DT U.S. 3909

‘HIV tests should be offered in every dental practice’ / News / World News / The practice’s ‘annual exam’ / Financial & Digital Matters / Same-day inlay/onlay technique / Headline Oral biofilms 101: the basics / GNYDM News / DTSC symposia on world tour / Industry / Cosmetic Tribune 10/2009 / Hygiene Tribune 10/2009

Open PDF View E-paper Edit Epaper Edit Epaper ads save

Table of contents

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

December 2009

www.dental-tribune.com

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

A popular topic

Implantology discussed in N.Y. and Sweden.

u page 1B

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

Endo technology

Endo-Eze TiLOS offers the best of both worlds.

u page 1C

Vol. 4, Nos. 39 & 40

CHosmetiC
RiBUNe
YGIENE TtRIBUNE
the
Dentistry
Newspaper
· U.s.
edition
TheWorld’s
World’sCosmetic
Dental Hygiene
Newspaper
· U.S.
Edition

Implant-retained dentures

Several options offer functionality and esthetics.

upage 1D

‘HIV tests should be offered in
every dental practice’
By Daniel Zimmermann, DTI Group
Editor

According to the latest figures
from the United Nations organization UNAIDS, more than 34 million
people worldwide are currently living with the HIV virus. Because it can
take up to 10 years before progressing to AIDS, early testing can be a
life-saving factor.
New tests for HIV checks in dental
practices have recently been developed. Dental Tribune Asia Pacific
met with Dr. Catrise Austin, who
maintains a dental practice — VIP

Smiles — on 57th Street in New York
City, to speak about HIV testing in
her practice and how such testing
could help to create a heightened
awareness of the disease amongst
patients.
Dr. Austin, would you tell our
readers the reason you decided
to offer free HIV tests to your
patients?
The idea for offering free HIV tests
to my patients arose earlier this year
once I had learnt that doctors other
than medical doctors can offer HIV
testing in their practices. I said to

Greater N.Y. Dental Meeting: The place to be!

myself: “Why not add another service
to our existing checklist of lesions or
cavities and give patients the opportunity to know their status in a different setting?” I saw this as a unique
opportunity for me as a dentist to
diagnose HIV in its early stages.
Unfortunately, the virus is still
highly prevalent. In New York City
alone, there are 94,000 confirmed
cases and it seems that the number of infections is not improving in
2009/2010.
Why should dental offices test for
infectious diseases such as HIV/

AIDS or tuberculosis in the first
place?
My opinion is that HIV tests should
be offered in every dental practice
because the oral cavity is one of the
g DT page 2A

America’s Toothfairy
unveils 2009 holiday cards
By Fred Michmershuizen, Online Editor

Are you looking for a way to
spread some holiday cheer while
promoting good oral health for children at the same time?
If so, you might want to consider sending some do-it-yourself
cards available from the National
Children’s Oral Health Foundation:
There is so much that goes on during the Greater N.Y. Dental Meeting, there
is no way we could summarize it all. If you were unable to attend, here is a
taste to whet your appetite for next year (Trust us, it’s worth the trip!).
g See pages 16A, 17A

Dr. Catrise Austin, New York City

America’s Toothfairy (NCOHF).
The way it works is simple: You
visit the America’s Toothfairy Web
site, make a donation ($5 minimum)
and then you can download your
choice of design to print out or send
as an e-card to loved ones, friends
and business associates.
g DT page 2A
AD

Dental Tribune America
213 West 35th Street
Suite #801
New York, NY 10001

PRSRT STD
U.S. Postage
PAID
Permit # 306
Mechanicsburg, PA

[2] =>

Interview & News
all over the world interested in offering the test because it is easy for the
patients and takes only a little bit of
time.
Is the test optional?
The test is completely optional and
we offer it to all our patients, from
teenagers who are in high school
and probably sexually active to those
in their 60s and older. We do not discriminate because the virus does not
discriminate.
Since we began administering the
test in August, we have offered it to
about 150 patients of which about 60
percent have taken it. Fortunately,
we did not have any positive testing
so far.

f DT page 1A
first places that shows signs of HIV
infection. You can detect signs of
herpes and other sexually transmitted diseases in the mouth as well,
and so we look for lesions and other
signs or symptoms of the disease.
I am currently not aware of other
tests that may diagnose diseases
other than HIV/AIDS; it would be
fantastic if we were able to diagnose
everything through the mouth.
How does the test work?
The test is called OraSure Advance
and it tests for antibodies in the
blood system. It uses an oral swab,
which we take under the upper and
lower lips and place in a developing
solution directly at the beginning of
our dental appointments.
The results are available within
20 minutes and we can start with
normal treatment immediately after
we have done the test.
Unfortunately, I often encounter
skepticism from some of my colleagues about the comfort level and
the way to introduce the test to a
patient in a dental setting. I tell them
every time that the test is very easy
to apply without making the patient
feel uncomfortable.
I guess that like most new ideas it
takes some getting used to, but it will
be successful because we are helping to save people’s lives.
So we hope to get more dentists

What happens if a patient tests
positive?
We are fully trained and prepared
in case a test is positive. If a patient
tests positive, we counsel him or her
immediately and help him or her call
a primary health physician to schedule a confirmatory test.
It is important to note that the test
that we offer is a screening test only
and not a confirmed test. If a patient
does not have a physician, we usually
refer him or her to one of the clinics
in the New York City area with which
we have a partnership.
There are thousands of people in
the US and more around the world
who are unaware that they are
HIV/AIDS infected. Do you think
that regular checks in dental practices could help to create more
awareness of the disease?
That is something I would like to
see happening as more dentists
begin administering the test. It is
time to recognize that we should be
concerned with the patient’s holistic health, not only his or her oral
health.
I am the first dentist in New York
to offer the test, and I would love to
be the trailblazer and help to make
the test the standard of care in dental
practices around the world.
The greatest joy for me is when
a patient says that he or she would
have never undergone this test if it
were not for me. DT

Dental Tribune | December 2009

Stewart president of CDA
By Fred Michmershuizen, Online Editor

The California Dental Association
recently elected a new president and
new officers. Dr. Thomas Stewart,
a U.S. Navy captain and dentistry
veteran of more than 30 years, was
elected president of the CDA. He
was installed recently at the CDA’s
House of Delegates meeting in Sacramento and will serve a one-year
term.
Also taking office at the CDA’s
House of Delegates meeting were
Carol Gomez Summerhays, DDS,
immediate past president; Andrew
Soderstrom, DDS, president-elect;
Daniel Davidson, DMD, vice president; Clelan Ehrler, DDS, treasurer;
Alan Felsenfeld, DDS, speaker of
the house; and Kerry Carney, DDS,
editor.
As president, Stewart will continue CDA’s mission of improving the
oral health of all Californians.
“As I begin my year as president,
I recognize the many challenges that
face our profession and our service
to the public, especially in these economic times,” Stewart said.
“This year’s state budget crisis
resulted in the loss of two government programs that provided dental
education and services to both lowincome children and adults. This
has had a tragic impact on the number of people who experience barriers to receiving dental care. Dentists
must be the leaders, providing the
expertise to develop solutions to this
problem.”
“CDA is truly fortunate to have

a president of the caliber of Tom
Stewart,” said Dr. Thornton A. D’Arc,
a longtime CDA volunteer leader.
“Tom is visionary, but his vision is
tempered by his common sense.”
Stewart has been a leader in the
field of dentistry since he graduated
from Howard University College of
Dentistry in 1972. He served four
years in the U.S. Navy on active duty
as a dentist and then 19 years in the
naval reserve, retiring as a captain
in 1997. He has operated his own
practice in Bakersfield since 1976.
Stewart has also held leadership
positions at the local and national
level. He has been a member of the
American Dental Association since
1976 and served on the ADA Council
of Communications from 1994 to
1995. He is a member of the Kern
County Dental Society and served
as president, six years as a trustee
and was a long-time member of the
board of directors.
In addition to his DDS degree,
Stewart also received honorary
degrees from the Pierre Fauchard
Academy, the International College
of Dentists and the American College of Dentists.
He has also been a Kiwanis Club
member for 33 years (with a perfect
attendance record); on the Teen
Challenge of Kern County Advisory
Board for 23 years; and has been
on the board for 20 years of STEPS
(Special Treatment Education and
Prevention Services), a local drug
and alcohol treatment and rehabilitation organization, serving two
years as president. DT

This holiday card is one of several designs available from America’s Tooth Fairy.
f DT page 1A
“As you surround yourself with
loved ones and count your blessings
this holiday season, please consider
spreading some holiday cheer to
children across our country who
are suffering severe pain from a
disease that is completely preventable,” said Fern Ingber, CEO of
NCOHF. “Pediatric dental disease,
the No. 1 chronic childhood illness
in our country, knows no holiday.”
According to America’s Tooth-

fairy, 100 percent of each dollar
contributed goes directly to programs and services that provide
underserved children with comprehensive oral health services and a
renewed hope for a brighter future.
“These holiday cards are a small,
simple way to give back this holiday
season while encouraging friends
and family to do the same,” Ingber
said.
To participate in the holiday card
program, visit www.ncohf.org/yoursupport/tribute-cards. DT

[3] =>

0A
Dental TRubric
ribune | December 2009

Dental Tribune
| Month 2009
3A
News

Headline
‘Dentcubator’
meets in New York
Deck

By Daniel Zimmermann, DTI Group
Editor
By line

Year after year, dental companies
spend millions on the research and
development
of new products. Nobel
tk
Biocare, which is one of the biggest
spenders in the dental industry, uses
about 4 to 5 percent of its annual
turnover for R&D.
However, there are thousands of
ideas developed by individual dentists that will never be implemented because their inventors lack the
funds or expertise to market their
ideas or are downsized by shrinking
R&D budgets in difficult economic
times.
For such ideas, there are usually incubators. Introduced in the
late 1950s as physical buildings
that housed many small businesses,
incubators have become a significant tool in the business world for
assisting early-stage companies.
Their main goal is to accelerate the successful development of
entrepreneurial companies through
support resources and services such
as finding attorneys, funding prototypes and finding distribution channels.
In fact, a study by the University
of Michigan found that almost 90
percent of start-up companies stay
in business for the long term with
the help of incubating programs.
Worldwide there are an estimated
5,000 of these incubator networks,
with 1,400 operating in the United

States alone. In dentistry, there was
no such network until Dentcubator
was founded at the Greater New
York Dental Meeting (GNYDM) last
year.
Originating in Massachusetts
from a loose network of renowned
dental specialists around the globe,
the program has evaluated 48 submissions thus far and aims to support as many as 80 over the course
of the next five years.
Panels of dentistry experts — such
as Steve Buchanan, Sonia Leziy,
John McSpadden, Lorne Lavine,
Jöerg Strub, Ron Jackson, Ken Aliment and Tom McCarty — evaluate
new ideas on a regular basis.
Dentcubator is a virtual entity,
which means that its members meet
by phone, e-mail or through Webi-

nars. Once an idea is submitted
through one of the committees, it
undergoes a four-week screening
process to evaluate its marketing
potential. Special emphasis is placed
on the ability to re-design a product
for emerging markets such as Asia
or Latin America.
“By testing each submission for
its applicability to emerging market
countries, we have the opportunity
to offer the products and techniques
associated with outstanding oral
health care to a broader audience
than the typical markets of Western
Europe, Japan or the United States,”
a Dentcubator representative said
during this year’s GNYDM.
Once the idea has been approved
for funding, the network provides its
services with compensation taken

in equity in the ownership of the
idea. The process typically takes up
to three months to be completed.
After Dentcubator becomes an equity partner, develops and protects
the idea, discussions are initiated
with the directors of acquisition or
R&D departments at global dental
companies.
Dentcubator sees itself as a complement to traditional R&D and as
an alternative source for funding,
development and access to market
resources.
“We are under no circumstances
in the business of replacing R&D
budgets,” the Dentcubator representative said. “We are the nursery
that takes the small seed of an idea,
grows it and then brings it to market.” DT

Trident provides funding for new
NCOHF grants
By Fred Michmershuizen, Online Editor

Thanks to the generosity of Trident chewing gum, the National Children’s Oral Health Foundation:
America’s
Toothfairy
(NCOHF) recently awarded grants
totaling $100,000 to four not-forprofit university and communitybased dental programs.
“For over 40 years, Trident has
been an innovator and leader in
oral care advancements, beginning
with the introduction of Trident in
1964 as the first cavity-fighting,
sugar-free gum,” said Lesya Lysyj
of Cadbury North America, manufacturer of Trident.
“Our partnership with NCOHF
enables us to continue our commitment to promote good corporate citizenship in the communities we touch by helping to raise
awareness and funds to fight oral
disease among thousands of chil-

dren in need,” Lysyj said.
The Trident Toothfairy Grants,
which fund critical early childhood oral health treatment and
educational training programs,
were awarded to:
• Howard University in Washington, D.C.;
• the University of California at
San Francisco;
•the University of Illinois at
Chicago and
• the Arkansas Oral Health
Coalition.
Each
institution
received
$25,000 to help reach thousands of
young children and caregivers in
their communities.
The facilities are members
of the NCOHF’s national affiliate network and are dedicated
to delivering comprehensive oral
health treatment and preventive
educational programs to millions
of underserved children and their
families.

