DT U.S.

Patient’s stem cells harvested - transplanted into jaw / Uncover the practice profit killers / Reorganize your practice / Uncover the practice profit killers (Continued from page 5) / In this economy - customer service matters more than ever! / Worldental Communiqué / Steps to selling a dental practice / The keys to early cancer diagnosis: careful examination & timely biopsy / Education / Event / Industry News / Cosmetic Tribune 3/2009 / Hygiene Tribune 3/2009

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

April 2009

www.dental-tribune.com
AAE comes to Orlando

Dr. Ivan Ho, a Southern California-based dentist and founder of
Platinum Dental, recently performed
a concentrated stem cell transplant
for one of his patients in need of
implants. The innovative procedure,
called a bone marrow aspirate concentration (BMAC), is reported to be
the first on the West Coast and only
the second performed in the United
States.

Industry standards state that
33 percent of total practice
production should come from
the hygiene department.

Modifiying a straight abutment
with porcelain to create a custom
abutment for minimal cost and
improved esthetics.

uPage

Patient’s stem
cells harvested,
transplanted into jaw
By Fred Michmershuizen, Online Editor

The business of hygiene

Custom implant abutment

The AAE is inviting specialists
and GPs to “Engage, Energize
and Educate” at its Annual
Session.
uPage

Vol. 4, Nos. 9 & 10

Ho harvested and transplanted
stem cells from the patient’s own
bone marrow into his jawbone to
create a dense bone structure to
which a dental implant can later be
permanently set. The procedure was
conducted on March 23 at Platinum
Dental in Rancho Santa Margarita,
Calif.
The process involved the harg DT page 2

uPage

ADA calls on Congress
to increase IHS funding
The Indian Health Service
(IHS), the federal health program
for American Indians and Alaska
Natives, is getting some increased
attention from the American Dental
Association (ADA). John S. Findley,
DDS, president of the ADA, recently
told the U.S. House Committee on
interior appropriations that the IHS
dental workforce, already understaffed, faces a significant number of
retirements by the most experienced

dentists. Findley pointed out that
this occurs at a time when “childhood caries and periodontal disease
among diabetics are rampant.”
Findley said that nearly 65 percent
of the agency’s dental specialists are
eligible for retirement this year. He
asked the subcommittee to increase
the program by $1 million to train
new specialists and to ensure future
budgets include that funding. DT

AAE holds Root Canal Awareness Week
By Dental Tribune Staff

Ask people which dental procedure they fear most and you will
invariably hear the same answer:
the root canal. Such fears often keep
people away from dental offices altogether, but the American Association of Endodontists (AAE) wants
to change that. To help dispel such
fears among the general public, the
AAE recently conducted its third
annual Root Canal Awareness week.

1-800-22-FLEXI • www.edsdental.com • 89 Leuning St., S. Hackensack, NJ 07606

treatment and increase understanding of the procedure as one that is
virtually painless. The week also
sought to raise awareness of endodontics as a specialty and highlight
the importance of endodontists.

Root Canal Awareness Week provided an opportunity to dispel longstanding myths about root canal

Root Canal Awareness Week was
held March 29 through April 4, but
the AAE offers its advice to the general public all year long. For more
information, visit www.rootcanalspecialists.org. DT

x-tra fil Dental Tribune_11_08:-

14.10.2008

16:27 Uhr

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News

Dental Tribune | April 2009

DENTAL TRIBUNE
The World’s Dental Newspaper · US Edition

g DT page 1

Publisher
Torsten Oemus
t.oemus@dtamerica.com

vesting of the stem cells through
a small incision in the hip bone of
the patient, Jason Morgan, on the
morning of the procedure. Using a
centrifuge, Ho isolated and concentrated Morgan’s stem cells from the
plasma, transplanted them into his
jaw and then added an allograft.

President
Peter Witteczek
p.witteczek@dtamerica.com
Chief Operating Officer
Eric Seid
e.seid@dtamerica.com
Group Editor
Robin Goodman
r.goodman@dtamerica.com

During a telephone interview
with Dental Tribune after the procedure, Ho explained that the stem
cells will work with the surrounding tissue to eventually generate
healthy, dense bone tissue to which
the dental implant can be permanently attached.

Editor in Chief Dental Tribune
Dr. David L. Hoexter
d.hoexter@dtamerica.com
Managing Editor Endo Tribune
& Online
Fred Michmershuizen
f.michmershuizen@dtamerica.com
Managing Editor Implant Tribune
Sierra Rendon
s.rendon@dtamerica.com

The ultimate goal with this procedure, Ho explained, is to find better,
new ways of growing bone. “The
stem cells should allow for better
quality bone growth and better healing,” he said.

Managing Editor Ortho Tribune
Kristine Colker
k.colker@dtamerica.com

A patient’s stem cells are harvested through a small incision in the hip bone
so that Dr. Ivan Ho can perform a transplant.

Stem cells have been used for
many years by neurosurgeons and
orthopedic surgeons to generate
bone for procedures such as spinal
and tibia fusions. Now, Ho is applying the stem cell transplant procedure to dental applications to provide an option for patients who may
not have previously been candidates
for a tooth implant because of poor
jawbone density.

to perform. He added that it provides
faster healing, less pain and better
results than other implant procedures.
“This minimally invasive procedure is an innovative, advanced
long-term alternative to existing
tooth replacement options such as
dentures, bridges and even traditional bone grafting procedures,”
Ho said. “In addition to providing
better and faster healing, the transplantation of the patient’s own stem
cells enables the body to increase

Ho described the outpatient procedure as minimally invasive and
relatively painless, and said that it
takes between one and three hours

Fun fact: Angie’s List
Do you want to know what your patients are saying about you?
Do you check sites like Angie’s List and Yelp.com to find out what
patients are saying about your practice?
Yes … 11%

No … 89%
(Source: Chicago Dental Society)

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bone growth in the jaw through
angiogenesis to permanently support the dental implant. Because the
use of dentures and bridges carry
a high risk of problems in many
cases — resulting in gum disease,
tooth decay and the loss of viable
teeth — additional costly surgical
procedures are necessary, where
dental implants are the most natural
solution and provide the best longterm results.”
For more than 18 years, Ho has
been practicing dentistry out of his
Platinum Dental offices in California. He has been described as a pioneer in improving the present state
of dentistry, primarily by using the
most sophisticated, patient-friendly
ways of delivering advanced dental care. Ho received his degree
in dentistry from the University of
Southern California and is a member of more than 10 professional
dental societies. He achieved diplomat status from the International Congress of Oral Implantology,
graduated from the MISCH Implant
Institution, and received mastership
training at the Las Vegas Institute
(LVI) for Advanced Dental Studies.
Ho is also a Fellow in the American
Academy of Implant Dentistry. Ho
offers the latest technology to his
patients, and he is one of the few
dentists in Orange County, Calif., to
offer the PRP (platelet rich plasma)
procedure.
Platinum Dental, with two locations in South Orange County, Calif.,
is a dental practice consisting of a
team of highly trained and skilled
clinicians devoted to restoring and
enhancing the natural beauty of
smiles using state-of-the-art procedures. Platinum Dental provides
comprehensive treatment planning
and uses restorative and cosmetic
dentistry to achieve optimal dental
health for its patients. For more
information, visit www.platinumdental.net. DT

Product & Account Manager
Mark Eisen
m.eisen@dtamerica.com
Marketing Manager
Anna Wlodarczyk
a.wlodarczyk@dtamerica.com
Sales & Marketing Assistant
Lorrie Young
l.young@dtamerica.com
C.E. Manager
Julia E. Wehkamp
E-mail: j.wehkamp@dtamerica.com
Art Director
Yodit Tesfaye Walker
y.tesfaye@dtamerica.com
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

© 2009, Dental Tribune America, LLC.
All rights reserved.
Dental Tribune strives to maintain the utmost
accuracy in its news and clinical reports. If
you find a factual error or content that requires clarification, please contact Group Editor Robin Goodman, r.goodman@dtamerica.
com. Dental Tribune cannot assume responsibility for the validity of product claims or for
typographical errors. The publisher also does
not assume responsibility for product names
or statements made by advertisers. Opinions
expressed by authors are their own and may
not reflect those of Dental Tribune America.

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

www.dental-tribune.com
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Practice Matters

Dental Tribune | April 2009

5

Uncover the practice profit killers
Sally McKenzie, CMC

They say the evidence never lies.
Here are the clues: Production fluctuates regularly. Collections are
shaky. The schedule is either feast
or famine. Hygiene is booked solid
yet the hygienist is spending almost
as much time sitting and waiting
as she/he is scraping and cleaning.
All these seemingly inconsequential
details of the typical dental practice
are, in fact, the smoking gun, the
fingerprints left behind, the DNA
of a crime scene in which practice
profits are the victim.

added up just fine, at least the way
you looked at it. You reasoned that
you simply had to take the plunge,
it was now or never. Unfortunately,
now you’re wishing it had been
never.
Many doctors convince themselves that because the space looks
good and it’s in a good location, they
will be able to improve productivity.
They don’t conduct a careful investigation of the area. Worst of all, they
simply disregard the importance of
the 5 percent parameter.
For example, let’s say you pro-

duce $25,000 per month. You collect
$21,000 per month and you want to
move into a new facility with a total
rent of $2,500 per month, which
would be a $1,450 increase over
what you are paying now. You justify
the increase by telling yourself that
a couple more crowns per month
will take care of it, not a problem. If
only it could be that simple.
With a $2,500 per month rent bill,
you will have to collect a handsome
$50,000 each month to stay within
the 5 percent guideline. Therefore,
you will have to increase collections by a whopping 29 grand to

You know how the hairs stand
up on the back of your neck when
you’re staring at those practice
financial reports that are telling
you something isn’t right? Or that
chill that washes over you when
you realize that you may not be able
to pay yourself this month? Then,
seemingly without warning, there is
so much red ink the books look like
a crime scene. Time to bring in the
investigators.

cover that itty-bitty, little $1,450
per month rent increase. Feel like
you’ve been robbed?
Moreover, there is no guarantee
that the bigger, better space will
bring in more patients, particularly
when times get tough … unless
you develop a plan for how you
will attract new patients and, most
importantly, keep the patients you
already have.
If you’ve already signed your
profits away for the next 30 years
g DT page 8
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The industry standard for overhead is 55 percent of collections.
If you are currently at 60 to 65
percent, you probably don’t need
to notify the authorities. If yours is
higher, you may be looking at doin’
hard time. Some practices report
their overhead as high as 80 percent. They are making a mere 20
cents on the dollar! Now that is
criminal. The first step in arresting
the profit killers is to lay down a few
financial laws.
Establish the following budget
targets:
• Dental supplies = 5%
• Office supplies = 2%
• Rent = 5%
• Laboratory = 10%
• Payroll = 20%
• Payroll taxes & benefits = 3%
• Miscellaneous =10%
While there are several factors
that influence overhead, look first
at the most frequent offenders: high
expenses, inconsistent production
and low collections.

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One of the probable high expense
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gorgeous new space that you were
certain the patients would absolutely love. At the time, before the
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[7] =>

Dental Tribune | April 2009

Practice Matters

Reorganize your practice
By Louis Malcmacher, DDS

general dentist. If you haven’t seen
Twisted Files yet, you need to learn
about them and how they can boost
the speed of your endodontic procedures.

There is no question now that
the recession has hit our economy
and has hit us hard. Many dentists
are reporting a slowdown in their
schedules with patients putting off
treatment longer and increased
cancellations. Note that I said many
dentists are, but not all dentists are
reporting this. Some dentists are
actually reporting that their numbers are up and their practices are
increasing.

2) Implants: Learn to love the
edentulous and denture patient
again and learn about narrow diameter implants, which are affordable
and easily accepted by patients. The
system I use in my own practice is
Atlas Narrow Diameter Implants by
Dentatus. Take one of their excellent courses and in a few hours,
you will be well versed in placing these implants. Dentatus has
developed an extremely easy system for general dentists that consists of only two surgical burs. The
key to their system is their TufLink silicon liner, which retains the
denture incredibly well. There are
significant advantages to this system because of its unique retention
system without the challenges with
housings and O-rings.

So why are some dentists doing
better in the recession, some dentists doing the same as before, and
some dentists worse and even much
worse? As I meet hundreds of dentists every single week wherever I
lecture, the answer always comes
down to two things — attitude and
reorganization.
First, your attitude will make all
the difference in the world. Yes,
we all know that the recession
has caused huge job losses and an
incredible lack of consumer confidence. If you and your dental office
are going to roll up into a ball out
of fear, and patients can see the
fear in your eyes, I can guarantee
you that they won’t go ahead with
treatment and you subconsciously
will steer them away from doing
any dentistry at all.
What every other business and
industry is doing now is reorganizing and shifting the way they do
business. This is the key to survival
and even to thrive. The sure way to
failure is to do nothing or, worse,
keep thinking that the way I have
always done things is the way I will
be doing them in the future.
It is time to reorganize your professional career as a dentist. When
times were good, dentists used the
excuse that they were too busy

in their offices to learn new skills
through continuing education. Stop
making excuses for yourself and
get out there and get trained and
retrained in new areas of dentistry
that you have not been involved
with before. The most successful
dentists we see are the ones who
have invested in themselves and
their teams with quality continuing
education to learn new skills.
Here are some suggestions, especially for a down economy, of some
procedures that are big winners for
patients and for your practice.
1) Endodontics: There are so
many quality endodontic courses
out there that I would not even
know where to begin. In terms of
endodontic systems, the Twisted
File system by Sybron Endo couldn’t
be easier and was designed for the

3) Botox and dermal fillers: Even
in the current economy, these are
very popular patient treatments
that dentists around the country
are now starting to learn and offer.
These services are not only for medical/dental spas, but also for every
routine dental practice. You can
use these procedures to enhance
cosmetic dentistry, treatment of
TMJ and bruxism and smoothing
of facial wrinkles to enhance your
esthetic dental cases. This is certainly one of the hottest topics I
speak about in my lectures. Handson training opportunities are available through a number of venues
and can be found on my Web site
www.commonsensedentistry.com.
4) Lasers: Laser dentistry is here
and it is time you get on board. The
big advantage is that you can greatly reduce or eliminate the need for
local anesthesia. You need to make

a wise choice in this field. The Powerlase laser by Lares Research is a
hard and soft tissue laser; it uses
the right wavelengths available for
all uses, which most other lasers
cannot claim. Lares Research is a
recognized and trusted name in
dental handpieces, and now in dental lasers.
Simply put, your best investment is
yourself and your training. In this
economy, now is the time to look at
yourself with a critical eye and see
how you can improve and add to your
clinical skills. By doing so, you are
following a sure recipe for success for
the challenges that we all have to
deal with every single day. DT

About the author

Dr. Louis Malcmacher is a practicing general and esthetic dentist
and an internationally known lecturer and author. You can 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,
audio CDs, botox and dermal filler
training, and sign up for a free
monthly e-newsletter.

