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Dentist offers advice on dental care for chemotherapy patients / News / One or two employees don’t make a ‘team’ / Receivables at risk / Levin Group celebrates its 25th anniversary / Total facial esthetics for every dental practice / Sedation Dentistry Week / Online / Nation’s Capital Meeting / The last microscope skeptic / Industry News / HYGIENE TRIBUNE 3/2010

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

April 2010

www.dental-tribune.com

ENDO TRIBUNE
The World’s Endodontic Newspaper · U.S. Edition

Web site troubles?

Learn the 10 rules to determine if your Web
site is doing what it should.
u page 4A

Back to the egg

Dr. Serota offers Part II of ‘An evidence-based
endodontic implant algorithm.’
u page 1B

Vol. 5, No. 8

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

Sterilization as a ‘romance’

Sterilization is one of the most important safety
measures a dental office undertakes. upage 1C

Dentist offers advice on dental care
for chemotherapy patients
Virtually everyone knows someone who has battled cancer, and
the effects of chemotherapy and
radiation on a patient’s hair, eyebrows and digestive system are
widely known among the general public. But what many people
don’t know about is the havoc that
such treatment wreaks on teeth
and gums.
Dr. Steven McConnell of Marin
County, Calif., said he is seeing an
increase in the number of patients
seeking dental care after completing cancer treatment. He said he
has found a few simple home-care

routines can help patients alleviate
the dental side effects of cancer
treatment.
“The primary goal of supportive
care is to help stabilize the mouth
by restoring moisture, minimizing anything that causes dryness,
balancing the pH of the mouth and
strengthening the tooth surface,”
McConnell said.
As soon as radiation or chemotherapy treatments start, oral
health is immediately affected. The
mouth becomes drier and gum
recession and mouth sores start
occurring. A common complaint

(Photo/ © Dreamstime.com)

Nation’s Capital Dental Meeting

is difficulty eating, drinking and
swallowing. Often patients must
rely on IV nutrition, as eating and
drinking is too painful. As the
mouth becomes drier, the teeth
also become weaker and more susceptible to decay.
This is a critical time to have
regular hygiene visits to promote
optimum oral health. However,
McConnell said, most oncologists
often discourage hygiene appointments. Frequently, the side effects
of a dental cleaning can increase
the bacteria levels in the bloodstream and risk the health of a

patient while her or she is in treatment.
During this time of treatment,
supportive dental care is imperative to dental health. McConnell
g DT Ê page 3A

ADA pilot program
enters second year
The Community Dental Health
Coordinator (CDHC) pilot program,
funded by the American Dental Association (ADA), is entering its second
year. The three-year program trains
student classes of six each at its three
U.S. program sites to become community health workers with a special
focus on dental skills, and work in
underserved communities, helping

The District of Columbia Dental Society will host its 78th annual Nation’s
Capital Dental Meeting April 8–10 at the Washington Convention Center.
g See pages 16A, 17A

Dr. Steven
McConnell

residents improve their oral care.
A second group of students is now
being welcomed into the program,
while the initial student group moves
on to six-month clinical internships,
the second phase of their training.
In most cases, it is expected that
CDHCs will return to work in their
g DT Ê page 2A
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News

DENTAL TRIBUNE | April 2010

Award to help dental students
offer dental care to troops
The ADA Foundation awarded
its 2009 Bud Tarrson Dental School
Student Community Leadership
Award to the University of Nevada
at Las Vegas (UNLV) School of
Dental Medicine in recognition of
an oral health treatment program
for National Guard troops.
The UNLV School of Dental Medicine will receive $5,000 with the
award to enhance student education and outreach to underserved
populations.
“This selfless effort by these dental students exemplifies what the
ADA Foundation and the Tarrson
Access to Oral Health Care Award
are all about,” said Dr. Arthur
A. Dugoni, president of the ADA
Foundation.
“We are improving the lives and
dental health of others by connecting people and investing in the
human potential of so many individuals.”
In 2008, UNLV dental students
founded the Sergeant Clint Ferrin Memorial Clinic to help meet
the oral health needs of National
Guard troops deemed non-deployable because of dental problems.
Some of these troops cannot
access dental care because they are
not on active duty, making them
ineligible for military benefits. The
program has since expanded to
include all local military veterans
with limited access to dental care.
The first clinic, held in July 2008
at the UNLV School of Dental Medicine, treated 19 patients. Since
then, there have been six additional clinics, with approximately 30
patients receiving free treatment
at each session, including more

than 100 veterans. UNLV dental
students, supervised by Nevada
licensed dentists, provided treatment that included restorations,
root canals, extractions, crowns
and dentures.
The clinic honors the memory
of a UNLV dental student’s brother
killed in action in 2004, while serving in Operation Iraqi Freedom.
Created in 2003 in memory of
philanthropist Bud Tarrson, former CEO and owner of the John O.
Butler Co., the Tarrson Award recognizes one exemplary volunteer
community service project developed by dental students enrolled
in a predoctoral dental education
program.
A Chicago native, Tarrson was a
director of the former ADA Health
Foundation (now ADA Foundation)
from 1994 to 1999.
Between 2004 and 2008, the
Tarrson Award honored outstanding community service on the part
of a practicing dentist or lay person. In 2009, the ADA Foundation
rededicated the Tarrson Award
program to highlight significant
dental student outreach to vulnerable communities.
“The new approach to this
annual award program supports
the efforts and acknowledges the
initiative and outreach of dental
students across the country,” said
Linda Tarrson, who initiated the
award in honor of her late husband.
“Selecting this year’s recipient
was difficult because there are so
many outstanding student programs that are supporting the ideals of professional service and out-

Tell us what you think!
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reach to the community.”
She added, “I’m extremely proud
of the UNLV program and its students for their desire to go beyond
what is expected and to be of service to those in the community
who are truly in need of oral health
care.”
The ADA Foundation is a catalyst
for uniting people and organizations to make a difference through
better oral health. Since 1991, the
ADA Foundation has disbursed
nearly $31 million to support such
charitable activities.
In addition to funding grants
for dental research, education,
scholarships and access to care,
the foundation supports charitable
assistance programs, such as relief
grants to dentists and their dependents who are unable to support
themselves due to injury, a medical condition or advanced age; and
grants and loans to those who are
victims of disasters. DT
(Source: ADA Foundation)

About the ADA Foundation
The ADA Foundation’s
primary goal is to connect
people and organizations in
order to effect a positive difference via improved oral
health.
For more information
about grants awards through
the ADA foundation, please
visit www.adafoundation.
org.

f DT Ê page 1A
home communities, eliminating the
social and cultural barriers that otherwise could impede their effectiveness.
The primary functions of the CDHCs
are oral health education and disease
prevention. CDHCs are trained to perform limited preventive procedures
and to help patients needing dental
care navigate the system, linking them
with dentists to provide that care.
Participants at a kickoff event at Rio
Salado College in Tempe, Ariz., held in
late March, included six new students
from each of the three pilot-program
sites, and current students who are
moving into the internship phase of
their training, CDHC educators and
ADA leaders.
Program pilot sites are Temple University in Philadelphia, which focuses
on urban areas; the University of Oklahoma, where CDHCs will concentrate
on remote rural communities; and
the University of California at Los
Angeles, in conjunction with Salish
gÊ Continued , ‘ADA pilot …’

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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 | April 2010

Meridian chart shows teeth
and organ relationships
Many people are familiar with
Chinese medicine or acupuncture
and have heard about meridians,
the channels through which energy flows in the body. Each organ,
gland and body structure has an
associated meridian, including the
teeth.
What does all this mean to health
and wellness? Well, if someone has
a bad tooth, the energy flow through
the meridian belonging to that tooth
will be altered. This in turn can
affect the health of all the other
organs on that meridian.
For example, tooth #14, the
upper left first molar tooth, is on the
same meridian with the kidneys,
liver, spleen, stomach and breast.
So, if this tooth has a problem, it
may affect energy flow through the
meridian, and the health of those
organs may be affected as well.
Dr. Thomas L. Stone, MD, a pioneer in alternative medical diagnostic and treatment strategies,
once attended a dental health

seminar, and when he
was asked why an MD
would attend a dental
conference, he said, “I
know you dentists are
killing my patients. I
just want to find out
how you are doing it.”
One holistic dentist was so inspired
The front teeth are connected to the kidneys.
by Stone’s statement
The stomach is connected to the premolars. This
that he wrote a book
is something that practitioners of traditional
titled “Rescued By My
Chinese medicine have known for thousands of
Dentist,” which is an
years. Now, TALKInternational.com has develaccount of his patients
oped an Interactive Meridian Tooth Chart to
with health problems
allow the dentist and patient to learn about the
related to their merrelationship between the teeth and the body as
cury amalgam fillings.
an aide for overall health and wellness issues.
Experienced biolog(Photo/www.talkinternational.com)
ical dentists who have
an understanding of
The Interactive Meridian Tooth
the teeth and body connection are
able to consider the oral cavity for Chart is located at www.talkinter
the possible cause of symptoms in national.com/toothchart.html. DT
patients who have been unable to
secure a diagnosis through regular
allopathic medicine channels.
(Source: PRWeb)

f DT Ê page 1A

ucts that are antibacterial, help
mineralize the teeth and help balance the health of the mouth.
Sadly, even after cancer treatments are completed, many of
these painful and destructive
consequences can continue, McConnell said. Mouth sores tend
to disappear, but the dryness and
gum recession often persist and
the teeth that are weakened by the
treatments are much more susceptible to decay.
When treatments are completed, and after being released for
dental treatment by the oncologist,
it is then imperative for patients
to return to regular dental care.
The first concern for the dentist,
he said, is to assess any changes in
dental health.
A complete set of dental radiographs is imperative to look for any
change to the supporting bone and
any evidence of decay or infection.
McConnell said he recommends
patients who have had chemotherapy receive digital radiographs, as
they offer 90 percent less radiation
exposure. Often there are areas
of decay that should be treated
as soon as possible, he said. A
thorough gum evaluation is recommended, as are any treatments
to detect any early signs of gum
disease.
The link between oral health
and overall health is now well
documented, McConnell said, and
establishing optimum oral health
is important for everyone at any
age. But after cancer treatment, he
said, it is imperative.

recommends antibacterial mouth
rinses that are alcohol-free. Mouth
washes or mouth rinses with alcohol promote dryness, so at all costs
patients should avoid any containing alcohol, McConnell said. The
antibacterial properties help minimize plaque formation and also
help prevent mouth sores.
McConnell said his favorite
brands are Closys and Breath Rx,
because they are alcohol-free and
have antibacterial properties. Both
companies also make toothpastes
that complement the rinses. McConnell recommends patients use
the rinse at least two to three times
a day and the toothpaste on an
extra soft brush after every meal.
McConnell also recommends a
remineralizing paste specifically
designed to strengthen the tooth
surface and make it less susceptible to decay. A secondary benefit
of the paste is that it also helps to
balance the pH of the mouth and
support better saliva flow.
The paste is applied to the teeth
once a day after brushing. Patients
may find these products online or
in stores, if they are not available
from their dentists.
Other products, such as Biotene,
help promote saliva flow, and different toothpastes have shown the
ability to remineralize weak tooth
surfaces, McConnell said. He said
the Closys, Breath Rx and remineralization pastes like MI Paste are
easiest to use and most effective.
The key, he said, is for patients
to avoid any products that promote
dryness and to incorporate prod-

