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Managing the practice micromanager (entree) / Nominations sought for Office Manager of the Year Award / Courageous & determined: Dr. Tilda Loew / Managing the practice micromanager / Five more of the top 10 reasons why associateships fail / Practice & Financial Matters / One-stop - full service ‘Web Systems’ / Industry / Cosmetic Tribune 6/2009 / Hygiene Tribune 6/2009

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

AUGUST 2009

www.dental-tribune.com

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

Getting ahead with ICOI

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" Section 1B

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

Implants vs. Endo

7+,$8,34$(+"1(,$8,4#,*$4+,$4#"$9":)-141,3$13$";4,*$(-,)56

" Section 1C

VOL. 4, NOS. 21 & 22

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

Shading technique

Natural teeth are difficult to imitate.

" Section 1D

Managing the practice Adding fluoride varnish to your armamentarium
micromanager
By Sally McKenzie, CMC

It is said that the No. 1 fear for
most people is public speaking. That
may be true unless you happen to
be a dentist/practice owner. In that
case, I would argue that for many of
these types, what they fear the most
is loss of control.
They are accustomed to doing it
all themselves, and handing over
responsibility for even seemingly
insignificant tasks can be a struggle.
Consequently, these micromanaging dentists are stressed out,
working and working, yet never able
to actually get ahead.
Forget quality of life, forget balance, forget dreams … these practi-

tioners are living their jobs.
Meanwhile, the employees working in these practices are operating
in misery mode. They are treated
like children; therefore, they act like
children. They’ve learned that the
dentist won’t be happy unless he/
she does it his/her way.
“Don’t do anything unless you’re
told. Don’t make a decision on your
own. Don’t take the initiative to
address an issue yourself. And, if
possible, please don’t think unless
directed to do so.”
It’s not an environment that quality employees will tolerate for long;
so this is why they seem to change
! !" # page 5A

!"

Fluoride varnishes have been used in Europe, Canada and Scandinavian
countries since the 1980s, but are relatively new to the United States.
!Hygiene Tribune, page 1E

FDA action on amalgam
The American Dental Association
(ADA) agrees with the U.S. Food and
Drug Administration’s (FDA) decision not to place any restriction on
the use of dental amalgam, a commonly used cavity-filling material.
The FDA ruling issued categorizes encapsulated dental amalgam as
a Class II medical device, placing it
in the same class as gold and toothcolored composite fillings.
The ADA has supported a Class
II designation for dental amalgam

since 2002, when it was first proposed by the FDA.
“The FDA has left the decision
about dental treatment right where
it needs to be — between the dentist and the patient,” states ADA
President Dr. John Findley. “This
decision underscores what the ADA
has long supported — a discussion
between dentists and patients about
the full range of treatment options
! !" # page 2A
!"

Dental Tribune America
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Suite #801
New York, NY 10001

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[2] =>

News

DENTAL TRIBUNE | AUGUST 2009

Nominations sought for Office
Manager of the Year Award
By Fred Michmershuizen, Online Editor

Does your practice have an
exceptional office manager? Someone who makes your workday fly by
with ease, someone who takes care
of you, your associates and your
patients with incredible skill and
talent? If so, the American Association of Dental Office Managers
(AADOM) wants to hear from you.
The AADOM is holding its fifth
annual Office Manager of the Year
Award, and it is accepting nominations through Sept. 14
Behind every successful practice
is an office manager who displays
innovative thinking, business acumen and leadership qualities. Just
ask Melanie Duncan, the 2008 winner of the AADOM Office Manager
of the Year Award.
“I love problem solving, whether
it be computer issues, scheduling
problems or helping patients find a
way to pay for care,” Duncan said.
“I truly love helping people achieve
the best oral health possible.”
Each year at its annual conference, the AADOM recognizes exceptional individuals such as Duncan
and highlights their accomplishments. The annual Dental Office
Managers Conference will be held
Oct. 16 and 17 in Las Vegas.
The AADOM is the country’s larg!"$

DENTAL TRIBUNE
The World’s Dental Newspaper · US Edition

Publisher
Torsten Oemus
t.oemus@dtamerica.com
President & CEO
Peter Witteczek
p.witteczek@dtamerica.com
Chief Operating Officer
Eric Seid
e.seid@dtamerica.com
Group Editor & Designer
Robin Goodman
r.goodman@dtamerica.com
Editor in Chief Dental Tribune
Dr. David L. Hoexter
d.hoexter@dtamerica.com
Managing Editor/Designer
Implant Tribune & Endo Tribune
Sierra Rendon
s.rendon@dtamerica.com
Managing Editor/Designer
Ortho Tribune & Show Dailies
Kristine Colker
k.colker@dtamerica.com
Online Editor
Fred Michmershuizen
f.michmershuizen@dtamerica.com

With its annual Office Manager of the Year Award, the AADOM recognizes
excellence in office management.
est professional organization for
office managers, practice administrators and other practice management staff. The AADOM is committed to creating and maintaining a
network of dental professionals to
share resources and information,
helping all members achieve the
highest level of professional and
personal development.
The 2009 AADOM Office Manager of the Year will be featured on the
cover of The Observer, AADOM’s

publication for dental office managers; will receive free registration
in 2010 to the annual Dental Office
Managers Conference; and a check
for $1,000 courtesy of CareCredit,
AADOM’s founding partner.
“We’re delighted to support the
AADOM in recognizing the valuable contribution these professionals have made, and support their
professional and personal growth,”
said Cindy Hearn, CareCredit’s
senior vice president of marketing.
For nomination details and information about the conference, visit
www.dentalmanagers.com. !"

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

Dental Tribune America, LLC
213 West 35th Street, Suite 801
New York, NY 10001
Tel.: (212) 244-7181
Fax: (212) 244-7185

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

# !" #page 1A
to help patients make educated decisions regarding their dental care.”
Dental amalgam is a cavity-filling material made by combining
mercury with other metals such as
silver, copper and tin. Numerous
scientific studies conducted over the
past several decades, including two
large clinical trials published in the
April 2006 Journal of the American
Medical Association, indicate dental amalgam is a safe and effective
cavity-filling material for children
and others.
And, in its 2009 review of the scientific literature on amalgam safety, the ADA’s Council on Scientific
Affairs reaffirmed that the scientific
evidence continues to support amalgam as a valuable, viable and safe
choice for dental patients.
“Dentists are doctors specializing
in oral health care,” Findley states.
“We encourage people to talk with
their dentists if they have any questions about their oral health.”
Additional information about dental amalgam and other cavity-filling
materials may be found on the ADA’s
Web site at www.ada.org. !"
(Source: ADA)

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

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

[3] =>

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[4] =>

Extraordinary Dentist

DENTAL TRIBUNE | AUGUST 2009

Courageous & determined: Dr. Tilda Loew
This is one in a series of articles devoted to recognizing extraordinary individuals who
overcame great adversity to practice dentistry
By David L. Hoexter, DMD, FACD, FICD,
Editor in Chief

Heart pounding, nerves on edge,
tension and pressure mounting …
do you remember taking the dental practical examination for licensure? Everything you have been
working for the past four years
culminates in this practical test.
Even though you have passed
all the written and oral exams
given to you for the past four years,
everything depends on passing this
practical exam now.
To practice the art of dentistry,
to earn an income, to provide a living, to pay off debts incurred these
past years, to feed your family, to
pay the rent … all depends on this
test. Compounding the strain are
questions such as: Will the patient
that you need to produce the specific restorations show up? Is the
grading instructor going to be in a
bad mood?
Now imagine taking this exam
three different times at 10-year
intervals, each time in a different
!"

