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A Statistical Look at the State of Dentistry (see page 106) Dentaltown Magazine www.dentaltown.com October 2011 » Volume 12, Issue 10 October 2011 » Volume 12, Issue 10 » Practice Management/Statistics Howard Speaks: Howard Goes to Mexico page 12 Professional Courtesy: Profile: AMD LASERS Can Golf Help Your Dental Game? page 16 Meet the Ironman of Dentistry page 94 Should You Bother with Long-term Care? by Dr. Douglas Carlsen, page 62 Periodical Publications Mail Agreement No. 40902037 A Division of Farran Media, LLC www.dentaltown.com DOES YOUR FLOW GIVE YOU ONLY HALF RESTORATIONS? )'& ( %$# # & ( %$$) ® #%!$ ""# $'""%" ' ! #$#' %&"#" '#&( %$'" "##$ (&( "%&"# ! #$# Only 2.99% vol. shrinkage* Extreme high radiopacity of 500 Al% for GrandioSO Flow White Opaque shade to line cavity margins. Easy x-ray Flow and Heavy Flow *"#$+ ' ! #$#$$" #$" % " %##%"# ##"#$ "$ # Highly viscous GrandioSO Heavy Flow does not slump 12 shades are available in non dripping syringe or unit dose caps including A5 for geriatric dentistry Excellent polish and polish retention " " ""( %" FREE SAMPLE &( ' ' " ' # $'''& " Call 1-888-658-2584 VOCO America, Inc. · 555 Pleasantville Rd Suite 120 NB · Briarcliff Manor, NY 10510 · www.vocoamerica.com · [email protected] contents October 2011 Long-term Care: insurance feature Should You Bother? You can’t be sure if or when you will need long-term medical care. Dr. Douglas Carlsen explains how to approach the insurance issue. 62 106 by Douglas Carlsen, DDS 62 dental statistics dental statistics http://www.adea.org/publications/tde/Documents/See%20All%20Predoctor al%20Dental%20Applicants%20and%20Enrollees%20GraphsLatest.pdf http://www.adea.org/publications/tde/Documents/Total%20U.S.%20Dent al%20School%20Graduates%201960-2009.pdf A statistical look at the state of dentistry 34.3% 39.4% I I I Utah 1 Alan Miller, founder of AMD LASERS I I I I I 2008-09 I I I I Number of Dental School Graduates Per Year Source: American Dental Association, Survey of Advanced Dental Education, 2008-2009 http://www.adea.org/publications/tde/Documents/Total%20U. S.%20Dental%20School%20Graduates%201960-2009.pdf Articles 12 16 Howard Speaks: I Went to Mexico and All I Got Was This Incredible Experience Each month, Dr. Howard Farran shares his unique insights about the dental profession. This month, Dr. Farran’s message to dentists centers on his recent mission trip to Mexico, providing dental care to those in need. Professional Courtesy: Better Dentistry Through Golf Dr. Thomas Giacobbi talks about the connection between golf and dentistry. 18 Second Opinion: The Importance of the Generalist-Specialist Relationship in the New Economy Dr. Jay Reznick explains that in order to keep the dental profession afloat, general dentists and specialists must work together. 68 Why You Should Know: W Promote Dr. Thomas Giacobbi introduces readers to W Promote, a full-service online marketing firm. 70 Rent-a-Dentist Dr. Joe Steven Jr. explains the importance of having a dental community. I I dentaltown.com « October 2011 I 54 October 2011 » dentaltown.com Statistics 4,796 2000-01 continued on page 80 78 It’s All About 1 West Virginia Texas I I I % .3 46 % .2 47 % .5 46 % % .0 .6 45 46 % .2 44 1960-61 1 Virginia Tennessee I 1 I % % .8 .7 53 52 % % .4 53 .3 53 % % .9 54 .7 55 3,253 1 4,171 04 10 1970-71 3 Wisconsin 2 Washington 1 3,749 20 20 09 08 20 3 20 03 20 02 01 20 20 00 20 1 1980-81 % 07 .9 43 20 % 05 1 5,256 % .6 .0 56 % % .3 44 .7 43 20 06 2 South Carolina 4 1990-91 % .1 20 13,742 12,178 4,796 1 Ohio 1 Oregon 2 Oklahoma 2 Pennsylvania 1 Source: American Dental Education Association, U.S. Dental School Applicants and Enrollees, 2009 and 2010 Entering Classes http://www.adea.org/publications/tde/Documents/Applicants%20by%20Gender,%202000%20to%202009.pdf 36.2% 12,463 4,714 http://www.adea.org/publications/tde/Documents/2010%20Dental%20Schools%20list.pdf 1 4,233 55 56 % .7 41 % .4 56 % .3 40 % .7 59 Female 46.1% 41.7% 10,731 4,515 2008 Male vs. Female Dental School Applicants Male 9,433 4,478 2007 Nebraska 1 2006 New Jersey 2 4,350 2005 Applicants 58.9% 57.7% 7,537 8,176 54.3% 4,443 2004 Graduated 53.7% 7,770 4,349 2003 82.6% 7,412 4,367 2002 North Carolina 1 4,171 2001 Missouri 3 4,233 5,123 2000 Mississippi 1 Michigan 2 Maryland Iowa Illinois 1 Minnesota 3 Massachusetts 1 Kentucky 1 Louisiana 3 Florida Arizona 1 Indiana Alabama Colorado 1 Georgia 1 District of Columbia 6 Connecticut 2 California EDUCATION Current Number of Dental Schools by State 1990 Nevada statistics Percentage of Dental School Graduates vs. Applicants New York about it’s all 1 continued on page 64 October 2011 » dentaltown.com 79 Check out this statistical look at the state of dentistry. 76 Restoration of a Central Incisor with Tetric EvoCeram Dr. David Hacmoun discusses the intricate fabric of enamel in this restorative case presentation. 82 12 Marketing Ideas that Don’t Break the Bank The marketing budget is often the first area to get cut during a recession. Dr. Rhonda Savage explains smart ways to market a practice. 92 Precision in 3D Dr. Justin Moody discusses the benefits of using CBCT for implants and implant restorations 94 Office Visit: I Am Ironman Winner of the Rhode Island Half-Ironman and practicing dentist, David Kahn balances his two passions. 100 Office Visit: Serving Those Who Have Served Dentists and students at University of Las Vegas volunteer at a charity for veterans to receive needed dental work. 104 Shared Traits of Highly Successful Practices Rachel Stutzman identifies five key commonalities among dental teams that contribute to the success of the practice. Dentaltown (ISSN 1555-404X) is published monthly on a controlled/complimentary basis by Dentaltown.com, LLC, 9633 S. 48th St., Ste. 200, Phoenix, AZ 85044. Tel. (480) 598-0001. Fax (480) 598-3450. USPS# 023-324 Periodical Postage Paid in Phoenix, Arizona and additional mailing offices. POSTMASTER: Send address changes to: Dentaltown.com, LLC, 9633 S. 48th St., Ste. 200, Phoenix, AZ 85044 continued on page 4 2 October 2011 » dentaltown.com “T “The he HyFlex CM™ file is a fantastic instrument for the gener general en al practitioner practitioner tione oneer looking to achieve excellence in endodontics endodontics. tics The tics. The he HyFlex C CM M™ fifile ille addresses ddresses both the science and art of of modern moddeern endodontics.” endodontics endodontics. endo doodoontics o ” ® ® John R. 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USA & Canada 800.221.3046 | 330.916.8800 Fax 330.916.7077 | coltene.com PATENT T PENDING contents October 2011 continued from page 2 Message Boards Townie Clinical 26 Practice Management: The Most Important Measure of Dentist Efficiency Dentists have so many different practice styles and staff sizes. What is the best metric for comparison? 42 36 Practice Management: Morning Huddle – Again Did you give up on the morning huddle? Give it a second chance. Hygiene and Prevention 113 114 From Trisha’s Desk: Creating Your Personal Oral Health Directive Perio Reports • Perio Pathogen Linked to Brain Abscess • Saving Questionable and Hopeless Teeth • Obesity and Dental Caries in Adolescents, No Direct Link • Toothbrush Age and Plaque Removal • Triple-headed Toothbrush • Soft vs. Medium Toothbrushes 118 120 124 Hygienetown.com Message Board: Tongue Stud Damage – A Case Study 126 Hygienetown.com Message Board: Increase Doctor’s Production Profile in Oral Health: Townies Doing Research Feature: Facing Our Fears Kathy Beard, RDH, discusses her personal experience with obsessive-compulsive disorder. ©2011 Dentaltown.com, LLC. All rights reserved. Printed in the USA. Publications Mail Agreement #40902037 Return undeliverable Canadian addresses to Station A, P.O. Box 54, Windsor ON N9A 6J e-mail: [email protected] 4 October 2011 » dentaltown.com Cosmetic: Difficult Veneers This well-documented case followed all the right steps, and the feedback is priceless. Learn from this case! Product Profiles 80 86 Zest Anchors Zest Locator Overdenture Attachments Removable Prosthodontics: An Overlooked Opportunity Dr. Frank Lauciello of Ivoclar Vivident tackles the issue of prosthodontics among the baby-boom generation, and explains how the need is growing. In This Issue 6 22 50 60 91 112 128 Dentaltown.com Highlights Industry News New Product Profiles Dentaltown Research: Endodontics Around Town: The 2011 Greater New York Dental Meeting Ad Index Dentally Incorrect remium P Partials & Dentures Premium Denture Heat-cured Lucitone 199TM Fracture resistant Premium teeth Free patient ID $ 129 00 Complete - Per Arch Cast Metal Partial Fracture resistant premium teeth Accurate fit Non-allergenic $ 149 00 Per Arch Partial About Us... • A full-service dental lab for over 40 years • Convenient 7-10 day in-lab turnaround time • We do NOT outsource to other labs Non-allergenic - monomer-free Includes premium teeth $ 14900 Partial - Per Arch • 5 year guarantee – FREE remake policy* • Member NADL (National Association of Dental Labs) * Certain limitations and restrictions apply Authorized Lava®/IPS Emax®CAD Milling Center Call: (800) 443-8048 www.continentaldental.com DentTown 10-11 dentaltown.com highlights ▼ CASEPRESENTATION Implant Case – Variations on a Theme Another terrific case of an implant-retained partial denture. Variations on a Theme DENTALTOWNFEATURES MESSAGEBOARDS ▼ Monthly Poll Posterior Composite Techniques, Tips, Tricks, Black Magic, etc. Looking for a tip, trick or technique? ▼ Posterior Composite Techniques Removable Prosthodontics Have you delivered more than six arches of complete dentures in 2011? A. Yes B. No I Would Like to Extract Teeth This collection of oral surgery videos will be very informative! Like to Extract Teeth CONNECTWITHUS Find Dentaltown on Facebook www.facebook.com/dentaltown Follow Dentaltown on Twitter www.twitter.com/dentaltown Media Center Video: After reading “Howard Speaks: I Went to Mexico and All I Got Was This Incredible Experience” on page 12 visit the media center to view a video with more of Howard’s thoughts on this subject. Online CE Balancing Esthetics and Function of Direct Composite Restorations – Jason Olitsky, DDS In this course, Dr. Jason Olitsky shares his philosophy for creating beautiful smiles with one of today’s contemporary direct composite materials. continued on page 8 6 October 2011 » dentaltown.com Visit Booth 1314 at ADA Nearly 4 million patients have seen the light. How many patients are looking for you? With nearly four million smiles* and counting since 2001, Zoom is the undeniable world leader in professional in-office whitening systems. Using proven light-activated technology to provide dramatic results in one office visit, it’s no wonder that patients ask for Zoom by name more than any other professionally dispensed whitening system. Whether you are looking to attract new patients, energize existing patients, or enhance your treatment portfolio, Zoom is an excellent choice. • Clinically proven to whiten an average of 8 shades in 45 minutes† • The professional whitening system asked for by name • Full range of marketing materials to support implementation into your practice Get Zoom and get going. Call (888) 576-4466 to learn more. philipsdiscusdental.com/zoom.php * Data on file. † Excluding preparation time. © 2011 Discus Dental LLC. All rights reserved. To be dispensed by a dental professional only. ADV-3478 090911 dentaltown.com highlights continued from page 6 11 Message from the Online Community Manager ▼ 10 Just Better Together Some things in life are just better together, like peanut butter and jelly, movies and popcorn, Tom Selleck and a moustache. The best combination in dentistry is Dentaltown.com and Dentaltown Magazine. Even though your Dentaltown.com account will never expire, your Dentaltown Magazine subscription will. Sure, you can view the current and archived issues online, but you can’t If you have questions about the site, call me at 480-445-9696 or e-mail me at [email protected]. See you on the message boards, Kerrie Kruse Online Community Manager login when you’re on an airplane, and let’s face it, your kids are usually hogging your iPad. Send in the renewal card from this issue or log in to Dentaltown.com and visit the My Profile section to continue to receive our Website’s better half. And, like Tom Selleck’s moustache, it’s nice to look at! HELPCENTER GETTAG Feature of the Month Throughout Dentaltown You might not always have time to read a thread in its entirety, but you never have to lose your place in the discussion. Use the bookmark feature to track where you are in threads so that you don’t miss a post. Check out the Help Center’s Feature of the Month for more information! Magazine, you can scan tag codes to access information directly from your smartphone. To scan these codes, visit http://gettag.mobi/ to download the free barcode reader to your mobile device. You can then scan every code you see in Dentaltown Magazine to access additional information, enter contests, link to message boards, comment on articles and more! VIDEOTUTORIAL How to Update Your Signature Let Townies know more about you and where you practice by setting up your signature. You can add a custom image and link it directly to your Web site. Go to the Media Center and click on the Tutorial section to watch a short video with step-by-step instructions. 8 October 2011 » dentaltown.com SAME SUBSTANCE. TRANSFORMED. Gutta-percha. Crosslinked gutta-percha core. GuttaCore obturators are the first to feature a core made of actual gutta-percha that’s been crosslinked. Crosslinked gutta-percha gains a subtle, flexible strength that won’t melt when heated, yet allows you to retreat or create post space with unprecedented ease. Call 1-800-662-1202 for a demo that might change the way you think about obturators. New GuttaCore obturators. Transforming gutta-percha from the inside out. © 2011 DENTSPLY International, Inc. ADGCCGPCO8/10 DENTSPLY Tulsa Dental Specialties DENTSPLY International, Inc. 5100 E. Skelly Drive, Suite 300 Tulsa, OK 74135 1-800-662-1202 1-800-597-2779 (fax) www.tulsadentalspecialties.com dentaltown staff Editorial Advisory Board *Continuing Education Advisory Board Member Rebecca Bockow, DDS Krieger Aesthetic & Reconstructive Dentistry Seattle, WA Kenneth Koch, DMD Real World Endo Wilmington, DE Dennis Brave, DDS Real Word Endo Wilmington, DE Arnold Liebman, DDS Dr. Arnold I. Liebman Brooklyn, NY Doug Carlsen, DDS Golich Carlsen Denver, CO Stan Mcpike, DDS Stan Mcpike, DDS Jonesboro, AR Howard M. Chasolen, DMD Sarasota, FL John Nosti, DMD, FAGD, FACE Advanced Cosmetic and General Dentistry Mays Landing, NJ Mark Fleming, DDS* Mark J. Fleming, DDS, Inc. Sarasota, FL Krzysztof Polanowski, DDS Stomapol Serocka, Wyszkowa, Poland Regional Sales Managers Mary Lou Botto • [email protected] Steve Kessler • [email protected] Geoff Kull• [email protected] Seth Gibree, DMD, FAGD North Georgia Smiles Cumming, GA Jay Reznick, DMD, MD Southern California Center for Oral and Facial Surgery Tarzana, CA Executive Sales Assistant Leah Harris • [email protected] Stephen Glass, DDS, FAGD* Advanced Dentistry of Spring Spring, TX Lloyd Ritchie Jr., DDS Lloyd K. Ritchie Jr., DDS Pensacola, FL Brian Gurinsky, DDS, MS Brian Gurinsky, DDS, MS Denver, CO Donald Roman, DMD, AFAAID Roman Dental Arts Paramus, NJ Eyad Haidar, DMD Weston Dentistry Weston, MA Tom Schoen, DDS Schoen Family Dentistry Wabasha, MN Joshua Halderman, DDS Northstone Dental Group Columbus, OH Timothy Tishler, DDS Northbrook Dental Care, Ltd. Northbrook, IL Glenn Hanf, DMD, FAGD, PC McDowell Mountain Ranch Dentistry Scottsdale, AZ Glenn van As, BSc, DMD Canyon Dental North Vancouver, British Columbia, Canada Editorial Director Thomas Giacobbi, DDS, FAGD • [email protected] Hygienetown Editorial Director Trisha O’Hehir, RDH, MS • [email protected] Editor Benjamin Lund • [email protected] Assistant Editor Marie Leland • [email protected] Copy Editor/Staff Writer Chelsea Patten • [email protected] Creative Director Amanda Culver • [email protected] Graphic Designer Corey Davern • [email protected] Vice President of Sales & Business Development Pete Janicki • [email protected] Marketing Director Jerry Kaster • [email protected] Circulation Director Marcie Coutts • [email protected] I.T. Director Ken Scott • [email protected] Internet Application Developers Angie Fletchall • [email protected] Nick Avaneas • [email protected] Electronic Media Production Artist Amy Leal • [email protected] MultiMedia Specialist Devon Kraemer • [email protected] Message Board Manager/Director of Continuing Education Howard M. Goldstein, DMD • [email protected] Online Community Manager Kerrie Kruse • [email protected] Publisher Howard Farran, DDS, MBA, MAGD • [email protected] President Lorie Xelowski • [email protected] Controller Stacie Holub • [email protected] Receivables Specialist Kristy Corley • [email protected] Seminar Coordinator Colleen Larkin • [email protected] 10 October 2011 » dentaltown.com William Kisker, DMD, FAGD, MaCCS* Dental Care of Vernon Hills Vernon Hills, IL © 1999–2011 Dentaltown.com, LLC. All rights reserved. Printed in the USA. Copyrights of individual articles appearing in Dentaltown reside with the individual authors. No article appearing in Dentaltown may be reproduced in any manner or format without the express written permission of its author and Dentaltown.com, LLC. Dentaltown.com message board content is owned solely by Dentaltown.com, LLC. Dentaltown.com message boards may not be reproduced in any manner or format without the expressed written consent of Dentaltown.com, LLC. Dentaltown makes every effort to report clinical information and manufacturer’s product news accurately, but cannot assume responsibility for the validity of product claims or typographical errors. Neither do the publishers assume responsibility for product names, claims, or statements made by contributors, in message board posts, or by advertisers. Opinions or interpretations expressed by authors are their own and do not necessarily reflect those of Dentaltown.com, LLC. The Dentaltown.com “Townie Poll” is a voluntary survey and is not scientifically projectable to any other population. Surveys are presented to give Dentaltown participants an opportunity to share their opinions on particular topics of interest. LETTERS: Whether you want to contradict, compliment, confirm or complain about what you have read in our pages, we want to hear from you. Please visit us online at www.dentaltown.com howard speaks I Went to Mexico and All I Got Was This Incredible Experience by Howard Farran, DDS, MAGD, MBA, DICOI; Publisher, Dentaltown Magazine About 20 years ago, I was invited to give a lecture in Lafayette, Louisiana, by one of the world’s greatest dental implantologists, Dr. Jerome Smith. When I arrived Jerome began telling me about the missionary dental clinic he’d set up with Dr. Carl Breaux and the Rev. Larry Myers of Mexico Ministries in Atoyac de Alvarez, Guererro, Mexico. It wasn’t really a clinic, seeing as they didn’t have a proper facility, and at the time they were only set up for extractions. Jerome asked me if I’d consider going on the next trip with him. I figured it was worth the experience, so I left my brand new family, practice and the United States and shot down to Mexico. Now, I’m not the most religious guy in the world, but going on this trip with Jerome and his crew was one of the very few spiritual experiences I’d ever had in my life. Like you probably are now, I was carrying a lot of weight on my shoulders between the stress of home and raising a family, to the stress of the dental practice and managing a staff and patients. I was trying to learn endo, perio, pedo and prostho. I had so much on my mind then, but when I arrived in Atoyac de Alvarez, and I started working on people who had no electricity, sewage or running water, everything I was worried about back home melted away. It was one of the most relaxing environments I’d ever been in. The poverty these people lived in was hard to imagine, yet everyone there had a smile on their faces. There were no phones or fax machines or freeways. Nobody was late for work, nobody was worrying about how much they owed on their Visa card. Nobody was stressed out – aside from the fact that they needed medical care. They were the happiest most thankful people I’d ever seen in my life. I bumped my head one time and 20 kids laughed about it for 10 minutes straight. It was so cool. I came back from that trip more energized and excited and ready to work than if I’d gone on a two-week cruise in the Bahamas. I’m serious. Jerome Smith is very devoted to this mission. He’s traveled to this area in Mexico 35 times in the last 20 years and has sunk a lot of his own personal money into giving this severely underserved population medical and dental care. He has attracted a growing list of volunteer physicians, dentists and nurses, along with lay people who have given generously of their time and resources to this “work in progress.” Slowly but surely Jerome and his team have laid a foundation, built some brick walls and have brought the people of Atoyac de Alvarez a full-fledged clinic for medical, dental and plastic surgery. Jerome recently invited me to travel with him to Mexico this year, and this time I brought two of my four sons with me. We made the trek with three dental school instructors and seven dental students from the Arizona School of Dentistry & Oral Health – A.T. Still University. It was so rewarding for me to watch these seven dental students go to work. We treated more than 300 patients on this trip. We would work all day and talk about dentistry until midnight every single day. These students entered into the sacred and sovereign profession of dentistry for all the right reasons – treating their fellow man and doing the right thing every time. They’re not out to “make a killing,” work two days a week and drive Beemers and Benzes around. We’d talk all night about stuff like composites and the aesthetic/health compromise. My boys got to talking with these dental students and really got turned onto dentistry – for the first time I can remember! I can’t think of any other trip I’ve taken my boys on that had such a positive impact on all of us! I can retire and die in peace after witnessing the next crop of dentists getting ready to enter the profession with such passion and drive to do the right thing. They did such great work on this trip to Mexico. Dentistry is going to be in great hands. Some time in your careers as dentists, you owe it to yourself to take a trip like this. There are so many reasons for it! Yes, you are serving a needy population of people who are grateful for your help, and that is by far one of the greatest rewards of going on a missionary trip like this. But there are other, more subtle benefits to you. I grew up Catholic and Catholics are big into marriage retreats. When we were little, once a year, our mom made us go on these weekend retreats with the Catholic church. We’d comcontinued on page 14 12 October 2011 » dentaltown.com howard speaks Find us on Facebook continued from page 12 www.facebook.com/dentaltown plain and moan about it for days, but we always returned home better for the experience. It took us out of our routines and opened our eyes to the world around us. That’s what this trip to Mexico was like for me and my sons! Guys, you don’t realize how much time you are spending on e-mail, texting, reading, working and watching 24hour news channels until you’re taken out of your element. What is great about trips like these is being able to break your routine. When you leave your home, leave your country and go to a village that doesn’t have an Internet connection or even a telephone, you begin to realize how weighted down you are. In that week I talked to my sons more than I talked to them the entire summer – and we all live under the same roof! I work, they work, our social lives rarely intersect, we’re all preoccupied with e-mail and texting, someone usually has headphones on and if we’re ever in the same room, one is playing a video game, the other is watching ESPN and the other one is on the phone. We’re spending time occupying space, but not spending any quality time together. But being down there in the jungle for a week we had some of the deepest discussions we had in months, if not years. It was just an incredible father and son experience. Here’s something else you should always remember: We have it good here in the States. The United States and Great Britain are two of the richest nations on the planet. When we look at the almost 200 countries that make up the world, 20 of those countries Howard Live Seminars 2011-2012 Howard Farran, DDS, MAGD, MBA, DICOI, is an international speaker who has written dozens of published articles. To schedule Howard to speak to your next national, state or local dental meeting, e-mail [email protected]. 14 10-14-11 ■ Bucks County, Pennsylvania Eastern Dental Society [email protected] www.eastern-dental.org 2-17-12 ■ Tarzana, California Southern California Oral/Facial Study Club [email protected] www.facebook.com/pages/SoCalOralFacial-Study-Club 818-996-1200 3-2-12 – 3-3-12 ■ Birmingham, UK The Dentistry Show www.thedentistryshow.co.uk October 2011 » dentaltown.com have 82 percent of the world’s wealth and the remaining countries fight over the remaining 18 percent. On Planet Earth today, you have about seven billion people, and for one billion of those people, it’s a pretty awesome life; for the next four billion, life isn’t quite so awesome; and for the bottom two billion, life really sucks. And of that bottom two billion there are thousands of people who wish they’d never been born. To think that it’s 2011 and the number-one cause of death on the planet is diarrhea from drinking tainted water is just grotesque. We drive around in our brand-new, sleek, tricked-out cars equipped with GPS and satellite radio and Bose surround-sound systems, and every three seconds some toddler in the third-world dies from diarrhea. Not to mention the horrific turmoil in places like Sudan that should outrage every single one of us. Even if we don’t want to go on trips like this, we should at least throw some money at people like Jerome and the other volunteers who do! I’m sure Jerome Smith doesn’t want me to write this but I am going to write it: The operating budget for his facility in Mexico is somewhere around $100,000 a year and Jerome, along with Drs. Russell Romero, Carl Breaux, Tom Mattern and Tom Watson have run this operation for about 20 years. Jerome has gone down there 35 times. He and a handful of volunteers are this village’s only health care. Dentaltown Magazine reaches more than 100,000 of you each month. If each one of you donated a dollar to Jerome Smith each year, this clinic in Mexico could operate worry free. Here’s the bottom line: I highly recommend taking yourself out of your comfort zone and traveling to a far off land to do dentistry for a population that really needs you. Did you read that? I’ll write it again. They need you! You need to reconnect to the reason we all got into this great profession in the first place – to help those in need. It’s a professional spiritual awakening, I swear. You need to get away from your morning lattés and e-mail. You need to leave your cell phone, fax machine, iMac and iPad behind. You need to stop stressing about your crazy schedule, new patients, broken appointments, overhead, the economy, the debt ceiling and the Republican debates! Ditch your life for five days. Make this your vacation! Why sit on the beach like a lump for a week when you can change the lives of people who need you? If you don’t want to travel, OK, fine, then how about you open up your pocketbook and donate some money to a guy like Jerome Smith. Log on to www.latinworldministries.com, check out the Web site, and give him $20, or $50 or even $100! Donations can also be mailed directly to: Latin World Ministries 2 Whitney Circle Texarkana, TX 75503 You can afford to skip a steak dinner one night. Instead of the $75 you’re going to drop at the restaurant one night this week, go buy some Kraft dinner and some fish sticks and put the rest of that money to good use. The world will be better for it. ■ Simply the Best, Simply BlueLine ® BlueLine® Esthetic Denture Teeth embody the true beauty and detail found only in natural dentition and are ideal for either complete or partial dentures. • Exclusive BlueLine® layering process for natural esthetics • Simplified mould selection with the patended BlueLine FormSelector® Prescribe BlueLine on your next case! 100% CUSTOMER SATISFACTION GUARANTEED! ivoclarvivadent.com Call us toll free at 1-800-533-6825 in the U.S., 1-800-263-8182 in Canada. ©2011 Ivoclar Vivadent, Inc. BlueLine and Formselector are registered trademarks of Ivoclar Vivadent. professional courtesy Better Dentistry Through Golf by Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine Has a patient ever asked you why dentists like golf so much? Did you know there is more to the connection between golf and dentistry than just an old stereotype? I recently slipped a golf question into Dentaltown.com’s monthly online poll because I was curious to know if I was playing as much golf as my colleagues. I was shocked to discover only 18 percent of respondents play golf more than 15 times per year. I thought that number would be higher. Another 34 percent surveyed indicated they play less than 15 times per year for a total of 52 percent who play golf. I thought it would be helpful to compare dentists to the general population. The best statistic I found was in the neighborhood of nine percent (which means there are 28.6 million golfers over the age of six, according to a National Golf Foundation report published in 2009). Ask a patient why there is such a high percentage of dentists who play golf, they might say, “Because they are rich and work four days a week.” I would suggest that the relationship between golf and dentistry is much stronger than that. GOLF DENTISTRY • Golf is an adjunct to many business meetings because it will reveal more about the people you are with than a business lunch. • Put someone in a dental chair and you will learn things about him that his friends don’t know. • Golf is filled with highs and lows; you can be playing well and then lose your composure after you hit an errant shot. Now you must figure out a way to get back on course. • Some procedures are completed without complication, but others present surprises when your patient is “feeling it,” your proximal contact is light, a file is separated, a root tip breaks off, an impression has a bubble… figure out a solution and get your case back on track. • Golf will test your patience. • Patients will test your patience. • Golf is never the same game twice, even when you play on the same course. • Every day in your dental practice is different, even when you see the same patients from one day to another. • Putting requires a player to read the contours of the green and make a decision about the best path and speed for his putt. • Dentistry requires that a dentist can mimic the existing contours of an anterior tooth when shaping a composite filling on the adjacent tooth. • Golf is a game you can play with others, but the end result is yours alone (your score). • There are many people in your office who help you do dentistry, but you are ultimately responsible for the end results. • Read a golf magazine and you will find endless articles about improving your game and the latest equipment. • Read a dental magazine and you will find endless articles about improving your practice and the latest equipment to assist your efforts. • A small number of golfers are quick to purchase the latest driver or newest game-enhancing ball. • A small number of dentists will be the first on their block to own the latest piece of equipment or newest material. • Golfers buy new equipment to hit the ball straighter, farther or improve accuracy. • Dentists buy new equipment and materials to provide faster, better or more profitable dentistry. • No matter how good you are at golf, you want to get better. • No matter how long you’ve been a dentist, you can always get better. • The satisfaction from sinking a long putt, hitting a great drive or scoring a birdie brings you back for more. • Cementing a crown without adjustments, finishing an extensive treatment plan or receiving a letter from your patient; these are moments that make it possible to come back another day. Golf Trivia The golf tee was invented by a dentist. Dr. George Franklin Grant received a patent for “an improved golf tee” in 1899. There were other methods for teeing up a ball prior to his patent, but Dr. Grant has been credited as the inventor of the modern, wooden, peg golf tee by the United States Golf Association. 16 October 2011 » dentaltown.com The conclusion is simple, play more golf and your dentistry will improve. Please post this article on your refrigerator when you are out at the golf course so your family will know why you went golfing. If you have a question, or just want to go out for a round of golf, you can reach me by e-mail: [email protected] ■ NEW, NEW W, from the leader in rotary rotar cutting technology technology... ologyy... . 