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GENESEE DISTRICT DENTAL SOCIETY Information • Education • Entertainment

WINTER/SPRING 2010

Photo by Jori Lewis, DDS

geneseegenesee

An Interview withDr. Ray Gist:President-Electof the ADA

MiDOOR - Flint 2010

NEW FEATURE:ECONOMICSSMACKDOWN!

3Genesee District Dental Society smile genesee winter/spring 2010

WINTER/SPRING 2010

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contentsMiDOOR - Flint 2010 5

Board Meeting Minutes 6 - 7

An Interview with Dr. Ray Gist:ADA President-Elect 8 - 9

Events in the Society 10 - 11

The Dreaded Single Central 12

Patients get a positive dental experience with positive thoughts 13

Endodontic Technology:Where We Stand Today 14 - 15

Economics Smackdown 16 - 17

2010 Postcard Marketing Initiative 18

geneseegeneseeBOARD OF DIRECTORS

Dr. Steven SulfaroPresident 607 N. Saginaw St.Holly, MI 48442

Dr. Denise PolkPresident Elect4170 Lennon Rd. Ste. DFlint, MI 48507

Dr. Luis PerezPast President2222 S. Linden Rd. Ste. DFlint, MI 48532

Dr. Alison LaddSecretary5399 N. Saginaw St.Flint, MI 48504

Dr. Jay WerschkyExecutive DirectorG-3269 Beecher Rd.Flint, MI 48532

Dr. Zelton JohnsonTrustee To M.D.A.4170 Lennon Rd. Ste. BFlint, MI 48507

Dr. Jori LewisEditorG-3269 Beecher Rd.Flint, MI 48532

ADDITIONAL BOARDMEMBERSDr. Dan BriskieDr. Debra ChinonisDr. Greg PeacockDr. Richard HallidayDr. Bill BeckDr. Mark MedelDr. Tim VanitveltDr. Jay BerthiaumeDr. Trina FloydDr. Scott MortimerDr. Lori Thomas

Genesee District Dental SocietyG3269 Beecher RoadFlint, Michigan 48532


president’s notes2010 is a new year and a new beginning inmany ways. I think most would agree that2009 was fraught with challenges a-plenty.Not only did we as dentists and smallbusiness owners face the ongoing pooreconomy and shrinking area population, butwe were also affected by dramatic changes indental insurance coverage -- namely, thecancellation by General Motors and Chrysler

of Delta dental benefits for all retirees. Years ago, once a personwas hired into one of the “Big Three” auto companies, they wereset for life. They had a steady, good paying job with excellentfringe benefits. Upon retirement they felt secure knowing thatthey had fully funded pensions and benefits for life.

A lot has changed with the decline of the auto industry.General Motors and Chrysler went into bankruptcy and federalgovernment control. There is a story I read recently that talkedabout some the consequences of having a federal hand in theauto industry. As the story goes, an auto task force was formedby the federal government to help solve the problems of theAmerican auto industry. The panel of experts was/is headed bya PhD laureate automobile engineering professor from theUniversity of Michigan. Also on the panel were/are tworepresentatives from Washington D.C. The two Washingtonbeaurocrats announced at the first meeting of this group thatthey knew what was wrong with Detroit. They had a solutionthat would solve all the auto industries problems. The majorproblem with the American automobile industry is that they areproducing the wrong types of vehicles. According to these“experts” from Washington, the “Big Three” need to focus theirtime and energy into developing a car that would run on liquidhydrogen and have a range of over 600 miles between fill-ups.The head of the commission, the professor from U of M, statedthat this was not a new concept. He was quite familiar withthis technology as research has been ongoing for years. Besides,for a vehicle to have a range of over 600 miles would require afuel tank larger than the car itself. “What you are proposing isimpossible; it violates the laws of physics,” he said. The twofrom Washington became indignant and questioned, “Whosponsored these laws of physics? We are going back toWashington and have them repealed!”

Lord, help us. With the government intervention into GeneralMotors and Chrysler, the running of the auto companies hasbecome political. I think all would recognize and agree thathealth care costs for the “Big Three” is a major concern. Theyincur huge costs to provide health care benefits to their workers -both active and retired. I argue that, realistically, dental benefits

are a VERY small piece of the health care pie. We should beproud as dental care professionals that we have kept dentalhealth care cost increases over time low compared to medicine.By terminating dental benefits, these companies are savingrelatively little compared to what they are spending for medicalbenefits. Therefore, the termination of dental insurance benefitsis much more political than economic. They can demonstrate toWashington that their workers are making real sacrifices.Unfortunately, we and our patients are caught in the middle.

In December, our GM and Chrysler retirees received a niceChristmas present with the announcement of the Delta DentalCOBRA policy. This is a very generous plan that gives thosefolks who lost their coverage access to their same Delta plan withrelatively little out-of-pocket cost. This is a very positive step inthe right direction, not only helping our patients to maintaintheir oral health by making it affordable, but hopefully will helpspeed us dentists and small business people on down the road torecovery and a much improved 2010.

