DT U.S. 2709

An interview on stem-cell research in dentistry with Prof. Thimios Mitsiadis - head of the Institute for Oral Biology at the University of Zurich / Hundreds line up to receive free dental care / CDA meeting offers something for everyone / Experience is no substitute for training / The dental office manager’s role in a practice transition / Business continuity and IT mangement (Part 2 of 2) / Protecting yourself from employee theft - fraud and embezzlement (Part 1 of 2) / ADA celebrates its 150th anniversary in Hawaii / Vegas offers lots to do after a day of learning / Endodontics Extraordinaire 2 / New paradigm for crown preparation: Great White Ultra carbide instruments (part1) / New paradigm for crown preparation: Great White Ultra carbide instruments (part2) / Industry News / InTouch Practice Communications earns top honors from ADA / Cosmetic Tribune 7/2009 / Hygiene Tribune 7/2009

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

September 2009

www.dental-tribune.com

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

Office managers meet in Vegas

What to do after the lectures have ended?
u Page 16A
Check out our list!

Patient acceptance

Vol. 4, Nos. 27 & 28

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

Preventing cancer

Learn the Mix-to-Match Method, an extra step
Oral cavity cancer is one of the most preventable
u Page 1B cancers in the U.S.
worth your time.
u Page 1C

The ADA says ‘Aloha!’ from Hawaii
‘These are exciting
times in which we live’
An interview on stem-cell research in dentistry with Prof. Thimios
Mitsiadis, head of the Institute for Oral Biology at the University of Zurich
Dental Tribune Germany: Prof.
Mitsiadis, which factors determine
the formation of enamel?
Prof. Thimios Mitsiadis: This is
a very complex process, which is
determined by the dental epithelium
at a very early stage and different to
that of the skin epithelium that covers the body.
There is a multitude of transcription factors, one of which is Ptx2,
which governs the formation of oral
and dental epithelium.
Based on this, there are other
transcription factors. At the moment,
we only know of Tbx1, which co-

forms the ameloblasts. Of course,
there are further transcription factors that we do not yet know much
about and that are regulated by certain growth factors.
The transcription factors occur
within a very tight timeframe to
form enamel. It is a highly complex
process from the beginning to the
final formation.

The ADA celebrates its 150th
anniversary this
year! At last year’s
meeting, DeeDee
was on hand to
teach children
the importance of
brushing.

Which factors may disrupt the
formation of enamel?
Dental enamel can be damaged

gSee page 14A

g DT page 2A

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Hundreds line up to
receive free dental care
By Fred Michmershuizen, Online Editor

At various events around the country, hundreds of people with little or
no insurance have been lining up for
hours for the chance to receive free
dental and medical care.
In La Crosse, Wis., for example, the
Wisconsin Dental Association (WDA)
and WDA Foundation held a twoday event, called Mission of Mercy,

in which 1,533 children and adults
received dental care at no charge.
More than 900 volunteers, including
170 dentists and 87 hygienists, were
involved in the setup, two treatment
days and cleanup of this inaugural,
large-scale oral health care event, held
at the La Crosse Center.
Medical professionals from Wisg DT page 3A
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[2] =>

Interview & News

f DT page 1A
from the start because there are
genetic factors that disrupt the correct formation of enamel. However,
epigenetic factors that occur during
the course of a pregnancy, for example, result in a deterioration of dental enamel through discoloration.
In addition, we are currently
examining the effects of fluoride.
Fluoride protects the tooth, but may
also lead to its decomposition during the process of dental enamel
formation. Other epigenetic factors,
such as the consumption of alcohol,
can affect the formation of dental
enamel.
Dental erosion is a growing problem, which is certainly driven by
the increase in life expectancy.
However, statistics demonstrate
that younger patients are also
increasingly being affected. What
is the cause of this development
from your point of view?
Yes, it is a fact that loss of enamel
has been detected mostly in elderly
people. In my opinion, two factors
have to be considered here. Nowadays, we know much about prevention, but in the past many people
did not take care of their teeth sufficiently.
General health conditions and
other diseases were considered
more important. Research and medication in these areas have improved
significantly. Over time, however,
we realized that we had not paid sufficient attention to our many dental
problems.
Another possible reason is migra-

Dental Tribune | September 2009

‘We recently formed a European
consortium with researchers working with
stem cells in Germany, Finland,
Switzerland, Italy and France. The
objective is to isolate stem cells from
teeth, the face and the head, and to use
them to generate products.’
tion. We tend to travel more and live
in various countries. For example,
I was born in Greece, but now live
in Spain with my Spanish wife. My
children, therefore, possess features
of both nations. This may result in
abnormalities and deterioration of
enamel.
What innovative perspectives have
arisen from these new findings?
These are exciting times in which
we live. It is evident that in the near
future — in about 20 to 30 years—
we will be able to create new tissue with the aid of microbiology
and genetics. Clinical studies that
examine the use of dental stem cells
for the regeneration of jawbone are
already under way.
This is proof that progress in this
regard is being made. We just need
more information on how to achieve
natural protection.
What progress has been made in
stem-cell research for the forma-

DENTAL TRIBUNE
The World’s Dental Newspaper · US Edition

Publisher & Chairman
Torsten Oemus
t.oemus@dental-tribune.com
Vice President Global Sales
Peter Witteczek
p.witteczek@dental-tribune.com
Chief Operating Officer
Eric Seid
e.seid@dental-tribune.com
Group Editor & Designer
Robin Goodman
r.goodman@dental-tribune.com
Editor in Chief Dental Tribune
Dr. David L. Hoexter
d.hoexter@dental-tribune.com

tion of enamel?
We recently formed a European consortium with researchers working
with stem cells in Germany, Finland,
Switzerland, Italy and France. The
consortium’s objective is to isolate
stem cells from teeth, the face and
the head, and to use them to generate products.
With stem cells, for example, natural implants could be produced.
There are also tests being conducted
in Italy to recreate teeth, but in my
opinion this is far too complex to be
realized at the moment.
At this stage, we should only concentrate on creating tissue as a
replacement for damaged or
destroyed material, such as dentine
and dental tissue. DT
[Editor’s Note: This interview
originally appeared in the July 2009
edition of our sister publication Dental Tribune Germany (No. 4, Vol. 7,
2009).Translation was provided by
Annemarie Fischer, Germany.]

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

Distraction
osteogenesis
vs. autogenous
Endosseous implants fare equally
well after either distraction osteogenesis or autogenous bone grafting,
according to a new report published
in the September 2009 issue of the
Journal of Oral Implantology, the
official publication of the American
Academy of Implant Dentistry and
of the American Academy of Implant
Prosthodontics.
Following alveolar reconstruction, endosseous implants support
and retain the prosthesis. Therefore,
it is important for the method of
alveolar reconstruction to be highly compatible with the subsequent
implantation. The authors conducted a retrospective analysis to determine whether distraction osteogenesis or autogenous bone grafting
offers a greater chance of clinical
success.
The authors included 82 consecutive patients from the patient population of Loma Linda University in
a retrospective analysis of the two
alveolar reconstruction techniques
g continued

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

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

[3] =>

0A
Dental TRubric
ribune | September 2009

Headline

f DT page 1A

consin and four other states — Iowa,
Illinois, Kansas and Minnesota —
took part. In all, 6,900 procedures
— including 1,700 extractions, 1,525
fillings, 597 cleanings, 135 treatment
By line
partials and at least 18 denture repairs
— were performed.
“Charity alone is not a sufficient
health
tk care delivery system for meeting the needs of some 1 million lowincome individuals enrolled annually

Deck

f continued
and the subsequent endosseous
implantation. All patients had been
evaluated for implant success in a
36- to 61-month follow-up. Implants
preceded by autogenous bone grafts
had a success rate of 97 percent, and
those preceded by distraction osteogenesis had a success rate of 98
percent. There was no statistical difference between the two methods.
The entire article, “Implant Success in Distracted Bone Versus
Autogenous Bone-Grafted Sites,” is
available online. Visit www.allen
press.com/pdf/orim-35-04-196-200.
pdf. DT
(Source: Journal of Oral
Implantology)

in the state dental Medicaid, BadgerCare and BadgerCare Plus programs,”
stated the WDA in a news release
following the event. “These patients
suffer for various reasons: failure to
care for their own oral health; inability
to find a dental office for routine care,
because small businesses can’t absorb
too much income loss; and lawmakers’
failure to sufficiently fund the dental
care they promise.”
Organizers of the event estimated
that more than $850,000 in donated
care was offered.
The WDA acknowledged the support of various corporate sponsors
— including Delta Dental of Wisconsin, Henry Schein Dental, the Henry
Schein Employee Sunshine Committee, American Orthodontics, the La
Crosse Community Foundation and
Ho-Chunk Nation — for making the
event possible.
The event in Wisconsin is one of
many such events being held nationwide. Another similar event, held at
the L.A. Forum in Los Angeles, offered
both dental and medical care free of
charge. About 1,500 people lined up to
receive care at that event.
Such events are drawing the attention of many manufacturers of dental supplies and equipment. One of
them, Aseptico, provided dental exam
and treatment equipment for the Los
Angeles event, according to Stefan A.
Gefter, director of international sales.

Dental Tribune
| Month 2009
3A
News

A patient receives free
dental care as part
of a two-day event
held by the Wisconsin
Dental Association.

“Aseptico regularly supplies public
health and humanitarian organizations, either directly or through dealers, with portable dental equipment
as part of our business,” Gefter told
Dental Tribune.
“While we are directly involved in
all such events, it is always gratifying
to see portable equipment being used,
regardless of manufacturer, to help
those less fortunate.”
According to a government report,
“Oral Health in America,” released
by the National Institute of Dental
and Craniofacial Research, 110 million Americans do not have dental

insurance and there are enormous
oral health disparities according to
socioeconomic determinants.
“We need to find a way for all
Americans to experience optimal oral
health, especially children under 5
and our elderly,” said Dr. Harold
C. Slavkin, a policymaker, educator
and researcher who was one of the
authors of the report.
“From my perspective, comprehensive health care must be available
for all people of all ages and must
include mental, vision and oral health
with an emphasis upon prevention,”
Slavkin said. DT
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AD
1/4 Page
9 1/4 x 3 3/8

[4] =>

Event News

Dental Tribune | September 2009

CDA meeting offers something for everyone
By Robin Godman, Group Editor
& Fred Michmershuizen, Online Editor

The California Dental Association held CDA Presents the Art and
Science of Dentistry Sept. 10–13 at
Moscone West in San Francisco.
The meeting featured four days
of educational offerings. One of the
highlights was a session featuring Joe Massad and Jack Turbyfill.
Friendly jibes between the speakers and amusing simulated “patient”
videos were a hearty warm-up for
attendees of their joint lecture.
These two “giants” in removable
prosthetics have a long-standing and
entertaining repartee, the goal of
which is imparting their knowledge
to all those within earshot.
During their dueling dentures
match — complete with a simulated
boxing poster of the two speakers
in gloves and trunks — Massad and
Turbyfill took turns answering six
questions that helped illustrate their
different approaches to treating
edentulous patients.
For example, the first question
was: How do you arrange anterior
maxillary teeth? In turn, each speaker presented a case that helped to
illustrate his answer to the question.
Those who stayed for the entire
two and half hours of this lecture
walked away with pearls of information about how to make not only
a comfortable, esthetically pleasing
and functional denture, but also how
to make the entire experience a
pleasant one for the patient.
In another educational highlight
of the meeting, a quartet of lecturers
presented “Forensic Dentistry: ‘CSI:
San Francisco’ — Who was this?”
The speakers for the forensic dentistry session were Anthony “Rick”
Cardoza, DDS; Duane E. Spencer,
DDS; James D. Wood, DDS; and
Jeannine Willie.
Moving at a fast pace and using
actual casework to illustrate the
leading principles of forensic dentistry, the four presenters taught
attendees how to acquire an understanding of the varied roles of forensic dentists as well as the forensic
value of dental records. Attendees
also learned how to cooperate with
the legal system.
The lecturers’ second session
focused on the analysis of bitemarks
and how they are used within the
legal system.
Detailed case presentations illustrated human and animal bitemarks
and covered the spectrum from good
to bad, and even ugly, aspects of
such cases. Understanding the limitations of bitemark analysis was a
prime focus of the course.
Meeting attendees also crowded
the exhibit hall floor for three days
of commerce and hands-on learning. Among the highlights:
Those who stopped by the Triodent booth expressed interest in
the company’s new Griptab tool for
holding and placing indirect restora-

A copy of the poster
given away during
Dr. Joe Massad and
Dr. Jack Turbyfill’s
‘Dueling Dentures
Match at Ringside’
(we were one of the
lucky ones to get it
autographed, too!).

