) / Does Your Patient Suffer from Dry Mouth? / Media CME / Meetings & Moore / Botox and dermal fillers for every dental practice (part2)

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April 2010_DTME 4/21/2010 2:42 PM Page 1

DENTAL TRIBUNE
The World’s Dental Newspaper · Middle East & Africa Edition
PUBLISHED IN DUBAI

April 2010

Trends & Applications

4Page

Media CME

Botox and dermal fillers for
every dental practice

MIDDLE EAST
EVENTS 2010

Cutaneous sinus tracts:
An endodontic approach

Hours

4Page

In Cooperation with the Faculty of Dentistry at the Royal College of Surgeons in Ireland

Ajman University Organized a Joint
Accredited Dental Conference
In its quest to promote the Innovative Medical Environment, the
College of Dentistry at Ajman University of Science & Technology
(AUST) and the Faculty of Dentistry
of the Royal College of Surgeons in
Ireland (RCSI), in collaboration
with the Dental Society of the Emirates Medical Association, have organized a multi-disciplinary dental
conference themed, “Advancing
Excellence in Dental Care.”
The two-day event has kicked
off Sunday 4th April at the Sheikh
Zayed Centre for Conferences and
Exhibitions, under the patronage
of H.E. Dr. Saeed Abdulla Salman,
AUST President. In his address
read by Dr. Ahmad Ankit, AUST
Vice President for External Relations and Cultural Affairs, Dr.
Saeed Salman praised the achievements in higher education and scientific research attained by the
United Arab Emirates under the
wise leadership of H.H. Sheikh
Khalifa bin Zayed Al Nahayn, President of the UAE, and H.H. Sheikh
Mohamed bin Rashed Al-Maktoum, Vice President of the UAE
and Ruler of Dubai.
“It is our three dimensional vision – education, information and

NO. 4 VOL. 8

4Page

Ajman University of Science
and Technology member
wins the Arab Dental
Universities Union Award.
The College of Dentistry in
Ajman University of Science and
Technology has organized a tribute ceremony for Dr. Raghad
Hashim, Assistant Professor and
the Head of the Growth & Development Department at the College of Dentistry for her prize
winning of the best scientific research of faculty members in
Arab universities on dentistry in
2009.

investment - that has enlightened
our endeavors and contributed to
the institution’s achievements so
far” said AUST President. “AUST
College of Dentistry,” he explained,
“was the first of its kind in the UAE
when it began offering accredited
programs in the year 2000. Since
that time it has succeeded in fulfilling dozens of projects and initiatives in academia, and serving the
community by providing oral care
to more than 100,000 patients."
Prof. Abdul Azim Ahmed,
Chairman of AUST Innovative
Medical Environment Commission welcomed the participants

saying that "The conference is the
fruition of the endeavours of both
AUST's IMEC and CoD, in implementation of the Reform and Development Plan, devised by the
University's higher administration." Prof. Abdul Azim added that
"the conference is a perfect opportunity for AUST community as well
as other dentistry faculty and students from peer institutions to acquire first hand experience in dental care and to relate with a number

DT page 2

The research was themed the
relation between children oral
health and eating habits. The
prize is awarded by the Union of
Arab Universities in Association
with the Arab Colleges of Dentistry in Beirut, Lebanon.
It is worth noting that Dr.
Hashim had been awarded many
prizes before, to name but a few,
she came first in Al-Owais Award
for Studies and Scientific Innovation in 2005 for the best research
on health and medical sciences
in the UAE, entitled the health
and environmental condition of
the children in Ajman. She also

won Colgate Award after presenting her work at the International Association of Dental Research (IADR) conference held
in Washington, USA in 2005.
During her presence at another
IADR conference in New Orleans, USA, Dr. Hashim had one
of her researches been nominated for the Giddon Award in
2007. DT
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[2] => DTME

April 2010_DTME 4/21/2010 2:43 PM Page 2

DENTAL TRIBUNE Middle East & Africa Edition

News & Opinions
Editorial Board

Prof. Abdullah Al-Shammary, Restorative Dentistry, KSA
Prof. Hussain F. Al Huwaizi, Endodontics, Iraq
Prof. Samar Burgan, Oral Medicine, Jordan
Dr. Abdel Salam Al Askary, Implantology, Egypt

DENTAL TRIBUNE
The World’s Dental Newspaper · Middle East & Africa Edition

Dr. Talal Al-Harbi, Orthodontist, Qatar
Dr. Mohammed H. Al Jishi, Bahrain
Dr. Lara Bakaeen, Prosthodontist , Jordan
Dr. Aisha Sultan, Periodontist, UAE
Dr. Kamal Balaghi Mobin Aesthetics, Iran

President/CEO

Yasir Allawi
y.allawi@dental-tribune.ae

Director mCME:

Dr. D. Mollova
info@cappmea.com

Marketing manager

Khawla Najib
khawla@dental-tribune.ae

Production manager

Hussain Alvi
dentalme@dental-tribune.ae

Published by Education Zone
in licence of Dental Tribune International GmbH
© 2010, 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.