[8] =>

Practice Matters

Dental Tribune | April 2009

Today’s busy but always wired
patients are much more likely to
respond promptly to text messages
and e-mail reminders than many
practices realize.

g DT page 5

or more, consider renting a portion of the space to another dentist.
Consult your attorney for necessary legal guidance, but consider
asking the renting dentist to pay a
specified amount each month or a
percentage of his/her production or
collections. Determine if the renting dentist is to provide his/her
own staff and telephone lines and
what hours the incoming doctor will
work. But don’t be too quick to take
the money and run. Remember,
the new dentist now appears to be
associated with your practice. Make
sure you are renting to someone
whose standards are consistent with
your own and will reflect positively
on you and your practice. In addition, regularly check the interest
rates, this may be an excellent time
to refinance.

Be specific: When making appointments, state the day, date, time
and length of the appointment. For
example, “Mrs. Smith, your 45-minute appointment is on Tuesday, April
28 at 9:50 a.m. If you are unable to
keep this appointment, please call
us at least two days in advance to
allow another patient the opportunity to see the doctor at that time.”
Take note: Be prepared to take
steps to fill gaps in the schedule
when they occur. Ask patients if
they would consider changing their
appointment if one becomes available sooner. Keep a list of those
patients willing to move their
appointments to fill unexpected
voids in the schedule.

They don’t do the time, so you pay
the crime.
Would you knowingly allow
someone to steal $40,000 from you?
The logical response is, “Well, of
course not!” OK, so explain why
you’re allowing no-shows and last
minute cancellations to take at least
that amount from your practice
every year.
Broken appointments are the
bane of virtually every practice, and
one of the most expensive profit
pinchers. Admittedly, you may not

About the author

be able to absolutely eliminate broken appointments and no-shows,
but you can take steps that will go a
long way in reducing the impact of
this income slayer. The easiest and
most efficient means is to confirm
all appointments. It is also the most
cost-effective method of ensuring
that patients are in the chair when
they are supposed to be. Here’s how
to effect this.
Guidelines: First, make sure
everyone is on the same page. Establish guidelines for broken appointments. Once you define the policy,
be sure to communicate it clearly
and regularly to both new and existing patients.
Training: Next, designate and
train the appointment coordinator
to handle confirmation calls. This
should be viewed as an essential
personal phone call from the practice, not a routine chore that some
poor employee is stuck with. The
importance of dental care is the
focus of this phone call. Emphasis is
on both the value the practice places
in the patient as well as the value of
the appointment to the patient.

Sally McKenzie is CEO of
McKenzie Management, which
provides success-proven management solutions to dentistry
nationwide. She is also editor of
The Dentist’s Network Newsletter, www.thedentistsnetwork.net;
e-Management Newsletter from
www.mckenziemgmt.com; and
The New Dentist™ magazine,
www.thenewdentist.net. She can
be reached at (877) 777.6151 or
sallymck@mckenziemgmt.com.

Pay attention to your choice of
words when speaking with patients.
Terms such as “routine,” “regular,”
even “cleaning,” can minimize the
patient’s perception of the need and
importance of the appointment. In
addition, be careful not to “invite”
cancellations.
For example, “Mrs. Jones, this is
Mary from Dr. Wheeler’s office. I just
was checking to see if you planned to
keep your appointment tomorrow.”
That approach gives patients a clear
opportunity to back out at the last
minute. In fact, it almost sounds as
though the caller hopes the patient

does cancel. Instead, use the confirmation call to emphasize the significance of this appointment and that
the doctor is expecting the patient
at the designated time.
Personal contact: Make personal
contact with the patient 48 hours
in advance of the appointment and
resist the temptation to leave a
message. If a message is left, the
appointment cannot be considered
confirmed until the practice makes
contact personally with the patient.
To avoid telephone tag, request
a daytime phone number and/or
cell phone number from patients.
In addition, schedule time for the
coordinator to contact patients after
hours at home for those who are
difficult to reach during the day.
Electronic contact: Explore
e-mail and text messaging appointment reminder services as well.

Additionally, keep a list of
patients who cancel, don’t show or
don’t reschedule appointments and
follow-up with those patients. Contact “no shows” within 10 minutes
of their appointment time. Indicate concern for their absence. “Mr.
Smith, this is Jane from Dr. Carol’s
office. We were expecting you for a
3 p.m. appointment today and were
concerned when we had not heard
from you. Is everything OK?”
But don’t let the last minute cancellers dictate your schedule. After
two “no shows,” you should consider the patient unreliable. Tell
the patient you will contact her/him
when an opening is available, and
she/he can determine if that time
will be convenient.
Implement a few key steps to
ensure that your No. 1 line of income
— the patients — is in the chair and
paying for your quality dentistry. By
doing so, you’ll ensure that “noshow” patients and last minute cancellations won’t rob your practice
profits. DT

Fun fact: flossing
How often do you floss?
In a recent survey conducted by the Chicago Dental Society, dental
professionals were asked how often they floss.
More than once a day … 11%
Once a day … 60%
Less than once a day … 22%
(Source: Chicago Dental Society)

Tell us what you think!
Do you have general comments or criticism you would like to share?
Is there a particular topic you would like to see more articles about?
Let us know by e-mailing us at feedback@dtamerica.com. 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@dtamerica.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.

www.dental-tribune.com

[9] =>

Dental Tribune | April 2009

Practice Matters

In this economy, customer service
matters more than ever!
By Roger P. Levin, DDS

What constitutes superior customer service? More than you might
think.
Truly excellent customer service doesn’t happen by accident. It
requires a system that dictates how
every patient every hour of every
day will be treated. And that system
is absolutely vital to your practice.
In today’s economy, your customer service can be nothing less than
top notch. Remember that patients
are looking at every dollar they
spend. They are looking for reasons
to skip dental appointments. Something like poor customer service
is all the justification they need.
You can’t afford to let that happen.
Your customer service must make
it clear to patients that what your
practice has to offer is worth their
time and hard-earned money.

The far-reaching effects of customer service
Customer service has an impact
on every aspect of your practice and
helps lead to total success. Office
appearance, staff members, location and even parking all combine
to shape your patients’ attitudes

Contact info

Dr. Roger P. Levin is chairman and chief executive officer of
Levin Group, the leading dental
practice management firm. Levin
Group provides clients with Total
Practice Success, the premier
comprehensive consulting solution based on the implementation of high-performance systems.
A third-generation dentist, Levin
is one of the profession’s most
sought-after speakers, bringing
his Total Practice Success Seminars to thousands of dentists and
dental professionals each year.

about your practice. If their perception is positive, that’s good customer service. If their view of your
practice is unfavorable, you should
not be surprised when patients drift
away from your practice.
Improving your customer service is a sure way to strengthen
your competitive advantage. Every
dental office should be trying to
achieve what Levin Group calls
Stage III Customer Service™. You
want to exceed patient expectations at all times. Patients must feel
special from the moment they walk
into the office, whether it is the first
time or the 50th time. It’s the key
to case acceptance and long-term
patient retention.
The quality of your customer service determines how comfortable
you make patients feel. Their level
of comfort therefore determines
how successful your case presentations are. Remember that patients
will not accept treatment in an
environment that does not meet
their expectations. In this economy,
your goal is to exceed those expectations.

Superior customer service requires
a system
Your system for customer service
must be one that can be repeated
for every patient, every day. You
should outline the steps that lead
to exceptional customer service
so that all employees know what
you want to have happen for every
patient, every single time.
So just how can you improve the
customer service in your office?
Here are six of the many recom-

mendations from Levin Group’s
Stage III Customer Service curriculum.
1) Give new patients clear instructions for getting to your office. This
is easy to overlook. Some patients
may become frustrated just getting
to your office. Are you on a busy
street or an unmarked side road?
Will your patients have to pay for
parking? If so, does your office validate? Give clear instructions and
directions to patients when they
call to avoid a negative reaction.
2) Do not make patients wait.
When you fail to keep your appointment times with patients, you set
the stage for their impression of
your customer service — no matter what other positive experiences
they had in your office. You ask that
they arrive on time so make sure
they can be seen on time!
3) Provide your staff members
with clear job descriptions. Knowing exactly what is required of
staff members will make them less
stressed and friendlier to patients.
Develop phone scripts so that your
staff members are prepared when
patients call. This will make for
clearer, easier interaction with
patients.
4) Be sure to greet patients warmly in the treatment area. Whether
they are arriving for a hygiene visit,
an evaluation or treatment, patients
need to feel welcome. Something as
simple as a smile or a handshake is
a good beginning toward achieving
this goal. Team training is the key,
as I discuss in my GP Blog at www.
levingroupgp.com.

5) Give patients something to help
them remember your office. Pens,
key chains, and notepads are just
a few of the many mementos you
can give your patients to keep your
practice foremost in their minds.
Giveaways like this don’t constitute great customer service — they
merely reinforce it.
6) Think carefully about the specialists to whom you refer. If your
patients have a bad customer service experience in a specialist’s
office, then it will reflect poorly
upon you. Make sure the specialists you work with have the same
attitude toward customer service
as you do.

Conclusion
Customer service goes far, far
beyond simply being nice. It’s about
making every interaction with every
patient a pleasant experience. By
consistently providing high levels
of customer service, you are helping protect your greatest investment — your practice.
Superior customer service isn’t
a luxury. In today’s economy, it’s a
necessity.
Dental Tribune readers are entitled to receive a 50 percent courtesy
on a Levin Group Total Success
Practice Potential Analysis™, an inoffice analysis and report of your
unique situation conducted by a
Levin Practice Development Specialist. To schedule the next available
appointment, call (888) 973-0000
and mention “Dental Tribune” or
e-mail customerservice@levingroup.
com with “Dental Tribune” in the
subject line. DT

[10] =>

Message from the president World Dental Exhibition
Each FDI Annual World Dental
Congress (AWDC) has a distinctive
flavour and presents the unique
opportunity to learn about the culture and customs, as well as oral
health issues, in another part of the
world, which adds to the attraction
of these meetings. This is the time of
the year when both our FDI staff and
the members of the local organising
committee (LOC) shift into top gear
as the excitement of the approaching
congress builds. Knowing the members of the Singapore Dental Association as I do, I can assure you that a
most memorable congress is in store
for us this year.
FDI’s Education Committee,
working with the LOC, has an
impressive array of speakers lined
up for our scientific programme.
The broad range of topics will
include gerodontology, oral cancer, salivary biomarkers, and
implants. Forums conducted as
workshops will address current topics, such as bisphosphonates.
Anyone who has attended an
international dental meeting in
Singapore, like the biennial IDEM
meeting, knows what excellent hosts
our colleagues in Singapore are. The
social events are planned to take
advantage of the remarkable tourist
attractions, as well as the marvellous climate and exciting cuisine
enjoyed in this exquisite city. At
Singapore Night, a sunset ride on the
Singapore Flyer, the world’s largest
observation wheel, will give spectacular views of the tropical paradise all the
way to Indonesia. You will also enjoy
exotic food while networking with
international colleagues. The Gala
Dinner at Orchidville also prom-

ises to be a
memorable
event, especially
for
those of us
for whom
such stunning tropical
gardens are
only seen in
movies or on
postcards!
The Suntec SingaDr. Burton Conrod
pore Inter(DTI/FDI)
national
Convention and Exhibition Centre
is a modern venue providing all the
facilities needed under one roof. This
year, even the Welcome Ceremony
will be held on-site, and with many
excellent hotels close to the Centre,
attending all events will be very convenient.
Location, facilities, and scientific
and social programmes are all important ingredients for a successful dental congress. The AWDC, however,
is really all about people, and we
need you in attendance to help us in
Advancing Dentistry at the Crossroads
of the World. FDI congresses are
designed to promote oral health
globally. Our Singapore colleagues are really putting out
the welcome mat for us, and all our
committees and staff have worked
hard to deliver a first-class congress.

At this year’s FDI AWDC in Singapore—known for its advancements in technology and keen business sense—the FDI World Dental
Exhibition is sure to follow suit, spotlighting all of the latest innovations
in the dental industry and showcasing the full range of all the top com
panies from around the globe.

The exhibition is free of charge to
all those registered for the congress;
for those who wish to explore the
exhibition only, passes can be purchased on-site for a small fee.
Please look at our Web site for
opening hours and the regularly
updated list of exhibitors. FDI

News in brief

See you in Singapore! FDI

Dr. Burton Conrod
FDI President

Limited attendance courses

Spotlight on limited attendance courses at FDI AWDC Singapore 2009
How do limited
attendance courses differ from
those offered in
the main scientific programme?
What additional
perspectives do
they offer congress attendees? The
FDI has created limited attendance
courses to give congress attendees
the opportunity to gain additional
knowledge and skills from renowned
international experts in their field in
a more personal setting. The dental
topics addressed in these courses are
best delivered to smaller groups in a
practical hands-on setting.