Jeannine Willie, from
left, Dr. Anthony
‘Rick’ Cardoza,
Dr. Duane E.
Spencer and Dr.
James D. Wood just
prior to their joint
lecture,‘Forensic
Dentistry: “CSI: San
Francisco” — Who
was this?’

tions. Sort of like a handle to a cup,
the Griptab is designed to make handling restorations easy. Also new at
Triodent was the Triotray for posterior impressions and the company’s
prevously released V3 Ring for Class
II composites.
At the WOW Oral Care booth,
tooth whitening inventor Michael
Arnold was showing attendees his
new WOW Powder Oral Rinse, a
plaque absorbent featuring xylitol
and baking soda that is designed
to leave users with a clean taste
and fresh breath. Designed for people who cannot brush, the product
cleans and disinfects while making
teeth whiter.
At the 3M ESPE booth, attendees could check out the new Lava
chairside oral scanner. Designed
to help dentists increase productivity by reducing seating times and
remakes, the Lava allows the practitioner to capture and simultaneously
view continuous 3-D video images
on a touch-screen monitor.
For those who want to be able to
keep track of patients via iPhones or
BlackBerrys, PracticeWorks introduced a new application. The PEARL
enables clinicians to view and act
upon real-time information related to patient and treatment details,
scheduling, financials, call-backs,
prescriptions and more.
Because the application was
designed specifically for the iPhone
and BlackBerry, it takes full advantage of the systems’ specific capabilities. For instance, with the iPhone,
practitioners are able to not only
view digital X-rays but to zoom in on
them for a more detailed look.
MyRay was offering a wireless
digital X-ray system called the

X-pod. This pocket-sized device is
capable of instant diagnostic-quality
radiographic images in the palm of
your hand. Just like with an iPhone,
you can zoom in and out by the
touch of your fingers.
Discus Dental introduced Insight
ultrasonic inserts, featuring LED
technology that offers enhanced visibility in the maxillary buccal, maxillary lingual, mandibular lingual,
furcation and gingival/tissue transillumination. Also new from Discus
was the Riskontrol disposable air/
water syringe tip, featuring separate
air and water lines.
DentalEZ Group introduced a
new everLight LED operatory light,
an alternative to halogen-based
operatory lights. It provides colorcorrected lighting and a precise
light pattern.
According to DentalEZ, it lasts
30,000-plus hours, or 10 times longer than halogen, reducing the need
for regular replacement of light
bulbs. It also uses less than 35 watts
of energy, which is 70 percent less
than halogen-based systems.
Even Under Armour was at the
CDA fall meeting. The company that
revolutionized the sports apparel
industry has designed a mouthpiece
for athletes in non-contact sports.
Crafted for optimal fit and comfort, the Under Armour Performance
Mouthwear is designed to help athletes train harder and compete at a
higher level than before. It was one
of many offerings at the booth of
Patterson Dental, exclusive distributor of the mouthpiece.
Many companies, including
DEXIS and others, offered educational presentations right on the
exhibit floor. DT

[5] =>

[6] =>

Practice Matters

Dental Tribune | September 2009

Experience is no substitute for training
By Sally McKenzie, CMC

Problems, problems, problems. At
times, it can feel as if the problems
are going to take over your existence.
If you’re fortunate to have a reasonably well-adjusted attitude about
life and work, you’ve probably come
to realize that problems are a fact
of life and not all problems are bad.
In fact, in dentistry, you make your
living identifying and solving oral
health problems for your patients.
However, some problems can
be far more draining than others,
namely, dealing with the dreaded
problem employee. Take this scenario:
The dentist has a vacancy to
fill. She needs to hire a scheduling coordinator immediately. She
wants someone with plenty of experience because there will be little
time for training in her busy practice. A pleasant personality and nice
demeanor are good qualities to have
if they are part of the package, but
the driving factor on the winning
applicant’s scoring sheet will be
experience.
The resumes come in and in a
matter of weeks, the dentist finds
Cassandra. She definitely brings
experience, having worked in two
dental practices and a medical office
in the past 10 years. Cassandra is it,
and the dentist can’t wait to get her
in the door and at the desk so that
she can scratch this vacancy problem off the list. Slam, bang, another
hire done, back to the important
stuff — dentistry.
Eight weeks down the road more
serious problems have taken over.
The schedule is a disaster. No-shows
have skyrocketed. On some days
production comes to a screeching
halt, other days the team is racing from dawn till dusk. And at
least once a week the dentist or the
hygienist is double-booked, sending
everyone scrambling.
The dentist is about to have a
meltdown and Cassandra is about to
have a meltdown. That list of problems has grown tenfold. So what
went wrong? This dentist was drawn
in by the illusion of experience.
When hiring a new employee,
how many times have you said: “I
want to get someone in here who
AD

can hit the ground running!” Dentists often think that just because the
employee brings experience she/he
will know exactly how to perform
the job she/he is hired for, and
according to the dentist’s preferred
standards.
It doesn’t occur to the hiring dentist that the new employee cannot
“hit the ground running” without
some training, without a job description or without daily feedback and
periodic performance reviews.
Certainly, a more experienced
new hire may pick up systems more
quickly, but it doesn’t mean you
show the experienced new hire the
desk, the computer, the phone and
the bathroom and expect her/him to
perform as though she/he has been
in your office for years.

Spell it out
New hires need to understand your
big picture. What are your goals
for the practice and how does this
employee’s responsibilities fit into
achieving those goals? Explain it to
the new hire. Just because the new
hire has worked in another dental
practice before does not mean she/
he will understand your objectives,
your desires and your preferred
ways of doing things.
However, if you share your
vision and goals, you help your new
employee understand that she/he is
not just another cog in your practice
wheel. She/he is essential to the
success of something much greater.
There is far more satisfaction in
any job when specific goals are
identified and ultimately reached
than merely going through the
motions of just another day in just
another practice. Everyone needs
finish lines to run toward and stars
to reach for.
Spell out your preferences or suffer the consequences. That experienced new employee brings the last
office’s system protocols into your
practice, unless she/he is trained
otherwise. Cassandra had come
from a practice in which the dentists
wanted to be very busy, so patients
were booked in any and every available slot.
She was unfamiliar with the new
practice’s recall system because her
former employer used automatic
text messages and e-mail to confirm

appointments. Yes, she had experience managing a recall system, but
she wasn’t responsible for making
several daily calls. Consequently,
she didn’t recognize the importance of that function. Plus she was
never given a job description, which
should have spelled out her duties
exactly. To make matters worse,
the scheduling program in the new
office was totally different than what
she had used in the past.

Success is a step-by-step process
When a new employee is hired she/
he must be given a clear job description that details the job responsibilities. Each employee also needs to
know exactly what you expect her/
him to accomplish in the job.
Specify the skills that the person
in the position should have, and outline the specific duties and responsibilities of the job. This enables individual employees to better understand their specific role as well as
how they fit into the overall success
of the team.
In addition, new hires, as well as
existing staff, need to be told what
exactly they will be held accountable for and how their performance
will be measured. Establish individual performance goals for each
employee.
With input from the team member, establish individual goals that
complement practice goals, such
as increasing the collection ratio,
improving accounts receivables,
expanding production, reducing
time to prepare treatment rooms
and increasing clinical skills.
Next, there simply has to be a protocol for training the new employee
and orienting her/him into the practice. Create a list of areas that the
new employee must be educated on
immediately as well as a list of those
areas she/he should be exposed to
during the coming months.
At a minimum, provide job-specific instruction to ensure that new
employees are prepared to carry
out their duties according to your
specific expectations. In today’s dental marketplace, a wide variety of
affordable educational options are
available. It will save you from a
whole host of major practice problems down the road and ensure that
neither you nor your employee is
ready to “hit the ground running
right out the back door.”
Give feedback early and often.
Remember, the vast majority of
employees want to know how they
are doing and if they are meeting
your expectations. Ongoing feedback is essential in helping to guide
employees constructively, to help
them solve problems, to direct them
over obstacles and, most importantly, to encourage them. Feedback is
what you give to employees publicly
to recognize something they do well,
and privately to redirect them if they
are moving off course. It is ongoing;
it doesn’t happen once a year or

once every six months — that would
be performance reviews.
Performance reviews are given on
a schedule, typically at least twice a
year, and more frequently with new
staff. These provide opportunities to
sit down one-on-one with individual
team members and discuss their
overall performance and their progress toward achieving their goals.
Performance reviews are one of
the most effective tools in measuring employee success. Take steps to
ensure your office has a formalized
performance review process. At a
minimum, appraise performance in
these areas:
• Following instructions, cooperation, quality of work, initiative,
innovation, time management, communication, and flexibility
• Work ethics
• Attitude
• General characteristics, e.g.,
professional appearance, verbal
skills, ability to work under pressure, organization skills, ability to
prioritize
• Attendance
Experience is certainly an excellent quality for any new hire to bring
into the practice, but it’s no guarantee that the employee will succeed.
Every new hire needs some measure of training, a new employee
orientation to the practice and clear
guidelines and direction from day
one. DT

About the author

Sally McKenzie is CEO of
McKenzie Management, which
provides succes proven management services to dentists
nationwide.
In addition, the company
offers a vast array of practice
enrichment programs and team
training. McKenzie is also the
editor of an e-Management
newsletter and The Dentist’s
Network newsletter sent complimentary to practices nationwide. To subscribe, visit www.
mckenziemgmt.com and www.
thedentistsnetwork.net. She is
also the publisher of the New
Dentist™ magazine, www.the
newdentist.net.
McKenzie welcomes specific practice questions and can
be reached toll free at (877)
777-6151 or at sallymck@mcken
ziemgmt.com.

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[10] =>

10A Practice Matters

Dental Tribune | September 2009

The dental office manager’s role in a practice transition
By Domenick Lobifaro

Much like a conductor is to an
orchestra, a dental office manager
is critical in the operations of a dental practice. He or she helps bring
all the different aspects of a dental
practice into one unified element.
The dental office manager wears
many different hats and is talented
in the area of multi-tasking.
On any given day, an office manager’s duties can range from dealing
with a patient billing issue to calling
the credit card processor repair man
to fix the credit card machine while
simultaneously meeting and scheduling patients.
Office managers play an integral
part in managing a dental practice.
The dental office manager is usually the first and last person to meet
and greet the patient and should do
so with a pleasant smile no matter
what critical emergency exists at
that moment. The manager is the
dentist’s front line and, in many
ways, sets the tone of the office for
both the patients and staff.
During a practice transition, in
a scenario where a young dentist
purchases a practice from a retiring
dentist, the role of a dental office
manager becomes even more crucial.
In an interview with Stacey Weinman, a dental office manager in
Westfield, N.J., Weinman revealed
that during the practice transition
she experienced, the biggest challenge the new dentist faced was
managing change from both the
staff’s perspective as well as the
patient’s perspective.
In general, people don’t appreciate sudden change. The office staff
would like things to stay the same,
AD

The office manager is the dentist’s
‘front line,’ and sets the tone of the
office for both patients and staff.
especially if they’ve been with the
practice for a number of years.
They expect their salaries and benefits to stay the same, their hours
to be unchanged and, most of all,
they want to feel that their jobs are
secure.
Weinman went on to say that one
hurdle she helped overcome was
having the staff switch their payroll
frequency from weekly to bi-weekly.
Despite this appearing to be a minor
change in the eyes of the new management, it was, in fact, a big deal
for the staff.
Weinman was able to use her
strong communication skills to
effectively explain to the staff the
reason for the change and the steps
the dentist would take to assist in
alleviating the financial hardship
it may cause. Within a few weeks,
the staff had become accustomed to
their new pay frequency and their
were no complaints about it.
From a patient’s standpoint, having a new dentist is a significant
change, therefore extra care should
be taken to ensure that the level of
service is unaltered and that it is
“business as usual.” This does not
imply that there shouldn’t be any
changes. The key is to manage the
change in a way that the patients
feel comfortable and embrace it.
Charlotte Leone, a dental office
manager in Chicopee, Mass., said

that during a practice transition she
was involved in about a year ago,
the former dentist performed all the
patient hygiene. The new dentist
felt that performing hygiene was
not the best use of his time so
he hired a hygienist. Before their
appointments, Leone contacted the
patients and communicated that a
new hygienist would perform their
next cleaning instead of the dentist.
By the time they were seated in
the chair at their appointment, the
patients were excited about being
seen by their new hygienist. Leone’s
technique of using her communication skills and providing ample
notice to the patients proved to be
successful in managing the change
effectively so that the patients were
at ease.
During a transition, the dental
office manger is normally the one to
help the new dentist understand the
culture of the practice and act as the
liaison between the dentist and the
office staff.
He or she must be the eyes and
ears of the dentist and must continue to assist the dentist in maintaining a well-organized, cost-effective
practice by handling the day-to-day
operations and allowing the dentist
to focus mainly on the dentistry
aspect of the business.
The dental office manager must
oversee the personnel issues, han-

dle payment and billing duties,
maintain accurate and complete
patient records and help the office
run smoothly and effortlessly overall so that the staff can perform their
jobs well.
In many cases, the dental office
manager is the solid stake in the
ground everyone can depend on
during the uncertain period of practice transition when many a variety
of changes are at hand.
Especially during the first year in
practice, the dental office manager
plays a major role in determining
whether the new dentist will be successful.
When the transition period is
over, this vital member of the dental
team can then put even more of his/
her focus on helping the new dentist
to grow the practice. DT

About the author
Domenick Lobifaro is the
managing tax director of LLI
Advisory Group, which is composed of certified public accountants and business advisors.
For more than 17 years, he has
provided tax, accounting and
business consulting services to
high net-worth individuals and
closely held businesses with a
concentration in health care.
Formerly a tax manager at
Rothstein Kass, he has extensive
experience in corporate, partnership and individual taxation.
Lobifaro and his firm serve as
the independent public accountants for the American Association of Dental Office Managers,
www.dentalmanagers.com.

