DT U.S. 3309

Tankersley is new president of ADA / Protecting yourself from employee theft - fraud and embezzlement (part 2) / They stew - they fume - they leave … What drives good employees away? / A new generation of athletic mouthguards / Get ready for live demos at the Greater N. Y. Dental Meeting / What’s new in New York City? Plenty! / Plenty to look forward to at DTSC Symposia / The Internet has changed - but have you changed with it? / Case presentation is the key to success / They are doing business the American way / Industry / Cosmetic Tribune 9/2009 / Hygiene Tribune 9/2009

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Table of contents

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

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DENTAL TRIBUNE

November 2009

www.dental-tribune.com

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

The functional esthetic zone

Athletic mouthguards

TodayÕ s mouthguards guide occlusion.

This is a prominent factor in smile design.

u Page 1B

u Page 12A

vol. 4, Nos. 33 & 34

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

HIPAA rules

Dentists are required to comply with these rules.
u Page 1C

‘Our ultimate goal: Tankersley is new president of ADA
to improve lives’
By Robin Goodman, Group Editor

You and I met at the California
Dental Association convention in
San Francisco at your Mobile CT
Imaging van. What drew you to
get involved with that business
endeavor?
About two years ago, three colleagues and I saw the growing influence of cone-beam CT technology
on dentistry. We felt that it would
someday soon become the standard
of care for implant placement and
pathology detection, and eventually
g DT Ê page 2A

Dr. Eric Yabu

The Greater N.Y. Dental Meeting

Ronald L. Tankersley, DDS, who
practices oral and maxillofacial surgery in Newport News, Williamsburg
and Hampton, Va., was installed as
president of the American Dental
Association (ADA) and will lead
the 157,000-member organization’s
efforts to protect and improve the
public’s oral health and promote
advances in dentistry.
Tankersley’s installation took
place during the ADA’s recent 150th
Annual Session in Honolulu. He previously served as ADA presidentelect.
Tankersley served a four-year
term as a member of the ADA Board
of Trustees representing the Sixteenth District, which includes
North Carolina, South Carolina and
Virginia. As a trustee, Tankersley
served as board liaison to the Dental Economics Advisory Group, the
Committee on the New Dentist, the
Council on Access, Prevention &
Interprofessional Relations and the
Council on Ethics, Bylaws & Judicial
Affairs.
Tankersley’s previous responsibilities with the ADA include serving as chair of the Council on Dental Benefits, the Strategic Planning
Committee, the Advisory Committee
on the Code, the Diagnostic Coding
Committee, the Standing Committee
for Diversity and the Dental Content
Committee.
In addition, Tankersley participated on the ADA’s Future of Healthcare/Universal Coverage Taskforce.

Dr. Ronald L. Tankersley
Tankersley is a former president
of the Virginia Dental Association,
Virginia Society of Oral and Maxillofacial Surgeons and Southeastern
Society of Oral & Maxillofacial Surgeons.
He earned his dental degree from
the Medical College of Virginia
School of Dentistry, where he also
completed his residency in oral and
maxillofacial surgery.
Tankersley is a fellow of the
American College of Dentists, the
International Colleges of Dentists
and the Pierre Fauchard Academy,
an international honorary organization for dentists.
Tankersley and his wife, Gladys,
reside in Newport News and are the
parents of two children, Kenneth
and Christine. DT
AD

A live dentistry presentation during last year’s Greater N.Y. Dental Meeting.
Get the full story on the Live Dentistry Arena and what to see and do in NYC.
gLive Demos, page 15A

Dental Tribune America
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[2] =>

Interview

DENTAL TRIBUNE | November 2009

‘I went into dentistry not
because I like teeth, but
because I like people’
f DT Ê page 1A
even ortho treatment planning and
endo diagnosis.
We thought the technology was
amazing. However, we saw that
many dentists and their patients
don’t have access to CBCT because
the scanners are costly and radiology labs are often far away.
That’s when we decided to install
a CBCT scanner in a van and form
Mobile CT Imaging to bring the service to dentists in the San Francisco
Bay Area.
How has the service been received?
Dentists, and especially patients,
that use our service greatly appreciate the convenience of our mobile
service.
Generally, we meet the patients
at their dental office, that way they
don’t have to worry about finding an
unfamiliar location.
And because the dentists know
that patients will be more accepting of a referral that doesn’t involve
driving to a remote lab, dentists tend
to use CBCT more.
Are you a general dentist? How
long have you been practicing?
Yes, I am a general dentist and have
been practicing for 16 years after
graduating from U.C. San Francisco
ADS

in ’93. My wife, Geraldine Lim, and
I share a practice in Oakland, California where we’ve been since ’96.
Are there any aspects of dentistry
that you particularly enjoy?
I really enjoy keeping up on the latest technology that dentistry has to
offer, including lasers. I have owned
a Waterlase for years and several
years ago implemented a Periolase
into my practice. I think a Diagnodent is indispensable.
Last year, our practice went
paperless and even got certified as
Oakland’s first green dental practice. In addition to ensuring that my
patients receive the best treatment
available, it keeps the practice of
dentistry interesting for my staff and
me.
I understand that you are an assistant clinical professor at U.C. San
Francisco, what do you teach?
Three years ago, I introduced an
elective course on sports dentistry
and trauma management.
The goal of the course was to give
dental students, usually third and
fourth year students, some experience in sports medicine by involving
them in the care of student-athletes
at U.C. Berkeley.
These students help conduct preparticipation exams, take impres-

sions for mouthguards and fabricate
and deliver mouthguards.
I think it offers a fun and interesting way for the students to reinforce
what they have already learned
about intraoral exams, impressiontaking techniques and even occlusal
concepts.
For the university, it’s a great way
to make sure that their hundreds of
athletes are monitored and treated
well.
So what is your role at U.C. Berkeley?
I am one of the team dentists. In
addition to exams and mouthguards,
I make myself available for dental
emergencies and routine care for
the student-athletes.

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
Managing Editor/Designer
Implant Tribune & Endo Tribune
Sierra Rendon
s.rendon@dental-tribune.com

Have you ever had to treat a
player during a game?
I’ve seen and addressed many oral
injuries after games, including
stitching up a football player’s lip
in the locker room, but I have only
been called to treat a player during
a game once. In that case, I had to
numb up a football player’s tooth
at halftime so he could make it
through the second half.

Managing Editor/Designer
Ortho Tribune & Show Dailies
Kristine Colker
k.colker@dental-tribune.com

Is sports dentistry a major part of
your practice?
While I do see my share of studentathletes as patients, I wouldn’t consider sports dentistry as a big part
of my practice. I view it more as a
way for me to involve myself in the
community.
I have made custom mouthguards
for athletes ranging from kindergarten soccer to the NFL. I know many
sports injuries are preventable with
a custom mouthguard, and I would
say that it is a mission of mine to
spread this notion.

Sales & Marketing Assistant
Lorrie Young
l.young@dental-tribune.com

Any final thoughts or words of
advice you’d care to share with
our readers?
I think it is important for us as
dentists to always stay mindful of
our ultimate goal: to improve lives.
In the dental office, this means our
patients and our staff.
While the practice of dentistry
can be stressful, we are very fortunate to have the opportunity to
touch many lives.
Last month, a patient of mine
came in for a crown prep. I walked
into the room and asked, “So, how
have you been?” He said, “Not well.
To tell you the truth, I’m struggling
just to get by.” I asked him if he
wanted to talk about it. He told me
that three months ago his adult son
passed away.
His appointment was for an hour
and a half, and we spent almost all
of it talking. He was sobbing, and
I was tearing up trying to console
him. He was in so much pain that it
hurt me. At the end of the appointment, we hugged and all I could say
was, “I’m so sorry. Stay strong.” He
thanked me for listening.
It was one of the most rewarding
appointments of my career and a
strong reminder of why I went into
dentistry — not because I like teeth,
but because I like people. DT

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.

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

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.

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] =>

[4] =>

Financial Matters

DENTAL TRIBUNE | November 2009

Protecting yourself from employee
theft, fraud and embezzlement (part 2)
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.

Other preventative areas
Each office should use a time clock,
and the dentist must initial manual
entries. Petty cash should be counted and balanced daily. The amount
of receipts plus cash on hand should
equal the same balance every day.
The outside of the envelope containing the petty cash should be
used to monitor the daily balance.
Each day, the date, the receipt
total, the cash total and the sum of
receipts and cash should be listed
along with the initials of the person
reconciling the petty cash.
When the age of computerization
came to dentistry, one of the selling
points was that computers would
make it more difficult to embezzle.
Nothing could be further from the
truth.
Whether computer-related, computer-enabled or computer-camouflaged, the use of computers has
made embezzlement easier than
ever unless the proper safeguards
are instituted.
Preventing theft by computer
requires a thorough understanding
by the dentist of the security features built into the office’s software.
This information must be carefully
reviewed with the software vendor’s
support team to ascertain that access
AD

been done and when payment is
expected.
In addition to demonstrating that
the dentist is monitoring things, this
also greatly assists in making certain
that collection procedures are being
followed, thereby keeping accounts
receivable under control.

Dealing with embezzlement

Computer reports are designed to
help a practice avoid theft problems,
but that means someone has to read
them.
to various features of the system is
correctly restricted.
No system should allow the deletion or erasing of accounts or charges by staff or allow deletion/disabling of the entire system.
The statement generator should
never be turned off. Any patient
complaints relative to payments and
balances must be carefully investigated.
Computer reports are designed
to assist in avoiding theft problems.
But to work, someone (i.e., the dentist) must review them. These will
only take a few minutes to review,
but this must be done.
Adjustment, refund and write-off
reports should be read by the dentist daily. The dentist should scan
posting reports daily. The dentist
can quickly spot incorrect charges
posted for procedures he/she has
just performed.
The accounts receivable (A/R)
aging report should be checked
monthly and discussed monthly
with the financial coordinator. The
financial coordinator should be prepared to respond to each account
over 90 days old with why, what has

Dealing with embezzlement, fraud
and theft involves four steps. Discovery is the first step. It is the dentist’s
responsibility to diligently observe
what is going on in his/her office
relative to the handling of money.
If theft is suspected or discovered,
the next step is investigation. Before
making any accusations, the dentist
must make certain that the evidence
supports the alleged crime.
This means reviewing entries,
reports, patient account records,
etc., to gather the hard evidence
necessary to confront the thief.
Prosecution is the next step. This
is sometimes harder for the dentist than the realization that his/her
trust has been betrayed. However, it
is a necessary step. If not, the theft
will continue, either from you or
another dentist. This means calling
the police.

Reasons dentists do not prosecute
Why do some dentists elect to forgo
prosecution? Topping the list is
the fear of a slander suit. Avoiding
this allegation is the purpose of the
investigation stage.
If you have the evidence, you are
not guilty of nor can you be accused
of slander. Involving the police once
you are certain you have become a
victim will aid in protection against
these false allegations.
In addition, many dentists fear
to prosecute because of fear of the
IRS. After all, they have unreported
income. If one fails to report and
prosecute the theft, the IRS takes
the position that income has been
fraudulently under-reported.
If one reports the loss to the
authorities, the IRS views this as
proof that a loss by theft has occurred
and therefore the under-reported
income is offset by the theft loss and
no charges will be levied by the IRS.
Non-reporting of employee theft
can also be the fear of blackmail.
Some of the dentists suffering losses
from theft are themselves involved
in insurance fraud, unreported
income and/or income tax evasion.
They know the offending staff member is aware of this and, out of fear
of retaliation, they elect to terminate
the employee but not prosecute.

Recovery

The last of the four steps of dealing
with employee theft is recovery.
Total recovery is usually not possible.

Even if successfully prosecuted
involving a judgment requiring
repayment, most staff members
involved in theft no longer have
the money nor do they possess the
ability to repay, even if spread over
a lifetime.
Actual judgments issued such as
$50 per month until the amount
embezzled has been repaid would
require 100 years of monthly payments to recover a $60,000 loss
(that does not even include interest).
The best chance of partial recovery comes from the office insurance
policy. Limits of $10,000 to $25,000
are common. The policy will pay
the actual amount of loss or the
policy limit, whichever is lower.
However, most policies require
the reporting of the loss to police
and prosecution if advised by the
local district attorney.

Conclusion
Most theft, fraud and embezzlement is avoidable if minimal safeguards are instituted.
However, the dentist must take
an active role. Dentists who blindly trust their employees are the
easiest targets and may suffer the
greatest losses.
Many new dentists who acquire
their dental practice by purchasing
an existing practice face the same
problem relative to implementing safeguards as older dentists in
practice for many years face.
How can you solve this dilemma?
Blame it on your accountant.
Tell your staff that your accountant has recommended certain
changes be made in how things are
done because this represents better
compliance with GAAP (generally
accepted accounting principles).
In this manner, these changes
will barely be questioned, except
perhaps by a staff person who is
guilty of theft. DT

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
ppt@henryschein.com.

