DT U.S. 1410

Dental team from Boston University serves up smiles in Mexico / Opinion Feedback / All-inclusive badge - no ‘per lecture’ fees / Florida sends you on a flight to success / FDI World Dental Communique (Mar/Apr 2010) / The mouth as construction site / Seen & Heard: CDA Meeting / Industry / COSMETIC TRIBUNE 6/2010 / HYGIENE TRIBUNE 5/2010

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The World’s Dental Newspaper · U.S. Edition
www.dental-tribune.com

IMPLANT TRIBUNE
The World’s Implant Newspaper · U.S. Edition

What’s to come?

Restorative-driven implant dentistry: the future
is now.
u page 1B

Vol. 5, No. 14

CosmetiC tRiBUNe

HYGIENE TRIBUNE
RIBUNE

the World’s Cosmetic Dentistry Newspaper · U.s. edition

Esthetic rehabilitation

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

A multi-disciplinary approach to correct a patient’s compromised dentition.
u page 1C

The many sides of xylitol

The perfect primer on xylitol answers all your
questions and concerns.
upage 1D

Dental team from Boston University
serves up smiles in Mexico
By Fred Michmershuizen, Online Editor

A team of volunteers from Boston
University Henry M. Goldman School
of Dental Medicine (GSDM) recently
conducted an outreach trip to Teacapan, Mexico, in which more than
250 underprivileged children were
screened and treated.
The outreach program is called
Project Stretch.
“This was my fifth mission and my
third time in Teacapan,” said Kathy
Held, assistant director of extramural programs at GSDM and longtime
Project Stretch volunteer. “Each year
I say, ‘It can’t get any better than this,
so I will quit while I’m ahead,’ but
each year has proven to be as unique

and wonderful of an experience as
the last one.”
Other GSDM team members
included Clinical Assistant Professor
Dr. Frank Schiano, Robin Yamaguma
and Ismael Montane. According to
Held, the team worked both effectively and efficiently.
“Dr. Schiano was a machine, providing more treatment with his partner, RN and Dental Assistant Cree
Bruins, than anyone of us could fathom,” Held said. “While Dr. Schiano
was reading the child’s records, Cree
was preparing the child for treatment
— they were a great chair-side team.”
“Robin and Ish took turns working outside, where they primarily
concentrated on performing exams

Head west for the PNDC

and atraumatic restorative treatment on deciduous teeth using hand
instruments and glass ionomer filling
material,” Held said. “They also took
turns working inside, where they had
a fully operational dental unit to complete procedures, including extractions, amalgams and composites on
permanent teeth.”
“Ish worked like a real trooper
through the day and Robin was
always so gentle with the children,”
Held said. “After an extraction one
child turned to her and gave her a big
hug. I was so proud of them.”
“I was so impressed with the organization of Project Stretch in Teacapan,” Schiano said. “They have made
tremendous progress over the last

six years, growing from a small mission providing preventive services to
a near-fully equipped dental clinic
offering more involved and comprehensive restorative care. Perhaps
the biggest reward was seeing the
successful efforts of previous teams,
which helped me realize the difference we were making in the lives of
these children and their families.”
g DT page 2A

Readers replied
We garnered a lot of feedback from an
article that ran in the No. 12 edition and
which also apppeared online. Take a
peek to see what readers had to say about
'Where have all the periodontists gone?'
by Louis Malcmacher, DDS, MAGD.

Some 9,000 dental professionals
from around the
globe will convene
in Seattle for the
123rd annual
Pacific Northwest
Dental Conference
(PNDC), to be held
June 17 and 18.

(Photo/Boston University GSDM)

May 2010

‘Where have all
the periodontists
gone?’

g See pages 3A–6A
(Photo/Faberphoto, Dreamstime.com)

g See page 7A

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[2] =>

2A News

Dental Tribune | May 2010

Associations seek health care
provider exemption from
financial reform legislation
By Fred Michmershuizen, Online Editor

As lawmakers in the nation’s capital debate proposed financial services
reform legislation, the nation’s leading dental associations are asking
Congress to exempt health care providers from oversight by a proposed
new federal agency.
According to the American Dental Association (ADA), the Academy
of General Dentistry (AGD) and
other groups, the proposed Consumer Financial Protection Agency,
which is part of the financial regulatory reform legislation currently
under consideration in the Senate,
would lead to unnecessary costs and
increased administrative burdens for
practitioners without any benefit to
their patients.
The ADA, AGD and about 20 other
associations recently sent a joint letter to key lawmakers who are working on the proposed legislation asking that they exclude their professions from the bill.
As currently written, the Restoring
American Financial Stability Act of
2010 would subject health care providers who regularly charge interest
on outstanding bills or allow patients
to pay in installments to federal scru-

The World’s Dental Newspaper · US Edition

Financial services reform legislation being debated in Washington could
hurt dental practices, according to the ADA and other dental associations.
(Photo/Jake McGuire)

tiny.
The letter, which was sent to Sen.
Christopher Dodd and Reps. Barney
Frank, Spencer Bachus and Richard
Shelby, reads: “Though the provisions
are intended to clarify the limitations
and exclusions of the bill, we believe
they actually raise more questions
as they may be interpreted as applying to health care practitioners who
regularly charge interest and allow
patients to pay in installments (subparagraph B). In addition, we remain

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
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DENTAL TRIBUNE

concerned that the term ‘engaged
significantly’ in subparagraph (C) is
not defined and could lead rulemakers to include those providers who
utilize those payment options for the
benefit of their patients.”
The letter also states, “Given the
scope and reach of the bill’s language, health care practitioners
would, we believe, be covered by the
legislation leading to unnecessary
costs and increased administrative
burdens for practitioners without any
benefit for our patients.”
“While we recognize and thank
you for including committee report
language that speaks to this issue,
specifically mentioning a health
care provider group (dentists) as not
intended to be covered; ultimately
the report language falls short of
ensuring that all health care providers will be exempt from the law,” the
letter continues.
In addition to representatives from
the ADA and AGD, also signing the
letter were representatives from the
American Academy of Oral & Maxillofacial Pathology, the American
Academy of Pediatric Dentistry, the
American Academy of Periodontology, the American Association of
Endodontists, the American Association of Oral & Maxillofacial Surgeons, the American Association of
Orthodontists, the American College
of Prosthodontists, the American
Medical Association and the Hispanic
Dental Association. DT

f DT page 1A
“This experience has left a lasting
impression in my mind and heart,”
Schiano said.
“It is awesome to see what a few
committed individuals can do for
the children of Teacapan,” Yamaguma said. The trip took place March
20 to 27. DT

Online Editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.com
Product & Account Manager
Mark Eisen
m.eisen@dental-tribune.com
Marketing Manager
Anna Wlodarczyk
a.wlodarczyk@dental-tribune.com
Sales & Marketing Assistant
Lorrie Young
l.young@dental-tribune.com
C.E. Manager
Julia E. Wehkamp
j.wehkamp@dental-tribune.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
© 2010 Dental Tribune America, LLC
All rights reserved.
Dental Tribune strives to maintain the
utmost accuracy in its news and clinical reports. If you find a factual error or
content that requires clarification, please
contact Group Editor Robin Goodman at
r.goodman@dental-tribune.com.
Dental Tribune cannot assume responsibility for the validity of product claims
or for typographical errors. The publisher also does not assume responsibility
for product names or statements made
by advertisers. Opinions expressed by
authors are their own and may not reflect
those of Dental Tribune America.

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

[3] =>

Dental Tribune | May 2010

Opinion Feedback

Dear Reader,
I am happy to report that Dental Tribune has received many provocative responses (some of which
appear below) to the opinion piece
by Louis Malcmacher, DDS, MAGD,
“Where did all the periodontists go?”
in the Vol. 5, No. 12 edition.
Personally, I am still here and I
didn’t know that the rest of us had
gone anywhere, but I guess that,
too, can be a topic of provocative
discussion.
First off, let me acknowledge that
the piece was supposed to be labeled
as our new Opinion section, but due
to a production error, the article
retained the Practice Matters section label. However, even without
the correct section label, the piece
achieved our goals for it: it got people writing us with their responses.
The goal of the new Opinion section is to give dentists a forum in
which to agree, disagree, discuss
and inform, and given the response
to the first article, it has certainly
achieved this goal.
Thankfully, we live in a country
where our Constitution guarantees
us the right to free speech. You

Dear Dr. Hoexter,
We are writing this letter in response to Dr. Louis
Malcmacher’s article, which
appeared in the May issue of
Dental Tribune, titled “Where
did all the periodontists go?”
First of all, let us assure
you that, as a specialty, periodontology is alive and well,
and the increasing number of
research studies supporting
the perio-systemic link demonstrates that the role of the
periodontist is more relevant
than ever. While we agree
with Dr. Malcmacher that general dentists are the “quarterbacks” of the dental team,
we also view the periodontist
as the specialty team member
who is uniquely qualified in
providing an accurate prognosis of all viable treatment
options, whether it is noninvasive periodontal therapy,
periodontal surgery or extraction followed by replacement
with dental implants.
Dr.
Malcmacher
mentions that he has spoken to
many periodontists but this,
in our view, is anecdotal
and does not accurately represent the entire periodontal profession. We believe
that the majority of periodontal
specialists make ethical decisions every day regarding
retention of the dentition versus extraction and placement

should feel privileged to exercise
that right and send in a response
to future Opinion section articles
should you be moved to do so.
That being said, Malcmacher’s
article is especially provocative
because he discusses an approach
that allows patients to determine
the dental treatment that they
will receive based on the patients’
own habits, rather than depending on evidence-based facts, proven
knowledge and objective clinical
results.