[11] =>

0A
Dental TRubric
ribune | September 2009

Dental Tribune
| Month11A
2009
Digital
Matters

Business
continuity and IT mangement (part 2)
Headline
By Lorne Lavine, DMD

Deck

In part 1, we looked at ways to
By line
monitor the network 24/7 and be
alerted to problems.
Well, what if there’s a true disaster
— tk
fire, flood, theft — and your entire
network is destroyed?
I’ve just developed a complete paradigm shift in how I approach data
backup and protection. Let’s look at a
typical scenario. An office has a dedicated server and perhaps eight to 10
computers throughout.
The office backs up nightly to an
external hard drive or tape and that
device is removed from the office
every evening and taken offsite.
So, if anything ever happens to the
office server, you’re protected, right?
As I’ve found out over the past few
years, the answer is usually no.
The problem isn’t that your data is
offsite and protected — you’ve got that
covered. The problem is how long it
takes to recover from a disaster.
If someone accidentally deletes a
file or your practice management data
becomes corrupted, that’s easy — just
restore the missing or corrupted file
from your backup. You’re still able to
run the practice with no downtime.
But, what if something happens to
your server or main computer to make
it non-operational? Motherboards can
get destroyed by power surges. Servers can be stolen or ruined by fire or
flood.
If you don’t have a server that is
running, what do you do with the
backup? That’s the real problem that
had me worried for a long time —
how long would it take for a support
technician to get an office back up and
running if the server was gone?
Unfortunately, I found out the hard
way with a few of our clients that the
answer is: too long.
The fastest we were able to get an
office up and running was 24 hours,
and that was because they were able
to go out and purchase a brand new
server locally.
The other offices averaged 48–72
hours, and a few were longer than
that.
AD
That’s the real problem that has
been overlooked by many dental
offices when it comes to their backup
system: not if the data is protected,
but how much downtime will the
practice suffer if something goes
wrong?
Consider that if your server is
down, you are down. You cannot
schedule patients, cannot take digital X-rays, cannot create treatment
plans, cannot access patient data —
you’re literally dead in the water.
But what if there was a system
available that could guard against
this? What if there was a way to be
back up and running within 30–60
minutes, even if your server was
destroyed?
What if you could combine this
system with automatic backup to an
offsite location that required no input
from you or your staff? Wouldn’t a

system like this be valuable for any
dental practice?
Systems like this have been available for a few years for large corporations as they really couldn’t recover from a disaster without it.
The concept is called “business
continuity” and that seems to be a
proper description: being able to
continue to run your business even
in the face of a disaster to your technology systems.
The main deterrent for a dental
practice to incorporate something
like this was cost, but the costs have
now dropped enough to make it a
g DT page 14A

About the author

Dr. Lorne Lavine, founder
and president of Dental Technology Consultants (DTC), has

more than 20 years invested in
the dental and dental technology fields. A graduate of USC,
he earned his DMD from Boston
University and completed his
residency at the Eastman Dental Center in Rochester, N.Y. He
received his specialty training
at the University of Washington
and went into private practice
in Vermont until moving to California in 2002 to establish DTC,
a company that focuses on the
specialized technological needs
of the dental community.

AD
1/4 Page
9 1/4 x 3 3/8

[12] =>

12A Financial Matters

Dental Tribune | September 2009

Protecting yourself from employee
theft, fraud and embezzlement (part 1)
By Eugene W. Heller, DDS

As a practice owner, a dentist will
face a multitude of business-related
tasks, issues and challenges. The
rewards far exceed the drawbacks,
but there are challenges.
One of the challenges may be
employee theft. Estimates of the
number of dentists who will experience theft at least once during their
dental career range from 35–50 percent.
Estimates in dollar loss range
from $100 to $500,000 plus. Loss due
to employee dishonesty may take the
form of theft, fraud or embezzlement.
With certain minimal protective
measures, the majority of this theft
is preventable. The key is to understand where the potential exists for
theft to occur and to implement strategies to prevent the loss.

Meet the ‘thieves’*
Jane the Eraser: Jane simply withheld
any cash payments that were made
for services and then erased the
patient’s account information after
posting the payment (and giving the
patient a receipt), thereby removing
any record of the payment from the
system.
Estimated loss: $50,000 plus over a
three-year period. The dentist recovered $25,000 from his office insurance plan. Jane was ordered to pay
$10,000 in restitution.
Doris the Duplicator: When hired,
Doris had successfully lobbied
against computerization, convincing
the dentist that it was not as efficient
as the old manual pegboard system.
In turn, Doris kept a duplicate set of
patient ledgers.
Payments and receipts were
recorded on the duplicate ledgers
while charges were posted on the
real ledgers. Over a period of 18
months, Doris stole an estimated
$40,000.
Mary the Master: Mary was
involved in skimming, taking cash
and not posting it; layering, a technique involving the taking of checks
and withholding them for posting
later; and an excessive need for petty
cash, going through about $100 per
week.
AD

checks are all red flags that should be
investigated.

Preventing theft

To prevent theft — and hopefully avoid visiting a legal office —
remove the opportunity for employees to be dishonest.
Mary also set up a second business
checking account in the dentist’s
name (she was the only authorized
signer) and subsequently diverted
the office credit card deposits to that
account.
Mary paid all office bills using
erasable ink, which allowed the
checks to be made out to her personally, and then she changed them
back to legitimate vendors after they
cleared the bank. The deposit slips
never matched the bank deposits
actually made, and subsequently the
checking account could never be balanced with the ledger.
The dentists noted that while
each year their taxable income had
increased over the previous year,
according to the computer their
accounts receivable had spiraled out
of control and were showing a balance of $500,000 plus. Over a fiveyear period, Mary had embezzled
$400,000.

Definitions
Different terms can be used to
describe loss by staff dishonesty.
Theft is simply defined as “the taking
of another’s property.” Embezzlement is the theft of an employer’s
property while in the embezzler’s
trust.
It is also defined as a misappropriation or conversion of entrusted
money, property, etc., to the personal use of the employee. Fraud is
the intentional deception that causes
another to give up his/her money,
property, etc.

Understanding the thief
There are different reasons for individuals to steal. It may be the need
for money; for others, it is revenge
or the feeling they are not compensated properly for their work; and for
some, just like gamblers who continue to lose but continue to bet, it is
the excitement.
Staff members who steal do share
certain characteristics. Many have
lifestyles beyond their means; excessive debt from children, spouses/significant others, and former spouses/
significant others; or excessive habits
including alcohol, drugs and gambling.
Employees who are likely to steal
are intelligent, knowledgeable in
office procedures, personable and
friendly. They may be tireless workers who are willing to put in uncompensated overtime — rarely taking
allotted vacation time. Basically, the
perfect employees, except for one
tiny character flaw — they are dishonest!

Signs theft may be occurring
The most common sign that theft by
embezzlement may be occurring is
patient complaints regarding their
accounts.
Also note that constant requests for
petty cash reimbursements should be
closely monitored. Outright theft of
petty cash in a multiple-staff office is
difficult to track.
Excess patient account writeoffs or adjustments and inactivated
accounts are also warning signs, as
are increases in accounts receivables
with no off-setting increase in overall
office production.
Missing
documents/invoices,
insurance claim forms, explanationof-benefits (EOB) forms, patient
checks, practice checks, checking
account records, patient clinical
records, patient account records, etc.,
are definite signs of a problem as are
sloppy filing and record keeping.
The practice checking account also
holds potential signs of a problem.
Unusual deposit patterns and deposits; inability to balance the checking account; and missing sequential

Whether theft takes the form of fraud
or embezzlement, theft by an employee shares three steps. For theft to
occur, all three components of the
theft triangle must be intact.
The first component is motive. The
employee needs a reason to steal.
The next component is opportunity. In a dental office, unimpeded
access to the funds with minimal or
no restraints, checks or accountability
provides an easy route to employee
theft.
And, finally, the third component is
the need to rationalize behavior creates justification that what they are
doing is acceptable.
The key to preventing theft is to
remove the opportunity.
Controlling access to opportunity
must be done to avoid theft with these
five steps:
1) Control how money is handled.
2) Split money-handling duties;
discrepancies can be more easily
noticed in this way.
3) The dentist must also do some of
the money handling duties by authorizing account adjustments; checking
the adjustment report daily; authorizing check refund requests; signing
and mailing all checks if a staff person makes out the checks for vendors.
The signed check should not be put
back into the control of a staff person.
4) The dentist or his/her accountant must open and balance the
bank statement. This means bank
statements should be mailed to the
dentist’s residence or directly to the
accountant.
5) Either the accountant or a payroll service should prepare payroll. If
a payroll service is used, it is the dentist’s or accountant’s responsibility to
call the information into the payroll
service. DT *All names are fictitious.
Part 2 of this article will appear
in DTUS Vol. 4, Nos. 31 & 32.

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 both state dental associations and
numerous dental schools. Heller is
presently 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.

[13] =>

[14] =>

14A ADA Meeting

Dental Tribune | September 2009

ADA celebrates its 150th anniversary in Hawaii
The American Dental Association will hold its Annual Session
and World Marketplace Exhibition
at the Hawaii Convention Center
in Honolulu from Sept. 30 through
Oct. 4.
The meeting, which is the ADA’s
150th anniversary celebration,
will feature the latest technology
and educational offerings amid
the tropical paradise of the Aloha
State.
“This year’s annual session continues its great tradition of bringing unique learning opportunities,
cutting-edge technology and the
newest and most popular dental
products and services,” said Dr.
Robert Skinner, 2009 chair of the
Council on ADA Sessions.
“Join us in Hawaii to take advantage of these outstanding offerings,
help observe the 150th anniversary
of the ADA and, at the same time,
celebrate the accomplishments of
our great profession.”
The ADA Annual Session offers
attendees the choice of more than
180 relevant and topical continuing education courses, the majority of which are free with registration.
Registration
also
includes
entrance into the World Marketplace Exhibition, featuring more
than 350 suppliers of dental products and services, and access to
the ADA’s Distinguished Speaker
Series.

Sidney Poitier to speak
The Opening General Session will
take place at 5:30 p.m. on Wednesday, Sept. 30, at the Waikiki Shell
and will feature an address by
Sidney Poitier, an Academy Awardwinning actor, writer, director and
diplomat. He has been described
as a political and artistic trailblazer for more than half a century.
Poitier has had an incalculable
impact on American culture since
the early 1950s, when he began
appearing in a string of groundbreaking movies that addressed
issues of racial and social inequality.
To listening audiences he narrates his struggle to achieve equality for himself and other black
actors, as well as the films that
would make him one of the world’s
most popular and respected actors,
including “No Way Out,” “The

f DT page 11A
very viable option for dental offices.
For most practices, they are looking
at a startup cost of around $1,500 and
then monthly fees to back up the data
of around $50–$100.
We’ve been installing these types
of systems for a few months now
and have been very pleased with the
results. The system has two components: a device that sits in the office

Waikiki (Photo: Hawaii Tourism Authority/Joe Solem)

Blackboard Jungle,” “Lilies of the
Field,” “The Defiant Ones,” “A
Raisin in the Sun,” “Guess Who’s
Coming to Dinner” and “In the
Heat of the Night.”
The opening session will also
include Hawaiian cultural performances and a special tribute to the
ADA’s 150th anniversary.

Education
Attendees will be able to select
from more than 180 continuing
education options, both inside and
outside the classroom.
The schedule for continuing
education is as follows:
• Thursday, Oct. 1, through Saturday, Oct. 3, from 7:30 a.m. to
3:30 p.m.
• Sunday, Oct. 4, from 7:30 to
10:30 a.m.
Education in the Round, a livepatient educational environment,
will feature live patient procedures
conducted in a fully functional
dental operatory, in an interactive format between speaker and
attendees.
This high-tech learning environment includes images captured
on intraoral cameras and displayed
on 60-inch flat-screen monitors.
Meeting attendees will also be
able to earn C.E. on the exhibit floor. A Live Operatory Center
will enable dental professionals to
experience the latest technology
on the market and learn how it can
enhance their ability to effectively

with a copy of the data, and online
backup to secure servers that are
spread around the country.
The unique aspect of the in-office
device is its ability to provide “virtualization”: if your server goes down,
you can tell the device to act as a
virtual server.
As far as your computers are concerned, the real server is still up and
running. Even if the entire office
burned down, within a short period

diagnose and treat patients. The
2009 Live Operatory Center will
feature a CAD/CAM stage and a
new competition hub.
For those who wish to extend
their stay on the islands while
earning C.E. on Maui, Kauai or the
Big Island of Hawaii, post-session
courses will take place on Tuesday
and Wednesday, Oct. 6 and 7, at
three Marriott resorts: the Wailea
Beach Marriott Resort and Spa, the
Kauai Marriott Resort and Beach
Club and the Waikoloa Beach Marriott Resort & Spa. All courses take
place from 8 to 11 a.m., leaving
attendees with plenty of time for
the afternoon sun.
On Maui, you can expand your
skills with a “mini” implant course
taught by Dr. Gordon Christensen
on Tuesday. Then on Wednesday,
he will teach how to integrate mini
implants into your practice.
On Kauai, you can expand your
practice with an advanced Invisalign course on Tuesday, then
learn how to build a corresponding business model with the Pride
Institute on Wednesday.
And on the Big Island of Hawaii,
you can expand your mind with
an esthetic photography class on
Tuesday, followed up with a fun
vacation photography class on
Wednesday.

Exhibits

able to find solutions for business
needs and explore the latest in
dental products and services.
Hundreds of exhibitors will
allow participants to touch, feel
and “test drive” the latest products
on the market.
The World Marketplace Exhibition hours are as follows:
• Thursday, Oct. 1, through Saturday, Oct. 3, from 7:30 a.m. to
3:30 p.m. each day.
Every day on the exhibit hall
floor, meeting attendees will be
able to play a “Super Sweepstakes”
for a chance to win cash and prizes. A photo booth will offer free
souvenir photos.
Attendees can pre-order a
“Grab-and-Go” lunch and enjoy
it in the hall, or get a meal or
snack at one of the exhibit hall
restaurants. An Exhibit Hall Closing Party will be held from 1:30 to
3 p.m. on Saturday.

150th anniversary
The ADA launched the celebration
of its 150th anniversary at its 149th
Annual Session in San Antonio last
October. Annual session attendees
this year can join their colleagues
in helping the ADA culminate its
150th birthday at “An Evening
under the Stars,” from 7:30 to 9:30
p.m. on Friday, Oct. 2.
The famed Waikiki Shell is the
site of the celebration, featuring
spectacular Hawaiian music and
culture against the backdrop of
Diamond Head Crater, one of the
state’s most famous landmarks.