At the congress in Singapore, the
limited attendance courses will be
held on Tuesday, 1 September, the
day before the main scientific programme of the FDI AWDC begins.
This year, the courses cover a
wider range of clinical subjects, such
as endodontics, sinus lift implant
surgery, third molar surgery, the
immediate overdenture, paedodontic emergencies, practice management, and paedodontic behavioural
management.
Detailed information on each of
the limited attendance courses can
be found on the FDI Web site. FDI

(DTI/Daniel Zimmermann)

Scientific programme

More than 50 sessions over six
days structured around this year’s
theme of Advancing Dentistry at
the Crossroads of the World will
highlight the latest advancements
and techniques in the dentistry
world.

Registration

Those wishing to attend the
Congress need to complete the
registration forms and return them

to the FDI head office by 25 July
2009. After this date, participants
are invited to register on-site at
the Congress venue.
Take advantage of the early
bird rates by registering before 15
May 2009.

Official Carrier

Receive up to 20 per cent discount with the Star Alliance network! FDI

[11] =>

Dental Tribune

Worldental Communiqué

Social events, day tours &
post-congress excursions
Information available online
Social events

No FDI congress would be complete without the time-honoured tradition of Local Night and Gala Dinner events. This year is no exception: each evening is one rich in
Singapore culture, ambience, and
cuisine.
Singapore Night will take place at
the newest addition to the Singapore
skyline: the Singapore Flyer! After

Reduced
hotel rates
Singapore is known for its outstanding hotels and award-winning
customer service. Pacific World, the
FDI’s official accommodation office,
is proud to offer a large choice of
hotels for our congress attendees.
Many of the hotels are conveniently
located within walking distance or
a short taxi ride from the Congress
Centre.
You can treat yourself to a luxury
five-star hotel, like the famous Mandarin Oriental, or choose a more
relaxed atmosphere at the Albert
Court. Whatever your choice, all
of our official hotels are sure to
please.
For more information on the rates
for most of the hotels and
all of our official hotels, visit the
Pacific World Web site. FDI

About the publisher
Publisher

FDI World Dental Federation
13 Chemin du Levant, l’Avant
Centre
F-01210 Ferney-Voltaire,
FRANCE
Phone: +33 4 50 40 50 50
Fax: +33 4 50 40 55 55
E-mail: info@fdiworldental.org
Web: www.fdiworldental.org
DI Communications
F
Coordinator/Managing Editor

Laurence Jocaille
DI Worldental Communiqué
F
is published by the FDI World
Dental Federation. The newsletter and all articles and illustrations therein are protected by
copyright. Any utilisation with
out prior consent from the editor
or publisher is inadmissible and
liable to prosecution.

a ride on the Flyer, experience the
delicacies of Singapore cuisine in
the open-air market atmosphere at
the Marina Bay. A national institution in Singapore is the orchid—its
national flower. What better place
to enjoy the sumptuous Gala Dinner
than one surrounded by the magical
gardens of Orchidville? You will be
immersed in a tropical atmosphere,
sure to be a magical retreat from the
bustle of the city.

For more information on these events,
as well as the FDI Welcome Ceremony,
please visit the FDI Web site.

Day tours

The Singapore Dental Association
is proud to host the 2009 FDI AWDC
and eager to share the rich cultural heritage of Singapore with all
congress attendees. Attendees are
offered the opportunity to discover
Singapore by immersing themselves
in its culture: in addition to the
sightseeing day tours offered this
year, like visits to the Singapore
Zoo or the famed Orchidville, there
are several day tours that allow you
to participate in everyday activities,
like the Tea Workshop or the What’s
Cooking activities, where you will

learn to cook local specialties. Places
for these activities for small groups
are sure to be filled quickly; book
early to ensure your spot!

Post-congress excursions

For attendees wishing to explore
more of what the Asia Pacific Region
has to offer, we invite you to check
out our post-congress excursions: be
swept away by Indonesian charm on
the exotic island of Bali, indulge yourself in a Malaysian getaway, or discover the appeal of the Thai culture.
Each excursion can be tailored to your
needs by choosing different hotels and
tours for certain destinations.
Please look at the information on
these tours on the FDI Web site. FDI
AD

[12] =>

12 Financial

Dental Tribune | April 2009

Steps to selling a dental practice
By Eugene W. Heller

Henry Schein sales representatives are frequently asked how to go
about selling a practice or bringing
in an associate. Many dentists do
not know where to start or what is
required to successfully complete
the anticipated transition. This is
Henry Schein Professional Practice
Transitions’ role. What follows is a
partial list of the steps involved.
1. Meet with the seller/owner to
determine his or her ideal transition
(sales) plan and assist in identifying
the most likely type of transition and
candidate.
2. If a full or partial sale is
involved, gather the necessary tax
returns and other documents and
discuss documentation and missing or unclear information with the
AD

seller’s/owner’s accountant.
3. Conduct the necessary financial
analysis and appraisal calculations.
4. Discuss the appraised value,
determine the asking price and
list the practice for sale or that an
associateship is available. (The listing agreement gives the broker the
“right” to offer the practice).
5. Implement the necessary
marketing plan including advertisements, Web site listings and
announcements to the area.
6. Respond to various inquiries,
secure confidentiality agreements
and discuss opportunities with prospective candidates.
7. Qualify the candidate to their
ability to secure financing, if ownership will be offered, and qualify

their ability to take over the practice
when considering the production
required and their business skills
background.

securing final loan documentation
required to the close loan, such as
proof of satisfaction of unpaid prior
liens.

8. Introduce the candidate to the
seller/owner and show practice.
This will typically require multiple
meetings per prospective candidate.

15. Act as trust and closing agent
for final document execution and
money transfer.

9. Write the “offer to purchase”
and any subsequent “counteroffers,” or write the proposed templates for the Employment Agreement and Letter of Intent.
10. Secure financing. Prepare the
financing request (loan package),
discuss the transaction with finance
vendors, and secure financing commitment.
11. Draft the initial transfer document template (Practice Sale Agreement). Discuss the template with
buyer and seller and negotiate the
agreement between the parties,
redrafting as required.
12. Present the proposed template
to the individual parties’ attorneys
and accountants, discuss questions
and/or required changes, and present requested changes to the opposing party and their consultants,
coordinating final negotiations. If
required by parties’ attorneys, prepare final documents.
13. Provide guidance, checklists and other material to both
parties relative to required steps
prior to commencement of associateship or closing (that is, drafting of announcement, handling
staff issues, printing new owner’s
business cards, securing business
checking account for new owner,
and payroll arrangements).
14.

Assist

www.dental-tribune.com

finance

source in

The average practice sale involves
100–200 hours. A transition involving an associateship leading to a
partnership may typically involve
more than 200 hours. Henry Schein
Professional Practice Transitions’
role is to facilitate these arrangements based upon the knowledge
gained from our 15 years experience involving hundreds of transitions. DT

About the author
Dr. Eugene W. Heller is a 1976
graduate of Marquette University School of Dentistry. His preprofessional school background
included accounting and smallbusiness tax consulting. During
his 15 years in clinical practice,
his curriculum vitae in practice
management was extensive. During the past 10 years, Heller has
been involved as a consultant to
hundreds of practice transitions
involving the sale of practices and
the formation of partnerships,
group practices, office-sharing
arrangements and other practice
transitions, in addition to conducting practice appraisals for many
of these transactions. He is presently the vice-president and chief
operating officer for Henry Schein
Professional Practice Transitions,
the dental practice transition division of Henry Schein Inc. Heller
can be reached at hsfs@henryschein.com or (800) 730-8883.

[13] =>

When It’s Time to Buy, Sell or Merge Your Practice

You Need A Partner On Your Side
ALABAMA

Birmingham—GR $758K #10105
Birmingham—5 Ops, GR $706K #10104
Birmingham Suburb—3 Ops, 3 Hygiene Rooms #10106
CONTACT: Dr. Jim Cole @ 404-513-1573

ARIZONA

Shaw Low—2 Ops, 2 Hygiene Rms, GR in 2007 $645,995
CONTACT: Tom Kimbel @ 602-516-3219

CALIFORNIA

Alturas—3 Ops, GR $551K, 3 1/2 day work week #14279
Central Valley—4 Ops, 2,000 sq. ft., 2007 GR $500K. #14266
Dixon—4 Ops - 2 Equipped, 1,100 sq. ft., GR $132K #14265
Fresno—5 Ops, 1,500 sq. ft., GR $1,445,181 #14250
Lindsay/Tulare—2 practices, Combined GR $1.4 Million #14240
Madera—1,650 sq. ft., 3 Ops, GR $449K #14269
Madera—1,060 sq. ft., fully plumbed building for sale #14270
Madera—7 Ops, GR $1,921,467 #14283
Modesto—12 Ops, GR $1,097,000, Same loc for 10 years #14289
Oroville—3 ops 3 days of hygiene 2005 GR $338K #14178
Porterville—6 Ops, 2,000 sq. ft., GR $2,289000 #14291
Red Bluff—8 ops, GR over $1 Million, Hygiene 10 days a wk.
#14252
Red Bluff—3 Ops, 990 sq. ft., 2007 GR $201K #14282
Redding—5 Ops, 1950 sq. ft. #14229
San Francisco—4 Ops, GR 875K, 1500 sq. ft. #14288
South Lake Tahoe—3 Ops, 647 sq. ft., 2007 GR $534K #14277
CONTACT: Dr. Dennis Hoover @ 800-519-3458
Bakersfield—7 Ops, 2,200 sq. ft., GR $1,916,000 #14290
Camarillo—3 Ops w/room to expand, 1,495 sq ft, GR
$500K #14246
Thousand Oaks—General Prac, New Equip, Digital #14275
CONTACT: Dr. Steve Rizer @ 805-405-6568
Grass Valley—3 Ops, 1,500 sq ft, GR $714K #14272
Santa Rosa—Patients records sale - Appox 245 patients. #14286
Santa Rosa—3 Ops - 4th avail, 1,225 sq. ft., GR $143,731
#14287
Yuba City—5 ops, 4 days hyg, 1,800 sq. ft., GR $500K #14273
CONTACT: Dr. Thomas Wagner @ 916-812-3255
Sunnyvale—3 Ops - Potential for 4th, GR $271K #14285
CONTACT: Kelly McDonald @ 831-588-6029

CONNECTICUT

East Hartford—2 Ops, GR $450K #16109
Fairfield Area—General practice doing $800K #16106
New Haven—Perio practice-associate to partner #16107
New Haven Area—Associateship general practice #16102
Southburg—2 Ops, GR $250K #16111
CONTACT: Dr. Peter Goldberg @ 617-680-2930

FLORIDA

Ocala—Associate buy-in #18113
Pensacola—4 Ops, GR approx $550K, large lot #18116
Port Charlotte—General practice for sale #18109
Port Charlotte—3 Ops, 1 Hygiene Room, GR $295K #18115
Southern—General practice for sale #18102
CONTACT: Jim Puckett @ 863-287-8300

GEORGIA

Atlanta Area—2 Ops, 2 Hygiene Rms, GR $480K #19114
Atlanta Suburb—3 Ops, 2 Hygiene Rms, GR $861K #19125
Atlanta Suburb—2 Ops, 2 Hygiene Rms, GR $633K #19128
Dublin—Busy Pediatric practice seeking associate #19107
Mabelton—6 Ops, GR $460K, Office shared with Ortho #19111
Macon—3 Ops, 1,625K sq ft, State of the art equipment #19103
Near Atlanta—2 Ops, 2 Hygiene Rms, GR $700K #19109
North Atlanta—Spacious Oral Surg. Office, GR 518K #19123
Northeast Atlanta—4 Ops, GR $750K #19129
Northern Georgia—4 Ops, 1 Hygiene, Est. for 43 years #19110
NW Atlanta Suburb—GR $780K, Upgraded Equip #19113
Savannah (Skidaway Island)—4 Ops, GR $500K #19116
Savannah—Group practice seeking associate. #19108
South Georgia—4 Ops, 1 1/4 acres #19121
South Georgia—GR $520K #19119
South Georgia—1,800 sq. ft., GR 400K #19124
CONTACT: Dr. Jim Cole @ 404-513-1573

IDAHO

Boise—Dr looking to purchase a general dental practice #21102
CONTACT: Dr. Doug Gulbrandsen @ 208-938-8305

ILLINOIS

Chicago—3 Ops, Condo available for purchase #22108
Chicago—8 Ops - 3 Equipped #22114
Chicago—3 Op practice for sale #22108
Chicago—14 Ops, $2 Million specility office, On site lab #22121
Chicago—Established Practice Looking for Dentist #22122
1 Hr SW of Chicago—5 Ops, 2007 GR $440K, 28 years old
#22123
Kane County—4 Ops, building also available for purchase
#22115
Naperville—5 ops, 4,000 sq. ft., GR over 1 Million #22120
Rockford Area—5 ops solid practice. Very good net #22118
Western Cook County—4 ops producing $725K annually.
#22117
CONTACT: Al Brown @ 800-668-0629

INDIANA

Indiana—GR $450K #23109
St. Joseph County—GR $270K on a 3 1/2 work week. #23108
CONTACT: Al Brown @ 800-668-0629

KENTUCKY

Eastern Kentucky—3 Ops, Good Hyg. Program, Growth
Potent.#26101
CONTACT: George Lane @ 865-414-1527

MAINE

Auburn—Looking for Assoc.GR $2 Million #28111
Lewiston—GP Plus real estate, state of the art office #28107
CONTACT: Dr. Peter Goldberg @ 617-680-2930

MARYLAND

Southern—11 Ops, 3,500 sq. ft., GR $1,840,628 #29101
CONTACT: Sharon Mascetti @ 484-788-4071

