dental chronicle - may 2010

CANADIAN ORTHODONTISTS SAY

their patient population has signifi-cantly changed in the last two

decades, with many more adult patientsnow walking through their office doors.

“There is greater awareness of treat-ment, and the fact that you can wearbraces at any age,” says Toronto ortho-dontist Dr. Peter Gold, whose practiceprimarily consists of adult patients.

“People now assume that they willkeep their teeth for life, so they want toenjoy the benefits of having great teeth.If patients wear braces when they are intheir 40s, they can look forward to hav-ing a nice smile at age 50, 60, and 70.Baby boomers, in particular, do notwant to think of themselves as old.”

MORE TREATMENT OPTIONSTechnology advances in orthodontics,such as the emergence of Invisalign, mar-keted as the “clear alternative to braces,”have created more treatment options foradult patients, notes Dr. Gold. “Invisalignis more esthetic and easier to clean,” saysDr. Gold, pointing out some patients optfor two different appliances such as insidebraces on the top row of the teeth andInvisalign on the bottom row.

The standard of care in orthodonticsis continually being raised, observes Dr.Gerald Zeit, a Toronto orthodontist,president of the Canadian Association ofOrthodontists (CAO), and clinicalinstructor at the University of Toronto in

the faculty of dentistry for nearly twodecades. He is taking a sabbatical fromteaching as current president of the CAO.

“The standard of care is to not justhave straight teeth, but to place well-aligned teeth in the right position withinthe whole dental-facial structure,” saysDr. Zeit. “We want to ensure that weprovide the right amount of lip supportand show off the teeth when you laugh,smile, and speak. That is becoming abigger part of the whole diagnostic andtreatment effort.”

Physics is a discipline that entersinto how orthodontics works, observesDr. Zeit. Newton’s Law, which statesthat for every action, there is a reaction,is certainly a principle that comes intoplay in orthodontics, says Dr. Zeit.

The advent of tools such as tempo-rary anchorage devices can be used to

DentalChronicleCanada’s National Newspaper of Dentistry

n May 31, 2010

Head of dental team at VancouverOlympics talks about his experiencesDr. Chris Zed says athletes don’t pay as much atten-tion to their oral health as they should. See page 24.

P r a c t i c e p o i n t e r s

Just listeningcan defuseconflict withyour patientsn Some patients just need to

talk, and this consultant’sadvice is to listen to whatthey have to say

MANY DENTAL PRACTITIONERS

should use the principle ofactive listening to help defuse

conflicts with dissatisfied patients,according to a marketing researchexpert.

“Don’t react and try to justify yourown behavior,” says Scott McDonald,principal of Scott McDonald andAssociates, Inc., based in Sacramento,Calif. “So often, people have workedthemselves up into a state, and you don’tknow why they are reacting. People justneed a chance to talk, so just be quietand let them say what they need to say.

IT’S CALLED AGGRESSIVE LISTENINGMcDonald’s firm specializes in market-ing research and demographic profilingfor professional practices, and it alsoproduces reports to help dental prac-tices understand their customer base.According to McDonald, employingthe technique of “aggressive listening”will guide a conversation with a patientwho is expressing complaints.

“If you guide the conversation,you can take what they said and carry itin a direction that is helpful,” saidMcDonald. “You can ask questionssuch as what they want the ultimateoutcome to be. If you can write downwhat they say, then so much the better.”

Knowing a patient’s value system

DentalVitae

—please turn to page 10


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ODA calls for improved oralhealth legislation for seniorsPOOR ORAL HEALTH CAN HEIGHTEN THE

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by Louise Gagnon,Correspondent, Dental Chronicle

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What you need to knowabout Digital ImagingIN THIS INSTALMENT OF DENTAL

CHRONICLE’S new series on GreenDentistry, advances in digital imagingcan improve care and minimize envi-ronmental impact, compared to film-based systems. Turn to page 13

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Dental Chronicle National Editorial Board

Hassan Adam, Yellowknife, N.W.T.

Véronique Benhamou,Montreal, Que.

Barry Dolman, Montreal, Que.

Neil Gajjar, Mississauga, Ont.

Cary Galler, Toronto, Ont.

Wayne Halstrom,Vancouver, B.C.

Mel Hawkins, Toronto, Ont.

Ira Hoffman, Chomedey, Laval, Que.

Mark Lin, Toronto, Ont.

Ed Lowe, Vancouver, B.C.

Scott Maclean, Halifax, N.S.

John Nasedkin, Vancouver, B.C.

Ken Neuman, Vancouver, B.C.

Brian Saby, Red Deer, Alta.

Ken Serota, Mississauga, Ont.

Paresh Shah, Winnipeg, Man.

Andrew Shannon,Vancouver, B.C.

Howard Tenenbaum,Toronto, Ont.

William E. Turner, Thunder Bay, Ont.

GROWING UP IN HONG KONG, Dr. Mark Lin’sparents—who were medical doctors—stressedthe importance of a career that would allow himto help others but maintain a work/life balance.In Hong Kong, the family lived on the hospitalgrounds and his parents were often called out inthe middle of the night to check their patients.

“After a while that lifestyle got to them,” Dr.Lin told DENTAL CHRONICLE, “and I rememberthem saying that no matter which profession youchoose, choose one that is not as involving as[being a physician] because you cannot reallyleave your job completely behind when you are

dealing with patients of this nature.” Dr. Lin’s family came to Canada in 1975, when he was eight years old. After

graduating from the Biochemistry Specialists honors program at the University ofToronto, he worked toward a dental degree from the University of Detroit Mercy,where he was on the Dean’s list for four consecutive years and finished in the topfive per cent of his class.

“I decided on dentistry as a career because it would allow me to still be in the med-ical field, and yet be able to walk out and leave work behind. The other component isthat I have always liked the concept of ownership and being my own boss,” he noted.

“If I had decided on a medical career that involved me working in a hospital,well, then I would have had to deal with political issues and other circumstances thatare tough to control,” he said.

Dr. Lin practiced general dentistry for 13 years, and then completed his postgraduate training in Prosthodontics at the University of Toronto. He maintains a fulltime specialty practice as a prosthodontist with focus on full mouth reconstructionsand implant surgery and prosthetics. He also works part time as an Associate inDentistry at the University of Toronto. At the university, he serves as a surgicaldemonstrator in the post graduate Periodontics department.

“I enjoy lecture and presentation opportunities because it allows me to shareinformation and brush up on data.”

Dr. Lin is finding that in the dental profession, general dentists are sometimeshesitant to get involved in implant dentistry, and he encourages professionals to getup to speed in terms of embracing this body of knowledge so that they can start toincorporate restorative dentistry into their practice.

He recommends that dentists take CE courses to further their knowledgebecause most universities do not have enough time to incorporate implant dentistryinto their curriculum.

College of Dental Surgeons ofSaskatchewan—Annual Session9 to 11 September, 2010SaskatoonTel: 306-244-5072Fax: 306-244-2476 Website: http://www.saskdentists.com

Dental Technician’s Association ofBC—Annual Convention17 to 18 September, 2010Surrey, BCTel: 604-278-6279Toll free: 1-888-495-4566Website: http://www.dtaofbc.ca/

Edmonton & District Dental Society(EDDS)—Northwest Dental Expo24 September, 2010EdmontonTel: 780-642-8270 Fax: 780-642-8267Email: [email protected]: http://www.edds.ca/

Thompson Okanagan DentalSociety—Annual General Meeting &Conference28 to 30 October, 2010Kelowna, BCTel: 250-832-2811 Fax: 250-832-2811 Email: [email protected]: http://www.todsmeeting.com/

It may have reached your attentionthat while other dental publications arescaling back, and publishing smaller edi-tions, Dental Chronicle continues to growand expand, and offer you an improvedand more useful information package.Thank you for noticing, and for contribut-ing to our success through your support.

Attending the College of Dental Surgeons annual session in Saskatoon? 2We’d love to receive your impressions of the presentations and session highlights. E-mail us at [email protected]

Have a digital photograph of an upcoming meeting destination? Send it to us at [email protected]. We’ll publish selected photos and reward photographers with gift-card prizes.

May 31, 2010 n 3DentalChronicle

DentalChronicleCanada’s National Newspaper of Dentistry

EDITORIAL DIRECTOR

R. Allan RyanSENIOR ASSOCIATE EDITOR

Lynn BradshawASSISTANT EDITOR

Josh Long

SALES & MARKETING

Henry RobertsPhil Diamond

PRODUCTION & CIRCULATION

Cathy DusomeCOMPTROLLER

Rose Arciero

PUBLISHER

Mitchell Shannon

Published six times annually by the proprietor, ChronicleInfor mation Resources Ltd., from offices at 555Burnhamthorpe Rd., Suite 306, Tor onto, Ont. M9C 2Y3Canada. Tele phone: 416.916.2476; Fax 416.352.6199.

E-mail: dental@chroni cle.ws

Contents © Chronicle Information Resources Ltd, 2010, except where noted. All rightsreserved worldwide. The Publisher prohibits reproduction in any form, including print, broadcast,and electronic, without written permission. Printed in Canada.Subscriptions: $59.95 per year in Canada, $79.95 per year in all other countries, in Canadian or USfunds. Single copies: $7.95 per issue. Subscriptions and single copies are subject to 5% GST.

Chronicle Information Resources Ltd. is the official representative of Dental Tribune International(DTI) in Canada. All published material related to Dental Tribune is subject to copyright by DTI.

Canada Post Canadian Publications Mail Sales Product Agreement Number 40016917. Pleaseforward all correspondence on circulation matters to: Circulation Manager, Dental Chronicle,555 Burnhamthorpe Rd., Suite 306, Toronto, Ont. M9C 2Y3 Canada.E-mail: [email protected] ISSN 1916-0437

Since 1995, Ideas in the Service of Medicine. Publishers of: The Chronicle of Skin & Allergy, The Chronicle of Neurology & Psychiatry, The Chronicle of Urology & Sexual Medicine, The Chronicle of Healthcare Marketing, Drug Rep Chronicle, Best Practices Chronicle, healthminute.tv, and Linacre’s Books.

Each issue, Dental Chronicle is honored to introduce you to the distinguished members of ourNational Editorial Board. This month, we welcome Dr. Mark H.E. Lin of Toronto.

NOW:

MOREMORE NEWS.

MOREMORE PAGES.


4 n May 31, 2010 DentalChronicle

DISAPPOINTED BY THE ABSENCE OF

specific regulations governing dentalcare for senior citizens in recent

provincial government legislation, theOntario Dental Association has issued aspecial report on oral health and agingthat calls for a “required program throughregulation” for all seniors living in long-term care facilities in the province.

