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T H E J O U R N A L O F T H E O N TA R I O D E N TA L A S S O C I AT I O N
APRIL 2015
Connect, Learn and Excel at
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Toronto | May 7–9
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CLINICAL | Dental Management of the Stroke Patient
BUSINESS | Hoping to Own Your Own Practice?
MEMBERS | Fee Guide and Dental Plan Q+A
CASE STUDY 12
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RESULTS
Dr. Charles Blumenfeld
Hon. B.Sc., D.D.S.
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Ontario Dentist is the official journal of
the Ontario Dental Association, dedicated
to supporting the Association’s Mission
and Vision by providing members with
educational information relevant to their
profession and the dental practice
environment in Ontario.
PUBLISHER
Marcus Staviss
EDITOR
Dr. Carlos Quiñonez
APRIL 2015
Volume 92 | Number 3
ART DIRECTOR
Kimberley Strange
MANAGING EDITOR
Julia Kuipers
ASSOCIATE EDITOR
Gilda Swartz
CLASSIFIEDS CO-ORDINATOR
Catherine Solmes
■ upfront
8
Letters
Applause for Dr. Smith
Dr. Laszlo Szoke
10
What You Should Know About
Travel Advisories
Dr. Pat Duronio
EDITORIAL BOARD CHAIR
Dr. David A. Walker
EDITORIAL BOARD
Dr. Peter Copp
Dr. Yoav Finer
Dr. Ian McConnachie
Dr. Simone Seltzer
Dr. Ingrid Sevels
Cover Article/ASM
Learn From the Best at the
ODA’s Annual Spring Meeting
Helen McDowell
14
Editorial
The Truth Is Out There
Dr. Carlos Quiñonez
32
16
Opinion
Grey Market Dental Materials
and the Duty of Care
Dr. Lionel Lenkinski
Corporate Laws
Policy Brief: Dental
Professional Corporation
Laws in Canada
Michael Carabash,
Michael James Moeller,
Nicholas Dunn, Kester Ng and
Dr. Carlos Quiñonez
18
Oral Health Strategy
The History Behind the OHS
Dr. Deborah Saunders and
Bonnie Dean
36
20
Orofacial Pain and Management:
The Challenge for Dentists
Interview with Dr. Barry Sessle
Bonnie Dean
Making a Difference
The Joy is in the Journey:
Order of Canada Recipient
Dr. Tom Harle
Bonnie Dean
ISSN 0300 5275
Cover:
iStockPhoto.com
4
Ontario Dentist • April 2015
At a Glance: PHIPA Resources
28
Copyright: The Ontario Dental Association.
Reprint only by permission of the ODA.
CONTACT US
4 New Street, Toronto, Ont. M5R 1P6
Tel: 416-922-3900
Fax: 416-922-9005
Email: [email protected]
www.oda.ca
25
President’s Page
Patient + General Practitioner +
Specialist = Happy Ending
Dr. Gerald Smith
The opinions expressed in Ontario Dentist are those
of the authors, and do not necessarily reflect the
opinions of the ODA, Editor or Editorial Board.
DISPLAY ADVERTISING INFORMATION
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30 East Beaver Creek Road, Suite 202
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PHIPA
The 10th Anniversary of
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Roberta MacLean
12
DISCLAIMER
Advertising must comply with the advertising
standards of the ODA. The publication of an
advertisment or inclusion of a polybagged item
should not be construed as an endorsement of,
or approval by, the ODA.
24
■ clinical
40
Clinical and Policy Abstracts
Bacteremia in Two Implant Surgery Approaches,
and Choosing Between Endodontic and Implant Therapy
Dr. Ingrid Sevels
42
Clinical Feature
Dental Management of the Stroke Patient
Dr. David Walker
APRIL 2015
ODA Board of Directors
Volume 92 | Number 3
President
Dr. Gerald Smith
Thunder Bay
Look for your
Oral Health Month
poster polybagged
with this issue.
President-Elect
Dr. Victor Kutcher
Burlington
Vice-President
Dr. Jack McLister
London
Past President
Dr. Rick Caldwell
New Liskeard
Dr. Raffy Chouljian
Toronto East
■ business
46
Dr. Arnold Fleming
Waterloo Wellington
Practice Management
Hoping to Own Your Own Practice?
Dr. Bernie Dolansky and Bill Henderson
Dr. Charles Frank
Essex
Dr. Kim Hansen
Brockville
Dr. Lesli Hapak
Essex
■ members
48
ODA Continuing Education
Calendar
50
Members in the Media
The Natural Compassion of the
Dental Community
Bonnie Dean
51
53
54
55
55
Welcome to New Members
56
Fee Guides and Dental Plans
Suggested Fee Guide Coding and
Dental Claims/Plans Questions
In Memoriam
Dr. Donald Lewis Bigelow
Dental Calendar
ASM Class Reunion Listings
Web Talk
NEW: Health Advisories Section
Wini Lo
Community News
Heritage Plaque in Recognition
of Dr. John Adams
Catherine Morana
59
Classified Order Form
60
Classifieds
66
Advertiser Index
Dr. David Stevenson
Rideau
Dr. Andrew Syriopoulos
Toronto East
Dr. Larry Tenaschuk
Halton-Peel
Dr. LouAnn Visconti
Timmins
Dr. Arnie Weingarten
North Toronto
Chair of General Council
Dr. Roger Howard
Ottawa
Mission of the Ontario Dental Association
Coming in May
The Royal Canadian Dental Corps
Celebrates Centennial Anniversary.
At the Ontario Dental Association we provide
innovative and inspired leadership to deliver
exceptional value by:
• Promoting the highest standards of dental care and
supporting our diverse membership in their
pursuit of professional excellence and personal
fulfillment;
• Fostering a collaborative workplace environment
which promotes creativity and personal growth
while celebrating achievements; and
• Advocating with a unified voice for accessible and
sustainable optimal oral health for all Ontarians.
April 2015 • Ontario Dentist
7
upfront
Letters
Applause for Dr. Smith
This is a letter to all practising dentists
in Ontario. I applaud Dr. Gerald
Smith, the President of the ODA, for
his stand on the dental needs of vulnerable patients (“All Dentists Need
to Support Vulnerable Patients,”
Ontario Dentist, January/February 2015).
It is also a very sorry state of affairs
that people on the Ontario Disability
Support Program (ODSP) lose their
benefits on reaching the age of 65.
People with disabilities who required
our support before that age are certainly not any better equipped physically, emotionally or financially to
handle their personal health situations after age 65. They have not magically lost their disabilities, yet,
suddenly, the little support that they
have received, is immediately removed.
Another similarly difficult situation
occurs when disabled children reach
the age of 18 and are no longer welcome in the office of the pedodontist
who has treated them since early
childhood. They have lost the only
dental home that they have known. I
recently saw one such patient at the
Seniors Dental Clinic at St. Peter’s
Hospital. She is now 21, and her parents were unable to find a dentist to
treat her for the past three years.
I would also like to add to Dr.
Smith’s remarks in addressing the
needs of the elderly. The “Grey
Tsunami” is on the horizon. Every
one of us deals with elderly patients
on a daily basis, and how we care for
them in our offices is an important
part of our professionalism. It’s important to arrange the physical set-up
of our offices to be comfortable and
8
Ontario Dentist • April 2015
Photo courtesy Dr. Laszlo Szoke
safe for all our patients, but we have
to be aware that the eyesight, hearing
and reflexes of elderly adults may be
diminished and that we must be prepared to give them assistance, if necessary. It’s incumbent upon us to treat
with respect the people who have
made our personal and professional
lives so rewarding over the past many
years, (and for some of us, many
decades). The cities of Toronto and
Hamilton, as well as other communities, have guidelines for accessibility,
regarding the physical aspects of our
offices.
We must also deal with our patients
who can no longer come out of their
homes to see us. These people have
been our patients for many years, and
deserve our treatment skills if they
can no longer come to our office. It is
our duty to make treatment available
at a reasonable cost, where these patients live. A small percentage of our
patients live in nursing homes, and
may receive care from a nursinghome based practice. But our patients
would still be grateful to see their own
dentists. We should have a network of
dentists willing to visit those patients
who are not served. One suggestion
would be that local component societies could have equipment to lend to
dentists to visit these patients.
Portable units are readily available,
some so small that they can fit into a
carry-on bag. A simple armamentarium, good lighting and a strong suction are really all that is needed for
most simple extractions.
We need more facilities like Sunnybrook in Toronto and St. Peter’s in
Hamilton, where more advanced
equipment is available to transfer
wheelchair-bound patients to the
dental chair, or a wheelchair tilt, so
that patients can stay in their own
wheelchair. Our patients need the
availability of general anesthesia, or
deep sedation, either in hospitals or
private clinics. The only dental department in the Hamilton hospital
system was closed many years ago.
We need to prepare for all these patients in many different ways. We
need to communicate among ourselves better, and have readily available public lists of the facilities that
are geared to the care of the elderly. In
Hamilton, we receive calls regularly
continued page 10
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Letters
from people searching for seniors’ dental care from Simcoe
to Mississauga. We need to be more available, more visible.
The ODA website could have a referral system for the dental care of the elderly.
In the U.S., there is a call for a geriatric dentistry specialty, and some patients would benefit greatly from this
resource. However, the vast majority of patients would be
best served by their own dentist, first and foremost, then by
those dentists with a special interest in the care of the elderly
and then as a final step, would the services of a specialist be
indicated.
My last suggestion is to support the Special Care Dentistry Association. It is headquartered in Chicago, but about
10 percent of the members are Canadian. Together we can
improve the dental health of all the vulnerable patients in
Ontario.
Dr. Laszlo Szoke
Private Practitioner and Director of the
James Morreale Seniors Dental Clinic,
St. Peter’s Hospital,
Hamilton, Ont.
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Ontario Dentist • April 2015
Travel Advice About
Travel Advisories
Recently the Globe and Mail published an article in the
travel section that I feel was irresponsible, given the realities of international travel. The article was about a great vacation on the island of Roatan, Honduras, and the writer
happened to mention that the Department of Foreign Affairs had a travel advisory about travel to Honduras. What
the writer failed to add was that most travel insurance plans
will not cover you if you travel to a country that has a
Canadian government travel advisory. Considering that
dentists travel to developing countries to do volunteer
work, I think this is a critical issue.
I have been volunteering in Paraguay and I always check
the government website before I leave. As with most travel
insurance plans, my contract states that I am not covered
if there’s a travel advisory. I want to emphasize that my
contract (I read it carefully) does not provide any exceptions. It doesn’t matter that the advisory may be about a
dangerous level of crime. If, while I am in the country, I
have a heart attack, I will not covered because of the travel
advisory. If volunteers are depending on their insurance to
evacuate them back to Canada in case of a sudden illness or
injury, they may be out of luck. If you don’t have a copy of
your travel insurance contract, ask for one from your insurance provider. Then read it carefully.
Dr. Pat Duronio
Lion’s Head, Ont.
Need help?
Wondering where to start?
call 1-800-268-5211 toll free – any time
The Members’ Assistance Program (MAP) is a confidential counselling service
that helps dental professionals manage issues that could affect their physical,
emotional or financial well-being. It’s also a referral and information service —
including information on parenting and eldercare issues.
For information on wellness support go to
www.oda.ca/member/supportservices
Members’ Assistance Program from CDSPI is a
professional helpline supported by the Ontario Dental
Association, for the dental team and their families. You
do not have to be an ODA member or have products
through CDSPI to use this service.
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upfront
President’s Page
Gerald Smith
DDS
Patient + General Practitioner + Specialist
= Happy Ending
As professionals, or more importantly as health-care
professionals and doctors, we put the needs of our patients
ahead of our own. It could be said we have a fiduciary-like
responsibility: a duty of care, an ethical duty and a duty of
loyalty to our patients in much the same way directors do
to the organizations they represent. We are held accountable. Dentists continue to enjoy self-regulation in the
province of Ontario because our Regulatory Body does the
same in fulfilling its responsibility and mandate to protect
the public — our patients.
Often a general practitioner becomes a “jack of all trades”
when it comes to treating patients, but certainly GPs are
not the “master of all.” This brings me to the point of this
President’s Page: the importance of specialist colleagues.
Specialists are an integral part of a dental team and a necessary part of the profession who work in conjunction with
GPs to provide optimal oral health for patients. Unfortunately, there are instances when GPs feel the need to do
everything within the scope of their practice, or worse, feel
fully capable of treating all cases in every discipline in dentistry — the perceived “master of all.”
There are times when GPs’ clinical experiences or their
continuing education (a few short courses) provide them
with a false sense of confidence. Standards of practice exist.
We must remember that we are all held to a standard of
care that would be equivalent to the treatment results available, or the best outcome that could be expected, relative
to our peers, in the geographical area in which we practice.
To put it another way, I believe that, if general practitioners are going to provide any treatment, especially for the
more challenging and/or risky cases, treatment outcomes
should be clinically acceptable and more or less equal to
those of a local specialist, if one exists. This standard becomes even more important should something not go as
well as planned, or should a complaint arise. One must take
into account all of the potential risk factors that may complicate treatment and adversely affect the outcome. If risk
factors exist that may compromise the success rate that a
GP cannot predictably overcome — refer. It is in the best interest of the patient — and the GP as well. As my friend, Dr.
12
Ontario Dentist • April 2015
Karam Ashoo, stated in a CE course he presented, “A good
outcome is the holy grail of all dental procedures.” Our responsibility as dentists is to do all that we can to ensure a
good outcome for our patients, who have entrusted us with
caring for their oral health. Patients must leave your office
better off than when they arrived.
Specialists are available to support GPs in daily practice;
they are not just there to bail out GPs or deal with problem
patients. It’s best if GPs know their limitations and identify those cases that are likely beyond their level of expertise and therefore best served by the appropriate specialist.
We could all ask ourselves: Who would I want working on
me if I had similar treatment requirements? What is in the
best interest of my patient? What is the most suitable
course of action that will result in a happy ending?
GPs are the primary treatment co-ordinators and hence
the “responsible dentists.” If you are a GP, assist and guide
your patients through the treatment process, from your office, to the specialist’s office and back again, until the treatment is successfully completed. Know the credentials of
your specialists and understand their referral process.
Clearly convey your general expectations in the relationship and the specific expectations with each case. Good
communication and collaboration between GPs and specialists is imperative to maintain continuity and quality of
patient care. Communication is a dialogue that goes both
ways between the referring GP and specialist, with the patient kept well informed throughout. This will ensure a
good outcome for everyone involved: GP, specialist and,
above all, patients.
Dr. Gerald Smith maintains a general dentistry practice in
Thunder Bay, Ont. He may be reached at [email protected].
Are you a GP looking for specialists in your area?
A great starting place is the ODA Member Directory
(a member-only benefit), which lists ODA member specialists
according to geographical location. The ODA Member
Directory is available on the ODA website, at
www.oda.ca/member.
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J Provides continual protection from dentin hypersensitivity
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Building a hydroxyapatite-like layer over exposed dentin
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Protecting patients from the pain of future sensitivity
The reparative hydroxyapatite-like layer firmly binds to
collagen in dentin.1,16 In vitro studies have shown it is:
J Built up over 5 days1
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Fluoridated hydroxyapatite-like
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1. Earl J, et al. J Clin Dent. 2011;22(Spec Iss):68–73. 2. LaTorre G, et al. J Clin Dent. 2010;21(Spec Iss):72–76. 3. Edgar WM. Br Dent J. 1992;172(8):305–312. 4. Arcos D, et al. A
J Biomed Mater Res. 2003;65:344–351. 5. Greenspan DC. J Clin Dent. 2010;21(Spec Iss):61–65. 6. Lacruz RS, et al. Calcif Tissue Int. 2010;86:91–103. 7. De Aza PN, et al. Mat
Sci: Mat in Med. 1996;399–402. 8. Burwell A, et al. J Clin Dent. 2010;21(Spec Iss):66–71. 9. West NX, et al. J Clin Dent. 2011;22(Spec Iss):82–89. 10. Earl J, et al. J Clin Dent.
2011;22(Spec Iss):62–67. 11. Efflandt SE, et al. J Mater Sci Mater Med. 2002;26(6):557–565. 12. Parkinson C, et al. J Clin Dent. 2011;22(Spec Iss):74–81. 13. Du MQ, et al. Am
J Dent. 2008;21(4):210−214. 14. Pradeep AR, et al. J Periodontol. 2010;81(8):1167−1113. 15. Salian S, et al. J Clin Dent. 2010;21(3):82−7. 16. Zhong JP, et al. The kinetics of
bioactive ceramics part VII: Binding of collagen to hydroxyapatite and bioactive glass. In Bioceramics 7, (eds) OH Andersson, R-P Happonen, A Yli-Urpo, Butterworth-Heinemann,
London, pp61–66. 17. Wang Z, et al. J Dent. 2010;38:400−410. Prepared December 2011, Z-11-518.
upfront
Editorial
Carlos Quiñonez
DMD MSc PhD FRCD(C)
The Truth is Out There
I was recently watching The X-Files; you might remember
it, the ’90s TV show where FBI agents Fox Mulder and Dana
Scully investigate strange and unexplainable phenomenon.
As the story goes, Scully consistently questions Mulder’s
commitment to believing the incredible, and in one
episode, Mulder quips: “This is the essence of science, you
ask an impertinent question, and you’re on your way to a
pertinent answer.” Hold on to this thought.
Now let’s turn to another X-File, my PhD. At the end of
my doctoral studies, I experienced what many new academics fear: the idea that I would never come up with any
new research questions — at least not any good ones. To
pose clear, answerable and interesting research questions is
actually a difficult thing and constitutes one of the most
creative aspects of the research enterprise. One of my collaborators at the time suggested that, as a matter of practice, I should be in contact with the editors of leading
journals to ask what areas they think we need to research.
He said that editors have a good sense of what we don’t
know and what we need to know.
Similarly, as an academic, I am often asked what there is
left to learn about oral diseases, dental treatments, access to
care, etc., that we don’t already know. Surprisingly, I have
found there is quite a lot. So what follows are “impertinent
questions” that are currently guiding us “on our way to pertinent answers.”