The goal is to encourage health
with proven minimally invasive
treatments, and this can only be
done with evidence-based facts,
proven knowledge and objective
clinical results. Malcmacher clearly
stated that he bases his opinion on
no authoritative evidence except
discussions with dentists he has had
during his travels.
Malcmacher makes an analogy
of being a quarterback, so allow me
to build on that analogy and leave
you with this to think on: a quar-

terback who doesn’t play with an
effective, cohesive team gets sacked
every time. DT
Best Regards,
David L. Hoexter
Editor in Chief
AD

[4] =>

4A

Opinion Feedback

Dental Tribune | May 2010

AD

of implants. Periodontists typically strive
to base treatment planning on scientific and clinical evidence, not on what
is easier for the patient or profitable for
the dentist.
General dentists and periodontists live
and practice in a society that craves
immediate gratification, where patients
often demand quick fixes with minimal
effort or change in behavior. Both general dentists and specialists are undermining their clinical expertise and professional authority when they succumb
to patient-dictated treatment options.
That is why the entire dental team of
GP, hygienist and specialist must provide
a united front in explaining to patients
why oral hygiene is important, why they
should make every effort to save their

natural teeth (if appropriate), and why
they should accept the recommended
course of treatment, maintenance and
the at-home regimen.
We would welcome the opportunity to
address this topic in greater detail in a
Practice Matters rebuttal article.
Regards,
Samuel B. Low, DDS, MS, MEd
President, American Academy of
Periodontology
Donald S. Clem, III, DDS
President Elect, American Academy of
Periodontology

From: Dr. Eric Hamrick
Sent: Tuesday, May 11, 2010
To: Louis Malcmacher
Subject: Where have all the periodontist gone
Good afternoon, Dr.Yowza. I wanted to
briefly comment on your article. I am a practicing, board-certified periodontist who has
been in private practice for 26 years. I teach
one day a month with the residents at the
Medical University of South Carolina School
of Dentistry, and also lecture on the topics
of periodontics and implant therapy to study
clubs both locally and nationally.
I enjoyed your article, as I thought the title
was very appropriate for our current time
in dentistry. What I stress to periodontists,
especially the youger ones, is the need for
practice diversification. In my practice, here
are some of the procedures I provide for my
referring doctor’s patients:
• Basic periodontal therapy, including the
LANAP proceedure, where it is appropriate.
• Mucogingival surgery, including a number of different procedures on both teeth and
implants.
• Implant therapy for both edentulous and
partially edentulous patients. This includes
multiple types of bone grafting procedures,
except for extra-oral grating (from hip or
tibia).
• PAOO, OR Wilkodontic surgery.
• Uncovery of impacted teeth as part of
orthodontic therapy.
Where I think our profession has failed
our patients the most in regard to providing good, comprehensive care, especially
periodontal care, is that dentists for the most
part have lowered the standard in regard

to how they define periodontal health. Just
because someone has been through scaling
and root planning doesn’t mean they are
automatically stable. My experience is that
very few dentists do a good re-evaluation to
determine what has happened, and they just
assume the patient is OK.
As you mentioned in your article, some
patients are better served by having the
guarded teeth extracted and replaced with
implants to reach the goal of periodontal
health and stability: however, economics
often dictates treating some questionable
teeth in an effort to keep the dentition intact,
which often requires surgery of some form,
including the LANAP procedure.
I think there will always be the need for
periodontists, as I don’t think too many general dentists are going to tackle the entire
list above. Although there is some overlap
with us and oral surgeons, I simply say let
the general dentist in any given area use the
specialist he or she thinks is best for patients
and their needs.
Thank you for taking the time to read my
comments.
Sincerely,
Eric Hamrick
Periodontics of Greenville
One Charis Drive
Greenville, SC 29615
(864) 271-4330
info@periogreenville.com

From: Louis Malcmacher
Sent: Tuesday, May 11, 2010
To: Dr. Eric Hamrick
Subject: RE: Where have all the periodontist gone
Hi, Eric, thanks so much for your comments.
I have gotten a lot of responses to this
article, many periodontists ranging from
“periodontists should only do evidencedbased periodontal therapy and the rest is
bogus,” that I was “crazy and lasers don’t
work at all” and “LANAP is a bunch of hooey”
to e-mails like yours.

Either way, my mission is to get a discussion going and this article certainly did that.
All the best! Thanks and have a great day!
Louis Malcmacher DDS, MAGD
27239 Wolf Road
Bay Village, Ohio 44140
(440) 892-1810
www.commonsensedentistry.com

[5] =>

Dental Tribune | May 2010
Subject: Re: Where did all the periodontists go? |
Dental Tribune International
From: Dr. Stuart J. Froum
Sent: Monday, May 10, 2010
To: dryowza@mail.com
Cc: r.goodman@dental-tribune.com
Dear Dr. Malcmacher,
I am writing in response to your commentary in the Dental Tribune
posted [online] on May 7, 2010, titled “Where did all the periodontists go?” In answer to this question, I would say “We’re still here.”
Your observation that there have been changes in all specialties (you
cite orthodontics, endodontics and periodontics in your article) is of
course accurate. Any specialty that has not undergone change in light
of all of the new emerging information, technologies and materials
would certainly be failing our patients and profession.
One of the most significant changes in the periodontal specialty
has been that clinical diagnoses, treatment planning and treatment
procedures are now decided, wherever possible, on evidenced-based
data and controlled clinical studies as reported in peer-reviewed scientific literature. As such, your
reporting that you are being
told by many periodontists
whom you “spoke to over the
last couple of years” that “they
would rather remove teeth
and place implants than actually treat patients through traditional periodontal surgery
and try having them maintain
their dentition” is quite disconcerting.
As a periodontist who treats
patients in private practice,
and as a clinical professor in
the department of periodontology and implant dentistry
at New York University Dental Center who teaches periodontics and implant dentistry
to periodontal residents in
training, I feel that the periodontists you are quoting are,
at the very least, misguided
and should be made aware
of a number of facts that may
change their opinions.
First, by and large, most of
the periodontists I meet in my
lectures and travels around
the country realize the value
of attempting to save a tooth
or teeth that can be retained
in a healthy functional and an
esthetic state.
In fact, traditional periodontal treatment including
both non-surgical and surgical techniques, have very high
success rates in accomplishing this goal as shown in longitudinal studies (see Hirshfeld and Wasserman, J Perio
1978; Oliver J, West Society
Perio 1969; Goldman MJ et al.,
J Perio 1986, etc.) over 20–50
years. It has been known for
over three decades that periodontal surgery, when not
followed by good professional and personal care, will in
many cases fail (Nyman et al.
J Clin Perio 1977).
That is why successful surgical treatment designed to
save teeth requires meticulous and regular professional
maintenance. Becker et al. (J
Perio 1984) and others have
shown that when this maintenance is provided, a surgi-

Opinion Feedback

5A

cal approach to treatment of moderate and advanced periodontitis is
highly successful. Patient compliance, even when not optimal, must
be reinforced by frequent maintenance and recall. This requires a
team effort by the referring dentists, hygienist and periodontist, which
will result in tooth retention and successful treatment in most cases.
To extract teeth and place implants is not the panacea that you and
those periodontists that you spoke to believe it is. First, the 94 percent
implant success rates you quote should be qualified. You mean a 94
percent implant survival rate because success implies implants that
lose no more then 0.2 mm of bone per year following final restoration
and remain esthetically pleasing to the patient.
By the way, these long-term survival rates that are often quoted are
based on use of implants with surfaces that are no longer available
(i.e., machined surface implants) and no longer being placed. Therefore, to compare long-term success of implants versus treated teeth
is not possible because long-term data on currently used implants is
lacking.
However, as I stated above, there are many long-term studies showg DT page 6A