Presidential Gala
An evening honoring the American Dental Association President,
Dr. John Findley, and the ADA’s
150th anniversary will be held
on Monday, Oct. 5 at the Hilton Hawaiian Village, Mid-Pacific
Conference Center Coral Ballroom.
The cost to attend is $110 per
person. Attendees will get a threecourse dinner and be able to dance
the night away while listening to
favorite hits.
This celebration is designed to
be a perfect finale for the meeting.
To learn more about the meeting, visit the ADA online at www.
ada.org/goto/session. DT

At the World Marketplace Exhibition, meeting attendees will be

(Source: ADA)

of time, you could access your data
from a home computer or laptop and
function normally.
This is the concept behind business continuity: that no matter what
happens, the office will be able to
function normally with little to no
downtime.
In a down economy, every practice worries about its spending, and
that’s no different when it comes to
technology purchases such as back-

up and business continuity.
The questions to ask, though, are
what would it cost to the practice to
not have business continuity, and
what is it worth to be able to sleep
well at night knowing your office will
recover from a disaster?
Feel free to contact my company,
Dental Technology Consultants, to
get more info about the business
continuity systems we now recommend. DT

[15] =>

[16] =>

16A AADOM Meeting

Dental Tribune | September 2009

Vegas offers lots to do
after a day of learning
Are you heading to Las Vegas for
AADOM’s Annual Dental Managers
Conference on Oct. 16 and 17? In a city
with so much to do, you will definitely
want to plan things out a bit. To help,
we checked with the folks at Only
Vegas, the official Las Vegas tourism
Web site, to find out what is new on the
Strip and beyond.

The M
In March, the M Resort, Spa and Casino opened. Situated higher in elevation than other resort-casinos on the
Las Vegas Strip, the M Resort provides
optimal views of the world-famous Las
Vegas skyline.
The resort features more than 92,000
square feet of gaming, plus a 14-screen
digital movie entertainment complex,
nine restaurants and a state-of-the-art
spa and fitness center.

Eat with the fishes
There is a new restaurant at the Golden Nugget — Chart House Aquarium
— featuring a 50,000-gallon tropical
aquarium.

Party with Charo
International music sensation
Charo is back on the Las Vegas Strip
in her new show, “Charo in Concert:
A Musical Sensation,” at the Riviera
Hotel & Casino. The musical variety
show features Charo’s virtuoso flamenco guitar accompanied by a full

orchestra performing her biggest hits
and a cast of world-renowned Spanish
flamenco dancers.

Motown music
“Smokey Robinson Presents Australia’s Human Nature, The Ultimate Celebration of the Motown Sound,” a new
show at the Imperial Theater, features
Australia’s top-selling vocal group featuring Aussie charm and the most
celebrated Motown Hits.

Music legend

week in the 1,265seat Terry Fator
Theatre at The Mirage.
Don’
The comic impersonator,
t mis
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seven
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pre
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puppets, combines the Iart
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ITED
tion
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Ofcelebrity impressions.
!

fice M

a
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ore de l and netw
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Pink’s Hot Dogs
ils ohas
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yet
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Pink’s Hot Dogs Las Vegas is located ac
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ister, resisit w for den
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and
lounge is set in thevheart
inside Planet Hollywood Resort & CasiMiN
is ra and has the vibe ww.d
of the Las VegastStrip
no, directly accessible to foot traffic
tOrs
enta
• with the
of a late-night spot blended
along Las Vegas Boulevard.

aNag

Signing on as the first rock and roll
resident artist in Las Vegas, legendary
guitarist Carlos Santana brings “Supernatural Santana: A Trip Through the
Hits” to The Joint at The Hard Rock
Hotel & Casino through a multi-year
deal with AEG.

The 1,900-square-foot hot dog joint
is the first free-standing Pink’s Hot
Dogs in Las Vegas and offers 14 varieties of hot dogs as well as many other
culinary creations. Exclusive to the
Las Vegas location, Pink’s also offers
alcoholic beverages, as well as both
indoor and outdoor seating.

‘Lion King’

Rock with Hagar

Disney Theatrical Productions and
Mandalay Bay have opened the awardwinning Broadway phenomenon “The
Lion King” at the Mandalay Bay Theatre.
The production is virtually identical
to the others seen around the globe
and is staged with all of the same
music, sets and costumes that have
made it a worldwide phenomenon.

Rock legend Sammy Hagar is opening
his world-famous Cabo Wabo Cantina
this fall inside Miracle Mile Shops at
Planet Hollywood Resort & Casino.
The two-level, 15,000-square-foot
nightclub and restaurant will replace
the highly visible location previously
occupied by Trader Vic’s.
Offering a blend of live music and
coastal Mexican fare, Cabo Wabo Cantina will feature a traditional and contemporary selection inspired by Cabo
San Lucas as well as a cocktail menu
with a heavy emphasis on tequila.

Fator factor
Terry Fator, winner of NBC’s “America’s Got Talent” performs five shows a

AD
1/2 Page
9 1/4 x 6 3/4

iNsur
aNce
casualness of a local eatery.
First Food caters to those who stagger in to feed their late-night cravings,
as well as those looking for an early
breakfast or midday business lunch.
From breakfast to late-night, the
menu features American eats and
drinks created by Executive Chef Sam
DeMarco.

More than just Krug
Representatives of Krug, the world’s
premiere champagne, and acclaimed
French chef Guy Savoy, have
announced the opening of The Krug
Room at Restaurant Guy Savoy at Caesars Palace Las Vegas — the first of its
kind in the United States.
Krug Rooms are private dining
rooms where groups can gather to
enjoy a seasonal, six-course pairing
menu of decadent cuisine served with
a range of Krug champagnes including
vintages. DT (Source: OnlyVegas.com)

& fiN

[17] =>

0A
Dental TRubric
ribune | September 2009

Dental TPreview
ribune | Month17A
2009
Meeting

Headline
Endodontics
Extraordinaire 2
Deck
2010
conference supports the Endodontic Research Lab at University of the Pacific, Arthur A. Dugoni School of Dentistry
By line

A conference focused on the latest
advances in endodontics will give
practitioners
a chance to learn from
tk
several renowned experts and also
contribute to new research initiatives
in the field.
Endodontics Extraordinaire 2 will
feature key individuals who have
helped shape the highest standards
of excellence in endodontics.
The conference will be held March
26 and 27, 2010, at the Fairmont
Hotel in San Francisco.
In recent years, new technologies
have greatly increased the quality of
care possible to the clinician practicing endodontics.
Drs. Clifford Ruddle and L. Stephen Buchanan will review and discuss the most significant advances
in the quality of care that can be
achieved by modern endodontic
techniques.
Drs. Alan Gluskin and Ove Peters
will focus on the consensus for current standards of practice and the
latest research in the field.
Dr. John West will highlight what
it means to achieve optimum perfor-

Endodontics
Extraordinaire 2
March 26 & 27, 2010
San Francisco
Fairmont Hotel
mance in endodontics for your own
professional growth and treatment
success.
Part of the event proceeds will
help fund further research opportunities and development of the endodontic research laboratory at the
University of the Pacific, Arthur A.
Dugoni School of Dentistry in San
Francisco.
The school is organizing the event
following the success of a similar
endodontics conference held in 2003.
“Endodontics Extraordinaire 2
will focus on the very latest methods
and outcomes of endodontic care by
masters in the field,” said Dr. Alan
Gluskin, DDS, chair of the school’s
department of endodontics.
“All of our presenters have been

The endodontic
research lab at the
University of the
Pacific, Arthur A.
Dugoni School of
Dentistry currently
focuses on two core
lines of research: the
testing of root canal
instrumentation/
disinfection techniques and aspects
of the host response
during healing of
periradicular lesions.
intimately involved in the educational program at Pacific through
past and ongoing support for our
programs.”
The school welcomes inquiries
regarding current projects and
potential collaborations in the field
of endodontics.
For more information, contact
Dr. Gluskin at (415) 929-6527 or
agluskin@pacific.edu.
University of the Pacific, Arthur
A. Dugoni School of Dentistry also
recently announced a series of

other continuing dental education
events slated for this fall, winter and
next spring.
The courses span numerous
areas of dentistry and are open to
dental hygienists, assistants, general practitioners and specialists
interested in keeping their skills up
to date.
To register for the Endodontics
Extraordinaire 2 conference, or
other continuing education events,
visit dental.pacific.edu/CE1 or call
(415) 929-6486. DT
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18A Industry Clinical

Dental Tribune | September 2009

New paradigm for crown preparation:
Great White Ultra carbide instruments
By George Freedman DDS, FAACD, FACD

The standards of dental care have
evolved rapidly during the past 50
years.1 Today’s best practice modalities
require both tooth conservation and
clinical efficiency.2 These concepts are
not always mutually compatible. The
efficient and preferably rapid removal
of existing tooth structures and restorative materials must be accomplished
with minimal heat generation during
the preparation phase.3
As clinical efficiency is increased
with faster and more aggressive cutting tools (Fig. 1), it is clinically imperative that tooth preparation avoid the
excessive heat generation that could
possibly damage the remaining tooth
structure and endanger the health of
the pulp.4,5
In most clinical situations, water
and air coolants are utilized in conjunction with high-speed bur preparation to reduce the risk of thermal
damage to the tooth.6 The clinical efficiency of tooth preparation is largely
dependant on the shape and design
of the cutting bur, and the number of
steps that comprise the overall treatment.
The more often that the dentist
must change burs during tooth cutting,
the more time consuming the process
and the less efficient the technique.
ADS

Practitioners use both visual and
tactile clues to determine tissues to be
removed. Darker dentin is assumed
to be affected by caries; it should be
removed (unless, of course, it is rehardened secondary dentin). Lightly
colored dentin and enamel are presumed to be healthy tissues. For the
dentist to observe color differences
during preparation, the bur’s rotation
should remove debris as quickly and
effectively as possible (Fig. 2).
The earliest dental burs were manufactured from a variety of metals
that were harder than natural tooth
structure. With time, steel became the
preferred bur metal. Developments
in particle-to-metal adhesion technology resulted in the first diamond burs.
These burs were preferable for highspeed tooth preparation to steel.
The subsequent introduction of carbide cutting instruments was a leap
forward for dentistry; carbide offered
more effective tooth preparation with
less surface striation than diamonds.
More recently, crosscuts and innovative attack angles were introduced
to the carbide cutting shank to make
preparation better, faster and easier
(Figs. 3a, b).
In the past, dentists have tended to
favor diamond burs for extra-coronal
tooth preparation while carbide burs
have been used largely for intra coro-

Fig. 1

Fig. 3a

Fig. 2
Fig. 3b

Fig. 5

nal cutting.7 The relative popularity
of carbide and diamond burs varies
considerably in various parts of the
globe, largely due to local availability,
cost and education.8
One factor that is often not considered by the clinician is that as diamond
burs are used, their cutting efficiency
tends to decrease dramatically. Their
cutting diamonds tend to wear down
and debris accumulates in the bur
cavities (Fig. 4), reducing efficiency.9
In order to compensate, dentists tend
to press harder on the tooth with the
bur in order to maintain the earlier
cutting efficiency. Inadvertently, this
actually decreases the efficiency of the
procedure and increases the potential
for heat formation.
Diamond burs tend to grind tooth
structures while carbide burs CUT
these same materials. This leads to
the conclusion that crown and bridge
preparation, where rapid and effective
gross tooth reduction is required and
desirable, is best accomplished with
carbide instruments.
Recent research has indicated that
when a crown or onlay restoration is
to be bonded to the tooth surface, carbide bur preparation can improve the
bond to the dentin.10 A more effectively
bonded crown increases the longevity
of the restoration by decreasing leakage, and thereby the possible adhesive
failure of the restoration. Carbide burs
typically generate a smoother surface
and the partially visible smear layer.11
This smear layer may be more

Fig. 4
easily dissolved and incorporated by
self-etching primers, thus providing
a stronger hybrid layer. This results
in higher bond strengths.12 Cross-cut
carbide burs improve the retention of
crowns cemented with zinc phosphate
by approximately 50 percent. Thus,
the use of finishing burs on axial walls
is discouraged.13
Current concepts of conservative
dentistry dictate that a minimum of
healthy tooth structure be removed
during the preparation prior to the
restorative process. Natural enamel
and dentin are very likely the best
dental materials in existence. Tooth
structure conservation is thus inherently a desirable dental objective.
Consequently, minimally invasive
procedures that allow a greater part
of the healthy tooth structure to be
preserved are preferable (Fig. 5).14
The patient also benefits greatly from
minimally invasive dentistry. There is
typically less discomfort during treatment, and a greater likelihood that the
repaired tooth will last a lifetime.
The dental profession tends to take
burs for granted. They are frequently
used for patient treatment every day,
and their effectiveness and efficiency can have dramatic impact on the
practice. It is interesting to note that
if the practitioner uses burs that are
just 10 percent more efficient, the
savings in operative time can easily
increase practice billing significantly
g continued

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Dental TRubric
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Dental Tribune
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2009
Industry
Clinical

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tk

f continued
without any corresponding increase
in overhead. Thus, the entire revenue
increase goes directly to the bottom
line.
Generally, burs are one of the least
expensive components of the dental
armamentarium, at least relatively. A
small difference in bur cost can often
make a major clinical impact. The
most important parameter to consider
is to select the best bur for the job,
keeping in mind that a small added
expense of opting for a premium
instrument can pay off handsomely.
Some burs are designed for single
use. They can be sterilized and reused, but often exhibit a significantly
decreased cutting efficiency. Other
burs are designed to be sterilized and
re-used.
Recent research at the University
of Rochester, Eastman Dental Center,
jointly undertaken by the prosthodontic and the mechanical engineering
departments, examined the efficiency
of various dental burs with respect
to cutting rate and load needed to
complete standardized preparations
in Macor samples. Both air-driven and
electric handpieces were tested.
The cutting rate represents the
speed at which the bur (reflecting its
material composition and design) cuts
through a standardized material. The
faster the speed the more efficient
the preparation. The load measures
the operator pressure needed to cut
effectively. A higher required load will
cause more operator fatigue at the end
of a long working day.
In the air-driven high-speed handpiece, the SS White Great White Ultra
(SS White Burs, Lakewood, N.J.) had
AD
a significantly greater cutting rate
than the other burs tested (Fig. 6).
In addition, the Great White Ultra
bur required the least load, or operator pressure, for effective preparation
(Fig. 7).
Similar results were observed for
electric high-speed handpieces. The
SS White Great White Ultra had a cutting rate significantly greater than the
other burs tested (Fig. 8) and required
the least load, or operator pressure, for
effective preparation (Fig. 9).
In practical terms, the Great White
Ultra burs cut between 11–35 percent faster than the other burs tested.
This can save the practitioner between
one to three minutes on a 10-minute
preparation procedure. The decreased
load translates into greater operator
comfort.
Dental bur design has developed
varying flute angle and cutting charac-

Fig. 6

teristics that are specific to the intended task. Operative, cavity and crown
preparation carbide burs have flutes
(dentates) that are designed deep and
wide, creating a more aggressive cutting of enamel with increased speed
and efficiency (Fig. 10).