What is oral disease? It might surprise you that we don’t
necessarily have a clear answer to this question. Sure, caries
is an outcome of fermentable foodstuffs sitting on teeth,
which bacteria eat, creating acid that demineralizes
enamel. We also now know that periodontal disease is
partly an outcome of the body’s immune response to bacteria. That said, we are in the early stages of learning how
inflammation, stress, gene-environment interactions and
the oral microbiome (the totality of the microbial ecological community), determine oral health and disease. It may
be that caries has an immunological component, and that
periodontal disease severity has more to do with the body’s
response to stress than with bacterial loads, and that both
diseases are more likely determined by socio-economic
status than foodstuffs on our teeth.
14
Ontario Dentist • April 2015
Why is oral health different? This is a common question when trying to figure out the role of oral health in systemic health, and when thinking about health policy
responses to oral diseases. Some say that oral health is different because “it won’t kill you.” Really? I challenge that
assumption. Indeed, we know of unique pathological situations where oral infections ultimately do kill, but we are
now learning that oral disease might represent a slow,
chronic burden on the body that accumulates over time,
and which influences the burden of systemic health conditions. We are exploring the links between oral health and
cardiovascular disease, diabetes, cognitive decline, and preterm and low-birth-weight infants, among others. Interestingly, whether oral disease is a causal agent may not even
matter. What matters is what burden poor oral health places
on the body in terms of determining morbidity and morality outcomes in these systemic diseases and conditions.
Do we have evidence for what we do? This might surprise you, but in the health policy world, I’ve heard dentistry referred to as an “evidence-free zone.” This is unfair.
We do have evidence for the procedures we undertake
daily, such as fluoride therapies, sealants and implant supported dentures; yet we do lack evidence on the therapeutic benefit and appropriateness of other treatments,
including polishing, scaling in children and third-molar
extractions. Moreover, we know little about the longevity
and cost-effectiveness of much of our care. Indeed, this has
partly driven the American Dental Association to establish
the Dental Quality Alliance (DQA), which aims to develop
performance measures for oral health care. Essentially, the
DQA is trying to figure out what works and what doesn’t in
dentistry.
What does this all mean? To me, the above points to
the fact that we still have a lot to learn about the major diseases and conditions that we treat — and that is a great
thing. Think about it, maybe one day we will treat oral diseases medically as opposed to surgically. As one of my colleagues once told me, maybe we’ll be treating caries and
periodontal disease with pills and growing teeth in petri
dishes.
Editorial
Importantly, the above also tells me
that there are policy drivers pushing
us to rationalize what we do and how
we do it, especially as private and
public funders become more stringent
about their investments. Ultimately,
we are being asked to provide evidence for how best to organize and
deliver dental care such that we
achieve the greatest health, social and
professional outcomes. I believe we’re
up to the task.
Your dental practice may not
be meeting the minimum
requirements under the
Occupational Health and Safety Act.
Are you one of them?
Safety Compliance for Dental Practices
Dr. Carlos Quiñonez is the Editor of
Ontario Dentist. He may be reached
at 416-979-4908 ext. 4491 or at
[email protected].
T: 416.283.7233
TF: 1.855.260.7233
Need help?
Wondering where to start?
call
1-800-268-5211
toll free – any time
The Members’ Assistance Program (MAP) is a
confidential counselling service that helps dental
professionals manage issues that could affect their
physical, emotional or financial well-being. It’s also a
referral and information service — including information
on parenting and eldercare issues.
dentalpracticesafety.com
[email protected]
CERTIFIED HEALTHAND
SAFETY CONSULTANTS
ODA Extended Health Care Insurance
– a safety net
should the
unthinkable happen
Whether you’re a practice owner, an
associate, new grad or retired, odA
extended Health Care insurance should be
part of your overall financial protection plan.
designed for odA dentists, it provides the
best combination of features, cost and value
on the market.
For information on wellness support go to
oda.ca/member/
supportservices
Members’ Assistance Program from CDSPI is
a professional helpline supported by the
Ontario Dental Association, for the dental
team and their families. You do not have to be
an ODA member or have products through
CDSPI to use this service.
ConTACT us TodAy
For More InForMATIon:
Call 416-922-4162 ext. 3368
if you’re in the Toronto area, or call toll free at
1-866-739-8099 ext. 3368
or email us at [email protected].
April 2015 • Ontario Dentist
15
upfront
Opinion
Lionel Lenkinski
DDS Cert Endo
Grey Market Dental Materials
and the Duty of Care
As professionals, we are often judged by how we meet our
“standard of care.” This may be defined by the specific
standard of conduct that is imposed by law or regulation
upon an individual, which, if violated, could result in
liability or regulatory action of some sort or another. Often,
this is an argument between experts in courts and/or
regulatory proceedings. Yet there is another element to
consider, regarding the “duty of care”.
The duty of care is the legal obligation to maintain a certain standard. Why does this matter? There is an emerging
issue that can place you right into the middle of these legal
issues, the use of grey market dental materials. When we
perform dental procedures, whether they are restorations,
endodontic treatment, or implants, where materials are
placed into the oral cavity, we have a professional obligation to ensure the correct use and authenticity of these
materials, and that they have been cleared for use in
Canada. What is the issue?
We often receive flyers in our mail from third-party resellers of dental supplies and materials, and there are often
“perceived” price advantages to buying these items. With
the costs of running a dental practice increasing rapidly,
we are all looking for ways to lower our expenses — and
saving on materials is tempting. However, what appears to
be a bargain may be trouble instead.
• These materials may have been imported from elsewhere
and may not have been approved by Health Canada for
use.
• They may not be of the same quality as those intended
for the Canadian market.
• The expiration date may be inaccurate.
• While these materials may have the same trademark as
known brands, the composition may vary and the handling characteristics can be different, as they may have
been produced for use in another country.
Our regulatory framework is such that not only must the
company that produces the goods be approved by Health
Canada, but also so must the distributors. In Canada, all
dental goods fall under the auspices of the Medical Devices
16
Ontario Dentist • April 2015
Regulations controlled by Health Canada. This level of
scrutiny assures the public that all devices are traceable
from the time of manufacture until their use in the oral
cavity. This means there is a great deal of scrutiny that goes
into the approval of all dental materials, and into who can
distribute them, in order to ensure public safety. In the
event that a widespread problem occurs with a material or
device, Health Canada issues a recall to distributors and
end users.
There have been recalls of materials, devices and drugs
that not only have affected us as practitioners, but also as
patients and consumers. These events become front page
news very quickly. Aside from the bad press, you place yourself at risk should you use unregulated or unapproved materials in patient care. This points back to the “duty of care.”
Our duty of care is clear and, in the most basic definition, is to above all do no harm. Harm may result from
using materials not intended or approved for use in
Canada. Why take this risk? If you knowingly violate this
and an untoward outcome results, you may have two masters to answer to, the regulators and the civil courts. You
can find the information necessary to identify both approved manufacturers and distributors on the links to the
Health Canada website, listed below. Using approved materials is cheap insurance for practising safely.
Information is available from the following two links on
Health Canada’s website.
• To find approved manufacturers, visit www.hc-sc.gc.ca/
and search for MDALL
• To find authorized distributors, visit www.hc-sc.gc.ca/
and search for Establishment licences compliance
Dr. Lionel Lenkinski is the Executive Director and Program
Manager of the Canadian Dental Protective Association, a
mutual defence organization representing Canadian dentists in
regulatory matters. He also maintains a private practice in
Toronto in the specialty of endodontics. Dr. Lenkinski may be
contacted at [email protected].
68.635% (w/w) Sodium Perborate
upfront
Oral Health Strategy
Deborah Saunders
BSc DMD
Bonnie Dean
The Oral Health Strategy:
Bridging Medicine With Dentistry
The history behind the strategy.
The Oral Health Strategy (OHS) came
into existence in mid-2003. Originally
called The Value Project, the initial
objective was to identify what “value”
dentists can offer their patients. The
Value Project was presented to General Council by Dr. Rick Caldwell in
November 2002.
Research was conducted to better
understand the public’s opinions and
attitudes towards dentists, oral health
care and the services provided to
them by dentists. Based on that research, the ODA developed the Oral
Health Strategy. The OHS was designed to build awareness of the many
associations between oral health and
the overall health of patients, and of
the key role that dentists can play as
their patients’ oral health-care specialists. The intention was to convey a
more accurate perception of dentists
as overall health-care providers, and
to help patients see their dentist as
part of their primary health-care team.
The ODA wanted to promote
themes for Oral Health Month (OHM)
that will connect good oral health to
good overall health. To guide the development of the OHS, the ODA established an advisory panel to provide
clinical expertise to ODA staff to develop communications materials and
educational programs for members
and the public.
18
Ontario Dentist • April 2015
The first OHS campaign was
launched in June 2003 and focused
on oral cancer awareness. The topic
continued to be part of the focus in
the 2004 and 2005 OHS campaigns;
materials were designed for members
to use to “prompt your patients to ask
you questions about their health” and
“to enhance your value with your patients by giving them the personalized information they need but do
not have and are unlikely to get anywhere else.”
The ongoing oral cancer awareness
campaign was augmented by a successful advertising campaign featuring the tagline, “Oral cancer isn’t this
easy to spot … ask your dentist” with
a flashing red light placed on an extended tongue (left). This image was
plastered everywhere, from billboards
to buttons all across the province.
Other OHS campaigns through the
years emphasized the role dentists
play in multidisciplinary approaches
to conditions that affect oral and
overall health, such as: drugs and
dentistry (with the focus on the use of
oral and IV bisphosphonate medications and their impact on oral
health); tobacco use (clinical interventions); sleep disorders; and sexually transmitted diseases.
In 2013, the panel was made into a
committee — the Oral Health Strategy
Advisory Committee. While the title
may have changed, the members who
serve on the OHS committee continue
to share our knowledge as dentists
with our colleagues in other healthcare professions — ultimately providing enhanced comprehensive overall
care to our patients.
Dr. Deborah Saunders is the Chair of the
Oral Health Strategy Advisory Panel.
Bonnie
Dean
is
the
ODA’s
Communications Specialist and provides
staff support to the OHS. Bonnie may be
contacted at [email protected].
Oral Health Strategy
Orofacial Pain and Management:
The Challenge for Dentists
Chronic pain of the face, mouth and jaws can be treated,
but the hard part is identifying the cause.
Bonnie Dean
Dentists are accustomed to treating patients who have pain
in the face, mouth and jaws; a large percentage of this type
of pain is odontogenic in nature.1 However, some patients
experience persistent orofacial pain without having an obvious dental problem. Some of the most common pain
conditions in the body occur in the orofacial region and
many are chronic (i.e. lasting more than three months).
These can range from the more common temporomandibular disorders (TMD) and burning mouth to lessfrequent disorders such as trigeminal neuralgia and
“atypical” odontalgia.2
These chronic pains represent a challenge to dentists:
since these conditions may present symptoms similar to a
toothache, the cause can be difficult, at first, to identify.
Some patients may undergo unnecessary and irreversible
dental treatments (e.g. root canals or extractions) before
the true cause of their pain is correctly identified. One reason why the diagnosis and treatment of non-dental orofacial pain is so challenging is the inadequate education most
dentists receive regarding pain in general.
Dr. Barry Sessle is a Professor in the Faculty of Dentistry
as well as the Canada Research Chair in Craniofacial Pain
and Sensorimotor Function at the University of Toronto.
In a 2009 article in the JCDA, “Why Are the Diagnosis and
Management of Orofacial Pain So Challenging,” Dr. Sessle
notes that the topic of pain is given little attention in the
curriculum of most dental schools in North America (an
omission that applies to other health professional programs
as well). This limitation is problematic because most
chronic pain represents a diagnostic or management challenge due to its complexity and multidimensionality. Managing a patient with chronic orofacial pain requires a
clinician who understands and appreciates the biopsychosocial basis of pain; without a grounded understanding
of this, chronic pain is often misdiagnosed, undertreated
or not treated appropriately.
20
Ontario Dentist • April 2015
Dr. Sessle believes that dental schools should offer adequate and appropriate coverage on the topic of pain in
their DDS/DMD curriculum and he recommends that more
continuing education courses be offered to enhance the
knowledge that general practitioner dentists have about
the complexity of orofacial pain. This recommendation is
one of the reasons why the 2015 Oral Health Strategy is focusing on orofacial pain and management and will offer a
comprehensive symposium on the topic for ODA members
at this year’s Annual Spring Meeting. (For more details on
the OHS and the 2015 symposium, see sidebar page 22.)
In light of the upcoming ASM symposium, I asked Dr.
Sessle about recent advances in pain research, whether the
gap between knowledge and practice has lessened, and
how dentists can enhance their understanding of the pain
their patients may be experiencing.
In your JCDA article, you discuss the challenges of
diagnosing and managing orofacial pain. That was in
2009; have things changed at all since then?
Five years is probably too short a time to expect major
changes, given the number of challenges and factors influencing them. Nonetheless, several positive steps have been
taken to raise awareness among the public, policy makers
and clinicians about pain (including orofacial pain): the designation of October 2013 to October 2014 as the Global Year
Against Orofacial Pain by the International Association for
the Study of Pain (IASP); the establishment of a National
Pain Strategy by the Canadian Pain Society to foster pain
awareness, management, education and research here in
Canada; a published report from the Institute of Medicine in
the United States, which has drawn attention to the “pain
epidemic” and its socioeconomic impact; and other publications drawing attention to these topics.
Some dental schools in Canada are now also placing greater
emphasis in their curricula on pain. Another recent initiative
in Canada has been the establishment of an Orofacial Pain
Oral Health Strategy
Team which, at its first workshop (co-sponsored with the
Network for Canadian Oral Health Research and the Canadian Institutes for Health Research), identified new directions for improving diagnosis and management of chronic
orofacial pain states, as well as several opportunities for collaborative orofacial pain research and education.3,4
What would explain the considerable gaps in
knowledge and management of pain? Does the cause
rest solely on dentists or are other factors involved,
i.e. public awareness?
Yes, public awareness, or rather lack of it, has been a factor,
as I pointed out in my 2009 article. However, steps have
been taken to address this as I mentioned above. Certainly
the limited education that the vast majority of dentists
have received in the past as dental students is a major reason, but it is also important to appreciate that pain, especially when it has become chronic, is very complex and
may be associated with comorbid conditions including
those affecting the emotional and psychological state of
the chronic pain patient. These features can make it inherently difficult for a clinician to diagnose and appropriately
manage the patient, irrespective of the specific expertise of
the clinician, and often require the involvement of an interdisciplinary health-care team.
Also adding to the difficulty is the uncertainty surrounding the causes and processes underlying most
chronic pain states, although the increased research focus
on pain over the past four decades has seen many insights
gained as to the etiology and pathogenesis of chronic pain
states, including those in the orofacial region. Some of
these have occurred in just the past six years or so.
What types of insights have come from the recent advances in
pain research and management?
These advances have recently been outlined in a book that
I have just edited.5 For example, there have been discoveries from animal models of non-neural as well as neural
processes in orofacial tissues and in the brain that are involved in acute and chronic orofacial pain states, as well as
the introduction of new approaches to help with the diagnosis or management of these pain states through the application of recently developed techniques (e.g. brain
imaging; quantitative sensory testing; and novel analgesic
drugs).
A few dentists have told me that they see more patients being
referred to them by their physicians for orofacial pain. Are
you aware of an increase in these types of referrals? How
large of a problem do you see this becoming, given your
assertion that dentists aren’t adequately educated or
knowledgeable about pain?
I am not aware of any clear evidence of a general trend
along these lines, but if it is occurring, maybe it is not a
problem, in the sense that it could be related to the success
of the steps that I mentioned earlier to raise pain awareness
amongst clinicians, including physicians. It becomes a
problem if the dental clinician does not have the knowledge base and expertise to deal effectively with the orofacial pain condition of the patients who are being referred.
continued page 22
April 2015 • Ontario Dentist
21
Oral Health Strategy
What can practising dentists do to enhance their knowledge
on pain?
There are a number of resources that dental clinicians can
access. These include: participating in continuing education courses on pain that are provided by academic institutions, licensing bodies and professional and scientific
organizations such as the Canadian Pain Society (a national
chapter of IASP), the Academy of Orofacial Pain, and the
Academy of Craniofacial Pain; becoming a member of one
or more of these organizations and accessing their online
resources and attending their annual meetings; attending
pain-related sessions that are often provided by the ODA,
Canadian Dental Association and dental-specialty meetings; reading some of the many review articles and clinical
and research papers that are published each year in several
journals that focus on pain, including the one with a specific orofacial pain focus (the Journal of Oral & Facial Pain
and Headache); and reading recently published books
that have this focus and provide up-to-date information on
orofacial pain topics.
References
1.
Scully, C. (2008). Oral and Maxillofacial Medicine: The Basis
of Diagnosis and Treatment (2nd ed.). Edinburgh: Churchill
Livingstone. Pp. 98, 99,104,107,159–162.
2.
Sessle, B. J. “Why Are the Diagnosis and Management of
Orofacial Pain So Challenging”, J Can Dent Assoc 2009:75:4,
p. 275.
3.
Lavigne, G. J. and Sessle, B.J. “Canadian Orofacial Pain
Team Workshop Report on Global Year Against Orofacial
Pain.”
Pain Res Manag, 2015:20:1.
4.
Cairns, B.E., Kolta, A., Whitney, E., Craig, K., Rei, N. Lam,
D.K., Lynch, M, Sessle, B., Lavigne G. “The Use of Opioid
Analgesics
in the Management of Acute and Chronic Orofacial Pain in
Canada: The Need for Further Research.” J Can Dent Assoc.
2014:80:e49.
5.
Sessle, B. J. (Editor), Orofacial pain: Recent Advances in
Assessment, Management and Understanding of Mechanisms,
IASP Press, Washington, D.C., 2014
The ODA Oral Health Strategy Advisory Committee Presents the
Orofacial Pain and Management Symposium
At the 2015 Annual Spring Meeting
This unique and comprehensive program of four lectures and a hands-on workshop will
break down the multidimensional nature of non-odontogenic orofacial pain and provide
an understandable and applicable approach for the general-practitioner dentist. Our roster of expert speakers reflects the multidisciplinary nature of orofacial pain management.