According to ODA president Dr.Ira Kirshen, the report, Oral Health andAging: Addressing Issues and ProvidingSolutions is the association’s response tothe government’s failure to change regu-lations contained in the Long Term CareHomes Act of 2007, which, three years

later, has yet to be proclaimed.“We’ve been meeting with govern-

ment fairly often about the different draft[the government]is going to bring inabout the act,” Dr.Kirshen said in aninterview withD E N T A L

C H R O N I C L E .“When we startedto see that [gov-

ernment representatives] weren’t listeningto our solutions we decided to issue thisspecial report so the government couldunderstand our position better, and so thepublic could understand what’s really

required.“This report is part of our continu-

ous effort to lobby and to promoteaccess to oral healthcare.”

The report highlights two importantissues the ODA believes must beaddressed immediately: a general igno-rance of the importance of good oralhealth and significant concerns regardingthe quality and availability of oral health-care services for the frail elderly in Ontario.

“They are the people who needassistance to maintain even the mostbasic levels of personal care, whether athome or in a long term care facility,” thereport states. It also notes that althoughmost Ontarians (69 per cent) do notbelieve that bad teeth are an inevitableconsequence of old age, good oralhealth is beyond the capabilities of thefrail elderly and seniors who dependupon others for their daily personal care.

Age, the report adds, increases thelikelihood of chronic illness such as dia-betes, and more than 100 diseases can pro-duce adverse effects on oral health. Thereverse is also true: poor oral health, partic-

ularly periodontal disease, heightens therisk of respiratory infections, cardiovascu-lar disease (heart and stroke), and diabetes.

Bacterial pneumonia, particularlyaspiration pneumonia, is the leadingcause of death for long term care resi-dents and a definite association has beenestablished between gum disease andpneumonia. Inflammation is a significantrisk factor for heart disease, and the bac-terial growth generated by periodontaldisease can intensify inflammationeverywhere in the body.

“When bacteria in infected gumsbreak free, they can enter the blood-stream, attach to blood vessels and causeclots, which aggravate high blood pres-sure and increase the chances of a heartattack or stroke,” the report summarizesregarding the results of several clinicalstudies that examined to issue of bacte-ria in the mouth.

The report recommends that a den-tist perform an oral examination of eachnew long term care resident upon admis-sion and annually thereafter. (This serv-ice, it notes, is mandated today in PrinceEdward Island).

The report also calls for setting up afully equipped “healthcare/wellnessroom” in all long term care facilities wheredentists and other healthcare profession-als can tend to the residents. These unitswould eliminate the need for ambulanceservices to hospitals and to dental clinics.

STAFF NEED TO BE TRAINEDTooth brushing and flossing must also beprovided twice each day to all long termcare residents who cannot perform thesetasks. All personal support staff employedat these facilities should be educatedregarding the importance of brushing andflossing, and equipped and trained to per-form the procedures correctly.

The ODA hopes the provincial gov-ernment will undertake an economicanalysis to learn how much untreated oraldisease among the frail elderly costs thehealthcare system. While acknowledgingthat healthcare dollars are few and farbetween, the ODA says this is one areawhere savings can be made, since treatingother illnesses such as heart failure andstroke is ultimately much more costly.

“We need to take care of the elder-ly, those who cannot care for them-selves,” Dr. Kirshen said in a statement.

“This is serious. We need to help.”—Ian J.S. Moore

Correspondent

INDIA Evidence indicates gumtone gel, a commerciallyavailable gel containing Acacia arabica, may be a usefulherbal formulation to help improve plaque build upand gingival status, investigators report in theAustralian Dental Journal (55(1):65-69). Findings revealgumtone gel was shown to produce significant clinicalimprovement in gingival and plaque index scores whencompared to a gel placebo. Overall, this improvementwas comparable to one per cent chlorhexidine gel, butunlike chlorhexidine gel, gumtone gel was not associat-ed with tooth discoloration or unpleasant taste.

USA The loss of inferior alveolar canal (IAC) corticalintegrity might be associated with an increased risk ofexperiencing paresthesia after mandibular third molar(MTM) extraction, investigators reported in the Journalof the American Dental Association (141(3):271-278). Thisstudy was comprised of 179 participants who under-went MTM extraction (a total of 259 MTMs). Overall,the prevalence of paresthesia was 4.2 per cent (11 of259 teeth). The prevalence of paresthesia in groupthree (involving an interrupted IAC cortex) was 11.8per cent (10 of 85 cases), while for group 2 (involvingan intact IAC cortex) and group 1 (involving no con-tact) it was 1.0 per cent (one of 98 cases) and 0.0%(no cases), respectively. The frequency of nerve dam-age increased with the number of CT image slicesshowing loss of cortical integrity (p=0.043).

GERMANY Fluoride tablets seem to be effective in reducingthe occurrence of caries in children with already low

caries levels, especially among those whoalso use fluoridated salt as well. However,fluoride tablets increase the occurrence ofmild fluorosis in permanent incisors, researchers reportin the Community Dentistry and Oral Epidemiology (Apr 7,2010; online edition). Results show that the mean mod-ified defs was 3.2, and 58 per cent of children werecaries-free. Twenty-two per cent of the childrenrevealed mild fluorosis. Length of fluoride tablet usewas inversely associated (adjusted for age and SES)with caries-status at two to four years of use. Thisinverse association could mainly be observed in chil-dren who consumed fluoridated salt as well. Relativerisks for mild fluorosis were 1.8 and 2.7 for fluoridetablet use of two to four years and >/=5 years, respec-tively compared with zero to one year of use.

BRAZIL Providing home nutritional advice during the firstyear of life decreases caries incidence and severity atfour years of age in a low income community,researchers report in Community Dentistry and OralEpidemiology ( April 7, 2010, online edition). Findingsreveal that 53.9% of intervention children had earlychildhood caries. Overall, home counselling was deter-mined to have reduced caries incidence by 22 per cent.In all, severe early childhood caries incidence wasreduced by 32 per cent. The mean number of affectedteeth was lower for the intervention group (3.25) com-pared to the control group (4.15) (Mann Whitney U-test; p=0.023). No adverse effects were noted.

W o r l d w i d e d e v e l o p m e n t s i n d e n t i s t r y

ClinicalNewsODA wants better oral health legislated for seniors in long term care facilitiesn Poor oral health can heighten risk of respiratory infections, cardiovascular disease, and diabetes, especially for the frail elderly

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Clarifications and Correctionsn An article in the March 31, 2010 edition of Dental Chronicle

(“Lasers a staple in periodontal treatment,”, p. 1) incorrectly

referred to the position held by Dr. Douglas Dederich. Dr.

Dederich is a periodontal specialist who operates the Dederich

Clinic in Edmonton. He has an engineering PhD in laser/tissue

interaction, and is a professor at the University of Alberta.


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ClinicalNewsfacilitate the placement of dentalimplants in orthodontic care, notes Dr.Zeit. “There are a great number ofmovements that can be achieved becausewe can place anchorage points where weneed them, use them, and perhaps dis-card them,” says Dr. Zeit.

Orthodontics is a specialty that defi-nitely touches other areas of dental caresuch as periodontics, surgery, and prostho-dontics, observes Dr. Sheila Smith, aToronto orthodonist and associate in den-tistry at the University of Toronto.

“If a patient has periodontal disease,it can affect what you want to do ortho-dontically,” says Dr. Smith. “In somecases, combination therapy of orthodon-tics and prosthodontics is necessary.”

Dr. Smith notes the orthodontistmay work with a surgeon to optimize thepatient’s appearance in cases that requirea combination of braces and jaw surgery.

Different diagnostic tools such ascone beam computed tomography permitorthodontists to include accurate three-dimensional measurements in treatmentplans. “It is revolutionizing orthodonticsand what we do,” says Dr. Keith King, anorthodontist in Medicine Hat, Alta.

In addition, three-dimensional imag-ing data can be used to shape the appli-ance, as is the case with robotic wirebending. “It is appealing because it maylead to shorter treatment times, fewer

patient visits, and more accurate results,”says Dr. King, noting SureSmile purportsto offer treatments that will take about 12to 15 months vs. traditional orthodontictreatment that would take two years.

“The down-sides right now arethe high cost, asteep learningcurve, and the lackof scientific data[to support theclaims],” says Dr.King. “We reallywill not be able tomake the claimswithout random-ized, controlledtrials.”

Endodonticsis an area of den-tistry where carehas improved because of advances ininstrumentation, observes Dr. JeffreyCoil, Diplomate, American Board ofEndodontics, director of graduateendodontics, department of oral biolog-ical and medical sciences, faculty of den-tistry, University of British Columbia inVancouver.

Rotary instrumentation has revolu-tionized the way that endodontics is beingperformed, says Dr. Coil.

“Instruments are flexible, and theycan stay in the pathway of the root canal

and follow the curvature,” says Dr. Coil,noting nickel titanium files allow for moreexpected results. “You get a more pre-dictable shape of the root canal becausethe instruments are flexible. That has beena big change for both general practitionersand specialists doing root canals.”

That said, the ability of instrumentsto minimize decay has reached a plateau.Irrigation solutions will represent anopportunity to disinfect the root canal.

“What is emerging as an area offocus is how we irrigate and disinfect theroot canal,” says Dr. Coil. “Instrumentstake some of the bacteria out, but wewant to know what agents should beused at what pressures and volumes [todeal with bacteria]. We are dealing withbiofilms and colonies [of bacteria], whichyou find in waterlines and anywhere.There is a combination of bacteria.”

There are several choices of biologi-cally-balanced solutions that produce acleaner canal. The irrigation solutions areused to remove the smear layer. Tightadaptation to the root canal wall is difficultto achieve if the smear layer is present,and sealing of the root canal system is keyto a successful endodontic outcome.

It is not beyond the scope of gener-al dentists to perform root canals, partic-ularly with the new illumination and mag-nification tools that allow clinicians to seemore than the naked eye sees, but theremay be more complicated cases which

are best referred to an endodontist.“Dentists are trained in dental

school to do root canals, but there maybe cases that may be too difficult forthem to do,” says Dr. Coil.

LESS PAIN FOR MOST PATIENTSDr. Wayne Pulver, a Toronto endodon-tist with more than three decades ofexperience, head of the endodonticsdepartment at Mount Sinai Hospital inToronto, and past president of theOntario Society of Endodontics, saysthe landscape in endodontics haschanged. Better filling materials that aremore biologically acceptable allow forbetter sealing of the canal, he says.

“We now use a mineral aggregate orbioceramic cement which are both moretolerant of tissue,” Dr. Pulver added.

Bioceramic technology features thebenefit of allowing for bonding betweenthe bioceramic sealer and the canal wall,according to Dr. Pulver.

Today, patients undergoing rootcanals experience less post-operativepain because there is less tissue reaction,and patient comfort has also beenincreased with the use of the WANDanesthetic delivery system.