Fig. 7

Operative burs are either straight
bladed or crosscut. Straight-bladed
burs cut more smoothly but are slower, particularly with harder substrates.
Crosscut burs tend to cut faster, but
may create more vibration. Finishing
burs have more flutes, closer together

Fig. 8

and shallower, than operative instruments (Fig. 11). This design allows for
fine finishing and polishing of dental
materials or tooth surfaces.
The Great White Ultra bur is an
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20A Industry Clinical

Dental Tribune | September 2009

Fig. 11

Fig. 10

Fig. 9

Fig. 14
Fig. 15

Fig. 13
Fig. 12

f DT page 19A
innovative technological development that represents a new category
of crown preparation burs; it is more
sharply dentated than earlier crosscut
AD

burs. The unique geometry in the
blades’ design creates a bur that cuts
faster with less vibration in both tooth
structures and other dental materials
(Fig. 12).
The bur cuts faster and smoother

Fig. 16

because it does not “grab” or “catch”
the substrate, and thus does not stall
in harder materials. The novel design
creates less stress on the remaining
tooth structure and less frictional heat
that may irritate the pulp and damage
the supporting periodontal structures.
The aggressive cutting angle (Fig.
13) of the Great White Ultra allows
the operator to use less pressure on
the tooth during preparation (resulting in decreased tooth heating and
dentist fatigue). The tightly controlled
parameters of manufacturing quality
control develop a high degree of concentricity in the Ultra burs that offers
less vibration and chatter during use,
and decreased maintenance costs for
handpieces (Fig. 14).
The goals of conservative tooth
preparation include:15
1) Re-contouring the remaining
tooth and restored structures to a specified shape and size to accommodate
a crown.
2) Providing a depth guide on all
surfaces, including the occlusal, to
allow the crown to have sufficient bulk
and strength to withstand occlusal and
other intraoral forces.
3) Completing the preparation process with a single pass by one bur on
the buccal, lingual, mesial and distal.
4) Creating the intended marginal
finish, whether shoulder or chamfer,
at the same time as accomplishing
the gross preparation of the other surfaces.
5) Developing a surface that is suitable for bonding the indirect restoration.
6) Remaining conservative of tooth
structure.
7) Preparing the tooth quickly and
efficiently for both patient and dentist
comfort.

Fig. 17

For most dentists, the cutting speed
tops the list of features that are important in selecting dental burs. Carbide
manufacturers have produced a variety of designs and shapes that are
intended to reduce the time that it
takes a practitioner to prepare the
tooth for a crown.
The Great White Ultra bur cuts
quickly and smoothly through enamel. It negotiates amalgam and other
restorative materials with minimal
clogging and no drag or stalling in
these harder materials. The bulk
reduction in the crown preparation
phase can be accomplished with a
single instrument (Fig. 15).
The highly dentated body of the
Great White Ultra cuts efficiently and quickly, and combined with
the smooth tip, helps to provide two
reduction actions in one single pass
with a single bur (Fig. 16). The rounded, non-crosscut tip provides smooth,
precise and controlled margins with
the same cutting motions as the gross
reduction preparation. Thus, the Great
White Ultra is more efficient; there is
less chair time.
There are two preferred marginal
anatomies for crown preparation, the
chamfer and the shoulder. Accordingly, two margin-specific clinical
series of burs have been crafted. The
Great White Ultra 856 Series develops
a rounded axial-gingival margin providing a chamfer finish for the preparation (Fig. 17). The Great White Ultra
847 Series creates a 90 degree axialgingival wall and provides a shoulder
margin for crown restoration (Fig. 18).
The Great White Ultras are available
in a variety of diameters and cutting
lengths.
g DT page 22A

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[22] =>

22A Industry Clinical

Dental Tribune | September 2009

f DT page 20A
The Great White Ultra bur kits
organize a variety of shapes and sizes
that are typically used in routine crown
preparation. The bonus is that once
the correct bur is selected, the entire
preparation can often be completed
without changing to another instrument. Bulk reduction AND a smooth
margin are created with the same
reduction instrument.

Clinical case No. 1
The preparation of the bicuspid crown
is very rapid and straightforward. A
single pass of the Great White Ultra
bur reduces the bulk of the tooth at the
height of curvature and finishes the
chamfer margin simultaneously (Fig.
19). The inter-proximal preparation
must be accomplished without marring the surface of the adjacent tooth.
One of the thinner GWU burs may be
used (Fig. 20).
The buccal surface is not smoothed
out with a disc or diamond; the striations created by the bur increase
the surface area available for adhesion (Fig. 21). The occlusal reduction is completed to provide 1.5–2.0
mm clearance for the crown (Fig. 22).
The completed preparation, ready for
impressions, is viewed from the occlusal (Fig. 23). The entire circumferential preparation was completed with
AD

Fig. 18
a single Great White Ultra bur in a
single pass.

Clinical case No. 2
The molar crown preparation is begun
on the buccal surface (Fig. 24) and
continued circumferentially as in the
case above. The bulk and marginal preparations are completed at the
same time. The completed preparation, ready for impressions, is viewed
from the occlusal (Fig. 25).
The stone model is verified against
the intra-oral preparation, and the
crown is tried on extra-orally (Fig.
26). If the fit on the model is correct,
then the crown is tried intra-orally and
cemented on to the prepared abutment
(Fig. 27). A circumferential preparation that has even depth throughout
and adequate space for the restoration, as well as a well-defined margin (whether chamfer or shoulder),
results in a well-fitting and long-lasting
crown.

Fig. 19

Clinical case No. 3
Some practitioners prefer to use depth
grooves to guide crown preparation.
The Great White Ultra bur is well
suited to this task. The depth grooves
are placed quickly and evenly to the
desired preparation depth (Figs. 28a–
d) at the same time that the location of
the margin is determined.
The depth grooves are joined,
maintaining the selected depth of the
preparation and the location of the
restorative margin (Fig. 29a, b). The
occlusal surface is reduced to an ideal
depth and shape (Figs. 29a–c) and
the preparation, completed within a
matter of minutes, is viewed from the
occlusal (Fig. 29d).
It is reasonable to expect that Great
White Ultra burs can be used for multiple tooth preparations, and that they
can be cleansed effectively between
patients. There are two important
steps to follow for the proper steriliza-

tion of multiple-use tungsten carbide
burs.
Step 1: Burs should be cycled
through an automated washer such
as the Hydrim (SciCan, Toronto, Canada), that provides rapid and effective
washing, rinsing and drying with a
single push of a button. (The instruments may be cleaned manually, but
they should be pre-soaked to loosen
debris and handled with extreme care
to avoid skin punctures. Avoid cold
sterilizing solutions that contain oxidizing agents that can weaken carbide burs. Ultrasonic systems can be
used as well. The re-use of solutions
in these systems is less than ideal,
however. Separate the burs from each
other in a bur block during ultrasonic
immersion to prevent damage to the
cutting surfaces. Brush any remaining
debris away with a stainless steel wire
brush. Rinse and dry the burs.)
Step 2: It is only at this point that
sterilization can be initiated. The
importance of this step cannot be
overstated. Only the effective sterilization of burs eliminates the threat of
cross contamination to patients and
staff. Steam autoclaves will effectively sterilize carbide burs, but some
units may allow surface corrosion to
develop. Metal bur blocks may promote galvanic corrosion and should
be avoided. Both dry-heat sterilizers
g continued

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Dental TRubric
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Industry
Clinical

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tk Fig. 20
Fig. 24

Fig. 27

Fig. 21

Fig. 28a

Fig. 25

Fig. 22
b

Fig. 23

f continued
and chemi-claves can be used without
corroding or dulling carbide burs.

Conclusion
Great White Ultra burs are an innovative solution for the crown and bridge
tooth preparation process.
AD
The differential reduction provided by
the varied cross cutting of the bur’s
active surface allows intraoral multitasking.
Great White Ultras simplify the clinical procedure by reducing the circumferential bulk of the tooth and preparing the final margin at the same time.
Rapid cutting, less structural stress
and a more adhesive surface are additional advantages. DT

References
1.

von Fraunhofer JA, Siegel SC.
Using
chemo-mechanically
assisted diamond bur cutting for
improved efficiency. JADA 2003;
134:53–58.
Siegel SC, von Fraunhofer JA.
Cutting efficiency of three diamond bur grit sizes. JADA 2000;
131:1706–10.
Stanley HR, Swerdlow H. Reaction

Fig. 29a

Fig. 26

of the human pulp to cavity preparation: results produced by eight
different operative grinding techniques. JADA 1959;(5) 58:49–59.
4. Stanley HR. Traumatic capacity
of high-speed and ultrasonic dental instrumentation. JADA 1961;
63:749–66.
5. Zach L, Cohen G. Pulpal response
to externally applied heat. Oral
Surg 1965; 19: 515–30.
6. von Fraunhofer JA, Siegel SC,
Feldman S. Handpiece coolant
flow rates and dental cutting.
Oper Dent 2000; 25:544–8.
7. Siegel SC, von Fraunhofer JA.
Dental burs: what bur for which
application? A survey of dental schools. J Prosthodont 1999;
8:258–63.
8. Kimmel K. Optimal selection and
use of rotary instruments for cavity and crown preparations. Dent
Echo 1993; 63(2):63–9.
9. Siegel SC, von Fraunhofer JA.
Effect of handpiece load on the
cutting efficiency of dental burs.
Machining Sci Technol J 1997;
1:1–13.
10. Castro AKB, Hara AT, Pimenta
LA. Influence of collagen removal
on shear bond strength of one-

bottle adhesive systems in dentin.
J Adhes Dent 2000; 2:271–77.
11. Dias WRL, Pereira PNR, Swift Jr.
EJ. Effect of bur type on Microtensile Bond Strengths of Self-etching
Systems to Human Dentin. The
Journal of Adhesive Dentistry
2004; 195–203.
12. Nakabayashi N. Bonding mechanism of resins and the tooth (in
Japanese) Kokubyo Gakkai Zashi.
J Stomat Society, Japan 1982;

AD
1/4 Page
9 1/4 x 3 3/8

49:410.
13. Ayad MF et al. J. Prosthet Dent
1997; 116–21.
14. UCR. Freedman G, Goldstep F,
Seif T. “Watch and wait” is not
acceptable treatment. Ultraconservative Resin Restorations 1999;
1–14.
15. Freedman G, Goldstep F, Seif T,
Pakroo J. Ultraconservative Resin
Restorations. J Can Dent Assoc
1999; 65:579–81.

About the author
Dr. George Freedman is a founder and
past president of the American Academy of
Cosmetic Dentistry, a co-founder of the Canadian Academy for Esthetic Dentistry and a
Diplomate of the American Board of Aesthetic
Dentistry. He is the author or co-author of 11
textbooks, more than 600 dental articles, and
numerous Webinars and CDs, and is a team
member of REALITY. He lectures internationally on dental esthetics, adhesion, desensitization, composites, impression materials
and porcelain veneers. A graduate of McGill
University in Montreal, Freedman maintains
a private practice limited to esthetic dentistry
in Toronto, Canada.