MASSACHUSETTS

Boston—2 Ops, 2 Hygiene, GR $650K. #30113
Lowell—GR $400K #30106
Somerville—GR $700K
Sturbridge—5 Ops, GR $1,187,926 #30105
CONTACT: Dr. Peter Goldberg @ 617-680-2930
South Shore Area—3 Ops, GR $350K #30114
CONTACT: Alex Litvak @ 617-240-2582

MICHIGAN

Suburban Detroit—2 Ops, 1 Hygiene, GR $325K #31105
Grand Rapids Kentwood Area—3 Ops, Building available.
#31102
CONTACT: Dr. Jim David @ 586-530-0800

MINNESOTA

Crow Wing County—4 Ops #32104
Hastings—Nice suburban practice with 3 Ops #32103
Minneapolis—Looking for associate #32105
Rochester Area—Looking for associate #32106
CONTACT: Mike Minor @ 612-961-2132

NEVADA

Syracuse Area—6 Ops all computerized, Dentrix and Dexis
#41104
CONTACT: Donna Bambrick @ 315-430-0643
Syracuse—4 Ops, 1,800 sq. ft., GR in 2007 over $700K #41107
CONTACT: Richard Zalkin @ 631-831-6924
New York City—Specialty Practice, 3 Ops, GR $400K #41109
CONTACT: Marty Hare @ 315-263-1313

NORTH CAROLINA

Charlotte—7 Ops - 5 Equipped #42142
Foothills—5 Ops #42122
Foothills—30 minutes from Mtn. resorts #42117
Near Pinehurst—Dental emerg clinic, 3 Ops, GR in 2007
$373K #42134
New Hanover Cty—A practice on the coast, Growing Area
#42145
Raleigh Area—4 Ops - 3 Equipped #42128
Raleigh, Cary, Durham—Doctor looking to purchase #42127
Wake County—7 Ops, High end office #42123
Wake County—Beautiful Cutting Edge Digital Office #42139
Wake County—4 Ops #42144
CONTACT: Barbara Hardee Parker @ 919-848-1555

OHIO

Akron—Excellent Opportunity, 2,300 Active Pts, 6 days of
Hyg. #44141
Columbus—4 Ops, FFS practice for sale #44125
Darke County—35 yrs, 1200 Act. Pts, GR $330K #44139
Dayton—10 Ops, Associateship with buy-in option #44121
North Eastern—2 Yr. Old Facility, State of Art Tech. GR
$830K #44143
North of Dayton—6 Ops, 15 days of hygiene/wk #44124
South of Dayton—6 Ops, 4,000 sq. ft., GR $3 Million Plus
#44145
Toledo—2 Ops, GR $225K, Est in 1988 #4414
CONTACT: John Jonson @ 937-657-0657

PENNSYLVANIA

Beaver County—Ortho practice for sale. #47118
Mon Valley Area—Practice and building for sale #47112
Pittsburgh Area—High-Tech, GR $425K #47135
Pittsburgh—4 Ops, GR over $900K #47114
70 Miles Outside Pittsburgh- 4 Ops, GR $1 Million #47137
Robinson Township Area- GR $300K #47108
Somerset County—3 Ops, 2006 GR $275K+ #47122
Southside & Downtown Pittsburgh—2 practices for sale. #47110
CONTACT: Dan Slain @ 412-855-0337
Dauphin County—6 Ops, GR over $1,100K, Sale price $718K
#47133
Harrisburg—3 Ops, GR $383K, Listed at $230K #47120
Lackawanna County—4 Ops, 1 Hygiene, GR $515K #47138
Lancaster County—Associate positions available #47116
West Chester—3 Ops, 10 years old, asking $225K. #47134
CONTACT: Sharon Mascetti @ 484-788-4071

Carson City—5 Ops, 2 Hygiene, 2,200 sq. ft., GR $1 Million
#37105
CONTACT: Dr. Dennis Hoover @ 800-519-3458

RHODE ISLAND

NEW HAMPSHIRE

SOUTH CAROLINA

Rockingham County- 2 Ops, Home/Office #38102
CONTACT: Dr. Thomas Kelleher @ 603-661-7325

NEW JERSEY

Jersey City- 2 Ops, GR $216K, 2 days a week #39107
CONTACT: Dr. Don Cohen @ 845-460-3034
Marlboro—Associate positions available #39102
CONTACT: Sharon Mascetti @ 484-788-4071

NEW YORK

Bronx—GR $1 Million, Net over $500K #41105
Brooklyn—4 Ops, 2 Hygiene rooms, GR $1 Million, NR
$600K #41108
Dutchess County—80% Insurance, GR $200K #41106
CONTACT: Dr. Don Cohen @ 845-460-3034
Oneonta—3 Ops, Approx 1200 sq. ft. #41101
CONTACT: Deanna Wright @ 800-730-8883
Putnam County—6 Ops, GR $1.7 Million #41102
CONTACT: Dr. Peter Goldberg @ 617-680-2930

Southern Rhode Island—2 Ops, @ Hygiene, GR $750K. #48102
CONTACT: Dr. Peter Goldberg @ 617-680-2930
Charleston Area—8 Ops fully equipped #49101
Columbia—7 Ops, 2200 sq. ft., GR $678K #49102
CONTACT: Dr. Jim Cole @ 404-513-1573
TENNESSEE
Chattanooga—For sale #51106
Elizabethon—GR $400K #51107
Loudon—GR $600K #51108
Spring Hill—4 Ops, Good Hyg. Program, Fast Growing Town
#51103
Suburban Knoxville—5 Ops #51101
CONTACT: George Lane @ 865-414-1527
VIRGINIA
Burgess—General practice #55101
Danville Area—3 Ops #55105
Newport News—2 Ops, GR $804,433, Est 1980 #55109
CONTACT: Bob Anderson @ 804-640-2373
WISCONSIN
Southern Western—12 miles from Debuque, IA. #58115
CONTACT: Deanna Wright @ 800-730-8883

For a complete listing, visit www.henryschein.com/ppt or call 1-800-730-8883

[14] =>

14 Clinical

Dental Tribune | April 2009

The keys to early cancer diagnosis:
careful examination & timely biopsy
By Sara Gordon, DDS, MSc, FRCDC

The young man was just 19 when
he came in to see his dentist after
Halloween because of a sore on the
side of his tongue. A non-smoker and
non-drinker, he did not seem to be at
risk for cancer, so his dentist decided
to re-check the lesion before Christmas. By then the lesion was bigger.
When he finally had a biopsy in January, it was an invasive squamous
cell carcinoma.
Oropharyngeal cancer continues to claim the life of about one
American every hour, accounting
for 7,590 deaths in 2008, according
to the American Cancer Society.
Oral cancer takes a terrible toll if it
is not caught early as it can rob its
survivors of the ability to eat, speak
and taste.
Dentists often fail to detect oral
cancer until it has invaded deeply
because it can mimic common traumatic, infectious or immune diseases. When oral cancer is detected
early enough, it can be cured; recognized in its precursor stages, it
can even sometimes be prevented.
The cancer screening examination includes looking at and palpating the neck, scalp and face as
well as the mouth and oropharynx.
About two-thirds of oral cancers
arise in the lateral/ventral tongue
and the floor of the mouth, but
other common sites include the
retromolar pad, the tonsillar pillars,
the soft palate and the oropharynx. The dentist should thoroughly
examine the lateral tongue by gently pulling it forward with gauze,
and check the floor of the mouth
when the patient rolls the tongue
back against the palate.
The gagging dental patient is a
perennial problem, but it is more
important than ever to make the
effort to inspect this difficult region.
There has been a recent increase in
human papillomavirus (HPV)-associated squamous cell carcinoma of
the base of the tongue and tonsils
in young patients, a change that is
attributed to a rise in high-risk HPV
infection in the oral cavities of sexually active young adults.1 Nevertheless, the most common risk factors
for oral cancer remain tobacco and
alcohol use.

geal malignancies are squamous
cell carcinoma of the surface mucosa.2 Precancerous mucosal lesions
are often white and may appear
slightly rough; unexplained white
lesions are often called leukoplakia. Lesions such as that shown in
Figure 1 look rough because the
proliferating epithelium piles up on
the surface, and the thickened epithelium hides the red color of the
underlying blood vessels.
Malignancies of surface tissues,
as seen in Figure 2, are often red
and enlarged, and unexplained red
lesions are often called erythroplakia.3 Unexplained red lesions
are more likely than white lesions
to be diagnosed as malignancies
when they are biopsied because
the expanding malignancy causes
inflammation and secretes molecules that stimulate the formation
of new blood vessels. However, both
red and white lesions are capable
of representing malignancy. Malignancies may also cause spontaneous pain or paraesthesia. The general rule of thumb is that unexplained
red, white and/or ulcerated lesions
that persist for more than 10 days
should be biopsied.

Fig. 1: This rough white lesion was diagnosed on biopsy as moderate epithelial dysplasia.

Lichen planus, or lichenoid
mucositis, has generated heated debate about its premalignant
potential for years.4 It is now recognized that there are several conditions that can share the clinical
appearance of lacy white lines on a
red background and also the microscopic feature of a dense T-lymphocyte infiltrate along the basement
membrane. Lichenoid conditions
are probably not all equally likely to
generate squamous cell carcinoma.
A lichenoid drug reaction, for
example, is a reaction to a systemic medication that disappears
when the medication is withdrawn.
Lichenoid reactions also can result
from contact with an allergenic
material, such as a metal, in susceptible patients (Fig. 3), and for
other reasons.

The dentist should routinely
depress the tongue and examine the
soft palate and oropharynx while
the patient says “ah.” Even the act
of gagging presents a momentary
opportunity to glimpse the oropharynx and soft palate.

There are many reports in the
literature of cancer arising in a
patient previously diagnosed with
lichen planus5,6, but some retrospective analyses have confirmed
that the original clinical or even
microscopic diagnosis of lichen
planus was incorrect. 7 Apparent
malignant transformation of oral
lichen planus (OLP) may represent
“red and white lesions that were
dysplastic from their inception but
that mimic OLP both clinically and
histologically.”8 Figures 4 and 5
demonstrate this concept.

About 90 percent of oropharyn-

Warty-looking verrucous condi-

Fig. 2: This large red mass was a squamous cell carcinoma. The lateral
tongue is the most common site for oral cancer.
tions also may confuse dentists.
Many diseases in this group are
caused by HPV. Benign members of
this group include verruca vulgaris,
the common wart (Fig. 6), which is
self-limiting in most patients, and
condylomata, genital warts (Fig.
7), which can be widespread in the
immuno-suppressed patient.
There are also premalignancies
and malignancies in this group.
Proliferative verrucous leukoplakia
(PVL) is a multifocal verrucous disease that eventually turns into carcinoma in a substantial proportion
of cases. Figure 1 may represent a
case of PVL. Verrucous carcinoma
is a large warty malignancy that is
slow to invade but can degenerate
into squamous cell carcinoma.

www.dental-tribune.com

A number of commercial chairside
applications such as toluidine blue
staining, tissue reflectance, fluorescence imaging and brush tests
have appeared on the market in the
past decade, and they are intended
to help the dentist with early cancer
detection. Despite their attractive
marketing and their convenience,
they have not been shown by rigorous Cochrane analysis to either help
or hinder early cancer detection in
the general population. Even visual
screening programs have not been
proven to help reduce oral cancer
deaths, and more study is needed
in this field.9 Table 1 summarizes
the currently available adjunctive
technologies.
This leaves the dentist with a very

[15] =>

Clinical 15

Dental Tribune | April 2009
Table 1: Commercial techniques intended to aid oral cancer detection.
Technique

Example of common How it works
brand name

Toluidine blue vital dye

Orascan

Dyes proliferating tissues blue

Tissue reflectance

Vizilite

Enhances the appearance of white areas

Tissue autofluorescence Velscope

Abnormal tissue loses
normal green autofluorescence, looks black

Brush test

Superficial epithelial
sample is classified as
positive, negative or
atypical

Oral CDx

Fig. 6: Verruca vulgaris, the common wart, is a benign discrete warty lesion
that is usually self-limiting. It is caused by some types of HPV. It is more
familiar on the skin, and may spread to the mouth by direct contact.

Fig. 3: This lesion looks much like lichen planus, but it arose when the
orthodontic brackets were placed and disappeared when they were removed.
Lesions such as this are called lichenoid mucositis.

Fig. 7: Condylomata (genital warts) are also caused by HPV and may be
florid in immunosuppressed patients such as this one. They are benign.

Fig. 4: This rough white lesion was initially thought to be lichen planus, but
on biopsy it proved to be a microinvasive squamous cell carcinoma.

Fig. 8: Biopsy specimens should be of adequate size (3 mm or larger) and
should be taken from a representative area of the lesion. The dentist should
place them in formalin fixative immediately, and then transport them to the
oral pathologist for microscopic diagnosis.
Fig. 5: This photomicrograph of squamous cell carcinoma demonstrates an
area in which lymphocytes are attacking the overlying dysplastic epithelium,
giving a microscopic appearance that is similar to lichen planus. Such
an inflammatory reaction to dysplasia may explain why some cases are
initially misdiagnosed as lichen planus and later prove to be squamous cell
carcinoma.

powerful tool: the biopsy, which is
still the only technique that definitively diagnoses oral cancer. When
coupled with a thoughtful patient history as well as a thorough head and

neck examination, it can allow the
dentist to diagnose oral lesions with
as much confidence as possible.
g DT page 16

[16] =>

16 Clinical
g DT page 15

A biopsy is simply the removal of
tissue from a living patient for the
purposes of diagnosis. Whether the
dentist uses a scalpel, surgical scissors or a surgical punch, the aim is
to retrieve a piece of tissue that is
representative of the entire lesion
and preserve it en route to the oral
pathology laboratory (Fig. 8). At the
lab, the specimen is processed on
a glass slide and diagnosed microscopically. Usually it takes a week
or less for the oral pathologist to
finalize the biopsy report.
The American Academy of Oral
and Maxillofacial Pathology recommends that all tissue removed from
the oral cavity should be sent to an

Dental Tribune | April 2009
oral pathologist as a biopsy, unless
it results from a routine procedure
such as a gingivectomy for esthetic
and functional reasons. Most oral
pathologists’ services are covered
by the patient’s medical insurance. General pathologists will also
accept biopsies from dentists, but
oral pathologists receive at least
three years of specialty training
after dental school and are truly
specialists in oral disease.
By routinely examining every
patient thoroughly for signs of head
and neck cancer, and ensuring that
any potentially suspicious lesion
that persists for more than 10 days
is appropriately biopsied and sent
to an oral pathologist for diagnosis,
dentists may indeed save lives.

