DT U.S. 3509

Dentists collect Halloween candy in trick-or-treat buyback / Fiscally fit in 2009* / Practice Matters / Many orofacial injuries during sports are preventable / Greater N.Y. Dental Meeting / Industry News / Cosmetic Tribune 9/2009 / Hygiene Tribune 9/2009

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

November 2009

www.dental-tribune.com

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

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

The functional esthetic zone

Endodontic retreatment

How to weigh clinical considerations.

u Page 1B

This is a prominent factor in smile design.

u Page1C

Vol. 4, Nos. 35 & 36

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

HIPAA rules

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

Dentists collect Halloween candy in trick-or-treat buyback
By Fred Michmershuizen, Online Editor

Everyone knows candy causes
tooth decay. That means come Halloween, dental care professionals
are simply aghast.
Some dentists this year, however,
used a clever idea to cut down on the
need for drilling and filling. Around
the country, a number of dentists
gave cash and prizes to trick-ortreaters in exchange for their Halloween candy.
The sweets are being shipped to
American troops serving in Iraq and
Afghanistan.
“We bought back approximately
70 pounds of candy,” said Dr. Todd
Snyder of Aesthetic Dental Designs
in Laguna Niguel, Calif., one of the

dentists who held an anti-decay promotion this year.
“Surprisingly, I am amazed at
how much candy it takes to weigh
that much. We had a steady stream
every five to 10 minutes of parents
with one or two kids who would
drop off their candy.”
In addition to getting $1 per
pound for the candy they brought
in to dental offices, the children
also received toothbrushes and the
chance to win raffle prizes.
The programs are designed to
help kids maintain healthy teeth
and gums.
“Ditch the candy, that’s what
we’re saying,” said Snyder, who
g DT page 2A

Greater N.Y. Dental Meeting = no registration fee!

Dr. Todd Snyder, left, Dental Assistant Mimi Ramirez (red hair) and Patient
Care Specialist Trina Moskal show off some of the 70 pounds of candy they
bought from trick-or-treaters after Halloween this year.

Dentists can help identify
cardiovascular risk
A recent study indicates dentists
can play a potentially life-saving
role in health care by identifying
patients at risk of fatal heart attacks
and referring them to physicians
for further evaluation. Published in
the November issue of the Journal
of the American Dental Association,
the study followed 200 patients (101
women and 99 men) in private dental practices in Sweden whose den-

Heading to the Greater N.Y. Dental Meeting? Don’t forget to visit Times
Square and pull up a lounge chair to watch the hustle and bustle. (Photo/
g pages 15A, 16A
Julienne Schaer, NYC and Company)

tists used a computerized system,
HeartScore, to calculate the risk of
a patient dying from a cardiovascular event within a 10-year period.
Designed by the European Society of Cardiology, HeartScore measures cardiovascular disease risk
in persons aged 40–65 by factoring
g DT page 2A
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[2] =>

News

Dental Tribune | November 2009

Patients who have sensitive teeth
may be brushing too hard, AGD says
By Fred Michmershuizen, Online Editor

Do you have patients who complain about sensitive teeth, sharp
pains or discomfort triggered by
hot or cold? The culprit, according
to the Academy of General Dentistry, might be in their very own
hands.
According to a nationwide
member survey conducted by the
AGD, one in three dentists say that
aggressive toothbrushing is the
most common cause of sensitive
teeth. Acidic food and beverage
consumption was found to be the
No. 2 cause.
As the AGD pointed out in a
news release announcing the survey results, dentin hypersensitivity is a common oral condition
affecting approximately 40 million
Americans of all ages.
It is characterized by discomfort
or sharp and sudden pain in one or
more teeth and is often triggered
by hot, cold, sweet or sour foods
and drinks, pressure on the tooth
or even breathing cold air.
Van B. Haywood, DMD, said
that aggressive toothbrushing and
consuming acidic foods and beverages can lead to tooth sensitivity.
This is because over time, they can
wear down the enamel on your
teeth and even your gums.
“When the protective layer
ADS

of enamel erodes or gum lines
recede, a softer tissue in your teeth
called dentin can be left exposed,”
Haywood said. “Dentin connects to
the tooth’s inner nerve center, so
when it is unprotected the nerve
center can be left unshielded and
vulnerable to sensations, including pain.”
The survey also found that
several other factors in addition
to aggressive toothbrushing and
acidic foods and beverages can
cause tooth erosion and contribute
to the oral condition.
These factors include certain
toothpastes and mouthwashes,
tooth whitening products, broken
or cracked teeth, bulimia and acid
reflux.
Out of the nearly 700 general
dentists who responded to the survey, nearly 60 percent said that
the frequency of tooth erosion has
increased compared to five years
ago.
“Being able to detect tooth erosion in its early stages is perhaps
the most important key to preventing dentin hypersensitivity,” said
Raymond K. Martin, DDS, MAGD.
“Discoloration, transparency and
small dents or cracks in the teeth
are all signs of tooth erosion and
should be discussed with your
dentist as soon as possible.”
Fifty-six percent of dentists

surveyed say that patients manage tooth sensitivity by avoiding
cold foods and beverages, while
17 percent said that patients avoid
brushing the sensitive area of the
mouth.
“While these may seem like the
quickest and easiest ways to prevent sensitivity, none of them will
actually solve the problem,” said
Gigi Meinecke, DMD, FAGD.
For those who are already affected by sensitive teeth, the AGD recommends patients adhere to the
following actions to help alleviate
symptoms:
• Switch to a desensitizing toothpaste. There are many brands of
toothpaste made specifically for
sensitive teeth.
• Use a soft-bristled toothbrush.
When a patient uses a hard-bristled toothbrush, he or she may
be wearing away the enamel on
the teeth or causing the gums to
recede.
• Practice good oral hygiene. A
patient should floss regularly and
brush at least twice a day for two
to three minutes.
He or she should hold the toothbrush at a 45-degree angle, brush
gently in a circular motion and
hold the toothbrush in the fingertips rather than in the palm of the
hand.
• Avoid highly acidic foods and
beverages. A patient should make a
conscious effort to limit his or her
intake of highly acidic foods and
beverages every day. DT
(Source: AGD)

f DT page 1A
the person’s age, sex, total cholesterol level, systolic blood pressure
and smoking status.
Patients with HeartScores of 10
percent or higher — meaning they
had a 10 percent or higher risk of
having a fatal heart attack or stroke
within a 10-year period — were
told by dentists to seek medical
advice regarding their condition.
Twelve patients in the study, all
of them men, had HeartScores of
10 percent or higher. All women
participating in the study had
HeartScores of 5 percent or less.
Of the 12 male patients with
HeartScores of 10 percent or higher, nine sought further evaluation
by a medical care provider who
decided that intervention was indicated for six of the patients.
Two patients did not follow the
dentist’s recommendation to seek
further medical evaluation and one
patient was only encouraged by
his dentist to discontinue smoking.
Physicians for three patients were
not able to confirm their risk for
cardiovascular disease.

f DT page 1A
dressed up as a soldier for the postHalloween buyback event. His office
staff dressed up as well. His patients
loved it, and passers-by were
amused as well.
Snyder said he feels all the attention definitely made an impression
on people about the importance
of maintaining healthy teeth and
gums.
“It’s good to remind people that
visiting your dentist three times per
year and brushing and flossing daily
are great preventative measures,”
he said. “Doing away with excess
sweets altogether really gives teeth
a healthy boost.”
Other dentists holding similar
events this year included Dr. Jerry
Strauss of Aesthetic Dental Care, a
practice offering cosmetic dentistry
in Essex County, N.J, and Dr. Peter
Ciampi, of Spring Lake Dental Care
in Monmouth County, N.J.
The dentists pointed out that,
every year, kids across the globe
consume about 2 percent more
sugar than the previous year.
With about 50 million tons of
sugar being consumed annually,
extra attention needs to be paid to
make sure children are taking care
of their teeth and gums to maintain
oral health and prevent current and
future dental problems.
Moderating or even staying away
from candy altogether can not only
protect children from broken teeth
and damaged braces, it can also
lessen the risk of developing weight
problems or hyperactivity issues,
the dentists said.
“Kids can still have all of the fun
of trick-or-treating, and now their
piggy banks will benefit as well,”
Snyder said. DT

All 200 patients enrolled in the
study were 45 years of age or older
with no history of cardiovascular
disease, medications for high blood
pressure, high cholesterol or diabetes and had not visited a physician during the previous year to
assess their glucose, cholesterol or
blood pressure levels.
The study’s authors conclude
that oral health care professionals can identify patients who are
unaware of their risk of developing
serious complications as a result
of cardiovascular disease and who
are in need of medical interventions.
According to the authors, “With
emerging data suggesting an association between oral and non-oral
diseases, and with the possibility
of performing chairside screening tests for diseases such as cardiovascular disease and diabetes,
oral health care professionals may
find themselves in an opportune
position to enhance the overall
health and well-being of their
patients.” DT
(Source: ADA)

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Financial Matters

Dental Tribune | November 2009

Fiscally fit in 2009

Tax breaks and limited-time laws make 2009 the right time to invest in your practice
By Keith Drayer

The American Recovery and
Reinvestment Act of 2009 was
signed into law on Feb. 17 with
some of the best benefits having
limited remaining time eligibility.
Small business owners have limited time in 2009 to benefit from the
most lucrative tax incentives for
acquiring technology and/or equipment.
If your practice is ready to buy
equipment or software, the tax
incentives for doing so are better than ever. These benefits will
expire, or be reduced, as of Jan. 1,
2010.
The American Recovery and
Reinvestment Act accompanied by
lower interest rates make this a
strategic time to invest in your
practice to meet the demands of
today’s health care industry.
Because of these beneficial conditions, installing equipment and
technology in 2009 can create a
cash flow win-win for health care
practitioners “in the know.”

Can you deduct $250,000?
For the 2009 tax year, many small
businesses may potentially deduct
up to $250,000 if the equipment or
software is placed in service.
This valuable break is the Section 179 depreciation deduction
privilege, and it is an exception
to the general rule that you must
depreciate equipment and software
costs over several years.
Section 179 is an annual “use it

or lose it” accelerated deduction
benefit that optimally lowers taxable income.
The bonus depreciation is allowable for regular and alternative
minimum tax (AMT) purposes for
the tax year in which the property
is placed in service.
Property eligible for this treatment includes:
• Property with a recovery period of 20 years or less (almost all
dental equipment).
• Standard software/practicemanagement software.

