Dental Chronicle (Canada) Sept 30 2010 edition

AS DENTAL TECHNOLOGY AND TECH-niques improve, and the quest forminimally invasive dentistry has

risen to paramount importance formaintenance of structural integrity andpredictability, a far greater variety ofmaterials and techniques have becomeavailable to perfect the end results whenplacing anterior restorative options suchas veneers, implants, or other ceramicrestorative solutions.

To optimize the outcome of plac-ing a veneer, Dr. Andrew Shannon, aVancouver clinician who is a leader incosmetic dentristry in Canada and whohas been accredited by the AmericanAcademy of Cosmetic Dentistry since1997, says he might first opt for ortho-dontic treatment of a patient.

“If their teeth are not aligned,before taking away a lot of tooth struc-ture, it’s far better to align the teeth, sothe amount of aggression you need touse is minimized,” says Dr. Shannon.

Dr. Shannon, who has been listed asone of the Top 100 clinicians by DentistryToday for five years running and who haspresented to fellow clinicians at nationaland international meetings, says hisapproach is to present numerous optionsfor patients and then discuss the advan-tages and disadvantages of the options.

“The approach we take may comedown to what are the patient’s clinicalconcerns about what is going on in their

mouth,” he says. “There are many waysto achieve the end result. The treatmentplan may consist, for example, ofcrowns in conjunction with veneers, inconjunction with bleaching.”

When placing implants, it is impor-tant to consider the factors that increasethe likelihood of implant failure, such asheavy smoking or bisphosphonate ther-apy, adds Dr. Shannon.

FOUR GOLDEN RULES Dr. Ron Goodlin, a Toronto dentist whois also accredited with the AmericanAcademy of Cosmetic Dentistry and isthe Clinical Director of Education at theCanadian Institute for Cosmetic DentalEducation, presented a talk recently onminimally invasive placement of veneers,noting prepless and minimal prep

DentalChronicleCanada’s National Newspaper of Dentistry

n September 30, 2010

Dentist leads drag race team with FunnyCar that runs 405 km/h in the 1/4 mileDr. Brian Friesen of Winnipeg says his all-volunteerteam competes with the sport’s big guns. See page 24.

Y o u r f i n a n c e s

Fee-basedadvisors offerbest valuen Is your advisor fee-based

or on commission? It mightaffect the type of financialadvice he or she provides

FEE-BASED FINANCIAL ADVISORS ARE

the best choice for dentists toensure their own long-term finan-

cial health.“It’s important to deal with an advi-

sor who doesn’t offer products on com-mission, and then that way there is moreincentive to be up front and disclose thecosts of everything,” says Imran Syed,partner and principal with PallenburgWealth Management in Ottawa. “Youwant to find someone who is independ-ent and someone who charges foradvice and not for products. It is betterto deal with someone who does nothave in-house products [to sell].

“How someone gets paid is fun-damental to the type of advice thatthey provide,” said Syed, during a pres-entation at the annual meeting of theOntario Dental Association. “Aninsurance agent, for example, wouldtell you to buy more insurance.”

COST-SAVINGS WILL ADD UP OVER TIMEIt can be restrictive if dentists want topart ways with an advisor who is work-ing on a commission basis because thedentist, as an investor, will have to sellthe financial products to do so. “Thereare huge cost savings dealing with a fee-based advisor, plus there are conflicts ofinterest that are avoided,” he says.

Dentists should take advantage ofthe benefits of incorporation, such asthe opportunity to establish an individ-

DentalVitae

—please turn to page 13


Affiliated with

More patients compromisedDENTISTS SHOULD AIM TO PROVIDE CARE

that is suitable for a patient’s health andmental status, Dr. Trey Petty advised dur-ing the annual meeing of the OntarioDental Association. See page 12.

Implant fracture and the physical mechanisms for failure ..............19Three essential lessons for new dentists ..........................................2110 minutes with Dr. Richard Souviron ..............................................26

New this month

ProductsNew HandpiecesThe S600NL has a standard-sizedhead to allow easy, comfortable accessto the mouth posterior, the S700NLhas a torque head for greater power.

