Archive for the ‘Dental Training’ Category

New innovations in nanomedicine may be coming your way soon!

Tuesday, August 4th, 2015

By Dr. Kim Wright

It’s amazing the innovations happening in labs around the world right now.  Very soon we may have treatments for many more cancers that use nanoscale vehicles to deliver chemotherapy directly to tumors sparing healthy cells.  These drug vehicles are 200 times smaller than a red blood cell.  According to Scientific American’s April 2015 issue, labs at the University of Tokyo are researching several versions of nanodrug vehicles and are completing the final stages of clinical trials.  It is expected that research development speed will escalate in the next 5 years showing rapid growth in this exciting field.

The particles used to make up these drugs are cloaked in a variety of ways.  One way is they are made to “blend” in with the normal body tissues and therefore do not alert the immune system as a foreign body thus triggering their degradation.  They can also be constructed in a way to resist degradation by the bodies’ enzymes creating a longer life, thus allowing more of the chemotherapeutic agent to attack the cancer.  Some nanodrugs are created to be soft and flexibile allowing them to enter cancer tumors more readily and then degrade in the more acidic environment of the tumor where the chemotherapy drugs are released and are needed exclusively.  Other scientists are attaching cancer protein antibodies to these nanovehicles so that they are attracted to the cancer cells making delivery of their drugs very target specific.

This growing field of medicine could soon be the dominant way in which we fight cancer.  If you or someone you know is fighting cancer do your research and find out all the ways your cancer is being treated, your cancer may be the one where this therapy is being used!

 

wright

Global Diagnosis In Dentistry

Monday, January 12th, 2015

By William Robbins, DDS, MA

With the increased emphasis on interdisciplinary treatment in recent years, the deficiencies associated with traditional methods of diagnosis and treatment planning have become more evident and problematic. Many years ago when I was in dental school, I learned to gather a lot of information about the patient and then sit down and make a treatment plan. Dentistry was much simpler in those days. In a complex patient, the treatment plan was primarily dictated by information provided by study casts which were mounted on a sophisticated articulator in centric relation. At that time in history, the primary tools available for treating the complex restorative patient were functional crown lengthening surgery and increasing the vertical dimension of occlusion. The treatment plan was simply based on restorative space, anterior tooth coupling and resistance and retention form of the final preparations, with no focus on placing the teeth in the correct position in the face.  Practitioners did not have access to advanced periodontal, orthodontic, orthognathic surgery and plastic surgery tools that are currently available. With the advent and common usage of these new treatment modalities, the historical method of diagnosis and treatment planning is no longer adequately serving our profession. This style of treatment planning is only effective when prescribing single tooth dentistry. When the case becomes more complex, the old style of treatment planning doesn’t tell the dentist where the teeth and supporting structures fit into the patient’s face.

Global Diagnosis is a treatment planning strategy that guides the dentist through the process of diagnosing and sequencing an interdisciplinary treatment plan. It provides a systematic approach to diagnosis and treatment planning the complex interdisciplinary dental patient with a common language that may be used by the orthodontist, periodontist, and oral and maxillofacial surgeon, as well as the restorative dentist.

 

Robbins photoDr.  Robbins maintains a full-time private practice and is Clinical Professor in the Department of Comprehensive Dentistry at the University of Texas Health Science Center at San Antonio Dental School.  He graduated from the University of Tennessee Dental School in 1973.  He completed a rotating internship at the Veterans Administration Hospital in Leavenworth, Kansas and a 2-year General Practice Residency at the V.A. Hospital in San Diego, California.  Dr. Robbins has published over 80 articles, abstracts, and chapters on a wide range of dental subjects. He coauthored a textbook, Fundamentals of Operative Dentistry – A Contemporary Approach.  He is a diplomat of the Federal Services Board of General Dentistry and the American Board of General Dentistry. He is past president of the American Board of General Dentistry, the Academy of Operative Dentistry, the Southwest Academy of Restorative Dentistry, and is currently president of the American Academy of Restorative Dentistry.

Dentistry goes High Tech

Tuesday, September 2nd, 2014

By Paul Feuerstein, DMD

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The world of computers and smart devices has not escaped dentistry. Simple things like looking for cavities with a little bent sharp wire (the explorer), waiting for xrays to be developed or having a mouthful of putty impressions are things of the past. Also the way that small cavities are treated is changing with new chemistry including calcium that can replenish some lost enamel.

A new buzz word in dentistry is CAMBRA- Caries Management By Risk Assessment.  It basically states that the dentist does not need to pick up the dental handpiece very time there is a suspicious lesion.  There are many cases where you will get a “stick” and there is not conclusive radiographic evidence that there are caries in that tooth. If this is a patient with a high level of oral hygiene and few cavities, vs one who sits with a can of Mountain Dew at their desk all day, the proposed treatment is different.  New devices allow the dentist to measure the small cavities with lasers, heat and fluorescence and give a measurable marker to determine if this is something to fill, perhaps watch digitally or treat with new fluorides and recalcification products.

