DT U.S.

FDI - FOLA and DTI launch campaign for Haitian dentists / News / Are new patients tripping over your phone line? / Oral Pathology / Practice transition planning (part 1) / Thinking outside the box / Yankee Dental Congress: education from every angle / Hinman 2010 offers new highlights / Industry News

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DENTAL TRIBUNE
The World’s Dental Newspaper · U.S. Edition

February 2010

www.dental-tribune.com

Vol. 5, No. 3

HYGIENE TRIBUNE
The World’s Dental Hygiene Newspaper · U.S. Edition

Planning a practice transition?

Practice ownership is the major focus for most
u page 8
dentists.

Thinking outside the box

Dental makeovers without resorting to extensive
u page 10
surgical solutions.

We braved chilly Boston …

So you didn’t have to! Read all about the Yankee
Dental Congress.
upage 14

FDI, FOLA and DTI launch
campaign for Haitian dentists
By Javier M. de Pison, Editor in Chief
Dental Tribune Latin America

The president of the Haitian Dental Association, Dr. Samuel Prophet,
told Dental Tribune Latin America that he and several colleagues
he was able to contact in Port-auPrince were fine after the devastating earthquake in his country. “So
far, we only have reports of two
missing dentists,” Prophet wrote in
an e-mail.
The recent earthquake not only
devastated Haiti’s meager health
resources, but also most dental

practices. In a country were there
were only 500 dentists for nine million people before Jan. 12, 2010,
the extent of the devastation has
affected regular people and dental
professionals alike.
The president of the Latin American Dental Federation (FOLA), Dr.
Adolfo Rodríguez, launched a campaign immediately after the quake
to help both the general population
and dental professionals in Haiti.
Rodríguez, who is also the president of the Dominican Dental Assog DT page 2

Diagnose this: oral pathology
If this patient presented
in your office, what
diagnosis would you
make? Test your skills,
and expand your overall knowledge via our
new oral pathology
section written by
experts in the field.

FOLA president Adolfo Rodríguez, center, asks for help for Haiti at a meeting
in Panama. Rodríguez is flanked by the president, right, and vice president
of the Panama Dental Association.

Signs point to uptick for
dental products industry
By Fred Michmershuizen, Online Editor

After one of the worst slumps
in decades, the American economy has been showing signs of
improvement in recent weeks —
and several factors show better
days may be ahead for the dental
products industry as well.
The gross domestic product,

g See page 5 for the test

which is considered the broadest measure of economic activity,
expanded at an annual rate of 5.7
percent in the fourth quarter of
2009, its biggest jump in more than
six years.
The growth followed a 2.2 percent increase the previous quarter.
g DT page 3
AD

g See page 6 for the

answer (no skipping
to this page first!)

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News

f DT page 1
ciation (AOP), is asking companies
and dental professionals to donate
dental instruments, materials and
equipment. He is organizing the
campaign for Haiti with the help of
FDI World Dental Federation and
Dental Tribune International.
In addition, Rodríguez is putting
together teams of dental volunteers
to travel to Haiti once the major
health and humanitarian crises are
under control, or at least manageable, to attend to the dental needs of
the population.
The hub for this effort would be
the headquarters of AOP in Santo
Domingo.
“We also need to show our support for our colleagues in Haiti,
most of whom have lost everything,”
Rodríguez said. “We need to get
them back on their feet by helping
them to rebuild their practices.”

Lost practices
Prophet said in his e-mail that
“many of our colleagues have lost
their practices and we were thinking about how to help them. It’s very
good news to know that FOLA, FDI
and Dental Tribune are trying to
help Haitian dentists.”
If dentists know “that help is on
the way, they can have hope.” Den-

Dental Tribune | February 2010
tal Tribune will publicize this campaign for Haiti in its worldwide print
and online editions.
At a meeting in Panama, Rodríguez received the support of the
presidents of Central American dental associations, and made an emotional appeal to dental manufacturers to donate much needed supplies.
He said Colgate has already
agreed to donate brushes and toothpaste, and that he meet with KaVo in
Brazil at the San Paulo International
Dental Meeting meeting to ask for
donations of new and used dental
units.
Rodríguez added that it was moving to witness dental professionals
from countries with little resources
such as Honduras, Nicaragua and
El Salvador say that they will collect
funds from their members, secondhand equipment and dental supplies
to help their Haitian colleagues.
Some prominent Latin American
dental professionals from Brazil,
Uruguay and Costa Rica, among
others, have already expressed their
interest in participating in dental
teams to help the most urgent needs
of the Haitian population.
Conditions on the ground seem
to indicate that these teams would
operate in mobile units at the
Dominican-Haiti border, once the
most pressing health emergencies

and needs are somewhat under control.
The reason for this is that most of
Port-au-Prince is in ruins, and the
Dominican government has moved
the majority of its mobile health
resources to the border in an effort
to treat Haitians, and avoid a migratory exodus.
Rodríguez said that this tragedy
“is also an opportunity to build a
public health service that includes
dental care. We have asked the Pan
American Health Organization, FDI,
all Latin American dental associations, companies and other institutions for help in putting together
teams of dental professionals to
travel to Haiti and start working
there, and leave in place basic dental treatment centers.”
Rodríguez added that this would
be a long-term program that includes
rebuilding the dental school at the
university as well as private practices. It will also take some time to
start, and he said that the priorities would be treating children and
pregnant women.
Rodríguez also said he has asked
for funding from the government of
the Dominican Republic.
Companies and dentists interested in helping Haiti should contact
Rodríguez at arn@codetel.net.do or
by phone at (809) 519-0789. DT

Added raisins to cereal doesn’t
inrease acidity of dental plaque
Elevated dental plaque acid is a
risk factor that contributes to cavities in children.
However, eating bran flakes
with raisins containing no added
sugar does not promote more acid
in dental plaque than bran flakes
alone, according to new research
at the University of Illinois at Chicago College of Dentistry.
Some dentists believe sweet,
sticky foods such as raisins cause
cavities because they are difficult
to clear off the tooth surfaces, said
Dr. Christine Wu, professor and
director of Cariology Research at
the University of Illinois at Chicago College of Dentistry and lead
investigator of the study.
Nevertheless, studies have
shown that raisins are rapidly
cleared from the surface of the
teeth just like apples, bananas and
chocolate, she said.

In the study, published in the
journal Pediatric Dentistry, children ages 7 to 11 compared four
food groups — raisins, bran flakes,
commercially marketed raisin
bran cereal and a mix of bran
flakes with raisins lacking any
added sugar.
Sucrose, or table sugar, and sorbitol, a sugar substitute often used
in diet foods, were also tested as
controls.
Children chewed and swallowed
the test foods within two minutes.
The acid produced by the plaque
bacteria on the surface of their
teeth was measured at intervals.
All test foods except the sorbitol
solution promoted acid production in dental plaque over 30 minutes, with the largest production
between 10 to 15 minutes.
Wu said there is a well-documented danger zone of dental

Tell us what you think!
Do you have general comments or criticism you would like to share? Is
there a particular topic you would like to see more articles about? Let
us know by e-mailing us at feedback@dental-tribune.com. If you would like
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plaque acidity that puts a tooth’s
enamel at risk for mineral loss that
may lead to cavities.
Dr. Achint Utreja, a research
scientist and dentist formerly on
Wu’s team, said plaque acidity did
not reach that point after children
consumed 10 grams of raisins.
Adding unsweetened raisins to
bran flakes did not increase plaque
acid compared to bran flakes alone.
However, eating commercially
marketed raisin bran led to significantly more acid in the plaque, he
said, reaching into what Wu identified as the danger zone.
Plaque bacteria on tooth surfaces can ferment various sugars such
as glucose, fructose or sucrose and
produce acids that may promote
decay.
Sucrose is also used by bacteria
to produce sticky sugar polymers
that help the bacteria remain on
tooth surfaces, Wu said. Raisins
themselves do not contain sucrose.
In a previous study at UIC,
researchers identified several natural compounds from raisins that
can inhibit the growth of some oral
bacteria linked to cavities or gum
disease.
The study was funded by the
California Raisin Marketing Board
and the UIC College of Dentistry. DT
(Source: UIC College of
Dentistry)

