TECHNOLOGIES SUCH AS LASERS, DIG-ital imaging, and microscopy havefound a home in dentistry and offer

unique benefits to both patients andpractitioners.

“Lasers can be used on soft tissueslike gums,” explains Dr. Michael Popp, adentist based in Calgary. “They can alsobe used to treat herpetic lesions.”

Indeed, rather than take systemicmedications to treat a herpetic lesion, apatient can undergo laser therapy in adentist’s office and have that lesionremoved.

There are lasers available for use onhard tissues in the oral cavity, but theywork very slowly and cause pain, Dr.Popp said. “They are not yet ready forprime time,” explains Dr. Popp.

While only a minority of dentistsuse digital imaging in their offices inCanada, those who do find the technol-ogy offers significant benefit.However, it’s estimated that most den-tists continue to use analog silver halideX-ray film instead of digital radi-ographic systems.

“It’s a great advantage for thepatient because it reduces radiation by90 per cent,” says Dr. Gene Jensen, an

orthodontist based in Halifax andDartmouth, N.S., who uses digitalimaging daily and was one of the firstorthodontists in Canada to incorporatedigital imaging equipment in his prac-tice.

“Previously, we had to bombardthe patient with multiple X-rays for anumber of seconds before getting allthe information,” he says. “[Digital radi-ographic systems] give us 10 times theinformation that analog does.”

The traditional use of X-rays canproduce many more errors since imagesare distorted, explains Dr. Jensen. “The

DentalChronicleCanada’s National Newspaper of Dentistry

n March 31, 2010

Making people laugh helps dentist keephis medical career in perspectivePassion for yuks keeps Brantford, Ont. dentist on stagedeveloping his comedic touch. See page 24.

P r a c t i c e n e w s

Lasers a staplein periodontaltreatmentn Ongoing development,

refinement contribute topotential utility of lasers forgeneral practitioners

In this exclusive DENTAL CHRONICLE inter-view, Dr. Doug Dederich, a periodontal special-ist in Edmonton and president of Biolase,talks about some of the recent developments inlasers for dentistry, and how these advanceshave led to refinements in clinical techniques.

You wrote an article in JADA in2004; could you comment onwhat progress has been made in

lasers for perio since then? Clinical techniques have been refinedwith some of the laser wavelengths,Er,Cr:YSGG in particular. More clini-cal studies are of course needed to sat-isfy the new Standards of Evidencerecently issued in a Technical Report tothe Profession by the ADA.

What role do diodes and theER:CR:YSGG play in mild, moderate,and advanced periodontitis?These two lasers can be helpful in forthe general practitioner in treating earlyand moderate chronic periodontal dis-

ease. They canalso be a usefuladjunct for theperiodontist int r e a t i n gadvanced peri-odontal disease.Having any laser,however, does

not change the principles of good peri-odontal care as it relates to good rootdebridement and also the field of peri-odontal regeneration. The Er,Cr:YSGGcan enhance the biocompatibility of theroot surface which can be helpful in

DentalVitae

—please turn to page 5

—please turn to page 6

Affiliated with

Sports injuries: Counsellingpatients on best mouthguardOVER-THE-COUNTER MOUTHGUARDS

offer little protective value, while custommouthguards can prevent much dentaltrauma. See page 4.

Case report: Cutaneous sinus tracts—an endodontic approach ....19Welcoming new patients, aesthetically speaking ............................2310 minutes with Dr. Sherri Wise..........................................................26

New this month

ProductsProductsHandpiece LubricantBased on nano ceramic technology, thisproduct produces a boundary layer onmetal surfaces, to reduce wear and dragwithin the turbine and bearings.

Implant InstrumentsWith tighter radiusesand short rounded

tips, this set of medical grade titaniuminstruments has ideal hardness forimplant maintenance.

Oil-free Dental CompressorThis compact unitincludes an energy-sav-ing Seccomatt dryer toensure continuous dry,clean, compressed air.

Gingiva FormersCustomizable Gingiva Formers allowyou to achieve a natural and estheticgingiva contour with the formation ofintact papillae.

Request more information on these andother products advertised in this issue.

See page 25

Canada Post Canadian Publication Sales Product Agreement 40016917

by Louise Gagnon,Correspondent, Dental Chronicle

S p e c i a l R e p o r t

What you need to knowabout Green DentistryINTRODUCING DENTAL CHRONICLE’Snew series on Green Dentistry, show-ing you ways to attract new environ-mentally-conscious patients, and toultimately reduce your costs.

Turn to page 15DDrr.. DDeeddeerriicchh

New technologies leading toimproved benefits for patients

nnn Lasers, digital imaging, microscopy changing clinical practice

Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:36 PM Page 1

D

HY

VM

BM

NCWV

MIrC

MESH

JV

KV

BKPAV

HT

WT

De

SinceThe C

EN

A NEW A NEW SUPERHEROSUPERHEROFOR TOUGH BONDINGFOR TOUGH BONDING

Zirconia-Alumina-Metal Primer

BISCO’s Z-PRIME™ PLUS is intended for use as a surface treatment for the following indirect restoration substrates:

Zirconia (Lava, Cerec, Implant)Alumina (Procera) Metal/alloy (Titanium, PFM, Non-Precious, High Noble)Composite (Direct & Indirect)Endodontic Posts (Zirconia, Metal, Fiber)Intra-oral repairs

••••••

Zirconia

Composite

Alumina Intra-oral repairs

Metal/Alloy

Endodontic Posts

Z-PRIME™ PLUS

BISCO’s Z-PRIME™ PLUS is a single-component priming agent used to enhance adhesion between indirect restorative materials and composite resin cements.

Z-PRIME™ PLUS signifi cantly enhances bond strengths to Zirconia, Alumina and Metal substrates more or unlike any other surface primer on the market! Compatible with light-cured and dual-cured resin luting cements…phosphoric and carboxylic acid monomers.

Buy a Z-PRIME™ PLUS (4ml)

and receive a FREE Dual-Syringe of DUO-LINK™ or BISCEM™!

Promo Code: ZP-01

Offer expires March 31, 2010

Quebec OffiQuebec Offi ce: 800.211.1200 ce: 800.211.1200104A Chemin du Tremblay, Boucherville, QC, J4B 6Z6104A Chemin du Tremblay, Boucherville, QC, J4B 6Z6

Head OffiHead Offi ce: 800.667.8811 ce: 800.667.88112571 Smith Street, Richmond, BC, V6X 2J12571 Smith Street, Richmond, BC, V6X 2J1

BISCO DENTAL PRODUCTS CANADA INC.BISCO DENTAL PRODUCTS CANADA INC.w w w . b i s c o c a n a d a . c o mw w w . b i s c o c a n a d a . c o m

PDC Booth #: 1201-1304 ODA Booth #: 1245,1247 JDQ Booth #: 715-816

ComeVisit Us!

Upcoming Conventions

800.667.8811

Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:37 PM Page 2

Dental Chronicle National Editorial Board

Hassan Adam, Yellowknife, N.W.T.

Véronique Benhamou,Montreal, Que.

Barry Dolman, Montreal, Que.

Neil Gajjar, Mississauga, Ont.

Cary Galler, Toronto, Ont.

Wayne Halstrom,Vancouver, B.C.

Mel Hawkins, Toronto, Ont.

Ira Hoffman, Chomedey, Laval, Que.

Mark Lin, Toronto, Ont.

Ed Lowe, Vancouver, B.C.

Scott Maclean, Halifax, N.S.

John Nasedkin, Vancouver, B.C.

Ken Neuman, Vancouver, B.C.

Brian Saby, Red Deer, Alta.

Ken Serota, Mississauga, Ont.

Paresh Shah, Winnipeg, Man.

Andrew Shannon,Vancouver, B.C.

Howard Tenenbaum,Toronto, Ont.

William E. Turner, Thunder Bay, Ont.

A MCGILL UNIVERSITY GRADUATE, Dr. IraHoffman has always enjoyed working withhis hands. While he was growing up, he hada strong desire to get into the medical pro-fession, and when it came time to pick acareer it came down to a choice betweenbecoming a dentist or a heart surgeon.

“I decided not to become a heart sur-geon for the same reason I did not choosethe field of medicine—because I cannothandle death,” said Dr. Hoffman, whomaintains a private practice in Montreal, andis a faculty lecture at McGill University inthe Department of Restorative Dentistry.

“In dentistry the worse case scenario is that a patient loses their teeth—although I am always fighting for them to keep their teeth—but really that is theworse case scenario.”

Dr. Hoffman says that over the years he has maintained his interest in the fieldof dentistry by continuously keeping active and reinventing himself. Upon gradua-tion in 1978, he took a particular interest in esthetic dentistry and in 2000 he wasasked to become a clinical instructor at McGill University.

“I have enjoyed the opportunity McGill University has provided, which hasallowed me to pass along the knowledge I have gained regarding esthetics to my stu-dents,” he said.

One of Dr. Hoffman’s life-changing moments occurred when he was in hismid-30s. He had a skiing accident that resulted in his left leg becoming temporarilyparalyzed and, during this time, Dr. Hoffman said that he gained more appreciationfor a work-life balance.

“Since my leg was paralyzed it led me to believe that I might not be able towork again, which resulted in a life altering moment. It caused me to have more ofan appreciation for life. I now work to live, and I do not live to work,” he said.

“When I work I take it seriously, but I will never say I cannot afford to go ona vacation or that I do not want to take time off, because who knows what can hap-pen tomorrow. I take time off now, but it took my left leg becoming paralyzed tomake the importance of this life balance clear.”

Dr. Hoffman is a member of the University Advisory Council of the AmericanAcademy of Cosmetic Dentistry, Acting Chairperson of the University Co-ordinat-ing Committee of the Canadian Academy of Esthetic Dentistry, and a Fellow of theAcademy of Dentistry International and the International Academy of DentalFacial Esthetics.

Ontario Dental Association—AnnualSpring Meeting13 to 15 May, 2010TorontoTel: 416-922-3900Fax: 416-922-9005E-mail: info@oda.caWebsite: http://www.oda.on.ca/

Newfoundland & Labrador—AnnualGeneral Meeting27 to 29 May, 2010St. John’s, Nfld.Tel: 709-579-2362Fax: 709-579-1250E-mail: nfdental@nfld.net Website: http://www.nlda.net/

Jasper Dental Congress27 to 30 May, 2010Jasper, Alta.Tel: 780-432-1012Fax: 780-433-4864E-mail: adaadmin@telusplanet.netWebsite: http://www.abda.ab.ca

Denturist Association of Canada-Annual General Meeting28 May, 2010Whistler, B.C.Tel: 1-604-538-3123/1-877-538-3123Fax: 1-604-582-0317E-mail: dacdenturist@telus.netWebsite: http://www.denturist.org/

Annual Convention of the Ordre desdentists du Quebec29 May to 01 June, 2010MontrealTel: 514-875-8511Toll free: 1-800-361-4887Fax: 514-393-9248E-mail: dacdenturist@telus.net

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

Attending the Jasper Dental Congress, in Jasper, Alta.? 2We’d love to receive your impressions of the presentations and session highlights. E-mail us at dental@chronicle.ws

Have a digital photograph of an upcoming meeting destination? Send it to us at dental@chronicle.ws. We’ll publish selected photos and reward photographers with gift-card prizes.

March 31, 2010 n 3DentalChronicle

DentalChronicleCanada’s National Newspaper of Dentistry

EDITORIAL DIRECTOR

R. Allan RyanASSISTANT EDITOR

Lynn Bradshaw

SALES & MARKETING

Henry RobertsCOMPTROLLER

Rose ArcieroPRODUCTION & CIRCULATION

Cathy Dusome

PUBLISHER

Mitchell Shannon

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

E-mail: dental@chroni cle.wsContents © Chronicle Information Resources Ltd, 2010, except where noted. All rightsreserved worldwide. The Publisher prohibits reproduction in any form, including print, broadcast,and electronic, without written permission. Printed in Canada.Subscriptions: $59.95 per year in Canada, $79.95 per year in all other countries, in Canadian or USfunds. Single copies: $7.95 per issue. Subscriptions and single copies are subject to 5% GST.Chronicle Information Resources Ltd. is the official representative of Dental Tribune International(DTI) in Canada. All published material related to Dental Tribune is subject to copyright by DTI. Canada Post Canadian Publications Mail Sales Product Agreement Number 40016917. Pleaseforward all correspondence on circulation matters to: Circulation Manager, Dental Chronicle,555 Burnhamthorpe Rd., Suite 306, Toronto, Ont. M9C 2Y3 Canada.E-mail: circulation@chronicle.ca ISSN 1916-0437

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

Each issue, Dental Chronicle is honored to introduce you to the distinguished members of ourNational Editorial Board. This month, we welcome Dr. Ira D. Hoffman of Montreal.

Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:37 PM Page 3

gainiWhaGingCT-gdurin

Whaportafor aThe othermizinis a the needcontgingiing imvery and inflamalso the g

WhaCanaMy ainval

will ution

WhatreatpatieMy opostscalparoupain

In catageuse oMostence accescan pier. Atoxinbiocoresul

4 n March 31, 2010 DentalChronicle De

Wearing a mouthguard is one goodway for athletes to prevent dentaltrauma, but the mouthguard must

be properly fitted, according to a dentistfrom Manhattan Beach, Calif.

Delivering a talk about sports den-tistry at the annual meeting of theOntario Dental Association in Toronto,Dr. Ray Padilla, a consultant for the U.S.national soccerteam, the LosAngeles Galaxysoccer team, theLos AngelesAvengers footballteam, and theUniversity ofCalifornia at LosAngeles athletics, spoke about the impor-tance of wearing mouthguards, which areproperly fitted, to ward off dental trauma.

“Professional sports teams have adentist,” says Dr. Padilla. “They don’tneed us [community dentists]. They arealready getting a good quality of care.We need to worry about people who playpick-up games, high school sports teams,women’s teams, young children playing

sports, and the 50-year-olds and the 60-year-olds who play sports.”

Sports like baseball, football, rugby,basketball, water polo, and volleyball allpose a risk of orofacial trauma for play-ers. “There is a high injury rate with chil-dren when they are learning to play asport like baseball,” he says. “They arelearning how to catch, so there is a highrate of orofacial injuries.”

A 1989 study in Pediatric Dentistryfound three-quarters of oral injuriesamong high school athletes, includingbaseball and basketball players, occurredin athletes who did not wear mouthguards.

Some activities, such as inline skat-ing, carry a risk of orofacial trauma.“People wear elbow pads, wrist pads,knee pads, and helmets when they areinline skating, but they do not wearmouthguards,” Dr. Padilla notes. “[Amouthguard] is on the backburner forsome reason, but it should be the firstthing you think about.”

Younger patients with protrudingteeth are at increased risk for dentalinjuries in sports. Orthodontic treatmentshould be performed as soon as possibleon these younger patients to correct the

protrusion and lessen the risk of dentalinjuries in sports, according to Dr.Padilla. He added that patients who wearorthodontic appliances are still candi-dates for wearing mouthguards.

When it comes to mouthguards, cli-nicians cannot take a one-size-fits allapproach to designing them for patients,says Dr. Padilla. Going to the local sport-ing goods store to obtain mouth/dentalguard protection is not sufficient to pre-vent athletic injuries.

“These mouthguards are absolutelytrash,” says Dr. Padilla. “The injury rate insports among athletes wearing mouth-guards [purchased at] sporting goodstores is the same as the injury rate amongathletes wearing no mouthguards at all.”

There are “boil and bite” mouth-guards which attempt to fit the teeththrough boiling the mouthguard and try-ing to mold it to the teeth, but the mate-rial is unstable and does not permit evendistribution in the mouth, he said.

“You may set yourself up for a libelsuit if you recommend that a patientwear a ‘boil and bite’ mouthguard,” hesays. “The occlusion is unstable, and isoften displaced upon impact when the

athlete needs the protection the most.”Dentists needs to examine peer-

reviewed literature to assess the safetyand efficacy of protective mouthwear,says Dr. Padilla. “Do not believe whatyou read in Sports Illustrated,” he says.“Pay attention to the claims, marketingtools, and any conflicts of interest.”