Who can take the deduction?
This deduction is available whether
you are a sole proprietorship, partnership or corporation (S corporations are subject to different rules).
If you plan to acquire equipment
in the near future, purchasing it
before year’s end is prudent.

Annual Internal Revenue Code Section 179 Example

What type of financing is eligible?
Utilizing a finance agreement or
capital lease to acquire technology
or equipment will qualify for this
benefit, while true leases or fair
market value agreements will not.
If you use a finance agreement
to acquire your equipment and you
have deferred payments, you may
file your tax returns and achieve
the benefits before you have made
any payments.

Avoid last-minute decisions
Don’t wait too long to acquire technology or upgrade your office.
Although it is true that you can

Invest in your practice with HSFS
Henry Schein Financial Services
(HSFS) business solutions portfolio offers a wide range of financing
options that make it possible for you
to invest in your practice for greater
efficiency, increased productivity and
enhanced patient services.
HSFS helps health care practitioners operate financially successful
practices by offering complete leasing
and financing programs. HSFS can
help obtain financing for equipment

* This article appeared in our August editions, but as the year is about to come to
a close, we felt it beared repeating.

and technology purchases, practice
acquisitions and practice start-ups.
HSFS also offers value-added services including credit card acceptance, demographic site analysis
reports, patient collections, patient
financing and the Henry Schein Credit
Card with 2% cash back or 11/2 points
per dollar spent.
For further information, please call
(800) 853-9493 or send an e-mail to
hsfs@henryschein.com.

Calculations

Equipment not
more than $800,000

A. Equipment price
B. Section 179 deduction
C. 50% bonus depreciation
(A - B x 0.50)
D. 2009 MACRS deduction
(A - B - C x 0.20)
E. Total first year tax deduction
F. Combined federal and state tax
bracket
G. Total 2009 tax savings as a
result of capital expenditure
(E x F)

$300,000
$250,000

have equipment placed in service
by Dec. 31 to take advantage of the
incentives, waiting much longer
may mean that you will settle on
your selections because of diminished year-end choices.
Now is the right time to meet
with an equipment or technology
specialist and discuss acquiring
the optimal production-enhancing
technology and equipment that will
help your practice stay fiscally fit.

first-year bonus depreciation deductions equal to 50 percent of the cost
that is left over after subtracting
allowable Section 179 deductions
(if any).
If your business uses the calendar year for tax purposes, you only
have until Dec. 31 to take advantage
of the generous $250,000 allowance.
Don’t wait to see if 2010 will provide the same opportunity. Act now
and take advantage of all the benefits available through this current
legislative windfall. DT

Don’t forget bonus depreciation
Your practice may generally claim

$25,000
$5,000
$280,000
38%
$106,400

About the author
Keith Drayer is vice president
of Henry Schein Financial Services, which provides equipment,
technology, practice start-up and
acquisition financing services
nationwide.
Henry Schein Financial Services can be reached at (800) 8539493 or hsfs@henryschein.com.
Please consult your tax advisor
regarding your individual circumstances.

[5] =>

[6] =>

Practice Matters

“Changing the Payments Industry”

Dental Tribune | November 2009

‘Will my
insurance
cover that?’
By Sally McKenzie, CMC

How often does this simple question — “Will
my insurance cover that?” — stand between
treatment diagnosed and treatment accepted?
Five words that mark the great divide between
the care patients truly need and deserve and the
bare minimum that they often settle for.
Here’s the typical scenario. You present the
treatment plan. The patient is eager to proceed.
Then the financial coordinator steps in and
unveils the price tag.
The patient swallows hard and asks the question that she intuitively knows the answer to.
“Will my insurance pay for that?” Now what?
Everyone is just looking at each other, not sure
how to explain the situation to the patient.

Educate and communicate

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Don’t be caught stuttering and stammering
through these tricky situations. I recommend
you educate and communicate.
First, educate your patients about insurance
limitations and other financial options just as
you educate them about proper oral health care.
Specifically, patients must fully understand that
while standards of dental care have improved
dramatically in the last 25 years, dental insurance coverage remains virtually unchanged.
Most policies have a per calendar year cap
that has not been increased in more than two
decades — an important detail that patients often
aren’t aware of.
Next, communicate. Your financial coordinator should sit down with the patient and review
what’s covered in his/her dental plan according
to a prepared script (more on this later) in which
the situation and options are clearly articulated
and the coordinator is well prepared with the
answers to those frequently asked patient questions and concerns.
Discuss the calendar year cap, deductibles,
co-pays, coverage for preventive care, etc.

Using scripts
For example, “According to the information you
provided and additional information I gathered
from the insurance company, your employer has
purchased a package for you that includes the
following benefits and coverage.” Explain those
to the patient.
“The plan your employer provides offers a
small per calendar year balance of $1,000. This
will help cover some of the care you need. In
addition, your plan includes a deductible and copayments.” Explain those to the patient.
The greatest benefit of a script is that it is clear
how you will respond and you are prepared.
Dentist and team can better manage the messages to ensure they are clear and professional.
Scripts also are ideal for addressing patient
financial issues. When insurance plans fall short,
as they often do, scripts help staff to clearly educate patients on treatment financing options that
can bridge the financial divide.
For example, your financial coordinator might
script this approach: “Mrs. Patient, we offer four
convenient payment options to help you obtain
the care you need. The first is a patient financing
program offered through CareCredit. It allows
g DT page 8A

[7] =>

[8] =>

8A

Practice Matters

f DT page 6A

However, if Jane had a script,
she would know how to phrase
the confirmation call so as not
to encourage a cancellation. She
would be prepared with communication techniques that emphasize
the importance of keeping appointments.
She would be ready to politely
encourage and redirect the patient
to minimize the negative impact
on practice production. However,
even though effective communication is critical to Jane’s job, without
a script she doesn’t have the necessary tools to ensure that she can
succeed.

qualifying patients to secure zerointerest loans for up to 18 months.
“The second option provides a
5 percent reduction in the total
fee if the procedure is paid in full.
The third option would allow you
to build a credit on your account
and then begin treatment. And the
fourth option would allow you to
break your payments into equal
installments.”

Script the ‘routine’
Scripts are tremendously helpful with insurance and treatment
financing discussions, but they also
make a huge difference in how staff
handles those seemingly “routine”
conversations.
They can curb no-shows and cancellations, boost patient retention
and improve cash flow. Consider
the schedule: one simple question
can have a huge impact on whether
you reach or fall short of production
goals.
In many practices, the scheduling
coordinator is charged with making
sure patients are in the chair at the
appointed time. Unfortunately, the
individual is often left to figure out
how to accomplish this by trial and
error.
Here’s the typical scenario:
Scheduling Coordinator Jane conAD

Dental Tribune | November 2009

Staff acceptance of scripts
firms appointments every day.
She finds the process frustrating
because it seems that more patients
cancel or reschedule than actually
confirm.
The problem is Jane’s approach,
which usually goes something like
this: “Good Morning, Mrs. Madison. This is Jane from Dr. Krager’s
office. I was just checking to see if
you’ll be in for your appointment on
Thursday.”
Mrs. Madison, responds with
“No, I need to cancel that. I will call
back to reschedule.” Jane wraps up
the call with, “Thank you for letting
me know,” and promptly goes on to
the next person on the list.

While the justification for scripts is
obvious, the concept can be difficult
for staff to accept.
Say the word “script” to the dental team you may well be greeted
with a chorus of groans and “you
must be kidding, right?” Somewhere along the way, the idea of
the script became taboo.
The typical responses to the mere
suggestion of scripting is, “We’ll
sound ‘canned’; it won’t sound natural; what if I mess up my ‘lines’?”
Scripts are often mistakenly viewed
as barriers to natural conversation when, in reality, they are tools
for effective discussion that build
patient relationships and keep sys-

tems on track.
Scripts ensure that when it comes
to day-to-day patient communication, everyone is on the same page
and conveying the same messages.
For example, when new patients
call the practice a script helps the
team ensure that no matter who
takes the call, he/she is prepared to
gather necessary information.
When it comes to collections,
a script enables even those most
reticent to request payment from
patients to do so more effectively.
The schedule has fewer gaping holes because team members
understand how to consistently
reinforce the value of care in dayto-day discussions with patients.
Patient retention is strong
because team members know how
to effectively communicate with
patients whose payments are past
due, with those who have unscheduled treatment and with those who
have failed to cancel their appointments. They know what to say, how
to say it and when to say it because
they are prepared.
They aren’t in a situation in
which they have to think on their
feet, but the communication is as
natural and comfortable as it would
be if they were chatting with the
patient over coffee.
g continued

[9] =>

0A
Dental TRubric
ribune | November 2009

Dental Tribune
| Month 2009
9A
Practice
Matters

Headline
To
retire or not to retire?
Deck

By Stephen Safran, DDS
By line

I am a 1965 graduate of NYU College of Dentistry, and I practiced
until 2000. I was 58 at the time and
was
tk somehow bent on retiring in
my late or middle 50s when most
people thought that way.
Social security was available at
age 62 then, and the average age
men lived to was 66. My dad died
at that age and so did most of my
friends’ fathers. Thus, I figured I
could have a good 10 years to live
the “really good life.” Boy has that
changed.

‘Dad loves his work’
I was one of the few dentists I knew
who really loved his profession. The
reason I retired in 2000 was my wife
had suffered from breast cancer for
13 years and I wanted to take her
places and be with her full-time
until her death, which was in 2003.
After her death, I had sufficient
funds to live without working, but
I had not really considered what I
would do when I was alone and had
so much free time on my hands.
For two years I was a hermit. I
lost 25 percent of my body weight
in only a few months and did not
answer the telephone. Truthfully, I

f continued

Practice those scripts
The best scripts use words, phrases
and questions that prompt patients
to respond the way you want them
to respond.
Those who are able to use scripts
most effectively understand the
message they need to convey. They
know the information and material
thoroughly and are able to adapt
the scripts so they come across
naturally.
What’s more, those teams that
use scripts to their full advantage
practice, practice, practice and regularly engage in role-playing.
AD
Role-playing is essential in helping staff with average communication skills raise their level of performance. In addition, it enables
the team to determine how to best
phrase questions and determine
the most appropriate sequence for
AD

have little memory of those years.
Eventually, my dear brother and
a lifelong friend convinced me to
renew my dental license, go on
JDate (an online Jewish dating service) and get back into the real
world.
It was not easy, but I managed to
shed my hermit life. I met a woman
with whom I have become a partner
in life. Although this new relationship can never be what a 50-year
relationship was that began at the
age of 16, it is good to have a romantic partner back in my life.
The result of renewing my dental
license has translated into working the past two years as a dental
consultant for two 600-bed nursing
home facilities. This work has given
me a raison d’être, and the ability
to practice in a stress-free environment that also provides an income.