Traditional film xrays have been replaced by digital sensors which are faster, more accurate, use less radiation and don’t need environmentally unfriendly developing chemicals.  New advances have also brought us 3D xrays (Conebeam CT)  to enhance diagnosis and treatment planning. The dentist can now essentially do a CT scan on a tooth, group of teeth or the jaws. This is quite helpful in diagnosing patient problems as well as helping guide the development of a child’s teeth. Formerly difficult to diagnose problems such as root fractures, precise location of pathology or anatomical structures is now extremely accurate. Planning for tooth replacement with implants has also become more predictable, and in the realm of the general practitioners.

Impressions and laboratory techniques have also gone digital with  3D optical scanning devices replacing the puttys in the mouth, and CAD/CAM allows dental  labs to create extremely accurate restorations out of new more aesthetic materials that are more durable than ever before. This has also spilled right into the dental office with new milling units and software that allow the dentist to create the final restoration in just one visit so that patient does not have to come back for the “final” one.

In recent months, there has been an amazing convergence of these technologies.  Digital intraoral scans are being merged with Conebeam 3D scans. Many companies have standardized their devices allowing integration of components from different companies (like stereo components) creating more choices for the dentists to be able to personalize some of these systems. This comes with a large amount of new studying of the industry, which to some is troubling but to most is exciting.

It is a great time to be a dentist and a better one to be a patient.

FeuersteinDr. Feuerstein received his undergraduate training at SUNY Stony Brook studying chemistry, engineering, computer science and music. A 1972 graduate of UNJMD he maintains a general practice in Massachusetts. He installed one of the first in-office computers in 1978, teaching and consulting since then. As Technology Editor of Dental Economics, author of several technology articles, he lectures at many national and local dental meetings. His work with CAD/CAM helped develop the LAVA COS intraoral scanning system.  He was named Clinician of the Year at the 2010 Yankee Dental Congress and is an Adjunct Assistant Professor in General Dentistry at Tufts University.

Creating the Ultimate Doctor-Hygiene Patient Exam

Monday, August 4th, 2014

By Karen Davis, RDH, BSDH

Dental Clinic. The dentist explaining to his young patient how t

It seems as though the examination portion of the hygiene visit often lends itself to increased stress, but it doesn’t have to. Creating an ultimate experience is realistic and implementation of these tips will assist.

1.  Let go of the idea that a prophylaxis appointment is all the patient needs!

In practice after practice, dental hygienists are desperately attempting to educate the patient, change behavior, scale all calculus, remove all stain and plaque, perform and record periodontal evaluations, update radiographs, apply fluoride, identify restorative concerns, and so on, all in ONE appointment that lasts 45 – 60 minutes, IF you get started on time!  Sound impossible?  It is. The American Dental Association has done a great job defining the difference between a prophylaxis, scaling and root planing, and periodontal maintenance.  Early in the appointment, if data collected reveals a periodontal diagnosis, it is easy to determine which patients need additional therapy and which patients need preventive care.

2.  Don’t wait until the last five minutes of the appointment to have the exam

In most busy dental practices, waiting until the hygienist is completely finished before notifying the doctor for an exam is almost a guarantee of running behind. Notifying the doctor once data has been collected and potential treatment discussed enables the dentist to look for a natural break in a procedure, interrupt the hygienist during his or her treatment, perform the examination, then both return to completion of their treatments.

3. Use visuals to replace wordy descriptions

Patients will understand and retain information significantly better if audible and visual learning takes place together.  Instead of us doing all of the talking (while working on the patient with sharp instruments) clinicians should intentionally let  “pictures speak 1000 words”.  Intraoral pictures, before and after pictures, educational pamphlets, radiographic pictures, periodontal records, Caesy ®, etc., all assist in the co-discovery process necessary for patients to really understand and desire what we recommend.

4.  Sit the patient upright for communication

Contrary to how most of us commonly communicate with patients in the treatment room, if we are willing to pause, sit the patient upright to describe conditions and discuss possible treatment, we find we actually have to say less, because the patient’s ability to hear and retain information is significantly greater with the use of good eye contact and body positioning.  Sitting the patient upright also allows the patient to feel more comfortable and ask questions and enables us to become the listener. Most patients will not proceed with treatment until their questions have been answered!

5.  Ask for a commitment to treatment

In the treatment room, where value is created and treatment recommendations are made, prior to handing the patient off to an administrator, clinicians need to ask a closing question such as, “So, James are you ready to get started?” Even when the product we are “selling” is optimal oral health, asking the patient to make a commitment fosters ownership of their health.