“Most practitioners do a very goodjob of cleaning, shaping, and filling thecanal,” says Dr. Pulver. “There are a lotof GPs out there doing great endodon-tic work. Unfortunately, sometimes theyare not able to delineate between whatthey should or should not be doing.”

Dr. Pulver suggests general dentistscheck with the standards of practicedeveloped by the Canadian Academy ofEndodontics and consider consultingwith an endodontist to get a specialistopinion about a particular case. Thewebsite of the Canadian Academy ofEndodontics features a treatment classi-fication form that allows clinicians todecide on the degree of difficulty andrisk of a particular case.

“Endodontists would help them witha decision about a particular case,” saysDr. Pulver. “They can send the radiographto the endodontist to get their take on acase. The endodontist is there for thepatient and for the referring dentist.”

Dr. Pulver added that in some cases, itis of benefit if GPs refer their patients toorthodontists to ensure patient satisfactionand avoid the potential need for additionalprocedures.

“The geographical constraints inCanada may, for many patients, eliminatethe option to see an endodontist,” Dr.Coil concluded.

DentalChronicle

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Orthodontics and endodontics: Advances in diagnostics help patient carecontinued from page 1—

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Rosacea, a common skin condition, causes rednessin the face which is usually treatable with a topi-cal cream. Dentists, through simple observation,are in an ideal position to recognize the conditionand refer a patient for appropriate diagnosis andtreatment, according to Dr. Steven S. Fuchs, whopublished an article on the topic in the Journalof American Dental Association. To learn

more about rosaceaand how dentists canhelp patients with thecondition, DENTAL

CHRONICLE contact-ed Dr. StuartMaddin, a clinicalprofessor emeritus atthe department of der-

matology, University of British Columbia,Vancouver. In this interview, Dr. Maddin dis-cussed rosacea with assistant editor Josh Long.

What is rosacea, and how common is it?It’s a chronic inflammatory processinvolving the central face. It’s quite com-mon. You’re looking at two per cent,three per cent [of the population].Certainly, it’s been said that sunshine andsun damage do play a role.

What does rosacea look like?Well, usually there’s a redness or erythe-ma, and then some small pimples. Inother words, they’re the kind of peoplewho flush when told an off-color joke.The cheeks, nose, and forehead show theflush or the redness; the eyelids or styesmay be involved. So it’s very easy to diag-nose, and something for which we havevery effective treatment.

Why should a dentist bring rosacea tothe attention of a patient?Everyone benefits, if the dentist does.Especially the patient, because the earli-er the diagnosis is made, the earlier rela-tively inexpensive treatment can bearranged. People appreciate the fact thatsomebody takes an interest in them.These days many dentists, I think, arebeing asked to carry out not only routinemaintenance of the teeth, but they’realso asked to carry out cosmetic proce-dures on the teeth. [If the patient] endsup with a glowing set of nice white teeth,that is accompanied by a red flushed facefull of pimples, it’s not going to do verymuch. The patient would think a lotmore of the dentist who does take aninterest, not just in their teeth, but inproviding sensible information thatwould make them look better.

Who is typically affected?Both sexes, and after thirty-five or forty itbecomes obvious. We’re aware [of somepredispositions], it affects blue-eyed

blondes most often, but the more we getto know about other parts of the world wedo know that patients with darker skinincluding the Chinese are affected.

How can a dentist identify rosacea?Just look at the face, the central face,forehead, chin, nose. There’s nobody

that gazes at that part of the anatomylonger than dentists. The only thing itcan be mistaken for is acne, but acneoccurs in much younger people.

How would a dentist approach the topic?He’d just say to the patient, ‘Looking atyou, how long have you gotten out-

breaks of pimples on your forehead,your cheeks, and your nose? How longhave you been flushed? How long haveyou been red? How often do you getattacks?’ People in this day and age, theydon’t mind being involved, especially if

Rosacea: Dentists in unique position to recognize common skin conditionn Patients likely to respond positively to responsible inquiry and sensible information that would improve his or her appearance

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ClinicalNewsCompetitive environment means some dentists investigating spa servicesn Ability of clinics to offer dental patients additional services such as massage and facial stimulation might be marketing edge

IN A COMPETITIVE ENVIRONMENT AND

economic downturn, dental practi-tioners need to present added value to

their patients, and some are choosing toaccomplish this by incorporating “spa”services in their practice.

“My main goal is to promote healthand smiles,” says dentist Dr. SylvainLaforte, who operates Centre SantéSourire, a dental practice in Montrealthat expanded last fall to offer a range ofspa services to his clientele to provideoverall wellness.

Dr. Laforte saw an opportunity togrow and diversify his business when acommercial tenant in the building heowned left a substantial amount ofsquare footage unoccupied.

“I could have looked for another[commercial] tenant, but then I thoughtabout having a spa in that space,” explainsDr. Laforte, who has both generalist andspecialist dentists working in his practice.“I love spa services and going to the spawith my wife. I enjoy things like massage,

and I thought patients would find it relax-ing and enjoyable to be able to have suchservices available.”

Dr. Laforte hired other health pro-fessionals such as a nutritionist, kinesiol-ogist, psychologist, massage therapist,and medical esthetician to offer a menuof complementary spa services on thepremises, and he plans to hire a physio-therapist in the future.

NEW TECHNOLOGIES ATTRACTIVEApart from hiring staff, he investigatedthe purchase of new technologies tooffer novel spa treatments. One of thesenew technologies is the Dental M6, anon-invasive technology that mechani-cally stimulates muscles in the facearound the mouth, and the upper face,as well as the neck.

The technology performs severalfunctions to optimize an individual’s smileincluding detoxifying tissues around thesmile zone through lymphatic drainage,improving the tone and texture of the

skin around the mouth, lower face, andneck, and decreasing fine lines and wrin-kles around the mouth and neck. “It feelslike your face went to the gym because themuscles in your face get a workout,” saidDr. Laforte. “The muscles in your facefeel like they have been stretched.”

Because the Dental M6 technologyis on wheels, it is highly transportable, soit can be used in dental offices that mightbe short on space and cannot devotesquare footage to strictly spa services,according to Dr. Laforte.

“You can use a room in your [den-tal] practice for other things than justdentistry,” said Dr. Laforte. “It will makeyour practice more profitable.”

Dentists like Dr. Laforte are entitledto a basic training package, aimed at den-tal staff, when they purchase the DentalM6 technology. Indeed, the technologydoes not rob the dentist of time devotedto dental procedures since it can beoperated by non-dentists, including den-tal assistants, in a dental practice.

Dr. Laforte hired a decorator toalter the look of his practice, so it wouldappear more zen-like. The office is dec-orated in earth tones with scents oflavender or mint in the air designed torelax patients. There is a room reservedfor relaxation before and after dentaltreatments and spa treatments, which isequipped with low lighting and musicthat will help patients unwind.

APPEALS TO DENTAL PATIENTSChildren are welcome in the practice,but Dr. Laforte’s staff ask parents tobring children to a soundproof room inthe practice to minimize noise or disrup-tions to the clients undergoing spa serv-ices. Parents can choose to stay in thatroom with their children.

The space can accommodatepatients with disabilities, so those pati -ents can visit the office for dental or spaservices.

Dr. Laforte finds some of his den-tal patients also undergo the spa serviceshe offers while others visit only for den-tal care, and he has attracted a newdemographic who are visiting him forspa services. “We have received a lot ofpromotion through word of mouth[from the patients],” he said.

To encourage the spa portion of hisbusiness, Dr. Laforte is offering certifi-cates for his spa services to some of hisregular dental patients.

The dental spa trend has taken holdsouth of the border, but it is a relativelynew concept in Canada. Linda Mahieddine,vice-president of Montreal-based DanieleHenkel, the exclusive distributor of LPGAmerica’s Dental M6 Technology inCanada, said that many dentists need toaugment their range of services.

“Dentists are very business-orient-ed, and they want something new tooffer to their patients,” Mahieddine toldDENTAL CHRONICLE.

—Louise Gagnon, Correspondent

n Daniele Henkel Inc. is a Canadianleader in the medical aesthetics andtherapeutic industry. For more than12 years, the Quebec-based compa-ny has been providing complete busi-ness solutions, non-surgical aesthetictraining, and medical equipment toprofessionals in the medical, aesthet-ic, and therapeutic fields acrossCanada. More info at: www.danielehenkel.com

10 n May 31, 2010

is instrumental to understand-ing why a patient may be angry,

he says. One of the best ways to determine a patient’s valuesystem is to ask the patient how he or she spent a weekend.This may provide clues as to whether the patient values fam-ily, friends, or his or her own desires.

“You have to make it a regular part of your practice toask questions to learn something about patients,” saidMcDonald. “It is a pre-emptive measure. You need to listen,and it doesn’t hurt to care about patients.”

But when patients are in the act of complaining andthey are upset, that is not the time that you should be askingpatients questions to assess their values, he said.

IT’S CALLED AGGRESSIVE LISTENINGIt’s important to express sympathy when someone is com-plaining and to put one’s self in the shoes of the patient whois complaining, added McDonald.

“The smartest thing to do is express sympathy,” he said.“Sometimes people may realize that what they are complain-ing about is not significant. Sometimes people are looking forsomeone to complain to, and then they may laugh about it.”

Most people who are making complaints and expressingdissatisfaction will possess the ability to reason about the legit-imacy of their complaints, according to McDonald. “Theywill be pleased to know that you wanted to listen to them.”

Exceptionally, there may be patients who are not rea-sonable. They ask to have a procedure re-done when theyvery obviously did not follow instructions that were suppliedto them after an initial procedure.

“There will be a percentage of people who are not reason-

able,” he said. “You may have placed an implant for a patientand told them, for instance, not to eat peanut brittle for 48hours. They may come back after having eaten peanut brittle,and ask that the procedure be done again at no additional cost.They are adamant that you should do the procedure again.”

If a clinician judges the request to be unreasonable, it willbe an opportunity to suggest another surgeon who might bewilling and available to do the procedure, says McDonald.

“In the event that someone is asking for somethingunreasonable and you are not going to give it to them, youneed to help them find another place where they can get whatthey need,” said McDonald. “You may tell them of anotheroral surgeon who is across town who can help them.”

If a surgeon does decide to concede to the request, thesurgeon should state that he or she is not, in principle, inagreement with doing the procedure because the surgeonregards it as unreasonable. A patient is less likely to makeunreasonable requests in the future if the patient is made tofeel guilty about the request, said McDonald.

Still, there are some relationships with patients that areharmful, and severing such relationships is a wise move.“Just make a clean break,” he advised.