(Source: PRWeb)

fÊ Continued, ‘ADA pilot …’
Kootenai College in Montana, whose
graduates will work in Native American areas.
The recent kickoff event provided
current students from the University
of Oklahoma and UCLA, who began
their training a year ago, an opportunity to share their experiences as they
prepare for their six-month internships.
The initial student class from the
program’s most recent site addition,
Temple University, met enrollees affiliated with the two other schools at
the event. They received laptop computers, an orientation to their online
instructional training and a program
overview.
“We look forward to seeing these
individuals return to their communities as trained community health
workers and members of the dental team, playing an important role
in resolving barriers to help improve
residents’ dental care,” said Raymond
F. Gist, DDS, ADA president-elect.
“That’s what the Community Dental
Health Coordinators program is all
about.”
Although the CDHC is a new position, it is modeled on the community health worker, a demonstrated
member of the public health team
who focuses on health education,
prevention, disease management and
increasing access. Because the CDHC
will function much like community
health workers, the ADA believes that
they, too, will have a positive impact
on the oral health of their communities through education and outreach.
(Source: ADA)

[4] =>

News

DENTAL TRIBUNE | April 2010

Considering the anatomy of a
professional-looking Web site
By Mary Kay Miller

Your Web site is where your business resides online and the hub of
your Internet marketing campaign.
It is the virtual representation of
who you are and what you are
all about. Always incorporate good
design principles to ensure your
Web site reaches out to the maximum number of new patients and
engages as many people as possible.
When you are promoting your
treatment and services online, people cannot see you physically like
they would if they met you in your
office. People do judge you by your
cover. This is where a good Web site
design comes in.
In any professional practice, dentists and doctors spend hundreds
of thousands of dollars on office
design, decorating, marketing materials and customer service. Convenient locations should be chosen
and appropriate signs displayed so
patients have little if any difficulty
finding your office.
Your office should be clean and
tidy and your staff members should
emit a professional air with everyone dressed accordingly. The entire
presentation is a marketing strategy to show patients you care about
quality and are someone they can
trust to provide expert treatment
and care.

First impressions matter
The same is true with your Web site.
If your Web site is old and outdated
and is difficult to navigate, looks as
if you hired your next door neighbor
to set it up or, worse yet, you don’t
have one at all, you are literally
shouting to online visitors looking
for you that you are not professional
and you don’t provide quality care.
AD

If you have a professional-looking Web site layout, branded with
your message, you are giving visitors a positive perception. They will
see that you have paid meticulous
attention to every detail of your
business and you care about professionalism. They will also perceive
that you are organized and focused
on patients.
As you grow your practice in
today’s tech-savvy society, your
Web site, along with your business cards, letterheads and promotional materials, become the face
of your business. Every marketing
tool, both online and offline, has its
place and matters.
Attention should be paid to every
aspect of your Web site. Make sure
it performs optimally to serve its
purpose by attracting and engaging
patients to contact your office for a
new patient exam.
In today’s ADHD society, do not
give visitors a reason to click on the
“back” button. Time is precious to
visitors, so get to the point quickly
and without fluff. Statistics show:
• You have less than 8 seconds
to engage a visitor once he or she
clicks on your site.
• On average, a visitor reads only
2.5 pages on your site.
• If a page has more than 500
words and is not neatly organized,
most of the content will go unread.
• If your site is difficult to navigate, visitors will click away from it
immediately.
Here are ten important rules of
thumb to make sure your Web site
performs well.

No. 1: Do not use ‘splash’ or ‘flash
only’ intro pages
Splash pages are the first pages you
see when you arrive at a Web site.

They normally have beautiful imagery with words like “Welcome!” or
“Click here to enter.” They are pictures with no real purpose other
than to entertain. Visitors are not on
your site to be entertained; they are
there for content rich information.
If they want entertainment, they
will go to YouTube.

No. 2: Have simple and clear
navigation
Provide a simple and straightforward navigational menu that even
a young child will know how to
use. Stay away from complicated
flash-based menus or multi-tiered
dropdown menus.
If your visitors cannot figure out
how to navigate your site, they will
leave it. Design your site for an
Internet-challenged newbie. Keep it
easy and simple.

No. 3: Allow users to always know
where they are on your site
When visitors are deeply engrossed
in browsing your site, make sure
they know which part of the site
they are in at that moment.
This way, they will be able to
browse relevant information or navigate to any section of the site easily.
Don’t confuse your visitors because
confusion means “abandon ship!”

images is unnecessary. If you think
every image is essential on your
site, make sure each one is optimized correctly for quick loading.

No. 7: Keep your text paragraphs
at a reasonable length
Online reading of text is different
than reading the printed word. The
brain processes the information differently when read off a computer.
If a paragraph is too long, split it
into smaller separate paragraphs
or bullet point the content for easy
reading.
A block of text that is too large
will deter visitors from reading your
content. They will either move on or
click away.

No. 8: Make sure your Web site
complies with Web standards
Go to www.w3.org and make sure
your Web site is cross-browser
compatible. If your Web site looks
great in Internet Explorer but
doesn’t work properly in Firefox
and Opera, you will lose prospective
new patients. With all the problems
with Microsoft, Firefox and Opera
browsers are becoming more popular every day.

No. 9: Extra large/small text size

Make the content easy to read for
all ages and educational levels. If
visitors don’t understand what is
being said, they will click away. A
Web site is provided to inform and
impress visitors on a basic level. It’s
all about them, not you. Don’t speak
to them on your level; speak to them
on their level.

There is more to Web design than
graphics. User accessibility and
comfort is a big part of it also.
Design the text to be legible and
correctly sized. This enables your
visitors to read it without straining
their eyes.
No matter how good the content
of your Web site or your sales copy
is, if it’s difficult to read, you won’t
be receiving new patient calls. A
size 11 or 12 font in Arial, Verdana
or Trebuchet MS works best.

No. 5: Avoid using music on your
site

No. 10: Text and background page
color

If visitors are going to stay a long
time on your site reading content,
make sure they’re not annoyed by
music looping on and on. If you
insist on adding audio, make sure
visitors have some control over it;
volume or muting controls work
fine.
Music also slows the page loading. If your pages load slowly, users
will leave. The No. 1 page people
leave is the home page. The No. 1
reason why is loading time.
Remember, in the mind of those
looking at your site: visiting your
competition’s Web site is only one
click away. However, if they do, this
could cost you thousands of dollars.

On a computer, some colors are
more difficult to read than others.
Studies report black text on a white
background is the easiest to read.
White text on a black background,
although it looks nice, causes eyestrain and is difficult to read. A light
background with dark colored text
is always your best option.

No. 4: Write the content on a fifth
grade reading level

No. 6: Reduce the number of
images on your Web site
Images make your site load slowly
and, in many cases, a profusion of

As a business owner, it is your job
is to make sure your Web site does
what it’s meant to do effectively.
Even though you are not a Web
designer, it is your marketing
responsibility to ensure your Web
site does what it is supposed to:
engage and direct new patients to
contact your office for a new patient
exam. Don’t let minor mistakes in
design stop your site from performg DT Ê page 6A

[5] =>

[6] =>

Practice Matters

DENTAL TRIBUNE | April 2010

One or two employees
don’t make a ‘team’
If you are losing good employees on a regular basis, do you know why?
By Sally McKenzie, CEO

I recently had a conversation
with a dentist on that ever-popular
topic: employees.
This clinician went on and on
about how fortunate he was to have
had the “best” office manager any
practice could hope for, but now he
was frantically looking for someone to replace her because she’d
turned in her two-week notice. He
was crushed.
I asked him what set this person
apart from the others.
“She just takes care of everything,” he told me.
I was intrigued. “Everything?” I
asked.
The dentist went on to explain
that he could delegate virtually
anything to this person and it would
be done.
She could take care of insurance,
collections, billing, payroll, recall,
staff communications, case presentation, treatment planning. Why,
she even oversaw the office parties.
If it was someone’s birthday, she
baked the cake. What a woman!
In fact, he was about to start
a practice newsletter and this
employee was going to be responsible for writing, designing and
distributing it. This “super manager” might as well have leapt tall
buildings and worn a cape. Yet, I
was seeing red flags.
“Are all of those duties in her job
description?” I asked.
“Oh no,” he puffed. “I don’t like
job descriptions; they just limit
everyone’s responsibilities.”
Now the alarm bells in my head
were blaring loud and clear.
“You mentioned ‘staff communication,’ what does that involve?”

f DT Ê page 4A
ing at its highest level.
On the other hand, I also suggest
you listen to the recommendations
of your Web designer. I often find
many Web site designs are not user
friendly because business owners
want it to look good and insist upon
their own specific design ideas.
Web designers are in business
just like you are, so this can sometimes mean they have to sacrifice
the effectiveness of the site due to
demands from their clients. Their
customers are always right, even
if they don’t know what they are
doing.
Consider these recommendations

I asked.
“I have problems with my other
staff. My assistants don’t do things
the way I want. The hygienist is too
chatty. You know, the usual stuff.
I just tell the office manager to
handle it and she does.”
This was, indeed, a full-scale
alert: no job descriptions, no
accountability, no leadership.
Clearly, there are significant problems at this practice.
The dentist had used the office
manager as a gatekeeper to insulate himself from the other employees and from serious matters that
required his direction and involvement.
Whatever issue he didn’t want to
deal with, he just handed off to her,
from clinical particulars to patient
relations to business operations.
Not only was she the office manager, she was she was the de facto
leader, responsible for virtually
every major system in the practice
except the actual dentistry.