Lectures and Workshop*
Speakers
• Proven and Unproven Therapies: A Review of
the Literature
• Dr. Allan Gordon, Director of the Wasser Pain Management Centre, Mount Sinai
• Musculoskeletal Functional Disorders: Recap
Your Knowledge
• Causes of Orofacial and Oral Mucosal Pain:
Local and Systemic Disorder
• Causes of Orofacial Pain: Neurologic and
Vascular Disorders
• Workshop: Orofacial Pain and
Neuromodulators: Botulinum Toxin in the
Management of Cervical and Maxillofacial
Conditions
• Dr. Brian Freund, Oral & Maxillofacial Surgeon
• Dr. Miriam Grushka, Certified Specialist in Oral Medicine
• Dr. Edward Kassel, Neuroradiologist
• Dr. David Lam, Head and Assistant Professor, Oral & Maxillofacial Surgery,
University of Toronto
• Dr. David Psutka, Oral & Maxillofacial Surgeon
• Dr. Tanya Rouleau, Dental Oncologist
• Dr. Marvin Schwartz, Chief of the Division of Oral and Maxillofacial Surgery,
Rouge Valley Health Complex
*The workshop is a ticketed event and is limited to 35 attendees.
Please note that attendance at all four lectures are prerequisites for
the workshop. All lectures are Category 2 courses.
For details and registration information on the Symposium, please refer to the
ASM15 Preliminary Program or visit the ASM website at www.oda.ca/asm.
22
Ontario Dentist • April 2015
Oral Health Strategy:
Bridging Dentistry with Medicine
upfront
PHIPA
Roberta MacLean
10th Anniversary of Ontario’s
Personal Health Information Protection Act
This year marks the 10th anniversary of Ontario’s Personal
Health Information Protection Act (PHIPA). PHIPA has been
recognized across Canada as a benchmark for health policy
legislation. Despite this, breaches still occur and unauthorized access to patient’s personal health information appears to be a continuing problem in Ontario’s health care
sector.1
In the past few months, news reports have highlighted
Ontario hospital staff misusing confidential patient records
and snooping into hundreds of patient files. Even though
these PHIPA breaches did not occur in a dental setting, they
could have. As a dentist, it is important that you build a
culture of privacy in your office. Dentists need to take steps
to ensure that privacy policies, procedures, training and
awareness are in place. The Information and Privacy Commissioner of Ontario explains that: “Unauthorized access
to personal health information may cause harm to individuals and irreparably damage the trust relationship between custodians and the individuals to whom they
provide health care.” Further: “It is important that custodians and their agents recognize that the issue of authorized access to personal health information, regardless of
motive, is significant and must be taken seriously.” In addition to causing harm to individuals and damaging the
trust relationship, unauthorized access can also lead to disciplinary proceedings, privacy investigations and orders,
prosecutions for offences under PHIPA, and lawsuits.2
It is important to note that PHIPA breaches do not always take place on a large scale; everyday breaches commonly occur. Consider the following scenarios:
• You need to consult with one of your patient’s physicians. You take the call at reception, feet away from the
waiting room which is filled with patients. You state the
patient’s name and proceed to speak about her condition. This patient’s personal health information has now
been inadvertently shared with numerous unauthorized
individuals who have overheard the conversation.
• It is a busy day at the office. One of your patients is accompanied into an operatory and asked to take a seat.
Your staff did not switch over the viewing screen in time,
and the patient can easily view the X-rays and personal
health information of the previous patient.
• Your receptionist provides a print-out to one of your patients with the date and time of his next appointment.
However, in addition to the appointment information,
the upcoming appointment of his adult daughter is also
included. She has not authorized that this information
be shared. A privacy breach has occurred.
For additional information on this important topic,
please see the ODA’s new member resource titled, “At
a Glance: Ontario’s Personal Health Information Protection
Act (PHIPA)” on page 25. It is also available for download from: http://www.oda.ca/member/privacy.
Roberta MacLean is the ODA’s Health Policy Specialist. She
may be reached at [email protected].
24
Ontario Dentist • April 2015
1.
Information and Privacy Commissioner of Ontario. January
2015. Detecting and Deterring Unauthorized Access to Personal
Health Information. Available at:
https://www.ipc.on.ca/images/Resources/Detect_Deter.pdf
2.
Ibid.
PHIPA
At a Glance:
Ontario’s Personal Health Information
Protection Act (PHIPA)
This document has been prepared to help members understand their statutory obligations under the Personal Health
Information Protection Act, 2004. It is important to note that the information provided is not exhaustive; rather it is
meant to highlight important actions and definitions.
Ontario’s PHIPA governs the collection, use and disclosure of personal health information by health information
custodians, including dentists, who practise within Ontario. The objective is to achieve a balance between ensuring that personal health information remains secure, and achieving effective health-care delivery.1,2
Health Information Custodians and Their Agents
• Dentists and other health-care professionals are considered to be health information custodians (HIC).1 It is the
HIC’s responsibility to adhere to legislated requirements
regarding the collection, use and disclosure of personal
health information and to take reasonable steps to ensure that health information is securely stored.3
• An HIC is responsible for the personal health information in their custody or control.4 They should safeguard
personal health information from acts such as theft, loss
and unauthorized use, through physical safeguards (lockable filing cabinets), administrative safeguards (staff
training and access restrictions) and technical safeguards
(encrypting of electronic or digital records).2 For additional information on safeguards, see the Information
and Privacy Commissioner’s Fact Sheet on “Safeguarding
Personal Health Information” (2005).
• Agents are any persons who the HICs authorize to carry
out services or activities on their behalf.5 Agents can include employees of the custodian. For example, in the
dental profession, an agent of the dentist could be a dental assistant or dental hygienist.2 Agents have the same
obligations under PHIPA as the HIC and may only collect, use, disclose, retain or dispose of personal health
information in the course of their duties and within any
limits imposed by the custodian.4 It is the agents’
responsibility to notify the HIC if personal health information that they have handled is stolen, lost or accessed
by unauthorized persons.4
Identification of a Contact Person*
• Under PHIPA, a contact person must be identified. This
contact person is responsible for:
– Responding to access/correction requests of a record of
personal health information
– Responding to inquiries about the custodian’s information practices
– Receiving complaints regarding any alleged breaches
of PHIPA
– Ensuring overall compliance with PHIPA.5
* It is strongly recommended by the Royal College of
Dental Surgeons of Ontario (RCDSO) that a dentist be
the contact person within the dental practice.2
Developing a Written Statement
HICs are responsible for ensuring that a written statement
about information practices is available to the public.5 A
sample of this type of statement is available in Appendix B
of the RCDSO’s support tool, Compliance with Ontario’s Personal Health Information Protection Act.
continued page 26
April 2015 • Ontario Dentist
25
PHIPA
Consent Requirements
• HICs’ must obtain consent from individuals for the collection, use and disclosure of their personal health information, unless PHIPA states otherwise. Express
consent is explicit and direct (for example verbal or written), while implied consent is inferred from the individual’s actions/surrounding circumstances.5 When sharing
personal health information among HICs (such as hospitals, physicians and laboratories, to provide health care
to an individual), express consent is not required and the
HIC is entitled to reply an assumed implied consent.6 Alternatively, when disclosing personal health information
to a person or organization that is not a HIC (regardless
of the purpose of that disclosure), implied consent is not
appropriate and the HIC must obtain express consent
from the individual.7
• As the HIC, you may be asked by a coroner, the police or
a patient’s family member for access to that patient’s
health information for reasons such as identification or
criminal investigation. Provisions relevant to these types
of requests are outlined in section 40 of PHIPA.8 Additionally, the RCDSO explains: “According to a regulation
of the Dentistry Act, 1991, it is professional misconduct
for a dentist to give information about a patient to a person other than the patient or his/her authorized representative, except with the consent of the patient or
unless the dentist is required to do so by law. ‘By law’
means a court order or warrant from a coroner, judge or
justice of the peace.”8
• With very limited exceptions, PHIPA provides individuals with the right to access their own records of personal
health information, upon written request. HICs are encouraged, however, to provide access in response to verbal requests made by the individual and to communicate
with individuals about their own records.6
Recap of Actions
➜ As an HIC, it is your responsibility to take reasonable
steps to ensure that health information is securely
stored.
➜ HICs should safeguard personal health information
from acts such as theft, loss and unauthorized use
through physical, administrative and technical safeguards.
➜ Under PHIPA, a contact person must be identified. It is
strongly recommended by the RCDSO that a dentist
be the contact person within the dental practice.
➜ HICs are responsible for ensuring that a written statement is available to the public on information practices.
➜ HICs must obtain the consent of individuals for the
collection, use and disclosure of their personal health
information, unless PHIPA states otherwise.
➜ PHIPA provides individuals with the right to access
their personal health information.
PHIPA versus PIPEDA
➜ In addition to PHIPA, there is also federal privacy legislation, the Personal Information Protection and Electronic Documents Act (S.C. 2000, c.5), or PIPEDA, which
applies to organizations that collect, use and disclose
personal information in the course of commercial activities.
➜ In 2005, PHIPA was declared to be “substantially similar” to PIPEDA.9 As a result, HICs and their agents are
required to comply with PHIPA, but are exempt from
the application of PIPEDA to the extent that they collect, use and disclose personal health information in
Ontario. PIPEDA does continue to apply to the collection, use and disclosure of personal information by
HICs outside of Ontario.9,10
Looking for past issues
of Ontario Dentist?
Visit the member website and click on
“Ontario Dentist” in the top menu.
You can search the archives for
complete issues as far back as 2003.
visit www.oda.ca/member
26
Ontario Dentist • April 2015
PHIPA
References
1.
Information and Privacy Commissioner/Ontario. 2014. PHIPA. Available at: http://www.ipc.on.ca/english/PHIPA/
2.
Royal College of Dental Surgeons of Ontario. 2012. Compliance with Ontario’s Personal Health Information Protection Act. Available at:
http://www.rcdso.org/save.aspx?id=d6f5b224-2cb7-42b0-bada-52bc2df34bd8
3.
Information and Privacy Commissioner/Ontario. 2005. Fact Sheet Safeguarding Personal Health Information. Available at:
http://www.ipc.on.ca/images/Resources/fact-01-e.pdf
4.
Personal Health Information Act, 2004. S.O 2004, Chapter 3 Schedule A. Available at:
http://www.elaws.gov.on.ca/html/statutes/english/elaws_statutes_04p03_e.htm
5.
Information and Privacy Commissioner/Ontario. 2005. Frequently Asked Questions: Personal Health Information Protection Act.
Available at:
http://www.ipc.on.ca/images/Resources/hfaq-e.pdf
6.
Information and Privacy Commissioner/Ontario. September 2012. Dispelling the Myths Under the Personal Health Information
Protection Act. Available at:
https://www.ipc.on.ca/images/Resources/dispelling-myths-under-phipa.pdf
7.
Information and Privacy Commissioner/Ontario. 2009. Circle of Care: Sharing Personal Health Information for Health-Care purposes.
Available at:
https://www.ipc.on.ca/images/Resources/circle-care.pdf
8.
Royal College of Dental Surgeons of Ontario. 2005. Dispatch: Release of Patient Information of Deceased or Missing Patients. Available at:
http://www.rcdso.org/assets/documents/dispatch/dispatch_2005_v19_no4.pdf
9.
Ministry of Health and Long-Term Care. 2012. Personal Health Information and Protection Act, 2004 Declaration of PHIPA as substantially
similar to PIPEDA. Available at:
http://health.gov.on.ca/en/common/legislation/priv_legislation/phipa_pipeda_qa.aspx
10. Office of the Privacy Commissioner of Canada. 2013. Legal Information related to PIPEDA, Substantially Similar Provincial
Legislation. Available at:
https://www.priv.gc.ca/leg_c/legislation/ss_index_e.asp
Additional Information
Ontario Dental Association, Privacy:
http://www.oda.ca/member/privacy
DISCLAIMER:
Prepared by the Ontario Dental Association to help members
understand their obligations under Ontario’s Personal Health
Information Protection Act (PHIPA). This resource provides general information and does not constitute legal advice.
April 2015 • Ontario Dentist
27
upfront
Cover Article | ASM
Helen McDowell
ODA’s Annual Spring Meeting 2015
Metro Toronto Convention Centre, South Building, May 7-9
Practices Made Perfect:
Learn From the Best at
ODA’s Annual Spring Meeting
The Annual Spring Meeting (ASM), now in its 148th year, is
the signature event of the Ontario Dental Association. It
attracts more than 12,000 dental professionals annually
from Ontario, as well as the rest of Canada, the United
States and other countries. As our theme Connect–Learn–
Excel suggests, the ASM is a place to connect with peers,
colleagues, exhibitors and speakers to share best practices
and to network and socialize with fellow dental professionals. Our education program features more than 90 internationally renowned speakers covering a broad range of
clinical, practice management and personal development
topics. Improve your dental skills and your personal life by
taking the tools you’ve learned from the ASM programs
and implementing them into your practice and your life.
By attending the ASM, ODA member dentists have a terrific opportunity to receive 18 credits over the three days of
the convention, and cover RCDSO QA Categories, including Category 1 (Core), Category 2 and Category 3 courses
— all under one roof.
Register today!
Register online at www.oda.ca/asm-registration.
28
Ontario Dentist • April 2015
Keynote Speakers Provide Entertainment and
Inspiration
Ron James
Craig Kielburger
For our Opening Ceremonies on May 7th, we are delighted
to have Ron James — considered one of Canada’s top comedians. The star of his own CBC-TV program, The Ron
James Show, he cuts a wide swath through contemporary
culture with his razor-sharp wit and machine-gun delivery,
making him a standout among stand-up performers.
On May 8th, the keynote speaker is Craig Kielburger, a
social entrepreneur, New York Times best-selling author, and
a captivating speaker who has inspired millions to improve
their communities and the world through daily actions.
Along with his brother Marc, Craig is co-founder of Free
the Children, an international charity; Me to We, an innovative social enterprise; and We Day, a signature youth-
Cover Article | ASM
empowerment event. Through We Day, a series of inspirational stadium-sized events, Craig and Marc connect with
200,000 students from 5,000 schools every year. Speakers
and performers include Price Harry, Richard Branson and
Jennifer Hudson. Come and be inspired by this riveting
speaker and find out how you, too, can make a difference
in your community and the world.
ASM Speakers Represent the Best and Brightest
Minds in the Dental Industry
Headlining speakers, who are not only insightful but inspirational include:
• Dr. Howard Glazer
What’s Hot and What’s Getting Hotter
• Dr. Roger Levin
Set Your Practice on Fire: Increasing Production Through
Proven Business Systems
Getting to “Yes” – How to Dramatically Increase Case
Acceptance
• Dr. Jim Grisdale
The Myths and Realities of the Link Between Oral Disease
and Systemic Conditions, a New Paradigm in Dental
Practice. Where Do We Go From Here?
The entire dental team will benefit from the knowledge,
enthusiasm and energy of:
• Roger Levin
Set Your Practice on Fire: Increasing Production Through
Proven Business Systems
Getting to Yes. How to Dramatically Increase
Case Acceptance
• Nate Booth
If Disney Ran Your Practice:
Nine Things You Would Do Differently
The Diamond Touch: How to Enhance
All the Relationships in Your Life
• Amy Morgan
The Secrets to Attracting, Engaging and
Retaining Loyal, Committed Patients
Lead Your Team to a Winning Performance
• Tim Pendergrass
Dental Dynamics: An Ergonomic Approach
Dentistry – Talk About a Pain in the Neck!
Dentistry in Motion: Achieve Peak Performance
to Maximize Productivity
…and many more speakers.
Crown Lengthening Workshop
• Dr. Robert Lowe
Creative Treatment Planning and Problem Solving:
When It Doesn’t Go “By the Book”
• Dr. Gary Alex
Direct Posterior Composite Restorations and Adhesives:
What You Really Need to Know
Direct and Indirect Posterior Restorations:
A Unique, Hands-on Experience
…and these are just a few.
ASM15 provides dental hygienists with enhanced program
content from notable speakers such as:
• Judy Bendit
The Myths, Legends and Realities of OTC Dental Products
Positioning for Life-Ergonomic Advancements in Dentistry
Exhibits Floor – 75,000 Square Feet of Dental
Innovation
The ASM exhibits floor is always a focal point for ODA
members and their dental teams. It features 600 booths representing 300 exhibiting organizations, showcasing a broad
range of products and services for your dental practice and
your personal and financial life. Participate in demonstrations and test-drive the latest products and services available for the dental industry. Seek advice and guidance from
the experts, comparison shop, “kick the tires,” and take advantage of the valuable specials and discounts offered exclusively on the show floor. Your attendee bag will include
a coupon book of show specials; pick it up onsite at the
Metro Toronto Convention Centre on registration level 600.
The Heart and Soul of Ultrasonics
Jazz Up Your Routine With the Latest and Greatest in
Hygiene Products
• Cynthia Fong
Straightforward Ultrasonic Debridement
A Simplified Approach to Ultrasonic Instrumentation
Workshop
• Sherry Burns
The Perfect Fit
continued page 30
…and more.
April 2015 • Ontario Dentist
29
Cover Article | ASM
• The Relaxation Zone
is always a popular exhibit with attendees.
Take time out of your
busy schedule for a 10minute complimentary
neck-and-shoulder massage. It’s a worthwhile
and relaxing activity.
• Back by popular demand is the Health Check Zone
presented by the Cleveland Clinic. This interactive
area will include such features as blood sugar and cholesterol testing with a registered nurse. Take a lung function test and speak to a respirologist. Spend time with a
cardiologist and discuss your heart health, or complete a
grip test with an exercise physiologist. A health profile
would not be complete without a one-on-one discussion
with a registered dietitian regarding your diet and eating
habits. Attendees will be able to book their appointment
in advance of the show. Booking details will be communicated in future ASM newsletters.
• New for ASM15 – Two complimentary cocktail receptions: one on
Thursday, May 7 and one on Friday,
May 8, from 4:30 to 5:30 p.m.
Make plans to meet with peers
and colleagues on the exhibits
floor and enjoy food and
beverages. This is also a
great opportunity to spend
dedicated time with exhibitors after a busy day of
learning at the ASM.
• Also back by popular demand, after a two-year hiatus, is our Handwriting
Analysis feature. Your
handwriting is much more
than those marks you make
on paper. Stop by for an
analysis by Elaine Charel.