[5] =>

[6] =>

Practice Matters

DENTAL TRIBUNE | November 2009

They stew, they fume, they leave …
What drives good employees away?
By Sally McKenzie, CMC

It’s one of the most frustrating
and unpredictable situations dentists face.
Everything is humming along just
fine. The schedule is full. Production is solid. Collections are good,
and treatment acceptance is even
better. The team members have
their moments, but overall appear
to be functioning reasonably well.
Then, as they say, the other shoe
drops.
Your long-term business employee — the one who is the expert
on the computer systems, a master
scheduler and overall great employee — hands in her two-weeks notice.
There’s no hiding your shock and
disappointment. Why is she leaving?
And how is it that you did not see it
coming? What happened to trigger
this?
The scenario is all too common in
dental practices in every major city,
small town and growing metropolis.
Employee turnover is nothing new
— in fact, it happens about every

18 months in most dental offices.
After the initial shock and feelings
of betrayal subside, most dentists
shrug their shoulders and resign
themselves to the “good help is hard
to keep” attitude.
As most of you know, it’s even
harder to find good help. Estimates

for replacing an employee range
from $20,000 to 1.5 times the team
member’s annual salary. In addition, when it comes to quality personnel, you’re losing far more than
money when they walk out the door.
As McKenzie Management consultants have seen time and again,

when dentists ignore problems, the
good team members silently fume
and eventually leave. They see that
the clinician doesn’t address other
employees’ negative behaviors.
They become concerned, disappointed and angry. Eventually they
just start looking for another job.
What’s more, in most practices,
there’s no mechanism or process in
place for employees to effectively
share concerns or grievances.
Typically, most doctors or office
managers mistakenly believe that if
they claim the office has an “open
door policy” they’ve done all that’s
necessary to encourage employees
to come forward with concerns.
That’s not going to do it.
To keep good employees, team
members need to know that if they
have concerns or complaints, there
are procedures in place in which
they can voice their concerns and
know that they will be addressed
without fear of punishment.
I urge practices to implement an
g DT Ê page 8A

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[7] =>

[8] =>

Practice Matters

f DT Ê page 6A
“Employee Concerns Policy.” This
is a defined procedure in which
employees complete a form that is
available to them and give it to the
dentist anonymously if they choose.
Rather than saying, “We have an
open door policy,” the policy needs
to say that the employee will be
protected if he/she comes forward
with a concern. There will not be
any retaliation.
The dentist wants the employee
to come forward so that they can
discuss the issue. It may be as small
a concern as how staff breaks are
handled to the more serious issues,
such as reporting harassment.
The most important aspect of this
is that there is a section in which the
employee writes down his/her concern and the dentist writes down the
practice’s response to the employee’s concern. The employee knows
that the problem will get a response,
it won’t just be ignored.
One of the major benefits of a
process such as this is that it enables
the dentist or office manager to
learn much more about what’s happening in the practice and among
the team.
However, the greatest benefit is
that both employees and the dentist genuinely appreciate the policy
because it makes it much easier for
AD

the entire team to deal with problems as they arise.
Let’s face it, when it comes to
dealing with concerns and problems, if you’re just making it up as
you go along you are certainly going
to face many more obstacles than if
you have a policy in writing that you
consistently follow.
Unfortunately, as virtually every
dentist has learned, often the biggest practice problems are the walking, talking, breathing kind that you
must work with day-after-day.
And that leads me to my next
point: when you have problem
employees, how do you deal with
them? Read on.

Turning up the heat before the fire
In many practices, dentists do everything in their power to ignore problem employees as long as humanly
possible. Oftentimes, the situation is
not addressed until circumstances
become so bad that it is affecting
practice profitability.
Usually by the time it reaches
this point, morale is in the cellar, employee and patient turnover
has skyrocketed, and that problem
employee isn’t just a problem anymore. He/she is a full-blown, raging
disaster that is draining the life out
of the practice.
At this point, the dentist can no
longer hide in the patients’ mouths.

DENTAL TRIBUNE | November 2009
So, he/she resolves to Google “progressive discipline plan” and start
firing off those warning notices.
Moreover, that would be about
the time that the problem employee
hires an equally problematic attorney and starts laying the groundwork for one very long and expensive nightmare for the dentist and
the practice.
Yes, it can and often does happen
to small employers, even dentists.
In the few practices that actually
have employment policies, most

have been pulled from some other
business’ manual and are typically
very punitive in nature. Essentially,
they put the employee on the defensive before an issue even arises.
Equally troublesome is the fact
that oftentimes employees don’t
receive a complete policy handbook. They might get a list of do’s
and don’ts, but the actual policy
book is kept under lock and key in
the dentist’s private office.
g DT Ê page 10A

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.mcken ziemgmt.com and www.thedentistsnet
work.net. She is also the publisher of the New Dentist™ magazine, www.
thenewdentist.net.
McKenzie welcomes specific practice questions and can be reached
toll free at (877) 777-6151 or at sallymck@mckenziemgmt.com.

[9] =>

[10] =>

10A Practice Matters

DENTAL TRIBUNE | November 2009

‘In most cases,

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“warnings” usually
make employees
angry and create
hostility toward
the dentist.’
f DT Ê page 8A

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Every employee needs to have every policy in
hand. The policy handbook the employee is given
needs to be identical to the one the dentist has.
In addition, those policies should be affirmative rather than punitive. For example, most
progressive discipline policies are typically a
series of “warnings” that do far more to derail the
employment relationship than foster improvement in the employee’s behavior.
Everything says “Warning! Warning! Warning!
We are going to impose this on you if you don’t
change!” In most cases, all these warnings do is
make the employee angry and create hostility
toward the dentist.
An affirmative approach, however, treats
employees as human beings and gives them
the opportunity to take responsibility for their
behavior. And what warnings don’t accomplish,
oftentimes a conversation will.
It can be as simple as comments made in the
office to the employee about his or her behavior.
It can be time you schedule with the employee to
go over a concern, but you don’t raise it in terms
of “We’re giving you a verbal warning.” The
primary goal of these “counseling sessions” is to
exchange information.
The communication aspect is particularly
important in situations in which a good employee begins to slip. Virtually every employer has
seen an outstanding team member start to lose
effectiveness. This is the time for dialogue, not
progressive discipline.
You’ve invested tens of thousands of dollars
in this long-term employee. You want to know
what’s going on and you need to approach it in a
manner that will put the employee at ease.
Take the employee out of the office for coffee and have a conversation about what you’ve
observed. Make this conversation as non-threatening as you can. While the conversation is noted
in the employee’s file, nothing is given to the
employee in writing.
However, if the employee’s behavior is disruptive to the practice, the dentist needs to have a
more formal meeting with the employee. You will
want something in writing at this point to outline
behaviors that need to be corrected and what
needs to be done.
Specifically state the behaviors and the actions
the employee needs to take, but don’t refer to it
as a warning.
The key is preparation. Waiting until employee
behaviors are so problematic that they are damaging the practice, or dealing inconsistently with
issues such as tardiness, family leave, unprofessional conduct, dress code, etc., make the dentist
and practice highly vulnerable to litigation.
Instead of waiting until you reach the end of
your rope, reach for your practice’s employment
policy handbook instead.
Learn more at www.mckenziemgmt.com. DT

[11] =>

[12] =>

12A Clinical

DENTAL TRIBUNE | November 2009

A new generation of athletic mouthguards
Today’s mouthguards enhance performance, offer more protection and are more marketable
By Eric Yabu, DDS

Time to play a little “Dental Jeopardy!” Answer: gutta percha.
Question: What were the first athletic mouthguards made of? (OK,
even Alex Trebek would’ve had a
tough time with this one.)
Double Jeopardy! Answer: Has his
own line of custom mouthguards.
Question: Who is Shaquille
O’Neal?
Indeed, there is little doubt that
today’s athletic mouthguards are
not like your granddaddy’s mouthguards, but more like Shaq Daddy’s.

A Pure Power Mouthguard.

This image illustrates how a mouthguard
moves the condyle of the TM joint away
from the base of the skull.

Mouthguard history
Athletic mouthguards, or mouthpieces, have been around for nearly 120
years since a London dentist named
Woolf Krause developed them in
1890 to protect boxers from lip lacerations.
Known as “gum shields,” they
were made from gutta-percha.
Krause’s son Philip, also a dentist
and an amateur boxer, refined the
design and began making the shields
from vella rubber.
Mouthguards were first introduced in the United States by Chicago dentist Thomas Carlos in 1916.
For decades, mouthguards remained
largely unchanged.
It was not until the early 1960s
that a Canadian pediatric dentist
named Arthur Wood, appalled by the
number of dental injuries he saw in
hockey players, developed a “mug
guard” or “teeth guard” for which he
became known as the father of the
modern mouthguard.
Since then, mouthguard materials, fabrication techniques and subsequent fit have been improved to
increase both protection and comfort.

Mouthguards today
Most recently, mouthguard design
has been studied in an attempt to
enhance athletic performance as
well as decrease the incidence of
concussions.
The central focus has been on
the role of the mouthguard to guide
occlusion and, in turn, condylar position within the fossa.
There are three major players in
the performance-enhancing mouthAD

piece arena: Mahercor Laboratories, Pure Power Mouthguards, and
Under Armour Performance Mouthwear™ by Bite Tech. Each attempts
to enhance athletic performance by
improving strength, endurance, balance, flexibility and reaction time
while decreasing injury risk from
concussions and jaw injuries.

Maher guards and splints
Dr. Gerald Maher, a Massachusetts
dentist who specializes in TMJ and
facial pain, was one of the first to
explore how an athletic mouthpiece
can affect performance and protection. As the team dentist for the New
England Patriots, his primary goal
was to reduce the number of concussions the players suffered.
He concluded that 64 percent of
adults have misaligned mandibles
where the condyles do not sit on
the cartilage discs; and, if someone
suffers a blow to the jaw in this position, the condyles are more likely to
be driven into the base of the skull,
causing a concussion.
The Maher guards and splints
(www.mahercorlabs.com)
are
designed so that the opposing teeth
are seated in a centric relation position so that the condyles are in alignment with the discs. These discs
will then act as shock absorbers to
cushion the impact of the condyles
on the skull.
In addition, because of the thickness of the appliance, the condyles
are moved from a position where
they are resting directly against the
articular disc — or even against the

fossa in the case of patients with
internal derangements where the
disc is displaced, usually anteriorly
— to a position farther away from
the fossa on the articular eminence.
This would mean that it would
take a greater force to drive the condyles into the skull.
Earlier this year, Maher, along
with Drs. G. Dave Singh and Ray
Padilla, published a preliminary
study that suggests a customized
mandibular orthotic may decrease
the incidence of concussions. The
study, however, did not attempt to
explain the mechanism of protection.
While Mahercor Laboratories
does not market their line of mouthpieces and mouthguards for their
performance-enhancing effects and
doesn’t claim to have specific studies
to substantiate these benefits, some
of the athletes that have been outfitted with their mouthpieces claim to
have noticed a significant increase
in strength, balance and speed.
They attribute this effect to the
full-body benefits of a properly, CRpositioned mandible and point to a
1995 paper by Dr. Harold Gelb that
favors the premise that jaw repositioning can enhance appendage
muscular strength and athletic performance.
The Maher splint design is a Gelb
splint or MORA (mandibular orthopedic repositioning appliance). It
is not designed to offer soft tissue
protection, but Maher’s line also
includes upper full coverage mouthguards.
The Maher appliances may be
fabricated by dentists who are skilled
in capturing a CR bite by ordering it
through Mahercor Laboratories or,
more recently, Space Maintainers
Laboratory.
The laboratory fees range from
$75 for a custom mouthguard to
$175 for their protective splint, with
a recommend a retail price range of
$175 to $250 for the mouthguard and
$300 to $450 for the splint.

Pure Power Mouthguard
The biggest player in the performance-enhancing mouthguard mar-

ket is currently Pure Power Mouthguard or Makkar PPM™ (www.
makkaradvantage.com).
These mouthguards, developed
by Nova Scotia dentist Anil Makkar,
rely on the principles of neuromuscular dentistry. Simply put, this philosophy and treatment paradigm
is based on the principle that the
mandible is in its optimal position
when the muscles of the head and
neck are at rest. This “physiologic
rest” position is achieved by using
a TENS (transcutaneous electrical
nerve stimulator) unit.
Makkar and his company claim to
have a soon-to-be-released research
study that confirms the performance-enhancing effects of their
mouthguard versus traditionally fitted custom mouthguards.
They say that this study will show
a significant increase in vertical
jump as well as peak and average
power, which should be appreciated
by their marquee client Shaquille
O’Neal. They also claim their mouthguard can improve balance, flexibility, endurance, agility and recovery.
The PPM’s come as an upper
mouthguard for contact sports or
a lower splint-type mouthpiece for
other sports such as golf or running.
These guards may only be made
by a certified PPM dentist who is
trained in neuromuscular dentistry
and generally retail in the $1,500 to
$2,000 range.

Under Armour Performance
Mouthwear
The most recent mouthpiece to
enter the marketplace is the Under
Armour Performance Mouthwear™
by Bite Tech (www.pattersondental.
com/UnderArmour). Their design is
neither innovative nor proprietary,
however, Bite Tech is the only manufacturer of the three that can claim
peer-reviewed, placebo-controlled
studies to support their claims for
performance enhancement.
Their mouthpieces do not rely
on a CR or neuromuscularly determined bite, but simply the lack of
pressure in the fossa area created
g DT Ê page 14A

[13] =>

[14] =>

14A Clinical

DENTAL TRIBUNE | November 2009

f DT Ê page 12A
by a multicomposite reverse wedge
bite plate over the molars.This, their
research claims, prevents the neuroreceptors in the brain from feeling
pressure upon clenching.
That lack of pressure prevents
the hypothalamic-pituitary-adrenal
(HPA) axis from triggering, effectively interrupting the fight-or-flight
response.
Their studies showed a trend for
lowered cortisol levels and a significant reduction in lactic acid with the
wedge appliance.
Like Maher and PPM, Under
Armour’s Mouthwear comes in two
different designs: an upper mouthguard for contact sports and a lower
mouthpiece for non-contact sports.
These appliances may be distributed by authorized providers who
purchase a Launch Kit from Patterson Dental for $995. The laboratory
fee is $120 per guard and the recommended retail price is $499.