Dentists are often baffled when
team members quit. They feel they
have been blindsided.
They are left wondering what
exactly drives the quality staff to
go. In actuality, there are a number of reasons why staff members
leave, even during challenging economic times.
Is it the money? Not as often as
you might think, although employees will use this as grounds to
make their exit because they don’t
want to tell you or they are afraid to
tell you the real reason.
Certainly, the members of your
team want and appreciate salary

increases, but money is definitely not the only motivator and it’s
clearly not the best motivator to
keep good employees.
As long as the staff are paid competitively there is far more to keeping your team intact than tossing a
few more bucks their way.
Some leave because of how
they perceive they are treated in
the workplace. Human resources
surveys routinely show that more
than 40 percent of employees quit
because they don’t feel appreciated
by their boss.
Why is that important? Because
50 percent of job satisfaction is
determined by the quality of the
relationship that staff have with
you — the dentist — their boss.
In some cases, the dentist treats
the employees disrespectfully. He/
she is a screamer, a micromanager
or just mean and nasty. These practices churn through good employees at a record pace.
The only ones who stay are the
mediocre performers. They stick it
out with a bad boss because they
don’t have the confidence that they
can find another job.
Certainly, many dentists are very
nice people. They are not screamers or mean and nasty, but their
idea of managing people is to tell
them what they are doing wrong,
what they should be doing better,
where they are falling short and
so on.
Alternatively, they say nothing,
which is just as bad if not worse.
Can you think of specific instances
in the past few weeks in which you
have clearly and directly told the
top performers on your team that
you appreciate their work and their
contributions?

and evaluate your Web site from a
visitor’s point of view. If your Web

site needs updating or changes,
contact your Webmaster and talk it

Good employees: hard to find and
harder to keep

If not, I can virtually guarantee
that they think you neither recognize nor appreciate what they are
doing for you and your practice.

Silent soldiers

Oftentimes, when good employees
leave, dentists claim they had no
idea the employee wasn’t happy.
Consider the “super manager” in
the example above.
Why didn’t she speak up? It’s not
uncommon for the good employees
to remain silent. They don’t want to
bother the dentist.
They just keep taking the pressure, being the good stewards
that they are until they crack. In
reality, there is probably little the
“super manager” could have done
to change her situation.
In situations such as this, the
dentist simply will not or cannot
see where he/she is wrong. This
particular dentist believes that his
office manager is responsible for
“managing” every aspect of the
office as the dentist sees it.
In addition, as far as the dentist
was concerned: it worked, so why
change it? For the employee, she
saw only one way to remedy the
situation: quit.
The fact is that it is easy to
ignore the good employees. After
all, they don’t have to be coddled.
They can be counted on to get the
job done, and they are low- or even
no-maintenance.
The dentist tells him/herself
that these employees know what
they are doing.
They are good. They are independent. They can handle the additional responsibility. They don’t
need or want feedback or coaching.

over. Your practice growth depends
on it. DT

About the author
Mary Kay Miller is founder and CEO of Orthopreneur™ Marketing Solutions. After 30-plus years as a business and marketing coordinator for
professional practices, Mary Kay has narrowed her marketing expertise
to Internet Web 2.0 marketing, SEO (search engine optimization) and the
creation of marketing systems to save teams valuable time and effort.
Her book, “Marketing Your Practice Through Different Eyes,” was
released in May 2008 and is a free 100-page eBook available on her Web
site www.orthopreneur.com. It is the first multi-media eBook of its kind
in dentistry and the first book ever written on marketing for both dentists
and team members. It enables dentists and staff members to understand
and experience for themselves how the Internet and Web 2.0 marketing
engages and grabs the attention of today’s consumer.
(Upper Left Photo on Front Page/ © Saniphoto, Dreamstime.com)

[7] =>

DENTAL TRIBUNE | April 2010

As Vince Lombardi once said,
‘There is nothing more unequal than
the equal treatment of unequals.’
However, thinking this is a big
mistake.
Your top performers resent that
they show up on time (or early),
work hard every day, consistently
meet or exceed their performance
goals, and you say virtually nothing. But you’re going “gaga” over
the totally unreliable assistant’s
ability to actually take an X-ray that
you can read!
Which leads me to another key
reason why good employees are
hard to keep: You refuse to deal
with the problem performers.
There are few things more
demoralizing to top-flight staff
than a boss who looks the other
way when others on the team consistently disregard office policies,
bring poor attitudes to work, generate conflict, make excuse after
excuse for why they were late, why
they were sick, why they simply
cannot get their jobs done.
Believe me, your silent soldiers
know exactly who’s doing just
enough to get by. Yet, they get the
same pay raises, same vacation
time and the same perks as top
performers.
Understandably, capable staff
will only tolerate this for so long. As
Vince Lombardi once said, “There
is nothing more unequal than the
equal treatment of unequals.”
Ultimately, the good employees
arrive at the conclusion that the
dentist is either a coward or simply
prefers the poor performers, so
they choose to leave and go to a

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.thedentists
network.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.

practice where their contributions
are appreciated and the culture
encourages rather than discourages excellenceWake-up call
It usually takes a seriously troubling event — such as a major
financial shortfall, the departure
of a critical employee, etc. — for
the clinician to wake up to the fact
there might be a problem.
From there it takes an outsider,
such as a practice management
consultant, to sit down with the

Practice Matters
dentist and discuss his/her frustrations, why he/she cannot trust
other staff members, determine
where the system shortfalls are
occurring, assess training weaknesses and get to the bottom of why
the dentist cannot, or will not, lead
his/her team.
The case of the super manager
above is particularly unfortunate
because clearly the dentist had a
very dedicated and highly competent employee, which is common.
Practices will have one or two rocksolid staff and a host of mediocre
chair warmers.
Instead of creating systems of
accountability, instituting training
programs, developing job descriptions, etc., clinicians will simply
pile the critical duties on those that
they know they can count on. Ulti-

mately, everyone loses.
The good employees eventually break or burn out. The weak
employees are never given the
opportunity to grow and flourish.
Moreover, the dentist is losing
a fortune because, whether he/
she acknowledges it or not, things
are falling through the cracks simply because there are not enough
capable hands on deck to ensure
they don’t.
If you’re losing good employees,
don’t just sit back, shake your head
and tell yourself “good help is hard
to keep.” Find out what is driving
the exodus and seek outside assistance if necessary.
Once you get to the root of the
problem, I guarantee you’ll see
the improvement in your bottom
line. DT
AD

[8] =>

Financial Matters

DENTAL TRIBUNE | April 2010

Receivables at risk

Does your practice extend open credits to your patients?
By Keith D. Drayer

Does your practice extend open
credits to your patients? This is an
important question as veteran dental practice owners know that their
practice’s fiscal health, profitability
and success require balancing a prudent patient financing policy.
Balance allows the flexibility to
accommodate your patients, and it
needs to be firm enough to avoid
cash flow/collection problems that
may have material consequences for
both the clinicians and staff. Even
a temporary cash flow problem is
stressful for a practice owner, creating the potential for uncertainty in
making the payroll.
What is a dental practice’s uncollectible percentage? While this number will vary substantially (due to
many factors ranging from service
mix, use of practice management
software, aggressive or lax payment
policy compliance), when averaged,
it shows the nationwide number of
approximately 2.5 percent. Many
practice owners think they can live
with 2.5 percent. However, further
inspection reveals a more in-depth
appreciation of collection effectiveness on a practice.
Let’s suppose a practice grosses
$1 million annually. If the practice has bad debt or “uncollectible
receivables” of $25,000, that is 2.5
percent, then that write-off number
would be correct (See Table 1).
Accounts receivable trends for
any business, from a FORTUNE 500®
company to a dental practice, are
almost identical. Receivables are like
gravity. You can’t resist gravity and
you can’t resist receivables’ falling
value over time. Table 2 shows the
effects of time on receivables. Each
$1 of accounts receivable at 90 days
is statistically only worth $0.72.
Thus, the case can be made for
dental practices to devote more
focus to their “payment is due upon
service” policy so the practice is
not acting as a bank to patients.
Offering patients (monthly, more
affordable) financing options makes
optimal treatment acceptance more
AD

Practice Annual Revenue

$1,000,000

Eligible Receivables

$850,000

Practice Annual Revenue
Less: Cash Payments*
Eligible Receivables

Bad Debt

$25,000

Bad Debt

$25,000

Bad Debt as a %
of Eligible Receivables

2.5%

Bad Debt as a %
of Eligible Receivables

2.5%

$1,000,000
$150,000
$850,000

(* Cash = Cash + Checks)

Eligible Receivables

$600,000

Practice Annual Revenue
Less: Cash Payments
Less: Credit Cards
Less: Insurance
Eligible Receivables

Bad Debt

$25,000

Bad Debt

$25,000

Bad Debt as a %
of Eligible Receivables

12.5%

Practice Annual Revenue
Less: Cash Payments
Less: Credit Cards

$1,000,000
$150,000
$250,000

Bad Debt as a %
of Eligible Receivables

4.2%

Table 1

Table 2: Value of aged accounts receivable
$1 is worth the following amounts over time
likely, as well as removes a practice that offers selective financing
from appearing as credit officers
and lenders to patients.
Today, a good patient financing plan will accept from 50 to 60
percent of the patients who apply.
There are patient financing companies that indicate an approval rate
of 90 percent based on the total
patient base being considered. That

may be a misleading number as not
every patient wants to be approved.
Your patient-financing candidates
can automatically be any who might
remark:
◗ “I forgot my checkbook.”
◗ “Just bill me.”
◗ “I can pay you $100 a month
until we’re done.”
◗ “I want to have the treatment,
but can’t afford it now.”
◗ “Let me know the balance after
the insurance pay-in.”
It is prudent to offer patient
financing when you examine what
consumers are advised to pay on a
graded scale. Data reveals the recommended consumer order of payments is as follows:
1) Child support. By law, credit
bureaus must report any information received about overdue child
support, as long as it’s verified by
the proper agency and is not more
than seven years old. Consumers are
told this should be the No. 1 payment
priority. Penalties, considered quite
serious, include garnished wages,

$1,000,000
$150,000
$250,000
$400,000
$200,000

liens on property and a suspended
driver’s license. Dentists should be
aware that finance companies might
consider an open child support lien
on a credit bureau report as very
negative.
2) Mortgage. After more than 90
days, late mortgage payments can
end up on a credit record. Mortgages also tend to have hefty late payment fees, and if a mortgage holder
misses two or more, a lender may
start foreclosure proceedings.
3) Car loans. Repossession laws
vary — in some states repossession
happens after only one missed payment. Mass transit isn’t applicable
everywhere and the risk of not having a vehicle probably impedes a
person’s ability to work.
4) Taxes. The Internal Revenue
Service (IRS) is tough when taxpayers don’t pay on time. Penalties accrue with time and the clock
keeps going from the time of the
infraction.
5) Bank credit cards. Credit cards
are important. Paying them on time
is more important than ever as late
payments give all credit card issuers the right to reprice a cardholder
because of economic risk status.
Recent legislation was passed about
sudden rate increases from credit
card companies, though the effective date isn’t until later this year.
6) Department store cards. Many
will negotiate and/or accept lower
payments for various periods of
time.
7) Utilities (electric, gas, water).
Utility companies may work out
payment schedules for consumers
(though security deposits for future
services will be a factor). Nationwide, rules vary as regional regulators have rules protecting homeowners from losing vital services
g DT Ê page 10A