 

Davis

Ms. Davis is founder of Cutting Edge Concepts®. She is an international speaker and practices dental hygiene in Dallas, Texas. She has served on numerous advisory boards, is considered a key opinion leader to many corporations in the profession and is recognized by Dentistry Today as a “Top Clinician in Continuing Education”.  She is an accomplished author related to her passion of practicing on the cutting edge of the profession. Ms. Davis is a member of the American Academy of Oral & Systemic Health and the American Dental Hygienists’ Association.

 

Dental x-rays: What’s in Your Dose

Monday, June 2nd, 2014

By Dr. Dale Miles, BA, DDS, MS, FRCD (C), Diplomate American Board of Oral Maxillofacial Radiology

Doctor with xray

It doesn’t matter whether it’s a periapical, bitewing a panoramic or even a cone beam CT x-ray examination, our patients always seem to be questioning us as to the need for the x-ray. There isn’t a week, possibly even a day, that goes by the dental practice where a dental assistant, dental hygienist her dentist doesn’t hear the following question from the patient, “Why do I need these x-rays?”. And, unfortunately our answers are usually “all over the map”.

“Don’t worry Mr. Jones it’s just like spending one hour in the sunshine.” Don’t worry about Johnny Mrs. Smith it’s like flying across the country in an airplane.” Obviously somewhere at sometime the dentist or auxiliary has been told, heard in the lecture 10 years ago or read in the magazine a comparison made for dental x-rays to everyday activities. Patients are now becoming more sophisticated and actually are demanding real answers and real information to their questions. It is not appropriate to offer them a platitude without any data. It just isn’t that professional. And it doesn’t instill confidence.

The data is out there, and it’s somewhat easy to find. But searching for it really isn’t high on the list of tasks for most of us. In addition, talking about “milliesieverts” is just as foreign to many dentists and auxiliaries as it is to their patients. There is real data about the approximate dose for each x-ray modality, from periapical to cone beam imaging. You can find studies that look at receptor types with round versus rectangular collimation, studies that compare the dose from a panoramic to a certain number of periapicals and x-ray dose even between the various cone beam machines. However, with the myriad of factors that affect x-ray dose, from something as simple as our KV or MAs settings, or the fact that not all cone machines have the same size FOV (field of view), the dose data can be confusing.

So how do we answer our patients question. To date, the best data, or at least the best way that I found for you to use to talk to your patients about x-ray dose actually compares the risk equivalents of dying from everyday activities to the dental x-ray procedure we call on FMS (full mouth series).  Of course even this data comes from comparisons to a full mouth series of film-based radiographs. However, there are still 55% of us out there dental practice using film, despite the fact that faster receptors are available which also will reduce patient x-ray dose.

So, if this initial blog on x-ray dose doesn’t stimulate conversation, nothing will in the dental profession. You need to seek out good data, use something called selection criteria when determining the need for an x-ray exam and transition to the fastest receptors possible and rectangular collimation, which is now been made simple, in order to protect your patient in the best manner possible. Are you up to the task?

Time now to start peppering me with the questions which I’m sure will arise from this initial blog posting. I look forward to your comments and questions. BTW, this is the first time that I’ve accepted an invitation to “blog”. My time, like yours, has become my most precious commodity. But I’m willing to help you find the answers you seek.

 

Miles

Dr. Miles is a diplomate of the American Board of Oral and Maxillofacial Radiology and the American Board of Oral Medicine. He has authored over 130 peer-reviewed articles and 6 textbooks, including the best selling atlas on Cone Beam CT, Color Atlas of Cone Beam CT for Dental Applications published by Quintessence Publishing. Dr. Miles is in full-time practice of Oral and Maxillofacial Radiology in Fountain Hills, Arizona. He is the President and CEO of Cone Beam Radiographic Services, LLC., a CBCT reporting service for dentists and dental specialists and President of EasyRiter, LLC, which produces a simple CBCT report generating software for the profession.

 

 

The Perfect Board Patient

Monday, May 5th, 2014

By Paul A. Levi, Jr., D.M.D.

friendly doctor and pacient

Recently, in the predoctoral clinic at Tufts University School of Dental Medicine, the students were preparing to take the Northeast Regional Board examination. A student excitedly came to me and said, “Please evaluate my patient for the periodontal part of the NERB examination. I believe that she is perfect.” The patient must have 12 surfaces of very discernible subgingival calculus and at least two pockets deeper than 4mm. As we were walking to the operatory, the student further remarked that one year ago four quadrants of scaling and root planing had been completed for this patient. I remarked that, should this patient qualify as a Board patient, we as dentists have failed. The student appeared to be shocked at this remark.