Literature
1.

Ryerson AB, Peters ES, Coughlin SS, Chen VW, Gillison ML,
Reichman ME, Wu X, Kawaoka
K. Burden of potentially human
papillomavirus-associated cancers of the oropharynx and oral
cavity in the US, 1998-2003.
Cancer. 2008 Nov 15;113(10
Suppl):2901–9.
Marur S, Forastiere AA. Head
and neck cancer: Changing epidemiology, diagnosis and treatment. Mayo Clinic Proceedings
April 2008 vol. 83 no. 4 489–
501.
Pindborg JJ. World Health Organization Collaborating Center
for Oral Precancerous Lesions:
definition of leukoplakia and
related lesions: an aid to studies

on oral precancer. Oral Surg
(1978) 46: pp 518–39.
Greer RO, McDowell JD, Hoernig
G, Oral lichen planus: a premalignant disease. Pathology Case
Reviews (1999) 4: pp 28–34.
Bornstein MM, Kalas L, Lemp
S, Altermatt HJ, Rees TD, Buser
D. Oral lichen planus and
malignant transformation: a
retrospective follow-up study
of clinical and histopathologic
data. Quintessence Int. 2006
Apr;37(4):261–71.
Eisen D. The clinical features,
malignant potential, and systemic associations of oral lichen
planus: a study of 723 patients
J Am Acad Dermatol. 2002
Feb;46(2):207–14.
Fatahzadeh M, Rinaggio J, Chiodo T. Squamous cell carcinoma arising in an oral lichenoid
lesion. J Am Dent Assoc. 2004
Jun;135(6):754–9; quiz 796.
Lovas JG, Harsanyi BB, El
Geneidy AK. Oral lichenoid dysplasia: a clinicopathologic analysis. Oral Surg Oral Med Oral
Pathol. 1989 Jul;68(1):57–63.
Kujan O, Glenny AM, Oliver R,
Thakker N, Sloan P. Screening
programmes for the early detection and prevention of oral cancer. Cochrane Database of Systematic Reviews 2006, Issue 3.
Art. No.: CD004150. DOI:
10.1002/14651858.CD004150.
pub2. DT

About the author

Dr. Sara Gordon is an associate
professor in the College of Dentistry
at the University of Illinois at Chicago
in the Department of Oral Medicine
and Diagnostic Sciences. At UIC,
she is director of the Oral Pathology
Biopsy Service and director of Oral
Pathology Graduate Education. She
is a diplomate of the American Board
of Oral and Maxillofacial Pathology,
a fellow in Oral Pathology and Oral
Medicine of the Royal College of
Dentists of Canada, and president
of the Canadian Academy of Oral
& Maxillofacial Pathology and Oral
Medicine. Before becoming an oral
pathologist, she practiced general
dentistry for nearly a decade.
Department of Oral Medicine and
Diagnostic Sciences
801 S. Paulina (M/C 838),
Room 525B
Chicago, Ill. 60612
E-mail: gordonsa@uic.edu

[17] =>

[18] =>

18 Education

Dental Tribune | April 2009

Can prospective new patients
find you easily on the Internet?
By Mary Kay Miller

Just because you have a dental
Web site on the Internet doesn’t
mean prospective new patients can
find you online when searching for
dental treatment providers in your
demographic. Using correct keywords in the HTML source code and
written content on your Web site
pages is the key to driving prospective patients to your Web site on
Google. Unfortunately, less than 5
percent of dental Web sites can be
found on Google Maps and page one
of a Google search when tested with
the most common words patients use
to find dental treatment providers.
It’s a fact: your Web site ranking can make or break your online
presence and Internet marketing
initiatives. The better your page
ranking (the position your Web site
appears in the search engines when
someone is searching for a dentist in
your area) the more clicks you will
receive, which translates into more
new patient opportunities to build
AD

your practice. If you are not on page
one of a Google search you might as
well be invisible online. Whether we
like it or not, the Internet is here to
stay. The Internet is the most valuable and inexpensive PR marketing
tool available today to promote your
practice.
Google is “king” and “rules” the
Internet. It dictates the parameters
of online search and Internet marketing. It is also considered the only
search engine that counts. Google
attracts over 80 percent of all consumers researching online for products and information. Structuring
your Web site with correct keyword
placement, title tags, written content,
HTML design and URLs according to
Google guidelines will assure better
positioning of your Web site’s page
ranking.
Unfortunately, as a consumer,
most dentists have no idea if their
Web site has correct search engine
optimization (SEO) by their Webmaster to meet Google guidelines.

The time has come, especially in
today’s tough economic environment, to be proactive and take marketing responsibility for your Internet marketing program.
No business owner can afford to
haphazardly lose new patients to
their Internet competition. Google
does not care about Web site esthetics, your experience level or the size
or your practice. It only understands
arithmetic coding based on its own
rules. The first step to building your
online presence is understanding
Google’s rules and determining if
your Web site is performing correctly on the Internet. “You don’t
know what you don’t know ’til you
know it!”

Dental Tribune understands the
“Power of Internet Marketing” and
how it relates to dental professionals. They have asked me to present a
six-part C.E. credit series on Internet
marketing to educate all their subscribers. The subject of keyword
optimization of your site and how to
test your demographic will be
addressed in Part II: Google and SEO
– Can New Patients Find You Easily
on the Internet? This Webinar can be
accessed under www.DTStudyClub.
com under Online Courses. It may
be the most important marketing
course you take all year. Please find
additional information and registration online, or contact Julia at (416)
907-9836 or j.wehkamp@dtstudyclub.com. DT

Archived Webinars from
successful DTSC launch
now available!
On March 14, the Dental Tribune
Study Club was officially launched
through a full-day online C.E. festival, featuring five Webinars in
succession. Some 290 participants
joined in the festivities, representing 57 different nations, proving
that the DT Study Club truly is a
global concept.
Each Webinar included a onehour presentation, followed by a
20-minute live Q&A session between
the online audience and the speaker. Participants not only had the
opportunity to interact directly with
the opinion leader, but they also
received C.E. credits for their participation.
In case you could not attend the
live event, you will be pleased to
know that the archived lectures are
now available online under www.
DTStudyClub.com. Please log into
the Web site and complete the easy
and free membership registration.
You can find the archived courses
under “Online Courses” or use the
links below and click REGISTER >
LAUNCH NOW.
Dr. George Freedman, New
Techniques in Clinical Dentistry:
www.dtstudyclub.com/event/
New-Techniques-in-Clinical-Dentistry/23.html

Dr. Dan McEowen, The Advantage of Small FoV High Resolution
CBCT Imaging:
www.dtstudyclub.com/event/TheAdvantage-of-Small-FoV-High-Resolution-CBCT-Imaging/24.html
Dr. Garry Bey, Safer, Smarter
Endo: Tips, Tricks and Solutions for
Endodontic Success:
www. dt s t u d y cl u b . co m/e ven t /
Safer,-Smarter-Endo;-Tips,-Tricksand-Solutions-for-Endodontic-Success/22.html
Dr. Clark Stanford, Implant Overdenture Therapy:
www. dt s t u d y cl u b . co m/e ven t /
IMPLANT-OVERDENTURES;-Asolution-for-the-economically-challenged-patient/25.html
(Dr. David Clark’s Webinar, World
Class Obturation for General Dentists, will be posted online shortly. We
apologize for any inconvenience.)
These five Webinars were made
available through educational grants
provided by VOCO, PreXion, Obtura,
Discus Dental and Astra Tech.
Please don’t miss out on our
upcoming live and interactive
Webinars, which can be found
under:
www.dtstudyclub.com/
events/Online-Courses/all/ DT

www.dental-tribune.com

[19] =>

Education 19

Dental Tribune | April 2009

Social networking for dentists made easy!
your online identity
and will allow others
on the site to connect with you and
find common interests.

By Dan Marut, DMD

What is a social network?
For as long as humans have
walked the Earth we have been
social creatures. We pride ourselves
on family and form groups in order
to survive. These groups not only
allow us to survive but also thrive,
leading to new ideas and innovations. The Internet and some other
factors have led to the diminishment
of local groups and group activities.
People became free to roam the
world from their own house whenever they wanted to, but they still
yearned for connection. We need
it. It has become hotwired into our
development as humans. The Internet fragmented us. However, human
needs will not be denied. Just as the
Internet diminished human grouping, it is now bringing us together
like never before.

Components of online social networking
Profiles: Profiles serve as your
identity on the network. In short,
they are your online C.V. I would
encourage you to fill in what you are
comfortable with. Social networks
are about sharing and your experience will be enhanced by completing
your profile.
Friends: “Friends” are the foundation of any social network. Just
like in real life, your online friends
become part of your social fabric.
Online friends are able to keep up
to date on your actions on the social
network.
Groups: Online groups represent
like-minded individuals coming
together for collaboration, connections, sharing and learning about
a specific topic. Dentistry has been
called a cottage profession because
the predominant model of practice is
solo practice.
Online groups or online study
clubs provide a way to share knowledge, meet other dentists with similar interests, access a calendar of
events, share files and upload pictures and videos. For dentists, this
means we can now practice solo but
have the benefit of knowledge sharing and connectivity to a specific
group that is of interest to us.
Online social networks are powerful tools. They have taken the Web
from static Web pages and Q&A
forums to a dynamic, ever developing connected network of individuals who willingly share knowledge,
interests and professional goals.

Examples of online social networks
LinkedIn: Mostly for the corporate and business-minded crowd,
LinkedIn has a mature user type
who is interested in business networking.

Facebook: I enjoy using Facebook
to keep in contact with my personal
friends. However, I find it difficult
to sift through all of the non-dental
chatter to find what I am looking for
professionally.

Once
you’ve
explored the site,
join a group/study
club or two or three.
Groups/study clubs
allow you to connect,
collaborate
and share with others over a common
subject or cause. If you don’t see a
group/study club you are interested
in, feel free to create your own.

MySpace: If you’ve used MySpace,
perhaps you might think it is geared
toward a younger crowd. There are
many bells and whistles to choose
from.

The tools on NewDocs make it
very easy to create and manage your
own group or study club. Manage a
local study club or society by keeping all of your members up to date
on happenings, events, discussions,
etc. The best part is you don’t even
need to know how to create a Web
page to do this!

Professional social networks: Professional social networks are focused
on a particular profession and only a
particular profession. You won’t find
any spam-filled teenage chatter on
these. Momentum once reserved
for large social networks without
a focus is now moving into niche
social networks focused on specific
interests.

After you’ve accomplished the
above, you’re ready to move to the
next level and invite other professional friends and colleagues to join
NewDocs. The power of professional
social networking lies in the users
and the activity of those on the site.
The more people you can connect
with the more you will get out of
NewDocs.

Examples of professional social
networks

In short:
1) Register on NewDocs.com and
choose an “avatar” (profile picture).
2) Fill in your profile.
3) Explore the site by “clicking
around.” Be sure to click on other
users’ avatars.
4) Make “Friends.”
5) Join a group/study club or create one yourself.
6) Invite your professional friends
and colleagues to join NewDocs. This
will widen your network.

Sermo: This is the professional
social network for medicine.
LawLink: This is for lawyers.
NewDocs: NewDocs is the professional social network for the dental
profession. NewDocs is about dentistry and only about dentistry. You
won’t find (or be found by) high
school classmates here. You can join
professional “groups” or online study
clubs on NewDocs. You also have
the opportunity to create your own
group. Think of it as your own “mini
social network.”
Share files, use the calendar of
events, collaborate and discuss the
topics of your choice. If you have
certain information about a particular subject matter, you are able to
post a blog. The download section
on NewDocs has many useful tools,
forms, sample contracts, business
plans, etc.

How to get started?
Getting started in professional
social networking is easy, and NewDocs is the premier site. NewDocs
was created by a dentist and is exclusively about dentistry and the dental
profession. Visit www.NewDocs.com,
register (it’s free) and choose a profile image. Once registered, be sure
to fill in your profile. Your profile is

Social networking is here to stay
and professional social networking
is the natural progression of this
powerful Web-based tool. Take the
first step: become part of a network
and reap the rewards of professional
collaboration on a social network.
For those dentists looking to manage a study club or a dental association, the tools on NewDocs make it
not only easy but fun for all of its
members. Start today and find out
why professional social networking
is changing our professional world.
Dan Marut, DMD, maintains a
private practice in Ashland, Ore. He
is the founder of NewDocs, the professional social network for dentistry.
Marut is available to answer any
questions about the social networking
phenomenon. He can be reached at
Dan@newdocs.com or just find him
on NewDocs, he becomes your first
friend when you join!

Endodontic Instrumentation at the

23 Speed of Thought

APRIL

Dr. John T. McSpadden

Thursday, April 23, 2009, 7:00–8:30 p.m. EST
Learn to design and accomplish root canal
instrumentation in the most efﬁcient, most
effective manner with the least risk for
instrument failure.

The Anatomy of a Patient-Friendly
Website (Part 3 of 6)

07 Mary Kay Miller
MAY

Thursday, May 07, 2009
7:00–8:30 p.m. EST
Attract, Engage, and Direct Prospective New
Patients To Your Front Door.

