DT U.S. 1510

ADA Foundation funds initiatives to help prevent early childhood tooth decay (entry) / Platelet-rich plasma helps after extractions / ADA Foundation funds initiatives to help prevent early childhood tooth decay / Denmark esthetic congress / Employee vs. independent contractor: What’s the difference? / Outsourcing human resources / How plaque biofilm can be managed / Vegas for the non-gambler / CBCT technology: Informed dentists make informed decisions / Research study confirms microbial contamination / Research study confirms microbial contamination

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

June 2010

www.dental-tribune.com

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

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

Employee vs. contractor

The IRS uses 20 factors to determine the nature of a work relationship.
u page 5A

Vol. 5, No. 15

HYGIENE TRIBUNE

ENDO TRIBUNE
Endodontists and implants

Role of specialist critical in considering whether
u page 1B
tooth can be saved.

Bleaching overview

This “gateway” procedure is an easy way to increase office productions.
upage 1C

ADA Foundation funds initiatives to
help prevent early childhood tooth decay
Infants and children from 10
U.S. communities will benefit from
grants awarded this year by the ADA
Foundation’s Samuel Harris Fund to
help prevent early childhood caries
(ECC), which affects more than 25
percent of U.S. infants and children
aged 1 to 6 years.
Sometimes referred to as “baby
bottle” tooth decay, early childhood
caries is a rampant form of acute
decay made worse in infants and
toddlers by prolonged contact with
almost any liquid other than water.
This can happen by putting an
infant to bed with a bottle of formula, milk, juice or any beverage

containing sugar, or allowing them
to suck on a bottle or breastfeed
for longer than a single mealtime,
either when awake or asleep.
Left untreated, this decay can
cause pain and impact a child’s ability to chew and speak properly.
This year’s Harris Fund winners
designed programs that focus on
preventing ECC, including an educational component for pregnant
and parenting mothers and caregivers.
The following organizations
received grants, sharing $50,000:
• Colorado Area Health Education
Center of Aurora, Colo.

Dental museum devotes
day to animal teeth
By Fred Michmershuizen, Online Editor

The National Museum of Dentistry, located in Baltimore, plans to
hold a special event — called “Jaws
and Paws” — dedicated to teaching members of the general public
about animal teeth.
The family festival will be held
Saturday, June 26, from 10 a.m. to
4 p.m. The purpose of the event,
according to museum officials, is to
better educate people about their
own teeth.
“The variety of teeth in the ani-

mal kingdom shows us how different animals use their teeth for
different jobs,” said National Museum of Dentistry Executive Director
Jonathan Landers. “It also teaches
us how important it is to preserve
our own teeth.”
According to the museum, just as
human teeth adapted through time
to tear off a chunk of food and chew
it, the teeth of elephants, beavers,
snakes and lions evolved to perform
specialized tasks.

• La Clinica de La Raza of Oakland, Calif.
• Primary Health Care of Urbandale, Iowa.
• St. Vincent Healthcare Foundation of Billings, Mont.
• Youth & Family Services of
Rapid City, S.D.
• Children’s Dental Services of
Minneapolis.
g DT page 3A, ADA

(Photo/Sonyae, Dreamstime.com)

The ADHA 87th annual session
This year's meeting is brimming
with excellent
educational and
networking opportunities. We've got
the down low on
free things to do
in the city if you're
not a gambler.
g See page 14A

AD

g DT page 3A, Museum

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[2] =>

News Briefs

Dental Tribune | June 2010

Platelet-rich plasma
helps after extractions
The use of platelet-rich plasma (PRP)
following tooth removal appears to
speed healing and bone formation,
according to a recent article in the
Journal of Oral Implantology, the
official publication of the American
Academy of Implant Dentistry and the
American Academy of Implant Prosthodontics.
When a tooth is removed, poor
healing can lead to excessive bone loss
in the jaw that can delay tooth replacement, require costly reconstructive
surgery or even be impossible to fix,
according to the article, “Platelet Rich
Plasma to Facilitate Wound Healing
Following Tooth Extraction” (available at www2.allenpress.com/pdf/
ORIM36.1FNL.pdf).
“Patients and clinicians could benefit if a cost-effective, simple technique were available that decreased
bone-healing time and increased the
predictability of favorable results,” the
article states.
For the study, radiography techniques were used with patients to
detect bone changes after surgery to
remove molars — specifically, the
bilateral mandibular third molar.
For each patient, one extraction site
was treated with PRP and the site on
the other side of the mouth was not,
serving as the control. Three patients
received PRP on the right side and
three on the left.
The patients returned after the
operation for evaluations. Observers checked visually to evaluate tissue opening, bleeding, inflammation,
facial edema and pain. The early radiographs found a significant increase in
bone density in the PRP-treated sites.
“The PRP treatment had a positive
effect on bone density immediately
following tooth extraction,” the article
states.
Patients did not report significant
differences in their perception of pain,
bleeding, numbness, facial edema or
AD

temperature between the different
sites, according to the study.
Faster bone formation could benefit
patients who need immediate prostheses or dental implants, according to
the article, because the current fourto six-month wait for these could be
reduced to two to four months if PRP
is used.
Overall, the article states, PRP
increases the rate of bone formation
and decreases the healing time during the initial two weeks after surgery,
helping patients return to “full function” sooner.
(Source: American Academy of
Implant Dentistry)

Many with facial paralysis
are socially adjusted
A recent study reported in The Cleft
Palate–Craniofacial Journal, the publication of the American Cleft Palate–
Craniofacial Association, quantitatively
examined social competence, anxiety
and depression associated with Moebius syndrome, a rare congenital condition causing facial paralysis.
The condition can rob people of
the ability to smile, frown or even
raise an eyebrow. However, contrary
to previous studies, it does not appear
to increase anxiety and depression or
lower a person’s satisfaction with life.
Thirty-seven adults with Moebius
syndrome and an equal number of
subjects in a gender-matched control
group participated in the study, which
is described in the article “Living
With Moebius Syndrome: Adjustment,
Social Competence, and Satisfaction
With Life” (available at www2.allenpress.com/pdf/cpcj47.2FNL.pdf).
Moebius syndrome is a nonprogressive disease that occurs early in
prenatal life. It is typically charac-

terized by complete bilateral facial
paralysis, but also can include limb
or hand malformations and hypoglossia — weakness or malformation of
the tongue. Speech difficulties, which
can be mostly resolved with therapy,
are also frequently part of this condition. The cause of Moebius syndrome
is unknown.
“Many people with the condition
live professionally and personally successful lives,” the article states.
(Source: American Cleft Palate–
Craniofacial Association )

H1N1 epidemic offers lesson
for dentists
The H1N1 flu epidemic has lessons to
offer health-care providers, even dentists, according to a recent editorial in
Anesthesia Progress, the official publication of the American Dental Society
of Anesthesiology.
The limited amount of vaccine
available initially left pregnant women,
small children with medical conditions
and other high-risk populations waiting in long lines.
The problems encountered in
reaching certain segments of the population apply to the provision of dental care as well as other disciplines,
according to the article by Joel M.
Weaver, DDS, PhD, titled “What Can
We Learn From the H1N1 Flu Epidemic?” (available online at www2.
allenpress.com/pdf/anpr57.1fnl.pdf).
Weaver says special-needs populations are too often overlooked by dentists because of a lack of experience in
managing these patients in the dental
office.
“The addition of a highly skilled
mobile ambulatory general anesthesia
practitioner can transform a dentist’s
office into a fully monitored mini-operating room,” Weaver says.
This would allow dentists to provide
safe, high-quality care to people who
cannot otherwise cooperate with treatment, he says.
Weaver also notes positive changes in the health-care community and
beyond because of the H1N1 flu epidemic. Much as the impact of the HIV/
AIDS virus spawned the wearing of
gloves and other protective equipment
by dental professionals, this epidemic
is also bringing about transformations.
These include a better awareness of
hygiene and improved measures, such
as hand washing, that will decrease
the spread of illness. DT
(Source: American Dental Society of
Anesthesiology)
~ Text compiled by Fred Michmershuizen, Online Editor