DT Page 1

of prominent and experienced professionals in this field."
In the address of the dean of the
Faculty of Dentistry at the Royal
College of Surgeons in Ireland,
Prof. Patrick J. Byrne expressed his
thanks to Ajman University for organizing the conference and for
bringing together eminent speakers and participants from around
the world. Prof. Patrick, who
praised the existing partnership
between the RCSI and AUST,
briefed the participants on the objectives of the conference, saying
that: "keeping up with the literature and evidence of best practice
in one area of dentistry alone is
onerous, but keeping up with the
whole spectrum of modern dentistry may seem almost impossible.
We hope that in the two days you
will spend with us in Ajman University, we will be able to assist you
with that task."

Dr. Salem Abu Fannas, dean of
AUST College of Dentistry welcomed AUST guests and extended
his appreciation to Dr. Patrick
Byrne and his team from the Royal
College of Surgeons in Ireland,
Prof. Malcolm Harris from the University of Central Lancaster, as well
as Dr. Aisha Sultan, president of the
Dental Society of the Emirates
Medical Association for their support to this event which has
brought together leading academics and clinicians. ”This conference will promote research and
place our students in an international arena to mix with well established masters of Dentistry as a Science and as a Profession.” Dr.
Salem said.

PO Box 214592, Dubai, UAE, Tel + 971 4 391 0257
Fax + 971 4 366 4512 www.dental-tribune.com

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April 2010_DTME 4/21/2010 2:44 PM Page 4

DENTAL TRIBUNE Middle East & Africa Edition

Trends & Applications

Botox and dermal fillers
for every dental practice
The next big thing in dentistry may be expanding into the peri-oral and maxillofacial tissues
Esthetic dentistry has been an
absolute boom over the last 30
years, especially when it comes
to such innovative techniques as

teeth whitening and minimallyinvasive veneers like Cristal Veneers by Aurum Ceramics.

Now that the teeth look good,
what about the peri-oral and
maxillofacial areas around the
mouth and on the face? If the

teeth look good but we ignore the
rest of the face, then we have severely limited what we have done
in esthetic dentistry.
It is time to give serious consideration to extending the oralsystemic connection to the esthetic realms and facial pain areas of the face, which dentists are
more familiar than any other
health-care practitioner. As dentists, we can all do a magnificent
job of making teeth look great
and also give people a healthy
and beautiful smile.

Fig. 1: Strong forehead muscle contractions cause pain and unsightly
lines in the forehead.

Fig. 2: Botox treatment gives a more
esthetic appearance and eliminates facial pain.

Fig. 3: 42-year-old female had moderate nasolabial lines and uneven lips.

Everyone has a shade
And it’s simple to match it
Fig. 4: Dermal filler therapy gives this
patient a more youthful appearance
and fuller lips with a desirable pout
and creates soft tissue esthetics, which
complement her teeth.

She’s an A1B. And, with the improved, lifelike esthetics and “ single-shade simplicity”

of Filtek™ Z350 XT Universal Restorative, it’s the only shade you’ll need to restore
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Botox is a trade name for botulinum toxin, which comes in the
form of a purified protein. The
mechanism of action for Botox is
really quite simple.
Botox is injected into the facial muscles, but really doesn’t
affect the muscle at all. Botulinum toxin affects and blocks
the transmitters between the
motor nerves that innervate the
muscle.
There is no loss of sensory
feeling in the muscles.
Once the motor nerve endings are interrupted, the muscle
cannot contract. When that muscle does not contract, the dynamic motion that causes wrinkles in the skin will stop.
The skin then starts to smooth
out, and in approximately three
to 10 days after treatment, the
skin above those muscles becomes nice and smooth.
The effects of Botox last for
approximately three to four
months, at which time the patient
needs retreatment.
DT page 9

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April 2010_DTME 4/21/2010 2:44 PM Page 5