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

“Effective oral health practices must be established during a
child’s early years, and NCOHF is
fortunate that Trident understands
the key to eliminating pediatric
dental disease lies in comprehensive preventive therapies and educational programs,” said NCOHF
President and CEO Fern Ingber.
“These generous grants allow
NCOHF affiliates to establish programs that provide vital services
and smile-saving oral health care
basics for our nation’s youngest
generation,” Ingber said. DT

Children receive dental
screenings at the University of California
at San Francisco during a recent outreach
event conducted by the
National Children’s
Oral Health Foundation.

Visit NCOHF.org
The NCOHF is composed of
dental professionals, industry
leaders, philanthropic individuals
and concerned non-profit agencies.
It is the only independent nonprofit national children’s health
organization exclusively focused
on supporting delivery of comprehensive oral health care for economically disadvantaged children.

[4] =>

World News

Dental Tribune | December 2009

Lifeline Express: A journey with the
world’s first hospital train in India
By Neil Sikka, United Kingdom

India is a vast and varied country with a population of a billion,
of which 70 million are disabled
— more than the population of the
United Kingdom. I was looking forward to returning to my homeland
and to working alongside those on
the Lifeline Express.
While the word Delhi may conjure up images of crowding, poverty and sickness, Delhi domestic
terminal was like any other European airport — all Jasper Conrandesigned hotels, five-star cuisine,
designer shops and even a place to
grab a coffee and a chocolate muffin. It seems Delhi has changed
incredibly since my last visit three
years ago.
After a good evening meal (during which I choked over the wine
list as luxury items cost three times
more than in London; yet everyday
living costs less than one third),
I caught the red-eye flight from
Delhi to Jabalpur in the Madhya
Pradesh state. Touching down in
Jabalpur revealed a complete contrast.
A solitary, simple, small, plain
concrete terminus greeted us, surrounded by a barren and dusty
landscape. Jabalpur is just like
many other small towns in India:
low rise, an army presence and an
air of forbearance from all those
who go about their daily routine,
especially when it comes to the
traffic. Most importantly, it has a
railway station!

Lifeline Express
Neelam Kshirsagar, general manager of special projects for Impact
India, met me and immediately
took me to the Lifeline Express.
The train, consisting of six or
seven brightly painted wagons,
was parked in the siding where a
platform had been specially built.
There were families milling
around, waiting their turn for
treatment, not worried about the
baking platform and extreme heat.
A quick tour revealed two operating theatres, three beds in each,
with waiting and recovery areas;
AD

three large, gleaming, industrial
autoclaves; a lecture room; stores;
an office; a changing room; a staff
room and, finally, the dental room,
all wonderfully air conditioned!
I was introduced to Zelma Lazarus, the charismatic CEO of Impact
India. She explained that the Lifeline Express was here to provide
free treatment for all, but it could
only be successful with the support
and cooperation of the local community.
Local hospitals had been contacted many months prior to arrival, and teams of local orthopaedic,
eye, cleft lip and ENT surgeons
agreed to give freely of their time.
The local Hitkarni Dental College
was also supporting the project.
The director, Dr. Dhiranwani, and
his team would be assisting me for
the duration of my visit.

Getting things moving
As only certain types of operations
could be performed on the train,
all patients had to be screened
prior to commencement. The
orthopaedic team alone saw more
than 3,000 patients, of which 200
were suitable cases.
Lazarus explained that the only
way to “get things moving” was to
go straight to the district collector. He is the area head of local
government and in India holds a
position of considerable power and
influence.
He agreed to mobilise his network of officials to ensure that all
in the town and outlying villages
would be aware of the visit. The
collector also wanted to meet “the
dentist from London,” and so at
the duly appointed hour he arrived
for the inaugural ceremony of the
dental suite.
He assured me that he was committed to spreading the word and
promised me many patients for the
next day. To prove his point, he
brought along the local television
station to conduct an interview
with me (which was aired that
night).
The following morning I was
raring to go. I hadn’t been this
excited about going to work for

years. So at 9 a.m. on the dot, I
arrived at the platform ready, willing and able, only to find the place
virtually deserted.
Lt. Col. Randhir S. Vishwen
(who runs the Lifeline Express)
invited me into his office for a cup
of tea. In the nicest possible way,
he explained that in India when
a doctor says he starts at 9 am he
never arrives before 10.
As a result, patients never turn
up before 10:15. The team from
the dental college arrived at 9:30.
I had thought they would send a
dental nurse to assist me, but to my
surprise two dentists, Dr. Mangesh
Ghate and the newly qualified Dr.
Pratiba Patel; a hygienist, Amos;
and our nurse, Reena, welcomed
me.
Ghate explained that as it was
my first day they wanted to ensure
I was fully supported. He proposed
that as it was likely to be very busy,
we concentrate on those most in
need. Patel and he would initially
screen the patients and any nonurgent cases would be asked to
return at a later date.
Anyone else would be given a
written prescription for treatment.
This was of enormous assistance,
as my Hindi is terrible and most
patients spoke a local dialect (one
of 1,500 in India!).

Patients
True to the colonel’s word, at 10:15
the first patients arrived, and by 11
we had a queue of 20 people. We
turned the lecture facility into a
waiting and post-op room. Extractions and scaling were the order of
the day.
Many patients had never visited
a dentist in their life and most had
travelled enormous distances to be
treated.
By lunchtime, I had removed
more teeth than I had in the past
10 years. I was thankful for the
pristine ultra-sonic scaler, which
enabled me to provide some firsttime scaling. All those I treated
were incredibly grateful and
remained stoic despite the considerable pain they had been in
(probably for some years).
Some of those I examined had
difficulty in opening their mouths
and, on further investigation, I
noticed clinical changes on the
buccal mucosae consistent with
chewing tobacco and betel nut.
Ghate later confirmed that they
see many cases of submucous
fibrosis at the dental clinic.
I remained for the next two
days, after which it was time to
g DT page 6A

[5] =>

[6] =>

World News

Dental Tribune | December 2009

Australia: vaccine for
treating gum disease
Dr. Neil Sikka (right) is owner of
Barbican Dental Care in London.
He can be contacted at enq@
barbicandentalcare.com.
f DT page 4A
hand over to Dr. Ghate and his
team who would continue the service for three weeks.

Staggering numbers
By the end of my two days, we had
seen and treated 62 patients for
dental problems, a number that
rose to an impressive 334 at the
end of the three-week clinic.
The medical teams on the
Lifeline Express also treated 405
patients with eye problems, more
than 100 for cleft lips, 83 patients
with ear problems and 211 sufferers of polio — in total a staggering
1,134 patients were treated.
Impact India’s ultimate aim is
to raise awareness in communities of the medical benefits available to them by encouraging them

By Daniel Zimmermann, DTI Group
Editor

to demand treatment at local and
regional health centres. Most poor
Indians are illiterate and unaware
of their right to treatment.
For
instance,
in
Madhya
Pradesh, those below the poverty
line are entitled to £300 (U.S. $500)
in treatment a year, paid for by the
state. While funds are available to
treat those below the poverty line,
less than 10 percent of the allocated funds reach those in need.
On my final day, I asked Lazarus what her ultimate dream for
the Lifeline Express would be.
“Neil, I hope that one day the train
becomes defunct.
“If we can educate and inform
people of their rights, treatment
will be fully provided locally and
our train will be surplus to requirements.”
Here’s to hoping! DT

About Lifeline Express

The Lifeline Express is the
world’s first hospital train. To date
more than 500,000 patients living
in the remote rural interiors of
India, where medical facilities are
scarce, have been treated.
Last year Impact India introduced dental services as a trial
measure on the Lifeline Express
in Mandsaur in Madhya Pradesh.
Patients received free treatment
AD

for scaling, fillings, extractions
and minor surgeries, and biopsies
of a few patients were taken for
diagnosis.
This trial project demonstrated
that there was an urgent need for
dental health care.
In order to assist, Dr. Neil Sikka
has donated funds to cover the
costs of items such as a hydraulic
chair, an oil-free compressor, a
scaler with handpiece and other
essential equipment.
For his next trip, Sikka already
has a list of further equipment
needed, including syringes and
cartridges, sprays for disinfection,
tissues and sharps bins.
Many thanks to Claudius Ash
for donating 500 much-needed
toothbrushes, all gratefully distributed.
For more information on the
work of Impact India, visit www.
impactindia.org.

Scientists from the University of Melbourne, Australia, have
announced they have partnered
with CSl Limited and Sanofi Pasteur,
the country’s largest biopharmaceutical companies, to further develop
and commercialize a vaccine for the
treatment of gum disease.
The program, which took 10 years
in development, involves bacterial
peptides and proteins that trigger
the immune response to periodontal
inflammation. The vaccine is currently being trialed in mouse models
and expected to progress to clinical
trials soon, the researchers said.
The new vaccine approach is targeting the “ring leader” of a group
of pathogenic bacteria called P.
gingivalis that causes periodontitis.
According to a U.S.-based P. gingivalis research consortium, elevated
levels of the organism were found in
the majority of periodontal lesions,
as well as low levels in healthy sites.
In addition, the organism also
produces a number of enzymes that
have been shown to interact with
and degrade host proteins.

Although the bacterium can be
eliminated through periodontal
therapy, it is often found in recurrent infections.
“Periodontitis is a serious disease
and dentists face a major challenge
in treating it because most people
will not know they have the disease
until it’s too late and the infection
has progressed to advanced stages,”
says Professor Eric Reynolds, CEO of
the Cooperative Research Centre for
Oral Health Science and the head of
The University of Melbourne’s Dental School.
“This new approach will provide
dentists and patients with a specific
treatment.”
Traditional periodontal therapy
involves manual scaling and cleaning, and even surgery with instruments or dental lasers, in an effort to
contain the bacterial infection.
Reynold said the new line of vaccine products will possibly prevent
the progression of the disease, rather than managing its symptoms and
incurring damaging consequences.
Sanofi Pasteur has an option to an
exclusive worldwide license to commercialize the intellectual property
associated with these products. DT

Asia: less than average
in health care spending
By Daniel Zimmermann, DTI Group
Editor

Countries in Asia have been found
to spend less of their GDP for health
care than most other countries in
Europe and the United States.
According to a new health care
report by the Organisation for Economic Co-operation and Development (OECD) in Paris, France, only
New Zealand provided more money
for health care in 2007 than the average of all observed countries. Japan,
Korea and Australia, however, spent
less than the OECD average of 8.9
percent.
The United States currently
spends more on health than any
other country — almost two and a
half times greater than the OECD
average of $2,984 adjusted for purchasing power parity. Luxembourg,
France and Switzerland also spend
far more than the OECD average.
At the other end of the scale, in
Turkey and Mexico, health expenditure was less than one-third the
OECD average.
The 2009 edition of the OECD
Health at a Glance report also shows
that all countries could do better
in providing good quality health

care. Key indicators presented in
the report provided information on
health status and the determinants of
health, including the growing rates
of child and adult obesity, which
are likely to drive health spending
higher in the coming decades.
The report also had new data
on access to care, showing that all
OECD countries provide universal
or near-universal coverage for a
core set of health services, except
the United States, Mexico and Turkey. DT

[7] =>

[8] =>

Practice Matters

Dental Tribune | December 2009

The practice’s ‘annual exam’
Are you lulled into believing that you have a very active patient base?
By Sally McKenzie, CMC

I bet you’re intimately familiar with those
large cabinets you have in your office. You
know the ones; they are most likely near the
front desk area. They contain page after page
of vital information about your dental practice,
your procedures and, most importantly, your
patients.
They are your patient records and chances
are good that they take up a very large space in
your practice. Frankly, you could probably do a
lot with the area they consume.
However, this is practically sacred ground,
AD

and those huge files with all the important
records about all those patients who come to
see you day after day, well those have become
a source of comfort and reassurance.
Look at all of them! You must be the most
popular dentist in town! Too bad you could
gather up about half of them to use as kindling
at the next autumn bonfire.
Of every two patients that walk in the front
door, there is a good chance that one of them
will quietly slip out the back. It’s unlikely you’ll
notice until there seems to be a few too many
holes in the schedule or dollars are getting
tight.

Often the patients just fade away. That is,
unless you examine not only your patients’ dentition but their documentation at least annually.
It’s called a chart or record audit.

How to use the ‘yearly sticker’
Here’s what we see happening in dental practices all over the country. I know that you are
certain yours is different, and I wish it were,
but nine times out of 10 you’re in the same boat
with the rest of your dental colleagues, and
most of you are paddling up the same creek.
Dentists are often lulled into believing that
they have a very active patient base. After all,
there are oodles and gobs of charts.
One look at the yearly sticker tells
you at a glance how many of those
patients are active.
Unfortunately, often the yearly
stickers are showing you only what
you want to see and not the reality.
During our onsite practice consultations, we ask dental teams
when they place the yearly sticker
on the chart. The typical response
is: “Well, of course the sticker
would be placed on the chart the
first time the patient comes in for
any type of care that year.” Bzzz!
Sorry, that would be an incorrect
answer. Here’s why.
There are any number of
patients who are coming in only
when it hurts, but they haven’t
had an appointment with the oral
hygienist since Barack Obama
was a small-time legislator in the
Illinois General Assembly. Place
yearly stickers on the record when
the patient comes in for his/her
recall appointment.
If the yearly stickers are placed
correctly on records, charts can be
pulled for inactivity based on the
sticker. Most practices will keep a
patient’s record in the file for up to
two years; beyond that they should
be pulled.
In addition, if you are assigning patient records to emergency
patients, stop that habit immediately. Emergency patients who
have never been to the office for
treatment should not be given a
patient record because this adds
to the illusion of a substantial and
loyal patient base.