AD

[6] =>

6A

Opinion Feedback

Dental Tribune | May 2010

f DT page 5A
ing natural teeth, when treated with traditional periodontal surgery,
have excellent long-term prognoses (Lindhe and Nyman, J Clin Perio
1984). The fact that implant surfaces and designs are changing so rapidly makes it difficult to find any comparable long-term statistics for
implants currently being placed.
Moreover, currently used implants, like natural teeth, can and do
develop bone loss (peri-implantitis), which has been documented to
be more prevalent than formerly believed.
In fact, in a recent consensus report and literature review authored
by Lindhe and Meyle and published in the Journal of Clinical Periodontology 2008, they cite two cross-sectional studies documenting
that peri-implant mucositis occurred in 80 percent of the subjects and
in 50 percent of the implant sites. Peri-implantitis was identified in 28
percent and greater than 56 percent of subjects and in 12 percent and
43 percent of implant sites, respectively.
This was corroborated by a more recent study (Koldstand, J Perio
2010) that documented a prevalence of peri-implantitis of 11.3 to
47.1 percent. This, combined with the results of two long-term studies — Pjetursson (2004), who reported that 38.7 percent of patients
had complications in the first five years after implantation; and Lang
(2004), who reported that biological and technical complications
with implant-supported restorations occurred in about 50 percent of
the cases after 10 years in function — should dispel any beliefs that
implants are a trouble-free panacea when compared to retention of
teeth that require periodontal treatment.
As for your contention that new procedures, i.e., wavelength optimized periodontal therapy (WPT) and the LANAP procedure using a
Nd:YAG (neodymium: yttrium aluminum garnet) laser present minimally invasive alternatives for patients who want to keep their teeth
without “heavily invasive periodontal surgery,” I again refer to the
dental profession’s reliance on evidence-based data before recommending new treatment modalities. I ask you: Where’s the proof that
these modalities are as or more effective than what has been proven
through evidence?
Before using any new modality, any dentist should have histological, clinical and long-term proof that these procedures are effective.
Many therapies are “minimally invasive” but useless for effective
periodontal treatment.
Dr. Malcmacher, I’ve been performing and teaching periodontal
therapy for over 35 years and have seen trendy, minimally invasive
and “easy” therapies fall by the wayside when clinically tested in randomized controlled studies. The Keyes technique, many time released
local antibiotics (i.e., chlorhexidine in a gelatin chip, tetracycline
fibers, doxycycline hyclate in a polymer carrier or minocycline microspheres) and even lasers were tested scientifically and found to yield
little, if any, improvement over traditional scaling and root planning
(without surgical therapy).
Utilizing ineffective therapies to avoid traditionally effective ones
oftentimes results in progression of the disease around teeth that,
when finally referred to a periodontist, are truly hopeless and have no
other option but extraction.
However, the proper use of surgical regenerative procedures, with
a variety of grafts and membrane barriers, have shown that bone and
soft tissue that had been lost due to periodontal disease can be regenerated and questionable teeth saved. This has been well documented
over the last 30 years.
New products, i.e., tissue healing modulators, growth factors (BMP-

2) and even stem cells, are promising additions to currently proven
materials and techniques but require evidence-based research, which
in many cases is currently being performed before being recommended as replacement materials.
I feel that general practitioners and periodontal specialists should
be co-therapists in patient treatment. The decision to extract or
attempt to save a tooth should be made by the dental team, not by
one quarterback. I feel the periodontal specialist is in the best position to advise the referring dentist of the risks, options and treatment
required to save a tooth or teeth. I don’t see many patients who come
to my office or the New York University Dental Center clinic who
would rather have an implant than a healthy functioning tooth. That’s
why I advocate saving teeth, and periodontists are trained to save
teeth.
There certainly are circumstances where extraction and implant
placement is indicated and, here too, periodontists should be part of
the team involved in these decisions and procedures. Periodontists
have always been involved with soft- and hard-tissue esthetics around
teeth and implants, and certainly have the experience and expertise in
both areas. It would be best for the patient and treating team to be on
the same page when it comes to knowing the options, risks, benefits,
anticipated results and potential complications before any implant
treatment option is considered.
You concluded with the statement: “You are the dental clinician,
so it is for you, the periodontist and the patient to decide.” I couldn’t
agree more, but the decision should be based on sound evidencebased data that is currently available rather than promises or hype
from any company with minimal scientific long-term data to back up
their claims.
So again, to answer your question, “Where did all the periodontists
go?” “We’re here and available for a team approach to predictable
dentistry.”
I urge you and your readers to attend the Joint Periodontal-Restorative Dentist Conference that will be held in Chicago in April 2011
to see first hand how this collaboration can work. I also direct you
to a book I edited, “Dental Implant Complications — Etiology, Prevention and Treatment,” that will be published by Wiley-Blackwell
within the next two months (www.wiley.com/WileyCDA/WileyTitle/
productCd-0813808413.html).
The latter is a comprehensive textbook discussing potential implant
complications and how to avoid them. This should be of interest to all
dental practitioners be they general dentists or specialists. The book
emphasizes the team approach to avoiding unwanted complications
and results. If you have any questions or comments, please do not
hesitate to contact me.

Subject: RE: Where did all the periodontists go? |
Dental Tribune International
Date: Mon, 10 May 2010
From: Louis Malcmacher
To: Dr. Stuart J. Froum
CC: r.goodman@dental-tribune.com

Based on your excellent response and the many others I received
from dentists and periodontists on both sides of the “implant vs. teeth”
controversy, I feel that the article has succeeded in bringing the discussion to the forefront.
Thanks and have a great day!

Hi Dr. Froum,
Thanks for your detailed response. I agree with most of what you say.
My article was clearly just an observation, I did not make any judgments
or arguments whether the periodontists who prefer implants over natural teeth or vice versa were correct or incorrect, that was not the issue
and indeed it is up to every dental and periodontal clinician to decide
for themselves.
My objective was to get the conversation going about critically thinking through these clinical decisions, offering options to patients based
on their needs and desires, and cause the dental community to realize
that there is a change going on and to be proactive rather than reactive
to treatment decision making.

Best Regards,
Stuart J. Froum, DDS, PC
• Diplomate of the American Board of Periodontology
• Diplomate of the International Congress of Oral Implantology,
Periodontics and Implant Dentistry
• Clinical Professor and Director of Clinical Research Dept. of
Periodontology and Implant Dentistry at New York University College
of Dentistry
New York, N.Y. 10019-5404
Tel. (212) 586-4209
www.drstuartfroum.com

Louis Malcmacher DDS, MAGD

Tell us what you think!
Do you have general comments or criticism you would like to share?
Is there a particular topic you would like to see more articles about? Let
us know by e-mailing us at feedback@dental-tribune.com. If you would
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[7] =>

Dental Tribune | May 2010

All-inclusive
badge, no
‘per lecture’
fees

Pacific NW Dental Convention

Speaker list
• Dr. Pascal Magne & Michele Magne: OperatoryLaboratory Endeavor in Esthetic Adhesive
Restorations
• Dr. David Clark: Composites and Restorative
• Dr. Gerard Kugel: Esthetics, Laminate Veneers
and Whitening
• Dr. Brian Mealey: Periodontics, The Oral-Systemic
Connection
• Dr. M. Nader Sharifi: Removable Prosthodontics
• Dr. John West: Rotary Endodontics
• Dr. Brad McPhee: Implants
• Dr. James Grisdale: Soft-Tissue Grafting and
Implants
• Dr. Norman Sperber: Forensic Dentistry
• Dr. John Molinari: Infectious Disease, OHSA and
Infection Control
• Cynthia Fong: Air Polishing and Ultrasonic
Debridement

• Dr. Gregory Psaltis: Pediatric Dentistry and
Stainless Steel Crowns (with Dayna Dayton)
• Jill Taylor: Esthetic and Restorative Dental
Hygiene
• Shannon Pace: Esthetic Dental Assisting and
Temporaries
• Mary Govoni: Dental Assisting and Dental
Materials for Hygienists and Assistants
• Dr. Linda Niessen: Geriatrics and Women’s
Health
• Dr. Rhonda Savage: Communication, Front Office
and Practice Management
• Susan Gunn: QuickBooks and Embezzlement
• Katherine Eitel: Leadership and Front Office
Communication
• Debbie Castagna & Virginia Moore: Payment
Arrangements and Practice Management
• Dr. Bart Johnson: Pharmacology and Sedation
• Bob Gray: Memory Retention
• Dr. Marc Cooper: Practice Management
AD

(Photos/Bev Sparks)

It is that time again for nearly 9,000 dental professionals from
around the globe to unite in Seattle
for the 123rd annual Pacific Northwest Dental Conference (PNDC), to
be held June 17 and 18.
Brought to you by the Washington State Dental Association (WSDA)
and recognized as one of the premier
dental conferences in the country,
the PNDC offers two days of continuing education in the beautiful Pacific
Northwest.
ADA members can acquire up to
14 C.E. credits and attend any lecture they want by purchasing a full
conference badge for $265–$305 and
staff may register for $175.
While other dental meetings
throughout the nation charge per
lecture, PNDC attendees have access
to more than 50 speakers and 60 lectures at no additional cost.
The PNDC offers affordable, quality education for the entire office.
Check out some of this year’s highlighted speakers (see image).
However, for a complete listing
of speakers and course descriptions,
please visit www.wsda.org/pndcschedule.
In addition to top notch C.E., the
PNDC offers an array of other activities to keep attendees busy. With
a robust exhibit hall that features
more than 300 exhibiting companies, attendees will have the opportunity to shop the latest and greatest
in dental products as well as try their
luck at huge prize giveaway drawings throughout the conference.
To register or for more information, please visit www.wsda.org/
pndc or call (800) 448-3368.
The PNDC looks forward to seeing you in Seattle! DT