Comparing the options
Overall, the three different manufacturers offer mouthguards that are
very similar in design.
However, Maher recommends a
CR-driven occlusal scheme to orthotically correct the TMJ, PPM is based
on neuromuscular principles and
Bite Tech’s research concludes that
AD

Maher mouthguard.
Under Armour mouthguard.

Dr. Yabu made this custom mouthguard for a University of California football player to wear during
Breast Cancer Awareness month.
performance enhancement is not
related to a CR or neuromuscular
bite.
Maher’s primary focus is on protection, studying its mouthpieces’
ability to reduce incidences of concussions in NFL players and even
soldiers in Afghanistan.
PPM markets its appliances for
their performance-enhancing benefits, boasting a cadre of loyal professional athlete users.
Under Armour also concentrates
on performance enhancement, ref-

Under Armour mouthpiece.

Mouthguard secured to a football
helmet by a “Piecekeeper” mouthguard holder.
erencing its literature and an assortment of patents to back up its claims.

Evolving technology
From gum shields to mouthwear,
from gutta-percha to multicomposites, from Woolf Krause to Shaquille
O’Neal, mouthguard technology has
evolved to produce appliances that
are more protective, performanceenhancing and, maybe most of all,
more marketable. DT

About the author

Dr. Eric Yabu is a general
dentist in Oakland, Calif. His
practice is the city of Oakland’s
first certified “green” dental
office. He is an assistant clinical
professor at the U.C. San Francisco School of Dentistry and a
team dentist for the University
of California at Berkeley Sports
Medicine Program.
You may contact him at:
Advanced Technology Dentistry
4174 Park Boulevard
Oakland, Calif. 94602
(510) 530-7000
www.oaklandlaserdentist.com

[15] =>

0A
DENTAL TRubric
RIBUNE | November 2009

DENTAL TMeeting
RIBUNE | moNth15A
2009
Greater N.Y. Dental

Headline
Get
ready for live demos at the
Deck
Greater N. Y. Dental Meeting
By line

Once again, 21st century dentistry tk
is available with no tuition fees.
The Greater New York Dental
Meeting (GNYDM) is the only meeting where you can pre-register and
attend continuing education programs each day for free.
Following the success of last
year, the GNYDM, to be held Nov.
27 to Dec. 2 at the Jacob K. Javits
Center, will again showcase a Live
Dentistry Arena that will be bigger
and better than ever.

A Live Dentistry Arena will
be part of the
upcoming Greater New York
Dental Meeting.

Move beyond recorded surgeries

AD

While many dental meetings
offer workshops where attendees
watch a pre-recorded surgery, the
GNYDM leads the way out of the
“recorded past” and into the “living now!”
The Live Dentistry Arena will
allow attendees to feel as if they
are seated right beside the worldrenowned clinicians performing
procedures on live patients in real
time.
Eighteen 60-inch displays will
be strategically placed for easy
viewing around the Live Dentistry
Arena so attendees can watch these
live demonstrations up close.

Why should you attend?

This unique educational experience is conducted right on the
exhibit floor and is offered with no
tuition costs.
No one will want to miss these
procedures, which will feature the
latest materials and equipment
available on the market.

Limited seating

Last year, this history-making program not only easily filled the
arena’s 300 seats during the entire
four days of the exhibition, but also
had up to another 100 attendees
standing or seated on the floor outside the seating area.
AD
The arena’s capacity is limited
to 350 persons this year and will
be filled on a “first-come, firstseated” basis, so attendees should
plan to arrive early to avoid disappointment.

GNYDM is the first to offer this

As the first dental meeting to offer
such an experience in 2008, Executive Director of the Greater New
York Dental Meeting Dr. Robert
Edwab commented, “The chance
to watch dental procedures performed live — not pre-recorded
or on an inert model — affords an
amazing educational opportunity,
and we are thrilled to bring it back
for 2009.”
For more information, contact the Greater New York Dental
Meeting at (212) 398-6922 or visit
www.gnydm.com. DT

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

[16] =>

16A Greater N.Y. Dental Meeting

DENTAL TRIBUNE | November 2009

What’s new in New York City? Plenty!
By Fred Michmershuizen, Online Editor

New York City is a place of constant change.
For those who are coming to town
this year for the Greater New York
Dental Meeting (GNYDM), to be held
Nov. 27 to Dec. 2, the Big Apple has
a number of new — or improved —
attractions to keep things interesting
after the show closes for the day.
The first thing you might notice
upon walking around a bit is that
cars have been banned from large
portions of Times Square, Herald
Square and many other high-traffic
spots around town. In place of all
those honking vehicles are lots of
potted plants, tons of chairs and
abundant elbow room. That’s right
— you can now stroll or sit leisurely
in the middle of Manhattan and
enjoy the sights around you or just
people watch.
But there is much, much more
that is new. Read on if you want
some ideas to help make your trip
to New York City a memorable one.

The High Line
If you would like to take in some
truly interesting views of the city
streets and the Hudson River, you
absolutely must visit the High Line.
Even stuck-up New Yorkers will
tell you it’s really cool. You’ll get a
whole different perspective of the
city. Bring your camera.
The High Line is an elevated rail
ADS

platform for freight trains that was
constructed in the 1930s. It runs
above the streets along the West
Side of Manhattan between 10th and
11th Avenues. For decades nobody
knew about it. It sat abandoned and
overgrown with weeds. Today, it is
being transformed into an urban
park.
Section 1 of the High Line, which
runs from Gansevoort Street to 20th
Street, was officially opened to the
public in June. It features an integrated landscape that combines
meandering concrete pathways,
seating areas and lots and lots of
plants. As you take your stroll, you’ll
see a few older buildings in shocking
states of disrepair.
Then, only a few steps later, you’ll
walk by (or under) brand new office
buildings and hotels that look like
they belong in architectural magazines. You’ll also have a pigeon’s
eye view of the happenings on the
streets below.
The best way to experience the
High Line is to enter via the stairs at
Gansevoort and Washington streets
and walk north to the access point at
20th Street just west of 10th Avenue.
Or, you can start at the northern
end and walk south. There are also
entries at 14th, 16th and 18th streets.
The only elevator access currently
open is at 18th Street.
For more information, call (212)
500-6035 or visit www.thehighline.
org.

No, this is not
a trick photograph — you
really can walk
around now in
Times Square.
There are even
chairs to lounge
in as you watch
the hustle and
bustle. (Photo
courtesy of NYC
and Company)

New and improved TKTS Booth

The TKTS Discount Booth, which
sells discounted tickets to Broadway
and off-Broadway productions, has
been popular with locals and tourists alike for ages. The good news is
that the booth has been completely
renovated.
The lighted displays are much
easier to read now and there are
additional sales windows, making
the line move much faster than it
used to. There is even a lightningquick “play only” window.
Available shows change daily or
even several times each day, and
there is no guarantee that tickets for
any particular show will be available. But there are usually dozens
of productions to choose from, so
chances are good that you will be
quite pleased.
The tickets, which are for dayof-performance showings only, are
discounted up to 50 percent plus a $4
per ticket service charge. They now
take credit cards in addition to cash
and travelers checks.
For more information, visit www.
tdf.org — or better yet, just show
up. Tickets go on sale for evening
performances every day at 3 p.m.
(except Tuesdays, when they go on
sale at 2 p.m.) For matinee performances (Wednesdays and Saturdays
only) tickets are on sale from 10 a.m.
to 2 p.m.
While you are in the area, walk
directly behind the booth to the giant
red staircase. That’s also new — and
it is certainly worth a look. Climb to
the top, and you might just feel like
you are in the center of the universe.
Because it’s in the very heart of the
Theater District, you might even be
tempted to face all of New York City
as you hold your arms out like Carol
Channing and sing a few lines from
“Hello, Dolly!” while descending.

The new Yankee Stadium
Up in the Bronx, the New York Yankees — who, as this issue went to
press, were playing the Philadelphia
Phillies in the World Series — have a
brand new, state-of-the-art stadium
that opened this year.
To get there, hop any B, D or 4
subway train to the Bronx and get off
at the Yankee Stadium stop. While
you are there, you can also see the
old Yankee Stadium, which has not

been torn down yet.
If you are a baseball fan and are
so inclined, you can take a tour of
the new home of the legendary ball
club. The tour lasts about an hour
and includes visits to the New York
Yankees Museum, the dugout and
also Monument Park (relocated from
across the street), which is arguably the most historic place in all of
sports.
It contains the monuments of five
baseball icons — Babe Ruth, Lou
Gehrig, Joe DiMaggio, Mickey Mantle and Miller Huggins — as well as
a memorial to the victims of Sept.
11, 2001. There are plaques that
recognize the careers of 20 other
pinstriped legends, including Yogi
Berra, Reggie Jackson, Don Mattingly, Whitey Ford and Elston Howard,
and three commemorative plaques
marking visits made by three popes.
In addition to Jackie Robinson’s
No. 42, which is retired throughout
Major League Baseball, Monument
Park also commemorates the retired
uniform numbers of 16 players and
managers who have made outstanding contributions to the Yankees’
illustrious history.
The cost for the tour is $20 per
person. To buy tickets, call Ticketmaster at (877) 469-9849 or visit
newyork.yankees.mlb.com.

Citi Field
If you are not a Yankees fan, don’t
fret. The New York Mets also have a
brand new stadium that opened this
year — Citi Field, which was built
adjacent to the old Shea Stadium in
Flushing Meadows, Queens.
You might not be able to get
inside, but it’s worth a look nonetheless. To get there, take the 7 subway
train to Mets/Willets Point Station.
While you are in the neighborhood, you can also visit the adjacent Flushing Meadows Corona Park
— site of the 1964/1965 New York
World’s Fair and current home to
the USTA Billie Jean King National
Tennis Center.
Also nearby is the Queens Museum of Art, which houses the amazingly accurate panorama of the city
of New York, a scale model of every
building, bridge, park and street in
all five boroughs of New York City.
(Yes, it’s been updated this year with
the new Citi Field.) DT

[17] =>

[18] =>

[19] =>

DENTAL TRIBUNE | November 2009

Greater N.Y. Dental Meeting 19A

Plenty to look forward to at DTSC Symposia
and user-friendly laser technology to
keep perio treatment in your office.

• Nov. 29, 11:30 a.m.–12:30 p.m.; Highresolution Cone Beam with PreXion
3-D, Dan McEowen, DDS
Cone-beam computed tomography
(CBCT) offers a whole new paradigm
to dental radiography. From what have
been conventional 2-D images, dentists now have the ability to look at the
maxillo-facial region in any direction
and any thickness as well as in 3-D.
With the introduction of CBCT, the
specialist and general dentist alike can
now afford to own and enjoy the benefits of this fantastic diagnostic tool.

• Nov. 30, 3–4 p.m.; The Advantage of
Small FoV High-resolution CBCT Imaging, Dan McEowen, DDS
This presentation will instruct you
on how to take a 360 degree rotation
with either 512 or 1,024 projections
during the scanning time. You will
learn how to produce ready-to-go 3-D,
saggital and coronal images within 30
seconds after the scan axial.
Dr. McEowen will introduce PreXion 3-D, the only CBCT scanning unit
using its own built-in graphic cards, as
well as 3-D rendering boards, which
result in the highest resolution when
considering all smaller FoV CBCT
scanning devices.

• Nov. 29, 1:30–2:30 p.m.; Simplify
Esthetic Dentistry, Steven Weinberg,
DDS
Dr. Weinberg’s presentation is a
comprehensive, clinically-oriented
program addressing the constant state
of evolution in esthetic materials and
restorative techniques. Participants
will learn about a variety of materials,
techniques and philosophies to create
beautiful, long-lasting anterior esthetic
restorations in an exciting educational
environment.
• Nov. 29, 3–4 p.m.; The Beauty of Bonding, Howard Glazer, DDS
This presentation will encompass
the science of adhesion, the art of
composite restoration and the finesse
of finishing and polishing. Using the
most state-of-the-art materials, Dr.
Glazer will explain the advantages and
methods used to achieve the maximum esthetic and functional results
for patients.
• Nov. 30, 10–11 a.m.; E4D Sky: Dentistry’s Destination, Gary Severance,
DDS and Lee Culp, DDS
Demonstrating everything that dental professionals need for the design
and fabrication of single-unit glass
ceramic restorations, either chairside
or benchtop, the program will be an
interactive, entertaining and amazing
display of all that modern dentistry
offers for comprehensive care.
• Nov. 30, 11:30 a.m.–12:30 p.m.; Know
Your Products & Tools for Today’s
Healing Dentistry, Fay Goldstep, DDS
This program focuses on the new
technological advances that have
made healing possible: scientific,
accurate, reproducible and clinically
significant caries detection; the potpourri of the ingredients and tools that
the dentist needs for healing therapies;
giomers, the new healing composite
resin; photo-activated disinfection to
promote remineralization and healing;

• Nov. 30, 1:30–2:30 p.m.; OraVerse: In
Practice, Steven Glassman, DDS
OraVerse is a local anesthesia reversal agent that accelerates the return to
normal sensation after routine dental
procedures. Clinical documentation
showing the safety and efficacy of the
drug in clinical trials will be highlighted.