The secrets your writing will
uncover may surprise you!
Don’t Delay,
Register Today!
To register online and for
further ASM information
and program details, check
out the Preliminary Guide at
www.oda.ca/
asm-registration.
Join your colleagues who are already talking about the ASM.
Follow us on
Like us on
www.twitter.com/ODA_ASM
www.facebook.com/ODA.ASM
Helen McDowell is the ODA’s Manager of Events. She may be reached at [email protected].
30
Ontario Dentist • April 2015
upfront
Corporate Laws
Michael Carabash Michael James Moeller
BSc MA
BA LLB MBA
Nicholas Dunn
BSc MBA
Policy Brief:
Dental Professional Corporation Laws
in Canada
Historically, Canadian dentists delivered patient care
through various legal entities and business arrangements –
be it as sole proprietors or in partnership, association or
through cost-sharing with other dentists. Dentists could
not, however, practise through a corporation due to a general prohibition; this was meant to protect the public by
making it impossible for non-dentists to control dental
practices owned by corporations. This remained the status
quo in Canada for many years until dentists, seeking the
same tax benefits enjoyed by non-professionals who owned
and operated corporations, successfully lobbied the provincial governments to enact legislation to allow them to practise through a dentistry professional corporation1 (DPC).
What follows is a brief legal overview regarding who can
own a DPC in Canada.
Table 1.
Laws Governing Ownership of DPCs in Canada
Province
Who Can Own Voting Shares?
Who Can Own Non-Voting Shares?
British Columbia2 Dentists, their legal representative (e.g. executor/administer of
their estate or trustee in bankruptcy), or a holding company
whose voting shares are owned only by a dentist and whose nonvoting shares are owned by a Permitted Shareholder (see right).
A dentist or his or her spouse, child, parent, sibling or other relative, or someone who resides with the
dentist (each a Permitted Shareholder),4 or a holding company whose shares are entirely owned only by a
Permitted Shareholder or are held in trust by a Canadian resident on behalf of a Permitted Shareholder.
Alberta5
Dentists.
A dentist who also owns voting shares (a Voting Dentist) or his or her spouse, common-law partner or
child, or a trust, the beneficiaries of which are a Voting Dentist’s minor children.
Saskatchewan6
Dentists or their legal representative (e.g. executor/administer
of their estate or trustee in bankruptcy).
A Voting Dentist or his or her spouse, child or parent, a holding corporation whose shares are owned
by an aforementioned individual, or a trust, the beneficiaries of which are aforementioned individuals.
Manitoba7
Dentists or a Manitoba DPC.
A Voting Dentist or his or her spouse, common-law partner or child, or a holding
corporation whose shares are owned by an aforementioned individual.
Ontario8
Dentists.
A dentist or a Voting Dentist’s family member (i.e. spouse, child or parent) or one or more individuals,
as trustees, in trust for a Voting Dentist’s minor children.
Quebec9
At least one (1) dentist or a legal person, trust or other
enterprise, the voting shares of which are owned by a dentist.
At least one (1) dentist, a relative (either by direct or indirect line of descent) or spouse of a Voting
Dentist, or a legal person, trust or other enterprise whose voting shares are owned by an aforementioned
individual.
Nova Scotia10
A majority of the voting shares must be owned by a dentist.
There is no restriction on who can own non-voting shares.
New Brunswick11
A majority of the voting shares must be owned by one or
more dentists.
A dentist or a member of his or her extended family, a trust, all of the beneficiaries of which are a dentist
or a member of his or her extended family, or a holding company whose shares are owned by an
aforementioned person.
Newfoundland
and Labrador12
Dentists.
Natural persons (i.e. individual human beings), including a dentist providing dental services through the
DPC, or someone with an apparently familial or personal (i.e. non-commercial) relationship with a dentist
providing dental services through the DPC.13
Prince Edward
Island14
Dentists.
There is no restriction on who can own non-voting shares.
3
32
Ontario Dentist • April 2015
Corporate Laws
Kester Ng
BHSc
Carlos Quiñonez
DMD MSc PhD FRCD(C)
Who Can Legally Own a DPC?
The laws governing ownership of DPCs are presented in
Table 1. Importantly, they differ (sometimes widely)
throughout Canada.
Policy Rationale
These laws attempt to strike a balance between two objectives. The first objective, and that which has always been
paramount, is to protect the public. That is why, although
corporations generally limit the personal liability of shareholders, a DPC will not shield a dentist personally from
claims of professional negligence. Furthermore, since only
dentists can own voting shares and act as directors and officers, they alone control the DPC.15 This authority gives
dentists unfettered professional independence when it
comes to treating patients; it also allows them to avoid (actual or perceived) conflicts of interest which could have existed had they been accountable to, or in business with,
commercially driven non-dentist investors.
The second objective of the law is to allow dentists to
defer or avoid paying taxes by practising through a DPC. In
this regard, commonly used techniques include:
• leaving money in the DPC to be taxed at a lower rate, resulting in less tax being paid than if the dentist had
earned the income personally;
• income-splitting by paying discretionary dividends to
family members taxed in lower income-tax brackets;
• using the lifetime capital gains exemption on the sale of
shares of a DPC to avoid paying capital gains taxes (and
perhaps even multiplying the lifetime capital gains exemption by using family members);
• having a shareholder borrow and repay a loan from the
DPC without paying taxes;
• having a corporate will and a non-corporate will to save
on estate administration taxes; and
• having an employment agreement between the DPC and
the dentist that includes $10,000 tax-free death benefits.16
Are DPC Laws Becoming Less Relevant?
Notwithstanding these worthy objectives, the laws governing who can own shares in a DPC may be becoming less
relevant. The lure of above-average returns has led sophisticated and resourceful non-dentists to effectively own and
operate a dental practice without needing to own shares in
a DPC. In Ontario, for example, this first came to public
light in the 2012 case of Smilecorp Inc. v. Pesin.17 That case
involved a contractual dispute between Smilecorp Inc.
(non-dentist) and Dr. Daniel Pesin (dentist). Of note is how
they had structured their business relationship. Pursuant
to a management agreement, Smilecorp Inc. had licensed
Dr. Pesin to provide dental services to patients at its dental
practice. The history of that practice was such that, when
a dentist left, he or she left the patient charts behind for
the next incoming dentist. Although the management
agreement stipulated that Dr. Pesin was supposed to pay
fixed amounts to Smilecorp Inc. for renting premises and
using equipment, 55 percent of Dr. Pesin’s billings were
going to Smilecorp Inc. In essence, Smilecorp Inc. owned
and operated the dental practice.
All of this raises important questions, such as: What does
it mean to practise dentistry? Who can legally own the assets that make up a dental practice (and specifically dental
records)? How do non-dentists get paid if dentists are prohibited from fee-splitting with them? Stay tuned. These issues will be discussed in a future Ontario Dentist article.
Michael Carabash is an Ontario dental lawyer with his own
law firm DMC Law. His websites are www.DentistLawyers.ca,
www.DentistLegalForms.com, and www.DentalPlace.ca. He
can be reached at [email protected] or 647-6809530.
Michael James Moeller holds an MA in public administration
and is a DDS candidate at the Faculty of Dentistry, University
of Toronto.
Nicholas Dunn holds an MBA and is a DDS candidate at the
Faculty of Dentistry, University of Toronto.
Kester Ng is a DDS candidate at the Faculty of Dentistry,
University of Toronto, with interests in dental economics and
dental technology.
Dr. Carlos Quiñonez is an Associate Professor at the Faculty of
Dentistry, University of Toronto, and Editor of Ontario Dentist.
He may be reached at [email protected] or 416-979-4908.
Endnotes page 34
April 2015 • Ontario Dentist
33
Corporate Laws
Endnotes
1
And similarly named corporations.
2
Health Professions Act, R.S.B.C., 1996, c. 183, Part 4.
3
References to a “dentist” in this article shall mean an individual who is licensed to practise dentistry in that particular
province.
4
Note: these individuals must be related to, or reside with, a
dentist who is also a shareholder.
5
Health Professions Act, R.S.A., 2000, c. H-7, s. 109(1).
6
The Professional Corporations Act, c. P-27.1, s. 6(1).
7
The Dental Association Act, C.C.S.M., c. D30, s. 23.3(1).
8
Regulated Health Professions Act, 1991, S.O. 1991, c. 18 and
Certificates of Authorization, O. Reg. 39/02, s. 1(1)2.2.
9
Regulation respecting the practice of the dental profession within
a limited liability partnership or a joint-stock company, c. D-3,
r.9, Division II.
10
Dental Act, S.N.S. 1992, S. 40 and Professional Corporations
Regulations (Regulation 5), N.S. Reg. 186/93, s. 4(e).
11
An Act Respecting The New Brunswick Dental Society, Part IV, s.
21(2) and By-Law No. 22 of The New Brunswick Dental
Society.
12
Dental Act, 2008, S.N.L., c. D-6.1.
13
Newfoundland and Labrador Dental Board Advisory,
Professional Dental Corporations, point #11.
14
As per an email from Dr. Ray Wenn, Registrar of the Dental
Council of PEI, to Michael Carabash dated February 4, 2014.
15
More specifically: only dentists can vote in the board of
directors (who must also be dentists), who in turn appoint
the officers (who must also be dentists), who in turn hire or
engage others (e.g. employees, associates, suppliers, etc.) to
operate the dental practice on a day-to-day basis.
16
Note: this is a deduction to the DPC and a windfall to the
beneficiaries.
17
[2012] ONCA 853.
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the most important
decisions you will make
for your business. In order to
compete effectively in today’s challenging business
world, you need an accounting firm that is dedicated
to becoming an integral part of your organization.
Providing accounting, consulting, tax preparation services
for health care professionals throughout Ontario, DCY
Professional Corporation Chartered Accountants, works
on the tax issues and financial security of dentists,
allowing them to practice their profession without
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34
Ontario Dentist • April 2015
upfront
Making a Difference
Bonnie Dean
The Joy is in the Journey
Dr. Tom Harle’s lifelong mission of providing health care to the
vulnerable has taken him to North Korea, India and Peru.
It has also earned him the Order of Canada.
We ourselves feel that what we are doing is just a drop in the ocean. But
the ocean would be less because of that missing drop. – Mother Teresa
On December 24, 2014, the Right Honourable David Johnston, Governor General of Canada, announced 95 new appointments to the Order of Canada. One of those
appointees is Dr. Tom Harle, an Ottawa-area prosthodontist
and an ODA member of nearly 35 years. Dr. Harle was honoured for “his commitment to providing free dental services to homeless and vulnerable people in Ottawa and in
developing countries.”
That decree does little to convey the sheer amount of
charitable work Dr. Harle has done for the less fortunate. In
2001, he founded Health Teams International (Canada), a
non-denominational missionary organization that brings
multidisciplinary medical teams to developing countries to
provide free health-care services to the disadvantaged. His
next mission is to bring a 13-member team of physicians,
36
Ontario Dentist • April 2015
nurses, dentists, hygienists, opticians and a support worker
to provide health services to an estimated 1,300 patients in
the Dominican Republic.
Bringing his charity closer to home, in 2006 Dr. Harle
started the Homeless Dental Clinic in the Ottawa Mission,
to provide free accessible dental services to the homeless. In
2012, he launched the Portable Ottawa Dental Service, a
mobile clinic that provides no-cost dental care to young
pregnant women and mothers at various women’s support
centres across Ottawa. Dr. Harle does all this while running
a prosthodontic practice.
I interviewed Dr. Harle to find out more about this ODA
member who has made such a notable contribution to the
oral health of the vulnerable in his community and overseas.
Making a Difference
What does it mean for you to receive the Order of
Canada?
I hope that being recognized will again help to focus attention on the various disadvantaged and vulnerable
groups that continue to struggle with access to needed dental treatment. Our efforts are an imperfect offering for sure,
but until the various silos of care can be reconciled to include a more extensive and universal safety net, these types
of works will unfortunately continue to be required as stopgap measures. I’m hopeful, too, that the appointment may
also inspire others to develop projects and endeavours that
are capable of harnessing the natural compassion of dental
professionals to be a force for good in giving at-risk men,
women and children living at or below the poverty-line
hope and help for a better future.
What was your overall vision when you started the
Ottawa Mission Dental Clinic program?
Providing dental care to vulnerable patient groups requires
an extensive (and often expensive) back end of supporting
equipment, personnel, materials and supplies. Our vision
was to break down as many of those barriers as possible so
that volunteer clinicians could offer their skills without any
of the usual administrative, practice-management or financial distractions and burdens. We were also hoping that
the experience of working in these settings would put a face
to homelessness and help break down stereotypes volunteers might have had about individuals living on the street,
and to hopefully make them more able and compassionate dental health-care providers for any at-risk population
they choose to serve in the future.
Dr. Tom Harle treating a patient in Peru as part of a mission by Health
Teams International (HTI) Canada. HTI Canada, founded by Dr. Harle,
is a group of nondenominational health-care professionals who
provide medical, dental, vision, and hearing services in the form of
free clinics to the poor in Third World countries.
What challenges have you met along the way?
Volunteer recruitment and retention strategies consume a
considerable amount of energy. Though the Ottawa Mission Dental Clinic is the largest, volunteer-driven, faithbased, no-cost service of its kind in Canada, with more
than 100 chair-side helpers, it is the fruit of having invested
time and effort into a combination of: tapping into existing personal and professional relationships; sending out direct-mail appeals; cold calls; advertisements in local dental
bulletins; maintaining and updating our website
(www.homelessdentalclinic.com); and sending out bimonthly e-newsletters to volunteers and supporters.
Reducing and mitigating the effects of patients’ missed appointments is another hurdle we are working to overcome.
Fortunately, we have been able to decrease the net negative
impact of “no-shows” in our clinic to just 15 percent.
Have you noticed an increase in the need for these
services since you began your work at the Ottawa
Mission?
We have reached a steady state in terms of need for services.
Typically we have about 1,000 patient visits per year. To date,
over $1.93 million dollars’ worth of treatment has been provided at no cost to almost 8,000 of our “street friends.”
You’ve received some attention about your work at the
clinic and with the Order of Canada appointment; does
more public awareness increase donations and
volunteers to the clinic?
Yes, there has been a bump in volunteer enquiries and donations with the recent spotlight on what is being done by
the dental community in the national capital region to
Dr. Tom Harle treating patients at the
Ottawa Mission Homeless Dental Clinic.
continued page 38
April 2015 • Ontario Dentist
37
Making a Difference
help the homeless at the Ottawa Mission Dental Clinic and
for low- and no-income, at-risk young mothers and their
children with our no-cost Portable Ottawa Dental Service.
What have been the highlights of your work with the
clinic and with Health Teams International?
My highlights abroad would be working inside North Korea
back in 2006 with Health Teams International and experiencing firsthand the realities of a harsh totalitarian state. It
was both fascinating and heart-wrenching. This has been
countered-balanced by serving alongside the inspirational
role models at Mother Teresa’s Missionaries of Charity in a
leper colony in Calcutta in 2011. Closer to home would be
seeing the tears of joy and hearing the expressions of gratitude from many patients who had their missing teeth replaced and smiles restored.
(As a postscript to this question, Dr. Harle recounted an incident that happened to him at the Mission that remains a personal epiphany. See the sidebar below, “Images of Hope on the
Street”.)
Where do you see your charitable work heading in the
future?
We would like to build on our experiences through more
advocacy work, information transfer, networking and sharing of best practices with other service- and support centres involved in similar work across Canada and North
America. We are planning a workshop at the Annual Conference and Workforce Forum held by the Association of
Clinicians for the Underserved in Virginia this May and the
Global Missions Health Conference in Louisville, KY in November 2015 entitled, “A Dental Corporation with a Social
Mission.”
How would you encourage younger dentists to find the
time to volunteer and make the difference?
I would encourage younger dentists to not see volunteering
as an add-on activity but rather as an integral part of how
their lives and practices are defined and structured. In this
way, giving back becomes a fundamental core value that is
lived out through their practices.
In our case, we advance our corporate objectives through
our local and international non-profit charities by sharing
with them our private practice staffing functions, overhead
expenses, back office administration, funding support and
leadership elements. In this way, our social purpose remains central to our corporate objectives and operations.
The partnership yields benefits to both our dental corporation and to our hosted non-profit organizations. For the
former, this interconnection permits us to feature legitimate cause-related marketing, establish a unique corporate
branding within the dental community, enhance the image
of dentistry as a caring profession and provide a targeted
destination for our corporate philanthropy.
The non-profits gain ready access to a larger pool of potential professional dental volunteers, an expanding base
of prospective fundraising donors, and a widening platform
from which to inform others on the social determinants of
dental health and access to care issues that burden the disadvantaged and underserved.
To better understand how we are structured to do what
we do and why, check out our website: www.tomharle.com.
Images of Hope on the Street
Arriving for my afternoon volunteer session at The Ottawa Mission Dental Clinic with little time to spare, I jumped out of my
car and popped quarters into the parking meter. Calling out my “Hellos” to the homeless men milling about, I rushed into the
clinic. Several patients and two-and-a-half hours later, I suddenly realized that I had forgotten to keep feeding the meter!
Knowing that parking fines can get expensive in this part of town, I excused myself and hurried out onto the street expecting
to see a few tickets on my windshield. As I got closer, I heard a shout from a homeless man standing by the curb: “Don’t worry,
Doc! We fed the meter for you.”
I was humbled and touched to be on the receiving end from people on the street. That day, I was reminded that even those
with challenging lives have valuable lessons to teach us about the nature of God and His message of Grace that each of us
needs to hear. I am grateful for the experience of volunteering at the Ottawa Mission Dental Clinic that introduced me to the
presence of Jesus in some of the people we see as being most broken. It gave me hope that I, too, can reflect the spirit of Christ
in a fallen world. – Dr. Tom Harle
38
Ontario Dentist • April 2015
Making a Difference
Where do you find the time and energy to devote your
attention to these endeavours?
I have been blessed with both purpose and vision for my
life which has helped guide my energies and activities. The
support and encouragement of my family and loved ones
are an integral part in the successes I have known. Helping
to give direction to what I do has also been shaped by my
training, experiences and numerous mentors. I have been
fortunate to have assembled a strong team of like-minded
staff and committed volunteers who lighten the load immensely. But, above all my faith informs and guides me
most in what I do and why.