Scaling AdjunctArestin (minocyclinehydrochloride)microspheres decreasepocket depth in adult

patients with chronic periodontitis.

Picasso, Picasso Lite LasersPerfect for a first laseror for advanced laserexperts, the Picassoseries performs a widerange of procedures.

Ultrasonic ScalerErgonomic grip designs in hard andsoft styles, with a wide variety of tipstyles available in both 25K and 30Kfrequency options.

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

by Louise Gagnon,Correspondent, Dental Chronicle

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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.

DR. SCOTT MACLEAN’S DEDICATION TO HIS PROFESSION

emerges through the many hours he spends learningand teaching his art.

“I travel a lot to train, to train myself to make myskills the best that they can be and so that I can trainothers and do some lecturing and keep in touch withother people,” Dr. Maclean says.

It’s also clear to anyone who was seen him interactwith his patients.

“When they get out of the chair and give you a hugout of pure appreciation, it makes you feel that you’re doing a great job for them.,”said Dr. Maclean, or as his patients call him, Dr. Scott.

He believes in treating the entire patient, he said, not just their mouths or teeth,a belief he said came from his mentor, Dr. Carl Dexter, a dentist for fifty years.

Dr. Maclean said Dr. Dexter had a “robust practice,” which Dr. Macleanlearned first hand when he substituted there for another dentist.

“[Dr. Dexter’s practice] was based on treating people not mouths, and notteeth,” he said. “He was a great mentor in terms of professional development,believing that you need to be teaching, believing that you need to be learning.”

The last of these lessons Dr. Maclean seized with gusto, as he not only teach-es patients, but also teaches dentistry at Dalhousie University in Halifax.

He said that in teaching, he learns much from his students.“I think it keeps you sharp. Some of the students ask the best questions of the

profession,” said Dr. Maclean. “They have different views, because they’re not in aparadigm of thinking that dentistry is one way.”

Bone grafting and surgical placement of implants are what he’s learning now inhis continuing education couses, he said. “That’s my primary focus, surgical place-ment of implants and working with cadavers, and trying to advance my hand skillsto the highest level I can.”

Dr. Maclean said activities outside of his education has benefited his practice.One of these activities is football, for which he was inducted into AcadiaUniversity’s hall of fame during his undergraduate career.

“It taught me a lot,” he said. “You may be the best dentist in the world, butwhen you drop the ball [patients] don’t see you in that way. They see you as what-ever limitations you had on that particular day.”

At home, Dr. Maclean spends time with his wife, Cindy, and his three children:Alex, 18; Haley, 16;, and Emma, 13. “My business practice is really a second family.But my family’s number one,” he said.

“I always make sure there’s enough time in my life to go to games, and beinvolved with the number one people in your life.”

American Academy of CraniofacialPain, Canadian Chapter 4th AnnualInternational Symposium15 to 16 October, 2010TorontoTel: 519-435-0438Email: [email protected]: www.aacpcanada.ca

Thompson Okanagan Dental Society—Annual General Meeting, Conference28 to 30 October, 2010Kelowna, BCTel: 250-832-2811Fax: 250-832-2811Email: [email protected]

Toronto Academy of Dentistry 73rdAnnual Winter Clinic 201012 November, 2010TorontoTel: 416-967-5649Fax: 416-967-5081E-mail: [email protected]: http://www.tordent.com

Northeastern Society of Orthodontists(NESO) Annual Meeting11 to 14 November, 2010MontrealTel: 301-718-6510Fax: 301-656-0989Email: [email protected]: www.neso.org

It may have reached your attentionthat while other dental publications arescaling back, and publishing smaller edi-tions, Dental Chronicle continues to growand expand, and offer you an improvedand more useful information package.Thank you for noticing, and for contribut-ing to our success through your support.

Attending the Thompson Okanagan Dental Society AGM in Kelowna, B.C.? 2We’d love to receive your impressions of the presentations and session highlights.

E-mail us at [email protected] a digital photograph of an upcoming meeting destination? Send it to us at [email protected].