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Reznick, DMD, MD Second opinions are common in health care; whether a doctor is sorting out a difficult case or a patient is not sure what to do next. In the context of our magazine, the first opinion will always belong to the reader. This feature will allow fellow dental professionals to share their opinions on various topics, providing you with a “Second Opinion.” Perhaps some of these observations will change your mind; while others will solidify your position. In the end, our goal is to create discussion and debate to enrich our profession. –– Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine Times have changed since I went to dental school. Back then, dental education was about preparing the student to graduate and go out into the world and practice general dentistry. We had exposure to the dental specialties, such as endodontics, orthodontics, periodontics and oral surgery. But our didactic instruction and clinical experience was limited to the very basics and to simple cases that could be done easily by the average general dentist once in practice. For oral surgery, it involved a oneweek rotation in the junior and senior years in the school clinic, plus an additional week rotation at a state veterans’ facility and a public hospital. The cases the students managed were basically periodontally involved teeth with mostly intact crowns. Anything more complicated, such as surgical extractions, impacted teeth and soft-tissue procedures, other than a simple biopsy, was a case for the oral surgery residents. Dental implants were relatively new on the scene. Dr. Branemark had just introduced the concepts of osseointegration and modern implantology to the world. Not even the residents were doing implants then. Only the faculty was allowed to place implants, and only after completing an official certification course. Much has changed in dentistry since then. In many of the specialties, new instruments and materials have been developed to help make challenging procedures much easier, safer and more predictable. Most of these were introduced for use by specialists, but over time, many of these new endodontic shaping and filling systems, orthodontic brackets, wires and appliances, surgical instruments and dental implant systems have made their way into general dental offices. Most of these were used in offices of general practitioners whose practices were in more rural and remote areas, as every city, large and small, had more than its share of specialists who were available to treat the more complicated cases and patients. In the 90s and early 2000s, there was no financial pressure for general dentists to perform specialty procedures, since the economy was doing well and everyone was busy doing cosmetic and other lucrative elective cases. Why would anyone want to start doing impacted wisdom teeth, implant surgery, molar root canals, periodontal surgery, orthodontic therapy and similar treatment when those procedures could be difficult and complicated, even in the hands of experienced specialists? Who needed the headaches, especially when one could make more money doing more familiar, less stressful dentistry? The relationships back then between general practitioners and specialists were very strong. Every GP had two or three colleagues in every specialty to whom they referred their patients for braces, root canals, oral surgery, dental implants and periodontal procedures. Every specialist, in turn, had a list of dozens of “A” and “B” referrals, as well as a hundred or more “C” referrals who kept their schedules busy. Lavish holiday gifts, ski trips and dinners were commonplace for busy specialists to thank the general dentists who kept the patients and cash flowing. About 2007, things started to change and we started hearing about a recession on the horizon, but few of us paid any attention to it. I remember at the 2008 Townie Meeting hearing the first reports of practices slowing down. But for most of us, things were still great. Then, in September 2008, the stock market crashed and Alan Greenspan officially declared the U.S. economy was in a recession. That was when most of us started seeing a change in our practices, no matter where we practiced. Dental manufacturers saw decreased demand for many of their products and really started promoting more orthodontic, endodontic, periodontic, surgical and dental implant procedures to the general practitioner in an effort to maintain sales. This started a revolution in dentistry, in which many general dentists enrolled in continued on page 20 18 October 2011 » dentaltown.com second opinion continued from page 18 “What I have become increasingly concerned about is GPs getting in over their heads and getting their patients and themselves into trouble.” continuing education courses in order to increase the scope of their practices. Overall, this was a good thing since this increased access to advanced dental treatment for many patients who were unwilling or unable to travel to see a specialist. However, in the last year or so, we have seen a major change due to significant economic shifts. Patients are routinely delaying or deferring necessary dental and medical care because of job loss, loss of investments and fear of what might lie ahead. There are very few dental practices that have not been affected by the current economy. Fewer patients are calling for appointments, and even very successful practices are having trouble filling their chairs. With fewer patients coming in for restorative dental procedures, many practices are trying to fill those gaps by keeping procedures in-house that they would have ordinarily referred. Some practices are doing this by hiring recent specialty graduates to work in their offices a couple times per month, and others are simply tackling cases that they previously would not have bothered to do. As a result, referrals to dental specialists have dramatically declined, and many specialty practices are struggling to survive, especially in more urban settings. For the record, I have no problem with general dentists doing specialty procedures in their practices. In fact, one of the things I have done, and still do in my career is educate GPs in oral surgery and implantology. What I have become increasingly concerned about is GPs getting in over their heads and getting their patients and themselves into trouble. I get worried when I see threads on Dentaltown asking very basic questions about how to do a surgical procedure. The bottom line is, as much as we all need to make a living, we are also in a healing profession and always need to do what is best for our patients, even if it is not what is best for our bottom line. I have been teaching this message for many years in my continuing education courses on Dentaltown, OnlineOralSurgery and at the Scottsdale Center for Dentistry. If you would like to incorporate oral surgery and implant procedures in your practices, take the time to educate yourself in the proper way to do so. There are plenty of educational opportunities out there. Learn the right way to do surgery, how to avoid complications, how to manage complications and how to recognize the limits of your own comfort zone. Just because you have the 20 October 2011 » dentaltown.com time open in your chair does not mean that you should treat every patient. Everything you do in your practice should help to build your practice. Subjecting a patient to undergo a surgical procedure that is difficult, uncomfortable and prolonged will do just the opposite. There are procedures in oral and maxillofacial surgery that I refer to my colleagues because I do not do them often enough to be comfortable doing them. Can I do them? Yes. Can I fit them in my schedule? Yes. But, I elect to do what is best for the patient. I was told in residency that they could teach a monkey to do surgery, but what makes a surgeon is the ability to know when not to operate. We were also taught we should never do a procedure for which we could not anticipate and handle all of the possible complications. This comes from education and experience. If you choose to refer fewer patients to your specialists and treat them in your own practices, please make the investment in yourself to become more proficient at those procedures first. We all know how little specialty training we actually got in dental school and that most of what we see in practice is more complicated than what we did in school. One of the benefits of continuing education in the dental specialties is the ability to recognize the limits of your training. No matter how many root canal, impaction, grafting and implant procedures you do, there will always be some that are best managed by a specialist who has many more years of training and experience. That is why it is important, even in these changing economic times, to maintain a good relationship with a core of dental specialists to whom you can refer, ask for advice and get help. Most of us understand the pressures GPs are under and are very willing to help out in a sticky situation. However, that willingness might waiver if all specialists get from some are your complications. We need you. And, you need us. You do not need to treat every patient by yourself who comes in to your practice, even if times are slow. Learn to recognize which cases are within your comfort zone and which ones are beyond your expertise. Maybe, even take your specialists to lunch and talk to them about what is going on in your practice. We are all in this together and will make it through by working with each other. Try to always follow the principle of “do no harm” and refer your patients where appropriate. Your patients will be happier, and you will sleep better at night. ■ Needs N Ne eeeeed dss no d no tr ttraining, ra ng ra g, software sof so oft ftw ftw twa war are or or computers! co co ter te ers rs! Works Wo Wo orrk rks ks right rig ri i out ou o ut of ut of the the th he box! x!! Intraoral Dental Viewer Simply a Quick Look! $895 ADA Las Vegas – Booth #1561 GNYDM – Booth #2415 Try it Today. It’s Easy – RISK FREE 30-Day Trial. 315-565-4058 3 31 15-565 5--4058 www.drquicklook.com w ww.ddr drrq drq rqu quic qu uiic ick cckkklo loooookk..cco lo com om industry news Dental News in Brief The Industry News section helps keep you informed and up-to-date about what’s happening in the dental profession. If there is information you would like to share in this section, please e-mail your news releases to [email protected]. All material is subject to editing and space availability. AvaDent Digital Dentures Bring Removable Prosthetics into the Digital Age Global Dental Science (GDS), LLC, announces the introduction of AvaDent Digital Dentures. AvaDent’s breakthrough digital technology brings the precision, aesthetics, speed and profitability of CAD/CAM technology to removable dentistry. A series of half-day seminars are currently being offered throughout the U.S. to dentists who would like to learn more about AvaDent Digital Dentures. October 7/8: Buffalo; October 21/22: Dallas, Denver, Orlando; October 28/29: Tampa and Cincinnati; November 4/5: Vegas and Philadelphia; November 11/12: Scottsdale and Atlanta; November 18/19: Houston and Chicago; December 2/3: Miami and Los Angeles and December 9/10: Seattle and Kansas City. See page 50 for a write-up of the AvaDent Digital Dentures product. To learn more about AvaDent Digital Dentures call 855-AVADENT (282-3368) or go to www.avadent.com. Doctors Can Now Capture X-rays Directly to the Cloud with Curve Dental Curve Dental announced the completion of new digital imaging features, which allow doctors and staff to capture X-ray and intra-oral images directly to the cloud. Using the cloud to capture and store patient images eliminates the need for a server, affords unlimited storage and a proven backup and business continuity solution, and provides the dentist with access to the data from any computer with Internet access at any time. Currently the software is compatible with the Schick, Suni, Gendex, Eva and Owandy digital X-ray sensors, and will soon be compatible with the Kodak sensor. Call 888-910-4376 or visit www.curvedental.com for more information. Glidewell Laboratories Launches the Glidewell International Technology Center The Glidewell International Technology Center, a 2,800-square-foot training, education and technology demonstration center located on the Glidewell Laboratories campus in Irvine, California is now open. The center houses a fully functional operatory and surgical suite equipped with state-of-the-art dental equipment and technology, including a CBCT scanner and will offer live video demonstrations to a 40-seat interactive classroom auditorium. Experienced clinicians and technicians will provide comprehensive and affordable professional development and continuing education programs covering all aspects of modern implant and restorative dentistry. For more information or to register for upcoming courses, visit www.glidewellce.com or call 800-854-0970. Comlite Systems Releases the LAN4000 Comlite Systems has released the LAN4000 light signaling intra-office communication software. It easily installs on existing Windows networks and requires no additional wiring. The software allows dental offices to customize system layouts, button colors and labeling and has multiple chime options. Screen display sizing options and minimization help keep communications confidential. A free 15-day trial download is available from www.comliteinfo.com, or call 800-426-5271. continued on page 24 22 October 2011 » dentaltown.com industry news continued from page 22 Sesame Communications Named to Inc. 500|5000 List of Fastest-Growing Private Companies Sesame Communications has been named to the fifth annual lnc. 500|5000, an exclusive ranking of the nation's fastestgrowing private companies. In its debut year on the list, Sesame is ranked an impressive #2024 for its 125 percent growth over three years and $9.2 million in revenue in 2010. The companies on this year’s list report having created 350,000 jobs in the past three years, and aggregate revenue among the honorees reached $366 billion, up 14 percent from last year. Sesame’s ranking can be found at www.inc.com/inc5000/profile/sesame-communications and for more information regarding Sesame, visit www.sesamecommunications.com. DENTSPLY International Completes Acquisition of Astra Tech DENTSPLY International, Inc., has completed the previously announced acquisition of Astra Tech AB, a leading provider of dental implants, customized implant abutments, and urology and surgery products, from AstraZeneca. DENTSPLY anticipates this transaction will add approximately $200 million to the company’s net sales in 2011, and $600 million on an annualized basis. DENTSPLY also expects the transaction will be neutral to slightly accretive to adjusted earnings per diluted share in 2011. For more information, visit www.dentsply.com. Smile Reminder Evolves Into Solutionreach Smile Reminder has changed its name to Solutionreach. Smile Reminder recognizes its evolution from patient-to-practice communication to a comprehensive engagement platform with the new Solutionreach brand identity. Having serviced the health-care industry for more than a decade, the newly branded Solutionreach is looking forward to making its full suite of engagement tools available to businesses in a variety of markets in health care and beyond. For more information, please visit www.solutionreach.com. BIOMET 3i Has An App For That BIOMET 3i invites dental professionals worldwide to download the free BIOMET 3i App for the iPad and iPhone, Android and Blackberry smartphones. The BIOMET 3i Solutions App consists of two portals, one for the clinician and one for the patient. The Clinician Portal provides immediate access to BIOMET 3i Product and Service Solutions for clinicians. The Patient Portal is an interactive version of the BIOMET 3i Patient Education Brochure with easy-to-understand animated information tailored to the patient. The BIOMET 3i Solutions app is free and available to download and install directly from www.apps.biomet3i.com. Sterngold Dental, LLC, Announces the 2011 Three-Day Hands-On Attachment Courses The Sterngold Dental three-day hands-on attachment course is designed for both dentists and technicians. This intensive three-day program will leave you confident in your ability to design, prescribe and fabricate attachment-retained prostheses. Attachment courses will be held September 23-25 in Los Angeles, California at Los Angeles City College, and November 10-12 at Sterngold Headquarters in Attleboro, Massachusetts. Each course is limited to 15 participants. To register, and for more information, call 800-243-9942 or visit www.sterngold.com/sterngold/events/training for a printable registration form. 24 October 2011 » dentaltown.com INTR NTRRODUCING ODUC NG TTHE HE A ALL LL-N NEW EW K KDZ DZ B BRUXE RUXER . TTHE HE B BEST E S T FFULL U LL- C CONTO ONTO OUR UR Z ZIRCONIA RCON A SSO OLUTION O L U T ON AV VA AILAB L ABLLEE . EEXCLUSIVE XCLUS VELY FFRO RO OM M K KEEATING NG D DENTAL ENTAL A ARTS RTS . TThe he all-new all-new KD Z Bruxer Bruxer iiss ssoo p recise and and predictable predictable yyou ou ccan an p rep a nd rrest est a ssured tthat hat tthe he jjob ob iiss KDZ precise prep and assured d one tthe he ffirst irst time, time, eevery very time. time. Precision-milled Precision-milled and and finished finished by by hand, hand, itit fits fits and and functions functions flawlessly. flawlessly. done “BEST BEST LLOOKING OOKING KDZ ssolid olid zzirconia irconia ccrown rown oout ut tthere. here. TThe he K DZ Bruxer B ruxer is is not not just just better better than than gold, gold, these these are are better better looking looking tthan han ssome ome ccrowns rowns II’ve ’ve rreceived eceived from from other other labs. labs.” D Dr.r. RRoy oy D Davis, avis, N Nantucket, antucket, MA MA TTHE HE K KDZ DZ B BRUXER RUXER: FREE ADJUSTMENT & POLISHING KIT A $60 $ 6 0 value value with your first KDZ Bruxer case* CALL CALL O ORR CLICK CLICK TODAY TODAY 888-407-6571 888-4 888 407-6571 4 07- 6 571 keatingdentalarts.com keatingdentalarts.com Come C ome SSee ee U Uss At ADA LLas as V Vegas! egas! October October 1 10–12, 0–12, 2 2011 011 *O Offer ffer ccannot annot be be combined combined with with any any other other offer offer or or promotion. promotion . Free Free adjustment adjustment kit kit available available with with first first KDZ KDZ Bruxer B ruxer case case only. only. B Booth ooth #1 #1929 929 practice management message board This thread comes from the message boards of Dentaltown.com. Log on today to participate in this discussion and thousands more. The Most Important Measure of Dentist Efficiency Dentists have so many different practice styles and staff sizes. What is the best metric for comparison? Linc Posted: 8/9/2011 Post: 1 of 105 Often here, we have discussion about different practice styles. Low overhead. High grossing. Complex procedures. Bread and butter. One dentist, three hygienists. One dentist, one hygienist. But from a business point of view, your bottom line is all that really matters. So how can you compare all these different practice styles? What is a common way to compare the efficiency of different styles of practice? ■ Linc Kevin Tighe Posted: 8/9/2011 Post: 3 of 105 Take your average monthly production or collections and divide that number by the number of staff you have. That will give you a baseline to start from. Then implement an effective staff training program. The baseline should steadily increase. You can apply this to any practice model. ■ Linc Posted: 8/9/2011 Post: 5 of 105 That’s not a bad method. How do you compare a single dentist niche practice that only does short-term ortho with a large hygiene practice? Even though the niche practice might be much more efficient per staff member, the take-home pay might be less for the same hours worked. So in effect, the dentist in the hygiene-based practice might be using all those staff to make himself personally more efficient. ■ Linc Broken Dentist Posted: 8/9/2011 Post: 10 of 105 Production per hour depends on your fees and your insurance participation. So even if you can do efficient dentistry, production per hour can be low if your fees are low. ■ gregholm Posted: 8/10/2011 Post: 15 of 105 I probably wouldn’t care what practice type (GP everyday work vs. implant, etc.) or about much else, as long as I am able to net in the same hourly timeframe, in that $500K area. After that, it just wouldn’t matter. ■ browndawg Posted: 8/10/2011 ■ Post: 16 of 105 I bet most Townies would change their “style” to net in the $550K area. This can’t be the norm or I really missed the boat on this tooth fixing stuff. ■ continued on page 28 26 October 2011 » dentaltown.com New Lightweight Nike® Skylon Ace Frame available in Black and Varsity Red. ision VMagnified The ONLY Magnification Custom Manufactured to your measurements (never off the shelf) for TRUE Ergonomics The Lightest LED DayLiteTM Mini Just See It Today with our 45 Day, NO Obligation Trial. 760 Koehler Avenue | Ronkonkoma, NY 11779 | 1.631.585.3300 | 1.800.345.4009 [email protected] | www.DesignsForVision.com Nike and Nike’s Logo are registered trademarks of Nike, Inc. practice management message board continued from page 26 gregholm Posted: 8/10/2011 Post: 18 of 105 I really didn’t mean for that to be the point. The only point I was trying to make was who really cares how they do it – whatever it is. If they do care, they need to make a change. If they don’t, fine. There are all kinds out there, doing pretty much the same on a financial level. You will have extremes in just about everything. That doesn’t mean anyone or everyone could or should be doing things in that same way. ■ skuzma2dds Posted: 8/10/2011 Post: 19 of 105 From what I can tell... there are many practices with one full-time dentist, two assistants, two to three full-time hygienists and two full-time front desk staff that do $1-1.2 million with 50-60 percent overhead ($500K range). This type seems to be the most predictable method for a dentist to net $400550K. There’s a handful of dentists on here who do more than $2 million with 55 percent overhead or so... netting about $1 million. Not many, but a few. ■ gregholm Posted: 8/10/2011 Post: 23 of 105 If there is a procedure or a patient I really don’t want to take on – I don’t do it. I’m a single tooth kind of guy. I don’t like the stress I feel when doing the full mouth or the big cosmetic cases. On the right person, with the right circumstances I might do the case, but I refer far more than I complete myself. The odd thing is by doing this; neither my production efficiency/overhead efficiency nor net efficiency has ever suffered. continued on page 30 Over 5,000 dental professionals trained from 46 states and 28 countries! ® BOTOX & DERMAL FILLER THERAPY For Every Dental Practice AMERICAN ACADEMY of FACIAL ESTHETICS TM TM Join today and save an extra $200 on tuition Featuring: Dr. Louis Malcmacher, Dr. Peter Harnois, and the faculty of the American Academy of Facial Esthetics Limited Attendance! Sign up before November 1 - save up to $500 plus bring a team member for free! 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For more information 800-854-7256 www.glidewelldental.com Starting at $ 1,995* complete GLIDEWELL LABORATORIES Premium Products - Outstanding Value practice management message board continued from page 28 Some of these people just don’t have enough money, in my opinion. In fact, I would say that is a big component for my efficiency. I’ve learned when to hold ‘em and when to fold ‘em, as the saying goes. I think the stress factor becomes a larger and larger multiple as time goes on. ■ ut-bill Posted: 8/10/2011 Post: 25 of 105 Funny, I remember an article that Mike DiTolla wrote on this. He made a point that the most profitable were three or less units on a fixed case. After this, the cases became more complicated and the actual net profit was lower. Of course he backed it up with more numbers, but that was the gist of the article. ■ rscrawfo Posted: 8/10/2011 Post: 26 of 105 Good thread, Linc! Predictability is also important. It’s always nice to have a predictable monthly income rather than a feast or famine type practice. Many hygiene-based practices seem to have a very steady production level, and downturns in the economy seem to affect them less. They will never have the extreme high months, but they also never get the low months. The more hygiene patients you see, the more stable production seems to be. I think profit per hour worked is an excellent measure, but you must include all hours worked, including lab work, paying bills, etc. Many of the small efficient offices have low overhead because the dentist is doing all the extracurricular work (lab work, paying bills, ordering supplies, repairing equipment, doing up deposits, keeping the books, etc.). This could double the hours spent working. Many of the larger hygiene-based practices might have higher overhead, but the dentist spends much less time working. Personally, I do very little in my practice and the extra overhead it costs me is money well spent. ■ Linc, My answer to your question would be hourly production average for the dentist. We keep this on hygienists as well. It is amazing to watch a practice with two or three hygienists, once we start measuring this on Dental Dashboard. All of them increase and it really keeps them on their toes. It’s a great stat. Remember you better collect what you produce! I’m not impressed by high production without the collections being right there with it. It also gets interesting with two or more dentists in the same practice. ■ Sandy Pardue Posted: 8/10/2011 Post: 27 of 105 browndawg Posted: 8/10/2011 Post: 31 of 105 I am blessed to have a family practice with family that opened in 1976. My father worked unbecontinued on page 32 30 October 2011 » dentaltown.com General Dentists CAN do Ortho Before After Sixx Month Smiles That’s because Six Month Smiles makes it e easy asy to straighten teeth - from start to finish Starts with cosmetically-focused tr eatment goals (no ma jor changes to bite) treatment major Expertly positioned brackets come set in custom bondin g trays - ready for 1-step seating bonding Shape memory of tooth-colored tooth-colored wires wires gently guide teeth into position More predictable movements and shorter treatment times times than aligners (and lower lab fees too!) Unique, clear braces gives patients the smiles they want quickly The 2 Day Seminar will equip you with the skills and confidence needed to start treating right away Register now and your first case is free ($518 value) “Six Month Smiles has changed my practice dramatically. I never thought I could do fixed ortho, but the Seminar was so thorough and the system is so easy, I did 25 cases in the first six months! My team's morale is at an all-time high, and smile.”” my patients leave every appointment with a smile. - Dr. Tony Soileau, General Dentist Portland Los Angeles San Antonio Vegas Las Vegas Orlando Miami Phoenix Oct. 28-29, 2011 Nov. 4-5, 2011 Nov. 11-12, 2011 Nov. 18-19, 2011 Dec. 2-3, 2011 Jan. 13-14, 2012 Jan. 20-21, 2012 Register at www.SixMonthSmiles.com/dt or Call 866-957-7645 practice management message board continued from page 30 ▼ Check out these other Dentaltown.com message boards for ways dentists can become more efficient. Overhead Percentages 2011 Search: Overhead Percentages 2011 My Production Stinks Today but My Schedule is Full Search: My Production Stinks lievably hard through the 80s and 90s. Now we have massive competition and bad economic times and the game has changed. Fees are so much higher than they were. I can read in our charts where Dad was taking out all four impacted thirds for $375. Crowns were $250. Occlusals $40 and he managed to earn $200K a year at those fees. He came home, crashed on the couch and woke up to eat dinner. Rarely ate lunch. I do much better than he did working a lot less with less stress simply due to implementing systems, adding implant therapy and controlling costs. We have three docs now. Some months I feel rather pathetic doing four crowns with open holes in the schedule and producing $30K. Crowns are now $1,050 here. The key that I have noticed over time is that our overhead is much lower and we are doing so much less dentistry. Most of this must be due to fee increases over the years. But since we built the practice based on hygiene, it not only out produces, but out collects each of the individual doctors. I can’t imagine having it any other way. Working on four to six patients a day and collecting half of my net from hygiene profits with the phone rarely ringing on a weekend and having the time with the wife and kids. This has become a blessing – we never knew what we were blindly creating. And as Greg says, who cares how you get it if it is low stress and you enjoy the ride. ■ continued on page 34 Practice Made Perfect 4REMENDOUS%ARNING0OTENTIALs$ElNED#AREER0ATHTO/WNERSHIPs0ROVEN0RACTICE-ODEL #OMPREHENSIVE-ARKETING"USINESS3UPPORTs/NGOING0ROFESSIONAL$EVELOPMENT 2S\bWab]^^]`bc\WbWSaOdOWZOPZS\ObW]\eWRS /b/a^S\2S\bOZeS`SQ]U\WhSbVOb]càcQQSaaWaORW`SQb`SacZb]T S[^]eS`W\UO\Rac^^]`bW\UO[PWbW]caRS\bOZ^`]TSaaW]\OZaES ^`]dWRSO^`]TSaaW]\OZTOabÔQSRS\b`S^`S\Sc`WOZe]`YS\dW`]\[S\b POaSR]\O[cbcOZ`Sa^SQbbVObYSSâ]c`W\bS`SabaOZWU\SRB]USbVS` eSPcWZRO\RRSdSZ]âcQQSaaTcZÔbWS\bT]QcaSRRS\bOZ^ÒQbWQSa /a^S\2S\bOZ8]PaQ][&% 32 October 2011 » dentaltown.com ES¸dSU]bbVS^S`TSQb ]^^]`bc\WbgT]`g]c 8]W\/a^S\2S\bOZ bVS^`S[WS`\Sbe]`Y]T RS\bOZ^ÒQbWQSa &$$ '% 1]\\SQbeWbVca( /a^S\2S\bOZWaO\3=3 50% OFF! NE NEW! W! C Capture apture D Digital igital Images D Directly irectly to to the Cloud! EXTENDED EXTENDED SAVINGS SAVINGS OPPORTUNITY! OPPORTUNITY! Switch Switch to to Curve Curve and we’ll we’ll cut the implementation implementation ffee ee in half! Call C all 888-910-4376 for for details. details. visit www.curvedental.com www..curvedentall.c . om to to lea learn rn more more Things Y Things You o ccan ou an do on Curve: the Cloud Cloud with C urve: Digital Dig ital IImaging maging Charting Char ting TTreatment reatment P Planning lanning Perio Charting P erio Char ting SScheduling cheduling Billing Reporting R eporting Communicating C ommunicating EEducating ducating More! And M ore! Check O Out ut O Our ur Bene Benefits: efi fits: t F t Fewer ewer Hassles With OOur With ur CCloud-based loud-based Dental SSoftware offtware You’ll You’ll oou Never N ever W Worry orry About Back Backups ups and Upgrades Again Again When W hen yyou’re ou’re cchained hained to software sofftw ware that you you must must install, install,, configure, configure, upgrade, upgr pg ade, and backup backup tt M ore Time Time More tt M ore Choices Choices More it ccan an be a serious serious drag. drag. Curve Cur ve Dental can can free free you you from from complicated complicated servers, ser vers,, expensive expensive hardware upgrades. Alll yyou computer Internet har dware and troublesome troublesome upgr ades. Al ou need is a co mputer and an Inter net connection successfully managee yyour practice: scheduling, billing, ven co nnection to successful ly manag oour pr actice: sc heduling, ccharting, harting, bil ling, and eeven tt N oW orries No Worries tt M ore Money Money More imaging—alll of your stored safely fel ely and securely securely on on the cloud. cloud. Call Call today today digital imaging—al your data is stor ed saf learn savee 50% on the implementat implementation to lear n how how you you can can sav lementattion ffee. ee e . But you yoou must must hurry hurrr y as this offer extended off ffeer will ff will expire expire soon. soon. Call C all 888-910-4376 Join us on the cloud at www.curvedental.com ª$VSWF%FOUBM*ODt"%&/5"-508/0$5 ª$VSWF%FOUBM*ODt"%&/5"-508/0$5 practice management message board continued from page 32 Linc Posted: 8/11/2011 Post: 42 of 105 Generally when I take on a new procedure, I use the following method to get proficient. 1. Accept that it won’t be a money maker for a year or more. 2. Do some free cases to get going. Usually I make this a charity thing as well, so I get marketing mileage out of it. 3. Accept that my first few cases will not be as good as those I do in 10 years’ time. This is a big problem. I don’t advocate being a hack. However I do understand that a lecturer who has done 1,000 sinus lifts over five years is probably going to be better than me. You cannot be good without practice, and you cannot do any practice if you expect to be perfect your first time. The difficulty is that there are a lot of armchair experts on Dentaltown who will criticize the tiniest imperfection of other people’s cases, but then when they show their own, they will explain why it was appropriate to cut a few corners (normally because the patient was informed and declined. Don’t let armchair perfectionism cripple your attempts at new procedures. 4. I begin marketing new procedures as soon as, or shortly after I’m trained in them so that I get enough to be proficient. 