DENTAL TRIBUNE Middle East & Africa Edition

News & Opinions

Does Your Patient Suffer from Dry Mouth?
What is dry mouth?
We can all suffer from dry
mouth at some point, for example, if we are nervous or stressed.
So most of us are familiar with the
feeling of not having enough
saliva in our mouth to keep it
moist and lubricated. For some
people, however, dry mouth can
be a regular problem. As we get
older we are more likely to experience dry mouth, but it’s also a
problem that can affect people
from their 30s onwards.
What causes dry mouth?
Dry mouth occurs when the
salivary glands stop working effectively. Medicines are known
to cause over 60% of dry mouth
cases, with more than 400 different medications linked to dry
mouth. The number of medicines a patient takes is also directly related to the likelihood of
experiencing dry mouth. Health
conditions are also linked to dry
mouth, such as diabetes or Sjögren’s syndrome. People who
smoke, who are pregnant,
stressed, anxious or dehydrated
are also more likely to have dry
mouth.
What are the symptoms?
The symptoms of dry mouth
can include:
• difficulty in eating, especially
with dry foods, such as cereals or crackers • difficulty in
swallowing and speaking • a
burning sensation in the
mouth • taste disturbances •
painful tongue • dry, cracked,
painful lips • bad breath •
persistent difficulty in wearing dentures • feeling thirsty,
especially at night • dry,
rough tongue. Sometimes the
amount of saliva a person
produces may be reduced by
up to 50% before these symptoms are noticed. These
symptoms can sometimes
have a profound effect on self
confidence.
Does dry mouth cause other
problems?
Saliva plays a very important
protective role in the body. It not
only keeps our mouth moist, it
also helps to protect our teeth
from decay, helps to prevent infections and helps to heal sores in
the mouth.
Are your patients dry mouth
sufferers? •
Do they have difficulty swallowing certain foods? • Does
their mouth feel dry when eating
a meal? • Do they need to sip liquids to help you swallow dry
foods? • Are they taking multiple
medicines? If a patient answered
yes to any of these, he/she may
have dry
Products to ease dry mouth
The Biotène system is specifically designed to treat dry
mouth. The different products in
the Biotène system allow you to
choose the ones that best meet
your lifestyle and dry mouth
needs:
• 1 product specifically designed to help relieve your dry
mouth: the gel provides long lasting relief
• 2 products to help maintain
healthy teeth and prevent tooth

decay in people with dry mouth: a
toothpaste, with fluoride, and
mouthwash which can be used
twice a day in place of the usual
products. These are designed to
be gentle on your mouth as they
are alcohol-free and don’t contain harsh detergents. Biotène
supplements the make-up of normal saliva to replenish dry
mouths. It has a patented enzyme
formulation that:
AD

• helps supplement saliva’s
natural defences
• helps maintain the oral environment to provide protection
against dry mouth
• helps supplement saliva’s
natural antibacterial system weakened in a dry mouth.
Biotène’s gentle formulation is
also free from alcohol and harsh
detergents.

What else can a patient do to
manage dry mouth? •
Sip water or sugar-free drinks
often • Avoid drinks which dry
out the mouth, such as caffeinecontaining drinks (coffee, tea,
some fizzy drinks) and alcohol •
Chew sugar-free gums or sweets
to stimulate saliva flow • Avoid tobacco as this has a drying effect •
Use a humidifier at night to keep
the air full of moisture. To help

keep healthy teeth and avoid
tooth decay: • Brush teeth with a
soft toothbrush after meals and at
bedtime • Floss teeth gently
every day. If there is bleeding
from gums when flossing, this
could be a sign of gum disease. •
Use an SLS-free, fluoride toothpaste, like Biotène, with its gentle
formulation • Avoid alcohol-containing mouthwashes as these
can dry out the mouth • Avoid
sweet, sugary foods • Visit the
dentist at least twice a year for a
check-up.

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DENTAL TRIBUNE Middle East & Africa Edition

Media CME
2
Hours

Cutaneous sinus tracts:
An endodontic approach
Diagnosis and treatment for a successful outcome

isdiagnosis of an extra-oral
sinus tract usually leads to
a destructive invasive treatment of the local skin lesions that is
not curative and often mutilating (Fig.
1). Attempting to treat such lesions
with a circular incision of the orifice
of the cutaneous fistula and excision
of its entire tract with all the ramifications is not consistent with the present
standard of care. Unfortunately, cutaneous fistulae are sometimes treated
as though they are independent dermatologic lesions with the pathogenic
characteristics and treatment prognosis typical for mucosal fistulae. However, even skin biopsy may produce
unnecessary scarring.

Correct diagnosis is the key to
treating this kind of lesion. A gentle
digital finger pad pressure on the apical region of the area suspected can
create a discharge of pus. A DentaScan can provide reliable information
that will help with the final diagnosis
and the subsequent treatment plan. A
correct diagnosis will lead to a simple,
yet effective treatment—the removal of
the infected pulp canal tissue from the
root canal space—resulting in minimal
cutaneous scarring.
Cutaneous sinus tracts of dental
origin have been well documented in the medical literature,dental
literature,and dermatological literature. However, these lesions continue
to be a diagnostic dilemma. Patients
suffering from cutaneous fistulae usually seek treatment from a physician
or a plastic surgeon instead of a dentist and often undergo multiple surgical excisions, multiple biopsies and
antibiotic regimens with eventual recurrence of the cutaneous sinus tract
because the primary dental cause is
frequently misdiagnosed.
The evaluation of a cutaneous
sinus tract must begin with a thorough patient history and awareness
that any cutaneous lesion of the face
and neck could be of dental origin.
The patient’s history may include
complaints of dental problems.
However, patients may not have
any history of an acute or painful
onset. There may also be complaints
of episodic bleeding or drainage
from the cutaneous site with persistence of the cutaneous lesion. Occa-