Do you ‘have to’ retire?
The answer to that question is, of
course, no you don’t have to retire.
If you truly enjoy dentistry but do
not want as much stress in your life,
I highly recommend you rethink the
decision to retire completely from
dentistry. Besides, why should you
give up something you truly enjoy?
Personally, I used to have very

statements and questions.
For example, you would carefully
script where you place questions
involving insurance or statements
regarding the financial policy so as
not to send unintended messages to
patients.
What’s
more,
role-playing
enables the team to pay close attention to their tone and how their
words come across to others.
Are they perceived as being warm
and caring yet still assertive?
Do they come across as timid and
easily flustered or manipulated?
Alternatively, might they come
across as abrupt and cold?
Listening to responses and coaching each other on how to improve
those responses ensures that team
members are well prepared to handle routine patient communication
as well as the occasional difficult
exchange.
Moreover, it enables the dentist

little respect for any physician or
dentist who worked in a nursing
home. In my narrow view, I felt
these practitioners were incapable
of making a good living in private
practice so that is why they must be
working in a nursing home (don’t
throw the tomatoes at me just yet
please).
In this narrow view, those who
worked in nursing homes were
lumped into a heap along with
instructors at dental schools.
I presumed these men and
women also could not have a successful practice and likely worked at
their practice only a day or two per
week until they could build up referrals to do it full time (please, hold off
on those tomatoes a little longer).
Maybe my narrow views are true
for a few people, but now that I
am looking at this picture from the
other side of the fence, I can see
how wrong I was to think the way
I did.
By working as dental consultant
I have not given up on all the skills
I acquired through a lifetime of private practice: surgery, prosthetics,
diagnosing and relating to others.
Instead, in my new position I also
g DT page 10A

to hear how staff would react in specific situations and to redirect that
approach if it is inconsistent with
practice protocol or policies.
Scripting
and
role-playing
empower the team to respond to
patients cordially, yet effectively, in
every conversation from the most
mundane to the most important. DT

About the author

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

Sally McKenzie is CEO of
McKenzie Management, which
provides success-proven management solutions to dental
practitioners nationwide. She
is also editor of The Dentist’s
Network Newsletter at www.the
dentistsnetwork.net; the e-Management Newsletter from www.
mckenziemgmt.com; and The
New Dentist™ magazine, www.
thenewdentist.net. She can be
reached at (877) 777-6151 or sal
lymck@mckenziemgmt.com.

[10] =>

10A Practice Matters

Dental Tribune | November 2009

California as a model for
regulated medical waste disposal
By Burton J. Kunik, DDS, Sharps
Compliance Corporation

California ranks first in the United States for the number of dental
services provided. A survey released
in 2009 by the UCLA Center for
Health Policy Research showed
that the state has more than 31,000
licensed dentists, or approximately
14 percent of the nationwide total.
In addition to its size, the dental
community in California has another
distinction — compliance requirements with some of the most comprehensive state laws in the country
regulating medical waste disposal.
Regulatory policy in California
is often a model for other states,
and increasing nationwide concern
over the environmental implications
of medical waste disposal suggests
that dental professionals should be
familiar with California requirements and solutions.

California provisions
All dentists realize that their practices deal in materials and tools that
must be properly managed for staff
and patient safety, but too many do
not understand the dental office specifics of regulated materials.
Treatment byproducts such as
used gloves, masks, gowns, patient
bibs, lightly soiled gauze or cotton
rolls and plastic barriers are actually
not regulated medical waste.
According to the Centers for Disease Control and Prevention, only 1
to 2 percent of dental office waste
is actually regulated medical waste,
with needles and other medical
sharps composing the bulk of that

f DT page 9A
get to take part in meetings with the
medical staff at the nursing homes
and am called on by physicians to
diagnose diseases of the oral cavity and to teach them about these
diseases.
Working at nursing homes saved
me from what had become a hermit-like retirement. My mistake —
AD

‘Only 1 to 2 percent of dental office waste
is actually regulated medical waste, and
sharps are the bulk of that material.’
material.
Regulated medical waste is
defined by the California Division of
Occupational Safety & Health (Cal/
OSHA) as:
• liquid or semi-liquid blood or
other potentially infectious materials (OPIM), such as bloody saliva;
• contaminated items that would
release blood or OPIM in a liquid
or semi-liquid state if handled or
compressed;
• items that are caked with dried
blood or OPIM and are capable of
releasing these materials during
handling;
• pathological and microbiological wastes containing blood or OPIM;
• contaminated sharps;
• waste regulated by the California Health and Safety Code that
includes pharmaceuticals that are
not hazardous.

Disposal issues
In California, as in other states,
many dental offices pay for standard
monthly or quarterly collection of
regulated medical waste by medical
waste pickup services.
However, this is generally expensive because dental offices generate
minimal medical waste, and it is
disruptive when pickups are missed
or the collection process interrupts

and one I hope you will not repeat
— was that I did not really plan what
I would do when I retired and was
left alone as a widow.
My mortgage was paid off, I had a
retirement plan to carry me indefinitely, I had health insurance and
my children were grown and well
past their college years.
Had I maintained my practice,
I believe I would not have felt so

office workflow. For a small office,
this is just not cost-effective.

Effective option
Disposal by mail is an alternative
disposal option that can save the
dentist money and free up staff for
patient care.
Disposal by mail systems include a
sharps container specially designed
to be mailed through the U.S. Postal
Service and a pre-paid return-bymail package.
All costs of the container, packaging, return postage, destruction and
documentation are included in one
purchase price.
Systems are ordered on an asneeded basis without required contracts. Once filled, they are simply
handed to the postal carrier. Proof of
destruction is available through an
online manifest-tracking program.
Various sizes of disposal by mail
systems are available. Included
sharps containers can be placed on
a counter or mounted and locked on
the wall.
There are even disposal by mail
options allowing dentists to use their
own current sharps containers.
Besides the cost savings of the
disposal by mail, there are no calls
for pickups, no interruptions during
patient care, no monthly fees, no

alone, but I likely would have gone
through some horrible years following my wife’s death.
After her death, I needed to feel
some degree of being needed. I
needed to feel I was doing something as important as I was in my
private practice. I needed identity.
Now I have the best of both
worlds. I am nurtured by both residents and staff at the nursing homes
I consult for and I am able to nurture those around me in return.
If you are approaching retirement and you truly enjoy dentistry,
there is a way to still practice and
find yourself in an environment that
is considerably less stressful than
managing your own practice.
There are nursing homes all over
the country, and as the baby boomers come to retirement age, occupancy in facilities seems to grow
almost exponentially.
In many ways, dentistry may
be recession proof. Patients may
need to put off elective procedures,

contracts, no keeping up with waste
manifests because they are maintained online and no extra costs
beyond the basic system components.
The requirements for adherence
to the California Medical Waste
Management Act waste segregation
and storage limits are easily met
with the disposal by mail systems,
eliminating unnecessary pickups,
often required by some medical
waste disposal services.
Disposal by mail is also extremely
safe and can reduce liability and
the risk of non-compliance often
encountered by using other methods of medical waste management
such as encapsulation (which must
also disinfect the waste).
It is important to note that disposal by mail companies, like all
other forms of regulated medical
waste disposal, must be approved
by the state.
Disposal by mail is an effective
solution in any state, no matter what
the regulatory requirements. DT

Contact information
Former dentist Burton J. Kunik
is chairman and CEO of Sharps
Compliance Corp., a provider of
cost-effective disposal solutions
for medical and pharmaceutical waste generated outside the
hospital setting, www.sharpsinc.com. Kunik can be reached
at (713) 432-0300 or bkunik@
sharpsinc.com.

but the “bread and butter” dentistry cannot be done elsewhere by
any other clinician. Anyone who
has ever experienced a toothache
knows that.
And so, what was that question
again: To retire or not to retire? If
you truly enjoy dentistry, there is an
option for you to continue in your
chosen field. Pick up the phone and
get in touch with nursing homes in
your area.
You might find that being a
dental consultant during your socalled “retirement” is far more
rewarding than you ever could
have imagined. DT

Contact information
Dr. Stephen J. Safran
994 East End
Woodmere, N.Y. 11598
(516) 241-3787
sjs1942@optonline.net

[11] =>

0A
Dental TRubric
ribune | November 2009

Dental Tribune
| Month11A
2009
Clinical

Headline
Many
orofacial injuries during sports
Deck preventable
are
By line
By Eric Yabu, DDS

In
tk 1998, Orlando Magic center
Adonal Foyle took an elbow from
Utah Jazz’s Quincy Lewis to teeth
Nos. 8 and 9, causing the teeth to
luxate back.
In 2001, Dallas Mavericks’ Dirk
Nowitzki was elbowed by San Antonio Spur Terry Porter and tooth No.
8 was knocked out.
In 2003, Mavericks’ guard Steve
Nash was struck in the mouth by
Los Angeles Lakers’ forward Karl
Malone, chipping tooth No. 9.
Just last year, Indiana Pacer
Danny Granger had teeth Nos. 8 and
9 knocked out in a game against the
Boston Celtics — he wears a stayplate now.
The list goes on and on, and this is
only the NBA. We don’t have enough
space to delineate all the dental injuries hockey players have endured.

in football, boxing, ice hockey, field
hockey and lacrosse.
The NFL does not require mouthguard use and, as a result, sees not
higher than 50 percent of its players
protected with one.
Mouthguards are not only useful
for protecting teeth from fractures,
luxations or avulsions. They are
also critical for protecting against
soft tissue lacerations, damage to
the periodontium, mandibular and
g DT page 12A

The most common type of injury
Dental injuries are the most common type of orofacial injury sustained during participation in sports.
According to the National Youth
Sports Foundation for Safety, in the
United States, an estimated 5 million
teeth are knocked out each year during sports activities.
Also, as the NBA examples support, almost all of these dental injuries involve the maxillary central
incisors. A 2001 study by Gabris et al.
found that 85.87 percent of all dental
injuries from sports involved tooth
No. 8 and/or 9.