5. Yes, taking more CE is great, but no amount of CE will make you proficient. Only practice will do that. 6. You will get failures. Suck it up and learn from them. I had my first sea-o-pus implant the other day. What I meant by the statement that you shouldn’t do procedures that you don’t do often enough is that sometimes people learn a new procedure and for whatever reason, they don’t do it often. Like implants – there are a lot of dentists out there that only do 10 a year. The first implants you do, you don’t know which drill to use and you drill slowly and tentatively. It takes forever. If you are doing one a month, it’s like you are always doing your first implant. I didn’t make much out of rehabs when I first started them. Now they are very profitable because they proceed smoothly and efficiently, and prepping 10 crowns is always more profitable than one. I also get very few fractures now, although I did get a lot in my earlier days. Hope that helps. ■ Linc CoachDDS Posted: 8/18/2011 Post: 84 of 105 This is something I’ve really learned first-hand in the last few months of owning a practice. There’s a counterpart of efficiency that a lot of practice management experts don’t seem to grasp. There comes a time when one is so efficient that your head starts to spin... you make more mistakes, you get burnt out faster and your long-term overall efficiency is lower. My favorite days are with a nice easy flow. A crown in the morning, some fillings here and there, eight or nine hygiene patients in between and maybe an emergency or two. All adds up to a $3-4K day and I get to leave the office without feeling drained. Granted I can do those rollerskate $10K days just fine but they tax me. Doing that day in and day out would kill me and I’m young. I say the biggest measure of efficiency is how much your practice allows you to live the life you want to live. ■ Find it online at www.dentaltown.com 34 Dentist Efficiency October 2011 » dentaltown.com Introducing the newest additions to the Temrex Family of Basic Essentials BASIC ESSENTIALS Diapers and a pacifier BASIC ESSENTIALS Copalite Varnish and Solvent The original and most reliable dental varnish. Applied under gold and amalgam restorations this varnish will help retard decay and the recurrence of cavities. This well tested and completely reliable varnish has anti-microbial and antiviral properties. 1/2 oz. bottle each of Copalite Varnish and Copalite Thinner/Solvent holds enough to treat 600 teeth using two applications. ® ® For more information on Copalite Varnish & Solvent as well as DOC'S BEST™ Red (or White) Luting Cement with Activated Copper, Coplaite Snapbond and the Formatill Kit contact: 1-800-645-1226 or 516-868-6221 Fax: 516-868-5700 www.temrex.com practice management message board This thread comes from the message boards of Dentaltown.com. Log on today to participate in this discussion and thousands more. Morning Huddle – Again Did you give up on morning huddles? Give it a second chance. Steven Polevoy Posted: 7/7/2011 Post: 1 of 43 I just about lost it – again – during our pathetic, ridiculous, unproductive, disgusting excuse for a huddle. I never really get angry in the office, but the huddle thing just kills me. Charts are supposed to be prepped, hygiene is supposed to verify X-rays are upto-date, perio charting, see if there’s any outstanding treatments that need to be discussed with the patients, medical history updates, etc. Assistants are supposed to do the same. The front desk is supposed to go over yesterday, discuss any needed follow-ups and the whole thing is supposed to follow a YT2 (yesterday, today, tomorrow) format. Does it? No! And it never did. Does anyone have a productive huddle in the morning? How do you do it? ■ Steve Jamie Nicole White, CDA, RDH, BSDH Posted: 7/7/2011 Post: 2 of 43 Steven, I have attached a clinical assessment form that I have made up for the offices I consult in. It’s unfortunate but I have found that some hygienists tend to be lazy and not hold up their end of patient care assessment, which helps the dentist to stay consistent and proficient day in and day out. I hope this helps to organize your patient assessments in hygiene! [Editor’s note: Visit the message board online to view the attached clinical assessment form.] ■ davidpalmer Posted: 7/7/2011 Post: 6 of 43 Forget the morning huddle... Fire someone not doing their job and watch what happens. I tried a morning huddle for about a week a long time ago. Waste of time in my opinion. If after being trained and working for six months, my staff doesn’t know what to do, how to do it, etc. to make the office run smoothly and make my life easier, a morning huddle won’t help. ■ Tyler R. Twiss, DMD, MBA twisster Posted: 7/7/2011 Post: 8 of 43 Steven, Is any of this written down? It sounds like it is time for a checklist. I’m assuming there is currently no accountability for this long list of “supposed-tos.” If it is written down, they have something visual to see, and know that it is expected. This is a lot more effective than a routine that takes place out of tradition. ■ jbdent Posted: 7/7/2011 Post: 9 of 43 I think the morning huddle is a bunch of BS. I have a big staff that come in anywhere from 6:30 a.m. to 7:30 a.m. so we couldn’t do one anyway. Our review is at the end of the day for the next day and doesn’t require everyone knowing everyone’s continued on page 38 36 October 2011 » dentaltown.com Financing as advanced as the care you provide. Sometimes the best surprise is getting exactly what you expect. ChaseHealthAdvance takes the complexity out of patient financing. Give your patients just what they need from financing – a straightforward plan with affordable monthly payments. Patients choose a plan and know exactly what to expect from the first payment to the last. No surprises. ǦȜȝƽȜȣȝȟ Ǧ Ǧ Ǧʬ ǂǂ . Give your patients a trusted payment option to start their care: AdvanceWithChase.com/DT ȜǂȣȣȣǂȞȣȣǂȢȡȞȞ Information above is for providers and not for patient distribution. ©2011 JPMorgan Chase & Co. All rights reserved. DN1011 practice management message board continued from page 36 business. The staff members coordinate what they need to with the appropriate people. We don’t stand around in a circle singing Kumbaya. ■ Mike Scoles, DMD drscoles Posted: 7/7/2011 Post: 11 of 43 I think if you are having this meeting and it’s not effective, you need to look in the mirror. You are not leading well. We spend seven to eight minutes going over the schedule and I think it is beneficial. It keeps you from getting blindsided on things like “Hey Mrs. Smith, How’s your husband doing?” And Mr. Smith died a month ago. Or Suzy Soccer mom’s kid got a scholarship in synchronized underwater basket weaving and she’s very proud of it and you can congratulate her and you look like a rock star. Or Mr. Jones needs an FMX and you have that NTI seat at the same time, can someone in the front come back and push the button for me so we get it done faster... and stay on time? Or Bill has that fractured cusp on #3 and he knows he needs a crown but he’s been out of work for a year and he wants to keep an eye on it. Bill gets pissed when you keep overstating the obvious. Bill thinks you are a cool dude when you ask him how the job prospects are going and that we’ll keep watching that tooth and we can put a band aid on it to get him by if necessary. Depends on what type of office you want to have or are comfortable with. Do you want a bunch of independents running around, or do you want a cohesive teamoriented vibe? ■ Negotiating a Lease? Don’t let the landlord take advantage of you. “ Thanks sincerely for your determination to do right by your clients. “ - Dr. Joel Gonzales Gloucester, MA When you have good systems you don’t have to micromanage anything. Huddles should last no longer than 10 minutes. Staff comes prepared with data. The doctor doesn’t have to do anything. The staff report to the doctor. If they don’t come with the data, they go get it and come right back while the huddle continues. ■ Sandy Pardue Posted: 7/7/2011 Post: 13 of 43 We have four hygienists, four assistants, three front office and two docs (one is my wife). Our huddle is a little long in the tooth. 15 minutes easy. Yes, hygiene drags their feet but every day we discover some way to head off trouble, reroute the schedule, perform same day treatment and sing Kumbaya. ■ madmike Posted: 7/7/2011 Post: 14 of 43 To level the playing field, simply call toll-free or visit georgevaill.com/dt/ saldoc Posted: 7/7/2011 Post: 16 of 43 800-340-2701 We’ve had a huddle every morning for about six years. I think we got the format idea from Sandy and Dr. Westerman. continued on page 40 38 October 2011 » dentaltown.com practice management message board continued from page 38 ▼ Want to read more about morning huddles? Then check out these other message boards on Dentaltown.com. How is Your Morning Huddle? Search: How is Your Huddle Need Help with Morning Meetings Search: Morning Meetings David Kimmel, DMD dkimmel Posted: 7/7/2011 Post: 17 of 43 Find it online at www.dentaltown.com 40 Front office goes first and reports: yesterday’s production, yesterday’s collection, today’s scheduled production, lists any new patients coming in and relevant info about them, where they intend to place any emergencies that call (I find this very important and might offer my suggestions) and anyone coming in with large account balances. Back office reports premeds and allergies (latex), confirms all lab cases are in and addresses any inconsistencies in the schedule that do not match what is listed in the chart. Hygiene (two hygienists) lists teeth we are monitoring for crowns on each patient (these are teeth they are supposed to show with the intra-oral camera), note any FMXs needed, premeds, allergies, etc. Sterilization tech (who now acts as my second assistant) announces all the hygiene patients who need probe readings; she will help hygiene with those readings (we alternate between probes and X-rays every six months). And that’s it. I generally sit there nodding and saying that sounds good. I don’t want a lot of adlibbing or going off script. The whole thing usually lasts about five or six minutes. On rare occasion, I’ve had an employee announce at the huddle that they did not have time to prepare their report. I’ll gently remind them afterward that it is not acceptable to be unprepared for the huddle, and it usually doesn’t happen twice. It’s nothing too revolutionary, but it at least ensures the staff pays a minimum amount of attention to the day ahead. ■ Sal This is our 21st year with morning huddles. I could not imagine a day without one. One of the first things that comes to mind, are you giving your staff time to pull all of this information together? We have admin time set aside every day for chart review for the hygienist and the assistants, as well as for the front desk to get reports together to present each morning. No meeting can be productive without proper preparation. The other thought is you must inspect what you expect and give feedback as needed. The first time a staff member comes unprepared for a meeting, I would specifically let he/she know what I needed from him/her. I would ask if there is anything I could do to help he/she be prepared and then I would ask about being prepared for the next meeting. In your case, I would do this as a group. I’ve never had to go beyond this step. If I ever had to, it would result in writing the person up. If he/she continued to not perform, the staff member would be let go. Bottom line it’s your party and you are paying the bill. The key is to catch these problems before you get angry. My wife calls it being confrontational dysfunctional. On another note, we end our day with a quick wrap up. Each staff member just talks about one positive thing that happened during the day. Takes very little time and well worth the effort. ■ Morning Huddle Again October 2011 » dentaltown.com This thread comes from the message boards of Dentaltown.com. Log on today to participate in this discussion and thousands more. cosmetic townie clinical Difficult Veneers This well-documented case followed all the right steps, and the feedback is priceless. Learn from this case! Henry FCD Posted: 7/28/2011 Post: 1 of 9 Case is posted for critics and what could have been done better. Fig. 1 Fig. 2 Fig. 4 Fig. 3 Fig. 5 ▼ In these similar message boards Townies provide suggestions and constructive criticism when it comes to veneers. Below: Perio treatment is done. Conclusion: Healthy perio tissues Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 11 Veneers on Tetracycline Teeth - Help! Search: Veneers on Tetracycline Teeth Veneers, I Just Don't Get It Search: I Just Don't Get It Below: Preps and veneers Fig. 12 Fig. 13 continued on page 44 42 October 2011 » dentaltown.com Money-Back Guaran tee! -Day 0 3 * No Qu e s ti o n s A s k e d cosmetic townie clinical continued from page 42 Fig. 14 Fig. 15 Fig. 16 Fig. 17 Fig. 18 Fig. 19 Conclusion: “The professional man has no right to be other than a continuous student.” G. V. Black ■ I will be the first to make some suggestions here. 1) I think the preparations should have been carried through the interproximal areas. This would allow it to drop the contact points further toward the gingival area and potentially allow the interdental papilla to regenerate and close up the black triangles. John R. Nosti, DMD, FAGD, FACE John Nosti Posted: 7/28/2011 Post: 2 of 9 continued on page 46 In Office Dental Assisting School Make an Extra $75,000-$150,000 net per year HORIZON Mark Costes, DDS SCHOOLS OF DENTAL ASSISTING You Own Your Territory Forever! If you’re not holding Dental Assisting School sessions at your Dental Office then you’re leaving money on the table – lots of money. Let me explain … When you purchase my program your territory will belong to you alone – other Dentists in your territory will be locked out. By the same token, should a Dentist in your territory act on this before you, you’ll miss out on this tremendous opportunity. Your Assistant does all the Work! You Deposit the Checks & Enjoy life! For five years now I’ve held small Dental Assisting School classes at my Dental Office twice a week for 13 weeks per Mark Costes, DDS Call Today or Request Online for FREE information packet! 800-824-0895 session, 4 times per year. I’ve had one of my full time dental assistants teach the class, she also advertises for the school and all I do is deposit the checks and enjoy my life. It’s 100% passive income. There’s absolutely no reason why you should be missing out on this extraordinary income opportunity that’s available to virtually every Dentist, anywhere with an office. 44 October 2011 » dentaltown.com www.TeachDentalAssistants.com SPORT SPE SPECIFIC ECIFIC PROTECTIO PROTECTION ON The perfect fusion of strength, comfort and style has arrived with Fierce mouthguards. Fierce mouthguards come in various layers or levels depending upon what sport is being played and the necessary amount of protection required. Every Fierce mouthguard is 100% customized to the patient’s specific needs. CUSTOM CUS STOM DESIGN BENEFITS >> >> >> >> >> Precision occlusal indexing High-impact energy absorption 3.0 to 5.0 mm of sport-specific protection 10X more protection than off-the-shelf mouthguards 27 standard colors plus limitless custom designs mouthguar ds S tr en g th . P er f o r ma n ce . P r otectio n . Available exclusively from 877.337.7800 www.DDSLab.com LAB-300283 © 2011 DDS Lab. All rights reserved. cosmetic townie clinical continued from page 44 2) Maybe it was a seating issue, but the lengths of the centrals are off. 3) The axial inclinations could be improved on the laterals... again this would have been done with preparations that correct axial inclinations. It is hard for ceramists to correct this sometimes when the preps don’t correct it. 4) Do people like their front six teeth six shades whiter than their premolars? I never understand why people recommend the social six. If the person couldn’t afford to do 10 veneers, composite bonding on these teeth will improve his look. Check out Jason Olitsky’s CE course on Dentaltown.com, Balancing Esthetics and Function of Direct Composite Restorations. 5) Is that a picture of him “in occlusion” in the post-op picture? ■ Henry FCD Posted: 7/28/2011 Post: 3 of 9 John, I appreciate your suggestions. 1) I thought about carrying through the interproximal areas but with the recession I thought that can be cutting too much. 2) I had to compromise aesthetics to close the gap. I agree extending the prep could have been the best way to do it. 3) Is there anything that you can help me with when it comes to improving the axial inclinations? Photos? Something to read? 4) Will do. I’ll check out the course. 5) Yes, it is in occlusion. I would love that you do not stop. The reason I am posting is that they are not the best veneers I have done. ■ Andrew Z. Green DDS umazg Posted: 7/28/2011 ■ Post: 4 of 9 Is this patient perio stable? It doesn’t look like he had even a cleaning in a while let alone perio treatment. If the goal was toilet bowl white, mission accomplished. This is a tough case. ■ Henry FCD Posted: 7/28/2011 Post: 5 of 9 Yes, it is no BOP or deep pockets, stains from very heavy smoking. I wanted to go with A2 giving a natural look but was declined by patient. ■ ■ John R. Nosti, DMD, FAGD, FACE John Nosti Posted: 7/28/2011 Post: 6 of 9 First I want to backtrack a little bit and say that I want to congratulate you for having the confidence to come onto Dentaltown and post a case that you feel isn’t your best work... and to ask for criticism on top of it. That is very hard to do. I want to also say that I hope I did not come off sounding like a jerk with my last post, because as hard as it is to ask for criticism... it is very challenging offering criticism without having people think you are being condescending, or a knowit-all, etc. You can easily correct the centrals being two different lengths with a disc or porcelain polishing cup, etc. That is an easy fix. Here is a smile design photo to live by. Notice how continued on page 48 46 October 2011 » dentaltown.com Use Invisible Aligners with Complete Confidence Smart Moves ® Invisible Hard/Soft Aligner System Free personal one-on-one consultation for: No Special Training Courses or Commitments • Case Selection • Treatment Options • Estimate on the Number of Appliances Needed Less Expensive ) 1#1&1 12%12&1 $"2&21&31& 1 #"2%1 12%1#"2%1#1#32211& 1 $$1 !1& &31$ 2$2&12%1#%3 Aligner One Fabricated of 1.3mm Invisacryl ™* Hard/Soft material. Inner laminate is soft and highly elastic to provide exceptional tooth movement, seating, and patient comfort. Get started now! It’s easy. + &#&11! %1$ %21! %$#& 1 *1! %$1#131"2 800.828.7626 -11+### 716.871.1161 %"2 %1 " #1#1*1! %$1#&1 www.greatlakesortho.com Setup Made from upper and lower PVS impressions or stone models. One impression can produce up to three setups, two aligners per setup. Aligner Two Fabricated of hard 1mm Invisacryl, this aligner completes the tooth movement for the setup. 543210/.0-,+*)(' &32%$#"1! %$1$#&2%#"112"21& 1%2#&1(#21%&3 &1(& #11 &1# #&21&310/.0-,(0/ 211,"1423 " 10 %212&1& 13#21&3 &1 &2 SMLP312Rev042011 A less expensive, highly-effective solution for anterior tooth alignment. cosmetic townie clinical continued from page 46 the axial inclinations of the teeth start slanting toward the mesial as you go posterior. When the inclinations slant distal the teeth look flared and goofy. If they are too upright they look artificial. Take notice of the gingival zeniths and contact points (blue diamonds in the center and going toward the right side of the photo). You can literally spend 20 minutes or more discussing this photo and all the aspects of smile design. I offered my opinions that there are still black triangles but I neglected to ask you if this patient was concerned about them and whether the two of you discussed the case requiring more aggressive preps in order to attempt to correct it. Maybe he was fine with it, and in this case I would have prepped as you did. If he wanted the black triangles closed I would have prepped with slice preps and broken contacts. In all honesty, I don’t think this type of prep is really that much more aggressive from the preps you showed in your picture. The decision between the two isn’t deciding between prepping enamel only vs. dentin – either way you are on dentin. The after picture of him in occlusion looks a little off. Either his occlusion is compromised or he wasn’t closed down all the way. I am leading to believe he wasn’t closed down all the way or hit closed in a slightly protrusive position from his CO point. Did you deprogram and restore to CR with anterior guidance? I hope this post came off less offensive than my first. I am not trying to be a harsh guy here... just trying to provide the constructive criticism you requested... which again I commend you for! ■ Henry FCD Posted: 8/1/2011 Post: 7 of 9 John, Sorry for not getting back earlier. I appreciate you taking the time to answer my post. I think next time I will be going to fully break contacts for better aesthetic. By the way, I am not offended by any of your posts; I really believe this is the only way to learn. ■ rovster Posted: 8/9/2011 Post: 8 of 9 I agree with John’s first post, and second as well. First thing that jumped out was the preps. Although conserving a sliver of tooth structure, a full slice prep would have not only helped with the emergence contours, but also helped to establish more hygienic contours in the interproximal area that are more easily cleansable by the patient. The transition between restorative and these types of preps with such large spaces are funky at best, and tend to collect debris. I also agree the lab work, although not horrible, could definitely have been better. Did you make a temp and have the patient approve it before proceeding? Did you do a wax-up? Overall, not bad but there are lots of areas where little tweaks here and there could have led to a much better cosmetic result. Also, realize when you blow up your pictures on the computer screen, your imperfections really jump out and humble you. Kudos for posting. I’m sure at a “social distance” the case probably looks decent. ■ Find it online at www.dentaltown.com 48 Difficult Veneers October 2011 » dentaltown.com Removable Prosthetics: Four Simple Steps for Success Dentaltown and Ivoclar Vivadent are pleased to present a unique approach to treating patients who need complete and partial dentures. Hope you can join us. Hosted By: Dr. Frank Lauciello Date: Thursday, October 27, 2011 Time: 4 p.m. (PST)/7 p.m. (EST) Duration: 90 minutes Registration Fee: Free CE Credits: 1.5 ADA CERP or AGD PACE CE credits Sponsored By: Ivoclar Vivadent Register today: www.dentaltown.com/webcasts Approved PACE Program Provider FAGD/MAGD Credit Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. 12/01/2004 to 12/31/2012 Dentaltown.com, Inc. is an ADA CERP Recognized provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. new product profiles You are invited to visit Dentaltown.com to ask questions or post comments about the following New Product Profiles. If you would like to submit a new product for consideration to appear in this section, please send your press releases to Assistant Editor Marie Leland at [email protected]. AvaDent Digital Dentures AvaDent Digital Dentures make it possible for doctors to offer their patients a precise fitting, aesthetic denture in as little as two appointments. By using a simple impression taking technique and the proprietary AvaDent, Anatomical Measurement Device (AMD) doctors will use standard clinical procedures to gather all the necessary clinical information in just one easy appointment. The impression, AMD and prescription are then sent to the AvaDent Digital Facility for completion. The impressions and the AMD are scanned and using AvaDent’s breakthrough technology a virtually denture is created. Once all adjustments are made, the digital file is sent to the computer milling station where it is milled from a unique highly compressed, bio-hygienic base material. To learn more about AvaDent Digital Dentures call 855-AVADENT (282-3368) or visit www.avadent.com. AvaDent Digital Dentures OSSEOTITE 2 Parallel Walled Implant Alpen SteriX The OSSEOTITE 2 Parallel Walled Implant from BIOMET 3i is based on macrogeometric design enhancements of the legacy OSSEOTITE Implant and is designed for more immediate boneto-implant contact for achieving better primary stability. The new design has a longer parallel walled section for more direct implant body contact with the osteotomy walls. They are available in 3.25, 4.0, 5.0 and 6.0mm configurations and are manufactured from biocompatible commercially pure titanium. For more information, visit www.biomet3i.com. Alpen SteriX are gamma sterilized carbide instruments, pouched packaged, offering an aseptic bur right of the box, providing advanced infection control and convenience. Harmful bacteria capable of spreading infection are often found on carbides at purchase. On average, a carbide contains more than 100cfu (colony forming units), Alpen SteriX contains 0cfu. Available in packs of 10 and 50, with a five-year shelf life. Visit www.alpenrotary.com for additional information. Alpen SteriX OSSEOTITE 2 Implant continued on page 52 50 October 2011 » dentaltown.com implant inspir3D POWERFUL. RFUL. F FAST. A AST. FLEXIBLE. Introducing the all new i-CA i-CAT AT Precise. The power of i-CA i-CAT AT in a package p designed specifically for Implants and Oral Surgery Surgery.. Powerful Power ful Tools, To oo Fastest Workflow, ools, Workflow w, More Mor Clinical & Dose Control. www www.i-CAT.com .i-CA CA AT.com | 800 205 3570 Exclusively available through new product profiles continued from page 50 Ceramir Trx Plan Generator Ceramir crown and bridge dental luting cement is based on the patented technology – nanostructurally integrating bioceramics. Ceramir bioceramic dental cement integrates with natural tooth structure, is stable in the mouth and exhibits tooth-like physical and mechanical properties. Ceramir Crown and Bridge can be used for the permanent cementation of conventional prosthetics, made from metal or ceramics, provided these are suitable for conventional cementing. For more information, visit www.ceramirus.com. Trx Plan Generator is a time-saving software that streamlines and simplifies the treatment planning process using an easy to use point and click interface. Trx Plan Generator automatically builds a comprehensive explanatory narrative report on a letterhead layout. In addition to describing every dental and restorative problem, this narrative report can present focused dental or medical information, specifically customized for each patient. Visit www.dentaltrx.com or call 800-876-0644 for more information. Ceramir Trx Plan Generator PeelVue+ Sterilization Pouches Esthetic CrossRef The PeelVue+ Sterilization Pouches from DUX Dental now feature visual guides printed on the pouch called Closure Validators. Pouches that are not sealed properly have holes or gaps where contamination can seep in, defeating the purpose of the packaging. PeelVue+ sterilization pouches are available in 12 sizes and can process up to 275 degrees fahrenheit in a moist heat autoclave or Chemiclave. For more information, visit www.duxdental.com. The Esthetic CrossRef accurately records the patient’s midline and horizontal plane. The CrossRef allows the vertical and horizontal bars to be aligned after the bite registration material sets. This bite record can then be used to mount the casts on any articulator. In addition, it enables the lab to do a final check of the completed crowns or veneers by removing the upper bite material and placing the lower impression on the articulated models. For more information or for a free sample, call 800-626-5651 or visit www.whipmix.com. PeelVue+ Sterilization Pouches Esthetic CrossRef 52 October 2011 » dentaltown.com new product profiles LOOK SmartSim The SmartSim dental simulation bench was designed exclusively for dental schools and universities. Incorporating digital presentation, space-savings and functionality into each unit, SmartSim can be used as a simulation bench, multimedia station and student workspace. Fitted with a retractable mannequin, SmartSim realistically recreates patient positioning for users. The mannequin features double articulated joints, allowing for a wide range of inclination even at 90-degrees. For more information about the Midmark SmartSim, visit www.midmark.com/smartsim. with us SmartSim Managing your practice: Mouthwatchers Toothbrush The Mouthwatchers Anti-Bacterial Power Toothbrush works synergistically with toothpaste to fight tooth and gum decay. The bristles of each Mouthwatchers brush is composed partly of nanosized colloidal silver compound particles, making the brush both immune to becoming a home to microorganisms and having antibacterial tooth and gum cleaning effects even without toothpaste. The Mouthwatchers Power Toothbrush also features unique flossing bristles, which operate at 5,000 oscillations per minute to access the central fossa area of a tooth and periodontal pockets between the teeth and gums. Visit www.mouthwatchers.net for more information. Mouthwatchers Toothbrush Cash Flow Payments Business Growth Future Take your practice to new heights. Let our Practice Finance sales representative be your single source for customized financing to grow and expand your practice. • Up to 100% Financing • Acquisition Financing • Practice Debt Refinancing • Buy-ins or Buyouts • Expansions or Relocations • New Practice Start-Ups There has never been a better time to look up and look ahead with us. 800.313.8820 | [email protected] practicefinance.usbank.com ©2011 U.S. Bancorp. All rights reserved. Member FDIC dentaltown.com « October 2011 53 amd lasers corporate profile Alan Miller & AMD LASERS Go Global in Their Next Move to Ensure a Laser in Every Operatory by Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine Alan Miller, AMD LASERS’ founder and president, and his team have been hard at work since the company was acquired by DENTSPLY International earlier this year. Miller’s whirlwind, round-the-world tour to DENTSPLY’s worldwide locations will lead to the Picasso laser line introduction in many new geographic markets, greatly expanding the number of dentists around the globe who will offer improved patient care with this innovative laser technology. Before Miller left on his trip, Dentaltown Magazine sat down with him to discuss the future of AMD LASERS and laser dentistry. I think back to the time we first met. I believe it was in 2005. Your company back then was National Laser Technology which serviced and refurbished lasers. How did that experience influence the formation of AMD LASERS? Miller: It was a great experience from several standpoints. First, I got a good understanding of what dentists were looking for; they wanted laser technology – but they wanted it at an affordable price. The second thing it did was allow me to look at all the different laser platforms, both hard and soft tissue, and really figure out what dentists wanted most. They wanted reliable lasers. They wanted easy-to-use lasers. It was apparent that there was a real need for an affordable soft-tissue laser. When you told your family that your plan was to start selling lasers in a market that 54 October 2011 » dentaltown.com already had a number of players, did they meet your dream with skepticism? Miller: I think most people thought I was crazy. It was a great motivator for me. I’m one of those guys who if you tell me I can’t do it, I’m going to try 10 times harder to prove you wrong. No one around the world had taken this approach toward laser technology, which I knew would work. One of the strategies we implemented was a model the automotive industry has used for years: a single platform, then buying the internal components in high volume and assembling with as few touches as possible. This allowed AMD LASERS to drive down the price. Would it be fair to call you a serial entrepreneur? Miller: Yes. I have always enjoyed helping companies with projects, introducing technology. I grew up a nerd. I think I’m still one of those nerdy guys. I love technology. Through my dental career I have helped a number of companies take ideas or products that were in the beginning stages and ask: How do we get these products into mainstream dentistry? How do we package it? How do we make it affordable? How do we make it a desirable product? I really enjoy that. Did you set out to grow a company that would be the target of an acquisition? Miller: Yes, that was always my strategy. When you start a company the odds are stacked against you. You are better off going to Las Vegas and betting everything on red or black, frankly. In the business world, to get a company to $10 million is a small miracle. That was my goal. I bootstrapped the whole thing. To do it out of pocket and reinvest the earnings of the company to grow it is extremely difficult. But I knew at some point AMD LASERS would be bigger than I could personally manage. To really realize the dream of putting a laser in every corporate profile amd lasers operatory, I knew at some point we would need some help. We were going to need to scale it up. Do you have any business heroes? Miller: I admire Steve Jobs. I really like Apple. From the packaging standpoint, we try to treat our products much like Apple looks at packaging its products. The out-of-box-experience is unparalleled with Apple products. When our customers open up a Picasso laser, I want them to feel like they are opening up this little jewel. The product itself is unlike any other laser in the world. When I was developing it, I wanted the packaging to be an experience, too. It’s not just about the product for me. You made an expensive product affordable while maintaining features and quality that rivaled your competitors. Are you a hero and a villain? Miller: I am basically a businessman who listened to dentists and provided a