• Dec. 1, 10 – 11 a.m.; Technological Resources and Biological Concepts
in Minimally Invasive Endodontics,
Renato Leonardo, DDS
This course is ideal for the progressive general practitioner with a
minimally-invasive practice.
Along with hands-on training, clear
demonstrations and an educational
presentation, lecture participants can
expect information about vital and
non-vital pulp therapy, the Anatomic
Endodontic Technology (A.E.T.) System and the Apical Delivered Obturation (A.D.O.) System.

presentation skills, documentation
and record keeping will be discussed.
Focus will also be given to the tools
that can aid the implant focused practice.
• Dec. 2, 10–11 a.m.; Icon – Innovative Caries Treatment without Drilling,
George Freedman, DDS
The course topics include: from
research to chair-side; preserving
healthy tooth structure; interproximal
and smooth surface treatment options;
step-by-step clinical procedure; caries
infiltration: present and future.
• Dec. 2, 11:30 a.m.–12:30 p.m.
Immediate Tooth Replacement in the
Esthetic Zone, Barry Levin, DDS
The time frame of three to six
months of unloaded healing is not
always mandatory any longer. With
osteoconductive implant surfaces,
newer implant materials and proper
diagnoses, patients can often experience implant therapy without the
inconvenience of removable temporary appliances and bonded provisional restorations.
• Dec. 2, 1:30–2:30 p.m.; More Than Just
Teeth and Gums, Ron Schefdore, DDS
Dental professionals are now incor-

• Dec. 1, 3–4 p.m.; You’ve Taken
Implant Training ... What Do You Do
Next? Lynn D. Mortilla, RDH
This course will discuss integrating implants into your practice. Staff
education, auxiliaries’ responsibilities, identifying implant patients, case

• Dec. 2, 3–4 p.m.; My First Esthetic
Implant Case: Why, How and When?,
Marius Steigmann, DDS
Esthetic dental implants are of
increasing importance in today’s dentistry. Success from the esthetic aspect
requires bone height and width, softtissue architecture and prosthetic restorations close to nature.
Out of these three elements, it is
the soft-tissue frame that can be maintained or reconstructed not only using
surgery, but also with the right prosthetic elements.
The DTSC program is made available through educational grants provided by: SHOFU, PreXion, VOCO,
D4D, Novolar Pharmaceuticals, Ultradent, Chase, AMD Lasers, DMG, Straumann. For registration — it’s free for
GNYDM atendees — please visit www.
gnydm.com or send an e-mail to info@
gnydm.com. DT
AD

Denture Comfort
Tuf-Link
Silicone
Reline
3.0

• Dec. 1, 11:30 a.m.–12:30 p.m.; Affordable Soft-tissue Diode Lasers, Speaker
TBA
The newest diode lasers cover the
widest range of clinical indications.
They’re easy to use and incorporate
into every practice. In fact, they’re
so easy to afford that they should be
installed in every operatory.
• Dec. 1, 1:30–2:30 p.m.; Esthetics Using
Cosmetic Periodontal Surgery, David
Hoexter, DMD
A beautiful smile — the desired
image — must be healthy and maintainable. In today’s society this goal is
subjective and influenced by our interpretation of esthetics. Using periodontal techniques, specifically cosmetic
periodontal surgical techniques, Dr.
Hoexter will show how changing the
background of the desired image will
enhance it to appear brighter, cleaner,
healthier, yet physiological, as well.

porating blood screening, evidencebased supplementation, laser therapy,
DNA testing and physician referrals
into their office protocol to improve
dental treatment outcomes and
improve the overall health of dental
patients. Amazing patient testimonials
and treatment outcomes discussed.

It fits where
others cannot.
NOW it’s available
where others are not.
We are pleased to announce that our Atlas® NarrowBody Implants will be distributed exclusively through
Henry Schein Dental. The new benefits of far reaching
distribution and support will undoubtedly be of great
value to our customers.
Millions of edentulous patients have been neglected as implant
candidates because they lack adequate bone structure, are unable
to undergo lengthy procedures or have financial constraints.

Atlas has solved these problems.

1.8, 2.2 & 2.4 DIA.

WORKSHOP SCHEDULE

•

Available in 1.8, 2.2 & 2.4mm diameters

•

1 Hour, minimally invasive chairside procedure

•

No O-rings, housings or adhesives

•

Fewer components

Nov 9

Bay Area, CA

Dec

Charlotte, NC

Dec 7

Orlando, FL

Dec 11

Shreveport, LA

•

Fewer post-op visits

Jan 22

Kansas City, KS

•

More affordable

Feb

Washington, DC

Feb 19

Atlanta, GA

Feb 26

Miami, FL

Mar 5

Denver, CO

For additional course dates,
locations and fees,
contact us at 877-537-8862
Or see our brochure on line
www.dentatus.com

Learn to immediately incorporate implantology
into your practice. Atlas (4 CEU) Hands-On
Workshop participants will work on a demonstration model and practice everything from
drilling osteotomies to retrofitting a hard denture
and relining it with the extraordinary soft cushioning
TUF-LINK® silicone material.

Available exclusively through:
www.dentatus.com

• Nov. 29, 10–11 a.m.; One-step Adhesion, One-step Cementation, George
Freedman, DDS
Seventh generation adhesive materials have simplified the process of
dental bonding and made esthetic procedures very predictable. These new
products etch, bond and desensitize
in a single step, and virtually eliminate postoperative sensitivity while
decreasing the potential for marginal
breakdown.

[20] =>

20A Industry

DENTAL TRIBUNE | November 2009

The Internet has changed,
but have you changed with it?
USA Today and the Wall Street
Journal report that the Internet is
now America’s No. 1 vertical marketing channel. Dentistry is a vertical
market. Internet marketing is more
effective and less costly than any
form of print, media or broadcast
advertising.
Patients expect their dentist to
have a Web site. Today’s dentist
needs to pay attention to the Internet.
It can produce big results.
If you have a Web page presence
on the Internet, you need to ask
yourself, “Is it the right Web page?”
AD

A successful Web page requires four
ingredients: 1) immediate appeal, 2)
ease of use, 3) entertaining content,
and 4) it has to be found.
Just like in baking, leave out a
necessary ingredient and your cake
will taste funny.
Well, if your Web page isn’t competitive with immediate appeal or it’s
difficult to navigate or the content is
boring, it will not matter if your Web
site can be found because people will
leave the site and go on to the next
site.
On the other hand, if you have all

of the ingredients for a great Web
site, but no one can find it, your Web
site will not produce the desired
results.

How is a Web site found?
Every Web page has thousands, if
not tens of thousands, of constantly
changing algorithm values connected to it. For the sake of simplicity,
think of an algorithm value like a
credit score.
Everything connected with your
Web page has an algorithm value. It
is the aggregation of these algorithm

values that ranks a Web site when
searched.
Keywords, meta-tags and matching content are important and contribute to the site algorithm value.
For example, if someone types in
a search for “Chicago dentist,” every
dental Web site in Chicago with those
same common keywords is recognized; however, each site is ranked
based on its overall algorithm value.
Assuming that every Web site is
created correctly, which they are not,
how does a site climb over the Web
sites listed above it to eventually be
listed on page one?

There is no scientific answer
The Internet changes so often in an
effort to create a level playing field
that it is impossible to pinpoint a
constant solution.
You need a Web page design and
SEO (search engine optimization)
company that understands how to
do everything possible within the
framework of the actual Web page
design as well as how to work outside of the box to create additional
site value.

Who can help?
InfoStar, a 16-year-old company
located in Fair Oaks, Calif., administrates more than 500 dental Web
sites. The company provides SEO for
the Web sites that it administrates,
ensuring security, no third-party
involvement and immediate service.
InfoStar applies high-value algorithm factors such as time-on-site,
reciprocal link networking, social
Web site links and bookmarks, and
some magic of its own, with results
being Web pages steadily climbing
to page one.
InfoStar sets up a Google Analytics account for each of its SEO
accounts. Google Analytics is the
Internet report card — and it’s free.
It reports the keywords that were
searched to access a Web page,
number of site hits, which pages
were reviewed, how long someone was on a specific page, etc. It’s
necessary information to properly
manage a Web site’s performance.
InfoStar provides each client
direct access to the same information it uses to manage the Web page.
InfoStar thinks SEO should be a service center rather than a profit center and its monthly SEO fees reflect
that philosophy.
There is no guarantee on how
gÊ continued

[21] =>

0A
DENTAL TRubric
RIBUNE | November 2009

DENTAL TIndustry
RIBUNE | moNth21A
2009

Case
presentation is the key to success
Headline
By Roger P. Levin, DDS

Deck

Today’s economy has certainly
By line
made the practice of dentistry more
challenging. To grow, a practice
must focus on the fundamentals and
remain
tk adept at the skills required in
good times and bad.
One of those disciplines is case
presentation. Successfully communicating and convincing more patients
to accept the care they need can make
a tremendous difference in the profitability of any practice in any economy.
Levin Group has helped thousands
of practices refine their case presentation skills. These strategies can
grow a practice in the toughest economic environments.
Educate every patient at every
opportunity. No one feels comfortable blindly making a major decision.
Accepting a course of care at a dental
practice is no exception.
Routine hygiene visits and checkups may or may not reveal the need to
present a case. They always offer the
opportunity to inform patients about
the full range of services offered.
Emphasize the benefits to the patient.
Patients do need to be informed of
what actually happens in a given procedure, but a detailed explanation of

the reasons why must accompany the
description. Patients want to know
what the end result will be, understanding the time, expense and even
the discomfort they may experience.
Focusing on the benefits will help to
convince the most reluctant patients.
Use internal marketing. Brochures
and fact sheets alone do not secure
a patient’s decision. This information
can help them make their choice at
home or in the office.
They can reinforce what the patient
learned in consultation and contribute the last little bit of certitude he or
she needs to say yes.
Follow up. Follow up. Follow up.
Just because a patient left the office

without making a decision does not
mean he/she has decided against the
treatment. After thinking it over or
discussing it with family, a phone
call the next day may be the nudge
needed to make the decision in favor
of the case.
Ease the financial impact. The price
tag of treatment can be a significant
stumbling block for a patient. Offering
options like a discount for payment
in full, outside financing and other
financial arrangements can soften the
role expenses play in making the final
decision to accept treatment.
Successful case presentation is the
cornerstone of a thriving practice.
Stop by the Levin Group booth during

Dental Tribune readers are entitled to receive a 50 percent courtesy on a Levin Group Total Success Practice Potential Analysis™,
an in-office analysis and report of
your unique situation conducted by a
Levin Group Senior Practice Analyst.
To schedule the next available
appointment, call (888) 973-0000
and mention “Dental Tribune” or
e-mail
customerservice@levin
group.com with “Dental Tribune” in
the subject line.
AD

AMD LASERS:
Bart Waclawik,
New Chief
Operating Officer
AMD LASERS, the world leader in
comprehensive and affordable dental
laser technology, announced the addition of Bart Waclawik as chief operating officer.
In this newly created role Waclawik
will be responsible for daily global
operations, procurement, production,
quality assurance and general finang DT Ê page 22A

fÊ continued

fast a Web site will climb the ladder
to reach page one. There are only
20 spots on page one, and competition is becoming fierce for positive
search results.
InfoStar’s expertise in Web page
design and exclusive entertaining
content, along with its professional
SEO participation, does achieve costeffective positive results.
As an example, there are more
than 10,000 dental Web sites in the
greater Los Angeles area. It took
InfoStar almost three months to
get one of its clients listed on page
one with a search of “Los Angeles
Implant Dentist.”
That client is now listed in position No. 2 from the top on page
one. Please visit www.infostarproduc
tions.com for more information. DT

the Greater New York Dental Meeting to learn how these strategies can
make the difference for your practice
in the months and years ahead. DT

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

[22] =>

22A Industry

DENTAL TRIBUNE | November 2009

Medidenta now offers refining and waste disposal
With 65-plus years and counting, the
company Medidenta has truly withstood the test of time and earned the
trust of dental professionals around
the world. The company has recently
acquired a precious metal refining and
waste disposal operation, which will
now provide the entire dental community a service that will be unsurpassed
in integrity and value, bar none.
Since 1944, Medidenta has morphed
into a boutique of dental products
where it dares to be different. Some of
its products from the 1940s included
copper bands, pre-fabricated jacket
crowns and posts that sold for 15 cents
each. And yes, the original product line
even included Karat, a pure gold filling
material, not to mention genuine silver
points for root canal obturation, which
in fact was the endodontic standard of
care in the ’50s and ’60s.
Some of these items can be viewed
on the “Nostalgia” section on the company’s Web site, www.medidenta.com.
Medidenta’s product line has been synonymous with value because of “direct
to the dentist” pricing. The company’s
most significant breakthrough came
in 1969 when Medidenta introduced
the Giromatic®, the first automated
device for root canal therapy; however,
its start was with precious metals used
in dental appliances and root canal
therapy.
In July 2007, Robert Achtziger,
an employee of Medidenta since
1973, became the sole owner, president and CEO. He has implemented
many changes, from streamlining
and improving customer service to

increasing the research and develpment budget, which will result in some
major dental product introductions in
the coming months. Through personal
hobbies and friends, Achtziger has
developed a deep-rooted commitment
to environmental issues facing our
world.
“Precious metals are a natural
resource of our Earth. Our planet
has indeed experienced significant
advances in technology, but not without a price because our environment
is exhausting and neglecting its natural resources, and this will take an
effort by all to save and conserve our
natural resources for future generations,” Achtziger said.
While some corporations have only
just begun to initiate conservation and
recycling procedures, Medidenta has
already integrated these measures in
its daily business operations, knowing
it’s extremely desirous to implement
environmentally conscious changes
within the dental community it has
served since 1946.
As mentioned, Medidenta is
announcing it has acquired a refining
and waste disposal operation that will
now be integrated into Medidenta’s
respected product and service line.
This division will encourage recycling
and create initiatives, internally and
externally, that are kinder to the environment and enable dental offices
to earn top dollar on precious metal
scraps that are refined and recycled.
When Achtziger was asked, “Why
refining and precious metals and recycling?” his response was, “Some of