country and each in a different language. This is what Dr. Tilda Loew
had to do to continue to practice
dentistry.
Living in Bulgaria and a mother
of two, Loew dreamed of being
a dentist. To achieve her dream,
she attended dental school, passed
the arduous practical exams and
opened her own clinic. She continued her practice through Germany’s invasion of Bulgaria during
World War II and afterward. Then
the Russians had taken control of
Bulgaria, executing political dissidents in the name of Communism.
Suddenly, Loew’s husband was
arrested, accused and sentenced to
death as a dissident. Loew walked
20 miles to the police station, stood
tall (all five feet of her), shook her
finger at the police officer and
in a persuasive diatribe, earnestly
convinced him that her husband
was innocent. Incredibly, he was
released on the spot.
Fleeing Bulgaria, Loew and her
family found themselves in Israel.
Not speaking the language, she

‘Imagine
passing the
dentistry
exam in three
different
countries’
immediately acquired a job as a
dentist in a clinic and found living
quarters for the family. She quickly
learned Hebrew and passed the
exhaustive and strenuous dental
licensure examination once again
so that she could practice dentistry
privately.
Years passed and Loew’s children moved to England and then
to America. She followed to be
close to her children in the United
States. Again, the yearning to be
independent and practice dentistry
beckoned. She not only learned
English and attended dental classes, but she passed her licensure
exams and opened a successful
practice in Manhattan. She continued to take continuing education
courses, always keeping abreast
and up to date, even before regulations were enacted mandating this.
Loew has recently retired at the
age of 90. Yet, she volunteers as
she always did, to participate in the
Greater New York Dental Meeting (GNYDM), a meeting that consistently draws more than 50,000
people each year.
She also continues to take dental
education courses to keep herself
informed about her chosen passion. You can recognize her each
year at the GNYDM; she is the one
with the bright contagious smile.
Her daughter and son-in-law
have represented the United States
as ambassadors to Romania, and
her son, Dr. Anton Loew, and his
family have settled in New York as
well. Recently, Dr. Tilda Loew was
honored at an elaborate 90th year
birthday party. People came from
all over the world to celebrate with
her. One could hear her conversing in several languages to numerous adoring people. It was quite a
tribute for this remarkable woman.
Dr. Tilda Loew is a woman
whose burning desire to practice dentistry overcame political
burdens and language obstacles.
She fiercely defied adversity to

save her husband and practiced
dentistry in three different countries. She is a brilliant and vibrant
woman who felt privileged to have
the opportunity to be a dentist and
felt it a privilege to be allowed
to take a dental licensure exam.
She truly deserves our tribute and
appreciation. !"

About the author

Dr. David L. Hoexter is director of the International Academy
for Dental Facial Esthetics, and
a clinical professor in periodontics at Temple University, Philadelphia. He is a diplomate of
implantology in the International
Congress of Oral Implantologists
as well as the American Society
of Osseointegration, and a diplomate of the American Board of
Aesthetic Dentistry.
Hoexter lectures throughout
the world and has published
nationally and internationally. He
has been awarded 11 fellowships,
including FACD, FICD and
Pierre Fauchard. He maintains
a practice at 654 Madison
Ave., New York City, limited to
periodontics, implantology and
esthetic surgery.
He can be reached at (212)
355-0004 or drdavidlh@aol.com.

[5] =>

DENTAL TRIBUNE | AUGUST 2009

Practice Matters

# !" #page 1A
with the seasons.
By nature, dentists are high
achievers, and thus more likely to
be micromanagers. They didn’t get
through dental school by leaving the
details to someone else. Most are
intense, focused perfectionists. In
fairness, oftentimes the micromanaging dentist feels a strong sense
of responsibility. He/she may well
have built the practice from the
ground up and may feel that he/she
must control all aspects of it.
However, like most micromanagers, they tend to confuse activity
with accomplishment and, consequently, create bottlenecks of inefficiency. Even more frustrating for
these dentists and their staffs is the
fact that they are quite capable of
thinking strategically, but they simply cannot bring themselves to relinquish control.
They will not allow others to
problem solve, and they consistently
second-guess decisions. Yet, if the
practice is going to grow and truly
succeed, the dentist simply must
let go.
So how do you help a micromanaging dentist to relinquish a few of
those tightly held responsibilities?
Read on.

Strategies for staff
Don’t try to change your micromanaging dentist — only he/she can do
that. Instead, work with what you
have. One of the greatest needs your
micromanager has, outside the need
to feel needed, is the need to know.
Try to understand where the dentist
is coming from.
How can you help your dentist
achieve the goals and objectives that
he/she has for the entire practice?
Where does he/she want to take the
business? What matters most to this
person in terms of goals? What can
you do to help?
For example, perhaps your
micromanaging dentist really wants
more time for treatment planning
to encourage greater case acceptance, but at the same time insists
on giving all patients their post-op
instructions, which only puts everyone behind schedule.
Develop a detailed, step-by-step
plan that outlines how you could help
the dentist with this duty. Explain to
the dentist that you would like to
handle this in a way that he/she will
be completely comfortable with and
confident that patients receive the
post-op information they need.
Trust is critical to the micromanager. Take steps to build it by
keeping him/her informed from the
beginning and at every step along
the way. Even though you are perfectly capable of completing the task
without direction from the dentist,
be open to his/her input and suggestions.
Most importantly, be completely
dependable. If you drop the ball on
responsibilities that you’ve committed to, your micromanaging dentist
will not feel that he/she can trust
you and will swoop in and take over

yet again.
Stay one step ahead of your
micromanaging boss by updating
him/her regularly. You cannot communicate too much with this type of
person, but it is very easy to fall into
the trap of thinking that you’ve done
everything you need to keep him/
her informed.
If the dentist has to ask you about
the status of something you have
agreed to complete on her behalf,
you’re not holding up your end of
the bargain in her eyes.

‘Dentist, live and let go of the
minutia.’
How do you spend your days in the
office? I know it sounds like an obvious question, but I suspect that many
of you dentists would be surprised if
you took a close look at what actually consumes a fair amount of your
time. Certainly, you’re diagnosing
and treating patients, but just how
many of your working hours are
spent on other less important tasks?
Carry a notepad with you for
three to five days and write down
everything you do relating to your
practice, including reviewing patient
records, restocking paper products
in the bathrooms, talking to patients,
directing staff, calling in prescriptions, completing forms, evaluating
prices on supplies, straightening the
magazines in the reception area,
cleaning out the refrigerator, etc.
After you’ve gathered your data,
take a good look at the list. Is it
full of items that only the dentist
can do? Or do you have a multitude of duties that the staff, whether
it’s the assistant, hygienist, associate dentist, scheduling coordinator,
business manager, etc., could and
should be doing?
Lastly, are there items on that
list that no one should be doing
because they should be outsourced
or because of a lack of technology or
broken systems?
You know all too well that there
are only so many hours in a day.
You want to ensure that yours are
spent wisely, not squandered away
on activities with little or no return
to your practice. And this requires
that you invest some of that time

learning the art of delegation.

‘Dentist, delegate, delegate,
delegate … and communicate.’
From the list that you created,
choose the top items that directly
affect the growth of your practice,
specifically diagnosing and treating patients. Most everything else
on that list, such as giving post-op
instructions, developing the agenda
for the next staff meeting, mediating
the latest staff tiff, changing the light
bulbs, etc., should be delegated.
Now, before you panic at the
thought of relinquishing those
duties that you feel only you can do,
develop a plan to ensure that this
transition of tasks goes smoothly

and methodically.
Start by sharing your vision with
your staff. Are you the only one
who knows where you want to take
your practice? Being part of a team
means understanding the ultimate
goals and being vested in achieving
those goals.
Next, assess the strengths of those
you’ve surrounded yourself with.
No, they are not you. No, they didn’t
go to dental school. But, if you’ve
done your job and hired effectively,
chances are that your employees
will not only welcome the opportunity to grow as professionals, they
will excel as a result of it.
Consider the fact that professional training for some may be
necessary to ensure that they have
the opportunity to successfully meet
your expectations. Your objective in
delegating is to provide the resources to ensure that those charged with
these new responsibilities will succeed.
That also requires you to clearly
communicate your expectations.
Perhaps no one has been able to
meet your standards because no one
really knows what or how it is that
you want something done. Effective
delegation requires that the employee knows exactly what outcome you
want him/her to achieve.
For example, if you are going to
delegate delivering post-op instructions to your assistant, presumably
you want patients to leave fully
understanding which homecare
steps they will need to follow.
! !" # page 8A
!"$

About the author

[6] =>

Financial Matters

DENTAL TRIBUNE | AUGUST 2009

Five more of the top 10 reasons why associateships fail
By Eugene W. Heller, DDS

The “American Dream” is still to
own a home. The “Dentist’s Dream”
continues to be the ownership of
a practice. Thirty years ago, the
“dream” was to graduate from dental school, buy equipment, hang out
a shingle and start practicing. Today
the road to ownership is a little different.
Due to extensive debt, most new
graduates enter practice as associates to improve their clinical skills,
increase their speed and proficiency,
and learn more about the business
aspects of dentistry. Most hope the
newfound associateship will lead to

an eventual ownership position.
Instead, many find themselves
building up the value of their host
dentist’s practice, only to be forced
to leave. This forced departure is the
result of a non-compete agreement
when the promised buy-in/buy-out
doesn’t occur.
The following reveal five more
of the most common reasons many
associateships fail to result in ownership or partnership.