product that met their needs as they cared for their patients. We were talking about Apple and Steve Jobs. You are one of the first companies I’ve seen that has integrated the iPad into your products. What was the reaction from your customers? Miller: They said, “Thank you!” and, “It makes total sense.” Education in general has gone through a huge transformation over the last 20 years. Before, we would take educational material which would usually be on a VCR tape or a DVD or even online. We built a very intuitive iPad app for laser dentistry and put it at their fingertips; it was something no one has ever done. I saw it as a long-term solution to an age-old problem – how do you educate dentists on technology and have it there ready at their fingertips when they need it? continued on page 56 dentaltown.com « October 2011 55 amd lasers corporate profile continued from page 55 Looking around the world and getting this worldwide adoption of lasers, what do you think are the biggest obstacles? “Will AMD LASERS lose its identity as an innovator when it is part of such a large company?” What are your thoughts? Miller: I’ve been asked that question a lot. It is a very good question. The biggest obstacle of laser dentistry is not education. Dentists have been educated on laser dentistry for the last 15 years. As consumers, we are surrounded by lasers every single day. Dentistry has been exposed to lasers for a long time. The laser companies that have been out there have done a great job with educating dentists on why they need laser technology. The biggest obstacle has been price. Lasers like the Picasso should be viewed by the dental public as an affordable necessity. They should be accessible. I think that’s better for dentistry as a whole. Make laser technology affordable, make it attractive and make it available to dentists so they can help their patients. Miller: From the top down, DENTSPLY is a fantastic company with strong leadership and a commitment to innovation. At the end of the day, DENTSPLY focuses on providing solutions for better dentistry. While acquisitions serve as a growth strategy, the company looks for successful businesses with profitable operating models. Its businesses are enabled and empowered to build on their prior success by enjoying all the benefits a global corporation can offer. To illustrate that point, I am still president of AMD LASERS and we still have the same vision of putting a laser in every operatory. DENTSPLY has already started working with us to make that vision a reality. You have had notable success in a number of foreign markets. Two examples would be India and Turkey. How did you make it happen? Miller: I can truly say that the global success of AMD LASERS is thanks to our network of opinion leaders and passionate customers. We are surrounded by some of the best and brightest dentists from around the world. They really believe in what we are doing with laser technology. They travel and lecture around the world to introduce AMD to the local dental community. I’m excited to be working with DENTSPLY, which has a solid international reputation for quality and service. DENTSPLY understands our goal to make lasers affordable around the world. They’re going to make it reality. DENTSPLY International acquired AMD LASERS on June 1 this year and my first thought was, During the process leading up to the acquisition, did you have any hesitation? What scared you the most about making this step? Miller: I was never scared. It really came down to whom did we want to be in line with? It has been my job to figure out the best course of action for AMD. That is why I wanted to work with DENTSPLY. For me, the company has always been the gold standard. If you want to sell a company, as an entrepreneur you can’t get much better than DENTSPLY. With the vision of putting a laser in every operatory, DENTSPLY was the best solution. For the AMD customers who are already owners, are there any changes with this acquisition? Miller: Nothing is changing. We still offer that outstanding AMD LASERS experience. You are still going to get great customer service. We are still open from 8 a.m. to 8 p.m. EST five days a week. It’s how I wanted to build a company. I love the fact continued on page 58 56 October 2011 » dentaltown.com From Portland, Maine to Portland, Oregon We list what you need Harness the power of ADS through the Classified Ads on Dentaltown.com. Click on the Classified Ads section and search for Dental Practice for Sale. And don’t worry, all of the other classified ad categories you currently use are still there for your convenience. www.dentaltown.com/classifieds amd lasers corporate profile continued from page 56 that our customers love treating with the product and they refer other people to come to us. With the DENTSPLY acquisition, if anything, our current clients will say, “Wow! This is fantastic!” To illustrate that point, we’ve already received a lot of great feedback from customers. There is a certain sense of security when a leading company partners with you. You know you’re going to be around for a while. It’s a vote of confidence in the business and that’s a good thing. Discus Dental purchased Zap Lasers a few years ago and quickly dropped the name. Was that a good move? What is the plan for the AMD name and Picasso brand? Miller: I’m not sure it was a good move for them. I think it’s always good to stay true to yourself. That’s what AMD is doing. We built a strong brand with Picasso and with AMD, there is really no reason to change something that’s not broken. Can we expect to see dentists doing a lot more with lasers in the future? I hear about cutting frenums and soft tissue and doing laser troughing but, beyond those things, I don’t hear a lot of other treatments being mainstream. Miller: I’ve been asked that before – why don’t you talk about the other 50 uses of lasers? I keep coming back to my job and my responsibility which is to introduce laser technology and get dentists walking with lasers before we get them running. I think that is why we’re successful. We talk about basic uses. I want dentists and hygienists in their offices to put down the scalpel, to put down the electric cautery, to stop referring patients out for simple things they can do comfortably in their own offices. That’s where a soft-tissue laser really excels – the fact that it does replace a basic technology. Once laser dentistry gets to a comfort level, that’s when we will really start exploring what you can do with lasers. Whether it’s perio treatment or endodontic treatment, surgery or low level laser therapy, which is very strong in the European market yet not here in the United States. We’ll get to those things. We’ve got to walk before we run. Your analogy of teaching dentists to walk before they run is a good one. Are there new products in development? Is a hard-tissue laser in the cards? Miller: We have been working on a number of different laser wavelengths. We have been working on a hard-tissue laser for some time. With DENTSPLY and 58 October 2011 » dentaltown.com AMD LASERS together, we’re going to have some fantastic products coming out in the future. Millennium has done a good job of promoting very specific use of the laser in conjunction with periodontal treatment. When are we going to see a deeper penetration of laser use in periodontal treatment? What is it going to take? Miller: I think it’s a combination of things. We have a number of university clinical studies either underway or in planning stages. I really like Millennium. I applaud what they’ve done to date; they are a good company. The laser industry is a small one, and I like to see all of us do well. I’m really looking forward to getting lasers mainstream for periodontal treatment. It’s got to be a combination of scientific research and affordable technology. No matter how well the clinical evidence shows that lasers have a place in periodontal treatment, it’s never going to mainstream if the technology is not affordable. What does the future hold for Al Miller? Have you thought about starting another company? Miller: No. I want to see my vision and my dream come to fruition. I plan to be with AMD and DENTSPLY for many years to come. We’re working to make the Picasso line globally accessible. I enjoy it though. It’s a dream come true of mine. I love dentistry. Thank you for taking time out of your busy schedule to visit with our community. To view this interview in its entirety, please visit: http://www.dentaltown.com/profileamd For more information about AMD LASERS, visit www.amdlasers.com ■ Your patients need to know that Oral Healthcare Can’t Wait ® This FREE Brochure Gets The Message Across LOUD AND CLEAR Oral health is not something to be merely pushed aside, saved for a better economy, a better mood, or better weather. You know this. But your patients don’t always. Don’t let them give you, or their oral health, the brush-off. Download and print this persuasive patient education brochure, available in English and Spanish, and display it prominently in your waiting room. It’s also a good idea to mail it to patients who break their appointments or have become habitual no-shows. Take Action. Download your FREE brochures now at www.OralHealthCareCantWait.com Or call 877.389.9851 to order pre-printed brochures. © 2011 Dental Trade Alliance. Oral Healthcare Can’t Wait and Visit Your Dentist Now are registered trademarks of Dental Trade Alliance. Dental Trade Alliance Follow us on , and dentaltown research Dentaltown Research: Endodontics Dentaltown is digging a little deeper. Based on the monthly poll on Dentaltown.com we’re determining explanations for each poll result. Included with the poll statistics are the most popular write-in answers as well as small fun facts and recaps of the Townie Choice Award winning categories that coincide with our research topic. Don’t forget to participate in the poll on Dentaltown.com each month. The more opinions you can provide us, the more information and statistics we can supply to you. The following poll was conducted from August 5, 2011 to August 31, 2011 on Dentaltown.com. Do you do the majority of your endo in one visit? 542 total votes What percentage of the time do you refer your root canals to an endodontist? 44% Less than five percent 27% 14% 6% 9% 65% 35% Six to 30 percent 31-60 percent 61-80 percent More than 80 percent Yes No 474 total votes A similar question was asked in July 2006 What percentage of root canal treatments do you refer to a specialist? 14% None, I perform all RCT in my office 53% One to 20 percent 16% 10% 7% 21-55 percent 56-80 percent 81-100 percent How long have you been using your current file system? 1054 total votes 471 total votes 13% Less than one year 60 27% One to three years October 2011 » dentaltown.com 38% More than five years 22% Three to five years dentaltown research What type of posts do you use? 43% Metal 40% 7% 10% Non-metal Custom cast I don’t use posts 466 total votes Free Facts Endodontists According to the AAE there are approximately 4,000 active endodontists in the United States. How often do you replace enginedriven files? 446 total votes Source: www.aae.org/rootcanalspecialists/dentalprofessionalsandstudents/factsheet/ 2% 5,099,090 Annual estimate of molar endodontic therapy procedures (D3330) completed by general practitioners. When they break 30% When they seem worn out 36% Every other case 32% Every case Source: American Dental Association, Survey Center, 2005-06 Survey of Dental Services Rendered. Endodontics – The ENDO Files Forum Statistics Total number of threads: 11,023 Total number of posts: 171,306 Do you use warm gutta percha backfill? 473 total votes 33% Yes 67% No Endodontics: 2010 Townie Choice Award Winners Recap Canal Treatment – Lubricants & Cleaners: Premier Dental – RC-Prep Canal Treatment – Medicaments: Pulpdent Corporation – Calcium Hydroxide Endodontic Hand Instruments: DENTSPLY Tulsa Dental – Endo Access Kit Files/Reamers – Engine-Driven Files: DENTSPLY Tulsa Dental – GT Series X, ProTaper Universal & ProFile Vortex Files/Reamers – Hand Files: SybronEndo – K-Flex Files Gutta Percha Points: DENTSPLY Tulsa Dental – GT Series X, ProTaper & Lexicon Obturation Devices & Systems: DENTSPLY Tulsa Dental – GT & Thermafil Obturators Sealers & Cements: DENTSPLY Maillefer – AH Plus Jet Root Canal Sealer dentaltown.com « October 2011 61 insurance feature by Douglas Carlsen, DDS continued on page 64 62 October 2011 » dentaltown.com insurance feature continued from page 62 Dr. Bill and his wife, Carrie, always said their lives were blessed. Bill created a beautiful practice in the Pacific Northwest with both a long-term staff and loyal patients. In 2000, Bill retired at age 62. He and Carrie frequently hiked, fished and golfed. Bill worked part-time as a volunteer for the Forest Service while Carrie worked at a local hospital. They both dabbled in watercolors with the local art colony. The couple was told they had more than enough money to enjoy an easy retirement. Bill retired right at the peak of the tech and stock market boom, and immediately turned to more conservative investments. Again, he felt blessed. Bill and Carrie had a great PPO medical plan through Carrie’s job at the hospital, a financial portfolio that was safe from risk and a solid estate plan. In 2002, Carrie began to have mild forgetfulness, having a little trouble with names and remembering recent activities. She and Bill attributed this to age-related memory change. Over the next year, the symptoms worsened to include forgetting how to accomplish simple tasks like brushing her hair and teeth. Carrie had Alzheimer’s disease and needed full-time care. At first, Bill was optimistic, knowing that Carrie would be afforded the best possible care. Her health plan did pay well for doctor visits and medications. Soon, the dark side of retirement appeared. Bill had thought about, but never purchased a long-term care policy. This lack of action eventually proved costly. Bill’s health policy, like most, provided partial benefits for 90 days of skilled nursing care and 20 days of mental health inpatient care per year. However, by 2003, Carrie needed full-time skilled nursing care. Carrie’s nursing home costs rose to well over $70,000 by 2005, even with assistance from their health insurance policy. These changes meant severe curtailing of personal expenses. Many of us worry about another market decline like in 2008. What most of us don’t realize is that a more ominous potential disaster lurks ahead. It is the coming crisis of longer lives and nursing home fees that could devour a lifetime’s savings in less than 10 years. Traditionally, Americans cared for the elderly at home. This still occurs, but at a significantly reduced rate than even 30 years ago. Advances in longevity and disease control have created a more sophisticated system that obviates the possibility in most cases that the elderly can be assisted and housed without professional care. This burden on our health-care system, our finances and our domestic lifestyle will only increase as we advance in age. Table 1 shows some frightening statistics about care in the U.S. Genworth Financial also has a 2011 update with similar figures to MetLife’s, yet with state-by-state rates.2 Using a rate of $230 per day for nursing home care, three years of care would cost $251,850, and 10 years would cost $839,500. No wonder Dr. Bill has a financial problem. What is the government’s role? Medicare pays for a limited number of days of skilled nursing care after hospitalization. It does not offer long-term custodial care. And there is no Medicare supplemental policy to cover custodial care. State Medicaid plans do cover custodial care for the impoverished, but only after most assets are gone, and in facilities where you would least want to be. Traditional health-care plans don’t offer long-term care policies. Long-Term Care Insurance When to buy: Analyze at age 60 or before, as many patients need care before age 65. Levels of care: A policy should cover non-skilled, skilled and custodial care, either in your home, an assisted-living facility, adult day care center or nursing home. Make sure you have the home care option, even if it costs more. Elimination period: 90 days is normal. Benefit amount: At least $250 per day, $7,500 per month or $90,000 per year. As noted, rates are rising quite quickly – boomers born in 1950 will have $270,000 per year in nursing home fees at age 89 (see Table 2 on page 66). Length of benefit: The average benefit payment is for 2.4 years, yet Alzheimer’s patients often require assistance for more than a decade. Policies offer varying lengths, yet I would recommend five years minimum. Inflation protection: Get compound inflation protection, not simple inflation protection. Rates are rising rapidly, like any medical insurance. Consider a “guaranteed purchase option” also. This allows the later purchase of more insurance without a medical exam. Spousal discounts: Domestic partners might qualify in some states. Ask about “survivor waiver of premium.” This Table 1: Care in the United States1 $83,585 $229 $19 70% 40% Average annual cost of nursing home care in a major city Average daily rate for a private room in a nursing home Average hourly rate for non-skilled home health aids provided by a home health-care agency Percentage of boomers who will need long-term care after age 65. Percentage of long-term care recipients under age 65. continued on page 66 64 October 2011 » dentaltown.com They’ve always been there for you. Now it’s your turn. Join Oral Health America (OHA) and Ivoclar Vivadent as we elevate the oral health of vulnerable older Americans through the Wisdom Tooth Project® – an initiative dedicated to the well-being of older adults. Over 10,000 Americans reach retirement age every day, and many will go without the oral healthcare they need. But they can’t be healthy without good oral health! HOW CAN YOU HELP ? Multiply your impact. Donate to OHA between now and December 31st, and Ivoclar Vivadent will match 50 cents on every dollar to promote healthy mouths throughout the journey of life. Want to know more? Watch the video. Simply log onto www.oralhealthamerica.org/wisdomtoothvideo/ or scan the QR code with your smart phone. To make a donation that changes lives, visit oralhealthamerica.org or call (312) 836-9900 and ask for Emma. © 2011 Oral Health America insurance feature continued from page 64 Table 2: The Rising Costs of Long-term Care Year 1975 2005 2015 2039 Cost $7,2001 $74,0002 $106,0003 $270,0003 1. United Equitable Insurance Company, 1977. 2. MetLife Market Survey on Nursing Home and Home Care Costs 2005 Mature Market Institute, MetLife, September 2005. 3. “Facts About Long-Term Care,” American Council of Life Insurers, 2009. on $107,240 (76.6 percent of $140,000).3 The couple’s incomeneed thus jumps to $192,240 ($85,000 + $107,240). If five years of care is needed, the extra living amount for two is $52,240 times five, or $261,200. For two people for five years, the need is $522,400. The average doctor I encounter needs around $2 million for retirement, not including their home or long-term care insurance. Therefore, to self-insure, couples might need an extra halfmillion dollars or more. waives premiums for a surviving spouse if premiums have been paid for more than 10 years. Care coordinators: Make sure this is offered in your policy. These professionals are a must in many instances, especially with family members living a distance away. The cost should be included in the benefits. International coverage: If you plan to retire outside the U.S., definitely purchase this coverage. Non-forfeiture benefit: If the insurance company raises premiums and you cannot afford to continue paying, you still might retain some benefit from the policy. Cost: For the best information and a meaningful quote, go to the AARP Web site. Genworth Financial offers good plans at AARP and you can receive a quote without talking to an agent by visiting: longtermcare.genworth.com/SimpleEngine/private/ loginAARP.do. A quote at Genworth for a 60-year-old with all the bells and whistles mentioned above for $250/day coverage is approximately $4,000 per person per year, $8,000 per couple. A 50year-old couple can expect premiums of about 65 percent of a 60 year-old. A 70-year-old couple can expect rates about 65 percent higher than age 50, or about $13,000 per year. Insurer: You will want to purchase coverage from a large company that has shown stability for the long term. Genworth Financial, through AARP, is the only company I recommend in 2011. Combined Life and Long-term Care Policies According to Terry Savage, financial columnist for the Chicago Sun-Times, “These policies are funded by a large, single-premium deposit into a life insurance policy. Typically the money comes from savings that you don’t plan to use in your lifetime, but would otherwise leave to your heirs. If only some of the death benefit is used for care, the balance goes to your heirs. “Buying one of these combo policies gives you leverage to get more long-term care coverage than simply self-insuring by keeping the money in savings.”3 I’m normally not a fan of any life insurance policy that isn’t term life. This is an appropriate exception. OneAmerica, Lincoln National and Genworth all have good policies to investigate. Self-funding The average retired dental couple I talk to lives on an income of around $140,000 per year. If one needs nursing care that costs $85,000 per year, the other person can normally live References: Final Thoughts During the heyday of our professional lives, we concentrate our finances on homes, autos, travel, clothing, college for children and savings. In retirement, health issues not only occupy a large slice of time, but can also eat up most of our budgets. There isn’t a happy ending for Dr. Bill, only the knowledge that his children now will help out both Carrie and Bill financially. Terry Savage provides a meaningful discussion of longterm care in her new book, The Savage Truth on Money, found at any bookseller. ■ 1. Market Survey of Long-Term Care Costs, MetLife, October 2010 2. http://www.genworth.com/content/products/long_term_care/long_term_care/cost_of_care.html 3. Terry Savage, “Combined life, long-term care policies,” Chicago Sun-Times, downloaded Feb. 5, 2011 at www.suntimes.com/business/savage/3445374-452/care-insurance-policies-moneyterm.html Author’s Bio Douglas Carlsen, DDS, owner of Golich Carlsen, retired at age 53 from private practice and clinical lecturing at UCLA School of Dentistry. He writes and lectures nationally on financial topics from the point of view of one that was able to retire early on his own terms. Carlsen consults with dentists, CPAs, and planners on business systems, personal finance and retirement scenarios. Visit his Web site: www.golichcarlsen.com; call 760-535-1621 or e-mail at [email protected]. 66 October 2011 » dentaltown.com 85 + 5 8+See Below 876545321510/65.-,5,2651765+0*)621®5(1.',2™5&8%$5.-,#''5"65!/! 6* What’s the how behind the WOW!? Speed sensor O-rings: radial support Wave springs: axial support Speed-Sensing Intelligence (SSI) Superior Turbine Suspension (STS) maintains constant speed under load by automatically optimizing power to virtually eliminate stalling. ensures outstanding precision, accuracy, and control Don’t miss these HOT ATC specials ORDER NOW! LIMITED TIME OFFER. offer valid through 12/31/11 (615,5!5 36656/-5 -35830!' 1-*!. ,.5!5+0*)621®5(1.',2™5&8%5(5(1!31635!! 65)557!*0662 66065!5%-13-'5(-,365-35!5*5-63!1-3.5 ,.5!5+0*)621® (1.',2™5&8%5(1!31635!! 65)557!*0662 66065!53*5&8%5!*0665 %!''5.-,35-!'5(!'625636261!10651-*!.5!15 )))(1.',2&8%-/ MID20-1010-1 you should know Why You Should Kno 68 October 2011 » dentaltown.com You Should Know_Layout 1 10/19/11 10:09 AM Page 69 o w: you should know Wpromote by Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine Meet Mike Mothner, the founder and CEO of Wpromote, a full-service online marketing firm that serves about 2,000 clients across the world but mostly in the U.S., ranging from small local businesses all the way to Fortune 500 companies. Who was your first client? Mothner: Our first client that we helped with SEO and online marketing was a fingerprinting company, for people who need to get security clearance. How did you come up with the name Wpromote? Mothner: I was really into computers at the age of 15. I wrote a piece of software and I started buying domain names and helping people launch their Web sites in the late 90s. I came up with the concept of the service and I needed to think of a name. I happened to look down my list of dot com names that I owned and I saw Wpromote. I thought that is kind of short and easy to remember and W is kind of from World Wide Web. I wish I had a better, more romanticized answer. Search engine optimization (SEO) is the core of your business. How would you say this has become more sophisticated? Mothner: The core is organic search engine optimization. Helping Web sites have better content, more authority; and then search engine marketing and pay per click is the active advertising. That probably composes about half to two-thirds of our business now. In the past decade the SEO industry has gone from where you just needed to show up with text on your Web site to now where we are in a competitive, mature industry with a lot going on. There has been a lot of talk lately about Google’s decision to discontinue posting third-party reviews on its Places pages. What are your thoughts on that? Mothner: At the end of the day Google wants to be the source. Their thinking is it is a less “spammy” environment if they control the content. They got people involved in the beginning when they didn’t really have any reviews. There are definitely positive and negatives to it. I personally believe Google does care about the user and the honesty and integrity of the reviews. What I would consider the three main search engines are Google, Bing and Yahoo. How would you characterize those three? Mothner: I think it is very easy to fall into the trap of, “I only use Google.” The bottom line is that the combination of Yahoo and Bing basically are all powered by Bing. It is three properties but you are only dealing with two venues in which to focus SEO efforts as well as search efforts. If you have a relatively limited budget and you’re not going to have enough to cover everything, your first dollars are going to be better spent in Bing or Yahoo. How frequently does a dental office need to add fresh content to its Web site, Facebook page, etc.? Mothner: In the realm of a dentist office there is not much that changes. I have my services, I have my bio, I have the relevant information and it is not like that changes very often so it can be a challenge. From an SEO perspective we are adding content for Google not necessarily for the user so if you are a client of ours and we are adding five pages of content a month and we are picking key words and creating the content, etc. That has a quality benefit. It should be ongoing – that’s the key. The better way to have a more natural growth of content on the site is to have a blog on your site. You don’t have to really think about it from an SEO perspective, you just have to be routine about it. I can post a link to another article. I can post something about the happenings in the local town or schools. It can be more about updates for patients on things to do in the community. It doesn’t always have to be about teeth. For more information, visit www.wpromote.com. n dentaltown.com « October 2011 69 practice management feature RENT-a- DENTIST by Joe Steven Jr., DDS I have to admit that I kind of felt sorry for that doctor after our phone conversation! An out-of-state dentist called me at home to talk about some clinical concerns he had. We visited for about an hour, and before we said goodbye, he said, “Joe, thanks for talking to me tonight! I can’t remember the last time I talked to another dentist. It’s been years!” 70 October 2011 » dentaltown.com continued on page 72 practice management feature continued from page 70 I thought about how often Mark Troilo and I talk with each other since graduating together 33 years ago. We talked nearly every night about the clinical and management side of dentistry because we love talking dentistry! I realize that there is more to life than dentistry, and all dentists will have different levels of passion about our profession. This article is about what those conversations can do for a dentist. Because we talked dentistry all the time over the years, our practices grew very successful simultaneously. Our practices mirror each other very closely when it comes to the size, team, philosophies and production numbers. Is this just coincidental? I don’t think so. I believe it is a direct result of the fact that we discuss dentistry whenever we can. We learn from each other. We take turns trying out new products and systems, and then share our results. Over the last four years, we’ve had many discussions on incorporating associates. We discuss things that we learn at different seminars and work together to implement them into our practices. We even go so far as to joke about that if you don’t have a friend who is a dentist, go rent one! At our seminars Mark and I talk about how important it is to have a good friend who is a dentist whom you can talk with on a regular basis. We even go so far as to joke about that if you don’t have a friend who is a dentist, go rent one! We think it is that important. Mark and I have been very lucky to be best friends since dental school, so yes that makes it easy for us. But, what do you do if you don’t have a close dental friend? There are several things you can do. The easiest is to join some of the dental e-mail network groups. Dr. Howard Farran said it best when he started Dentaltown.com with the tagline, “Never practice alone again!” What a great way to learn from other dentists while building friendships. Dr. Mike Maroon and his friends started the ACE e-mail network, which accomplishes the same learning experiences. We started one with KISCO that you can join easily by going to our Web site. I’ve picked up many good ideas from these groups. Because of these networks, my daughter, Dr. Jasmin Rupp is doing Six Months Smiles, which has been great for our practice. So, if you don’t belong to any of these groups, what are you waiting for? They don’t cost anything. And please, don’t be afraid to share your input with others also. Joining a study club is another great resource. You can also start your own. Contact some of your colleagues in your area continued on page 74 72 October 2011 » dentaltown.com .-,+*)(+* * * '&% **$(#)+"#"!** (-+"!+ 9 )+*'&% )+*'&% ++*'&% ++*'&% -,1,11$751'713-4+41$71*4+1$7+4 1 1 1 1 1 1 1 1 '-7214$15+7$721,*1*/1/# 1 1 1 1 1 4177122,+,4*51!"1.-,+7*,*)1'71357716,,+1#,(-+"!+ 1 1 1 1 1 1 1 1 * * * * * 710/18$#1,'+4$1 1 1 1 1 $2,'1,++57+4*1 1 1 * * * * * 5 1/4 1 551$7'7,6711'435,7*+$/177+-1.-,+7*,*)1(, 1 1 1 1 1 1 5+4$1$4)$1 1 1 ,+-1/4 1 $14$27$#1 7*+,4*1$441427181-7*1/4 1 1 1 1 1 1 1 1'55# 1 -7177+-1.-,+7*,*)1(, 1 1 1 5+4$1$4)$157+1/4 1 1 1 11*21/4 1 $13+,7*+1771 1 1 1 -41,*)1+-7,$1+77+-1,5515441,+-1!"1$7 1 1 1 1 1 1 1 1 5+# * * * * * * * 1 1 1 1 1 1 1 * * * * *"+-,*!--")++ "+-,*!--")++ * * * * !"1.-,+7*,*)18773157'-,*) 1 1 1 11)7+1+77+-1+-7,$1045 1 1 1 +71-,+7+1767$/1+,7 1 1 1 ) $*+772#1+1541+-71/+71/4 1 1 1 1 1 671-7$2104 1 1 +1+-+1,)*,'*+5/1-,+7*1551 1 1 1 1 1 +77+-1*41++7$1-+1-271+-7/1$71+4107),*1,+-1*21*41++7$1-+1' 1 1 1 1 1 1 1 1 1 1 1 1 1 1 721+-7 1 2,'454$+,4*1)714,*)14421*210767$)71+,*1767*1+7+$'/'5,*71+,*# 1 1 1 1 1 1 1 1 1 !"12471,+1551*21,+1247141,+-11-,)-5/177'+,671*+,7*,+,6,+/133$4'-1*21 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 4$ 5+,4*#1-7107+1/1+41075,7671,+1,1+41+$/1,+#1$27$11+$+7$1,+1+42/#14 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 *21/4 1 $13+,7*+,551071+-$,55721,+-1+-71$7 1 1 1 1 1 1 5+###11 $+*!--")++*#) * * * * * * * * * * * * * * *+*#"-)#"*-"*)*+* * * * * * * ** , (-+"!+ PRODUCTS PRODUCTS 2011 2011 practice management feature continued from page 72 and visit with them about starting your own club. I belong to one here in Wichita, and we meet every three to four months. We discuss different dental topics and also dental politics. Our group has been very proactive in state politics and has made positive changes for the profession in our state. You can do the same. Along the way you just might pick up a close friend or two who you can call late at night to tell them that you broke another NiTi reamer in a patient’s tooth! If you practice in a medical or dental building with several other dentists, try to get all the dentists to go to lunch once a month or every other month. If you practice alone, call several dentists within a radius of a couple of miles, and invite them to do the same. While building good relationships with some colleagues, another advantage is that you might find good connections for covering each other’s office emergencies when those situations arise. And then of course, there are plenty of personal consulting programs out there that you can bring on board to help manage your practice. These programs are ideal for getting doctors more involved in the business side of their practice because now they have to talk dentistry on a regular basis with someone who is trying to help them. Too many times dentists are just so busy practicing dentistry and raising a family that they don’t have time to really implement and improve systems in their office. Can you become successful without any of the above? Sure you can, but the large majority cannot. It just makes sense that it is much easier to improve your practice if you have a friend, a colleague or a coach to help you through your dental business journey. Plus, it’s good to have someone you can call to vent some of your frustrations and problems. Better yet, it’s great to have someone you can share your clinical dental successes. All around, it is a much more beneficial way to practice dentistry! ■■ Author’s Bio Dr. Joe Steven graduated from Creighton Dental School in 1978 and has been in solo practice in Wichita, Kansas, up until June, 2007 at which time his daughter, Dr. Jasmin Rupp joined him. He is president of KISCO, a dental products marketing company, providing “new ideas for dentistry,” and is the editor of the KISCO Perspective Newsletter. Dr. Steven, along with Dr. Mark Troilo, presents the “Team Dynamics” seminar. Dr. Steven also presents three other seminars: “Efficient-dentistry,” “Efficient-prosthetics” and “Efficient-endo.” Dr. Steven also provides the KISCO Select Consulting Program to dentists in the form of a monthly audio CD recording. He also offers a coaching consulting program called the KISCO’s 21 Club. Contact info: [email protected]; 800-325-8649; www.kiscodental.com. 74 October 2011 » dentaltown.com &%$#%"!