Mouthguards significantly
decrease injury incidence
So why isn’t every athlete at risk
wearing a mouthguard? An athlete is
60 times less likely to sustain a dental injury when wearing a mouthguard.
In 1984, the American Dental
Association estimated that facemasks and mouthguards prevent
AD
more than 200,000 orofacial injuries
annually.
The ADA recommends mouthguards for participants in the following sports: acrobatics, basketball,
boxing, discus throwing, field hockey, football, gymnastics, handball,
ice hockey, lacrosse, martial arts,
racquetball, rugby, shot putting,
skateboarding, snowboarding, skiing, skydiving, soccer, squash, surfing, volleyball, water polo, weightlifting and wrestling.
While the skydiving recommendation is a little dubious (Is it really
going to make a difference if the
parachute doesn’t deploy?), it would
stand to reason that most of these
sports organizations should mandate mouthguard use to protect its
participants.
However, in the U.S., mouthguard
use is only required at some level

Chipped tooth no. 9.

AD
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9 1/4 x 3 3/8

[12] =>

12A Clinical
f DT page 11A
maxillary fractures, TMJ injuries
and concussions.

Room for debate
There is still some debate about
the effectiveness of mouthguards in
terms of reducing the incidence and
severity of concussions. However, it
stands to reason that if there is not
adequate cushioning of the mandible, a blow to the jaw could cause
the condyles to be violently pushed
into the base of the skull and even
into the brain cavity.
A mouthguard could provide this
cushioning as well as create a buffer
space between the condyle and the
fossa by translating the mandible
forward due to the thickness of the
guard.
AD

Dental Tribune | November 2009
A study by Hickey et al. that was
published in the Journal of the
American Dental Association in
1967 used cadavers to measure the
amount of force transmitted through
the skull.
Their measurements with and
without mouthguards showed that
the amount of intracranial pressure
and bone deformation in the skulls
reduced significantly with a mouthguard in place.

Three types of mouthguards
All mouthguards are not the same.
Basically, there are three types of
mouthguards.
Type I. The first are stock mouthguards. These are not fitted or customized to the teeth or alveolus in
any way. They are simply taken
out of the box and slipped into the

Lip laceration caused by truama by upper
incisors.
mouth.
They tend to be uncomfortable
and hamper speech and breathing
because they are bulky and teeth
need to be clenched for retention.
The only advantage is that they

Type I mouthguard.

are inexpensive, available for $1 to
$15 in sporting goods stores.
Type II. These mouthguards are
the “boil and bite” variety. These
represent about 90 to 95 percent of
the mouthguard market.
While newer versions of these
can look and sound quite impressive — e.g., Shock Doctor, BrainPad — and can even come with a
$1,500 guarantee for dental injuries
suffered during wear, they are not
particularly protective and tend to
be even less comfortable.
These mouthguards rely on the
user boiling the appliance and then
biting and molding it to create the
fit.
Quite often, the guards’ biting
surfaces are thinned out from 70
to 100 percent, leaving them with
minimal occlusal thickness or even
perforations.
As with the Type I mouthguards,
their advantage is cost, selling for
$1 to $40.
Type III. These mouthguards are
the truly customized guards. They
are formed by vacuum or pressure
forming one or more sheets of ethylene vinyl acetate (EVA) over a
dental cast of the athlete’s mouth,
usually maxillary.
They offer excellent retention
and a high level of acceptance due
to comfort.
However, they are more expensive than store-bought guards, ranging from $100 to $1,500.
Vacuum formed vs. pressure
formed. Type III mouthguards
should be broken up into two subtypes: vacuum formed and pressure
formed. The former are fabricated using a traditional vacuformer,
which uses 1 atmosphere of vacuum
suction to pull the EVA down over
the model.
It is difficult to laminate two or
more layers with this technique and,
because the pressure is minimal,
deformation of the guards occurs
over time due to the elastic memory
of the EVA material.
Pressure-formed mouthguards
are the gold standard of mouthguards today. They are fabricated by
using a positive-pressure thermoforming machine that may exert up
to 10 ATM of pressure.
There are three such machines
on the market: Drufomat by Raintree Essix, Biostar by Great Lakes
Orthodontics, and Erkopress by
Glidewell Laboratories.
g continued

[13] =>

0A
Dental TRubric
ribune | November 2009

Dental Tribune
| Month13A
2009
Clinical

Headline

About the author

Deck
By line

Sheets of ethylene vinyl acetate (EVA).
tk

Type II mouthguard.

Type III mouthguard.

f continued
These allow for extremely precise adaptation and chemical fusion
between multiple layers. The units
generally run in the $3,000 range.

Mouthguards round out your
service options
Because of the prevalence of sport
injuries and the fact that athletes
are participating at even younger
ages, today’s dental office should be
prepared to offer a Type III custom
mouthguard to its patients.
While the cost of purchasing
the equipment to fabricate these
guards may be prohibitive, there
are many laboratories — such as
Glidewell, Great Lakes Orthodontics and Mahercor Laboratories —
as well as manufacturers, such as
Pure Power Mouthguards and Under
Armour, that can help provide the
service. DT

A traditional
vacuformer.
The Drufomat.

The Erkopress.

The Biostar.

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
AD

AD

AD
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[14] =>

[15] =>

0A
Dental TRubric
ribune | November 2009

Dental TMeeting
ribune | Month15A
2009
Greater N.Y. Dental

IADEF
meets in N.Y.
Headline
Deck

By David L. Hoexter, DMD, Editor in
Chief
By line

The International Academy for
Dental-Facial Esthetics (IADFE)
will meet once again at the Greater tk
New York Dental Meeting, Monday, Nov. 30.
The academy is an honorary
service organization with the mission to foster interdisciplinary
education in the area of facial
esthetics.
Fellowship in the IADFE is by
invitation to those dentists, physicians and members of the cosmetics industry who have distinguished themselves in their

respective professions.
International meetings of the
IADFE are held at various locations around the world. This year
the annual meeting will take place
in conjunction with the Greater
New York Dental Meeting.
The Fellowship Cap and Gown
ceremony will be held at the Marriott Marquis at 6 p.m. Immediately following there will be a
reception/dinner at the private
Harmonie Club.
For information regarding the
IADFE, contact Dr. David Hoexter,
(212) 355-0004, DrDavidLH@aol.
com or Dr. George Freedman at
epdot@rogers.com. DT

The traditional “hats off” cap and gown ceremony for new IADFE fellows in
2008.
AD

More speakers
added to DTSC
Symposia roster
Dental Tribune America has partnered with the organizers of the
Greater New York Dental Meeting
to offer four days of symposia in the
areas of cosmetic dentistry, digital
dentistry, endodontics and implantology. The meeting is scheduled for
Nov. 29 to Dec. 2.
The newest addition to the program is Risk of Coronary Heart Disease in Association with Periodontitis
and Perimplantitis, to be held Nov.
29 and 30, from 4:15 to 5:15 p.m.
each day.
In a roundtable discussion, Dr.
Hans Dieter John, Dr. Richard Meissen and D. R. Gieselmann will discuss new technologies to detect
and reduce risk factors: from a
MMP8 (matrix metalloproteinase
8) diagnostic to biofilm reduction
for implants and anti-inflammatory
therapy.
Recent meta analysis reported an
association between periodontal disease (PD) and coronary heart disease (CHD) and show a significantly
higher risk of 1.14 to 2.22 of developing CHD.
AD
The new chairside detection of
MMP8 allows clinicians to monitor
periodontal disease status in a sitespecific manner and increase patient
compliance to treatment option and
relevance to general health and CHD.
This session is presented by the
Academy of Periointegration.
The symposia are free for registered Greater N.Y. Dental Meeting
attendees, but pre-registration is recommended.
Also, due to limited seating, register early to ensure preferred seating.
For registration, please visit www.
gnydm.com or send an e-mail to
info@gnydm.com.
International attendees requiring visas should e-mail customer
service@gnydm.com.
For more program details, please
check the schedule at www.DTStudy
Club.com. DT

AD
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9 1/4 x 3 3/8

[16] =>

16A Greater N.Y. Dental Meeting

Dental Tribune | November 2009

Going to GNYDM? The Big Apple has lots to do
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.

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.

New and improved TKTS Booth

Want to see a show? Then stop by the TKTS booth, located at Broadway
and 47th Street, to score some tickets. On the other side of the booth is a new
giant red staircase that is getting raves from both residents and tourists.
(Photo courtesy of NYC and Company)
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 TKTS Discount Booth, which
sells discounted tickets to BroadThe High Line
way and off-Broadway producIf you would like to take in some tions, has been popular with locals
truly interesting views of the city and tourists alike for ages. The
streets and the Hudson River, you good news is that the booth has
absolutely must visit the High been completely renovated.
The lighted displays are much
Line.
Even stuck-up New Yorkers will easier to read now and there are
tell you it’s really cool. You’ll get a additional sales windows, making
whole different perspective of the the line move much faster than it
used to. There is even a lightningcity. Bring your camera.
The High Line is an elevated quick “play only” window.
Available shows change daily or
rail platform for freight trains that
was constructed in the 1930s. It even several times each day, and
runs above the streets along the there is no guarantee that tickets
West Side of Manhattan between for any particular show will be
available. But there are usually
10th and 11th Avenues.
For decades nobody knew about dozens of productions to choose
it. It sat abandoned and overgrown from, so chances are good that you
with weeds. Today, it is being will be quite pleased.
The tickets, which are for daytransformed into an urban park.
Section 1 of the High Line, which of-performance showings only, are
runs from Gansevoort Street to discounted up to 50 percent plus a The new Yankee Stadium
20th Street, was officially opened $4 per ticket service charge. They Up in the Bronx, the New York
Anzeige METAL-BITE USA 2009/10:METAL-BITE 2009/10 01.11.2009 22:31 Uhr Seite 1
to the public in June. It features now take credit cards in addition Yankees — who, as this issue went
to press, were celebrating their
AD
27th World Series victory— have
a brand new, state-of-the-art staUniversal and scanable
dium that opened this year.
registration material,
To get there, hop any B, D or 4
that’s it!
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.
+ M
A
/C
D
The tour lasts about an hour
CA IM
C
and includes visits to the New York
Yankees Museum, the dugout and
R-SI-LINE ® METAL-BITE TM
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from across the street), which is
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• 2 Cartridges + 12 Mixing cannulas
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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] =>