[24] =>

[25] =>

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Dental TRubric
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Dental Tribune
| Month25A
2009
Industry
News

CBCT:
changing diagnosis and treatment planning
Headline

f DT page 2A

By Daniel McEowen

Deck

Since the introduction of coneBy line
beam computed tomography in 1999
in the U.S. market, there has been
a gradual shift in radiography paradigms.
tk Many of the early adopters
were unfairly accused of overuse
of this radiology technology with
comments such as, “If you have a
hammer, everything looks like a
nail,” or, “It’s way too much radiation compared to a panoramic, and
the information isn’t that valuable.”
Others in the specialty fields or
general dentists who had placed
many implants over the years said,
“It wasn’t needed and with enough
experience no one would need it.”
Interestingly enough, I had not met
one of those doctors who had actually used the technology, much less
purchased one to use in their own
office.
As technology has improved
in the last 10 years, we now have
CBCT machines that rival periapical
radiographs in clarity and diagnostic
capability. The days of using 2-D
images as the only diagnostic tool
are fast approaching an end. As this
technology progresses, dentists and
patients will demand the best quality
2-D and 3-D images to diagnose and
treatment plan their dental needs.
There are more than 17 manufacturers in the CBCT market today,
offering a wide variety of machines.
Some manufacturers offer machines
that perform a multitude of tasks
from a very large full head view
to reconstructed panoramic, 2-D
and 3-D images of every size with
moderate to good resolution. Other
manufacturers have chosen to use

a smaller, flat-panel detector to give
extremely high-resolution images
for accurate diagnosis.
PreXion 3D is one of those
machines with an 8x8 cm and 5x5
cm field-of-view (FOV). When performing surgical procedures, the
multiplaner views (slices) can be
viewed in any plane and thickness.
Three-dimensional views allow the
doctor to do virtual surgery before
doing any invasive procedures on
the patients.
I have found that when showing patients their own scan and
explaining it in the 3-D mode, there
is greater acceptance and under-

standing of the treatment you have
planned. It is true — “a picture is
worth a thousand words.”
Another factor that cannot be
ignored is the identification of
defects not visible on panoramic or
pericapical films. This eliminates
adding procedures during surgery
that patients had not planned on.
CBCT will change the way you
view endodontics from the initial
diagnosis to retreatments. The ability to look at a tooth from virtually
any angle eliminates surprises.
The high-quality images show

AD

About the author
Daniel
McEowen
is
a
1982
graduate
of Loma
AD
L i n d a
School of
Dentistry
and has
b e e n
in private practice for 26 years.
He is a founding member of the
World Clinical Laser Institute and
has been active in FDA approval
of oral surgery techniques using
erbium lasers. McEowen has been
involved in cone-beam technology
for more than five years and owns
3-D Imaging Center in Maryland.
He lectures throughout the United
States on the incorporation of cone
beam in the general dentist office
and is an advanced trainer for
PreXion 3-D cone beam systems.
McEowen is in active practice in
Hagerstown, Md., where he incorporates many new technologies.

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26A Industry News

Pediatric advanced
life support (PALS)
customized for dentists
By Heather Victorn

If you are a pediatric dentist, a
family practice dentist who treats
children or a dentist who performs
pediatric sedation, you should consider taking a pediatric advanced
life support (PALS) course.
Children are not simply small
adults. Their anatomy and physiology is vastly different. Even
practitioners who have attended
advanced cardiac life support
(ACLS) courses in the past should
still seek additional PALS certification.
Leading sedation dentistry and
emergency preparedness continuing education provider DOCS Education has expanded its curriculum
to offer a top-in-the-nation PALS
course customized for dentists.
Nearly every state requires dentists to have basic life support (BLS)
or CPR for health care providers
training. However, both courses
only teach basic skills for sustaining a patient’s life and do not teach
you how to use an automatic external defibrillator (AED) in the event
of a cardiac emergency.
Furthermore, they do not address
how to identify and treat the signs
and symptoms that can lead up to
a respiratory or cardiac emergency
in children, particularly in the dental setting.
Recognizing these signs and
symptoms can enable early intervention and prevent a small medical emergency from escalating into
a large one.
Changes in behavior, mood or
alertness can all be symptoms of
an allergic response. Often times
these first indicators of trouble are
misinterpreted as simply nervousness or agitation. When taught to
recognize the signs, the progression of respiratory and cardiac distress can often be resolved.
Because many of their allergies
and sensitivities haven’t manifested themselves yet, treating children presents unique challenges.
“Children are history in motion,”
says lead DOCS Education PALS
instructor John Bovia, Sr. “Their
AD

history is developing moment by
moment as they go through their
formative years. They haven’t
been labeled with certain allergies
because they haven’t experienced
them yet.”
DOCS Education’s PALS course
teaches essential techniques for
pediatric assessment and recognition of systems in distress, including airway obstruction, allergic
reactions, respiratory insufficiency
and hypoxemia.
Dentists learn standard pediatric
emergency protocols and how to
effectively run a mega-code emergency using dental office equipment.
The course also teaches participants how to use Broselow® Pediatric Tape, which provides precalculated emergency medication
dosages based on a child’s height
and weight.
Simulation is part of its foundation, and the course is designed to
be user-friendly with an emphasis on practice drills performed on
high-fidelity patient simulators.
These simulators provide realtime, real-world experience to maximize skill proficiency and preparation.
Training on how to use an AED
on pediatric patients experiencing
a cardiac emergency and understanding emergency drugs and their
administration via intraosseous and
other alternate routes of administration are covered in detail.
The next DOCS Education PALS
course will take place on Nov. 6 and
7 in San Francisco. To learn more or
register, visit DOCSeducation.org or
call (866) 592-9617.

Dental Tribune | September 2009

Start thinking ‘recovery’
By Roger P. Levin, DDS

The recovery is already under way for select practices. In fact, some
offices managed to avoid the full effects of this downturn altogether.
In spite of the worst economy in several generations, these practices
continued to grow. Maybe not as robustly as earlier in the decade, but
they are still growing today.
Levin Group clients are among this elite group. They have the highperformance systems, the pro-active leadership and a well-trained
team.
These dentists experience consistent growth and the freedom to
spend 98 percent of their day in direct patient care — diagnosing and
treating patients — while their team performs all administrative duties
independently and effectively.
It is this very reason that updated systems allow all dentists to experience greater professional satisfaction. Some of the proven systems we
teach our clients include:
• Greenlight Case Presentation™: Get 95 percent of patients saying
“yes” to all forms of treatment.
• Power Cell Scheduling™: A scientific method of time management
that increases production-per-chair while greatly reducing practice
stress. Increase production capacity by 30 percent.
• The Hygiene Maximizer™: Use your hygiene time for more than just
clinical care — educate patients about your full range of services. Add
$100,000–$200,000 in new production.
• Stage III Customer Service™: Treat all patients like VIPs and convert
new patients into long-term patients. Increase patient referrals by 20
percent.
• PowerScripting™: Know what to say and how to say it for all patient
interactions. Have all routine conversations documented in writing!
• The Immediate Collections Process™: Help all patients afford treatment while collecting monies owed on time. Collect 99 percent of fees
at the time of service.
By implementing these systems and mastering training techniques,
practices are recovering and growing during these difficult economic
times. These systems are a few of many that our Levin Group experts
teach clients.

The value of team training
For every new system, team members must train to understand and
use those systems effectively. The goal of systems training is to make
experts out of every staff member.
Once the team has completed training, practices see growth almost
immediately. The improved confidence and skill level of the team
members enables them to independently operate all practice systems,
freeing you to focus almost entirely on direct patient care.

Conclusion
Recovery is happening for those dentists who’ve taken the necessary
steps to safeguard practice growth. No matter what kind of economic
conditions develop in the future, the right systems and advanced team
training will lead you toward financial independence … sooner.
All dentists can choose recovery over survival. Which will you
choose?
Dental Tribune readers are entitled to receive a 20 percent courtesy
on the Levin Group’s Total Practice Success™ Seminar held for all general dentists on Oct 16 and 17 in Chicago. To register and receive your
discount, call (888) 973-0000 and mention “Dental Tribune” or e-mail
customerservice@levingroup.com with “Dental Tribune TPS” in the
subject line.

f DT page 26A
MB2 canals, split root systems and
multiple root exits and makes treatment success more certain. Impacted teeth from third molars to canines
are easily treatment planned in both
the multiplaner and 3-D views.
Periodontal defects can be visualized from any angle, and patient
understanding of “pockets” is dra-

matically increased. The hygiene
department will love the diagnostic
value when treating deep defects.
All of these valuable tools are
available in high-resolution PreXion
scans. You will never look at radiographs the same way once you adopt
CBCT technology. Your diagnosis
will be spot on, and your treatment
planning will be accurate based on
sound knowledge using CBCT.

[27] =>

0A
Dental TRubric
ribune | September 2009

Dental Tribune
| Month27A
2009
Industry
News

Headlinea ‘perfect product’ even better
Making
An
interview with DEXIS Sales Regional Manager Jeff Hales about the new Platinum Sensor
Deck
By Robin
line Goodman, Group Editor
By

What’s new with DEXIS these
days?
tk
DEXIS is a very unique product, and what I mean by that is
that DEXIS had the best product
on the market — we’ve had more
users, more happy owners than
any other company on the market,
and DEXIS had the most awarded
digital X-ray system — but the
company didn’t sit still with it.
It went ahead and took, in my
opinion, a perfect product, and
made it better. It improved upon
some of the things that have
always made DEXIS a wonderful
product.
For example, there’s no dead
space on the sensor, it’s 100 percent active and the corners are
rounded, which gives you the ability to do a full mouth series in less
than five minutes with a single
sensor.
Also, the way the cord is
designed is unique.
There are several patents on
the sensor; which make it easier, more ergonomic to fit in the
patient’s mouth, so you get all of
your images digital.
In addition, there is a direct
USB. DEXIS took all the components and electronics out of the
USB box and integrated it into the
sensor.
So there’s no additional USB
box with this system, making it
easier and more portable to move
from operatory to operatory.
With that said, there is image
quality. Image quality with the
DEXIS classic sensor was fantastic, yet with the new Platinum Sensor, it’s even improved.
There are more than 16,000
shades of gray. It gives you the
ability to see things that most sensors cannot pick up.
And in fact, it’s even better than
film. It’s very rare to have a sensor
AD
that not only is as good as film, but
actually better.
If summarized the high points
that you think would stand out
for a practitioner, what would
you say?
First, it’s patient comfort: the
ability to get any shot whether
you are dealing with children or
adults.
Second, it’s ease of use of the
software: it’s easier to use than
anything out there. Third, it’s the
image quality.
Those are primarily the three
biggest things that DEXIS does.
In fact, we’ve done shootouts
with other companies out there,
doing a side-by-side comparison,
and I just did one last week.
I was in Salt Lake City with a
very analytical dentist I’ve worked

with for about six months who has
been doing a lot of research and
wanted to have everything under
the sun.
He finally decided the best way
for him to do it was to have everybody come into his office, so the
three top players in digital X-ray
were there.
We were there, and two of our
competitors were there. And, I
have to say, it was not even a close
contest, and the dentist bought
from DEXIS. DT

Jeff Hale at
the DEXIS
booth
during
CDA’s fall
meeting in
September.

AD
1/4 Page
9 1/4 x 3 3/8

[28] =>

28A Industry News

Dental Tribune | September 2009
AD

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.
In order for them to 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
practitioners 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.

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

[29] =>

[30] =>

30A Industry News

Dental Tribune | Setptember 2009

InTouch Practice Communications
earns top honors from ADA
Company’s messaging services receive prestigious ADA Business Resources endorsements
By Lauren McCormak, Firstline Media

If you are looking for new ways
to maximize the potential of your
practice, consider improving your
patient relations with advanced
messaging services. Professional
on-hold messages and automated
appointment reminders are powerful tools for connecting with current
and future patients.
For the past 12 years, InTouch
Practice Communications (formerly
On Hold Advertising) has revolutionized the world of dental communications for thousands of dentists across North America.
The company’s name recently
changed to InTouch Practice Communications, but its high standards
for quality, great staff and tremendous products remain the same.
InTouch Practice Communications is the leading provider of such
services for the dental community.
In fact, InTouch was recently
awarded exclusive endorsements
for both products from the ADA®
Business ResourcesSM group.
InTouch Practice Communications Vice President Bill Schroe-der
said he was thrilled to be awarded
the endorsements. He states: “The
American Dental Association Business Resources group has done its
research.
It identified the need for our
products within the dental community and conducted a thorough
review of the firms in the industry.
“This was far from a ‘rubber
stamp’ endorsement. Analysts reviewed our financials, toured our
production facilities, interviewed
our employees and spoke with our
clients.
“In the end, our years of providing great products and outstanding

Stop by and visit
InTouch Practice Communications
ADA Annual Session Hawaii
booth Nos. 823 & 718
(Photo: Hawaii Tourism Authority/Kirk Lee Aeder)
customer service were validated by
this exclusive endorsement.”
InTouch Practice Communications currently offers PhoneTree
automated appointment reminder
systems for patient communications, a product that is trusted by
more than 45,000 clients.
The system sends phone, e-mail
and/or text message reminders
to patients by using information
already tracked in an office’s practice management software and asks
patients to confirm their appointments before sending a report of
all confirmed appointments to the
practice.
Appointment reminders are beneficial to a dental practice in many
ways. Dentists using PhoneTree see
as much as a 42 percent decrease in
missed appointments.
Reminders also reactivate missing patients by alerting them when
they are overdue for a check-up.
Simply put, the PhoneTree system saves your practice thousands

of dollars annually by retaining
business that would otherwise be
lost and reactivating patients that
have been absent.
Using an on-hold message service is also very beneficial to your
dental practice. Callers hear a
targeted message that creates an
interest in specific services offered
by the practice.
For example, a message focusing
on cosmetic whitening procedures
translates into increased customer
awareness and ultimately more
sales of that service.
InTouch Practice Communications provides fully customized programs to meet the needs of every
practice. A highly experienced staff
of scriptwriters makes each onhold message unique, professional
and easy to understand.
Dentists often use on-hold message services to support the image
of their practice. On-hold messages
are the perfect vehicle for educational information.