Reason No. 6: access to
patient base

Insufficient access to the patient
base by the associate can take different forms. Perhaps the senior dentist

never intended to turn over existing patients, but rather to give the
associate new patients or patients
obtained only by the associate’s own
efforts. Under such circumstances,
the productive capability of the
associate would be greatly compromised.
If the intended result is a partnership between the dentists, one of
the most important things that the
associate is buying is “equal access”
to the existing and new patient base.
The patient base comprises the
goodwill value of the practice and
typically constitutes 70 to 80 percent
of the value of a practice.
If the senior dentist fails to rec-

2009

Greater New York Dental Meeting
85

NO
Registration
Fee

Annual Session

ognize the need to turn over existing patients to the associate, then
the associate will be frustrated by
his/her efforts to produce dentistry,
earn a salary and improve skills.
It is common for the senior dentist to be concerned about turning
over existing patients; however, this
must occur if the relationship is to
blossom into ownership.

Reason No. 7: letting go

This problem is related to the senior
dentist’s unwillingness or inability to “let go” and turn treatment
responsibility over to the new dentist. In the case of a senior dentist
who is close to retirement, this may
be a very emotional decision. When
the senior dentist has identified
retirement pursuits, there will be a
greater ability to turn over practice
responsibilities to another dentist.
The new dentist who is considering an associateship should investigate the senior dentist’s outside
interests and activities in support
of an easier transition. Good signs
indicate that the senior dentist will
have no problem “letting go.”
Conversely, the senior dentist
who is proud of the number of hours
“lived” at the office or who has no
other interests in life should raise
serious concern on the part of the
new dentist as to whether or not this
dentist is willing to let go.

Reason No. 8:
philosophically speaking

Meeting Dates:
November 27th - December 2nd

Exhibit Dates:
November 29th - December 2nd

Mark Your Calendar

Reason No. 9: a good match

Unfortunately, personality conflicts
are a frequent reason for associate-

The Greater New York Dental Meeting is the Largest
Dental Convention/Exhibition/Congress in the United States

Untitled-1 1

Different business and/or practice
philosophies may reveal incompatibilities that may retard successful
completion of the practice sale. This
particular problem deals with integrity issues as well. It is important
for the new dentist to ascertain the
attitudes and philosophies demonstrated by the senior dentist.
A senior dentist who is willing
to share his/her practice numbers,
profit and loss statements and tax
returns with the new dentist generally indicates a dentist who is open
and honest. A dentist who is unwilling to share numbers and personal
financial information will probably
not change.
One important question to ask
a dentist who has been in practice
for more than 20 years is the status
of that dentist’s retirement plans. If
the senior dentist is having financial
stresses after 20 years of practice,
the partnership will probably not
occur.
A dentist who has a well-funded
pension/profit-sharing plan and is
proud of personal financial accomplishments provides a strong indicator that the practice will be strong
enough to launch the new dentist
into a similar state.

! !" # page 8A
12/24/08 9:51:32 AM

[7] =>

[8] =>

Practice & Financial Matters

# !" #page 5A
Tell your assistant exactly what
you want him/her to cover with
patients. Anticipate questions that
the patient might ask and formulate answers. Identify which written
materials will be given to patients.
Determine who will place follow-up
phone calls to patients, etc.
Together you can create a checklist of what is to be covered during the post-op discussion, which
will help the assistant understand
exactly what’s expected and put you
at ease in relinquishing this responsibility.
Or better yet, give general guidelines as to how you want the job carried out and be willing to allow the
staff member to complete the task
according to the plan he/she develops. Understandably, the staff member may take a somewhat different
approach than you do to achieve the
same outcome.
Encourage your staff to ask questions and be patient in answering
them. Remember, they are not going
to complete every task exactly the
way that you would, and they may
make a mistake or two along the
way.
Yet with ongoing positive and
constructive feedback, they will
develop the skills and confidence
that will enable you and your team
to achieve a whole new level of success. !"

About the author

Molar ‘seating’ anyone?
You’re a fantastic practitioner, and
when you go to dental meetings across
the country you focus mostly on the
educational opportunities and products
that allow you to provide the very best
in patient care. But how much fun are
you having with your patients and staff?
Kids will enjoy sitting on this giant
molar — made of durable plastic, not
dentin. We found this — and many
other fun products such as tooth-shaped
golf tees, tooth-shaped earrings, and
more — at the Museum Shop at Baltimore’s National Museum of Dentistry
(www.dentalmuseum.org/shop).

# !" #page 6A
ships failing to lead to buy-ins/buyouts. If two dentists have conflicting
personalities, there may be stress
and friction within the practice,
which will spill over onto the staff
and patients.
A few common-sense rules can
easily determine whether a potential for conflict exists. The assessment for personality conflicts will be
ongoing during the initial interview
process.
If there are significant concerns
about compatibility for dentists who
will be in a partnership arrangement spanning from three to five
years, the warning signs should be
carefully evaluated at the onset.
If a long-term relationship is
intended, it may be prudent to seek
professional personality assessments.

Reason No. 10: good advice

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

DENTAL TRIBUNE | AUGUST 2009

The final reason has, in fact, nothing
to do with the dentists or the practice. Instead, individual attorneys
have proceeded to cause problems
in the relationship.
It is extremely important that
both dentists realize the boundaries that must be set relative to their
attorneys’ involvement in finalizing
the buy-in/buy-out arrangements.
Attorneys should be your advisors,
not your decision-makers.
The negotiations relative to the
proposed buy-in/buy-out were conducted at the onset of your relationship as detailed in the Letter of
Intent.
Attorneys are not hired to “rene-

gotiate” the transaction. Attorneys’
personalities and styles should not
spill over into the dentists’ relationship.
Problems occurring while producing the Employment Agreement
and the Letter of Intent may be an
indication of significant problems
that can be anticipated at the conclusion of the employment period
and during the preparation of Partnership Agreements.

Summary

This article has been aimed primarily at a one-dentist practice
evolving to a two-dentist practice;
however, the issues apply equally
to larger group practices.
One-to-two-year associateships
with the senior dentist retiring
at the end of the associateship
and a three-to-five-year partnership ending with the new dentist
purchasing the remaining equity
position of the senior dentist at the
end of five years can also benefit
from the insights provided in this
article.
Unfortunately, nothing can
guarantee a successful outcome.
However, by identifying the potential pitfalls at the beginning of the
relationship, chances of success
can be greatly improved. !"