0A
Dental TRubric
ribune | November 2009

Dental Tribune
| Month17A
2009
Industry
News

Headline Pulpdent Embrace featured on TV show

LumiNRG light,
mirror and
instrument holder

Deck

By line

tk
The LumiNRG is an autoclavable,
LED-illuminated mirror and instrument holder that provides a bright,
focused and miniature long-life LED
light that can reduce the need to
constantly readjust the bulky overhead light.
It introduces a new level of bright
white light inside the oral cavity and
provides dental professionals with a
new level of comfort and visibility.
The minimal size ensures that
virtually no extra space will be taken
up in the already limited space of the
oral cavity, and is especially helpful
when working on the remote molar
teeth. The lightweight and ergonometric feel maximizes user comfort.
LumiNRG is designed to be used
with the dentist’s own standard
threaded or unthreaded mirrors. It
is based on a new patent that allows
the adjustment of the mirror to any
angle or depth from the light.
The LumiNRG can also be used
with many different tips and instruments, such as a scaler tip or a guttapercha plugger. It can be used with
any cone socket mirror provided it is
a standard 3 mm threaded diameter.
The desired instrument’s angle
can be adjusted for optimum light
by rotating the mirror. If the mirror
that is in the holder is rotated 180
degrees, it can be used as an illuminated cheek retractor providing
intense direct light on the work area.
The LumiNRG’s illumination
head can be placed directly into the
autoclave, along with other dental
instruments, after removing the battery pack.
There is no need to detach the
mirror or other instrument before
sterilization.
A second illumination head is
included in the kit. It uses only one
AD
standard AAA battery for hundreds
of treatments with a constant light
intensity.
The minimal size is especially
helpful when working on molars.
Other colored LED heads are
available, such as blue, for transillumination to detect cracks, fractures or crazing.
By purchasing an inexpensive
extra blue LED head, the dentist
can obtain a trans-illuminator that
would normally cost many times the
extra cost of a blue LED head.
LumiNRG is economically priced
under $80, a fraction of the price of
competing units, which offers the
advantage of economically providing a unit for every operatory.
For additional information, call
Dr. Jerome Farber, MedicNRG/USA,
at (888) 429-0240 or visit medicnrg.
com. DT

Pulpdent’s Embrace™ Wetbond™ Pit & Fissure Sealant was
featured on “The Doctors” television show in a segment that
aired Oct. 12 featuring “Extreme
Makeover” cosmetic dentist Dr.
Bill Dorfman.
The segment can be viewed

online at www.thedoctorstv.com/
main/procedure_list/635.
The episode, “Top ‘C’ Words
Everyone Hates,” included cavities as one of the “C” words.
In that segment, Dorfman
explained the value of sealants in
protecting teeth and then demonstrated by applying Embrace WetBond Pit and Fissure Sealant to his
own daughter’s teeth in a dental
operatory set up in the television
studio.
Embrace WetBond is the only
pit and fissure sealant that bonds
to the moist tooth, making it easier and faster to apply and less

technique sensitive.
Moist field placement facilitates the sealant procedure, especially when treating children,
and ensures the best results.
Published studies show unsurpassed results with Embrace.
Pulpdent manufactures highquality products for the dental
profession, including adhesives,
composites, sealants, cements,
etching gels, calcium hydroxide
products, endodontic specialties
and bonding accessories.
For more information call
(800) 343-4342 or visit www.
pulpdent.com. DT
AD

AD
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[18] =>

18A Industry News

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 million 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.
g continued

[19] =>

0A
Dental TRubric
ribune | November 2009

Dental Tribune
| Month19A
2009
Industry
News

Headline Seiler unveils two new dental microscopes

f 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.

The company has also more than doubled the size of its home office from 70,000 to 150,000 square feet

To say Seiler Instrument Corp.’s
precision microscopes have a long
history with optics would be a bit
of an understatement.
With over 64 years of history in
dealing with the design and manufacturing of optical equipment,
Seiler Instrument Corp. now provides that equipment to the medical, dental, military, architectural, construction and planetarium
markets.
Founded in St. Louis in 1945
with the knowledge and expertise
by a master of fine optics from the
Zeiss University School of Fine
Optics in Germany, the Seiler
Instrument Corp. began making
and repairing small microscopes
and survey equipment.
In 1950, the Seiler Microscope
division was formed to distribute
Zeiss (Jena) Surgical Microscopes
in North America, making them
one of the first surgical microscope providers in the United
States.
Seiler has become a major provider of surgical and compound
microscopes to the dental, ENT,
ob./gyn. and laboratory markets.

Also, Seiler has
released
the
new
Seiler iQ that offers
the same new light
source, but comes in a
smaller package with
three steps of magnification and a new
design.
Both models have
five different mounting options: floor, wall, high wall,
ceiling and table mounts.
To get more information on
Seiler, visit www.seilerinst.com. DT

New home office
With all of Seiler’s history it is
amazing that the word “new”
could be used to describe Seiler,
but in 2009 that has been one of
the most popular terms around
their new building.
Recently,
Seiler
has
moved its home office from a
70,000-square -foot facility to a
new 150,000-square-foot facility to
better serve its customers.

New microscopes
In addition to the company’s new
building, it has also released two
new microscopes for the dental
market, the Seiler iQ and the Evolution xR6.
“We took a conventional
approach to the redevelopment of
these scopes. We directly asked
the dentists what they wanted in
a dental microscope; they told us
and we listened,” said Nicholas
Toal, marketing coordinator for
Seiler.
Listening is something that is
normally hard to do for a large
company these days, but “Seiler
knows that customers are the
boss, and catering to those customers keeps the boss happy,”
said Dane Carlson, division manager of Seiler Microscopes.

AD
1/4 Page
9 1/4 x 3 3/8
Seiler xR6 and iQ

The Seiler Evolution xR6 is the
newly redesigned, six-step microscope that comes with the new
50-watt metal halide bulb, which
is the brightest standard light
source in the market with a bulb
life of over 1,500 hours and a standard halogen backup.

Seiler Instrument Corp.’s has relocated its corporate headquarters to
this 150,000-square-foot facility in St.
Louis.

ADS

[20] =>

[21] =>

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

November 2009

www.endo-tribune.com

Vol. 4, No. 11

Practical clinical considerations
in endodontic retreatment
By Richard E. Mounce, DDS
& Gary Glassman, DDS

Non-surgical endodontic retreatment (NSER) of failed root canals is
almost exclusively a specialist procedure due to the complexity of diagnosis, treatment planning and advance
techniques required for retreatment
procedures.
As implants have become more predictable, the level of clinical success
required with NSER in an attempt to
retain the natural dentition has taken
on new significance. This article was
written to review and discuss several
key conceptual strategies for retreatment of failed root canals to optimize
the outcome of the procedure.
It will be taken for granted that the
clinician appreciates the value of the
surgical operating microscope (SOM)
(Global Surgical, St. Louis, Mo.) as well
as ultrasonics in retreatment procedures. While it is beyond the scope of
this paper to elaborate at length on the
use of the SOM, its use is associated
with improved outcomes of NSER as
well as endodontic surgery.
Conceptually, NSER can be broken
down into several key steps:
1) Determination of restorability. It is
the bias of the authors that the determination of restorability is a key component of NSER success. Treatment provided on teeth that are non-restorable is
obviously contraindicated. If these teeth
were extracted from the pool of candidates for either endodontic therapy or
NSER, success rates for both treatments
can only go up. Figures 1–3 show
three different cases that were poorly
treated, using inappropriate concepts
and in which removal was indicated.
Had the initial endodontic therapy been
carried out correctly, the probabilities
of clinical success would obviously be
far greater and the option of implant
therapy irrelevant.
In the context of NSER, rather than
compound the existing failure, the cliAD

Dr. Jeffrey
Linden

Linden
explains
canal
anatomy
By Fred Michmershuizen, Online Editor

Fig. 1: Endodontic treatment carried out with significant iatrogenic events
resulting and other clinical defects.
nician should carefully examine the
case at hand and evaluate whether the
tooth can be retreated and, if so, what
the likely success rates will be. Alternatively, the teeth pictured in figures 4–6
have been carried out to a high standard and have a much better chance
of long-term success. The difference
between the two sets of outcomes is in
large measure related to the different
levels of preoperative risk assessment.
2) Preoperative diagnosis and assessment of risk factors. The determination
of restorability is, as one aspect of its
assessment, whether the tooth is vertically fractured and/or whether treatment will make vertical fracture likely.
In addition, if the tooth has not had an
overt iatrogenic event, the clinician
should decide what the possibility is
that the contemplated treatment will
lead to one.
Near strip perforations through
overzealous shaping can lead to overt
strip perforations if the removal of

existing obturation material is not performed passively and with the correct
methods (heat removal first, mechanical second, solvents and patency files
third).
To place highly tapered rotary nickel titanium (RNT) files into large canals
at high speed is predictive of mid-root
strip perforation. Minimizing this risk
will be addressed in detail below.
3) Access. If at all possible, the crown
should be removed. Leaving crowns in
place and making access risks leaving
portals for coronal microleakage, unset
restoratives, caries and fractures. It
also minimizes access to both achieve
g ET page 4B

Dentists are always interested
in learning about ways to improve
the care they provide to patients.
At lectures and hands-on workshops across the country, they
gather to learn from experts in
their respective fields. One such
expert, Dr. Jeffrey Linden of New
York City, has been sharing his
expertise for some time now on
endodontic techniques and equipment.
The topic of Linden’s presentation is canal anatomy — specifically, how it is different in the
coronal, middle and apical thirds
of the root. Linden demonstrates
how specialized instruments are
used for optimal and efficient
g ET page 2B

Endodontist releases book
Pacific Sky Publishing announces the publication of the non-fiction book “Dead
Stuck”
by
Dr.
Richard Mounce,
available through
Amazon.com and
DeadStuck.com.
“Dead Stuck”
boisterously
describes
how
being an endodontist has provided Dr. Richard
the author unique Mounce
opportunities and
challenges in marital and parental
relationships, how he once wore girl

repellent, his addiction to world football, how he diverted flights with fire
on the wing and the mortal danger he
encountered while cave diving.
Part adventure-story collection,
travelogue and semi-autobiographical personal memoir, Mounce says of
“Dead Stuck”: “I wrote it to speak my
truth on a number of subjects without
hiding behind politically correct clichés and platitudes … my hope is that
sharing the contents of ‘Dead Stuck’
will resonate with those who can see
themselves in some part of its varied
subject matter.”
g ET page 2B

[22] =>

News

Endo Tribune | November 2009

Linden

ENDO TRIBUNE

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

f ET page 1B

cleaning and shaping.
The tools in Linden’s arsenal
include the LightSpeed instrumentation, EndoVac irrigation and HotTip obturation systems available from
Discus Dental Smart Endodontics, as
well as the Obtura 3 Max corded obturation system available from Obtura
Spartan.
As Linden explains, canal anatomy
is different in the coronal, middle
and apical third. The three instrument shapes in the LightSpeed system
are custom designed to address these
differences, enabling optimal and
efficient cleaning and shaping from
orifice to apex. In addition, Linden
says, the EndoVac allows for efficient
irrigation of the canal while the new
HotTip gutta-percha obturation device
offers warm vertical compaction coupled with the freedom of a cordless,
lightweight and ergonomic design.
Those who attend Linden’s workshops are able to try this equipment
for themselves.
Linden most recently presented
hands-on technique workshops at
Columbia University, and he is scheduled to present at various other dental
schools in the coming weeks.