[9] =>

[10] =>

10A Practice Matters Interview

DENTAL TRIBUNE | April 2010

Levin Group celebrates
its 25th anniversary
Levin Group, a leading dental practice management consulting company, celebrates its 25th
anniversary this year. Founded in 1985 by Dr.
Roger P. Levin, a third-generation dentist, the
company has grown from a small, part-time business into one of the leading dental consulting
firms. Below, Dr. Levin, chairman and CEO of
Levin Group, talks about how the Levin Group has
changed and his views on the challenges dentists
face today.
Why did you start Levin Group?
I wanted to help dentists and specialists improve
the quality of their lives. That was the goal then,
and that still is the goal today. Since 1985, Levin
Group has been providing dentists and specialists
the breakthrough systems and the leading-edge
expertise that they need to grow their practices.
For dentists and specialists, a better quality of
life starts with the practice because that’s where
doctors spend the majority of their time.
Levin Group provides customized solutions that
help dentists increase production and profitability,
manage their practices more effectively and with
more confidence, reduce stress and inefficiency,
drive growth and referrals, and enjoy what they
do more.
How has Levin Group changed since 1985?
I started the company as a one-man operation in a
room in our dental office. I was always interested
in the business side of dentistry. Colleagues liked
what I was doing in my practice, and I developed a
reputation as someone who could help other dentists improve their practices. This led to speaking
engagements, which ultimately led to consulting
to dentists and specialists.
Innovation has been a hallmark of our growth.
As we developed new and innovative solutions, we
continued to grow. I am grateful for the success
and for Levin Group becoming a leading dental
consulting firm here and abroad.
We have eight divisions, and locations in Baltimore and Phoenix, with more than 100 employees. We provide management consulting, marketing consulting, executive coaching, transitions and
financial planning services.
What is new on the horizon for Levin Group?
In the next few months, we will be launching the
Levin Group Practice Management Resource Center — a state-of-the-art Web portal for dentists and
specialists who are looking for the best solutions
to increase production and grow their practices.
In addition, we will offer a series of new
products, including patient brochures, practice
management books and audio presentations. We

want every dentist and specialist to have the best
management and marketing resources right at their
fingertips.
What is the biggest challenge facing dentists and
specialists today?
Doctors face incredible challenges now. They have
to do so many things well. It begins with providing
optimal patient care, but they also have to keep up
with the latest clinical techniques and technologies,
manage the practice, lead the team and operate a successful business.
But the biggest challenge for most clinicians is the
business side of dentistry. Dental schools do a great
job of turning dental students into excellent clinicians,
but few dentists have the management skills to effectively and successfully run a dental practice. Especially in this economy, dentists are struggling to increase
production. I hear this all the time and I reassure them
that increasing production is still attainable. They
need to work on getting the right systems in place.
Most practices have incredible potential, but too
often that potential remains unrealized for a large
portion of a dentist’s career because he or she never
received the business training to maximize that potential.
Levin Group works with each and every client to
reach his or her true potential, which includes continually increasing production, referrals and profit;
enjoying a low-stress practice with high professional
satisfaction; and reaching financial independence as
soon as possible.
Any additional advice for today’s dentists and
specialists?
Practice success depends on combining excellent clinical skills with excellent business skills. When dentists
have both, they’ll be amazed at what they can achieve!
The best leaders realize that they can’t do everything and that they can’t do everything well. That’s
why highly successful practitioners surround themselves with excellent management systems so they
can focus on what they do best — practice superior
dentistry and provide excellent patient care.
Dentists should love what they do. Too often, the
business side of the practice takes away from the
enjoyment of dentistry. With the right management
systems in place, dentists can increase their production, lower their stress and enjoy what they do even
more.
Mark Twain once said, “The secret of success is
making your vocation your vacation.” With the right
systems, dentists can do exactly that! DT
If you would like more information about the Levin
Group’s programs and seminars, visit www.levin
group.com.

f DT Ê page 8A
and keeping consumers safe.
8) Student loans. Federal student loans may be deferred
during times of financial challenge. When loans are deferred,
payments aren’t required, but you can’t qualify for deferment
once the loan is in default, so don’t wait until you are behind
in payments to apply. Continue making payments until your
request is approved.
9) Health-care bills. Most medical bills aren’t reported to
credit bureaus until they are sent to collection agencies. Doctors will rarely initiate a patient credit check before starting a
major treatment case.
With health care bills ranked in order at No. 9 and a new
era with a tough economy, can your practice benefit from a
proactive approach to patient financing? DT

About the author
Keith D. Drayer is vice president of Henry Schein Financial
Services. Henry Schein Financial Services represents the
only 3.99 percent same-as-cash
patient financing and no dedicated terminal program. Henry
Schein is the leading distributor of services and products to
office-based health care practitioners. Drayer can be reached
at hsfs@henryschein.com or
(800) 443-2756.

[11] =>

Clinical 11A

DENTAL TRIBUNE | April 2010

Total facial esthetics
for every dental practice
By Louis Malcmacher, DDS

Esthetic dentistry has evolved
during the last 30 years. This article will demonstrate some of the
advancements of the past few years
as well as where we are going in the
near future.

Case study
This is an interesting case on a
number of levels. The patient’s history is of a 42-year-old female who
approximately two years ago wanted
a smile makeover. Figure 1 shows
her preoperative smile.
The patient presented with Class
I occlusion and with a midline discrepancy. She wanted a more even
appearance to her teeth and a whiter
color. The midline discrepancy was
of no consequence to her esthetically.
Her periodontium was healthy
and she requested a minimally invasive approach. Teeth #8 and #9 are
full ceramic crowns that are not the
same shade as her natural teeth.
Although the shade discrepancy is
minor, this did concern her. She
had read about a popular minimally
invasive veneer and was referred to
a dentist for those veneers.
Figure 2 shows this same patient
after her minimally invasive
veneer treatment. She presented in
our office with these veneers and
expressed her disappointment with
these veneers done by her previous
dentist due to a few reasons.
She felt that the teeth had no
character, were “dead looking” and
not lifelike at all, and the cuspids
especially were too bulky, both in
their appearance and to the feel on
the inside of her cheeks.
This picture is representative of
the biggest challenges and complaints that many dentists have
about no prep/minimal prep veneers
— that they are too opaque and
too bulky. At this point, the patient
was not yet interested in further
treatment to correct her smile even
though she was unhappy with the
results.
We see in Figure 3 this same
patient a few months later. She is still
unhappy with the appearance of the
veneers, but a much greater concern
is the fractures that have occurred
with these veneers. Figure 4 shows
a retracted close up view of her case.
The incisal one-third of the veneer
had broken on tooth #5, the veneer
on tooth #7 had completely come off
and a temporary veneer was hastily
placed, and the all-porcelain crown
on tooth #8 had fractured at the
gingival third. This is a combination
of material and bonding failures as
well as poor management of the

Fig. 2

Fig. 1

Fig. 4

Fig. 5

case from the clinical and laboratory
aspects.
This patient also reported having
facial pain on both sides of her face
and in her temple areas. You may
also notice how square the angles
of her jaws are. This was not due
to her skeletal structure, but to the
excessive function of her masseter
muscles.
Upon occlusal examination, her
occlusion was not equilibrated within normal limits. That combined with
the contraction intensity of her masseter and temporalis muscles significantly contributed to her facial pain.
In addition to all of this, she
expressed interest in smoothing the
facial wrinkles around her lips, the
crow’s feet wrinkles at the corner of
her eyes when she smiles caused by
the zygomaticus muscles, as well as
the wrinkles in her forehead.
At this point, obviously, the patient
is in need of retreatment of this case
and we chose to use Aurum Ceramics Cristal Veneers for this case. Figure 5 shows the removal of all the
veneer and composite materials as
well as the two all-porcelain crowns
on teeth #8 and #9.
Here is where this case really
presents a challenge and why working with a talented esthetic ceramic
laboratory really starts to pay off. You
can imagine that the all-porcelain
crowns will be at least 3 to 4 mm
thick circumferentially while some
of these other Cristal veneers may
range anywhere from 0.3 mm thin
in some areas to 1 mm thick in other
areas, even on the same tooth.
When working with a minimally
invasive approach, the ceramist has
to have an excellent understanding
of the ceramic he or she is using
g DT Ê page 13A

in order to provide the dental clinician with a finished case where the
shades of all the different restorations will all match together. This is
especially true when doing no preparation/minimal preparation veneers.
The right and left side views as
shown in Figures 6 and 7 will show

Fig. 3

Fig. 6
that aside from the two central incisors, all of the other preparations
are minimally prepared in enamel,
which will certainly pay off in the
final strength of this veneer case
when the correct materials are used.
At the preparation appointment,
botulinum toxin type A (Botox) was

Fight oral cancer!
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.oralcancerselfexam.com. This new Web site was developed for
consumers in order to show them how to do self-examinations 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 self-examinations. 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?

[12] =>

[13] =>

Clinical 13A

DENTAL TRIBUNE | April 2010

Fig. 7

Fig. 8

Fig. 9

f DT Ê page 11A

the excellent adaptation, texture and
color match that was achieved. As
the clinician, I used the exact same
shade of cement on every restoration
in this case.
Aurum Ceramic did an incredible job in working with the Cristal Veneer Porcelain to achieve this
match, which made my job seating
these veneers incredibly easy.

Figure 10 is a lifestyle photograph
of the patient. The patient reports
that her facial pain is gone.
Comparing this to the postoperative picture of the veneers she had
previously, these veneers are very
lifelike, not at all bulky and have
definition.
In addition, with the combined
treatment of facial injectables and

delivered to the following sites: 12
units to the forehead area for the
forehead wrinkles and facial pain; 8
units in each lateral obicularis oculi
for the crow’s feet wrinkles; 12 units
in each temporalis muscle and 20
units in each masseter muscle for
the treatment of facial pain and to
reduce the intensity of the muscle
contraction; and 7 units in the obicularis oris muscle to smooth the lip
lines.
Figure 8 shows the completed
case after insertion and after occlusal equilibration. These Cristal
Veneers and crowns are excellent
in terms of size and shape and have
eliminated the bulkiness and lack of
texture that the patient previously
complained about.
Aurum Ceramics is known as a
highly esthetic dental laboratory
and it is now bringing their esthetic
experience into the minimally invasive veneer market.
Figure 9 shows a close-up of teeth
#7 through #10 and you can see

About the author

Dr. Louis Malcmacher is a
practicing general dentist and
an internationally recognized
lecturer, author and dental consultant known for his comprehensive and entertaining style.
An evaluator for Clinicians
Reports, Malcmacher is a consultant to the Council on Dental
Practice of the ADA.
You may contact him at (440)
892-1810 or e-mail dryowza@
mail.com. His Web site is www.
commonsensedentistry.com,
where you can find information about his lecture schedule, Botox and dermal filler
hands-on workshops, audio
CDs, download his resource list
and sign up for a free monthly
e-newsletter.