Unfortunately, on examining the patient, she qualified. Somehow we did not motivate this patient sufficiently to take care of herself, and although we provided the patient a service of calculus removal last year, we did not provide the service of health. The patient explained that since the student said, “I completed the scaling,” her periodontal treatment was completed, and now she could get her fillings done and her dental therapy would be finished.

I discussed with my student that the procedure of scaling and root planing is not just the mechanical act of taking calculus off of the teeth and smoothing roots, but is educating the patient to understand that it is her responsibility to remove the plaque/biofilm thoroughly on a daily basis. Since biofilm is invisible to the patient they must concentrate on their techniques and be seen for professional hygiene at regular intervals consistent with their needs.

The student then asked, “How frequently should a patient be seen for hygiene maintenance therapy? The sacred cow of dentistry is every six months. This began many years ago when it was said that it takes six months to develop caries, and thus we should see our patients to prevent the caries from becoming large and significantly compromising the tooth. Prevention today, especially with fluoride and sealants does not mean preventing the caries from becoming too deep. It means preventing caries from initiating and preventing periodontal diseases including gingivitis. The latter taking only a few days to occur.1

I suggested that in determining a hygiene interval for our patients, we look at the hygiene status at the time of the maintenance appointment as well as their susceptibility to dental caries and/or periodontal diseases. A hygiene maintenance interval of six months is appropriate for patients with no caries experience and no gingival/periodontal diseases; however, those who present with susceptibility and presently excellent plaque control would do best on a four month interval rather than six months shortening the interval by two months. As humans our lives change and other concerns can affect our routines, thus we may change our hygiene thoroughness. If seen that one time more during the year, we are likely to intervene before dental disease occurs and truly be preventive.

 

1. Loe, Harold, Else Theilade, and S. Borglum Jensen. “Experimental Gingivitis in Man.” Journal of Periodontology. 36.3 (1965): 177-187. Web. 24 Feb. 2012

 

Levi

Dr. Levi was born and raised in Newton, MA. He attended Hebron Academy, then St. Lawrence University, where he decided to study dentistry after graduating from SLU.  He attended dental school at Tufts University School of Dental Medicine after which he accepted a residency in general dentistry in Burlington, VT.  He joined the Navy as a dental officer and served in Great Lakes, IL for two years.  Following that he earned a certificate in Periodontics from Tufts School of Dental Medicine after which he and his family moved to Burlington, VT to open his practice in Periodontics in 1971.  Among the many positions that he has held are Treasurer of VT State Dental Society, AAP Board of Periodontics, AAP Board of Dental Examiners and is now an officer as well as an examiner, and president of the AAP Foundation.  He has taught at the UVM School of Dental Hygiene and is presently on the faculties of Harvard University and Tufts School of Dental Medicine  and Universidad International de Catalunya.

 

Forensic Odontology

Monday, March 3rd, 2014

By Dr. Rick Cardoza

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The field of forensic odontology is that area of dentistry concerned with the application of law in both criminal and civil proceedings. There are two disciplines within forensic odontology, postmortem identification and bite mark (pattern injury) analysis.  Forensic odontologists also assist authorities with multiple fatality incidents, age determination based on tooth development, recognition of child abuse/intimate partner violence (IPV) and participate in civil proceedings as an expert witness.                                                    

    

Dental Identification

As forensic dental identification specialists, we are typically the last conventional option for postmortem identification.  DNA is also now utilized but due to its high cost and the extensive time required for analysis, it is used sparingly or when absolutely no other option exists. Other forms of postmortem identification include visual, personal effects, fingerprints, scars, marks, tattoos, and medical radiographs.

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Forensic dental identification has been successful because of the nature of the human dentition.  The enamel is the hardest substance in the body and the only exposed portion of the skeletal system (fig. 1, 2).  Teeth are very resistant to thermal damage, blunt force trauma, and the dentition remains stable during tissue decomposition.  In addition, the dentition is unique to a specific individual.  This includes not only the morphology of the coronal portion of the tooth but the morphology of the roots, pulpal chamber, and their relationship to their surrounding structures (i.e. sinus proximity, mandibular canal proximity, interproximal bony trabecular patterns etc.).  Following the natural dentition, if you add man made dental restorations, the unique combination for any given individual can factor into the millions.

There are numerous important reasons for identifying the deceased.  A legal certification of death is necessary to consummate legal matters such as life insurance, wills, etc.  There are family and personal reasons as well (closure).  In criminal investigations, it is important to establish the identity of the victim in order to proceed with the criminal investigation and to identify the suspect.  In a fire for instance, the bodies are often burned beyond visual recognition (fig. 3).  Personal effects are also destroyed or lost in the fire. Even if the personal effects are recovered they may not be considered reliable due to the typical calamity which surrounds a fire.  A forensic anthropologist will examine the remains of the skeletal system and can then determine age, race and sex of the victim.  Positive identification is best performed by examination of the surviving dentition by the forensic odontologist.  In a fire where the temperatures may be very high (1000°C) even the dental remains may be destroyed.  Crowns may fracture or explode leaving only the roots.  The bone may also be completely consumed leaving only scattered roots with no bony sockets for reference.