[8] =>

Fla. National Dental Convention

Dental Tribune | May 2010

Florida sends you
on a flight to success
2010 FNDC, to be held June 10-12 in Orlando, offers
three days of education, new technology — and fun!
By Fred Michmershuizen, Online Editor

The 2010 Florida National Dental
Convention (FNDC) will be held
June 10 to 12 at the Gaylord Palms
Resort and Convention Center in
Orlando. The theme of the meeting
is “Approach to Success: Piloting
Your Way to Dental Excellence.”
Organized by the Florida Dental Association, the meeting offers
three days of education not only for
dentists, but for administrative staff
and hygienists as well.
“The FNDC Committee plans
years in advance for each FNDC,
and I think we have a great slate
for 2010,” said Neil E. Torgerson,
DMD, general chair of the Committee on the Florida National Dental
Convention.
New at this years’s FNDC is a
Dental Assistant Roundtable, a
course in which dental assistants
will be introduced to new products
and techniques.
And for practitioners who have
always wanted intensive training
but haven’t been able to commit to
a weeklong residency, the FNDC
has established mini-residencies in
the most sought-after areas.
The FNDC is offering three-day
mini-residencies in implants and
endodontics. The FNDC is also
offering a two-day anatomy and
dissection course.

Educational highlights
The meeting will offer 115 continuing education courses, including 81
lectures, 25 workshops, three miniresidencies and two master series.
“This year’s meeting has everything you and your team need to
sharpen and hone your skills,”
AD

said Charles Llano, DDS, program
chairman of the meeting.
“As I planned this program, I
kept in mind the need for all us to
continue to grow and educate ourselves in order to be the best in our
profession. Getting a dental degree
is just the beginning — the learning
continues throughout our career.”
Some of the educational highlights include the following courses:
• Facial Aesthetics for the Dental
Practitioner
Friday, 8 to 10 a.m.
This course, led by Richard
Joseph, DMD, is a presentation on
concepts of facial esthetics, proportion, balance, “hallmarks of beauty”
and the terminology of aging.
Current facial cosmetic procedures for rejuvenation will be
reviewed. Special emphasis will
be given to the areas of lip and
peri-oral procedures that will be of
interest to dentists.
This will serve as an introduction to neurotoxins and dermal fillers and a primer for attending a
hands-on workshop.
The cost of this course is $60.
• Neurotoxins and Dermal Fillers
for Facial Rejuvenation
Friday 10:30 a.m. to 5 p.m.
This hands-on workshop led by
Richard Joseph, DMD, will include
a two-hour didactic lecture and
three and a half hours of hands-on
instruction in administering neurotoxins and dermal fillers.
Participants will need to have a
volunteer present for the hands-on
portion of the workshop.
The cost of this workshop is
$2,495.

(Photo/Florida Dental Association)

• Successful Implants
Thursday, Friday and Saturday
from 8:30 a.m. to 4 p.m.
This mini-residency, led by Dennis Thompson, DDS, MS, will prepare participants to implement the
use of a system that prevents bone
and tissue loss around anterior
implants.
In addition, it will allow participants to utilize a single implant to
attach to natural teeth (an implant/
tooth bridge).
The cost of this course is $1,895.

be reviewed.
The cost of this course is $1,895.

• Hi-Tech Endodontics in the 21st
Century
Thursday and Friday, 8:30 a.m.
to 4 p.m., and Saturday from 8:30 to
11:30 a.m.
In this course, led by Samuel
O. Dorn, DDS, PA, and Kenneth
J. Zucker, DDS, MS, participants
will be introduced to the usage of
many new endodontic techniques
and instruments from a variety of
manufacturers.
Participants will have exposure
to many of the most popular nickel
titanium instrument systems as well
as several different apex locators,
ultrasonic, irrigation and obturation
devices.
In addition, attendees will have
the opportunity to complete endodontic procedures on extracted
teeth, plastic blocks and anatomically accurate acrylic teeth models
using the dental operating microscope, and visualize the final results
using digital radiography.
The cost of this course is $1,895.

According to meeting organizers,
nearly 450 exhibitors will share
their knowledge and expertise, as
well as the latest and most innovative products, services and dental
technologies, in the FNDC Exhibit
Marketplace.
“Our exhibit hall is filled with
exhibitors waiting to show you all
the latest in technology and materials for your practice,” said Torgerson. “It is a one-stop shopping
experience for all that dentistry has
to offer.”
Meeting attendees are encouraged to take advantage of convention specials, learn about the latest
products and place on-site orders.
In addition to hundreds of presentations, demonstrations and
products, the FNDC exhibit hall
will also feature table clinics, C.E.
verification stations and a variety of
fun activities.
The exhibit hall hours are as follows:
• Thursday, June 10: 9 a.m. to 5:30
p.m.
• Friday, June 11: 9 a.m. to 5:30 p.m.
• Saturday, June 12: 9 a.m. to 3 p.m.

• The TEAM Approach to Implant
Dentistry
Thursday, Friday and Saturday,
8:30 a.m. to 4 p.m.
This mini-residency, led by Will
Martin, DMD, MS, and James D.
Ruskin, DMD, MD, is intended for
dentists who desire to increase their
knowledge of the restorative and
surgical phases of implant treatment for their patients.
The clinical management of the
patient from consultation, treatment planning, surgical placement
of implants in the mandible and
maxilla, peri-operative and postoperative care and complications will

Other edutcational tracks
In addition to the course highlights
mentioned above, the meeting will
also offer educational tracks for
administrative assistants and dental
hygienists.
“Whether you come for one day,
or all three, the courses are there to
help you master your profession,”
Llano said.

FNDC Exhibit Marketplace

Friday in Paradise
The FNDC will also offer plenty of
fun. A “Friday in Paradise” event
will be held in the Gaylord Palms
atrium on Friday afternoon and
evening.
There will be live music, dancing and entertainment for kids —
including stilt walkers and balloon
artists. Everyone is invited, and the
tickets are free.
More information about the
meeting is available online, at www.
floridadentalconvention.com. DT

[9] =>

[10] =>

FDI teams up with OSAP
to improve global patient
safety standards
The FDI World Dental Federation is participating in an official
review of the WHO Patient Safety
Curriculum Guide, together with the
Organization for Safety and Asepsis Procedures (OSAP), International Federation of Dental Educators
and Associations (IFDEA) and other
leading global medical profession
associations.
Patient safety is an emerging discipline, aiming to reduce harm to
patients caused by health care and
to identify opportunities for improving patient outcomes. According to
the WHO Research Priority Setting
Working Group on Patient Safety,
tens of millions of patients worldwide suffer disabling injuries or
death due to unsafe medical care
every year.
The multi-professional WHO
Patient Safety Curriculum Guide
was first published in 2009 to provide medical schools with guidelines
for teaching patient safety, and has
since been downloaded by more
than 1000 institutions in 100 countries.
In growing recognition of the
harms caused by health care, the
WHO initiated a review of the Guide
and invited the FDI World Dental
Federation to participate as a pri-

FDI Corporate Partners
Meeting in Chicago

(Photo/Mike Liu, DTI)

mary partner in the project, together
with the International Council of
Midwives and other members of the
World Health Professions Alliance
(WHPA), International Council of
Nurses, International Pharmaceutical Federation and World Medical
Association. Professors Takashi
Inoue and Nermin Yamalik, of the
FDI Education Committee, will be
contributing to the review. Details
are expected to be finalized during a
consensus meeting at the 2010 OSAP
Annual Symposium in June. FDI

The annual FDI Corporate
Partners Meeting took place at the
end of February during the 145th
Chicago Dental Society Midwinter
Meeting. FDI President Dr. Roberto Vianna opened the meeting,
welcoming and thanking FDI corporate partners for their unwavering support, particularly in view
of the economic challenges still
affecting businesses worldwide.
Joining the FDI president at the
meeting were FDI President-Elect
Dr. Orlando Monteiro da Silva;
Councillor Dr. Kathryn Kell; Executive Director Dr. David Alexander; and other full-time FDI professional staff from the finance,
communications and congress
departments.
Alexander presented a detailed
report of ongoing FDI activities
and achievements in 2009, including the introduction of a new FDI
website, preparations for the 2010
Annual World Dental Congress in
Salvador da Bahia, Brazil, future

congress venues, progress on the
Global Caries Initiative and a summary of internal process improvements across the organization.
Alexander reminded participants of the critical importance
of partnership between the FDI
World Dental Federation and the
dental industry, encouraging an
“open dialogue, which strengthens our relationship and brings
mutual benefits to both parties.”
The presentations portion of
the meeting included a financial
review by Jerome Estignard, FDI
director of finance and operations,
who summarized the 2009 yearend results and budget forecasts
for 2010 and beyond.
The annual FDI Corporate Partners Meeting is held in the first
quarter of each year, alternating
venues between the Chicago Dental Society Midwinter Meeting and
the International Dental Show in
Cologne, Germany. FDI