Fig. 10

veneers, we were able to go beyond
the teeth and give this patient a great
looking, natural smile. DT
(Photos/Provided by Dr. Louis
Malcmacher)
AD

[14] =>

14A Events

DENTAL TRIBUNE | April 2010

Sedation Dentistry Week

The week coincides with the switch to daylight-saving time
The second Sedation Dentistry
Safety Week, which was held March
15–19, coincided with the switch to
daylight-saving time, when tens of
millions of Americans reset their
clocks and made the extra effort to
check their smoke alarms.
Once again this year, more than
10,000 dental professionals participated in the weeklong program,
which was aimed at reinforcing
their skills in providing for the
health and safety of all patients.

AD

Sedation dentistry, an increasingly popular method of receiving
dental care, provides adult dental patients an anxiety-free, painfree alternative to standard dental
treatments. While ensuring that
patients are the most comfortable
they’ve ever been before, during
and after each visit, the first and
foremost priority of sedation dentists is always patient safety.
“One reason why so many
adults who previously dreaded

dental visits have become such
ardent fans of sedation dentistry is
because it is pain-free, amazingly
effective, and most importantly, it
is safe,” said Dr. Michael Silverman, who is considered one of the
world’s leading sedation dentistry
educators.
Silverman served as national
chairman of the 2010 Sedation
Dentistry Safety Week.
The five-day event was inaugurated in March 2009. Again this

Dr. Michael
Silverman
year, sedation dentists throughout
the country joined with their team
members to review key safety procedures that apply to each and
every patient.
These dedicated health-care
professionals also checked core
safety equipment and supplies and
spent time reminding patients of
ways in which they can assist their
dentists in making all dental visits
both safe and enjoyable.
Silverman and his colleagues
at DOCS Education, an educator of sedation dentists, hosted
the weeklong program. Since its
founding 10 years ago, DOCS Education members have provided
more than 1.5 million adult dental patients safe treatments that
adhere to or exceed standards recommended by the American Dental Association and approved by
individual state dental boards.
Specific themes were assigned
to each day of Sedation Dentistry
Safety Week:
• Monday, March 15 — Annual
Sedation Dentistry Safety Day
• Tuesday, March 16 — Myth
Busting: Debunking the 7 Most
Common Misconceptions About
Safe Sedation Dentistry
• Wednesday, March 17 — Reality Bites: Highlighting Television
Reality-Show Contestants Who
Can Elevate Their “Star Appeal”
With A Safe, Sedation Dentistry
Makeover
• Thursday, March 18 — A
Heart-to-Heart About Oral Health:
Recognizing the Dangers of Avoiding the Dentist
• Friday, March 19 — Gold
Medal Dentistry: The 2010 Safe
Dentist of the Year Awards
All dentists who offer oral conscious sedation services to their
patients were encouraged to participate in the 2010 Sedation Dentistry Safety Week, regardless of
where they received their training.
More information on sedation
dentistry safety and available training programs is available from
DOCS Education at (877) 325-3637,
www.docseducation.com. DT
(Source: DOCS Education)

[15] =>

Online 15A

DENTAL TRIBUNE | April 2010

DTSC Hygiene Webinar series
Each Webinar is one hour and earns the viewer one ADA-CERP C.E. credits
At www.dtstudyclub.com, you
will find the three-part Webinar
series “Simple Advanced Treatment Modalities for the Dependent
Patient” with Hygiene Tribune Editor in Chief Angie Stone and Hygiene
Tribune author Shirley Gutkowski.

Part I: Who is taking care of the
dependent patient every day?
Are you sick and tired of nursing
assistants avoiding their duty to provide oral care to dependent adults?
Find out how much you have in
common with them.
Stone and Gutkowski bring their
tag-team program to the Web in this
first of three programs.
With their no-nonsense and
humorous approach, they show you
how to build the bridges between
“us and them.” Don’t miss this informative and scientific program.
Part I of this three-part series will
educate the attendees about who is
actually responsible for oral care in
nursing home facilities. Attendees
will learn what a typical day is like
in the life of a nursing assistant,

what education they are provided
and what their position is regarding
oral care.
Learning objectives:
• Understand the true daily work
of the nursing assistant.
• Know what education the nursing assistant has.
• Understand who the nursing
assistant is.

Part II: The Dental Profession Can
Assist Primary Caregivers with
Dependent Patients
Can’t get the nursing assistants
to brush and floss the dependent
adults they’re in charge of?
Never fear, Gutkowski and Stone
show you how to make an impression on caregivers that will stimulate change by shifting your own
thinking.
Part II of this three-part series
will concentrate on what dental professionals should be teaching during
the nursing home staff’s required
annual in-service training session.
Think you should be teaching
brushing and flossing? Join us to

find out!
Learning objectives:
• Gain knowledge on how to
develop an in-service training session.
• Know which simple advanced
treatment modalities improve the
oral health of nursing home residents.
• Understand the role xylitol plays
in oral health improvement.

Part III: How to Implement Your
Own Training Program Through
the Adopt-A-Nursing-Home
Initiative
The alphabet soup of titles can
be daunting to the oral care provider trying to bring the message of
simple novel approaches to oral care
in a facility. Stone and Gutkowski
bring their hard-earned knowledge
and first-hand experience to this
one-hour Web event.
This is the final part of the series
on oral care for the dependent adult.
It covers who is working at the care
facility, who to talk to and when to
call. Don’t miss this important infor-

mation and round out your new perspective on caregivers and dependent adults.
Part III of this three-part series
provides information on how to find
a home to adopt.
Discussions include:
• Who are the main players in
the nursing home environment that
need to be contacted?
• What should be said when contacting the facility?
In addition, complete information
regarding AANH will be discussed.
Learning objectives:
• Know whom to contact at a
facility to adopt the nursing home.
• Understand what to say to the
facility administrators.
• Know what the mission and
goals are of AANH.
Take advantage of this opportunity to earn three C.E. credits by
logging onto www.dtstudyclub.com,
and from the Online Courses menu
choose the Dental Hygiene option.
All three Webinars are offered for
$95 each. DT

Have you visited www.dental-tribune.com?
• General dentistry
“Many orofacial injuries during
sports are preventable”
In 1998, Orlando Magic center
Adonal Foyle took an elbow from
Utah Jazz’s Quincy Lewis to teeth
#8 and #9, causing the teeth to luxate back. In 2001, Dallas Mavericks’
Dirk Nowitzki was elbowed by San
Antonio Spur Terry Porter and tooth
#8 was knocked out. In 2003, Mavericks’ ...
The list goes on and on, and this is
only the NBA. We don’t have enough
space to delineate all the dental injuries hockey players have endured ...
www.dental-tribune.com/articles/
content/scope/specialities/section/general_dentistry/id/1104
“Dentistry: It really is the new
medical specialty”
www.dental-tribune.com/articles/
content/scope/specialities/section/general_dentistry/id/885
“Platinum is a patient’s best friend”
www.dental-tribune.com/articles/
content/scope/specialities/section/general_dentistry/id/810
• Endodontics
“Predictable apical microsurgery:
Patient preparation (Part 1)”
Surgery will never replace solid
endodontic principles and should
always be a last resort. Apical microsurgery consists of nine basic steps
that must be completely performed in
their proper order so we can achieve

the desired result for our efforts ...
www.dental-tribune.com/articles/
content/scope/specialities/section/endodontics/id/929
“Linden explains canal anatomy”
www.dental-tribune.com/articles/
content/scope/specialities/section/endodontics/id/1064
“Removal of warm carrier-based
products with the Twisted File”
www.dental-tribune.com/articles/
content/scope/specialities/section/endodontics/id/928
• Cosmetic dentistry
“Aren’t you that guy on ‘Extreme
Makeover’?”
In an interview with Cosmetic
Tribune, Dr. William M. Dorfman,
the face of modern cosmetic dentistry, discusses his chosen career, his
business, his television show — and
his penchant for treating all of his
patients as if they were celebrities ...
www.dental-tribune.com/articles/
content/scope/specialities/section/cosmetic_dentistry/id/543
“New smile, new life: Innovative
technologies and techniques can
transform a smile”
www.dental-tribune.com/articles/
content/scope/specialities/section/cosmetic_dentistry/id/544
“Anatomic stratification technique
for lifelike anterior composites”
www.dental-tribune.com/articles/
content/scope/specialities/section/cosmetic_dentistry/id/1024

• Dental hygiene
“Pest control in gums gardening:
Locally applied antimicrobials as
adjuncts to nonsurgical periodontal
therapy”
The focused use of chemotherapeutics as antimicrobials can
enhance the outcomes of nonsurgical periodontal therapy, resulting in
healthier mouths for our patients ...
www.dental-tribune.com/articles/
content/scope/specialities/section/dental_hygiene/id/606
“Top 10 causes of tooth discoloration”
www.dental-tribune.com/articles/
content/scope/specialities/section/dental_hygiene/id/578
• Practice management
“To retire or not to retire?”

I am a 1965 graduate of NYU College of Dentistry, and I practiced
until 2000. I was 58 at the time and
was somehow bent on retiring in my
late or middle 50s when most people
thought that way.
Social security was available at
age 62 then, and the average age
men lived to was 66. My dad died
at that age and so did most of my
friends’ fathers. Thus, I figured I
could have a good 10 years to live
the “really good life.” Boy has that
changed ...
www.dental-tribune.com/articles/
content/scope/specialities/section/
practice_management/id/1072
“Good patient communication can
help eliminate no-shows”
www.dental-tribune.com/articles/
content/scope/specialities/section/
practice_management/id/905 DT
AD

[16] =>

16A Nation’s Capital Meeting

DENTAL TRIBUNE | April 2010

Daily schedule at a glance
Thursday, April 8
Registration opens
7:30 a.m.

Registration opens
7:30 a.m.

Registered clinics
8:30–11:15 a.m.
and 1:30–4:15 p.m.

Registered clinics
8:30–11:15 a.m.
and 1:30–4:15 p.m.

Participation clinics
8:30 a.m. - 11:15 a.m.
and 1:30 p.m.–4:15 p.m.

Participation clinics
8:30–11:15 a.m.
and 1:30–4:15 p.m.

Capsule clinics
9–11 a.m. and 2:30–4:30 p.m.

Capsule clinics
9–11 a.m. and 2:30–4:30 p.m.

Exhibit hall opens
10 a.m.–5:30 p.m.

Invisalign® Clear Essentials I
8 a.m.–5:30 p.m.

University of Pittsburgh
Alumni reception
11:45 a.m.–1:15 p.m.

CPR re-certification
8:30 a.m.–12:30 p.m.

Howard College of Dentistry
Alumni/Student reception
5:30–7 p.m.
Monuments by Moonlight tour
7–10 p.m.