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

[9] =>

DENTAL TRIBUNE | AUGUST 2009

Industry

9A

One-stop, full service ‘Web Systems’
From customized Web sites to 3-D patient education videos, American Dental Software offers the full array of marketing
and educational software for the modern dental practice
You may ask yourself, “What is a
Web System?” Well, it is a fully functioning group of software programs
that incorporate a fully customizable
Web site, 3-D patient education videos,
HIPAA-compliant patient forms and
completely environmentally friendly
transfer of documentation as well as
patient communication software.
These are just a few of the tools
to help market your practice to millions of people over the Web, and in
your practice to your existing patient
population.
“We like to think of ourselves as
the one-stop company for the needs
of dentists when it comes to Internet
presence, marketing and software,”
says Senthil Kumar, co-founder and
CTO of American Dental Software.
“We started out as a company providing customized Web sites with
unlimited changes for dentists, and
since our humble beginnings we have
successfully developed a complete
Web system for the dental community.”
American Dental Software, a part
of Siva Solutions, got its start when
Kumar’s wife, Dr. Keerthi Senthil, cofounder and CEO, returned from one
of her lectures and handed Kumar
a brochure of a Web site company
charging a lot of money for a simple
site.
“Her thought was, ‘Everyone thinks
dentists have a lot of money and want
to overcharge them,’” Kumar says.
“We wanted to offer services and products at a more reasonable and honest
price.”
Since then, American Dental Software has focused mainly on providing customized Web sites to dentists,
with the level of involvement strictly
up to the dentist. The company offers
unlimited changes and content as well
as unlimited videos, interactive patient
forms that are HIPAA compliant and
unlimited support.

Web site package details
Every Web site from American Dental
Software comes with viewer customizable features such as increasing the
size and changing the color of the text
as well as changing the overall look of
the site.
Some of the other features included
with every Web site are a dedicated
search engine, blogs, directions linked
to Google maps, a FAQ page, postop instructions, 100 e-mail addresses
connected to the site, gallery pages
and online chats.
All clients receive two Web sites:
one with flash animation, which can
be viewed by patients with high-speed
connections, and another version
without any flash animation for people
who use dial-up.
Turnaround time for the initial Web
site and any changes along the build! !" # page 10A

Client testimonial
“I began to see the importance of a Web site when I realized that I could have my patients and referring doctors consult my site
and learn, clarify and introduce themselves to my office and the services I provide. At the AAOMS meeting in Honolulu I visited
several display booths and found the American Dental Software booth to be friendly, unpretentious and helpful. They listened
to my needs and assured me that they could provide a Web site that I,s my referrals and my patients would find user friendly.
“During the development phase of my Web site, the company was available, informed and willing to help at all levels to
build a Web site that reflected my values, my interests and my office philosophy. The cost was reasonable and included all
changes and updates that I would require as long as I wanted. I am glad to recommend its services to anyone in preparing a
Web site that you can be proud of.”
Vincent W. Farhood, DDS, FACD
Vacaville Oral Surgery, www.VacavilleOralSurgery.com
!"

[10] =>

10A Industry

DENTAL TRIBUNE | AUGUST 2009

# !" #page 9A
ing process is just one day, and the
dentists can give as much or as little
information as they like.
“We can build whatever the doctor

wants,” says Kumar, adding that some
dentists like to match their Web site
colors to their business cards and others to their office décor. “We can do it,
and at no additional cost.”
“Word-of-mouth marketing has

been proven to be the most effective
way to build new clients. A Web site,
which is an extension of your practice,
allows prospective patients to view
your services and learn more about
your office from the comfort of their
home,” Kumar added.

3-D patient education

!"

P&F Ad-DTA

1/14/09

2:45 PM

Although American Dental Software is
primarily focused on customized Web
sites, the company’s products do not
stop there. Three-dimensional patient
education and other tools to help dentists grow their practices also play a
strong role in the product line, which
is continually growing.
Three-dimensional patient education software, not only explains to
patients what exactly each procedure
is, but also explains the consequences
of non treatment in a clear, concise

Page 1

manner.
“Most of the time, doctors come in
and give presentations on why patients
should have treatment,” Kumar says.
“But what happens if they don’t have
the treatment done? We want them to
understand the consequences of inadequate treatment.”
Kumar says the software covers
most of the procedures a dentist would
normally perform, and as American
Dental Software continues to grow, so
does the library of procedures.

Continuous reception play
Along those same lines, American
Dental Software has just introduced
its continuous reception play. On a
monitor in the waiting room, videos on
topics such as implants versus bridges
or the need for veneers will play along
with videos that inform patients about
specials that are being offered at the
practice.
“It’s a way for patients to keep their
minds working while they are waiting,” Kumar says. “A patient might see
something out in the waiting room and
then go in to ask the dentist.”

Telephone/voice service
™

Another important product is the telephone/voice service. This includes
having patients fill out a survey or form
via an automated phone call. American
Dental Software also provides automatic appointment reminders, either
by phone, text or e-mail, which let the
patient confirm or reschedule.

HIPAA compliance
American Dental Software also offers
the option to have all of your forms
(medical history, insurance, new
patient registration) converted and
uploaded onto your Web site. Doing
so allows your patients to complete the
form online and submit them 128-bit
encrypted and fully HIPAA compliant
to your practice.

*

Instant connection to the practice
Sometimes, Kumar says, prospective
patients looking at a Web site want to
talk to the office immediately. American Dental Software has an option
where patients can click a button on
the site and be automatically connected to the office.
These calls can be recorded so
dentists can listen to them later as a
way to gauge quality control. At the
same time, the company offers a way
for dentists to track these calls along
with the number of people who have
clicked on the site.

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

Search engine optimization

For technical information
contact Pulpdent at

“How good is a Web site if people can’t
find it?” Kumar says, and then adds
that American Dental Software can
help dentists ensure their sites will
pop up high on search engines such as
Google and Yahoo.

800-343-4342
Order through your dental dealer.

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

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An industry leader
Overall, Kumar says American Dental Software will keep innovating and
leading the industry by offering the
dental community great products and
customer service at affordable prices.
! !" # page 12A

[11] =>

[12] =>

12A Industry

DENTAL TRIBUNE | AUGUST 2009

!"

!"#$%&'()"*#&"+(,-.*/"&
0*.1$*2-13$&43$&5"#161-.&
#6$$37&230%&*89,6#1.&*#&
:3$1)&;8"$*(6<&;-.1$6,*6&
6#0&:"7&="6,6#0
Agreement expands Henry Schein’s offering to
cover full breadth of dental implants

Henry Schein (NASDAQ:HSIC), the largest distributor of health care products and services to
office-based practitioners, and Dentatus, an innovative designer and manufacturer of precision hightech dental products, recently announced a five-year
agreement establishing Henry Schein as the exclusive distributor of the Dentatus Atlas narrow body
implant system in North America, Australia and New
Zealand. Through this agreement, Henry Schein
will now be able to offer dental practitioners the full
breadth of dental implants.
“In this important and growing market, the Dentatus Atlas system stands apart and is distinctly different
from other systems, with clear benefits that shorten
healing time and increase patient comfort,” said Stanley Bergman, chairman and CEO of Henry Schein.
“In North America alone, we estimate the edentulous population who could benefit from this technology to be approximately 50 million people, with
projected 6 million new edentulous patients per year.
We look forward to working closely with Dentatus
to offer these important new products to our North
American, Australian and New Zealand dental customers.”
The Dentatus Atlas implants surrounded with the
Tuf-Link Resilient Denture liner provides secure
retention and cushioned patient comfort. The
implant’s low profile eliminates the need to drasti! !" # page 13A

# !" #page 10A
“If a technology exists that is beneficial to dentists,
we offer it or are in the process of offering it very
shortly,” he says. “We have a very simple philosophy:
If our clients are doing well, we will be taken care of.
So we have an interest in the success of our clients.”
To see for yourself what American Dental Software has to offer, stop by the booth at an upcoming
show such as ICOI in Vancouver or AAP in Boston.
Or, for more information, contact American Dental
Software at (866) 342-6547, by e-mail at sales@AmericanDentalSoft ware.com and online at www.Ameri
canDentalSoftware.com. !"