Keeping staff members satisfied in their careers is key tomaintaining healthy office morale and maintaining healthy rela-tionships with patients. If staff members are not happy, theirconcerns should be addressed through an office manager when-ever possible. If their concerns have to do with salary, the sur-geon needs to address that issue directly with the staff member.

“If a person needs more money and there is no moremoney to give, you should write a letter of recommendation,and help them find other employment where they will make

Just listening can help defuse problems with patients continued from page 1—

DentalChronicle


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1-800-668-5558 | www.henryschein.ca

Contact your Henry Schein Sales Consultant today for an in-offi ce demonstration!

GOING GREEN

Digital Imaging...

One of the most practical long-term investments a dental offi ce can make.

No Processor

No Cleaners

No FixerNo Duplicator

No Film Mounts

No Disposal Charges

No DeveloperNo RepairsNo Film

Digital radiography eliminates the

need for X-ray processing chemicals

and fi lm. That’s not just good for the

environment, but also leaves more

money in your pocket.

It’s good for your patients too—

with digital X-ray, they are

exposed to less radiation than

with traditional X-rays!

Go Green and $ave Green!


DIGITAL IMAGING IN DENTISTRY IS

being adopted by more and moredentists, and one of the primary

reasons is that digital technology is reallya more eco-friendly approach to imaging.

“The quality and interpretation [ofimages] is unbelievable,” says Dr. WaynePulver, a Toronto endodontist for morethan 30 years, who says the use of digitalradiography in the office diminishesexposure of radiation to patients andalso does away with the processing ofharmful chemicals, which has been aconcern for dental staff.

EXPENDITURE HIGHER INIITIALLY“The fact that we can reduce radiationexposure to our patients and reducechemical exposure to our staff membersis great,” stresses Dr. Pulver. “We areable to send radiographs electronically.These are things that have vastlychanged how we practice.”

There is an obvious financial invest-ment to purchasing and installing digitalradiology technology in a dental office,

notes Clive Roberts, PhD, associate profes-sor, faculty of dentistry at the University ofBritish Columbia, Vancouver.

“The initial cost of the technologyis high, but the diagnosis is better [thanconventional, film-based systems],” saysDr. Roberts.

Dr. Roberts, who works out of theUBC Dentistry Microscopical ImagingCentre where he focuses on imaginganalysis of molecules, cells, and tissues,says the use of digital imaging in den-

tistry is on the increase because not onlyis it environmentally-friendly, but it alsooffers practicality. Indeed, digital imagescan not only be stored for record keep-ing, but they permit clinicians to easilytransfer the images to other dental spe-cialists or to insur-ance firms, asrequired.

“The imagescan be sent viaelectronic e-mail,which allows formore accuraterecord keeping,”adds Dr. Roberts.

A paper pub-lished in theJournal of theCanadian DentalAssociation in 2006found that justover half (52 percent) of 314 den-tists who were sur-veyed said digitalphotography (55per cent) and digi-tal radiography (53per cent) werequite useful orvery useful. Ofnote, less than halfof orthodontists (42 per cent) said digitalphotography (77 per cent) and digitalradiography (42 per cent) were quite use-ful or very useful.

About one in eight (12 per cent) ofdentists said they use digital radiography,and 43 per cent said they use digital pho-tography. Survey respondents cited digi-tal radiology as more useful in a practice

than electronic models, electronic refer-ral forms, and paperless charting,according to Dr. Carlos Flores-Mir, oneof the study’s investigators and associateprofessor and head of the division oforthodontics at the University ofAlberta in Edmonton.

“My perception is that there is acomponent of environmental awarenessin the equation, but other factors mayplay a more important role such as lessradiation exposure, faster processingtimes, and easier storage with digital imag-ing in comparison to the old standardimaging technology,” says Dr. Flores-Mir.

Overall, survey respondents citedthe cost of equipment and lack of com-fort with technology as the biggestobstacles to widespread adoption ofelectronic and digital technologies intheir practice.

“I perceive that the need for techni-cal training, compatible software orhardware, cost of equipment, lack ofcomfort with technology, and securityissues are factors that are taken into con-sideration,” notes Dr. Flores-Mir.

Another paper published in theJournal of the Canadian Dental Associationin 2005 concluded that diagnostic accu-racy using digital radiography is as goodwith traditional film in most cases. Whilealmost all investigators agree that digitalradiography requires less radiation perexposure than film, how much less is atopic that has been up for debate.

Estimates are that digital intraoralradiography demands 50 per cent to 80per cent less radiation per exposure thanfilm. One study of Dutch general practi-tioners found, however, that those den-tists using digital radiography took moreradiographs than those dentists who usedconventional radiographs, detracting fromthe benefit of significantly decreased radi-ation that digital radiography offers.

Traditional film also demands morein the way of greater office space andreal estate, and therefore cost, since adental practice requires more squarefootage to be able to process the film.

Another reason that conventionalradiography will fall out of favor is thatnew entrants to the profession are beinginstructed in digital technology, so it is anatural choice that they will use digitalimaging when they set up their ownpractices, according to Dr. AllanFarman, professor of oral and maxillofa-

May 31, 2010 n 13DentalChronicle

In this unique series of Special Reports, DENTAL CHRONICLE sets out to

examine the primary challenges facing dentists in Canada today. This

secondt instalment in the 2010 series The Year of Green Dentistry

looks at digital imaging, and relates the experiences of some practition-

ers and industry members as they adapt and implement some of these

new technologies. Publication of this series is made possible by Henry

Schein Canada.

“From Henry Schein’s perspective, we really believe it is our responsi-

bility as an active member of the dental industry to look for the trends that

are coming to dentistry,” says Peter Jugoon, Vice President, Marketing

and Planning, Henry Schein Canada. “We are doing a

number of things around being more environmentally

friendly, whether it is internal or external. For example,

our distribution centers have gone paperless, so peo-

ple are walking around with headsets on, being direct-

ed by central command to the bins and the products

they need to pick.” Jugoon noted that Henry Schein

has also reduced paper consumption in their shipment

packing, replacing paper with biodegradeable air bub-

ble pillows. They are also now using brown shipping boxes instead of the

white boxes that had to be manufactured through a bleaching process.

“We are doing more and more to ensure that green products are front

and center,” said Jugoon. “The issue around the environment is not isolat-

ed to dentistry; it’s a global issue that will only continue to grow as time

goes by.

“As the awareness of [green dentistry] increases, as manufacturers

come out with new green products that can be implemented into prac-

tices, and as patients demand it, that puts the impetus on us to provide as

many green solutions as possible.”

COMING IN THE NEXT ISSUE:

Water disposal and water use reduction

This Special Report on Green Dentistrywas written by Louise Gagnon, a frequentcontributor to DENTAL CHRONICLE.

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GreenDentistrySpecial Report: What you really need to know about digital imagingn High quality and better resolution, less potential for adversely affecting staff and environment among key considerations


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Special Report: What you really need to know about digital imagingcial radiology at the School of Dentistryat the University of Louisville inLouisville, Ky., and president of theAmerican Academy of Oral andMaxillofacial Radiology (AAOMR), theprofessional association dedicated toevidence-based diagnostic services inoral and maxillofacial medicine.

“Very few dental students havelearned how to use film,” says Dr.Farman. “Most will ‘go digital’ when theyenter practice. The groundswell is towarddigital, and the use of film is rather passé.”

Apart from chemicals used to processfilm, dentistry has traditionally discardedthe lead foils used in oral radiography,notes Dr. Farman. Dental staff are at veryhigh risk of being exposed to the lead foil.

“One does not wish for lead to beinappropriately recycled,” says Dr.Farman, noting lead is linked to reducedmental capacity in children exposed tounacceptably high levels.

FILM-BASED SYSTEMS IN DECLINEClearly, the adoption of digital radiogra-phy would eliminate the need for intrao-ral dental film with lead foil, and the con-comitant dangerous exposure to dentalstaff and patients, stresses Dr. Farman.

Dr. Farman notes that manufacturersof traditional film-based systems are start-ing to see declines of their sales, which hetakes as evidence that traditional, film-based systems are being phased out ingeneral dental practice and being replacedwith digital radiography technologies.

“Internationally, it depends on thewealth of the country,” says Dr. Farman.“The wealthier countries in the world aregoing digital in dentistry at a faster ratethan countries that are not wealthy.”

Still, the prices of intra-oral X-raysystems and panoramic X-ray systemshave come down since their initial intro-duction. The latest tools, like cone-beam,three-dimensional imaging technology,are more costly than systems that havebeen available for a decade or more.

Dr. Farman notes that that theAAOMR is developing guidelines on theappropriate use of cone-beam, computedtomography in dentistry, which representsa major advance in imaging in dentistry.

Dr. Farman suggests that if a den-tist has not yet gone digital and is con-templating making the transition, he orshe should purchase equipment from amanufacturer that has a strong history ofinvolvement with digital imaging, ratherthan a provider new to the field.

Dentists should also consider otherfactors such as the warranty for the equip-

ment and the service agreement for thetechnology, as well as whether they needto make upgrades to existing equipmentlike monitors to better view the images.

Indeed, digital radiographic imagingin dentistry is maturing and catching on

in Canada and globally. The next frontierfor digital radiography for a jurisdictionsuch as Canada is the implementation ofteledentistry, which has been in develop-ment since 1994 in the US. Teledentistry,like other types of telemedicine, can

either take the form of real-time consul-tations or a “store and forward” method.It would assist in providing specializedoral care to populations that have beenlargely underserved, such as the aborigi-

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continued from page 13—


GreenDentistryDental_May_10_rar12.qxd:Dental_May_10_rar12.qxd 26/05/10 2:19 PM

ODAN LABORATORIES OF MONTREAL

has introduced Rovamycine (spi-ramycin), for the treatment of oral

infections commonly encountered indentistry.

Rovamycine is a macrolide antibiot-ic active against a number of Gram-pos-itive organisms, including S. aureus(including penicillin-resistant strains),beta-hemolytic streptococci, S. viridians,S. faecalis, S. pneumoniae, Cor -ynebacterium diphteriae, clostridia, andGram-negative bacteria.

Rovamycine therapy is bacteriostat-ic at minimum inhibitory concentrations(MIC) and bactericidal at concentrationstwo to four times higher than its MIC.

“When compared to other major,well-known macrolides this antibiotic isvery popular for two reasons,” says Dr.Louis Z. G. Touyz, associate professor ofperiodontics at McGill University’s facul-ty of dentistry, Montreal. “In the pastdecades, Rovamycine has been used lessfrequently than erythromycin, and conse-quently it now has a lower prevalence ofallergies and a rarer prevalence of resist-ance, when compared to erythromycin.