DENTAL TRIBUNE
The World’s Dental Newspaper · US Edition

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Torsten Oemus
t.oemus@dental-tribune.com
Vice President Global Sales
Peter Witteczek
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Eric Seid
e.seid@dental-tribune.com
Group Editor & Designer
Robin Goodman
r.goodman@dental-tribune.com
Editor in Chief Dental Tribune
Dr. David L. Hoexter
d.hoexter@dental-tribune.com
Managing Editor/Designer
Implant Tribune & Endo Tribune
Sierra Rendon
s.rendon@dental-tribune.com
Managing Editor/Designer
Ortho Tribune & Show Dailies
Kristine Colker
k.colker@dental-tribune.com
Online Editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.com
Product & Account Manager
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m.eisen@dental-tribune.com
Marketing Manager
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a.wlodarczyk@dental-tribune.com
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Dental Tribune America, LLC
213 West 35th Street, Suite 801
New York, NY 10001
Tel.: (212) 244-7181
Fax: (212) 244-7185
Published by Dental Tribune America
© 2010 Dental Tribune America, LLC
All rights reserved.
Dental Tribune strives to maintain the
utmost accuracy in its news and clinical reports. If you find a factual error or
content that requires clarification, please
contact Group Editor Robin Goodman at
r.goodman@dental-tribune.com.
Dental Tribune cannot assume responsibility for the validity of product claims
or for typographical errors. The publisher also does not assume responsibility
for product names or statements made
by advertisers. Opinions expressed by
authors are their own and may not reflect
those of Dental Tribune America.

Editorial Board
Dr. Joel Berg
Dr. L. Stephen Buchanan
Dr. Arnaldo Castellucci
Dr. Gorden Christensen
Dr. Rella Christensen
Dr. William Dickerson
Hugh Doherty
Dr. James Doundoulakis
Dr. David Garber
Dr. Fay Goldstep
Dr. Howard Glazer
Dr. Harold Heymann
Dr. Karl Leinfelder
Dr. Roger Levin
Dr. Carl E. Misch
Dr. Dan Nathanson
Dr. Chester Redhead
Dr. Irwin Smigel
Dr. Jon Suzuki
Dr. Dennis Tartakow
Dr. Dan Ward

[3] =>

News

Dental Tribune | February 2010

Medical-dental health Fight oral
cancer!
links continue to build
By Fred Michmershuizen, Online Editor

New evidence shows improvements in oral health can have a
positive impact on reducing atherosclerosis, or plaque, in arteries.
The science behind why a diseased mouth puts one at a higher
risk for numerous systemic disease, such as heart attack, stroke,
Alzheimer’s disease and some forms
of cancer, continues to build.
As more dentists and physicians
become aware of how this affects
their patient’s general health and
medical condition, the public’s
expectations of the role their dentist
plays in health will likely shift.
“Almost a hundred years ago
there were a few dentists and physicians who were very forward thinking who postulated that dental disease could actually impact general
health,” said Dr. James McAnally,
CEO of Big Case Marketing, a marketing and case acceptance consulting firm for dentists with advanced
clinical training.
“Unfortunately, at that time,
quackery in medicine and dentistry
was being fought, and valid lines of
questioning were rejected instead of
explored, delaying the study of what
relationships were present between
the mouth and entire body.”
McAnally offered his remarks
during an interview about the role
of the dentist and heart health with
Dr. Dean Vafiadis, a New York-based
prosthodontist, on New York City
Cosmos radio FM 91.5 WNYE.
“In our current environment,
thanks to professional rigidity and

f DT page 1
Meanwhile, the jobs situation
may also be starting to improve.
The Labor Department reported
Feb. 5 that the American unemployment rate dipped from 10 percent to 9.7 percent in January,
causing some economists to speculate that the worst job market
in at least 25 years may at last be
getting better.
According to a recent report
from Robert W. Baird & Co., a
dental equipment rebound at the
end of 2009 was continuing into
January and the demand for dental consumables was picking up
slightly.
“We continue to believe slow/
steady recovery in 2010 will lead
to more normalized industrywide
performance in 2011,” stated
the report, titled “Dental Market
Rebound Continues in January,
2010 Optimism Growing.”
The report offered several spe-

failure to change the existing standards of care rapidly, regardless of
the science, most dental schools and
state dental licensing boards are
artificially slowing the progress of
advances in understanding of disease relationships from benefiting
the general population’s health,”
McAnally said.
Vafiadis, McAnally and many
other dentists are on the forefront
of putting the information needed in
front of the lay public so they can be
informed as to what they should be
hearing from their local dentist.
“The recent report out of Case
Western University where doctors
found the exact same strain of bacteria from a 35-year-old California
woman’s infected gums in her stillborn baby serves as a vivid example
of a direct systemic infection resulting from an oral infection,” McAnally said.
“While that makes for good headlines, the headline that isn’t being
put out there is the literal millions
in the population who will suffer
more whole body disease, worse
whole body disease and a potentially shortened lifespan simply as a
consequence of what their dentists

cific signs of optimism for the
dental products sector, including
the following:
Dental consumables demand is
not just stable, but slightly improving, the report said, as volumes are
flat to up slightly and 1 to 2 percent
price increases are sticking.
For distributors, a modest rotation away from telesales and Internet distributors back to value-adds
seems to be occurring, while manufacturers seem to be benefiting
from modest restocking at distributors and dental offices.
At the recent Yankee Dental
Congress in Boston, exhibit hall
booth activity was “generally
upbeat,” the report said.
“All in, we continue to believe 1
to 3 percent domestic dental consumables market growth in 2010
remains a reasonable assumption, with the upper end of that
range possible if December/January trends persist throughout the
year,” the report said. DT

aren’t talking to them about.”
As part of the interview, the Medical-Perio Referral Program, designed
for general dentists, periodontists,
oral surgeons and prosthodontists,
which allows an easy facilitation of
the physician-dentist relationship to
improve patient health in both environments, was also discussed.
“This is really a two-way street
that benefits every patient,” McAnally said. “If patients go to a dentist that is part of the referral program, they know they are under
the care of someone who understands the links in health and how
to do everything the current science
shows is effective to help the patient
become healthier and stay healthier.
“Furthermore,” he said, “by
improving the referral relationship
between the family practice physicians and cardiologists and the dentist, more medical patients with serious medical conditions are likely to
receive appropriate dental treatment
to reduce dental disease’s effects
on their systemic health. Everyone
wins. For some dentists, this referral
model literally recreates the entire
focus of a practice.”
Dentists or medical doctors interested in the Medical-Perio Referral Program can contact Big Case
Marketing at info@BigCaseMarket
ing.com, call (206) 601-6754 or visit
www.MedicalPerio.com. DT

Did you know that dentists
are one of the most trusted professionals to give advice?
Thus, no other medical professionals are in a better position to show patients that they
are committed to detecting and
treating oral cancer.
Prove to your patients just
how committed you are to fighting this disease by signing up to
be listed at www.oralcancerself
exam.com.
This new Web site was developed for consumers in order
to show them how to do selfexaminations for oral cancer.
Self-examination can help
your patients to detect abnormalities or incipient oral cancer
lesions early.
Early detection in the fight
against cancer is crucial and a
primary benefit in encouraging
your patients to engage in selfexaminations.
Secondly, as dental patients
become more familiar with
their oral cavity, it will stimulate them to receive treatment
much faster.
Conducting your own inspection of patients’ oral cavities
provides the perfect opportunity
to mention that this is something they can easily do themselves as well.
You can explain the procedure in brief and then let them
know about the Web site, www.
oralcancerselfexam.com, that
can provide them with all the
details they need.
If dental professionals do not
take the lead in the fight against
oral cancer, who will?
And in the eyes of our
patients, they likely would not
expect anyone else to do so —
would you? DT