An annual record audit
The only real means of assessing
true patient loyalty is to conduct
an annual record audit to ascertain
exactly how many patients continue to choose you as their dentist.
What? Is that a protest I hear?
“But we don’t have time to do
chart audits. Our patient retention must be fine because we are
so busy we are only allowed to
schedule vacations during years in
which a solar eclipse can be seen
in North America.”
Busy is often an illusion. It’s
g continued

[9] =>

0A
Dental TRubric
ribune | December 2009

Dental Tribune
| Month 2009
9A
Practice
Matters
AD

Headline ‘Busy’ is often an illusion.

f continued

commonly the clever
disguise of a dwindling patient base,
and it will fool nearly every practitioner
By line
from here to the sun.
Audit the charts
and review the key computer reports, including
thetkpast-due recall report, the missed appointments report and the unscheduled treatment
report.
This puts you in the position of being proactive rather than reactive to the ebb and flow of
your patient base. Start by making the most of
the information that is right at your fingertips.
Here’s how.
• Generate a report of patients due for recall
from today’s date to one year from today. Indicate that you are seeking to identify all patients
with and without appointments on the report.
• Count the number of charts in the file and
divide that by the number of patients on the
recall system. For example, if there are 4,759
patient records on file and 1,737 patients in
the recall system, patient retention would be
at 36%.
• Now subtract the number of active patients
from the number of total patient records in the
files. Using the example above that number
would be 3,022.
• Divide that number by the number of
months the charts represent. For example, if
you believe that active charts represent the
period from 5/2005 through 9/2008 that would
be 39 months. In this scenario, the practice
is losing 78 patients per month. (And if that
doesn’t send ice water through your veins,
nothing will.)
You can also look specifically at recall over
the last year. For example, if this was 10/09,
generate a report of patients due for recall with
and without appointments from 1/09 through
9/30/09 and divide by nine months.
If the total number of patients on the report
is 850, divide that by nine. This would indicate a
patient loss of 94 patients per month. Obviously
the patient base is shrinking.
Now what? Well don’t just sit there. Take
action, and do it today.

Deck

The only way to assess true patient loyalty
is to conduct an annual record audit.

Reconnect with inactive patients
In order to reconnect with inactive patients,
assign a patient coordinator the following tasks.
• Make a certain number of calls to viable past-due patients each day. For example,
your goal may be to connect with 10 patients
each day. When I say viable, I’m not talking
about trying to recapture the habitual no-show
AD
patients or those who don’t pay their bills. You
don’t want those patients back in your practice
anyway. You’re targeting the patients who,
for any number of reasons, have temporarily
drifted away.
• Schedule a specific number of appointments. It’s not just the phone calls that matter;
actually booking patients for an appointment is
key to the success of this effort.

• Track patient treatment to ensure that
those patients you connect with not only schedule but also complete treatment.
• Schedule the hygienist to achieve a daily or
monthly financial goal. Then keep the schedule full to ensure the hygienist can achieve
that goal. The scheduling coordinator and the
hygienist must work together to achieve this.
• Manage the unscheduled time units in the
hygiene schedule. If there is an opening, the
scheduling coordinator needs to be dialing for
dollars and fill it. Open appointments equals
money lost.
• Monitor and report on recall monthly during the staff meetings. This is a good opportunity to assess the system, evaluate what is
working and what isn’t and seek input from
others.
• Tweak your telephone scripts to ensure
that you know exactly what to say and how to
say it in those phone calls to patients.

Reacquaint patients with you
and your practice
Send a direct mail letter to every adult in your
active and inactive files who is or was a patient
in good standing. Be sure to include something about the importance of ongoing professional dental care and giving patients beautiful
smiles.
Explain that you value them as patients and
are concerned about their oral health as well
as their overall health and well being. Mention
new services offered, continuing education
accomplishments of the dentist and/or staff,
other improvements that have been made in
the practice, etc.
The bottom line is that you want patients to
feel that they are valued and appreciated by
you and your team.
Finally, encourage them to call your office
and schedule an appointment today. Assure
them that your business team will make every
effort to secure a convenient appointment time
for them — then make sure that is the case.
Consider setting aside popular appointment
times specifically for patients that are responding to the mailing.
If someone calls in response to the mailing and the business team says there isn’t an
opening for four weeks (or eight weeks or six
months), you’ve just wasted your time and your
money and convinced those long-lost patients
that your practice really is not interested in
providing care for them.
While a variety of practice systems likely
need to be examined to determine exactly what
is causing patients to seek care elsewhere, you
can take at least a few immediate steps to slow,
if not stop, the exodus. DT

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

“Changing the
Payments Industry”

One Flat Rate.
It’s that simple.

• ONE Flat Rate
• Eliminates ALL other Rates
and Fees
• Reconcile Your Statement
in Minutes
• QuickBooks Integrated
Solution
• Save Time and Money
• PCI Compliant Solutions

Call 877-829-5705 and
choose option 3 or visit us at
www.SingularPayments.com/
dentaltribuneus

About the author

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.mckenzie
mgmt.com; and The New Dentist™ magazine, www.thenew
dentist.net. She can be reached at (877) 777-6151 or sallymck
@mckenziemgmt.com.

www.SingularPayments.com
Sales_Info@SingularPayments.com

Singular Payments, LLC is a registered ISO/MSP of Wells Fargo Bank,
N.A., Walnut Creek, CA. American Express requires separate approval.

[10] =>

10A Financial & Digital Matters

Dental Tribune | December 2009

Headline
Modernize your collection

system for maximum profit

Deck
By line

By Keith Drayer

In today’s economy there are
many dental professionals who are
faced with the challenge of their
accounts receivable. Uncollected
receivables turn into pure losses.
Yet embracing a systematic
approach to collections can help
practices collect more funds and on
a more timely basis.
One mistake providers make is
not recognizing the signs of early
default. When a patient doesn’t pay
a bill within 60 days, hasn’t set up or
is not following a payment plan, the
patient is telling you that he/she is
not going to pay.
Should you use your staff’s time
trying to collect these accounts?
As a dental provider, you are
implementing state-of-the-art methods to treat your patients’ dental
needs. You also need to employ the
most up-to-date methods to keep
your practice fiscally healthy.
In the past, collection agencies

were the only “act on the block” and
viewed as the last resort to collecting your money. They can be expensive and often care little about your
relationship with your patients. You
had no control over how they treated
your patient and you never knew if
they collected your money or not.
Often the collector, who is paid on
a commission basis, “cherry picked”
over your accounts and attempted to
collect only the larger ones and did
not work the smaller ones.
In addition, many of your accounts
that were collectable were deemed
too small to work. Thus, you lost
money when you didn’t need to.
What is needed is a proactive,
systematic business model that will
work all of your delinquent accounts
equally.
Providers must take an approach
that will reduce losses as well as
speed up cash flow from past due
accounts. You need to work with
your patients quickly and effectively.
Outsourcing your collection

Recognize the signs of early default to
increase collections.

problems to a service bureau can
be much more cost effective than
working them in-house — and certainly more effective.
Utilizing a third-party collection
method that will keep you in complete control of the collection process is a must.

About the author

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 and

The third-party system should be
respectful but firm, and utilize every
possible legal tool to collect your
money.
The provider who utilizes a systematic third-party approach to
collect his/her money will see an
increase in the bottom line. DT

Keith Drayer is vice president
of Henry Schein Financial Services, which provides equipment,
technology, practice start-up and
acquisition financing services
nationwide.
Look for a regular column
on financial matters courtesy of
Henry Schein Financial Services.
Henry Schein Financial Services
can be reached at (800) 443-2756
or hsfs@henryschein.com.

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 additional information, please
call (800) 443-2756 or send an e-mail
to hsfs@henryschein.com.

Making sense of digital radiography
By Lorne Lavine, DMD

In my last article, we discussed
the advantages of digital X-rays and
looked at how to develop a positive
return on investment, specifically
focusing on improved diagnostics,
efficiency, reduced exposure times
and co-diagnosis.
While many dentists will spend a
lot of time evaluating the pros and
cons of sensors vs. phosphor plates
and the resolution of various systems, many offices still fail to realize
the importance of improving their
infrastructure to be able to handle
digital radiography.
A good digital system won’t do
you much good if you’re struggling
to make it work on outdated hardware and networks. Here are some

key areas that should be addressed
while you are also evaluating the
digital X-ray systems.

The computer server
The server is the lifeblood of any
network. Many dentists fail to
understand that the storage needs
for digital X-rays are exponentially
higher for images than if you just
have practice management software
data.
The server must have enough
memory to allow the server to multitask, should have fast hard drives
to push the data out to the workstations quickly, should have an operating system that allows for control
over the entire network and include
a replacement part policy that delivers new parts in hours, not days.

I currently recommend a Dell
T300 server with RAID 1 (mirrored)
500 GB hard drives, 4 GB of RAM,
Windows Server 2003 or Server 2008
(if your dental software supports
2008) and a four-hour contract.
One thing to be wary of are new
operating systems. For example,
while Windows Server 2008 has
been out for a year, many dental applications still do not work
properly with it. Check with your
software and hardware vendors for
compatibility issues before you purchase new systems.

The network
Make sure that besides the server,
you have proper network infrastructure throughout the office. Digital
images are quite a bit larger than

practice management data and
you’ll need to be running at a speed
of a gigabit (1,000 MB) per second.
Make sure all network cards are
10/100/1000 network cards, use a
switch (a smarter version of a hub)
that can handle the faster speed and
use either Cat5e or Cat6 cabling.
Cat6 cabling is recommended for
new offices because it will be able
to handle a faster speed once that
becomes the industry standard.

Computers in the ops
These computers typically need to
be faster than front desk computers.
One area to focus on is the video
card. Cheaper computers often ship
with the video chip fused on to
g DT page 12A

[11] =>

[12] =>

12A Digital & Practice Matters
f DT page 11A
the motherboard. You want to avoid
these, as they won’t be able to adequately handle the large video files
that you get with digital X-ray.
Instead, get a computer with a
discrete, or separate, video card. It’s
becoming increasingly difficult to
find computers preloaded with Windows XP, especially because Windows 7 was released on Oct. 22.
Because Windows 7 offers an “XP
Mode,” you should have no trouble
running any XP programs in Windows 7. However, as with the server,
do not use Windows 7 in your office
until the dental companies’ products

I personally don’t see much difference between monitors that are
800:1 and, say, 1500:1, but some
people claim they can diagnose better with these higher contrast ratio
monitors.

Data backup
We’ve talked about this in previous articles, but once you make
the decision to go digital with your
X-rays, having a good backup protocol and business continuity systems
are critical.
If your server goes down and you
don’t have this, not only will you not
be able to access patient information, you won’t even be able to take

‘Many dentists won’t even blink when
spending $20,000 on digital X-rays, yet they
try to save $100 by buying a cheap monitor.’
have been verified to work with this
new operating system.

Monitors
I consider this one of the most important decisions that needs to be made
when it comes to digital X-rays, and
often the most overlooked.
I see many dentists not even blink
when spending $15,000 to $20,000
on digital X-rays, yet they try to save
$100 on a cheap monitor.
The key statistic to evaluate is
the contrast ratio, the difference
between the whitest white and the
blackest black. Ideally, look for a
monitor that has a contrast ratio of
at least 800:1.

X-rays — this can be devastating for
a practice.
I recommend a system like the
DataProtect system we offer, which
combines an emergency server in
the office with an automated online
backup. Most offices will spend less
than $100 per month to have the
peace of mind of a great backup
without any worries.