sionally, there is a history of injury
to the tooth.
Correct diagnosis of the cutaneous sinus of dental origin should be
suspected by the gross appearance
of the lesion. These cases typically
present as erythematous, symmetrical, smooth, non-tender nodules of
one to 20 mm in diameter with crusting and periodic drainage in some
cases. The most characteristic feature
of the nodule is its depression or retraction below the normal surface.
This cutaneous retraction or dimpling
is caused by the fixation of the tract
to the underlying tissues and may be
secondary to the healing process or a
late finding in active disease. Lesions
that previously underwent biopsy and
treatment are usually characterised
by the absence of at least part of the
nodule and frequently by an orifice of
draining sinus at the base of the fixed
depression.
Endodontic infection, the product of cellular degeneration—bacterial toxins—and, occasionally, the
bacteria themselves within the canal
spread through the apical foramen
into the surrounding tissue. Thus, a
slow inflammatory process begins in
the tissue contained within the periodontal ligament. Left to itself, it may
manifest in a variety of ways, ranging
from simple widening or thickening
of the ligament to granuloma or cyst.
Sometimes a fistula may develop, with
the patient reporting intermittent discharge of pus.
The fistula provides a means of
continuous drainage of the lesion. The
opening of the fistula may be found on
the mucosa overlying the tooth that
sustains it, but often it may also be
found at a considerable distance from
the diseased tooth. In some cases, the
fistula may run in the space of the periodontal ligament of the same tooth.
It may even traverse the periodontal ligament of the adjacent healthy
tooth, thus simulating a lesion of periodontal origin. In such cases, negative
pulp tests performed on the crown of
the tooth, indicated by a gutta-percha
cone inserted into the fistula, assist in
making the correct diagnosis.
If the drainage of the fistula is not
continuous but intermittent, it is pre-

ceded by a slight swelling of the area
as a result of the increased pressure
of pus behind the closed orifice. When
the pressure becomes strong enough
to rupture the thin wall of soft tissue,
the suppurative discharge issues externally through the small opening
of the fistulous orifice. This orifice
may heal and then re-close, only to
re-open later. The discharge of pus is
never accompanied by intense pain.
At most, the patient will complain of
slight soreness in the area prior to
reopening of the external orifice. The
pus creates a tract in the surrounding
tissues, following the locus minoris
resistentiae. It may exit, at any point,
in the oral mucosa or even in the skin.
It is not uncommon, particularly in
young patients, to find a cutaneous
fistula at the level of the mental symphysis, if lower incisors are involved,
or in the sub-mandibular region, if a
lower first molar is involved. Also, it
may be found in the floor of the nasal
fossa, if a central incisor is involved.
Attempts to treat cutaneous fistulae with a circular incision of the
orifice of the cutaneous fistula and
excision of its entire tract with all the
ramifications cannot be considered to
comply with the present standard of
care and should be regarded as highly
undesirable. Most of the time, root
canal therapy is the ideal treatment
for such lesions. However, Grossman states that such tracts are lined
by granulation tissue. In his study,
Grossman was unable to identify any
epithelium at all. Bender and Seltzer
also conducted histological studies
of numerous fistulous tracts without
finding an epithelium lining. Given
the current state of knowledge and
scientific data, there is no reason to
recommend surgical removal of such
tracts, just as there is no reason to believe that even epitheliumlined fistula
tracts should not heal after appropriate endodontic therapy.
Obviously, these fistulae must be
distinguished from congenital fistulae
of the neck, both lateral-arising from
the second brachial cleft—and medial—
arising from rests of the thyroglossal
duct—which are lined by an epithelium. Such fistulae are of a different
pathogenesis and definitely do not
resolve spontaneously but only after
careful surgical excisions of the tract.

Fig. 1

Fig. 2a

Fig. 1_Post-op photo one week after external surgery to remove the patient’s sub-mandibular gland.

Fig. 2a_Panoramic X-ray showing some bone rarefaction under teeth
47 and 46.