DENTAL TRIBUNE
The World’s Dental Newspaper · US Edition

Publisher & Chairman
Torsten Oemus
t.oemus@dental-tribune.com
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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 Dental Tribune
Dr. David L. Hoexter
d.hoexter@dental-tribune.com
Managing Editor/Designer
Implant Tribune & Endo Tribune
Sierra Rendon
s.rendon@dental-tribune.com
Managing Editor/Designer
Ortho Tribune & Show Dailies
Kristine Colker
k.colker@dental-tribune.com
Online Editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.com
Account Manager
Mark Eisen
m.eisen@dental-tribune.com
Marketing Manager
Anna Wlodarczyk
a.wlodarczyk@dental-tribune.com
Sales & Marketing Assistant
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l.young@dental-tribune.com
C.E. Manager
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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] =>

News

Dental Tribune | June 2010
f DT page 1A, Musuem
For example, elephants use their
tusks — incisors that can weigh
up to 150 pounds — as weapons.
Beavers use their teeth to cut down
trees to make lodges. The fangs of
some snakes inject poison into their
victims. Lions use their teeth to
transport their young, defend themselves, and catch and tear apart
food.
The special event will feature
experts from the Maryland Zoo.
Visitors will be able to see a prehis(at left) A prehistoric shark’s tooth,
foreground, is part of ‘Jaws and
Paws’ at the National Museum of
Dentistry. (Photo/National Museum
of Dentistry)

toric shark’s tooth as big as a baseball glove, and they can explore a
special exhibit on the narwhal, an
Arctic whale with a six-foot-long
tooth.
Also on view at the museum are
George Washington’s teeth, vintage
toothpaste commercials and handson exhibitions about the power of a
healthy smile.
The museum is located at 31
South Greene St., a short walk from
the Inner Harbor. Admission is $7
for adults, $5 for seniors and students with ID, $3 for children ages 3
to 19; and free for ages 2 and younger. The museum is closed Mondays,
Tuesdays and major holidays.
More information is available at
(410) 706-0600 or online, at www.
smile-experience.org. DT
AD

f DT page 1A, ADA
• Community Health & Emergency Services of Carbondale, Ill.
• Dental Aid of Louisville, Colo.
• Geisinger Health System Foundation of Daville, Pa.
• New York University of New
York City.
Established by the ADA Foundation (ADAF) in 1999, the Samuel
Harris Fund is a permanent endowment, with a main objective of funding prevention and education programs to improve dental health of
underserved children and to combat
tooth decay.
The ADA Foundation is a catalyst
for connecting people and changing
lives. In its history, the ADA Foundation has disbursed nearly $36.5
million to support charitable activities. These include grants for dental
research and access to care, awards
and scholarships.
In addition, the ADA Foundation supports charitable assistance
programs, such as relief grants to
dentists and their dependents who
are unable to support themselves
due to injury, a medical condition
or advanced age; and grants to
dentists who are victims of disasters. DT
(Source: ADA Foundation)
Correction: On Page 14, Seen
& Heard: CDA Meeting, of the
No. 14 edition, John Safar of
Las Vegas, Stephen Chartier of
Las Vegas and Patrick Parson
of Alexandria, Va., should have
been identified as members of
the U.S. Air Force. Dental Tribune regrets the error.

[4] =>

Editor’s Corner

Dental Tribune | June 2010

Dr. Tif Qureshi (left), Prof. David L. Hoexter,
Dr. Kim Sperly and Dr. Elliot Mechanic stop for
a photo during the Denmark esthetic conference
in Copenhagen in May. (Photo/Provided by Dr.
David L. Hoexter)

Denmark
esthetic
congress
By David L Hoexter, DMD,FICD, FACD
Editor in Chief

Copenhagen once again led the way to a symposium of practical, educational and informative dentistry. Dr. Kim Sperly, the renowned Danish dentist
who is the head of the European Society of Cosmetic
Dentistry, led this non-political, educationally oriented organization.
Presenters gave unbiased, informative and practical information on techniques to improve predictability, diagnostic choices, esthetics and maintainability.
Supported by Dentanet, the participants were
constantly pampered with accoutrements of sophisticated snacks and drinks. These treats were definitely appreciated by presenters and attendants
(especially those special Danish brownies on the
last day).
The commercial booths were productive and
busy, equipped with knowledgeable personnel who
uplifted the professional atmosphere of the symposium. The participants appreciated the honest
straightforward, yet exciting, informative Danish
style.
The international presenters were certainly varied. Dr. Elliot Mechanic, from Montreal, Canada,
spoke on “The Artistic Smile Design: Building the
Esthetic Practice.” He emphasized the importance
of well-made temporary restorations to influence a
lab as a blueprint, as well as the key to an esthetic
restoration.
Coming from England were three diverse practitioners with the same directive: their use of the
Inmann Aligner. They emphasized the lower anteriors where there is crowding, with a conservative
tooth-saving esthetic result. Presenters from the UK
were Dr.Tif Quershi, Dr. Tim Bradstock-Smith and
Dr. James Russell.
Headlining the symposium, from the United
States, was Prof. David L. Hoexter from New York
City. His subject of “Regeneration of Esthetics and
Smiles Utilizing Implants and Cosmetic Periodontal
Surgery” covered every possible implant, implant
modality, bone graft and all esthetic periodontal
possibilities with their techniques made predictable.
This was an ideal symposium in that it was well
organized and provided informative education, and
its attendees appreciated this. DT

[5] =>

Dental Tribune | June 2010

Practice Matters

Employee vs. independent
contractor: What’s the difference?
The choice between the two comes with tax and non-tax consequences that affect your practice
By Stuart J. Oberman, Esq.

No. 5: Hiring, supervising and
paying assistants

Whether an associate dentist is
considered an employee or independent contractor could have
certain tax and non-tax consequences for the owner of a dental
practice.
From a tax standpoint, an
employer is required to withhold certain taxes. From a nontax standpoint, the major issue
is vicarious liability, whereby an
employer may be liable for the
negligent acts of an employee.
For tax and liability reasons,
the status of an associate dentist
must be clearly defined as either
an employee or independent contractor.
The following treasury regulations, §§31.3121(d)-1(c), 31.3306(i)
-1(b) and 31.3401(c)-1(b), state
that, generally, an employer/
employee relationship exists when
the person for whom services are
being performed has the right to
control and direct the individual
who performs the services.
Internal Revenue Ruling 87-41
provides 20 key factors to consider
whether an employer/employee
relationship exists.

If the person or persons for whom
the services are performed hire,
supervise, and pay assistants, that
factor generally shows control
over the workers on the job.

No. 1: Instructions
A worker who is required to comply with other persons’ instructions about when, where and how
he or she is to work is ordinarily
an employee.
This control factor is present if
the person or persons for whom
the services are performed has the
right to require compliance with
instructions.

No. 2: Training
Training a worker by requiring
an experienced employee to work
with the worker, by corresponding with the worker, by requiring
the worker to attend meetings or
by using other methods, indicates
that the person or persons for
whom the services are performed
want the services performed in a
particular method or manner.

No. 3: Integration
Integration of the worker’s services into the business operation
generally shows that the worker
is subject to direction and control.

No. 4: Services rendered
personally
If the services must be rendered
personally, presumably the person
or persons for whom the services
are performed are interested in
the methods used to accomplish
the work as well as in the results.

No. 6: Continuing relationship
A continuing relationship between

the worker and the person or
persons for whom the services
are performed indicates that an
employer-employee relationship
exists.

No. 7: Set hours of work
The establishment of set hours of
work by the person or persons for
whom the services are performed

is a factor indicating control.