Publisher & Chairman
Torsten R. Oemus
t.oemus@dental-tribune.com
Vice President Global Sales
Peter Witteczek
p.witteczek@dental-tribune.com
Chief Operations Officer
Eric Seid
e.seid@dental-tribune.com
Group Editor & Designer
Robin Goodman
r.goodman@dental-tribune.com
Editor in Chief Endo Tribune
Frederic Barnett, DMD
BarnettF@einstein.edu
International Editor Endo Tribune
Prof. Dr. Arnaldo Castellucci
Managing Editor/Designer
Implant & Endo Tribunes
Sierra Rendon
s.rendon@dental-tribune.com
Managing Editor/Designer
Ortho Tribune & Show Dailies
Kristine Colker
k.colker@dental-tribune.com

Dr. Mona Boside, a postdoctoral student at Columbia University, and Dr.
Jeffrey Linden, a clinician and educator, use the EndoVac irrigation system.

Richard “Rich” Mounce, DDS is a
root canal specialist (endodontist)
by profession. Aside from running
a private practice, he lectures and
writes globally in his specialty.

f ET page 1B

Rich and Laura live happily in Vancouver, Washington, USA.

Dead Stuck
One man’s stories of adventure, parenting and marriage,
told without heaping platitudes of political correctness

by Richard Mounce, DDS

“I was completely enthralled and riveted to every word you wrote.”
– Gary Glassman, Toronto, Ontario Canada
“No one has attempted to address the issues you mention in your
book, the life challenges personal and professional…You took them
on headfirst…it’s a great read. I laughed a lot.”
– John Weever, Dublin Ireland

“Congratulations on a fine piece of work!”
– Bob Gannon, Huntington Beach, California

by Richard Mounce, DDS

For more information or to purchase
the book, contact:
Pacific Sky Publishing
12503 SE Mill Plain #215

Product & Account Manager
Humberto Estrada
h.estrada@dental-tribune.com
Marketing Manager
Anna Wlodarczyk-Kataoka
a.wlodarczyk@dental-tribune.com
Marketing & Sales Assistant
Lorrie Young
l.young@dental-tribune.com
C.E. Manager
Julia Wehkamp
j.wehkamp@dental-tribune.com

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

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

Pacific Sky Publishing

Rich scuba dives in caves and
frequently loses cribbage matches
to his wife, Laura. Among many
life goals, he would someday like
Richard Mounce, DDS
to walk on top of the presidents’
heads at Mount Rushmore. After
he dies he wants to have his ashes spread (legally or illegally) at
Old Trafford, the home of Manchester United Football Club in
England.

Dead Stuck

Book
Speaking of the book, Dr.
Gary Glassman of Toronto, Canada, writes: “I was completely
enthralled and riveted to every
word you wrote. The metaphors
were clear … so clear that it has
inspired me to look clearly at my
life and to examine it more thoroughly and directly.”
Dr. John Weever of Dublin, Ireland, discussed the book’s originality
and candor: “… no one has attempted to address the issues you mention
in your book, the life challenges personal and professional … You took
them on headfirst … It’s a great read.
I laughed a lot.”
Mounce is an opinion leader in
the field of endodontics and is based
in Vancouver, Wash. This is Pacific
Sky’s first release. ET

ing Greater New York Dental Meeting
(GNYDM), to be held at the Jacob K.
Javits Center in Manhattan. ET

He will also offer a presentation,
titled “Innovative Endodontic Techniques,” on Dec. 1 during the upcom-

Online Editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.com

Vancouver, Wash. 98684
(360) 891-9111
PacificSkyPublishing.com
DeadStuck.com

Corrections

Endo 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 report the
details to Managing Editor
Sierra Rendon at s.rendon@
dental-tribune.com.

Dental Tribune America makes every effort to
report clinical information and manufacturer’s
product news accurately, but cannot assume
responsibility for the validity of product claims,
or for typographical errors. The publishers also
do not assume responsibility for product names
or claims, or statements made by advertisers.
Opinions expressed by authors are their own
and may not reflect those of Dental Tribune
America.

Editorial Advisory Board
Frederic Barnett, DMD (Editor-in Chief)
Roman Borczyk, DDS
L. Stephen Buchanan, DDS, FICD, FACD
Gary B. Carr, DDS
Prof. Dr. Arnaldo Castellucci
Joseph S. Dovgan, DDS, MS, PC
Unni Endal, DDS
Fernando Goldberg, DDS, PhD
Vladimir Gorokhovsky, PhD
Fabio G.M. Gorni, DDS
James L. Gutmann, DDS, PhD (honoris
causa), Cert Endo, FACD, FICD, FADI
William “Ben” Johnson, DDS
Kenneth Koch, DMD
Sergio Kuttler, DDS
John T. McSpadden, DDS
Richard E. Mounce, DDS, PC
John Nusstein, DDS, MS
Ove A. Peters, PD Dr. med dent., MS, FICD
David B. Rosenberg, DDS
Dr. Clifford J. Ruddle, DDS, FACD, FICD
William P. Saunders, Phd, BDS, FDS, RCS Edin
Kenneth S. Serota, DDS, MMSc
Asgeir Sigurdsson, DDS
Yoshitsugu Terauchi, DDS
John D. West, DDS, MSD

[23] =>

ENDO Tribune | November 2009

Technology 3B

AMD gains
certification for
its Picasso laser
‘It’s a proud day for our young company’
By Fred Michmershuizen, Online Editor

With international certifications
now in place for its Picasso diode
laser, AMD LASERS is poised for
continued growth in North America
as well as expansion into the European market.
AMD LASERS, based in Indianapolis, has attained International
Organization for Standardization
(ISO) 13485:2003 certification of its
medical device quality management
system in North America, Canada
and the European Union.
In addition, the quality management system demonstrates conformance to the Medical Device
Directive 93/42/EEC, allowing the
products to be CE marked, which
makes them available to be sold in
the European Economic Area.
“Achieving ISO 13485 certification
further demonstrates our leadership
and commitment to the highest standards of our industry,” said Alan
Miller, president and CEO of AMD
LASERS, in a news release announcing the certification. “We also have
many potential customers in Europe
eager to purchase the Picasso, so our
ability to use the CE mark is another
major step forward in our mission to
provide advanced, affordable dental
lasers around the world. It’s a proud
day for our young company.”
ISO 13485:2003 is the internationally recognized standard for the
development, production and servicing of medical products.
In order to obtain ISO 13485 certification, a company must demonstrate the ability to provide medical
devices and related services that
consistently meet customer and
regulatory requirements applicable
to medical devices and related services.
During the certification process,
AMD LASERS partnered with TÜV
Rheinland, an international service
group that serves as an ISO registrar, auditing the safety and quality
of new and existing products, systems and services.
“It has been a pleasure to work
with TÜV Rheinland,” said Amy
Szentes, compliance manager at
AMD LASERS. “They are the gold
standard in ISO registrars, and we
feel this certification validates all
of the hard work we have put into
both product quality and compliance.”
AMD LASERS was founded in
2006 to provide comprehensive and
affordable laser technology for den-

tal professionals.
More information about AMD
LASERS is available.
Call (866) 999-2635 or visit www.
AMDLASERS.com.

Alan Miller, president and CEO of AMD LASERS, is pictured in front of the
company’s facility in Indianapolis.

[24] =>

Clinical

Endo Tribune | November 2009

f ET page 1B

evacuation of the obturation material
as well as removal of objects of all
types that may be lodged in the canal
system (from posts to RNT file fragments, etc.). A compromised access
will limit both the tactile and visual
control of the clinician and, as a result,
some teeth that could otherwise be
retreated are compromised.
It is noteworthy that the vast majority of failed root canals show evidence
of overt coronal microleakage once
their crowns are accessed. This microleakage appears in the form of odor,
moisture, unset restoratives and voids,
among other visual clues. Assuring
that the post-endodontic result will be
sealed correctly is best accomplished
through removal of the crown, retreatment procedures and the placement of
a new coronal build up.
One of the authors (RM) uses a
self-etching, self-adhesive composite
cement for build-ups, Maxcem (Kerr,
Orange, Calif.) for its ease of use and
durability.
4) Removal of posts and coronal
obstructions of all types, including the
build up. While a comprehensive discussion of post and obstruction removal is beyond the scope of this paper, it
should be mentioned that the overriding principle in removal of all obstructions are to remove as little dentin as
possible to minimize both perforation
and the risk of vertical root fracture.
As a result, the greater the extent to
which procedures can be performed
that both cools the tooth to prevent
overheating during ultrasonic vibration and conserves tooth structure, the
greater the probability of clinical success. The Ruddle Post Kit* is invaluable in this regard if used correctly.
Coincident and related to post removal
involves choosing the correct ultrasonic tips.
5) Removal of canal contents. The
coronal access must be ideal before
either the orifice is managed or the
clinician progresses beyond the orifice. Attempting to remove obturation
material or shape the orifice without
attaining straight-line access is contraindicated.
Removal of canal contents is passive, gentle and done in three waves
(heat, mechanical and, finally, with
solvents). The Elements Obturation
Unit* (EOU) is an excellent source of
heat to remove gutta-percha. The heat
plugger of the EOU is used in the same
motion as the SystemB downpack. Usually in one or two down pack motions

Figs. 2–3: Endodontic treatment carried out with significant iatrogenic events resulting and other clinical defects.

Figs. 4–6: Endodontic treatment carried out within the standard of care.

Fig. 8a: Preoperative.