The targeted messages are a
great way to inform patients about
the importance of oral health, and
patients appreciate a practice that
is interested in their well-being.
InTouch’s Flex Plus plan offers
their on-hold message customers
a tremendous amount of flexibility.
This program not only allows for
unlimited changes to their primary
messaging, but also unlimited creation of “short subject” programs
that are designed to deliver very
specific, timely information about a
product or service.
Use of these short subject programs practically guarantees a caller will hear a message about the
matter at hand.
One of the most important
aspects of any messaging system is
ease of use. InTouch Practice Communications guarantees its products are simple to use and easy to
change according to your needs.
Make sure to visit InTouch Practice Communications at the ADA
150th anniversary Annual Session
in Hawaii. The company will be
exhibiting in booths 823 and 718
in the ADA Business Resources
endorsed provider area.
At the meeting, InTouch will
offer its lowest prices of the year to
celebrate the endorsement. Visitors
who place an order on the show
floor will receive a chance to win a
helicopter tour for two over Oahu.
The winner will get to view
Waikiki Beach, Diamond Head,
the Dole Pineapple Plantation and
Pearl Harbor from the beautiful
skies over Hawaii.
To learn more, visit InTouch
Practice
Communications
in
Hawaii, call (800) 493-9003, or
visit them company on the Web at
www.InTouchDental.com.

OctOber 16 -17, 2009, Las Vegas, NeVada

Don’t miss the premier educational and networking event for dental administrative professionals!
SPACE IS LIMITED! For more details or to register, visit www.dentalmanagers.com or call 732-842-9977.

Office MaNagers • Practice adMiNistratOrs • iNsuraNce & fiNaNce cOOrdiNatOrs • PatieNt & treatMeNt cOOrdiNatOrs

[31] =>

[32] =>

[33] =>

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

September 2009

www.dental-tribune.com

Vol. 2, No. 7

New approaches for patient
acceptance and appreciation
By Lorin Berland and Sarah Kong

This 51-year-old executive has
lived with the effects of tetracyclinestained teeth since she was a little
girl (Fig. 1a). All her life she wanted
to have a great smile, but she never
knew what her dental options were.
The general dentist she had seen
for many years told her there wasn’t
anything he could do to help her, so
he referred her to our office.
When the patient came for her
first visit, she had a number of dental concerns she wanted to address.
In addition to the severe tetracycline
staining, she felt her teeth were
worn from years of grinding. She
also had old resin bonding on her
lower front teeth that was not only
discolored, it was mismatched from
years of patching and re-patching
every time something would break
off.
After listening to her chief complaints and performing a thorough
exam and cleaning, we recommended she try deep bleaching and,
after evaluating the results of whitening, a minimum of four minimal
prep Microveneers™ for her lower
front teeth and her upper seven
teeth and a zirconium porcelain
crown for tooth No. 5 to achieve the
smile she was seeking.
Because her maxillary six anteriors had worn, flat incisal edges, it
was essential that we knew what the
patient hoped for in terms of shape
and length. We went over the Smile
Style Guide (www.digident.com) to
select a smile design (Fig. 2). With
the patient’s input, we determined
that P3 — pointed canines with
square centrals and round laterals — would look the best for her
(Fig. 3).
The length combination she liked
the most was L-2, laterals slightly shorter than the centrals and
canines (Fig. 4). We submitted her
pre-op photo to SmilePix for a cosmetic image (Fig. 5) and concluded
with PVS impressions (Splash, Discus Dental) and a bite registration
(Vanilla Bite, Discus Dental).
At her second consultation
appointment, we confirmed the
smile design and length combination she had previously selected by
showing her a diagnostic wax-up of
her upper and lower teeth (Fig. 6).
Matrices were fabricated from the

Fig. 1a: Pre-op full face.
wax-ups before this appointment
and were used to make an upper
and lower Slip-On Smile right on the
patient’s teeth.
We loaded the matrices with an
A-1 bisacryl temporary material —
such as Temphase (Kerr), Integrity
(DENTSPLY Caulk) or PERFECtemp
II (Discus Dental) — and seated
them in the mouth. After the material was set, the matrix was removed
and what remained on her teeth
was a new smile.
We took a series of photographs
with the Slip-On Smiles in place and
the patient was ecstatic. She was
able to see and feel what her teeth
could look like before committing
to any dental work (Fig. 7). The
patient was truly amazed by this and
wanted to wear the smile home to
show her husband.
Though the patient had loved the
selected smile design and cosmetic
image, she was not quite sure about
pursuing this treatment. This is
why the Slip-On Smile was such an
important part of her treatment presentation. She accepted the treatment as soon as she could experience her new smile firsthand.
We began her treatment with a
combination of in-office and takehome whitening. The incisals of the
canines and bicuspids, the part that
shows, had acceptable results.
We used this as a base shade,
planning to make the lower veneers

Fig. 1b: Post-op full face.
even lighter toward the front and
the upper veneers slightly lighter than the lowers. As planned,
teeth Nos. 6–12 were prepared for
Microveneers to preserve as much
natural, healthy tooth structure as
possible.
Tooth No. 5 had an existing
crown that the patient wanted to
replace to match No. 12, so it was
prepared for a zirconium crown at
the same time. Digital photographs
of the prep shades were taken for
our ceramic artist (Fig. 8).
Once the preps were finished and

refined, it was time to provisionalize
the teeth. While an assistant loaded
a tray with alginate, hydrocolloid
(Dux Dental) was expressed over
the prepared teeth for an impression. Then the alginate-filled tray
was seated in the mouth, directly
onto the hydrocolloid. After a mere
minute and a half, the impression
was removed with a snap and handed off to an assistant to pour.
In the lab, the impression was
disinfected and dried. Next, Mach-2
g CT page 2B
AD

[34] =>

2B

News

Cosmetic Tribune | September 2009

COSMETIC TRIBUNE
The World’s Dental Newspaper · US Edition

Publisher & Chairman
Torsten Oemus
t.oemus@dental-tribune.com

Fig. 8: Upper preps and prep shade.

Fig. 2: Smile Style Guide.

Vice President Global Sales
Peter Witteczek
p.witteczek@dental-tribune.com
Chief Operating Officer
Eric Seid
e.seid@dental-tribune.com

Fig. 5: Cosmetic image.

Group Editor & Designer
Robin Goodman
r.goodman@dental-tribune.com
Editor in Chief Cosmetic Tribune
Dr. Lorin Berland
l.berland@dental-tribune.com

Fig. 9a: Indirect provisionals on
instant silicone models.

Fig. 3: P-3, pointed canines with
square centrals and round laterals.

Managing Editor/Designer
Implant & Endo Tribune
Sierra Rendon
s.rendon@dental-tribune.com
Managing Editor/Designer
Ortho Tribune & Show Dailies
Kristine Colker
k.colker@dental-tribune.com

Fig. 6: Diagnostic wax-up and putty
matrices.

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

Fig. 9b: Indirect provisionals on
instant silicone models.
Fig. 4: Length code L-2, laterals
slightly shorter than centrals and
cuspids.
f CT page 1B

PVS (Parkell) was dispensed into the
impression to pour up the model on
a vibrator. A fast-setting bite registration material (SuperDent, Darby
Dental) was then placed directly
onto the Mach-2 for a model base.
In less than two minutes, an
accurate, instant silicone model
was ready on which to fabricate a
provisional — all of which was completed by an assistant and outside
the patient’s mouth.
Using the matrices made from
the diagnostic wax-up and approved
by the patient in her Slip-On Smile,
the provisionals were fabricated.
First, the instant silicone model
was lubicated with a water-based
lubricant such as KY Jelly. Next, the
putty matrix was filled with bisacryl
and then placed onto the silicone
model. After a minute and a half, the
provisional was set up and ready to
be trimmed.
Because this method of temporization involves a quick way to
make a model of the prepped teeth,
the provisional can be trimmed and
polished in the lab. Finishing provisionals in this manner is much more
accurate, kinder and easier for the
patient, and especially for the gingiva and the prepped and impressed
teeth (Figs. 9a, b, 10a–c).
To prepare the gingiva for the
final impressions, Expasyl (Kerr)

Fig. 7: Slip-On Smile full face.
was placed around the gumline.
Final impressions with a PVS material, such as Take 1 Advanced
(Kerr), or Virtual (Ivoclar Vivadent),
were then taken in custom trays. A
slow-setting material was used to
record her bite registration (SuperDent).
To cement the provisionals,
the same bisacryl was placed in
the temporaries and seated in the
mouth. The excess was removed
with a microbrush before the material set up. The patient loved the
way her provisionals looked and fit
(Fig. 11). There were no surprises
as she had chosen the smile design
she liked best before any work was
ever even started.
When she returned for the final
porcelain restorations, the patient
was concerned that they might not
look as good as her provisionals.
Because the minimal preparation
was all in enamel, we could try the
restorations with no anesthetic and
no discomfort. This is important to
the patient to really get a “feel” for
the teeth, especially when we are
increasing length.
We assured her that we would try
them in and get her approval before
they were seated permanently.
Thus, we invited her whole family to the seat appointment to offer
their opinions. As is often the case,

it was especially important to please
one family member in particular,
and this time it was her daughter.
For the try-in, we used different shade combinations of try-in
pastes to see what looked the most
natural. I call this the “Mix-to-Match
Method.”
This method is especially important when doing large cases with
multiple types of restorations and
porcelains.
In this case, feldspathic porcelain
was used to fabricate the veneers
while the crown was made with a
zirconium core.
When it comes to mixing cements,
we generally like to use the lightest shade for centrals and warmer
shades as we go distally. This Mixto-Match method helps to achieve a
natural-looking smile.
We ultimately decided, with the
patient’s input, to use a dual-cure
resin cement such as Maxcem
(Kerr), Multilink (Ivoclar Vivadent)
or PermaCem Automix Dual (Foremost) for the zirconium crown on
No. 5; Cosmedent Ludicrous for Nos.
8, 9, 24, 25; Bright for Nos. 6, 7, 10,
11, 12; and Yellow-Red Universal for
Nos. 23 and 26.
A fresh bottle of bonding agent,
such as Optibond Solo Plus (Kerr),
Excite (Ivoclar Vivadent) or Adper
Single Bond Plus (3M ESPE), was
selected. Using a fresh bottle
ensured that the bond would be at
its strongest potential.
The teeth were cured from all
angles with the FLASHlite Magna
g continued

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
E-mail: 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
© 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!

[35] =>

Cosmetic Tribune | September 2009

Clinical

About the authors
Dr. Lorin Berland, a fellow of the AACD, pioneered the
Dental Spa concept in his multi-doctor practice in the
Dallas Arts District. In 2008, he was honored by the
AACD for his contributions to the art and science of
cosmetic dentistry. For more information on The Lorin
Library Smile Style Guide, www.denturewearers.com
and Biomimetic Same Day Inlay/Onlay 8 AGD Credits
CD/ROM, call (214) 999-0110 or visit www.berlandden
talarts.com.

Fig. 10a

Fig. 11: Provisional full face.
the proposed treatment, but it was
the extra steps that ultimately
gained the patient’s appreciation of
the final results. CT
Fig. 10b

Fig. 10c
Figs. 10a–c:
Upper and lower indirect provisionals on instant silicone models.
f continued

(Discus Dental). Because it is a
LED, there is little danger of overheating the teeth.
Once the restorations were
seated, the patient was ecstatic
with the results. She simply could
not believe how natural her teeth
looked.
They were exactly the way she
had anticipated in shape and shade,
only better (Fig. 1b). The once
tetracycline-stained smile was the
only smile she had ever known.
Now, for the first time in her life,
she could look in the mirror and
smile with confidence knowing she
had a beautiful, natural smile.
In this case, a cosmetic image
was helpful in showing the patient
a 2-D photo of how her smile could
look.
Yet, it was not until she saw her
personalized smile design in real
life with the Slip-On Smile that she
could really feel and sense what
that new smile would truly be like.
She was pleased with every step
of her smile transformation, with
her provisionals and ultimately
with her final results.
Though the Mix-to-Match Method is an extra step that requires
more chair-time, the end results
justify the means.
And for this patient, that meant a
beautiful new smile with minimal
tooth reduction to achieve the most
natural esthetics.
Each step of this process gained
more of the patient’s acceptance of

Dr. Sarah Kong graduated from Baylor College of Dentistry, where she served as a professor in restorative dentistry. She focuses on preventive and restorative dentistry,
transitionals, anaesthesia and periodontal care. She is an
active member of numerous professional organizations,
including the American Dental Association, the Academy
of General Dentistry, the American Academy of Cosmetic
Dentistry, the Texas Dental Association and the Dallas
County Dental Society.

[36] =>

[37] =>

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

September 2009

www.dental-tribune.com

Vol. 2, No. 7

Oral cancer: Early detection saves lives
By Arlene Guagliano, RDH, MS

Cancer of the mouth or oral cavity is one of the most preventable
cancers in the United States today.
According to the Journal of the
National Cancer Institute, more than
35,000 Americans will be diagnosed
with oral or pharyngeal cancer this
year.
It will cause more than 8,000
deaths, killing roughly one person
per hour, 24 hours per day. Of those
35,000 newly diagnosed individuals,
only half will be alive in five years.
This is a number that has not significantly improved in decades.1
Although the overall incidence
of oral cancer has remained stable
with numbers only slightly increasing each year2, currently this is the
second year in a row in which there
has been an increase in the rate of
occurrence, about 11 percent over
last year.
The death rate for oral cancer is
higher than that of other cancers
that we hear about routinely, such
as cervical cancer, Hodgkin’s lymphoma, laryngeal cancer, cancer of
the testes and endocrine system cancers such as thyroid or skin cancer
(malignant melanoma).1
Oral squamous-cell carcinomas
(OSCCs) are the eighth most common cancer among men and the
14th most common among women
in the United States.3
It includes many parts of the
mouth: the lips, the buccal mucosa
of the lips and cheeks, the gingiva
and the area behind the wisdom
teeth, the floor of the mouth, the
hard palate, the soft palate and the
uvula, the tonsils and the tongue.4
The ratio of men to women diagnosed with oral cancer is 2:1 over a
lifetime, although the ratio comes
closer to 1:1 with advancing age.
Approximately 96 percent of oral
cancer is diagnosed in persons older
than 40, and the average age at the
time of diagnosis is 63 years.
However, recent evidence has
emerged indicating that oral cancers are occurring more frequently
in younger persons, those under 40
years old.2
Common symptoms of oral cancer include:
• A sore or lesion in the mouth
that does not heal within two weeks.
• A lump or thickening in the
cheek.
• A white or red patch on the gingiva, tongue, tonsil or lining of the
mouth.
• A sore throat or a feeling that
something is caught in the throat.