FDI explores preventive dentistry at 2010 AEEDC Dubai
FDI World Dental Federation introduces the Global Caries Initiative to the Gulf Region as part of a global consultation process
Representatives from the FDI
World Dental Federation, including
Dr. Roberto Vianna, FDI president,
were recently in Dubai for the 2010
UAE International Dental Conference
& Arab Dental Exhibition (AEEDC
Dubai), where they participated in
the AEEDC Conference Program, the
Gulf Cooperation Council Preventive
Dentistry Conference and the 7th
Annual Arab-Asian Scientific Dental
Alliance, introducing the FDI Global
Caries Initiative to key opinion leaders of the Gulf Region.
The Global Caries Initiative (GCI)
was first conceived during the Rio
Caries Conference in July 2009, where
conference attendees — including
leading experts in epidemiology,
cariology, dental education, preven-

tion and change management — conceded there is a need to establish a
broad alliance of key influencers and
decision-makers to effect fundamental change across health systems and
in individual behavior in order to
eradicate caries worldwide by 2020.
Departing from this objective,
the FDI World Dental Federation
embarked upon a global consultation
process to assess the potential challenges and impact of introducing a
preventive model to existing systems
for caries management.
The most recent seminar took
place at the 2010 AEEDC Conference Program: Dr. Julian Fisher, FDI
associate director of education and
g continued , ‘FDI explores …’

(Photo/Daniel Zimmermann, DTI)

[11] =>

Dental Tribune

Worldental Communiqué

11A

Members’ Corner
Dr. Michael Glick: outstanding scientist and clinician
In this interview with World Dental
Communiqué, Dr. Michael Glick discusses his work with the FDI World
Dental Federation and his views on
the role of the dental profession in
oral and general health.
In October 2009, you were appointed dean of the University at Buffalo
School of Dental Medicine. What
attracted you to this role and what
do you hope to achieve?
This position is a chance to have an
impact with respect to dental education and, consequently, the future of
dentistry: to build on the best of what
we’re doing and take it to the next
level. I am proud to be a dentist.
But, first and foremost, I see
myself as a health-care professional.
There is a small but growing trend
to enhance overall health by providing medically based point-of-care
screening in dental offices.
In fact, last year I coordinated a
seminar at the ADA Annual Session
that was a hands-on course for dentists in office-based medical screening. There is a small critical mass
developing that is eager to improve
oral health-care delivery and education is where it all begins.
You dedicate a lot of time to the
FDI World Dental Federation as
chairman of the science committee.
What motivates you to participate
in organized dentistry at the inter-

News
in Brief

national level?
Working with the FDI World Dental Federation is an opportunity to
make a difference, and I gladly give
my time to help bring about positive
change in the way the dental profession is perceived; for instance, in reevaluating how we provide care or
providing care to people who do not
have access.
The structural complexity of our
profession can be complicated, which
further emphasizes a need for unity
at the international level in order to
make any progress.
What does the FDI World Dental
Federation bring to the world of
dentistry?
The FDI is the largest dental organization in the world, bringing together representatives from many different countries as a unified, global
voice of dentistry. This gives us the
privilege and opportunity to make a
huge impact through the profession:
to act as the facilitator for change.
For example, in caries prevention,
the FDI is leading the Global Caries Initiative, a profession-led project
with the goal of significantly diminishing the prevalence of caries worldwide by 2020.
Other recent projects, such as the
Oral Health Atlas and Dental Ethics Manual, are further examples of
practical tools produced by the FDI
that dentists can use in their coun-

tries to support advocacy and awareness around oral health.
You recently attended the FDI midyear committee meetings in Geneva. What are some of the areas of
focus for the science committee in
2010?
This year, the Science Committee
wants to focus on setting a research
agenda to respond to major global
oral heath-care issues. We also want
to proactively generate collaboration between researchers in different
parts of the world and partner with
organizations working toward the
same goals, such as the International Association for Dental Research
[IADR].
As chairman, I see my role as a
facilitator: that is, does the committee
work reflect the mission and vision
of the FDI? This is a question I ask
myself when embarking on a new initiative. Another area of focus for the
committee is science and evidence
behind policy. To this effect, we are
working to design FDI scientific statements that will help underpin policy
and provide FDI members with valuable scientific resources.

tee, reflects my philosophy about
health. I am lucky to have the opportunity to have a voice in sharing these
beliefs with a larger group. But I see
many examples of how dentists make
a difference in their community at so
many levels — such as extending free
care. Every little bit makes a difference. FDI

How do your many responsibilities
relate to your personal vision in
oral health?
All of my work, whether as the dean
of a dental school, editor of JADA or
the chairman of the science commit-

Dr. Michael Glick is dean of the
University at Buffalo School of Dental Medicine in the United States. He
currently serves as chairman of the
science committee for the FDI World
Dental Federation.

2010 Congress News
Registration is open for the 2010 FDI Annual
World Dental Congress in Brazil.

The Editorial Board of Developing Dentistry,
an annual journal of public health and development published by the FDI World Dental
Federation, has announced an open call for
submissions. Visit www.fdiworldental.org for
more information.

scientific affairs, described the context of GCI in a presentation titled,
“The Global Caries Initiative: A
Profession-Led Call-to-Action,” and
Dr. Nigel Pitts of the University of
Dundee (Scotland) presented his
research related to “A New Approach
to Caries Classification, Detection
and Assessment: The Experiences of
ICDAS,” which addresses an underlying theme identified early in the
GCI consultation process; that is, the
need for the profession to establish
a common language for caries. Pitts
has been working with the FDI World
Dental Federation to explore an inter-

FDI Education and Scientific Affairs
Manager Dr. Julian Fisher
national caries classification system
within the context of GCI.
Vianna reinforced the FDI World

About the publisher
Publisher

Developing Dentistry: call for
submissions

f Continued, ‘FDI explores …’

Dr. Michael Glick

Dental Federation commitment to
oral health in an address to attendees of the Gulf Cooperation Council Preventive Dentistry Conference,
paying a special thank you to Professor Abdullah Al Shammery, dean
of Riyadh Colleges of Dentistry and
Pharmacy and an AEEDC International Scientific Advisory Board member.
Vianna said that the FDI World
Dental Federation “is delighted to
participate in this conference and
looks forward to working together
with the Gulf Cooperation Council
and FDI member associations to further prevention at the national
level.” FDI

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 without prior
consent from the editor or
publisher is inadmissible and
liable to prosecution.

[12] =>

[13] =>

Dental Tribune | May 2010

Cool Stuff for the Practice 13A

The mouth as construction site
Art 4 Your Practice offers handmade 3-D art for dentists
By Robin Goodman, Group Editor

How did this company get its start?
Cathy Howard: The owner of the
company, Mark Sanford, who is an
audiologist, was at an audiology convention and met the German people
who make this art for the hearing
world and promote it worldwide, and
he really liked the art.
They were new in promoting and
had done quite a bit in Europe, but
had no representation in the U.S. Mark
said that he wanted to promote this
for them in the U.S. because he was
already attending the major hearing
shows.
I worked for Mark full-time as his
bookkeeper, as we have five audiology offices in the Bay Area. He asked
me to help with the project because
he wanted to expand into the dentistry
art because there are so many dentists.
So that’s how we started in the dental business. He’s sent me to all these
dental events and I’ve been having a
fabulous time.
When I was in Chicago, our German
partner joined us there, and taught me
a lot of how they do things over there
to produce the art.
How long have you worked with
Mark then?
It’s been 10 years already and I still do
the bookkeeping. So this is so much
fun for me to get out of my little office
and meet with people.
How would you describe this art to a
dentist who might say, “Why would
I want 3-D art in my practice?”
It’s completely different than what
most people would call dental art,
specifically because it’s 3-D. You have
your shadowboxes, which you can
hang on a wall, or your showcase
pieces that can go on a counter or shelf
or table.
The theme of this artwork is the
mouth as a construction site, which is
why there is scaffolding, men working and the plans or blueprints of the
worksite. Thus, it’s akin to the dentist being the construction worker on
someone’s teeth.
What I think makes it most unique
is that it takes the dental business,
which can be rather scary for some
people, and makes it more consumer
friendly, fun and light.
They’re very well made and there
is a considerable amount of detail in
each one, which draws people to the
piece and makes it easy to spend a lot
of time looking at just one piece. General dentists and specialists buy them
for their offices and homes, and dental
labs buy them as well.
They are also a memorable gift and
they can be personalized to a certain
degree. For example, we can make
these into business card holders and
add a brass plate with the dentist’s
name. DT

Cathy Howard at her Art 4 Your Practice Booth during the CDA spring meeting in Anaheim, Calif. (Photos/Robin Goodman)
AD

[14] =>

14A Seen & Heard: CDA Meeting

Dr. Michael Mulvehill (from left), Dr. Suzanne Coulver,
Dental Assistant Vicki Boyd and RDA Kayla Noriega
drove down from Arcadia, Calif., to attend the CDA
meeting in Anaheim, Cali., for just one day.