Medidenta’s roots are with precious
metals, and the overwhelming majority of our product line is, in fact, recyclable so this was a natural fit for us.”
Thus, Medidenta is currently offering
some new services.
Refining precious metal scrap. Medidenta can now smelt and assay scrap
to determine the precious metal content, and pay the dental professional
the highest dollar amount within a
week. As a bonus, the practitioner will
receive valuable discount coupons for
other products listed in the Medidenta
catalog.
In-office amalgam separator. The
BOSS Amalgam Separator offers up
to three years of safety, convenience,
simplicity and environmental compliance for the ultimate protection for
the entire dental office.
Dental waste. Dental offices can
now forget about expensive long-term
contracts for disposal of dental waste.
The company’s Sharps PLUS system is
very easy: Fill it. Seal it. Ship it! Everything is included, including the tape,
at a substantial savings.
In an era of financial uncertainty
and mistrust of public conglomerates,
dental professionals have a trusted
name like Medidenta. This family-run
company that has served the profession for more than 65 years can now
recycle products and facilitate their
scrap and waste. This service offers a
profit center for the entire staff because
even old jewelry can be turned into
instant cash!
Medidenta is the home for direct
pricing and huge incentives. Take

They are doing business the American way
Triodent is not quite as American as
apple pie — try apple and kiwifruit pie.
This little company from Down
Under has from the beginning
embraced the American way. Founder
Dr. Simon McDonald drew his inspiration from American dental and business leaders and lists companies like
Apple and Google as his models.
When McDonald took his first dental invention, the Tri-Clip, to market in
2001, he instinctively launched it in the
United States. And when initial sales
were disappointing, it was advice from
American colleagues that got him back
on his feet.
AD

Committed to the U.S. market, he
persevered, developed new products
and strategies and has hardly looked
back.
“We just wouldn’t be where we
are without the U.S.,” McDonald says.
“American dentists are open minded
and have a receptiveness to change
that makes them the leaders they are.
They are willing to help and share
their knowledge and experience. That
makes them our customers and our
friends.”
Today Triodent Corporation is a
United States company, with fulfillment houses on the East and West

Dr Simon McDonald with the American Chamber of Commerce in New
Zealand Award.
coasts that have delivery times of just
three days to anywhere in America.
A Triodent booth will be found at
just about every U.S. trade show and
Triodent representatives are present
at many C.E. events across the nation.
Group headquarters are still based
in the small town of Katikati in New
Zealand’s beautiful Bay of Plenty, but
from there Triodent stands on the
world stage as a designer and manug DT Ê page 25A

advantage of Medidenta’s refining service and qualify for a bonus 10 percent
off products, including current incentive programs available at www.medi
denta.com.
The company wants your www.
medidenta.com experience to be
rewarding and pleasant. The Web site
allows you to explore in more detail
the new refining and recycling services and browse the general product
catalog filled with time-saving, costeffective products used in your everyday practice. You can browse the Web
site 24/7, and the company looks forward to serving all your needs today,
tomorrow and well into the future. DT
f DT Ê page 21A
cial oversight of the company. Furthermore, he will lead the engineering
effort on the next-generation of product development in order to continue
to position AMD LASERS as the world’s
most innovative and affordable laser
company.
“I couldn’t be happier about having
this level of talent at our company! As
a fast growing, young, global company, Bart brings the type of diverse
expertise we need to continue operating like a world-class, well-established
company. With his support and strategic excellence, I look forward to
taking our business to the next level of
growth as well as profitability,” stated
Alan Miller, president and CEO of
AMD LASERS.
Prior to joining AMD LASERS,
Waclawik worked for Remy International as manager of business development and strategic planning. Prior
to Remy, he spent 10 years working
for ArvinMeritor in roles of increasing responsibility and diverse scope
ranging from engineering, project
management, corporate strategy and
M&A, and international business
development. Waclawik is a graduate
of ArvinMeritor’s leadership development program and in his last role was
a manager of corporate strategy and
business analysis.
Waclawik graduated from the University of Notre Dame with an MBA
in finance and entrepreneurship and
holds undergraduate degrees in electrical engineering and physics from
Purdue University and Wabash College.
AMD LASERS, founded in 2006, is
the global leader at providing comprehensive and affordable diode laser
technology for dental professionals
who want to take their practice to the
next level. The innovation of Picasso, their high-quality and affordable
laser technology, enables thousands of
dental practices to provide advanced
patient care with ease.
AMD LASERS’ customers also
receive full-service customer care
support from a knowledgeable and
friendly staff. For more information
about AMD LASERS, please call (866)
999-2635, 317-202-9530 or visit online
at www.AMDLasers.com. DT

[23] =>

[24] =>

[25] =>

0A
DENTAL TRubric
RIBUNE | November 2009

DENTAL TIndustry
RIBUNE | moNth25A
2009

Headline
PhotoMed
Deck
G11 digital dental camera
The PhotoMed G11 digital dental
camera is specifically designed to
allow you to take all of the standard clinical views with “frame
and
tk focus” simplicity. The builtin color monitor allows you to
precisely frame your subject.
Focus and shoot. It’s that easy.
Proper exposure and balanced,
even lighting are assured. By
using the camera’s built-in flash,
the amount of light necessary for
a proper exposure is guaranteed,
and PhotoMed’s custom close-up
lighting attachment redirects the
light from the camera’s flash to
create a balanced, even lighting
across the field.

By line

Anterior contacts mirror.
G11 digital dental camera.

R2 dual-point flash bracket
PhotoMed’s new R2 dual-point flash
bracket is designed to give you
maximum flexibility in flash positioning. Bring the flash heads in
toward the lens for posterior views
and mirror shots. Spread the flash
heads out to the side for anterior
esthetic images and natural looking
smile shots.

f DT Ê page 22A

can Chamber of Commerce in New
Zealand Export Award for sales to the
U.S., and the New Zealand International Business Award for Research
and Development.
Because of its focus on R&D and a
mission to create products that make
the work of dental professionals easier, with better results, Triodent leads
the way in every area in which it is
represented.

facturer of smart, innovative dental
products. These products, used by dentists every day, are now sold in more
than 60 countries but the U.S. remains
by far the biggest market.
Triodent is one of New Zealand’s
fastest-growing companies and in
recent weeks has won two prestigious national awards — the Ameri-

R2 dual-point flash bracket.
Each flash head can be repositioned “on the fly” with one hand.
The R2 bracket is available in
Nikon or Canon configurations and
will work with Nikon’s R1 and R1C1
macro flashes and Canon’s MT24EX macro flash.

overjet and anterior contact.
The inset curved end follows
the curve of the arch for comfortable placement. The mirror can
also be used for standard occlusal arch views.

The anterior contacts mirror
makes it easy to photograph the

More information about each
of these produts is available at
www.photomed.net or call (800)
998-7765. DT

Its primary products include the V3
Sectional Matrix System, the Triotray
dual-arch impression tray and the new
indirect restoration placement aid, the
Griptab. All have one thing in common: they are advances in design and
function.
McDonald’s big breakthrough was
the V-Ring Sectional Matrix System.
The Triodent system, now in its V3 version, regularly wins industry awards

and is currently the matrix system
preferred by REALITY and The Dental
Advisor. More importantly it is the preferred – in fact, raved about – system
used by thousands of real dentists.
Increasing numbers of dentists are
also seeing Triotray and Griptab as
essential for their operatory drawer,
and McDonald is hopeful that these
new products will soon earn the same
industry accolades as the V3. DT

Anterior contacts mirror

Buchanan Hands-on

Unmatched CE experiences. Consistently ideal endodontic results.
Featuring GT Series X Files: reliability and safety with 1-3 file shapes
The Art of Endodontics 2-Day Laboratory Course includes molar anatomy
Limited to 14 participants, our flagship hands-on program allows you to work one-on-one with Dr. Buchanan to refine your skills and maximize
your clinical results. Tuition includes Procedural Atlas DVD and live patient demonstration. Course Fee: $2685 / CE Credits: 16
Location: Santa Barbara, CA / Offered Monthly - Next Dates: January 14-15, February 4-5, March 18-19

Exclusive to alumni of our hands-on programs, this course allows you to tackle molar endo at the next level.
Tuition includes Procedural Atlas DVD and live patient demonstration. Course Fee: $2885 / CE Credits: 16
Location: Santa Barbara, CA / Next Date: January 21-22

This was the best CE Class I have attended! I learned more about
Endo in those 2 days than over the last 9 years.

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

-Dr. Molly Weiandt, Anderson, Indiana, July 2009 Lab Participant

Molars Only 2-Day Laboratory Course for Alumni

From ideal access forms to precise three-dimensional filling techniques,
learn from one of the most respected clinicians using the best instruments available

Dental Education Laboratories. Your Premier Resource for Endodontic Training.
1515 State Street, Suite 16
Santa Barbara, CA 93101
GT Series X is a registered trademark of Dentsply
Tulsa Dental Specialties. Dr. Buchanan holds patents
for some instruments used in these courses.

For course information, contact us
toll free: 800 528 1590
worldwide: 805 899 4529
or visit www.endobuchanan.com

Dental Education Laboratories is an ADA CERP recognized provider and
an Accepted National Sponsor for FAGD/MAGD Credit. ADA CERP is a
service of the American Dental Association to assist dental professionals
in identifying quality providers of continuing dental education. ADA
CERP does not approve or endorse individual courses or instructors, nor
does it imply acceptance of credit hours by boards of dentistry.

[26] =>

26A Industry
AD

DENTAL TRIBUNE | November 2009
Savalife M100: Save time,
money … and lives
Every year
in the United
States, 30,608
emergencies occur in
dental offices, according
to the American Dental
Association.
So that they
can respond
when one of
them inevitably occurs in
their office,
dentists must
have
an
appropriate
emergency
response plan
and appropriate emergency response
equipment to match.
Savalife’s Quick Response M100 emergency
drug kit includes the pre-filled syringes, sprays
and inhalants needed to quickly and effectively
treat common patient emergencies, including
those related to angina, asthma, insulin problems, allergic reactions, fainting, heart attacks
and more.
As convenient as it is necessary, the kit saves
patients’ lives while also saving dentists’ practices, as appropriate emergency response can
reduce dentists’ exposure to risk and liability.
What’s more, because the kit is free when they
sign up for Savalife’s Automatic Drug Refill Program, it allows dentists to invest their time and
money where it belongs — with their patients.
For more information or to order, call (800)
933-5885 or visit www.savalife.com. DT

Boost success with sedation
dentistry and team training
By Alex Harris

Taking your dental practice to a higher level
requires a thorough examination of what your practice may be missing and what can be done better. For
most dentists, it isn’t giving their office a new look,
playing relaxing music or conducting more marketing. Attaining a high level of success requires taking
the steps necessary to stand out from the rest.
More and more dentists are finding that step to be
training in sedation dentistry. Through these learned
skills, protocols and acquired certifications, dentists
are able to meet the needs of the 90,000,000 people
in the United States who suffer from dental fear or
anxiety.1
In addition to the millions of healthy adult patients
who can benefit from sedation dentistry, there are
millions of others who have unique needs that necessitate specific training.
This type of training is available nationwide from
top C.E. programs like DOCS Education — North
America’s leading provider of sedation dentistry and
dental emergency preparedness education.
The organization offers courses on oral sedation, IV sedation, medically complex and pediatric
patients, advanced cardiac life support (ACLS), pediatric advanced life support (PALS) and much more.
gÊ continued

[27] =>

0A
DENTAL TRubric
RIBUNE | November 2009

DENTAL TIndustry
RIBUNE | moNth27A
2009

Headline Keep germs at bay even as you type

fÊ continued

The adaptability of methods and
protocols based on a patient’s unique
characteristics benefits both patient
and dentist. A strong understanding of
needs, risks and behavior makes treatBy line
ment easy and efficient for the dentist
as well as safe and pain-free for the
patient.
In
tk a perfect world, a dentist receiving training in a particular area or
method would be able to effectively
implement his or her new skills immediately upon returning to the practice.
However, anyone who has worked
in the dental profession knows that a
dentist is not just a “one-man-band.”
A dentist’s entire team has a hand
in ensuring the successful outcome of
all procedures. Lack of knowledge or
resistance to implementation of new
methods can be detrimental to office
productivity.
While most training programs
include segments designed for the dentists to relay to their teams, effective
implementation can only be ensured
by educating the team firsthand.
When dealing with high-fear
patients for sedation dentistry, team
members need to be educated in communication skills, patient monitoring,
emergency training and necessary
documentation before, after and during procedures.
Team training helps boost implementation by allowing the dentist to
focus on incorporating his or her new
skills rather than educating the team.
The dentist can hit the ground running
because his or her team is already up
to speed and ready to go.
Team members can also serve as
resources for each other rather than
monopolizing the dentist’s time.
Equally important to a successful
practice is team morale. Attending
training creates excitement among
team members and allows them to
take ownership of their role in the
office. Morale is boosted when team
members feel valued as an integral
part of the process. Team members
who do not receive training are much
more likely to be resistant to implementation.
All of these factors combined create a 53 percent higher success rate in
implementation for dentists who bring
AD
their teams to training sessions.2
To learn more about sedation dentistry, team training and available
courses offered nationwide, contact
DOCS Education at (866) 592-9617 or
visit DOCSeducation.org. DT

Deck

References
1.