The differential diagnosis of
the case in question included the
following:
• localised infection of the skin,
such as pyoderma, pimples, ingrown hairs and obstructed sweat
glands;
• traumatic or iatrogenic lesions;
• osteomyelitis;
• tuberculosis; and
• actinomycosis.
Case presentation
The patient was referred to me
from overseas with a large mandibular fistula, which had previously been misdiagnosed as an
infection of the sub-mandibular
gland. Surgery had been performed and his submandibular
gland had been extracted. The
woundhad not healed and the
clinical situation was fast worsening. Thus, the wound had opened
and subinfected with a heavy discharge of pus.
A dentist invited to see the patient immediately telephoned me
and sent a photo of the wound
to me via his mobile phone. Following my recommendation,the
patient was immediately put
under double antibiotic therapy
(Amoxicellin 1000mg twice daily, Metronidazole 500mg twice
daily). The patient presented
to my clinic the following day,
where we started with a detailed
questionnaire to collect all the
information about the history of
the wound. The patient reported
that he had been suffering from
this fistula for quite some time
already with intermittent phases
of discharge of an exudates and
numbness of the lower lip. No
dental pain was reported.
A panoramic X-ray showed
some bone rarefaction under
teeth 47 and 46, but no invasion
of the mandibular nerve tract
was evident (Fig. 2a). A dental
scan with 0.5 mm increment was
performed in order to gain a better idea of the clinical situation.
One of the sagittal slides (013)
clearly shows the lesion around
the distal root of tooth 47, surrounding the apical part and destroying the cortical bone invading the lower soft tissue (Fig. 2b).
Furthermore, the mesial root of
tooth 46 showed apical radiolucency, invading the tract of the
lower mandibular nerve (014;
Fig. 3). This pathology explains
the numbness of the lower lip,
while the pathology around the
distal root of tooth 47 explains the
extra-oral fistula.

The article has been accredited by Health Authority Abu Dhabi as having educational content and is acceptable for up to 2 (Category 1)
credit hours.
Credit may be claimed for one
year from the date of subscription.

Careful review of the axial
slides in the area of tooth 47 (006)
offers an idea about the amount
of bone destruction in the lower
lingual area. The axial slide under tooth 46 reveals the communication between the lesion
under the mesial root and the
mandibular nerve tract (Fig. 4).
Next, we established a clear
diagnosis that the lesion was an
extra-oral cutaneous fistula of
dental origin. The patient was
suffering from a large, infected
open wound and a suitable treatment plan had to be established
quickly. The following solutions
were presented:
1. Extraction of the teeth and
curettage of the area, with extra
attention paid to the mandibular
nerve: This plan could provide
the patient with a solution for
eliminating the infection and allowing the wound to heal. Yet,
two strategic molars would be
lost with this solution and a replacement would not be an easy
job with this amount of bone destruction in the infected area.
2. More conservatively, a root
canal treatment in order to clean
and disinfect the root canal systems of the two molars, followed
by an internal medication and a
3-D obturation capable of blocking the bacteria from reaching
the apical part and trapping the
remaining bacteria inside the
root canal system: This approach
would allow the patient to keep
his molars and would provide an
environment in which the healing process could begin. The risk
would be the establishment of an
external biofilm that cannot heal
by itself and may require microsurgical removal.
The patient and I decided
to preserve the two molars.
Immediately, root canal treatment, cleaning and shaping of
the canal space using TF files
(Sybron- Endo) with copious
and alternate irrigation of Chlorhexidine, SmearClear (SybronEndo), distilled water, and
sodium hypochlorite with ultrasonic activation in a well-established sequence, was performed.
An apical enlargement to size
40 in .04 taper was performed
after crown down with K3 files
(SybronEndo), to disturb the
biofilm mechanically and to
help reduce the colony formation
unit (CFU).

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DENTAL TRIBUNE Middle East & Africa Edition
An intermittent paste was
injected inside the shaped root
canal system. The paste of two
different antibiotics (Augmentin
and Metronidazole) was manually mixed and injected with a
paste filler. A hermetic temporary filling was placed for a week.
The wound was covered with a
dressing of steroids and antibiotic
paste to prevent further external
infection. A week later, the patient was already showing good
progress. The wound had started
to close and less inflammation
and swelling were observed (Fig.
5). The root canal was reopened
and cleaned, and no internal fluids were coming from the periapical region. RealSeal material
was used as obturation material
in a vertical condensation using
RCPSL (Hu-Friedy) and an immediate build-up was performed.
Thereafter, the patient was invited for regular control checkups. A few weeks later, a post-op
X-ray (Fig. 6) and photos were
taken. The wound seemed to be
in good condition and some skin
and fibrous tissues were forming.
While I was writing this article, the patient visited Beirut and
decided to come in for a checkup. He complained of a muscle
disturbance of his lower lip, but
all the previous numbness had
disappeared. He agreed to perform an i-Cat scan in order to
find out what was going on and
to detect any pathology. I was
amazed by the bone formation
and complete healing (Figs. 7–9).
The wound had also healed very
well (Figs. 10a & b). I contacted
a plastic surgeon and asked his
opinion regarding the muscle
disturbance. He posited that such
symptoms may be caused by the
tremendous loss of structure.
Discussion
An important diagnostic modality is the determination of the
nature of fluid draining (if any)
from the cutaneous sinus. During palpation, an attempt should
be made to milk the sinus tract.
Any discharge obtained should
be scrutinised to determine its
nature (saliva, pus or cystic fluid).
Culture and sensitivity testing
of the fluid should also be performed to rule out fungal and
syphilitic infection.
Laskin elaborates on the
physiological and anatomical
factors that influence the spread
and ultimate localisation of dental infections. Stoll and Solomon