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Forensic dental identification is most often accomplished by the comparison of the radiographs of the teeth of the decedent (postmortem) with the dental radiographs obtained from the dentist of the suspected victim (antemortem) (fig. 4, 5).  Ideally the antemortem radiographs furnished should be the original full mouth series.  Often this is not the case.  Children’s radiographs are typically bitewings only unless they have orthodontic records as well.  Often times duplicate radiographs, not the originals, are sent and have been either poorly duplicated and/or are not labeled right and left for orientation.  In addition, the antemortem radiographic image may be of poor quality due to improper operator technique (cone cuts, overlapping interproximals, elongation/foreshortening, etc.) or poor processing (contrast, burned images, etc.).  When poor antemortem radiographs are compared to an ideal postmortem radiograph, the two may not appear consistent. This could seriously hamper the identification effort.

In forensic dental identification, we stress that good quality, properly mounted and labeled original antemortem radiographs be sent for comparison.  In addition, copies of the victim’s dental treatment progress notes should be submitted as well.  This allows the forensic dentist to verify dental treatment that was performed subsequent to the date of the radiographs.

It is important as practicing dentists to keep complete patient records on file and continually update them, including the radiographs.  One of your records may be needed for the purpose of a postmortem dental identification.

Bite Mark Analysis

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The study of bite marks involves the analysis of teeth contacting another object or medium. Thus, bite mark analysis is a type of forensic pattern analysis similar to tool mark analysis.  Unlike dental identification which is a quantitative analysis, bite mark analysis relies on the odontologist’s interpretation of the pattern therefore bite mark analysis is primarily subjective in nature.  It is for this reason that bite mark opinions, though based on scientific methods and principles, can be highly variable based on the individual’s interpretation of the pattern injury resulting in experts often giving different levels of opinion on the same pattern injury.  The consequence we see today is that bite mark analysis has become highly controversial and in the United States there have been twenty four exonerations by DNA testing of individuals after they had been previously charged or convicted where the charges/convictions were based partially on faulty bite mark evidence.

The study of bite mark analysis involves the comparison of the pattern injury or bite mark to the suspect biters dentition.  The classic appearance of a bite mark is two semicircular or ovoid arches that oppose each other with a central ecchymosis (fig. 6).  The bite mark pattern is photographed from multiple angles with a scale present for reference.  In addition, the bite mark is swabbed for possible suspect DNA.  On the biter it is necessary to take full arch dental impressions of both the maxillary and mandibular arches.  In addition, complete dental charting of all the present, missing, and restored teeth including charting anomalies such as fractures, spaces, rotations, etc., wax bites, and intraoral photography.  If the accused suspect biter is in jail then collection of these records will require a court order and the individual has the right to have his attorney present (note: the biter could also be the victim who bit their attacker in self-defense).

cardoza 3

Once all the records are collected on the bite mark and the suspect biter then the odontologist can complete his analysis.  The analysis consists of a comparison of the bite mark photo which has been digitally resized to life size 1:1 proportions to an overlay of the incisal/occlusal edges of the suspect biters teeth.  This is accomplished by creating a digital hollow volume overlay of the dental models by scanning the models, using a flatbed scanner, into the computer (fig 7).  Then with the use of photographic software the incisal edge overlay can be inverted and superimposed onto the bite mark pattern photo for comparison and analysis (fig 8).

Finally, the odontologist will submit his report to the entity that retained him.  In this report the odontologist will list all the steps he took to complete the analysis and formulate an opinion.  The range of opinions include: The Biter (absolute), Probable (more likely than not), Possible (cannot be excluded from suspect biter population), Exclusion (did not make the bite), and Inconclusive (not enough data or poor quality data to formulate an opinion).

In summary, forensic odontology is an exciting field where dental health care professionals can utilize their skill and training in dentistry for a field complete outside of dentistry.  Choosing a career path as a forensic odontologist or forensic dental autopsy technician (the auxiliary’s role in forensic dentistry) should not be viewed as a hobby but in fact a second career in addition to your primary career in the field of dentistry.  The hours can be long and the monetary return low or even non-existent but the personal reward and satisfaction can be great.

 

Cardoza

Dr. Cardoza is a forensic dental consultant for the County of San Diego Office of the Medical Examiner, County of Imperial Office of the Coroner, State of California Department of Justice and is the Director of the California Dental Identification Team (CalDIT).  Dr. Cardoza graduated from Northwestern Dental School in 1985 and maintains a general dental practice in El Cajon, California. Dr. Cardoza is a Fellow of the American Academy of Forensic Sciences and is a Diplomate of the American Board of Forensic Odontology.