Patient education is necessary toinform patients of the value of a mouth-guard that is customized for them.“They may not want to spend $200 on amouthguard when they can buy one at asporting goods store for $15,” he says.

The solution lays in general dentistsproviding custom-made mouthguards fortheir patients, says Dr. Padilla. It is best ifdentists can make the mouthguards them-selves, but if a laboratory manufactures themouthguards, dentists should be informedof the process and materials used.

BETTER FIT EQUALS MORE USE“If you choose not to make the dentalappliances yourself, call the lab to makesure you know what machines they areusing to make them,” says Dr. Padilla. “Ifthey are using vacuum machines, you arenot getting a quality product. They needto use pressure machines.”

The pressure machine allows forlamination of the athletic mouthguardand provides the best fit and protection,according to Dr. Padilla, who disclosedhe has no consultancy relationships withany manufacturers.

“If the mouthguards fit better, theathletes are more likely to wear them , soyou get better compliance,” he says.

If mouthguards are made using vac-uum machines, they never fit after limitedwear and tear, stresses Dr. Padilla.“Vacuum machines use low heat, and vac-uum mouthguards don’t fit after two orthree days of wear,” says Dr. Padilla.“[The vacuum machine] can’t achieve con-sistent and adequate occlusal separation.”

To achieve balanced occlusion, theposterior occlusal surface of the mouth-guard should be warmed, the mouth-guard should be placed in the patient’smouth, and the patient should be askedto bite down lightly and carefully until allposterior teeth occlude.

There are no evidence-based data tosuggest that wearing mouthguards willprevent concussions, but manufacturersmay purport that is one of the benefits ofwearing a mouthguard, notes Dr. Padilla.

—Louise Gagnon

USA Increased concentrations of cigarette smoke condensatedecreases cell proliferation and increases cytotoxicity inhuman gingival fibroblasts, researchers report in theJournal of Periodontal Research (2009; volume 44(6):704-713). Human gingival fibroblasts were exposed for 72hours to various concentrations of total particulate mat-ter cigarette smoke condensate. Cell proliferationdecreased by more than 50 per cent when the concentra-tions of total particulate matter cigarette smoke conden-sate were above 200 µg/mL, and cytotoxicity increasedto more than 30 per cent when the concentrations oftotal particulate matter cigarette smoke condensate wereabove 400 µg/mL. In all, cigarette smoke condensateincreased the collagen-degrading ability of human gingi-val fibroblasts, especially at a concentration of 100µg/mL (1.5-fold increase, compared to control.

THE NETHERLANDS The incidence of new tooth surfacesexhibiting erosion, in erosion-free children, appears todecrease significantly with age, investigators report inthe Journal of Dentistry (2010; Volume 38 (2):83-172). Inthis study, researchers evaluated tooth erosion threetimes with 1.5 year intervals in a sample of 622 chil-dren, aged 10 to 12 years at baseline. Findings showthat tooth erosion was present in 30.4 per cent of the11-year-olds, and 44.2 per cent in 15-year-olds. In all,deep enamel was eroded in 1.8 per cent of the 11-year-olds and in 23.8 per cent of the 15-year-olds. Overall,

the incidence of new tooth surfacesexhibiting erosion, in erosion-free chil-dren, decreased significantly with age, whilethe progression in children with erosion did not change.

JAPAN Dentin strengthened by UV irradiation retains itsstrength after dehydration because of chemical changesin collagen, researchers reported in the Journal of DentalResearch (2010; volume 89(2):154-158). Beam-shapeddentin specimens from the crowns of human thirdmolars were subjected to flexural testing. Overall, datashow that flexural strengths were two and three timesgreater than those in the control group after five min-utes of UV irradiation and heating to 140°C, respec-tively. After 30 days of rehydration, the heated speci-mens reverted to their original strength, while the UVspecimens were 69 per cent stronger than the original.

AUSTRALIA Significantly more post-orthodontic white-spotlesions regressed with remineralizing cream compared toplacebo over 12 weeks, scientists reported in the Journal ofDental Research (2009; 88(12):1148-1153). Fifty-five partici-pants (aged 12 to 18 years) with 408 white-spot lesionswere recruited; 23 were randomized to the remineralizingcream and 22 to placebo. The product was applied twicedaily after fluoride toothpaste use for 12 weeks, and 92per cent of lesions were assessed as code two or three.For these lesions, 31 per cent more had regressed withthe remineralizing cream than with placebo at 12 weeks.

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

ClinicalNewsSports injuries: Dental trauma can be prevented with custom mouthguardsn Mouthguards purchased at sporting goods stores of little protective value, and may put you in jeopardy if you recommend them

Clicontin

DDrr.. PPaaddiillllaa

Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:37 PM Page 4

gaining attachment. What other procedures do you use the YSGG for? Gingival contouring, conditioning of root surfaces prior toCT-grafting, osteoplasty and ostectomy, and root conditionduring reattachment and regeneration procedures.

What are your thoughts on the introduction of a totallyportable handheld 940 nm diode laser that is affordablefor any practice?The 940 nm diode laser has less penetration than some of theothers, and this is actually a good thing with respect to mini-mizing the risk of deep thermal damage. The 940 diode laseris a good all-around laser forthe general practitioner whoneeds to do minor soft tissuecontouring, pocket therapy, orgingival troughing prior to tak-ing impressions. It can also bevery useful in biostimulationand reduction of pain andinflammation. Since it costs less than the Er,Cr:YSGG and isalso a multi-functional laser, I think it probably fills a niche forthe general practitioner who wants to have a soft-tissue laser.

What advice would you like to give general dentists inCanada about lasers for periodontal therapy? Specialists? My advice would be to remember that technology does notinvalidate well-established principles of periodontal therapy,

such as the need for excellent rootdebridement or creating the conditionsthat make bone regeneration possible.Advance periodontal disease often resultsin furcation problems that require surgicalaccess and the training to performadvanced regenerative therapy, so it’s myview that these lasers can be an adjunct tospecialist services such as regenerationand CT grafting. So while these lasers cantake many mild and moderate conditionsand make their therapy more conservativeand patient friendly, the advanced cases

will usually still require the expertise in surgery and regenera-tion of a periodontist.

What role can minimally invasive, non-surgical periodontaltreatments such as laser technology play in improvingpatient treatment compliance?My own anecdotal experience with these lasers is that thepost-operative morbidity is surprising low compared toscalpel surgery. It doesn’t take long for the word to getaround that good results can be obtained with much lesspain for the patient.

In cases of severe, intractable periodontitis, what advan-tages does surgical treatment with the laser hold over theuse of the scalpel? Improved healing?Most recalcitrant pockets seem to exist because of the pres-ence of calculus in most cases. Surgery can provide betteraccess to these areas than nonsurgical therapy. Using the lasercan provide a dry field in many cases, making visualization eas-ier. Also, the Er,Cr:YSGG can remove calculus, denature endo-toxin, and condition the root surface, all of which improves thebiocompatibility of the root surface. In theory, this shouldresult in better attachment gains than traditional therapy.

icle DentalChronicle

st.”peer-afetywear,whatsays.eting

y touth-

hem.on aat a

ys.ntistss forest ifhem-s themed

entalmakey area. “Ifu areneed

foruardtion,osedwith

them , so

vac-miteddilla.vac-o ordilla.con-on.”

theuth-uth-ent’sskedtil all

ta towill

urersts of

dilla.gnon

sm

It’s YourMoney

Hello, I picked up your e-mail address from DENTAL CHRONICLE magazine. I am adentist, married to—and practicing dentistry with—another dentist. We haverecently incorporated our practice and are beginning to accumulate some capi-tal that I am at a loss as to how to deal with. We are both maximizing ourRSP’s every year and are drawing an income from the practice that puts usboth into the top tax bracket. I have been investigating the purchase of a lifeinsurance plan within the corporation, but I find that the methods of extractingthat capital upon my retirement are greatly dependant on Revenue Canadanot changing regulations or tax laws. Do you have any opinion about thisinsurance? Do you simply invest the money within the corporation and pay thehigh corporate tax on your investment income? Or would it be better to divi-dend it to my spouse and I, and pay our tax and invest it personally. Is there adramatic difference in tax on investment income on a personal level versus ona corporate level? Thanks for your time. Dr. J.

Thank you for an excellent question Dr. J. You describe a common challenge.

First of all, the top tax rate on earnings in Ontario is 46.4 per cent while your corpo-

ration pays 16.5 per cent up to 500K per year, (15.5 per cent in July). The tax rate on

investment income is the same 46.4 per cent personally but 48.7 per cent corporate-

ly. In both cases, half for capital gains and two-thirds for dividends. What it means is

that leaving money in the corporations saves you 29.9 per cent (soon 30.9 per cent),

but you face higher taxes when investing in the corporation.

That last comment might make it seem logical to pay it out and invest personally,

since the tax rate would be a bit lower on the growth, but giving up almost a third

before you even start doesn’t make sense, not to mention erasing the whole point of

having the corporation in the first place.

There are several ways to invest without incurring this significant tax. Using a life

insurance policy as you mentioned can work, but future tax changes isn’t the prob-

lem. The big concern is getting a program that provides full disclosure, works effec-

tively, and has a reasonable chance of actually delivering on projections (many

don’t). Like running a practice; if you can’t generate revenue and manage your

costs, you likely won’t make money. (We actually felt the need to design our own pro-

gram to truly maximize growth and minimize expenses.)

There are other options depending on your objectives. What I recommend is letting

us provide you with a complimentary financial practice analysis. This calculates your

taxes both while you practice and when you retire, gives you projected net incomes

under differing structures, giving you both a lot more information on which to base

decisions. You can email me for the form we need completed to do this, which does-

n’t need to be precise and should take no more than about five minutes. All informa-

tion provided is kept strictly confidential.

Send your questions to: mark@strategicedge.net

Mark O’Farrell is a chartered financial consultant to the dentistry profession and pro-

vides complimentary financial practice analysis to dentists across Canada.

Website: www.strategicedge.net

Toll-free phone: 1-866-682-4829 (1-TOO-MUCH-TAX)

Mark O’Farrell

Clinical laser updatecontinued from page 1—

Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:37 PM Page 5

Hmolapreseing oand M

sion,the dsurgCaroresealarge

studyhavethosthirdincrenon havethe istudypatiewerethird

BMI CInveagedmatiical accoone third342 and h69 sua me

and

Vin

Acy

Mad

By By the

By Iwe

your

pictures can give you an erroneous view of what isgoing on, and it can lead to misdiagnosis. Digital imag-ing is less invasive for patients.”

Dr. Jensen made a six-figure investment to equiphis office with digital technology and he estimates thatabout one-third of dentists in Canada have digitalequipment that allows them to use equipment likefibre-optics.

“It allows me, as an orthodontist, to measure thedigital X-ray as if I’m measuring that particular object inthe patient’s mouth,” says Dr. Jensen. “There is an algo-rithmic formula in the digital world that scales the sizeof the picture on the screen.”

If patients see the problem, they are willing tospend funds for dental treatments, and the use of digi-tal technology permits dental practitioners to accurate-ly display oral health challenges, according to Dr.Jensen.

“If a patient has a problemwith their temporomandibularjoint, a normal X-ray won’t cap-ture the problem,” he says. “Thedigital world can allow thepatient to see what is wrong withtheir jaw, for example.”

PRACTICE IS MORE EFFICIENTDr. Everardo Ramirez, a dentist based in Kitchener,Ont., says the use of digital imaging in his practice ren-ders it more efficient. Digital imaging helps dentists todeliver better dentistry, provide more accurate diagno-sis, and depending on the case, save a tooth or find oralhealth conditions.

“The patient gets a fraction of the amount of radi-ation that he or she would get in normal radiography,”says Dr. Ramirez. “It is faster, and there are no chemi-cals involved in the processing, so it is environmentally-

friendly. The images can be stored in a computer andcan be sent to your colleagues or to an insurance com-pany.”

A review article published in Oral Radiology in 2004cited numerous disadvantages to the continued use ofanalog film including the cost of film and solutions, thecost in processing equipment and darkroom space, andhuman resources necessary for processing and proces-sor maintenance. In addition, the low photon efficien-cy leads to a comparatively high radiation dose, andduplications of the images are always inferior to theoriginal image. Moreover, processing chemicals aretoxic to the environment and costly to dispose of.

The use of microscopy has applications forendodontic procedures and for the placement ofimplants, he explains.

Dr. Ramirez uses microscopy because it providesadded magnification to a dentist’s field of vision. “Weare working with a field that is small, so there are vitalstructures that we need to see better,” he says. “I use itfor implant surgery and when I perform root canals.You need to see the nerves [of the tooth] if you aregoing to place an implant. You would need to see if itis in the path of the implant.”

Dr. Paresh Shah, a clinical instructor in the facultyof dentistry at the University of Manitoba in Winnipegand a member of the advisory board for DentalChronicle, agrees that patient safety is vastly increasedwith digital imaging.

BIG IMPROVEMENT IN DIAGNOSTICS“If it’s quicker, faster, easier, and safer, then that is thebetter option,” says Dr. Shah, who holds a proficiencycertificate in esthetic dentistry from the State Universityof New York at Buffalo.

The image is expanded and permits improved con-trast, he explains.

“Diagnostics improves dramatically,” says Dr.Shah, a past board member of the Manitoba Dental

Association. “The best system is theone where the sensor goes right in themouth. You take a picture, andthrough a USB connection, the picturegoes right to your screen and you havethe picture in one second. You don’thave to wait for the image to developand find out if you need to re-take pic-tures.

“The sensors are thicker than con-ventional film, and it takes some gettingused to placing the sensors,” says Dr.Shah. “It’s a little bulky for patients whogag, but you can practice enough to placeit properly. The resolution that you get,the clarity that you get, and the diagnosticability you get is first class. The cost ofthe system doesn’t bother me because ofthe time that we save.”

In addition to the more obviousbenefit of enhancing a practitioner’svisual field, ergonomics is what droveDr. Shah to using microscopy in his

practice.“I went to magnification for the reason of

ergonomics,” says Dr. Shah. “I was having neck painand shoulder pain from slouching. Automatically,once I started using magnification, I was able to sitwith a more ergonomic, upright posture. My neckpain and shoulder pain went away. The use of mag-nification provides more comfort and better func-tion.”

The enhanced view results in better treatmentbecause of more accurate diagnosis of what is takingplace in the oral cavity.

“You can’t treat what you can’t see,” he said. “Ifyou can’t see the problem, how will you even knowthere is a problem? If you magnify something, you seeit better. We are treating areas where there is blood andsaliva, and sometimes the human eye doesn’t see thosethings. It is helping us do a better job.”

Microscopes have traditionally been used by spe-cialist practitioners who perform endodontic proce-dures such as root canals, but more and more generaldentists are using microscopes for restorative dentistry,according to Dr. Shah.

“It is a learning curve,” says Dr. Shah. “You canattach a camera or video camera to the lens, so you canphotograph what you are doing and project it onto ascreen. It can be interactive from a diagnosis point ofview because you can show the patient what is goingon. The patient can see the bone, the tooth, and thecavity.”

Microscopes are being used for periodontal plasticsurgery, where fine needles and sutures on the gums arebeing applied. “They are hard to put in place using justthe eye alone,” says Dr. Shah.

SOFT TISSUE LASERS OF BENEFITMany practitioners use soft-tissue lasers for gum prob-lems. They can treat root sensitivity on a tooth. Onestudy demonstrated that hypersensitivity can be suc-cessfully treated with low-level laser therapy (LLLT).Indeed, dental lasers may be used to seal tubules locat-ed on the root of the tooth that are responsible for hotand cold tooth sensitivity.

“I use it to recontour gum tissue for esthetic rea-sons,” says Dr. Shah, noting it can be used to treatcanker sores.