[4] =>

4
AD

Practice Matters

Dental Tribune | February 2010

Are new patients tripping
over your phone line?
By Sally McKenzie, CMC

It’s the usual busy day in the dental practice.
The phone is ringing. Patients are flowing in and
things are moving along smoothly. Sure there’s a
cancellation or two and maybe an emergency. As
the dentist passes the front desk, he hears Linda,
the business assistant, wrapping up a conversation.
“No, I’m sorry, we don’t.” We don’t what?
What don’t we do that someone wants to know
about? The dentist makes a mental note to
follow-up with Linda. He’s overheard her give
similar replies in the past and meant to ask her
about it before.
Here’s what the dentist didn’t’ hear …
Linda: Good morning, Dr. Stanton’s office,
Linda speaking.
Carolyn: Hello Linda, my name is Carolyn
Samson. I recently moved to town and I was just
calling to find out if the doctor is accepting new
patients.
Linda: Yes, he is, although the schedule is pretty
full right now.
(Without even realizing it, Linda is sending
a message to this prospective patient that she
might not be welcome in the practice. It’s already
a busy place and Linda doesn’t know how the
office is keeping up with the patients it has, let
alone encouraging any new patients to join. That
comes through loud and clear to the caller.)
Carolyn: Do you offer any Friday afternoon
appointments?
Linda: No, I’m sorry, we don’t.
(Silence ensues for a few moments while
Carolyn waits for another option from Linda, but
none is offered.)
Carolyn: OK, thank you. Goodbye.
To Linda, this is just a routine inquiry — nothing special, and she doesn’t think much about it.
After all, there’s no established protocol. She’s
just answering questions as they come in.
No, the practice doesn’t offer Friday afternoon
appointments because the office is closed, but
perhaps the practice offers Wednesday evening appointments or Saturday morning appointments.
Alternatively, perhaps the practice sees new
patients at a specific time of day so that the dentist can spend quality time with the patient and
is less likely to be interrupted with emergencies
or oral hygiene exams.
Yet, Linda makes no effort to offer possible
alternatives or to educate the patient on the
options and why they would be worth considering. She simply answers the questions the prospective patient asks and feels she’s done her
job. It’s a common scenario because few practice
employees are trained to properly handle phone
communication.
Meanwhile, dentists go about performing dentistry and seldom give those perfunctory phone
duties a second thought. In fact, only 12 percent
of dentists believe the telephone has a major
impact on their practice even though it is typically the only point of entry for new patients.
In addition, only 5 percent of practice staff is
trained to properly handle patient phone calls.
The vast majority simply wing it.
The irony is that while dentists typically place
little importance on the telephone, this is the
make it or break it point of contact in the opinion of most patients. It is through the telephone
conversations with your office that prospec-

tive patients begin to assess the competency of
the dentist and team and whether this practice
deserves their business and that of their families.
In today’s consumer-driven dental marketplace, the old cliché that you only get one chance
to make a first impression couldn’t be truer. If
your practice doesn’t measure up, chances are
very good that prospective new patients will be
moving on to the next office on their list, and this
loss is yours.
In fact, if poor telephone protocol causes your
practice to lose just 20 new patients a month and
each would spend an average of $1,000 on dental
care a year, that’s 240 patients and nearly a quarter of a million dollars.
But it’s usually not until dentists start feeling
the effects of poor phone communication in the
form of scheduling problems, fewer new patients,
no shows, financial strain, etc., do they begin to
question just how those perfunctory phone duties
are handled.

Have you been disconnected?
How well does your team manage phone calls
from current and prospective patients? The truth
is you don’t know until you hear both sides of the
conversation.
In the medical community, “mystery shoppers” have been used for several years. Dentistry
is embracing the concept as more practices have
come to realize that they are profoundly dependent upon a satisfied patient base.
McKenzie Management has developed a telephone assessment protocol in which a professionally trained and certified “mystery shopper”
makes multiple calls to a dental practice and
assesses the effectiveness of the team’s telephone
skills.
The calls are recorded and the dentist has the
opportunity to hear firsthand what is transpiring
between his/her staff members and prospective
patients. What we are finding is that dentists
are often very surprised by what they hear and,
unfortunately, not in a pleasant way.
Dentists really cannot judge how well their
staffs handle telephone communication until they
hear it firsthand. Does the business team use
proper phone etiquette and correct grammar?
Do patients have to wait too long on hold or for
someone to answer?
How does the staff handle questions and
requests for information? What are the staff’s
tone, attitude and demeanor? Do staff members
come across as welcoming and helpful or annoyed
and rushed? Most importantly, how many new
patients might be lost month after month because
of inadequate telephone protocols?
While the reality of how phone calls are commonly handled can be an unpleasant shock, we
also find that it tends to be a major incentive for
dental teams to identify exactly where protocols
can be established so that the practice can make
improvements right away.
Oftentimes, very capable dental employees
unwittingly drive new patients away because
they simply haven’t been trained, and educating
staff on effective telephone communication can
significantly improve their approach. Moreover, it
can prevent the loss of hundreds of patients and
tens of thousands of dollars every year. However,
it doesn’t stop there.

Callers expect follow-through
Another element of effective telephone commug continued

[5] =>

Oral Pathology

Dental Tribune | February 2010

Diagnose this ...
Welcome to a new topic area
among the pages of Dental Tribune!
The thanks for this new topic area
go to a number of oral pathologists
who seek to expand their role in

the dental community by writing for
Dental Tribune.
These authors will provide us
with selected case studies to help
educate our readers about the vari-

ous oral pathology situations they
might encounter in daily practice.
We hope you enjoy this new topic
area and welcome your feedback at
feedback@dental-tribune.com. DT

Identify the ulcer
The patient presents with an ulcer on the left lateral border
of the tongue. The patient noticed the ulcer — which causes
pain and a burning sensation when eating — about three
months ago. The patient has smoked five cigarettes a day for
the past seven years.
Clinical examination of the lesion shows that the ulcer is
reddish-grey in color with slight sloughing, inflamed margins,
a firm and indurated base and about 2 x 2 cm in size.
Which type of ulcer is this?
a) Tuberculosis associated ulcer
b) Traumatic ulcer
c) Squamous cell carcinoma
d) Apthous ulcer
e) Herpetic ulcer
(See page 6 for the answer)

f continued
nication is follow-through. Take the
example of Carolyn Samson who
tried to get an appointment in Dr.
Stanton’s office.
She calls your office again and
requests that information be sent to
her home about the dentist and what
the practice has to offer. She’s also
interested in any literature on whitening and implants. Ms. Samson is a
professional.
Any service purchased — whether
it’s service for her car, her home or
her oral health — is purchased only
after careful research and evaluation.
Your business assistant is busy
with a number of things on this Monday morning. She quickly jots down
Ms. Samson’s name and address and
promises to mail the information out
as soon as possible.
In this instance, as soon as possible is about three months later
when your business assistant happens upon the scrap piece of paper
with her note to “send practice info,
whitening, implants to Carolyn Samson, 222 Green Street.” Prospective
new patient Ms. Samson has likely
already found her new dentist by
this time.
All the superior dentistry you
have to offer cannot make up for a
lack of follow-through on the part
of your staff. The experience that
prospective new patients have when
they call your office is the make it or
break it opportunity.
It doesn’t matter if they know
you personally. It doesn’t matter if
they’ve heard you’re fantastic from
their colleague or personally seen
your work and been wowed by it.
If the front desk is too busy to

take the time to make prospective
patients feel valued and welcome,
if the material they request is never
received, if they simply don’t get the
impression that their investment in
your practice will be appreciated,
they are not likely to bother making
the appointment.
For most practices, just being
aware of how prospective new
patient inquires are handled is a
big step in the right direction. Start
paying attention. Keep a list of the
types of questions and requests the
practice receives and discuss how
the office responds to these.
If patients are asking for information that you don’t have readily available, establish a timeline to create
the necessary informational materials. Establish a protocol for handling
all inquiries, including calls from
new patients seeking appointments,
calls from prospective patients seeking information about the dentist,
the practice, procedures offered, etc.
Prospective patients who request
information must be sent the material the day the request is made
— not the next day, not at the end
of the week, not when the business
team gets around to it — the day
they ask for it.
Consider including additional
information about the practice such
as the dentist’s commitment to providing the best possible care for
patients; information emphasizing
specific qualities about the practice
that set it apart from others; dentistry for the entire family; painless
dentistry techniques; cosmetic dentistry; sedation dentistry; a commitment to never make the patient wait
more than five to 10 minutes, etc.
Prospective patients are giving
you permission to market your prac-

tice, to educate and inform them.
They expect it and they want to
know what you have to offer. Make
the most of it.
If ever there were a perfect occasion to sell the practice and the services offered, it’s when prospective
new patients call your office. They
are interested, ready and willing to
learn more.
Make sure that your frontline is
well trained and prepared to welcome every caller to your practice
and you’ll ensure that prospective
new patients don’t get tied up in
your phone lines. DT

About the author

Sally McKenzie is CEO of
McKenzie Management, which
provides success-proven management solutions to dental
practitioners nationwide. She is
also editor of The Dentist’s Network Newsletter at www.thedentist snetwork.net; the e-Management Newsletter from www.mckenzie mgmt.com; and The New
Dentist™ magazine, www.thenew
dentist.net. She can be reached
at (877) 777-6151 or sallymck
@mckenziemgmt.com.