“Most severe diseases involvingreactions from white blood cells willmanifest some form of purulent exudateand when one encounters periodontaldisease forming a lot of pus, I deem

Rovamycine as the drug of choice. Thisis because the drug localizes in leuco-cytes and takes the antibiotic directly tothose sites where the bacteria are active.”

In a recent review of the antibiotic’sindications and modes of action, Dr.

Touyz noted thatover 90 per centof Canadianshave bleedinggums from gin-givitis at one ormore oral sites.Not all cases ofgingivitis progress

to periodontitis, as at most 25 per centmay develop periodontitis, and only asmaller percentage will develop aggres-sive forms of the disease. Rovamycine iseffective against most putativepathogens for these moderate andaggressive forms of periodontitis.

“When compared to other major,well-known macrolides like erythromy-cin, roxithromycin, clarithromycin,josamycin, midemycine, and the azelideazythromycin, Rovamycine has an effec-tive MIC against their combined rangeof susceptible microbiota,” Dr. Touyzwrote in his review, “albeit at slightlyhigher concentrations. Spiramycin asRovamycine has been shown to be effec-tive against a wide range of micro-organisms. Most of these are often

involved in general human infections.”Rovamycine will concentrate intra-

cellularly in scavenger phagocytes andleukocytes and when carried in whiteblood cells to all active loci of infection.In cases of severe periodontitis andnecrotizing gingivitis, Rovamycine con-centrates in neutrophils and polymorphsand is transported by these white bloodcells “to the base of advancing fronts ofperiodontal pockets where bacterialdamage is most active.”

EFFECTIVE WITH METRONIDAZOLE“Combining antibiotic regimens agonisti-cally increases their spectrum of effect,and may be used to control severe infec-tions,” Dr. Touyz commented regarding acombination regimen of amoxicillin(against Gram-positive aerobic organisms)and oral metronidazole (against anaerobicorganisms) that produces a potent effect.

“Because prevalence of penicillin isnow so high, clinically, substitutingamoxicillin with spiramycin [asRovamycine] has been successfullyapplied. Each drug could be prescribedseparately for concurrent use.”

B-lactam inhibitors should not beused in combination with Rovamycine, hecautioned, to avoid linking bacteriocidaldrugs—that interrupt cell wall divisions—with bacteriostatic agents that interferewith ribosomal protein synthesis.

Rovamycine may also interfere withother oxidation, reduction, hydrolysisenzymes and/or cytochrome function,such as cytochrome p450.

Meta-analysis of the efficacy ofantibiotics in gum disease found thatwhile mechano-therapy was effective forboth control and treatment groups, mostsevere cases improved more rapidlywhen systemic antibiotics were alsoused. Accordingly, patients with themost severe periodontitis benefit mostfrom this pharmacotherapy, andRovamycine, alone or in combinationwith oral metronidazole, as an adjunct tophysical therapies, is among the mosteffective treatment regimens (Haffajee etal: Ann Periodontol 2003; 8(1):115).

Tetracyclines are also effective localand systemic agents in periodontitis, Dr.Touyz wrote in his review, but systemicuse of Rovamycine is a better choicewhen the goal is to eliminate spirochetesand putative perio-pathogens from theinvasive climax ecosystem biofilms thatdevelop in this disease.

Available in capsules of 750,000(Rovamycine 250) and 1,500,000 i.u.(Rovamycine 500), the adult dosage ofRovamycine is 6,000,000 to 9,000,000i.u. daily in two divided doses (two tothree capsules of 1,500,000 i.u.) b.i.d. Insevere cases the dosage may be increasedto four to five capsules, b.i.d.

The usual pediatric dose is 150,000i.u. per kg body weight every 24 hoursfor five to six days.

Patients should be cautioned againstthe possibility of rare side effects, such asdiarrhea or other odd symptoms. Shouldthese highly unlikely events occur, stop-page of the medication is indicated.

—Ian J.S. MooreCorrespondent

Rovamycine effective antibiotic treatment option for buccal cavity infectionsn Spiramycin active against many organisms, with a lower prevalence of resistance and allergies compared to erythromycin

nal populationin Canada.

“It [teledentistry] is emerging [as anarea of dentistry] in terms of capabili-ties,” says Dr. Jeffrey Coil, director ofgraduate endodontics, department oforal biological and medical sciences, fac-ulty of dentistry, University of BritishColumbia in Vancouver.

Pilot projects in teledentistry in theUS have demonstrated that access tospecialized dental care has been extend-ed to rural and remote populations inthat country.

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continued from page 15—

Special Report ondigital imaging


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DENTAL TRIBUNE | MAY 31, 2010 Clinical Practice

Using resorbable barriers to make root recession coverage predictableDiagnosis and treatment for a successful outcome, by Drs. David L. Hoexter, Nikisha Jodhan and Jon B. Suzuki

Gingival recession is defined as

the location or displacement of

the marginal gingival apical to

the cementoenamel junction (CEJ).1

Recession is the exposure of root

surface, resulting in a tooth that

appears to be of longer length.

From a patient’s perspective,

recession means an unesthetic

appearance and is associated with

aging onset.

The gingiva consists of free and

attached gingival tissue, as seen

macroscopically. The free marginal

gingiva, located coronal to the

attached gingiva (AG), surrounds the

tooth and is not attached to the

tooth surface. The AG is the kera-

tinized portion of gingival tissue

(KG) that is dense, stippled, and

firmly bound to the underlying

periodontium, tooth, and bone.

In ideal health, the most coro-

nal portion of the AG is located at

the CEJ, where the most apical por-

tion is adjacent to the muco-gingival

junction (MGJ). The MGJ represents

the junction between the AG (kera-

tinized) and alveolar mucosa (non-

keratinized).2

There are numerous etiological

factors that may result in recession.

Generally, the etiology can be cate-

gorized as either mechanical or as a

function of periodontal disease pro-

gression.

Recession usually occurs due to

tooth malposition,3-5 alveolar bone

recession,6,7 high muscle attach-

ments and frenal pull,8 and iatro-

genic factors related to restorative

and periodontal treatment proce-

dures.3,9

The detrimental effects of

recession include compromised

esthetics, an increase in root sensi-

tivity to temperature and tactile

stimuli, and an increase in root

caries susceptibility due to cemen-

tum exposure. Thus, the main ther-

apeutic goal of recession elimination

is gingival root coverage in order to

fulfil esthetic demands and prevent

root sensitivity.

Miller classifies recession defects

into four categories:

o Class I: marginal tissue recession

does not extend to the MGJ;

o Class II: marginal tissue recession

extends to the MGJ, with no loss of

interdental bone;

o Class III: marginal tissue recession

extends to or beyond the MGJ; loss of

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orthothe international magazine of orthodontics

_clinicalTreating class III dento-skeletal malocclusions with the “Muscle Wins” philosophy

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Essential Dental Media

Official Media Partner of

Continued on page 18

Dental Tribune International Publishing Group is

composed of the leading dental trade publishers

around the world. Its combined portfolio includes

more than 100 trade publications that reach over

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guages. The group’s activities also include the organi-

zation of continuing education programs as well as

dental congresses and exhibitions.

The World Dental Federation (FDI) and numer-

ous regional dental associations, such as the Latin

American Dental Federation (FOLA) and the Asia

Pacific Dental Federation (APDF), have chosen Dental

Tribune International Group as their official media

partner.

Dental Tribune is the first global newspaper for

dental professionals in a concise and highly readable

format that is published in the native language of the

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tional correspondent network and renowned local edi-

torial boards ensure the highest journalism standards.

As the Canadian affiliate of the Dental Tribune

International network, Dental Chronicle is pleased to

present this special section containing articles of

interest from the global editions of Dental Tribune.

Management of prospectivepatient phone calls ................19


Clinical Practice DENTAL TRIBUNE | MAY 31, 201018

Resorbable barriers help with root coverageinterdental bone is apical to the CEJ but

coronal to the apical extent of the margin-

al tissue recession;

o Class IV: marginal tissue recession

extends beyond the MGJ; interdental bone

extends apical to the marginal tissue

recession.

A possible treatment modality for

recession includes restorative/mechanical

coverage, such as cervical composite

restorations. This kind of treatment may

effectively manage root sensitivity and

root caries. However, such treatment

entails a longterm compromise from an

esthetic perspective. Composite restora-

tions stain over time, and any marginal

leakage may lead to secondary caries,

recurrence of sensitivity and/or local

inflammatory changes.

Additionally, color matching can be

difficult and such restorations may

involve the undesirable removal of vital

tooth structure in order to create ade-

quate retention form. Thus, clinicians

must determine whether the restorative

benefits outweigh the esthetic shortcom-

ings and whether is it possible to employ

a treatment modality with few, if any,

functional and esthetic disadvantages.

Another treatment modality for

recession is muco-gingival surgery. Muco-

gingival surgery refers to periodontal sur-

gical procedures designed to correct

defects in the morphology, position and/or

amount and type of gingiva surrounding

the teeth.11 In the early development of

mucogingival surgery, clinicians believed

that there was a specific minimum api-

cal-coronal dimension of AG that was nec-

essary to maintain periodontal health.

However, subsequent clinical12-15 and

experimental studies16,17 have demon-

strated that there is no minimum numer-

ical value necessary.

However, for esthetics, a uniform

color and value of AG is desirable among

adjacent teeth.18 Some of the earliest tech-

niques for correcting recession involved

extension of the vestibule.19

The subsequent healing usually

resulted in an increase of AG. However,

within six months, as much as a 50 per

cent relapse of the softtissue position was

reported.20,21 Thus, these techniques did

not adequately address recession.

In order to improve esthetics and

increase KG for root coverage procedures,

current periodontal surgery largely

involves the use of gingival grafts. There

are a multitude of surgical techniques,

which can be distinguished based on the

relationship between the donor and recip-

ient sites.

Gingival graft procedures involve

either (a) pedicle soft tissue grafts, which

maintain the pedicle blood supply or (b)

free autogenous soft tissue grafts.

Techniques involving the latter type

require the clinician to prepare two sur-

gical sites: one to harvest the tissue and

another one to prepare the recipient site.

In this case, the autogenous softtissue

graft has a separate blood supply to the

recipient site. Combinations of (a) and (b)

have also been reported.22-24

The pedicle soft-tissue graft was first

described by Grupe and Warren in 1956.25

This involved raising a full thickness flap

and laterally positioning and then sutur-

ing donor tissue into place from an adja-

cent area while maintaining a pedicle

blood supply. This technique and others

that followed were designed to increase

the zone of AG.

Later modifications of the technique

included the double papilla flap26—intro-

duced by Cohen and Ross in 1968—the

oblique rotational flap,27 and the rotation-

al flap.28 Another type of gingival move-

ment flap was described later as the coro-

nally repositioned flap.29 This technique

involves mobilizing a full thickness flap

and repositioning the tissue to the CEJ,

thereby covering the exposed recession.