The use of a diode laser can overcome a herpeticlesion, which is a contraindication for a dental visit. “Ican treat cold sores in a minute,” says Dr. Shah.

Another application for LLLT is the treatment ofmucositis prior to radiotherapy/chemotherapy inpatients undergoing radiotherapy/chemotherapy. Stillanother application of LLLT is the reduction or elimi-nation of paresthesias that may present after oral sur-gery, particularly in the mandibular region.

Low-intensity, soft-tissue dental lasers may also beused to speed up the bleaching process associated withteeth whitening.

High-powered lasers such as the carbon dioxidelaser has a potential application in oral surgery, and theArgon laser can be used in minor surgery and compos-ite curing.

continued from page 1—

ClinicalNewsNew technologies lead to improved diagnostics and patient care

6 n March 31, 2010 DentalChronicle

DDrr.. SShhaahh

De

Ali Sigal (right), a second year dental student at the University of

Toronto, organized a weekend event in Oakville, Ont. that was

designed to make people with special needs feel more comforable

about getting their teeth cleaned. She was joined at Sharing

Smiles by fellow dentistry students, and the past-president of the

Ontario Dental Association, Dr. Larry Levin.

(Simon Wilson/Canadian Press Images)

Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:37 PM Page 6

HAVING VISIBLE THIRD MOLARS RAISES

the potential for periodontalinflammatory disease on non-third

molars, according to longitudinal datapresented in Toronto at the annual meet-ing of the American Academy of Oraland Maxillofacial Surgery.

Speaking at an oral abstracts ses-sion, Dr. David Hill Jr., chief resident inthe department of oral and maxillofacialsurgery at the University of NorthCarolina, Chapel Hill, noted that theresearch he was reporting on is part of alarger analysis.

“This is a component of a broaderstudy,” said Dr. Hill. “Historically, wehave two different population studies:those who have visible presence of athird molar and whether that results inincreased risk of periodontal disease onnon third-molar teeth and those whohave third molars that are not visible andthe impact on periodontal disease. Thisstudy looked at the differences betweenpatients who had no third molars thatwere visible and those who had visiblethird molars.”

BMI CRITERION FOR STUDY PARTICIPATIONInvestigators recruited adult subjectsaged 14 to 45 years with four, asympto-matic third molars to two academic clin-ical centers. They divided subjectsaccording to whether there was at leastone third molar visible or whether allthird molars were not visible. A total of342 subjects were in the visible group,and had a median age of 26. There were69 subjects in the not visible group, witha median age of 21.

Both groups had low tobacco use,and there was no statistical difference

between the two groups, according toDr. Hill. Subjects in the visible groupwere more likely to have completed col-lege than those in the not visible group,p<0.01.

The researchers defined periodontalinflammatory disease as the presence ofa probing depth of greater than or equalto 4 mm in at least one non-third molar.Investigators rounded the number to thelowest whole number.

Subjects with diabetes were exclud-ed from the study, as well as subjectswho had very severe periodontal diseaseprior to enrolment. Additionally, ifpatients had taken antibiotics in the pastthree months they were excluded fromthe study.

The American Academy ofPeriodontology would call for excludingsubjects who have a body mass index(BMI) of more than 29 in the study,noted Dr. Hill.

“The reason for BMI being a crite-rion is that it has been found thatpatients with a BMI of greater than 29have an increased level of serum inter-leukin-6,” explained Dr. Hill, noting therelationship between IL-6 and thepathogenesis of periodontitis.

Investigators measured probingdepths to diagnose periodontal inflam-matory disease, defining periodontal dis-ease as a probing death of greater thanor equal to 4 mm.

“Each tooth had six sites wherethese probing depths were monitored,”explained Dr. Hill.

PATIENTS SHOULD BE ALERTEDDr. Hill and his fellow researchersfound that patients in the visible groupwere significantly more likely to have atleast one probing depth greater than 4mm on non-third molars when com-pared to patients in the not visiblegroup, 59 per cent vs. 35 per cent. Inboth groups of patients, 1st and 2ndmolar teeth were more affected thannon-molar teeth, when controlling fordifferences in age between the twogroups.

“Our findings suggest visible pres-ence of asymptomatic third molars maybe an indicator of periodontal inflam-matory disease in non-third molars,”said Dr. Hill. “Although all visible,asymptomatic third molars may not berisk markers for periodontal pathology,

patients should be alerted that visiblethird molars and adjacent molarsshould be monitored over time for thispossibility.”

The goal of the research is to edu-cate the public regarding the need forpatients to have their wisdom teethremoved, said Dr. Hill. “Even if patientsare asymptomatic, they are prone toother issues,” he said.

ONGOING STUDY TO EXAMINE OTHERISSUES, SUCH AS ANGLE OF THIRDMOLARSWhile Dr. Hill did not cite statistical dataon how many patients have third molarsextracted, patients with better dentalcare are more likely to have their thirdmolars extracted, he said.

“The percentage would be higher forthose who have maintained normal, rou-tine dental care,” said Dr. Hill. “As a

result, they are more educated about it.They are in the dental office more often,and they are more likely to be referred forextraction of their wisdom teeth.”

The longitudinal study, which isongoing, will also look at other issues,such as the angle of third molars and thedegree of impaction, to assess if thosefactors have an influence on the presenceor absence of periodontal disease, headded.

Previous studies have observed thelink between visible third molars and peri-odontal disease.

A study on pregnant women pub-lished in the Journal of Oral andMaxillofacial Surgery in 2007 found sub-jects’ detected levels of periodontal dis-ease were greater at enrolment and post-partum if visible third molars weredetected.

—Louise Gagnon

Visible third molars raise periodontal disease potential on other molarsn Goal of research is to provide more evidence that it is in the best health interest of most people to have wisdom teeth removed

Access your product informationyour product informationyour way your way through Dental Chronicle’s

READER SERVICE

More information is available on all of theadvertised or highlighted products in this

edition of Dental Chronicle

By FAXBy FAX Go to page 25, circle the number ofthe product, provide your contact info and

fax (toll free) to 1-800-865-1632

By PHONEBy PHONE Call our toll free Reader Service Hotline at 1-866-632-4766

By INTERNETBy INTERNET Go to our product informationweb site, indicate the product, and pr ovide

your contact info: www.dentalchronicle.info

We'll do the rest

n ofpaincally,o sitneckmag-unc-

mentaking

. “Ifknowu seed andhose

spe-roce-neralistry,

canu cannto ant ofoing

d the

astics are

g just

rob-Onesuc-

LLT).ocat-r hot

rea-treat

peticit. “I

nt ofy inStill

limi-sur-

o bewith

oxided thepos-

icle

Osseointegration remains one of the biggest challenges in implant

dentistry, and scientists from North Carolina State University report

they have developed a ‘smart’ coating that could help hip, knee, and

tooth replacements bond more closely with bone, and ward off infec-

tions. Their research, which received funding from the U.S. govern-

ment, could open doors to much safer and functional implants in den-

tistry.

According to the researchers, the new coating is comprised main-

ly of hydroxylapatite, a naturally occurring mineral also found in dentin

and dental enamel. When applied to an implant it creates an amor-

phous outer layer touching the surrounding bone. This layer will dis-

solve over time, releasing calcium and phosphate, and encourage

bone growth into the coating.

“We call it a smart coating because we can tailor the rate at which

the amorphous layer dissolves to match the bone growth rate of each

patient,” says Dr. Afsaneh Rabiei, an NC State associate professor of

mechanical and aerospace engineering and co-author of a paper

describing the research. “This is important because people have very

different rates of bone growth.”

He added that his team also incorporated silver nanoparticles

throughout the coating to act as antimicrobial agents as the amor-

phous layer dissolves. This will not only limit the amount of antibiotics

patients are likely to require following surgery, but provide protection

from infection at the implant site for the life of the implant, Dr Rabiei

said.

Current coating processes utilized in dentistry that involve hydrox-

yapatite and other forms of calcium phosphate, have shown several

disadvantages and limited flexibility in controlling coating crystallinity.

Earlier studies also found that hydroxylapatite may not resorb quickly

enough, and consequently block the space for the growth of new

bone tissue.

—Daniel Zimmermann, DTI files

Scientists develop smart coating for dental implantsnn Coating can be tailored to patient’s rate of bone growth

March 31, 2010 n 7DentalChronicle

Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:37 PM Page 7

ClinicalNewsSleep apnea: Options for patients who can’t (or won’t) use a CPAP devicen CPAP considered the gold standard for treatment of sleep apnea, but some patients are looking for additional options

MAXILLOMANDIBULAR ADVANCE-ment (MMA) surgery can be per-formed to treat severe obstructive

sleep apnea syndrome (OSAS) in patientswho choose not to use continuous posi-tive airway pressure (CPAP), according toresearch presented at the annual meetingof the American Academy of Oral andMaxillofacial Surgery in Toronto.

“CPAP is the gold standard for treat-ment [of OSA],” said Dr. Susan Conrod,a resident in oral and maxillofacial surgeryat Dalhousie University/Queen ElizabethII Health Sciences Centre in Halifax, andone of the study’s investigators.

“Most patients try CPAP firstbecause it is the gold standard and

because it is non-invasive,” said Dr.Conrod. “These patients did not want touse CPAP for one reason or another. Theydid not like to use it every night to sleep.”

The patients in the retrospectiveseries were referred for surgery either bya sleep specialist, family physician, den-tist, or specialist dentist, such as anorthodontist, she said.

QUALITY OF LIFE AFFECTEDThe patients had respiratory disturbanceindices (RDIs) of greater than 100,noted Dr. Conrod, with any numberabove 30 indicating severe OSAS.Having OSAS has a definite impact onthe quality of life of patients, she added.

“Greater than 100 is probably the

most severe [apnea] that we have seen,”said Dr. Conrod. “We wanted to look atpatients with very severe sleep apnea.These are patients who almost never geta good night’s sleep. One of the patientssaid he was unable to drive and was evenafraid to take the bus because he wasafraid he would fall asleep on the bus.

“The sleep apnea can be detrimen-tal to their health,” she said. “We wantedto see what the results of the surgerywere with this group of patients. Wewanted to see how much benefit theywere getting from the surgery.”

Investigators performed a chartreview of 175 patients who had under-gone MMA surgery between 1996 and2008. They found 12 patients, including

nine males and three females, who hadRDIs of more than 100 and who hadundergone the surgery between 2000and 2006. The patients had a mean ageof 38, with a range of 26 to 50.

“The surgery is designed to advancethe maxilla or upper jaw and the lowerjaw,” she said. “The idea is by advancingthose things and the associated tissues,then the airspace is increased. They are lesslikely to obstruct when they are sleeping.”

The pre-operative polysomnographshowed a mean RDI of 119.2, and amean minimum oxygen saturation of72.1 per cent. Patients had a post-op,mean RDI of 17.3 and a mean minimumoxygen saturation of 85.5 per cent, withnine of the 12 subjects having RDIscores of less than 15. Statistical analysesfound significant enhancements in bothRDI (p<0.001) and minimum oxygensaturation (p=0.008) after MMA surgery.Patients were followed for an average of9.5 months after surgery.

Investigators had pre-operativeEpworth Sleepiness Scale (ESS) scores foreight of 12 patients. The mean pre-opera-tive ESS score was 12.7. The postopera-tive mean ESS score was 5.0, a differencethat was statistically significant at p=0.007.

“Everyone who responded to thequestionnaire indicated they experiencedan improvement in quality of life,” shesaid. “They said that the surgery wasworthwhile, and that they would under-go it again.”

Indeed, where all eight patients whoresponded to the questionnaire reportedhaving daytime sleepiness prior to sur-gery, only one patient indicated theycontinued to have daytime sleepinessafter undergoing surgery.

Each patient undergoes a clinicalexamination and radiographic examinationto assess feasibility of the MMA surgery.

“We want to see the diameter of theairway and the position of their upperand lower jaw,” she said. “Because we areadvancing them, and if they already hada maxillomandible positioned anteriorly,then we would not have as much roomto bring them forward and thus make asignificant improvement. In mostpatients, there is enough room for us toperform the surgery.”

The patients who would not be con-sidered medically fit for any surgerywould not be regarded as candidates forMMA surgery.

—Louise Gagnon

8 n March 31, 2010 DentalChronicle

The principle of good patient care is key to ensuring a successful career in oral and maxillofacial surgery.

Speaking in Toronto at the annual meeting of the American Academy of Oral and Maxillofacial Surgery (AAOMS)

about one’s man journey from residency to near retirement, David Rainero, DMD, an oral and maxillofacial sur-

geon based in Walnut Creek, Calif., said other concerns should always be secondary to patient care.

“No matter what you do, never lose sight of the patient,” said Dr. Rainero, a fellow of the AAOMS who has

30 years of experience. “You can be financially very successful or be a very good surgeon, but if you don’t

take good care of patients, it doesn’t make any difference. Everything else will fall into place if you are taking

good care of patients.”

Clinicians can become disorganized very quickly in a maxillofacial surgery practice if systems are not in

place, said Dr. Rainero. “It’s important to have systems of organization and standardization of protocols.”

Risk management can be achieved in an oral and maxillofacial surgical practice through the implementa-

tion of protocols that create a safe environment for a patient, said Dr. Rainero.

In his practice, he devised documentation relating to various aspects of the practice. He has developed

forms for employee evaluations, inventory, schedules, and patient management. Many offices are now adapt-

ing their forms in an electronic medical record format, said Dr. Rainero. In addition, he has developed check-

lists of how to take care of patients and how to do so in a safe manner.

“Some of the protocols have been modified over the years because they didn’t work at first,” he added.

A contemporary scenario is one in which a young resident joins an established oral and maxillofacial sur-

gery practice, with an aim to becoming a partner or taking over the practice when the senior partner retires.

“A high percentage of those fall apart after one to two years,” he said. “That is the biggest pitfall that res-

idents face. It happened to me and to many others I know. You can take steps to avoid it, but [the agreements]

fall apart because people didn’t get enough information before they started.

“The transition from being an employee to being a partner is where things fall apart,” he says. “This is

because each doctor had a different idea of how that would happen, both in the amount of time it would take,

the amount of money it would take, and how they would practice. Some people have a whole different philos-

ophy of how they would practice. It ends up being like a bad marriage."

Clinicians need to ask the right questions of each other before they begin a working relationship.

“There are also financial considerations that need to be spelled out beforehand,” he said. “A clinician might

put a dollar value on their practice that the resident does not agree with.”

In his experience, there are generational differences in attitudes toward fair financial compensation and the

amount of hours that clinicians should work in an average week. Older clinicians also need to welcome the input

from younger clinicians who work alongside them. “Some of the older practitioners resent the knowledge that

younger clinicians have about technology,” he said. “That kind of approach will not get them very far.

“They [residents] are coming out of training completely paperless, and we are making the difficult transi-

tion from the paper-based office to being paperless. We know we have to make that adjustment. There's so

much we can learn from them.”

The rule of thumb should be that each party come to the table with an open mind so that the working rela-

tionship is fruitful, according to Dr. Rainero. —Louise Gagnon

What’s the secret to a long and successful career? Good patient carenn Oral and maxillofacial surgeon provides insights into clinical practice management

Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:37 PM Page 8

hadhad

2000n age

vanceowerncingsues,e lessing.”raphnd an oft-op,mumwithRDIlysesbothygengery.ge of

atives forpera-pera-ence.007.

thenced

” shewas

nder-

whoorted

sur-they

iness

nicalationery.f theppere are

y hadiorly,oomake amostus to

con-rgerys for

gnon

icle

Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:37 PM Page 9

10 n March 31, 2010 DentalChronicle

ClinicalNewsPacific Dental Conference to be held at expanded Vancouver facilityn Expanded exhibit hall in Vancouver Convention Centre West Building to host more than 500 exhibitor showcases

IF THE SUCCESSIVE YEARLY INCREASES

in delegate numbers at previous con-ferences are any indication, there

will be a record number of attendeesagain this year at the Pacific DentalCon ference in Vancouver, April 15 to17.