 

Avoiding Organized Dentistry to Save Money on Dues—Think again!

Monday, August 5th, 2013

By: Vanessa Browne, DDS

ODA logo (color)

With the continued rise of educational debt, many dental students are graduating with difficult financial decisions to make. The job market is saturated, many are getting married and starting families, high monthly loan payments are around the corner, and many also are craving delayed gratification for eight or more years of very hard work. It is natural, then, for some to make the decision to delay all unnecessary costs. For some recent graduates, the choice has been to forgo membership in the American Dental Association, the Oregon Dental Association, and their local dental society as a means to save money as they are establishing themselves in the dental community. However, I believe this is the worst choice that a new dentist can make. The benefits of being a member of our dental societies far outweigh the cost.

Dental societies function as a tripartite membership. This means when you become a member, you hold membership at three levels: the national level (American Dental Society), the state level (Oregon Dental Association), and the local level (Oregon has 17 local dental societies). More than 71% of Oregon’s dentists belong to the ODA. While this is an impressive number, the opposite number is staggering. 29% of dentists in Oregon are practicing without the support, network, protection, community, and education that being a dental society member provides. I believe that joining your dental society is a commitment to continued growth as a professional.  Here are just a few ways that organized dentistry can help you:

Peer Relationships

Upon graduation, many new dentists begin working and sometimes lose connections with classmates and the dental community. This is understandable as starting a practice, joining a practice, or becoming an associate is a time-consuming process. However, this is a missed opportunity to seek advice from mentors, learn practice management and clinical techniques from peers, empathize or share experiences among colleagues, and network for leadership, professional, or career opportunities. There are over 2,100 dentist members in the ODA, and 9 staff at ODA working to help provide information, answer questions, and support the profession.

Advocacy

 A portion of the dues paid to the dental societies goes to supporting and protecting the profession. This includes lobbying for specific dental issues. A few of the recent issues facing dentistry include eliminating national license testing with a push toward portfolio licensure for dentists, educating legislators about the negative effect the new medical device tax will have on the cost of oral health care, impeding insurance companies from dictating rates for treatment that insurance does not cover, and providing alternative solutions to the proposed mid-level provider model.

Serving the Community

Being a part of the dental society gives dentists many opportunities to give back to the community. Not only does organized dentistry help educate the public about oral health and the importance of seeking dental care, but it also serves to advocate for changes such as water fluoridation, increased funding for research, dental care for underserved populations and public health initiatives, and increased insurance coverage for dental services. Beyond this, there are opportunities for dental professionals to volunteer in the community through events like Mission of Mercy (November 24-27, 2013) and Give Kids a Smile (February).

Education

Every dental society hosts at least one conference a year with a collection of continuing education courses and a vendor showcase with member discounts. Also available throughout the rest of the year are additional continuing education courses, leadership training, and numerous publications. The Oregon Dental Association publishes its newsletter “Membership Matters” and this blog “The Tooth of the Matter.” The American Dental Association has its own journal “Journal of the American Dental Association” and newsletter “ADA News”. Beyond education for members, these dental societies also provide numerous public health resources and patient education tools that can be used in your office.

Career Protection

Dental societies offer three specific resources for career protection: Insurance for your personal and practice needs, peer review, and a well-being committee. The ADA sponsors life and disability insurance plans at a reduced rate for members. Other dental societies also endorse malpractice insurance companies and other necessary insurance providers. Peer Review is a process by which patients and third party payers can voice concerns or disputes that are resolved by a collection of your colleagues. This allows the dentist and patient to have dental care evaluated in a non-combative environment at a local level. These issues are often resolved at this level and do not have a need to progress to a lawsuit. The Well Being Committee offers dentists who struggle with alcohol and controlled substances an opportunity to get back on track without losing his or her license.

Practice Support:

The ADA and ODA have endorsed programs of products or services and often offer discounts to members. All of the dental societies also have several opportunities to seek employment or place classified ads. These are sometimes the first place individuals will look. Both the ADA and ODA help with patient referrals by listing your practice information on their websites and when patients seek dental care in a certain area, the staff will refer to its members. Additionally, the ADA has a professional product review that provides unbiased dental product information that is scientifically sound, clinically relevant, and user friendly. The ADA also has a center for Evidenced Based dentistry that provides research and gives you access to systematic reviews. Using both of these resources, organized dentistry allows dental professionals to make informed decisions about their practice.

 

So How Much Will This Cost You?