We’ll publish selected photos and reward photographers with gift-card prizes.

September 30, 2010 n 3DentalChronicle

DentalChronicleCanada’s National Newspaper of Dentistry

EDITORIAL DIRECTOR

R. Allan RyanSENIOR ASSOCIATE EDITOR

Lynn BradshawASSISTANT EDITOR

Josh Long

SALES & MARKETING

Henry RobertsPhil Diamond

PRODUCTION & CIRCULATION

Cathy DusomeCOMPTROLLER

Rose Arciero

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.ws

Contents © 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: [email protected] 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. Scott Maclean of Halifax.

NOW:MOREMORE news.

MOREMORE pages.


DentalChronicle

The Picasso and Picasso Lite fromAMD LASERS, distributed in Canada by Oral ScienceAt $2,995, the affordability of thePicasso Lite diode laser makes it anattractive option for dentists, said Dr.Glenn van As, who operates CanyonDental Centre in North Vancouver.

“Its elegance and simplicity havebrought many new users into the laserdental field in the last year or two,” hesaid.

Dr. van As said the laser is easy touse, primarily because of its small size.

“One of the interesting things isthat in the past a laser was made multi-opby putting it on a cart, and carrying thelaser between laboratories,” said Dr. vanAs, who said this strategy was necessaryfor lasers that were too difficult to carryaround unassisted. That is no longer thecase with the Picasso Lite, Dr. van Assaid, which weighs in at 0.9 kg.

“It’s a unit you can easily carry fromroom to room.”

Assembly is also easy, said Dr. vanAs. “A dental practice can easily incorpo-rate one of these in a very short periodof time,” he said. “I always laugh, it cantake a certified dental assistant 10 to 15minutes to put it together for you. Itwould probably take the dentist half anhour. But it’s easy enough to put togeth-er, and there’s a quick install DVD.”

The Picasso Lite pays for itself, saidDaniel Ménard, president of OralScience, the company that distributes thePicasso lasers in Canada.

He said the Picasso Lite allows den-tists to keep patients within their prac-tice, rather than having to refer them toother dentists.

“There are biopsies, for example. Alot of dentists are sending [patients whorequire them] elsewhere,” he said, whenthese dentists might easily treat the

patient in-house with the relatively inex-pensive Picasso Lite laser.

Dr. van As said there are many pro-cedures that are made significantly easier

by the PicassoLite laser.

“The lasercan be used toreduce the com-plexity, to get thesoft tissue out ofthe way and thenallow you to con-

tinue on with your task,” said Dr. van As.“But there are procedures that the den-

tist may not want to use because theyinvolve suturing or a chance of bleeding,but that can be now completed by theaverage general dentist using the laser.”

He said the Picasso provides a solu-tion that is ideal for everyone involved.“It’s going to be a win-win situation forboth your patients and your practice,”said Dr. van As.

Softlase Pro laserThe Softlase Pro diode laser has roomfor eight preprogrammed settings.Procedures can be accessed through atouch screen that also includes voiceconfirmation to ensure users know whatchoice they have selected. At 1.35 kg, it’sportable enough to be moved anywherein the office that has access to a 110 volt

outlet.

Ivoclar Vivadent—Odyssey Lasers Ivoclar Vivadent offers two diode lasers.The Odyssey Navigator weighs 1.12 kgand features a touch screen monitor, ahighly rated design and navigation abili-ty, and a screen that can be inverted.There’s room for eight user-defined pro-grams, and there’s no need to cleave orstrip fiber from this laser after each use,as dentists can just snap on a new tip.The 2.25 kg Odyssey 2.4G laser has anLED display, an aiming beam to helpplace the laser, and allows for three userdefined programs.

Periowave PW1100“Not all lasers are cutting lasers,” notedDr. Cary Galler, describing the Perio -wave PW1100 disinfecting laser.

“When people talk about lasers,generally they think about cutting,because that is what a laser does—this isa non-cutting laser,” said Dr. Galler, aperiodontal specialist in Toronto whouses the Periowave PW1100 in his prac-tice to eliminate pockets of bacteria andimprove the outcomes of periodontaltherapy.