[13] =>

Industry 13A

DENTAL TRIBUNE | AUGUST 2009

Dentistry grown up:
utilizing sedation to
care for children
By Alex Harris & Michelle Hannah

Savalife M100: Save time,
money … and lives
Every year in the United States,
30,608 emergencies occur in dental
offices, according to the American
Dental Association. So that they can
respond when one of them inevitably occurs in their office, dentists
must have an appropriate emergency response plan and appropriate emergency response equipment
to match.
Savalife’s Quick Response M100
emergency drug kit includes the
pre-filled syringes, sprays and inhalants needed to quickly and effectively treat common patient emergencies, including those related to
angina, asthma, insulin problems,

allergic reactions, fainting, heart
attacks and more.
As convenient as it is necessary,
the kit saves patients’ lives while
also saving dentists’ practices, as
appropriate emergency response
can reduce dentists’ exposure to risk
and liability.
What’s more, because the kit is
free when they sign up for Savalife’s
Automatic Drug Refill Program, it
allows dentists to invest their time
and money where it belongs — with
their patients.
For more information or to order,
call (800) 933-5885 or visit www.
savalife.com.

# !" #page 12A

Dentures can be easily removed and
reseated without any stress. Patients
are able to laugh, smile, maintain a
nutritious diet and eat their favorite
foods with confidence.
Dentatus Atlas implants provide
patients with substantial relief from
the pain and discomfort they previously endured with ill-fitting dentures,
while stimulating the jawbone so less
bone is lost. Dentures fit more comfortably and properly support facial
features that may have been previously lost, enhancing a patient’s self
esteem.
“In Henry Schein, we believe that
we have found a sophisticated distribution partner that can compellingly
communicate the significant benefits
of the Dentatus Atlas system to dental practitioners,” said Bernard Weissman, president of Dentatus USA.
“The company’s track record of
success in growing technology-driven
products is impressive, and we look
forward to a close collaboration that
will strengthen the position of this
innovative implant system in these
important markets.” !"

cally reduce the denture, and its small
diameter allows placement where significant bone loss has occurred without bone augmentation.
The Atlas flapless surgical procedure, which is significantly less expensive than a conventional implant procedure, shortens healing time and
reduces discomfort.
The procedure requires no surgical incision and no sutures — both
of which are typical for wider, more
conventional implants — and it can be
performed using only local anesthesia
in the general dentist’s office in only
45 to 60 minutes. The patient can walk
out of the office wearing his or her
refitted denture right away.
With Dentatus Atlas implants, denture wearers of any age can experience healthier and better looking
smiles with comfortable and fully
functioning dentures. After undergoing the procedure, patients are able
to keep their dentures in place while
sleeping, brush them in the morning
and treat them like natural teeth.

While adults can be like children at the dentist, the reverse is
not true. There are many distinctions between adults and children
when it comes to dentistry. Failure
to recognize these distinctions can
result in significant harm and even
death. Specific training in pediatric
sedation is essential for treating
children.
Each child must be treated
according to his or her unique characteristics. Fears, age, weight, medications, supplements and allergies
are just a few factors that must be
considered. Special considerations
should be made for children who
are autistic, hyperactive, obese,
asthmatic or prone to seizures.1 An
understanding of pediatric anatomy, physiology and psychology provides the framework for safe and
effective sedation.
Using oral sedatives and/or
nitrous oxide to properly sedate
children can not only be effective
for the procedure at hand, but can
help lay the foundation for lifelong
comfort with the dentist. Even older
pediatric patients who have previously had negative experiences are
able to develop new comfort and
resolve dental anxiety.
Fear of needles (belonephobia) and other dental-related fears
often begin in childhood. Even very
young children can be emotionally
scarred by a painful dental experience. Though these young children
may be unable to understand why
they are experiencing pain, the cognitive association is formed and a
lifelong fear develops.1
Oral sedation can help resolve
these issues. Tense moments of
fear and strain transform into a
relaxed calm. The calm presents
the opportunity to complete more
high-quality dentistry in less time,
creating better patient comfort and
more practice profitability.
Sedation is not only a tool to
help anxious patients, it can also
increase patient safety. A squirming
child afraid of the dentist and the

sharp metal instruments used is a
recipe for disaster. However, when
properly sedated, a child’s procedures can be completed quickly and
safely.
Isolated cases of health emergencies represent a small possibility that dentists should be prepared for.2 Acidosis and cellular
death develop much more rapidly
in children during cardiac arrest
as they lack the oxygen reservoir
that adults have in their tissues and
blood. The cells in a child’s heart
die quickly, and thus timing is of the
utmost importance.2 A dentist must
know how to immediately and properly act in a medical emergency
should one occur.
Proper training in pediatric oral
sedation, anatomy and the psychology of children can be found at the
Pediatric Oral Sedation Dentistry
course offered by DOCS Education.
The course teaches safe, effective
and predictable oral sedation techniques, as well as safety procedures
specific to children. The differences
between children and adults are
immense. Proper knowledge and
precautions cannot be ignored.
A dentist should not assume that
sedation procedures are consistent across the board regardless
of patient age. The uniqueness of
children demands proper education
and training to protect the interests
of dentist and patient alike.
To learn more about pediatric
oral sedation and DOCS Education’s
Pediatric Oral Sedation Dentistry
course, visit DOCSeducation.org or
call (866) 592-9617. !"
1.

Dionne, R. et al. (2006). Balancing efficacy and safety in the use of
oral sedation in dental outpatients.
The Journal of the American Dental
Association, Vol. 137(4). Retrieved
from:
jada.ada.org/cgi/content/
full/137/4/502.
Malamed, Stanley F. (2004). Emergency medicine in pediatric dentistry:
preparation and management. Oral
Health, 94(2), 37–46. Retrieved July
9, 2009, from CBCA Reference. (Document ID: 566438011).
!"

[14] =>

14A Industry

DENTAL TRIBUNE | AUGUST 2009

The International Cone
Beam Institute: Educating.
Training. Connecting.
ICBI wants every dental professional to become a cone-beam expert
The International Cone Beam Institute (ICBI) is an independent organization of cone-beam, computerized
tomography (CBCT) experts that provides the highest level of education,
training and product information for
3-D technology to dental professionals worldwide at www.ExploreConeBeam.com.
As a vendor-neutral organization,
this is an industry first where a com-

pany is providing information to both
the dental professional, future imaging centers and the vendor on an
international level.
General information such as the
different cone-beam scanners available in the United States and international markets, as well as information about available third-party software, is available to everyone without
charge.
The ICBI Web site
provides in-depth and
customized
vendor
analysis to help practitioners understand this
comprehensive technology. ICBI’s educational
faculty has the industry
expertise to consult with
dental
professionals
looking to incorporate
CBCT into their practices, and to ensure that
every important question is answered during the decision making
process, including questions about medical billing and ROI (return on
investment).
For those who are
already CBCT users,
! !" # page 15A

The new Nikon D5000.

The new Canon Rebel T1i.

New cameras from Nikon & Canon
Canon and Nikon are introducing
new “upper entry level” digital SLR
cameras: the Nikon D5000 and the
Canon Rebel T1i.
The Nikon D5000 slots in between
the entry level D60 and the D90, and
splits the difference in features. The
D5000 matches the D90’s 12.3 megapixel resolution and includes the same
720P HD video clip mode.
New to the Nikon D5000 is the variangle LCD monitor that allows you to
shoot from various angles. This is the
first Nikon SLR model to feature an
adjustable LCD screen. Even if you
never use Live View, the vari-angle
screen allows you to protect the LCD
screen.
The LCD screen size is 2.7 inches
and, like the D60 (2.5 inchaes), has
230,000 pixels of screen resolution. In
comparison, the D90’s screen does not

move, but is 3 inches and has 920,000
pixels.
Canon’s newest Rebel series camera is called the T1i. The Rebel T1i
gains the 15 megapixel resolution and
the higher resolution screen from the
Canon 50D while also adding in 1080P
HD video clip capability (first seen in
the 5D Mark II).
The size and weight of the Rebel T1i
is identical to the Rebel XSi.
Visit the PhotoMed Web site to view
a chart that shows the upgrades to the
Rebel line over time, as well as more
information about the Nikon D5000. !"
PhotoMed International
14141 Covello St., #7C
Van Nuys, Calif. 91405
Tel.: (800) 998-7765
Fax: (818-) 908-5370
Web: www.photomed.net