Dental Tribune | May 2010

Terry Aldredge of Henry Schein Dental and Lynda Stallworth, RDH, of Los Angeles stopped for a chat on the
exhibit hall floor.

Anthony ‘Rick’ Cardoza, DDS, and
Joyce Galligan, RN, DDS, pause for
a candid photo during the midday
break for their lecture on ‘Emergency Prepardness: The Role of Dental
Professionals.’

AD

The men in blue (that would be the
U.S. Navy’s blue) are (from left):
John Safar of Las Vegas, Stephen
Chartier of Las Vegas and Patrick
Parson of Alexandria, Va.

Bryant Irawan is still a student, but
aspires to be a dentist like his father
and attended the meeting with him
(OK, I confess, it was the iPad that
caught my attention!).

Photos & Captions/
Robin Goodman)

[15] =>

Industry 15A

Dental Tribune | May 2010

Plak Smacker: new
ultrafine toothbrush

(Photo/Plak Smacker)

Plak Smacker announces the
release of its new adult brush, the
Ultrafine Toothbrush.
Perfect for patients with receding gum lines and sensitive surfaces, the Ultrafine’s tapered
extra-soft bristles provide up to
three months of gentle brushing without compromising plaque
removal.
The rubber grip handle offers
comfortable support and reduces
slippage during use.
Available in four colors, the
Ultrafine Toothbrush is sure to be
a favorite among patients.
For more than 20 years, Plak
Smacker has been focused on
introducing new, innovative
products to help patients feel
good about a trip to the dental
office.
For more information or to
place an order, please call (800)
558-6684 or visit www.plak
smacker.com. DT

Velopex’s air abrasion
unit
There are many uses of the Velopex Aquacut Quattro Fluid Air Abrasion Unit.
Cutting enamel, composite, dentine
• fissure cleaning and sealing
• composite repair
• cavity preparation
• white spot removal
• pre-bonding conditioning
of enamel
Stain removal
• fissure cleaning and sealing
• stain removal
• caries removal
Cleaning and polishing
• fissure cleaning and sealing
• caries removal
Etching
• etching
• porcelain repair
• metal bonding
• treating lab work
• pre-bonding conditioning of
enamel
• wash and dry
The Aquacut Quattro will give

The
Aquacut
Quattro
and stand.
(Photo/
Velopex)

you greater control and flexibility
than any other piece of equipment
you own. Some of its other benefits
include:
• no vibration, turbine noise,
heat generation or smell,
• greatly reduced need for local
anesthesia,
• a handpiece that creates a
fluid curtain around the powder
medium,
• a triple-action foot control that
speeds treatment by allowing cut,
wash and dry operations through
the same handpiece,
• no chipping or stress fracturing,
• minimal loss of sound tooth
material. DT

[16] =>

[17] =>

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

May 2010

www.dental-tribune.com

Vol. 3, No. 6

Esthetic rehabilitation

Using provisional restorations to improve results in complex restorative cases
By Christopher C.K. Ho, BDS. Hons., Grad.
Dip. Clin. Dent., M. Clin. Dent.

The esthetic rehabilitation of
patients with a functionally compromised dentition frequently involves a
multidisciplinary approach incorporating several different treatment modalities.
A correct esthetic and functional
diagnosis with an appropriate treatment plan as well as careful material
selection and application are critical
factors in the successful restoration.
The following case presentation
demonstrates a multi-disciplinary
approach to re-create an esthetic smile
in a female patient with a functionally
and esthetically compromised dentition.
Patients requiring prosthodontic
rehabilitation often have multiple concerns (esthetic, functional and health)
and have left rehabilitation for some
time due to fear, cost and time constraints. It is the goal of treatment
to provide an esthetic and functional
dentition with minimal maintenance
over the long term.

Treatment planning & procedures
The primary objective was to re-create an esthetic smile and to establish
a functional occlusion. This would
involve orthodontic, periodontal and
restorative modalities.
Periodontal treatment. The patient
underwent a preliminary treatment
plan that included professional oral
hygiene and reinforcement of oral
hygiene practices.
Orthodontic treatment. In order to
correct the tipped and drifted mandibular teeth that were a consequence
of missing teeth.
Diagnostic wax-up. This allows the
team to preview the desired esthetic
appearance. The diagnostic wax-up
provides guidelines of the desired
treatment and a blueprint for the final
restorations. This wax-up also allows
the manufacture of putty keys for provisionalization and reduction guides
for the preparation process.
Gingival recontouring. A 940 nm
diode laser (Biolase EZlase) was utilized to improve soft-tissue esthetics.
Periodontal bone sounding was performed to ensure that biologic width
was not invaded and then gingival
tissues were lased to improve the gingival contour, symmetry and gingival
zeniths.
Preparation. For all-ceramic crowns
it is recommended that an axial reduc-

tion of 0.8 mm to 1 mm and an occlusal
reduction of 2 mm be made as these
materials need a certain thickness to
withstand masticatory and parafunctional stresses.
Finish lines are recommended to
be chamfers or 90-degree rounded
shoulders to provide sufficient bulk
at the margins and allow the transference of stresses adequately around the
margins.
To minimize stress concentration
within the restoration, all line angles
should be rounded, all sharp edges
smoothed, and boxes and grooves and
“butt’” type shoulders are contra-indicated.
Impression procedure. The use of a
double zero retraction cord (Ultrapack
#00, Ultradent) was placed into the
gingival sulcus as a first cord and then
a retraction paste, Expasyl (Kerr), was
then placed over the first cord.
The correct use of this retraction
paste should see blanching of the gingival tissues as the paste is extruded
into the gingival sulcus. An impression
was made with a polyvinyl siloxane
material (3M Imprint 3).
Maxillo-mandibular relations. The
Kois Dento-Facial Analyzer System
registers and transfers the patient’s
occlusal plane as well as tilts in the
occlusal plane in three planes of space
to the articulator related to an average 100 mm axis-incisal distance. This
allows orientation for esthetic positioning of the anterior teeth in relation to
the midline of the face and ensures
correct orientation of the incisal plane.
Provisionalization. The provisional
restorations are duplicated from the
diagnostic wax-up that incorporates
the proposed changes. It allows the
patient a “test run” of the final result
by allowing her to see a preview of the
planned result. This is an essential step
in the planning process.
The aims of provisionalization are
as follows.
Health: pulpal protection and periodontal health and gingival stability.
Function: the provisional restorations can be used to assess and alert
if there are any occlusal and phonetic
problems with the proposed changes. The pronouncing of “V” and “F”
sounds should create a light contact
between the central incisor and the
“wet-dry” line of the lower lip.
Esthetics: the provisional restorations can be used to assess the basic
shade to be chosen, incisal edge disg CT page 2C

Fig. 1: Smile photograph showing asymmetry in smile, maxillary cant, slanted midline, negative buccal corridor and poor axial inclinations.

Fig. 2: Retracted frontal photograph.
AD

[18] =>

2C Clinical

Cosmetic Tribune | May 2010
f CT page 1C

Fig. 3: Orthodontic treatment to upright tipped teeth and correct occlusal
plane.

Fig. 4: Gingival recontouring completed.

Fig. 5: Crowns sectioned to allow insertion of Christensen crown remover for
removal.

play, form and shape of teeth, dental
midline location, lip support, parallelism of incisal plane to inter-pupillary
line as well as the curvature of lower
lip.
Evaluation of esthetics provided by
the provisionals at this stage is crucial
in guiding the patient to the amount of
display necessary for an esthetic smile.
The provisional crowns were constructed with Protemp 4 (3M-ESPE), a
bis-acryl resin composite. All contours
were kept curvaceous and smooth with
space made available for the patient to
use interdental cleaning aids due to
the provisionals being totally splinted
together.
The patient is given instructions on
oral hygiene during the provisional
phase and is asked to return in two to
three days time for final approval.
I recommend this delayed approach
of assessing the provisionals as the
patient is not pressured into deciding if
she likes the provisionals on the day of
preparation. The patient is often anesthetized with associated facial palsy
and cannot adequately assess esthetics
at this time.
Patients will also often ask friends
and family about the proposed changes
and the extra time allows the patients
to accustom themselves to the new
“look.”
If the provisional restoration
requires modifications, the provisionals can be adjusted and an impression
then made for communication to the
ceramist of the additional changes.
Cementation. The crowns are
received back from the laboratory and
tried in the mouth. I prefer not to
use local anesthetic for the patient
to approve the final esthetics before
cementation.
However, if local anesthesia is
required, an alternative technique
is to use the AMSA local anesthetic
block technique so that the injection
achieves pulpal anesthesia of the central incisors through the second premolar without collateral numbness of
the face and facial muscles of expression.
This is best achieved with a computer-controlled injection system —
such as the Wand (Milestone Scientific) that delivers a virtually painless
palatal injection.
Once the patient is happy and
approves the final esthetics, the restorations are prepared for cementation.
The patient returned to the office one
week later to allow a final examination of the esthetics, phonetics and
occlusion.