No. 8: Full time required
If the worker must devote substantially full time to the business of
the person or persons for whom
the services are performed, such
person or persons have control
g DT page 6A

[6] =>

Practice Matters

Dental Tribune | June 2010

f DT page 5A
over the amount of time the
worker spends working, and
impliedly restricts the worker from doing other gainful
work. An independent contractor, on the other hand,
is free to work when and for
whom he or she chooses.

No. 9: Doing work on
employer’s premises
If the work is performed on
the premises of the person
or persons for whom the services are performed, that factor suggests control over the
worker, especially if the work
could be done elsewhere.

No 10: Order of sequence set
If a worker must perform services in the order or sequence
set by the person or persons
for whom the services are
performed, that factor shows
that the worker is not free to
follow the worker’s own pattern of work but must follow
the established routines and
schedules of the person or
persons for whom the services are performed.

No. 11: Oral or written
reports
A requirement that the worker submit regular or written
reports to the person or persons for whom the services
are performed indicates a
degree of control.

No. 12: Payment by hour,
week, month
Payment by the hour, week
or month generally points to
an employer-employee relationship. Conversely, payment made by the job or on
a straight commission generally indicates that the worker
is an independent contractor.

No. 13: Payment of business
and/or traveling expenses
If the person or persons for
whom the services are performed ordinarily pay the
worker’s business and/or
traveling expenses, the worker is ordinarily an employee.
An employer, to be able
to control expenses, generally
retains the right to regulate
and direct the worker’s business activities.

No. 14. Furnishing of tools
and materials
The fact that the person or
persons for whom the services
are performed furnish significant tools, materials and other
equipment tends to show the
existence of an employer/
employee relationship.

No. 15. Significant investment
If the worker invests in facilities that are used by the worker in performing services and

‘An associate dentist should have an
employment contract that specifically
states whether he/she is an employee
or independent contractor.’
are not typically maintained
by employees (such as the
maintenance of an office rented at fair value from an unrelated party), that factor tends
to indicate that the worker is
an independent contractor.

No. 16: Realization of profit
or loss
A worker who can realize a
profit or suffer a loss as a result
of the worker’s services (in
addition to the profit or loss
ordinarily realized by employees) is generally an independent contractor, but the worker
who cannot is an employee.

No. 17: Working for more
than one firm at a time
If a worker performs more
than de minimis services for a
multiple of unrelated persons
or firms at the same time, that
factor generally indicates that
the worker is an independent
contractor.
However, a worker who
performs services for more
than one person may be an
employee of each person,
especially where such persons
are part of the same service
arrangement.

Protecting your practice
In the past few years, the IRS
has taken an active role in the
dental profession in order to
determine whether an associate dentist is an employee or
an independent contractor.
The declassification or
determination that an associate dentist is actually an
employee instead of an independent contractor could have
substantial tax and liability
consequences for the owner of
a dental practice.
Therefore, in order to protect the owner of a dental
practice, an associate dentist
should have an employment
contract that specifically states
whether the associate dentist
is an employee or independent
contractor, as well as other
terms in order to protect the
owner of a dental practice
from potential problems. DT
(Front Page Photo/
Greatsky, Dreamstime.com)

About the author

No. 18: Making service
available to general public
The fact that a worker makes
his or her services available
to the general public on a
regular and consistent basis
indicates an independent contractor relationship.

No. 19: Right to discharge
The right to discharge a worker is a factor indicating that
the worker is an employee
and the person possessing the
right is an employer.
An employer exercises
control through the threat of
dismissal, which causes the
worker to obey the employer’s
instructions.
An independent contractor,
on the other hand, cannot be
fired so long as the independent contractor produces a
result that meets the contract
specifications.

No. 20: Right to terminate
If the worker has the right to
end his or her relationship
with the person for whom the
services are performed at any
time he or she wishes without
incurring liability, that factor indicates an employer/
employee relationship.

Stuart J. Oberman, Esq.,
has extensive experience in
representing dentists during
dental partnership agreements, partnership buy-ins,
dental MSOs, commercial
leasing, entity formation
(professional corporations,
limited liability companies),
real estate transactions,
employment law, dental
board defense, estate planning and other business
transactions that a dentist
will face during his or her
career.
For questions or comments regarding this article,
visit www.gadentalattorney.
com.

[7] =>

Dental Tribune | June 2010

Practice Matters Interview

Outsourcing
human resources
Just how much HR can a practice outsource? We wanted to know so we asked some experts
By Robin Goodman, Group Editor

One day I was chatting with
Dr. Lorin Berland, the editor in
chief of Cosmetic Tribune, and he
mentioned how much outsourcing
his human resources has saved
his sanity. As this was something I
was not aware a dentist could do,
I decided to get the full story from
Berland’s Dental Practice Specialist Robert Whitehead at Odyssey OneSource, the professional
employer organization (PEO) that
provides his HR outsourcing.
What is a professional employer
organization, or PEO?
In addition to practicing dentistry, as a business owner, dentists
are faced with managing increasingly complex employment issues,
including government compliance, employee benefits, workers’
compensation, payroll, payroll tax
compliance, unemployment claims
and much more.
Most dental practices already
outsource one or more of the above
tasks using a piece-meal adoption approach. This requires the
dentist to manage multiple vendors that each specialize in one
area, such as payroll processing,
employee benefits or government
compliance. Unfortunately, these
vendors don’t work together, so it
is up to the dentist to coordinate
their efforts.
For example, an employee
termination would likely trigger
activity in three areas and would
require the dentist to contact three
separate vendors.
Odyssey OneSource enables
the practitioner to integrate all
employment-related activities into
one simple outsourcing arrangement. As a PEO, Odyssey OneSource enters into a co-employment relationship with the dentist’s employees.
This enables Odyssey to directly
assume many of the liabilities that
fall to the practitioner as their
employer, and more importantly,
assume responsibility for the timeconsuming and non-productive
tasks required of employers.
What problems does Odyssey
OneSource help solve?
Most dentists learn about HR management the hard way, by encountering problems. This reactive process can be very costly in terms of
dollars, goodwill and time. A typical dental practice simply cannot
justify the cost of a HR manager,

so Odyssey OneSource has created
an outsourced solution that goes a
step further by assuming many of
the employer liabilities that clinicians shoulder today.
As the employer of record with
government agencies, Odyssey
assumes the liability for payroll,
payroll taxes, unemployment
claims, EEOC claims, fiduciary
obligations and more.
Like larger organizations, dentists can benefit from strategic HR
practices. Strategic HR focuses on
recruiting and retaining the best
employees, compensating them
properly, providing competitive
employee benefits, offering training and development, and monitoring and measuring employees’
performance.
Over time, these are the activities that make a good dental practice a great dental practice.
Our program enhances topand bottom-line organizational
performance by strengthening a
practice’s most important asset —
employees’ performance.
Does Odyssey OneSource have
programs expressly for dental
practices?
Yes, as part of our commitment to
the dental industry, we have created a web portal especially for dentists and specialists, www.odyssey
onesource.com/dental. Dentists are
well educated as clinicians, but
often insufficiently trained in business management and labor regulations.
Odyssey partners with practice
owners to help them grow their
business through a full range of
strategic human resource administration and management solutions.
Our human resources experts
have an intimate understanding
of the laws and labor regulations
that affect a practice. By letting
Odyssey’s subject-matter experts
handle the ever-growing number
of complex issues associated with
being an employer, a clinician can
put even more focus on his or her
patients.
Can you give us a few specific
examples of Odyssey OneSource’s
solutions?
Odyssey recognizes that each dental practice is unique. We get to
know each practice, the clinicians
and team members in order to
tailor our highly customizable program especially for them. Here are
some questions that we ask during
our initial consultation:

Would you like to upgrade your
employee benefits?
Odyssey provides health, dental,
life and vision insurance options
that are vastly more comprehensive than a typical dental practice
can obtain on its own. We have
several options available in order
to suit the needs of different practices.
One popular option lets the
practice enjoy the benefits of a
top-rated PPO at very attractive
rates by incorporating health savings accounts, or HSAs.
HSAs are triple-tax-advantaged.
Contributions go into the accounts
on a tax-free basis, earnings on
HSA balances accumulate tax-free
and distributions are paid out taxfree — provided that they are for
qualified medical expenses. Participants enjoy the convenience of
a debit card to pay for qualified
medical expenses.
Our HSA pays annual exam/
wellness benefits at 100 percent
with no deductible required. HSA
contributions may be paid by the
employee, a family member of the
employee, the employer or a combination of all three. Account balances roll over without limitation
from year to year. The accounts
are completely portable so when
individuals terminate employment,
they take their HSA with them.
Is your employee timekeeping
process automated and integrated with payroll?
Most dental practices use a cumbersome and antiquated timecard
system to record hours worked.
Odyssey offers an automated system that electronically maintains
your time clock data and is fully
integrated with our payroll system.
One simple command confirms
your time clock data is ready for
processing. We take care of payroll processing, direct deposits, tax
deposits, tax filings, garnishment
administration and payroll account
reconciliation.
Are you, or someone on your
staff, adequately trained to
avoid costly IRS penalties?
The IRS reports that one out of
every three employers has been
assessed a penalty for a payroll tax
mistake, with total penalties totaling billions of dollars.
In addition, given the everchanging nature of tax regulations,
it’s easy to make an error that can
g DT page 8A

[8] =>

Practice Matters Interview

f DT page 7A
grossly affect the practice’s bottom
line. Odyssey’s integrated solution
relieves the clinician of payroll tax
liabilities.
Is your practice in compliance
with all state and federal labor
regulations?
An essential element of human
resources is reducing an employer’s liability. From written policies to dispute resolution, dentists
depend on Odyssey OneSource to
anticipate and avoid potential HR
nightmares.
Odyssey provides a thorough
HR assessment at the onset of our
arrangement in order to identify
specific areas of concern.
We reduce a clinician’s exposure to employee claims and suits
by customizing practice-specific
training and providing employment practices liability insurance,
or EPLI, that covers the clinician
in the event of a claim.
Dental-specific safety training
is also available. This allows the
dentist to refocus his or her internal compliance efforts to patientrelated risk mitigation.
Is your practice in compliance
with all applicable OSHA reguAD

lations? When was the last time
that your safety policy was
reviewed?
In today’s litigious society, practices must plan for potential problems. Odyssey’s proactive approach
to risk management helps to maintain a safe and productive work
environment.
Our comprehensive solution
helps a clinician maximize the
practice’s biggest investment —
the employees — by minimizing
job-related hazards and managing
claims that do occur.
Odyssey employs certified safety
professionals that are knowledgeable about OSHA guidelines and
risk management best practices.
Does your practice maximize
retirement savings opportunities
for the clinician and his or her
employees?
One of Odyssey’s key benefits is
our executive deferred compensation plan, which offers highly compensated professionals the opportunity to defer up to $100,000 in
annual earnings using a 409a plan.
This allows the clinician to defer
income until a later date, helping
the dentist to accumulate wealth
by placing him or her into a lower
tax bracket.
The tax savings alone often

Dental Tribune | June 2010

More information …
Odyssey OneSource’s HR outsourcing arrangement also provides the
following benefits:
• Competitive employee benefits, including health, dental, life and
vision insurance, retirement plans and voluntary benefits that help clinicians attract, engage and retain the best employees.
• A deferred compensation plan that allows a practice to save up to
$100,000 annually on a tax-deferred basis.
• A full-featured 401(k) plan that offers employees a bona-fide retirement option with no required contribution or administration on the
clinican’s part.
• Immediate access to Odyssey’s experts, processes and systems,
which are all designed to promote HR best practices.
• An integrated approach that eliminates the need for the dentist to
coordinate the activities of multiple vendors, or even worse, attempt to
perform these complex functions himself/herself.
• Elimination of significant employer liabilities including payroll tax,
unemployment claims, workers’ compensation claims and more.
• Avoidance of costly employment-related lawsuits, such as wrongful
terminations, sexual harassment, discrimination and more.

exceeds the entire cost of our service.
The practice’s employees can
also benefit from a 401(k) plan that
we administer. We have investment advisors to assist employees
with their investment decisions.
The practitioner can decide
whether or not to match employee
contributions and can even offer a
profit-sharing option if desired. DT

Contact info
For more information please
visit
www.odysseyonesource.
com/dental or contact Robert Whitehead at RWhitehead@
odysseyonesource.com.

[9] =>

[10] =>

[11] =>

Dental Tribune | June 2010

Webinar Interview 11A

How plaque biofilm can be managed
By Fred Michmershuizen, Online Editor

Dental Tribune spoke with Dr.
Fotinos Panagakos about his upcoming webinar.
You have an upcoming course on
the management of biofilm and
gingival management. Would you
please tell our readers why this
topic is important?
Periodontal diseases are a set of
poly-microbial diseases characterized as dental-plaque/biofilm–
induced gingival inflammation that
without treatment can result in the
loss of periodontal support tissues,
bone loss and, ultimately, tooth loss.
For the past several decades, significant clinical and basic research
has established the complex microbiology and pathology of periodontal
diseases, and, specifically, that they
involve a combination of bacterial
infection, host immune reaction and
bone metabolism, as well as genetic
and environmental risk factors.
The importance of bacterial
plaque to the onset and progression of periodontal diseases is well
accepted. While more than 400 species of bacteria can be detected in the
oral cavity, only selective pathogenic
species produce products harmful to
gingival tissues.
Microbial products of specific
pathogens, such as lipopolysaccharide (LPS) and proteolytic enzymes,
directly or indirectly trigger a host
tissue response by inducing inflammatory protein (cytokine) production, increasing the levels of inflammatory mediators, which leads to
inflammation and tissue destruction.
Without intervention or treatment, supporting tissues will be
destroyed, clinical pockets will form,
bone resorption will occur and, ultimately, the tooth will be lost.
How does plaque biofilm affect the
surrounding soft tissue?
The plaque biofilm, if not removed,
will trigger a chronic inflammatory
disease of the gingiva and periodontium. This will result in the destruction of gingival connective tissue,
periodontal ligament and alveolar
bone. The periodontium responds to
the tooth-borne biofilm by the process of inflammation.
The dental biofilm is composed
of numerous bacteria, which tenaciously adhere to the tooth surface.
Scientists are now beginning to
understand the complex molecular
interactions that occur, for example,
between the bacteria and salivary
pellicle that coats the tooth, and
between gram-positive cocci of early
plaque and gram-negative filamentous bacteria that populate the tooth
as plaque matures.
Recent work has identified a
set of complex signaling pathways
— referred to as quorum sensing
— between bacteria, mediated by
soluble chemicals produced by the
bacteria.

Clinically, inflammation is seen
as redness, swelling and bleeding
upon probing. However, at molecular and cellular levels, the inflammatory process is defined by cellular
infiltrates and the release of a variety
of cytokines.
The main provoking factor that
induces inflammation of gingival tissue is the presence of bacterial biofilm on the teeth/gingival interfaces.
The products of biofilm bacteria are
known to initiate a chain of reactions
in the tissue leading to host response
as well as the destructive process.
How can patients better manage
plaque biofilm at home? Are there

certain techniques and/or overthe-counter products that are
especially beneficial?
Control of the biofilm/plaque begins
with daily oral hygiene. Mechanical
cleaning of the teeth and associated
gingival tissue removes the bulk of
biofilm that has developed in the
time since the last oral hygiene session. Within a few hours of meticulous tooth cleaning, bacteria colonize
the tooth surface primarily around
the gingival margin and inter-dental
spaces.
The developing biofilm releases
a variety of biologically active prod-

Free one-hour
webinar
June 29, 7 p.m. EST
‘Biofilm, Gingival
Inflammation and its
Management’
by Dr. Fotinos
Panagakos
Visit DTStudyClub.
com to register!