In conclusion
Digital X-rays are a great option, but
dentists need to make sure they take
the time, and spend the money if
necessary, to ensure a smooth transition by having proper hardware
infrastructure. DT

About the author

Dr. Lorne Lavine, founder and
president of Dental Technology
AD

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

Dental Tribune | December 2009

Dealing with stress
in the 21st century
By Ros Edlin, United Kingdom

Ask the average man in the street
for his opinion as to whether or not
dentists experience stress and your
query will, in all probability, be met
with a look of incredulity and a snort
of derision. After all, isn’t stress in the
domain of the poor patient rather than
the high-earning, fast-living, Porschedriving dentist?
A media-fuelled opinion such as
this may be true for a minority of
dentists, but for the majority this is
an entirely inaccurate assessment of
dentistry today.
What is true, however, is that dentistry has been identified as one of the
most stressful of the health professions. A recent study by HL Myers and
LB Myers conducted using an anonymous cross-section of 2,441 U.K. GDPs,
found that 60 percent of GDPs reported
being nervy, tense or depressed, 58.3
percent reported headaches, 60 percent reported difficulty sleeping and
48.2 percent reported feeling tired for
no apparent reason1 — all signs possibly related to work-related stress.
So why are dentists so susceptible
to stress? Not only are they required
to work in an intricate manner in a
sensitive and intimate part of the body,
sitting in the same position for long
periods of time, but they also have to
be responsible for the smooth running
of the practice with regard to both staff
and patients, as well as managing the
financial aspect.
Added to this are the ever-increasing demands and expectations of
patients and the constant awareness
of running behind schedule. As if this
wasn’t enough, they have to ensure
that they maintain clinical excellence
in the eyes of regulatory bodies.
Faced with all these factors, and
for the most part, not having received
any particular training in, for example,
people skills or financial management,
it is little wonder that many dentists
fall victim to stress-related illnesses,
either mental, physical or both.
Stress itself is not an illness but
is, according to the Health and Safety Executive (HSE) definition, “the
adverse reaction people have to excessive pressure or other types of demand
placed upon them.”
The HSE also “makes an important distinction between the beneficial effects of reasonable pressure and
challenge (which can be stimulating,
motivating and can give a ‘buzz’) and
work-related stress, which is the natural but distressing reaction to demands
or ‘pressures’ that the person perceives they cannot cope with at a given
time.”
The concept of perception is particularly relevant in that, faced with the
same situation, a difficult procedure
or a demanding patient, one dentist
may relish the challenge and yet the
other be trembling in his shoes! Also

pertaining to the definition of stress
are the notions of control and change.
It is clear that we function best
when we are in control of our circumstances, when we feel we are responsible for our successes or failures due
to our own personal attributes. This
could also include the responsibility of
the welfare of both patients and staff.
As is often the case, however, bureaucracy mitigates against this feeling of
control, which could result in workrelated stress.
The recent NHS Dental Contract for
the U.K. is a prime example where it
can be argued that dentists have a loss
of control of their own destinies. It also
illustrates the importance of involvement in the process of change for the
best results to be achieved. “Today’s
dental environment is not going to
change to accommodate the individual. It’s the individual who needs to
learn to accommodate to the environment if he or she does not want to pay
the price of chronic stress.”2
There is no doubt that we all need
pressures and challenges in our lives
to get us up in the morning and to
keep us going. These can galvanise
us into achieving great things, to work
at our most productive level, but we
have to be aware that having unrealistic goals or expectations can possibly result in the “law of diminishing
returns” — i.e., the more we push ourselves to reach that elusive goal, the
less well we can sometimes perform.
This is not to underestimate the thrill
of achievement, but it is worth paying
heed to the warning signs.
These warning signs are like traffic
lights in our lives. Green means that
everything (or nearly everything) is
going well with us. We are enjoying
our work; the practice is flourishing;
we have a great team and the patients
are appreciative. Home and social life
is good; the children are behaving
themselves and the sun is shining.
Then perhaps things start to go
slightly awry — your valued nurse
leaves, creating extra work for the rest
of the staff, and leaving you feeling as
if you’ve lost your right arm. You find
yourself staying later at the surgery to
catch up and you are aware that you
are feeling more tired than usual. At
the surgery, you feel your concentration slipping slightly and you are
becoming tense and irritable.
This situation may carry on for
a while with perhaps other events
occurring to add to the mix — a complaint or family illness for example.
At home, your evening glass of wine
is turning into two or three. You are
sleeping badly, relationships are suffering and you are starting to feel that
you can’t cope.
The red light is beckoning! If the
symptoms continue to intensify to
the extent of absolute exhaustion, ill
g continued

[13] =>

0A
Dental TRubric
ribune | December 2009

Headline
f continued

health and the inability to cope, it could
be advisable to seek help.
Personality can also have a bearing
on the dentist’s ability to cope with
stressful situations. A study carried
By line
out by Professor Cary Cooper et al.3
suggested that dentists had a tendency
to exhibit “Type A” behaviour. People
with
tk Type A personalities tend to be
driven, highly ambitious, impatient,
aggressive and intolerant.
They have high expectations of
themselves and those around them.
“Type B” personalities, although they
may be equally ambitious and successful, are able to perform in a calmer and
more relaxed manner. People can fluctuate between these two behaviours,
which are said to be on a continuum.
A successful practice is one where
effective stress management strategies
are firmly in place. This contributes
to the atmosphere of well being and
competence within the practice. Its
positive effect emanates throughout
— the staff feels valued and motivated
and the patients feel more relaxed and
welcome, which is a “win-win” situation for all concerned.
Achieving this ideal situation does
not come naturally to many practitioners who may require guidance.
It may be necessary to consider what
your goals and aspirations are in relation to both yourself and your practice.
Hopefully, some of the coping strategies that follow will be of assistance.

Deck

Dental Tribune
| Month13A
2009
Practice
Matters

or going out at lunchtime to listen
to music or having a relaxing bath.
The importance of relaxation is that it
enables you to switch off and recharge
your batteries.
Equally important is physical exercise. Exercise burns up the excess
adrenaline resulting from stress,
allowing the body to return to a steady
state. It can also increase energy and
efficiency. Do find an exercise that
you enjoy and that will motivate you to
continue doing it.
Balance your diet. Eat breakfast,
drink sensibly and include lots of
water to rehydrate the system. Include
complex carbohydrates (whole meal
bread, jacket potatoes [with the skin
on]) in your diet, to counteract mood
swings, and fruit and vegetables to
provide vitamin C to support the
immune system.

Manage your time (and yourself)
efficiently. Again, taking a step back
and reviewing your working practice
is essential.
Do you have an allotted time for
dealing with emergencies and administration? Are you constantly running
behind schedule, causing your stress
levels to escalate? Developing leadership and organisational skills will
enable you to feel more in control of
your working environment.
Ensure that your staff members are
properly trained and aware of their
individual roles and responsibilities.
Encourage a culture of mutual support, whereby asking for help is not
viewed as weakness.
Talking over your problems with
someone you trust can be such a help.
As mentioned previously, some dentists may be excellent practitioners but

sadly lacking in interpersonal skills.
An ability to listen is a gift. If you feel
you need some training in communication, there are plenty of courses
available.
By incorporating at least some of
these strategies into your everyday life
and your working life, you could create an environment that is stress-free
and an environment in which it is a
pleasure to work. It could make the
difference between a good practice
and an outstanding one. Who wouldn’t
want that? DT
References are available from the
publisher.

PNDC

Take a step back. In terms of individual stress, try to take a step back
and assess where the stress is coming
from. Writing a list of causes from the
most stressful down to the least will
help you gain some perspective on the
problem and may inspire you to tackle
some of the issues raised. It is even
possible that you could be the cause of
the stress!
You may need help in dealing with
some of these issues. Try not to let
pride stand in the way of getting the
help you need.
It could also be useful to employ
this technique with your staff by asking
them to identify the sources of stress.
“By airing and discussing grievances,
concerns and new strategies, the various members will feel part of the denAD
tal team and provide mutual support in
time of stress.”4
Relaxation is vital. For the individual, relaxation techniques are also
recommended. Although it is often
thought that relaxation is not compatible with working in a dental surgery,
with organisation and planning it is
feasible. (Some European countries
manage successfully to incorporate
this into their working day.)
A prerequisite would have to be a
competent receptionist who would not
fill your appointment book so full that
you do not have time to breathe, let
alone try some deep breathing (which
is excellent for calming you down).
Take in a deep breath (don’t hold
it) and count one, two, three as you
exhale slowly.
In your everyday life, having a period of relaxation is vital. It could be
as basic as taking breaks in the day

Ros Edlin is a freelance stress consultant from Hale, United Kingdom. She
can be contacted at ros@stresswatch.
co.uk.

AD

paciﬁc northwest dental conference · june 17-18, 2010

SAVE THE DATES!
Join us for the 123rd

Paciﬁc Northwest Dental Conference
Seattle, Washington · Washington State Convention & Trade Center

Featuring:
• More than 90 educational lectures and workshops
• Continuing education tacks for the dental team
• More than 300 commercial exhibits
• Hands-On displays and demonstrations

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

For details on attending or exhibiting, please contact the
Washington State Dental Association at 800-448-3368 or
visit www.wsda.org.

Call today to reserve your booth and
secure sponsorship opportunities!

Sponsored by:

Certiﬁed by:

[14] =>

14A Clinical

Dental Tribune | December 2009

Same-day inlay/onlay technique
By Lorin Berland, DDS, FAACD

I’m always looking for ways to
help my patients get the dentistry they want and deserve. More
and more patients are demanding
esthetic, reliable alternatives for
their old, defective amalgams.
They still want to avoid crowns,
root canals and multiple visits. This
is why I’ve been providing reliable,
durable and much appreciated biomimetic same-day inlays and onlays
for years.

What is biomimetic dentistry?
Biomimetic dentistry is conservative, preservative dentistry. We treat
weak, fractured and decayed teeth
in a way that conserves tooth structure and helps preserve strength.
This helps provide resistance to
bacterial invasion. It reduces the
need to drill down teeth for crowns
and will reduce postoperative discomfort, as well as the need for
two appointments, and possible endodontic treatment.
In essence, it is utilizing the latest
in dental materials and technology
to keep what we’ve got for as long as
we’ve got — just as nature intended.
Unlike other parts of our bodies, our
teeth do not mend on their own.
It is, therefore, imperative to conserve as much natural tooth structure as possible. We strive to do this
with same-day inlays/onlays.
This means no excessive tooth
removal, no cumbersome temporaries and no time-consuming and
uncomfortable second visits.

Biomimetic: to copy/mimic nature
Nature is our ideal model. In order
to mimic nature, we must understand what nature looks and feels
like.
We need to know how it moves
and functions. In other words, we
study nature’s properties so that
we can better replicate it. We want
stronger dental units — teeth and
restorations — not just stronger
crowns.
Now it is possible to rebuild teeth
with newer materials and techniques that more closely simulate
natural teeth and hold up better to
the hearty demands of life.
Through advances in dental adhesives, we strive to make the compromised tooth whole, using materials
that best mimic dentin and enamel.
Our patients can testify that biomimetic restorations look and feel
much better than traditional dental
restorations.

Biomimetic dentistry is
conservative
Modern adhesives and bonding
techniques are the driving force of
biomimetic dentistry.
With traditional dentistry, healthy
tooth structure is destroyed and/or
removed in order to retain a new

restoration.
By using advanced adhesive
techniques and properly fashioned
inlays and onlays, dentists can help
save their patients’ teeth, time and
money.
We could say that preservation
and conservation lie at the heart of
biomimetic dentistry. It is a win-win
situation for everyone.
I think every dentist who sees a
lot of old amalgams should consider offering these restorations. Most
dentists probably have almost everything they need to do so, including
the patients.
All that is most likely needed is an
indirect composite and curing system, a portable hydrocolloid impression method, silicone injectables for
die and model work and disposable
articulators. That’s it.
In addition, once a dentist has all
that, in addition to same-day inlays/
onlays, the dentists will be ready
to provide patients with lab-quality
transitionals and temporaries as
well as custom trays on an immediate, low-cost basis.
That means better dentistry.
Sound good?
We know it’s the right thing to do.
It’s what we would do for ourselves.
Gordon Christensen says, “The lack
of use of tooth-colored onlays is one
of the most frustrating situations I
see in current restorative dentistry.”
People hate temporaries. The
worst aspect about temporizing
inlays and onlays is they always
come out when you don’t want them
to and sometimes won’t come out
when you do want them to at the
second, or “bond” visit.
Patients hate having to come
back to get numb for yet another
uncomfortable appointment.
Moreover, that second visit is
what keeps many people from being
proactive about replacing all of their
old amalgams. In addition, it’s also
what makes it so costly – for your
patients and for you.
That’s why if you incorporate
these restorations in your practice,
your overhead goes down and your
profits increase — all while taking
better care of your patients.
Same-day inlay/onlays will definitely benefit your patients and your
practice.
For a minimum investment in
new equipment and materials, and a
very short and easy learning curve,
you and your assistants can quickly
begin to replace defective amalgam
restorations and at the same time
conserve and reinforce remaining tooth structure — and so much
more!
Your quadrant and full-mouth
dentistry will definitely increase
along with patient satisfaction,
referrals and profits.
Look at the benefits for you and
your patients:
• No temporaries means no “lost

Fig. 1: Large, broken-down amalgam.

Fig. 2: Immediate post-op, occlusal.

Fig. 3: Immediate post-op, buccal.

Fig. 4: Broken, unhappy tooth No. 19.

Fig. 5: Amalgam and caries removed
showing dentinal floor fracture.

Fig. 6: Self-etch primer.

Fig. 8: Onlay on model.
Fig. 7: Final prep.

Fig. 9: Happy tooth, happy patient.
temporary” emergencies between
appointments.
• No costly second appointments
means patients appreciate getting it
all done the same day.
• No lab bill means reduced overhead costs.
If you’d like more information

Fig. 10: Same day inlay/onlay CDCOM cover.
on the Biomimetic Same Day Inlay/
Onlays 8-AGD credit CD-ROM that
outlines the materials, equipment
and techniques, please call (214)
999-0110 or e-mail ashley@dallas
dentalspa.com. DT

About the author
Dr. Lorin Berland, a fellow of the
AACD, pioneered the Dental Spa concept in his multi-doctor practice in
the Dallas Arts District. In 2008, he
was honored by the AACD for his
contributions to the art and science of
cosmetic dentistry.
For more information on The
Lorin Library Smile Style Guide,
www.denturewearers.com, a “Fullmouth Rehab in 2 Visits” DVD and
Biomimetic Same-day Inlay/Onlay 8 AGD Credits CD-ROM, call (214) 9990110 or visit www.berlanddentalarts.com.