[15] =>

Industry 15A

DENTAL TRIBUNE | AUGUST 2009

Mojo Veneer Cement shifts
confidence, not shade
Give your patients their mojo
back with the cement that leaves
shade shift behind and helps you
create a seamless, natural-looking
smile. Pentron is proud to introduce
Mojo™ Veneer Cement, the latest in
adhesive technology from Pentron
Clinical.
Mojo Cement is a light cure,
esthetic cementation system that is
designed for use with porcelain,
ceramic and composite veneer restorations. This ideal cement offers
two very important features: tryin gels that consistently match the
polymerized cement and no detect-

able shade shift.
The simple, highly versatile
shade selections designed for a simple warming or brightening of the
veneer allow this material to be used
with a wide range of veneer cases,
while offering the least amount of
detectable shade shift available.*
The corresponding water soluble
try-in gels, included in the comprehensive kit, allow for a perfect
match to the cured cement. Mojo
Cement lets you give your patients
the self confidence they deserve.
Pentron Clinical is an established
leader in the dental industry, offer-

ing a wide variety of products
to suit your restorative needs.
As a pioneer of dental adhesive
technologies, Pentron Clinical
continues to demonstrate its
commitment to advancing dentistry one innovation at a time.
The company’s portfolio of
trusted, quality dental products
includes: Fusio™ Liquid Dentin, Breeze® self-adhesive resin
cement, Lute-It Luting Cement,
FibreKleer® Posts, Bond-1® SF Solvent Free SE Adhesive, Correct Plus®
impression materials and Artiste®
Nano Composite.

# !" #page 14A

offers a connection to oral-maxillofacial radiologists who can provide
reading services to aid in the interpretation of CBCT scans.
ICBI also has a blog where users
can exchange case studies, ideas and
techniques about how to capture the
highest quality images. In addition,
ICBI members have access to special

consulting services, online training
and training seminars.
The Interntional Congress of Oral
Implantologists (ICOI), the world’s
largest implant education organization, fully endorses the ICBI. Additional partners of ICBI include Dental
Tribune International (www.dentaltribune.com) and Dental Tribune

ICBI provides training to maximize
the power of this technology and to
help them achieve an expert level of
confidence.
ICBI Web site members are able
to review case studies and get advice
from CBCT experts. In addition, ICBI

For more information visit the
Web site, www.pentron.com, or call
(203) 265-7397. !"
* when compared to leading materials

Study Club (www.DTStudyClub.com).
The International Cone Beam Institute wants every dental professional
to become a CBCT expert! Upcoming
seminars include Atlanta, Sept. 25 and
26, and Charlotte, S.C., Oct. 9 and 10.
For more information about these
seminars please visit www.Explore
ConeBeam.com. !"
!"

Dentist Preferred. Patient Approved.
t STA provides confirmation when you’re in the right
location for the intraligamentary injection
t STA allows you to anesthetize one tooth
– no collateral numbness
t STA delivers profound anesthetic for 30-45 minutes
Stop waiting for the Block, start using the
STA intraligamentary injection as
your PRIMARY technique
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is the MOST comfortable injection for the patient.

800.862.1125
www.stais4u.com

[16] =>

[17] =>

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

August 2009

www.dental-tribune.com

Vol. 2, No. 6

Shading technique in direct aesthetic restorations
By Sushil Koirala, Nepal

Natural teeth are complex in structure and difficult to imitate because
many colours are distributed through
the enamel and dentin.1 The structural components of teeth — enamel,
dentin and pulp — have different
characteristics that greatly influence
their optical properties.2
It is well accepted that the colour
of a tooth is basically determined by
its dentin component.3
Dentin represents the opaque and
complex core — rich in hue, chroma
and fluorescence — and is covered by
an enamel shell, which is translucent
and opalescent.
This diversity, and the alteration
between enamel and dentin, explain
the unique and individual nature of
the appearance of a natural tooth.
The result achieved by applying
clear and translucent material (similar to enamel) over a saturated and
opaque material (similar to dentin)
has been described as the “double
effect layer.”3
Clinically, it is very important
to have a detailed examination of
colour, opacity, translucency, texture,
surface gloss and the presence of
any special characterization such as
hypo-calcification, stain crack, etc. of
the tooth in need of restoration.
The detailed study of these components and colour mapping are quite
helpful in choosing the appropriate
restorative materials and shading
technique.
There are two shading techniques
commonly used in direct aesthetic
restorations: the blended shading
technique and the layered shading
technique.
Blended shading technique
In this shading technique, also known
as the traditional shading method,
two or more shaded restorative materials might be used to match the real
shade of a tooth in different regions
(Fig. 1).
Restorative materials with different chroma are used and blended
together with overlapping surfaces to
create the desired effect. The “double
effect layer” concept is not applied in
this technique.4

Fig. 1: Blended shading technique.

Fig. 2: Layered shading technique.

Fig. 3a: White spots on teeth #11 and
21.

Fig. 3b: Mono-layered shading
technique.

Fig. 3c: Selective grinding of white
spot.

Fig. 3d: Application of enamel shade.

Fig. 3e: After finishing and polishing.

Fig. 4a: Cervical abrasion on teeth
#23, 24 and 25.

Fig. 4b: Bi-layered shading technique.

Fig. 4c: Application of dentin shade.

Fig. 4d: Application of enamel shade.

Fig. 4e: After finishing and polishing.

Layered shading technique
This technique, also known as the
natural shading technique, is based
upon the anatomic and optical characteristic of the natural teeth and
emphasises the importance of using
materials specifically designed to
emulate the dentin and enamel layer
g CT page 3D

[18] =>

2D News

Cosmetic Tribune | August 2009

A great smile makes you appear smarter, more successful COSMETIC TRIBUNE
The World’s Dental Newspaper · US Edition

By Fred Michmershuizen, Online Editor

It’s no surprise that an improved
smile can make a person appear
more intelligent, successful and
attractive. Research conducted by
Chicago-based Beall Research &
Training, on behalf of the American Academy of Cosmetic Dentistry
(AACD), backs that up.
Dr. Anne Beall, a social psychologist and market research professional, carried out the independent
study for the AACD.
Pictures of individuals before and
after undergoing cosmetic dentistry
procedures were shown to more
than 500 Americans, a statistically
valid cross section of the population.
AD

The respondents were asked to
quickly judge their impressions of
the people in the pictures.
Those with improved smiles were
rated more attractive, intelligent,
happy, successful in their career,
friendly, interesting, kind, wealthy,
popular with the opposite sex and
sensitive to other people.
“We’ve been telling people that a
beautiful smile was a great investment in their futures. Now we have
independent evidence,” said Dr.
Marty Zase, president of the AACD.
Perhaps what’s most interesting
is that the respondents were not told
that the study had anything to do
with dentistry. CT

(Source: AACD)

A better smile makes you appear more
successful all around, according to a
survey.

Editor in Chief Cosmetic Tribune
Dr. Lorin Berland
d.berland@dtamerica.com
Managing Editor/Designer
Implant & Endo Tribune
Sierra Rendon
s.rendon@dtamerica.com
Managing Editor/Designer
Ortho Tribune & Show Dailies
Kristine Colker
k.colker@dtamerica.com
Online Editor
Fred Michmershuizen
f.michmershuizen@dtamerica.com
Product & Account Manager
Mark Eisen
m.eisen@dtamerica.com
Marketing Manager
Anna Wlodarczyk
a.wlodarczyk@dtamerica.com
Sales & Marketing Assistant
Lorrie Young
l.young@dtamerica.com
C.E. Manager
Julia E. Wehkamp
E-mail: j.wehkamp@dtamerica.com

Dental Tribune America, LLC
213 West 35th Street, Suite 801
New York, NY 10001
Tel.: (212) 244-7181
Fax: (212) 244-7185

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

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

Tell us what
you think!
Do you have general comments or criticism you would like to share? Is there
a particular topic you would like to see
articles about in Cosmetic Tribune?
Let us know by e-mailing feedback@
dtamerica.com. We look forward to
hearing from you!