g DT page 12A
AD

[12] =>

12A Webinar Interview

Dental Tribune | June 2010

f DT page 11A
ucts, including lipopolysaccharides [endotoxins],
chemotactic peptides, protein toxins and organic
acids. These molecules diffuse into the gingival epithelium to initiate the host response that
eventually results in gingivitis and, in some circumstances, inflammatory periodontal diseases.
Clinically, gingivitis is characterized by a change
in color — from normal pink to red — with swelling and, often, sensitivity and tenderness.
Gentle probing of the gingival margin typically elicits bleeding when gingivitis is present.
Because gingivitis is often not painful, it may
remain untreated for many years. Lack of management at this stage may result in disease progression. This is why periodontal disease is often
depicted as a spectrum of severity.
Given the complexity of periodontal diseases
and the importance of oral health, one of the
critical questions is how to best prevent and treat
periodontal infection. Clinical procedures such as
scaling and root planing provide immediate and
universal benefits, whereas effective routine oral
care can help maintain a healthy oral environment and decrease the occurrence of oral disease.
It is interesting to speculate that a therapeutic
agent that combines both antibacterial and antiinflammatory efficacy may provide a unique and
beneficial approach to the prevention and treatment of periodontal diseases via daily oral-care
procedures, not only for high-risk individuals,
but also for the general population. The current
therapeutic strategy to control periodontal infections involves mechanical removal of deposits,
both supra- and subgingival. This also could
involve the use of topical and systemic antimicrobial agents.
Can topical antimicrobials applied via an
oral delivery system, such as toothpaste, rinse,
or gelsm help with the management of dental
biofilm?
A unique triclosan/copolymer/fluoride dentifrice technology, found in Colgate® Total®, has
been developed and clinically proven to enhance
conventional oral care procedures. This technology uses a patented system consisting of
a broad-spectrum antibacterial agent, triclosan
and a polyvinylmethylether/maleic acid (PVM/
MA) copolymer to deliver sustained antibacterial
activity in the oral cavity, thereby controlling dental plaque and preventing and treating gingival
inflammation.
Triclosan is a broad-spectrum antibacterial
agent that has been shown to kill oral pathogens,
and clinically effective concentrations of triclosan
are present up to 12 hours post-brushing, providing an anti-bacterial benefit between brushings.
In practice, this triclosan/copolymer/fluoride
dentifrice has been proven to deliver statistically
significant and clinically relevant benefits in the
prevention of caries, the reduction of dental calculus buildup and oral malodor, as well as the
control of dental plaque and treatment of gingivitis.1
Such a multi-benefit oral-care technology can
significantly enhance routine oral care procedures and help to maintain a healthy oral environment.
Control of the plaque biofilm through effective oral hygiene procedures, in combination
with the use of a product such as Colgate Total,
can provide most patients with an effective
regimen to maintain good oral health between
dental visits. DT

References
1. J Clin Dent 16 (Supplement):S1–S20, 2005.
* For a longer version of this inteview please visit
www.dental-tribune.com/articles/content/scope/
specialities/section/general_dentistry/id/2284.

[13] =>

[14] =>

14A ADHA Preview

Dental Tribune | June 2010

Vegas for the non-gambler
The American Dental Hygienists’ Association convenes in Las Vegas for its 87th annual session June 23–29
By Robin Goodman, Group Editor

Gambling isn’t the only thing Las
Vegas has to offer its visitors. There are
quite a few things to do in the City of
Lights that won’t cost you a dime.

Free things to do

• Bellagio fountain show: On weekdays,
the show is every 30 minutes from 3–8
p.m., and then every 15 minutes until
the clock strikes midnight. On weekends, the schedule is the same, except
it begins at high noon. The best time
to view this show is after dark though,
and every show is different.
• Mirage volcano fountain: Wait
until nightfall when you can watch the
volcano erupt every fifteen minutes
until midnight.
• Epic battle at Caesars Forum
Shops: Taking place in the fourth
rotunda, a 50,000-gallon, saltwater
aquarium is the backdrop for an epic
battle complete with smoke and fire.
Who’s fighting to rule Atlantis? Well,
Alia, Atlas and Gadrius of course! The
show is daily and takes places every
hour from 10 a.m. to 11 p.m.
• Bacchus statues at Caesars Forum
Shops: Held in the first rotunda, this
is a special effects show. Bacchus —
the god of wine and merriment —
awakes from his slumber and promptly decides that what he and shoppers
at the Forum need is a little party (a
seven-minutes-long party to be exact).
Other gods, such as Apollo, Plutus and
Venus, join in the revelry. This show is
also daily and takes place from 10 a.m.
to 11 p.m.
• World’s largest permanent circus:
Visit the Circus Circus hotel for acrobats, aerialists, high wire acts, jugglers
and magicians. Daily shows begin at 11
a.m. and last until midnight.
• Fremont Street experience: This
pedestrian mall covers five blocks and
is covered by a barrel vault canopy
that is four blocks long and 90 feet
AD

at its highest point. At the start of the
show, all the lights in the buildings are
turned off. The show begins every day
at dusk.
• MGM Grand lion habitat: Only
1.5 inches of glass separates you from
the lions as they feed, groom, play and
sleep. Visitors can also learn interesting lion facts from the plaques that are
part of the exhibit (i.e., lions sleep 18 to
20 hours a day on average). The lions
live on a ranch that is 12 miles away
from the hotel and are rotated through
the exhibit in blocks of six hours per
day. While there are 31 lions in total,
only a few will be in the habitat at any
given time.
Here’s an interesting fact: Each lion
gats a bath and his/her hair blown dry
before going into the habitat. There are
presentations by the lion trainers but
the frequency is unpredictable as they
depend on the lions’ activity levels at
any given moment.
If the gods favor you during your
visit, you’ll watch as the trainers handfeed the lions or engage in playtime
with them. The habitat is open every
day from 11 a.m. to 7 p.m. Meal times
are 11:15 a.m. and 4:40 p.m. every day.
• Rio Hotel and Casino Show in the
Sky: Costumes, dancing and a different
show three times a day all take place
above the casino floor. The shows
begin at 7 p.m. and occur every hour
until midnight from Thursday to Sunday. If it’s a Wednesday night, you can
enjoy Latin tunes with a strong Brazilian influence by Michito Sanchez &
Bahia.
• Venetian “streetmosphere”: A variety of street performers, from actors to
opera singers, will liven up your experience as you window shop through the
Grand Canal Shoppes on the cobblestone streets. There are performances
at various locations throughout the
day, and keep your eyes peeled for “living statues” in St. Mark’s Square and
near the Ann Taylor store. At night, you

can enjoy music from the Venetian
Trio at St. Mark’s Square.
The Gondolier March is another
sight, and takes place at the start and
end of every day when the gondoliers
march through the shopping mall and
end up in St Mark’s Square. And don’t
forget to look up! Yes, up! The painted ceiling displays Italian landmarks,
which gives the illusion of being outside even though you are inside and
out of the sun’s heat. The days here
start at 10 a.m. and do not end until
11 p.m.
• Ethel M. Chocolate factory tour:
It’s never too early in the day for
chocolate, and what could be better
than a free tour of a chocolate factory?
Ethel M. is open daily from 8:30 a.m.
to 7 p.m.
• Bellagio Hotel chocolate fountain: Visit this casino for a 27-foot tall
chocolate fountain with 2,100 pounds
of melted chocolate flowing through
it. Some 25 handcrafted glass vessels catch the cascading chocolate.
The chocolate is kept at 120 degrees
Fahrenheit and it takes six pumps to
circulate it all.
It took two years to design, plan and
engineer the fountain, which contains
more than 500 feet of steel piping.
Michel Mailhot of Canada designed
the fountain. Open daily from 7 a.m.
to 11 p.m.
• Paris Las Vegas Eiffel Tower: It
does cost you a dime to gawk at this
replica of the tower found in Paris,
albeit it is only about 50 percent of the
original’s size.
• Hawaiian Marketplace: Remember, window-shopping is free. Yet,