[15] =>

0A
Dental TRubric
ribune | December 2009

Dental Tribune
| Month15A
2009
Clinical

Headline
Oral
biofilms 101: the basics
Deck

By Amit Sachdeo, Michael J. Costello,
By
line Gil-Levin, Peter Arsenault and
Angelica
Robert F. Wright

Biofilms are adherent communitk
ties of bacteria, fungi or protozoa
living in a self-produced milieu
of non-living matrix compounds.1
Their formation is complex and
dependent on bacterial communication, which results in a specialized, pseudomulticellular existence.1–3
In the human body, biofilm formation offers pathogenic microorganisms
protection
against
host immune defenses and antibiotics.1,3,4 Their development on
hard, non-shedding surfaces such
as teeth, artificial implants and
indwelling catheters is ubiquitous,
but they often colonize tissue cells
as well. The United States National
Institutes of Health estimates that
more than 80 percent of human
microbial infections are caused by
bacteria growing as biofilms.5

Oral biofilms
The dense accumulation of bacteria was first reported by G.V. Black
in 1898 in his description of dental plaque.6 Dental plaque remains
perhaps the most well studied
example of a biofilm.
The human oral cavity has been
found to contain more than 700 different species of bacteria.7 Some of
these species have been associated
with the pathogenesis and progression of dental caries8, periodontitis9,10, dental implant failures 11,
denture stomatitis and oral yeast
infections such as candidiasis.12
With the link between these
infectious, inflammatory oral dis-

eases and systemic disease well
established, investigation of oral
biofilms is more essential than
ever.13–23

Gingivitis and periodontitis
Gingivitis and periodontitis are diseases caused by bacteria that colonize the oral cavity in supragingival
and subgingival biofilms.24,25 The
community of bacteria observed in
oral biofilms is distinct from those
commonly cultured from saliva.26 It
is recognized, however, that saliva
can act as a reservoir for species
that are usually found in biofilms.
These planktonic individuals are
free to seed new oral sites and are
implicated in the transmission of
oral diseases. Transmission of oral
flora can be vertical (from mother
to child) or horizontal (from spouse
to spouse).27–29
Loee and Theilade showed that
without brushing, dental plaque
deposition leads to gingivitis in
three weeks or less.24,25
Much research has been dedicated to identify the etiologic bacterial species present in the dental plaques of patients with oral
pathologies. Socransky et al.30 were
the first to categorize these oral
biofilm communities. They used
genomic DNA probes and checkerboard DNA-DNA hybridization31 to
identify bacteria in health and disease using 13,261 plaque samples.
Their study found three bacterial
species, Bacteroides forsythus, Porphyromonas gingivalis and Treponema denticola, to be associated
with increased pocket depth and
bleeding on probing. These species, associated with clinical measures of periodontal disease, were

labeled as the “red complex.”30
Research followed to identify
pioneer organisms and uncover the
bacterial composition changes in
plaque that lead to disease. Ritz32
noted that anaerobes succeed aerobic and facultative species, suggesting that the reduced environment created by the presence of
aerobes makes it more favorable
for anaerobes to colonize.

Dental restorations
Crown restorations require proper physiologic contours to minimize plaque accumulation and the
associated biofilm. Crowns should
restore teeth to the natural physiologic contours. Stein and Kuwata
coined the term “emergence profile” to describe the contour of a
tooth or crown as it relates to the
adjacent free gingival margin.33
A crown should have a straight
emergence profile to allow for
proper home care.34 Crown restorations with cervical over contours cause gingival inflammation and plaque accumulation.35
Even though glazed porcelain and
polished porcelain seem to deter
plaque, when examined microscopically, they are much more
porous than highly polished high
noble alloy.36
Historically, it was believed that
supra-gingival margins were kinder to the periodontium and easier
to finish and maintain rather than
subgingival margins. 37 However,
contemporary literature dictates
that the location of the margin
is not as important as the dentists’ skill in providing a well-fitting
margin with a smooth finish.38
Basic principles from fixed

prosthodontics regarding minimizing the biofilm should be followed
for partial veneer restorations and
conventional operative procedures
such as amalgams, composite resin
restorations and glass ionomer
restorations. These restorations
should also restore the tooth to the
normal physiologic contours, have
good marginal integrity and have
favorable polished surface properties.
Bonding resin to the surface or
liquid polished coatings have been
shown to significantly reduce the
biofilm thickness on dental restorations.39

The edentulous subject
Most studies to date have examined
oral biofilms in the dentate subject,
leaving us with limited knowledge
regarding biofilms in the edentulous or complete-denture-wearing
patient.
A recent study by Sachdeo et al.40
provided the first step in defining
the organisms that are associated
with the edentulous on both the
soft (mucosa) and hard surfaces
(denture).
The results from this study
showed that periodontal pathogens
Aggregatibacter actinomycetemcomitans and P. gingivalis that
were believed to have disappeared
from the oral cavity after extraction
of all natural teeth41,42 were clearly
present in biofilm samples from the
edentulous patients.
The finding of these periodontal
pathogens in the denture-wearing
population by Sachdeo et al. is
of great concern because if there
g DT page 17A
AD

AD

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

[16] =>

16A GNYDM News

Dental Tribune | December 2009

2nd DTSC Symposia
covers all the bases
By Robin Goodman, Group Editor

From left: Ann Hochman (P&G), Dr. Roger Levin (Levin Group), Vero Sanchez (P&G) and Steve Pospisil (Levin Group). Visit www.virtuallyplaque
free.com to enter Crest/Oral B/P&G Oral Health’s six-month-long Dream
Practice Sweepstakes.

Win a Dream Practice
Sweepstakes from P&G
By Robin Goodman, Group Editor

Procter & Gamble Oral Health
announced during the Greater New
York Dental Meeting that it is collaborating with Levin Group to offer
dental practices a chance to win in
the Dream Practice Sweepstakes.
During the six-months of the promotion, 12 winners will receive a
yearlong Levin Group Total Practice
Success™ Management Consulting
Program. Two dental practices will
be randomly selected every month
from all entries.
When asked where the impetus
came from to offer such a sweepstakes, Associate Marketing Director
of P&G Oral Health Ann Hochman
replied: “We really want to see professionals thrive, particularly in this
economy. We are committed to seeing patients and practices succeed.
Healthy offices are tightly linked to
healthy patients.”
And, of course, healthy offices are
what Levin Group is all about. Dr.
Roger Levin explained that winners
will receive the entire consulting program as if they had approached Levin
Group directly.
So it’s not a diluted or condensed
version, but rather the complete consulting program that gives them the
best chance of increasing production
and reaching total success. “We are
delighted to be working on behalf of
Procter & Gamble,” Levin said.
The Levin Group Total Practice
AD

Success Management is designed to
help a practice identify objectives in
12 specific areas and to attain each
one of them.
The 12 areas include: case acceptance, case presentation, change
management, communication, executive coaching, financial planning,
goals and Life Map,™ hygiene productivity, patient finance, scheduling, team building and vision.
If you are interested in entering the contest, it’s just a few clicks
away: visit www.virtuallyplaquefree.
com where you can enter every day
of the month.
Each month, a winner will be chosen and the slate of submitted entries
will be wiped clean to start all over
again the next month.
Procter & Gamble Oral Health is
highly focused on total patient solutions, and Hochman said the company felt it had to do more for the
professional.
“This really feels right, to do more
for the professional community. Our
focus is total office health as well
as patient health. We are thrilled to
partner with Levin Group for the
Dream Practice Sweepstakes,” Hochman said.
From its side of this partnership,
P&G brings its well-established
Pro-Health System — a three-step
hygiene regime — to the aid of dental professionals seeking to bring
all-day and all-night protection to
their patients. DT

The second Dental Tribune Study
Club Symposia, held Nov. 29 to Dec.
2 during the Greater New York Dental Meeting, featured lectures on
various topics led by experts in
their fields. Participants not only
earned C.E. credits, but also gained
an invaluable opportunity to learn
about various aspects of dentistry
and how to integrate a variety of
treatment options into their practice.
Many of the DTSC Symposia sessions were standing room only.
Here is a summary of the offerings.

Day 1
Dr. George Freedman kicked off this
year’s DTSC Symposia with his lecture “One-Step Adhesion, One-Step
Cementation.” Dentists filled the
room to learn about new impression materials and one-step resin
cements.
The crowd stuck around to listen to Dr. Dan McEowen’s lecture,
“High resolution Cone Beam With
PreXion 3D,” which taught them the
differences between currently available CBCT scanning systems.
After lunch, Dr. Steven Weinberg presented “Simplified Esthetic Dentistry.” Although the seats
were filled, a number of dentists
didn’t mind standing to learn about
the constant state of evolution in
esthetic materials and restorative
techniques.
Next, Dr. Howard Glazer lectured
about “The Beauty of Bonding,”
encompassing the science of adhesion, the art of composite restoration and the finesse of finishing and
polishing.
Drs. Dirk Gieselman, Richard
Meissen and Maria Ryan wrapped
up the first day of the DTSC Symposia with a round table discussion
on “The Risk of Coronary Heart Disease in Association with Periodontitis and Periimplantitis.”

Day 2
The second day of the DTSC Symposia started off strong with Dr. Gary
Severance and Dr. Lee Culp. In
their lecture, “E4D Sky: Dentistry’s
Destination,” the duo demonstrated
everything that dental professionals
need for the design and fabrication
of single unit glass ceramic restorations.
During the next lecture, “Know
Your Products & Tools for Today’s
Healing Dentistry,” Dr. Fay Goldstep focused on dental therapy,
which makes removal of tooth and
periodontal structures and less
intervention in the healing process
possible.
Dentists returned after lunch to
learn about “OraVerse — In practice,” as taught by Dr. Steven Glassman. He explained that OraVerse

is a local anesthesia reversal agent
that accelerates the return to normal sensation after routine dental
procedures.
Finally, Dr. Derek Fine ended day
two with his lecture, “Awareness in
Three Dimensions,” in which he
explored the basics of cone-beam
imaging and why it is an important
adjunct to the modern dental practice.

Day 3
Dr. Renato Leonardo kicked off day
three with “Technological Resources and Biological Concepts in Minimally Invasive Endodontics,” by
illustrating hand, rotary and oscillatory instrumentation of the root
canal system as well as root canal
filling materials and techniques.
Dr. George Freedman returned to
the podium next to discuss “Affordable Soft-tissue Diode Lasers,”
introducing the newest diode lasers,
which cover the widest range of
clinical indications.
Next, the crowd learned from
Dr. David Hoexter about “Esthetics
Using Cosmetic Periodontal Surgery.” Using periodontal techniques,
he demonstrated how changing the
background of the desired image
will enhance it to appear brighter,
cleaner and healthier, yet physiological as well.
The day ended strong with Lynn
Mortilla’s lecture, “You’ve Taken
Implant Training ... What Do You
Do Next?” in which she discussed
integrating implants into the practice.

Day 4
The fourth and final day welcomed
Dr. George Freedman up on the
stage for a third time, to present his
lecture “ICON — Innovative Caries
Treatment without Drilling.” Among
other important matters, Freedman
discussed preserving healthy tooth
structure and interproximal and
smooth surface treatment options.
The second lecture of the day
boasted Dr. Barry Levin, who was
lecturing at the DTSC Symposia
for a second year in a row. In his
lecture “Immediate Tooth Replacement in the Esthetic Zone,” Levin
discussed immediate temporization
and the immediate sense of security
and esthetics it gives the patient.
After lunch, attendees returned to
experience Dr. Ron Schefdore discuss how dental professionals are
now incorporating blood screening,
evidence-based supplementation,
laser therapy, DNA testing and physician referrals into their office protocol to improve dental treatment
outcomes and improve the overall
health of dental patients.
The DTSC Symposia 2009 came
to an end with a live broadcast all
g continued

[17] =>

0A
Dental TRubric
ribune | December 2009

Dental Tribune
| Month17A
2009
GNYDM
News

Scrapbook

Headline
Deck
By line

Dr. Howard Glazer was one of many speakers at the recent DTSC Symposia.

All participants who attended a full
day of DTSC Symposia lectures were
eligible to put their names in for a
drawing for one year worth of free
C.E. on www.DTStudyClub.com. Dr.
Hoang-Anh Nguyen won a year of
free, unlimited C.E. tuition on www.
DTStudyClub.com.

f DT page 15A
is an association between these
microbes and systemic health13–23,
then the edentulous population is
at equal risk, if not higher, than
their dentate counterparts.

Systemic health

Volunteers work with public-school
students Dec. 1 at the Greater New
York Smiles Children’s Program.

Meeting attendees get revitalized at
the oxygen bar set up by Singular
Payments, booth No. 1617. The company offers credit card processing
services with one flat rate.

About the authors
Dr. Sachdeo received his doctorate in oral biology and certificate in prosthodontics from
Harvard University. He is currently an assistant professor at
Tufts University School of Dental Medicine in the department
of prosthodontics and maintains
a private practice in Boston.
Sachdeo’s area of research is
studying the composition and
development of oral biofilms.
His work has been published in
the Journal of Prosthetic Dentistry, Journal of Prosthodontics,
Journal of Dental Research and
various other peer-reviewed
journals. Sachdeo has also
been the recipient of numerous
awards and grants.

Ronald Tankersley, president of the
American Dental Association, and
Torsten Oemus, president of Dental
Tribune International, discuss dental
education issues at DTI’s media
lounge at the Greater New York
Dental Meeting.

Anzeige METAL-BITE USA 2009/10:METAL-BITE 2009/10

22:31 Uhr

Universal and scanable
registration material,
that’s it!