[6] =>

6

Oral Pathology

Dental Tribune | February 2010

Identify the ulcer (the answer)
How to rule out other aetiologies

Which type of ulcer is this?
a) Tuberculosis associated ulcer
b) Traumatic ulcer
c) Squamous cell carcinoma
d) Apthous ulcer
e) Herpetic ulcer
Answer:
c) Squamous cell carcinoma

Factors that point to OSCC
• Persistent for more than two weeks
• Associated habits (tobacco use)
• Indurated base
• Absence of general signs and symptoms
(i.e., fever, pulmonary signs)
• No evidence of any injury

Tuberculosis associated ulcer
Oral tuberculosis is very rare and when
present it is usually secondary to pulmonary tuberculosis and may pose a diagnostic problem.
• Coexisting pulmonary disease
• Other signs and symptoms of tuberculosis
• Ulcer
1. Irregular edges and minimal
induration
2. Granular or covered with pseudomembrane
3. Most often painful
Traumatic ulcer
Diagnosis based upon history (biting, denture irritation, drugs, e.g., aspirin).
• Ulcer
1. Generally diagnosed at acute
stage
2. Shallow base and non-raised margins
3. Mildly painful

Recurrent apthous ulcer
One of the most common ulcers seen in
the oral cavity, commonly misdiagnosed
and poorly understood.
• Recurrent, one or more at a time
• Types: Minor (1 cm), major (>1 cm)
and herpetiform (pin-head size)
• No prodromal symptoms, takes days to
months to heal
• Begins at adolescent age and frequency
decreases with age
Herpetic ulcer
It’s a viral infection, afflicts most of the
population; sub-clinical or clinical infection.
• Numerous, pin-head sized vesicles
in the beginning that collapse and
coalesce later to form large shallow
and irregular ulcer
• Very painful
• Associated prodromal symptoms
• Types: acute (commonly seen at an
early age); recurrent (often seen in the
immunocompromised and may solely
present as herpes labialis) DT

Answer: (e) All of the above should be circled.

Please circle all the aetiology/aetiologies of
an oral ulcer (answer is at the end):
a) Physical and chemical trauma
b) Infection
c) Malignancy
d) Malnutrition
e) All of the above

Digging deeper into oral pathology …
1. Five-year survival rate is 50 percent
2. Commonly seen above the age of 40
years
3. Most commonly associated with chronic
trauma
4. Can present both as endophytic and exophytic growth
5. Ulcers (endophytic pattern) commonly
present with rolled borders
6. Precancerous lesions may or may not be
seen
7. OSCC of the soft palate and oro-phayrnx
are easiest to diagnose
8. Most common site is tongue
9. Clinical evaluation should include TNM

Please choose the correct answer:
11. If treatment of intraoral SCC is guided by
the clinical stage (TNM), which consists of:
a) Wide (radical) surgical excision
b) Radiation therapy and chemotherapy
c) Surgical excision and chemotherapy
d) Combination of the above

AD

Discussion
Squamous cell carcinoma of the mouth constitutes the sixth most common cancer worldwide, and the third most common in developing countries, with evidence of an increase in

t

incidence and mortality, particularly in young
adults.
It accounts for more than 90 percent of all
oral malignancies.
Patients with oral cancer generally do poorly,
with the five-year survival rate for carcinomas
of the tongue and floor of the mouth being less
than 40 percent.
The most important risk factors for oral carcinogenesis remain tobacco and alcohol.
Apart from the risk factors, the possibility
of a genetic predisposition has also been suggested.
Many oral carcinomas are preceded by clinically evident premalignant lesions. DT

Answers

classification (T = tumor size and how
far it has spread; N= spread to the lymph
nodes; M = metastasis)
10. Final diagnosis is a histological (biopsy)

1: True; 2: True; 3: False; 4: True; 5: True; 6:
True; 7: False; 8: True; 9: True; 10: True; 11: d

Let’s explore your knowledge about oral
squamous cell carcinoma (OSCC).
Mark true (T) or false (F) next to the following questions:

About the author
Dr. Monica Malhotra is an assistant professor
at the Sudha Rustagi Dental College in India and
also maintains a private practice.
Malhotra completed her master’s in oral
pathology at the Manipal Institute, India, in 2009.
In 2008 she was presented with a national
award for the best scientific study presentation by
the Indian Association of Oral and Maxillofacial
Pathology.
You may contact her at drmonicamalhotra@
yahoo.com.

[7] =>

[8] =>

Financial Matters

Dental Tribune | February 2010

Practice transition planning

This is part 1 of a two-part series on this topic
By Eugene Heller, DDS

For most dentists, ownership of
their dental practice is the major
focus of their energy expenditures,
financial situation and professional
lives.
Years of blood, sweat and tears,
coupled with the relationships
formed with both staff and patients,
have caused dentists to form a deepseated emotional attachment with
their practice.
For many, the dollar value of that
practice represents a significant portion of their financial assets.
For the new dentist, there is a definite value in acquiring the patient
base that has taken the transitioning
dentist years to develop and will provide an immediate and substantial
cash flow.

All experience transition
Whether it is due to a change in
career direction, a desire to cut back
on the responsibilities of ownership
while still enjoying the benefits of
clinical dental practice or the desire
to retire from dentistry, every practice owner faces an ownership transition.
Ownership transition can be a
total sale or a partial sale, that is, the
formation of a partnership. The level
of success achieved as a result of this
practice transition will be directly
linked to the amount of detail given
to, and the successful execution of,
the “Transition Plan.”

A buyer’s market
Decreased dental school enrollments
and other demographic factors have
created an imbalance in the numbers of graduating versus retiring
dentists.
This trend, which will continue
for at least the next 10 years, has
contributed to falling dental practice
sale prices, and has created a buyer’s
market.
This dental work force shortage
has made finding dentists to serve in
more rural dental practices, which
are difficult to market, almost impossible. These changes in the marketplace relative to practice transitioning have made advance, detailed
AD

over another.
The major factors considered
include:
(1) the practice’s overhead to revenue percent,
(2) number of active patients,
(3) new patient flow,
(4) recall system effectiveness.

transition planning mandatory.

Goals of a successful transition
Before discussing the development
of a transition plan, a brief discussion of the goals of transition is
required. In addition to identifying
the actual goals, each dentist will
need to assign an order of priority to
these goals.
This prioritization will have a significant impact on certain aspects of
the transition plan. The most common goals discussed by dentists
include:
(1) In accordance with their preferred timetable, a desire to transfer
patient care responsibility.
(2) Securing future employment
for their staff and giving back to the
profession by passing the baton to a
new dentist.
(3) Maximizing their practice
equity (financial gain from the sale).
There is no right or wrong order
to the priority emphasis. The economic health of the transitioning
dentist will usually determine the
order of the priorities.
If the practice sale proceeds are
a significant portion of the dentist’s
retirement assets, then maximizing
the financial return will be at the top
of the list.
If the clinician has a well-funded pension plan or other financial
resources, and the sale proceeds will
enhance the quality of retirement
rather than providing the primary
support for retirement, the order
of importance will typically be the
desire to provide continuity of patient
care, ongoing employment and passing the baton, where maximizing the

financial gain appears at the end of
the list.