(Photos/www.stockxchng.com)
you might find it difficult to resist the
wares at this 80,000-square-foot shopping mecca. It’s just a block north
of the MGM Grand and is fashioned
after the international marketplace in
Honolulu.
There are cart vendors as well as
regular stores under the shade of an
awning so you can avoid the direct sun
if you want to. There are a variety of
food options here too, so you can slake
that thirst and feed an appetite at the
end of your Hawaiian hike.
• Las Vegas sign: You’ve seen it in
movies and photos, but why not snap
your very own picture of this famous
sign? The sign is near the Mandalay
Bay Casino, which is the southern end
of the strip. DT
(Sources: www.wikipedia.com,
www.about.com, www.vegas.com,
www.tripadvisor.com,
www.virtualtourist.com)

[15] =>

Dental Tribune | June 2010

Industry Interview 15A

CBCT technology: Informed dentists
make informed decisions
Imagine a technology that brings
the most detailed knowledge of the
patient’s dental anatomy and greater treatment predictability right into
the dental office. A good imagination is no longer necessary to
achieve that goal. That technology,
CBCT imaging, is not just a dental
daydream but also a reality every
day in many dental offices nationally and internationally.
Before and after investing in
CBCT, many professionals take
advantage of educational opportunities to grow their knowledge of
this imaging method. On June 25
and 26, in La Jolla, Calif., Imaging
Sciences International and Gendex
Dental Systems will be hosting the
fourth International Congress on
3-D Dental Imaging. There, dental
professionals will hear about 3-D’s
past, its present uses and successes,
and future implications. The twoday symposium offers insights into
field-of-view options for various
specialties, detailed clinical application and hands-on training with 3-D
planning software programs, and
discussions of legal issues.
Three-dimensional technology is
already redefining dental outcomes
across a broad spectrum of treatment options, including implants,
bone grafting, oral surgery, orthodontics and endodontics. The ability to capture a 3-D image of the
mouth and to view it from all angles,
together with the capability of rotating that 3-D mode and zooming in
on details, can only result in more
effective dental treatment.
With cone beam, all of the information can be coordinated for integration with other applications, such
as guided implant placement software or CAD/CAM. The recent integration of E4D and i-CAT®/GXCB500™ allows clinicians to combine
high-resolution three-dimensional
cone-beam scan data and digital
impression scan data so that they
can simultaneously plan implants
and restorations together in one
cohesive system (Fig. 1).
Software navigates the clinician
through this process and ultimately
reduces the risk of poorly placed
implants. For immediate-load
implant cases, pairing these two
technologies offers chairside milling of surgical guides so that the
patient can be completely treated
from implant placement to the seating of the restoration in one visit.
Dentists who have already implemented 3-D technology are seeing results, from more proficient
diagnosis to more defined treatment planning and increased case
acceptance. Speakers at the conference, such as i-CAT-owner Dr.
Steven Guttenberg and GXCB-500
HD-owner Dr. John Flucke, will
share their experiences on how

CBCT is helping to change the face
of dentistry across a wide range of
procedures.
How is dental imaging broadening the scope of dental procedures
for the general dentist as well as
specialties?
Dr. Steven Guttenberg: With 3-D
imaging, the dental profession
is experiencing a real paradigm
shift. Dental radiography has come
a long way from the first X-ray

taken by Wilhelm Roentgen of his
wife’s hand in December of 1895.
However, even with a panoramic
radiograph, we are getting a 2-D
representation and making diagnostic and treatment decisions for a
three-dimensional object.
CBCT imaging gives dentists the
opportunity to diagnose and plan
treatment more efficiently. While I
thought that I would use my i-CAT
g DT page 16A

(Photos/Provided by Imaging Sciences)
AD

[16] =>

16A Industry Interview
f DT page 15A
primarily just for implant procedures, I now use it for everything —
taking out a tooth that is close to the
nerve, exposing a tooth for orthodontics, for implants, TMJ treatment
and trauma. Three-dimensional
imaging touches all aspects of dentistry, from endodontics looking at
teeth cross-sectionally, to orthodontics for non-surgical treatment or
for integration for SureSmile robotic
archwire technology.
When I think about the many
ways that scans can be viewed and
the scope of information that each
scan provides (Fig. 2), the list of procedures that can benefit from this
technology just keeps getting longer
— I use it for extraction, pathology, orthognathic surgery, airway
AD

studies, dento-maxillofacial trauma,
implants, bone grafts and evaluation
of the paranasal sinuses.
What type of dentist really needs
3-D imaging?
Guttenberg: Being at the congress
last year was an eye-opening experience. I witnessed how doctors of
different specialties and general
dentists use this innovation. For any
practice to expand and improve, a
dentist must embrace change. Physicist Thomas Kuhn, who first coined
the term paradigm shift in 1962,
noted that scientific advancement
is not evolutionary, but is rather “a
series of peaceful interludes punctuated by intellectually violent revolutions. In those revolutions one
conceptual world is replaced by
another.”

Dental Tribune | June 2010
Cone beam, to me, represents a
revolutionary concept in imaging.
Six or seven years ago, it was just
being looked upon with curiosity,
but now it is becoming the standard
of care for dental radiography. Education in the possibilities that 3-D
imaging brings to the practice is
invaluable.
While 2-D still has its place in
the dental practice, many patients
need more for optimal care. Change
is not easy, but it is necessary to
change to move forward and to provide patient care in a better manner. Three-dimensional imaging is
definitely a paradigm shift, letting
dental professionals see the same
information in an entirely different
way. Nothing else really describes
what is going on here.

What do you tell general practitioners who may feel intimidated by
this technology?
Dr. John Flucke: That question is
exactly the reason that I entitled
my seminar, “Scrabble and Alphabet Soup — Bringing Simplicity to
Cone-Beam Technology”. There is a
lot of hesitation on the part of some
general dentists that cone beam
is just for the realm of the specialist or the dental school. When
faced with acronyms such as CBCT,
cone-beam computerized tomography, or terms such as voxel, the
three-dimensional equivalent of a
pixel, they get intimidated by the
mishmash of initials and unfamiliar
words. They just want an X-ray.
After becoming educated about
3-D imaging, they realize that it
is not as intimidating as they first
expected. I am not an electrical
engineer or radiologist; I am just
a dentist who uses 3-D cone beam
to improve patient care, and that
is why it is important to hear about
this technology from people like me.
Far more important than the Scrabble and alphabet soup, imaging is
all about providing the best possible
outcome for the patient.
Can you share a case from your
own practice?
Flucke: There are so many cases,
but this case in particular was very
satisfying. A new patient arrived at
my practice eight months after seeing her previous dentist, who she
had seen for the past 10 years. The
patient had always been diligent,
almost fanatical, about her dental
health, but was two months overdue
for a cleaning.
We took a CBCT scan and found
an undetected cyst growing in the
mandible almost to the point of
causing a fracture of the mandible
(Fig. 3). When we pointed this out,
the patient responded, “Maybe that
is why my lip goes numb sometimes, and I get these shooting pains
in my jaw.”
While the patient wondered why,
even throughout her regular visits
to the dentist this condition went
undiagnosed, I recognized that the
previous dentist was not really at
fault. The dentist had been taking
the necessary required radiographs
over the years, 20 film 2-D surveys, but this patient needed more.
Because of the various options in
viewing 3-D technology, I sent the
scan out to a radiologist and subsequently referred the patient to an
oral surgeon. The CBCT showed
that as the cyst grew, it was putting
pressure on the nerve, causing the
pain and numbness.
Four different outcomes were
possible for this condition, and two
could have either been life-altering
or life-threatening. Fortunately, the
situation turned out to be benign,
necessitating some extractions and
bone grafting. Afterward, the patient
asked, “Why did I go somewhere
else for 10 years, and the dentist
never saw this, when you found this
after 10 minutes?” It was all thanks
to CBCT.