Fig. 7a: Preoperative.

Fig. 7b: Postoperative.

per canal, approximately half of the
gutta-percha can be removed with this
motion alone. Removal of gutta-percha
with the heat tips also creates a space
into which the RNT instruments can
be placed and remove shreds of guttapercha that remain along the walls.
Both the removal of gutta-percha
with heat as well as with RNT instruments is done dry. These two successive steps allow the vast majority of
gutta-percha to be removed and, if performed correctly, minimize the amount

of solvent and time that will be required
to be placed in the presence of hand
files to achieve patency.
At all costs the RNT files that are
used to remove gutta-percha should
be entered passively and as gently as
possible, used with an upward brush
stroke away from the furcation. Placing
them apically with force into the mass
of gutta-percha can easily lead to strip
perforation, especially if the existing
dentinal wall next to the furcation is
relatively thin from the start due to previous overzealous shaping.
6) Assessment and repair of iatrogenic events, if possible. The two most common iatrogenic events encountered are
canal transportations and separated
instruments, commonly RNT files. The
deeper the instrument fragments, the
lesser the chance that they can be
retrieved. This said, ideal access, crown
removal, use of the SOM and creation
of the ideal orifice size can all go far
toward fragment visualization despite
being at or slightly beyond a curvature
in the apical third of a root.
In addition, the use of the thinnest
ultrasonic tips possible that allow the
clinician an optimal view of the fragment, used in a counterclockwise

Fig. 8b: Postoperative.

Fig. 9a: Preoperative.

Fig. 9b: Postoperative.

[25] =>

Clinical 5B

ENDO Tribune | November 2009
motion to remove the dentin that binds
the fragment, is optimal. RNT fragments should not be directly vibrated
(touched) by ultrasonic tips. Doing so
will cause them to shatter.
In addition to ultrasonics, it is worthy of mention that there are many
systems available that engage the fragment with either frictional retention or
possible tube and glue options.
If they cannot be bypassed, instrument fragments that are entirely
beyond the apical curvature are generally left in place and obturation is
placed up to them. In the event of
clinical failure after leaving RNT fragments, it may be required to follow
NSER with root resection and retrofill.
7) Achievement and maintenance of
apical patency. Once the canal is evacuated of gutta-percha, the clinician will
need to spend as much time as it takes
to either achieve apical patency or
determine that apical patency is unattainable. Fortunately, in many clinical
failures, the apical third of a large
number of roots has not been touched
due to an inaccurate determination
of working length as well as an inadequate cleaning and shaping.
In any event, in the apical 3-4 mm
of a root with #6, 8 and #10 hand K
files, the clinician should place one
drop at a time of chloroform into the
canal until the hand K files just reach
the MC. Once the estimated working
length is reached, the electronic apex
locator can be used and the first determination of true working length can
be obtained.
A common clinical question
encountered revolves around when
and where to stop attempts at achieving patency. In essence, when is it time
to fill to the depth gained in the canal
in the absence of patency?
If repeated attempts to gain patency have failed using precurved hand
K files of the appropriate length and
diameter, especially if the clinician is
sure that he or she has removed all of
the previous obturation materials, the
canal should be cleaned and shaped to
an optimal diameter despite the blockage and then obturated. This recommendation notwithstanding, an experienced clinician can often gain patency
where an inexperienced one cannot.
This difference in skill level is usually related to the amount of pressure
used, the correct curvature of the hand
K file, the correct diameter of the hand
K file and adequate irrigation and clinical experience.
8) Achievement of the optimal master apical diameter. The achievement
of the correct apical diameter is corAD

related with enhanced cleanliness in
the endodontic literature. Such larger
apical diameters provide greater irrigant flows as well as removal of necrotic
dentin up to the MC. It is a common
finding in failed endodontic cases that
both the apical diameter and master
apical taper are too small.
One way to determine the ideal
master apical diameter is gauging.
Alternatively, the clinician can simply
instrument the canal to the desired
master apical diameter keeping in
mind that non-vital teeth have higher
failure rates in large measure because
they are harder to cleanse relative to
vital teeth (where the emphasis is on
asepsis rather than disinfection of an
already infected canal).
9) Obturation. One benefit of creating larger apical diameters is the ease
of cone fit as well as obturation, be
that obturation with a master cone or
obturator. Given that one of the most
significant causes of clinical endodontic failure is the loss or lack of coronal
seal, it makes intuitive sense to bond
the obturation. In both in vitro and in
vivo studies, RealSeal* in the master
cone and RealSeal One Bonded Obturator* form, has been shown to resist
the movement of bacteria in canals to a
statistically significant degree relative
to gutta-percha.
In addition to placing a coronal
seal in No. 10 below, this provides
an invaluable step in addressing one
of the weaknesses of gutta-percha, a
material that does not bond to dentin,
does not bond to sealers, and which is
entirely dependent on the placement
of a coronal seal for it to function clinically. Bonding obturation is simple; the
clinician clears the smear layer with
a liquid EDTA such as SmearClear
and subsequently rinses with distilled
water. After drying the canal, the RealSeal self-etching sealer is placed in the
canal and obturation takes place with
either the aforementioned RealSeal
master cones or RealSeal One Bonded
Obturator.
10) Placement of a coronal seal.
A number of clinical principles and
steps have been addressed that can
conceptually and clinically streamline
endodontic retreatment procedures.
Emphasis has been placed on optimal visual and tactile control, removal
of crowns before retreatment, passive removal of previous obturation
materials and obstructions, repair
and revision of previous treatment,
achievement and maintenance of apical patency and master apical diameter
optimization.
We welcome your feedback. ET

ET About the authors
Dr. Richard E. Mounce is the author of
the non-fiction book “Dead Stuck,” “one
man’s stories of adventure, parenting,
and marriage told without heaping platitudes of political correctness,” by Pacific
Sky Publishing, DeadStuck.com. Mounce
lectures globally and is widely published.
He is in private practice in endodontics in
Vancouver, Wash.

Dr. Gary Glassman graduated from the
University of Toronto, Faculty of Dentistry
in 1984 and was awarded the James B.
Willmott Scholarship, the Mosby Scholarship and the George Hare Endodontic
Scholarship. A graduate of the Endodontology Program at Temple University in
1987, he received the Louis I. Grossman Study Club Award for academic
and clinical proficiency in endodontics.
The author of numerous publications,
Glassman lectures globally on endodontics and is on staff at the University of
Toronto, Faculty of Dentistry in the graduate department of endodontics. Glassman is a fellow and endodontic examiner for the Royal College of Dentists
of Canada, and the endodontic editor
for Oral Health dental journal. He maintains a private practice, Endodontic Specialists, in Toronto, Ontario, Canada. He
can be reached through his Web site at
www.rootcanals.ca.

[26] =>

Opinion

Endo Tribune | November 2009

Modern endodontics means safer,
more effective and less expensive
By Barry Musikant, DMD

With all the new endodontic paraphenalia that is presently out, one
can easily get confused in deciding
what best meets your endodontic
needs. Perhaps, one of the best ways
to bring a logical approach to decision making is to have a set of criteria, goals that you wish to achieve,
and then use those goals as a measuring stick to see how different
tools and techniques hold up. That is
more or less the approach we have
tried to employ as we develop ways
to most effectively accomplish our
endodontic tasks.
I believe there are three goals that
must all be met. The instruments
used to shape the canals should not
break — period. They should shape
the canal adequately, a dimension
that is wide enough to remove most
of the pulp tissue as well as provide
a space that is large enough so it can
be effectively irrigated to remove
chemically what was not removed
mechanically.
Finally, they should not distort
the canals in the act of shaping.
The closer any system can come
to achieving these three goals, the
more effective it will be in producing successful results. Of course, we
would also like to use systems that
are inexpensive, negotiate through
the canals with minimal resistance
and are easy to use, but I would consider these pluses only after the first
three criteria are met.
To attain these three goals, different approaches have been advanced.
Rotary NiTi has been proven to be
most effective in producing nondistorted canal shaping in a simplified manner.
By that I mean, after glide path
creation, the instruments are generally fed into the canal space and
whether curved or not, the rotating
NiTi instruments stay centered in
the canal and produce a smooth
continuous taper, a result advocates
of this approach say is ideal. The
drawbacks to rotary NiTi result from
its shape memory, a property that
directs the instrument to snap back
to its original straight position (Fig
AD

Fig. 1: The drawbacks to rotary
NiTi result from its shape memory, a
property that directs the instrument
to snap back to its original straight
position.
1). In a curved canal it cannot snap
back, but the shape memory characteristic causes the instrument to
selectively work against the outer
wall of a canal.
As long as the flexibility of the
instrument remains high, the cutting force against the outside wall
remains negligible and distortion
is not an issue. However, as the
shaping instruments increase in
taper and tip size and the flexibility
decreases, the potential to distort to
the outside wall increases, aggravated further by canals of increasing
curvature. From a practical point of
view, the shape memory property
often limits the shaping of curved
canals with rotary NiTi to preparations not exceeding 25/06 and often
no more than a 20/04.
Given the limitations of non-distorted shaping of curved canals with
rotary NiTi, the goal of adequate
canal shaping may not be met. The
literature is pretty much in agreement with the need for apical preparations of not less than 30 with 35
being more preferable. Less than
this and the canal space is not adequate to provide for effective irrigation with a greater potential to leave
tissue behind. Since its introduction,
separation has been an issue for
rotary NiTi and it has affected its
use in many ways. To prevent breakage, the following observations have
been documented in the literature:
1) The creation of a glide path by
other means is essential before the
use of rotary NiTi.
2) As the curvature of a canal
increases, so does the torsional
stress and cyclic fatigue that the
rotary NiTi instruments are subject

Fig. 4: Before

Fig. 2

Fig. 3

to.
3) Increased torsional stress and
cyclic fatigue lead to an increased
incidence of breakage.
4) As the tip size and taper of the
NiTi instruments increase, the higher the incidence of breakage when
negotiating curved canals. Please
note the complex interrelationship
between instrument size and canal
curvature.
5) As the rotational speed
increases the incidence of breakage
increases.
6) Only single usage is recommended.
7) Abrupt curves are not amenable to rotary NiTi shaping.
8) Canals that bifurcate, merge,
dilacerate and recurve are to be
avoided too.
None of these limitations means
that the instruments cannot be used,
but they do deviate from the ideal
of what we want from a shaping
system.
Another approach is to use the
traditional K-file, the instrument
that most dentist who do rotary NiTi
employ manually when creating
the glide path. These instruments
are typically used with a horizontal watch-winding stroke with the
occasional vertical pull stroke when
removing the instrument to clean it
off. K-files are designed with a tight
series of fairly horizontally oriented
flutes.
It is a simple rule of carpentry
that in order for a blade to cut it
must be at a right angle to the plane
of motion. Anyone who has ever
planed a piece of wood understands
this principle. When we shape a
canal wall, we are seeking the same
planning action. Unlike an experienced carpenter, however, the
horizontally oriented flutes along
the shank of the K-file are poorly designed to plane the walls of
the canal when the watch winding
motion is employed. The most effective way they would remove dentin