Factors affecting successful
transitions
Prior to discussing the components
of a transition plan, it will be useful to understand what is presently
occurring in the transition marketplace. For a successful transfer of
ownership, we must first have an
interested new dentist.
Subsequently, location is at the
top of the list relative to a new dentist’s interest in a specific practice
opportunity.
As previously discussed, rural
practices, although typically more
profitable than big city practices,
are having serious recruitment problems.
Ninety percent of all practice sales
today are in communities with populations of 50,000 or more, and 80
percent of these sales are in cities
where the metro population exceeds
500,000.
The second factor is the practice’s
ability to meet the financial needs of
the new dentist. As a result of current levels of dental school-related
debt, the new dentist must meet specific levels of production to pay for
the practice acquisition, school loans
and basic living expenses.
Therefore, a practice needs to
provide, on the average, $300,000
worth of production for an employed
dentist, and $400,000 worth of production if the dentist is purchasing
a practice.
It is for this reason that 85 percent
of total practice sales involve practices with gross receipts of $350,000
to $500,000.
While the highly productive and
profitable practices of today frequently exceed $500,000 in annual
receipts, the average new dentist
(five years or less since graduation)
does not possess the clinical skills
required to produce this level of dentistry, and subsequently, sales trend
toward the lower grossing practices.
After finding a suitable location
and determining that the practice
will provide for the financial needs
of the new dentist, the new dentist
will consider a multitude of other
factors in selecting one opportunity

In addition:
(5) quality and length of the staff’s
prior employment,
(6) practice history,
(7) types of procedures previously
offered and/or produced,
(8) involvement in any discounted
dental plans,
(9) appearance of the physical
space occupied by the practice, and
(10) the age, type and appearance
of the equipment and furnishings
will play a major role in the selection
process.
The 10 items listed above represents the major concerns and factors
reviewed by the new dentist.
However, the owner dentist is
concerned with:
(1) the ability of the new doctor to
pay for the practice — obtain financing with all the school debt, the tax
implications and subsequent net proceeds derived from the sale,
(2) the personality and ability of
the new dentist to relate to patients
and staff,
(3) the amount of post-sale relationship required between the seller
and buyer, and of course,
(4) the new dentists’ clinical competence.
With the exception of the final
concern, the other factors can be
readily determined and resolved.
Today, 100 percent owner financing is readily available, the tax implications can be calculated and, typically, several meetings with the new
dentist will address the communication skills and personality of the new
dentist. DT

About the author
Dr. Eugene W. Heller is a 1976
graduate of the Marquette
University School of Dentistry.
He has been involved in
transition consulting since 1985
and left private practice in 1990
to pursue practice management
and practice transition consulting on a full-time basis.
He has lectured extensively to
both state dental associations
and numerous dental schools.
Heller is the national director
of transition services for Henry
Schein Professional Practice
Transitions. For additional
information, please call (800)
730-8883 or send an e-mail to
ppt@henryschein.com.

[9] =>

[10] =>

Clinical

Dental Tribune | February 2010

Thinking outside the box
By Drs. Jay Padayachy and David Bloom,
United Kingdom

When it comes to extreme dental makeovers, amazing transformations can be achieved without
resorting to some of the extensive
surgical solutions that might otherwise be required.
As dentists, we naturally lean
toward our historical training,
which might involve treatment
plans that don’t embrace some of
the newer concepts available to us
as restorative dentists.
Many years ago, the concept of
leaving an anterior restoration high
in the bite to create space would
have been regarded with scepticism.
However, now this “Dahl Principle” is readily accepted and used
to create anterior occlusal space in
certain clinical situations by allowing a combination of anterior intrusion and posterior “over eruption.”
Likewise, this thinking can
extend to more complicated situations. Yet, as long as there is sound
treatment planning via adherence to
sound aesthetic and occlusal principles together with fully informed
consent, amazing transformations
can be achieved without resorting
to some of the extensive surgical
solutions that may otherwise have
been required.

Communicate with your patient
The starting point for all of this
is: ask the patient what he or she
wants to achieve and fully discuss
all available treatments; this may
include extended orthodontic therapy with or without surgery.
From here, a sound understanding of the principles of smile design
is essential (see Table 1, below)
and an understanding of occlusal
schemes.

Table 1: Criteria of smile design
• Incisal edge position at rest
• Midline and cant
• Width: height ratio and Golden
Proportion
• Buccal corridor
• Smile line
• Axial inclination
• Embrasures and contact points
• Gingival zeniths and heights

• Arch form
We will now demonstrate many
of the principles we have discussed
in previous articles, but applied to
some more complex cases.

Case study No. 1, Figures 1–11
This 34-year-old woman presented
having seen us on the television
show “Extreme Makeover U.K.”
She had not visited a dentist for 10
years and disliked the fact that her
front teeth did not show. She was
also aware that her gums bled when
cleaning.
A full examination revealed early
periodontal breakdown with BPE
scores of three in all sextants. She
had a plaque score of 42 percent and
bleeding scores of 58 percent.
Her initial treatment focused
on achieving health and involved
periodontal care, direct posterior
composite restorations to treat early
decay in previously unrestored
molar teeth and indirect restorations (one crown and one tooth
coloured inlay) to replace heavily
restored and leaking posterior restorations.
Most importantly, her dental
health was vastly improved as a
direct result of the dental education
she received from her re-attendance
before any cosmetic concerns were
dealt with.
As for her cosmetic concerns,
all options for her severe anterior
open bite were discussed, including
orthodontics with or without orthognathic surgery.
The patient refused any orthodontics as well as any surgery and
wished to pursue the restorative
option available to her.
A diagnostic wax up allowed a
visual diagnostic try-in to show the
patient what could be achieved with
four anterior restorations to lengthen the teeth.
The possible tongue thrust element to her AOB was discussed and
she was fully informed that this
could mean that the AOB would
open somewhat post treatment.
The patient approved the aesthetics and decided upon this line
of treatment. She was advised that
there would be a greater amount

Fig. 2: Pre-op lips at rest.

Fig. 1: Pre-op full face smiling.

Fig. 3: Pre-op retracted in occlusion

Fig. 4: Visual diagnostic try-in.

Fig. 5: Visual diagnostic try-in, lips
at rest.

Fig. 6: Visual diagnostic try-in, full
smile.

Fig. 7: Visual diagnostic try-in,
retracted in occlusion.

Fig. 8: Post-op smile.

of unsupported porcelain than
ideal and, therefore, care would be
required when incising into anything hard.
For this reason also, it was decided to place 360 degree veneers for
increased structural integrity. As
the procedure was agentive, it was
possible to ensure all preparations
were entirely within enamel.
Whilst the final result does not
follow all the principles of smile
design, these should be considered
as a guide in such extreme cases.

The final restorations on the central incisors may be 18 mm long,
but fit in with her smile beautifully.
The life-changing effects of this
cosmetic transformation by only
treating four units and whitening
are self-evident.

Case study No. 2, Figures 12–18
This 42-year-old woman presented
as part of the “Extreme Makeover
U.K.” television show.
She hated the appearance of the
teeth, including their length and the

[11] =>

Clinical

Dental Tribune | February 2010

Fig. 9: Post-op retracted in
occlusion at day of fit.

large spacing between them.
She had a naturally outgoing
personality, but over time, she felt
embarrassed to smile and now
would hold her hand over her
mouth even when talking to people.
Previously she had undergone
periodontal treatment and surgery
at a teaching hospital; this had been
stable for more than 10 years.
When one first looks at her teeth,
one would assume that they would
be all mobile. However, they were
all stable with no mobility evident
at all despite having half and twothirds horizontal bone loss.
This made discussion of her
treatment options more straightforward as a mixture of crowns
and veneers could achieve what
she wished for without the need for
multiple extractions and dentures

or implants.
But she was informed that two
teeth would need to be electively
root filled to achieve these desired
aims as they were either a long way
out of the arch or too long.
Given the constraints imposed by
the show’s timings (work to be completed within six weeks) orthodontic
treatment would have proved difficult, but she was still informed of
this option.
She was advised that orthodontics would minimise the risk of root
treating any teeth, but she declined
this treatment.
Five upper veneers, three veneer
onlays and two Procera crowns
were placed along with four lower
veneers to correct the lower spacing.
She was advised of the impor-

11

tance of ongoing hygiene maintenance to ensure adequate plaque
control around the anterior restorations that now had a much fuller
contour gingivally as they were in
effect porcelain cantilevers.

Case study No. 3, Figures 19–25
This long-standing patient of more
than 15 years had always been
unhappy with her smile and existing crowns.
The UR1 crown had been under
review for some time and when the
tooth developed caries under the
margin, it was time to replace it.
All options were discussed with
the patient, including just replacing
the one crown, orthodontic treatment (with or without surgery) to
g DT page 12
AD

Fig. 10: Post-op smile at day of
fit.

Fig. 11: Post-op portrait.

Fig. 12: Pre-op smile.

[12] =>

Clinical

Fig. 13: Pre-op smile.

Dental Tribune | February 2010

Fig. 14: Pre-op retracted smile in
occlusion.

Fig. 16: Post-op smile.

Fig. 15: Post-op smile.

Fig. 20: Pre-op smile.

Fig. 17: Post-op retracted in occlusion.