The dental societies realize that new dentists are graduating with enormous debt loans.  To decrease the burden of membership dues, the American Dental Association and most dental societies structure their dues on a graduated scale over 5 years. Usually, membership in the first year in practice is free. This means that even if you don’t know where you are going to practice, it is beneficial to join to have access to this wealth of resources. At the national level, dues are 25% of full national dues your 2nd year in practice, 50% your 3rd year in practice, 75% your fourth year in practice, and 100% your fifth year in practice. State and local dental societies have a similar system. There are also member get a member discounts to encourage dentists to invite their colleagues to join. Depending on your location, full dues for tripartite membership by your fifth year vary from $900 to $1,800. Students who pursue graduate training also have a reduced rate of $30 for national dues and begin the reduced dues five-year program when their graduate education is complete.

Convinced Yet?

Being a member of organized dentistry can lead to career opportunities, referral connections, educational opportunities, practice management support, risk management answers, reduced rates on endorsed products, unbiased and scientific information on clinical products, support at the legislative level, license protection with peer review, social opportunities, and more. The small cost of membership is worth a lifetime of benefits.

How Do I Get Involved?

The best way to get involved in your dental society is to visit the websites and read the newsletters for upcoming events. It is best to start with your local dental society. Look for New Dentist events, Continuing Education courses, opportunities to be a mentor/mentee, or upcoming conferences such as the Oregon Dental Conference or the American Dental Association New Dentist Conference. There are also numerous opportunities to volunteer with events like the ODA Mission of Mercy (November 24-27, 2013) and Give Kids a Smile (held annually in February).

Check out the following website for more information:

http://www.ada.org/

http://www.oregondental.org

 

IMG_6409Vanessa Browne, D.D.S, is a 2012 Loma Linda University Dental Graduate who is currently in her orthodontic residency at Oregon Health and Sciences University in Portland, OR. She is a member of the California Dental Association, the Oregon Dental Association, the American Dental Association, the American Association of Orthodontists, and the Pacific Coast Society of Orthodontists. As a dental student, Vanessa held numerous roles as a leader in organized dentistry including the chair of the California Dental Association student delegation. She is passionate about encouraging dental students and new dentists to join organized dentistry. You can contact her at vnbrowne@gmail.com

Dental Implant Concerns Related To Patient’s Health

Monday, July 8th, 2013

Capped Dental Implant Model

By Dr. Don Callan

The goal of dental implants is to provide function, longevity and esthetics for dental patients in an environment that can be maintained with routine oral hygiene procedures. Dental implants are no longer experimental, exotic or rare. Implants are the treatment of choice for an increasing number of people who want the best that dentistry has to offer. Dental implants have proven to be a valuable treatment of choice for replacing missing teeth and have been developed from the anatomy of natural teeth. Dental implants are also subjected to periodontal disease (periodontitis) caused by oral bacteria (periodontal pathogens). Both patients and dentists should be aware of possible complications that can affect the patient’s oral and systemic health when implants are placed, even if excellent esthetic results are achieved. Professional implant maintenance and diligent patient home care are important factors. However, because a portion of the implant is below the gum level (subgingival), patients and clinicians have limited control over hygienic measures to prevent infection. Therefore, implant design is an important factor.

Periodontal pathogens have been linked with increased risk of systemic illness and complications in existing diseases.  Recently, several articles detailing these findings have been published, emphasizing the importance of the association between periodontal disease and systemic health problems.  In fact, recent reports of oral infections have been shown to be associated statistically with mortality. With periodontal disease, millions of oral bacteria are in direct physical contact with gum tissue, which provides an easy portal to the circulatory system.  After entering the bloodstream, periodontal pathogens have been shown to increase the risk of cardiovascular disease, strokes, lung disease, rheumatoid arthritis and may hinder glycemic control in diabetes. Sufficient evidence exists to conclude that both periodontitis and Peri-Implantitis involve the same bacteria. This same inflammatory process can damage healthy tissue and lead to bone loss around the implant.

In addition to optimizing esthetic and functional results, infection (Peri-Implantitis) of gum and bone tissue surrounding the implant is of major concern. These infections have driven many developments in dental implant design and use. Treatment of dental patients is rapidly moving from an approach focused primarily on esthetic and functional concerns toward an approach, which focuses on optimal health as a critical goal. Numerous published studies promote the prevention of oral bacteria harboring around implants as a key outcome in addition to traditional measures of implantation success.

Studies have shown periodontal pathogens surrounding dental implants will contribute to implant infections and is the main cause of implant loss and systemic concerns. Some patients may have significant infection and bone loss with no symptoms and may not pursue adequate follow-up care that would identify those conditions. Researchers have identified specific periodontal pathogens around and within the micro-gap of implant systems as the same seen in periodontal disease. Some implant companies are developing new designs for the elimination of the microgap issue. Therefore, it is important for all implant patients to see the dental professional for routine care and evaluation of the health around the implant.  It is possible for patients who maintain optimum hygiene care to suffer from implant infections if bacteria are harbored within, around, and between implant components.