Death of a Sales Man;
Birth of The Helping Professional

Barry, C.M.C., R.R.D.H.
12 Peter
Tuesday, May 12, 2009, 7:00–8:30 p.m. EST
MAY

Discover new strategies for communicating
with your patients in a more buyer-based,
service-focused and solution driven way. Boost
your ability to inspire patient interest in our
services; by learning to more effectively speak
our patient’s language.

Increase Net Revenue, Foster
Employee Conﬁdence

19 Michael Moore
MAY

Tuesday, May 19, 2009
7:00–8:30 p.m. EST
The Five Keys to Effective Employment
Relations for the Dental Ofﬁce

Video – Today’s Most Powerful
Patient Magnet (Part 4 of 6)
Kay Miller
09 Mary
Tuesday, June 09, 2009
JUNE

7:00–8:30 p.m. EST
Video not only entertains, it fully engages
your target audience when educating patients
and delivering your marketing message both
internally in the ofﬁce and online to the
community.

Web 2.0 Marketing (Part 5 of 6)

02 Mary Kay Miller
JULY

Thursday, July 02, 2009
7:00–8:30 p.m. EST
What Is It… and Is Social Networking The Right
Marketing Tool For You?

[20] =>

20 Event

Dental Tribune | April 2009

Review

Participants attend courses in glass-enclosed
workshops at the Greater New York Dental Meeting
participants alike were thrilled with
this new addition to the already
impressive array of programs, products and services available on the
exhibit floor. During these workshops, attendees were able to try
out the most innovative technologies and learn from some of the
world’s most acclaimed health care
professionals. Many of the products
showcased in these classrooms were
brand new, state-of-the-art tools and
afforded participants the unique
opportunity to be able to touch, feel
and experiment with these devices
and gadgets, some of which have not
even been released to the general
public yet.

During its record-breaking 84th
annual session, the Greater New
York Dental Meeting (GNYDM)
attracted 57,854 registrants from all
50 states and 123 countries. The
GNYDM is the largest dental congress and exposition in the United
States, and its organizers feel an
obligation to exhibitors and attendees to excel in hosting a conference
that showcases the latest products
and procedures modern dentistry
has to offer.
Dr. Robert Edwab, the Greater
New York Dental Meeting’s executive director, insists that new and
innovative programs are constantly
created and developed to ensure
that the GNYDM delivers the best
conference possible. To that effect,
multiple new programs were instituted at the 2008 meeting.
Among the numerous new programs, and perhaps one of the most
successful endeavors of 2008, was
the addition of four glass-enclosed
workshop classrooms. These “glass
classrooms” were constructed with
walls made of plexiglass so that
anyone walking by on the exhibit
floor could easily look in and see the
dental products being used inside
the workshops.
To gain the maximum amount
of exposure, these classrooms were
strategically placed around the
exhibit floor and the educational
courses ran throughout the day dur-

Dr. Reza Dilmahomed, left, and Dr. Guy Ward, dentists from Liverpool, England, hone their endodontic technique during a workshop conducted by Dr.
Stephen P. Niemczyk in a glass-enclosed classroom on the exhibit floor of the
2008 Greater New York Dental Meeting. (DTI/Photo Fred Michmershuizen)
ing normal exhibit floor hours. All
four classrooms ran simultaneously
and covered a broad spectrum of
up-to-date, hands-on procedures
including: endodontics, implants,
restorations, veneers and composites.
In 2008, the exhibit floor was
already jam-packed with dentists,
potential product buyers, distributors and manufacturers, but the glass
classrooms gave exhibitors one more
reason to be excited because of the

extra traffic this attracted. “We want
our valued exhibitors to recognize
our continued support and financial
investments made to benefit their
companies,” Edwab stated. With this
rare opportunity for their products
to be seen in action by everyone
walking the exhibit floor, numerous
companies jumped at the chance to
have their merchandise showcased
during the workshops held in these
unique classrooms.
Both exhibitors and workshop

With the huge success of 2008’s
glass classrooms, plans for two additional glass-classrooms are already
well under way for 2009. Be sure to
check the Web site, www.gnydm.
com, for information and updates
on this year’s glass classrooms and
all the other exciting new programs
offered at the 2009 meeting.
Remember, there is never a preregistration fee. Mark your calendar
for Nov. 27 to Dec. 2 and come be a
part of the excitement of the 2009
Greater New York Dental Meeting
and experience all that New York has
to offer! For additional information,
please contact the Greater New York
Dental Meeting at 570 Seventh Ave.,
Ste. 800, New York, N.Y., 10018-1806;
Tel. (212) 398-6922; Fax (212) 3986934; e-mail info@gnydm.com. DT

IADR’s Williams calls out for excellence
and impact in research
By Javier Martínez de Pisón
DT Latin America

President-elect of the International Association for Dental Research
(IADR) Dr. David Williams has asked
colleagues to focus on conducting
research that has practical impact
for global oral health. In his speech
during the IADR’s 87th General Session and Exhibition in Miami he said
that the profession has a responsibility to ensure the continuation of
research.
“But in Europe we have a new
mantra: Excellence with Impact,”
said Williams in his conference titled,
Global Uncertainty and Global Challenges,” which was attended by 5,000
researchers, including a large contingent from Latin America and Asia

dental schools, as well as presidents
of the FDI World Dental Federation
and national dental organizations.
The president-elect said researchers have a challenge as the torch
bearers of global oral health. “We
are well aware that the global burden of oral disease is immense and
our leadership in these issues is
essential.” He added that dental
caries is one of the most common
chronic diseases worldwide while
periodontal disease affects up to 15
percent of the population and oral
cancer is the eighth most common
cancer worldwide.
“We need fundamental research
to improve our basic understanding of the diseases which concern
us,” explained Williams. “But we

also need to deliver ethical, effective, evidence-based care. We need
effective prevention as well as more
effective treatment, and we need to
establish the kind of workforces that
are appropriate in different global
settings. And all of this without forgetting about the links between oral
and systemic health, and the implications this could have for general
health and wellbeing.”
In addition, IADR’s current president, Dr. J. M. ‘Bob’ ten Cate of the
Netherlands, asked for an International Year of Oral Health within
five years to bring oral health to the
attention of a large audience.
The IADR’s 87th General Session
and Exhibition in Miami was held
from April 1–4. Future meetings will

www.dental-tribune.com

Dr. J. M. ‘Bob’ ten Cate, IADR president, at the IADR 87th Session and
Exhibition in Miami. (DTI/Photo Jan
Agostaro)
be the World Congress on Preventive
Dentistry in Phuket, Thailand, September 7–10, and the IADR General
Session and Exhibition in Barcelona,
Spain, July 14–17, 2010.

[21] =>

Event 21

Dental Tribune | April 2009
Review

IDS Cologne flourishes
despite economic trouble
After five days, the 33rd International Dental Show (IDS) at the
Cologne convention center closed
with an increase in exhibitors, visitors and exhibition space. More than
1,820 exhibitors, an increase of 4.5
percent, from 57 countries took part
in IDS 2009.
With foreign participation at 65
percent and a more than 10 percent
increase in international exhibitors,
the IDS broadened its significance
as a global trade and communications platform even further. The
6.9 percent growth in visitor numbers was achieved via domestic and
international visitors.
Dr. Martin Rickert, chairman of
the Association of German Dental Manufacturers, said, “The 33rd
International Dental Show gave us,
above all, the positive signal we
were looking for. Our projections
about a positive development in dental markets have been outstandingly
confirmed. I am certain that this IDS
will serve as a lasting impetus for
the global dental industry and for
the international health care market
along with it.”
With more than 1,100 presentations, new products and advancements, the International Dental

Show 2009 once again demonstrated
its potential as an international innovations platform. According to Rickert, this was made up of three main
trends.
First, natural teeth are being kept
for as long as possible through early
and comprehensive diagnostics and
minimally invasive treatment methods. Second, if dentures are necessary, they should look as natural as
possible and offer the highest esthetics and functionality. Finally, the
digitization and networking between
practice and laboratory increase efficiency in the economic production of
dentures.
For Oliver P. Kuhrt, managing
director of Koelnmesse GmbH, IDS
2009 was a superlative event: “The
IDS is the prime example of a successful world trade fair and a magnet for the dental industry. It combines all the elements necessary for
successful business and is a global
communications, trade, innovations
and product platform all rolled into
one,” he said.
IDS takes place in Cologne every
two years and is organized by the
Gesellschaft zur Förderung der Dental-Industrie GmbH (GFDI), the commercial enterprise of the Association

“IDS has confirmed its status as the
leading international trade show in
dentistry. We are certain that the
show’s outcome will give positive
signals for the global dental market
and international health markets as
well,” he added.

of German Dental Manufacturers
(VDDI) and staged by Koelnmesse
GmbH, Cologne.
“It is good news that in spite of the
turbulence in the financial market,
the dental industry and the health
economy can, overall, sustain as
solid markets,” Rickert said during a press conference in Cologne.

Please visit english.ids-cologne.de
for information about this event. DT

Preview

Montreal welcomes dentists from around the world
the second largest city in Canada
and the largest French-speaking
city in the world outside of France.
Blending its French accent with
that of many other ethnic communities, Montreal charms its visitors
with its Euro-American ambiance.

Montreal is definitely the place to
be this Memorial Day weekend!

R_Dental_114x88_Messe

13:39 Uhr

For more information, please
visit www.odq.qc.ca and click on
“Journées dentaires internationales
du Québec.” DT

12.10.2006

Seite 1
AD

ES SI

Featured speakers this year
include Dr. John Kois discussing

A multicultural city, Montreal is

Universal and scanable registration material, thatʼs it!

• high viscosity • high final hardness • Shore-A 94
• setting time about 60 s • scanable for powderless
3D-data registration of antagonists
(CAD/CAM)

“Interdisciplinary Treatment Planning,” Dr. Stanley Malamed presenting “Medical Emergencies in
the Dental Office,” Dr. Henry Gremillion lecturing on “TMD pain,”
Dr. Harald Heymann on “Adhesive/
Esthetic Dentistry” and Dr. Terry
Tanaka speaking on “Prosthodontic
Problems,” just to name a few.
In addition, there will be workshop presentations on composite
resins, rotary endodontic systems,
periodontal and oral surgery and
the Invisalign system. All lectures
are CERP approved for continuing
education credits.

R-SI-LINE ® METAL-BITE

Available
at:

dental

Canada’s largest annual meeting,
JDIQ has grown exponentially in
recent years. With more than 3,500
dentists in attendance from all corners of the world and 225 exhibitors
occupying 100,000 square feet of
exhibition space, this year’s meeting will be better than ever.

HNOLO

Following a record-breaking
attendance year in 2008, more than
11,000 delegates are expected to
attend the 38th annual Journées
dentaires internationales du Québec (JDIQ) to be held in Montreal,
Canada, from May 23–26.

TE
C

+
CAD/CAM
CIM

Biß zur Perfektion

www.pattersondental.com

R-dental Dentalerzeugnisse GmbH
E-mail: info@r-dental.com, r-dental.com

[22] =>

22 Industry News

Dental Tribune | April 2009

Breakthrough in bonding technology:
solvent-free bonding agent
teeth faster than ever by requiring
Pentron Clinical Technologies
®
™
only a one-coat application.
recently introduced Bond-1 SF
Solvent Free SE Adhesive, a unique,
Bond-1 SF forms an interactive
solvent-free, self-etch, light-cure,
bond between the minerals of the
one-coat, bonding agent to be used
tooth structure and the resins of the
for all your direct composite bondbonding agent without the use of
ing needs. Pentron Clinical Technolacetone, water or alcohol, providing
ogies has removed the solvent while
a superior bond to both dentin and
preserving the high bond strengths
enamel. While many might consider
associated with conventional bondthis the next “generation” of bonding agents. Removing the solvent
ing agents, Adrienne Collins, the
from this revolutionary product not
Pentron Clinical Technologies prodonly addresses common technique
uct manager, states: “We didn’t feel
issues, such as over or under drying,
the
but
facilitates
the restoration
of
P&Falso
Ad-DTA
1/14/09
2:45 PM Page
1 immediate need to assign a gen-

eration to this new bonding agent
as we feel this product
is in a league of its
own and makes
the practice of
referring to bonding agents with
generations obsolete.”
Bond-1 SF Solvent Free SE Adhesive is available in two convenient
delivery systems. The syringe offers
unique flocked needle tips that facilitate easy, direct placement into the
prep, while the free-standing single
dose provides the ultimate in infec-

™

tion control.
Pentron Clinical is an established
leader in the dental industry, offering a wide variety of products to suit
your restorative needs. As one of the
pioneers of adhesive technologies,
Pentron Clinical has successfully
demonstrated its commitment to
advancing dentistry one innovation
at a time. Its portfolio of trusted,
quality dental products includes:
Breeze® self-adhesive resin cement;
Build It® FR™ core build up material;
FibreKleer® Posts; Correct Plus®
impression materials and Artiste®
Nano Composite. For more information visit the company’s Web site,
www.pen tron.com, or call (203)
265-7397. DT

Try ClearMatch for 45
days for only $99!
We’ve got a new
way for you to experience ClearMatch
Shade
Mapping
software. Try it in
your office on your
cases for 45 days for
only $99. You can
process as many
cases as you would
like within those 45 days and we’ll
even credit the $99 towards the purchase of a full copy when you decide
to upgrade.

Simply take a photo with a shade
tab in the image and import it into
ClearMatch. A few clicks later, you
have accurate shade and value maps
that you can print or e-mail to your
lab. Our Web site has a self-running
presentation that allows you to see
the software in action. Take a look
and call us today for your trial copy.