also emphasise that the ultimate
path of the sinus (irrespective of
the source) depends on several
factors: most importantly, the
anatomy of the tooth involved,
muscular attachments to the jaw,
fascial planes of the neck, and
involvement of permanent or deciduous teeth. Cutaneous rather
than intra-oral lesions are likely
to occur if the apices of the teeth
are superior to the maxillary
muscle attachments or inferior
to the mandibular muscle attachments.
A pustule is the most common of all purulent draining lesions and is readily recognised by
its superficial location and short
course. Actinomycosis exhibits
multiple draining lesions and
characteristic fine yellow granules in the purulent discharge.
The tooth is often not involved
radiographically. If a sinus tract
does not close after appropriate
removal of the primary cause, the
most common alternative cause
is actinomycosis. (Fig. 5)
The challenge in these kinds
of cases is to assemble all the
pieces of the puzzle and build up
a full idea of the clinical situation.
Assembling the pieces means
that all the diagnostic materials,
such as a history questionnaire,
X-rays, CT scans, and sometimes
biopsy and bacteria culturing,
must be provided in order to establish a correct diagnosis. Most
of the time, the solution will only
be a simple routine that must be
performed in certain conditions.
Turning to solutions that are
more complicated—and that certainly can be more profitable—is
not always the right choice, nor
the most ethical one.

Fig. 2b_Sagittal slide showing
Fig. 2b
the lesion around the distal root
of tooth 47.

Fig. 5

Fig. 3_The mesial root of tooth
46 showing apical radiolucency,
invading the tract of the lower
mandibular nerve (014).
Fig. 4_Axial slide under tooth 46

Fig. 3

Fig. 4

Fig. 5_One week after steroids and antibiotic treatment.
Fig. 6

Fig. 7

Fig. 6_Post-op X-ray a few weeks after treatment.

Fig. 8

Fig. 9

The author would like to
thank Yulia Vorobyeva, PhD, interpreter and translator, for her
help with this article. DT
Figs. 7–9_i-Cat images showing good bone formation and complete healing.
Fig. 10

Fig. 10b

About the author
Dr Philippe Sleiman received his DDS
from the Lebanese University School
of Dentistry in 1989. He conducted a
DES in the endodontic programme at
St Joseph University and a PhD at the
Lebanese University Dental School.
He has authored several international
articles. He has his own line of instruments with the Hu-Friedy company
and contributed to several project developments, and he has lectured internationally. Dr Sleiman is an instructor
at the Lebanese University and an international trainer for the University
of North Carolina. He is a fellow in the
ICD and the AAE. Dr Sleiman maintains a private practice in Beirut, Lebanon, and in Dubai, UAE. Dubai, UAE
and can be reached at phil2sleiman@
hotmail.com.
Figs. 10a & b_Post-op woundhealing.

MEDIA CME
Self-Instruction Program
Dental Tribune Middle East & Africa
in collaboration with CAPP introduce
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mCME gives you the opportunity to
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They can either sign up for a one-year
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Articles and Questionnaires will be
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[8] => DTME

April 2010_DTME 4/21/2010 2:44 PM Page 8

8

DENTAL TRIBUNE Middle East & Africa Edition

Meetings & More

MIDDLE EAST EVENTS 2010
MAY
May 4, 2010 - May 6, 2010 Doha, Qatar
Qmedic 2010
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Contact Person: Habib Alphonse
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May 13, 2010 - May 15, 2010 Colombo, Sri Lanka
APDC Asia Pacific Dental
Congress

C/o Sri Lanka Dental Association
Tel/Fax: +94 11 2595147
E-mail: slda@sltnet.lk
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Congress and Exhibition Venue:
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May 13, 2010 - May 14, 2010 Dubai, UAE
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Oct 29, 2010 - Oct 31, 2010 Mumbai, India
World Dental Show 2010
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Venue: MMRDA Ground, Bandra
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NOVEMBER
Nov 2, 2010 - Nov 6, 2010 Alexandria - Egypt
AIDC 2010 - 17th Alexandria
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Faculty of Dentistry, Alexandria
University
Tel: +203 481 1787
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[9] => DTME

April 2010_DTME 4/21/2010 2:45 PM Page 9

DENTAL TRIBUNE Middle East & Africa Edition
DT Page 4

When is Botox used?
The areas that Botox is commonly used for smoothing of facial wrinkles are the forehead,
between the eyes (glabellar region), and around the corners of
the eyes (crow’s feet) (Figs. 1, 2)
and around the lips.
Botox has important clinical
uses as an adjunct in TMJ and
bruxism cases, and for patients
with chronic TMJ and facial pain.
Botox is also used to complement esthetic dentistry cases; as
a minimally-invasive alternative
to surgically treating high lip line
cases; for denture patients who
have trouble adjusting to new
dentures; for lip augmentation;
and has uses in orthodontic and
periodontic cases where facial
muscle retraining is necessary.
No
other
health-care
provider has the capability to
help patients in so many areas as
do dentists with Botox and dermal fillers.

care professionals, including
dermatologists and plastic surgeons.
It is time to stand up for what
we know and what we can accomplish.