In summary, the patient, dentist and the implant manufacturer have their respective areas of responsibility to maintain implant success. Infection about dental implants is the number one cause of failure; therefore, the patient must maintain excellent home care procedures of the implant and visit the dental office for routine cleanings. The dentist is responsible for proper surgical procedures and instruction to the patient for home care procedures. The implant manufacturer must be aware of the causes of implant failures in order to change or correct the design of dental implants as needed to promote long-term success. A poor implant design will affect esthetics, function and the ability to allow proper home care as well as professional cleanings of the implant and its restoration. IMPLANT SUCCESS IS A TEAM EFFORT: THE PATIENT, DENTIST AND MOST OF ALL THE MANUFACTURER OF THE IMPLANT.

 

DPCDr. Callan received his B.S., B.A. degree from the University of Arkansas in Business Management and Marketing. He received his D.D.S. degree and a Certificate in Periodontics from the University of Missouri at Kansas City. Dr. Callan maintains a private practice and hospital appointments limited to Periodontics with an emphasis on tissue regeneration and implant dentistry in Little Rock, Arkansas. Dr. Callan has authored 61 publications about dental implants and tissue regeneration. Dr. Callan has presented lectures in the United States and internationally, including the University of Moscow, Russia, China, Japan, UK, Mexico, Canada, Central America, and South America, on various topics including dental implants, Peri-Implantitis, bone regeneration, soft tissue regeneration, implant maintenance, oral and systemic periodontal health, marketing to the dental patient and treatment planning of the edentulous patient.

 

 

 

Look Before You Leap… The Treatment of Snoring and Obstructive Sleep Apnea

Monday, June 3rd, 2013

 By Gail Demko, DMD

Sleep Apnea and CPAP

All medical and dental professionals are looking for ways to offset decreases in reimbursement, often by acquiring new skills that allow expansion into previously untapped patient populations. Many dentists have become interested in providing oral device therapy for patients who snore and or have obstructive sleep apnea. All dentists possess the skills required to fabricate oral devices, we learned them in dental school. We are adept at using many different impression materials, adjusting and modifying multiple types of mouthpieces, can analyze occlusal contacts on complete dentures and have a passing knowledge of clonic bruxism and tonic bruxism (clenching).

The treatment of patients with snoring and obstructive sleep apnea requires not only these basic mechanical skills but an understanding of the overall disease process. This is a medical disease with medical complications and comorbidities. Just as untreated caries will lead to endodontic involvement and possible tooth loss, untreated sleep apnea can lead to hypertension, heart attack, stroke or an increased incidence of various cancers. Dentists are fully in control of treating all outcomes of the carious process but we are not trained to deal with the severe medical outcomes of untreated sleep apnea.

You must understand that we are part of the medical team. We work with physicians to appropriately treat patients with snoring and sleep apnea. Diagnosis of disease, be it snoring or sleep apnea, lies within the arena of medicine, not dentistry (just ask your malpractice insurer). To treat a patient who complains of snoring without appropriate medical consult and medical diagnosis may result in the resolution of snoring without control of the underlying sleep apnea. This patient could go on to suffer heart failure, have a motor vehicle accident or develop hypertension. Resolution of the patient’s symptom of snoring may allow both you and the patient to assume that the underlying sleep disordered breathing has also been controlled; snoring often resolves before there is control of the obstructive sleep apnea. This presumption can be very dangerous to the patient and could have serious consequences for your practice.

Many companies now market legal medical diagnostic sleep testing equipment directly to dentists. The sales rep tells you that this will allow you to “screen” patients in your practice for snoring and sleep apnea. These are not screening devices; these are legal medical diagnostic tools. The standard of care requires evaluation of the patient by medical provider not just remote evaluation of the data obtained through home sleep testing by a physician licensed in your state.

So approach this field in a responsible way. Learn about the diseases of sleep disordered breathing. Understand all available treatment options and know when oral appliance therapy may not be appropriate for the individual patient in your practice.

Treating medical diseases requires that you be part of the team. Physician, surgeon, general dentist, orthodontist, nurse practitioner and respiratory technician: all of these have a part to play. As dentistry evolves and continues to move back in synchrony with medicine it is time to forge new alliances with our medical colleagues to provide improved outcomes for all of our patients.

 

Demko

Dr. Gail Demko started her career in dental treatment of OSA at Beth Israel Deaconess Medical Center in 1989. In 1997, she was the first dentist in the US to limit her practice to the treatment of OSA. She became the expert advisor to the FDA in the area of oral appliance therapy in 2004 and has been active in professional groups for some time. At present , she is President of the AADSM, a member of  the Board of Directors of the Massachusetts Sleep Society, on the editorial board of the Journal of Sleep And Breathing and holds the distinction of having the first certified dental sleep medicine office in New England. She continues to practice full-time in Weston, MA.