Instead, the Periowave PW1100activates a specialized methylene blue-based solution that penetrates the pock-ets and stains residual bacteria. Dr.Galler then uses the Periowave PW1100,a red laser, to activate the methylene bluesolution and kill bacteria in the pocketsvia singlet oxygen formation. Theprocess leaves behind a balance ofGram-positive bacteria which arerequired for establishment of good peri-odontal health.

Dr. Galler said reducing the numberof pathogenic bacteria prevents the pro-gression of disease, and the Periowaveprocess is able to painlessly reach and killthese bacteria in deep pockets.

“You can do this in an environmentwhen the pocket is deeper because thelight penetrates quite deeply into the oraltissues.”

One of the advantages of thePeriowave disinfection system, Dr.Galler said, is that it can serve as an alter-native treatment in situations where sur-gery is not possible.

“Patients have conceptions on howthey wish their care to be directed, andthey often overrule you,” said Dr. Galler,“even though you might explain the ben-efits of your treatment, they may not

ClinicalNewsThe Dental Chronicle Buyer’s Guide: Dental lasers available in Canada n Advances in laser technology means the units are becoming more useful for both hard and soft tissues, and more affordable

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LASERS THAT ONCE COST $50,000 AND COULD ONLY BE

used for specific approved indications are now muchmore affordable and can be employed to accomplish a

variety of preventive, cosmetic, and surgical treatments foryour patients, on both soft and hard tissues. In addition tobeing much kinder to the practice pocketbook, lasers arenow small enough to fit on a tray table so they can be easi-ly transported to different examining rooms. In fact, someof the new lasers can even fit into your pocket.

The following Laser Buyer’s Guide, assembled by theeditors of DENTAL CHRONICLE, outlines the main featuresof most of the lasers available to Canadian dental practi-tioners, as of press time.

Please check out our online laser survey athttp://ow.ly/2IoD9. We’d welcome the opportunity tohear your comments regarding experiences with lasers inyour practice, and we’ll publish a report based on readerresponses in an upcoming issue. Additional comments canbe emailed to [email protected]

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agree with you.”Dr. Galler said that can happen if a

patient is afraid of surgery, or cannotafford the procedure. He said there arealso medical conditions that increase therisk of surgery, such as diabetes or if thepatient is on blood thinners.

Dr. Galler said the disinfection sys-tem works well in conjunction with tra-ditional treatments, but shouldn’t beused for all patients nor as a replacementfor mechanical cleaning.

“It’s not approved for monothera-py,” he said. “And that’s an importantpoint, so you don’t just squirt the lasereverywhere and send the patient home.You still have to do the mechanicalinstrumentation,” including scaling androot cleaning.

“I strongly believe that this does killbacteria when it’s used properly in theright concentration with the right periodof time, and that produces better clinicaloutcomes,” he said. “It’s painless treat-ment.”

Dr. Galler saidhe uses the Perio -wave PW1100 laser,though a new modelhas been developed,the Perio wave HHL-1000, a laser slightlylarger than a pen. Itwas made availableto dentists in Can -ada as of mid-August.

Nick Loebel,who holds a PhD inbiomedical engineer-ing and is OndineBiopharma’s ChiefTechnical Officer,

said the HHL-1000 was designed inresponse to clinicians who wanted a

smaller laser unencumbered by fiberoptic cables and power cords.

“You still have clinicians who say,‘operatory space is limited,’” said Dr.Loebel, quoting some of the feedbackhe received from dentists, “'and they alsodon’t like the fact that there’s a powercord involved when you’re charging it,[or] a fiber optic cable that transfers lightfrom the station to the handpiece.”

Generally, Dr. Loebel said, dentistswere willing to accept this, until the

Periowave HHL-1000 provided themanother option in the form of a cordlesslaser the size of a pen.