“We expect 11,000 plus partici-pants,” says conference director Dr.Marke Pedersen, of Vernon, B.C., presi-dent of this year’s conference.

“It’s the biggest meeting, period,that occurs annually in Vancouver. Itincludes people representing all aspectsof dentistry: dentists, hygienists, certifieddental assistants, front desk people,receptionists, students, and theexhibitors.”

The three-day event will be packedwith Hands-on-Courses, Open Sessions,continuing education courses concurrentmeetings of associated societies andalumni meetings, and special events.

HIGHLIGHTS OF SCHEDULED SPEAKERSThe scientific program begins at 8:30a.m. Thursday and continues until theend of Saturday afternoon. More than100 speakers will discuss and or demon-strate on a wide range of topics, fromanesthesia to restorative/operative den-tistry.

Speakers include Janet Press, a Fel -low of the American Academy of LaserDentistry who will talk about diode lasertherapy and how patient acceptance ofthis therapy is increased when it is intro-duced as an adjunct to care.

Dental surgeon Terry Ratkowski,who served a stint in Afghanistan, willdiscuss the conflict there and describethe on-site medical and dental facilitiesavailable to treat injuries and maxillofa-cial trauma.

In his lecture Tobin P. Bellamy willrecommend several procedures for thegeneral dentist to follow in clinical situa-tions, includingextraction of thefirst molar anddealing with thesinus.

C h a r l e sShuler, dean andprofessor of theUniversity ofBritish Columbia’s faculty of dentistryplans to discuss the latest researchregarding the use of bisphosphonatesand their associations with osteonecro-

sis, and advise on how to prevent thisside effect.

SPECIAL EVENTS AT NEW CONVENTION CENTREThursday, 5:30 p.m. to 7 p.m. Wineexpert David Lancelot offers samplesfrom his hand-picked choices of small-production, fine wines from countries inthe southern hemisphere during thisalways well-attended Life is Too Short toDrink Bad Wine event. On the 3rd FloorFoyer. Price: $37.00 + GST.

Friday, 6:45 p.m. to 10 p.m. Yourchance to “burn the floor” on a techno-lit dance floor during Abba Cadabra, aperformance tribute to the Swedishgroup ABBA. Cost: $25.00 + GST.

Saturday, 6 p.m. to 1 a.m. The BritishColumbia Dental Association presentsits Toothfairy Gala, a fund-raising and

awards gala in support of the B.C.Cancer Agency’s Dental EmergencyRelief Fund. A champagne receptionprecedes a four-course gourmet dinner,awards ceremony, silent auction, anddance. Cost: $225.00 + GST. Ticketsmay be purchased via the conferenceweb site www.pdconf.com . Tables of 10are available.

A FEW SUGGESTIONS FOR DINING OUT IN VANCOUVER Sun Sui Wah is renowned for its roast-ed squab, just one of several signaturedishes. The main menu also includeslobster and sprawn, dungeness crab andgeoduck. 3888 Main Street. Reservationsrecommended. 604-688-7466.

Ciopinnos Mediterranean Grill wasjudged Vancouver Magazine’s “Restau rantof The Year.” In addition to a regularmenu that includes linguini with half lob-

ster and crab risotto, Chef Pino Posteraroalso offers 10 daily specials. 1133 HamiltonStreet. Valet parking. Reservations recom-mended. 604-688-7466.

Blue Water Cafe features Arctic char,West Coast Sable Fish, and WhiteSturgeon among others as its mainplates. The restaurant also has a raw barthat features oysters, sushi, sashimi andnigiri. 1095 Hamilton Street. Valet park-ing. Reservations recommended but“will attempt to accommodate.” 604-688-8078.

West has a complete menu featuring fish(squab, lobster), beef (rib eye steak, ten-derloin), lamb, and chicken. 2881 SouthGranville. Valet parking. Reservationsrecommended but “will attempt toaccommodate.” 604-738-8938.

PLACES TO GO, THINGS TO DO Vancouver Art Gallery. Running untilMay, Leonardo da Vinci: The Mechanicsof Man is an exhibition of 34 of theartist’s pen and ink anatomical drawingson 18 sheets of paper. Drawn during thewinter of 1510-1511, the works are onloan from Her Majesty Queen ElizabethII from the Royal College, Windsor. TheVancouver Art Gallery occupies anentire downtown city block bounded byGeorgia, Hornby, Robson, and Howestreets. Tickets: Adult: $19.50. Seniors:$14.00; Children:$7.00. 604-662-4700.

Pacific Theatre. An off-Broadway suc-cess, Refuge of Lies, by Canadian play-wright Ron Reed is a play about a formeryouthful Nazi collaborator—now an 82-year-old man—living in Vancouver. Thestory of “one man’s experience withfinding himself trapped in a world ofdeception” according to a reviewer. Boxoffice: 604-731-5518.

Stanley Park has so many points ofinterest it will take more than one visit toview them all. The Brockton PointLighthouse and nearby totem poles,Prospect Point, and the VancouverAquarium are just a few of many thatshouldn’t be missed. You can walk, jog,drive, or rent bicycles or rollerbladesavailable at stores on Georgia andDenman Streets.

More information at www.pdconf.com

DDrr.. BBeellllaammyy

Vancouver’s ever-evolving skyline includes many recentupgrades. The just-expanded Vancouver Convention Centre atCanada Place (above) is the site of the Pacific Dental Conference

Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:37 PM Page 10

$300-$600 a day is typical of the revenue dentists add to their practice after making a Waterlase MD Turbo part of their treatment offerings.

A study soon to be published by the Roger Levin Group indicates that the Waterlase MD helps attract

new patients and increase treatment acceptance of day-to-day restorative cases that can cover the cost

of a laser by providing an alternative to needles and drills, for patients who are anxious or fearful.

When you are ready to move beyond restorative laser dentistry, the Waterlase MD and Biolase’s

unmatched training programs provide you with new easy-to-learn options for the management of

moderate to severe periodontal disease, endodontics, and soft tissue procedures to add to your treatment

offerings.

Contact your Biolase Laser Specialist at 888-424-6527 or your Henry Schein consultant

at 800-645-6594 to discuss your return on investment in laser technology.

Deep Pocket Therapy with

New Attachment™

NEW Radial Firing Perio Tip™ provides an easy-to-learn, minimally-invasive

alternative treatment for moderate to advanced periodontal disease.

Easy Class V and Other

Day-to-Day Cavity Preps

performed quickly and with minimal or no bleeding.

Multi Quadrant Same Day Convenience

and Greater Patient Comfort

lead to increased case acceptance and new patient referrals.

Now FDA cleared for calculus removal in pockets with periodontitis.

And for All Your Diode Laser Needs

Now Faster! High-speed Turbo

Cutting of Hard Tissue

Works with no noticeable difference in cutting speed compared to a high-speed

drill according to clinicians. Existing Waterlase MD owners can

upgrade to Turbo speed by contacting their Henry Schein Consultant.

Attract New Patients and Increase Treatment Acceptancewith the Waterlase MD™ Turbo Hard and Soft Tissue Laser

The BiolaseTotal Solution

Practice Integration

Service +Support

ClinicalR+D

Industry Leading Technology

Training + Certification

New!

• ComfortPulse™ for Greater Patient Comfort during Soft-tissue Procedures

• 20-minute Full-mouth Whitening

• Hygiene Applications

• TMD Pain Therapy & Relief

• Battery Pack Portability

The ONLY Total

Diode Solution with

WHITENING AND PAIN THERAPY HANDPIECE

940

© 2010 Biolase | Biolase.com

Wehthtiw

aercnIttA

T™DMesalretaW

mtaere TTrsawet Ncart

dnadraHobruTTu

ct Anemneitaw P

saLeussiTtfoS

cnatpeccdns atn

re

ecWehthtiw

tfeve03$

TDMesalretaW

g a Wnikar metstsiistnee dunea0 a d06$-00

dnadraHobruTTu

De MsalretaWWar pieho td tds a

fl oacipyyps ttyiya

saLeussiTtfoS

obruD TTuecitcarp

ehf t

re

oyneh

esala

tapw

ydut

ratf

arotserdnoyebevomotydaererauo

deenotevitanretlanagnidivorpybre

tpeccatnemtaertesaercnidnastnei

eLregoRehtybdehsilbupebotnoos

aerr tiehf tt org a Wnikar met

MesalretaWeht,yrtsitnedresalevita

aeraohwstneitaprof,sllirddnaseld

sesacevitarotseryad-ot-yadfoecnat

alretaWehttahtsetacidnipuorGnive

nireffffet onemtaDe MsalretaWWa

s’esaloiBdnaDM

.lufraefrosuoixn

tsocehtrevocnactahts

tcarttasplehDMesa

.sgnobruD TTu

6-008

tcatn

sgnire

tared

hctam

y

inonruterruoyssucsidot4956-546

tatsilaicepSresaLesaloiBruoy

.s

dne,esaesidlatnodoireperevesotet

wuoyedivorpsmargorpgniniartdeh

yy

.ygolonhcetresalnitnemtsevn

ehcSyrneHruoyro7256-424-888

serudecorpeussittfosdna,scitnodod

ehtrofsnoitponrael-ot-ysaewenhti

,y

ntatlusnocnie

tnemtaertruoyotddaots

fotnemeganame

spery Ptivay CCaaD-ot-yaD

rehtd Ons V asaly CClsaE

r Petaerd Gna

at Snardaui QtluM

troffomot CConeitaP

ecneinevnoy CCoae Dma

r Nesaoir DuoYo

r Aod ffonY

L sdeeNedo

llA049

.gnideeo blr nl oaminimhtid wny alkciud qemrofrepspery Ptivay CCaaDotyaD

aw ped nnaesaercno id tael

r Petaerd Gna

weN

.slarrefet rneitecnatpecce asad c

troffomot CConeitaP

r NesaL

ulSdiD

Y TToLNe OhTTh

a

ne

nu

sst Crt

s

cW

deeN

htin woitu

latoTTo

in Therapy & Relief

Applications

te Full-mouth Whitening

sue ProceduresComfort during

for Greater™Pulse

tnatlusnon Ciehcy Srner Hiehtcatnoy cd beepo sbruo Te tdargpu

s crenwD oe Msalretag WnitsixE.snaicinilo cg tnidroccl alirds-hgio a hd tearpmod ceepg snittunereffie dblaecitoo nh ntis wkroW

eussid TTiraf Hg onittuC

brud TTueeps-hgi! Hretsaw FFaoN

red pecnavdamtaere tvitanretlanarel-ot-ysan ea

niril FaidaW REN

tw AeN

ekcop PeeD

.gnitc

nac

deepsne ic

ob

e kcon pl iavomerlA cDw FoN

.esaesil datnodoiroe ttaredor mot fnem

evisavni-yllamini, mnsedivor™ ppio Tireg P

™tnemhcatt

htiy wpareht TThe

.sititnodoireh ptis wtesuluclar cod ferae

s

noitulol SatoTToesaloie BhT

aloi0 B10© 2 Battery P

D+RlacinilC

onhceTTetsudnI

a

moc.esaloie | Bs Pack Portability

ygolognidaey Lrt

noitacfiitreCg + niniarTTr

in Therapy & Relief

noitargetnIecitcarP

roppuSecivreS

tr+icle

eraromiltoncom-

char,Whitemainw bar

andpark-

but604-

g fishten-

outhtionst to

untilanics the

wingsg thee onbethThe

s and by

Howeniors:0.

suc-play-rmern 82-Thewithd ofBox

s ofsit toPointoles,uverthatjog,

ladesand

com

Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:37 PM Page 11

ClinicalNewsSteps you can take to help preserve your practice revenuen Identifying and separating variable expenses and fixed expenses key to maximizing profit for the efficient dental practice

There are certain steps dentists can taketo avoid the loss of significant rev-enues, according to a former practic-

ing dentist and consultant on maximizingprofit and efficiency in a dental practice.

Speaking in Toronto, Dr. CharlesBlair suggested it is crucial to identifyand separate expenses.

“You have variable expenses, andyou have fixed expenses,” Dr. Blair, anauthor and contributing editor to Dental

Economics, said during a presentation atthe annual meeting of the AmericanAcademy of Oral and MaxillofacialSurgery. “Rent would be a fixed expense.Marketing is also a fixed expense.”

Costs like supplies and laboratory

costs are largely variable expenses,according to Dr. Blair, president of Dr.Charles Blair and Associates, Inc. inMount Holly, N.C.

It is key to calculate a true estimateand the reality of overhead expenses. If adentist is spending $100,000 annually oncontinuing dental education through tak-ing courses in exotic locations, thatexpenditure should not be regarded asoverhead cost.

There should be a 2 to 1 ratio ofdoctor compensa-tion to staff com-pensation as ageneral rule, saysDr. Blair. “If thestaff compensa-tion was at 22 percent, then we wantthe doctor to have44 per cent com-pensation,” he says.

The goal should be about $200,000of production per non-doctor employeein the office, says Dr. Blair.

GETTING A BETTER HANDLE ON COSTSThe relationship that an oral surgeon haswith a patient is different than the onethat a general dentist has with his or herpatient, notes Dr. Blair. The more irreg-ular nature of the relationship can affectpayment plans.

“You basically see the patient forprescription dentistry,” he says. “Withthat, you like to encourage payment upfront since you don’t see the patient reg-ularly. We also like to give the patientsome options…the bottom line is tomake sure the office does not take a hit.”

The practice can be more efficient ifscheduling can permit multiple extrac-tions as opposed to single extractions atone visit, notes Dr. Blair. “You wouldlike to make more money in a singlevisit,” he says.

It is generally a good principle to keepcredit tight for patients, but dentists shouldaccept all major credit cards. Financing canbe long-term, which is usually over 12months, or it can be interest-free. “Theidea is that we want to create a plan that isin the budget for patients,” he says. “If youoffer up to a year, they will ask for a year.You should ask the patient how much timeis needed to pay for a $1,200 treatment.

“They may say they need three orfour months. Don’t advertise that youoffer a longer-term financing program,” hesays. “If they say they need a longer peri-od, then you could mention it is available.”

—Louise Gagnon

EMS-SWISSQUALITY.COMEMS-SWISSQUALITY.COM

1+1=3THE NEW AIR-FLOW MASTER PIEZON – SUB- AND SUPRAGINGIVAL AIR POLISHING PLUS SCALING – FROM THE NO 1 IN PROPHYLAXIS

For more on prophylaxis > www.ems-swissquality.com

Sub- and supragingival air polishing

as with the Air-Flow Master. Plus

scaling as with the Piezon Master

700. It all adds up to three applica-

tions in one with the new Air-Flow

Master Piezon, the latest develop-

ment from the inventor of the

Original Methods.

PIEZON NO PAINVirtually no pain for the patients

and extra-gentle on the gingival

epithelium: maximum patient com-

fort is the decisive plus brought by

the state-of-the-art Original Piezon

Method. Not to mention the

uniquely smooth tooth surfaces.

These extra benefits are the result

of linear oscillating action aligned

with the tooth surface delivered by

the Original EMS Swiss Instru-

> Original Piezon Handpiece LED with EMS Swiss Instrument PS

> Original Air-Flow and Perio-Flow handpieces

ments and matched perfectly to the

new Original Piezon Handpiece

LED. Proverbial Swiss precision

combined with intelligent i.Piezon

technology.

AIR-FLOW KILLS BIOFILMGetting rid of harmful biofilm down

to the bottom of deep pockets. This

is the essence of the Original Air-

Flow Perio Method. The subgingival

reduction in bacteria prevents tooth

loss (periodontitis) or implant loss

(periimplantitis). And uniform tur-

bulence of the air-powder mixture

and of water prevents soft-tissue

emphysema – even when reaching

beyond the boundaries of prophy-

laxis – due to the action of the Perio-

Flow nozzle.

And when the job at hand is con-

ventional supragingival air polish-

ing, nothing counts more than the

unequaled efficacy of the Original

Air-Flow Method. Effective, fast,

reliable and stress-free treatment

without damage to the connective

tissue, no scratching of the tooth

sur face. Thanks to the gentle

application of biokinetic energy.