Based on U.S. Census population
data accessed on Oct. 21, 2009
from
www.census.gov/main/
www/popclock.html and Dionne,
R.A., Gordon, S.M., McCullagh,
L.M., and Phero, J.C. (1998).
Assessing the need for anesthesia
and sedation in the general population. Journal of the American
Dental Association, 129, 167–173.
Statistic based on DOCS Education sales and equipment records
using purchase of a pulse oximeter as an indication of sedation
implementation.

By Fred Michmershuizen, Online Editor

With all the concern these days over the H1N1
virus and other harmful pathogens, it always pays
to err on the side of caution when it comes to
cleanliness.
We’re told by medical professionals to wash our
hands. But what about washing the surfaces our
hands touch?
This waterproof keyboard can be wiped down
with disinfectant cleaners, allowing you that added
benefit of knowing you are keeping germs away.
It comes in acrylic for $399 and in glass for $429.
Visit www.cleankeysinc.com for more information.

Build

a levin Practice™
with levin GrouP’s

total Practice success™
Our commitment is to help every dentist grow regardless of the economy.
Every practice has the potential to transform into A Levin Practice™ and anticipate these results:
•
•
•
•
•
•

Continually increasing production
Continually increasing profit
Continually increasing patient referrals
A low stress practice environment
High levels of professional satisfaction
Reaching financial independence sooner

Dentists who grow their practices are implementing effective marketing and
management systems allowing them to outperform other practices. You can’t afford to
sit back and wait for something to happen. You have to act now to make a difference!
To learn more about Levin Group’s comprehensive consulting programs and seminars,
go to www.levingroup.com or call 888.973.0000.

“successful people have always been the
ones who act on opportunities.
the economy is improving, don’t miss
your opportunity to grow!”

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

Roger P. Levin, DDS - Chairman & CEO, Levin Group, Inc.

Next Seminar for General Dentists:
Grow Your Practice 30% Now
Las Vegas, NV
March 11 - 12, 2010

visit www.levingroup.com
for a complete list of
upcoming seminars!

www.levingroup.com
888.973.0000

[28] =>

[29] =>

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

November 2009

www.dental-tribune.com

vol. 2, No. 9

the functional esthetic zone: the prominent
factor in developing a pleasing smile design
By Joseph J. Massad, DDS,
Joseph Thornton, DDS,
William Lobel, DMD,
Richard June, DDS,
Tony Daher, DDS
and Sam Strong, DDS

This article will detail the steps
utilized to orthopedically reposition a patient’s existing diminished, acquired mandibular posture and fabricate two new prostheses within the confines of the
functional esthetic zone and at the
same occlusal vertical dimension.
Due to the patient’s strong desire
to have a dramatic change, both
final protheses were presented to
her to select from.
Even though there may be differences on dentists’ views of
esthetics, the patient generally
influences much of the outcome.
In 1999, Vanblacon1 cited a definition of esthetics in the Journal
of Prosthetic Dentistry that is still
germane today: “Esthetics objectifies beauty and attractiveness
and elicits pleasure.” However, we
must ask: “Who is the authority on

Fig. 1: People around the world have
varying perceptions of beauty.
esthetics?” (Fig. 1).
As long as we can agree that the
key to esthetics lies in individual
perception, the mystery is much
easier to solve. The mouth is presented to the world via lips and
teeth, and has long been a focus for
varied opinions of what is the best
appearance.
Individual perception is strongly
tempered by environmental influ-

Fig. 2: Severely worn prosthetic teeth displaying an acquired Class
3 occlusal scheme.
ences and contemporary societal
mores and foci.2
We as dentists must also understand that the emotion of the patient
plays a very real and important
role in the perception of beauty.

Case presentation
A 44-year-old female presented
for replacement of her existing
10-year old complete dentures

(Fig. 2). During the assessment,
the patient revealed her desire to
look natural, like a “real person.”
She discussed her embarrassment
in public as she felt inferior to her
coworkers.
The patient’s evaluation included an assessment of her existing prosthesis as well as her oral
g CT Ê page 4B

Patient appeal ratings: the science behind Web sites that work
By Frith Maier, CEO

Cosmetic dentists are clinical
perfectionists. To an extraordinary
degree, you take personal pride in
the smiles you restore and think of
the patients wearing these smiles
as walking advertisements for your
work. Until now, there has been
a dearth of information regarding
what consumers care about and how
they respond to cosmetic dentists’
sites. No longer.
Earlier this year at the AACD
Annual Session, Sesame Communications shared the results of a breakthrough market research study that
investigated how patients choose a
cosmetic dentist online. In this study,
participants from across the United
States were recruited and screened
by Resolution Research, an independent market research firm, to ensure
that they were currently searching
for a cosmetic dentist.
Participants were between the
ages of 21 and 59, had a household income of at least $60,000 and
intended to make an appointment
within 60 days.
The facilitator and the partici-

pants were connected and recorded
via telephone and the Internet in
one-on-one interviews. Participants
were asked to think out loud as they
navigated the Web sites and provide honest feedback, either positive
or negative. No consideration was
given to the company that designed
the sites.
At the end of each session, the prospective patients completed a survey
about the likelihood of them making an appointment with the cosmetic dentist whose site they evaluated. Amazingly, 80 percent of the
Web sites reviewed by prospective
patients failed to persuade them to
make an appointment. After reviewing the results of this research, Dr.
Mickey Bernstein commented, “This
study reveals the mindset of today’s
dental patients. It deserves a long,
hard look!”
Following are some specific findings regarding patient preferences
and what appeals to them in a dental
practice Web site. Some of the discoveries may well surprise you.
Cosmetic dentistry shoppers are
different. In two previous studies
commissioned by Sesame Commu-

nications, prospective general dentistry and orthodontic patients gave
high scores to Web sites that conveyed a warm, personable practice.
Cosmetic dentistry patients, on the
other hand, are more focused on
treatment options. They consistently

go straight to the procedures page of
your Web site. They want to know
what conditions are corrected by
specific procedures, what the procedures involve, how long they take,
g CT Ê page 2B
AD

[30] =>

Practice matters

CosmetiC tRiBUNe | November 2009

f CT Ê page 1B

and they want “before and after” photos.
Reality reigns. Patients want to see images of
“regular people” just like them. They found sites
that were overly glamorous, contained advertising
images or photos of celebrities or models to be
disingenuous.
Cosmetic dentistry shoppers are impatient. Anything that slows consumers down or forces them
to think about where to find information is likely
to send them on to another Web site. Introduction
pages, flash sites with small page size, pop-up and
auto-play music and video all led patients to click
off.
Other factors that drove patients away were
hard-to-use menus or navigation, pages with an
overwhelming amount of text and “coming soon”
signs.
Don’t try to “sell” them. Newsletter sign-ups that
pop up, promotional coupons and too many “call
now!” messages turned out to be a turn-off. Participants reported that these made them feel the
doctor was desperate.
Information attracts. Patients are more likely to
call for an appointment when your Web site makes
it easy to find answers to their questions. They
want to know about the clinician’s credentials
and the team’s commitment to ongoing education.
Information about the modern technologies used
in the practice impact their perception about how
current you are on clinical skills. Finally, without
going into specifics of fees, your Web site needs to
make clear that you provide financial options.
From the findings of the Cosmetic Dentist Consumer Behavior Study emerged a Patient Appeal
Rating™ that quantifies the effectiveness of cosmetic Web sites. This data-driven tool empowers
you to create a custom Web site that uniquely differentiates your practice while ensuring that it will
be high performance.
“Sesame’s research was eye-opening.” says Dr.
Corky Willhite. “The findings were specifically
related to the cosmetic patients I want to attract
and they used this information in the design of
my new Web site. The result greatly exceeded my
expectations!”
With the tough economy and increasing competition, it’s important to be online and be in touch.
A complete patient connection strategy needs to
incorporate secure access for patients to their
appointment, account and treatment information,
reminders, feedback and survey mechanisms,
search engine optimization and online collaboration as well as online marketing. It all starts with
your Web site: building it to attract new patients
and making it work 24/7 to maintain their trust.
I encourage you to download a complimentary
copy of the complete whitepaper reporting on the
Cosmetic Dentist Consumer Behavior Study at
www.cdpatientappealrating.com/cosmetictribune.
While you’re there, you can request a free Patient
Appeal Rating for your Web site to find out how
your site ranks with prospective patients. CT
Frith Maier writes and lectures frequently on
how dentists can best serve their patients in a 24/7
online world. As founder and CEO of Sesame Communications, she has championed extensive market research studies on dental patient behavior to
understand their communications preferences.

Contact information
Frith Maier, CEO
Sesame Communications
15 South Grady Way, Ste. 420
Renton, Wa. 98057
Fax: (425) 430-0219
Toll-free: (877) 633-5193
www.sesamecommunications.com

[31] =>

[32] =>

Clinical

Figs. 3a, b: In
3a, note the
overclosured
nose-chin position. In 3b,
gummy smile
and flat smile
line.

CosmetiC tRiBUNe | November 2009

Figs. 4a–d: a)
Gummy flat
smile line; b)
high smile
displays excess
gingival show;
c) resting lipto-ridge crest
is +5 mm
(measured
with Massad
Lip Ruler); d)
high smile lipto-ridge crest
is -5 mm.

Figs. 5a, b:
a) jaw recorder
pin set at patient’s
OVD, b) compass
set at patient’s
OVD.

f CT Ê page 1B

tissues, occlusal vertical dimension, tolerance index, bone height,
tissue character, tissue mobility,
facial asymmetry, muscle tenacity
and vertical ratio of facial mask
to alveolar ridges. Our findings
revealed a flat smile line and
gummy display compounded with
extreme loss of occlusal vertical
dimension, making her face appear
to be many years older (Fig. 3).
The intra-oral tissue examination revealed a mandibular anterior epulus fissuratum, which necessitated surgical excision before
initiating the fabrication of any
prosthesis. Of particular concern
was the vertical relationship of
the median alveolar ridge crest to
the upper lip at repose and when
smiling.3 A distance between 8 to
10 millimeters at repose and 4 to
5 millimeters when smiling will
generally provide the practitioner
adequate space (called the esthetic
zone) to set prosthetic teeth.
In addition, bulky maxillary
anterior alveolar ridges may also
provide inadequate space for optimal prosthetic tooth positioning
and proper labial flange extension
without causing protrusion of the
upper lip. This measurement is
recorded with the esthetic lip ruler
(www.GDIT.us) (Fig. 4).

Alveoplasty is often performed
to reduce ridge height and bulk to
accommodate the fabrication of an
esthetic prosthesis. However, for
this patient, alveolar ridge reduction may have adversely affected
denture stability. In extreme cases,
the LeFort 1 osteotomy has become
a standard and predictable surgical
approach4, but it is not a financially
attractive option, especially in this
depressed economic time.
With the advent of a larger
range of longer necked prosthetic
tooth designs, the practitioner can
generally achieve an acceptable
result, as long as the patient is
aware that there will be some gum
show, but to a lesser extent than
the patient’s existing prosthesis.
Furthermore, the prosthesis may
be slightly compromised due to
the lessened strength of the bond
between the prosthetic teeth and
the denture base.
The lip ruler can be used to
measure both the upper and lower
vertical measurement of the functional esthetic space (zone). This
ruler has proven to be an invaluable aid when determining the distance between the premaxillary or
premandibular ridges to the lips
at repose and smiling, giving the
practitioner the ability to properly
treatment plan the final prosthesis.
In this patient, the resting upper

Figs. 6a–c:
a) Jaw recorder
with cured resin
splint showing tracing on upper striking plate, b) Cured
splint at OVD, c) A
= centric relation,
B = left lateral, C =
right lateral, D =
protrusive

lip measurement was recorded as
a +5 millimeters and the smiling
lip measured a -5 millimeters. This
was an extreme case that required
special efforts to accomplish a satisfactory outcome: a minimum of
10 to 14 millimeters of prosthetic
tooth height (measured from the
incisal edge to the cervical neck)
would be required to disguise the
excessive gingival display.
Accomplishing the desired smile
line with reduced gum show would
mandate both the thinning of the
denture base and the scalloping
of the lingual surfaces of the prosthetic teeth to be able to position
the teeth as close to the ridge as
possible.
After proper healing of the epulus fissuratum’s surgical site was
observed, the patient’s existing
prosthesis was relined with a resilient polyethyl methacylate material
(Permasoft, Dentsply Prosthetics).
This liner would allow the tissue to
rebound and provide better adaptation during the fabrication time
of the new prosthesis. The patient’s
occlusal vertical rest position was
taken utilizing the exhaustive technique, and repeated several times
to verify accuracy.
It is our treatment protocol to
deprogram the patient’s musculature from the existing acquired
occlusion at the closed vertical

posture. Therefore, an occlusal
splint was fabricated allowing 2
millimeters of freeway space.5 The
splint was fabricated by mounting a central bearing device to the
existing denture prosthesis.
The central bearing device was
originally introduced by Hesse in
1887.6–8 However, it lost favor in the
general dental arena due to complexities in mounting of the device
and overall difficulty of use. All
previous devices were constructed
of metals and would not readily
adapt to any irregular or reduced
vertical situation.
The newer disposable, adjustable devices can be utilized not
only in the edentulous, but also
in the fully dentate and combination patient (jaw relation recorder,
www.GDIT.us). This new recorder
was designed by the lead author
to improve upon all previous deficiencies in the central bearing
devices, allowing for practitioner
versatility.
Mounting this device to the
patient’s existing maxillary and
mandibular prostheses allows the
practitioner to adjust the vertical
relationship to the desired occlusal
vertical dimension (Fig. 5). The
central bearing device provides
equalization of occlusal pressure
gÊ continued