Dr. Steven Sulfaro

Head Start Dental HomesThe Genesee District Dental Society is teaming up withHead Start to provide dental homes for Head Startpreschoolers as part of a statewide and nationalcollaborative. Dr. Trina Floyd and Dr. Alison Ladd areworking with Head Start Oral Specialist, Ms. MichellePatton, to coordinate referrals. You can request whatdays you would like Head Start children scheduled atyour office and how many or how few referrals youwould like a month. You will be providing prevention,education, and dental care to some of the state's mostvulnerable children. Pediatric dentist, Dr. Alan Klein,has agreed to see your referrals for the children who aremedically compromised or have Early Childhood Caries.To have Head Start preschoolers referred to your office,please email Dr. Alison Ladd at [email protected] Genesee District Dental Society members who havealready signed up are listed below. Thank You!

Dr. Jameel Aftab Dr. Debra ChinonisDr. Mark Eastman Dr. Trina FloydDr. Larry Grzegorzewski Dr. Alan KleinDr. Alison Ladd Dr. Jori LewisDr. William Moon Dr. Janice PilonDr. Denise Polk Dr. Emily SchwartzDr. Steven Sulfaro Dr. Greg Yassick

NOTICE: Dinner meeting schedule change!Please note a schedule change for the months of March and April. The new schedule is as follows:

WEDNESDAY March 10, 2010Speaker: Dr. Charlie CoxTopic: Dentinal Hypersensitivity Causes and Treatment

TUESDAY April 13, 2010Speaker: Dr. Dan GeorgeTopic: The Use of Temporary Anchorage Devices in Orthodontics


The Michigan Department of Community Oral HealthProgram, the Genesee District Dental Society, and MottCommunity College will be hosting a Michigan Day of OralHealth OutReach (MiDOOR) event in Flint on May 22,2010. MiDOOR is a state-of-the-state top priority forGovernor Granholm. The First MiDOOR event took placeon May 16, 2009 with the success of treating over 400patients at the University of Detroit-Mercy Dental School.Some 80-plus MDA member dentist volunteers along withvolunteer support staff provided free emergency dental care toneedy patients. Emergency care consisting of examinations, x-rays, extractions, restorations, prophys, root canals anddenture repairs was performed. This first MiDOOR programwas a resounding success, leaving lasting positive impressionsfor all involved.

With the continued dire straights of the local economyleading to a tremendous need for dental care by the under-served population, I sought to bring this same MiDOORexperience to Flint. A committee of various dental health careprofessionals has been formed and has been meeting sinceNovember 2009. The initial thought was to mimic the U ofD MiDOOR project of last year and use Mott CommunityCollege’s Richard and Rose Marie Shick Dental Clinic as thesole site for the project. On the appointed day, patients inneed would line-up, first-come first-served, and would receivetheir care at Mott. After careful thought and deliberation bythe committee, it became apparent that the facilities at theMott Clinic are far too limited. To truly help as many folks as

possible, it has been decided to use Mott’s Clinic as a centralexamination and triage facility and possibly to do prophysthere as well. The bulk of the emergency dental care is to be“farmed-out” to a network of dental offices volunteering theirtime and talents to help those in need in and around the cityof Flint. Transportation for patients back and forth fromMott to the dental offices is being arranged. The committeeis working with various dental supply representatives toacquire as many donated dental supplies as possible in orderto keep the cost of providing care to those in need at aminimum. My goal is to have the only cost be the office’stime and talent.

This continues to be a work in progress and the programcontinues to evolve. The obstacles and challenges remaingreat. The greatest of these is signing-up as many volunteerGDDS member dentists and support staff as possible who arewilling to donate their time and talents. If you and/ormembers of your staff are interested in helping, please contactme at 248-634-4671 or e-mail [email protected]. Myhope is to help as many in need as possible. Granted, this willbe just a drop in the bucket compared to the over-all need outthere. We all already reach out to our own patients in needin our offices on a daily basis, but I think that the GDDS’sparticipation in MiDOOR will demonstrate, in a public way,that we as dental professionals are sensitive to the needs of thepeople in our community and are banding together to dosomething positive to help.

Steve Sulfaro, DDS

MiDOOR: Flint 2010

Dr. Odus Baldridge AnnouncementThe Genesee District Dental Society lost another senior statesmanon Tuesday, January 19 with the passing of Dr. Odus Baldridge.Odie was a fixture in the dental society and a highly respectedoral surgeon known for his fearlessness when faced with achallenging surgery. There was almost nothing that he couldn'tdo or attempt. Besides his oral surgery skills, he was a world classfisherman as well as an avid golfer and skeet shooter.

If you knew Odie and could call him your friend, as well as acolleague, you were blessed. If you didn't know Odie, you missedout on a very talented, dedicated and wonderfully uniqueindividual who just happened to spend his life caring for the oralsurgery needs of the people of Genesee County.