#% !#%!$ Cele Ce Celebrating ele g Pra P Pr Practice rra acti ac ctic ice ce Suc Success sponsored spo o onsor re ed by Gold d Dust Dental Lab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ENTERTAINMENT. CAMARADERIE. THE COSMOPOLITAN APRIL 2012 25-28 OF LAS VEGAS – 35 – – 23 – DR. HOWARD DR. GARY FARRAN DR. TARUN AGARWAL DR. MIKE BARR DR. MARVIN BERLIN DEWOOD DR. DAVID HORNBROOK DR. LORNE LAVINE DR. MARK HYMAN DR. SCOTT LEUNE TRISHA DR. RICHARD O’HEHIR, RDH DR. MICHAEL MELKERS DR. SAMEER PURI DR. DAVID MADOW DR. TIF QURESHI MADOW DR. UDAY REEBYE DR. ANTHONY REGANATO DR. JAMES RUSSEL DR. RYAN SWAIN FIND OUT MORE AND REGISTER AT TOWNIEMEETING.COM SUPER SAVER EARLY BIRD Until 10/31/11 Until 2/29/12 Dentist $895 $1,195 $1,495 PROGRAMS FOR THE ENTIRE OFFICE RDH $549 $699 $749 Clinical, Practice Productivity, Hygiene, CEREC, Hands-On & Workshops! Staff, Lab Techs, Assistants, Guests $399 $449 $599 Dental Student $399 $399 $499 Social Pass $199 $199 $225 HELP US CELEBRATE 10 YEARS We’re making our tenth meeting the best yet. Don’t miss it! UNMATCHED ENTERTAINMENT Experience our legendary social events like the Golf and Poker Tournaments. REGISTER NOW AND SAVE! Take advantage of Super Saver pricing now. Register at towniemeeting.com. Special Townie Rate at THE COSMOPOLIT TA AN of Las Veg e as per $219 nigh nightt CALL 877.551.7 . 772 AND MENTION TOWNIE MEETING. Poker Tournament $250 Golf Tournament $200 Inman Aligners Workshop Dentists $695 Team Communication Workshop Dentists $695 with Dr. Michael Melkers REGULAR RATE Staff $200 Staff $295 STAY CONNECTED WITH TOWNIE MEETING ON FACEBOOK & TWITTER! Call 866-336-8696 for more information. restorative feature continued from page 76 Fig. 1: Pre-operative view: fractured central incisor Fig. 2: Considerable loss of dental enamel; fracture line near the pulp Fig. 3: Mock-up made of composite resin (A4) for the palatal silicone matrix Fig. 4: Preparation of a featheredge under rubber dam isolation 78 October 2011 » dentaltown.com A very close inspection of dental enamel reveals its intricate fabric. Having to reproduce these fine structures and shade nuances seems a daunting task. Due to the research and development efforts of dental composite manufacturers over the past few years, materials are now available to facilitate the placement of restorations. Nevertheless, the appearance of composite resin restorations is often marred by a grayish shimmer. The following clinical case shows a way to avoid this problem and realize the natural-looking results envisioned by the patient. An 11-year-old male patient presented for surgery with a fractured central incisor (Fig. 1). The clinical examination revealed that the tooth was sensitive to temperature and percussion. A fracture close to the pulp was diagnosed (Fig. 2). Clinical evidence of a periodontal trauma was not found. I recommended the tooth be reconstructed by layering composite resin using a minimally invasive and conservative restorative technique. Shade Selection I determined the shade in daylight at the beginning of the treatment before the teeth were dried. I used the shade guide of the composite resin, which I subsequently used during the restorative procedure (Tetric EvoCeram). In order to check the selected tooth color, I applied a composite layer to a tooth and polymerized it. For the cervical area, I chose dentin shade A2 and for the incisal area enamel A1. The Mock-Up The treatment area was locally anaesthetized and the tooth was reconstructed free-handedly using a composite resin (deviating from the tooth color), without preparation or the application of an adhesive. I decided to use an easily recognizable shade; in this case A4 (Fig. 3). After polymerization, the shape and exact position of the margin and the occlusion were refined. Finally, a silicone matrix of the palatal surface and the margin was fabricated with a putty impression material. This matrix would facilitate the subsequent layering procedure. After the fabrication of the silicone matrix, the provisional restoration (mock-up) was removed. Later a composite resin in the desired tooth color would be placed. The Cementation Protocol When the adhesive was applied on the restoration, it was important to ensure that the tooth surface was not too wet. The placement of a rubber dam with ligatures is standard procedure. The rubber dam provides an unobstructed view of the treatment field and increases the safety and comfort of the practitioner and the patient. The tooth substance was prepared with a featheredge in the labial enamel. This preparation design ensures tight sealing and forms the basis for an unobtrusive transition between the natural tooth structure and the composite resin (Fig. 4). The enamel and dentin were cleaned with a mixture of pumice and pure chlorhexidine (Paroex) at 0.2 percent. Next, Telio CS Desensitizer was applied. Due to the wide enamel edge, the total-etch technique was used. That is, the tooth was etched with phosphoric acid before the adhesive was applied. Therefore, the enamel was etched for 30 seconds and the dentin for 15 seconds with total etch. This etching gel contains 37 percent phosphoric acid. The surfaces were rinsed for 20 seconds and then carefully dried according to the “wet-bonding” principle (adhesion on moist surfaces). As a result, the enamel was dry, while the feature restorative dentin remained somewhat moist. This drying step requires utmost care when this type of adhesive is used. If the moisture content within the dentin tubules is too high or if the collagen fibers collapse due to excessive drying, the penetration of the adhesive, and therefore the bond strength, is reduced. The single-component adhesive ExciTE was applied to the enamel and dentin and allowed to react for 10 seconds. An indirect stream of air was used to evaporate the solvent contained in the adhesive. In the process, the air spray was applied on a mirror in the mouth, which was held at an angle to the prepared tooth surface. As soon as the surface was lustrous, the adhesive was further polymerized for 10 seconds (low power mode of the bluephase G2 LED curing light). Layering of the Composite Resin First, the composite resin was applied to the palatal areas. The enamel material A1 was applied in the silicone matrix. In order to avoid the formation of bubbles, the composite resin was distributed very carefully. The matrix was placed in the patient’s mouth and positioned on the palatal surface with light pressure. The composite resin was polymerized for 15 seconds using the soft start mode (Fig. 5). Small lobes of dentin material (A2) were subsequently applied. The position of these lobes was individually determined. The aesthetic results were based on the contralateral teeth, which served as a comparison. In this case, the mamelons were clearly separated. They ended below the incisal edge (Fig. 6). By observing the existing anatomical features, a natural-looking and aesthetic outcome was achieved. The composite resin was applied in small amounts, which were periodically cured with a bluephase curing light in the soft start mode. The dentin material was applied and light-cured. Next, the incisal edge of the tooth, that is, the outermost part of the restoration, was reconstructed. Small portions of the translucent incisal material were placed between the dentin mamelons. A probe came in useful in these narrow areas. Finally, the entire labial surface was coated with Tetric EvoCeram Bleach 1, making sure both the dentin lobes and the incisal edge were completely covered. The bleach shade made the tooth appear lighter. The dentin material imparted the composite resin restoration with a tooth-like appearance. The shade was responsible for the tooth’s natural-looking brightness. Surface Finishing The aesthetic outcome is largely based on the successful re-creation of the surface texture. The imitation of the shape and surface details is just as important as that of the fine color nuances. In the treatment of a child’s tooth in particular, it is important to take the micro- and macro-anatomical structure into consideration. The surface was finished with finishing diamonds (first red, then yellow). Spray was not used. Work was done using a surgical microscope. The restoration was finally polished with the Astropol system (using water spray). In contrast to polishing discs, these rubber tips do not harm the surface structure. Conclusion The fabrication of natural-looking, highly aesthetic restorations is a rewarding task with Tetric EvoCeram materials and the increment technique. The bleach shade on the tooth surface brightens the restoration. This approach is extremely helpful in the restoration of children’s teeth. With the help of this adhesive technique, teeth can be restored in a minimally invasive way (Figs. 7a, b). ■ Fig. 5: Build-up of the palatal surface with enamel material (A1). The precision of the morphology is already impressive at this stage. Fig. 6: Lobes are created with dentin material (A2). The translucent material is placed between these mamelons. Figs. 7a, b: A comparison: before and after: The shade on the surface of the restoration imparts the tooth with the necessary brightness. Author’s Bio Dr. David Hacmoun practices in France. He can be reached at [email protected]. dentaltown.com « October 2011 79 product profile Zest Anchors Zest Locator Overdenture Attachments Locator Root Attachment Locator Implant Attachment Locator Bar Attachment 80 For 40 years Zest Anchors has been in the design and manufacturing of overdenture attachments. Zest pioneered self-aligning attachments to combat the damage done by the improper seating of overdentures. Zest’s Locator Attachment is designed with the primary benefits of ease of insertion and removal, customizable levels of retention, low vertical profile and exceptional durability. Its most critical design feature is its innovative ability to pivot, which increases the Locator’s resiliency and tolerance for the high mastication forces an attachment must withstand and allows it to compensate for the path of insertion even with up to 40 degrees of divergence between implants. During seating, while the Locator male pivots inside the denture cap, the system’s self-aligning design centers the male on the attachment before engagement. These two actions in concert allow the Locator to self-align into place, enabling patients to easily seat their overdenture without the need for accurate alignment and without causing damage to the attachment components. This self-aligning feature also increases the durability of the Locator Attachment. 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With the Locator Attachment’s unique design, the overall restorative height of the overdenture is significantly reduced on all brands of endosseous implants. With a total attachment height of only 3.17mm (male plus 1mm cuff height) for an externally hexed implant, the Locator saves a minimum of 1.68mm of interocclusal space compared to other overdenture attachments. The Locator Attachment also has twice the amount of retention surface area compared to other overdenture attachments available. Its unique dual-retention feature, which includes inside and outside retention, ensures long lasting performance and predictable durability. Zest offers three Locator Attachments for the various types of overdenture treatments. The Locator Implant Attachment is the premier attachment for implant-retained, tissuesupported overdentures and is available for virtually every implant system. When a treatment plan calls for an overdenture bar, the Locator Bar Attachment provides the same self-aligning feature, superb retention, a low-profile design and long-lasting durability. It is also offered in three options for the fabrication of a resilient attachment on an implant-supported cast alloy or milled titanium bar. The Locator Root Attachment is a supra-radicular design with a choice of a straight post and 10- or 20-degree angled posts to accommodate divergent roots. A special cast-to version is also available. Locator has become the overdenture attachment that is embraced by clinicians worldwide. It is currently available for more than 350 different implants produced by more than 70 manufacturers, meaning that almost any implant platform has a compatible Locator Attachment to fit. Now, patients all over the world are enjoying a better quality of life, without the worry of ill-fitting dentures. For more information, call 800-262-2310 or visit www.thepivotingdifference.com. ■ October 2011 » dentaltown.com 1972 ZEST Anchor Aachment ® 2012 ZAAG Aachment ZEST LOCATOR Aachment System (Implant, Bar & Root Aachments) (Implant, Bar & Root Aachments) ® ® SATURNO Pivoting O-Ring Aachment ™ The Next Generation of Overdenture Aachments Leading four decades of overdenture aachment system innovations. For forty years, we’ve been raising the bar in overdenture aachment innovations. From pioneering pivoting, self-aligning aachments to exciting breakthroughs on the horizon, ZEST continues to define the overdenture aachment market. It’s why over 70 implant manufacturers have partnered with us to customize our third generation aachment, LOCATOR, and made it compatible with over 350 different implant products. It’s also why millions of patients are now enjoying a beer quality of life every single day. We’re proud of what we’ve accomplished, but we’re not standing still... in the coming year, watch for exciting new product introductions designed to once again provide your practice with increased revenue opportunities and even more satisfied patients. For more information download a QR app to scan this code, visit our new microsite at www.thepivotingdifference.com/DTOWN, or please call 1.800.262.2310. ©2011 ZEST Anchors LLC. All rights reserved. ZEST®, LOCATOR®, ZAAG® and ZEST® Anchor are registered trademarks and SATURNO™ is a trademark of ZEST IP Holdings, LLC. marketing feature by Rhonda R. Savage, DDS Elmer Wheeler, a selling genius from the 1940s, said: “Don’t sell the steak, sell the sizzle.” But, you can’t sell the sizzle if the patient doesn’t trust you. Think about the “steak” as your basic dental services. The “sizzle” is above and beyond. The sizzle can be those little things that increase your bottom line: adult fluoride, night guards, sealants, cosmetic whitening, nitrous oxide or referrals of new patients by existing patients. Also, the “sizzle” can be big things like cosmetic dentistry, implant restorations, orthodontic treatment or laser-assisted periodontal treatment. You can’t offer the steak or the sizzle unless you get new patients in the door and you keep them in your practice. You won’t attract word-of-mouth referrals from your existing patient base if your patients don’t trust you. Step into your patient’s shoes. Would you choose your dentist or physician if he or she were totally about self-respon- 82 October 2011 » dentaltown.com sibility? How about if he had the reputation of placing your needs above his? “My dentist makes recommendations based on what’s right for me, not on what’s best for him!” As a privately practicing dentist, former dental assistant and front office person, I look at the business of dentistry from the inside out. Who do you stack up against, from a competition standpoint? As a consultant and a dentist, I can say that my products are a head and shoulders above the competition. Can you say the same about yours? People are willing to pay a premium for these qualities. You’ll attract more new patients if this is your reputation. People shop up if they have the opportunity. Price is only an issue in the absence of value. What’s holding your practice back from creating value? Is it training or refining your team’s talents? There are five areas of critical training that exist in dentistry. feature marketing Visit us at ADA, October 10-12, 2011 Clinical and motivational verbal skills Financial presentation skills Communication systems within the office Leadership skills for the doctors Effective business systems You’ll need to personally examine your practice and consider how you fare with your “steak and sizzle” in each of these categories. It doesn’t make sense to spend your precious time and money on marketing if you don’t engender trust in your patients. This is true whether you’re a fee-for-service practice, a participating provider or a Medicaid-based practice. Marketing is one step; keeping the patients is another. First, you need a defined goal. In order for your practice to grow, you should be seeing between 25-40 new patients a month per doctor. As an established practice, you need 10-20 new patients a month. If you have an associate, I recommend your goal be 50 new patients per month. Your need for new patients depends upon your demographics, practice style and number of years you’ve been in practice. As an established practice, if you have less than 10 new patients per month, your practice is declining. A growing practice should have a marketing allowance of two to six percent of collections. Consider spending twothirds of your budget on internal marketing and one-third on external marketing. I’ve worked with some rapidly growing scratch practices who see a high number of PPO patients, primarily obtained by billboard marketing, magazine and newspaper ads and neighborhood mailers. If you consider the PPO adjustment as a marketing tool, how much of your gross production could be technically considered “marketing”? Your team members need to understand that PPO participation can be considered one way to build a practice. Be careful, however, that you work to keep those hard-earned patients. If you get too many new patients, don’t have an adequate staff and there’s no effort to recall or reactivate, you’ll be a revolvingdoor-type of practice. Here are 12 strategies to market your practice: 1. Stay Connected One very powerful marketing tool is a confidential patient survey (Smile Reminder is one company offering a great electronic survey). Or, you can choose to do an in-office survey; a mail-in survey will obtain more information because the patient can choose to be anonymous. E-mail me if you’d like a copy of our in-house survey. Have your front desk team let the patient know you’re asking all of your patients for their help. Give them a self-addressed, stamped envelope and inform them that the survey can be anonymous or signed. continued on page 84 Booth #1060 OraRisk HPV ® salivary diagnostic test The OraRisk® HPV test determines who is at increased risk for oral HPV-related oral cancers. Advancing Patient Wellness Through Salivary Diagnostics Studies reveal that the human papillomavirus, particularly HPV-16, has been definitively implicated in oral cancers.1,2 In fact, over 50% of oropharyngeal tumors contain the HPV genome (DNA).2 Early detection of oral HPV is a fundamental element of a patient’s overall wellness plan. The OraRisk® HPV salivary diagnostic test is a non-invasive, easy-to-use screening tool to identify the type(s) of oral HPV, a mucosal viral infection that could potentially lead to oral cancer. The test enables clinicians to establish increased risk for oral cancer and determine appropriate referral and monitoring conditions. To order OraRisk® HPV testing supplies, contact your Henry Schein® representative at 800.372.4346 References: 1. Ragin CC, Modugno F, Gollin SM. The epidemiology and risk factors of head and neck cancer: a focus on human papillomavirus. J Dent Res. 2007 Feb;86(2):104-14. 2. Fakhry C, Gillison ML. Clinical implications of human papillomavirus in head and neck cancers. J Clin Oncol. 2006 Jun 10;24(17):2606-11. PRODUCTS 2011 For more information, www.OralDNA.com/professionals 877.577.9055 Exclusively Distributed by © 2011 OralDNA® Labs Inc. All Rights Reserved. OralDNA® Labs is a subsidiary of Quest Diagnostics® Inc. dentaltown.com « October 2011 83 marketing feature continued from page 83 Recall and reactivation is truly the best form of internal marketing. What is your percentage of effectiveness in getting your patients back in the door? Stay in touch with your patient base with a newsletter. The least costly is a electronic version (Smile Reminder, Demand Force and TeleVox are some companies to research). Make it 50 percent non-dental, fun and interesting! Also, send birthday cards, anniversary cards, sympathy cards and daily thank you cards to patients. 2. Call Patients Post-treatment Are you calling patients post-treatment to see how well they’re doing? Your patients will be very impressed that the doctor is calling them! You should call after major treatment. Patients love it! Also, your hygienists should call after any scaling and root planing, within 24 hours post-treatment. 3. Call New Incoming Patients Within one to two days of scheduling, call new patients to greet them and welcome them to the practice. This will certainly set you apart from other dentists and decrease new patient failures! Ninety-five percent of the time, you’ll be leaving a message. This is what I say: “Hi, I’m Dr. Rhonda Savage. I understand you’ve made a new patient appointment with my practice. I wanted to call and let you know we’re looking forward to having you in our practice. If you have any questions, feel free to call me at 555-1212.” 4. Evaluate Facility Appearance One significant part of marketing is the appearance of the facility. Is cleanliness an issue? Hold your cleaning company accountable. I recommend an outside cleaning company; if you must use internal help, the cleaning person needs to be held at the same level of accountability as an outside cleaning company. In order to see what the patients see, set aside 20 minutes at your next team meeting for a patients’ perspective exercise (PPE). Everyone walks in silently from the outside and looks at all the spaces. Each staff member should make notes on a pad of paper. Then meet and combine the notes and ideas into three categories: ideas that cost nothing, ones that cost a little, and those that cost a lot. You will be amazed at what a little “spring cleaning” can do! I always recommend that all spaces be “patient ready” at all times. Does your facility project warmth in color and décor? You don’t need to spend a lot of money to create a warm look with paint, carpet and décor. The entire team needs to be involved in cleaning their personal space or have an assigned operatory. They should be cleaning their operatory from top to bottom quarterly. This is not the job of a cleaning crew. Doctor, does your desk need cleaning? Dusting? Your space should be kept as neat and clean as the rest of the office. Cleaning the blinds is the duty of the cleaning crew. They should be cleaned quarterly or at least semi-annually. 84 October 2011 » dentaltown.com Make certain the front entrance area is kept clean on a daily basis. Have a well-lit exterior, with colorful flowers if possible. Consider the use of small, decorative white lights to illuminate trees and create interest at nighttime. 5. Consider Professional Image If you’re interested in presenting a higher level of care, you might consider professional dress. The front desk needs closedtoed shoes and a professional top with little or no cleavage visible. Even in warm areas, I recommend the team avoid capris and sandals. If someone appears at work with cleavage, they should be sent home to change. Everyone should reflect the image that you want your office to be known for! Consider the image as part of your PPE discussion. 6. Adding Services An addition of new services within your practice will help make your practice stand out from others. One company to consider is OralDNA. Ask your hygiene department to research its products. Also, have your staff wear one of many magnetized buttons that say, “Ask me about Six Month Smiles!” or “Ask me about Cosmetic Whitening.” Check out RLM Dental Marketing for these buttons; place them in a basket and have everyone grab one each morning at your morning huddle. 7. Personal Marketing Outside the Practice The doctor needs to be active personally in the community. All team members need to actively refer when out in the community. Give your team $25 per new patient referral from outside sources (personal family members do not count). 8. Keep an Up-to-date Web Site Do you need to increase the search engine visibility of your Web site? Do a local search to check your placement. Also, review the image of your site. Does it draw patients in within the first few seconds? Blog, blog, blog on your Web site. You need video, rave reviews and Facebook on your opening page. Look into the QR code! Have rotational promotions on your site. 9. Consider Patient Financing Look into alternate patient financing as part of your marketing program. I personally have worked with CareCredit all my years in private practice. If the patient doesn’t qualify for CareCredit or ChaseHealthAdvance, consider ComprehensiveFinance.com. 10. Evaluate Patient Services What’s in the patients’ best interest? What can you offer them? Consider X-rays every year for the majority of your patients. Unless the patient is a clean, healthy adult, you cannot diagnose what you don’t see. Sometimes, even those that appear clean and healthy can surprise you! feature marketing Booth #1060 Visit us at ADA, October 10-12, 2011 11. Front Desk Organization The front desk needs to be prepared for everything. Examples include: checking insurance benefits ahead of time, knowing whether a patient is covered for X-rays. Prior preparation says, “We’re professional and you can trust us!” It is a marketing tool! Also, look into On Hold Messaging as a form of advertising. Customer service is reflected in your recare/reactivation efforts. This is a front desk responsibility. Keep your front desk accountable for preparedness and organized systems. Consider a white board to greet new patients and welcome back returning patients. Or place a picture board in the reception area to create instant connections. MyPerioPath & MyPerioID PST ® ® ® salivary diagnostic tests 12. Show Thanks Step up your “thank you” program versus a flat $25 credit to their account/new patient. Have an internal raffle semiannually. Put the patient’s name in a fish bowl when they refer a new patient or “like” you on your Facebook Fan Page. Have a great non-dental prize like an iPad as a first prize, then in-office whitening as a second prize, then a kid’s Sonicare toothbrush as third. A downturn in the economy is when you need to count on creativity and innovation the most. You can utilize the talents of the team to accomplish the majority of these efforts. It takes the entire team to offer and perfect your “steak and sizzle.” So… pull out the barbeque and have a team meeting this week to review your current marketing efforts! ■ Advancing Patient Wellness Through Salivary Diagnostics MyPerioPath® Salivary DNA test that determines the cause of periodontal infections The MyPerioPath® test will reveal what pathogenic bacteria are responsible for the infection, which is valuable information you need to treat patients more effectively and with more predictable outcomes. MyPerioPath® test results also serve to establish a baseline reading, so you can monitor treatment effectiveness over time. Author’s Bio Dr. Rhonda Savage began her career in dentistry as a dental assistant in 1976. After four years of chairside assisting, she took over front office duties for the next two years. She loved working with patients and decided to become a dentist. Savage graduated with a BS in biology, cum laude, from Seattle University in 1985; she then attended the University of Washington School of Dentistry, graduating in 1989 with multiple honors. Savage went on active duty as a dental officer in the U.S. Navy during Desert Shield/Desert Storm and was awarded the Navy Achievement Medal, the National Defense Medal and an Expert Pistol Medal. While in private practice for 16 years, Savage authored many peer-reviewed articles and lectured internationally. She is active in organized dentistry and has represented the State of Washington as president of the Washington State Dental Association. Savage is the CEO for Miles Global, formerly Linda L. Miles and Associates, known internationally for dental management and consulting services. She is a noted speaker who lectures on practice management, women’s health issues, periodontal disease, communication and marketing and zoo dentistry. To speak with Dr. Savage about your practice concerns or to schedule her to speak at your dental society or study club, please e-mail [email protected], or call 877-343-0909. MyPerioID® PST® Salivary DNA test that determines who is at increased risk for severe periodontal infections The MyPerioID® PST® test identifies individual genetic susceptibility to periodontal disease and enables you to establish which patients are at increased risk for more severe periodontal infections due to an exaggerated immune response. To order MyPerioPath® & MyPerioID® PST® testing supplies, contact your Henry Schein® representative at 800.372.4346 PRODUCTS 2011 For more information, www.OralDNA.com 877.577.9055 Exclusively Distributed by © 2011 OralDNA® Labs Inc. All Rights Reserved. OralDNA® Labs is a subsidiary of Quest Diagnostics® Inc. dentaltown.com « October 2011 85 product profile by Frank Lauciello, DDS According to a 2002 estimate based on data from the national epidemiologic survey, edentulism has declined 10 percent each year.1 Yet, due to the growth of the U.S. population aged 50, which is estimated to increase in the next 10 years by 79 percent,1 the number of adults predicted to need complete dentures is expected to increase from 53.8 million in 1991 to 61 million in 2020.2 Dentures are and will continue to be essential in dentistry for the aging population. However, there is hesitation by many clinicians to treat the edentulous patient, which can be extremely challenging due to the subjectivity of the treatment. Everything from the proper selection of teeth, where to position the teeth, how to communicate to the lab and judging variability of vertical and centric jaw positions, among many other aspects, are difficult to control and predict. Therefore success is often compromised leaving the clinician feeling not in control of the outcome and consequently removable treatment is perceived as a liability rather than a profitable, enjoyable part of practice. With the successful introduction of implant dentistry the edentulous state can be remarkably improved which has inspired a renewed interest for the edentulous patient to seek retreatment. Depending on the number of implants placed, there are a variety of restorative options that can now be considered. If properly diagnosed and efficiently treated, these restorations represent a tremendous financial incentive for the clinician and dental lab. Unfortunately denture techniques and materials of IV Bracket Implant 86 October 2011 » dentaltown.com the past offer limited solutions. Today’s clinicians are less apt to engage in time-consuming chairside removable procedures and have become more reliant on laboratory support. This, of course, requires accurate communication with the dental lab. A Systematic and Simplified Approach The challenge for the professional team is to seek out a denture system that will enable accurate impressions and patient records, tooth selection that is patient specific and aesthetic, communication of essential patient information to the lab and special attention to the accurate and hygienic processing of the denture base material. Having the opportunity to work with a multitude of dental laboratories, clinicians and academics has given me the opportunity to evaluate many suggested systems of treatment for the edentulous patient. I consider the Ivoclar Vivadent removable system presented in this article as a composite of ideas, techniques and materials that is a logical solution to minimize the subjective variables of removable treatment that cause time consuming miscommunications and ultimately less than desirable outcomes. This system has been taught in our educational programs for several years and