Fig. 1: The ViziLight Plus.

Fig. 3a: Normal
tongue in normal
light.

Fig. 2: The VELscope.
• Difficulty chewing or swallowing.
• Difficulty moving the jaw or
tongue.
• Numbness of the tongue or
other area of the mouth.
• Swelling of the jaw that causes
dentures to fit poorly.1
Oral cancer is caused by damage
to the DNA of cells in the mouth.
There are two distinct pathways
through which most people come
to have oral cancer. Many years
ago, the most prevalent pathway
was through the use of tobacco
and alcohol, but today the growing
pathway is through exposure to the
human papilloma virus (HPV), the
same one that is responsible for the
vast majority of cervical cancers in
women.
Whichever the pathway, damage
to the cells occurs and they malfunction, mutating into cancer cells. The
anatomical malignancy sites associated with each pathway appear to
also be different from each other.
In the broadest terms, they can
be differentiated into the following
areas: HPV-related appear to occur
on the tonsillar area, the base of the
tongue and the oropharynx while
non-HPV positive tumors tend to
involve the anterior tongue, floor of
the mouth, the mucosa that covers
the inside of the cheeks and alveolar
ridges.
It is now confirmed that HPV is
the most common virus group in the
world today, affecting the skin and
mucosal areas of the body. More

Fig. 3b:
Normal tongue
viewed
with the
VELscope.
than 100 different types/versions of
HPV have been identified. Different
types of the human papilloma virus
are known to infect different parts
of the body. There are certain forms
of HPV that are sexually transmitted
and are a serious problem.
Today, in the younger age group,
including those who have never
used tobacco products, there are
those who have oral cancer, which
is HPV-viral based.
Two types of genital tract HPV in
particular, HPV 16 and HPV 18, are
known to be linked to oral cancer
and have been conclusively implicated in the increasing incidence
of young, non-smoking, oral cancer
patients. The HPV group is the fastest growing segment of the oral cancer population to date.1
Oral cancer is among the most
debilitating and disfiguring disorders seen in today’s oral health
environment. Tumors affecting a
patient’s mouth, tongue and soft palate can prohibit proper swallowing
and speech.5
In addition, the cancer can spread
to other parts of the body, causing
disability and even death. The survival of patients and the quality of
life after treatment depend on early
diagnosis. Eighty-one percent of
patients with oral cancer survive at
least one year after diagnosis. Early
detection is the key.4

The best defense against oral cancer is early discovery. Early detection is complicated by the fact that
many lesions in their earlier stages
may be completely asymptomatic.
Historically, unaided visual examination, palpation and radiographs
were the only methods available
for oral cancer screening. In recent
years, screening technologies have
become available to supplement
the visual examination and help the
clinician identify suspicious lesions
that require further investigation.6

Adjunctive screening aids

ViziLight Plus. Technology such
as light-based detection systems
increases a clinician’s ability to see
tissue changes that the naked eye
might miss. One such technology is
ViziLite Plus, a simple screening tool
that helps visualize suspect tissues
in the oral cavity (Fig. 1).
Lesions that may have gone
unnoticed to the naked eye will be
more visible using Toluidine blue
(T-Blue) tissue dye and chemiluminescent light, which marks and
identifies oral lesions.
The patient rinses with a dilute
acetic acid solution, and abnormal
squamous epithelium tissue will
appear acetowhite when viewed
under ViziLite’s diffuse low-energy
g HT page 2C

[38] =>

Editor’s Letter

Hygiene Tribune | September 2009

Dear Reader,
Have you have taken me up on
my challenge to have written something by the time you receive this
edition?
I hope that some of you have
tried your hand at this project. If
you have, read on to learn what to
do now. If you haven’t, that’s OK
because you can still read about the
next step in the process.
Once you’ve written an article, it
is important to have others read it;
and in this case, the more pairs of
eyes that do this, the better it is for
you the writer.
You should ask readers to answer
the following questions: Is the main
idea of the article apparent? Is the
article concise and to the point?
Does the article teach readers something or give them something to
think about?
These three questions actually
summarize what are likely to be
the most common objectives of any
writing you undertake. If a reader
answered no to any one of them, ask

him or her to give you a bit more
feedback as to how things fell short
in that area.
Having more than one pair of
eyes read the article results in a
variety of feedback, some of which
may form a repeated refrain and
some of which may not.
Before you set about the next
step, which is doing a round of revisions, summarize the feedback you
received.
With the list of feedback nearby,
you can begin to revise. Reread the
article with this feedback in mind
in order to determine where in the
article you need to make changes.
The end goal is to have the three
basic questions answered with not
only a yes, but a resounding yes.
Once you feel you’ve achieved that,
the document is ready for the next
step in the process.
Work on your revisions for now.
In next month’s edition I will explain
the next step on the path to publication.

f HT page 1C

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
Product & Account Manager
Mark Eisen
m.eisen@dental-tribune.com

Angie Stone, RDH, BS
Editor in Chief

Marketing Manager
Anna Wlodarczyk
a.wlodarczyk@dental-tribune.com

biochemical information about the
cells at and just beneath the surface.
This gives clinicians the ability
to see early biochemical changes
before they present more obviously,
and therefore to detect lesions earlier in the disease process.7
Figue 3a is an image of a normal
tongue in normal light, and Figure
3b is an image of a normal tongue
with the use of the VELscope (images courtesy LED Dental).
Figure 4a shows a tongue with
an area that appears normal under
white light. However, Figure 4b
shows the area as seen under the
VELscope. The dark area is VELscope positive, which was confirmed
by biopsy as carcinoma in situ
(images courtesy of LED Dental).

Fig. 4a: Close-up of
the tongue in
normal light.

In-office tissue test

Fig. 4b:
Tongue
close-up
with the
VELscope
showing
in situ
carcinoma
that was
confirmed
by biopsy.
wavelength light.
Normal epithelium will absorb
the light and appear dark. ViziLite
can assist a dentist or hygienist in
identifying an abnormality in the
oral cavity that may need further
testing, such as a biopsy.
It has been difficult to determine
which tissues in the mouth are cause
for concern. It is with continued
research that technology has forged
forward and developed adjuncts for
the oral health care professional
to intervene when early signs are
unclear.

HYGIENE TRIBUNE

VELScope. The VELscope integrates four key elements: illumination, sophisticated filtering, natural
tissue fluorophores and the power of
human optical and neural physiology (Fig. 2).
Next to public awareness, which
is essential regarding the risk factors in oral cancer, the role of the
dental professional is the first line
of defense in early detection of the
disease.
The VELscope illuminates tissue
with specific wavelengths that interact with and provide metabolic and

OralCDx BrushTest. An essential
tool for early detection of oral cancer is the OralCDx BrushTest, or
oral brush biopsy (Fig. 5). This is the
only painless test for oral dysplasia
(pre-cancer) and cancer.
The BrushTest was found to be
at least as sensitive as a scalpel in
ruling out dysplasia and cancer in
every study in which the same tissue
was simultaneously tested by both
OralCDx and a scalpel biopsy.8,9
This procedure is simple and can
be done right in the dentist’s chair.
It results in very little or no pain or
bleeding, and requires no topical or
local anesthetic.
Firm pressure with a circular
brush is applied to the suspicious
area. The brush is then rotated five
to 10 times, causing some pinpoint
bleeding or light abrasion. The
cellular material picked up by the
brush is transferred to a glass slide,
g continued

Sales & Marketing Assistant
Lorrie Young
l.young@dental-tribune.com
C.E. Manager
Julia E. Wehkamp
E-mail: 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
© 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.

[39] =>

Clinical

Hygiene Tribune | September 2009
f continued

Fig. 5:
The OralCDx
BrushTest.
6.
preserved and dried.
The slide is then mailed to a
laboratory along with written documentation about the patient and a
detailed description of the questionable area of the mouth. At the laboratory, the sample will be examined
for cells that show signs of change,
such as dysplasia or full malignancy.
A pathologist examines the cells
to determine the final diagnosis. A
lab report is then sent to the dentist, and experts from the pathology
department provide patient-specific
follow-up guidance by telephone for
every abnormal OralCDx report.

Oral Cancer Risk and Detection: The Importance of Screening Technology; Lynch, Denis
P. DDS Ph.D; www.ineedce.com/
pathology.html.
John C. Kois, DMD, MSD, and

P&F Ad-DTA

1/14/09

2:45 PM

Page 1

Edmond Truelove, DDS, MSD;
Detecting Oral Cancer: A New
Technique and Case Reports,
Dentistry Today, 2006, Oct;
25(10):94, 96–7.
“Oral
cytology
revisited”;
R. Mehrotra, M. Hullmann,
R. Smeets, T. E. Reichert, O.
Driemel; Journal of Oral Pathology & Medicine Volume 38,
Issue 2, Date: February 2009,
Pages: 161–166.
“Improving Detection of Precancerous and Cancerous Oral
Lesions:
Computer-Assisted
Analysis of the Oral Brush Biopsy”; James J. Sciubba, D.M.D.,
PH.D.; and for the U.S. Collaborative
OralCDx
Study
Group (JAMA) Journal of the
American Dental Association
1999;130:1445–1457.

About the author
Arlene Guagliano, RDH,
MS, is an associate professor
at Farmingdale State College
in the department of dental
hygiene and an assistant professor at Hostos Community
College in the dental hygiene
unit. Her professional experience includes 29 years in clinical practice specializing in geriatric dental care, oral cancer
screening for early detection,
dental hygiene education, caries management and periodontics. She can be reached at
arlene.guagliano@farmingdale.
edu, or via phone at (516) 6800231.
AD

™

A final word

The American Dental Association
states that 60 percent of the U.S.
population sees a dentist every year.
One only has to look at the impact
of the annual PAP smear for cervical
cancer, the mammogram to check
for breast cancer, or PSA and digital
rectal exam for prostate cancer to
see how effectively an aware and
involved public can contribute to
early detection, when coupled with a
motivated medical community.
The dental community needs to
incorporate adjunctive technology to
the screening process and assume
the same leadership role as the
medical community if oral cancer is
to be brought down in the future
from its undeserved high ranking as
a killer.1 HT

Contains no
Bisphenol A

References
1.
2.

The Oral Cancer Foundation
2007; www.oralcancerfounda
tion.org.
Inside Dentistry—The Forgotten Disease “Oral Cancer: Early
Detection and
Prevention”
Nelson L. Rhodus, DMD, MPH;
January 2007; Vol 3, No 1.
Chaturvedi, Anil K., Engels, Eric
A., Anderson, William F., Gillison, Maura L.; Incidence Trends
for Human Papillomavirus —
Related and Unrelated Oral
Squamous Cell Carcinomas in
the United States; Journal of
Clinical Oncology; February 1,
2008; Vol. 26, No. 4.
University of Texas Cancer Center; Oral Cancer M.D. Anderson
Cancer Center; www.mdander
son.org/diseases/oralcancer.
Baker, Gerry I.: Radiation Therapy to Head and Neck, Dental
Hygiene News, Fall 1991, Vol. 4
No. 4, p 1, 2.

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[40] =>

This interactive DVD
is written, directed,
and narrated
by Dr. Stanley
Malamed, dentistry’s
leading expert in
the management
of medical
emergencies.

Dr. Stanley Malamed
Dentist Anesthesiologist

“You don’t get a chance to save a life
you’ve lost. So get it right...the first time.”

Contains 14 different situations that can and do arise in the dental office
Including Cardiac Arrest, Seizure, Allergic Reaction and many others...
Dr. Malamed breaks down these scenarios using high definition 3D
animations and stunning dramatizations.
Great for in-office training sessions or individual training.
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[cover] => DT U.S. 2709

[toc] => Array ( [0] => Array ( [title] => An interview on stem-cell research in dentistry with Prof. Thimios Mitsiadis - head of the Institute for Oral Biology at the University of Zurich [page] => 01 ) [1] => Array ( [title] => Hundreds line up to receive free dental care [page] => 03 ) [2] => Array ( [title] => CDA meeting offers something for everyone [page] => 04 ) [3] => Array ( [title] => Experience is no substitute for training [page] => 06 ) [4] => Array ( [title] => The dental office manager’s role in a practice transition [page] => 10 ) [5] => Array ( [title] => Business continuity and IT mangement (Part 2 of 2) [page] => 11 ) [6] => Array ( [title] => Protecting yourself from employee theft - fraud and embezzlement (Part 1 of 2) [page] => 12 ) [7] => Array ( [title] => ADA celebrates its 150th anniversary in Hawaii [page] => 14 ) [8] => Array ( [title] => Vegas offers lots to do after a day of learning [page] => 16 ) [9] => Array ( [title] => Endodontics Extraordinaire 2 [page] => 17 ) [10] => Array ( [title] => New paradigm for crown preparation: Great White Ultra carbide instruments (part1) [page] => 18 ) [11] => Array ( [title] => New paradigm for crown preparation: Great White Ultra carbide instruments (part2) [page] => 22 ) [12] => Array ( [title] => Industry News [page] => 25 ) [13] => Array ( [title] => InTouch Practice Communications earns top honors from ADA [page] => 30 ) [14] => Array ( [title] => Cosmetic Tribune 7/2009 [page] => Supplement1 ) [15] => Array ( [title] => Hygiene Tribune 7/2009 [page] => Supplement2 ) ) [toc_html] =>

Table of contents

[toc_titles] =>

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