The use of free gingival grafts was

described in the 1960s by Sullivan and

Atkins.30 The free autogenous graft can

be made up of either epithelialized gingi-

va or connective tissue.

Initially, the therapeutic goal was to

increase the zone of KG. The clinical

objective has now evolved to covering the

recessed root with a zone of attached KG.

This can be achieved in one or two

stages. Initially, Sullivan and Atkins

described a one-stage procedure in 1968.

Its purpose was to increase the zone of KG

without concentrating on coverage of a

recessed root. In the 1980s, a two-stage

modification was suggested for an

increase in root coverage, which proved

to be more successful with increased pre-

dictability. This involves first placing the

free gingival graft or the free connective

tissue graft apical to the area of recession

and using the coronally repositioned tech-

nique after healing.

Free autogenous grafts are predomi-

nantly harvested from the palate.

Recently, materials other than gingival

grafts have been explored. Using a guided

tissue regeneration (GTR) technique, an

acellular dermal matrix has been report-

ed to yield favorable outcomes in root cov-

erage.31,32 This material may provide the

patient with a less invasive alternative

than a palatal donor site in order to

achieve root coverage.

Procedures combining both free

grafts and pedicle techniques have also

been detailed. For instance, when a con-

nective tissue graft is employed, the graft

is placed sub-epithelially with a coronal

advancement of the overlying keratinized

tissue. GTR techniques have also been

developed more recently. In 1992, Pino

Prato, et al described a combination tech-

nique of sub-epithelial placement of a

membrane with coronal advancement of

the flap, such as e-PTFE.33

The function of the membrane is to

maintain space during the healing peri-

od for tissue regeneration to occur. From a

patient's perspective, biodegradable mem-

branes with GTR might be preferable in

order to avoid a second-stage surgery for

membrane removal.

The goal is to restore gingival

health, color, and esthetics by covering

the exposed root predictably with healthy

gingival tissue and, in doing so, decrease

sensitivity. Using GTR and coronal reposi-

tioning techniques, we achieve pre-

dictably covered roots.

Variations in muco-gingival proce-

dures have been developed to include root

surface bio-modifications by treating the

root surfaces with a variety of materials.

These measures enhance the regenera-

tion process of a new connective tissue

attachment. In order to increase root cov-

erage, a new clinical attachment is nec-

essary.

Root surface bio-modification

involves treating the root surfaces with

citric acid, tetracycline, or EDTA in order

to remove the smear layer and expose

dentinal tubules and thus facilitate a new

fibrous attachment. An enamel matrix

derivative claimed to support the action of

enamel matrix proteins by inducing acel-

lular cemetum, periodontal ligament,

and alveolar bone formation is also avail-

able in the range of root surface bio-mod-

ification materials.

The following case report considers

predictable esthetic root coverage by com-

paring a GTR technique to a non-GTR

technique in a split-mouth procedure

involving the same patient.

Case report

A young, adult male patient presented

with recession bilaterally in his maxilla.

The upper right maxilla had extensive

recession on teeth #6 and #7 (Fig. 1). The

upper left maxilla had similar recession

on teeth #11 and #12. Additionally, tooth

#11 had a cervical groove, which was

stained and hard but not decalcified.

After local anesthesia using lido-

caine, the desired flap design was com-

pleted. There was an adequate zone of KG

present before treatment, which was pre-

served and repositioned.

Upon reflection of the tissue, the full

Fig. 1: Pre-op labial view of anteriorteeth: recession on tooth #6; tooth#7 surrounded by a small adequatezone of keratinized apical tissue.


Fig. 2: Flaps reflected preserve theinterproximal tissue, which preservesthe blood supply and preventsblack triangles (unesthetic interproximalspaces)

Fig. 3: The GTR membrane was shaped andplaced over the root surfaces of teeth #6 and#7.

Fig. 4: Gingival tissue was coronallyrepositioned, covering the membranesand the roots of teeth #6 and #7, andsutured in place.

Continued from page 13

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It's the usual busy day in the dental

practice. The phone is ringing. Patients

are flowing in and things are moving

along smoothly. Sure there’s a cancellation

or two and maybe an emergency. As the

dentist passes the front desk, he hears

Linda, the business assistant, wrapping

up a conversation.

“No, I’m sorry, we don’t.” We don’t what?

What don’t we do that someone wants to

know about? The dentist makes a mental

note to follow-up with Linda. He’s overheard

her give similar replies in the past and

meant to ask her about it before.

Here’s what the dentist didn’t hear …

Linda: Good morning, Dr. Stanton’s office,

Linda speaking.

Carolyn: Hello Linda, my name is Carolyn

Samson. I recently moved to town and I

was just calling to find out if the doctor is

accepting new patients.

Linda: Yes, he is, although the schedule is

pretty full right now.

(Without even realizing it, Linda is send-

ing a message to this prospective patient

that she might not be welcome in the

practice. It’s already a busy place and

Linda doesn’t know how the office is

keeping up with the patients it has, let

alone encouraging any new patients to

join. That comes through loud and clear

to the caller.)

Carolyn: Do you offer any Friday after-

noon appointments?

Linda: No, I’m sorry, we don’t.

(Silence ensues for a few moments while

Carolyn waits for another option from

Linda, but none is offered.)

Carolyn: OK, thank you. Goodbye.

To Linda, this is just a routine inquiry -

nothing special, and she doesn’t think

much about it. After all, there’s no estab-

lished protocol. She’s just answering ques-

tions as they come in.

No, the practice doesn’t offer Friday

afternoon appointments because the office

is closed, but perhaps the practice offers

Wednesday evening appointments or

Saturday morning appointments.

Alternatively, perhaps the practice

sees new patients at a specific time of day

so that the dentist can spend quality time

with the patient and is less likely to be

interrupted with emergencies or oral

hygiene exams.

Yet, Linda makes no effort to offer

possible alternatives or to educate the

patient on the options and why they would

be worth considering. She simply answers

the questions the prospective patient asks

and feels she’s done her job. It’s a common

scenario because few practice employees

are trained to properly handle phone

communication.

Meanwhile, dentists go about per-

forming dentistry and seldom give those

perfunctory phone duties a second

thought. In fact, only 12 per cent of den-

tists believe the telephone has a major

impact on their practice even though it is

typically the only point of entry for new

patients.

In addition, only 5 per cent of prac-

tice staff is trained to properly handle

patient phone calls. The vast majority

simply wing it.

DENTAL TRIBUNE | MAY 31, 2010 Clinical Practice 19


Are new patients tripping over your phone line?Consultant discusses importance of making prospective patients feel welcomed over the phone


The irony is that while dentists typically

place little importance on the telephone,

this is the make it or break it point of con-

tact in the opinion of most patients. It is

through the telephone conversations with

your office that prospective patients begin

to assess the competency of the dentist and

team and whether this practice deserves

their business and that of their families.

In today’s consumer-driven dental

marketplace, the old cliché that you only

get one chance to make a first impression

couldn’t be truer. If your practice doesn’t

measure up, chances are very good that

prospective new patients will be moving

on to the next office on their list, and this loss is yours.

In fact, if poor telephone protocol causes your practice

to lose just 20 new patients a month and each would spend

an average of $1,000 on dental care a year, that’s 240

patients and nearly a quarter of a million dollars.

But it’s usually not until dentists start feeling the

effects of poor phone communication in the form of sched-

uling problems, fewer new patients, no shows, financial

strain, etc., that they begin to question just how those per-

functory phone duties are handled.

Have you been disconnected?

How well does your team manage phone calls from cur-

rent and prospective patients? The truth is you don’t know

until you hear both sides of the conversation. In the med-

ical community, “mystery shoppers” have been used for

several years. Dentistry is embracing the concept as more

practices have come to realize that they are profoundly

dependent upon a satisfied patient base.

McKenzie Management has developed a telephone

assessment protocol in which a professionally trained and

certified “mystery shopper” makes multiple calls to a den-

tal practice and assesses the effectiveness of the team’s tele-

phone skills.

The calls are recorded and the dentist has the oppor-

tunity to hear firsthand what is transpiring between

his/her staff members and prospective patients. What we

are finding is that dentists are often very surprised by

what they hear and, unfortunately, not in a pleasant way.

Dentists really cannot judge how well their staff members

handle telephone communication until they hear it first-

hand. Does the business team use proper phone etiquette

and correct grammar? Do patients have to wait too long on

hold or for someone to answer?

How does the staff handle questions and requests for

information? What are the staff ’s tone, attitude, and

demeanor? Do staff members come across as welcoming

and helpful or annoyed and rushed? Most importantly, how

many new patients might be lost month after month

because of inadequate telephone protocols?

While the reality of how phone calls are commonly

handled can be an unpleasant shock, we also find that it

tends to be a major incentive for dental teams to identify

exactly where protocols can be established so that the

practice can make improvements right away.

Often times, very capable dental employees unwitting-

ly drive new patients away because they simply haven’t

been trained, and educating staff on effective telephone

communication can significantly improve their approach.

Moreover, it can prevent the loss of hundreds of patients

and tens of thousands of dollars every year. However, it

doesn’t stop there.

Callers expect follow-through

Another element of effective telephone communication is

follow-through. Take the example of Carolyn Samson who

tried to get an appointment in Dr. Stanton’s office.

She calls your office again and requests that infor-

mation be sent to her home about the dentist and what

the practice has to offer. She’s also interested in any liter-

ature on whitening and implants. Ms. Samson is a profes-

sional.

Any service purchased—whether it’s service for her

car, her home, or her oral health—is purchased only after

careful research and evaluation.

Your business assistant is busy with a number of

things on this Monday morning. She quickly jots down Ms.

Samson’s name and address and promises to mail the

information out as soon as possible.

In this instance, as soon as possible is about three

months later when your business assistant happens upon

the scrap piece of paper with her note to “send practice

info, whitening, implants to Carolyn Samson, 222 Green

Street.” Prospective new patient Ms. Samson has likely

already found her new dentist by this time.

All the superior dentistry you have to offer cannot

make up for a lack of follow-through on the part of your

staff. The experience that prospective new patients have

when they call your office is the make it or break it oppor-

tunity.

It doesn’t matter if they know you personally. It doesn’t

matter if they’ve heard you’re fantastic from their colleague

or personally seen your work and been wowed by it.

If the front desk is too busy to take the time to make

prospective patients feel valued and welcome, if the mate-

rial they request is never received, if they simply don’t get

the impression that their investment in your practice will

be appreciated, they are not likely to bother making the

appointment.

For most practices, just being aware of how prospec-

tive new patient inquires are handled is a big step in the

right direction. Start paying attention. Keep a list of the

types of questions and requests the practice receives and

The World’s Fastest Matrix?