[17] =>

Dental Tribune | June 2010

Industry Interview 17A
AD

Fig. 1: Proficient technology: CBCT and CAD/
CAM integration.

Fig. 2: Amazing views into a patient’s anatomy.

Fig. 3: Previously undiagnosed disease found on a
CBCT scan.
What is your main message to dentists contemplating implementation of CBCT?
Flucke: I’m a general dentist. I use and believe in
this technology. I have seen so many scans that
have changed the course of treatment or provided the missing information for difficult diagnoses. By being a speaker at the conference, this
is what I want people to know: Don’t be afraid to
use 3-D imaging. Use it because it is the smart
and the best thing to do. The end game is making
the lives of our patients better and cone-beam
3-D imaging is the best way to do that.
Dr. Guttenberg offers a parting thought from
George Bernard Shaw to encourage colleagues
to educate themselves on 3-D technology to better understand its benefits to the dental practice.
“Progress is impossible without change, and
those who cannot change their minds cannot
change anything.”
g DT page 18A

[18] =>

18A Industry Interview

Dental Tribune | June 2010

Fight oral
cancer!
f DT page 17A
For a full list of the topics and
speakers that will be featured at the
fourth International Congress on
3-D Dental Imaging and registration
information, visit www.i-CAT3D.
com. DT

About the interviewees
Dr. John Flucke practices in
Lee’s Summit, Mo.; he is a wellrecognized expert and educator
in dental technology.
Dr. Steven Guttenberg is
an oral and maxillofacial surgeon, practicing in Washington,
D.C., where he is director of the
Washington Institute for Mouth,
Face and Jaw Surgery.

Attend the fourth
International Congress on
3-D Dental Imaging online
Don’t miss the opportunity to learn from the industry’s leading experts on 3-D imaging, planning and treatment Learn
how to incorporate, afford and use the technology in your
practice today.
On June 25 and 26, the fourth International Congress on 3-D
Dental Imaging hosted by Imaging Sciences and Gendex Dental Systems will be broadcast live online to provide those who
cannot make it to La Jolla, Calif., an opportunity to learn about
the benefits of 3-D imaging technology. Please see program
details at www.i-cat3d.com.
Online participants will receive ADA-CERP C.E. credits.
Registration for the two-day, live online broadcast is $149
and provides access to the archived recording for 30 days, to
review at your convenience. Attendees require an online computer with audio capabilities. Please register at www.DTStudy
Club.com under Online Courses. See you online!

Prove to your patients just
how committed you are to
fighting this disease by signing up to be listed at www.
oralcancerselfexam.com. This
website shows patients how to
do self-examinations for oral
cancer.
Self-examination can help
your patients to detect abnormalities or incipient oral cancer
lesions early. Early detection
in the fight against cancer is
crucial and a primary benefit
in encouraging your patients
to engage in self-examinations.
Secondly, as dental patients
become more familiar with
their oral cavity, it will stimulate them to receive treatment
much faster.
If dental professionals do not
take the lead in the fight against
oral cancer, who will? And in
the eyes of our patients, they
likely would not expect anyone
else to do so — would you?

[19] =>

Dental Tribune | June 2010

Industry News 19A

Research study confirms
microbial contamination
Bacterial contaminants on
patient napkin holders
The primary purpose of The Dental Advisor study was to evaluate the
presence and composition of bacterial contaminants on patient napkin holders (i.e., bib chains) before
and after patient care appointments.
Experiments were also performed
to investigate the effectiveness of
cleaning procedures on reusable bib
chains.
As expected, control, unused metal
and plastic napkin holders were
found to harbor very few contaminant bacteria. Metal and coiled plastic napkin holders that were quickly
wiped between use on patients with
an EPA-approved, intermediate level
disinfectant showed more bacterial
contamination compared to unused
controls.
The highest levels of bacterial
contamination were found on metal
and plastic napkin holders sampled

after use on multiple patients without cleaning between treatment
appointments.
Of additional interest, culture of
re-used and wiped plastic napkin
holders yielded a mean colony count
that was almost two times greater than that found for the metal
chains (41.3 vs. 21.9 cfu/mL). This
increased microbial load may have
occurred because of the more complex, coiled structure of the former
type of napkin holder.
Thorough cleaning of this type of
chain could require a greater effort
on the part of dental personnel in
order to reach less accessible areas.
For the present study, personnel
were asked to only perform a quick
wiping motion over the chain with
the moist towelette.
Contamination of chains could
have occurred by a few different
mechanisms:
1) prolonged contact of the bib
chain with the patient’s neck, there-

Fig. 1: Bacterial contamination isolated from a metal napkin holder, which
was reused on eight patients without
any cleaning procedure between uses.
(Photo & logo/Provided by DUX Dental)
by contacting normal epithelial bacterial flora;
2) exposure of the chain to
microbe-containing aerosols and
spatter generated during treatment
and
3) handling of the napkin holders with gloves contaminated during
patient care.

Microbial contamination was
found on both metal and coiled plastic napkin holders after use during
patient care. The highest concentrations of isolated bacteria were
observed on bib chains where a
cleaning procedure was not performed between patient uses.
Although cleaning chains with a
disinfectant wipe between patient
appointments lessened the microbial
load, resultant bacterial levels were
still higher than those noted for new
unused patient napkin holders. DT
(Source: THE DENTAL ADVISOR
Research Report #29, June 2010;
www.dentaladvisor.com/clinicalevaluations/infection-controlcorner.shtml)

[20] =>

[21] =>

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

June 2010

www.dental-tribune.com

Vol. 3, No. 6

Enlightened and whitened
An overview on bleaching and patient assessment
B1

A3.5

By Julie Seager, RDH, BS

Bleaching options

A patient who is happy with his or
her smile will ultimately be a more
compliant patient. One of the easiest and most significant methods to
achieving an esthetically pleasing
smile is to bleach the teeth.
There are reports of teeth whitening dating back more than 1,000
years, and today people are now
more than ever wanting this cosmetic procedure.
Surveys show that more than 80
percent of people want whiter teeth,
but only 15 percent have ever used
a bleaching product. That leaves
65 percent of patients eligible to be
approached about bleaching.
Proper patient evaluation and a
good approach can bring a large
increase in case acceptance for
bleaching.
Thoughtful consideration of
the patient’s age, habits and current restorations should be used
when determining which bleaching
product should be matched to the
patient.
Dental offices should have several product options available as not
every patient has the same bleaching needs.

With so many bleaching products
on the market, it is easy to be
confused about what is safe and
effective to recommend to patients.
Many dental offices already provide
the service of take-home bleaching
trays to patients.
The trend of in-office bleaching
is gaining popularity as techniques
and equipment become more cost
effective and easy to administer.
The two types of take-home
bleaching gels available to patients
are carbamide peroxide and hydrogen peroxide. Carbamide peroxide
gel is a slow-release gel with about
one-third the strength of hydrogen
peroxide.
It usually works with a two- to
four-hour release time, making it
ideal for patients who want to wear
trays while they sleep.
Hydrogen peroxide gels are faster acting, releasing the peroxide
between 30 and 60 minutes, and
will usually come in concentrations
from 5 to 10 percent. Some manufacturers also now offer 35 to 40
percent carbamide peroxide gels for
home use, which only require a 25to 30- minute application.
This gel concentration is perfect

Fig. 1: The
shade-guide
arranged in
color value
order.

(Photo/Yuris, Dreamstime.com)
for patients who do not have much
time to whiten, want fast results and
are not prone to sensitivity.
In-office bleaching gels usually
are 25 to 30 percent hydrogen peroxide and need to be used only
with supervision of a professional
to ensure the gel is properly applied
and will not harm the soft tissues.

Sensitivity
Several dental manufacturers recognize that sensitivity can limit a
patient’s whitening potential, and
now there are several bleaching
gels that contain fluoride, amorphous calcium phosphate (ACP) or
a combination of the two.
Patients with dentinal hypersensitivity can often pose a big challenge to teeth bleaching, but this
can be easily remedied with proper
pre-treatment protocol.
For 10 days to two weeks prior
to beginning the bleaching process,
a sodium fluoride or product containing ACP should be used once or
twice a day and then again as needed during the course of treatment.
If performing chairside bleaching, care should be taken to cover
exposed root surfaces and worn
incisal edges with a protective dam
or bonding agent.