Jay A. Werschky, DDS


GDDS board meeting minutes

Attendees:Dr. Trina Floyd, Dr. Lori Thomas, Dr. Steven Sulfaro, Dr. LuisPerez, Dr. Bill Beck, Dr. Richard Halliday, Dr. Scott Mortimer,Dr. Jay Berthiaume, Dr. Denise Polk, Dr. Alison Ladd, Dr. Mark Medel, Dr. Jay Werschky, Dr. Zelton Johnson, Dr. Dan Briskie, Dr. Debra Chinonis

Excused: Dr. Gregory Peacock, Dr. Tim Vanitvelt, Dr. Jori Lewis

Guest: Barry Simon • Previous Director of the Builder's Association of Flint• Current Editor of newsletter• Discussed current economy, future economy of the area

Call to Order: The meeting was called to order by Dr. StevenSulfaro at 7:15 p.m.

Approval of the Agenda: Agenda approved as written.

Approval of the Minutes: Motion to approve the minutes given by Dr. Dan BriskieSecond by Dr. Zelton JohnsonVote: Minutes were approved as written.

Executive Director Report:Report given by Dr. Jay Werschky• Thank you was received from the Community Foundationof Flint for the $100.00 contribution to the Dr. Turri HealthFund in memory of Dr. Milt Panzer.• Financial standing is good

- About the same as last month- Will have dues checks starting to come in soon- We currently have about 237 members, 25 life

members.• Ms. Wendy Jamrog wants GDDS to partner with the

United Way for the GKAS promotion.• Dr. Alan Klein donated $10,000 to Hurley hospital to

match the contest money they won.• Dr. Jay Werschky is working on guidelines for dinner

meetings.- GDDS has been giving $500 honorarium to speakers.- Most speakers have had sponsors.- All day seminars are subsidized about 50% and the

balance paid by attendees. These must be self sustaining with that arrangement.

• Ethics committee- Dr. Mac Conover chairs GDDS ethics committee.- Reviewed case of dentist requesting membership

- Dr. Mac Conover recommends approval of membership.

- Dr. Luis Perez motions to approve dentist for membership. Dr. Denise Polk seconds. Board approves.

Trustee Report:Report given by Dr. Zelton Johnson• There will be a decrease in membership due to

demographics and aging of the dentist population.• Delegates need to keep up to date on resolutions that will be

before the HOD.• DRNA is offering 40% off amalgam separators.• MDA Building is completed; open house is scheduled

Friday, December 4th, 2009 at 5p.m.• MDA Board still discussing plans for financing (special

assessment on mortgage).

Old Business• MiDOOR- Michigan Day of Oral Health Out Reach

- No formal approval for use of facilities- We have been told that a letter is being drafted to give

us approval for the use of Mott C.C.- May is a good possibility for the date.- Dr. Steven Sulfaro has spoken with Jill Moore (state

recruiter for MiDOOR)- GDDS MiDOOR Committee: Dr. Jay Werschky,

Dr. Denise Polk, Dr. Zelton Johnson, Dr. Steve Sulfaro,Dr. Luis Perez, Dr. Mark Medel, Dr. Sue Weiss (MCC),Ms. Darlene Boersema (MCC); Dr. Steve Sulfaro will also ask Dr. Juliana Hukill to be part of the committee.

- Dr. Zelton Johnson points out that UDMSD MiDOOR was a one day event with many chairs and supplies on site. MCC has limited chairs and no equipment. He and Dr. Dan Briskie suggest making MiDOOR event similar to GKAS - a multiple site eventat several offices following a centralized triage event. Board discusses possibilities.

- Dr. Briskie suggests including Henry Schein in on the project.

- Committee will meet at Dr. Luis Perez's office November 19th at 6 p.m.

• GKAS - Dr. Steven Sulfaro-chair- Dr. Steven Sulfaro has registered GDDS with state

and national organizations.- Event scheduled for February 5, 2010.- Twenty-eight members sign-up to participate at the last

dinner meeting.

NOVEMBER 5, 2009


- Social worker, Ms. Wendy Jamrog, would like GDDS topartner with the United Way on this project. United Way would do publicity and provide patient names.

- Dr. Steven Sulfaro will call MDA/ADA to see if there are any stipulations on partnerships.

- Dr. Jay Werschky will discuss further with Ms. Wendy Jamrog and speak with Ms. Carol Lutey concerning MCHC overflow.

- Discuss marketing- United Way will help if we partner with them.- Dr. Trina Floyd suggests handbills to schools and

pharmacies.- MDA Matching Funds- Dr. Steven Sulfaro motions to create and print patient

reminder cards targeting the patients of GDDS members who have recently lost their dental insurance. Dr. Scott Mortimer seconds motion. Board approves.- There will be 4 sets; 25,000 each- One set will be passed out at each dinner meeting-

Jan, Feb, Mar, Apr.- Reminders will be printed on dinner invitation

postcards. • Email Addresses

- Dr. Jay Werschky will send GDDS roster to Dr. Steven Sulfaro's office.Dr. Steven Sulfaro's office will contact dentists for their email addresses.

• Dr. Dick and Rose Marie Schick Dental Hygiene Clinic Dedication- Dr. Denise Polk, Dr. Luis Perez, and Dr. Steven Sulfaro

attended the event.- Pictures will be in Smile Genesee.