With the Air-Flow Master Piezon,

it all adds up – from diagnosis and

initial treatment to

recall. Prophylaxis

pros are invited

to f ind out for

themselves.

DDrr.. BBllaaiirr

Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:37 PM Page 12

nses,f Dr.c. in

mate If ay ontak-thatd as

o of

0,000oyee

TSn has

oner herrreg-ffect

t forWithnt up

reg-tients tohit.”

ent iftrac-ns at

wouldingle

keephouldg canr 12“Thehat isf youyear.time

nt.e oryou

m,” heperi-

able.”gnon

Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:37 PM Page 13

EN

np

and dtal cpatiebecaronm

StratFarafirst Farathe nfourSuchticesparefrienposeSuchthesresp

Den

In

to

Th

loo

enc

and

sib

res

tre

Ma

ber

inte

pap

hea

to t

Jug

red

pac

bub

shi

had

pro

fro

not

gro

com

tice

as

GSpn D

• All patient information is stored electronically,

eliminating the need for paper charts

• The new Clinical Notes templates eliminate the

need for written treatment notes

• Patients fi lling out new patient and insurance

paperwork online eliminates paper and reduces

time in the waiting room

• Integrating digital radiographs and intraoral

images eliminates the need for hazardous fi lm

processing chemicals

• Electronic appointment reminders help your

offi ce reduce missed appointments as well

as eliminate the need for written or post card

reminders

• eClaims spared approximately 9,000 trees last

year with the submission of insurance claims

and attachments electronically

• The eCentral Insurance Manager eliminates

paper claim reports and a fi ling cabinet by

putting an electronic claim archive at your

fi ngertips

Call 1-800-668-5558 or go to www.henryschein.caGOING GREENGOING GREEN

paperlessTake your Practice

with

Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:37 PM Page 14

ENVIRONMENTAL AWARENESS AND THE

need to act to minimize harm to theplanet is a common theme in 2010,

and dentists are developing environmen-tal consciousness in response to theirpatients’ heightened awareness andbecause of their own worries about envi-ronmental sustainability.

Front Street Dental Centre inStratford, Ont., led by Dr. AliFarahani, has billed itself as Canada’sfirst eco-friendly dental office. Dr.Farahani worked in collaboration withthe nearby University of Waterloo andfourth year honors student MittaleSuchak to explore consumption prac-tices at traditional dental offices, com-pared to those at the environmentally-friendly type of practice that he pro-posed. Dr. Farahani also acted asSuchak’s honors supervisor for herthesis “The En viron mentally-responsible Dental Practice.”

During research, they surveyed

dental offices to determine their levelof dental resources, electricity, energy,chemical and water usage, and waste.They also determined the type offlooring, paint, and lighting found inthe offices, as well as the types of com-

puter monitors and dental vacuumpumps.

“It meansthat we are notextracting morefrom the environ-ment than naturecan produce,”says 34-year-oldDr. Farahani,who opened hispractice in April2007. “When Icreated the office,I thought it wasthe right thing todo. A lot of den-tistry is verywasteful andharmful. We pro-duce two bags ofgarbage in aweek, whereasmost off ices pro-duce that muchgar bage in a day.There is a lot ofgarbage createdjust from one visit.”

Dr. Farahani uses reusable patientbibs, tea tree oil as a disinfectant, anduses re-usable stainless steel tips insteadof plastic suction tips. He calculated thatby using stainless steel he could avoidthe disposal of 100,000 plastic tips to hislocal landfill. In addition, he uses stain-less steel (Hu-Friedy) prophy cups

instead of the disposable ones. Dr.Farahani’s practice saves approximately24,600 gallons of water per year by usinga dry dental vacuum pump from SableIndustries.

“Moreover, we do not have theusual chemical soup that is found indental offices,” he says. “You will notfind the usual chemical smells. Ourpatients appreciate that. We use prod-ucts that are very gentle like hydrogen

peroxide.”While estab-

lishing a very‘green’ dentalpractice repre-sented an addi-tional upfrontcost to Dr.Farahani that heestimates to beabout $75,000more than thecost to launch astandard practice,he has no doubtthat being an envi-ronmentally ethi-

cal entrepreneur will pay off in the longrun.

“I’m certain it will be worth it,” hesays.

For the time being, there is anabsence of incentives or grants avail-able to dentists who want to make theiroffice more ‘green,’’ notes Dr. Fara -hani.

CONCERN ABOUT ENVIRONMENTIn the U.S., the Eco-Dentistry

March 31, 2010 n 15DentalChronicle

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

to examine the primary challenges facing dentists in Canada today.

This first instalment in the 2010 series The Year of Green Dentistry

looks at Best Practices for Green Dentistry, and relates the experi-

ences of some practitioners and industry members as they develop

and adapt to green programs. Publication of this series is made pos-

sible by Henry Schein Canada.

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

responsibility as an active member of the dental industry to look for the

trends that are coming to dentistry,” says Peter Jugoon, Vice President,

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

ber of things around being more environmentally friendly, whether it is

internal or external. For example, our distribution centers have gone

paperless, so people are walking around with

headsets on, being directed by central command

to the bins and the products they need to pick.”

Jugoon noted that Henry Schein has also

reduced paper consumption in their shipment

packing, replacing paper with biodegradeable air

bubble pillows. They are also now using brown

shipping boxes instead of the white boxes that

had to be manufactured through a bleaching

process.

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

front and center,” said Jugoon. “The issue around the environment is

not isolated to dentistry; it’s a global issue that will only continue to

grow as time goes by.

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

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

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

as many green solutions as possible.”

COMING IN THE NEXT ISSUE:

How digital imaging can improve your practice

This Special Report on Green Dentistrywas written by Louise Gagnon, a fre-quent contributor to Dental Chronicle.

SSwwiifftt

DDrr.. FFaarraahhaannii

MMiinnkk DDrr.. CCooooppeerrJJuuggoooonn

DDrr.. FFoonngg

—please turn to page 17

GreenDentistrySpecial Report: What you need to know about going green, part 1n Dentists who choose to develop green practices may find themselves at head of pack with new environmentally conscious patients

Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:37 PM Page 15

SpAssoCanaals ichoistaindispowashof pcan EDAtivesprocmarkings,has adian(www

cerntrendnatioa codisinwherfecte“Thetheirand standpoin

adoprely olosopchemable that systehas thirdusingry anfillin

dentfairlyawarnow therelong

salesIntera debe otake to sting one, the

contin

GDental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:38 PM Page 16

Special Report: What you need to know about going green, part 1Association led by Dr. Fred Pockrass, aCanadian, supports dental profession-als in making environmentally soundchoices, whether it is ordering re-usablestainless steel suction tips instead ofdisposable plastic ones, or switching towashable cloth patient barriers insteadof petroleum-based plastics. A practicecan be certified as eco-friendly by theEDA following assessments of initia-tives in the areas of dental process andprocedures, office administration andmarketing, and office design, furnish-ings, and construction. Dr. Fara hanihas been asked to serve as the Can -adian president of the association(www.ecodentistry.org).

“Dental practices are more con-cerned [about the environment], and thetrend is spreading,” says Larry Town,national sales manager for Miele Canada,a company that manufactures washer-disinfectors for dental instruments,where instruments are cleaned and disin-fected before the sterilization process.“They are increasingly cognizant abouttheir electricity use, water consumption,and use of chemicals from a ‘green’standpoint and from a cost-saving stand-point.”

For its part, Miele Canada hasadopted an approach so that it does notrely on chemicals a great deal. “Our phi-losophy has been to not heavily rely onchemicals, so that dental practices areable to reduce the amount of chemicalsthat the average practice flushes into thesystem,” explains Town. The Sierra Clubhas labelled the dental industry as thethird largest user of mercury in the U.S.,using about 40 metric tonnes of mercu-ry annually to produce silver amalgamfillings.

The phenomenon of ‘greening’ indentistry in North America actually isfairly recent compared to the level ofawareness in Europe, notes Town. “It isnow catching on in North America, butthere has been a push in Europe for along time,” says Town.

Andy Whitehead, vice-president ofsales and marketing for CrossTexInternational, says the business case fora dental practice to go green may notbe obvious, but practitioners need totake the long view that the upfront costto starting a green practice, or convert-ing an existing practice to a greenerone, will save money in the long run forthe practice, and that it will also be

Responsibility for GenerationsMiele Dental Washer-Disinfectors take innovation and performance to the next level to ensure ultimate infection control.

to process instruments, we are committed to the long term protection of the environment. German made. Environmentally friendly.No compromises.

Tel: 888-325-3957www.miele.ca/green

For more information on the G7881 Dental Washer-Disinfector, please contact us:

continued from page 15—

Case StudyWhen they moved their dental office from one location on Martindale Road in St. Catharines, Ont., to a larger space onMartindale Road, Dr. Lain Vendittelli and his partner Dr. Hamit S. Ranu implemented changes to be more eco-friendly.

“Our old office was crammed, and it didn’t make sense to go green in thatoffice,” explains Dr. Vendittelli, who has been in practice for close to twodecades. “The intention ofmoving into this facility wasnot to go green, but it madesense to do so.”

Dr. Vendittelli found,however, that it was cost prohibitive for him to perform significantdesign renovations to be greener. “There is a federal grant systemavailable to retrofit buildings, but not for buildings that are less thanfive years old,” he says, noting that he may take advantage of thegrant system if it is still in place when the building that houses hiscurrent practice turns five years old.

Salespeople have kept him informed of what is available interms of green technology and green practices. “It was an educationfrom [dental supplier] Henry Schein,” says Dr. Vendittelli. “The

salespeople have kept us upto date, presenting us with thevalue of using new technolo-gy. The salespeople havekept us informed of what isavailable and what works.”

The incorporation of digital radiography into Martindale Dental has preclud-ed the use of toxic processing chemicals, and many other offices are taking thatapproach and moving away from traditional radiography, according to Dr.Vendittelli.

“It is great because it allows us to see the images almost instantly,” explainsDr. Vendittelli. “The amount of radiation is less, and we can treat patients muchfaster. The systems have become better, and the images have become sharper.”

Another technology that he uses that is kinder to the environment is an amal-gam separator. A hauler certified by Ontario’s Ministry of the Environment picks upthis particular class of waste. The practice also sterilizes its instruments in a more

environmentally-friendly fashion.“Our standards are quite high, and the patients appreciate features like digital radiography,” says Dr. Vendittelli.

“We also explain how we have altered our process in sterilizing instruments.”

—please turn to page 18

GreenDentistryDental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:38 PM Page 17

DE

Den

com

aro

mor

650,

gua

zati

den

ous

Am

Pac

Tri

par

den

form

cou

tion

tori

Inte

pre

inte

Welaes

Special Report: What you need to know about going green, part 1

regarded as socially conscious behav-ior.

In a competitive economic envi-ronment, being ‘green’ may be a featurethat distinguishes a dental practicefrom others, and may be a factor thatleads patients to choose to visit thatpractice.

ENVIRONMENTAL AWARENESSDr. Anna Fong, a dentist in RichmondHill, Ont., a suburb of Toronto, optedto go green when she opened her ownpractice in 2008. Driven by strongfeelings about environmental issuesand with the assistance of a dentalrepresentative who pointed the way togreen options for a dental practice,Dr. Fong went solo in an eco-friendlyfashion.

“When you start from scratch, youcan build the office the way you want it,”says Dr. Fong. “We try to do the best wecan and have as small a carbon footprintas we can.”

Dr. Fong’s office has features suchas digital radiography, which lessens radi-ation exposure to patients, as well aseliminates the need for not-so-environ-mentally friendly processing chemicalsnecessary for traditional radiography. Dr.Fong has also gone paperless by imple-menting digital charting. “We are doingas much as we can to recycle,” says Dr.Fong.

Her predominantly female staff isunquestionably on board with thegreen philosophy that Dr. Fong prac-tices. “They have heightened con-sciousness about the environment, andpeople apply [for jobs] because theylike our office philosophy,” says Dr.Fong.

One of Dr. Fong’s suppliers isMicrylium Laboratories, a manufacturerthat began in the infection control fieldin May 1994 with the intent of main-taining proper infection control byusing products that do not have thenegative environmental consequencesassociated with toxic, polluting disinfec-tants.

“It is the whole reason we startedthe company,” says Dean Swift,research director at MicryliumLaboratories. Micrylium was able tosupplant chemical disinfectants witheco-friendly substances that did notreduce the efficacy of products. Theyemploy, for example, totally biode-grabable surfactants and do not manu-facture products that contain endocrinedisrupting chemicals such as alkyl ornonyl phenol ethoxlates.

“The majority of our customersbuy the products because they workand because of the results,” says Swift.

“We work on physical chemistry ratherthan toxic chemistry, and that is why weget good results. Everything we pro-duce is biodegradeable and pharmagrade USB. Most people buy our prod-ucts because of the quality and effec-tiveness. The fact that they are green issecondary.”

Micrylium wants to set an examplethat proper hygiene and infection con-trol does not need to translate to the useof harsh, toxic chemicals, according toSwift.

INCREASINGLY IMPORTANT FOR STAFFThe use of non-toxic chemicals tocleanse a dental practice may have moreappeal to staff, who are typically femaleand may be contemplating mother-hood.

“Many staff at dental offices areyoung women who are thinking of hav-ing children, and their personal health isa factor,” says Swift. “They don’t want to

be spraying carcinogenic things aroundthe office if they are of child-bearingage. We have many dental assistants whotell us they have quit their jobs becausethe dentists started using other productsthat may be toxic to clean and disinfectthe offices.”

Montreal-based Medicom is one ofthe firms that is capitalizing on the greenmovement in dentistry. It has developeda environmentally friendly non-wovensponge product called SafeGauze Greenthat has been manufactured in an envi-ronmentally-conscious manner and is asabsorbent as a comparable syntheticproduct.

“We have tested it against our ownsynthetic product, and it was moreabsorbent,” says Claudia Mink, brandmanager at Medicom. “We wanted tomake sure it performed on parity withour own product.”

Mink notes that there is anincreased consciousness in dentistry tominimize the impact that dental prac-tices have on the health of the environ-ment.

Dr. Barry Cooper, who operates duPortage Dental Clinic in the nationalcapital region of Gatineau-Ottawa, sayshe uses the most biologically compatiblematerials that he can for his patients. “Ihave not inserted amalgam in patients’mouths for more than 25 years,” says Dr.Cooper, noting he uses high-end andhigh noble alloys for procedures such ascrowns. “You need to use biocompatiblematerials and take the time to do long-lasting work. With this approach, there isless need for retreatment and thus lesstotal carbon footprint.”

Apart from basics like recyclingpaper at the office, Dr. Cooper used‘green’ paints, such as an ultra-lowvolatile organic compound, and a fireretardant on a wood ceiling in his officeto comply with fire code regulations.

With the use of digital radiographyand photography, there is no staff expo-sure to film-based toxic chemicals and adramatic reduction in radiation exposureto his patients. Furthermore, no dark-room means less of a carbon footprintwhich is “overall more respectful andkinder to the planet.

“There is also the square footage ofrunning a dark room,” says Dr. Cooper.“[Digital radiography] is beneficial to thepatient because we reduce the number ofX-rays, so it means less radiation expo-sure cumulatively.”

continued from page 17—

DENTAL SYSTEMS

TM

www.basevacdental.com

Distributed by Sable Industries IncContact for a dealer near you

1.800.368.8106 www.sableindustriesinc.com

ENGINEERED GREEN WITH ZERO EFFECT ON THE ENVIRONMENT

NO OIL OR WATER IS USED 100% DRYNO OIL OR WATER IS USED 100% DRYNO OIL OR WATER IS USED 100% DRYNO OIL OR WATER IS USED 100% DRY

Product of CanadaProduct of CanadaProduct of Canada

GreenDentistryDental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:38 PM Page 18

DENTAL TRIBUNE | MARCH 31, 2010 Clinical Practice 19

Cutaneous sinus tracts:An endodontic approachDiagnosis and treatment for a successful outcome, by Dr. Philippe Sleiman

Misdiagnosis of an extra-oral

sinus tract usually leads to a

destructive invasive treat-

ment of the local skin lesions that is

not curative and often mutilating

(Fig. 1). Attempting to treat such

lesions with a circular incision of the

orifice of the cutaneous fistula and

excision of its entire tract with all

the ramifications is not consistent

with the present standard of care.