AD

Friday, April 9

Exhibit hall opens
10 a.m.–5:30 p.m.
Georgetown University Alumni
Association reception
11:45 a.m.–1:15 p.m.

University of Maryland
Alumni reception
4–5:00 p.m.
President’s reception & Capitol
Steps in Exhibit Hall C
5:30–7 p.m.

Saturday, April 10
Registration opens
7:30 a.m.
Registered clinics
8:30–11:15 a.m.
and 1:30–4:15 p.m.
Participation clinics
8:30–11:15 a.m.
and 1:30–4:15 p.m.
Capsule clinics
9–11 a.m. and 2:30–4:30 p.m.
Invisalign Clear Essentials II
8 a.m.–5 p.m.

(Photo/ © Chrishowey, Dreamstime.
com)

LUMINEERS® smile design
workshop
8 a.m.–5:30 p.m.

Exhibit hall opens
10 a.m.–2 p.m.

CNA risk management
seminar
8 a.m.–12:30 p.m.

Columbia University Alumni
reception
11:45 a.m.–1:15 p.m.

Dental Hygiene Program
8:30 a.m.–4:15 p.m.

Dental Hygiene luncheon
11:45 a.m.–1:15 p.m.

What to do in D.C.?
Or really, what isn’t there to do here?

By Robin Goodman, Group Editor

Aside from the obvious offerings
our nation’s capital offers, there is
quite a lot to do in this city of just less
than 600,000 residents (as of 2009,
that is, says the Census Bureau).
Founded on July 16, 1790, the city
was at first a separate municipality,
but in 1871, Congress merged the
city with its municipality so it officially (and legally) became know as
the District of Columbia.

Cherry Blossom Festival
During the Nation’s Capital Meeting, attendees will catch the tail
end of the National Cherry Blossom
Festival, which runs from March 27
through April 11.
This festival does not take place
only on the trees themselves, but
rather is a citywide effort between
the arts, city attractions, Japanese
culture and restaurants.
Although the event ends in the
middle of April, hotel discounts run
through the end of the month, so
take a couple of days to enjoy some
local color before or after the dental
meeting. Even though you will likely
miss the peak date for cherry blos-

som blooms, April 1–4, the expected
bloom dates range from March 28 to
April 9. You can view the blossoms
by foot, by bike or boat, so bring
comfortable shoes.
For all the latest info on the festival, please visit the Web site at
www.nationalcherryblossomfestival.

Free things to do in D.C.
Thanks to the local experts at www.
washington.org, I now know that
there are at least 100 free (and
“almost free”) things to do in D.C.
Their list is broken down into 10
items under each of the following
topic headings: African-American
experience, arts and culture, around
town, D.C. outside, economical eats
and cheap happy hours, family-fun,
GLBT-friendly, international D.C,
musts for history buffs and performances.
I encourage you to visit the original list online, but have chosen a few
items from some the topic headings
to feature here in the hopes they
might spark your interest (mine certainly is!).

Performances
A family-friendly option is Satur-

[17] =>

DENTAL TRIBUNE | April 2010

Nation’s Capital Meeting 17A
made between 11 a.m.–12:15 p.m.).
Once again, because this is a free
activity, space is available on a firstcome, first-served basis.

International D.C.

(Photo/ © Diademimages, Dreamstime.com
day morning at the National Theatre, which offers anything from
ballet to puppet shows. Get there
early as tickers are free and are
passed out a mere 30 minutes before
the show begins (think: “you snooze
you lose”). Visit them online for all
the details, www.thenationaltheatre.
com.
On Sundays there is a local drum
tradition that is 40-years strong.
When weather permits, you can listen to the drum circle at Meridian
Hill Park from 3–9 p.m. Enjoy listening to the drum beats and see if you
can keep up with the African dancing (don’t forget to bring your drum
if you have one!).
In addition, on Sunday nights
there is live music to be found at
the National Gallery of art (www.
nga.gov), which features a variety
of musical options such as choral
music and even opera. Once again,
be prompt as the doors open at 6
p.m. and there is no admittance after
6:30 p.m.
OK, let’s say you want to sleep
in, but are able to re-route your
day before dinnertime on a Monday
(provided you can stay that long, of
course). There is a free performance
at 6 p.m. and 7:30 p.m. by the Reflections Dance Company on April 12
in the Helen Heyes Gallery at the
National Theatre.

Family fun
Get starry eyed at the Rock Creek
Park, which houses an astronomy
laboratory and allows you to see the
stars on a dome-shaped ceiling (Did
you know it’s the only planetarium
operated by the National Park Service?).
There is regular programming on
Saturdays and Sundays that shares a
handful of the fundamental concepts
in astronomy. Get more information
at www.nps.gov/rocr.
How would you like to make
some money while you’re in D.C.?
Well, you can certainly see millions of dollars being printed at the
Bureau of Engraving and Printing
(www.moneyfactory.gov). The tour
is 40-minutes long and heads out
every 15 minutes during the hours
of 9–10:45 a.m. and 12:30–2 p.m.
(reservations for large groups can be

So, what will it be today: Chinatown?
Germany? Mexico? Rome?
At the corner of 7th and H Street,
NW, you can snap a photo of yourself under the Chinatown Friendship arch. If you have a taste for Chinese food after that, make a beeline
for 619 H Street, NW, the home of
Tony Cheng’s Restaurant.
Awarded a place on the list of
Washington’s best 100 restaurants
as well as a “Best Bargain Award” by
the Washingtonian, you can either
order off the menu or opt for the all
you-can-eat buffet (www.tonycheng

restaurant.com).
Take in some Mexican art at the
Mexican Cultural institute, portal.
sre.gob.mx/imw. This year, the
country celebrates its bicentennial
of independence and the Mexican
Revolution’s centennial. The current exhibition features the works
of native Washingtonian Elizabeth
Catlett, which she created in Mexico
while part of an artistic collective.
“Sprechen Sie Deutsch?” If not,
but you have an interest in German
arts, culture and language, a visit to
the Goethe Institut is definitely in
order.
Located in the Penn Quarter,
there is a collection of film presentations and discussions, literature
and notable speakers (www.goethe.
de/ins/us/was/enindex.htm). DT

[18] =>

18A Industry Clinical

DENTAL TRIBUNE | April 2010

The last microscope skeptic
By Patrick Wahl, DMD, MBA

I didn’t have a microscope, and I
didn’t need one. And I sure didn’t like
being lectured to or told how to live
my life by those who had them. I had
come back into practice in 2006 after
a number of years away when I was
speaking and consulting full-time. I
returned to a specialty that seemed to
have passed me by.
When I first practiced in the 1990s,
microscopes had been the exception.
Now, they had become the rule. But
I already had an endless wish list
of needed supplies and equipment
in addition to all of those expensive
rotary files. A microscope just wasn’t
my first priority.
Practicing again after several years
away was challenging. I sought out
all of the information and help I could
get, and began participating in the
ROOTS e-mail discussion forum. I
was amazed by what my colleagues
were posting. What is a middle mesial
canal? I didn’t remember any mention
of them during my endodontic residency in the early 1990s.
Perhaps I could ignore canals that
probably weren’t there. But there
were several occasions when I could
not find canals that I knew were there.
Where is the mesial-lingual canal on
this mandibular molar? How embarrassing!
There is such a thing as a mandibular molar with only two canals, but I
knew this wasn’t one of them. I had to
refer the patient to a real endodontist
— one with a microscope.
A friend of mine and a world-class
endodontist, Bill Watson, told me that
one day, I would think of the microscope as I do the rubber dam — I won’t
want to work without one, because
it makes my life easier. Bill’s remark
stayed with me.
I never did like the saying, “You
can’t treat what you can’t see,” because
I had been treating things I couldn’t
see every day for years. But Bill’s point
about the microscope, like the rubber
dam, was the microscope makes life
easier! Now that was right up my alley.
Soon, I had accumulated most of the
supplies I really needed. But I was getting tired of working blindly. Let’s face
it; that’s what I was doing. I couldn’t
see anything with my 2.5x loupes that
I couldn’t see without them. And my
AD

4.5x loupes gave me a headache. I
dreaded putting them on, because
my assistant would have to orient me
where to look. They were heavy and
there was very little depth of field. It
was unnatural, and I avoided them.
There had to be a better way.
I researched microscopes for
years. The prices were daunting. I
have friends that have multiple microscopes, each costing $45,000! For that
price, I want to be able to put the top
down and drive it around on weekends! I had concerns about buying a
used microscope, and even most of
the used ones often cost almost as
much as my first car.
But I had also been hearing some
good things about the Seiler 202 — a
stripped-down, basic microscope that
did the job, and from a company with
a great reputation. I could get a new
Seiler 202 for far less than many used
microscopes.
Sadly, I learned that the 202 had
been discontinued, but I was excited
to find out why: the Seiler iQ would
replace it, with improved lighting,
optics and construction. Now was the
time, and the Seiler iQ would be my
choice.
I bought two of the new Seiler iQs,
one for each of the offices in which
I work, and I’m thrilled with them.
What is most remarkable to me is
how easy it is to use a microscope in
endodontics. I had been afraid microscopes would be especially cumbersome and difficult to use, but the
opposite has been the case.
I actually find the microscope
much easier and more natural to use
than loupes, at least easier to use
than high-magnification loupes. The
lowest power on the microscope is
superior to the highest level on the
loupes that I had used. And the highest power on the Seiler iQ is far more
than I think I’ll ever need.
The microscope also has a larger
field of view, and the light is so bright
you can usually see all the way down
the canal to the apex. If it gets any
brighter, I just might be able to see
the future!
Why pay more to get less? I am
amazed at the quality and ease of use
of the Seiler IQ. There is a learning
curve when it comes to mastering all
its uses, but I was able to pull it over
and see everything I needed to see

‘What is most remarkable to me
is how easy it is to use a microscope
in endodontics.’