Bonnie Dean is the ODA’s Communications Specialist. She
may be reached at [email protected].
Resources for Starting a Charitable Program
Do you recognize a need in your community for oral
health services, but don’t know how to go about
starting a charitable program? Dr. Tom Harle
suggests the following resources to get you started.
National Association of Free and Charitable Clinics
1800 Diagonal Road, Suite 600, Alexandria, VA 22314
Web: www.nafcclinics.org
(Advocacy and service for free clinics)
National Free Clinic Foundation of America
1240 Third Street, S.W. Roanoke, VA 24016
Web: www.freeclinics.us
(Volunteer clinic resource centre)
Volunteers in Healthcare (VIH)
111 Brewster Street, Pawtucket, RI 02860
Web: www.volunteersinhealthcare.org
(Starting a dental project using the clinic model, and starting
a free health clinic)
Do you have children attending
dental school outside of Ontario?
Did you know the ODA offers a special membership rate
for dental students attending school outside of Ontario?
At only $69, this membership program provides out-of-province
students with full access to the ODA member website, free
attendance at the ASM, a subscription to Ontario Dentist, and more.
Spread the word — ensure that all students have access to the
Ontario Dental Association.
For those looking to return to practise in Ontario, this is an excellent
way to stay up-to-date on the latest trends within the profession.
Christian Community Health Fellowship
2595 Central Avenue, Memphis, Tennessee 38104
Web: www.cchf.org
Association of Clinicians for the Underserved
Web: www.clinicians.org
Health Intervention Services
Web: www.hisgr.org
Safety Net Dental Clinic Manual
Web: www.dentalclinicmanual.com/
For more information,
please email [email protected]
or visit www.oda.ca/member.
April 2015 • Ontario Dentist
39
clinical
Brief summaries of current topics
relevant to everyday dental practice.
Clinical and Policy Abstracts
Ingrid Sevels
DDS BA
Bacteremia in Two Implant Surgery
Approaches, and Choosing Between
Endodontic and Implant Therapy
Bacteremia and Implant Surgery
This study investigated the incidence, duration and type of
bacteria that lead to bacteremia related to conventional
and computer-assisted flapless implant surgery.
Clinicians placed 377 implants in 68 edentulous jaws.
One group of 34 patients received implants using the conventional technique and 34 received implants using the
flapless computer-assisted stereolithographic (SLA) technique. Preoperative and postoperative blood samples monitored bacteremia in both groups.
Results were as follows:
• One week postoperatively all patients healed without
complications.
• Fifteen minutes after the last implant placement, 62 percent of the conventional group and 12 percent of the
flapless group demonstrated bacteremia.
• Thirty minutes after placement, one patient in each
group had bacteria present.
• Staphylococcus eipdermidis and Streptococcus viridans
were the bacteria most often isolated.
Isolation of any bacteria does not necessarily indicate an
infection. The immune system usually destroys such invaders. The bacteremia in these surgical patients was transitional. However, significantly fewer bacteria were present
in the flapless surgery group than in the conventional surgery group. Patients at risk for developing bacteremia may
benefit from the use of computer-assisted SLA template
guided flapless implant surgery.
Clin Oral Invest 17:1985-1993, 2013
40
Ontario Dentist • April 2015
Endodontics or Implant Therapy?
This study examined factors that influenced the choice between root canal therapy and implant therapy. Nonsurgical
root canal therapy has produced the same success rates over
the past 50 years despite the development of new techniques for preparation and irrigation. Factors associated
with improved outcome include preoperative absence of periapical radiolucency, root filling with no voids, root filling
to within 2mm of the radiographic apex, and satisfactory
coronal restoration. Crowned root canal teeth have a six
times higher rate of survival than non-crowned teeth. Surgical root canal treatment has advanced into the use of microsurgical techniques where the success rate is 94 percent
as opposed to 59 percent for traditional surgical methods.
For implant therapy failure rates are due to, early lack of
osseointegration, premature loading, excessive surgical
trauma, fracture of implants or retainer, and prolonged
marginal infection (peri-implant mucositis or peri-implantitis) causing bone loss. Systemic reviews have reported implant survival rates as high as 97.2 percent and 95.2 percent
after five and 10 years. Contraindications to root canal
therapy are diabetes, immune disorder, and hypertension,
periodontal disease, quality of coronal tooth structure and
bleeding disorders. Contraindications for implant therapy
include, infectious disease, pregnancy, cancer chemotherapy and systemic bisphosphonate therapy. Single anterior
teeth implants for persons under 25 years of age are not
recommended. Root canal therapy and implants have comparable outcomes. Dentists must present various options
and risks to the patient so the best decision can be made.
Br Dent J 216:325-330 2014
Clinical and Policy Abstracts
Conservative Smile Improvement
This case study involved a man who wanted a natural appearance to his smile and to limit his treatment to conservative measures. The treatment involved dissimilar
restorative materials for maxillary incisors, which required
careful colour coding and communication with the laboratory. The patient presented with a worn and discoloured
restoration on tooth 12, an old PFM crown restoration on
tooth 11 where the metal margin was visible and colour
did not match adjacent teeth. The left central incisor, tooth
21 had discoloured fillings.
After reviewing various options with risks and advantages with the dentist, the patient decided to replace the
PFM crown on tooth 11, veneer tooth 21, and place a class
III composite restoration on the mesial of tooth 12. And
the teeth would be bleached.
Treatment involved the following:
• Study casts for assessment of proper tooth morphology.
• Removal of cast metal post and PFM on tooth 11.
• Replacement of metal post on tooth 11 with zirconia.
• Replacement of PFM with porcelain jacket crown.
• Porcelain veneer placement of tooth 21.
• Placement of composite resin bonding on tooth 12.
After removal of PFM crown and post, the clinician
bleached the tooth internally, prepared the shoulders with
adequate ferrule and applied a pink opaquer.
Stump shade, colour map drawing, photographs and custom shading enabled the ceramist to establish proper value
to materials, outline form, contours and surface anatomy.
With close collaboration the team was able to achieve successful restorations with a high level of patient satisfaction.
J Calif Dent Assoc 42: 319-324,2014
Dr. Ingrid Sevels is a member of the Ontario Dentist Editorial
Board and a 1971 graduate of the Faculty of Dentistry,
University of Toronto. She received a BA in English and
Professional and Creative Writing in 2002. Dr. Sevels currently maintains a part-time clinical practice in Oakville, Ont.
She may be reached at [email protected] or at
www.oakvilledentalcare.com.
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April 2015 • Ontario Dentist
41
clinical
David A. Walker
DDS MS FRCD(C) FADSA
Clinical Feature
Dental Management
of the Stroke Patient
Introduction
Dental practitioners are treating many more patients of advanced age due to improved lifestyle and advanced medical
care. In spite of this, cerebral vascular accidents or strokes
still occur. This article briefly reviews medical issues associated with stroke patients and outlines important considerations for dental care for the post stroke patients.
Pathophysiology of Stroke
There are an estimated 50,000 strokes in Canada each year.
That’s one stroke every 10 minutes. Each year, more than
14,000 Canadians die from stroke and it is the third leading cause of death in Canada.1
Approximately 85 percent of strokes are ischemic in nature due to blockages (clots) in major vessels and subsequent infarct in the brain. Approximately 15 percent of
strokes are hemorrhagic in nature and result from a weakened blood vessel (aneurysms and arteriovenous malformations (AVMs)) that ruptures and bleeds into the
surrounding brain.2
Transient Ischemic Attack (TIA), namely a mini-stroke or
“warning stroke,” has a sudden onset and is caused by a
clot. The only difference between a stroke and TIA is that,
with TIA, the blockage is transient. TIA symptoms occur
rapidly and usually last less than five minutes; the average
is about a minute and usually causes no permanent injury
to the brain. While the vast majority of strokes are not preceded by TIA, about a third of people who experience TIA
go on to have a stroke within a year.2
Recognition and Management of Stroke
Screening for stroke can be accomplished based on the
Cincinnati pre-hospital stroke assessment, which requires
assessment of only three factors; presence or absence of facial droop, arm drift/ weakness, and abnormal/slurred
speech (trouble saying “can’t teach an old dog new tricks”).
If any one of these three signs is abnormal the probability
of stroke is 72 percent. (See Table 1).2, 3, 4
42
Ontario Dentist • April 2015
Should the unlikely event occur that a patient is suspected of having a stroke or TIA in a dental office, prompt
recognition of the circumstances and appropriate activation of emergency medical services (911) is of paramount
importance. It is important to support the airway, breathing and circulation (ABCs), monitor vital signs, and supplement with oxygen if needed. Perform a pre-hospital
stroke assessment, establishing the time of symptom onset
(last normal circumstances), and early EMS transport to a
stroke centre is paramount. The earlier the patient reaches
the emergency department the sooner further medical
triage and diagnostic imaging can be undertaken including MRI or CT scan. The earlier the diagnosis and treatment
of stroke the better the outcome.3, 5
Stroke management is best accomplished by a medical
team, including a neurologist. For hemorrhagic stroke, neurosurgical consultation is necessary as is possible surgical
intervention. Medical treatment strategies for an ischemic
Table 1.
F.A.S.T. Sudden Signs and Symptoms of Stroke
Face Drooping
Arm Weakness
Speech Difficulty
Time to call 911
Additional signs of a stroke
may include:
– Sudden numbness or weakness of
the face, arm or leg, especially on
one side of the body.
– Sudden confusion, trouble
speaking or understanding.
– Sudden trouble seeing in one or
both eyes.
– Sudden trouble walking,
dizziness, lack of balance or coordination.
– Sudden severe headache with no
known cause.
Clinical Feature
stroke includes early fibrinolytic therapy (recombinant
Tissue Plasminogen Activator (rTPA)). Hyperglycemia is
associated with poor neurologic outcomes for most neurologic problems and dextrose containing IV solutions
should be avoided in suspected stroke patients. Prevention
of stroke by controlling risk factors is ultimately the best
management (See Table 2).3, 5
Timing of Dental Treatment of the Post-Stroke
Patient
When can dental care be undertaken after a patient sustains a stroke? The severity of the stroke, the patient’s level
of neurological functional deficit and medical stability will
determine when dental care can be undertaken. Classic
signs of neurologic deficit after brain stroke include, contra
lateral hemiparesis (paralysis/ motor weakness) of the body
which may limit ambulation and movement, cranial nerve
deficits on the affected side which can affect speech, swallowing and airway management. Neurologic cognitive abilities can be difficult to assess depending on the nature and
severity of the stroke and the residual neurologic deficit.
Neural tissue can take months and years to recover from
acute injury. In some cases the neurologic deficit may be
permanent.3, 5 Timing of dental treatment is based on medical clearance, the degree of neurologic deficit and the ability of the patient to safely tolerate the dental procedure.
Up to one- third of strokes recur one month post-stroke
and the risk remains elevated for six months to a year.6
Consultation with the neurologist or physician managing the patient’s care is of paramount importance prior to
proceeding with any dental intervention. Many post-stroke
patients are in chronic care facilities for an extended
period of time during rehabilitation. Pre-existing medical
co-morbidities such as heart disease and diabetes can affect
neurologic outcomes and dental treatment.
If the patient’s neurological status is precarious or unstable it would prudent to defer dental procedures until the
patient becomes stable. Decisions have to be made whether
the dental circumstances can result in significant infection,
Table 2.
Risk Factors for Stroke
➜
Age
➜
Diabetes
➜
Previous stroke or TIA
➜
Tobacco
➜
Hypertension
➜
Obesity
➜
Hyperlipidemia
➜
Physical inactivity
➜
Heart disease
➜
Alcohol excess
➜
Atrial Fibrillation
➜
Family History
bacteremia or further medical risks to the patient versus the
risk of providing the dental or surgical procedure. If the patient is neurologically unstable and there is an urgent dental infection this may be treated by oral antibiotics or best
be treated in a hospital environment where additional
medical care is readily available should problems arise.
Dental Management of the Stable Stroke Patient
Patients with good recovery post-stroke with mild neurologic deficits usually tolerate dental procedures with attention to the issues discussed next. In patients with moderate
to severe neurologic deficits, the major oral concerns after
stroke are the ability to swallow and maintain an airway.
The risk of aspiration is significant in some post stroke patients and can result in significant derangements of lung
function including aspiration pneumonitis and pneumonia.7,8 Careful assessment of oral function prior to introducing dental treatment is important, particularly if any
irrigation is to be utilized. Careful questioning is a must as
to ability to masticate food, swallow, issues of coughing or
aspiration, as noted either from family, health care provider
or those managing the patient in a chronic care facility, or
at home. Often, there are cognitive changes post stroke and
the patient may not be able to provide consent to procedures. In this case, a power of attorney or legal guardian,
who is often a family member, must be involved to give adequate consent for dental procedures.
In post-stroke patients with neuromuscular deficits, examination and obtaining adequate radiographs can be
challenging due to behavioral and neuromuscular issues.
Often the patient’s ability to maintain oral hygiene is significantly reduced resulting in plaque accumulation,
gingivitis, periodontitis, root caries and diminished overall oral care. Due to cranial nerve deficits patient may be
a mouth-breather prone to dry mouth, which is another
contributor to gingival and mucosal chronic desiccation,
and increased microflora, and caries.7, 8
Practical Patient Issues in Treatment
If the patient is neurologically stable with medical clearance it would be advisable to schedule shorter appointments in the early portion of the day. These patients tend
to tolerate dental treatment better when they are rested and
not fatigued. Also, should problems arise medical attention
is easier to obtain earlier in the day versus the last appointment of the day. Having wheelchair access in the dental office is important and allows patients who are
post-stroke to be transported to and from the dental office
and be positioned comfortably. Extra physical assistance
may be required in order to place the patient in a dental
chair, which requires training and experience to avoid a fall
or injury.
continued page 44
April 2015 • Ontario Dentist
43
Clinical Feature
Procedural Issues in Treatment
Judicious use of local anesthetic (avoid local anesthetic toxicity with neurologic consequences) with limited epinephrine (to avoid hypertension) is appropriate. Monitoring
pulse and blood pressure is appropriate and additional
monitors if sedation is required. Various afflictions of the
muscles of mastication may result in spasticity or incoordination of the jaw and tongue and this may prove problematic with unusual movements during various dental
procedures.7, 8 Extra precaution should be undertaken to
help manage these abnormal movements and prevent injury during dental procedures. Extra care should be taken
for any type of irrigation whether it is with an air rotor or
irrigation associated with a surgical procedure, as these
patients have impaired swallowing reflexes and can very
easily aspirate any solution in the mouth. Vigilant assistance in suction and or possible oropharyngeal screen may
aid or benefit in this area.
Sedation Issues in Treatment
Medical consultation and a great deal of caution are required when considering sedation for a neurologically impaired post stroke patient. As their neurologic function is
already limited, a hypoxic episode could result in further
worsening of the neurologic status. If sedation is required,
nitrous oxide and oxygen techniques may be a consideration for many post stroke patients. Intravenous sedation
techniques should be only undertaken with those with advanced training in sedation and anesthesia. The margin of
safety with deep sedation for neurologically impaired
patients is very narrow and requires expert management.
Patients on Stroke Prophylaxis
Many patients who are status post-stroke are on prophylaxis against further stroke, and may be on antiplatelet
drugs such as Aspirin (Bayer), clopidogrel (Plavix, BristolMeyers Squibb), or on occasions more advanced anticoagulants such as warfarin (Coumadin, Bristol-Meyers Squibb),
or dabigatran (Pradax, Boehringer Ingelheim) for chronic
atrial fibrillation. Approximately one in four (25–35 percent) of patients who have had a stroke will have another
stroke within their lifetime6. Medical consultation should
be obtained regarding the risk of stopping antiplatelet/
anticoagulant drugs for significant surgical procedures
where hemostasis may be an issue. In high-risk patients,
antiplatelet and anticoagulants may be maintained
(warfarin International Normalized Ratio INR, less than 3)
and local hemostatic measures can be used (atraumatic surgery, gelfoam (Upjohn Pharmacia), surgical (Ethicon), bone
wax, electrocautery, extra sutures, periodontal packing).
Referral to a dental specialist may be appropriate.
44
Ontario Dentist • April 2015
Summary
Recognition and management of a stroke event requires
early recognition, early activation of EMS and early hospital treatment to maximize acceptable or positive outcomes.
Dental management of the post-stroke patient must involve medical consultation to determine the neurologic
stability of the patient, as well as timing of treatment from
the time of stroke event and during rehabilitation. A multitude of factors must be taken into consideration and
adjustments will be needed for dental treatment. Well
recovered stroke patients may tolerate most dental procedures. In those patients with significant neurologic deficits,
judgment is required to determine whether the dental
procedure is worth the medical risks of worsening neurologic circumstances due to the stress of the procedure itself
and possible significant bleeding issues that may occur.
Appropriate consent must be obtained, and for a patient
with advanced neurologic disability, treatment by a dental
specialist, possibly in a hospital environment, may be most
appropriate.
Dr. David Walker maintains a private practice in Toronto, and
is a Staff Oral and Maxillofacial Surgeon at the Hospital for Sick
Children in Toronto. Dr Walker is a Fellow of the Royal College
of Dentists of Canada, a Diplomate of the American Boards of
Oral and Maxillofacial Surgery and National Dental Board of
Anesthesiology and is Chair of the Editorial Board of Ontario
Dentist. He may be reached at [email protected].
References
1.
Heart and Stroke Canada Statistics
www.heartandstroke.com/canada 2014
2.
American Stroke Association www.strokeassociation.org
2014
3.
Acute Ischemic Stroke, Advanced Cardiac Life Support,
Provider Manual, Field et al, P 187-191 American Heart
Association 2004
4.
Stroke Facts | cdc.gov www.cdc.gov/stroke/facts 2014
5.
Braunwald E., Fauci A., Kasper D. et al Harrison’s Principles
of Internal Medicine 15th ed. pp 2369-71 McGraw –Hill,
New York
6.
Preventing Recurrent Stroke: Targets for Managing Risk ...
National Stroke Association www.stroke.org, 2014
7.