- Takes less than 5 seconds to apply ...

DENTAL TRIBUNE | MAY 31, 2010

First impressions impact businessContinued from page 19

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extent of the underlying recession was

evident (Fig. 2). The area and recession

were uncovered following removal of

debridement and granulomatous tissue.

The resorbable membrane material

was shaped and placed on the exposed

roots. The membrane was first placed on

tooth #6 and thus the tooth appeared

darker as it absorbed blood. The mem-

brane was placed on tooth #5 second and

thus the tooth had not absorbed the blood

at the time of the photograph, which

accounts for the color difference at this

time.

The coronally repositioned flap was

sutured in place with the flap covering

the now submerged membranes and pre-

vious recession (Figs. 3, 4). Periodontal

dressing (Coe-Pak, GC) was utilized as a

bandage and placed over the surgical

area. It was removed a week later at the

same time as the sutures. The patient

then lavaged and returned to the usual

oral hygiene routine, initially lightly and

gradually more vigorously.

Once healed and oral health was

maintained, the recession was covered

and health regenerated. Upon periodontal

probing, no pockets were present (Fig. 5).

The final view presents a visual symme-

try of health and color that is maintain-

able.

Recession was also present at the

maxillary left side (teeth #11 and #12; Fig.

6). After local anesthesia of the areas

involved, a full thickness mucoperiosteal

flap was completed. This exposed the

extent of the recession defects (Fig. 7).

Tooth #11 was treated, as was the other

side of the mouth, by utilizing the GTR

technique using an acellular connective

tissue membrane to preserve the space

for regeneration.

Tooth #12 was treated the same way,

except that no membrane barrier,

resorbable or non-resorbable, was used

(Figs. 8, 9). Thus, there was no use of a

GTR technique on tooth #12. Both teeth

had the flap manipulated with the coro-

nally repositioned graft, covering the

recessed root and suturing to the CEJ

level.

Both sides were covered with peri-

odontal dressing. Antibiotics (tetracycline)

and an analgesic (Tylenol-Codeine) were

prescribed for the first week after the

operation.

One week after the surgical phase,

the dressing and sutures were removed

and the mouth lavaged. Oral hygiene was

restored to good, maintainable habits fol-

lowing the healing phase of over two

months. Upon observation, tooth #11, for

which the GTR membrane had been

employed, had re-attached healthy gingi-

va that was not probable.

The recessed root and the stained

cervical groove were covered. In contrast,

tooth #12, for which no GTR membrane

had been utilized, displayed recession as

prior to the surgery (Fig. 10).

In summary, this split-mouth tech-

nique demonstrated that using an acellu-

lar resorbable barrier membrane is more

predictable for achieving root recession

coverage than coverage of a recessed root

without such a membrane.

Dr. David L. Hoexter, Tel.: (212) 355-0004

E-mail: [email protected]

Clinical Practice DENTAL TRIBUNE | MAY 31, 2010

Acellular resorbable barrier membrane useful

22

Continued from page 20

discuss how the office responds to these.

If patients are asking for information that

you don’t have readily available, establish

a timeline to create the necessary infor-

mational materials. Establish a protocol

for handling all inquiries, including calls

from new patients seeking appointments,

calls from prospective patients seeking

information about the dentist, the prac-

tice, procedures offered, etc.

Prospective patients who request

information must be sent the material the

day the request is made—not the next

day, not at the end of the week, not when

the business team gets around to it—the

day they ask for it.

Consider including additional infor-

mation about the practice such as the

dentist’s commitment to providing the

best possible care for patients; informa-

tion emphasizing specific qualities about

the practice that set it apart from others;

dentistry for the entire family; painless

dentistry techniques; cosmetic dentistry;

sedation dentistry; a commitment to

never make the patient wait more than

five to 10 minutes, etc.

Prospective patients are giving you

permission to market your practice, to

educate and inform them.

They expect it and they want to

know what you have to offer. Make the

most of it.

If ever there were a perfect occasion

to sell the practice and the services

offered, it’s when prospective new

patients call your office. They are inter-

ested, ready, and willing to learn more.

Make sure that your frontline is well

trained and prepared to welcome every

caller to your practice and you’ll ensure

that prospective new patients don’t get

tied up in your phone lines.

Sally McKenzie is CEO of McKenzie

Management, which provides success-

proven management solutions to dental

practitioners nationwide. She is also edi-

tor of The Dentist’s Network Newsletter at

www.thedentistsnetwork.net; the

e-Management Newsletter from

w w w . m c k e n z i e m g m t . c o m ;

and The New Dentist magazine,

www.thenewdentist.net.

She can be reached at (877) 777-6151

or [email protected]

Fig. 5: Post-op view: the previouslyrecessed roots of teeth #6 and #7 arecovered with attached pink, keratinizedgingival tissue, with no pocketdepth upon probing.

Fig. 6: Pre-op labial view of anterior teeth.

Fig. 7: Cervical groove on tooth #11 is solid,hard and non-carious.

Fig. 8: GTR membrane placed overthe root surface of tooth #11 only; nomembrane was placed on the surfaceof the recession of tooth

Fig. 9: Gingival tissue coronally repositioned tocover the GTR membrane on tooth #11 andtooth. Fig. 10: Post-op view.

Ensure staff respond to inquires in a timely mannerContinued from page 20

About the author

Contact the author


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DENTISTS FROM THE UNIVERSITY OF

British Columbia who took care ofthe oral health care of Olympic

athletes did not win a medal, but theygained memories that will last a lifetime,says Dr. Chris Zed. Dr. Zed led dentalcare on behalf of the VancouverOlympic and Paralympic 2010 WinterGames Organizing Committee.

“My previous experience with theOlympics has always been from a specta-tor stand point until now. Being involvedin taking care of dental services to theathletes was an amazing way to beinvolved,” says Dr. Zed, associate deanof UBC Dentistry, Vancouver.

One of the most memorable, butunpleasant, moments was when NodarKumaritashvili, a 21-year-old Olympicluger from Georgia died in a track acci-dent during a training run hours beforethe official start of the Winter Games.

“Our team was there when Nodardied, and I feel it is the most memorablehospital/polyclinic moment. We feltdeep sadness for his family and his fellowteam-mates from Georgia,” said Dr. Zed.

This experience helped provide per-spective and insight into what these ath-letes do, as well as the amount of effort,energy, and risk involved in promotingtheir sport and moving forward toaccomplish their athletic goals.

“It was an experience that allowedus to recognize how fortunate we are asclinicians to be able to help, but to cometo terms with the fact that sometimesunfortunately we cannot help,” he said.

On a more positive note, Dr, Zedadded that his more clinical memorable

moments happened when treating a goldmedallist who actually brought their goldmedal into the clinic. He indicated thatthe athlete was interested in advancingtheir overall oral health.

During the conversation with theathlete, Dr. Zed commented that theindividual held onto their medal andthen spoke about what it means to be alead Olympic athlete and to be an over-all representative for their country andtheir sport of choice.

“I think listening to this particularathlete speak inspired our staff to feellike they wanted to be a team of profes-sionals and to showcase the elite den-tistry services that Canadians have accessto, in regards to quality and patient caredelivery,” he told DENTAL CHRONICLE.

Over the course of the Olympics,Dr. Zed indicated that his team of vol-unteers—consisting of dentists, hygien-ists, and dental assistants—took turnsworking two eight hour shifts daily andwere on call 24 hours a day, seven days aweek to look after the dental care of

both Olympic and Paralympic athletes.“I am grateful for all of the volun-

teers who took time out of their sched-ule to assist us in taking care of the ath-letes. These individuals were really com-mitted,” said Dr. Zed.

He added that often times whenthey were in a pinch with regards to astaff shortage his team members wouldtake on extra shifts in order to fulfil thedental care clinical requirement.

Dental service over the course of theOlympics was the second busiest health-care service, according to Dr. Zed. Hisdental team screened and took care ofapproximately 18 per cent of the athletes.

“We were surprised to find thatsome of the elite athletes had bodiesthat were in top shape yet their oralhealth was so poor. Really, it was toughto believe that there was such a majordisconnect between their mouth and therest of their body,” Dr. Zed commented.

The overall dental care focus forthe Olympic Games consisted of anoral cancer screening and awarenessprogram; dental trauma care responseassistance; and a dental injury preven-tion program, which involved encourag-ing athletes to use mouth guards.

Also, Dr. Zed noted that they had asun awareness program aimed at increas-ing awareness regarding risk associatedwith sun exposure and its correlation tolip cancer among alpine athletes.

“There are definitely evidence-based studies out there that report on the

risks associated with high levels of sunexposure and damage to the lips, as wellas the potential of sun exposure accumu-lation years down the road resulting inpotential cancer,” he cautioned.

Dr. Zed told DENTAL CHRONICLE

that he was pleased with the overall careprovided. His team, through dental screen-ing of athletes, saw and treated everythingfrom tooth decay to lost and broken fill-ings, to abscesses, to acute infections, andto trauma and dental fractures.

Overall, the promotion of theirmouth guard and mouth trauma preven-tion program resulted in providing 200athletes with mouth protective devices.

Dr. Zed said that one of his mostspectacular spectator Olympic momentsinvolved watching Alex Bilodeau winCanada’s first gold medal.

“Most people said, wow he won thegold medal. I, however, thought tomyself, wow, he is wearing a mouthguard, which he spat out as he rantoward his brother.”

—Lynn Bradshaw

24 n May 31, 2010 DentalChronicle

Leisure, travel, and making the most of your own time

DentalVitaeP r o f i l e

Providing oral care atVancouver Olympics Local dental team treated athletesn Message: Some athletes don’t take care of their oral health

in the same way they look after the rest of their bodies

it’s going to help improve their appearance.

How important is early detection and management?The earlier the intervention, the more satisfactory the outcome. The less damage tothe face, and the easier it is to control. The longer it persists, the more fixed it gets,and the more difficult it becomes to treat.

What are the more severe manifestations of the disease?Ocular rosacea, the area around the eyes can get red, and styes, and it gets pretty ugly.Or the drunkard’s nose, the big red bulbous nose, that’s part of rosacea.

How and where would a dentist typically refer a patient for medical diagnosis?Well, the patient that you’re working on usually has a family practitioner. So you say tothe patient, ‘Look, if I were you I would check with my family physician. You just tellthem you’ve got this problem and it’s gotten worse, you have some concerns.’ You cantell the patient if the doctor doesn’t want to do it, they can refer them to a dermatolo-gist.’

What are the current therapeutic options? There’s a flock of them. There are [topical] therapies with metronidazole [such asNoritate, MetroGel, Rosasol, etc.] and more recently azelaic acid [Finacea]. If it’s moreadvanced the doctor may have to prescribe [systemic] doxycycline or tetracycline.Residual effects or broken blood vessels can be successfully treated with a laser.