[19] =>

Clinical

Cosmetic Tribune | August 2009

f CT page 1D

Fig. 5a: Non-vital and discoloured
teeth #11, 21 and 22.

Fig. 5c: Application of opaque (flowable) shade to mask discolouration.

Fig. 5d: Application of final enamel
shade.

Fig. 5b: Tri-layered shading technique.

Fig. 5e: After finishing and polishing.

Fig. 6a: Fractured teeth #11 and 21.

Fig. 6b: Complex bi-layered shading
technique.

Fig. 6c: Creating a flowable frame
using translucent enamel.

Fig. 6d: Flowable frame after curing.

Fig. 6e: Application of white tint
after dentin shade.

Fig. 6f: Application of final enamel
shade.

Fig. 6g: After finishing and polishing.

of the natural teeth.
This technique involves the correct selection of a dentin and enamel
group of materials with their layerby-layer arrangement (Fig. 2).1 An
opaque and effect group of materials are also used during the layering procedure to achieve the desired
tooth characterisation.
Various concepts of layered shading techniques — e.g., basic, classic,
modern and trendy — are used in
direct aesthetic restorations.
Each of these concepts is based
on the specific arrangement of the
two or three layers of the restorative
materials usually needed for large
Class III and Class IV restorations or
incisal build-ups.
None of the above concepts mention single- or mono-layering techniques, which are frequently used in
aesthetic dentistry.
These concepts are hard to understand, not comprehensive and also

do not explain the clinical use of a
special opaque group of materials.
Hence, the layering techniques may
be better classified as follows.4

sion. As opaque materials are used,
proper shade selection and thickness
of the dentin and enamel layers are
critical to achieve an aesthetically
successful result (Figs. 5a–e).

achieving successful aesthetic restorations.
The new concept of classification of layered shading techniques
is simple to understand and easy to
remember as the name itself suggests the required number of the layers and various groups of restorative
materials necessary to restore the
tooth defects.
This classification also helps clinicians to imagine and understand
the aesthetic complexity of restorations. CT

Mono-layered shading technique
This is a very common and simple
layering technique using only one
group of materials, either dentin or
enamel shade, to restore the defective natural tooth (Figs. 3a–e).
Bi-layered shading technique
This technique demands a higher
level of clinical skill than in monolayering as it uses both the dentin
and enamel group of the materials
during restoration (Figs. 4a–e).
Tri-layered shading technique
This is the advanced level of layering
technique where dentin, enamel and
opaque materials are used in combination to mask the dark tooth discolouration or to block light transmis-

Complex-layered shading
technique
Any layered shading technique that
requires special effect materials (tint,
stain) during the restorative process is classified under the complex
category of this particular layered
shading technique. In this category,
the effect group of the materials is
normally used in between dentin
and enamel layers of the natural or
restorative layers of the restoration
(Figs. 6a–g).
Conclusion
We rarely use the blended shading
technique in modern aesthetic dentistry because the layered shading
techniques are more predictable in

Editorial Note: A list of references is
available from the publisher.

Contact info
Dr. Sushil Koirala is president of
the Vedic Institute of Smile Aesthetics (VISA). He can be reached at
skoirala@wlink.com.np.

[20] =>

[21] =>

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

August 2009

www.dental-tribune.com

Vol. 2, No. 6

Adding fluoride varnish
to your armamentarium
By Anita Roth, RDH, BSDH

Dental caries is an infection, and
the most common chronic childhood
disease. It is still a major public
health problem.1 About 28 percent of
the children between the ages of 1
and 5 are affected by early childhood
caries.2
About 90 percent of adults olderthan 40 are affected by caries, and
one fourth of adults oler than60 are
edentulous.1 In adults older than 70,
studies have showed an increased
risk of caries. The cause of this is
due to increased medication that
causes xerostomia and a decrease in
salivary flow.1
Some causes of dental sensitivity are the exposure of dentin due
to recession, abrasion, erosion and
periodontal therapy. Adults with
dental sensitivity, due to exposed
dentin, account for 20 to 30 percent
of cases in the United States.
When the dentin is exposed to
stimuli such as cold, hot, mechanical
(a toothbrush) or chemical (a rinse),
a painful response occurs.3
Fluoride varnishes have been
used in Europe, Canada and Scandinavian countries since the 1980s,
but are relatively new to the United
States.4 The Food and Drug Administration (FDA) approve fluoride varnishes for treating sensitive teeth
and use as a cavity liner.4
What is it? How does it work?

tion of fluoride varnish should occur
two times a year for two years.
The recommendation is every
three months for individuals at a
higher risk for caries. The right
amount and time interval for fluoride varnishes have not yet been
established.5

Fluoride varnish is a highly concentrated form of fluoride, which is
applied to the tooth’s surface as a
type of fluoride treatment.5 Fluoride
varnish adheres to the tooth structure for a longer period of time than
any other fluoride treatment.
Most fluoride varnishes contain 5
percent sodium fluoride in a colophony/resin base. Also, in most states,
health care professionals must apply
the fluoride varnish.5
Fluoride varnish works by intensifying the amount of fluoride in
the superficial exterior of the tooth.
This increases the absorption of
fluoride in the early phase of demineralization.5
The fluoride varnish is in contact with the tooth structure for
up to seven days. This is a longer
period of time that allows a greater
amount of fluoride to be deposited
on the tooth surface and work more
effectively during the early stages of

demineralization.5
Application procedure
It is recommended, but not required,
that a prophylaxis be performed. A
toothbrush, gauze or cotton roll may
be used as well. Excess moisture
may be removed with cotton rolls or
gauze. The varnish will stick to the
tooth surface with some moisture
present.
A thin layer of varnish is painted
on the tooth as per manufacturers
direction (0.5 ml). A thin brush or
single dose applicator may be used.
The varnish will set when in contact with the saliva. To spread the
varnish in between the teeth, dental
floss can be used interproximally.
So the fluoride varnish does not
come off prematurely, the patient is
instructed not to brush until a four to
six hour interval is over and to avoid
hot or alcoholic beverages or foods.2
To control or reduce caries, applica-

Advantages/disadvantages
Fluoride varnishes are available in
various flavors for younger patients
and do not have a bitter taste. The
application is easy and the fluoride
varnish sets quickly in the presence
of salvia.
They are good for patients with
a gag reflex and require minimal
equipment set up. Fluoride varnishes are considered safe due to the
small amount of varnish used and
the quick set time.
Some fluoride varnishes can leave
a temporary yellow discoloration of
the teeth for about 24 to 48 hours.
Indications
Fluoride varnishes may be used on
children younger than 5 years old
who are at moderate to high risk of
caries. They serve as a desensitizing
and caries prevention agent for root
surfaces as well as a cavity varnish.
They are also utilized around
orthodontic bands and for people
who might swallow fluoride. They
cannot be used in areas of obvig HT page 3E

Top 10 causes of tooth discoloration
By Fred Michmershuizen, Online Editor

Your job as a dental hygienist is to
help your patients maintain healthy
teeth and gums. They also want to
leave your chair with whiter teeth —
in fact the whiter the better. Nobody
wants discolored, dirty-looking teeth.
As you know, the causes of tooth discoloration are many and varied. Some
factors can be reduced by changes in
patient behavior, while others causes
are beyond the control of the patient.
A recent article at WebMD.com
pointed out the top 10 culprits of tooth
discoloration. Here they are:

1. Food and drink. Coffee, tea, carbonated beverages and red wine can
discolor teeth. Even certain fruits and
vegetables can cause stains.
2. Tobacco products. Smoking or
chewing tobacco can stain teeth.
3. Inadequate brushing and flossing. If a patient doesn’t brush and floss
regularly, it is more likely that plaque
and stain-producing substances such
as coffee and tobacco will cause tooth
discoloration.
4. Disease. Several diseases that
affect enamel and dentin can lead
to tooth discoloration. Treatments

for certain conditions can also affect
tooth color. For example, head and
neck radiation and chemotherapy can
cause teeth discoloration. In addition,
certain infections in pregnant mothers can cause tooth discoloration in
the infant by affecting enamel development.
5. Medications. The antibiotics tetracycline and doxycycline are known
to discolor teeth when given to children whose teeth are still developing
(before the age of 8). Mouth rinses
and washes containing chlorhexidine
and cetylpyridinium chloride can also
stain teeth. Antihistamines (such as