Little J., Falace D., Miller C., Rhodus N. Eds Neurologic
Disorders, Stroke in Dental Management of the Medically
Compromised Patient, pp 469-474 7th Ed Mosby 2008
8.
Fatahzadeh M., Glick M. Stroke: epidemiology, classification, risk factors, complications, diagnosis, prevention, and
medical and dental management. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod. 2006 Aug; 102(2):180-91. 2006
May
business
Information on the business
management of a dental office.
Practice Management
Dr. Bernard Dolansky
Bill Henderson
Hoping to Own Your Own Practice?
Times have changed. Here’s what you need to
know to keep pace with investor dentists.
If you are a young dentist who wants to buy a practice, you
have advantages that “investor dentists” do not have. If
you understand and work with those advantages, you can
get the practice you really want. Our two previous articles
(in the October 2014 and March 2015 issues of Ontario Dentist)* focused on the factors driving the selling prices for
dental practices, and why we expect prices will likely continue at their recent highs. The role of investor dentists was
identified as a major contributing factor driving prices to
their current levels and one that will likely help keep them
at least as high as they currently are.
With so many owners buying a second or third practice
(or more), the traditional path to practice ownership —
graduate, associate for two to four years to build your skill
set and confidence, then buy a practice — increasingly
seems like a dream for many young dentists.
Advantages That Investor Dentists Have
Most young dentists already have a good, albeit exaggerated, perspective on the advantages that investor dentists
have. They are:
• Financial Resources. Not only are investor dentists
free from student debt, they usually have significant equity in their current practice(s), which they can use to secure financing for a new practice, or they have access to
other sources of capital.
• Clinical Experience and Access to Specialists.
Many investor dentists have developed one or more specialized skills such as implant placement or orthodontics, which they provide themselves or through travelling
specialists. These specialized skills allow them to do more
procedures in the practice, increasing cash flow versus
what a new young dentist might be able to do on his or
her own.
46
Ontario Dentist • April 2015
• Management Experience and Confidence. Investor
dentists have bought at least one practice, and sometimes many practices. They likely have the experience to
manage the process well. They also have practice management experience, which should allow them to run the
purchased practice more effectively, giving them more
cash flow to be able to justify a higher purchase price.
How to Mitigate the Investor’s Advantages
The investor dentist’s advantages may be intimidating. So,
how does a young dentist compete? First, work to mitigate
these advantages.
• Financial Resources. Despite what you may think,
you may not be at a disadvantage here. Even if you have
student debt, banks are usually still prepared to loan you
— at prime — most, if not all of, the money you will
need to buy a practice, with only the practice as security
— and that is equal to what an investor dentist will get
from a bank. In some instances investor dentists may actually face more bank scrutiny as their total debt moves
upward and attracts more examination from departments in the bank that worry about the high level of exposure.
• Clinical Experience and Access to Specialists. Use
the time before you buy a practice to build up your experience and skills with some more specialized procedures, so you do not have to refer out as much work once
you own. As long as you develop good skills, your extra
knowledge will benefit patients by providing more services to them from within the practice, while also improving your bottom line. You might also consider
partnering with a classmate or colleague who has a complementary (clinical or business) skill set to yours.
Practice Management
• Management Experience and Confidence. You cannot duplicate the experience and confidence that current
practice owners have. But you are able to hire people who
can. The most important advisor when you are looking to
buy a practice is an accountant — but only a very experienced dental accountant is going to be able to advise you
properly on the purchase of a practice. Find out from your
accountant exactly how many purchases or sales of practices he or she has been involved with in the past year. Simply having “a lot of clients who are dentists” is not good
enough. If your primary advisor has not been involved in
several purchases or sales in the past year, that accountant
does not have enough experience to effectively advise you
in such a varied and rapidly changing market.
Your Not-So-Secret Advantages
Investor dentists recognize you have advantages, too, including three important competitive ones they can never
duplicate:
• Productivity. You have the ability and the will to work
harder and care more than any associate an investor dentist will hire. Most owner dentists will work longer hours,
spend more time at the office, and make more sacrifices
than any associate working for an investor dentist. And,
unlike an investor dentist, you will likely end up taking
on administrative work instead of paying others to do it.
It costs investor dentists a lot more to do what you will
do, and the people they hire will likely not do it as well,
or care as much. You are, in effect, the owner in the store
and that can be unbeatable.
• Continuity. Once you own a practice, you are not
going anywhere. And, if you have good dental and people skills, you will build long-term, trusting relationships
with your patients. As their faith in you grows, they will
refer more and more new patients to you. That loyalty
adds huge value to your practice, and is something that
investor dentists cannot duplicate because they are dependent on associates, who can leave at any time to buy
their own practice or take another position elsewhere.
The “revolving door of associates” is the investor dentist’s primary risk — and you do not have it.
• Most Vendors Prefer to Sell to You. While some
vendors only care about selling to the highest bidder, irrespective of who that bidder is, you would be surprised
how many are prepared to sell at a bit of a discount to
someone who will be an owner-operator. Dentists who
are staying on for some time after the sale often feel it
will be a more enjoyable experience to work with a dentist who is now what they once were. And some simply
feel that it is the way dental practices should operate. So,
depending upon the vendor, you often have an advantage that the investor dentist cannot duplicate.
Conclusion
Although more and more practices are selling to investor
dentists, we still see a lot of younger dentists, who are currently associates, being successful at buying a practice. But
it is not as easy as it used to be. You need to be prepared to
take the risk, have the confidence to do so, and surround
yourself with experienced advisors to offset your own lack
of experience. But if you do that, you can leverage the advantages you have that investors cannot compete with —
your ability and motivation to work harder, the practice
benefits that come with being an owner operator, and the
fact that, all other things being equal, many vendors would
prefer to sell to someone like you.
One last piece of advice: Your perfect, dream practice is
not the one that you will buy, but rather the one that you
shape and mould from the practice you have purchased.
Dr. Bernard Dolansky is Past President of the ODA, the Ottawa
Dental Society, the CDA, and the Dentistry Canada Fund. He
is currently a partner at Tier Three Brokerage Ltd., and assists
dentists with transition planning, practice purchase and sale,
evaluations, associateships, retirement planning and partnership
arrangements. You may reach him at [email protected]
or 613-794-1977.
Bill Henderson is the President of Tier Three Brokerage Ltd.,
one of Ontario’s leading dental practice brokerages. A
recognised industry expert in dental practice valuations and
sales, Bill is a regular presenter for the ODA as well
as other industry organisations. He may be contacted at
[email protected], or 416-578-7061.
*Back issues of Ontario Dentist, including “What is a
Dental Practice Really Worth” in October 2014
Ontario Dentist and “Dental Practice Values” in March
2015 Ontario Dentist, by Dr. Bernard Dolansky and
Mr. Bill Henderson, are available online. Visit the ODA
website at www.youroralhealth.ca/member/ and click
on Ontario Dentist, in the top banner.
April 2015 • Ontario Dentist
47
At a Glance ODA
2015 CE Calendar
Continuing Education Program
The ODA CE program has expanded beyond the ASM to include practice management seminars, category 1 (core) and category 2 webinars –
both live and recorded – online tools and podcasts. Visit www.oda.ca/member/CE for further details. Questions: Contact [email protected]
Upcoming 2015 ODA Category 1 (Core) Webinars
LIVE ONLINE WEBINAR: Diagnosis and Management of
Orofacial Pain
September 18, 2015 | 1 CE
Presented by Dr. H. Tenenbaum
LIVE ONLINE WEBINAR: Diagnosis and Management of
Mucocutaneous Diseases of the Mouth
September 25 2015 | 1 CE
Presented by Dr. H. Tenenbaum
LIVE ONLINE WEBINAR: What’s in your toolbox? Part 1:
Making the most of your diagnostic tools in Oral Radiology,
Oral Medicine and Oral Pathology: Selecting a Diagnostic Aid.
October 23, 2015 | 1 CE
Presented by Dr. K. Perschbacher and Dr. S. Perschbacher
LIVE ONLINE WEBINAR: What’s in your toolbox? Part 2:
Making the most of your diagnostic tools in Oral Radiology, Oral
Medicine and Oral Pathology: Describing Lesions with Meaning
October 30, 2015 | 1 CE
Presented by Dr. K. Perschbacher and Dr. S. Perschbacher
Registration for webinars is not yet available, regularly check
http://www.oda.ca/member/CE for details.
AVAILABLE ON DEMAND
Recorded Webinars, Category 1 (Core)
The following Category 1 webinars have been recorded and archived and are available on demand
exclusively to ODA members. Earn 1 CE credit/webinar, from the convenience of your home or office.
RECORDED WEBINAR: Local Anesthesia – What’s New
Presented by Dr. David Isen
RECORDED WEBINAR: Dentistry for the Specially Challenged Patient
Presented by Dr. Fred Margolis
RECORDED WEBINAR: That Doesn’t Look Normal…Now What? A Case-Based Review of What
You Need to Know in Oral Medicine, Oral Pathology and Oral Radiology
Presented by Dr. K. Perschbacher and Dr. S. Perschbaker
RECORDED WEBINAR: Oral Care for the Elderly Patient – A Collaborative Approach
Presented by Dr. David Clark
RECORDED WEBINAR: Management of Non-Responsive Periodontitis
Presented by Dr. Howard Tenenbaum
Recorded Webinars, Category 2
RECORDED WEBINAR: Breakthrough Shaping and Cleaning of the Root Canal System
Presented by Dr. G. Glassman
RECORDED WEBINAR: Innovations in Endodontic Obturation and The Restoration of the
Endodontically Treated Tooth
Presented by Dr. G. Glassman
Podcasts MORE PODCASTS TO COME!
ODA Live Learning Center
Your post-ASM destination for learning, with access to many of the
conference sessions recorded during the ASM. Learn at your own pace
at your convenience, available 24/7.
[email protected] or call 289-695-5400
Practice Management Online Tools
•
•
•
•
Purchasing a Practice Checklist
Transitioning Out of Your Practice Checklist
Tax-Saving Strategies Online Resource
E-Assessment: Managing Overhead Costs
Ontario Dental Association 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. Concerns or complaints about a CE provider may be directed to the
provider or to ADA CERP at www.ada.org/cerp
AGD- Accepted Program Provider
FAGD/MAGD credit
05/01/2013 to 06/30/2015
Provider ID # 214575
New Dentist Podcast Series
• Don’t Tax Yourself: Four Key Strategies to
Save More Money, Andrea Chan
• Buying In – How to Purchase a Practice the
Right Way, Andrea Chan
• Trust Me! How to Find a Trusted Business
Advisor, Andrea Chan
• Practice Value Consideration When Looking
to Purchase a Practice, Dr. Bernie Dolansky
• Consent and Capacity,Dr. Cécile Bensimon
• Ethical Parameters Involving Bad
Outcomes, Dr. Richard Speers
• Leadership in the Dental Office,
Dr. Roger Howard
• Dental Practice Finances, Dr. Roger Howard
• Dental Practice Planning and Budgeting,
Dr. Roger Howard
• Developing the Dental Leader in You!
Peter Barry
Transitioning Dentist Podcast Series
• What Are Your Transition Options,
Dr. Bernie Dolansky
• It’s all in the Planning: Creating a
Transition Plan That Works,
Dr. Bernie Dolansky
• Selling Shares Versus Assets,
Dr. David Chong Yen
Female Dentist Podcast
•
•
•
•
48
Ontario Dentist • April 2015
• Communicating for Clarity and Progress,
Peter Barry
• Your Leadership is a Team Sport, Peter Barry
• Creating a System of Accountability at the
Front Desk, Dr. Rhonda Savage
• Take Back Your Blank Cheques, Mariana Bracic
• Why Good Facts Make Bad Law,
Mariana Bracic
• Why the Law is an Ass, Mariana Bracic
• Drop Debt: Strategies for New Dentists to
Climb Out of Debt (Part 1), Archie Pedden
• Drop Debt: Strategies for New Dentists to
Climb Out of Debt (Part 2), Archie Pedden
• Legal Matters When Purchasing a Dental
Practice – Part 1, David Rosenthal
• Legal Matters When Purchasing a Dental
Practice – Part 2, David Rosenthal
• Legal Matters When Purchasing a Dental
Practice – Part 3, David Rosenthal
• Purifying Your Professional Corporation, Dr. David
Chong Yen
• Multiplying Your Capital Gains Exemption, Dr. David
Chong Yen
• Planning for Financial Independence, Mark McNulty
• Determine Your Readiness to Sell, Mark McNulty
Leadership Differences Between Men and Women, Dr. Lynn Tomkins
Hiring Firing and Retaining Staff, Dr. Lynn Tomkins
Effective Strategies in Managing a Dental Team, Dr. Lynn Tomkins
Women Working with Women, Dr. Rhonda Savage
Members in the Media
The Natural Compassion of the Dental Community
_______
Bonnie Dean
On December 22, ODA Board member Dr. Charles Frank
was interviewed on AM 800 CKLW in Windsor about the
city’s decision to remove fluoride from the water supply,
and the impact it has had on the teeth of his patients (“Fluoride Removal From Windsor Water a Problem”). The removal of fluoride is hurting the people least able to look
after their health, that is, “the more vulnerable segments of
the population — children, the elderly, the infirm,” said
Dr. Frank. The interview aired throughout the next day
during the station’s news updates.
Windsor pediatric dentist Dr. Alexandria Meriano was
also interviewed about fluoridation by CBC News Windsor
in light of possible changes to the Safe Drinking Water Act
being proposed by some MPPs at Queen’s Park. If passed,
these changes could make fluoridation mandatory across
the province. (“Fluoride Could Return to Windsor’s Drinking Water,” December 23). In the article, Dr. Meriano states
that fluoridated water strengthens enamel and prevents
decay in developing teeth. “When we’re talking about levels like 0.7 parts per million, those are safe levels, safe to be
ingested and also beneficial to prevent the cavities.”
Dr. Gary Glassman was featured in a Global News segment about his Goodwill Oral Health Project, which works
to provide oral health care and education to people in
Kingston, Jamaica. (“Endodontist Brings Dental Care Education to Developing Countries,” January 5). For more than
15 years, Dr. Glassman and his longtime friend, Dr. Len
Boksman, have been setting up free oral health clinics in
Kingston, where they teach dental students about the latest technologies and procedures, sometimes in the toughest and most challenged communities.
Dr. Stephen Abrams was mentioned in a Wall Street Journal review of claims made about the light-based devices
that can detect tooth decay earlier than X-rays (“Tooth
Decay Detected by Laser and Light Systems,” WSJ.com, January 5). Dr. Abrams is President and founder of Torontobased Quantum Dental Technologies Inc. which makes one
such device, the Canary System, which uses heat and light
reflected from the tooth to warn of changes in the structure of the tooth. The article’s conclusion is that these devices can find signs of decay earlier than X-rays, but
suggests that dentists use other examination methods —
including X-rays and visual exam — before treating the
cavity.
50
Ontario Dentist • April 2015
In a January 24 article, the Toronto Sun declared that more
needs to be done to help welfare recipients access dental
care in Ontario. However the article also highlighted the
good works of two members: Dr. Christena Chruszez, a
retired dentist and 50-year member who volunteers in
Toronto at the Evangel Hall dental clinic and who has, according to the Sun, “donated her time one day a week for
three years,” and Dr. Tom Harle, director of the Ottawa
Mission Dental Program and a recent recipient of the Order
of Canada. (For a full profile of Dr. Harle, please see Making a Difference on page 36 in this issue of Ontario Dentist).)
In the article (“Dental Care for Welfare Recipients Needs
Work”), Dr. Harle “insisted he doesn’t want this to be all
about him — that he’s only working to ‘harness the natural
compassion of the dental community.’”
On February 4, ODA President Dr. Gerald Smith was
interviewed by Fairchild Television, a Cantonese cable television network, about illegal dentistry. Dr. Smith talked
about the risks unlicensed dentists pose to the public and
suggested that viewers talk to their dentists about treatment and payment plans. He stressed that dentists put the
needs of their patients first and are focused on giving “the
best care in an affordable way.”
Dr. Howard Lim was also interviewed, and explained
how foreign-trained dentists can get licensed in Canada.
According to Dr. Lim, those who practise illegally are those
whose dental knowledge is so far below our standard that
they cannot pass the National Dental Examining Board
exam or were not accepted into the Qualifying Program
and thus can cause tremendous harm — and even death —
to the public.
Due to Ontario consolidating its dental financial assistance
programs, the Wellington-Dufferin-Guelph Public Health’s
free fluoride varnish program for elementary children is
uncertain. Dr. Robert Hawkins, a consultant with
Wellington-Dufferin-Guelph Public Health, was interviewed: “What we’re trying to do is stop the cycle of kids
having dental disease,” he said. (“Future of fluoride varnish
program in Guelph area schools is uncertain,” Guelph
Mercury, January 24.)
ODA Past President Dr. Jack Cottrell represented the
dental corps at the grand opening ceremony of a new medical and dental clinic in San Jose Villaneuva, El Salvador.
(“Durham Medical Teams Help Open New Clinic in El
Members in the Media
Salvador,” Port Perry Star, January 19.) The clinic was built
by Speroway, an international, non-profit charitable organization, with the support of two Canadian foundations:
the C.H. Stiller Memorial Foundation and the Pottruff
Family Foundation. Both organizations have ties to team
members from Port Perry. Dr. Jerry Isenberg was also
part of the medical-dental team.
Dr. Timothy Agapas sponsored a “Manuary” event at a
Queen’s University pub to raise awareness for treatment for
head and neck cancer. (“Nog Hosts Shave-Off,” Queen’s
Journal, January 30.) A similar concept to Movember, Manuary is a charity that started five years ago and is in its second year at Kingston General Hospital. The event raised
money through a raffle and by asking the crowd for money
prior to its “shave-off,” which featured shaving the beards
of two volunteers.
According to the article, Dr. Agapas has a keen interest
in raising awareness about head and neck cancer, especially
oral cancer. “Last year, 93,000 men and women [in Canada]
were diagnosed with oral cancer and the unique aspect of
oral cancer is such that — if treated early — it can be cured
completely,” he is quoted as saying. Dr. Agapas also encouraged readers to see a dentist at least once a year to identify the early warning signs of oral cancer. “He or she is
uniquely trained to look at diseases of the mouth to identify subtle changes that might not be noticed until they become very aggressive.”