Unfortunately, cutaneous fistulae are

sometimes treated as though they

are independent dermatologic lesions

with the pathogenic characteristics

and treatment prognosis typical for

mucosal fistulae. However, even skin

biopsy may produce unnecessary

scarring.Correct diagnosis is the key to

treating this kind of lesion. A gentledigital finger pad pressure on theapical region of the area suspectedcan create a discharge of pus. ADentaScan can provide reliable

information that will help with thefinal diagnosis and the subsequenttreatment plan. A correct diagnosiswill lead to a simple, yet effectivetreatment—the removal of theinfected pulp canal tissue from theroot canal space—resulting in min-imal cutaneous scarring.

Cutaneous sinus tracts of dentalorigin have been well documentedin the medical literature, dental lit-erature, and dermatological litera-ture. However, these lesions continueto be a diagnostic dilemma. Patientssuffering from cutaneous fistulaeusually seek treatment from a physi-cian or a plastic surgeon instead of adentist and often undergo multiplesurgical excisions, multiple biopsies,and antibiotic regimens with eventu-al recurrence of the cutaneous sinustract because the primary dentalcause is frequently misdiagnosed.

The evaluation of a cutaneoussinus tract must begin with a thor-ough patient history and awareness

that any cutaneous lesion of the faceand neck could be of dental origin.The patient’s history may includecomplaints of dental problems.However, patients may not have anyhistory of an acute or painful onset.There may also be complaints ofepisodic bleeding or drainage fromthe cutaneous site with persistenceof the cutaneous lesion. Occasionally,there is a history of injury to thetooth.

Correct diagnosis of the cuta-neous sinus of dental origin shouldbe suspected by the gross appear-ance of the lesion. These cases typi-cally present as erythematous, sym-metrical, smooth, non-tender nod-ules of one to 20 mm in diameterwith crusting and periodic drainagein some cases. The most characteris-tic feature of the nodule is its depres-sion or retraction below the normalsurface. This cutaneous retraction or

Dental Tribune International Publishing Group is

composed of the leading dental trade publishers

around the world. Its combined portfolio includes

more than 100 trade publications that reach over

650,000 dentists in more than 90 countries and 25 lan-

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

zation of continuing education programs as well as

dental congresses and exhibitions.

The World Dental Federation (FDI) and numer-

ous regional dental associations, such as the Latin

American Dental Federation (FOLA) and the Asia

Pacific Dental Federation (APDF), have chosen Dental

Tribune International Group as their official media

partner.

Dental Tribune is the first global newspaper for

dental professionals in a concise and highly readable

format that is published in the native language of the

country in which it appears. An experienced interna-

tional correspondent network and renowned local edi-

torial boards ensure the highest journalism standards.

As the Canadian affiliate of the Dental Tribune

International network, Dental Chronicle is pleased to

present this special section containing articles of

interest from the global editions of Dental Tribune.

Welcoming new patients,aesthetically speaking ............23

Where can you reach 600,000+dentists in 25 languages monthly?

cosmeticcosmeticdentistry _ beauty & science

issn 1612-7390 Vol. 2 • Issue 1/2007

_specialty_specialtyTreatment of a class-II deformity withskeletal open bite and latero-occlusion

_expert article_expert articleSmile for more self-confidence?

_tandem feature_tandem featureThe use of smile libraries for cosmeticdentistry

12007

rootsrootsthe international magazine ofthe international magazine of endodonticsendodontics

_clinical_clinicalTreatment of a tooth with a lateral radioluceny: a diagnostic dilemmaa diagnostic dilemma

_case report_case reportSilver point retreatment: a case report

_interview_interviewImplants in endodonticsImplants in endodontics

1120072007

i s sn 1616-6345 i ssn 1616-6345 Vol. 2 Vol. 2 •• Issue 1/2007Issue 1/2007 lablabthe international magazine of dontal technology

_Feature Article_Feature ArticleThe New Era of ForamenalLocation

_Special_SpecialControl and elimination ofendodontic infection

_Case Report_Case ReportICase vPresentations from Endodontic Practice

issn 1616-6345 Vol. 2 • Issue 1/2007

12007

_Feature ArticleThe New Era of Foramenal Location

_SpecialControl and Elimination of Endodontic Infection

_Case ReportCase Presentations from Endodontic Practice

i s sn 1616-6345 Vol. 2 •• Issue 1/2007Issue 1/2007laserinternational magazine of laser dentistry12007

orthoorthothe international magazine ofthe international magazine of orthodonticsorthodontics

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

_innovation_innovationVirtual indirect bonding in 3-D: Virtual indirect bonding in 3-D: does it have a future in orthodontics?does it have a future in orthodontics?

_science_scienceThe impact of genes on facial morphologyThe impact of genes on facial morphology

1120072007

i s sn 1616-6345 i ssn 1616-6345 Vol. 1 Vol. 1 •• Issue 1/2007Issue 1/2007 perioperiothe international magazine ofthe international magazine of periodontics

_clinical_clinicalSupportive oral care in Supportive oral care in cancer patienttscancer patientts

_science_scienceMedications: impact on oral healthMedications: impact on oral health

_meetings_meetings“Selling a product, not a procedure...”“Selling a product, not a procedure...”

1120072007

i s sn 1616-6345 i s sn 1616-6345 Vol. 1 Vol. 1 •• Issue 1/2007Issue 1/2007

implantsimplantsinternational magazine ofinternational magazine of oral implantology

_case report_case reportUtilization of Zirconium Oxide in FixedRestorations on Implants and NaturalRestorations on Implants and NaturalTeethTeeth

_implant market_implant marketImplantology still runs the business Implantology still runs the business in 2007in 2007

_DGZI events_DGZI events33rd Arab-German Implantology MeetingArab-German Implantology Meetingof DGZI—Dubai, April 5–6, 2007of DGZI—Dubai, April 5–6, 2007

1120072007

i s sn 1616-6345 i ssn 1616-6345 Vol. 8 Vol. 8 •• Issue 1/2007Issue 1/2007

Essential Dental Media

Official Media Partner of

See Page 20

oundaringwhoause

ductsnfect

ne ofgreenopedoven

Greenenvi-is ashetic

ownmorerandd towith

anry toprac-iron-

es duionalsays

atiblets. “Ients’s Dr.and

ch asatibleong-ere is

less

clingused-lowfire

ffices.aphyxpo-nd a

osuredark-printand

ge ofoper.o theer ofxpo-

Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:38 PM Page 19

cal rin a immwas post-seemsues

and dcle dhad dto finamazThe ed a cle dby th

An imnatuDurisinusdetersensiout f

tors ttal inpath factomuscinvolthan teethrior t

lesionand lesiondischsinusmarycosis

pieceationrials,someordertion wcertaed—aright

The aand t

Dr. PUnivthe ethe Leral withopmeinstrtrainthe Itice phil2

DE

Cutaneous sinus tracts: An endodontic approach

dimpling is caused by the fixation of thetract to the underlying tissues and may besecondary to the healing process or a latefinding in active disease. Lesions that pre-viously underwent biopsy and treatmentare usually characterized by the absenceof at least part of the nodule and frequent-ly by an orifice of draining sinus at thebase of the fixed depression.

Endodontic infection, the product ofcellular degeneration—bacterial toxins—and, occasionally, the bacteria themselveswithin the canal spread through the api-cal foramen into the surrounding tissue.Thus, a slow inflammatory processbegins in the tissue contained within the

periodontal ligament. Left to itself, it

may manifest in a variety of ways, rang-ing from simple widening or thickeningof the ligament to granuloma or cyst.Sometimes a fistula may develop, with thepatient reporting intermittent dischargeof pus.

The fistula provides a means of con-tinuous drainage of the lesion. The open-ing of the fistula may be found on themucosa overlying the tooth that sustainsit, but often it may also be found at a con-siderable distance from the diseased tooth.In some cases, the fistula may run in thespace of the periodontal ligament of thesame tooth. It may even traverse the peri-odontal ligament of the adjacent healthytooth, thus simulating a lesion of peri-odontal origin. In such cases, negativepulp tests performed on the crown of thetooth, indicated by a gutta-percha coneinserted into the fistula, assist in makingthe correct diagnosis.

If the drainage of the fistula is notcontinuous but intermittent, it is precededby a slight swelling of the area as a resultof the increased pressure of pus behindthe closed orifice. When the pressurebecomes strong enough to rupture the thinwall of soft tissue, the suppurative dis-charge issues externally through the smallopening of the fistulous orifice. This orificemay heal and then re-close, only to re-open later. The discharge of pus is never

accompanied by intense pain. At most, thepatient will complain of slight soreness inthe area prior to reopening of the externalorifice. The pus creates a tract in the sur-rounding tissues, following the locusminoris resistentiae. It may exit, at anypoint, in the oral mucosa or even in theskin. It is not uncommon, particularly inyoung patients, to find a cutaneous fistulaat the level of the mental symphysis, iflower incisors are involved, or in the sub-mandibular region, if a lower first molar isinvolved. Also, it may be found in the floorof the nasal fossa, if a central incisor isinvolved.

Attempts to treat cutaneous fistulaewith a circular incision of the orifice ofthe cutaneous fistula and excision of itsentire tract with all the ramificationscannot be considered to comply with the

present standard of care and should beregarded as highly undesirable. Most ofthe time, root canal therapy is the idealtreatment for such lesions. However,Grossman states that such tracts are linedby granulation tissue. In his study,Grossman was unable to identify anyepithelium at all. Bender and Seltzer alsoconducted histological studies of numer-ous fistulous tracts without finding anepithelium lining. Given the current stateof knowledge and scientific data, there isno reason to recommend surgical removalof such tracts, just as there is no reason tobelieve that even epitheliumlined fistulatracts should not heal after appropriateendodontic therapy.

Obviously, these fistulae must be dis-tinguished from congenital fistulae of theneck, both lateral-arising from the sec-ond brachial cleft—and medial—arisingfrom rests of the thyroglossal duct—which are lined by an epithelium. Suchfistulae are of a different pathogenesisand definitely do not resolve spontaneous-ly but only after careful surgical excisionsof the tract.

The differential diagnosis of the casein question included the following:• localized infection of the skin, such as

pyoderma, pimples, ingrown hairs,and obstructed sweat glands;

• traumatic or iatrogenic lesions;

• osteomyelitis;• tuberculosis; and• actinomycosis.

Case presentationThe patient was referred to me fromoverseas with a large mandibular fistula,which had previously been misdiagnosedas an infection of the sub-mandibulargland. Surgery had been performed andhis submandibular gland had beenextracted. The wound had not healed andthe clinical situation was fast worsening.Thus, the wound had opened and subin-fected with a heavy discharge of pus.

A dentist invited to see the patientimmediately telephoned me and sent aphoto of the wound to me via his mobilephone. Following my recommendation,the patient was immediately put under

double antibiotic therapy (amoxicillin 1000mg twice daily, metronidazole 500 mgtwice daily). The patient presented to myclinic the following day, where we startedwith a detailed questionnaire to collect allthe information about the history of thewound. The patient reported that he hadbeen suffering from this fistula for quitesome time already with intermittentphases of discharge of an exudates andnumbness of the lower lip. No dental painwas reported.

A panoramic X-ray showed somebone rarefaction under teeth 47 and 46,but no invasion of the mandibular nervetract was evident (Fig. 2a). A dental scanwith 0.5 mm increment was performed inorder to gain a better idea of the clinicalsituation. One of the sagittal slides (013)clearly shows the lesion around the distalroot of tooth 47, surrounding the apicalpart and destroying the cortical boneinvading the lower soft tissue (Fig. 2b).

Furthermore, the mesial root of tooth46 showed apical radiolucency, invadingthe tract of the lower mandibular nerve(014; Fig. 3). This pathology explains thenumbness of the lower lip, while thepathology around the distal root of tooth 47explains the extra-oral fistula.

Careful review of the axial slides inthe area of tooth 47 (006) offers an ideaabout the amount of bone destruction in

the lower lingual area. The axial slideunder tooth 46 reveals the communicationbetween the lesion under the mesial rootand the mandibular nerve tract (Fig. 4).

Next, we established a clear diagno-sis that the lesion was an extra-oral cuta-neous fistula of dental origin. The patientwas suffering from a large, infected openwound and a suitable treatment plan hadto be established quickly. The followingsolutions were presented:1. Extraction of the teeth and curettage of

the area, with extra attention paid tothe mandibular nerve: This plancould provide the patient with asolution for eliminating the infectionand allowing the wound to heal. Yet,two strategic molars would be lostwith this solution and a replacementwould not be an easy job with thisamount of bone destruction in theinfected area.

2. More conservatively, a root canal treat-ment in order to clean and disinfectthe root canal systems of the twomolars, followed by an internal med-ication and a 3-D obturation capable ofblocking the bacteria from reachingthe apical part and trapping theremaining bacteria inside the rootcanal system: This approach wouldallow the patient to keep his molarsand would provide an environment inwhich the healing process couldbegin. The risk would be the estab-lishment of an external biofilm thatcannot heal by itself and may requiremicrosurgical removal.The patient and I decided to preserve

the two molars. Immediately, root canaltreatment, cleaning and shaping of thecanal space using TF files (SybronEndo)with copious and alternate irrigation ofchlorhexidine, SmearClear (Sybron-Endo),distilled water, and sodium hypochloritewith ultrasonic activation in a well-estab-lished sequence, was performed.

An apical enlargement to size 40 in.04 taper was performed after crown downwith K3 files (SybronEndo), to disturb thebiofilm mechanically and to help reducethe colony formation unit (CFU).

An intermittent paste was injectedinside the shaped root canal system. Thepaste of two different antibiotics (aug-mentin and metronidazole) was manuallymixed and injected with a paste filler. Ahermetic temporary filling was placed fora week. The wound was covered with adressing of steroids and antibiotic paste toprevent further external infection. A weeklater, the patient was already showinggood progress. The wound had started toclose and less inflammation and swellingwere observed (Fig. 5). The root canalwas reopened and cleaned, and no inter-nal fluids were coming from the periapi-

20 Clinical Practice DENTAL TRIBUNE | MARCH 31, 2010

Case ReportFrom Page 19

Fig. 1: Post-op photo one week after external surgery to remove thepatient’s sub-mandibular gland.

Fig. 2a: Panoramic X-ray showing some bone rarefaction under teeth 47and 46.

Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:38 PM Page 20

cal region. RealSeal material was used as obturation materialin a vertical condensation using RCPSL (Hu-Friedy) and animmediate build-up was performed. Thereafter, the patientwas invited for regular control checkups. A few weeks later, apost-op X-ray (Fig. 6) and photos were taken. The woundseemed to be in good condition and some skin and fibrous tis-sues were forming.

While I was writing this article, the patient visited Beirutand decided to come in for a checkup. He complained of a mus-cle disturbance of his lower lip, but all the previous numbnesshad disappeared. He agreed to perform an i-Cat scan in orderto find out what was going on and to detect any pathology. I wasamazed by the bone formation and complete healing (Figs. 7–9).The wound had also healed very well (Figs. 10a & b). I contact-ed a plastic surgeon and asked his opinion regarding the mus-cle disturbance. He posited that such symptoms may be causedby the tremendous loss of structure.

DiscussionAn important diagnostic modality is the determination of thenature of fluid draining (if any) from the cutaneous sinus.During palpation, an attempt should be made to milk thesinus tract. Any discharge obtained should be scrutinized todetermine its nature (saliva, pus, or cystic fluid). Culture andsensitivity testing of the fluid should also be performed to ruleout fungal and syphilitic infection.