Fig. 19: Pre-op full face.
Fig. 18: Post-op portrait from the
“Extreme Makeover U.K.” show.

f DT page 11
correct the Class III malocclusion or
instant orthodontics by opening her
vertical dimension and so jumping
the anterior crossbite.
Before deciding on a definitive
plan, a wax-up was made so a visual
diagnostic try-in could be carried
out to give the patient an idea of how
she would look if the crossbite were
corrected by restorative means.
She was happy as to what could
be achieved and decided she wanted
the restorative pathway as so many
of her teeth were already crowned
or heavily restored.
This also gave us the opportunity
to bridge the space mesial of the
UR6 and so build out the buccal corridor in this area.
By crowning the very heavily restored lower right-hand side
molars, the tilting of these molars
could also be improved at the same
time.
It is important to plan all these
changes at the same time because
opening the vertical means less
occlusal reduction is required. The
only unprepared tooth that required
preparation was the UR3.
AD

This received a minimal veneer
preparation; palatal coverage was
not required on this tooth due to the
Class III nature of the occlusion.
However, the pre-operative planning with a diagnostic wax up is
essential for this.
Whilst the final result appears
somewhat flared in the retracted
view, the smile and full face demonstrate that the result works well.
Again she was advised of the
importance of ongoing hygiene
maintenance to ensure adequate
plaque control around those restorations that now had a much fuller contour gingivally as they were
also, in effect, porcelain cantilevers.

Conclusion
To quote two eminent colleagues:
“Learning smile design is the
process of training your eye to
spot details you can fix” (Dr. Chip
Steele).
“The hand can only perform what
the eye has been trained to observe
and the mind has striven to understand” (Dr. Newton Fahl).
The out-of-the-box thinking
required for some of these extreme
dental makeovers can only truly
occur with a thorough understand-

About the authors

A graduate of the Newcastleupon-Tyne Dental School, Dr.
David Bloom has been a principal at Senova Dental Studios
since 1990 focusing on comprehensive restorative and cosmetic dentistry.
A past president of the British
Academy of Cosmetic Dentistry
(2007–2008). Bloom is also an
accredited member of the BACD.
He is a member of The British Society of Occlusal Studies,
The British Society of Restorative Dentistry, The British Dental Association and is a sustaining member of The American
Academy of Cosmetic Dentistry
(AACD).
He is also a fellow of the
International Academy of Dental
Facial Aesthetics. Bloom is on
the editorial board of the Journal of Cosmetic Dentistry, the
official journal of the American
Academy of Cosmetic Dentistry.
Bloom is a clinical director of CO-OP.R8 seminars and
instructs and lectures on all
aspects of cosmetic dentistry in
the U.K. and the United States
(www.coopr8.com).

A graduate of the Newcastleupon-Tyne Dental school, Dr. Jay
Padayachy has been a principal
at Senova Dental Studios since
1998, focusing on comprehensive
restorative and cosmetic dentistry.
A full member of the British
Academy of Cosmetic Dentistry,
he is a member of The British Society for Occusal Studies,
The British Society of Restorative
Dentistry, The Pankey Association, The British Society of Periodontology and the American
Academy of Cosmetic Dentistry
of which he is a sustained member.
In addition, he is a director of
CO-OP.R8 Seminars and lectures
in all aspects of cosmetic dentistry in the U.K.
Find out more about CO-OP.
R8’s cosmetic dentistry treatments, including tooth whitening, porcelain veneers, dental
veneers, gum disease treatments,
dental implants or general dental
surgery.
Contact CO-OP.R8 for more
details or to request a brochure.
Also, check out the new “Extreme
Makeover” feature.

[13] =>

Dental Tribune | February 2010

Fig. 21: Pre-op retracted in occlusion.

Fig. 23: Post-op smile.

Clinical

13

Fig. 24: Post-op retracted in occlusion, now Class 1.

AD

Fig. 22: Post-op full face.

Fig. 25: Post-op portrait.

ing of the principles involved in
smile design and their application
and modification to fit each individual scenario together with correct
occlusal planning.
Thus, aesthetics with longevity (functional aesthetics) can be
achieved.
When correctly applied, the
results can be life changing and
can be achieved in ways that may
previously have been deemed not
possible. DT

Acknowledgements
Luke Barnett Dental Ceramics,
www.lukebarnett.com
[Editorial Note: This article first
appeared in Dental Tribune U.K.
Edition, Vol. 2 No. 5.]

[14] =>

Meeting Review

Dental Tribune | February 2010

Yankee Dental Congress:
education from every angle
Yankee Dental Congress 35,
held Jan. 28–30 in Boston, offered
plenty of opportunities for dental
professionals to learn and grow,
both in lecture halls and on the
exhibit hall floor.
For someone looking for a little
education and/or C.E. credits during the meeting, all he or she
had to do was wander around the
exhibit hall floor like a pinball
and it wouldn’t be long before he
or she would stumble across one
of the six classrooms, the Live
Dentistry Theatre or the many
opportunities available at individual booths.
The six classrooms featured
speakers such as Marilyn Ward,
DDS, who spoke about “Predictable In-office Whitening,” which
was a Discus Dental hands-on
course.
Other classroom topics included
Dr. Robert Lowe’s lecture, “Composite Restorative Dentistry: A
Blend of Artistry and Technique,”
which was sponsored by VOCO.
Live dentistry included Bart
Blaeser, DMD, MD, who spoke
about “Cone-beam Tomography
Implant Imaging and Treatment
Planning with Live Surgical Procedure” in the morning (Keystone
Dental).
Carl Boscketti, DMD, took to the
stage to offer “Live Patient Demonstration Utilizing CEREC Restoration” (Patterson and Sirona).
The Live Dentistry stage also
featured Frank Milnar, DDS,
speaking about “Creating A Composite Veneer” (VOCO).
Dr. Ben Miraglia lectured at
the Align Technology booth about
“Invisalign: From Evolution to
Innovation.” Many other speakers
offered presentations at several
other booths.
Gregory Sawyer, DDS, presented “Immediate Denture Stabilization with IMTEC’s MDI Small
Diameter Implant System” (Imtec
Corp.).

More than 400 exhibitors
Meanwhile, more than 400 com-

panies offered the latest in dental products and technology. The
exhibit hall was bustling with
activity.
Those looking to stock up on
fluid dentin, cements and adhesives for example, found they
were in the right place. There
were plenty of endodontic files
and obturation equipment, latex
gloves, orthodontic appliances —
and much, much more.
Many companies offered educational presentations right in their
booths for small groups, so attendees could can learn something.
Some companies offered special
giveaways — including tickets to
see the Red Sox or Celtics, making
attendance not only worthwhile
for one’s practice but also a lot of
fun.
Other highlights on the exhibit
hall floor included the following:
• At the P&G Professional Oral
Health booth, attendees learned
about an oral care regimen that
includes use of the Oral-B Professional Care SmartSeries 5000
with SmartGuide, Crest PROHEALTH Toothpaste and Crest
PRO-HEALTH Rinse.
• Attendees learned about gingivitis reduction at the Colgate
booth.
• At the Triodent booth, attendees checked out the V3 Ring for
posterior composite restorations
and the Triotray for posterior
impressions.
• The new Under Armour Performance Mouthwear was on display at the Patterson Dental Supply booth. A launch kit was available to help dentists become an
exclusive provider for this new
technology.
• At the DMG America booth,
there was a lot of interest in the
new Icon caries infiltrant, which
offers treatment without the use
of a drill.
• At the InfoStar booth, company reps were on hand to show

At the DMG booth there is a lot of interest in the new Icon caries infiltrant,
which offers treatment without the use of a drill. (Photo/Fred Michmershuizen,
Online Editor)

i.c.e. Account Executive Matt Parker shows off the company’s Glowrite
sign, a write-on/wipe-off LED-illuminated sign with seven different color
options. The sign can cycle through all colors or just the one of your
choosing. There are four sizes available, one of which is double-sided.
(Photo/Robin Goodman, Group Editor)

g DT page 16

At the P&G Professional Oral Health booth, attendees learn about an oral
care regimen that includes use of the Oral-B Professional Care SmartSeries
5000 with SmartGuide, Crest PRO-HEALTH Toothpaste and Crest PROHEALTH Rinse. After the presentation, many attendees took the opportunity
to brush their teeth at convenient tooth brushing stations. (Photo/Fred
Michmershuizen, Online Editor)

[15] =>

Dental Tribune | February 2010

Are you prepared
should one of your
patients have a
medical emergency
while being treated
in your office?
Lewis Soraich of
HealthFirst Corp.
can set you up
with an emergency
preparedness kit
and a training
DVD.