Fig. 1

Fig. 2
Figs. 1, 2: The middle mesial is clear only at a severe angle that cuts off the
rest of the tooth.
on day one with my very first patient.
The construction is rock solid and gorgeous. It goes where you need it, stays
where you put it, and even comes
standard with the inclinable head that
is so necessary for dentistry.
Since adopting the microscope into
my routine, I have already found a
number of fourth canals in maxillary molars that I would not have
found without the microscope. What
is remarkable is how easy it is — how
obvious the canals are with the magnification and light, and how easy it is
to use a microscope for endodontics.
Some of the fourth canals I would
have found without the microscope,
but I would have done so blindly and
would never have really known what I

was dealing with.
It is surprising how clear
everything is under the microscope. And with the microscope,
I can use a Munce bur (www.cjm
engineering.com) — a surgical length
bur with a strong but thin shaft — and
actually see what I’m doing. Wow!
Last week, I found a mesio-lingual
canal in a lower molar that I would not
have found without the microscope.
Again, what is remarkable is how easy
and obvious it was as soon as I pulled
the microscope over.
It was especially gratifying to me
because I had sent two such cases to
the best endodontist I know, Dr. Jung
Kim in Wilmington, Del., last year
when I couldn’t find them. They were

[19] =>

DENTAL TRIBUNE | April 2010
Hear Dr. Wahl speak
Dr. Patrick Wahl will speak at the meeting of the
Virginia Dental Association in historic Williamsburg,
Va., June 17–20, (www. virginiameeting.org), and at
the Wichita District Dental Society in Wichita,
Kansas, on Sept. 12, 2011, (www.wichitadds.net).

probably hiding in the exact same
configuration.
I found the mesial-buccal canal
right away upon access. It was clearly a mesial-buccal canal, and it was
equally clear there was an unfound
mesial-lingual as well. No luck uncovering a mesial-lingual canal with a
bur. No luck with an ultrasonic. No
nothing.
I pulled the microscope over. It was
obvious under such bright light and
magnification that there was a ledge
of dentin overhanging the lingual
aspect of the mesial-buccal canal, and
almost certainly a canal underneath.
Indeed, the mesial-lingual canal was
directly adjacent to the mesial-buccal
canal. It could not have been easier to
use a Munce bur to uncover the ledge.
I used to believe that only burs
could uncover canals. Now, I am
learning that often, our burs have
already uncovered canals, but they
will remain hidden under ledges,
invisible to the naked eye without the
magnification and light provided so
easily by the microscope.
Just yesterday, I found my first middle mesial canal. Oh, I know that others have been finding them routinely
for 15 years. Now, I will be, too.
At the lowest level of magnification
(5x), it was as if there were three tiny
light bulbs along the mesial aspect of
the access floor — one bright white
light corresponding to the mesial buccal canal; one bright light corresponding to the mesial lingual canal and an
equally clear and bright light in the
middle.
And I had never troughed between
the mesial buccal and mesial lingual
canals — I never had to. The bright
light representing that third mesial
canal was already visible.
I no longer want to do endodontics
without a microscope, just as I would
not want to do endodontics without a
rubber dam. If you are interested in
endodontics, if you treat any molars at
all, don’t waste money on loupes. Get
a Seiler iQ floor mount.
It’s affordable, extremely simple
and natural to use, and its quality construction is obvious, like closing a door
on a Mercedes.
Thank you, Glenn van As (glenn
vanas@mac.com). Glenn is a general
dentist who uses a microscope for
every procedure. His DVD taught me
everything I needed to know about
microscopes, even before I bought
one. I review it on occasion and pick
up more tips each time.
Thank you, Stefan Luger (www.
dentalmicroscopy.com). Stefan is the
microscope consultant who sold me

the microscopes and made sure they
were installed correctly. Most of all,
I want to thank the ROOTS endodontic e-mail discussion forum (www.
rxroots.com), which helped me along

Industry Clinical 19A
the whole way. I hope you will join the
discussion. DT

article, and has received no compensation for writing this article.

Wahl has no financial interest in
any of the companies mentioned in this

(Photos/Provided by Dr. Patrick
Wahl)

About the author
Dr. Patrick Wahl is an endodontist in private practice in Wilmington, Del. He completed his
endodontic postgraduate training
at the University of Pennsylvania
and serves on the faculty of Temple University where he teaches
a practice management class. He
can be reached through his Web
site, www.officemagic.com.

[20] =>

20A Industry News

DENTAL TRIBUNE | April 2010

Fast loading Steriband
Matrix Retainer
In studies published in the British
Dental Journal, Lowe et al.1 and Whitworth et al.2 demonstrated blood on
post-sterilization-assembled matrix
bands and concluded that it is not
possible to clean assembled matrix
bands with any method currently
available to dental practitioners.
Dr. Simon (Paddy) Jones is a leading U.K. dentist with a practice in the

northeast of England. He qualified
in 1985 and has worked mainly for
the British National Health Service
since then. For the past six years,
he has also served as a vocational
trainer for the Northern Deanery of
Newcastle University Dental School.
He is a keen sportsman, avid blues
music fan and car rally enthusiast.
Jones came up with the idea for

and designed Directa’s revolutionary Steriband Matrix Retainer out of
the frustration and time wasted fiddling and loading matrix bands into
conventional matrix retainers while
dealing with cavities. He also wanted
to minimize risks of cross-infection.
The Directa Steriband Retainer
simplifies loading of a matrix band
with its unique clamping device and

Dr. Simon Jones, inventor of the
Directa Steriband Matrix Retainer.

Directa’s Steriband Matrix Retainer
(Photos/Provided by Directa)
easy loading design. Furthermore,
the design eliminates tearing of
matrix bands because the matrix
can be removed from its retainer, even while still in the patient’s
mouth. The matrix is removed horizontally, rather than vertically, and
is easily dissembled in seconds for
easier cleaning and decontamination in an ultra-sonic bath or washer
disinfector.
For both patients and the dental
team, all reusable matrix retainers
pose a cross-infection risk, which
demonstrates the absolute necessity
to change the matrix band between
every patient and not even attempt
to sterilize it. Potentially, the dental
nurse faces the greatest risk when
removing a contaminated matrix
band from the retainer, which is
often a difficult and hazardous process.
Since Steriband Matrix Retainer
was introduced onto the market, it
has aroused a great deal of interest
among dentists and dental technicians because of its ease of use
and fast loading — with all types of
matrix bands including Toffelmire
and Siqveland, normal and ultrathin, stainless steel and clear polymer — and safety features.
The price of Steriband Matrix
Retainer has recently been lowered considerably due to improved
production techniques, making it a
must for all dental surgeries.
Information about Directa products and distributors may be found
on www.directadental.com or by
calling (203) 788-4224. DT

References
1) C L Whitworth et al., BDJ. Vol.
4, 2007
2) Lowe et al., BDJ. Vol. 192 No
1, 2002

[21] =>

DENTAL TRIBUNE | April 2010

Industry News 21A

Tri Hawk targets
‘the bur connoisseur’
Tri Hawk recently unveiled a new
multi-faceted corporate marketing
campaign for its proprietary line of
dental burs. At the core of the campaign is a strategy to target only the
most demanding bur users.
“Over the past 40 years, we have
learned that many dental practitioners take the attitude that ‘a bur is a
bur,’” said Tri Hawk founder and CEO
Gustel Fischer. “More discriminating clinicians, however, are able to
appreciate a bur that truly provides an
unparalleled combination of cutting
speed, user and patient safety, and
resistance to breakage. Those are the
people for whom Tri Hawk burs are
designed.”
This new positioning is reflected in
the company’s new tagline: “For the
bur connoisseur.”
Key elements of the marketing
campaign include: a more contemporary and distinctive logo; a greatly
expanded Web site featuring a comprehensive online store; an all-new
journal advertising campaign; an
extensive catalog showcasing the
company’s unique product line and
history; and a high-impact trade show
booth design.
The company has also expanded its
offering of diamond burs to complement its extensive line-up of standard,
surgical, metal-cutting carbide and
finishing burs.
The campaign was launched successfully at the Chicago Dental Society Midwinter Meeting in February.
According to Scott Macdonald, Tri
Hawk marketing manager for North
America; “We could not be more
pleased with the reception of our new
campaign. Despite the still-recovering
state of the economy, our show sales
were the highest we have experienced in eight years.”
According to Macdonald, Tri
Hawk’s new booth attracted exceptional traffic, and the new catalog
received glowing reviews from both
existing and new customers.
Tri Hawk’s singular focus has
always been designing, manufacturing and marketing the most effective
dental burs possible, which the company says gives it a significant edge
over competitors that produce a wide
variety of products.
“We have an intense passion for
burs for the simple reason that we consider them to be the most important
instruments used by the dental practice,” said Fischer. In order to meet
the needs of the most exacting dental
practitioners, Tri Hawk employs proprietary bur designs, metal blends
and manufacturing processes, and
even designs its own bur-making
equipment. Customer feedback and
independent studies indicate that Tri

Hawk burs provide a combination of
cutting speed, strength and safety that
is unmatched in the industry, according to the company.
In particular, Tri Hawk’s Talon
metal- and crown-cutting burs feature an exclusive over-the-top blade
design that allows the burs to cut
not only horizontally but vertically as

well. As a result, Talon burs are able
to cut through even the most challenging materials in a fraction of the
time of other leading burs.

About Tri Hawk Corporation
The privately held Tri Hawk Corporation, founded in 1969, has its corporate headquarters and manufacturing

facility in Morrisburg, Ontario, Canada and U.S. headquarters in Massena,
N.Y.
Tri Hawk sells its products in
more than 80 countries throughout
the world, including Europe, South
America, Africa and Asia. For more
information, call (866) 874-4295, or
visit www.trihawk.com. DT

[22] =>

[23] =>

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

April 2010

www.dental-tribune.com

Vol. 3, No. 3

‘Romancing the spore’
Spores are romanced through each step of the sterilization process
By Patricia M. Pine, RDH

“The Way We Were” and
“Romancing the Stone” are great
old romantic movies. However,
“the way we were” in sterilization
should be just a memory in dentistry. Antiquated methods like cold
sterilization no longer serve us.
The dental community continues to change and has gone
full-throttle with new products for
both clinician and patient comfort.
Sterilization techniques have kept
pace with science and given professionals new ways to “romance
the spores.”
One of the most important safety
techniques a dental office can provide for its patients is proper sterilization. Until there is a fear-ridden
news story, patients don’t often
think about sterilization because it
is a behind-the-scenes technology.

Public fears began in the ’80s
with the AIDS scare in fear that
HIV could be contracted in dental
offices. Back then and now, the risk
for transmission of HIV is small.
What the public and many professionals don’t consider are the
newer more virulent risks like
MRSA, C-def, and H1N1 as well as
the old stand-bys such as TB (See
Table 1: Glossary of ‘bugs’).
As oral health-care professionals, we cannot take the sterilization
process for granted.
Consistency of sterilization
practices requires a comprehensive program ensuring operator
competence and proper methods
of cleaning and wrapping instruments, loading and operating the
sterilizer and monitoring the processes.
The goal in any sterilization
department is to disassemble spore

Table 1: Glossary of ‘bugs’
MRSA

methicillin-resistant Staphylococcus aurous

C-Def

Clostridium difficult infection

H1N1

Swine flu

Tuberculosis

proteins to prevent harm. We need
to romance the spores.