S SI O

+ M
/CA
CAD IM
C
E
CHNOL

• High final hardness - Shore-D 40
• Setting time about 60 s
• Scanable for powderless 3D-data
registration of antagonists (CAD/CAM)
• Perfect physical parameters
• 2 Cartridges + 12 Mixing cannulas

R-SI-LINE ® METAL-BITE TM
Available at

R-dental
Dentalerzeugnisse GmbH
E-mail: info@r-dental.com
r-dental.com Biß zur Perfektion
R

dental

Robert F. Wright
Harvard University School of
Dental Medicine, Department
of Prosthodontics
188 Longwood Avenue
Boston, Mass. 02115

01.11.2009

AD
1/4 Page
9 1/4 x 3 3/8
Amit Sachdeo
Michael J. Costello
Angelica Gil-Levin
Peter Arsenault
Tufts University School of
Dental Medicine, Department
of Prosthodontics
One Kneeland Street
Boston, Mass. 02111

Ron Nguyen, left, helps show
GNYDM attendees how his product
Ultralight works. Nguyen’s product
is the first in history invented by a
dental student while still in
school.

A complete list of references is
available from the publisher.

For those who were not able to
attend these lectures at the Greater
New York Dental Meeting, they will
be offered online as C.E. accredied Webinars at www.DTStudyClub.
com within the next month.
In addition, the 2010 online calendar is available for these and
other C.E. programs. DT

Several researchers have looked at
the strong association between oral
health and systemic disease. Connections with pre-term birth, low
birth weight, diabetes, chronic kidney disease and risk factors associated with cardiovascular disease,
atherosclerosis and stroke, have
been established with periodontal
AD
disease.13–23,43,44
This information becomes even
more significant with the finding
of A. actinomycetemcomitans and P.
gingivalis in the edentulous40 and
implant patient.45,46
It is therefore extremely critical
that we develop ways to reduce or
perhaps even eliminate the development of periodontal pathogens in
the oral cavity to help minimize any
risk associated with these microorganisms on the systemic health of
an individual.
Long-term investigations are
most certainly warranted to look at
different biomaterials and prophylactic techniques that would help
achieve better plaque control in the
oral cavity. DT

Lectures available online

Winner of drawing

The ‘Posterior Resin Composite
Experience’ offers attendees a handson learning opportunity the morning
of Nov. 29.

the way from Germany. Dr. Marius
Steigmann presented live online to
an audience in New York on “My
First Esthetic Implant Case — Why,
How & When?” Dentists learned
the correct perspective to apply all
of the elements necessary for their
first esthetic implant.

A runner-up, Dr. Adam Vaghari,
will receive one free registration for
the Webinar of his choice.
“Thank you to all participants
who submitted their names in the
draw and attended the DTSC C.E.
Symposia at the GNYDM this year,”
said Julia E. Wehkamp, C.E. director for Dental Tribune.

IMP

f continued

A student explores the art of brushing one’s teeth on a set of giant teeth
during the Greater New York Smiles
Children’s Program. Children from
local schools spent the day learning
the importance of oral health.

pattersondental.com

Seit

[18] =>

18A DT Study Club

Dental Tribune | December 2009

DTSC symposia on world tour
The Dental Tribune Study Club
is an educational-based online
community that inspires new possibilities while creating greater
expectations in online learning.
Dental Tribune has scoured the
world to find dental meetings with
a proven platform for education,
communication and development.
The following are premier
attractions for the international
dental community at large and
will each feature a Dental Tribune
Study Club C.E. Symposia in 2010.
• April 16–18: IDEM — International Dental Exhibition in Singapore
• April 26 & 27: Dental Salon,
Moscow, Russia
• June 9–12: Sino-Dental, Beijing,
China
• Sept. 2–5: FDI World Congress,
Salvador da Bahia, Brazil
• Sept. 23–25: CEDE Poznan
Exhibition, Poland
• Oct. 28–31: DenTech, Shanghai,
China
• Nov. 28–Dec. 1: Greater New
York Dental Meeting, New York City
During each meeting, a leading
AD

panel of specialists will offer ADA
C.E.-accredited lectures covering
various dental specialties. Participation is free for show attendees, but pre-registration is recommended for preferred seating.

‘Getting started in...’ Webinars
Each “Getting started in…” program includes up to five successive
Webinars that provide a thorough
introduction to the techniques,
products and practice management
impact in that field of dentistry.
Each Webinar will include a
one-hour presentation followed by
a live Q&A session between the
online audience and the speaker.
Participants receive up to five
C.E. credits and attendance is free
for the first 100 registrants. The
2010 schedule is as follows:
• March 13: Getting Better in
Practice Management
• April 3: Getting Started in
Orthodontics
• May 22: Getting Started in
CAD/CAM
• May 29: Getting Started in
Implants
• July 24: Getting Started in Digi-

tal Imaging
• Aug. 14: Getting
Started in Endodontics
• Aug. 27: Getting
Started in Lasers
• Oct. 9: Getting
Started in Cosmetic
Dentistry
• Nov. 6: Getting
Started in Magnified Dentistry

Discussion forums
DTSC offers discussion
forums
focused on helping today’s practitioners stay up to
date.
With the ability to share resource
material from colleagues, networking possibilities are created that go
beyond borders to create a truly
“Global Dental Village.”
Further, the site offers a growing database of case studies and
articles featuring topics that are
important to today’s dental practitioners.
We encourage you to share your
cases for review with like-minded

practitioners with the chance to
win free tuition for C.E.-accredited
Webinars.
Registering as a Study Club
member is free and easy. We
encourage you to visit www.
DTStudyClub.com and join the
community. For additional details,
please contact Julia Wehkamp at
j.wehkamp@dtstudyclub.com or
(416) 907-9836. DT

[19] =>

0A
Dental TRubric
ribune | December 2009

Dental TIndustry
ribune | Month19A
2009

Curve
Dental: simplicity, efficiency, flexibility and fun
Headline
Deck

By Kristine Colker, Managing Editor

As the story goes, at the age of 16,
By line
whiz kid Matt Dorey started and grew
a successful IT company that helped
dental practices install computers,
networks
and software. When he was
tk
19, he asked a pivotal question: “If
you can shop online, bank online
and book travel online, why can’t you
manage your practice online?”
Of course, the only answer he
heard was, “That’s a wonderful idea,
Matt!” So in 2005, Dorey founded
Curve Dental, a Web-based company
that prides itself on being simple,
flexible, efficient, cost-effective and,
just as important, fun. Dental Tribune
sat down with Vice President of Marketing Andy Jensen to find out more
about Curve Dental.
What are the main things the company offers to clinicians?
We offer Web-based dental software
that delivers three key benefits.
1) The software is simple. It’s Webbased. How difficult can the Web be?

Almost anybody can navigate around
the Web and complete many different tasks. Simplicity also means less
training. If the dentist is closing his or
her practice for two or three days to
train the staff, how much is that costing? Software is supposed to deliver
a return on investment, not create
another barrier to increasing production.
2) Flexibility. Our dental software
is an extension of the staff’s lifestyles
because it is Web-based. Everyone
is shopping online. More and more
people are banking online. More than
one-third of all travelers are booking
online. And the number of online
traders is increasing exponentially.
Why? Because people like convenience and simplicity. If you can shop
online, bank online and book travel
online, you should be managing your
practice online, too.
3) Boosting efficiencies. Reducing the amount of time required to
accomplish any one task results in
an increase in efficiency. The key
test is accomplished by asking this

one question: “Can I do it faster with
paper?” If the answer is “yes” then
what is the point of using the software? From charting to scheduling
to billing, you’ll see that Curve Hero
passes the test.
• Bonus benefit: Outstanding customer service. Our dental software is
no better than our customer service.
Our software is a subscription service, so we have to exceed our customers’ expectations every month.
That’s pressure to perform, and we
love to make our customers happy.
How does Curve Dental differ from
other dental software/office management companies?
Two differences: First, our dental
software is Web-based. People use
the Web because it offers a level of
convenience, flexibility and simplicity
that can’t be found anywhere else. All
that’s needed is a Web browser and
an Internet connection.
Second, because our software is
Web-based, it is more intuitive. Our
customers find that charting is much

simpler, scheduling is more flexible and generating reports is easier.
When developing the software, we
can approach certain tasks with a
completely different perspective not
generally available to legacy software
developers. When you see a demo of
Curve Hero, you’ll be very impressed
by the less-is-more design.
For those who are used to their
office management software not
being Web-based, how does Curve
Dental’s work?
Anyone who has visited Amazon,
Travelocity or their local bank will
admit they were able to understand
how to use the service with no formal
training. Of course, managing a practice is much more complex than shopping online or booking a ticket online;
but the concept is still very much
applicable. Our customers are completely trained and using the software
live with half as much training as
legacy client-server software requires.
g DT page 20A

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

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

recyclable so this was a natural fit
for us.” Thus, Medidenta is currently
offering some new services.
Refining precious metal scrap. Medidenta can now smelt and assay scrap
to determine the precious metal content, and pay the dental professional
the highest dollar amount within a
week. As a bonus, the practitioner will
receive valuable discount coupons for
other products listed in the Medidenta
catalog.
In-office amalgam separator. The
BOSS Amalgam Separator offers up
to three years of safety, convenience,
simplicity and environmental compliance for the ultimate protection for
the entire dental office.
Dental waste. Dental offices can
now forget about expensive long-term
contracts for disposal of dental waste.
The company’s Sharps PLUS system is
very easy: Fill it. Seal it. Ship it. Everything is included, including the tape,
at a substantial savings.
In an era of financial uncertainty
and mistrust of public conglomerates,
dental professionals have a trusted

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

name like Medidenta. This family-run
company that has served the profession for more than 65 years can now
recycle products and facilitate clinicians’ scrap and waste.
This service offers a profit center
for the entire staff because even old
jewelry can be turned into instant
cash.
Medidenta is the home for direct
pricing and huge incentives. Take
advantage of Medidenta’s refining
service and qualify for a bonus 10
percent off products, including current incentive programs available at
www.medi denta.com.
The company wants your www.
medidenta.com experience to be
rewarding and pleasant. The Web
site allows you to explore in more
detail the new refining and recycling
services and browse the general product catalog filled with time-saving,
cost-effective products used in your
everyday practice.
The company looks forward to
serving all your needs today, tomorrow and well into the future. DT
AD

[20] =>

20A Industry

Dental Tribune | December 2009

MonoCem by Shofu
tions. Easy to clean up, MonoCem has
an unlimited working time and 100
percent polymerization.
MonoCem’s dual-cure formula
light cures in 40 seconds and now
completely auto cures in only 3½ minutes. Available in 7 gram syringes,
MonoCem has a low film thickness of
less than 12 microns, eliminates sensitivity and has a high fluoride release.
“MonoCem self-adhesive resin
cement is a very simple to use and
very effective cement. It handles well
with excellent flow properties and
cleanup is easy. MonoCem exhibits
all of the ideal properties of a cement
used for luting adhesive ceramic res-

SELF-ADHESIVE RESIN CEMENT
torations,”
Dr.
Eugene Atenucci
1
2
3
from Huntington,
N.Y., said.
With a convenient direct-dis4
5
6
pensing, auto-mix
syringe delivery
system, MonoCem
offers color stability for long-term
esthetics in transcom, for a new MonoCem steplucent or bleach
by-step guide. The helpful how-to
white shades for indirect cementation
is a useful tool that clearly illusof crowns, bridges, inlays, onlays and
trates MonoCem’s fast and easy
posts.
application. DT
Visit Shofu online, www.shofu.
Push here to bleed tube†
before putting on mixing tip.
Express 1-2mm onto pad

Twist to
remove cap

†First use only

1. Prepare Tooth
rinse and leave moist

2. Restoration Preparation
place MonoCem directly into crown
discard mixing tip and recap syringe

3. Restoration Seating
place crown onto preparation
FLASH cure excess 1-2 seconds

4. Remove Excess Cement
use a suitable instrument and
gently remove excess

5. PFM Non-Disturb Phase
maintain positive pressure for 2-1/2 minutes
then light cure margins for 20-40* seconds
with complete auto cure in 3-1/2 minutes
REMOVE any additional cement

6. Clear and Clean Contacts
floss up/down and pull
through to clean margins

*Light cure times vary. All ceramic, crown and inlay/onlay
cementation light cure for 20-30 seconds. Post and core
cementation light cure for 40 seconds. Refer to MONOCEM
DIRECTIONS FOR USE for more detailed instructions.