has provided clinicians and dental labs with a successful framework to increase profitability and success. I have grouped the discussion into four categories: impressions and patient records, tooth selection, communication and denture base processing. This article is not meant to be totally comprehensive, so each of these categories will be outlined and lightly addressed. Impressions and Patient Records Understanding the anatomy and physiology of the edentulous mouth is critical in developing an accurate impressioning technique. Knowledgeable border molding is particularly important for the mandibular arch which has the major complication of having the tongue as a major determinant of retention and stability. For the mandibular arch, the choice of impression materials is not nearly as critical as the impressioning technique. On the other hand, the stability and retention of the maxillary denture is more a product of adhesion and cohesion and is best product profile impressioned using a technique and material that captures the tissues in a rested mucostatic condition. Briefly stated, the mandibular impression requires a preliminary impression, custom tray, border molding and final wash. The maxillary impression can be a single entry irreversible hydrocolloid impression which if done carefully can be considered the final impression relatively routinely. The AccuDent System 1 is an excellent system of material and tray design and is the choice for single entry final impression systems. Making a provisional centric jaw record can provide a significant form of communication to the dental lab. The centric tray is a tool that provides a platform to retain impression putty material to record a tentative intra-oral relationship. This will allow the casts to be mounted early in the procedure for diagnostic purposes and it also allows the laboratory an option to assemble a bite-recorder. I have always been an advocate for bite-recorder devices to facilitate vertical and centric jaw registrations. Unfortunately they have a history of being intimidating and therefore rather unpopular. A little-known device called the Gnathometer M is a unique instrumentation that not only provides the bite-recorder option but can also be used to simplify the mandibular final impression procedure. Having the casts mounted using the centric tray record greatly facilitates the assembling of the Gnathometer M by the dental lab. As we all know, border molding the mandibular impression can be extremely challenging. This device allows the patient to be in a stable closed-mouth position. Once the mandibular impression is made, the white Accudent Centric Tray bite tabs can be removed and the bite-recorder elements attached allowing vertical dimension to be accessed and provides a stable tracing pin to stabilize the bases while the centric record is made. In selected circumstances an intra-oral Gothic arch tracing can also be performed. These techniques greatly improve and simplify the challenging procedures of mandibular final impressioning and jaw registration. Chairtime is reduced since the laboratory provides support. Denture Tooth Selection Often times this responsibility is delegated to the dental laboratory. Although most laboratory technicians can provide assistance, it is a bit unfair since they do not have the advantage of seeing the patient. Denture tooth selection systems of the past (square, tapering, ovoid) have focused on criteria that are inaccurate and impossible to effectively practice. The BlueLine denture tooth system was the first to break from these old systems and reclassify their maxillary anterior teeth by size – small, medium, large – and individual characteristics of soft and bold. This concept has been further advanced with the PHONARES new line of denture teeth, which also classifies the teeth to age. These are logical criteria that are teachable and have made tooth selection simplified and more accurate for the clinician. Both systems provide individual FormSelectors, including a facial meter, which measures the interala distance and helps to determine an appropriate size for the anterior tooth selection.9 The selection of denture tooth material is dependent on optics, wear and toughness. The BlueLine is representative of Gnathometer continued on page 88 dentaltown.com « October 2011 87 product profile continued from page 87 the premium, double cross-linked polymethylmethacrylate (DCLPMMA) and the PHONARES represent a nano-hybrid composite (NHC) resin chemistry. Cross-linked PMMA chemistry has been the standard in the industry for many years and has acceptable aesthetics, wear and exceptional toughness. The composite resin chemistry has improved optical qualities due to the opalescence of composite resin materials. Wear is also significantly enhanced which is an advantage for implant restorations which tend to show premature wear with conventional PMMA. However in situations where there is minimal restorative space, the PMMA-based denture tooth might have the advantage since it has more “toughness” and less chance for fracture when it is ground thin. Posterior denture tooth occlusion choices are primarily classic semi-anatomic, lingualized and non-anatomic (monoplane). If aesthetics of the premolar area are important, the semianatomic choice has better aesthetics in this area because the buccal cusps of the maxillary premolars are functional and set similar to natural dentition. If function or prevention of cheek biting is most important, lingualized occlusion has an advantage since the maxillary buccal cusps are tipped upward accentuating the penetrating quality of the maxillary palatal cusp. In addition, the tipped maxillary buccal cusps protect the cheek tissues from being “bit” during function. Non-anatomic teeth set monoplane are thought to be the least challenging tooth form to set, however aesthetics and function are compromised. FormSelector DCL material Vivodent DCL NHC material Phonares NHC Tools of Communication Lingual 88 Tools of Communication There are many tools that help gather patient information and communicate to the dental laboratory. The centric tray, Gnathomether M and FormSelector have previously been mentioned. The Papillameter is used to measure maxillary lip length to determine the necessary amount of incisal display.9 Denture gauge measures the incisal length of the patient’s existing denture. Both these devices help to communicate the appropriate incisal length of the maxillary wax rim or denture teeth; otherwise the lab must use average values. The biteplane is an invaluable tool for evaluating the horizontal plane and occlusal plane of the maxillary wax rim. The flat set up table is used to mount the maxillary cast with wax rim. This orientation transfers the hori- October 2011 » dentaltown.com Papillometer product profile zontal plane and occlusal plane to the Stratos Articulator. The table also serves to provide a template for setting the maxillary anterior denture teeth and assures that they will be the same length and horizontal plane as the maxillary wax rim. The Stratos Articulation System is very user-friendly and is the favorite of many dental laboratories. It has an extremely accurate and durable calibration so there is never need to send the articulator in the mail since the casts will fit accurately on the laboratory Stratos. The structure of the instrument is also very durable and easy to maintain. The wide assortment of components allows many options for mounting and setup templates. In addition the articulator is very presentable in appearance. Each step of the communication process is managed by a comprehensive case planning software called Intercom. Developed by Ivoclar Vivadent, Intercom, improves communication between the dentist and dental laboratory, and virtually guides the user through each step of a fixed or removable restoration. Each step is accompanied by treatment-related literature, videos and similar tools helping to specify the appropriate process parameters. Upon case completion the software produces a detailed prescription, which can be e-mailed or sent as hardcopy to a designated lab partner. Denture Base Processing Once approval is received to fabricate the definitive denture prosthesis, a precision injection molding process eliminates the inaccuracies in fit and function that could otherwise be caused by poly- Dental gauge Bite plane merization shrinkage. Traditional denture materials are hand measured, leaving room for inconsistencies and mixing errors, and standard trial packing is predisposed to warpage and shrinkage. However, the SR Ivocap system combines controlled heat and pressure polymerization, so denture bases consistently demonstrate an accurate fit, a high degree of polymerization and high polishability.10 Ivocap compensates for acrylic shrinkage by continuously flowing the exact amount of material needed into the flask during the entire polymerization curing cycle.10,11 The material is distributed in pre-measured capsules, requiring no measuring which eliminates human error and also prevents direct material contact with the skin minimizing the risk of irritation.10 And although the features and benefits of the SR Ivocap injection system seem immediately beneficial to the laboratory technicians, their significance to dentists and to their patients cannot be overstated. The accuracy of injection processing improves denture base stability and retention which assures the patient the best possible fit and minimizes the necessity for postinsertion adjustment. In addition this system results in a denture surface that is more dense and therefore more polishable and resistant to plaque accumulation, which helps to ensure proper oral hygiene after delivery of the prosthesis.10,12 Conclusion According to recent projections, the edentulous population will increase for at least the next 10 years, along with demand Stratos Conventional denture Ivocap denture Intercom continued on page 90 dentaltown.com « October 2011 89 product profile continued from page 89 for removable prosthodontic care. To meet this demand, more dentists must provide this service, but their ability to do so is predicated on the availability of systematic and easily integrated denture solutions. Although edentulous cases might be intricate, they also present an opportunity for the dentist and laboratory technician to collaborate to ensure outstanding rehabilitation results for the patient.13,14 Ivoclar Vivadent’s removable denture systems provide viable solutions to the clinical challenges of edentulism and denture fabrication. Eliminating the complexities of denture fabrication with methodical steps and reliable laboratory techniques, dental professionals can improve the quality of life for edentulous populations using simplified and highly accurate techniques. ■ References 1. Douglass, CW, Shih A, Ostry L. Will there be a need for complete dentures in the United States in 2020? J Prosthet Dent. 2002 Jan;87(1):5-8. 2. Waldman BH, Perlman SP, Ling Xu. Should the teaching of full denture prosthetics be maintained in schools of dentistry? J Dent Ed. 2007 Apr;71(4):463-466. 3. Vogel RC. Implant overdentures: a new standard of care for edentulous patients – current concepts and techniques. Inside Dentistry. 2007;1(Suppl 2):30-36. 4. Henry K. Q&A on the future of implants. Dental Equipment and Materials. September/October 2006. 5. Rossein KD. Alternative treatment plans: implant supported mandibular dentures. Inside Dentistry. July/August 2006. 6. Glantz PO. Biomaterial considerations for the optimized therapy for the edentulous predicament. J Prosthet Dent. 1998;79(1):90-2. 7. Komiyama O, Kawara M. Stress relaxation of heat-activated acrylic denture base resin in the mold after processing. J Prosthet Dent. 1998;79(2):175-81. 8. Radford DR, Callacombe SJ, Walter JD. Denture plaque and adherence of Candida albicans to 9. 10. 11. 12. 13. 14. denture-base materials in vivo and in vitro. Crit Rev Oral Biol Med. 1999;10(1):99-116. Kreyer Robert. Dentures using a coordinated system for removable prosthetics. Information supplied by Ivoclar Vivadent. Dent Prod Report.2006 Apr:1-2. SR Ivocap.The successful technique. [Brochure]. Amherst, NY: Ivoclar Vivadent;2009. Salim S, Sadamori S, Hamada T. The dimensional accuracy of rectangular acrylic resin specimens cured by three denture base processing methods. J Prosthet Dent. 1992;67(6):879-81. Richmond R, Macfarlane TV, McCord JF. An evaluation of the surface changes in pmma biomaterial formulations as a result of toothbrush/dentifrice abrasion. Dent Mater. 2004;20(2):124-32. Strong SM. Adolescent dentistry: multidisciplinary treatment for the cleft lip/palate patient. Pract Proced Aesthet Dent. 2002;14(4):333-8; quiz 340, 342. Rudd RW, Rudd KD. A review of 243 errors possible during the fabrication of a removable partial denture: part i. J Prosthet Dent. 2001;86(3):251-6. Author’s Bio Dr. Frank Lauciello graduated from the State University of New York at Buffalo (SUNY), School of Dental Medicine in 1969 and completed his Prosthodontic training at the Buffalo VA Medical Center. He is a Clinical Associate Professor in the Restorative Department at SUNY at Buffalo and was director of the Veterans Administration Advanced Prosthodontic Program from 1973-1998 and Chief of the Dental Service from 1996-1998. He is presently Director of Removable Prosthodontics Research, Development, & Education for Ivoclar Vivadent, Amherst, NY and Director of the Implant Esthetic Center of Excellence in Sarasota, Florida. Dr. Lauciello is a Diplomat of the American Board of Prosthodontics and has authored 25+ articles including several chapters of textbooks. He is actively involved in dental research and new product development. 620 PATIENTS SCREENED.* 28 LESIONS UNDISCOVERED WITH THE NAKED EYE. 5 DYSPLASIAS. VELSCOPE DIDN’T MISS ANY. When it comes to oral cancer, it’s what you can’t see that can be most troubling. A recent study of routine patients by the University of Washington highlighted the potential benefits of complementing standard oral-soft-tissue-examination with a fluorescence visualization device. The VELscope Vx system is used in combination with traditional head and neck exams to detect abnormal mucosal areas including oral cancer and premalignant dysplasia. It’s an easy-to-use, affordable and effective screening tool that involves no messy dyes. Give yourself the added help of VELscope Vx and know for sure that you’re doing everything in your power to care for the health—and the life—of your patients. * Edmond L. Truelove et al, General Dentistry, July/August 2011, 281-289. See Prevention in a New Light NEW Tissue under normal light. Ti Illumination with VELscope Vx reveals area of cancer. NOW WITH AN OPTIONAL DIGITAL CAMERA FOR EASY PHOTO-DOCUMENTATION LED Dental Inc. | 1-888-541-4614 | velscope.com facebook.com/VELscope 90 October 2011 » dentaltown.com around town The 2011 Greater New York Dental Meeting The Greater New York Dental Meeting is hosting its 87th meeting this fall! Join thousands of other dental and health professionals in the Big Apple. Take CE courses, learn about new products in dentistry, meet up with colleagues and go see a Broadway musical, all in a single day. Registration Registration is available online and free of charge until the start of the meeting on November 25. Attendees can also register on-site for $30. Scientific Session Friday, November 25 – Wednesday, November 30 Invisalign Expo Sunday, November 27 – Wednesday, November 30 SomnoMed Sleep Appliance Expo Sunday, November 27 – Wednesday, November 30 Exhibit Hall Hours Sunday, November 27 – Wednesday, November 30 9:30 a.m.-5:30 p.m. (closes at 5 p.m. on Nov. 30) The exhibit hall is located at the Jacob K. Javits Convention Center at 655 West 34th Street, New York City. Continuing Education Full-day and half-day seminars, “lunch & learns,” table demonstrations and live-patient demonstrations all contribute to the CE program available through the GNYDM. Highly regarded educators tackle dental topics from A to Z. Proof of attendance is required to claim credit. To view the 2011 speaker schedule click the “Courses and Events 2011” tab on the left sidebar menu. Special Events Dinner Dance Saturday, November 26 • 7-11 p.m. Price: $125 Marriot Marquis – Broadway Ballroom – Sixth Floor Celebrity Luncheon with George Stephanopoulos Monday, November 28 • 12-2 p.m. Price: $75 Special Events Hall – Level 1 Wednesday Night Happening Come for dancing, fun, food and a cash bar Wednesday, November 30 • 6:30-9:30 p.m. Price: Free (for those registered) Marriot Marquis – Westside Ballroom – Fifth Floor For more information about the dental meeting, including accommodations and directions, visit www.gnydm.com. For more information about travel and activities in New York City, visit www.nycgo.com. ■ dentaltown.com « October 2011 91 digital imaging feature Planning dental treatment can be complicated, especially in the case of exacting procedures such as implants and their restorations. Knowledge of available space between teeth, measurements of bone and root angulations can change the course of treatment, and in some cases even preclude the need for surgery. To gain the detailed information needed to treatment plan and execute these procedures, practitioners are turning to cone beam 3D imaging instead of 2D radiography methods. I research all that I can about implants and value my colleagues’ opinions on CBCT. I find that we share a common view of the benefits of CBCT. “The cone beam scan is very significant in uncovering anatomical conditions that would not be apparent on a 2D X-ray,” said Steven Guttenberg, DDS, MD. “CBCT technology provides detailed, precise data in a 3D format that can be rotated 360 degrees, enlarged and sliced in any direction.” Like Dr. Guttenberg, I have experienced inherent differences between planning in 2D and 3D. John Russo, DDS, MHS, offers, “3D imaging provides safety for my patients and confidence that I am formulating a good diagnosis before developing a surgical treatment plan.” Utilizing cone beam scans in 3D imaging software can alert the clinician to potential complications prior to surgery, such as undercuts in the mandible or the need for grafts. As CBCT imaging becomes a part of more dental procedures, new treatment tools within software applications are being developed to make the processes even safer and more efficient. For example, using a program that provides the tools for complete treatment Fig. 1: 2D view of implant sites offering only a flattened, buccal-to-lingual perspective. Fig. 2 Fig. 2: 3D cross sections showing the clear need for sinus augmentation and an undercut in the mandible along with precise measurements that aid in planning for these conditions. Fig. 1 Fig. 3: Multiple and helpful views offered when planning implants in 3D imaging software. Fig. 4: Progressive 3D planning of implants and restorations. Credit: CBCT images taken with i-CAT Precise scan in Tx Studio, Imaging Sciences. Fig. 4 Fig. 3 92 October 2011 » dentaltown.com feature digital imaging by Justin Moody, DDS planning for both the placement and restoration of implants, including abutments and crowns, creates precision throughout the entire procedure. Dr. Guttenberg notes having the right software is important, because of “the opportunity for integrating the scan with guided surgical techniques and other state-of-the-art applications.” For one particularly difficult case, he sent his 3D scan to a third-party software firm that produced a stereolithic model of the patient’s jaw so he could simulate surgery before working on the patient. All these options are made possible by 3D CBCT technology. As with any technology, it’s not just about choosing a method; there are decisions to be made regarding equipment. In the case of cone beam modality, selecting a CBCT machine with flexibility in image size and lowered radiation exposure gives dentists the clinical control to respond to individual patient’s needs while complying with ALARA (as low as reasonable achievable). Machines which offer low-dose scans while delivering a great amount of anatomical information are especially helpful maintaining this control. In many of my 3D imaging cases, such as follow-up scans where I want to monitor the healing of grafts, I can avoid over-exposing the patient by reducing the height of the scan to cover just the area needed. While 3D imaging allows implant cases to be quicker and easier, more importantly, it aids in patient understanding and helps build relationships with other dentists. I can plan most cases in a few minutes, from when I take the scan to when I start going over options with the patients. As I go through the software with them, they can see their own mouth in 3D and really understand why I suggested a particular type of treatment. CBCT’s reliability is instrumental for case referrals. My colleagues send patients to me because they know I will use the 3D scan to place the implant as precisely and least invasively as possible. When placing implants, making the right decisions on size and placement is a matter of precision. The added dimension provided by CBCT offers the information needed to guide the dentist to a successful outcome. With cone beam technology, the dentist gains clinical control, efficiency, accuracy and confidence. Patients gain much more – an implant experience that they can understand and trust. ■ Author’s Bio Dr. Justin Moody is a graduate of the University of Oklahoma College of Dentistry. As a supporter of organized dentistry and continuing education, he is a member of the American Academy of Implant Dentistry, International College of Oral Implantologists, Academy of Osseointegration as well as the ADA, state and local societies. He is a diplomate in the American Board of Oral Implantology/Implant Dentistry and the ICOI, associate fellow and fellow of the AAID and holds mastership and fellow status at the Misch International Implant Institute. Dr. Moody lectures throughout the country on implant dentistry and is in private practice in Crawford, Nebraska. He can be reached at [email protected]. dentaltown.com « October 2011 93 office visit by Chelsea Patten, staff writer, Dentaltown Magazine David Kahn, a graduate of University of Pennsylvania School of Dental Medicine, doesn’t live the average life of a recent grad. Not only is he up to his elbows at St. Charles Hospital for his general practice residency, he also took home the win for the Rhode Island Half-Ironman in July (that’s 70.3 miles swimming, biking and running!) and was one of 40 participants invited to the World Championships in September. Herein, Kahn gives his two cents about life right after graduation and discusses how he balances his two passions. What made you choose dentistry? David Kahn: Growing up I always wanted to go into sports medicine. I swam all through high school and college, so I had a strong background in sports. I come from a family of dentists. My father and two of his brothers joined practices in 1980 and my grandfather has been the practice manager since 1990. After my 94 October 2011 » dentaltown.com third year of undergrad, I decided I wanted to continue the family tradition. I get my dose of sports by training for triathlons. Describe a typical day for you. Kahn: I am in a one-year general practice residency at St. Charles Hospital in Port Jefferson, New York. Completing a residency is part of New York State’s licensing requirements. However, I would choose to do a hospital residency regardless because of the clinical experience I could gain before going on to private practice. My day-to-day schedule varies. There are two other co-residents, and we trade off mornings observing and assisting the OR, pre-surgical testing and the dental clinic. In the afternoons all three of us are in the dental clinic. We then have rotation in the ER until 7 p.m. One of us is on call every three weeks. [Editor’s Note: At press time, the three residents will have finished their rotations and will be spending most of their time in the clinic.] office visit Photograph by Karl Rivenburgh continued on page 96 dentaltown.com « October 2011 95 office visit continued from page 95 I train before and after work. My coach writes my workouts, and it’s different every day. Sometimes I finish a day at the hospital – for instance this week I had two four-hour workouts after working 11-hour days at the hospital. Sometimes it can be pretty difficult. What is your favorite procedure to perform? Kahn: Going through dental school all the procedures I performed were dictated by curriculum and requirements. With residency, I have the opportunity to treat cases that interest me. I try to keep an open mind and experience a little of everything. Maybe I’ll get a better idea of what procedures I’m partial to by the time I start private practice. What sparked your interest in athletics? Kahn: I have swum my whole life. I was seven-time New York State High School Champion and New York State Swimmer of the Year. I went to University of Texas, which has a great sports program. I lived and breathed swimming for years. After I stopped swimming, I was looking for something else. I didn’t want to put on weight like a lot of people do after they stop swimming. While I was out on a jog, I came across someone who used to be a swim coach. He had a triathlon team and encouraged me to check it out. That’s how I got into it. Can you give us a mini lesson on what an Ironman is? Kahn: Sure. I compete in Half-Ironman (HI) competitions which are 70.3 miles – a 1.2-mile swim, a 56-mile bike ride and a 13.1-mile run. A Full-Ironman (FI) would be double that distance – 140.6 miles. The problem with the FI competitions is that you need to be able to put in four- to five-hour blocks of training at least three times a week. This just won’t work with my schedule right now. There are four distances for triathlons (sprint, Olympic, halfIronman and Ironman). World Triathlon Corporation (WTC) is a company that puts on the Ironman races. The term “Ironman” has become synonymous with the distance. I race on the Ironman circuit because it is the best established company. They have races, year round, all over the world. Since I’m busy, my race schedule has to line up perfectly with my dental schedule. They seem to have the right locations at the right time. Plus, they’re organized. They know how to put on races. What goes into preparing for such a feat – training, diet, etc.? Kahn: My workouts vary from week to week. It’s difficult to write a training program and then when you throw in working eight to 12 hours a day, it makes it more complicated. I have a great coach named Siri Lindley who writes my training programs. She is a two-time world champion and runs a coaching program called Sirius Athletes. She held the number-one ranking in the world for the Olympic distance when she retired and went into coaching. Training schedules vary at different points in the year. Base training is building up fitness – long, slow stuff. As races get closer, I increase the intensity of the work – higher effort, higher heart rate stuff. Some days I just run. Some days I might swim and bike. It’s all different. I train anywhere from two to seven hours per day. Those longer ones are on weekends. During the week they’re shorter. I put in around 18 to 23 hours of training per week. I just try to eat healthy, avoid the sweets the best I can. I’m not on a regimented diet though. My trouble foods are bagels and muffins. I just try to stay away from them. Had you done a Half-Ironman prior to your Rhode Island win? Kahn: I’ve raced for four years. I’ve probably done close to 20 WTC races, but 30 races overall. When I first started out, I just wanted to finish one. Now, I will compete in up to eight HI in a year. This year I’ve done five so far. It takes discipline, but I love the challenge. Who are your mentors? Kahn: From dental school, Dr. Raul Figueroa, Keith Dunoff, Mary Sidawi and Alan Rauch influenced my clinical education significantly. My father and uncles are great dental resources, and I discuss with them frequently. My parents were, and still are, such a support system, not just with school but with sports as well. continued on page 98 96 October 2011 » dentaltown.com From “Stat!” to Stats Find it all on Dentaltown.com • Tips from peers for handling clinical emergencies • Ask a specific question get a specific answer • Free classifieds, industry news, relevant online CE and much more! office visit continued from page 96 Also, when it comes to sports, John DeMarie, Eddie Reese, Kris Kubik and my current coach Siri Lindley have each had a tremendous impact on not only my athletic career but my discipline and perseverance. How do you balance work and life? Kahn: Balance is hard. I have to make sacrifices and decisions and sometimes I miss out on things I want to do. That comes with the territory. I have chosen two things – dentistry and Ironman competitions – that take a ton of dedication… but I’m passionate about both. It’s a commitment and it’s important to not get upset when those things that I have to give up come along. When it gets overwhelming (like days with a 12-hour day at the hospital and a four-hour workout) I just have to remind myself that it will get better. It always eventually does and I become a better dentist and a better triathlete because of it. 98 October 2011 » dentaltown.com What do you want to do after your residency? Kahn: After my residency I plan to go into the family practice. I want to maintain the practice’s quality, which my family has built over the last 30 years. I’ve had the opportunity to learn quite a bit in residency and I want to continue to expand on those abilities and my education throughout my career as a practitioner. If you weren’t a dentist, what do you think you’d be doing right now? Kahn: I would be a professional triathlete. I have a pro license but at this point in my life, I’m not using the sport as a main source of income. But if I wasn’t a dentist I would do it full time. I could also use my sports training for teaching or coaching. I suppose we should all be so lucky to have more than one life passion. Thanks so much for chatting with us. ■ veterans clinic SERVING THOSE WHO HAVE SERVED by Chelsea Patten, staff writer, Dentaltown Magazine Sergeant Clint Ferrin was killed by a roadside bomb on a dusty street in Baghdad in 2004. There was a memorial service, a 21-gun salute and the awarding of well-deserved posthumous medals… but John Ferrin had a different and less conventional idea to keep his brother’s legacy alive. The dedicated soldier and family man had lost an anterior tooth during combat training. He went two years before receiving a temporary prosthodontic appliance and never received a permanent prosthesis. John combined the frustration regarding the lack of affordable and available dental care with the appreciation and honor he had for his personal hero and he ran with it. His vision: a free dental clinic to serve those like his brother who put mission before all else. The men and women of the Armed Forces often neglect their oral and general health care in order to focus on the mission at hand. Dental work requires taking time off from duties and fronting out-of-pocket expenses. Since John knew there was a large population of underserved veterans in his immediate area, he and other like-minded people began the Sergeant Clint Ferrin Dental Clinic to provide accessible and affordable dental care. The kernel for the idea started in 2007 when John first entered dental school at University of Nevada, Las Vegas School of Dental Medicine (UNLV-SDM). It developed quickly into a brick-and-motar, 100 October 2011 » dentaltown.com veterans clinic John Ferrin (above), founder of clinic and brother of Sgt. Clint Ferrin (above left). Group photo, from left: Jeff Roberts, Mike Uffens, Dan Salus, John Ferrin, Jeremy Manuele, Chad Aitken, Jesse Falk, John Quinn, Nadim Guirguis and Brian Hirsbrunner. continued on page 102 dentaltown.com « October 2011 101 veterans clinic continued from page 101 fully functioning clinic by July 2008. Students use the clinic as a way to gain experience with dental procedures all while helping vets who need care. Michael Lloyd, fundraising chair member for the clinic, says, “Saturday is the heart and soul of the Sergeant Clint Ferrin Dental Clinic.” Held one Saturday every month and lasting for about four hours, the university provides clinic space, dental materials and staff for the operation. Currently, UNLV-SMD is the only dental school which operates a clinic for veterans. An average of 35 veterans are treated by dental students each Saturday the clinic is open. The students are supervised by licensed dentists, all of whom volunteer their time. From simple restorations to full-mouth extractions, the clinic aids in treating the overwhelming number of veterans in need. The majority of veterans do not qualify for free dental treatment through the Department of Veterans Affairs (VA), says Lloyd. The VA has strict guidelines to determine whether a veteran is eligible. Lloyd uses a current patient as an example: Sam* served three tours of duty in Iraq and Afghanistan as an Army scout. During his last tour he was injured by a grenade that went off near his face, sending shrapnel into his jaw. The injury resulted in him being medically 1. discharged from the military. Unfortunately, the VA would not cover any of his dental care because he is not 100 percent disabled and because the injury to his face was written up as a jaw injury instead of as an injury to his teeth (even though two of his teeth were extracted due to the injury). Unfortunately this is only one of many situations returnee soldiers face. Veterans are often put in the predicament of needing, but not being able to afford quality care. The clinic tries to provide care to anyone who meets the criteria, but with the demand reaching more than 100 applications per month, they have to set some guidelines. In order to qualify for care at the clinic, the recipient must be a U.S. Veteran, must have an income of less than $25,000 per year and must not have dental insurance (and have the documentation to prove all three). From there, priority is based on need and wartime experience. Veterans from WWII, Korean War, Vietnam, Desert Storm, Operation Enduring Freedom and/or Operation Iraqi Freedom qualify for eligibility. Another group served in the clinic is members of the National Guard. Unlike active duty troops, National Guard troops do not get full dental coverage and have often joined the National Guard to aid in their struggling budgets. “Our mission is to serve those who have served,” says John. The clinic is recognized as a 501(c)(3) nonprofit organization and therefore is funded from donations and grants. Their 2. 