Do patients want this?
Is there a market for these
services? In 2008, close to $3 billion was spent on botulinum
toxin and dermal filler therapy in
the U.S.
Think about this: that was
money spent on non-surgical,

Trends & Applications 9

elective, esthetic procedures that
could have been spent on esthetic dentistry, but the patient
made a distinct choice.
Interestingly, these procedures become more popular in
an uncertain economy because
patients want to do something to
look better that is more affordable than surgical esthetic options.

How do you get there?
Like anything else you do, offering this type of service requires training. The learning

they have had or would like Botox
or dermal filler therapy.
You will be overwhelmed at
the positive response and
shocked at the number of people
you know already receiving
these treatments.

curve is short because you already know how to give comfortable injections. I often give training sessions in Botox and dermal
fillers and dentists are amazed
how easy these procedures are to
learn and accomplish compared
to everything else we do.

Conclusion

Finding practice models is
easy: start asking family and
friends who will fight to have you
practice on them.
If you want even more proof,
ask women in your practice if

What’s the next big thing in
dentistry? It may come as we start
expanding outside of the teeth
and gums into the peri-oral and
maxillofacial tissues, which is
within every dentist’s skill set.

VITA Easyshade Compact –
The exact shade in the blink of an eye.
of

What about dermal
fillers?
Dermal fillers, such as
hyaluronic acid (Juvederm Ultra
and Restylane) are commonly
used to add volume to the face in
the nasolabial folds, oral commissures, lips and marionette
lines (Figs. 3, 4).
As we age, collagen is lost in
these facial areas and these lines
start to deepen. These dermal
fillers are injected right under
the skin to plump up these areas
so that these lines are much less
noticeable.

dig
i

T
tal he
too new
th
sh gen
ad era
e d tio
ete n
rm
ina

Dermal fillers are also used
for lip augmentation and are
used by dentists for high lip line
cases, uneven lips and to make
the peri-oral area more esthetic.
The face looks more youthful and
is the perfect complement to any
esthetic dentistry case that you
do.

We as dentists give injections
all the time; this is just learning
how to give another kind of injection that is outside the mouth, but
is in the same area of the face that
we inject all the time.
Dentists also have a distinct
advantage over dermatologists,
plastic surgeons, medical estheticians and nurses who commonly provide these procedures
in that we can deliver profound
anesthesia in these areas before
accomplishing these filler procedures.
Patients who undergo such
treatment by other health practitioners can be quite uncomfortable during the procedure, and
indeed this is one of the biggest
patient complaints about dermal
fillers.
Many dentists are surprised
to find that more than half of the
United States allow dentists to
provide Botox and dermal fillers
to patients. Why wouldn’t you
provide these services if you already offer whitening and esthetic dentistry to your patients?
I would make the strong argument that dentists are the true
specialists of the face, much
more so than most other health-

3384 E

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tio
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[10] => DTME

April 2010_DTME 4/21/2010 2:46 PM Page 10

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The Digital Therapeutic ChainFrom the Patient to the Production

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[11] => DTME

April 2010_DTME 4/21/2010 2:46 PM Page 11

Time to talk about dry mouth?
Dry mouth is an increasingly common condition, primarily
related to disease and medication use.
In fact more than 400 medicines can cause dry mouth1 and
the prevalence is directly related to the total number of
drugs taken.2

Ask your patient
Some patients develop advanced coping strategies for dealing with
dry mouth, unaware that there are products available that can help
to alleviate the symptoms, like the biotène system.
Diagnosis may also be complicated by the fact physical symptoms
of dry mouth may not occur until salivary flow has been reduced by
50%.3

Diagnosing dry mouth
Four key questions have been validated to help determine the
subjective evaluation of a patient’s dry mouth:4
1
2
3
4

Do you have any difficulty swallowing?
Does your mouth feel dry when eating a meal?
Do you sip liquids to aid in swallowing dry food?
Does the amount of saliva in your mouth seem to be too little, too
much or you do not notice?

Clinical evaluations can also help to pick up on the condition, in
particular:
s USE OF THE MIRROR @STICK TEST PLACE THE MIRROR AGAINST THE BUCCAL
mucosa and tongue. If it adheres to the tissues, then salivary
secretion may be reduced
s CHECKING FOR SALIVA POOLING IS THERE SALIVA POOLING IN THE FLOOR OF
the mouth? If no, salivary rates may be abnormal
s DETERMINING CHANGES IN CARIES RATES AND PRESENTATION LOOKING FOR
unusual sites, e.g. incisal, cuspal and cervical caries.