Discover Magazine published a blog post about the water
fluoridation debate and how social media is used to successfully spread misinformation (“The Science Battle on Social Media,” Blogs.DiscoverMagazine.com, January 22). It
includes a quote from (and a link to) a 2010 National Post article which featured Past President Dr. Harry Höediono:
“My greatest fear here is [that,] with the advent of the Internet, and with the advent of social media, that a small
vocal minority of individuals who are perhaps misinformed
are able to reach a great number of people.” ■
For these and past media clips, visit the Members in the Media section of the ODA member website.
In Memoriam
The ODA regrets to announce the passing of:
Dr. Donald Lewis Bigelow, on January 19,
2015, at the age of 81. Dr. Bigelow was a graduate of the University of Toronto’s Faculty of
Dentistry’s class of 1956, and he registered with
the RCDSO the same year. He practised as a
general practitioner in Ottawa, was a member
of the Ottawa Dental Society, and after retiring,
relocated to British Columbia. Dr. Bigelow was
a 50-Year Member of the ODA and is survived
by his children, Sue and Steve.
April 2015 • Ontario Dentist
51
Are you
missing out?
Do we have your current email
on file at the ODA? You could be
missing out on important ODA alerts and
updates, including event announcements
from your local component society.
Log in to the odA website at www.oda.ca/member
and view your profile to see what email we have on file.
or simply send an email to [email protected] and tell
us what email address you would like us to use.
In addition, please add [email protected] and
[email protected] to your safe senders’ list
to help ensure that our alerts aren’t going to spam.
52
Ontario Dentist • April 2015
DENTAL Calendar
May 1-2, 2015
at the Marriott Toronto Eaton Centre Hotel
GENERAL COUNCIL MEETING
The Annual General Council meeting will be held on the following date:
MARK YOUR CALENDARS FOR MAY 2015!
The ODA’s 148th Annual Spring Meeting
May 7-9, 2015
Metro Toronto Convention Centre, South Building
For exhibiting opportunities and/or class reunion listings,
please contact Vicky Hatzopoulos:
Tel: 416-355-2266
Toll-free: 1-866-739-8099, ext. 2266
Email: [email protected]
CHAIR A SESSION AT THE
2015 ODA ANNUAL SPRING MEETING!
The Ontario Dental Association is seeking
volunteers to chair sessions for the upcoming
148th Annual Spring Meeting (ASM) being held May 7 – 9, 2015
at the Metro Toronto Convention Centre, South Building
Volunteers who are selected as Session Chairs will
not be required to pay the registration fee of $125.
Although we try and pair you with your session of choice,
we cannot guarantee that we will be able to accommodate your
selection as sessions are allotted on a first-come, first-served basis.
If you are interested in chairing a session, please email
Teresa Tomassetti, Conference and Events Co-ordinator at
[email protected].
TRIBUTE
2015 CLASS REUNIONS BEING HELD DURING——————————————
THE ASM 2015
8T5
University of Toronto, Class of 8T5
– 30th Reunion
Thursday May 7, 2015. 6:00 pm – 9:00 pm
Ripley’s Aquarium (adjacent to the Metro Toronto Convention Centre)
Please forward your current email and mailing address to Laura Tam.
Contact: Laura Tam
E-mail: [email protected]
6TO
University of Toronto, Class of 6T0
– 55th Reunion
Friday, May 8, 2015.
Appetizer Reception 5:00 pm, Dinner 6:30 pm, Live Music 5-8 pm
University of Toronto’s Faculty Club
41 Willcocks Street, Toronto M5S 1C7
Contact: Donald Chong
Email: [email protected]
7T0
University of Toronto, Class of 7T0
– 45th Reunion
Friday May 8, 2015.
Cocktail Hour 6:00 pm – 7:00 pm, Dinner 7:00 pm
Keating Channel Pub & Grill
2 Villiers Street, Toronto
Causal “Village House Pub Nite”
Contact: Rob Bond
Email: [email protected]
7T5
University of Toronto, Class of 7T5
– 40th Reunion
Friday, May 8, 2015. 6:00 pm
Arcadian Court
401 Bay Street (Simpson Tower), 8th Floor, Loft Room #5, Toronto
For tickets, please contact:
Contact: Donna Brode
Email: [email protected]
Contact: Jack Cottrell
Email: [email protected]
8TO
Dr.
David Goodbrand
University of Toronto, Class of 8T0
March
15,
th 1946 — November 11, 2014
Reunion
– 35
Friday May 8, 2015.
Champagne Reception 6:00 pm
Dinner 7:30 pm, Dancing 9:00 pm - 1:00 am
Shangri-La Hotel (University at Dundas), Toronto
Business Attire/Black Tie Optional
Contact: Cary Letkemann
Email: [email protected]
Tel: 905-648-8848
9T0
University of Toronto, Class of 1990
– 25th Anniversary Celebration
Friday May 8, 2015.
Cocktails and Dinner – 6:00 pm
Ritz Carlton Hotel, Toronto
SAVE THE DATE
Contact: Dr. Les Diamond
Email: [email protected]
9T5
University of Toronto, Class of 9T5
– 20th Reunion
Friday May 8, 2015.
Cocktails and Dinner - 6:30 pm
Ki Modern Japanese and Bar
181 Bay St., Bay Wellington Tower, Toronto
Contact: Dr. Dino DiSanto
Email: [email protected]
Tel: 519-217 0755
Contact: Dr. Michelle Crystal
Email: [email protected]
Tel: 416-209-7808
Schulich Dentistry Alumni Reception
Friday, May 9, 2015. 6:00 pm – 8:00 pm
Ontario Room, InterContinental Toronto Centre, Toronto
www.westernconnect.ca/dentistry_reception
April 2015 • Ontario Dentist
53
Web Talk
NEW: Health Advisories Section
_______
Wini Lo
The Health Advisories section of the member website has a new look, with
an updated and easier way to get important updates and advisories.
First, to access the Health Advisories section, find the
new button on the right side of every webpage on the
member website.
The Health Advisories main webpage features alerts
about critical events that could affect the delivery of oral
health care and access to dentistry, with the date of the
latest notification. Sections that have been very recently
updated will be denoted with “NEW!” in red font. A recent archive is also available. Click to access the compiled content and updates issued by Health Canada, the
Ministry of Health and Long-Term Care, and Public
Health Ontario for each specific disease/virus.
The Health Advisories section can also be accessed
directly via www.oda.ca/member/healthadvisories
(login/password is required).
Send your questions and suggestions regarding the member website to [email protected].
We look forward to answering any questions you may have in the next issue of OD.
54
Ontario Dentist • April 2015
members
Community News
Heritage Plaque for Noted Public Health Dentist,
Dr. John Gennings Curtis Adams
_______
Catherine Morana
In October 2014, the ODA was gratified to learn about the interest in a
commemorative plaque erected in
memory of noted public health dentist Dr. John Adams (1839–1922).
The effort was spearheaded by longtime ODA-member Dr. David Kenny
who organized sponsorships from numerous organizations, including the
ODA, to help finance the heritage
plaque. Plans to commemorate the
life and work of Dr. John Adams are
long overdue.
Described by Dr.
Kenny as a “zealous visionary for dental care of children”, Dr. Adams would
open the first free dental hospital in
North America in 1872.
The hospital, called Christ’s Mission
Dental Hospital would relocate in
1896 to the corner of Elm and Bay
Street (then called Teraulay Street).
This building still stands today and
will be the site of the plaque unveiling on April 29, 2015.
Years before the public health
movement galvanized an awareness
of the role prevention plays in public
health, Dr. Kenny notes that Dr.
Adams was already lobbying for free
government-run dental infirmaries
for the poor. His story is outlined in
Dr. Kenny’s recent article “John G.C.
Adams: Father of Dental Public
Health in Canada”, published in the
Journal of the History of Dentistry. Dr.
Adams, along with his wife Sarah,
would make extensive visits to poorhouses and orphanages, reporting on
the high rates of rampant decay and
abscesses which he observed were accepted as a norm by parents and children alike. His vocal calls for dental
school inspections went unheard for
decades, until 1911, when the City of
Toronto finally appointed a dental inspector for schools. At the time, there
would be calls to erect a monument to
Dr. Adams, but nothing would come
of it.
Time has only improved our perspective on the scope of Dr. Adam’s
achievements. Dr. Kenny cites Dr.
Adams’ pioneering concept of prevention as the foundation for Public
Health Dentistry and Pediatrics Dentistry in Canada today. And as reported by historian and former
Ontario Dentist Editor Dr. Jim Shosenberg in an Ontario Dentist Editorial in
1997, it would take until 1983 for
dental school inspections to be legislated province-wide in Ontario.
Heritage Toronto will be sending
out a press release regarding details of
the plaque unveiling six weeks before
the event which will occur at the corner of Elm and Bay on the afternoon
of April 29, 2015. An ODA Advantage
with more information will also be
delivered to ODA members closer to
the event. ■
Dominion Dental Journal, Volume XXXIV,
Official Organ of all Dental Associations in
Canada, Editor, A. E. Webster, Toronto.
The ODA extends a warm welcome to the following new members:
Dr. Atousa Ahadnejad, Richmond Hill
Dr. Anmar Mahdi Al-Glao, Orléans
Dr. Mohammed H Maki Al-Hashimi, Mississauga
Dr. Ali Amer Al-Rubayee, Richmond Hill
Dr. Sidika Nilay Cakmakci, Toronto
Dr. Afson Ferdosmakan, Thornhill
Dr. Emeka Kingsley Iloabachie, North York
Dr. Saman Jomehri, Etobicoke
Dr. Neda Kadivar, North York
Dr. Alireza Kamali, Thornhill
Dr. Sahib Maallah, London
Dr. Nerdin Umaid Medhat, Oakville
Dr. Navneet Kaur Minhas, Markham
Dr. Salma Nikooie, Etobicoke
Dr. Sharareh Pourmand, Markham
Dr. Yasir Salah Shakir, Mississauga
Dr. Jonas Jose Barbosa Stefani, Toronto
Dr. Sarika Mohan Vakade, Brampton
Dr. Emma Ling Bo Wong, Etobicoke
April 2015 • Ontario Dentist
55
members
Fee Guides and Dental Plans
Suggested Fee Guide Coding
and Dental Claims/Plans Questions
In order to provide support to our members regarding the
correct use of the ODA Suggested Fee Guide and dental benefit plans, Practice Advisory Staff at the ODA publish a regular column in Ontario Dentist. As always, we welcome your
phone calls and emails and ask that you continue to contact us with any questions you may have.
Q. I am a GP performing a procedure that does not
have a procedure code in the GP Guide, but there
is a code for this service in one of the ODA specialty guides. Can I use that code even though it is
not in the GP Guide and if so how will third-party
payers process my patient’s claim?
A. There is nothing that prevents a dentist from using any
code assuming that the code is being used to accurately describe the treatment prescribed or performed. When a dentist uses the procedure code, he/she is certifying that it is an
accurate statement of the services performed.
Third-party payers are required to process claims based
upon the provisions of the specific contract under which
benefits are being claimed. If the plan reimburses on the
basis of the GP Guide and the procedure code is not in the
GP Guide reimbursement would be declined. If the service
performed is a benefit of the plan but does not appear in
the GP Fee Guide, reimbursement would likely be declined
because it is not in the Fee Guide that is applicable to the
dentist’s classification of certificate.
Prior to performing the treatment it would be prudent to
advise the patient that the treatment may be an out-ofpocket expense. The best way for a patient to determine if
the service will be covered by the plan is to submit an estimate for a pre-determination of benefits.
Q. I am removing the root of a retainer tooth that
is part of a fixed bridge and keeping the crown
portion attached to the pontic. Do I use the code
for a root amputation or would this be considered
an extraction?
A. If a root removal is being performed on a tooth that is a
retainer for a fixed bridge, coding would depend on the
number of roots present for that tooth. If all roots
(whether the only root of a single rooted tooth or all roots
of multi rooted tooth) are being removed, the correct code
to use is 71201; Odontectomy, (extraction), Erupted Tooth, Surgical Approach, Requiring Surgical Flap and/or Sectioning of
Tooth. The Standard Dental Claim Form should be completed with additional explanatory information included
in the For Dentists Use Only Box.
In situations where the root removal involves some —
but not all — roots of the tooth, the procedure would be
coded as a root amputation. (i.e.: one or two roots are removed from a three-rooted tooth)
For additional information about completing claim
forms, please refer to the Dental Benefit Plan Handbook for
Dental Offices available on the ODA member website or,
contact the Practice Advisory Services Department.
Q. My patient presented with an infection. Antibiotics and pain medication were prescribed.
Two weeks later the patient returned and the root
canal therapy was started; a second appointment
was required to complete the treatment. Is it appropriate to use the pulpectomy code at the first
appointment?
A. A pulpectomy is described as an emergency procedure
and/or as a pre-emptive phase to the preparation of the
root canal system for obturation.
56
Ontario Dentist • April 2015
Fee Guides and Dental Plans
If a pulpectomy is performed as an emergency procedure
it would be appropriate to use the code that describes the
number of canals treated during that procedure. When the
patient returns to have the root canal completed, the code
that is used is based on the number of canals treated. Other
factors may also determine the root canal procedure code
to use as well; i.e.: exceptional anatomy, difficult access,
calcified canals etc. The fee for the root canal should be
reduced by 50 percent of the fee charged for the emergency
pulpectomy. It would be inappropriate to submit a code
for a pulpectomy if it is being performed as a pre-emptive
phase to RCT, and is not being performed as a separate
emergency procedure.
If the intent of treatment is to perform a root canal procedure and the pulpectomy is not performed due to an
emergency, the pulpectomy procedure is included as part of
the root canal treatment and would not be coded separately. The only code to use would be that which describes
the number of canals obturated.
The distinction to be considered is whether or not the
pulpectomy was performed as an emergency treatment. ■
DENTAL
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the unthinkable happen
Whether you’re a practice owner, an associate, new grad or retired,
odA extended Health Care insurance should be part of your overall
financial protection plan. designed for odA dentists, it provides the
best combination of features, cost and value on the market.
ConTACT us TodAy
For More InForMATIon:
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if you’re in the Toronto area,
or call toll free at
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or email us at [email protected].
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Please contact us at:
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This advertisement does not constitute an offering of securities and cannot be relied
upon for making your investment decision.Eligible investors should read the
Subscription Agreement prior to investing. Shares are not covered by government
deposit insurer, nor are they guranteed. Higgins Investment Group is an Exempt
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April 2015 • Ontario Dentist
57
Join the Remote Areas Program!
ODA’s RAP delivers care in 26 communities spread throughout northwestern Ontario,
from the Sioux Lookout area all the way up to the Hudson Bay coast.
Oral health needs of First Nations people are extensive and the program
provides an opportunity to help improve their oral health status.
Program pays a daily rate and covers costs such as travel, food and accommodation.
Gain a fabulous working and learning experience.
For more information, or to request an application form, please email
Janice Sawyer, Remote Areas Program at [email protected].
New!
ODA introduces the
Health Advisories Website
dentists and other health-care providers need to be alerted to critical events in the environment that could
affect the delivery of oral-health care and access to dentistry. Access important notices and advisories issued
by Health Canada, the Ministry of Health and Long-Term Care, and Public Health ontario by visiting our new
Health Advisories website at www.oda.ca/member/healthadvisories.
Visit often to make sure you have the latest information and guidance on infectious diseases
(e.g. Ebola Virus Disease) and other adverse events.
www.oda.ca/member/healthadvisories
58
Ontario Dentist • April 2015
Classified Order Form
This form is for classified advertising in Ontario Dentist only.
NOTE: NO RECEIPTS/INVOICES WILL BE ISSUED.
COSTS: (noT InCLudIng HsT)
• odA Member (basic word count): . . . . $35/50 words
• non-member (basic word count): . . . . . . $75/25 words
• Additional words: . . . . . . . . . . . . . . . . . $8/10 words
• shading . . . . . . . . . . . . . . . . . . . . . . . . $20
• Marketplace: . . . . . . . . . . . . . . . . . . . . $250
Please keep a copy of this form as your receipt/invoice.
To submit a classified ad or for any questions, please contact:
Catherine Solmes
416-922-3900 ext. 3305 | Toll Free 1-800-387-1393 ext. 3305
email: [email protected] | Fax 416-922-9005
Rates as of October 2014. For current rates or for more information regarding ads with graphics, please contact Catherine Solmes.
HEADING:
❑
❑
❑
❑
❑
❑
❑
❑
AD CONTENT:
Accounting/Financial services
Associates
equipment (sales. leasing, rental, repair)
Hiring opportunities
Locum dentists
Miscellaneous
office space
Practice opportunities
NUMBER OF ISSUES:
Please indicate how
many issues you would
like your ad to run in:
Ad Title: __________________________________________________________________
Ad Text: __________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Phone: ____________________________________________________________________
Fax: ______________________________________________________________________
SAMPLE CLASSIFIED AD:
email: ____________________________________________________________________
Dental Associate needed (up to
three days per week) in the GTA.
Excellent opportunity with chance
for full-time position.
Phone: 416-123-4567
Fax: 416-123-2468
Email: [email protected]
Website: __________________________________________________________________
Please write your ad CLEARLY. (Attach separate sheet if necessary.)
THE ODA IS NOT RESPONSIBLE FOR SPELLING MISTAKES.
CLASSIFIED ADS MAY BE EDITED & CONDENSED TO CONFORM TO ONTARIO DENTIST STYLE.
CONTACT INFORMATION: (For AdMInIsTrATIve PurPoses onLy)
❑ odA Member
❑ non-member
odA Member Id #: ________________________ name: _______________________________________________________
(IF APPLICAbLe)
Phone number: ____________________________
COST:
email: ______________________________________________________
PAYMENT:
basic word count:
______________________
❑ cheque enclosed or sent
Additional words:
______________________
Sub-total:
$
______________________
name on Card: __________________________________________________________
HsT (13%):
TOTAL:
HsT # r108090945
$
______________________
$
______________________
❑ vIsA
❑ MasterCard
Credit Card #: __________________________________________________________
expiry date: ________________________________________
signature: ______________________________________________________________
Privacy: Please note that the information collected on this form will be used by the ODA for the purpose of publication by Ontario Dentist and for no other purpose. The ODA is committed to
protecting the privacy of your personal information. For more information about the ODA’s management of personal information, or the ODA’s use and disclosure practices, please contact the
Chief Privacy Officer or any Member Service Representative or Julia Kuipers at the ODA by calling 1-800-387-1393 or 416-922-3900, by email at [email protected] or by fax to 416-922-9005.