• January 12th Dinner Meeting- Correlates oral and systemic health.- Open to physicians- Invite put on Genesee County Medical Society website- Would be good to bring hygienists to meeting

New Business• MDA Resolution 14H-09 Dental Home/Head Start Lead

Dentist- MDA has asked each component society to designate a

lead dentist to work with Head Start and local dentists to provide Head Start children dental homes.

- Dr. Alison Ladd has agreed to the position.- Dr. Trina Floyd has been working with Head Start to

help provide screenings to pregnant women.- Meeting for November 13th at MDA headquarters has

been postponed until May 2010.- Announcement will be made at Tuesday's dinner

meeting.• ADA 2010 National Conference on the New Dentist

- Dr. D Kinra is GDDS Chairperson.- If he does not have a sponsor, GDDS will fund his trip.

Adjournment:Motion was made by Dr. Scott Mortimer to adjourn meeting. Second by Dr. Richard Halliday.• The meeting was adjourned at 8:44 pm

Next Meeting:January 7, 2010 at Empress of China

The Genesee District DentalSociety community outreachdisplay was on the road again inSeptember. Staff members GailPeterson, Deloris Ervin, and PauleHendrickson assisted Dr. TrinaFloyd at the South BendleElementary School and BendleMiddle School open houses.Thanks to Bendle Family HealthServices for providing GDDSanother opportunity to representdentistry in our community. Pleasecontact Dr. Jay Werschky if youhave interest in staffing the GDDSdisplay at a future event.

GDDS Community Outreach Display


by Denise A.Polk, DDS

This past year I have witnessed two historical events -- themaking of two presidents. The first was history in itself with theelection of our 44th president, but the one that is nearest anddearest to us in this community is the president-elect of theAmerican Dental Association, Dr. Ray Gist.

We know Ray has an impressive resume, but as I sat down totalk with him I learned more about the personal side of hissuccess and passion for dentistry, and especially organizeddentistry. I wanted to know how he reached this point in hiscareer. What is it about organized dentistry that makes him sodriven to always look for a better way of improving on what isalready a great profession? Take a moment to journey into ourchat and what makes Ray so passionate about dentistry.

Who, or what, inspired you to choose dentistry as a career?Gist: I became interested in a career in either dentistry ormedicine at a very young age. I found both very appealing,although I did not have a role model in either field at that time.

When I discussed my goals with my family, my mom was mymotivator and cheerleader, since I was the first in my family toattend college. I chose dentistry because I felt it would allow memore freedom and a more balanced lifestyle. That mindsethasn’t been completely accurate, but this career of mine has beenvery rewarding, and I expect it to continue to get better.

We will get back to the question of getting better, but tell mewhat attracted you to organized dentistry, and yourcommitment to becoming so involved?Gist: I was introduced to organized dentistry by Dr. FredBruner shortly after I returned from active duty in the Air Force,and was practicing dentistry at Mott Children’s Health Center. I quickly found out that the Genesee District Dental Society hada history of active involvement in organized dentistry, and whenI agreed to serve on my first committee, it snowballed!I saw the benefit of membership after attending several meetingsat the local and state level. Having questions answered aboutprivate practice and insurance issues, meeting continuingeducation requirements, learning about advocacy and the peer

interview with Dr. Ray Gist, ADA President-Elect


review/ethics process, and more! What a bargain!I was very impressed with the influence that GDDS hadthroughout the community and on the state level, and that myparticipation was so well received. This was an opportunity tolearn how dentistry worked on the inside, and I found it veryappealing.

When you speak of your career, explain how it can get betterthan being elected President-Elect/President of the AmericanDental Association?Gist: Maybe I should rephrase that comment! I really feel thatthis is the pinnacle of my career, and I will work feverishly tomake a difference during my term in office. I also look forwardto offering my assistance to those who follow me, to help keeporganized dentistry at the forefront of the tremendous changethat we are facing. The dental profession has the best model ofpractice in the healthcare field, and I would like to continue tohelp lead the changes necessary to keep it that way.

What do you find most challenging at this level of theTripartite?Gist: For me personally, balancing a family, a dental practice,and a partnership with the demands and commitments that theADA requires of its officers. I’m still trying to get my ADAphone to work! It has a calendar that is constantly updated withnew conference calls, meetings, and so on, but I can’t get it toring when someone calls. I’m getting a replacement as soon as Iget back to Chicago! I’m also finding it challenging to findsome windows in my schedule between now and October 2010.

For the ADA, the challenge is managing the business ofdentistry, which is inclusive. I look at the issues facing us, and Imarvel at how we keep this train running so smoothly down thetracks. We touch so many lives with our actions at this level withissues such as healthcare reform, access to quality dental care,mid-level providers, education, third party activities,membership, and a continuing list, that “getting it right”requires many hours of dialogue and many miles of travel. I havean office in the ADA building, and my desk is always full whenI travel to Chicago, even though I leave it empty when I comehome. These are challenges that I was familiar with before myelection, so this is nothing new. I welcome them.

What do you find most satisfying?Gist: Support from my colleagues, and I want to thank you,GDDS, for being there for me through the rigors of the electiveprocess, and continuing that support through your friendshiptoday. This keeps me motivated.