Special circumstances
Patients receiving cosmetic restorations after bleaching will benefit
from waiting two weeks for the oxygen and hydration in the tooth to
return to normal levels. At this time,
the final shade will have stabilized

and the teeth will achieve the strongest bonding strength.
Patients with white-spot lesions,
or fluorosis, will want to bleach
the teeth to an ideal shade and
then follow up with an air-abrasion
appointment to smooth and even
out the appearance and texture of
the enamel.
For patients with translucent
incisal edges, a very thin layer of
composite can be placed on the
lingual surface of the teeth after
bleaching as long as it does not
interfere with the bite, so the teeth
will not appear to have a bluish, seethrough appearance.
Patients with bruxing habits will
often have noticeably thicker and
darker teeth because of more calcified dentin. These patients will
most likely achieve the best results
by first using an in-office system
and then a high concentration takehome gel for touch-ups.
For parents who are concerned
about a child’s yellow or mottled
enamel, adult-supervised takehome bleaching kits may be used
with the option of chairside bleaching, as it may be performed on anyone with all permanent dentition.
Usually, a low-concentration
hydrogen peroxide gel works well
for children and teens because they
don’t have issues with staining habits or thick, calcified dentin.
Tetracycline stain is the most
challenging to remove, but excellent results can be achieved if a
g HT page 3C

[22] =>

News

Hygiene Tribune | June 2010

Dear Reader,
Recently I have been hearing a
commercial on the radio regarding
things in our world that alert us
before something potentially bad
or inconvenient happens to us.
The commercial talks about the
low fuel light in cars and how it
would not be very beneficial if the
light came on after the gas had run
out.
The ad also mentions how a
child would feel if he or she was
called to dinner after all the food
was gone.
There are many things taken for
granted when it comes to warning
us about impending dangers. Think
about smoke detectors. Hopefully, they begin to beep before the
house is on fire.
What if hazardous weather
warnings were posted on the radio
or television after the storm had
hit?
In truth, dental hygiene is based
upon this concept. It is the hygienist’s job to inform patients about
the condition of their mouths.
By the same token, patients rely

on us to inform them of looming
trouble.
A great way to achieve this goal
is by performing risk assessments
on patients to analyze each aspect
of oral health at every visit.
Many software programs have
the ability to predict the future
likelihood of periodontal disease.
Advanced
caries
detection
methods can assist the clinician in
closely monitoring caries before it
can be detected by traditional caries detection methods.
Sophisticated
oral
cancer
screening technologies can detect
trouble before the conventional
“gauze around the tongue” exam.
Use of these and other technologies can assist clinicians in knowing when to alert patients.
If we are not utilizing such technology, we are not treating patients
the way they should be treated.
What if all the warnings we take
for granted were taken away?
Maybe then we would realize the
importance of such mundane luxuries. HT

support local Smiles Across America
programs in California, Minnesota
and Nevada, expanding children’s
access to dental care through local
schools.
Additionally, two $15,000 Program
Champion grants were awarded to
established national oral health programs.
The first, America’s Dentists Care
Foundation (Missions of Mercy), has
helped more than 100,000 patients
and has provided more than $50
million in free dental services since
its inception in 2000.
The second, TeamSmile, uses the
popularity and power of professional
and collegiate sports partnerships to
bring patients in need together with
dental professionals and volunteers.
“In every community across the
country, there are children who
have limited or no access to dental care. These children have oral
infections that may be impacting
their ability to sleep, eat and learn.
“The 2010 grant recipients are
established programs that have been
proven to positively affect access to
care of children in need,” said Cindy
Hearn, Give Kids A Smile Advisory
Board member and senior vice president of marketing at CareCredit.

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, BS
a.stone@dental-tribune.com
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

Best Regards,

Online Editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.
com
Account Manager
Mark Eisen
m.eisen@dental-tribune.com

Angie Stone, RDH, BS

Give Kids A Smile grant
recipients honored at
annual gala
Five grant recipients of the Give
Kids A Smile Program Growth Fund
were honored at the third American
Dental Association Foundation Give
Kids A Smile Awards Gala at the
Decatur House on Lafayette Square
in Washington, D.C. For the third
year in a row, CareCredit donated
$100,000 to the fund.
The CareCredit donation has
enabled five key programs to expand
services and access to care for children in underserved communities.
The Hispanic Dental Association,
National Dental Association and
Oral Health America were selected
to receive 2010 grants to continue to
expand the availability of dental care
to underserved children.
The Hispanic Dental Association
is using the funding for outreach
programs that identify disadvantaged children and provide preventive services in Los Angeles, Dallas
and Boston.
The National Dental Association
is enhancing the Deamonte Driver Dental Project, which provides
oral health education through local
health fairs and connects vulnerable
children with a network of volunteer
dentists.
Oral Health America’s grant will

HYGIENE TRIBUNE

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.

The National Dental Association is
awarded a $15,000 grant from the
ADA Foundation Give Kids A Smile
Fund during a recent awards gala.
Pictured from left are Robert Henderson, PhD, ADA Foundation Board
of Directors; Dr. Darrell Clark, NDA;
Dr. Edward Chappelle, NDA; Steve
Kess, ADA GKAS National Advisory
Board chair; Dr. Hazel Harper,
NDA; Dr. Belinda Carver-Taylor,
NDA; Dr. Walter Owens, NDA; and
NDA Executive Director Robert S.
Johns. (Photo/Provided by ADA
News)
Today, CareCredit is offered by
more than 85,000 dental teams.
CareCredit is exclusively selected
for their members by most state and
national dental associations, including ADA Business Resources, AGD,
AAOMS and AAP, and is also recommended by leading practice management consultants.
The awards gala was held April
13. HT

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
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us know by e-mailing feedback@dentaltribune.com. We look forward to hearing
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to process.

[23] =>

Hygiene Tribune | June 2010

Clinical

f HT page 1C
patient is willing to put in the time
and effort. Because of the banding
of this type of stain and the deepseated hue, the most rapid and dramatic results will be with in-office
bleaching.
Depending on the severity of the
stain, this procedure may need to
be repeated, spacing appointments
no sooner than one week apart.
Often a patient with tetracycline
stains will still need six months or
more of home bleaching to achieve
a satisfactory shade.

How to approach patients
An easy way to approach patients
about bleaching is to make shade
assessment part of the recare
exam. Patients can be informed
that because teeth naturally darken
over time, a baseline shade will be
recorded.
Keep a shade-guide handy and
have it arranged in color value
order, rather than the usual ABCD
order. The progression for light
to dark value order is shown in
figure 1.
Have the patient agree to the
shade and then ask if he or she is
interested in bleaching. Because
most teeth will change an average
of eight to 10 shades, a very significant potential result can be shown
to the patient if he or she inquires
about the final shade.
Always document final bleaching shades with a photo of the teeth
and the matching color swatch
from the shade guide, again having
the patient agree on the shade.

Conclusion
Teeth bleaching can be a wonderful
“gateway” procedure, opening up
many other cosmetic options for
patients, and is a fun and easy way to
increase office production when the
entire dental team is on board. HT

About the author

Julie Seager, RDH, BS, is
currently practicing dental
hygiene in Northern California
and is a former RDH Practice
Adviser for Discus Dental. Her
website is www.hygienescene.
com. You may e-mail her at
juliecseager@yahoo.com.

Have you been thinking ‘outside of the box’
and seeing wonderful results in your practice?
If so, share your story with us and it might be
featured in Hygiene Tribune!
Please send stories to Group Editor
Robin Goodman at r.goodman@
dental-tribune.com.
AD

[24] =>

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[cover] => DT U.S. 1510

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