Fig. 5: After
would be with a push-pull stroke.
However, a push-pull stroke
impacts debris when the instrument is pushed apically and selectively removes dentin from the outer
wall when used in the pull motion.
The result of using an instrument
designed for push-pull with a watch
winding stroke is inefficiencies that
result in increased resistance along
length and debris buildup along the
shank that in turn lead to loss of
length and distortion of the apical
end of the canal preparation when
the dentist attempts to regain that
loss of length by using greater apical
force. Even if the dentist is going to
use rotary NiTi after glide path creation, the damage to the canal may
have already occured.
Another approach is the manual
use of K-reamers. Given the watchwinding motion that is used, the
K-reamer is a more rational choice.
There are about half the number of
flutes on a reamer compared to a
K-file (Fig. 2). Because the 16 mm of
working length is the same for both,
the flutes on a K-reamer are about
twice as vertically oriented as the
flutes on a K-file.
This is a crucial difference in
design because the increased vertical orientation of the flutes of a
K-reamer allows the blades of the
reamer to plane the walls of the
canal far more effectively when the
horizontally oriented watch-winding
motion is employed. As an added
benefit, the outer canal walls are
minimally distorted on the pull
stroke because the vertical blades
that work so well with a watchwinding motion are poor at cutting
dentin when a vertical motion is
applied.

[27] =>

Opinion 7B

ENDO Tribune | November 2009
Added benefits include a more
flexible instrument (due to the fewer
twists needed to create the smaller
number of flutes) and less engagement than a K-file simply because
there is less contact along length.
The insight into the benefits of
a K-reamer versus a K-file give the
dentist still another option when the
action of the reamers are further
enhanced by first applying a flat
along the entire working length and
then using these instruments not
only manually, but in a 30-degree
reciprocating handpiece.
A flat (Fig. 3) makes the instruments even more flexible, less
engaging along length and increases
the space available for debris that is
being generated. These three factors
together produce a superior tactile
perception letting the dentist know
exactly what the tip of the instrument
is encountering at any given time.
Having the ability to distinguish
between a tight canal and a solid
wall is crucial in preventing canal
distortions or outright perforations in
the apical third of the canal.
The 30-degree reciprocating
handpiece mimics the watch winding that is so appropriate for instruments of this design, but allows the
action to occur between 3,000–4,000
cycles/minute rather than the 60 or
so cycles that manual use would
produce. The design of the instruments and the method of delivering
the required motion give the dentist
the ability to negotiate through a
canal space within a matter of a few
seconds and a few strokes.
The 30-degree reciprocating
motion also virtually eliminates the
torsional stress and cyclic fatigue
that are the main factors in instrument breakage. Canal distortion is
minimized by going past the constriction through a 25 relieved reamer, preventing the buildup of debris
that is the cause of instrument deviation and canal transportations.
The rapid back and forth movement of the reciprocating handpiece
produces a modified balanced force
that keeps the instruments centered
as long as patency is maintained.
The goal of non-breakage, adequate
canal enlargement and non-distortion are all met with a system that
is inexpensive and relatively easy to
master.
In summation, we see an interesting progression in the ability of the
instruments to reach our goals.
If we take the K-file as the starting
point, its limitations are obvious and
those limitations are tied to the subsequent use of rotary NiTi because
of NiTi’s need for the creation of a
glide path before its usage. Rotary
NiTi brings the benefits of shaping canals within narrow parameters
without distortion in an effective and
rapid way. However, when going
beyond those parameters, it subjects
the canal to increasing degrees of
distortion while increasing its own
chances of breaking.
These limitations lead to the need
for further instrument development
that produces non-distorted and
adequate shaping so canals could
be cleansed predictably in both

ET About the author

Fig. 6: Before

Fig. 7: After

the mesio-distal and bucco-lingual
planes. The relieved instruments
enhanced by their use in a 30-degree
reciprocating handpiece do away
with broken instruments, introducing a relatively simple technique
while accomplishing all our original
goals.
From the point of view of the
original goals we want to attain, the
combination of relieved K-reamers

and the 30-degree reciprocating
handpiece comes closer to achieving
these goals than the other systems.
The fact that they are about 90 percent less expensive on a per use basis
is an added plus.
See these clinical examples
(Figs. 4–7). To discuss this, and other
dental topics further, please feel
free to join me at www.endomail
messageboard.com. ET

Barry Lee Musikant, DMD, is co-director of dental research and co-founder
of Essential
Dental Systems (EDS).
The
company’s roots
stem
from
the
desire
for product
improvements to the
items of focus
in
lectures
and daily practice. His research and
business partner is Allan S. Deutsch,
DMD. Musikant and Deutsch have
a combined 60-plus years of practice experience. Contact them at
info@edsdental.com.

[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 page 4C

Patient appeal ratings: The science behind Web sites that work
By Frith Maier, Sesame Communications

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 participants 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
mind-set 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 Communications, 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
g CT page 2C
AD

[30] =>

2C Practice Matters

Cosmetic dentistry
online shoppers are
quite different than
shoppers looking for
general dentistry or
orthodontics.
f CT page 1C

specific procedures, what the procedures involve, how long they take,
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 adverAD

tising 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

Cosmetic Tribune | November 2009
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 eyeopening.” said 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

Contact information

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. 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] =>

4C 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 page 1C

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
g continued

[33] =>

Clinical

Cosmetic Tribune | November 2009
f 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 page 6C
AD

[34] =>

6C 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 page 5C

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

g 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
Lorrie Young
l.young@dental-tribune.com
C.E. Manager
Julia E. Wehkamp
j.wehkamp@dental-tribune.com

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

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

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

[35] =>

Clinical

Cosmetic Tribune | November 2009
f 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
glossary of prosthedontic
terms. 7th ed. J. Prosthet Dent
1998; 81: 39–110.
2. Massad J.J. A perspective on
dental beauty. Dent Today
June 1999; 46–49.
3. Massad J.J. Goljan K.R. A
Method of prognosticating
complete denture outcomes.
Compend Contin Educ Dent
1994; 15:900–907.
4. Massad J.J. etal Gingival smile
enhancement for the edentulous patient by using a LeFort
1 osteotomy. J Prosthet Dent
1991; 66: 151–154.
5. Pleasure MA. Correct vertical dimension and freeway
space. J AM Dent Assoc 1951;
43:160–3
6. Kapur K.K., Yurkstas AA. An
evaluation of centric relation
records obtained by various
techniques. J Prosthet Dent
1957; 7:770–86.
7. Hesse F Ur Mechanik der
kaubewegvngen des menschlichen kiefers. Deutsch Monatsschr Zahn 1887; 15:517–23.
8. Hesse F. The masticatory
movements of the lower jaw
and the rules for prosthesis
deducible there from. Dent
Cosmos 1900; 42: 1004–7.
9. Kuebker WA. Denture problems: causes, diagnostic procedures, and clinical treatment. 11. Patient discomfort
problems. Quintessence Int
1984; 15: 1131–41.
10. Fish E.W. Principles of full
denture prosthesis. London:
John Bale, Sons & Danielsson,
Ltd; 1933, p.1–8.
11. Beresin V.E., Schiesser FJ. The
neutral zone in complete dentures. J Prosthet dent 1976;
36:356–67.
12. Meyer F.S. A new, simple and
accurate technic for obtaining balanced and functional
occlusion J AM Dent Assoc
1934; 21:195–203.
13. Meyer F.S. Can the plane
line articulator meet all the
demands of balanced and
functional occlusion in all
restorative work? J Colorado
Dent Assoc 1938; 17:6–16.
14. Kuebker WA. Denture problems: Causes, diagnostic procedures, and clinical treatment. II. Patient discomfort
problems. Quintessence int
1984; 15:1131–41.
15. Dabadie M, Renner RP.
Mechanical evaluation of
splint therapy in treatment of
the edentulous patient. J Prosthet Dent 1990;63:52–5.
16. Levin B. Impressions for complete dentures. Chicago: Quintessence; 1984, p. 71–158.
17. Turrell AJ. Clinical assessment of vertical dimension. J
Prosthet Dent 1972; 28:238–46.

18. Meyer FS. A new, simple and
accurate technic for obtaining balanced and functional
occlusion. J Am Dent Assoc
1934; 21:195–203.
19. Meyer Fs. Can the plane
line articulator meet all the
demands of balanced and
functional occlusion in all
restorative work? J Colorado
Dent Assoc 1938; 17:6–16.
20. Massad J.J, Connelley ME. A
simplified approach to optimizing denture stability with
lingualized occlusion. Compend Contin Educ Dent 2000;
21:555–80.
21. Lang BR. A review of traditional therapies in complete dentures. J Prosthet Dent 1994;
72:538–42
22. Rudd KD. Morrow RM, Edwards
N, Espinoza AV. Relining and
rebasing. In: Morrow RM,
Rudd KD, Rhoads JE, editors.
Dental laboratory procedures:
complete dentures. Vol 1. 2nd
ed. St. Louis: Mosby; 1985. p.
364–82.
23. Carlsson GE. Biological and
clinical considerations in making jaw relation records. In:
Zarb GA, Boucher, Carlsson
GE, Bolender CL, Boucher CO,
editors. Boucher’s prosthodontic treatment for edentulous
patients. 11th ed. St. Louis:
Elsevier, 1997. p. 197–219.
24. Zarb GA, McGivney GP. Completing the rehabilitation of the
patient. In: Zarb GA, Boucher,
Carlsson GE, Bolender CL,
Boucher CO, editors. Boucher’s prosthodontic treatment
for edentulous patients. 11th
ed. St. Louis: Elsevier; 1997.p.
358–8.
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 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 receivable)?
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 page 2D

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 page 3D
AD

[38] =>

2D

Practice Matters

f HT page 1D
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
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

3D

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 page 1D
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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