Contains no
Bisphenol A
If you’re one of the 1,000s of dental professionals who know
EMBRACE™ WetBond Pit & Fissure Sealant is easier to apply
because it bonds to moist tooth surfaces, provides a better seal and
is long lasting, you’re on top of your profession.
Now after six years of clinical use,
EMBRACE Sealant sets a new standard
of success – intact margins, no leakage,
no staining, caries-free.
Six-year followup photo
photo courtesy of Joseph P. O’Donnell, DMD

Mirror handles and kits
now in stock
For technical information
contact Pulpdent at

800-343-4342
Order through your dental dealer.

One call can bring a smile to your face and your patients:

� Long lasting
�
� Easy to apply – only sealant that bonds in a moist field
�
� Margin-free seal
�
� Fast light cure
�
� Fluoride releasing
�
*Contact Pulpdent for study.

PULPDENT

Corporation

80 Oakland Street • Watertown, MA 02471-0780 • USA

pulpdent@pulpdent.com • www.pulpdent.com

In our last e-mail newsletter we
introduced our new Universal Mirror
Handle, but they were not yet available. We now have them in stock. We
showed the new handle for the first
time at the CDS meeting in Chicago
and they were extremely popular.
We have them available individually
or in kits with three mirrors.
PhotoMed International
14141 Covello St., #7C
Van Nuys, Calif. 91405
Tel.: (800) 998-7765
Fax: (818) 908-5370
Web site: www.photomed.net
E-mail: info@photomed.net
www.dental-tribune.com

[23] =>

Industry News 23

Dental Tribune | April 2009
New Mydent
pouch features
dual internal
indicator
Mydent
International has introduced
the Defend+Plus Sterilization Pouch with a
built-in dual internal
indicator. The new
pouches save time and money by
eliminating the need to use separate
indicator strips.
Defend+Plus pouches feature
the same superior design and quality construction of standard Defend®
pouches, but include a built-in dual
internal indicator (steam and ETO).
This allows the user to see that the
correct sterilization temperature is
reached within the instrument compartment without having to place an
indicator strip inside the pouch. The
dual internal indicator provides an
extra measure of security.
Defend+Plus Pouches with builtin dual internal indicator are offered
in five sizes, packaged 200 to a box
and are available from most dental
dealers.
Mydent International, home to
Defend infection control products,
disposables and impression material systems, provides dependable
solutions for defensive health care.
Mydent urges health care professionals to: DEFEND. Be smart. Be safe.

Pulpdent introduces first invisible veneer cement
Pulpdent Corp. has released
Kleer-Veneer™ Light-Cure Veneer
Cement, the first invisible veneer
cement. Kleer-Veneer is also available in opaque shades.
Kleer-Veneer is a unique, moisture tolerant, self-adhesive veneer
cement. No bonding agents or silane
are required. The distinctive consistency holds the veneer securely
in place without drift before light
curing.
Kleer-Veneer is available in clear,
opaque white, opaque cream and
opaque pink. The clear cement is

invisible and does not alter tooth
shade. The opaque shades can be
used when neutralizing existing
tooth color is desired.
The Kleer-Veneer intro kit contains four 1.2 ml syringes, one of
each shade, plus 20 applicator tips.
Refills contain one 1.2 ml syringe
Kleer-Veneer plus 10 applicator tips.
Pulpdent manufactures highquality products for the dental profession, including adhesives, composites, sealants, cements, etching
gels, calcium hydroxide products,
endodontic specialties and bonding

accessories. For more information
call (800) 343-4342 or visit www.
pulpdent.com. DT
AD

VAnCOuVer, CAnAdA
August 20-22, 2009 ❖ Vancouver Convention Centre

ICOI World Congress XXVI
12th Annual IPS Symposium and
12th Congress of the Asia Pacific Section

For more information on Mydent
International and its products, call
(800) 275-0020 or go to www.defend.
com. DT

The next generation
of safety
Crossex introduces
their Non-Latex Dental
Dam with excellent tear
resistance, great color
contrast with teeth, in
lavender and medium
gauge. Crosstex Dental
Dams isolate procedures from
blood and saliva, tongue and cheek
interference, while reducing contaminated aerosols and risk of patients
swallowing/aspirating foreign bodies. Also available are: powder-free,
low protein, latex dental dams. Both
products drastically reduce the risk
of allergic latex reactions. Crosstex
once again leads the dental industry
in safety and efficiency!

For more information please contact the ICOI Central Office
at (973) 783-6300 or visit our website at www.icoi.org

Sold Worldwide through Dental
Dealers
Crosstex
Hauppauge, N.Y. 11788-4209
Tel: (631) 582-6777
Fax: (631) 582-1726
Toll Free: 888-CROSSTEX
www.crosstex.com
E-mail: Crosstex@crosstex.com DT

Photo Credit: Tourism Vancouver

Sponsored by:
The ICOI is an ADA CERP
recognized provider.
AGD - Accepted Program Provider
FAGD/MAGD Credit, 05/06 - 06/09

[24] =>

[25] =>

Cosmetic TRIBUNE
The World’s Cosmetic Dentistry Newspaper · U.S. Edition

April 2009

www.dental-tribune.com

Vol. 2, No. 3

A simple, esthetic, custom
implant abutment
By John Highsmith, DDS, DICOI, AAACD

In implant reconstruction, the
dimension from the implant platform to the crest of tissue, especially in esthetically critical areas,
is often more than 2 mm. Many
implant manufacturers supply a
straight abutment for cement with
the implant, which significantly can
reduce the cost to the dentist.
However, these abutments tend
to have a margin about 1 mm tall,
which limits their use to relatively
thin tissue. The problem with using
a short margin abutment with thick
tissue is that the margin ends up in
an area where it can be impossible
to clean up all the excess cement,
leading to periodontal infection
(“cementoma”).
There are several options available currently.
• Purchase an abutment with a
taller machined margin, which
the dentist can prep to the
desired height and contour. This
can work, but there is the additional expense of the abutment
and the possibility of the metal
abutment showing through thin

Fig. 1

Fig. 2

Fig. 3

Fig. 4
tissue.

Fig. 5

Fig. 6

• Zirconia abutments, which can
be either prepared or custom
milled, such as the Atlantis abutment. These work well, but add
expense to the case. The zirconia
is also always a white color.
• A third option is herein described,
where the straight abutment is
modified with porcelain to create

Chicago dentist provides
free care one day each year

a custom abutment at minimal
cost and improved esthetics.
This patient desired a dental
implant retained crown to replace
the retained primary tooth #C (Fig.
1). The cuspid had erupted into
the lateral position, which was congenitally missing. We removed the
primary cuspid and immediately
placed a Biohorizons 4 x 12 mm
implant (Fig. 2). I wanted the implant
platform to be 2–3 mm below the
desired free gingival margin, which
actually necessitated a slight osteot-

omy (Fig. 3). If this had not been
done, the final crown might look
too short. A healing cap was placed
and a denture tooth was bonded to
the adjacent teeth with composite
resin. The implant was allowed to
osseointegrate for six months before
loading.
At uncovery, a screw-retained
temporary was fabricated to form
the tissue contours. A straight abutment was cut to length and sand-

By Fred Michmershuizen, Online Editor

Dr. Theodore M. Siegel wanted to
give back to the local community, but
he didn’t want to just write a check
to a charity. He wanted to do more.
So he decided that for one day every
year, he would open up his practice
to all local patients and offer free
services. Since his annual “Dentists
With Heart” event began in 2005,
Siegel said, more than 2,000 patients
have been treated with more than
$1.25 million in care.
“For many, dentistry is an unaffordable luxury. Every year on Valentine’s
Day, our office provides free dental
care to the less fortunate people in
our community,” said Siegel, whose
Chicago practice, Big Smile Dental,
offers a wide variety of cosmetic den-

Theodore M. Siegel, DDS, started
‘Dentists With Heart’ in 2005. Since
then, more than 2,000 patients have
received free treatment.
tistry services, including complete
smile makeovers, teeth whitening,
porcelain veneers and more.
g CT page 2

g CT page 2

experience
www.aacd.com • 800.543.9220
25 AnniversAry AACD sCientifiC session
Monday, april 27 - Friday, May 1, 2009 • Honolulu, Hawaii
th

Celebrating 25 Years of exCellenCe

[26] =>

Interview

Cosmetic Tribune | April 2009

COSMETIC TRIBUNE

g CT page 1

The World’s Dental Newspaper · US Edition

Publisher
Torsten Oemus
t.oemus@dtamerica.com

blasted. A thin layer of opaque flowable (Flow-it!, Jenric Pentron) was
placed to block out the metal, then
the temporary crown was built up
with increments of flowable composite to create the crown shape
(Fig. 4).
After polishing the subgingival
portion to a high shine, the temporary was screwed into place, cotton
was placed over the screw, and the
incisal portion was filled in and
contoured with flowable composite.
The temporary crown was left in
place for six weeks for tissue healing (Fig. 5).
The temporary was then removed
after we were satisfied that the tissue was pink and healthy, and an
impression ball cap was placed on
an abutment. An impression was
taken with a thin body impression
material within just a few minutes of
removing the temporary to avoid tissue collapse (Figs. 6, 7). Photos were
taken to communicate shade to the
ceramist (Fig. 8).

President
Peter Witteczek
p.witteczek@dtamerica.com
Chief Operating Officer
Eric Seid
e.seid@dtamerica.com
Group Editor
Robin Goodman
r.goodman@dtamerica.com

Fig. 7
The ceramist took the straight
abutment that came with the implant
and contoured it for clearance with
the opposing dentition. The margin
of this abutment would be too far
apical for adequate cement clearance, so he modified it with porcelain specifically developed for
titanium (Vita Titainium Porcelain,
Vident).
Emergence profile can be developed as needed for the soft tissue
profile, as well as adding a pink
color to blend in with the gingival
tissue (Figs. 9, 10). That can help

in the esthetics if there is any tissue
recession in future years, as well as
maintaining the gingival color. A
porcelain-to-metal crown was fabricated with a porcelain butt margin.
At delivery, the modified abutment was placed and the crown
tried in. After any adjustments and
approval obtained from the patient,
the abutment screw was torqued
into place. The screw access was
filled in with Fermit-N (Ivoclar)
and light cured. The crown was
cemented with RelyX luting cement

→

Siegel expressed appreciation for
the many individuals and companies
that provided support. For the most
recent event, supplies were donated by Patterson Dental, Kerr, HuFriedy, Top Quality Mfg., Vital Rx
Pharmacy, Ivoclar Vivadent, Larry
Garrett and Frank Sasco. Several

Managing Editor Implant Tribune
Sierra Rendon
s.rendon@dtamerica.com
Managing Editor Ortho Tribune
Kristine Colker
k.colker@dtamerica.com
Product & Account Manager
Mark Eisen
m.eisen@dtamerica.com

Sales & Marketing Assistant
Lorrie Young
l.young@dtamerica.com

For the most recent “Dentists With
Heart” charity day, people braved
cold winds and snow and began lining up at midnight. By the time the
practice opened its doors at 9 a.m.,
the line had begun to wrap around
the block. Patients received free
cleanings, fillings, extractions, root
canals and cosmetic procedures.

“I would like to thank my family, my entire staff, our volunteers
and our sponsors who insisted upon
working without pay,” Siegel said. “I
am truly grateful to all of them for
their passion, their help and their
dedication to help those in need.
Their hard work is an inspiration to
everyone.”

Managing Editor Endo Tribune &
Online
Fred Michmershuizen
f.michmershuizen@dtamerica.com

Marketing Manager
Anna Wlodarczyk
a.wlodarczyk@dtamerica.com

g CT page 1

Siegel is not able to provide all
this care by himself. Those offering
free services included Dr. Anu Garg,
Dr. Josephine Puleo and Dr. Christopher Quick of Big Smile Dental,
Dr. Henry Lotsof of Ravenswood
Dental Group at Methodist Hospital,
Dr. Gary Hosters of Norwood Park
Periodontics and Dr. David Hanson
of Lincoln Park Institute. Other volunteers included students from the
Harper College RDH program, plus
hygienists, support staff and even
patient volunteers.

Editor in Chief Cosmetic Tribune
Dr. Lorin Berland
d.berland@dtamerica.com

C.E. Manager
Julia E. Wehkamp
E-mail: j.wehkamp@dtamerica.com
Art Director
Yodit Tesfaye Walker
y.tesfaye@dtamerica.com

Doctors and staff gather at Big Smile Dental for a group photograph.
Everyone who works the ‘Dentists With Heart’ event does so for free.

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
© 2009, Dental Tribune America, LLC. All
rights reserved.

Patients wait in line outside Big Smile Dental to receive free treatment.
local restaurants provided catered
food for patients and volunteers.
Siegel said there are many people without medical insurance in
Chicago and an even greater number without dental insurance. Siegel explained that he and his staff
feel that dental care is a necessary
service that should be available to
everyone, even those who are unable
to afford insurance. The practice’s
goal is to raise awareness in hopes
that it will be easier in the future for
uninsured people to find a dentist in
the Chicago area to help ease their

tooth discomfort and disease.
“I truly feel blessed and proud to
be able to help so many people in
need,” Siegel said.
More information about the annual “Dentists With Heart” charity
event is available on the Big Smile
Dental Web site, www.bigsmiledental.com. For doctors who wish to set
up a similar event in their own communities, Siegel has prepared an
information packet. To receive the
information, contact Siegel directly
at bigsmiledental@aol.com. CT

Cosmetic 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@
dtamerica.com. Cosmetic 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 Cosmetic Tribune?
Let us know by e-mailing feedback@
dtamerica.com. We look forward to
hearing from you!