CEMENTS

MonoCem, Shofu’s self-adhesive resin cement, has a new and
improved formula with complete
auto cure in only 3½ minutes. The
same reliability and superior performance — now faster — makes
MonoCem the ideal time-saving
choice.
According to Dr. Richard Berry
from Medway, Mass., “MonoCem
is the easiest, fastest and strongest
cement I have ever used.”
With a self-etch, moisture tolerant formula, MonoCem bonds
strongly to all substrates — dentin, enamel, porcelain, all-ceramic
restoration or metal-based restoraAD

f DT page 19A
What are some of the features
Curve Dental offers and what do
dentists need to know about them?
Curve Hero provides all of the necessary features for a dentist and staff to
manage the practice, from billing to
scheduling to charting. We also provide bridges to a number of different
imaging systems.
What about price? Is it comparable to other practice management
options?
The cost of legacy software is deceptive. According to a study by the Gartner Group, the licensing fees represent only 9 percent of the actual costs
of purchasing the software. Implementation, hardware, IT services,
maintenance and training make up
the remaining 91 percent. We use a
subscription plan.
If you compare the two in price,
legacy software has an enormous
up-front licensing fee with monthly
technical assistance and service fees
— plus training and data conversion
fees. In contrast, a dentist using Curve
pays a low monthly subscription,
which provides the clinician with the
software, technical assistance — in
many different forms — and updates,
which are installed automatically.
The dentist will also pay a comparatively low, one-time implementation
and training fee.
If someone were to ask you why he
or she should consider Curve Dental above all the other options out
there, what would you say?
Moving to the Web is moving with the
flow of technology. Switching from
one legacy dental software to another
is moving against the flow of technology and an investment in tired, dated
technology. DT

Contact Curve Dental
Vice President of Marketing Andy
Jensen says the best way for dentists
and staff to learn more about Curve
Dental is to use the Web at www.
curvedental.com. Of course, he says,
charming dental software experts can
be reached at (888) 910-4376 or via
e-mail at info@curvedental.com.

[21] =>

0A
Dental TRubric
ribune | December 2009

Dental TIndustry
ribune | Month21A
2009

Headline
PhotoMed cameras and mirrors
Deck
By line

Anterior contacts mirror.
G11 digital dental camera
R2 dual-point flash bracket.

G11 digital dental camera
The PhotoMed G11 digital dental camera is specifically designed
to allow you to take all of the standard clinical views with “frame
and focus” simplicity.
The built-in color monitor
allows you to precisely frame
your subject, focus and shoot.
It’s that easy.
Proper exposure and balanced, even lighting are
assured. By using the camera’s
built-in flash, the amount of

light necessary for a proper exposure is guaranteed.
In addition, PhotoMed’s custom
close-up lighting attachment redirects the light from the camera’s
flash to create a balanced, even
lighting across the field.

R2 dual-point flash bracket
PhotoMed’s new R2 dual-point
flash bracket is designed to give
you maximum flexibility in flash
positioning.

Bring the flash heads in toward
the lens for posterior views and
mirror shots.
Spread the flash heads out
to the side for anterior esthetic
images and natural looking smile
shots.
Each flash head can be repositioned “on the fly” with one hand.
The R2 bracket is available in
Nikon or Canon configurations
and will work with Nikon’s R1 and
R1C1 macro flashes and Canon’s
MT-24EX macro flash.

Seiler Instruments
To say Seiler instrument company has 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 now provides that
equipment to the medical, dental,
military, architectural, construction and planetarium markets.
Founded in St. Louis, Mo., in
1945 with the knowledge and
expertise by a master of fine optics
from the Zeiss University School
of Fine Optics in Germany, Seiler
Instruments began making and
repairing small microscopes and
AD
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.
Since then, Seiler has become
a major provider of surgical and
compound microscopes to the
dental, ENT, OB/GYN and laboratory markets.
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 its
new building.
Recently, Seiler has moved its
home office from a 70,000 squarefoot facility to a new 150,000
square-foot facility to better serve

its customers.
In addition to their new building, the company 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, the 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” says
Dane Carlson, division manager of
Seiler Microscopes.
The Seiler Evolution xR6 is the
newly redesigned, new 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 more than 1,500 hours
and a standard halogen backup.
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.
To get more information about
Seiler, visit www.seilerinst.com. DT

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

Anterior contacts mirror

The anterior contacts mirror
makes it easy to photograph the
overjet and anterior contact.
The inset curved end follows
the curve of the arch for comfortable placement. The mirror
can also be used for standard
occlusal arch views.
More information about each
of these produts is available
at www.photomed.net or call
(800) 998-7765. DT

[22] =>

[23] =>

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

December 2009

www.dental-tribune.com

Vol. 2, No. 10

Enhancing quality of life with
implant-retained dentures
By Terry Myers, DDS

Fortunately, some people can
take the small events that increase
quality of life for granted — having a
conversation, tasting delicious foods
and smiling without self-consciousness are daily occurrences that are
rote for some, but luxuries for others.
While certain patients can maintain a happy, productive life with
standard dentures, for others with
special needs, dentists must find
alternatives that fit with the patient’s
lifestyle and budget. Everyone
deserves the confidence and selfesteem that a beautiful smile can
provide. With the proper equipment
and new procedures, doctors can
provide patients with function and
fashion.
A variety of implant options offer
functionality and esthetics. For one
of my patients, an implant-retained

Fig. 2

Fig. 1
denture fit her financial and physical requirements. The 64-year-old
German woman has basically wellmaintained diabetes, occasionally
struggling with insulin levels as well
as other health issues, such as skeletal back problems.
She had reached a point in her
dental history where she would
need her few remaining upper teeth
extracted and replaced by a den-

ture. She had been researching the
possibility of denture implants. She
did not want traditional dentures
because she gagged quite easily,
and the thick base of the denture,
plus her German accent, made her

speech difficult to understand. In
addition, due to her diabetes, she
occasionally got painful and slow-toheal sores on her palate under her
dentures.
Technology helped me to achieve
the clinical care and physical appearance that this woman needed. Imaging played a big part in my treatment
plan. For the diagnostic part, I used a
GXCB-500™, medium field-of-view
cone-beam unit from Gendex that
gave me a three-dimensional view of
her dentition (Fig. 1).
This imaging method allowed me
to determine whether implants were
even possible for the patient because
I couldn’t identify all of the details
without determining the width and
height of the bone to see if a bone
graft was necessary.
She had already stipulated that
she did not want a bone graft. Withg CT page 2D

Dentistry and continuing education
Dr. Terry Myers discusses his passion for continuing education and his interests away from the office.
Dr. Myers, how did you become
interested in practicing dentistry?
As a child, I wanted to pursue a job
where I could work with my hands.
I was interested in building model
ships and airplanes, and thought
about pursuing a career as an orthopedic surgeon.
Then, in high school, I dated a
dentist’s daughter and noticed that he
was able to set office hours and have
weekends off, unlike the surgeons
I knew who spent long hours at the
hospital.
Because I appreciated family life,
I decided on the dental path. I also
enjoyed the hands-on aspect of dentistry. Most medical positions do not
have the opportunity to get that close
to patients.
How do you keep up with technological advances in dentistry?
I graduated from dental school in
1987, and taught at the Advanced
Education in General Dentistry program at University of Missouri in
Kansas City for 16 years.

When I moved to private practice
and built the office, I wanted to make
sure that we offered educational
opportunities to my colleagues.
We built an education center in
the basement with an audio-visual
and projector system that can seat 40
people for lectures and 20 for handson courses.
We try to offer one course per
month. We’ve done courses on the
Gendex cone beam and Nobel Guided
Systems, and hold a 10-week dental
assisting program twice a year.
I may not be a part of the university
system anymore, but I still have a love
for education because I believe that
we all continue to learn during our
lives and careers.
What do you do when you are not
practicing dentistry?
Music is one of my biggest loves. I
enjoy big band music, and play baritone sax in a big band. We try to make
it to the Glenn Miller Festival every
year at his birthplace in Clarinda,
Iowa. I also play oboe and English

horn in the local symphony orchestra.
My other loves are my wife, Kathy,
10-year-old daughter, Katie, and 17year-old son, Glen, who is hoping to

follow in my dentistry footsteps. I
hope that I have inspired him to a
career that he can really sink his
teeth into! CT
AD

[24] =>

2D Clinical & News

Cosmetic Tribune | December 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

Fig. 3

Chief Operating Officer
Eric Seid
e.seid@dental-tribune.com

Fig. 4

Fig. 6
f CT page 1D

out the 3-D scan, I would need to
refer the case to an oral surgeon.
By just looking, feeling or with a
2-D X-ray of the ridge, there didn’t
seem to be enough bone in the area
for a successful implant. Besides
the bone, on a 2-D pan, her sinuses
appeared so big that I didn’t want to
chance complications.
I was able to ascertain from the
3-D scan’s cross-sections (Fig. 2)
that she had enough bone to place
an implant denture. During the surgical procedure, with my intra-oral
digital X-ray (DEXIS®), I could check
if the implants were properly situated above the sinus level. My mix
of imaging options gave me the vital

information I needed to complete
my treatment plan with confidence.
After imaging, I decided on fullarch implants on teeth Nos. 4, 6, 8,
10, 11 and 14. Because of her diabetes, the implant denture needed to
be removable so that she could clean
very well around it.
It was very important to the
patient that she did not have a prosthesis that looked like a denture.
She had all of her natural lower
dentition, and we were able to use a
combination of shades (A2–A3.5) to
maintain a natural appearance.
Trubyte Portrait IPN teeth were
used because of their natural shading from gingival to incisal edge.
The locator attachments, like little
gaskets, make it easy for the patient
to remove her denture for proper
hygiene and re-seat it in the right
place every time.
After finding out the condition and
measurement of her ridge and gums,
we decided on six 3.5 Nobel Replace

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

Fig. 5
implants of 13 mm in length. I chose
the Nobel Guided Surgery protocol
(Figs. 3, 4) because I had to be very
precise regarding the length of the
implant in relationship to her sinus
as well as her small amount of bone.
During the surgery, I used my digital X-ray to check the drill lengths
and placements very quickly right at
chairside (Fig. 5). That’s the beauty
of guided surgery and digital radiography — much of the information
is determined beforehand, taking
away the stressful element of surprise during the procedure (Fig. 6).
Taking into account possible
healing issues because of her diabetes and small amount of bone, I
didn’t immediately load the denture
onto the implants, but instead put on
healing caps and let the area heal for
g continued

Editor in Chief Cosmetic Tribune
Dr. Lorin Berland
d.berland@dental-tribune.com
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

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

Dr. Lisa Marie Samaha, center, is
pictured with patients Terry Cane,
seated at left with framed certificate,
and Michael Boyd, seated at right,
along with her staff and the patients’
family members.

Virginia dentist gives two patients new smiles
By Fred Michmershuizen, Online Editor

When Dr. Lisa Marie Samaha of Port Warwick Dental Arts
in Newport News, Va., decided to
hold a Smile Makeover Contest, she
intended to award one patient with
free care.
But after reviewing the applications she decided to present two
awards, not one.
The practice received many compelling stories, and two exceptional
individuals stood out.
As a result, Michael Boyd of
Hampton, Va., and Terry Cane of
Williamsburg, Va., were selected
to receive life-enhancing and lifesaving dental treatment that began

in October.
“It was such a heartwarming presentation, for all of us,” said Abby
Sharpe, who works in Samaha’s
practice. “You could really tell the
impact it had on our winners. They
are both so deserving.
“They will both be undergoing
tens of thousands of dollars in treatment over the next month or so and
are just so excited and appreciative.”
Samaha and her team had specific criteria for the contest winners.
When reviewing the candidates,
they considered whether the individuals had life-threatening levels
of dental disease, or if they had
damage severe enough to keep

them from sharing a smile with
others.
They considered the candidates’
personal economic circumstances.
They also took into consideration
whether the candidates had devoted
their lives to helping others.
Samaha, founder of Port Warwick
Dental Arts, prides herself on offering compassionate care resulting in
beautiful smiles.
She provides a wide range of
esthetic, reconstructive, surgical
and comprehensive dental care.
Her practice offers a non-surgical
program for periodontal disease
treatment that highlights nutrition,
specialized testing and state-of-theart laser therapy. CT

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!

[25] =>

Clinical

Cosmetic Tribune | December 2009

About the author

Dr. Terry Myers completed his
residency in advanced general
dentistry and served as an instructor in the Advanced Education

Fig. 7

in General Dentistry Residency
Program and director of the faculty practice at the University of
Missouri-Kansas City School of
Dentistry.
He is a fellow in the Academy of
General Dentistry, and a member
of the Academy of Cosmetic Dentistry as well as the Dental Sleep
Disorder Society.
Myers is on the board of directors at Research Belton Foundation and is a participating provider
for the dental care program to
improve children’s dental care.
His private practice is in Belton,
Mo. He can be reached by e-mail
at office@keystone-dentistry.com.

Close-up
AD

Fig. 8: Decay under crowns.
f continued

four months.
For denture cases, it is important
to keep current on new methods
and technologies and for patients
to understand their options and
improve outcome through proper
care.
With digital imaging and 3-D
technology, I can better educate my
patients by pointing out their particular areas of concern on the large
computer monitor.
For extra insight, a Web site
called www.denturewearers.com
offers helpful information and tips
for dentists and patients about the
various denture-related options,
denture care and how different
medical conditions such as diabetes,
heart disease and oral cancer affect
denture choices.
Being apprised of the facts and
researching the choices, such as the
patient and I did, facilitates treatment acceptance and success.
For this patient, the implant eliminated the palate of the denture,
which had caused much of her gagging, speech and soreness problems.
Besides functioning very well, her
beautiful teeth give her the encouragement to speak with confidence
and smile with teeth showing instead
of pursed lips (Fig. 7).
Moreover, she has a renewed
pleasure in eating because she can
utilize the taste buds on her palate
again.
Giving patients their smiles back
always leaves a really good taste in
my mouth too. CT

[26] =>

[27] =>

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

December 2009

www.dental-tribune.com

Vol. 2, No. 10

An introduction to lasers in dental hygiene
By Jeanne M. Godett, RDAEF, RDHEF

What is a laser? How does it
work? How long have lasers been
used in dentistry? How do they benefit our patients? How are lasers
integrated in dental hygiene? Are
there any disadvantages to the use
of a dental laser?
These and more were the questions I had when I first became
interested in using laser technology. In short, this technology has
simplified my dental hygiene day.
I now have more time in my
hygiene treatment regimen to
introduce comprehensive restorative dentistry, granting my clients the dentistry they want and
deserve along with the ability to
pr=eserve their investment.