Benadryl), antipsychotic drugs and
drugs for high blood pressure also
cause teeth discoloration.
6. Certain dental materials. Some of
the materials used in dentistry, such
as amalgam restoration, especially silver sulfide-containing materials, can
cast a gray-black color to teeth.
7. Advancing age. As a person ages,
the outer layer of enamel on his or her
teeth gets worn away, revealing the
natural yellow color of dentin.
8. Genetics. Some people simply
have naturally brighter or thicker
g HT page 2E

[22] =>

News

Hygiene Tribune | August 2009

HYGIENE TRIBUNE

f HT page 1E
enamel than others.
9. Environment. Excessive fluoride, either from environmental
sources like naturally high fluoride
levels in water, or from excessive
use, such as fluoride applications,
rinses, toothpaste and fluoride supplements taken by mouth, can cause
teeth discoloration.
10. Trauma. Damage from a fall
can disturb enamel formation in
young children whose teeth are still
developing. Trauma can also cause
discoloration to adult teeth.
Some of these factors can’t be controlled, but others can be. By encouraging your patients to make a few
simple lifestyle changes, you may be
able to help them prevent discoloration of their pearly whites. Coffee
AD

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

Publisher
Torsten Oemus
t.oemus@dtamerica.com
President & CEO
Peter Witteczek
p.witeczek@dtamerica.com
Chief Operating Officer
Eric Seid
e.seid@dtamerica.com
Group Editor & Designer
Robin Goodman
r.goodman@dtamerica.com

drinkers or smokers might be persuaded to cut back or quit altogether.
And of course, it never hurts to
remind your patients that brushing
and flossing regularly will make their

next trip to see you result in much less
scraping and polishing. HT
(Source: WebMD)

Editor in Chief Hygiene Tribune
Angie Stone RDH, BS
a.stone@dtamerica.com
Managing Editor/Designer
Implant Tribunes & Endo Tribune
Sierra Rendon
s.rendon@dtamerica.com
Managing Editor/Designer
Ortho Tribune & Show Dailies
Kristine Colker
k.colker@dtamerica.com
Online Editor
Fred Michmershuizen
f.michmershuizen@dtamerica.com
Product & Account Manager
Mark Eisen
m.eisen@dtamerica.com
Marketing Manager
Anna Wlodarczyk
a.wlodarczyk@dtamerica.com
Sales & Marketing Assistant
Lorrie Young
l.young@dtamerica.com
C.E. Manager
Julia E. Wehkamp
E-mail: j.wehkamp@dtamerica.com

Dental Tribune America, LLC
213 West 35th Street, Suite 801
New York, NY 10001
Tel.: (212) 244-7181
Fax: (212) 244-7185
Published by Dental Tribune America
© 2009 Dental Tribune America, LLC
All rights reserved.
Hygiene Tribune strives to maintain
utmost accuracy in its news and clinical
reports. If you find a factual error
or content that requires clarification,
please contact Group Editor Robin
Goodman, at r.goodman@dtamerica.
com. Hygiene Tribune cannot assume
responsibility for the validity of product
claims or for typographical errors.
The publisher also does not assume
responsibility for product names
or statements made by advertisers.
Opinions expressed by authors are
their own and may not reflect those of
Dental Tribune America.

Tell us what you think!
Do you have general comments or criticism you would like to share? Is there
a particular topic you would like to see
articles about in Hygiene Tribune? Let us
know by e-mailing feedback@dtamerica.
com. We look forward to hearing from
you!
If you would like to make any change
to your subscription (name, address or
to opt out) please send us an e-mail at
database@dtamerica.com and be sure to
include which publication you are referring to. Also, please note that subscription changes can take up to 6 weeks to
process.

[23] =>

Clinical

Hygiene Tribune | August 2009
f HT page 1E
ous decay, when the patient is
concerned about discoloration or
in patients with low risk of caries.
According to a recent study, fluoride
varnishes were shown to be 14 times
more successful than fluoride gels.1
What’s available?
The following companies offer fluoride varnish products.
• AllSolutions* (5 percent NaF in
a natural resin), available in a unitdose with an applicator. Dentsply
Professional. Phone (800) 989-8826;
Web site www.dentsply.com.
• Cavity Shield (5 percent NaF in
a natural colophonium resin), available in a unit-dose with an applicator. Omni Products. Phone (800)
445-3386; Web site: www.omniphar
ma.com.
• Durafluor (5 percent NaF in a
natural colophonium resin). Medicom. Phone: (800) 435-9267; Web
site www.medicom.com.
• Duraphat** (5 percent NaF in a
natural colophonium resin). Colgate
Oral Pharmaceuticals. Phone (800)
2-COLGATE (800) 225-3756; Web
site www.colgateprofessional.com.
• Fluor-Protector (0.1 percent
difluorosilane in a polyurethane
base). Ivoclar Vivadent North America. Phone (800) 327-4688, Web site

www.ivoclarvivadent.us.
• Varnish America (5 percent NaF
in a natural colophonium resin),
available in a unit-dose with an
applicator. Medical Products Laboratories, Inc. Phone (800) 523-0191,
Ext. 326; Web site www.medical
productslaboratories.com.
• ClearShield (5 percent sodium
fluoride) Zenith Dental. Phone (800)
662-6383; Web site www.zenithden
tal.com/clearshield.
Conclusion
Fluoride varnish is advantageous
for children, adults and the elderly
who are at a higher risk for tooth
decay and for those who experience
dental sensitivity. Fluoride varnish
has helped contribute to improved
dental health and comfort.
Fluoride varnish should be added
to the practitioner’s toolbox to protect teeth and improve overall
health. In addition, fluoride varnishes can be utilized outside of the dental office in medical and community
programs, and has been shown to be
the best treatment due to the length
of time it adheres to the tooth structure. HT
References
1. Dais A. Joyce RDH, BA, MPH,
MSEd. Fluoride Facts. Dimensions of Dental Hygiene.

www.dimensionsofdent
alhygiene.com/ddhright.
aspx?id=1173&terms=fluoride.
Accessed January 2009.
Hayes J. Mary, DDS, MS. Are you
using fluoride varnish? www.
wdjournal.com/articles/print.
html?id=322316&bPool=DE.pen
net.com%2fWDjarticle_tool_bar.
Accessed January 2009.
Radjenovich Donna, RDH,
BS.
Fluoride
varnish
to
the rescue. www.wdjourn
al.com/articles/print.
html?id=196790&bPool=DE.
pennnet.com%2fWDjarticle_

tool_bar. Accessed January
2009.
Lin Jenn-Yih, DDS, MS & Berg
H. Joel, DDS, MS. Going off
label. www.dimensionsofdent
alhygiene.com/ddhright.aspx?i
d=539&terms=fluoride+varnish.
Accessed January 2009.
www.kdheks.gov/ohi/down
load/Flvarnishpaper.pdf.
Accessed January 2009.

* AllSoultions is now called NUPRO.
** Colgate has a new product available
called PreviDent Varnish.

About the author

Anita Roth graduated from
the dental hygiene program
at Hudson Valley Community
College in Troy, N.Y., in 1986
and completed her bachelor’s

degree in dental hygiene, from
State University of New York at
Farmingdale in May 2009. She
is currently participating in a
research program on periodontal disease at Stony Brook University.
Roth is a member of the
American Dental Hygienist
Association and was given the
Poster Presentation Award at
the April 18, 2008, Conference
of Science, Health, Engineering
and Technology.
For more information, questions or comments, contact Roth
at anitaroth@mac.com.
AD

[24] =>

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