COSMETIC TRIBUNE
The World’s Dental Newspaper · US Edition

Publisher & Chairman
Torsten Oemus
t.oemus@dental-tribune.com
Vice President Global Sales
Peter Witteczek
p.witteczek@dental-tribune.com
Chief Operating Officer
Eric Seid
e.seid@dental-tribune.com
Group Editor & Designer
Robin Goodman
r.goodman@dental-tribune.com
Editor in Chief Cosmetic Tribune
Dr. Lorin Berland
d.berland@dental-tribune.com
Managing Editor/Designer
Implant & Endo Tribune
Sierra Rendon
s.rendon@dental-tribune.com
Managing Editor/Designer
Ortho Tribune & Show Dailies
Kristine Colker
k.colker@dental-tribune.com
Online Editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.com
Product & Account Manager
Mark Eisen
m.eisen@dental-tribune.com
Marketing Manager
Anna Wlodarczyk
a.wlodarczyk@dental-tribune.com
Sales & Marketing Assistant
Lorrie Young
l.young@dental-tribune.com
C.E. Manager
Julia E. Wehkamp
j.wehkamp@dental-tribune.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
© 2010 Dental Tribune America, LLC
All rights reserved.
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@dental-tribune.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.

Conclusion
The esthetic rehabilitation of a patient
with a functionally compromised
dentition frequently involves a multidisciplinary approach. The proper
sequence and planning involving
periodontal, orthodontic, esthetic and
restorative treatment is required with
communication between the whole
team, from the patient and ceramist to
the treating clinicians.
The use of provisionalization is a
significant factor in achieving a successful esthetic outcome for both the
Fig. 6: Use of Expasyl for hemastasis and retraction.

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@
dental-tribune.com. We look forward to
hearing from you!

[19] =>

Cosmetic Tribune | May 2010

Clinical

3C

Fig. 8 (at left): Patient has returned
after two to three days for review
of provisionals to ensure approval
of change in shape, color and other
desired changes before final crowns
are made.

Fig. 9: Palatal view of all-ceramic
crowns.
Fig. 7: Use of Kois Dentofacial Analyzer to align midline and
incisal plane.
AD

Fig. 10: Frontal view of completed
all-ceramic crowns.
patient and dental team. Provisionalization allows patients to preview their
future teeth, enabling them to assess
the esthetic and functional changes.
Invaluable information can be
learned in regards to esthetic factors
including incisal display, bucco-lingual position of teeth, smile line, shade,
and in addition, functional criteria can
be assessed with phonetic and occlusal
changes. CT

About the author

Dr. Christopher C.K. Ho lectures on esthetic and implant
dentistry in Australia and other
countries.
He teaches at several universities within Australia and the
United Kingdom, and is a faculty
member for the Global Institute
for Dental Education.
Ho has a referral-based private practice in prosthodontic
and implant dentistry in Sydney,
Australia.

[20] =>

[21] =>

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

May 2010

www.dental-tribune.com

Vol. 3, No. 5

The many sides of xylitol
What is xylitol? How does it work?
How long has it been around? How
does it benefit me? Where do I find it?
How much do I need? Are there any
disadvantages?
These are some of the questions
I am asked by my patients, friends
and even cashiers when I mention
xylitol. I’ve educated many a convenience store worker in my quest for
a particular gum or mint I know to
contain xylitol. This one ingredient
has enhanced my life as well as the
lives of many others.
Xylitol was once only found in
health food stores, however, it has
become much more mainstream
and is now readily available at retail
outlets. This availability makes it
much easier for patients to incorporate it into their daily schedule,
and as a result, reap the multi-sided
benefits.

What is Xylitol?
Xylitol, a naturally occurring sugar
substitute, is clinically proven to be
a natural enemy of bacteria. Xylitol
is often referred to as wood or birch
sugar because it was typically man-

ufactured from birch trees. However, today xylitol is mainly extracted
from corncobs. This is more practical considering the vast amount of
xylitol that is being produced and
consumed. Other natural sources of
xylitol include plums, strawberries
and raspberries.
Pure xylitol looks like sugar
because it has a white crystaline
appearance and it even tastes like
sugar. However, it has 40 percent
less calories than sugar. Only onethird of the absorbed xylitol gets
metabolized in the body.

(Photo/Karens4, Dreamstime.com)

By Sandra Berger, RDH, BS

How does it work?
Over 400 strains of bacteria inhabit
the human mouth. Sugar is one of
the major energy sources for these
bacteria and helps them proliferate.
When these sugars are consumed, acid is produced, creating a
highly acidic enviroment in the oral
cavity that demineralizes enamel
and makes it vulnerable to attack
by bacteria, leading to tooth decay.
Because xylitol is a five-carbon
polyol, it is not metabolized by
mouth bacteria, and as a result, no
acids are produced in the mouth
that can cause tooth decay.

The sweetness also stimulates
saliva flow, which neutralizes any
acids that have been formed and
rinses away excess sugar residue.
Xylitol helps keep an alkaline enviroment in the oral cavity that is
inhospitable for mouth bacteria.
Thus, xylitol is both non-cariogenic in that it does not contribute
to caries formation, and it is cariostatic because it prevents or reduces the incidence of new caries.

Xylitol actually reduces the
amount of plaque and the number of Mutans streptococci (MS) in
plaque.

How long has it been around?
German chemist Emil Fisher and
French chemist M.G. Bertrand first
discovered xylitol in the late 1800s.
The first attempt at producing xylig HT page 3D

Jessica Simpson says she only brushes
three times a week (really!)
By Fred Michmershuizen, Online Editor

Some might call this “TMI” or
“too much information,” but Jessica
Simpson recently told Ellen DeGeneres that she only brushes her teeth
three times a week because she
doesn’t like her teeth to feel “slippery.” Simpson made her dental
hygiene confession recently on
DeGeneres’ television show.
Most dental professionals would
assume that the blond bombshell,
who some would say has a million
dollar smile, would take better care
of her pearly whites.
Apparently, Simpson — who
once wondered aloud on a television show whether a can of Chicken
of the Sea tuna was tuna or chicken — falsely assumes that flossing
every day, using mouthwash and
occasionally wiping her teeth with
a shirt are acceptable alternatives
to brushing.
But a representative from the

not-for-profit Delta Dental Plans
Association, based in Oak Brook,
Ill., says Simpson is in danger of
losing her smile, and that any children who may be looking to her as
a role model could be in for some
pain if they choose to follow her illconceived oral hygiene practices.
“While flossing and using mouthwash are certainly good oral health
practices, doing these things while
neglecting daily brushing is like
running around in the shower and
calling yourself clean. Sure, you feel
pretty good afterward, but chances
are you missed some crucial spots,”
said Chris Pyle, director of public
relations for the Delta Dental Plans
Association, a provider of dental
insurance.
And that “slippery” feeling is
actually a good thing, Pyle said.
According to Pyle, there’s a name
for that coating Simpson said she
needs to give her lips traction, and
it’s called plaque — a naturally

occurring coating of bacteria.
Flossing and mouthwash alone
are not sufficient to remove all of
the plaque that’s hiding on teeth,
according to Pyle.
What’s worse, he said, Simpson’s hygienic transgression is not
a victimless crime. Prospective love
interests should know that harmful
bacteria are transmissible through
kissing.
“Sure, at the end of the day, a
person thinking about kissing Jessica will need to weigh the risks
with the reward. In this case, it still
might be worth the risk but, come
on, Jessica, brush twice a day and
the possibilities are endless,” Pyle
said.
Delta Dental is a national network of independent dental service
corporations specializing in providing dental benefits programs to
more than 54 million Americans in
more than 93,000 employee groups
throughout the country.