Rosacea: Dentists can help patientscontinued from page 9—


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Therapeutic Spotlight Please circle the numbers corresponding to the product on which you wish to receive information

Please send me information concerning the products selected above

Your name..............................................................................................................................................................................................Your practice address ..........................................................................................................................................................................Your city, prov., code ............................................................................................................................................................................E-mail address ......................................................................................................................................................................................You may... o request this material by e-mail: [email protected] o request this material by fax: 1-800-865-1632o request this material by mail: Dental Chronicle, 555 Burnhamthorpe Road, Suite 306, Toronto, Ont. M9C 2Y3

Clinpro 5000 1.1% Sodium FluorideAnti-Cavity toothpaste strengthensenamel and reverses white spotlesions. Contains fluoride, calcium,and phosphate,componentsfound in saliva. Abarrier is createdaround the calcium so it can coexistwith fluoride ions, but saliva breaksdown the barrier and the other ingre-dients are absorbed by the teeth, pre-venting the initiation and progressionof demineralization. From 3M ESPE.Circle #113 on feedback form

The Quick-Stat FREE by VistaDental products is a colorless, non-staining viscous gel that controlsminor bleeding. The combination ofa propri-etary sur-factantandpaddedStat-Flo Tip for delivery, allow betterwound penetration and more pro-found hemostasis. From BiscoCanada.Circle #114 on feedback form

Medicom SafeMask Guardian isan innovative procedural face maskwith a unique patented antimicrobialand antiviral technology. Treatedfabrics traps and inhibits bacterialsurvival and propagation. It can actas anextra lineofdefensefor alldentaland medical professionals, andpatients. From Medicom.Circle #115 on feedback form

TempSpan Transparent TemporaryCement, a colorless eugenol-freeresin-based cement for retaining pro-visional restorations, secures provi-sional crownsand bridgeswithout influ-encing theoverlying color. Light cure for aninstant set or wait 5-½ minutes for achemical cure. Easily removed with-out damaging preparation or restora-tion. Auto-mix syringe. From PentonClinicalCircle #116 on feedback form

Centrix Encore D/C MiniMix is thefirst dual-cure, automix compositecore buildup sold by the dose. Each

kit con-tains 36cartridges,netting0.5 mL ofmaterial.

Each cartridge has its own mixingnozzle and our exclusive needletip.Available in two radiopaque, fluo-ride shades. From Centrix Dental..Circle #117 on feedback form

AurumTek milled custom implantabutments are compatible with avariety of implant systems. Palette ofshades ensure seamless transitionbetween abutmentand crown.Customize height,width, margin, andangulation.CAD/CAM milled in-house in as littleas two days. Titanium base allows ametal-to-metal connection betweenscrew and abutment. From AurumCeramic Dental Laboratories.Circle #118 on feedback form

Zimmer ERA Mini Implant Systemby Sterngold Dental, LLC, is nowexclusively distributed by Zimmer

Dental Inc. Thesystem enablesthe transitionalfunction of a den-ture during theosseointegrationof traditionalimplants, as wellas long-term,

affordable, chair side denture stabi-lization. From Zimmer Dental Inc.Circle #119 on feedback form

Build-It Light Cure Core Materialformulation produces outstandingphysical properties and is compatiblewith 4th through 7th generation bond-ing agents.Cures to adepth of 10 mmwith 20 sec-onds of curingtime per surface; no need for layer-ing. Non-sticky, sculptable handlingfor quick and easy use on tooth struc-tures and posts. In both syringe andsingle dose. From Penton Clinical.Circle #120 on feedback form

Medicom SafeGauze Green, envi-ronmentally friendly in every respect,uses onlyorganicallygrown cotton,completely freeof toxic pesticides and insecticides,chlorine, and bleach. Uses FSC certi-fied Lyocell, a wood pulp based fiber;100% natural and 100% biodegrad-able. A portion of sales proceeds isdonated to ChariTREE, the children’senvironmental learning and treeplanting charity. From Medicom.Circle #121 on feedback form

Vista Visco-Tip can help you deliv-er calcium hydroxide with precisionand ease. The flexible end on thispatented tip conforms easily to dif-ferent canalshapes andimproves theflow of viscousmaterials.Combine it withVista-Cal orother brands of calcium hydroxide.From Bisco Canada.

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A selection of the month’s most innovative new products

Web site URLs for Dental Chronicle advertisers

Bisco Canada http://www.biscocanada.com Dentsply Canada http://www.dentsply.ca Germiphene http://www.germiphene.comGSK Inc. http://www.www.gsk.caHenry Schein http://www.henryschein.caMedicom http://www.medicom.comOdan Labs http://www.odanlab.com Oral Science http://www.oralscience.comsanofi-aventis Canada http://www.sanofi-aventis.ca

READER SERVICEFor more information on these advertised products circle the correspondingproduct number. Visit http://www.dentalchronicle.info for more informationBisco Canada ........................................Vista Dental Products 101Dentsply Canada ....................................Aquasil Ultra 102Germiphene ............................................Amalgam Boss 103GSK Inc. ................................................Sensodyne 104GSK Inc. ................................................Pronamel 105Henry Schein ..........................................DEXIS 106Medicom ................................................SafeTouch Gloves 107Medicom ................................................SafeGauze Green 108Medicom ................................................Duraflor Halo 109Medicom ................................................Safe Mask 110Odan Labs ..............................................Rovamycine 111Oral Science ..........................................Cetacaine 112

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26 n May 31, 2010

The Toronto Globe & Mail Data suggestsOntario and Quebec have similar toothdecay rates, despite the Quebec is theprovince with the lowest fluoridation rate of municipal water supplies, whileOntario has the highest rate (April 16, 2010).

Although individuals from Quebechave more cavities than people inOntario, the difference is slight. Datashow among children aged six to 19years—considered the most decay-pronepart of the population—the rate inOntario was lower by less than half acavity per child. Similarly, in the six to 11year old age groups, Ontario kids have3.5 per cent fewer cavities than those inQuebec: 1.7 cavities compared to 1.76 inQuebec. In the 12 to 19 age group,Ontario youths have 15.8 per cent fewercavities than those in Quebec: 2.35 cavi-ties compared to 2.79.

Times of India Research published inPreventive Medicine suggests green tea con-tains antimicrobial molecules called cate-chins that may promote dental health(April 20, 2010).

During this investigation, YasushiKoyama of the Tohoku UniversityGraduate School of Medicine and col-leagues looked at more than 25,000

Japanese men and women between age 40 and 64. Findings reveal that men who drank at least

one cup of tea a day were 19 per cent less likely tohave fewer than 20 teeth than those who did notdrink green tea. Tea-drinking women had 13 percent lower odds. Investigators concluded that greentea may have bacteriocidal effects, which would havea positive effect teeth, but only the tea is consumedwithout sugar.

Sky News A dental device called CarieScan PROmay assist dentists in the detection of early toothdecay, which might make drilling and fillings history(April 6, 2010). The device passes a small electricalcurrent through the teeth; when tooth decay isdetected, CarieScan PRO uses traffic light colors toindicate to the operator the level of decay.

“What I’ve been able to do is diagnose decayearly and make sure it’s treated with fluoride varnishrather than putting in a filling,” said Wembley, UK-based dentist Dr. Martin Delahaye. The device isundergoing further trials, including in the US.

What the lay press is saying

You just got back from Australia, how did you place in that race?I was in sixth place going into the long day which is usually mystrength. I wasn’t happy being sixth having won a race before,so I made a move to try to win. As it happens with the extremeheat and humidity, this time I ended up getting a cramp andhaving to wait a few hours at a rest point. Out of two-hundred[racers], I came in seventeenth. Only one hundred and fortyactually finished the race. I didn’t place [as] competitively as Iwould have liked.

I imagine the Canadian Forces keep you pretty active. To whatdegree did your military training prepare you for the run? Well, when you’re a member of the Canadian Forces you areallocated a certain amount of extra hours for physical training.So, I have the benefit of an hour and a half for lunch hour if Ineed it. I also have access to a state of the art gym I can useevery day that’s only five minutes away from the doorstep of myclinic. That’s like a blessing that I was definitely able to use. AlsoI have access to the [the gym facilities] twenty four hours a day.If I have to do a really long run, maybe about four or five or sixhours on a treadmill, I don’t have to worry about the gym clos-ing time or anything like that. Access to facilities is the pricelessadvantage I have over being a dentist in a private practice.

Of all the physical challenges you've faced before, where doesthis rank? This ranks by far the hardest.

And what of the non-physical challenges? My mom’s a cancer survivor and I remember first goingthrough the ordeal a few years ago and at that point I thought,“you know what, that’s what real struggle is about.”

At no point in my training or my desert race, no matter

how much distress I was in, or how much pain I was in, did Iconfuse it with the other kind of stress in my life. I treatCanadian Forces members that put themselves and their bodiesin harms’ way for decisions that our government makes to pro-tect our interests. And you realize the stress their families gothrough months at a time when they’re doing their tours.Those are the real guys that actually should be commended forall the stress they have to work through.

Having participated in more than two desert races, you nowqualify for the last race, on the continent of Antarctica. Do youever plan to visit the frozen continent? The fee for Antarctica is too prohibitive. It’s a ten-thousand-dollar fee to take part in the race, and for that reason I chosenot to do that part. I chose to do the Australia race because Iwanted to do four races, I wanted to do a thousand kilometersin total and it’s hard for me to walk away from a sport that Iexcel at and enjoy, but at a certain point you have to draw yourpriorities. I have my family to think about, I can’t spend thatkind of money.

Plus you're trying to raise money for charities. That was also very taxing because when I was raising money forthe United Way, it was very difficult to explain to people that Iwasn’t collecting money for myself that I was collecting for [theUnited Way] and I was racing for free. But the fact of the mat-ter is I paid for my race and all my expenses myself.

In this instalment of Dental Chronicle’s ongoing series of interviewswith notable clinicians and researchers, Dr. Danis spoke with assis-tant editor Josh Long. The editors invite your suggestions for future subjects of this feature. Please e-mail your suggestions to:[email protected]

TTeenn mmiinnuutteess wwiitthh...... Capt. Mehmet Danis

DentalChronicle

DentalVitae

CCaapptt.. MMeehhmmeett DDaanniissis a dentist with the CanadianForces stationed in Toronto wholikes to run races that can last fordays. He’s participated in four250 km desert races— the Gobiin Mar. 2008, the week-longAtacama Desert Crossing in Chilein 2009, which he won, theSahara race in Oct. 2009, and hejust returned from another desertrace in Australia in early May.Each time, he has raced to raisemoney for the United Way. So far,he has raised about $10,000.


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dental chronicle - may 2010

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