Consequences of unmanaged dry mouth include caries,
halitosis and oral infections.

Saliva’s natural defences
Saliva’s natural defences contain a mixture of proteins and enzymes,
each of which plays a specific role:5

Protein:
s LACTOFERRIN n CHELATES IRON $EPRIVES BACTERIA OF IRON WHICH IS
essential for bacterial growth.

Enzymes:
s LYSOZYME n DISRUPTS CELL WALLS OF BACTERIA RESULTING IN CELL DEATH
s LACTOPEROXIDASE n SYNTHESIS OF HYPOTHIOCYANITE A POTENT
antimicrobial agent.

The biotène patented salivary LP3 enzyme
system
The biotène formulation supplements natural saliva, providing
some of the missing salivary enzymes and proteins in patients
with xerostomia and hyposalivation to replenish dry mouths.
The biotène system allows patients to choose the right product
to fit in with their lifestyles:
s RELIEF PRODUCTS /RAL "ALANCE GEL
s HYGIENE PRODUCTS TOOTHPASTE AND MOUTHWASH
The range is specifically formulated for the sensitive mucosa of
the dry mouth patient:
s ALCOHOL FREE

s 3,3 FREE

s MILD FLAVOUR

The biotène formulation:
s HELPS MAINTAIN THE ORAL ENVIRONMENT AND PROVIDE PROTECTION
against dry mouth
s HELPS SUPPLEMENT SALIVAS NATURAL DEFENCES
s HELPS SUPPLEMENT SALIVAS NATURAL ANTIBACTERIAL SYSTEM
weakened in a dry mouth.

GSK welcomes
biotène to its oral
care family

leaders in dry mouth treatment
1. %VESON *7 @8EROSTOMIA 0ERIODONTOLOGY 2. 3REEBNY ,- 3CHWARTZ 33 @! REFERENCE GUIDE TO DRUGS AND DRY MOUTH n ND EDITION 'ERODONTOLOGY 3. $AWES # @(OW MUCH
3ALIVA )S %NOUGH FOR !VOIDANCE OF 8EROSTOMIA #ARIES 2ES 4. &OX 0# "USCH +! "AUM "* @3UBJECTIVE REPORTS OF XEROSTOMIA AND OBJECTIVE MEASURES OF SALIVARY GLAND PERFORMANCE *!$!
5. 4ENUVUO * @#LINICAL APPLICATIONS OF ANTIMICROBIAL HOST PROTEINS LACTOPEROXIDASE LYSOZYME AND LACTOFERRIN IN XEROSTOMIA EFFICACY AND SAFETY /RAL $ISEASE

[12] => DTME

April 2010_DTME 4/21/2010 2:46 PM Page 12

Everyone has a shade.
And it’s simple to match it.

She’s an A1B. And, with the improved, lifelike esthetics and “single-shade simplicity”

© 3M 2010. All rights reserved. 3M, ESPE and Filtek are trademarks of 3M or 3M ESPE AG. *In vitro data on file.

of Filtek™ Z350 XT Universal Restorative, it’s the only shade you’ll need to restore
her beautiful smile.
Simple to use
s %XCEPTIONAL HANDLING
s -ORE "ODY SHADES FOR SINGLE SHADE RESTORATIONS
s "OLD EASY TO READ COLOR CODED LABELS
Lifelike esthetics
s %XCELLENT POLISH
s 7IDE RANGE OF SHADES AND OPACITIES
s )MPROVED mUORESCENCE
Unique nanofiller technology
s "ETTER POLISH RETENTION THAN A MICROlLL
s 7EARS BETTER THAN LEADING COMPETITORS
s /UTSTANDING STRENGTH FOR ANTERIOR AND POSTERIOR USE
Your simple solu
solution for lifelike restorations is Filtek Z350 XT Universal Restorative.

FFiltek
iltek ZZ350
350 XXTT
™

Universal
Universal Res
Restorative
torative

) [page_count] => 12 [pdf_ping_data] => Array ( [page_count] => 12 [format] => PDF [width] => 888 [height] => 1237 [colorspace] => COLORSPACE_UNDEFINED ) [linked_companies] => Array ( [ids] => Array ( ) ) [cover_url] => [cover_three] =>

[cover] => DT Middle East and Africa

[toc] => Array ( [0] => Array ( [title] => Ajman University Organized a Joint Accredited Dental Conference [page] => 01 ) [1] => Array ( [title] => Botox and dermal fillers for every dental practice (part1) [page] => 04 ) [2] => Array ( [title] => Does Your Patient Suffer from Dry Mouth? [page] => 05 ) [3] => Array ( [title] => Media CME [page] => 06 ) [4] => Array ( [title] => Meetings & Moore [page] => 08 ) [5] => Array ( [title] => Botox and dermal fillers for every dental practice (part2) [page] => 09 ) ) [toc_html] =>

Table of contents

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