Laskin elaborates on the physiological and anatomical fac-tors that influence the spread and ultimate localization of den-tal infections. Stoll and Solomon also emphasise that the ultimatepath of the sinus (irrespective of the source) depends on severalfactors: most importantly, the anatomy of the tooth involved,muscular attachments to the jaw, fascial planes of the neck, andinvolvement of permanent or deciduous teeth. Cutaneous ratherthan intra-oral lesions are likely to occur if the apices of theteeth are superior to the maxillary muscle attachments or infe-rior to the mandibular muscle attachments.

A pustule is the most common of all purulent draininglesions and is readily recognized by its superficial locationand short course. Actinomycosis exhibits multiple draininglesions and characteristic fine yellow granules in the purulentdischarge. The tooth is often not involved radiographically. If asinus tract does not close after appropriate removal of the pri-mary cause, the most common alternative cause is actinomy-cosis (Fig. 5).

The challenge in these kinds of cases is to assemble all thepieces of the puzzle and build up a full idea of the clinical situ-ation. Assembling the pieces means that all the diagnostic mate-rials, such as a history questionnaire, X-rays, CT scans, andsometimes biopsy and bacteria culturing, must be provided inorder to establish a correct diagnosis. Most of the time, the solu-tion will only be a simple routine that must be performed incertain conditions. Turning to solutions that are more complicat-ed—and that certainly can be more profitable—is not always theright choice, nor the most ethical one.

The author would like to thank Yulia Vorobyeva, PhD, interpreterand translator, for her help with this article. DT

Dr. Philippe Sleiman received his DDS from the LebaneseUniversity School of Dentistry in 1989. He conducted a DES inthe endodontic program at St. Joseph University and a PhD atthe Lebanese University Dental School. He has authored sev-eral international articles. He has his own line of instrumentswith the Hu-Friedy company and contributed to project devel-opment, and has lectured internationally. Dr. Sleiman is aninstructor at the Lebanese University and an internationaltrainer for the University of North Carolina. He is a fellow inthe ICD and the AAE. Dr. Sleiman maintains a private prac-tice in Beirut and in Dubai, UAE, and can be reached atphil2sleiman@hotmail.com

DENTAL TRIBUNE | MARCH 31, 2010 Clinical Practice 21

Fig. 2b: Sagittal slide showing thelesion around the distal root oftooth 47.Fig. 3: The mesial root of tooth 46showing apical radiolucency,invading the tract of the lowermandibular nerve (014).Fig. 4: Axial slide under tooth 46.

Fig. 5: One week after steroids and antibiotic treatment.

Fig. 6: Post-op X-ray a few weeks after treatment.

Figs. 7 to 9: i-Cat images showing good bone formation and complete healing.

Figs. 10a & b: Post-op woundhealing.

hslideationroot4).

agno-cuta-atientopen

n hadwing

ge ofaid toplanth action. Yet, lostment

thisn the

reat-nfecttwo

med-ble ofching

theroot

wouldolarsnt in

couldstab-that

quire

servecanalf theEndo)on ofndo),loriteestab-

40 indownb theduce

ectedThe

(aug-uallyer. A

ed forith aste toweekwinged tolling

canalnter-iapi-

2010

Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:38 PM Page 21

Eand n

dexte

every

grou

in th

that able, tion sanxieinfluworkhad and expeeasie

Desir

Ther

facia

exam

ceive

denti

day i

man

Howe

not a

cosm

denta

to th

requ

desir

ic tr

Step I’ve wdentitens

es mnot t

beento perespo

you piececour

ceed dard

Step In agoals

DE

WDr.

Are you settling for mediocrity? Is your practice mere-

ly getting by? Do you feel surrounded by complacen-

cy? Is there a lack of excitement or enthusiasm?Perhaps it’s not that the team is outwardly negative or

difficult, it’s just that “average” has become simply goodenough in their minds.

New ideas seldom emerge because they are shot downas quickly as they surface. Issues with systems are perpet-ually on the backburner, kept there by the proliferation ofexcuses explaining why the changes won’t work, can’twork, or would simply be too much work to fix.

So there you stand having lost control of the practiceyou once loved. It's become the daily grind, and it seemsthat you wile away the hours at the mercy of those whoseemingly care to do nothing more than simply get by.

As familiarity breeds contempt, complacency breedsmediocrity. If teams are not challenged to continuouslyimprove, then when the push is on to do things differentlythe shift can be unnecessarily traumatic because the staffmembers feel threatened and they resist any change.

They’ve settled into their “way” of doing things anddon’t understand why what seems to have worked perfect-ly fine in the past is suddenly called into question.

Sounds like a major issue with the team, right?Wrong. What we have in circumstances such as this

is more likely to be a major issue with the leadership. Theteam mirrors the leadership of the practice.

Take off the rose-colored glassesLook carefully at your team. Do they reflect your commit-ment to excellence? Are they open to change? Are you will-ing to challenge them to make changes? And are you will-ing to invest the time to educate them on why change isnecessary?

Or, do you shun better, more efficient systems and pro-cedures because “Mary Jane” has been there since thebeginning of time and you decided long ago that it’s notworth it to challenge her negative attitude and poor per-formance?

You rationalize your fear of addressing the problem bytelling yourself that she handles all the insurance, or sheknows all the patients, or whatever the excuse.

If you’ve chosen to ignore the problem, you’ve abdicat-ed your responsibility as the leader. You can count MaryJane as one of your concrete blocks—as in dead weight teth-ering your practice to an average standing for all time.

Being the leader takes courage to examine systems,processes, and staff. Change those things that don’t work,but most importantly, challenge everyone—not just your-self—to continuously improve.

They follow the leaderYour team members are taking their cues from you. If youhave a Mary Jane and she is unwilling to change or dothings differently, she is the shining example for the rest ofthe team to follow suit.

Employees are expert “boss watchers”. They are quiet-ly watching as you look the other way, make excuses, andallow employees such as Mary Jane to run the show.

The irony is that most employees want to excel, andthey want to be challenged. But they look to the dentist tobe the leader and address Mary Jane’s unacceptable atti-

tude and poor performance. Yes, I know it’s not easy, but it’smandatory.

Read on.

Reluctant leadersDentists by virtue of their position as CEO of the practiceare the leaders, but often they don’t take to that role natu-rally, and frequently they do not have leadership experi-ence to prepare them for the responsibility.

Dentists are trained to be excellent clinicians and theyare. They are not, however, trained to have the necessarycommunication or business skills to lead teams and steerclear of complacency.

However, dramatic leadership improvement can occurunder the right circumstances if the dentist truly wants apractice that reflects the level of excellent dentistry he orshe provides.

In order to improve leadership skills and avoid settlinginto a state of mediocrity and ultimately the loss of powerand control over the practice, dentists must take threeessential steps:

• Change your definition of leadership;• Change your behavior as the leader; and• Change your expectations of the desired outcomes.

The leadership definition for small businesses is quitedifferent than it is for large companies. The vision is tomake a good living. The plan is to work hard every daydelivering the best service and quality to patients.

The required communication skills consist of know-ing what you want your staff to do and telling them.

The leader must explain to the staff what is expectedof them, how their performance will be measured andhow that performance will be rewarded. In exchange, thefollowers will be paid and appropriately recognized.

Rather than allowing your practice to sink under theweight of mediocre minions, choose to build and lead ateam of star players. Focus initially on the following man-ageable steps. You will see improvement almost immediate-ly. Those who are valuable to the future success of thepractice will emerge as will those who aren’t.

Step No. 1: Get the right people into the right jobs.Some employees are perfectly at ease asking for payment,while others feel as if they were making some extraordi-narily difficult demand of the patient. In the Mary Janeexample above, she may be an excellent employee who isin the absolute wrong position.

I highly recommend personality testing to place yourteam members in positions in which they can excel, not justget by. The Keirsey Temperament Sorter Test found atwww.keirsey.com is an excellent tool to use for this process.

Step No. 2: Tell it like it is.Develop job descriptions for each position. Specify the skillsnecessary for the position. Outline the specific duties andresponsibilities.

Include the job title, summary of the position, and itsresponsibilities and a list of duties. This is an ideal tool toexplain to employees exactly what is expected of them.

DENTAL TRIBUNE | MARCH 31, 2010

See Page 23

Free yourself from the daily grindIf you dread going to the practice each day, it’s time to reevaluateyour leadership role, says business consultant Sally McKenzie

The World’s The World’s Fastest Matrix?Fastest Matrix?

- Takes less than 5 seconds to apply ...

Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:38 PM Page 22

Every dentist has the ability to offer

non-surgical aesthetics. A dentist’s

underlying knowledge of the head

and neck region, as well as the skills and

dexterity required to be able to perform

everyday dental tasks offers a solid

grounding from which to build a career

in this fast-paced industry.As well as technical skills, I believe

that dentists by nature have to be person-able, and possess excellent communica-tion skills to help alleviate any stress andanxiety within patients. This calminginfluence is hugely beneficial whenworking with patients who may not havehad facial aesthetic treatments before,and may not be sure of exactly what toexpect. After all, a calm patient is mucheasier to work with.

Desired vs. required

There are many benefits to performing

facial aesthetics within a practice. For

example, being able to combat pre-con-

ceived ideas about what happens in a

dentist’s chair. In the course of a normal

day in surgery, dental phobia is a hurdle

many practitioners have to overcome.

However, I have found that patients are

not as nervous when they are having a

cosmetic procedure—despite being in a

dental environment. I believe this is due

to the ‘desired vs. required’ phenomenon.

When a patient is informed that they

require a procedure, the concept is not a

desirable one. If a patient desires aesthet-

ic treatment, regardless of how long it

will take, or how painful it is, people find

strength to temper their anxiety in order

to benefit from having the treatment.

Having an appealing facial aesthet-

ic treatment in a dental environment

also helps alleviate the general fear of

visiting the dentist. They realize that the

environment is not as scary as they may

have imagined, and understand that they

are safe in the hands of someone they

trust. The environment is then associated

with a pleasurable experience; their

practitioner after all has provided them

with something that they desired, so the

fear of returning lessens considerably.

Boosting your client base

As well as helping patients face their pho-

bias, I have found that I have also inher-

ited a lot of dental clients from the facial

aesthetics side of my business—one of the

major benefits to offering the service. If

your practice is set up well, patients

should be able to get their hands on infor-

mation about the cosmetic dentistry pro-

cedures you offer while in the practice for

facial aesthetics treatments.

I find patients who are interested in

facial aesthetic surgery are generally more

open to alternative forms of cosmetic pro-

cedures, and may be more likely to

enquire about dental options. After all,

nobody wants a rejuvenated face let down

by a non-aesthetically pleasing smile.

A good earnerFinancially, the facial aesthetic market, asa stand-alone modality, is highly prof-itable. Products such as Botox are defyingthe recession as consumers are choosingto opt for longer-lasting cosmetic treat-ment instead of short-lived expensive non-medical-based high street skin care rou-tines. Also, a growing acceptance of suchcosmetic procedures means that thedemand for noninvasive procedures isincreasing, and being able to offerpatients such a service has the potentialto increase revenue. DTAbout the author

Dr. Bob Khanna is widely regarded as oneof the world’s leading exemplars of den-tistry and facial aesthetics. President andfounder of the non-profit organization TheInternational Academy for AdvancedFacial Aesthetics (IAAFA), Dr. Khannaheads the only UK organization to com-bine medical and dental professionals. Heis the appointed clinical tutor in facialaesthetics at the Royal College of Surgeonsand has trained thousands of dentists anddoctors through the Dr. Bob KhannaTraining Institute.

Step No. 3: Train.I’ve watched this mind-boggling scene hundreds of times:dentists allowing untrained team members to handletens of thousands of dollars in practice revenues.

Nothing creates distrust, generates conflict, or caus-es more internal problems than team members who arenot trained.

They feel insecure and vulnerable because they’vebeen tossed into a situation in which they are expectedto perform duties and are largely guessing at how thoseresponsibilities are to be carried out.

This is a recipe for failure. Think about it: wouldyou hand them the instrument tray, a couple of hand-pieces, and say, “Have at it, let's see what you can do”? Ofcourse not.

Team members must be given the training to suc-ceed and expected to meet specific performance stan-dards.

Step No. 4: Encourage the best.In addition to job descriptions and clear and specificgoals, your team will also wants to know how you will

measure its success. When the time comes to evaluate your team, that

too should follow specific guidelines; it’s not just a matterof assessing whether your assistant is a nice person. It isabout evaluating how well she/he is able to carry outher/his responsibilities.

Used effectively, you’ll find that employee perform-ance measurements and reviews can provide criticalinformation that will be essential in your efforts to makemajor decisions regarding patients, financial concerns,management systems, productivity, and staff throughoutyour career.

Moreover, performance measurements and a credi-ble system for employee review consistently yield moreeffective and higher performing team members.

The fact is that when we understand the rules of thegame and how we can win, life and work are a lot morefun and rewarding.

Step No. 5: Celebrate.Inspire the team with a practice vision and goals, andrecognize the progress you make together in achievingthose goals. Take time to pat yourselves on the back forthe accomplishments that you achieve.

Create incentives for staff members to use their

skills and training to develop plans to continuouslyimprove patient services, boost treatment acceptance,and build a better practice, and reward them for theirefforts.

If you create a structured environment with clearexpectations and a plan for total team success, then theMary Janes and the rest of the crew will likely rise to theoccasion. And you will no longer be suffering through thedaily grind.

Rather, you will be the leader of a happy and suc-cessful team that is not only open to change and con-tinuous improvement, it is actively pursuing it everyday.

Sally McKenzie is CEO of McKenzie Management, whichprovides success-proven management solutions to dentalpractitioners nationwide. She is also editor of TheDentist's Network Newsletter at www.the dentistsnet-work.net; the e-Management Newsletter fromwww.mckenziemgmt.com; and The New Dentist maga-zine, www.thenewdentist.net. She can be reached at (877)777-6151 or sallymck@mckenziemgmt.com.

DENTAL TRIBUNE | MARCH 31, 2010 Clinical Practice 23

Welcoming new patients, aesthetically speakingDr. Bob Khanna discusses the benefits of offering non-surgical facial aesthetic treatments

Free yourself from the daily grindFrom Page 22

About the author

About the author

ut it’s

cticenatu-peri-

theyssarysteer

occurnts ahe or

tlingowerhree

mes.

quiteis to

y day

now-

ectedand

, the

r thead a

man-iate-f the

ment,ordi-Janeho is

yourt justd atess.

skillsand

nd itsool to

010

nd

Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:38 PM Page 23

De

KaeSecthe

Th

CusalloestformlarlyerymeproDesindgrinas ThoCirc

Pur(DBis mgrahantimconThemois peasmamigFroCirc

W

BBHMMOSS

LAUGHTER is truly the best medicine,says Dr. Pio Modi, a dentist whooperates his practice by day and, at

night, moonlights as a stand-up comedi-an.

“My two career choices are com-pletely different. I am a dentist and aprofessional, but when I leave the officeto perform comedy, I think of myselfsolely as a comedian,” said Dr. Modi,who works as an associate dentist atAvenue Dental in Brantford, Ont.,where he has resided for a majority ofhis life. Performing as a comedian helpshim maintain a work and life balance, hesays.

The commute from Brantford toToronto to perform his comedy showstakes about an hour and 15 minutes, andhe says he wouldn’t do that drive sooften if he didn’t have a passion forcomedy.

COMBINING DENTISTRY AND COMEDY“Comedy is a nice stress reliever and it issomething I really love to do. It helps meto keep busy because I am the type ofperson who always needs to be doingsomething.”

His interest in comedy started whilehe was studying dentistry at theUniversity of Toronto, where he had anopportunity to participate in somesketches for a musical show organizedby third-year dental students.

“I did a couple of sketches for

Dentantics in my thirdyear and they went overwell. I had so much fundoing it, and I thoughtthat I might be good atcomedy,” he said.