[27] =>

Clinical

Cosmetic Tribune | April 2009

3

Fig. 10

Fig. 8

and color the subgingival material
for the best esthetics, all at a cost
less than a milled zirconia abutment
because the abutment came with the
implant.
Thanks to Mr. Kent Decker CDT
for his artistry and help in developing this technique. CT

Fig. 11

Fig. 9
(3M) and final photographs taken.
The “after” photograph shown (Fig.
11) demonstrated the healthy tissue.
This post-op photo was two years
after the case was delivered.
The use of titanium porcelain on
the abutment allowed the ceramist
to control emergence profile, bring
the margin to a cleansable level

About the author

Dr. Highsmith received his dental degree from the University of
North Carolina School of Dentistry
in 1984, after which he completed
a general practice residency at the
Veterans Administration Medical
Center in Baltimore, Md. He has
been in private practice in Clyde,
N.C., since 1985. He is an accredited member of the AACD, a clinical
instructor at LVI, a diplomate of
the ICOI, and a fellow of the Misch
Implant Institute. He takes more
than 200 hours of continuing education annually, and considers his
mentors Omer Reed, Bill Strupp,
John Kois, Frank Spear, Bill Dickerson, Clayton Chan, Paul Sletten,
Mark Hyman, Darryl Nabors, Steve
Burch, Bill Domb and Carl Misch.
John Highsmith, DDS
AACD Accredited Dentist
Diplomate, International
Congress of Oral Implantologists
Fellow, Misch Implant Institute
LVI Clinical Instructor
E-mail: schminsk@bellsouth.net

AD

[28] =>

[29] =>

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

April 2009

www.dental-tribune.com

Vol. 2, No. 3

The business of hygiene
By Editor in Chief Angie Stone, RDH, BS

The title of this article inevitably bothers some hygienists. After
all, hygiene school does not teach
anything about the “business” of
hygiene, so many hygienists feel
running a hygiene department as a
business is wrong and impinges on
the quality of care.
Dental hygiene curricula is
focused on educating students to be
safe clinicians upon graduation. This
rigorous schedule does not allow for
time to be spent on non-clinical
education. What is taught in school
is what clinicians feel is right. While
schools need to focus on patient
care in order to produce clinicians,
the lack of education regarding the
business side of hygiene makes it
difficult for hygienists to understand
that dental hygiene is a business.
Yet, in reality, dental hygiene is
a business within a business. The
hygiene department is responsible
for bringing in enough money to
pay for all the expenses incurred
by the department, cover hygiene
salaries and benefits, and make a
profit. Industry standards state that
33 percent of total practice production should come from the hygiene
department, and that hygiene wages
and benefits should never exceed
33 percent of hygiene production.
The last industry standard suggests
that 33 percent of hygiene production
should come from periodontal codes.
If these standards are met, the
hygiene department should operate as a profitable business. If these
standards are not met, the dentist needs to subsidize the hygiene
department with his/her production.
Hygienists need to be aware of their
percentages. If stats are not at the
level they should be, the hygienist needs to take measures to help
improve them.

Recall system

Quite frequently, hygiene numbers that are below the industry
standard are that way because of
an inefficient recall system. One of
the biggest problems an inefficient
recall system causes is openings in
the schedule. A chair that is sitting
empty is not bringing revenue in.
Even worse is that an empty chair
is actually causing the department
to lose existing money if the hygienist is paid while the chair is vacant.
An evaluation of this system can be

undertaken by answering the following questions:
• Does the office have a staff
member whose job description
includes responsibility for the
recall system?
• Is the hygiene schedule full
(less than 30 minutes open per
hygienist per day)?
• Is the amount of production
lost due to open time being
monitored?
• How does the office determine
the amount of hygiene hours
needed each month to accommodate all the patients in need
of a professional cleaning and
oral examination?
• Is the available hygiene time
based upon the number of
active recall patients in the
practice?
• Is the amount of hygiene hours
needed determined every three
months?
A “no” response to two or more
of these questions points to a potentially inefficient recall system. Without fixing this system, the hygiene
department will struggle to meet
industry standards, and probably
will always need subsidizing from
the dentist’s production.

Periodontal protocol system

Editor in Chief Angie Stone utilizes Florida Probe’s ‘GoProbe’ to help her deliver periodontal standard of care to her patients.

Another deficiency that leads to
not meeting industry standards is
the lack of a sound periodontal
protocol system. Without a system
in place, hygiene departments are
prophy driven. Fees collected primarily from prophys will not sustain
a hygiene department. In today’s
dental climate, no hygiene department should be prophy based.
Research shows at least 33 percent of the adult population has
some form of periodontal disease.
It would make sense then that at
least 33 percent of adult patients,
in any given practice, should be
in a periodontal program. Having
patients who require periodontal
services receiving necessary treatment is a win for the patient and
a win for the hygiene department.
Perio services are charged out at a
higher rate and, therefore, can help
g HT page 3

T EACH T R AVEL LEAR N
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Tel: 202-296-0928 • E-mail: info@hvousa.org

[30] =>

Editor’s Letter

Hygiene Tribune | April 2009

HYGIENE TRIBUNE

Dear Reader,
As spring nears, hygiene students
across the country have taken written and clinical exams so they can
finally become a real registered dental hygienist. Excitement looms as
they anticipate being in an actual
dental office, treating patients who
will not be in the chair for four hours
at a time. They are eager to use their
newly found skills to improve the
oral health of the world. What enthusiasm they carry with them out into
the dental hygiene workforce!
As licensed dental hygienists, we
can relate to graduating students for
we too have experienced the same
feelings. Some of us have been in
clinical practice for many years and
may still feel exhilaration in the
hygiene operatory. Others among
us, while we may still be practicing
clinically, are not completely satisfied with this setting. When thoughts
turn to transitioning out of clinical
hygiene, the vision of academia may
be the first option that comes to mind.
Teaching is a great fit for many, but
it is not a great fit for all. What else

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

Publisher
Torsten Oemus
t.oemus@dtamerica.com

then can one do with an associate’s
degree in dental hygiene?
I want to invite you on an exploration regarding this question. Over
the next several months, I will offer
ideas of avenues to explore. The
dental hygienist of today has many
career options available. The trouble is we don’t always know what
is available or how to get to a new
level. How can we know what we
haven’t been taught? Hygiene schools
have a responsibility to make sure
their graduates are only safe beginners. There is hardly time to provide extensive education in regard to
alternative career paths available to
hygienists — and as editor in chief,
that’s my job.
Join me next month for the beginning of a journey that is sure to
travel over roads less traveled by
dental hygienists. Each month I will
highlight an avenue available to colleagues who are looking to add to
their clinical hygiene career. It is my
hope that many readers of Hygiene

President
Peter Witteczek
p.witeczek@dtamerica.com
Chief Operating Officer
Eric Seid
e.seid@dtamerica.com
Group Editor
Robin Goodman
r.goodman@dtamerica.com
Editor in Chief Hygiene Tribune
Angie Stone RDH, BS
a.stone@dtamerica.com
Managing Editor Endo Tribune
& Online
Fred Michmershuizen
f.michmershuizen@dtamerica.com

Tribune will find something appealing to their particular dreams.

Managing Editor Implant Tribune
Sierra Rendon
s.rendon@dtamerica.com

Best Regards,

Managing Editor Ortho Tribune
Kristine Colker
k.colker@dtamerica.com
Product & Account Manager
Mark Eisen
m.eisen@dtamerica.com

Angie Stone, RDH, BS
Editor in Chief

Sales & Marketing Assistant
Lorrie Young
l.young@dtamerica.com

Ozone therapy

C.E. Manager
Julia E. Wehkamp
E-mail: j.wehkamp@dtamerica.com

By Robin Goodman, Group Editor

Art Director
Yodit Tesfaye Walker
y.tesfaye@dtamerica.com

During the recent IDS in Cologne,
Germany (read the review in DTUS
on page 21), I had the opportunity
to speak to Managing Director Dr.
Domagoj Prebeg about his company, Biozonix, and the advantages of
ozone therapy. Its Ozonix unit is currently awaiting FDA approval, but its
devices have been approved for use
in Europe for 10 years already.
When you say “ozone,” most
people will raise their eyebrows in
alarm, so how is it used in medicine?
Very few people know that ozone
has been successfully used in medicine for nearly 125 years. What people hear about are “holes in the
ozone layer” and “ozone warnings”
in cities plagued by smog. However,
ozone is no more than 1 percent of
smog, and ozone is not at all harmful in small doses — it’s just that it’s
easy to detect in smog. It’s actually
the waste created from burning fossil fuels, which create smog, that are
harmful. So we should really call
them “smog warnings” as the ozone
found in smog is not to blame for any
respiratory problems.
Numerous studies have shown that
ozone is a strong oxidant that can
eliminate viruses, bacteria and fungi;
stimulate the immune response and
healing mechanisms; increase oxygenation and blood flow; and balance metabolic reactions. Because

Marketing Manager
Anna Wlodarczyk
a.wlodarczyk@dtamerica.com

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

oxygen [O2] is the main source of
energy for human cells, it is obvious why ozone [O3], as an energized
form of oxygen, has such a beneficial
effect on human health.
How does the Ozonix ozone generator work?
Ozonix uses high-frequency plasma technology that generates an
electromagnetic field at the tip of the
plasma probes used with the unit.
The field disassociates the surrounding oxygen molecules to form ozone
molecules right at the tip of the
probe. When you apply the tip of the
probe to diseased tissue for 20 to 60
seconds, the ozone completely disinfects the area and promotes healing.
A variety of ergonomically designed
probes come with the unit, which
means you can reach any area in the
oral cavity.
Will the patient feel any pain,

and is it safe to use ozone like
this?
Yes, it is completely safe. Most
people are familiar with the highfrequency electromagnetic field
[HFEF] used in physiotherapy for
muscle stimulation or relaxation.
Ozonix’s HFEF is 3,000 times lower
than the one used in physiotherapy.
Therapeutic concentrations of ozone
are present only in the treatment
area, and are limited by the concentration of oxygen in the surrounding
atmosphere and the reversion of
ozone to oxygen. Treatment is not
only painless, but shortly thereafter the patient will experience a
reduction of pain in the area. Ozone
therapy is the cleanest, safest, most
gentle and completely natural medicine available to man.
(Please visit the company’s Web
site at www.biozonix.com for more
information.)

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@dtamerica.
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@dtamerica.
com. We look forward to hearing from
you!

[31] =>

Clinical

Hygiene Tribune | April 2009

g HT page 1

sustain hygiene.
If a periodontal protocol does not
exist, patients are not being examined thoroughly for the presence
of periodontal disease. The most
important element in detecting periodontal disease is completion of a
periodontal probing and charting.
Current standard of care requires
that patients receive six-point periodontal probing and charting on an
annual basis at minimum. While this
is the standard of care, the American
Academy of Periodontology has stated that 73 percent of dental offices
do not diagnose periodontal disease.
According to the American Dental

Association, 50 percent of the offices diagnosing periodontal disease
do not probe on a regular basis.
This means, at best, 13.5 percent
of dental offices across the country
are meeting the periodontal probing
standard of care.
Implementation of a periodontal
protocol that mandates annual probing/charting of all adult patients is
the first step toward delivering the
current periodontal standard of care
and increasing hygiene revenue.
Protocol also needs to dictate treatment needs to be delivered based
upon probing/charting data.
Review of an existing recall system can typically be completed by

dental practice management consultants. Information can also be
found on dental practice management Web sites. Periodontal protocols can be found in textbooks, Web
sites and in conjunction with many
periodontal
related
products.

Knowledge of what a successful
recall system is and what an effective periodontal protocol is, followed
by implementation of both systems,
will will certainly lead to an
improvement in the business of
hygiene. HT

About the author
Angie Stone graduated in dental hygiene from Madison Area Technical College and obtained a bachelor’s in psychology from Upper Iowa
University. Prior to obtaining her hygiene degree, she was a dental assistant for 15 years, five of which were in the United States Navy. She has
taught both dental assisting and dental hygiene courses at the technical
college level. Stone has authored many articles and speaks on several
topics throughout the country. Learn more about Stone at her Web site
at sharprdh.com.

Study shows flossing reduces mouth bacteria
By Dental Tribune Staff

In dental offices all over the
world, patients are often instructed
they are not flossing enough or
instructed to floss more. As the old
saying goes, you only need to floss
the teeth you want to keep. After
all, not flossing regularly can lead
to tooth decay and to periodontal
disease, the leading cause of tooth
loss in adults.
A recent study published in the
Journal of Periodontology (JOP), the
official publication of the American
Academy of Periodontology (AAP),
demonstrates that including flossing
as part of one’s routine oral care can
actually help reduce the amount of
gum disease-causing bacteria found
in the mouth, therefore contributing

to healthy teeth and gums.
The study, conducted at New
York University, examined 51 sets
of twins between the ages of 12 and
21. Each set was randomly assigned
a two-week treatment regimen with
one twin brushing with a manual
toothbrush and toothpaste and the
other twin brushing with a manual
toothbrush and toothpaste and flossing. At the end of the two-week trial,
samples were taken from both pairs
of twins and compared for levels of
bacteria commonly associated with
periodontal disease.

Kornman, editor of the Journal of
Periodontology.
“Twins tend to share the same or
similar environmental factors such
as dietary habits, health and life
practices, as well as genetics. In
this case, the only difference was

flossing, and the outcome was significant. Flossing may significantly
reduce the amount of bad bacteria
in the mouth.”
For more information, contact
the American Academy of Periodontology, www.perio.org.
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The study findings indicated that
those twins who did not floss had
significantly more of the bacteria
associated with periodontal disease
when compared to the matching
twin who flossed in addition to tooth
brushing with toothpaste.
“This study illustrates the impact
flossing can have on oral health.
The twins experimental model is a
powerful tool to help sort out genetic and environmental factors that
often confound the interpretation of
treatment studies. This study demonstrates that flossing can have an
important and favorable impact on
an individual, as compared to that
of a non-flossing individual with
similar genetics and possibly similar habits,” explains Dr. Kenneth
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[32] =>

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• Contains 14 different situations that can and do arise in the dental office
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• Dr. Malamed breaks down these scenarios using high definition 3D
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• 7 Continuing dental education credits available.

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2/26/09 4:29:49

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[cover] => DT U.S.

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Table of contents

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