3. 4. 2. George Bitar, class of 2013, with oral surgery patient. 3. Dr. Daniel Orr, UNLV surgeon. 1. Jesse Falk (left), 2011 graduate. 4. Sarah Kitchen, class of 2012 and Colby Meeder, class of 2014 with oral surgery patient. 102 October 2011 » dentaltown.com veterans clinic sponsors include: Henry Schein, Veterans of Foreign Wars, Veterans for Freedom, American Legion, Anthem Periodontics and Dental Implants, Mvestor Media, Ballard Spahr (community partner), Acrylic Works, Astratech Dental, Performance Dental Lab, Two Ocean Dental Lab, CloudPeak Dental Lab and Sunstone Dental Care, just to name a few of the generous philanthropists which believe in the clinic’s mission. The American Dental Association is also a subsidiary. Additional funding comes from National Guard screenings. The National Guard will pay the clinic to come out to their various facilities and perform screenings on soldiers. Saturday clinics are funded by the UNLV-SDM, which provides the materials to complete most of the procedures. The clinic itself has to pay for the prosthodontic materials. Fortunately, many gracious labs in the area donate units. The clinic may be “officially” open on only one Saturday per month, but students are constantly working on veteran patients during UNLV-SDM’s normal business hours. The students are able to get needed experience and the veterans are able to receive needed dental care. It’s a win-win situation. “Most of the veterans who we treat have not seen a dentist for years, if not decades, due to their financial constraints,” says Lloyd. Sergeant Clint Ferrin served in the U.S. Army 82nd Airborne division and left the legacy of his hard work and service to the country. Now, thanks to his hero-like persona and his brother who thought of him as just that, his legacy lives on in more than name alone. If you would like more information about the Sergeant Clint Ferrin Dental Clinic, visit www.veteransdentistry.org. The site also houses the volunteer application, patient application and a portal to donate funds. ■ *Names of patients have been changed 5. 6. 5. John Ferrin, left, and Todd Davis, right. 7. Marlow Rillera, class of 2014, patient coordinator with patient. 8. Dr. Adam Gatan, UNLV endodontist with patient. 8. 7. 6. UNLV faculty that help with the clinic, back row from left: Dr. William Leavitt, Dr. Richard Walker, Dr. Gerald Fox and Dr. Douglas Ashman. Front row from left: Dr. Andrew Ingle, Dr. Richard Hamilton, Dr. Wendy Woodall and Dr. Daniel Orr. 9. Saliem Tsighe, left, class of 2012, with Dr. Richard Walker. 9. 10. 10. Top row, from left: Nadim Guergis (class of 2011 went on to ortho at UOP), Chris Capua (class of 2013), Broc Hammon (class of 2014), John Ferrin (founder, class of 2011), Spencer Armuth (class of 2014), Zac Soard (Class of 2014) and Chad Hanson (class of 2014). Bottom row: Cody Besso (class of 2014), Todd Davis (class of 2013), Austin Burnett (class of 2013), Heather O’Dell (Class of 2013), Benjamin Brown (class of 2014), Marlowe Rillera (class of 2014) and Jeremy Manuele (class of 2012). dentaltown.com « October 2011 103 practice management feature by Rachael Stutzman What makes a practice successful? Is it the location or its systems and processes? Is it the exceptional patient experience it consistently delivers? Or is it the doctor’s leadership and the team’s attitude? Recently, my team of more than 100 practice development managers shared what they have identified as key commonalities, or “best practices,” among dental teams that contribute to the success of the practice. Their insight came from visiting thousands of dental teams. Interestingly, many of the attributes my team of practice development managers identified are the same factors for success that were cited in a recent Dentaltown online poll. 1. Successful practices make marketing a priority. In a struggling economy, many practices immediately reduce or eliminate marketing to save money. Practices that are seemingly least impacted by the current economy budget for, and consistently invest in, marketing. We hear that, on average, these practices set aside about three percent of production to do both patient retention communications and also to increase new patient flow. This is consistent with the June 2011 Townie poll which found 28 percent of Townies believe consistent marketing has the biggest impact on success. One area of focus is online marketing, including having an up-to-date Web site and a Web site optimized for smartphones, a Google keywords campaign and using patient e-mails to maintain consistent communication. 2. Successful practices invest in themselves. In highly successful practices, patient communications are not left to chance. Each team member is provided communication skills training, usually thorough scripts and role playing, to 104 October 2011 » dentaltown.com ensure patients hear a consistent and positive message. From how the initial phone call is handled through to how treatment fees and payment options are discussed, the doctor and team pre-determine how each patient interaction should be conducted, a system is created and then scripts and training are provided to ensure consistency. In the Townie poll, 20 percent chose “scripting for presenting treatment plans” as having the greatest impact on their practice. In addition to investing in the team, dentists in top practices also invest in themselves through CE and practice management courses. 3. Successful practices have a plan. My team of practice development managers consistently find top performing practices have goals that they write down and share with the entire team. Then together they create a plan to achieve them. These practices don’t “wish” the economy would get better, or “wish” that they had more patients; they work together to figure out how to reach their practice goals in a way that benefits patients, the practice and each of them as individuals. The larger practice goals are broken down into monthly and daily goals as well as team and individual goals. These goals determine how the team schedules patients and staff for the day. There is nothing more powerful than a team working together to achieve a shared vision. In fact, the Townie poll also found this to be consistent with the findings of the practice development team, with 22 percent of responding Townies citing setting measureable goals as the second-most impactful tool for success. 4. Successful practices have confidence in their patients. Other attributes shared among practices that have strong feature practice management production and strong patient relationships are the unwavering conviction that their patients deserve and desire to have a beautifully healthy smile. This conviction gives the team the confidence to recommend and present complete dentistry in a way that clearly communicates to patients the value of the treatment. We all know that patients do not accept dentistry that has never been recommended to them. And they don’t accept dentistry if it’s presented as an “option” rather than a recommendation that will enable them to meet their oral health or aesthetic goals. Of course, patients might choose to move forward with care that only meets their immediate needs, but it’s important to plant the seed so they are aware of the care recommended and can plan for it in the future. 5. Successful practices provide financial options. Experienced dental teams know the two primary barriers to treatment acceptance are still cost and fear. Of the two, fear might be the most difficult to address because solving cost concerns is as simple as providing a range of payment options including cash, major credit cards and a health-care credit card. Of those responding to the Townie poll, about 20 percent found offering financing to be the biggest contributor to their success. In addition, thriving practices consistently let patients know – even before the clinical examination – all the payment options available so patients can choose what’s best for them and their financial situation. They don’t wait until the patient has expressed concerns with cost because that means the patient has already moved into a “no” mindset and the barrier to treatment acceptance has been set. The most compelling shared behavior among dentists and teams who seem to continue to perform through any economic climate is an attitude of service and a commitment to patients. When patients can hear, see and “feel” that their dentist and his or her team is on their side and want what’s best for them and their oral health, the foundation of a longterm relationship is laid. And ultimately, having happy patients who routinely come in for care and refer their friends and family is the single-most critical component for longterm success. ■ Author’s Bio Rachael Stutzman is Vice President of Practice Development at CareCredit. For more information about CareCredit, call 800-8599975 or visit www.carecredit.com. *UHDWHU1HZ * UHDWHU1HZ <RUN'HQWDO < RUN'HQWDO 0HHWLQJ 0 HHWLQJ 6 6FLHQWL¿F0HHWLQJ'DWHV FLHQWL¿F0HHWLQJ'DWHV ) )ULGD\1RYHPEHU ULGD\1RYHPEHU : :HGQHVGD\1RYHPEHU HGQHVGD\1RYHPEHU ([KLELW'DWHV ( [KLELW'DWHV 6 XQGD\1RYHPEHU 6XQGD\1RYHPEHU : HGQHVGD\1RYHPEHU :HGQHVGD\1RYHPEHU )RU$GGLWRQDO,QIRUPDWLRQYLVLW ) RU$GGLWRQDO,QIRUPDWLRQYLVLW : :::*1<'0&20 ::*1<'0&20 dentaltown.com « October 2011 105 dental statistics about it’s all statistics A statistical look at the state of dentistry 1 1 Missouri 2 Minnesota 1 Michigan 3 Maryland 1 Massachusetts 2 Louisiana 1 Kentucky 3 Illinois 1 Indiana 1 Iowa 3 Florida 1 Georgia 1 District of Columbia 1 Connecticut Alabama 6 Colorado 2 Arizona 1 California EDUCATION Current Number of Dental Schools by State 04 20 03 20 10 20 09 20 20 08 07 20 06 20 05 % .9 % % .3 43 44 .7 % % 20 0% . 56 % .6 55 1% . 56 43 % .4 56 .3 .7 41 7% . 59 40 Female 20 20 20 Male 02 01 00 Male vs. Female Dental School Applicants 7% . 53 8% 3% 4% . 52 . 53 . 53 % .3 46 % .2 47 % .5 46 0% 6% . 45 % .2 . 46 % .9 54 % .7 55 44 Source: American Dental Education Association, U.S. Dental School Applicants and Enrollees, 2009 and 2010 Entering Classes http://www.adea.org/publications/tde/Documents/Applicants%20by%20Gender,%202000%20to%202009.pdf 106 October 2011 » dentaltown.com dental statistics http://www.adea.org/publications/tde/Documents/See%20All%20Predoctor al%20Dental%20Applicants%20and%20Enrollees%20GraphsLatest.pdf http://www.adea.org/publications/tde/Documents/Total%20U.S.%20Dent al%20School%20Graduates%201960-2009.pdf Percentage of Dental School Graduates vs. Applicants 1990 4,233 5,123 2000 4,171 2001 4,367 2002 4,349 2003 82.6% 53.7% 7,770 58.9% 57.7% 7,537 8,176 54.3% 4,350 2005 4,478 2006 4,515 2007 4,714 2008 4,796 Applicants 7,412 4,443 2004 Graduated 9,433 46.1% 10,731 41.7% 36.2% 12,463 13,742 12,178 34.3% 39.4% 2 1 1 4 2 1 1 3 1 2 3 1 1 1 North Carolina Nebraska New Jersey Nevada New York Ohio Oklahoma Oregon Pennsylvania South Carolina Tennessee Texas Utah Virginia Washington 4,233 1990-91 1980-81 I I I I I I I I I Number of Dental School Graduates Per Year Source: American Dental Association, Survey of Advanced Dental Education, 2008-2009 http://www.adea.org/publications/tde/Documents/Total%20U. S.%20Dental%20School%20Graduates%201960-2009.pdf I continued on page 108 I dentaltown.com « October 2011 I 1960-61 2000-01 2008-09 I 3,253 I I I I I I 3,749 1970-71 I 1 4,796 4,171 5,256 1 West Virginia 2 Wisconsin 1 Mississippi http://www.adea.org/publications/tde/Documents/2010%20Dental%20Schools%20list.pdf 107 dental statistics % 81.1 continued from page 107 DENTISTS 116,372 Total Number of 132,835 General Dentists of independent dentists are in solo practice 1993 Source: ADA; 2009 Survey of Dental Practice “Characteristics of dentists” 2000 in U.S. Source: ADA Distribution of Dentists publications - ADA Health Policy Resources Center *Provided by ADA Department of Membership, Marketing and Tripartite Relations 10,375 146,675 7,184 6,134 4,953 5,252 3,343 2009 1 150,043* 2 3 4 5 6 Total Number of Specialists in the United States 2010 1. Oral and Maxillofacial Surgeons 2. Endodontists 3. Orthodontists & Dentofacial Orthopedics 4. Pedodontists 5. Periodontists 6. Prosthodontists Source: American Dental Association, Survey Center, 2009 Distribution of Dentists in the United States by Region and State Dentists to Population Ratio by State Alabama Alaska Arizona Arkansas California Colorado Connecticut 1:3,064 1:1,683 1:2,422 1:2,982 1:1,569 1:1,955 1:1,774 Indiana Iowa Kansas Kentucky Louisiana Maine Maryland 1:2,674 1:2,404 1:2,411 1:2,259 1:2,690 1:2,545 1:1,809 Sources: American Dental Associaton, Survey Center, 2009 Distribution of Dentists in the United States by Region and State. http://www.census.gov/schools/facts/ 2009 Data for States with More Than 20,000 People Without a Dentist ARKANSAS 75 4 22,086 COLORADO NEBRASKA 93 20 35,905 NORTH DAKOTA 53 17 53,386 64 9 28,217 GEORGIA ILLINOIS 159 24 211,479 102 12 29,960 Total # of counties Total # of counties without a dentist Total of county population without a dentist KANSAS 105 12 31,015 MISSISSIPPI 82 4 31,246 SOUTH DAKOTA 66 16 53,205 VIRGINIA 136 5 30,000 * Data for Alaska, California, Florida, Indiana, Minnesota, New Jersey, New Mexico, Utah, Vermont and Wyoming not provided. http://apps.nccd.cdc.gov/synopses/ProgramDataV.asp?ProgramID=20 108 October 2011 » dentaltown.com dental statistics According to the ADA Department of Membership, Marketing and Tripartite Relations, in 2010, of the total active licensed dentists (all specialties) in the United States… 187,898 60.2% Approximately are Caucasian 9.2% are Asian 4.0% are Hispanic 3.5% are African American Approximately Approximately Approximately 0.3% Less than Source: ADA Department of Membership, Marketing and Tripartite Relations, 2010 1998 2006 2009 are American Indian Male: 140,000 Female: 23,513 Male: 140,000 Female: 35,444 Male vs. Female Professionally-active Male: 144,775 Female: 41,309 General Dentists Source: ADA; 2009 Survey of Dental Practice “Characteristics of dentists” Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois 1:2,792 1:1,183 1:2,452 1:2,912 1:1,520 1:2,023 1:1,893 Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska 1:1,991 1:2,036 1:3,098 1:2,623 1:2,023 1:2,065 Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota 1:2,441 1:2,113 1:1,587 1:2,731 1:1,645 1:2,789 1:2,302 Ohio Oklahoma Oregon 1:2,382 1:2,485 1:1,812 Pennsylvania Rhode Island South Carolina 1:2,067 1:2,405 1:1,666 Dental Health Professional Shortage Areas [HPSAs] As of April 5, 2011 1:2,790 South Dakota Tennessee Texas Utah 1:2,362 1:2,616 1:2,770 1:1,919 Vermont Virginia Washington 1:2,245 1:2,120 1:1,805 West Virginia Wisconsin Wyoming 1:2,596 1:2,140 1:2,258 http://ersrs.hrsa.gov/ReportServer?/HGDW_Reports/BCD_ HPSA/BCD_HPSA_SCR50_Smry&rs:Format=HTML3.2 33,444,731 Estimated Underserved Population 51,475,776 Population of Designated HPSAs 9,968 Practitioners Needed to Achieve Target Ratios continued on page 110 dentaltown.com « October 2011 109 I I I I I I I I I I I I rd cu I y a oc I I I tu I I I % rs 4/21/08 Active Date I I 10 t S ivit .2 a y 0 I I I d it y So ur ce: n d Pu bli she r’s da ta u ti v y a ac it y % it y 10 .4 S kly 8 c u of rs w on ee a y iv oc F ri % rs kly on ac t I I kl y on ac I y a I d ee I s w I e of I n I oc cu rs % rs act d ivit a y y ee 16 T k .0 h ly 8 u o on f w I I y I ti v I ty 1 of 2 oc w .2 cu ee 4 I I I I a I I I I I I I I I Posts in a Day I d I I oc I I 2,516 I I cu I I I o n y ti v a ac d % it y 16 . 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I w lto cu ta I I en vi October 2011 » dentaltown.com I D oc 110 7%acti ed .9 kly n W 16of weceurs o oc dental statistics continued from page 109 DENTALTOWN Dentaltown Magazine Print and/or Digital Edition is Mailed to 128 Countries* *and there are members of Dentaltown.com from 190 countries Source: Publisher’s data I I I I I I dental statistics Dentaltown.com As of August 24, 2011 If you took all Total number of registered users on Dentaltown.com: 140,455 154 Total number of message board posts: 2,706,182 continuing education courses listed on Dentaltown.com you could earn Total number of message board topics: 161,391 Total number of message board views: 36,814,654 Total number of Dentaltown.com CE course views: 367,034 I I I I I 312 265.5 I I I I ADA CERP Credits Source: Publisher’s data I I I I I I I I I I I I I I I I I I I I I I I I I I I I of the Week I Tuesday Active Day I I I I I I I I I I I I I I I I I 263 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I Source: Publisher’s data 12:0012:59 p.m. I I I I I I I I I I I I I I I the average I I I I I I I Registrations in a Day I I I I I I I I I I I AGD PACE Credits I I I I I I I I I I I I I I I I I I I 16,800 Weekend Visits I I I I I I I I I I I I I I I I I I CE Courses Completed in a Day I I I 169 I I Length of Visit I I I I I I I I I I I I I I I I 31,410 Weekday Visits 0:17:04 I I I I I I I I I I I I I I I I I I Source: Publisher’s data I I themost I Active Hour dentaltown.com « October 2011 111 I I I I I I I I ad index AD INDEX Our advertisers make it possible for us to bring Dentaltown Magazine to you each month free of charge. 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Our advertisers want to hear from you. -057 ADS www.adstransitions.com 001 AMD LASERS, LLC www.amdlasers.com 866-999-2635 028 American Academy of Facial Esthetics www.facialesthetics.org 800-952-0521, ext: 1 032 Aspen Dental Mgmt., Inc. www.aspendentaljobs.com/87 866-212-9721 017 Brasseler USA www.brasselerusa.com 800-841-4522 039 Burbank Dental Laboratory www.burbankdental.com 800-336-3053 043 CAO Group, Inc. www.caogroup.com/dental 800-372-4346 011 CareCredit www.carecredit.com/dental 866-246-6401 037 ChaseHealthAdvance www.advancewithchase.com/dt 888-388-7633 003 Coltène/Whaledent, Inc. www.coltene.com 800-221-3046 005 Continental Dental www.continentaldental.com 800-443-8048 033 Curve Dental, Inc. 072 Dentist Identity www.dentistidentity.com 800-303-6029 051 Imaging Sciences www.i-cat.com 800-205-3570 067 DENTSPLY Midwest www.dentsply.com 800-278-4344 (fax) 065 Ivoclar Vivadent, Inc. www.oralhealthamerica.org 312-836-9900 009 DENTSPLY Tulsa www.tulsadentalspecialties.com 800-662-1202 015 Ivoclar Vivadent, Inc. www.ivoclarvivadent.com 800-533-6825 (US) 800-263-8182 (Canada) 027 Designs for Vision, Inc. www.designsforvision.com 800-345-4009 025 Keating Dental Arts www.keatingdentalarts.com 888-407-6571 007 Discus Dental, Inc. www.philipsdiscusdental.com/zoom.php 888-576-4466 119 Dr. Harold Katz, LLC 800-973-7374 www.therabreath.com/probiotics 073 Evolve Dental www.korchallenge.com 866.763.7753 098 GetDentalPatients.com www.getdentalpatients.com 038 George Vaill www.georgevaill.com 800-340-2701 045 DDS Lab www.ddslab.com 877-337-7800 IBC Demandforce, Inc. www.dental.demandforce.com 800-210-0355 059 Dental Trade Alliance www.oralhealthcarecantwait.com 877-389-9851 112 090 LED Dental www.velscope.com 888-541-4614 063 Lighthouse PMG www.lpmg360.com 888-207-9385 029 Glidewell Laboratories www.glidewelldental.com 800-854-7256 075 Gold Dust Dental Lab www.golddustdental.com 800-513-6131 047 Great Lakes www.greatlakesortho.com 800-828-7626 105 Greater New York Dental Meeting www.gnydm.com 044 Horizon Schools of Dental Assisting www.teachdentalassistants.com 800-824-0895 October 2011 » dentaltown.com 041 Quantum Leap Success www.qlsuccess.com 480-744-6682 021 QuickLook, Inc. www.drquicklook.com 315-565-4058 128 Ribbond, Inc. www.ribbond.com 800-624-4554 Insert Scientific Metals www.scientificmetals.com 888-949-0008 071 Shatkin F.I.R.S.T., LLC www.shatkinfirst.com/dentaltown 888-4-SHATKIN 031 Six Month Smiles www.sixmonthsmiles.com/dt 866-957-7645 Insert Solution21, 019 LSK121 Oral Prosthetics www.lsk121.com 888-405-1238 074 New Patients, Inc. www.newpatientsinc.com 866-336-8237 Insert Officite, www.curvedental.com 888-910-4376 013 Keller Laboratories, Inc. www.kellerlab.com 800-325-3056 BC Procter & Gamble www.dentalcare.com/clinical LLC www.officite.com/dt 888-501-8920 083 OralDNA Labs, Inc. www.oraldna.com/professionals 877-577-9055 085 OralDNA Labs, Inc. www.oraldna.com 877-577-9055 Inc. www.solution21.com 877-423-8101 035 Temrex Corporation www.temrex.com 8800-645-1226 077 Townie Meeting, LLC www.towniemeeting.com 866-336-8696 023 Tuff Kids Crowns, LLC www.tuffkidcrowns.com 855-883-3543 053 US Bank [email protected] 800-313-8820 099 Park Dental Research Corporation www.parkdentalresearch.com 800-243-7372 IFC VOCO America, Inc. www.vocoamerica.com 888-658-2584 030 Practice Café www.practicecafe.com 888-575-2233 123 Xlear, Inc. www.sprydental.com 877-599-5327 117 Procter & Gamble 81 Zest Anchors, Inc www.facebook.com/professionalcrestoralb www.thepivotingdifference.com/dtown 800-543-2577 800-262-2310 from trisha’s desk hygiene & prevention Creating Your Personal Oral Health Directive by Trisha E. O’Hehir, RDH, MS, Hygienetown Editorial Director No one wants to think about it, but you could end up in a nursing home one day due to either an accident or complex medical issues requiring others to care for you. Lawyers urge people to have a signed advanced health-care directive, consisting of two forms. One is a living will, specifying what healthcare actions be taken if through illness or injury you become unable to make those decisions yourself. The other form is a power of attorney or health-care proxy specifying who will make your health-care decisions if you can’t. Missing from these directives is a specific oral health-care directive. In the five wishes document, a comprehensive living will from the Aging with Dignity Organization, oral health falls under general grooming, not health. But since oral health is so important and needs to be addressed every day through both oral hygiene and diet, a specific oral health directive should be in place as well. What specific directions would you like caregivers to follow to maintain your oral health? Or, as some Townies on Dentaltown suggested for nursing home patients, would you opt for full-mouth extractions? They weren’t suggesting it for themselves, but did for nursing home residents. What if one day you become a nursing home resident? Do you think those Townies would still want full-mouth extractions for themselves? In 1993, this became a reality for Irene Woodall, RDH, PhD, a leader and visionary in the dental hygiene profession. While skiing in Colorado she suffered an aneurysm. With speedy medical care, she was rushed to the hospital and underwent brain surgery that prevented a more intense stroke that would have taken her life. Instead, she suffered severe brain damage taking away her short-term memory and severely affecting her cognitive and physical abilities. Irene is now confined to a wheelchair and requires care around the clock. In the midst of all the medical care needed to deal with the stroke and rehabilitation, her dental care was overlooked. Her daughters are overseeing her care at a long-term care facility in the Chicago area and were shocked to find that their mother, a consummate dental hygienist, now has severe dental disease! To cover the extensive dental costs ahead, they created the Irene R. Woodall Special Needs Trust from which donations will be used for Irene’s oral health-care needs. Had Irene had an oral health-care directive in place when she suffered the stroke and subsequently was moved to a long-term care facility, her oral health and diet would have been addressed the way she wanted, not overlooked because of other issues. Oral health will impact general health, so it shouldn’t be overlooked in any situation. What would you want done for your oral health on a daily basis if you suffered a stroke and were confined to wheelchair and unable to perform your own oral hygiene? I know what I would want – five exposures to xylitol every day, MI Paste morning and evening, twice-daily brushing with the 30 Second Smile toothbrush using baking soda to keep the pH of my saliva up, tongue scraping, interdental cleaning with either the Sunstar Soft Picks or flossing with water. I’d also specify the diet I want. Write out your own oral health directive today just in case something unforeseen happens one day and write your directive with the hope that it will never be needed. ■ In This Section 114 118 120 124 126 Perio Reports Message Board: Tongue Stud Damage – A Case Study Profile in Oral Health: Townies Doing Research OCD Feature: Facing Our Fears Message Board: Increase Doctor’s Production dentaltown.com « October 2011 113 hygiene & prevention perio reports Perio Reports Vol. 23 No. 10 Perio Reports provides easy-to-read research summaries on topics of specific interest to clinicians. Perio Reports research summaries will be included in each issue to keep you on the cutting edge of dental hygiene science. Perio Pathogen Linked to Brain Abscess Periodontitis is a bacterial infection that contributes to the overall inflammatory burden on the body. Periodontal pathogens are linked with several systemic diseases, including infectious bowel diseases, atherosclerosis, coronary heart diseases, stroke, diabetes and rheumatoid arthritis. Aggregatibacter actinomycetemcomitans (Aa) is a major periodontal pathogen, found most often in association with endocarditis. A man, age 42, with a history of heavy smoking and alcohol abuse was admitted to a hospital in Leeuwarden, the Netherlands, complaining of confusion and reduced consciousness over the previous three days. Lab tests revealed an elevated white blood cell count and a moderately elevated C-reactive protein level. His oral health was poor. A CT scan of the brain revealed four lesions. No other lesions were found elsewhere in the body. The patient was treated with dexamethasone and a followup CT scan showed no changes. Biopsy confirmed inflammation and abscess formation. Aa was the primary microorganism detected. IV antibiotics were begun. Nine days later, the patient’s condition worsened, yet a new CT scan showed no change in the abscesses. It was decided to drain the abscesses and an oral surgeon extracted five teeth with advanced periodontitis. Antibiotics were continued for six weeks. At one year follow-up, he was doing fine. Several other published case reports confirm the presence of Aa in a variety of infections in non-oral areas of the body. Clinical Implications: Poor oral health can impact more than the teeth and gingiva, when oral pathogens travel to other parts of the body. Good oral health is necessary for good general health. Rahamat-Langendoen, J., van Vonderen, M., Engström, L., Manson, W., van Winkelhoff, A., Mooi-Kokenberg, E.: Brain Abscess Associated with Aggregatibacter Actinomycetemcomitans: Case Report and Review of Literature. J Clin Perio 38: 702706, 2011. ■ 114 October 2011 » dentaltown.com Saving Questionable and Hopeless Teeth The primary goals of periodontal therapy are to stop disease progression and save teeth. Treatment planning aggressive and chronic periodontal cases includes identifying teeth that are questionable or hopeless. Researchers have shown that with healthy gingiva (no gingivitis) the tooth survival rate is 99.5 percent. In the presence of gingivitis (gingival index score of 3) survival rate drops to 63.4 percent. Researchers at the University of Greifswald in Greifswals, Germany, looked back at dental school charts for periodontal patients who had been treated and monitored with supportive periodontal therapy (SPT) for 15 years. Those who showed signs of bone loss (on at least two teeth) before age 34 were diagnosed with aggressive periodontitis (AgP). Those with bone loss (on at least two teeth) appearing after age 40 were diagnosed with chronic periodontitis (CP). Each group had 34 patients. Periodontal therapy consisted of scaling and root planing and in some cases, access flaps were needed to reach all subgingival deposits. Antibiotics were used only rarely. SPT intervals were individualized for each patient ranging from three to 12 months. Teeth considered hopeless were those with 50 to 70 percent bone loss. Hopeless teeth were those with more than 70 percent bone loss. In the AgP group there were 262 questionable teeth and 63 hopeless teeth. After 15 years, 88 percent of questionable teeth and 60 percent of hopeless teeth survived. Tooth survival rates were similar for both the AgP and CP groups. Clinical Implications: Many questionable and hopeless teeth can be saved with effective supportive periodontal therapy and good patient compliance. Graetz, C., Dörfer, C., Kahl, M., Kocher, T., El-Sayed, K., Wiebe, J., Gomer, K., Rühling, A.: Retention of Questionable and Hopeless Teeth in Compliant Patients Treated for Aggressive Periodontitis. J Clin Perio 38: 707714, 2011. ■ perio reports hygiene & prevention Obesity and Dental Caries in Adolescents, No Direct Link Dental caries and childhood obesity are growing problems worldwide. Changes in diet and lifestyle are impacting the health and nutritional status of many populations. Decreased fruit and vegetable consumption, decreased physical activity and increased snacking on highly processed foods contribute to these declining health levels globally. Researchers at the University of Copenhagen in Copenhagen, Denmark wanted to know if there was a link between dental caries and childhood obesity or if there were lifestyle factors shared by both. The researchers evaluated 385 adolescents from eight municipalities in Denmark. The teens were all 15 years of age. Dental records were available and written questionnaires were mailed to the teens and their parents. The questionnaires provided basic demographic data and information on eating breakfast, daily fruit consumption, physical activity, smoking and alcohol consumption. BMI was calculated for each student from weight and height measurements. There was no direct correlation between obesity and dental caries in this group. Sixteen percent of the group was classified as obese and 62 percent of the group had no decayed, missing or filled teeth (DMFT). The average DMFT for the group was two. However, those who had no decay reported more healthful habits: eating breakfast, eating fruit, exercising and no smoking or drinking. Teenagers who did not eat breakfast were more likely to smoke and drink alcohol. Bad habits begun as children are likely to follow these teenagers into adulthood, leading to more significant health problems. More must be done to address both obesity and dental caries earlier. Clinical Implications: Dentists and physicians should work together to manage both obesity and dental caries. Cinar, A., Christensen, L., Hede, B.: Clustering of Obesity and Dental Caries with Lifestyle Factors Among Danish Adolescents. Oral Health Prev Dent 9: 123-130, 2011. ■ Toothbrush Age and Plaque Removal Many studies are published measuring plaque removal effects of both manual and power toothbrushes, but few are published on the impact of toothbrush wear on plaque removal. One reason might be the lack of a standard way to measure toothbrush wear. Toothbrush wear varies considerably between people and many use their toothbrushes for much longer than the recommended three months. Researchers at Ponta Grossa State University in Brazil devised a method to determine toothbrush wear by measuring bristle splay from the brush head. They were able to categorize toothbrush wear into three categories: low, moderate and high wear. A total of 110 undergraduate, non-dental students were recruited from the university for this four-month study. Subjects were randomly assigned to one of four groups, having plaque and toothbrush wear measured at four weeks, eight weeks, 12 weeks and 16 weeks. The students were all given a new manual toothbrush, plastic toothbrush cover, Colgate toothpaste and instructed to brush and floss three times daily. Baseline plaque and gingivitis scores were recorded. Subjects returned at their assigned time. No statistical difference in gingivitis scores was measured at any time point. There was more gingivitis on lingual surfaces than on facial surfaces. Plaque scores remained similar throughout the study, with more plaque found on lingual surfaces than on facial surfaces. Toothbrush wear increased over the 16-week study, but this wear didn’t impact plaque or gingivitis scores. Clinical Implications: Toothbrush age or wear might not be an important factor in effectively removing plaque. The toothbrushing method used and the time spent on lingual surfaces might be more important. Pochapski, M., Canever, T., Wambier, D., Pilatti, G., Santos, F.: The Influence of Toothbrush Age on Plaque Control and Gingivitis. Oral Health Prev Dent 9:167-175, 2011. ■ continued on page 116 dentaltown.com « October 2011 115 hygiene & prevention perio reports continued from page 115 Triple-headed Toothbrush Children under the age of 10 usually need their parent’s help to effectively brush their teeth. Children do not effectively remove bacterial biofilm due to lack of motivation and poor manual dexterity. A triple-headed, manual toothbrush is available from DenTrust in Newport, Rhode Island and is designed to clean facial, lingual and occlusal surfaces with one motion. This design does not rely on manual dexterity to effectively reach all surfaces. Researchers at the University of Sao Paulo in Brazil compared the triple-headed toothbrush to a Researchers at Franciscan University in Santa Maria, Brazil conventional manual toothbrush. They asked two wanted to know the difference between medium and soft toothquestions. First, was the new brush better at plaque brushes for plaque removal and soft-tissue abrasion. A total of 25 removal and second, did it matter if the mother or undergraduate students participated in the study, all free of gingivitis. the dentist did the toothbrushing. Four-year-old At baseline, the students were asked to refrain from all oral hygiene children were selected from two kindergarten classes for 96 hours, to allow plaque to accumulate. Using disclosing solufor the study. tion, plaque scores for all facial surfaces were measured except central In this cross-over study, each child received incisors and third molars. toothbrushing with both brushes at different visFor the experiment, students were randomly assigned to brush its, one week apart. Disclosing solution was used two contra-lateral quadrants with the medium brush and the other to measure plaque scores both before and after two quadrants with the soft toothbrush. This way, both right and left brushing with the assigned toothbrush. The mothsides of the mouth were brushed with both the soft and medium ers and the dentist were instructed in the use of brushes. The lower quadrants were brushed with Colgate Triple both toothbrushes and they practiced on a Action toothpaste and the upper quadrants were brushed without typodont until proficient. toothpaste. Upper quadrants were brushed first, before lower quadThe mothers were more efficient in removing rants. Each quadrant was brushed for 30 seconds. plaque with the triple-headed toothbrush than with Both medium and soft toothbrushes removed significant the conventional toothbrush. The dentist was more amounts of plaque. There was no difference in plaque removal efficient with the manual brush than with the triplebetween brushing with or without toothpaste for the soft toothbrush. headed toothbrush. Overall, the dentist removed 76 The medium toothbrush with toothpaste removed more plaque than percent of plaque compared to 53 percent removed without toothpaste. Both brushes removed more plaque from facial by the mothers. surfaces than from proximal surfaces. The medium toothbrush removed more plaque than the soft toothbrush in the premolar area. Clinical Implications: The triple-headed toothBoth brushes removed more plaque in premolar areas than molar or brush might be an option for parents who are not anterior areas. The medium toothbrush caused more cervical abrasions than the effectively removing all plaque from their chilsoft toothbrush and the medium toothbrush with toothpaste resulted dren’s teeth with a conventional brush. in more tissue abrasion than without toothpaste. Oliveira, L., Zardetto, C., Rocha, R., Rodrigues, C., Clinical Implications: Soft toothbrushes with or without toothWanderly, M.: Effectiveness of Triple-Headed paste should be recommended. Toothbrushes and the Influence of the Person who Performs the Toothbrushing on Biofilm Removal. Oral Zanatta, F., Bergoli, A., Werle, S., Antoniazzi, R.: Biofilm Removal and Health Prev Dent 9: 137-141, 2011. ■ Gingival Abrasion with Medium and Soft Toothbrushes. Oral Health Prev Dent 9: 177-183, 2011. ■ Soft vs. Medium Toothbrushes 116 October 2011 » dentaltown.com P&G and Crest Oral-B are proud to partner with the National Breast Cancer Foundation, Inc.