[33] =>

Clinical

CosmetiC tRiBUNe | November 2009
fÊ continued

and increased denture base stability during the procedure.
Once the vertical relationship is
set, ethyl methacylate was mixed
to a doughy consistency and placed
on the mandibular posterior occlusal surfaces of the existing worn
denture. The patient was then
asked to close until the vertical pin
occluded with the striking plate,
and then slide her jaw forward,
and then back, and then side to
side, and then in all directions.
The patient continued these
movements until final resin polymerization was obtained. The splint
was then trimmed and polished.
The patient wore the occlusal splint
until the completion and delivery
of the new prosthesis9 (Figs. 6a–c).
A maxillary wax rim was fabricated utilizing the dimensions
from the previous lip ruler reading. With these measurements, the
prosthetic technician can fabricate the record base to the proper
height to minimize the dentist’s
chair time. This patient’s resting
lip-to-ridge crest measurement
was recorded to be +5 millimeters,
and the wax rim was fabricated to
duplicate this distance.
The esthetic rim was then
placed in the patient’s mouth and
analyzed as to the support of the
maxillary lip. Any required alterations were made at this time. The
rim was then marked confirming
the resting lip line. The patient was
then asked to smile, and the smiling lip line was marked.
A midline position was also
taken by standing directly in front
of the patient and marking the center position while the patient was
smiling. Once this was completed,
a face bow record was made.
The completed esthetic blueprint provided the prosthetic technician with information on setting
the length of the anterior teeth
and the height of the cervical or
apical portion of the neck of the
tooth, allowing customization of
the esthetic design (Fig. 7a).
The patient’s functional mandibular neutral zone position was
then recorded. An acrylic base
plate was made and green stick
compound adapted to this rim to
fabricate the neutral zone base.
The height of the neutral zone base
was determined at the assessment
appointment by utilizing the lower
half of the lip ruler to measure the
premandibular ridge crest to mandibular resting lip distance.
By using this measurement to
form the base, the pre-fabricated
base will reach the vertical height
of the resting lower lip when placed
in the mouth. The neutral zone
base was heated in warm water
until the compound softened, very
much like a soft-boiled egg. Care
was taken not to overheat the compound material to ensure the proper consistency.
This softened neutral zone base
was then placed on to the patient’s
mandibular ridge and the patient

was given the instruction to swallow while sipping warm water in
order to stimulate the facial muscles to contract and expand.
While swallowing, the lips move
inward while the tip of the tongue
and the lateral border of the tongue
move outward. At the same time,
the external facial muscles and the
buccinator muscles move inward.
Every patient has different muscle tenacity, even from the left
to right side of the face. Some
patients have weak and flaccid
muscle tone, which will generally
produce a wider base record, while
patients with heavy muscle tone
will record a narrow base (Fig. 7b).
This record was indexed on the
model with a silicone material,

b.
Figs. 7a, b: a) Esthetic blueprint
with midline, resting lip, high smile
lip markings, b) Completed functional neutral zone record following
lips, cheeks and tongue.

Figs. 8a, b: a) Silicone index of neutral zone record; b) A = space to set
posterior teeth; B = anterior teeth to
be set within space to match phonetics and esthetics.

g CT Ê page 6B
AD

[34] =>

Clinical

CosmetiC tRiBUNe | November 2009

CosmetiC tRiBUNe
the World’s Dental Newspaper · Us edition

Publisher & Chairman
Torsten Oemus
t.oemus@dental-tribune.com
Vice President Global Sales
Peter Witteczek
p.witteczek@dental-tribune.com
Chief Operating Officer
Eric Seid
e.seid@dental-tribune.com

Fig. 9: Original prosthesis in place.

f CT Ê page 5B

thus allowing the prosthesis to be
made within the confines of the
functional pressures of the lips,
cheeks and tongue (Fig. 8).
This neutral zone procedure
dates back to the early 1900s when
it was initially described by Sir Wilford Fish in the United Kingdom.10
It was later improved upon and
Frank Schiesser and Victor Beresin
published a method in 1974.11
Studies have supported this
physiological method of maintaining the actual tone of the muscles
of facial expression and mastication. When recorded appropriately,
patients have noted improved stability and retention of complete
dentures, especially in those cases
with severely resorbed mandibular
alveolar ridges.
Both the esthetic blueprint
record and neutral zone record
combined with the face bow record
were utilized in the final tooth setup.
The final procedure was to
record the patient’s centric relation position using the vertical
relationship of the patient’s occlusal splint, which was made earlier.
This occlusal splint was reevaluated on several occasions to determine the patient’s acceptance.
It has been the lead author’s
experience that most patients who
are orthopedically repositioned
from a severely closed vertical posture will adapt without rebound.
However, it is necessary for the
practitioner to re-evaluate the
patient on a weekly basis to verify
the adaptation before final occlusal
records are made.
Once the patient indicated that
she was comfortable with the
improved vertical dimension, this
relationship was transferred with
the use of base plates mounted
with the jaw-recording device. The
same central bearing device was
placed on a set of maxillary and
mandibular stabilized base plates
made from the definitive impressions.
The same method of adjusting
the central bearing pin to the proper vertical spacing was done to
match the accepted occlusal splint
spacing. The patient’s protrusive,
retrusive and eccentric movements
were recorded.
To allow reading of the record-

Fig. 10: New prosthesis, option No. 1.

Fig. 11: New prosthesis, option No. 2.

Group Editor & Designer
Robin Goodman
r.goodman@dental-tribune.com

ing, the striking plate against
which the pin rubs was coated
with an inking solution. The practitioner should be able to view the
patient’s jaw movements by analyzing the tracing marks.
Generally, the patient will form
an arrow. The tip of the apex is
considered the physiological centric relation, the side opposite the
apex is considered the protrusive
movement, and the left and right
markings that go from the center
of the apex outward to the left, and
outward to the right, are considered the eccentric movements.
The tracing in this patient
appeared to be consistent and
repeatable. 12,13 Many tracings
will not initially show an optimal apex. This is generally the
case when a patient has not been
deprogrammed from a closed
vertical relationship and may be
experiencing TMJ symptoms. After
deprogramming with a splint, the
tracing will usually display a more
favorable marking.
In this particular case, we utilized the patient’s existing final
occlusal vertical dimension from
her occlusal splint because she
reported that the spacing felt very
comfortable after three or four
days and no other areas of concern were noted. Knowing this, the
same vertical dimension was transferred to the record bases and fixed
into position at the apex with PVS
bite registration material (Regisil,
Dentsply Caulk).
Once this recording was transferred to the record bases, the
practitioner had acquired all of
the information that the prosthetic
technician would require to position all the denture teeth in the
desired relationships.
The case was then sent to the
prosthetic technician with directions to set the teeth within the
confines of the functional esthetic
neutral zone space on the mandible and the esthetic space on the
maxilla at the vertical dimension
recorded.
The technician was instructed
to set two different prosthetic tooth
sizes and moulds and send back
two wax try-ins for patient review.
In the first case, a tooth size was
selected to be congruent with the
patient’s face. However, the tooth
had reduced incisal to cervical
height, which we knew would give
the patient some gum show, albeit

less than in her existing prosthesis.
A second set up utilized a larger
mould to give the patient less gum
show. Yet, it also gave the patient
a more prominent horizontal position of the maxillary teeth.
Each set up was completed and
placed into the patient’s mouth
and measured to be at the same
occlusal vertical dimension with
the same freeway space. Please
note that in the prosthesis with
the smaller mould, the patient displayed a very pleasing smile with a
narrow buccal corridor. This tooth
size matched the patient’s smile
line, however, she did have more
gingival show with a high smile or
when she was laughing.
The set up with the larger tooth
minimized the gum show, but displayed a wider buccal corridor.
Both mandibular dentures were
set to the same neutral zone index.
The buccal-lingual positions of the
posterior teeth were set identically,
however, the mandibular anterior
teeth were placed to the front of
the neutral zone labial-lingually,
but still within the desired space.
The patient related that both
mandibular dentures felt equally
extremely stable. In each of the
finished cases, when the patient
produced an exaggerated laugh,
gingival show was noted. However,
in the set that was made with the
larger size and mould, the gum
show was minimized.
The patient was asked to test
chewing different foods with each
and determine any differences in
efficiency. Additional food tests
were performed to determine
adverse food collection under or
settling on the sides of the prosthesis. The patient reported that
eating, food collection, speech,
retention and stability were very
acceptable, and it was very hard to
say one was better than the other.
The patient’s lip posture in both
cases appeared to be significantly
improved over her existing prosthesis.
At the end of the day, the patient
was asked to choose which prosthesis would be best for her. Please
note that the function and phonetics in both the first and second prostheses were evaluated and
found to have no measurable differences.
Please compare the patient’s ini-

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

gÊ continued

Managing Editor/Designer
Implant & Endo Tribune
Sierra Rendon
s.rendon@dental-tribune.com
Managing Editor/Designer
Ortho Tribune & Show Dailies
Kristine Colker
k.colker@dental-tribune.com
Online Editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.com
Product & Account Manager
Mark Eisen
m.eisen@dental-tribune.com
Marketing Manager
Anna Wlodarczyk
a.wlodarczyk@dental-tribune.com
Sales & Marketing Assistant
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l.young@dental-tribune.com
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213 West 35th Street, Suite 801
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Tel.: (212) 244-7181
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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] =>

Clinical

CosmetiC tRiBUNe | November 2009
fÊ continued

tial prosthesis where she had a flat
smile and excess gingival show
with the first prosthesis and the
second prosthesis. Observe each
smile design.
Note how the maxillary incisal edges approximate the lower
vermillion border. Compare the
differences in the tooth arrangement. Compare the buccal corridor
display.
Each reader can choose his
or her personal preference as to
beauty (Figs. 9–11). This question
was asked earlier, “Who is the
authority of esthetics?”
The authority of esthetics could
be a mother or father, brother
or sister, uncle or aunt, niece or
nephew, grandmother or grandfather. It could be the mother’s
daughter, it could be the husband’s
wife, it could be your worst enemy.
The authority of esthetics lies in
the eye of the beholder.
We find that it is extremely
important that we relate to our
patients while the procedure is
being performed and at the assessment appointment, that there will
be differences between the opinions of family members, friends
and the patients themselves of
what is esthetic.
I ask you, the reader, which
smile display would you choose?
Please e-mail me from my Web site
at www.joemassad.com with your
answers, and I will let you know
which smile design the patient
chose.

Conclusion
I hope this article has given a perspective of how we assess a patient,
especially for those who have a
compromised esthetic space, in
order to set prosthetic teeth in such
a fashion as to match a functional
esthetic zone.
This article also demonstrates
that a patient with a severely closed
occlusal vertical dimension can be
orthopedically repositioned to a
comfortable and repeatable vertical dimension.
The splint therapy will act to
deprogram the patient’s musculature from the acquired, worn down
occlusal vertical dimension and
provide feedback before completion of the final prosthesis.
If a patient is motivated to look
better, he or she should be willing
to wear a splint to allow the body to
verify an appropriate stable vertical at a repeatable stable centric
relation. CT
To learn more about advances
in the field, I encourage you to stay
in contact with me via my Web site
at www.JoeMassad.com or www.
GDIT.us.
For other great information for
you and your patients, I recommend www.DentureWearers.com,
developed by Dr. Lorin Berland of
Dallas.
The

authors

would

acknowledge the prosthetic artistry
of Zarko Danilov, prosthetic technician, Carmichael, Calif.

References
1.

VanBlarcom CW (Ed). The
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18. Meyer FS. A new, simple and
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22. Rudd KD. Morrow RM, Edwards
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Dental laboratory procedures:
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23. Carlsson GE. Biological and
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patients. 11th ed. St. Louis:
Elsevier, 1997. p. 197–219.
24. Zarb GA, McGivney GP. Completing the rehabilitation of the
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Carlsson GE, Bolender CL,
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25. Gysi A. Practical application
of research results in denture
construction. J Am Dent Assoc.
1927; 16:199–223.
26. DeVan MM. The concept of
neutrocentric occlusion as
related to denture stability. J
Am Dent Assoc 1954; 48:165–9.
27. Smith RA. Cavalcnti AA, Wolfe
JE. Arranging and articulating
artificial teeth. In: Dental laboratory procedures: complete
dentures, volume 1. 2nd ed.
Morrow RM, Rudd KD, Rhoads
JE, editors. St Louis: Mosby;
1986. p. 223–75.
28. Rudd KD, Morrrow RM, Espinoza AV, Leachman JS. Finishing and polishing. In: Dental
laboratory procedures: complete dentures, volume 1. 2nd
ed. Morrow RM, Rudd KD,
Rhoads JE, editors. St. Louis:
Mosby; 1986. p. 312–38.
29. VanBlarcom CW (Ed). The
glossary of prosthodontic
terms. 7th ed. J Prosthet dent
1999; 81:39–110.
30. Ricketts RW. Ch 9, Divine Proportion. In Goldstein RE (Ed).
Esthetics in dentistry. 2nd ed.
Hamilton: BC Decker, Inc.
1998: 187–205.
31. Frush JP, Fisher RD. The
dynesthetic
interpretation
of the dentogenic concept. J

Prosthet Dent 1958; 8:558–581.
32. Morley J. Smile design terminology. Dentistry Today 1996;
15:70.
33. Massad JJ. An integrated
approach to optimizing orofacial health, function and
esthetics: a 5-year retrospective study. Int J Periodont Rest
Dent 1998; 18:71–79.
34. Seluk LW, Brodbelt RHW,
Walker GF. A biometric comparison of face shape with
denture tooth form. Shape of
teeth and face has no relevance. J Oral Rehabil 1987;
14:139–145.
35. Marbrito C. Elements of a
beautiful smile. New Mexico
Dent J 1996; 47:20–21.
36. Massad JJ, Brannin DE, Goljan
KR. Gingival smile enhancement for the edentulous
patient by using a Le Fort
1 osteotomy. J Prosthet Dent
1991; 66: 154–154.
37. Massad JJ, Goljan KR. A method of prognosticating complete denture outcomes. Compend Contin Educ Dent 1994;
15:900–907.