Staff support at the ADA is tremendous, just as it is at thestate and local levels. I have to get pointed in the right directionand get a push to make sure that I’m in the right place at theright time, and our flight coordinator knows where we are at alltimes.

I enjoy being a role model for dental students, potential dentalstudents, and new graduates, and assisting in our efforts todiversify and unite our profession. The ADA will host adiversity summit this summer in Chicago, which will be the firstof many, and the Institute for Diversity continues to welcomevery talented dentists.

I enjoy my relationship with dental schools, and I’m lookingforward to giving the commencement address to the nextgraduating class at the University of Michigan.

I have developed relationships with dentists, allied personnel,and affiliates throughout the country, and I appreciate thewealth of knowledge and creativity among us all. The next twoyears will bring even more gratifying experiences, and I’mlooking forward to them.

How would you describe your main focus for success,considering the issues that you have described?Gist: The dental profession has unlimited potential for success,in my view. I would like to see us harness that potential with aunited voice. Too many of us work in silos, and although wehave brilliant solutions for many issues facing us, we don’tbroadcast those solutions with a single, loud voice for dentistry.My main focus is to unite that voice.

The interview left me with an even deeper appreciation oforganized dentistry and why someone like Dr. Ray Gist is justright for this position. We all know how special Ray is todentistry, and now so does America!


EVENTS in the Society

Dr. Jim Cantwil

Presenters Donna Rosebush and Joseph La Bella

ALL-DAYSEMINARJanuary 22, 2010 at Genesys

“How to Write anEmployee Policy Manual”

Speaker Dr. Richard Nagelberg


Dr. Zelton Johnson and Dr. Jay Werschky Jill Phillips and Dr. Jori Lewis distribute postcards

Dr. Daniel Lechota, Dr. Jim Williams and Dr. Luis Perez

Record attendance at the January dinner meeting.

JANUARYMEETING


By Scott Ward, DTI Dental Lab

Clear and detailed digital photography is essential.Close-up pictures taken straight on as well as from rightand left side views help the technician follow the contourand surface texture of the adjacent teeth.

A photograph taken with a black surface placed behindthe tooth provides us with the best way to see existingcharacterization to duplicate incisal translucency andmammelons. PhotoMed International sells black metalContrasters that can be autoclaved. Visit them atwww.photomed.net or call 800-998-7765. You mayalso use ovals cut from black plastic folders to serve thesame purpose on a disposable level.

We can easily go darker with a minor two day repair, butto go lighter usually requires a full remake. Involve yourteam members in shade selection (especially if you’remale) since women have a natural tendency to see colorbetter than men. Each tooth has three zones; incisal,body and gingival. Choose each shade separately. Youcan use multiple shade guides.

Photos taken with shade tabs in place are quite helpfuleven though exact color may not be duplicated through

digital photography. Be sure to hold the shade tab in thesame plane as the tooth with the number on the tabclearly showing. A ring light will provide the bestlighting for these photographs. Shooting these shotsfrom a view slightly to the side helps eliminate the glareon the surface of the tooth, which occurs when shootingstraight on. Also shooting a couple of shots without theflash can be helpful.

For all-ceramic restorations, stump shade photographsare also essential. Often, as stated earlier, trauma is thereason for these restorations to be needed, and darkdentin adds even more of a challenge for the technicianto overcome. Use any shade guide (it is not necessary toonly use the ivoclar stump guide) to find the closestmatch to the dentin and photograph it in the samemanner as the main shade photographs, keeping theguide in the same plane as the prepared tooth. Whenfabricating the restoration, our technicians make a stumpthe shade of the patient’s prepped tooth. Without thisinformation, the restoration will be the correct shade butmay not match in the mouth due to the color of thedentin. Color-mapped drawings are helpful also.

Always tell your patient the next visit will be a try-in, sothat if at first we don’t succeed, none of us look bad to

the patient. If any adjustments areneeded, repeat the photography stepsabove, add any additional helpfulinformation, and return the crown tous for a second try.

Lastly, if upon your initial diagnosisyou identify a huge challenge to matchthe other central, either talk to thepatient into doing at least two teethOR have the case done by a local labso you can send the patient in for acustom shade appointment. Since theonset of bleaching, Ward Lab offersfree custom shade mapping. Give us acall with your difficult shade cases. Asalways, feel free to contact us with anyquestions or concerns.

THE DREADED SINGLE CENTRAL


We’ve all seen the TV skits about the dentist from hell. Sitcomsand movies do their best to fill young minds with the "funnybut scary" dental stories. As a result, people are pre-programmed with some level of fear before they ever get to thedentist office.

Yet, because "getting our teeth fixed" is inevitable, dentists haveto get past these fears to do their job. Professionally,Hypnotherapists get rid of these fears for a living. They do itquickly and easily. But sometimes dentists themselves canquickly head-off these fears on the spot.

Here’s a little trick that works wonders with fear in the dentalchair. To be successful, go toward what you want, as opposed togoing away from what you don’t want. This works because weget what we think about.