CA003-May 2013
members
Advertising must comply with the advertising standards of the ODA.
The publication of an advertisement should not be construed as an
endorsement of, nor an approval by, the ODA.
Classifieds
ASSOCIATES AVAILABLE
Periodontist available for part-time
position in the GTA.
Email: [email protected]
ASSOCIATES WANTED
Associate Dentist Wanted – GTA
Altima Dental is one of Canada’s largest
and fastest-growing dental groups.
Excellent
opportunities
available
throughout the GTA. For more information, visit our website or email us.
Website: www.altima.ca
Email: [email protected]
Phone: 416-785-1828
General Dentist – Bermuda
We are looking for a full-time general
dentist for our high-end, modern,
multi-specialty practice in beautiful
Bermuda. Applicant should have two
years
of
experience
or
more.
Phone: 441-296-0011
Fax: 441-263-3019
Email: [email protected]
Website: www.parlavilledental.com
Associate Dentist
A modern, established, multi-location
dental network in Muskoka is looking
for a full-time or part-time associate.
The existing, long-term associate is
relocating out of the area. If interested,
please email your resumé.
Email: [email protected]
Associate Position
Midland, Ont. (1.5 hours north of
Toronto)
We are looking for a highly motivated
and friendly associate to join our team
of energetic staff. The right candidate
will be offered one day per week in our
practice. Please submit your resumé to
the attention of Shelly.
Phone: 705-526-5241
Fax: 705-526-2433
Email: [email protected]
Website: dentistrybythebay.ca
60
Ontario Dentist • April 2015
Extremely busy office in
Woodstock, Ont., is looking for a
full-time or part-time associate.
Must be comfortable with all
aspects of general dentistry.
Phone: 905-581-8828
Email: [email protected]
Associate Needed
Ottawa, Ont.
Part-time associate needed to replace
relocating dentist. Two to three days
per week. Excellent opportunity with
chance for a full-time position.
Email: [email protected]
Associate Endodontist
Kitchener, Ont.
Deer Ridge Periodontics is presently
looking to incorporate an endodontist
into the practice as either a full- or parttime associate, with the potential for
partnership in the near future. We are
seeking out a highly motivated individual to join our team and help build the
practice. The office is located in a new
building with state-of-the-art facilities
and paperless charting. If you are interested in learning more about this
opportunity, please email Leslie.
Email: [email protected]
Dental Associate
Sudbury, Ont.
Busy new Sudbury dental office is looking for a new associate to fill the shoes
of a retiring associate, who has a full
patient load.
Phone: 705-566-0975
Fax: 705-566-0297
Email: [email protected]
Associate Opportunity
Kingston, Ont.
Full-time dentist with experience and
excellent chairside manner required for
large group practice in well-established
office. Candidate would need to be proficient in general dentistry, with special
interests in oral surgery and endodontics. Please email your C.V. or questions.
Email: [email protected]
Associate Dentist Opportunity
Cobourg, Ont.
Busy family dental practice is looking
for a friendly dentist with excellent
communication skills to join our team.
Fax: 905-372-9439
Email: [email protected]
Associate Wanted
Cambridge, Ont.
Do you love endo, surgery and
implants? Huge opportunity for the
right kind of caring dentist in a large
group practice. One hour from Toronto.
Email: [email protected]
Red Deer, Alta.
Full-time associate wanted immediately
for a nine-op, established, growing dental practice. Bright, spacious office with
new, up-to-date technology and equipment. Excellent opportunity with the
possibility of partnership.
Phone: 403-347-8880
Fax: 403-347-2133
Email: [email protected]
Website: www.associatesdental.com
Associate Required
Orillia, Ont.
We are looking for an associate to join
our well-established family practice.
Seeking an individual who has excellent clinical and communication skills
and who is eager to join our friendly
and efficient team.
Email: [email protected]
Associate Dentist Wanted –
Cambridge, Ont.
At Altima Dental, associates can focus
on dentistry instead of the needs of a
small business. That’s the beauty of a
group practice; the freedom and flexibility to practice with colleagues who
share your professional interests, and
the ability to focus on your patients.
Excellent opportunity available at our
Cambridge location. Visit our website
or email us.
Website: www.altima.ca
Email: [email protected]
Phone: 416-785-1828
Classifieds
Endodontic Associate Needed
Part-time position available for
endodontic practice in Brampton.
Please email your C.V.
Email: [email protected]
Phone: 905-454-9900
West of Toronto
Part-time Associate
Busy, fully booked from day one.
Opportunity to practise dentistry in a
well-established office that thrives on a
value-based and positive working environment.
Modern
technologies,
exposure to implants, cosmetics, Cerec
technology and the ability to refer to the
many specialists within the practice.
Email: [email protected]
Full-time Associate Needed
Leamington, Ont.
We are seeking a full-time associate for
our general practice. No evenings or
weekends. New grads are welcome.
Excellent earning potential.
Phone: 519-322-2866
Fax: 519-322-1769
Email:
[email protected]
Cornwall and/or Hawkesbury
(Alfred), Ont.
Very busy family dental practices are
looking for a part-time/full-time associate.
Email: [email protected]
Phone: 450-370-7131 (Carole)
Thunder Bay, Ont.
Earn at 45%
Full-time associate position. Outstanding
opportunity for a dynamic, skilled individual to join our two large,
well-established practices – one in
Thunder Bay and one two hours east of
the city. Please submit your C.V. by
email.
Email: [email protected]
Ottawa, Ont.
Full-time associate needed. Outstanding
opportunity for a dynamic, dedicated
team-oriented individual to join a large,
well-established, busy group practice in
Kanata, (Ottawa) Ont. Please submit
your C.V.
Email: [email protected]
Maternity Leave/Part-time
Associate Position
Experienced dentist needed full-time to
fill maternity leave starting April 2015.
Excellent opportunity to remain as an
associate part-time. No weekends.
Office situated outside the GTA in the
Hanover area. Fully booked from day
one. Amazing staff, good patient base
and a whole range of dentistry.
Email: [email protected]
Associate Position
Position available immediately for a
busy, well-established practice 20 minutes north of Barrie. Newly renovated
office with two hygienists and an oral
surgeon. General anesthesia available.
New grads welcome! Reply by email.
Email: [email protected]
Fax: 705-325-1090
Want to place a Classified Ad?
Contact: Catherine Solmes
416-922-3900 ext. 3305 or
[email protected].
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April 2015 • Ontario Dentist
61
Classifieds
Associate Required
Peterborough, Ont.
Truly unique opportunity to join a
well-established office with a caring
team in a busy family practice. Positive
attitude, sense of humour and flexibility in scheduling and location will lead
to a successful and rewarding position
for the right individual. Please contact
us by email.
Email: [email protected]
Endodontist and a General
Dentist Needed
A busy, modern London, Ont., office is
looking for an endodontist one
day/week. Will consider a foreigntrained dentist with a strong
background in endodontics. Also looking for a general dentist (part- or
full-time) with minimum two years’
experience. All patients are fee-for-service. Please email resumé.
Email: [email protected]
Toronto Associate Wanted
Established general practice. Part-time,
may lead to full-time. Two to three days
per week, including some weekends.
Please send resumé.
Phone: 416-498-8988
Fax: 416-498-8987
Email: [email protected]
62
Ontario Dentist • April 2015
OMFS Associateship
A well-established group practice in
southwestern Ontario is seeking an oral
and maxillofacial surgeon for associateship leading to partnership.
Our full-scope modern surgicentre and
hospital-based practice provides dentoalveolar, implant, orthognathic,
reconstructive, TMJ and trauma surgery
under deep sedation or general anesthesia. We enjoy partnering with a very
supportive dental, medical and specialist referral network in our community.
We are seeking a personable, energetic,
ambitious, caring individual who wishes to be part of a large dynamic team
and further its reputation. The candidate must be eligible for licensure to
practise as a specialist in oral and maxillofacial surgery in Ontario, including
Fellowship in the Royal College of
Dentists of Canada (RCDC).
Our diverse university community has
many amenities and provides an excellent environment in which to raise a
family. Its high-living standards and
easy access to recreational and cultural
activities make it a top community in
southwestern Ontario. Forward C.V.
and inquiries by email.
Email: [email protected]
Hay River, N.W.T.
The team at the Hay River Dental Clinic
is looking for a full-time associate who
wants to be busy with a full caseload
and a wide variety of dental treatments
from day one. We are a paperless,
seven-chair facility with three excellent
dental hygienists and friendly, longterm staff. Join us in a beautiful small
town on the south shore of Great Slave
Lake where the summer nights can be
spent on the beach and the winter has
amazing outdoor activities. Please
email your resumé.
Phone: 867-874-6664
Fax: 867-874-3233
Email: [email protected]
Website: www.hayriverdentalclinic.com
Part-time associate required.
Pickering, Ont. Evenings and
Saturdays. Please email your
resumé.
Email: [email protected]
Price Increase Notice!
The prices of the Ontario Dentist
classified ads will be increasing as of
June 1, 2015. For more information, or
if you would like to place a classified ad
in an upcoming issue of OD, please
contact Catherine Solmes at
416-922-3900 ext. 3305 or
[email protected].
Classifieds
Ontario Dentist Marketplace
Northern Ontario Associate
Opportunity
Very busy, state-of-the-art practice four
to five hours north of the GTA needs a
full-time associate dentist immediately.
Expand your professional skills while
taking home $250,000, or much more,
in the first year. You will be busy from
day one. Our friendly and professional
team will support your success. The
ideal candidate will be hard-working
and dedicated to high quality dentistry
as well as excellent patient care and
communication. Please send resumé.
Email: [email protected]
Associate Needed
Barrie/Orillia, Ont.
Our busy practice is seeking a full-time
associate dentist for offices in Barrie
and Orillia. This full-time position with
condensed hours is suited to an experienced dentist (five+ years) who enjoys a
busy environment and is a team player.
Candidate should be competent in general dentistry, RCT, implants and Cerec
restorations. We provide an environment of learning and professional
growth and seek a candidate who
would like to grow with our practice.
Email: [email protected]
Kingston, Ont.
Looking for an associate to work three
days a week in a very busy, well-established, modern practice with good
patient flow. Please submit your resumé
by email.
Email: [email protected]
Earn 50%!
Full-time associate needed in Bracebridge
(two hours north of Toronto).
Email: [email protected]
ACCOUNTING/
FINANCIAL SERVICES
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for Professionals and Businesses
We are driven by a single objective: to
put more money in your pockets
instead of in the pockets of the government. Contact us for FREE Special Tax
Savings Report. Leach Bradbury.
Phone: 1-800-368-0747
Fax: 613-738-8788
Email: [email protected]
Website: www.lb-ca.ca and
www.managefinancialwealth.ca
April 2015 • Ontario Dentist
63
Classifieds
EDUCATION/TRAINING
LOCUM DENTISTS AVAILABLE
Hands-On Extraction Classes
Learn advanced extraction techniques,
elevating flaps, suturing, third molar
removal, sinus perforation closure,
using instruments properly, and how to
handle large abscesses and bleeding.
Classes combine lecture and participation on live patients.
Website: www.weteachextractions.com
Phone: 843-488-4357
Email: [email protected]
Hygiene Locum
Keep your hygiene department active
while you are away! I am a retired dentist willing to administer local
anesthetics and do recall exams,
hygiene checks, prescriptions and
Xrays as needed. Willing to travel within Ontario.
Dr. Michael Veer
Phone: 226-934-4014
Email: [email protected]
HIRING OPPORTUNITIES
Full-Time Certified Dental
Assistant
Come work with us in beautiful
Bermuda. We are looking for a full-time
CDA to join our modern, multi-specialty practice. Applicant should have two
years of experience.
Phone: 441-296-0011
Fax: 441-293-3019
Email: [email protected]
Website: www.parlavilledental.com
Locum dentist with more than 30
years in general practice, including
15 years locum experience, will provide
locum services during illness, maternity
leave or other leaves of absence, vacation, etc. Will accept part-time or
full-time locum position. Willing to
travel anywhere in Ontario. Available
immediately.
Please contact Dr. Peter Rockman.
Phone: 905-889-7474
Phone (cell): 416-564-8303
Email: [email protected]
Hygiene Locum
Want to keep your office open and
hygiene department working while you
are away? I am an experienced and
retired GP who can cover your office,
do recall exams, hygiene checks, review
X-rays, prescriptions and emergency
treatment
for
your
patients.
Experienced (35+ years) in all areas of
general practice including ortho,
implants and dentures. Willing to travel in Ontario.
Dr. Ken Lawlor
Phone: 416-568-4476
Email: [email protected]
Experienced Family Dentist
Skilled in all aspects of general dentistry, available for locums in the GTA
and anywhere else in Ontario. Great
demeanour with adults, children and
staff. Excellent references available.
Dr. Stanley F. Okorofsky
Phone: 416-515-0664
Cell: 647-227-3344
Email: [email protected]
Want to place a Classified Ad in Ontario Dentist?
Contact: Catherine Solmes
at 416-922-3900 ext. 3305 or [email protected].
64
Ontario Dentist • April 2015
Classifieds
LOCUM DENTISTS WANTED
Locum Dentist Needed
Ottawa, Ont.
Locum dentist needed to cover a maternity leave (May 2015 to October 2015)
in a busy, modern practice in east
Ottawa. Full-time hours Monday
through Thursday and one evening.
Please email your resumé if you are
interested.
Email: [email protected]
OFFICE SPACE AVAILABLE
New Medical/Professional Centre
Stouffville, Ont.
Now leasing two-storey, 28,620 sq. ft.
building located in the sought-after, 45acre Beacon Hill Business Park,
surrounded by residential communities. Distinctively designed, ample
parking, professionally landscaped
grounds.
Contact: Stephanie Settembri
Phone: 905-761-7707 ext. 312
Email: [email protected]
Website: gottardoconstruction.
gottardogroup.com/175mostar.php
Dental Office For Lease
Scarborough, Ont.
401/Kennedy Road area. Excellent
exposure. Fully built clinic. Tenant
inducements. Brokers welcome.
Phone: 905-853-5550
Cell: 416-388-5248
Email: [email protected]
SERVICES
Should I associate, start from
scratch or purchase? Should I
grow my practice or sell? Where
are the best locations to start from
scratch? Should I buy this practice?
How successful can I be? How competitive is this region? How many people in
this area need a dentist and have insurance, and how much do they spend on
restorative and cosmetic dentistry?
What marketing ideas are most effective for my community? Should I offer
assignment? Dental Strategy is the
Canadian leader in dental market
demographics and dental business
intelligence, and can help with
answers. For more information visit
www.dentalstrategy.ca .
UPHOLSTERY SERVICES
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Phone: 905-737-0100
Phone (cell): 416-909-2752
Email: [email protected]
www.norasupholstery.com
Price Increase Notice!
The prices of the Ontario Dentist
classified ads will be increasing as of
June 1, 2015. For more information, or
if you would like to place a classified ad
in an upcoming issue of OD, please
contact Catherine Solmes at
416-922-3900 ext. 3305 or
[email protected].
VAILABLE
AV
A
IN THE GTTA
Learn how to set up our
ambulatory services
in your practice.
Schedule a consultation on how
to offer Full-Arch Implant Dentistry.
Our experienced team of clinicians will work with you to
implement this revenue generating service in your practice.
Grow your practice and reduce your stress. Improve
your patients’ quality of life with our customized implant
solutions and make them advocates, promoters, and loyal
followers of your practice.
www.ConexisDental.com
416 901 6894
[email protected]
Complete Implant Solutions
that Add Value and Distinction
April 2015 • Ontario Dentist
65
Classifieds
ADVERTISER INDEX
Beyes Dental Canada Inc......................................6
Meridian Sales & Appraisals.........................62, 64
Canadian Dental Protective Association................19
MKR Cabinets ...................................................31
Cappellacci Daroza LLP......................................39
MNP ................................................................35
Carestream .......................................................45
Ontario Dental Association .....................15, 39, 58
CDSPI..............................................................IBC
Procter & Gamble ....................................IFC, OBC
CIBC Wood Gundy Securities .............................41
ROI Corporation................................................61
Conexis Dental Services .....................................65
Sea Course Cruises............................................57
DCY Professional Corp .......................................34
Selog Medical Contractors/think Giraffe Design....51
Dental Office Consulting.....................................52
Shaw Group of Dental Laboratories .....................21
Dental Practice Safety.........................................15
Specialty Dental Products....................................27
Glaxosmithkline .................................................13
TD Bank Financial ................................................3
Higgins Investment Group ...................................57
The Wyndham Group at Raymond James Ltd ..........9
J. J. Quality Instruments.......................................41
Tier Three Brokerage Limited ...............................49
MBC Legal........................................................23
Vintage Brands..................................................17
McNulty Group .................................................11
Voco Canada......................................................5
Mendlowitz Janelle Simone LLP............................10
saving you money on the products and services you need.
Learn more about the offers and how to take advantage of them at
www.oda.ca/member/signature-select
Visit today – visit often!
66
Ontario Dentist • April 2015
CASE STUDY 8
30% increase
in patient
referrals.
ISSUE
We
or oral hygiene.
ing spent on po
be
as
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an
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motivate our pa
SOLUTION
practice to
a priority in our
as
e
en
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focus on or
thodontic treat
We decided to
s throughout or
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an
to give
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ensure healthy
ow” initial bond
“w
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e to talk about
iv
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both.
the patients so
lped us deliver
alth Solutions he
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orth
O
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nt
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RESULTS
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e Crest + Oral-B
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Within six month
oral hygiene ch
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we had a 45
faction and a 30
tis
sa
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pa
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led to increase
the first year.
referrals within
Dr. Tracey Hendler
DDS, MSD, Cert. Ortho, FRCD(C)
Dr. Tracey Hendler has not been
compensated to appear in this ad.
Find out how our programs are paying off for other practices at
www.HealthyPracticeNow.ca
We mean business.
business