What is a laser?
The word laser is an acronym for
“light amplification by stimulated
emission of radiation.”
We can thank Albert Einstein
for theorizing that photoelectric
amplification could emit a single
frequency, or stimulated emission,
which explains how a laser operates. Light is a form of energy that
exists as a particle, called a photon,
and travels in a wave. A photon
wave has three basic properties.
Velocity: The speed of light.
Amplitude: The vertical measurement of the height of the wave,
from the zero axis to the peak,
which describes the energy of that
wave. For convenience, energy is
measured in millijoules, or thousandths of a joule.
Wavelength: The horizontal
distance between any two corresponding points on the wave. In
dentistry, we use wavelengths that
range between 450 nm and 10,600
nm.
Laser light is distinguished from
ordinary light in that it is monochromatic, it can be visible or
invisible and each wave is coherent or identical in physical size and
shape. Laser energy is nonionizing
radiation.
Lasers were introduced to dentistry in 1960 and are capable of
providing results comparable to
or superior to conventional techniques and instruments.
There are more than two dozen
indications for laser use ranging
from simple gingival troughing for
homeostasis to caries detection,
caries removal, tooth preparation
and curing.
Laser energy can be reflected,
absorbed, transmitted or scattered
within the target tissue or can pass

Fig. 1: KaVo laser calculus detection tip.
through without any effect on the
tissues.
The diode family of lasers range
in wavelengths from 808 nm to 1,064
nm. These are soft-tissue lasers and
are absorbed in hemoglobin, other
blood components and melanin.
The Nd:YAG 1064 nm wavelength
is also a soft-tissue laser and also
absorbed in hemoglobin, blood
components and melanin.
Hydroxyapatite does not absorb
these wavelengths.
The two erbium lasers are the
only hard-tissue lasers with wavelengths of 2,780 nm and 2,940 nm.
This laser energy is best absorbed in
water and tooth structure.
The CO2 laser is also a softtissue laser with a wavelength of
10,600 nm. This wavelength is best
absorbed, such as the erbium family, in water and tooth structure.
However, this laser is only used on
the soft tissues. A dentist or hygienist must choose the best laser for the
desired treatment.
Erbium lasers use extremely
short pulse durations and can easily
ablate layers of calcified tissue with
minimal thermal effects.
Because of the unique absorption
properties, all wavelengths have different penetration depths within the
tissues. The erbium and CO2 lasers
are absorbed on the surface of the
target tissue where the diode and
Nd:YAG lasers can reach several
thousand microns deep into the tissues.

Lasers in daily practice
With the integration of lasers, I
finally have the ability to achieve
a higher level of health for my
patients.
The first laser I use in my clinical appointment is the 655 nm
wavelength laser to detect subgingival and supra-gingival calculus with the laser perio tip attached
(Note that the DIAGNOdent uses

a standard tip for caries detection
and a separate tip for perio calculus detection, so two tools in one
just by changing the tip.).
Calculus has never been easier to detect, making my clinical
scaling time minimal (Fig. 1). My
patients leave with less sensitivity,
trauma and discomfort.
Secondly, I use my diode laser to
reduce the bacteria and pathogens
within my client’s sulcus or periodontally infected pocket by simply
taking a small optic fiber, almost
half the size of a periodontal probe,
and shining photonic laser energy
into the sulcus.
This is what we in the laser
hygiene community call laser
decontamination 1, or laser bacterial reduction (LBR), which is
the reduction of the bacteria and
pathogens within the sulcus.
I then proceed with the use of
ultrasonics and hand instruments
for biofilm and calculus removal
from the hard tissues, finishing
with the use of the diode laser for
laser degranulation (curettage), so
again entering a diseased periodontal infected pocket with the
same optic fiber.
I am able to selectively remove
granulation tissue produced by
infections and inflammatory diseases like periodontitis.
Today hygienists have the ability
to simply and selectively remove
bacteria living in our clients’
mouths.
Research shows, 96 percent
of the germs that are found in
the periodontal pocket are pigmented and can thus be selectively
destroyed by the laser.
By simply shinning photonic
laser energy into our clients’ sulcular tissue, we can safely and
effectively lower the bacteria in
our clients’ sulcus for up to 56
days.2 Additionally, the light energy
through biostimulation can speed

up the process of wound healing and similar regenerative processes.
For a finale, I end my client’s
appointment with the same 655 nm
wavelengths for laser caries detection, again the KaVo DIAGNOdent.
I can give my clinician the necessary information to diagnose
decay in our patient’s teeth for a
higher gold standard of minimally
invasive dentistry. Treating caries
at its earliest inception preserves
our patients’ natural enamel for
their lifetimes.
My newest laser purchase has
been the KaVoGENTLEray 980nm
Premium. This laser has water irrigation. Water irrigation offers less
tissue trauma, along with 12 watts
of gentle micro-pulsing energy.
Pulsing allows the tissues to
thermally relax and cool before
each additional pulse. Each pulse
is taking place within milliseconds.
I personally use Closys to irrigate while lasing the tissues, producing an antimicrobial irrigation
along with water cooling.
This is the only diode laser of
its kind available. I am thoroughly
enjoying the healthy rewards this
laser has offered my clients.
Having worked with and
instructed on diode lasers of wavelengths from 808 nm to 1,064 nm
wavelengths over the past eight
years, I highly recommend the
benefits the 980 nm wavelength
has to offer my clients.
This wavelength is also absorbed
more readily in water vs. the other
diode wavelengths.

Any disadvantages?
A perceived disadvantage of some
practices is the initial cost. However, with proper training and laser
integration (I consider this to be
my specialty), the ROI (return on
investment) can be less than three
months.

The bottom line
I love working with dental offices
throughout the country, assisting
them in the integration of laser technology, offering their clients’ this
new gold standard in technology.
The offices I have worked with
are seeing improved health for their
clients. In conjunction, they are seeing their hygiene departments run
at a profit.
I highly recommend that if you
are going to use laser technology,
you seek out education. The Academy of Laser Dentistry (ALD) is a
g HT page 3E

[28] =>

News

Hygiene Tribune | December 2009

Are children receiving
prompt cleft lip/palate
treatment?

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
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

Cynthia H. Cassell, Julie Daniels, Robert E. Meyer (2009) Timeliness of Primary Cleft Lip/Palate Surgery. The Cleft Palate-Craniofacial Journal: Vol.
46, No. 6, pp. 5885–97.
Results: 406 children in North Carolina with OFC were continuously
enrolled in Medicaid during the first two years of life. Overall, 78.1 percent
of children had surgery within 18 months. About 90 percent of children
with cleft lip (CL), 58 percent of children with cleft palate (CP), and 89.6
percent of children with cleft lip and palate (CLP) received timely cleft
surgery; the mean age at which surgery occurred was 5 months. Children
whose mothers received maternity care coordination, received prenatal care
at a local health department, or lived in the southeastern or northeastern
region of the state were more likely to receive timely cleft surgery.
The timely repair of orofacial cleft
(OFC) can greatly improve a child’s
medical and psychosocial well-being.
The American Cleft Palate–Craniofacial Association (ACPA) has set
forth guidelines for the optimal time
by which primary repair surgery
should be received, broken down by
type of OFC.
A retrospective study, published
recently in The Cleft Palate–Craniofacial Journal (Vol. 46, Issue 6, Nov.
2009) was conducted to determine
whether children with OFC receive
primary repair surgery within the
time recommended by these guidelines.
The study, conducted in North
Carolina, found that most children
in that state are undergoing primary
repair surgery by the recommended
age.
The study involved vital statistics,
birth defects registries and Medicaid
files for resident children with OFC
born between 1995 and 2002.
The many variables analyzed fell
into five broad categories: maternal, child and system characteristics,
perinatal care region and place of
residence.
The findings suggest that most
(78.1 percent) North Carolina children with OFC received primary
repair surgery by the time recommended by the APCA guidelines.
Percentages varied among cleft lip
(about 90 percent), cleft palate (58
percent) and cleft lip and palate (89.6
percent).
According to the authors of the

study, “Children whose mothers
received maternity care coordination, received prenatal care at a local
health department, or lived in the
southeastern or northeastern region
of the state were more likely to
receive timely cleft surgery.”
The populations least likely to
receive the surgery in a timely manner were African-American/non-Hispanic and those in the southwestern
region of the state.
This is most likely due to the distance to the craniofacial center and
the services provided by the different
centers.
To read the entire article, “Timeliness of Primary Cleft Lip/Palate Surgery,” visit www.pinnacle.allenpress.
com/doi/abs/10.1597/08154.1?journalCode=cpcj HT

More information
The Cleft Palate–Craniofacial Journal is an international, interdisciplinary journal reporting on clinical and
research activities in cleft lip/
palate and other craniofacial anomalies, together with
research in related laboratory
sciences.
It is the official publication of the American Cleft Palate–Craniofacial Association
(ACPA).
For more information, visit
www.acpa-cpf.org/.

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
Aall rights reserved.
Hygiene Tribune strives to maintain
utmost accuracy in its news and clinical
reports. If you find a factual error or
content that requires clarification, please
contact Group Editor Robin Goodman at
r.goodman@dental-tribune.com.
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.

[29] =>

Clinical

Hygiene Tribune | December 2009

3E

Hungry for hygiene C.E.?
Watch ‘Simple Advanced
Treatment Modalities for the
Dependent Patient’
at
www.DTStudyClub.com.
Only $95 for three hours of C.E.!

Fig. 2: Laser fiber in sulcus.

f HT page 1E

P&F Ad-DTA

1/14/09

2:45 PM

Page 1
AD

non-bias resource for laser education, www.laserdentistry.org.
Invest in laser technology, invest
in a higher level of health for your
clients. Profit from hygiene excellence. HT

References
1.

2.

3.

™

Donald J. Coluzzi, DDS; Robert A. Convissar, DDS. Atlas
of Laser Applications in Dentistry. Quintessence Publishing
Co., Inc. 2007.
Norbert Gutknecht, et al. Proceedings of the 1st International Workshop of Evidence
Based Dentistry on lasers in
Dentistry, 2006, Quintessence
Publishing Co. Ltd. Aachen,
Germany, pp. 3–231.
J.E. Horton, et al. Decontamination of Pocket. M.E. Neill
1997 supplement 1992 ISLD
Abstract 46, moritz 2006.

*

About the author

Contains no
Bisphenol A
If you’re one of the 1,000s of dental professionals who know
EMBRACE™ WetBond Pit & Fissure Sealant is easier to apply
because it bonds to moist tooth surfaces, provides a better seal and
is long lasting, you’re on top of your profession.

Jeanne M. Godett has been
making a professional difference in people’s lives for more
than 25 years. She has consulted
with hygienists throughout the
United States and Canada providing instruction, guidance and
productivity guidelines related
to hygiene and the use of lasers.
Jeanne Godett Consulting
“Profiting from Hygiene
Excellence”
Tel.: (916) 412-6867
E-mail: jghygiene@aol.com

Now after six years of clinical use,
EMBRACE Sealant sets a new standard
of success – intact margins, no leakage,
no staining, caries-free.
Six-year followup photo
photo courtesy of Joseph P. O’Donnell, DMD

For technical information
contact Pulpdent at

800-343-4342
Order through your dental dealer.

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

✔ Long lasting
■
✔ Easy to apply – only sealant that bonds in a moist field
■
✔ Margin-free seal
■
✔ Fast light cure
■
✔ Fluoride releasing
■
*Contact Pulpdent for study.

PULPDENT

®

Corporation

80 Oakland Street • Watertown, MA 02471-0780 • USA

pulpdent@pulpdent.com • www.pulpdent.com

[30] =>

) [page_count] => 30 [pdf_ping_data] => Array ( [page_count] => 30 [format] => PDF [width] => 765 [height] => 1080 [colorspace] => COLORSPACE_UNDEFINED ) [linked_companies] => Array ( [ids] => Array ( ) ) [cover_url] => [cover_three] =>

[cover] => DT U.S. 3909

[toc] => Array ( [0] => Array ( [title] => ‘HIV tests should be offered in every dental practice’ [page] => 01 ) [1] => Array ( [title] => News [page] => 03 ) [2] => Array ( [title] => World News [page] => 04 ) [3] => Array ( [title] => The practice’s ‘annual exam’ [page] => 08 ) [4] => Array ( [title] => Financial & Digital Matters [page] => 10 ) [5] => Array ( [title] => Same-day inlay/onlay technique [page] => 14 ) [6] => Array ( [title] => Headline Oral biofilms 101: the basics [page] => 15 ) [7] => Array ( [title] => GNYDM News [page] => 16 ) [8] => Array ( [title] => DTSC symposia on world tour [page] => 18 ) [9] => Array ( [title] => Industry [page] => 19 ) [10] => Array ( [title] => Cosmetic Tribune 10/2009 [page] => 23 ) [11] => Array ( [title] => Hygiene Tribune 10/2009 [page] => 27 ) ) [toc_html] =>

Table of contents

[toc_titles] =>

[cached] => true )