A few weeks back, a young man came to me for stuttering. Hisparents spent thousands on speech therapists with no luck. Thefirst thing I told him is this: "You can’t stop stuttering by tryingto stop stuttering. You stop by becoming verbally smooth!"Three weeks later he didn’t stutter anymore.

Similarly, you can’t rid people of fear by trying to make themless afraid. If you want happy patients, get them thinking about

happy things! Happiness is mutually exclusive with fear, stress,worry and anxiety. We can’t simultaneously be happy andworried, happy and anxious, etc. As a result, when we fillourselves with happy thoughts, fear melts away.

To watch client fears vanish, just ask them this as part of aconversation: "You know, I’ve been thinking about this: Whatdo you think is the best day of your life?" Get them talkingabout any happy memory and their fear vanishes.

Then, as you begin working tell them, "See if you can come upwith a ‘top five moments’ list. Think about which of your lifemoments would be on that list." Challenge them to think abouthow they would create new examples of their happiest moment.As they think while you work, it just could be the best dentalexperience they’ve ever had!

John Tomlinson, BAS, MA, CHt, is the owner of Tomlinson Medical Hypnotherapy, LLCwww.tomlinsonhypnotherapy.com8382 Holly Road, Suite 2Grand Blanc, MI 48439 810.771.7105

Patients get a positive dentalexperience with positive thoughts

Visit SmileGenesee.com


By Mike and Matt LindemannThe practice of endodontics has dramatically changed in the past20 years, mostly due to new technologies that have allowed us tobe more efficient and effective. The operating microscope,ultrasonic instruments, nickel titanium rotary instruments,mineral trioxide aggregate (MTA), and irrigation devices arelargely responsible for these changes (1).

The operating microscope provides the clinician two notableadvantages: magnification is obvious but equally important isshadowless, coaxial light. In many instances, a clinician mustlocate a canal orifice that has undergone extensive calcificmetamorphosis and do so solely on colors and textures revealedby the high magnification and intense light of the operatingmicroscope. It also allows for precise placement of intra-canalmaterials such as calcium hydroxide, gutta percha, MTA andapical barriers of resorbable collagen. Further, microsurgicaltechniques permit apical root resection as close to perpendicularto the root canal as possible, minimizing the amount of root

structure that is removed and thereby contributing to optimumstructural integrity of the root. The microscope facilitatesplacement of small diameter sutures (7-0) for soft tissue closure,achieving faster healing by reducing tissue trauma and wickingfewer bacteria into the mucosa. This results in rapid healing forthe periapical tissues and minimal scarring from incisions.

Ultrasonic energy has helped clinicians achieve betterendodontic success in many ways. First, with careful use, itremoves minimal tooth structure to reveal challenging anatomythat would normally not be accessible due to the visionobstruction of a slow speed hand piece head if burs are beingused for exploration. However, use of an ultrasonic hand piece ator below the level of the furcal floor should be done withextreme caution to avoid communication with the surroundingperiodontium. Second, ultrasonic tips have made revision ofprevious treatment more successful. The clinician canpredictably remove posts, obturation materials and separatedinstruments which previously required surgical treatment. Other

Endodontic Technology:Where We Stand Today


uses are for denser compaction of MTA in various apical barriertechniques and for perforation repairs.

The use of nickel titanium (Ni-Ti) files, rotary instruments andpluggers has been a tremendous advancement for the dentalprofession. Ni-Ti rotary files have exponentially increased canalpreparation efficiency. What once took two or maybe three onehour appointments to locate, instrument, clean, and obturatethe canals well can now be done in significantly less time, evenon a molar with challenging anatomy. Significantly, Ni-Ti alsoallows maintenance of the original root canal anatomy with lesscanal transportation or ledging which can result in retaineddebris in the apical third of the canal and compromised apicalhealing. This advancement is not without a downside, namelycyclic metal fatigue. Rotating metal, even Ni-Ti, around a simpleor multiplanar curve creates minor stress fractures in theinstrument making it highly susceptible to separation, often inan area where retrieval is difficult without irreversible structuraldamage to the tooth. Caution should always be used with rotaryfiles to avoid possible misadventures and provide the best clinicaloutcome for the patient. Sometimes the apical third of achallenging root canal should be prepared with stainless steelhand files before use of rotating instruments despite the setbackin efficiency.

MTA is a remarkable material for pulpal and osseous exposuresin teeth where treatment was thought to be hopeless. For lackof a better description, MTA is essentially Portland cement ormedical grade concrete. The Foundation of the AmericanAssociation of Endodontists spent millions of dollars to researchand develop this material. The following are just a few examplesof its use. First and foremost, the clinician can repaircommunications between the pulp and the periodontium, aslong as defect size does not compromise the structural integrityof the tooth or expose MTA to the oral bacteria. Second, a tightpermanent apical seal can be accomplished in a tooth with anopen apex or “blunderbuss” anatomy when used with aresorbable apical barrier. Without an apical constriction, guttapercha obturation techniques often fail due to the inability toobtain an adequate apical seal. Third, it can be used as theretrograde filling material in apical microsurgery and is thematerial of choice over calcium hydroxide for Cvek pulpotomiesin developing permanent teeth. In pulpotomy cases, MTApromotes predictable apical root development and increased rootwall thickness. Most MTA pulpotomies should require nofuture endodontic treatment. Manipulation and management ofthe material in its moist state can make its clinical usechallenging. Situations where there is excess moisture duringcompaction can prevent adequate density of the material forproper setting and canal sealing.