How to romance the spores
Warm baths, massages, thick spa
towels and a bow around the package set the mood for romancing
the spores. Spores are romanced
through each sterilization step.
Spore-contaminated
instruments are placed in the hot tub (the
enzymatic bath) for a 20-minute,
massage-removing bio-burden.
After bathing, rinsing causes

contaminated debris to sluice down
the instruments.
This is followed by a natural
drip-dry period on towels. This
allows for visual inspection and
prepares the instruments for entering the sauna.
Wrapping up for saunas is routine. Using paper pouches with
inner and outer indicators is one
option.
g HT Ê page 2C

Tips to prevent tooth grinding
By Keri Kramer, Chicago Dental Society

How are Americans dealing with
these difficult economic times?
They’re taking the stress out on
their teeth, if you ask dentists. In
the fall of 2009, the Chicago Dental
Society surveyed more than 250
of its members to see if stressing
about the economy was wreaking
havoc on patients’ oral health.
Nearly 75 percent of dentists surveyed said their patients reported increased stress in their lives.
In addition, 65 percent of dentists
said they have seen an increase in
jaw clenching and teeth grinding
amongst their patients.
Jaw clenching and teeth grinding, or bruxism, can be a temporary
nuisance during stressful times that
causes headaches and sleep problems, but it can also cause lasting
problems for your teeth and gums.
It can lead to muscle inflammation, broken teeth or even damaged
dental work, such as crowns and
fillings.
Dentists are sharing the following tips with their patients to help
them cope with the pressures of the
world — before their teeth pay the
price:

Take a pain reliever. If grinding and clenching is causing you
headaches and muscle soreness in
your jaw, take an anti-inflammatory
medication, such as Advil or Aleve,
shortly before bedtime.
Massage. Try massaging the
muscles along your jaw line, from
the joint near your ear all the way
to your chin to relieve jaw soreness.
Avoid caffeine. Coffee may help
you get going in the morning, but
caffeine combined with stress can
lead to increased muscle tension.
Increase your consumption of
water. If cutting caffeine completely
from your life won’t work for you,
the least you can do is try to avoid
it within several hours of bedtime.
Be careful with your diet. When
the jaw muscles get inflamed, it’s
best to go easy on them for a while
by avoiding foods that require vigorous chewing. Ice and gum chewing are a definite no-no. And don’t
even think about that triple-decker
cheeseburger that almost requires
you unhinge your jaw to eat it.
Exercise. You didn’t want to hear
this one did you? However, exercise
relieves stress and reduces anxiety,
the two biggest culprits of grinding.
Meditate. Try a yoga class to

achieve some relaxation. Even taking a moment before bedtime to do
some deep breathing can be a big
help.
Wear a mouth guard. If you have
serious grinding and clenching
issues, talk to your dentist about a
mouth guard to wear at night.

About the CDS
The Chicago Dental Society recently
held its 145th annual Midwinter Meeting, which brought more than 30,000
dental professionals to Chicago in
February. The meeting is a forum for
dentists to learn about new products,
technologies and methods. HT
AD

[24] =>

News

HYGIENE TRIBUNE | April 2010

Dear Reader,
The dentist I have worked with
over the last 12 years has often
told me his mother, Mrs. Dubats,
always said to her children, “Do
what you do best.”
At work, this comment most
often comes after one of us has
complained about something or
played a practical joke. It has
become a sarcastic comment in
our office and one that we all
understand.
While we have fun with this,
I am not sure is the way Mrs.
Dubats intended it to be used. You
see, there is a deeper meaning to
that comment.
We should live by this saying. This is especially true in the
hygiene department.
I listen to team members complain that not all the hygienists do
as thorough a job with periodontal
therapy, that some provide more
patient education than others,
some perio chart all the time and
some do not.

My answer to these complaints
is, “Wow. You are so lucky to have
that situation!” They don’t expect
this response.
Having diversity on a team
allows team members to focus
on areas where they excel. For
instance, take my office.
I excel in treating periodontal
patients, so I spend most my time
doing that. My colleague is amazing with children, so she sees the
majority of our little patients.
We don’t focus on what we
may not be so good at, but instead
we look at what we do well and
what interests us. This mindset
has taken stressful situations and
turned them into positive experiences.
Keep the thought, “do what you
do best” in your mind for the next
month.
Do what you do best and encourage others to do what they do best.
Work as a team that is based upon
this principle.

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

Publisher & Chairman
Torsten Oemus
t.oemus@dental-tribune.com
Vice President Global Sales
Peter Witteczek
p.witeczek@dental-tribune.com
Chief Operating Officer
Eric Seid
e.seid@dental-tribune.com
Group Editor & Designer
Robin Goodman
r.goodman@dental-tribune.com
Editor in Chief Hygiene Tribune
Angie Stone RDH
a.stone@dental-tribune.com
Managing Editor/Designer
Implant Tribunes & Endo Tribune
Sierra Rendon
s.rendon@dental-tribune.com

I believe it can change your life.
Best Regards,

Angie Stone, RDH, BS

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
Mark Eisen
m.eisen@dental-tribune.com
Marketing Manager
Anna Wlodarczyk
a.wlodarczyk@dental-tribune.com

Reasons for sterilization failures

Sales & Marketing Assistant
Lorrie Young
l.young@dental-tribune.com

• Improper packing: Prevents penetration of sterilizing agent.

C.E. Manager
Julia E. Wehkamp
j.wehkamp@dental-tribune.com

• Improper loading: Overloading or packages too close together.
• Improper Timing: Not enough time at proper temperature to achieve
microbial kill; or a timer malfunction.
• Improper temperature: Not enough heat for proper time interval to achieve
microbial kill.
• Improper method of sterilization: Heat-sensitive items melt or distort.

f HT Ê page 1C
Another option is to “go naked”
by using cassettes still wrapped
and tied with a bow (indicator
tape.)
Cassettes keep instrument sets
orderly, saving time and preventing accidental exposures. Both of
these procedures must allow the
sauna (steam) to breathe through
while denuding the protein that
causes diseases.
The romance is doomed to failure if the packets are stuffed together with no room to truly experience the warmth of the sauna. It
becomes a competition with some
packets selfishly grabbing all the
heat and others enviously going
without. The most important step:
proper loading of the sterilizer.
The finale of this romance ends
with the instruments free of disease-producing protein, completely dry and ready to caress the next
patient safely. This sounds like
a spa treatment or a made-forTV movie, yet the consequence of

messing up this romance is more
than loss of a relationship; it could
be loss of life.

Was it a successful romance?
The next question to answer is
if the romance was successful.
Are your instruments truly sterile? Authorities recognize bacterial
spores, i.e., Bacillus spores, as the
most resistant type of microbes,
making spore testing the closestto-ideal measure of eradication.
Routine weekly spore testing
and biological monitoring of equipment for patient safety is not an
option. It is a must.
The spore-test used depends on
the type of sterilizer. Steam sterilizers should be tested for Geobacillus stearothermophilus. For dry
heat sterilization, the test should
be for Bacillus atrophaeus.
In case of a positive spore test,
the sterilizer must be removed
from service to review the operating procedures. If the problems are
procedural, these can be corrected
immediately.

A second spore test should then
be performed. If the test is again
positive, previously sterilized
instrument packs must be removed
from service. An immediate call
for service on the unit is necessary
and asking for a replacement sterilizer. Upon arrival of the temporary sterilizer, spore testing should
be performed.
After repair of the original practice unit, there needs to be negative spore test in three consecutive empty chamber sterilization
cycles.
Only then can the sterilizer be
put back into service.

What does OSHA have to do with
it?
The federal government requires
OSHA training on an annual basis
and before a new employee is
hired. Use the lists and photos
to assist in review of sterilization
procedures as part of each new
employee’s OSHA training as well
as part of every employee’s annual
training.

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.
Hygiene Tribune strives to maintain
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.
Hygiene 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.

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
articles about in Hygiene Tribune? Let
us know by e-mailing feedback@dentaltribune.com. We look forward to hearing
from you!
If you would like to make any change
to your subscription (name, address or
to opt out) please send us an e-mail
at database@dental-tribune.com and be
sure to include which publication you are
referring to. Also, please note that subscription changes can take up to 6 weeks
to process.

[25] =>

Clinical

HYGIENE TRIBUNE | April 2010
When was your last infection
control training? Is everyone on
the same page? Is it time to bring
in a professional trainer?

True romance
Actually, the true romance isn’t
really between the practice and
the spore. The true romance is
between the practice and the
patients of record and the new
patients they refer.
Eradicate patients’ spoken or
unspoken fears by inviting questions about the behind-the-scenes
sterilization process used in your
practice by offering tours of your
office.
Don’t assume patients of record
already know how you effect proper sterilization. Creating trust and
comfort by providing the best care
on every level will result in referrals from content patients. HT

Methods of sterilization*
• Remove bio-burden from instruments prior to packaging via ultrasonic device.
• Use sterilization pouches with both inner and external monitoring devices.
• Cassettes reduce possible exposures, increase organization of instruments and eliminate the need to
handle highly contaminated instruments.
• Load pouches or cassettes into the sterilizer, leaving room for steam to circulate between each bag
(see photo).
• Place pouches on separate trays. They must not touch sides, bottom, top or inside of the sterilization
chamber.
• Place cassettes horizontal on each tray, or vertical on a special rack, with space for steam circulation.
• Monitor sterilizers with biological test strips and control indicators at least weekly.
• Maintain sterilization records in compliance with state and local regulations.

References
• Guideline
for
Disinfection
and Sterilization in Healthcare Facilities, 2008. Available at www.cdc.gov/hicpac/
pdf/Disinfection_Steri
lization/Pages72_79Disinfection_
Nov_2008.pdf. Retrieved 2/10/10.
• From Policy to Practice: OSAP’s
Guide to the Guidelines, 2003.
Organization for Safety and
Asepsis Procedures.
• Cottone, J, Terezhalmay, G,
Molanari, J. Practical Infection
Control in Dentistry, 2nd Edition, 2005, Lippincott.
• Guideline for Disinfection and
Sterilization in Healthcare Facilities, 2008 Centers for Disease
Control and Prevention.
(Photos/Provided by Patricia M.
Pine, RDH)

* Adapted from OSAP manual “From Policy to Practice 2004”

About the author
Patricia M. Pine, RDH, has more
than 30 years of experience. She is
currently practicing as a periodontal therapist in Scottsdale, Ariz.,
utilizing her laser skills. Pine promotes risk management presentations that combine organizing the
hygienists’ day while incorporating new technology and minimally
invasive dentistry that is evidenceand scientific-research based.
Pine is founder of “U”nique
Dental Organizational Services.
She provides practices with safety
exercises that keep teams up to
date and safe in all aspects of
infection control including OSHA

guidelines.
She encourages risk management in all venues of dentistry.

Time management, oral cancer,
office policies and procedures,
including recordkeeping are a few
of her speaking topics.
Her career has been multifaceted and includes clinical dental
hygiene, dental hygiene education, and speaking nationally and
internationally. She has also contributed to several dental hygiene
magazines.
You may visit Pine’s Web site
at www.uniquedentalservices.com.
There you can take a short quiz
that will test you on infection control updates by clicking on the inoffice tab at the top.

[26] =>

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