Dr. Robert Lowe’s lecture, ‘Composite Restorative Dentistry: A Blend of Artistry and Technique,’ is well-attended at the Yankee Dental Congress. Standing in the background in a white lab coat is VOCO Clinical Manager Nicole
Russell, representing the lecture’s sponsor. (Photo/Robin Goodman, Group
Editor)

Meeting Review

15

Those who stopped by the
Owings Corning booth
could enter a contest to
win a basement finishing
system (and say hello
to the Pink Panther of
course!).

At the Shofu Dental booth, interest was high in the BeautiBond adhesive,
which contains not one but two powerful monomers. Pictured are Ricardo
Youngblood, left, Lynne Calliott and Lenny Sulkis.
AD

[16] =>

16

Meeting Review

The exhibit hall is bustling with activity at Yankee Dental Congress 35.
(Photo/Robin Goodman, Group Editor)

Dental Tribune | February 2010

Gil Frellick discusses the features and benefits of the CEREC AC CAD/CAM
system during a presentation on the exhibit hall floor at Sirona’s booth.
(Photo/Fred Michmershuizen, Online Editor)

AD

Dr. Thomas McGarry of the McGarry
Implant Institute in Oklahoma City
was one of the speakers on Thursday,
Jan. 28. After his presentation,
McGarry spent time browsing the
exhibit hall floor.

f DT page 14
attendees their company’s SideKick patient education tool.
• At the Shofu Dental booth,
interest was high in the BeautiBond adhesive, which contains not
one but two powerful monomers.
• At the VOCO America booth,
there was lots of interest in Amaris
Gingiva, a light-cured composite
system in gingival shades. It’s an
alternative to surgery for patients
with severe gum recession.
• At the Zila booth, attendees  
learned about Rotadent, which is
described as much more than just
a power toothbrush. Rather, it is a
whole system for home periodontal therapy.
• At the Henry Schein Dental booth, attendees learned more
about the E4D technology and how
it can be incorporated into a dental practice.
• At the Glove Club booth, former New England Patriots football player Rodney Harrison and
current Red Sox pitcher Jon Lester were signing autographs for
attendees who made a purchase. DT

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Dental Tribune | February 2010

Meeting Preview

Hinman 2010 offers new highlights
The 98th Thomas P. Hinman Dental
Meeting will take place March 25–27
in Atlanta. According to organizers, the
2010 meeting is where excellence will
abound. In fact, the Hinman meeting is
known for its world-renowned reputation of excellence — bringing together
the highest quality programming from
the foremost authorities in the field of
dentistry.
Some of the highlights at Hinman
2010 include the following:
• More than 60 leading experts in
the field of dentistry will offer presentations.
• More than 25 percent of courses
offer the opportunity for hands-on participation.
• New, all-day educational tracks
will be offered for dental hygienists,
assistants and business office personnel.
• Also new this year is Art in the
Hall. Hinman and The Foundation for
Hospital Art will combine forces to
create murals for medical facilities in
need. Meeting attendees can stop by
and paint for a few minutes or stay
until a mural is finished.
• Two hours on Saturday will be
dedicated exhibit hall time, with no
education held during this period.

• The exhibit hall will offer courses
for assistants and doctors, interactive
artwork and the return of the popular
Hinman Eatery.
The meeting also offers plenty of
networking opportunities and social
events.

Educational opportunities
This year, Hinman has designed special, full-day courses for each team
member. A “Prevention Convention”
for hygienists will be held on Thursday, a “Business Office Bonanza” and
an “Assisting Extravaganza” will be
held on Friday.
These special courses are offered
so that each team member can get
a variety of information on different
topics from six of the most respected
lecturers in their specific areas of
expertise.
In addition, there are separate
speaker “tracks,” highlighting all the
speakers who might be of interest to
hygienists, business office staff and
assistants, respectively.
Each lecture is 50 minutes with a
mid-day break for lunch and to visit
the exhibit hall. These special courses
are offered at a special fee of $75 for
the full day.

A variety of lunch options are available at the Hinman Eatery in the
exhibit hall.
This year’s keynote session not only
presents an esteemed roster of expert
speakers, but also features one of Hinman’s more unique keynote speakers
in recent history. Frank W. Abagnale
is one of the world’s most respected
authorities on the subjects of forgery,
embezzlement and securities documents. His name might sound familiar. The movie “Catch Me If You Can,”
starring Leonardo DiCaprio and Tom
Hanks, was based on his life and book.
In addition, an auxiliary reception
will be held on Friday night and a
dentist reception on Saturday night.
With live music and buffets filled with
appetizing foods, attendees will get to
spend time catching up with friends
and colleagues and dancing into the
wee hours of the night.

Technical exhibits
Hinman’s 90,000-square-foot exhibit
hall will feature the leading dental
industry companies, sharing the latest
products and services in the dental
field.
The hall will not only feature nearly
400 leading industry companies, but

will again include the Hinman Eatery,
where attendees can take a break
and grab something to eat and drink
without having to leave the convention
center and search for other options.
In addition, Hinman has heard
many attendees say that they want
more time in the exhibit hall that
doesn’t conflict with the course schedule.
On Saturday, there will be two
hours of dedicated time in the exhibit
hall when attendees don’t have to
worry about missing a course and
can devote more time to visiting their
favorite booths.
The exhibit hall floor will be
open on Thursday from 10 a.m. to 6
p.m.; Friday from 9 a.m. to 6 p.m.;
and Saturday from 9 a.m. to 4:30 p.m.
Meeting attendees can start their
exhibit hall visits with complimentary
morning and afternoon snacks each
day.
Snacks and drinks will be available
in the rear seating areas while supplies last. In the afternoon, cocktail
bars will be open to purchase drinks
each day.
More information on the Hinman
meeting is available online at www.
hinman.org. DT
AD

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Dental Tribune | February 2010

Industry News

Grow your dental practice
Three ways to start doubling your growth right now, even if you’ve hit a plateau
By Jay Geier

How would you like to double
your practice growth? How would
you like to double your net income?
Of course you would! But what we
want and what actually happens are
two different things.
When you first started your dental
practice, you felt the excitement.
You experienced large percentages
of growth for the first few years.
Then your dental practice became
stagnant.
You’re not seeing growth in your
dental practice now. Your “adjusted
gross income” and “net income”
decreased to the point where it
depresses you to look at the numbers on your tax return.
You have hit a plateau and it
is commonplace for all businesses,
including dental practices, to hit a
plateau at some point in their life.
Many will hit multiple plateaus.
Now I completely understand why
hitting a plateau or even a decline

in business would depress you. It’s
because you’re seriously feeling
the squeeze. You discovered that
your expenses don’t plateau just
because your income has flattened
or declined.
• Your staff wants more money.
• You need more space.
• You need to purchase updated and emerging technologies and
equipment.
• It takes more money to run your
practice.

or you don’t even have a plan. If you
have been in practice for any significant amount of time and you are not
investing heavily in your practice, I
wouldn’t be surprised if you’re experiencing a plateau in your business
right now.
See, if you’re not learning better
ways to build your practice then you
are just doing the same thing over
and over again. How is that going
to solve your problem and take your
practice to the next level? It isn’t.

Not only do your expenses rise at
the office, but they rise at home too.
You’ve got kids, private schools, bigger houses, insurance, higher taxes.
So how can you as a dental practice owner get off the plateau, take
your business to the next level and
make more money?

Get the right employees:
implement a ‘no mediocre
employee’ tolerance policy

Get the right training, skills and
resources you need to build your
business
Look, you’re either on plan, off plan

With so many people unemployed
today, you can find top talent. There
is no reason why you have to accept
mediocre performance.
Remember, you get what you
deserve. If you hire mediocre
employees or if you keep mediocre
employees, then you deserve to get
mediocre or sub-par results along
with the gray hair you’ll get for deal-

ing with these people.
In addition, it doesn’t take much
effort to hire the right staff. In fact, I
have a hiring system that allows you
to hire new staff with less than 60
minutes of your time.