The most recent advancement is how the root canal system iscleansed after preparation and before obturation. The world'sbest preparation of the canal space means little if the spacecontains bacterial debris and biofilm. Periodontal resolutionfrom an endodontic lesion can be compromised if bacteriapersist in large numbers on the dentinal walls and in thedentinal tubules. The bacteria have the potential to leak toxicbyproducts through the apical foramen and tiny lateral canals,unless they are significantly removed. A good endodontic mottowould be, “No bugs, no problems.” Thorough irrigation afterpreparation significantly contributes to endodontic treatment's97% success rate (2). Passive placement of sodium hypochloriteor chlorhexidine 2% in the chamber during the instrumentationphase unfortunately does not provide adequate cleansing of theroot canal system, especially in the middle and apical thirds ofthe canals. As Tim Allen from Home Improvement best statedit, “We need more power.” This is where ultrasonic irrigationand negative apical pressure irrigation become cruciallyimportant.

Briefly, ultrasonic irrigation is accomplished by an endodonticultrasonic hand piece that delivers sodium hypochloritethroughout the tooth with energy in the form of acousticstreaming (mixing) and cavitation from imploding bubbles thatdisrupt and dislodge bacteria and other debris from the rootcanal system. Negative irrigation is the process of placing avacuum in the apical third of the canal near the canal terminusto draw large amounts of irrigants the length of the root canalsystem. When these techniques are combined, debris removal isoptimized.

The intent of the current article is to briefly showcase the bestrecent advancements that facilitate clinical endodontic care. It'sexciting for us to resolve challenging and nearly impossible casesand have the patient smile knowing they will be able to maintaintheir natural tooth well into the future. Our goal is to provideuseful endodontic information and updates or tips through aseries of articles in Smile Genesee that will address sequentialsteps in conventional endodontic treatment. The next article forSmile Genesee will discuss diagnosis. We will then explore localanesthesia and access, instrumentation and irrigation, and finally,obturation and post-operative care. Other topics can be visited at the end of the series if requested.

References1) Ruddle CJ. Endodontic Advancements: game-changingtechnologies. Dent.Today. 2009;28:82-84.

2) Salehrabi R., Rotstein I. Endodontic treatment outcomes in alarge patient population in the USA:An epidemiological study. J.Endodontics. 2004;30:846-850.


A series of economic discussions will appear in the next few issuesof Smile Genesee. The discussions will take place between Dr. JayBerthiaume, a local endodontist, and Barry Simon, the pastExecutive Director of the Builders Association of Metro-Flint. Mr. Simon is now the editor and publisher of “Veritas” and has aB.A. degree in economics.

Berthiaume: It seems in the discussion of money that thedifficulty is separating the concept of money and the concept ofwealth. Money and wealth are two distinctly different things.Would you outline the difference?

Simon: While “wealth” is historically measured in its monetaryvalue, we often forget that another measure of wealth is its “use.”It's the value of that “use” that often creates a discrepancybetween money and “real wealth.”

To simply illustrate these differences, let's look at someone whobuys a light (pick-up) truck for $25,000. While the truck had avalue of $25,000 to the buyer at the time of purchase, itsmonetary value declined immediately when he drove it off thelot, and continued to decline over the period of time hemaintained ownership.

However, he still had, comparatively, the same value in drivingthe vehicle. Thus, while the monetary value likely declined 60%over the following four years, his wealth was technicallyunaffected until he sold the truck.

But, let's suppose he attached a plow to the same truck, andused it to supplement his income by removing snow from 20parking lots at $60 per plow. And, on average over those fouryears, each lot was plowed six times.

In simplistic terms, the wealth created from that truck increasedan additional $28,800 over the period, and he still had theoriginal ($25,000) value in use during those 1,437 days hewasn't plowing. On the day he unloaded the truck, while itsresidual monetary value was only $10,000, his accumulatedwealth over the period can be measured at $53,800 (value of usederived from plowing; the residual value; and $15,000 in valuederived from “personal use”).

The point is, “wealth” can be measured by the value of anyitem's use. Whether we're looking at an airliner, autoproduction machinery, a pick-up truck, or a dental office, theresidual monetary value is usually far short of the actual “wealth”created.

Berthiaume: Except for a barter economy, goods are exchangedfor money, and money is exchanged for goods. This means thatmoney is involved in half of all exchanges. If we fool aroundwith money, what is the consequence?

Simon: Economics, along with being called “dismal,” has oftenbeen referred to as the science of “scarcity.” Consequently,“ancient” (19th and 20th Century) economic theory suggestscreating too much money will make us victim to “demand pull”inflation, as too many dollars would be chasing too few goods.