He started takingcomedy classes at TheSecond City in Torontoshortly after his interestin comedy was piqued.The courses he took last-ed from 2000 until 2003and consisted of eightmodules of classes eightweeks in length.

“They have a livetheater there and they doa lot of improv shows,”Dr. Modi said.

“I find that improv and comedy arereally different, but the training andexperience helped set me in the rightdirection and provided me with the con-fidence to perform.”

He debuted as a comedian in 2002during an open mike session in Dayton,Ohio, but he didn’t realize that it wasactually a competition.

“When I was on stage I was reallynervous. I could feel myself shaking likecrazy but I managed,” he said.

“I find that I am a little nervouseach time I perform because really Inever know how the audience is going torespond,” Dr. Modi said.

SOMETIMES THEY LAUGH“Sometimes they laugh and sometimesthey don’t. After a while though, whenyou do a lot of shows, you realize thatdoing badly on stage occasionally is partof the experience and it becomes easiernot to take it personally.”

Over the last three years, Dr. Modi

has performed at several comedy clubsthroughout Ontario, including Yuk -Yuks, Absolute Comedy, and theHouse of Comedy. In 2007, he pro-gressed to the finals of YukYuks GreatCanadian Laugh Off, which was airedon the Comedy Network. More recent-ly, in the fall of 2009 Dr. Modi gave aperformance on a show called Accentin Toronto that was aired on CBCRadio.

COMBINING DENTISTRY AND COMEDYAdditionally, Dr. Modi has performed asan emcee for several comedy shows andsome corporate events.

“I would like to eventually start per-forming at corporate dental events andconventions,” Dr. Modi said, regardinghis comedic ambitions.

“So far, I have done some corpo-rate performances for different medicalsocieties, but it would be great if Icould do shows for dental functionsand conventions.”

Aside from comedy and dentistry,Dr. Modi also likes to stay physicallyactive. Last fall, he participated in theScotiaBank Marathon in Toronto. Dr.Modi noted that although he has donehalf marathons, that run was his firstmarathon.

“I enjoy working out, watchingmovies, and spending time with myfriends, family, and fiancé,” Dr. Modisaid.

“Tasha and I are busy getting readyfor our wedding this year, which we areboth very excited about.”

—Lynn Bradshaw

24 n March 31, 2010 DentalChronicle

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

DentalVitae

Former CDA president and University of Manitoba grad Dr. Tom Breneman

(right) placed the winning bid for a guitar signed by singer and former lead singer

of The Guess Who, Burton Cummings. Cummings was in his hometown of

Winnipeg to become the first recipient of Honourary Membership into the

University of Manitoba Dental Alumni Association. According to the organizers,

Cummings was recognized for his “talent, social conscience, and his years spent

as a vociferous proponent for all Winnipegers.” Proceeds from the guitar raffle

were slated to provide funding for a dental scholarship at the U of M.

DDrr.. MMooddii

P r o f i l e

Enter laughing: Dentistmoonlights as comedian Performance as a stress relievern Passion for yuks keeps Brantford, Ont. dentist

appearing on stage to develop his comedic touch

Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:38 PM Page 24

DentalChronicle March 31, 2010 n 25

Kaeser Oil Free Dental Compressors includes an energy savingSeccomatt dryer to ensure dry, clean compressed air. Kaeser incorporatesthe Permanent Power System to allow for continuous high air delivery.

Available in compact, space savingsizes. A five-year manufacturer’s warran-ty is included. Kaeser’s decades of expe-rience in compressed air technologyguarantee outstanding performance anddurability. From Sable Industries Inc..Circle #921 on feedback form

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

Please send me information concerning the products selected above

Your name..............................................................................................................................................................................................Your practice address ..........................................................................................................................................................................Your city, prov., code ............................................................................................................................................................................E-mail address ......................................................................................................................................................................................

You may... request this material by e-mail: dentalproducts@chronicle.ws request this material by fax: 1-800-865-1632request this material by mail: Dental Chronicle, 555 Burnhamthorpe Road, Suite 306, Toronto, Ont. M9C 2Y3

Customizable Gingiva Formersallow you to achieve a natural andesthetic gingiva contour with theformation of intact papillae, particu-larly efficient at the time of uncov-ery or directly after implant place-ment to create a natural emergenceprofile during tissue healing.Design a customized abutment forindividual requirements usinggrinders and add-on materials, suchas acrylic and composites. FromThommen Medical Canada Inc.Circle #911 on feedback form

The Surgically Clean Air 301Fsterilization chamber has six stagesof sterilization and protection, provid-ing the highest level of protectionfrom airborne bloodpathogens, suspendedparticulates, and organiccompounds. Destroysviruses such as SARS,Legionnaires, TB, andinfluenza strains, andgases, odors, fumes, andvapors as well. FromSurgically Clean Air, Inc.Circle #912 on feedback form

VITA shade management prod-ucts are now available at its onlinestore. For a limited time, all ordersplaced online will receive free ship-ping. Find all the VITA shade man-agement tools you are familiar with,from the Classical VITA shadeguide to the all-new VITA 3D-Master Linearguide and VITAEasyshade Compact digital shade-taking device. For additional infor-mation on products in the e-store orany VITA product, visitwww.vident.com. From Vident.Circle #913 on feedback form

AccuDose Tubes & Plugs quicklyand cost-effectively dispense anytype of composite or cement whilereducing voids and porosities in anyrestoration.Also eliminatesrepetitive pad-to-mouthmotion. Nocleanup orcross contamination. Fill. Load.Express. It’s that easy. FromCentrix Dental

Circle #914 on feedback form

EBA Wingrove Titanium ImplantInstruments are made with med-ical grade titanium and have ideal

hard-nessforimplant

maintenance. The three-instrumentset adapts for all your implant main-tenance needs. Tighter radiusesand short rounded tips give anadaptive edge. From PDT, Inc.Paradise Dental Technology.Circle #915 on feedback form

Puros Demineralized Bone Matrix(DBM) Putty, with or without chips,is made entirely from human allo-graft material and offers excellenthandling andtime-savingconvenience.The pre-mixed,moldable puttyis packaged foreasy extrusion and/or delivery. Itmaintains its form and resistsmigration in a fluid environment.From Zimmer Dental.Circle #916 on feedback form

HeatWave CustomizableImpression Trays mould to pre-cisely fit patient’s arch size and

contour. Heatthe tray in70°C waterfor 60 sec-onds, then

mould it by hand at the chairside.Eliminate the need to fabricate cus-tom trays. Stock four upper andfour lower tray sizes to fit all cases.From Clinical Research Dental..Circle #917 on feedback form

The Digital Doc ICON intraoralcamera has seven precision opticallenses, eight point LED lighting, andHi-Resolution CCD to give precisecontrol toeither handin any posi-tion with dualerogonomiccapture buttons. The camera hasvariable touch focus and sharpnessand range from 5 mm macro close-ups to full arch and full smile. FromDigital Doc.Circle #918 on feedback form

Cerma-Dent’s Handpiece Lubricant& Autoclave Protectant with freehandpiece repair and InstrumentSurface Sealer is based on nanoceramic technology that produces aboundary layer on metal surfaces, toreduce wear and drag within the tur-bine and bearings. The handpiecelubrication is 100% organic and han-dles water infiltration with no harmfuleffects. Enhance performance of yourair powered motors, reduce bearingfailures, vibration, noise, and increaseproduction rates. From Cerma-Dent.Circle #919 on feedback form

Duraflor introduces Halo, a 5%sodium fluoride natural white var-nish. A pre-measured unit dose,one step “peel and apply” packageeliminatesmesses and therisk of cross-contamination.Prevents,fights, and pro-tects againstcaries. Quick drying, with highestallowable fluoride concentration.From MedicomCircle #920 on feedback form

A selection of the month’s most innovative new products

Web site URLs for Dental Chronicle advertisers

Biolase http://www.biolase.comBisco Canada http://www.biscocanada.com Henry Schein http://www.henryschein.caMedicom http://www.medicom.comMiele http://www.miele.ca Oral Science http://www.oralscience.comSable Industries http://www.sableindustriesinc.com Strategic Edge http://www.strategicedge.net

READER SERVICEREADER SERVICEFor more information on these advertised products circle the correspondingproduct number. Visit http://www.dentalchronicle.info for more information

Biolase ..............................................ezlase Diode laser 901Bisco Canada ..................................Zirconia Metal Primer 902Henry Schein ....................................Paperless Practice 903Medicom............................................SafeTouch Gloves 904Medicom............................................SafeGauze Green 905Medicom............................................Duraflor 906Miele..................................................Washers/Disinfectors 907Oral Science......................................Cetacaine 908Sable Industries ..............................BaseVAC 909Strategic Edge ..................................It’s your money 910

Now: Get Now: Get mmoorree iinnffoorrmmaattiioonn yyoouurr wwaayy

901 902 903 904 905 906

907 908 909 910 911 912

913 914 915 916 917 918

919 920 921

NewProductsclubsYuk -

thepro-

Greatairedcent-ave acentCBC

ed asand

per-and

rding

rpo-dicalif I

tions

istry,cally

n theDr.

donefirst

hingmy

Modi

eadye are

shaw

icle

e

ii

Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:38 PM Page 25

26 n March 31, 2010

Toronto Star Scientists have developed a

new hearing aid device that conducts sound

through a back tooth rather than through

the ear (Feb. 2, 2010).

This new technology, called SoundBite, starts with a custom-built device fitted to

a molar and a wireless micro-

phone within the ear canal. A

digital audio device worn as a

thin cord behind the ear picks

up the sound from the micro-

phone and transmits it to the

tooth device, which produces

sound vibrations that reach

the cochleae through the

bone. According to the manu-

facturer, the tooth hearing aid

product does not interfere

with eating or speaking, and

they hope to have the device

on the market by mid-2010.

Canadian Press Alaska den-

tist Dr. Kirk Johnson saved a

bald eagle’s beak—and its

life—using a temporary

crown, sticky poster putty,

and a yellow highlighter, reports The

Canadian Press (Feb. 7, 2010). The bird

had been found in December with severe

damage to its beak. Staff at the local Bird Treatment and Learning Center turned to

Dr. Johnson, who patched up the beak with the same material used to make tem-

porary crowns for people. The ‘crown’ is being held on with

poster putty, and Dr. Johnson used the highlighter to help

blend the repair in to the beak. A representative from the

bird center reported that the eagle is doing just fine but is

not expected to be able to return to the wild.

Cherokeean Herald A management company that handled

billing and related services for dental practices has received

what has been described as a slap on the wrist for submitting

unlawful claims, reports the Texas news source (Jan. 27, 2010).

The Texas investigation into the dental management company

FORBA revealed the company improperly billed Medicaid

programs for pediatric dental treatments that were either

unnecessary or performed in a manner that did not conform

to recognized standards of care. The Medicaid-funded reim-

bursements at issue covered a range of dental services for

low-income children including baby root canals, crown place-

ments, tooth extractions, fillings, and sealants. In a $24 million

multi-state settlement, $546,000 was recovered for Medicaid.

What the lay press is saying

How did your life change in when you were in Israel?I went to Israel to volunteer as a dentist in 1997, and was hav-

ing lunch on a pedestrian street at a café when a triple bombing

occurred on that street.

What kind of trauma did you sustain in the bombing?About 40 per cent of my body was covered in second and

third-degree burns. I lost my hair and lost part of my hearing. I

had nails and shrapnel in my legs and feet.

Tell us about your road to recovery

It took about a year. I was in the hospital in Israel for about three

weeks. I then recuperated at my parent’s house for about six

months. I underwent physical therapy and occupational therapy in

Vancouver. There was psychological trauma I had to overcome. I

had post-traumatic stress disorder in association with any loud

noises or crowds. I did some counselling in Israel related to that.

What did you learn about yourself because of this event?

I learned that anybody can survive anything and that you just

need the will and determination to come back. You take the sit-

uation, do the work necessary to heal yourself, and you come

back stronger.

Do you practice dentistry today?

Yes, I have my own practice in Vancouver.

How are you trying to redress what happened to you?

I am involved with an organization called C-CAT, which is the

Canadian Coalition Against Terror. That organization is trying

to introduce legislation that will allow Canadian victims of ter-

rorism to sue the perpetrators responsible for it. It would help

people in Canada get benefits they have not been able to get.

To get assistance from the Canadian government now, you

would have to have been a victim [of terrorism] in Canada.

There are no programs available for those who have been vic-

tims [of terrorism] abroad. This law will help allow Canadians

access to medical services that they need. When I applied for

medical service plan benefits, I was told that I could not [get

the benefits] because I was not a victim of violence in the

province of British Columbia. I was told that the benefits

would not cover acts that occurred abroad.

What are your future personal goals?

I want to help in any way possible to get this bill passed by par-

liament. I have gone to Ottawa and have met with several sena-

tors, and I have testified at the hearings. I hope to be standing

present one day when they pass the law. This law will affect not

only me, but generations to come.

What are your future professional goals?

In our practice, we strive to provide exceptional dentistry and

to nurture the souls of people who are frightened and who

have dental phobias. I want to build a successful practice.

Would you go abroad again and volunteer as a dentist?Yes, I would do it in a heartbeat. I think it was just a case of

being in the wrong place at the wrong time. Many people in this

world have things that are hard in their lives, and I think differ-

ent people have different things happen to them. I was lucky

enough that I was spared and that I have been able to fully

recover from my injuries. I work hard to be a good person. I

help those in need that I can, in memory of the people who

died around me that day.

In this instalment of Dental Chronicle’s ongoing series of interviews

with notable clinicians and researchers, Dr. Wise spoke with writer

Louise Gagnon. The editors invite your suggestions for future

subjects of this feature. Please e-mail your suggestions to:

dental@chronicle.ws

Tenn minutess with...... Dr. Sherri Wise

DentalChronicle

DentalVitae

IInn 11999977,, DDrr.. SShheerrrrii WWiisseewas working in Israel as a volun-

teer when she was a victim of a

terrorist bombing in Israel that left

her with burn injuries and other

injuries that left her unable to work.

According to Canadian law, she

has been unable to seek compen-

sation for this violence that took

place on foreign soil. Now a prac-

ticing dentist, wife, and mother of a

two-year-old daughter, Dr. Wise is

lobbying for changes in Canadian

law that would allow Canadians to

sue foreign states that provide sup-

port to terrorists, and she hopes,

act as a deterrent to those who

funnel money to terrorists. She

graduated in 1991 with a BA

Honours from the University of

Manitoba, and completed a DDS at

Northwestern University in 1995.

“Larry is April in the ‘Dentists of Wall Street’ calendar.”

Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 08/04/10 2:03 PM Page 26

dereed tom-withlp

heis

eddting010).panyd

rmm-

ace-llionid.

c-nsrt

par-na-

ngnot

d

thisfer-y

I

wser

cle

Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:39 PM Page 27

With Cetacaine, l have reduced my use of local anesthetic injections for recall

and initial therapy scaling and root planing by at least 80%.

- Dr. Howard Tenenbaum - Professor of PeriodontologyToronto, Ontario

Cetacaine Topical Anesthetic LIQUID KIT is well-suited to control pain for scaling and root

planing, providing patients with effective non-injectable, cost-effective anesthesia.

The onset of anesthesia happens within 30 - 60 seconds and the duration typically lasts

30 - 60 minutes. Cetacaine also reduces chair time and can be used by Dental Hygienists.

Experience Cetacaine today at Booth 1629 - 1728 & profit from our exclusive offer for the 2010 PDC.

Buy 2 Cetacaine Kits & get 1 FREE

14 g bottle of Cetacaine Liquid20 Vista™ 1.2 mL Luer-lock syringes20 Vista-Probe™ 27ga tips

$110

Contraindications:

The complete Prescribing Information of Cetacaine can be found at www.oralscience.com/Cetacaine_PI.pdf

* Limit of one offer per dentist for the 2010 PDC 1 888 442.7070 oralscience.com

*

Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:39 PM Page 28