Get a ‘no excuse’ mindset
If you want to shorten the lifespan of
your plateau, then you need to stop
being your own worst competitor. I
mean this in the most caring, loving
way. You make and accept too many
excuses for why you can’t get new
patients.
For example, you blame the
recession. Yes, many small and large
businesses are failing. However,
we’ve doubled our business in this
economy. I have clients who’ve been
practicing dentistry for 35 years and
they had their best year ever in 2009.
A few of these top performers are
in the state of Michigan — one of the
hardest hit states during the recesg DT page 23

The adjacent tooth is innocent
Minimal invasive dentistry in reality

By Prof. Dan Ericson, Malmö University,
and President of the Academy of
Minimally Invasive Dentistry

Minimally invasive dentistry has
evolved as a concept in preventive
and restorative dentistry during the
last few decades.
The concept involves “a systematic respect for the original tissue”
(Ericson 2004). It means that dental
diseases preferably should be prevented, and that restorative dentistry
includes a minimum of removal of
healthy tooth substance to access and
restore a caries lesion.
Under this concept, prevention
of iatrogenic damage is, of course,
essential. Several researchers have
clearly demonstrated that, during
preparation of a Class II restoration,
the adjacent tooth is damaged up to
almost 70 percent.
Damaged teeth develop caries
at least twice as often compared to
undamaged teeth (Qvist et al. 1992;
Lussi and Gygax, 1998; Medeiros and
Seddon 2000). This certainly calls
for protection of the adjacent tooth
during preparation for the dentist
to be able to work safely and time
effectively.
A number of devices have been
used for this, ranging from a steelmatrix band to interproximal guards
of various kinds and thickness. Until
now a common difficulty has been
application and retention of such
devices during preparation.
It is urgent that the industry pro-

FenderWedge combines a wedge and
protective plate. It is easily inserted
like a regular wedge.
vides uncomplicated devices that
would warrant increased safety and
efficacy in operative dentistry. To
avoid iatrogenic damages should
always be first priority (Hippocrates).
References
• Ericson D. What is Minimally Invasive
Dentistry? Proceedings 1st European conference on preventive and minimally invasive
dentistry, Copenhagen, 2004. Oral Health Prev
Dent 2004; 3:287–292.
• Lussi A, Gygax M. Iatrogenic damage to
adjacent teeth during classical approximal box
preparation. J Dent 1998; 26:435–441.
• Medeiros VA, Seddon RP. Iatrogenic damage to approximal surfaces in contact with
Class II restorations. J Dent 2000; 28:103–110.
• Qvist V, Johannessen L, Bruun M. Progression of approximal caries in relation to iatrogenic preparation damage. J Dent Res 1992;
71:1370–1373.

Swedish company Directa has
developed FenderWedge®, a new
product that protects adjacent
teeth during Class II preparation.
FenderWedge:
• is easy to apply,
• is retained during preparation
by the wedge,
• results in pre-wedging before
placing the matrix for restoration,
• can also be used for protection
during crown preparation.
Data from 145 cases indicates
that FenderWedge® is simple to

apply and effectively protects the
adjacent tooth.
For more information about
FenderWedge and other Directa products, please visit Directa
online at www.directadental.com.
Directa representatives and
partners are currently operating
in more than 90 countries worldwide, and attend most major dental meetings.
Please call +46 (8) 506 505 75 or
e-mail info@directadental.com for
additional information. DT
AD

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Industry News

Dental Tribune | February 2010

AMD LASERS: one of the most
affordable soft-tissue dental lasers
In
January,
AMD
LASERS
announced the introduction of the
Picasso Lite soft-tissue dental laser.
Priced at $2,495, offering 2.5
watts of power and three customizable presets, Picasso Lite is the most
affordable and easy-to-operate dental
laser in the world, according to AMD
LASERS.
It was designed specifically to
replace the archaic use of scalpels
and electro-surge in the treatment of
soft tissue.
“With Picasso Lite, we accelerated
the paradigm shift in dentistry that
began with the introduction of the
Picasso soft-tissue laser in 2009,” said
Alan Miller, president/CEO of AMD
LASERS.
“We have ‘One Vision, One Goal’
— equipping every operatory with
a laser. Record numbers of dentists
are purchasing Picasso, and I’m sure
Picasso Lite’s more attractive price
and ease of use will quickly make it
the most popular laser in the world.
“Picasso Lite was designed specifically for first-time laser dentists

f DT page 21
sion. If they can get new clients and
double their practices, so can you.
Yet, you have to adopt what I call
the “two-economy system” mindset
that accepts no excuses.
I define the two-economy system as putting yourself in a bubble
where the economy is good, and
keeping everything out of the bubble
that you don’t have control over.
Thus, unlike most dentists who
let all of the negative energy ooze
into their office and into their existence, I reject it like the plague.
I adopted the policy that you
get what you deserve; there are no
excuses. I haven’t made an excuse
in 20 years.
If I get a bad result, I probably
deserved a bad result. It’s that simple. So, I don’t make excuses. I just
say, “I got what I deserved, and I
need to figure out why and how I’m
going to fix it so I get a better result
next time.”
If you can figure out what actions
and efforts it takes to deserve more,
then “Bingo!” you can get it.
If you make excuses about your
ability to generate new patients,
such as your town or the economy
or whatever other pathetic, whiny
excuse you might have made in the
past, you literally cannot do anything. It immobilizes you.

Want to start growing your dental
practice?
Here are your next steps:
• Get the training you need.

and hygienists, and at one-fifth the
cost of other lasers, it’s truly affordable. We’ve shipped Picassos to more
than 50 countries, and the number of
dentists and distributors interested in
Picasso is truly amazing. I think the
real winners are the patients.”
Picasso Lite cuts and coagulates
tissue with reduced trauma, bleeding and necrosis of tissue and is
used for soft-tissue surgery, including troughing, gingivectomies, frenectomies, exposing implants/teeth/
ortho brackets and treating aphthous
ulcers and herpetic lesions.
Featuring an ultra-compact, lightweight and sleek design, Picasso Lite
comes with an easy-to-learn setup DVD, online laser certification,
accessories, world power adapter
and a two-year warranty.
Another first for the laser industry
is Picasso Lite’s ability to use convenient disposable tips or a low-cost
strippable fiber.
“We are proud to offer Picassos
and now Picasso Lites free of charge
to universities and dental schools,

• Adopt a “no mediocrity” tolerance policy.
• Don’t make or accept excuses. When you complain, whine and
moan, you take all the power out of
your dental practice and completely
destroy the mindset of your staff.
Remember, it starts with you.
Are you ready to grow your dental
practice? DT

globally illustrating
our
commitment to
education and
charity,” said
Miller.

About AMD
LASERS
AMD LASERS
is a global
leader at providing ultraaffordable laser
technology for
dental professionals preparing to take their
practice to the
next level.
The
integration of the
Picasso line of soft-tissue dental
lasers enables every dental practice
to provide treatment for soft-tissue
surgery,
periodontal/endodontic
treatment, and laser whitening.
AMD LASERS is ISO 13485 and

C.E.-certified for worldwide distribution.
For more information about AMD
LASERS, please call (86) 999-2635,
(317) 202-9530 {for overseas dialers}
or visit www.AMDLASERS.com. DT

J. Morita to introduce
low-speed air motor at
Chicago Midwinter

About the author

Jay Geier adds 10 to 50 percent more new patients to his
clients’ practices with little or
no change to their marketing
or advertising budget by simply
leveraging their staff and getting
them to focus on new patients as
their No. 1 priority.
To see how your staff stacks
up against your competition
and more than 10,000 practices worldwide when it comes to
turning prospects into scheduled
appointments, take Geier’s new
five-star challenge for free at
www.SchedulingInstitute.com.

J. Morita will be introducing the
new Air Torx, low-speed air motor
at the Chicago Midwinter Meeting
in February. Air Torx offers efficient,
powerful and constant torque with
operational speeds up to 20,000 rpm.
Its innovative fluid dynamics generate about twice as much torque
compared to a conventional lowspeed motor in the 5,000 to 10,000
rpm range.
Air Torx is comfortable to operate: it is lightweight, perfectly balanced and delivers smooth power
control. Versatile, it can be used for a
wide range of tasks such as grinding
dentures, adjusting, finishing and
polishing restorations, and for tooth
polishing with a prophy angle.
Air Torx is designed for enhanced
durability and offers an extended
working life.
Other features include: forward/
reverse drive with continuous speed

control, double-lock connection,
autoclave-safe design and compatibility with standard ISO attachments.
For more information, call
888-JMORITA (566-7482) or visit
www.jmoritausa.com.

About J. Morita
J. Morita USA services North American dental professionals on behalf
of one of the world’s largest manufacturers and distributors of dental equipment and supplies, Japanbased J. Morita Corporation.
The North American office was
established in 1964 and is headquartered in Irvine, Calif.
J. Morita USA is one of the leading companies in the dental market offering innovative and highquality 3-D/pan/ceph imaging units,
delivery systems, handpieces, small
equipment and consumable dental
supplies. DT

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