The problem with that scenario is that, from 19th and 20thcentury perspectives, no economist could foresee the impact of21st century technology and the emergence of a “worldeconomy” on capacity, deliver, and (ultimately) prices. So, whatmay have been considered “too much growth in the moneysupply” when these ancient rules were written doesn't have animpact today.

The combination of the incredible growth in productivity that'sincreased capacity dramatically, coupled with competition fromforeign producers, has kept production costs down. And,

ECONOMICS SMACKDOWN

soaring demand for individual consumer goods has had virtuallyno impact on prices of particular items as marginal costs of thoseitems plummet once “research and development costs” arecovered.

Even basic material scarcities have been marginalized by newtechnologies in exploration, mining and harvesting. Thus, noone can define how much monetary growth is “too much.” Inother words, “fooling” with the money supply does notnecessarily have negative consequences.

It's true that in recent months some individuals, particularly inCongress, have attempted to blame Federal Reserve monetarycreation policies on the housing bubble. Many of those whomake the condemnation claim to be supporters of a “freemarket” economy.

What they refuse to see is that the combination of ignorance andgreed, not monetary policy, is what resulted in the bubble asfirms and individuals attempted to capitalize on the false senseof housing demand.

The value of a home, whether basic or luxurious, comes from itsability to serve as a residence. However, from 2003 through2006 roughly 38% of all homes sold were for non-residentialreasons, while roughly a quarter of all sales were strictly for“investment” purposes. Furthermore, realtors and mortgagebrokers, whether through greed or ignorance, often convincedindividuals to buy homes they couldn't (legitimately) afford withvirtually insane mortgage products under the premise that, ifthey couldn't make their payments in the future, they could “selltheir home at a big profit.”

What's ironic about this situation is that while individuals focusblame on the policies of former Federal Chairman AlanGreenspan, it was Mr. Greenspan who warned of the dangerfrom these “exotic mortgage” products. But unfortunately, noone listened back then, yet many seem anxious to cast stonestoday.

The economist realities of today suggest there remains room foreconomic growth around the world as backward nationsmodernize, while technology improves the capacity to meetrising demand. While there will be a time when the proverbial“brakes” must be used, one nation won't be effectiveindependently. In the 21st Century, “putting on the brakes” willneed international cooperation. In other words, we're no longerin control of our own destiny.

**Please look for further Q&A between Dr. Berthiaume and Mr. Simon in the next issue of Smile Genesee.

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The Genesee District Dental Society Board ofDirectors, in conjunction with Houser & HennesseeAdvertising recently developed a marketing campaign topromote the affordability of preventive dentistry. Theprogram is funded by the MDA Public Relations Fundand provides 100 postcards of each of four designs(shown) for the member dentists of the GDDS. That isapproximately 100,000 postcards available for thoseGDDS members who choose to utilize them. Theywere initially available for pick up at the January 12,2010 dinner meeting. In fact, 55 dentists picked up22,200 cards at that time. But that still leaves about78,000 ready for distribution.

Please understand that the dental society simply cannot afford to mail 400 postcards to all the dentists inGenesee District. I am requesting that you makearrangements to pick these cards up at the office ofGDDS Executive Director, Dr. Jay A Werschky, at G-3269 Beecher Rd. Please call 810-733-7120 to arrangea pick up time.

These postcards provide a wonderful message to allthose patients who have lost their dental insurance and

now feel they cannot afford to see a dentist. All youhave to do is place a stamp and your mailing label onthe card, address it to your patient and drop it in themail.

In the event you would like additional cards, it iseasy for you to obtain them as needed by going towww.smilegenesee.com/postcards. All the designsshown here, plus a few others, will be freely available onthe website. You can forward these to a printer of yourchoice OR select from the lower cost providers on thewebsite. This is a very affordable method to market toan increasing number of patients who have lost theirinsurance benefits yet need to be educated about theaffordability of preventive care.

We have 78,000 cards waiting to be distributed soplease give me a call!

Jay A. Werschky DDSExecutive Director Genesee District Dental Society

2010Postcard Marketing Initiative

Genesee District Dental Society

published byGenesee District Dental SocietyG3269 Beecher RoadFlint, Michigan 48532

PresortedStandard

U.S. PostagePAID

Flint, MIPermit #32

genesee

Mark Your CalendarGDDS DINNER MEETINGS

The GDDS dinner meetings will continue to be at the Flint Golf Club on Tuesdays (unless otherwise noted) with hospitality at 6 p.m., dinner at 6:30 p.m., and a speaker at 7:30 p.m.

February 9: Dr. Alfred Flanzblau, MD, U of M School of Public HealthTopic: Low Level Mercury Exposure Among Dental Professionals

WEDNESDAY, March 10: Dr. Charlie CoxTopic: Dentinal Hypersensitivity Causes and Treatment

April 13: Dr. Dan GeorgeTopic: The Use of Temporary Anchorage Devices in Orthodontics

MiDOOR: Saturday, May 22, 2010Please volunteer for triage at Mott CC or for treatment at your own office.

genesee district dental society information • education ... · genesee district dental society 4...

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