About the authors
Joseph Massad, DDS
• Director and professor,
removable
prosthodontics,
Scottsdale Center for Dentistry,
Scottsdale, Ariz.
• Clinical associate professor,
Department of Restorative Dentistry, Tufts University, Boston,
Mass.
• Clinical associate professor,
Department of Prosthodontics,
University of Texas, San Antonio, Texas
• Private practice, Tulsa,
Okla., www.joemassad.com
Joseph Thornton, DDS
• Clinical associate faculty,
Massad Learning Center
• Private practice, Snellville,
Ga.
William Lobel, DMD
• Clinical assistant professor,
Department of Prosthodontics
and Operative Dentistry, Tufts
University School of Dental
Medicine, Boston, Mass.
• Private practice, Saugus,
Mass.
Richard June, DDS
• Clinical Associate Faculty,
Massad Learning Center
• Private practice, Henry, Ill.
Tony Daher, DDS, MSEd, FACP
• Associate professor, Department of Restorative Dentistry,
Loma Linda University, California
• Private practice, Laverne,
California
Dr. Sam Strong, DDS
• Private practice, Little Rock,
Ark., www.strongdds.com

[36] =>

[37] =>

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

November 2009

www.dental-tribune.com

vol. 2, No. 9

New teeth in HIPAA rules
By Patti DiGangi, RDH

Money and economic woes are
foremost in the minds of most of
Americans and many dental professionals. Our schedules have an
unprecedented number of holes.
Patients are putting off care.
Our concentration is, and must
be, centered on caring for our
patients to the highest level we can
while keeping our offices financially
viable.
Why should we think about or
care about alphabet soup: HIPAA,
ARRA, EHR, or those other abbreviations taking place outside the practice when we’re worrying about AR
(account receivables)?
Someone in the practice should
be in charge of worrying about them
though. Discussions about electronic
health records (EHR) being easier
and less expensive have often been
in the news during 2009.
Vast amounts of electronic data
come with many new opportunities
for a new kind of theft and security
breaches orchestrated from continents far away.
The heightened potential for
identity theft and security breaches
is creating an atmosphere of fear

and concern. Uneasiness over the
privacy and security of electronic
health information fall into two general categories:
(1) concerns about inappropriate
releases of information from individual organizations, and
(2) concerns about the systemic
flows of information throughout the
health care and related industries.
These concerns are real and
appropriate.
HIPAA is about privacy and security. Many dental professionals only
know HIPAA as that form patients
had to sign a couple years ago. It
is thought HIPAA rules apply more
in the administrative part of dental
practices than the treatment rooms.
After 13 years of HIPAA regulation, some professionals still using
paper records assume their practice
is unaffected by HIPAA rules.
Dentists are required to comply
with HIPAA rules even if there is
only indirect transmission or receipt
of a patient’s protected health information.
For example, a dental office submits a paper insurance claim, and
these paper claims go to a clearinghouse that converts the paper claim
to an electronic claim for submis-

‘Dentists are required to comply with HIPAA rules
even if there is only indirect transmission or receipt
of a patient’s protected health information.’
sion to an insurance carrier.
This sequence makes the dental
practice a covered entity under the
HIPAA rules because the updated
privacy and security rules protect
patients both in the new digital age
and with traditional paper records.
In February, the American Recovery and Reinvestment Act (ARRA)
of 2009, commonly known as the
stimulus package, was signed into
law, thus making the Health Information Technology for Economic
and Clinical Health (HITECH) Act
the law of the land.
The HITECH Act provides
approximately $31.2 billion for
health care infrastructure and adoption of electronic health records.
Dentists who have small practices
are probably not going to qualify for
funding under ARRA unless at least
30 percent of patients are Medicaid
beneficiaries.
A lesser-known part of the

HITECH Act affecting practitioners
significantly expands the reach of
the HIPAA and gives it more teeth.
As of Sept. 23, 2009, requirements
for prompt notification of patients
when personal health data have
been compromised, and which limits the commercial use of such information, went into effect.
The HITECH Act increases
the civil monetary penalties for
HIPAA noncompliance to as much
as $50,000 per violation. HITECH
authorizes state attorneys general to
enforce HIPAA privacy and security
requirements.
HITECH extends HIPAA from a
reactive compliance requirement to
something broader and more preventive. HIPAA has not been rigorously enforced in the past.
Time will tell how the new
enforcement regime will work. Porg HT Ê page 2C

Hygienists group says more need access to care
The American Dental Hygienists
Association (ADHA) has taken a position on access to oral health care.
According to the ADHA, oral
health care is a fundamental component of total health care and is the
right of all people.
Yet, the ADHA says, 40 percent
of Americans are not getting the
care they need. A number of factors inhibit access to care, the most
evident being the inability to pay for
care, ADHA says.
Millions of Americans in both
rural and inner-city areas are unable
to obtain care because there are not
enough dentists practicing in their
communities.
The federal government estimates
that more than 31 million people live
in areas designated as “dental shortage areas,” where there is less than
one full-time equivalent dentist for a
population of 4,000 to 5,000.
Lack of access to oral health care
is a critical issue in the United States
due to disparities in the health care
delivery system, the ADHA says. This
is documented in a position paper

published by the ADHA.
Highlights of the paper include
the following:
• Dental caries is the most common chronic disease, nationally
affecting 53 percent of 6- to 8-yearolds and 84 percent of 17-year-olds.
• One in four American children
is born into poverty. Children and
adolescents living in poverty suffer
twice as much tooth decay as their
more affluent peers, while their disease is more likely to go untreated.
• Licensed dental hygienists, by
virtue of their comprehensive education and clinical preparation, are
well prepared to deliver preventive
oral health care services to the public, safely and effectively, independent of dental supervision.
• Each year, millions of productive
hours are lost due to dental diseases.
Children missed nearly 52 million
hours of school, or an average of
1.17 hours per child, in one year due
to treatment problems, according to
one survey. During that same time,
workers lost more than 164 million

work hours, an average of 1.48 hours
per worker, due to lack of treatment
for dental disease.
• From 1985–1986 to 1995–1996,

the number of dental hygiene graduates increased by 20 percent, while
g HT Ê page 3C
AD

[38] =>

2C

Practice Matters

Ê

f HT page 1C
traying a cavlier attitude with no
story or a minimal story about why
the practitioner didn’t comply with
HIPAA rules will be seen in a very
different light. It is likely professionals with these attitudes might be at
significant risk.
It is likely professionals with
these attitudes might be at significant risk.
The American Dental Association
is offering a downloadable electronic book to help dental offices comply
with the enhanced privacy and security breach rules (www.ada.org).
In January 2010, ADA will release
a new Complete HIPAA Compliance Kit for dentists that will feature
updated HIPAA privacy and security information and incorporate
AD

HYGIENE TRIBUNE | November 2009

HITECH changes.
In addition, it will include a
three-year update service assuring
a resource that covers all pending
changes.
The full impact of HIPAA/HITECH
changes is uncertain and remains

to be seen. Economic worries and
short-term goals shouldn’t blind us
into playing ostrich.
Times of uncertainty and complex challenges can lead to fear and
feelings of helplessness, but are also
times of powerful possibilities. HT

About the author
Patti DiGangi is a vision-driven person finding strength and direction from her inner
convictions. Like most true visionaries, she
views obstacles as learning experiences that
can be used for self-development. As a lifelong
learner, her energetic, thought provoking and
successful program development and mindbending view of what can be shines a bright
light for others to preview the future and find
their place in it. She can be contacted through
her Web site at www.pdigangi.com.

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

Publisher & Chairman
Torsten Oemus
t.oemus@dental-tribune.com
Vice President Global Sales
Peter Witteczek
p.witeczek@dental-tribune.com
Chief Operating Officer
Eric Seid
e.seid@dental-tribune.com
Group Editor & Designer
Robin Goodman
r.goodman@dental-tribune.com
Editor in Chief Hygiene Tribune
Angie Stone RDH, 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
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
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@dentaltribune.com.
Hygiene Tribune cannot assume
responsibility for the validity of product
claims or for typographical errors.
The publisher also does not assume
responsibility for product names
or statements made by advertisers.
Opinions expressed by authors are
their own and may not reflect those of
Dental Tribune America.

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

[39] =>

Editor’s Letter

HYGIENE TRIBUNE | November 2009

3C

Dear Reader,
We have been discussing article
writing and publishing in the last
few editions. Maybe after reading
these letters you have been motivated to put an article together.
If you have, you may want to
consider turning your article into a
presentation. If you have not written anything, maybe developing
and presenting a course would be
more to your liking. Presentations
will be the topic for the upcoming
editions.
Obviously, the first thing that
needs to be done is to decide what
to talk about. Remember, the reason for doing a presentation is to
provide education to your listeners.
Audiences do not look favorably
upon courses that are full of information they have heard before.
Have you had experiences that
are unique in your dental hygiene
career that others could benefit
from? Is there something you excel
at that you could teach your colleagues?
If you have a topic that is not
new, you need to decide how you
are going to make it different from

what hygienists have seen and
heard previously.
After you have decided on a
topic, you need to decide what
format you will use for program
development and presentation. The
most popular way of doing this currently is using Microsoft’s PowerPoint program.
If you decide to use PowerPoint
and never have before, I would recommend taking a beginner course.
Self-study courses are available
online. Many community colleges
or technical colleges offer courses
as well. Or maybe you have a colP&F Ad-DTA

1/14/09

2:45 PM

league who could share some tips
with you?
As you develop the course, you
might find it helpful to create an
outline. Then, each number, letter
or bullet point can become a single
slide.
Once the outline is prepared,
you can begin to construct the presentation in PowerPoint.
Think about a topic and how you
will develop it. Make your outline
and look into a PowerPoint class, if
you need one.I’ll discuss what comes
next in the upcoming issue of
Hygiene Tribune. HT

Page 1

Best Regards,

Angie Stone, RDH, BS
Editor in Chief
AD

™

f HT Ê page 1C
the number of dentist graduates
declined by 23 percent.
• Recent research identified periodontal disease as a risk factor for
heart and lung disease; diabetes;
premature, low birth weight babies
and a number of other systemic
diseases. Also, routine oral health
exams can uncover symptoms of
diabetes, osteoporosis and low bone
mass, eating disorders and HIV.
• The cost of providing restorative
treatment is more expensive than
providing preventive services.
• In addition to economic hurdles,
there are bureaucratic and legal barriers that prevent dental hygienists
from providing access to care. For
instance, state laws and regulations
limit access by imposing restrictive
supervision requirements on dental
hygienists.
The ADHA recommends several solutions to the access to care
issue. One is to develop partnerships
among health care organizations,
state and federal government and
other interested groups to educate
the public on the importance of oral
health and the integral role it plays
in total health.
Another solution is for state and
federal government to recognize
licensed dental hygienists as Medicaid providers.
One more solution would be to
relax state practice acts to allow
more dental hygienists to provide
oral health care to those who are not
currently receiving it. HT
(Source: ADHA)

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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.
7 Continuing dental education credits available.

Visit us at the 2009 Greater New York Dental Meeting
For Better Dentistry, booth no. 1801.

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[cover] => DT U.S. 3309

[toc] => Array ( [0] => Array ( [title] => Tankersley is new president of ADA [page] => 01 ) [1] => Array ( [title] => Protecting yourself from employee theft - fraud and embezzlement (part 2) [page] => 04 ) [2] => Array ( [title] => They stew - they fume - they leave … What drives good employees away? [page] => 06 ) [3] => Array ( [title] => A new generation of athletic mouthguards [page] => 12 ) [4] => Array ( [title] => Get ready for live demos at the Greater N. Y. Dental Meeting [page] => 15 ) [5] => Array ( [title] => What’s new in New York City? Plenty! [page] => 16 ) [6] => Array ( [title] => Plenty to look forward to at DTSC Symposia [page] => 19 ) [7] => Array ( [title] => The Internet has changed - but have you changed with it? [page] => 20 ) [8] => Array ( [title] => Case presentation is the key to success [page] => 21 ) [9] => Array ( [title] => They are doing business the American way [page] => 22 ) [10] => Array ( [title] => Industry [page] => 26 ) [11] => Array ( [title] => Cosmetic Tribune 9/2009 [page] => Supplement1 ) [12] => Array ( [title] => Hygiene Tribune 9/2009 [page] => Supplement2 ) ) [toc_html] =>

Table of contents

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