®—for every Give Hope PinkPack sold, Crest Oral-B will donate 3% to the National Breast Cancer Foundation to help in its mission to educate women about the importance of detecting breast cancer early. To learn more about what you can do to support this program, visit facebook.com/professionalcrestoralb or call Customer Service at 1-800-543-2577. Together, we can make a difference © P&G hygiene & prevention message board This thread comes from the message boards of Hygienetown.com. Log on today to participate in this discussion and thousands more. Tongue Stud Damage A Case Study Oral piercings are becoming more common and so are the problems they create. Remind patients of the dangers of oral piercings. periopeak Posted: 7/16/2011 Post: 1 of 49 This female patient in her early 50s had a tongue stud for 10 years. Check out the damage it caused. Class I mobility on 24 and 25, both are non-vital. Her periodontist recommended extraction of 24 and 25. Notice lack of attached gingiva. Endo was performed, then regenerative periodontal endoscopy (RPE) the same day with Emdogain. Limiting factor here will be the attached gingiva on the lingual. Buccal is all WNL with beautiful tissues. Patient was prescribed metronidazole 500mg BID for eight days. DNA test revealed high level of T. denticola. She is PST negative, smokes half a pack daily and eats very well. Periogain was recommended, two caps twice daily for host modulated therapy. Do you think she has a chance of keeping these teeth? ■ lindadouglas Posted: 7/16/2011 Post: 2 of 49 Judging by those periapical lesions I would have said the prognosis was hopeless, especially because she is a smoker, but I have seen your work before, so I would love to see the outcome after you work on this patient. I usually see tongue piercings on the young and foolish, but not on the middle-aged! I once read about someone who got a brain abscess after a tongue piercing. ■ Unbelievable the damage she was doing and didn’t even know it! ■ JERSEY DEVIL Posted: 7/17/2011 Post: 6 of 49 JGonzalesRDH Posted: 7/17/2011 Post: 7 of 49 118 Absolutely savable! Expensive, but she could have these teeth for another 10 years I bet. If mobility remains after RPE, what are they considering for restorative options? Did they take #24/25 out of occlusion? Would be interesting to see a full arch photo as well if you have one... doesn’t look like she has a lot of incisal wear, which is good. Great case study! Thanks for sharing. ■ October 2011 » dentaltown.com message board hygiene & prevention Just for your general drtoast information, when consid- Posted: 8/3/2011 ering treating this area with Post: 43 of 49 a CT graft I am mostly looking for the following: Is there adequate depth to the floor of the mouth? Does the remaining gingiva have some thickness to it so when I reflect it back I won’t wind up perforating through the tissue? (When this happens, you are in really bad shape, and you have now most likely made things worse than they were before.) Will the patient’s tongue allow me adequate access to do the surgery? And lastly, am I dealing with a highly compliant patient? I know that recession on the lingual aspect of lower anterior teeth is an extremely prevalent problem, and many of these patients would benefit significantly if they could have soft tissue augmentation procedures. I am definitely very careful and cautious when I decide to treat one of these problems. I think a very appropriate area to treat is when a patient has only his lower six anterior teeth present and there is significant recession on the lingual of a canine, which happens so often as the lingual bar of the partial has settled. This can be a very nice service to a patient, helping her so she doesn’t lose either the canine or worse still, the lower partial. (I am still a big believer in trying to preserve our own natural teeth where possible.) ■ periopeak Posted: 8/4/2011 Post: 44 of 49 Here are some threeweek post-op photos; nice tight tissue. ■ Find it online at www.hygienetown.com Tongue Stud Damage dentaltown.com « October 2011 119 hygiene & prevention profile in oral health Townies Doing Research by Trisha E. O’Hehir, RDH, MS Do you ever feel like a detective searching for the answers to clinical mysteries? Why can’t patients effectively brush their teeth? Why don’t pockets heal after they’ve been treated? If only you were a clinical researcher, you could answer those questions and solve those mysteries! As an active Townie, you can now become a Townie Researcher and participate in clinical research, gathering data to answer those questions. Hygienetown and Dentaltown now offer Townies the opportunity to test new products in their own clinical practices. These are not randomized, controlled clinical trials. There is no calibration between clinicians. Extensive data collection is not needed. On the other hand, these studies are not simply product evaluations. These are real-life pilot studies to determine just how new products work in the hands of regular clinicians with regular patients. These studies bridge the gap between randomized, blinded, controlled, clinical trials and personal experience. Top Townies, those who are active on the site, are invited to participate in the studies. If a particular project fits their schedule and their interest, they agree. Dentist and dental hygienist teams are invited to participate. The two most recent projects were directed toward hygienists, but since they work in practices owned by dentists, the dentist was informed about the study and agreed to the project as outlined. The goal of Townie Research projects is to add something new to clinical practice that interests both patients and clinicians. Patients are impressed that their dentist/dental hygienists are researchers and they are excited to be part of studies testing new products that are already on the market. Data collection involves the usual clinical and photographic data already being collected in practice today. We want to know how these products work if you simply buy them and start using them. The indices used are plaque scores, probing depths and bleeding upon probing. Our 120 October 2011 » dentaltown.com profile in oral health hygiene & prevention goal is not to add time to already busy appointments, but to make gathering the data useful in measuring the effectiveness of a new product. Townie Researchers receive a copy of the complete research protocol explaining what the product is, what the research question to be answered is and step-by-step instructions on how to gather data, instruct or treat the patient and what follow-up data is needed. Test products are sent directly to the practice from the manufacturer. Telephone conference calls with the researchers on a particular project help answer questions, revise the protocol if we find an easier way to treat the patients and give the Townie Researchers an opportunity to compare notes with each other. Reports from the latest two research projects are presented here. The Townie Researchers who participated enjoyed the experience and provided valuable information on the products they tested. Join them on the Townie Research message board to find out more about the studies and about becoming a Townie Researcher yourself! Patient 1: Before: 58 percent Effects of the 30 Second Smile Power Toothbrush on Plaque Removal A Clinical Practice Study People brush an average of 38 seconds and brush in an erratic pattern that doesn’t allow for equal brushing throughout the mouth. To overcome those difficulties, the 30 Second Smile power toothbrush was designed by Hydrabrush, Inc., located in Escondido, California, with a unique brush head that contacts maxillary, mandibular, facial, lingual and occlusal surfaces at one time, simply by biting into the brush and moving it gently around the arch. The 30 seconds that people now brush will reach all tooth surfaces equally. Townie Researchers selected patients in their practices who showed high plaque levels despite repeated instructions in oral hygiene. Townie Researchers provided the 30 Second Smile power toothbrush to a total of 12 patients. Data collection included baseline plaque scores and intra-oral photographs. Plaque scores were repeated approximately two weeks later, and in some cases further follow-up visits were scheduled. Both children and adults were included in the study. Before and after photos of the study reveal high baseline plaque levels. After using the 30 Second Smile toothbrush for two weeks, plaque levels were reduced. Plaque scores dropped from 58 percent to 25 percent (patient 1). Patient 2 began with a plaque score of 82 percent and returned two weeks later with a 21 percent plaque score. A null hypothesis was proposed for this study stating that no changes in plaque scores would be seen with the use of the 30 Second Smile toothbrush compared to previous brushing. Results demonstrated that a majority of patients in this study showed lower plaque scores after two weeks or more of using the new brush. Some showed no difference and none showed increased plaque scores using the 30 Second Smile toothbrush. Thus, the null hypothesis was disproved in this study. Based on these findings, the 30 Second Smile power toothbrush provides better plaque removal when used instead of a manual toothbrush for Patient 1: After: 25 percent Patient 2: Before: 82 percent Patient 2: After: 21 percent continued on page 122 dentaltown.com « October 2011 121 hygiene & prevention profile in oral health continued from page 121 These are real-life pilot studies to determine just how new products work in the hands of regular clinicians with regular patients. These studies bridge the gap between randomized, blinded, controlled, clinical trials and personal experience. Millimeters Mean Pocket Depth Reduction 1.8 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0 1.56 1.3 0.47 0.33 RDH-1 122 RDH-2 RDH-3 RDH-4 October 2011 » dentaltown.com those who are ineffective with daily plaque removal. For patients who are not effectively removing plaque with a manual or power toothbrush, the 30 Second Smile brush promises to provide an effective alternative. The unique design and ability to reach all areas without depending on the manual dexterity of the user makes the 30 Second Smile ideal for those who need a new way to effectively clean their teeth. A Clinical Practice Observation of the Effects of HybenX Instrumentation on Non-Responding Periodontal Sites by Dental Hygienists in the European Union Non-responding areas are common after completion of non-surgical periodontal therapy, due to remaining bacterial biofilm. These areas continue to show signs of disease with probing depths of 5mm or greater and bleeding upon probing. Bacterial biofilm is attached to root surfaces, floating within subgingival pockets and found within root surface calculus deposits. This subgingival bacterial biofilm can be disrupted with mechanical action or chemical desiccation causing the biofilm matrix to denature, precipitate and coagulate. This detaches the biofilm and allows it to be rinsed away. HybenX Plaque Biofilm Remover is a concentrated sulfate solution that causes desiccation by absorbing water, making it an effective solution for breaking down bacterial biofilm. It is both selective and self-limiting, making it a safe plaque removal agent for subgingival areas. HybenX is made by Epien Medical in St. Paul, Minnesota, makers of Debacterol. HybenX is not yet available in the U.S., but is available in many countries outside the United States. HybenX solution comes in pre-filled syringes for subgingival delivery prior to instrumentation. The HybenX will desiccate the bacterial biofilm and allow for effective subgingival calculus removal, resulting in reduced bleeding and reduced probing depths. Four Townie Researchers were recruited, each active international Hygienetown members, from England (2), Scotland (1) and Italy (1). All Townie Researchers received a copy of the research protocol and the HybenX product. Each hygienist agreed to treat five patients with subgingival instrumentation plus the application of HybenX. Data collection included baseline probing depths and bleeding scores on areas that did not respond to previous instrumentation (see chart). Probing depth reductions were seen in 10 of the 13 patients treated. Three patients showed no reduction in probing depth after treatment. Comparing Townie Researchers, the mean probing depth reductions were 1.56mm for RDH-1, 0.4mm for RDH-2, 1.3mm for RDH-3 and 0.33mm for RDH-4. The overall mean reduction was 0.92mm. Based on these preliminary findings, the use of HybenX in combination with subgingival instrumentation in sites that did not respond to initial scaling and root planing provided a benefit. Findings thus disproved the null hypothesis that no changes in probing depths and bleeding would be seen. Future studies will need to compare sites treated with instrumentation alone and sites treated with both instrumentation and HybenX to determine the impact of HybenX Plaque Biofilm Remover. ■ XYLITOL NATURAL. DELICIOUS. POWERFUL. Protect y Protect your our tteeth eeth with ith scientifically scientifically-proven, -proven, all-na tural X ylitol all-natural Xylitol X ylitol is a natural-occurring natural-occurring sugar Xylitol tha esearch has sho wn can thatt rresearch shown dr dramatically amatically impr improve ove the health of y your our teeth teeth and mouth. Spry gives gives y you ou a full line of great-tasting great-tasting or oral al car care e products, pr oducts, each rich in Xylitol Xylitol and c completely ompletely fr free ee of artificial ingredients. ingredients. To T o learn more, more, visit www.sprydental.com www.sprydental.com or call toll-free toll-free 1.877.599.5327. 1.877.599.5327. hygiene & prevention ocd feature by Kathy L. Beard, RDH, BSDH We are all aware of the common adage that experience is the best teacher. I would qualify this motto by adding… if we use that experience for good. Communication is one of the most powerful instruments we utilize within our armamentarium. Words and their inflection, as well as actions can encompass both positive and negative consequences. We must ask ourselves, how are we being received? The answer to this question is somewhat contingent on whom might be the recipient of our dealings. What cannot be contested is that everyone needs care and understanding. We all lead complicated lives and it is wise to remember this consideration while communicating with fellow staff members, other professionals and our patients. These principles have been profoundly illustrated to me during my personal struggle with obsessive compulsive disorder (OCD), and by the examples set by those caregivers who have encouraged me to face both my professional and personal fears. If it were not for the joint efforts of my physician, psychiatrist and clinical psychologist, I would not be where I am today. Everyone should have such personal care! I am also grateful for the skill and teamwork which I encountered at the Anxiety & Stress Reduction Center of Seattle (ASRC).1 124 October 2011 » dentaltown.com My primary objective in sharing this struggle is to provide hope for those who are openly or silently suffering with OCD, an anxiety disorder affecting 2.2 million Americans of both genders at the same rate.2 OCD frequently becomes apparent during the teen and young adult years, and typically progresses slowly.3 In retrospect, I can see where this was true in my life as well, but it was not until 2006, that I began noticing my life spinning out of control after an emotional encounter. I was placed on Zoloft by my physician, but found it did not agree with me. I began seeing a social worker/counselor from May 2006 to October 2007. By May 2008, I realized that I could not continue in clinical hygiene. I was experiencing severe obsessions and compulsions which became very apparent to my employer as well as my fellow employees. I was the first person in the office in the morning, and the last one to leave at night, often returning home after 10 p.m. or so. I was fearful I would make a mistake and inadvertently hurt a patient somehow. I would continually question whether the operatory was clean enough, and wonder if I cleaned the tray of instruments properly. Were my chart notes understandable? Did they clearly represent the treatment I had rendered? When I would return home, I would shower for one to two hours, often using a full bar of soap each shower session. ocd feature hygiene & prevention These worries spilled over into my personal, everyday activities as with OCD, and take medication, but it will never take over my well. I could no longer cook meals, and it became extremely dif- life again! I have learned many lessons which I will bring back with me ficult to touch our dirty laundry. These illustrations introduce examples of the most frequent to the dental setting, such as the benefits of taking time to varieties of OCD. The debilitating trepidation that someone understand the individual in my chair. What works for one permight be harmed by carelessness combined with the “rituals” sonality, might not work for another. Some might not know why they react in a certain way – I did performed trying to ease those fears for not understand where my fears came one, and “checking” items over and Some might not know why from! They just might need to know over again being another. The obsessive portion of OCD fears the worst, while they react in a certain way – that someone genuinely cares. Providentially, experiences of these the compulsive measures temporarily I did not understand where past few weeks have added to this relieve those fears.4 As I saw my clinical future slipjourney. As I contemplate these events, my fears came from! ping, I tried to find other avenues I realize they will be extremely helpful They just might need to to stay in the career I loved. I in caring for future patients. A family member recently had surgery which became founder/president of Premiere know that someone went awry. There was much confusion Hygiene Study Club from 2008genuinely cares. and miscommunication between all of 2009. I also earned my Bachelor of the different entities. It left me wonderScience degree in Dental Hygiene from Eastern Washington University’s Dental Hygiene Degree ing, are we sending our patients home understanding services Completion Program at Pierce College in 2009. Thankfully, rendered? Are they confused about what treatment they are scheduled for, or how to care for a surgical site? Are we attenthere was no clinical component to this schooling. In May 2010, I began the process of healing. I was referred tive, loving and kind? Do they feel cared for? There is much to to a psychiatrist who placed me on Prozac. I was referred to a ponder as we try and use our experiences for good. ■ clinical psychologist from the Anxiety & Stress Reduction Center of Seattle (ASRC). I was impressed by their confidence References 1. Anxiety & stress reduction center of Seattle (ASRC). (2010). Retrieved December 10, in evidence-based treatment: 2010, from EBTCS Web site: http://asrcseattle.com/ “Both evidence-based medicine (EBM) and evidence-based 2. Facts & statistics: Anxiety disorders association of America, ADAA. (2010). Retrieved practice (EBP) assert that making clinical decisions based on January 31, 2011, from Anxiety Disorders Association of America Web site: http://www.adaa.org/about-adaa/press-room/facts-statistics best evidence, either from the research literature or clinical 3. Obsessive compulsive disorder. (2010). ASRC of Seattle: Obsessive compulsive disorder. expertise, improves quality of care and quality of life. EBP is Retrieved December 10, 2010, from EBTCS Web site: http://asrcseattle.com/ unique because it includes the preferences and values of the ocdisorder.html client and family in the process.”5 4. Baer, L., Ph.D. (1992). Getting control: Overcoming your obsessions and compulsions. New York, NY: Plume. My psychologist employed a method known as cognitive 5. What is evidence based treatment? (2011). ASRC of Seattle – Evidence-based treatment. behavioral therapy (CBT), which assists individuals in recogRetrieved January 27, 2011, from EBTCS Web site: http://www.asrcseattle.com/ebt.html nizing actions which need to be modified.6 An example of this 6. What is cognitive behavioral therapy (CBT)? (2010). ASRC of Seattle: Cognitive method used in my case is known as exposure and response prebehavioral therapy. Retrieved December 10, 2010, from EBTCS Web site: http://asrcseattle.com/cbt.html vention.3 “The following statements illustrate this principle… 7. Foa, E. B., Ph.D., & Wilson, R., Ph.D. (2001). Stop obsessing!: How to overcome your 1. You cannot always control your thoughts. obsessions and compulsions (Rev. ed.). New York, NY: Bantam Books. 2. You cannot always control your feelings. 3. But you can always control your behavior. 4. As you change your behavior, your thoughts and feelings Author’s Bio will also change.”4 Kathy Beard, RDH, BSDH, has enjoyed the dynamics of a Also, two books were recommended to me and gave me dental hygiene career for more than 25 years. Her duties comfort as I went through the “recovery” process. They were as past president of Premiere Hygiene Study Club, as well Getting Control: Overcoming Your Obsessions and Compulsions by as her responsibilities in implementing a safety program, L. Baer4 and Stop Obsessing! How to Overcome Your Obsessions have enriched her understanding of the importance of and Compulsions by E.B. Foa.7 continued communication. She resides in Washington State with her In less than three months, and in approximately 13 seshusband, and has one daughter. sions, I was done with treatment. I will always have to contend dentaltown.com « October 2011 125 hygiene & prevention message board This thread comes from the message boards of Hygienetown.com. Log on today to participate in this discussion and thousands more. Increase Doctor’s Production Whether you’re new in practice or just experiencing a slump in your schedule, there are many ways to increase production. cln2th Posted: 5/13/2010 Post: 1 of 36 126 Greetings all! I hope that you might have some suggestions for me. I work with a new, young dentist who purchased this established 30-year practice in a small, rural community. I worked with the previous dentist for 22 years. My schedule has remained full, even as much as being booked solid a month in advance. The issue is that the doctor’s schedule has vacancies. How can I assist in increasing his production? Honestly, a majority of our patients do not need restorative care when they are examined during their care in my operatory. What should I be recommending? ■ timothyives Posted: 5/13/2010 Post: 2 of 36 I admire your loyalty to your employer. It sounds like he’s a real preventive dentist with a minimal intervention approach. Has your dentist explored other avenues such as Invisalign? Tooth whitening is also a great way to bring in patients and is minimally invasive. I am just beginning to realize the power of clinical photography. I’m finding that simply taking clinical photos, discussing them with patients and letting the patient have a copy has had a positive effect. These patients are starting to ask about orthodontics and aesthetic work, just by being presented with a photo – subtle marketing. ■ skr RDH Posted: 5/13/2010 Post: 3 of 36 Be sure that the previously treatment-planned items are discussed at each subsequent visit if it is not booked yet. There are also plenty of courses and tools to introduce to the practice to boost treatment acceptance and production. ■ shazammer1 Posted: 5/13/2010 Post: 8 of 36 I like the idea of “before and after” photos hanging on the reception area walls. It gives patients something to ponder while waiting. Or a big photo album of before and after photos. I ask every patient if he or she has ever considered whitening. Not that they need it, but that they would have spectacular results if they decided to because of the beige undertone of their teeth. Once whitening is done, many patients are eager to continue with more treatment. Make sure every staff member has gorgeous dentistry in their own mouths for show and tell to the patient. I make it a habit to talk over the patient. If I think some treatment would be good, say a crown or some cosmetic stuff, I will start to talk to the doc during the exam. Something like “George is not ready at this time to go ahead with that anterior crown on that discolored tooth, but when he is, what kind of time frame would he need for the appointment?” The doc and I discuss this without George so much as throwing in two words, but he is hearing it. ■ October 2011 » dentaltown.com message board hygiene & prevention I own a laser company so that is obviously what I would suggest. You sound like an excellent hygienist and I’m sure you can spot all the things that your doctor could be doing with a little diode i.e., frenectomies, fibroma removal, operculectomies (tons of those to do), treating ulcers and of course, perio (decontamination and sulcular debridement)... just to name a few. ■ Jim jimking Posted: 9/6/2010 Post: 11 of 36 We’re getting a laser in a week or so, and have many patients waiting for frenectomies already (our associate is trained and uses it elsewhere). Main reason we’re getting it is for relieving tissue/hemostasis for crown impressions, minor crown lengthening and to have another technology to brag about on the Web site. ■ skr RDH Posted: 9/6/2010 Post: 12 of 36 My office has struggled a bit with this also. Our patient population is a younger demographic, so their restorative needs are generally not extensive. We are currently working with a consulting firm. It’s too soon to evaluate the outcome, but what I’ve learned so far is that having someone who is objective to look at things will bring many missed opportunities to light. Hiring a consultant, of course, is a financial investment, but many have some type of guarantee. In other words, if they don’t help you increase your profit by X amount they will refund the fees you paid. ■ squirlsgirl Posted: 9/18/2010 Post: 16 of 36 I am also reminded of the fact that a regularly seen population of patients who have been in the practice for more than 30 years will not be providing you with opportunity for rehabs or even much more than naturally occurring repair work. You might need to start a program designed to bring in the new patients who are lingering out there and have not been seen by anyone for years or a lifetime. Ads touting laughing gas, sedation dentistry, comfort or painless anesthetic can fire up your phone calls. ■ shazammer1 Posted: 9/21/2010 Post: 18 of 36 My best advice is to use protocols and systems that you follow for consistency and thoroughness. Going over risk factors makes sure nothing is overlooked. This covers everything from gums, teeth, TMJ, smile characteristics and medical precautions. I feel good that I am being thorough and providing service that the patients need. ■ toothbat2000 Posted: 9/24/2010 Post: 30 of 36 End-of-the-year letters can be sent out to patients who have unfinished treatment encouraging them to use their benefits. We typically do ours in the fall and they always generate a good response. ■ dentmom Posted: 9/24/2010 Post: 31 of 36 Dr’s Production Find it online at www.hygienetown.com dentaltown.com « October 2011 127 dentally incorrect If you find a town which looks deserted, it’s probably for a reason. Take the hint and stay away! Do not search the basement, especially if the power has just gone out. If household appliances start operating by themselves, move out. Never read a book of demon summoning aloud, even as a joke. If you’re running from the monster, expect to trip or fall down at least twice. Also note, despite the fact that you are running and the monster is merely shambling along, it’s still moving fast enough to catch up with you. Don’t fool with recombinant DNA technology unless you’re sure you know what you are doing. #1 Fiber Reinforcement • • • • No memory Unsurpassed fracture toughness Superior ease of use Proven history of success Indefinite shelf life Follows any contour As a general rule, don’t solve puzzles that open portals to hell. When it appears you have killed the monster, never check to see if it’s really dead. Periodontal Splints Apply Composite Adapt Fibers Finished Splint Single-Visit Bridges When your car runs out of gas at night, do not go to the nearby desertedlooking house to phone for help. Before Ribbond Framework Completed Bridge Composite Restorations Before Sold directly by Ribbond, Inc. Fibers in Restoration 800-624-4554 [email protected] Videos and more at www.ribbond.com 128 October 2011 » dentaltown.com Restored Tooth MADE IN THE U.S.A. Ref. 3-11 If your children speak to you in Latin or any other language which they should not know or if they speak to you using a voice which is other than their own, run! ■

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