Jessica Simpson needs to take better
care of her teeth, according to dental
professionals. (Photo/Wallpaperez.
info)
Delta Dental recommends that
people brush their teeth at least
twice a day with a fluoride toothpaste, floss every day and make
annual visits to the dentist. HT

[22] =>

Editor’s Letter

Hygiene Tribune | May 2010

Dear Reader,
The dental profession in the United States is becoming more aware
of the benefits of xylitol. At this
point, dental publications, live educational courses and online courses
are buzzing with the good news
about xylitol, the amazing five carbon natural sugar.
While dental professionals around
the globe have been endorsing xylitol for many years, the United States
has been slow to hop on the bandwagon. One of the reasons for this
lag is the United States needed the
right xylitol products to be available,
and usage directions to be more
clearly defined.
Now the products are here and
the usage is simple: Use pure xylitol-sweetened oral care products in
place of ordinary toothpaste, mouth
rinse, chewing gum, mints and candies. Following such a plan will
ensure the recommended five exposures of xylitol daily are reached and
increased oral health will result.
Dental hygienists are enthusiastically embracing the role xylitol
can play in achieving dental health,
but hygienists are not receiving the

complete picture. The missing piece
is where to find quality xylitol products.
As a profession, we send our
patients to general supermarkets or
drugstores to purchase recommended products, and for the most part
patients are successful in locating
products we have suggested. This is
not true with xylitol.
While there are products containing xylitol sold at major retailers,
they typically are not 100 percent
sweetened with xylitol. This is an
important detail to be aware of.
Products where xylitol is not listed as the first ingredient are not as
effective as those listing xylitol first.
This can mislead patients into thinking they are getting the benefits of
xylitol by using the product when,
in all actuality, they are not getting
enough xylitol. So where can we
send our patients to purchase highcontent xylitol products?
The answer is: To health food
stores! These stores carry 100 percent xylitol sweetened products.
They even carry bulk xylitol, which
can be used to replace sugar in

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

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

the diet. While the dental profession is just beginning to turn its
head toward xylitol, the health food
industry is very aware of the benefits of xylitol and has been for a
long time.
There are also companies producing high-content xylitol products
that market to the dental industry.
Dental offices can order products
direct from the companies and have
them on hand to give or resell to
patients.
Xlear, a company based in Orem,
Utah, offers direct ordering, but it
has also recognized the disconnect
between the dental and health food
industries. To help mend this situation, Xlear has implemented the
“Bridging the Gap” initiative.
This program has been designed
to connect dental offices and their
patients with local health food
stores. These connections are being
made by a team of hygienist’s hired
by the company to operate as product educators.
Product educators visit dental offices on behalf of each store.
These representatives drop off samples of xylitol products, offer education and inform the office of the
nearest store offering 100 percent
xylitol sweetened products. On the
other side, each store knows which
offices have been connected with
their store and “Bridging the Gap”
has been put into motion.
This is networking at its best!
Hygienists are taking their career in
a new direction, knowledge is being
shared, referrals are going back
and forth between dental offices
and health food stores, more xylitol
products are being purchased and
used, and the bottom line is people
are getting healthier. Isn’t this what
our profession is all about?
If you would like more information regarding how to get your office
involved in “Bridging the Gap,” contact Xlear National Sales Manager
Chad Thomas at chad@xlear.com.
In addition, as you’ve likely already
noticed, this month’s article focuses
on the many sides of xylitol. HT .
Best Regards,

Angie Stone, RDH, BS

Managing Editor/Designer
Implant Tribunes & Endo Tribune
Sierra Rendon
s.rendon@dental-tribune.com
Managing Editor/Designer
Ortho Tribune & Show Dailies
Kristine Colker
k.colker@dental-tribune.com
Online Editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.
com
Product & Account Manager
Mark Eisen
m.eisen@dental-tribune.com
Marketing Manager
Anna Wlodarczyk
a.wlodarczyk@dental-tribune.com
Sales & Marketing Assistant
Lorrie Young
l.young@dental-tribune.com
C.E. Manager
Julia E. Wehkamp
j.wehkamp@dental-tribune.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
© 2010 Dental Tribune America, LLC
All rights reserved.
Hygiene Tribune strives to maintain
utmost accuracy in its news and clinical
reports. If you find a factual error or
content that requires clarification, please
contact Group Editor Robin Goodman at
r.goodman@dental-tribune.com.
Hygiene Tribune cannot assume
responsibility for the validity of product
claims or for typographical errors.
The publisher also does not assume
responsibility for product names or
statements made by advertisers. Opinions
expressed by authors are their own and
may not reflect those of Dental Tribune
America.

Tell us what you think!
Do you have general comments or criticism you would like to share? Is there
a particular topic you would like to see
articles about in Hygiene Tribune? Let
us know by e-mailing feedback@dentaltribune.com. We look forward to hearing
from you!
If you would like to make any change
to your subscription (name, address or
to opt out) please send us an e-mail
at database@dental-tribune.com and be
sure to include which publication you are
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to process.

[23] =>

Clinical

Hygiene Tribune | May 2010
f HT page 1D
tol was a mixture with a syrup-like
consistency.
Xylitol was not manufactured
in a crystalline form until World
War II, when war-associated sugar
shortages created the need to find
alternative sweeteners.
Early on, xylitol was primarily used in diabetic diets and infusion therapy for burn and shock
patients as well as for postoperative patients in Europe and Asia. It
was when further study into xylitol’s biological properties, including dental, that large-scale production was needed.
Industrialized xylitol manufacturing began in Finland in the
early 1970s in the form of gum
and mints. It quickly became a
daily part of Finnish life. Over the
next 35 years, global awareness
of the significant advantages xylitol offers continues, as does the
variety of items that contain the
substance.

How much do I need?
It was previously thought that the
benefits of xylitol were dose related, not frequency related. However, researchers from the University
of Washington did a series of studies in order to potentially substantiate these responses on Mutans
streptococci’s prevalence and possible reductions with xylitol.
In one study, the efficacious dosage of xylitol was researched and
the researchers concluded that MS
levels were reduced with increasing doses of xylitol. The effect leveled off between 6.88 grams and
10.32 grams per day.1
In the second study, the participants consumed 10.32 grams per
day (the higher leveling off amount
from the previous study) of xylitol
divided into two, three or four

administrations perday.
After five weeks of use, there was
no significant difference in MS levels in either plaque or unstimulated
saliva in groups consuming xylitol
two times per day.
However, significant differences
were seen in the groups consuming
10.32 grams xylitol over three and
four administrations per day. These
results confirmed previous suggestions regarding xylitol dosage and
frequency of consumption.
A dose range of 6 to 10 grams
divided into at least three consumption periods per day is necessary for
xylitol to be effective with chewing
gum as the delivery system.2
Thus, the frequency is as important as the amount of xylitol used.

‘The frequency of application
is as important as
the amount of xylitol used.’
tioned that it may be dangerous if
consumed by pets, such as dogs
and cats.

Many products in local grocery
stores contain xylitol. The easiest to
find are gum and candy, but check
the ingredients. Just because one
flavor or type contains xylitol does
not mean that all types of gum from
that manufacturer will contain it.
Health food stores will carry a
larger selection of products, such
as mouthwash, toothpaste, mints,
individual packets to use in coffee/
tea, bulk packaging to use in cooking, nasal sprays and neti pots.
Search the Internet for brands
and then ask your local pharmacy,
grocery or health food store to stock
the product. Many items may also
be ordered directly from the manufacturer.

Are there any disadvantages?

References

Xylitol was approved by the U.S.
Food and Drug Administration
(FDA) in 1963, and it has no known
toxic levels or serious known side
effects for humans; up to 40 grams
per day have been noted with little
more than a mild laxative effect.
Nonetheless, it should be men-

About the author

Conclusion
Prof. Jason Tanzer summed things
up best:
“Xylitol is inhibitory to the
metabolism, growth and plaque
formation by Mutans streptococci
... xylitol is conducive to remineralization of initial carious lesions ... I
have full confidence that these data
distinguish xylitol from any other
sugar substitute.”3
Xylitol is a low-glycemic sweetener and is metabolized independently of insulin. Xylitol does not
cause the sharp increase in blood
sugar levels or the associated
serum insulin response, which is
usually seen following consumption
of other carbohydrates.
Because of this and the dental
and medical benefits it provides,
xylitol can be recommended as a
sugar-free sweetener suitable for
diabetics as well as for the general
population seeking a healthier lifestyle. HT

Where do I find it?

1. Milgrom P, Ly K, Roberts M,
Rothen M and Mueller G. Mutans
streptococci dose response to
xylitol chewing gum. J Dent Res
2006;85:177–81.
2. Ly K, Milgrom P, Roberts M,
Yamaguchi D, Rothen M and
Mueller G. Linear response of

Sandra Berger graduated
from Ohio State with her RDH
and a BS in education. She is the
New Jersey clinical specialist for
Oral DNA Labs, a salivary diagnostic company.
Berger is currently vice president and C.E. chair of NJDHA.
She is a recipient of the Sunstar
RDH Award of Distinction 2007,
member of AmyRDH Listers and
Career Fusion Alumni 2009 and
2010.
Mutans streptococci to increasing frequency of xylitol chewing gum use: a randomized controlled trial. BMC Oral Health
2006, 6:6.
3. Prof. Jason Tanzer, Head of Connecticut School of Dental Medicine, “What experts say,” www.
xylitolinfo.com, 21 April, 2009.
AD

Visit us at the FNDC Booth #734

[24] =>

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