“They loved it,” said Dr. Loebel.“They said, ‘gotta have it.’ They all pre-ferred it over the base station format.”He also noted the HHL-1000 laser canbe used with rechargeable AAA batter-ies, which can be charged using thecharger included with the kit, or by any

ordinary battery charger.Dr. Veronique Benhamou, the

director of periodontology at McGillUniversity, has had the opportunity touse the HHL-1000 at her own practice.

“I think it’s great, with the sameoutcomes as the earlier model laser. Thedifferences are that I don’t have as muchclutter. I don’t have a foot pedal to dealwith, and I don’t have wire to deal with.

The laser is very light, very convenient touse,” said Dr. Benhamou.

She also said this system allowedher to effectively treat deeper pocketsthan with regular therapy, and that therewas less bleeding when she probed afterthe healing phase. She also found adecrease in inflammation and less reces-sion of soft tissue, and she said these

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�ClinicalNews

Picasso and Picasso Lite lasers now available to Canadian cliniciansn Picasso dental lasers have proven that laser dentistry has finally arrived in the industry, says laser company president

The Picasso series of lasers, distributedin Canada by Oral Science, weredeveloped by AMD LASERS ofIndianapolis, Ind. In this exclusive

interview, AMD LASERS Presidentand CEO Alan Miller spoke to Dr.George Freedman regarding the devel-opment of the Picasso laser and its

recent launch in Canada.

Why lasers? Why now?Great question! 2010 represents 50 yearsof lasers. But for most dentists, lasers

were too complicated and too costly.AMD LASERS has made lasers afford-able for the general practice, and they arerapidly becoming the standard of dentaltreatment. Patientsare educated andknow that lasersare the standard ofcare (take eye sur-gery for example),and they expecttheir dentist tohave the samelevel of technolo-gy in their prac-tice. It is a simplematter of supplyand demand: everypatient wants lasertherapy, dentistscan use lasers easi-ly and (due toAMD) they are a smart and small invest-ment.

You are considered to be the numberone laser company in the world. Howdid you accomplish that?Simple. I gave dentists what they havebeen asking for—a reasonably priced,high-quality laser and killer customersupport. When leading clinicians andacademics first tried the Picasso brand,they were instrumental in helping tofine-tune the product so that it would beperfect for the practice. This led to pub-licity in many industry publications, andsoon thereafter, we were able to rocketinto laser stardom. Picasso dental lasershave proven that laser dentistry has final-ly arrived in the industry. It took somevision, extensive investment, and a lot offaith. Picassos have won every dentaland design award possible and have beenthe laser of choice of experts, universi-ties, and neighborhood dentists andhygienists around the globe.

How will the Picasso brand’s availabili-ty in the Canadian market impact prac-titioners and AMD LASERS?Emerging into Canada will present awonderful opportunity for AMDLASERS to finally offer the Picassobrand of dental laser products and acces-sories to dentists who serve and practicein the Canadian market. It is a big plusfor us to add this market to the 56 coun-tries on six continents where we current-ly do business. I believe that manyCanadian practitioners, many whom wehave met at industry events, are anxiousfor the Picasso brand to come to Canada.

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veneers can be a welcome addition to apatient treatment plan.

“The patient’s concerns are oftenthat they don’t like the idea of cuttinginto the tooth,” he said. “If we can min-imize the amount of cutting into thetooth, that can be critical to the ultimatesuccess of the case by improving thestructural integrity of the tooth as wellas the bond strength of the ceramic tothe underlying tooth, and it makes it eas-ier for the patient to accept treatment.”

He sees four golden rules involvedwith the placement of veneers, withthose being first to avoid cutting into thetooth unless absolutely necessary. If cli-nicians do need to cut into the teeth, theyshould minimize the amount, becausethe more they cut, the more tooth struc-ture is removed, and the more they com-promise the structural integrity of thetooth. Secondly, clinicians should aim tomaximize the amount of enamel that theveneers can bond to. Although clinicianscan bond veneers to dentin, bonding toenamel is preferable because it providesfor a stronger bond. “The veneer will bestronger if they bond to enamel,” he says.

The third golden rule is to start withthe end in mind. Do a mock-up of wherethe ideal tooth position should be follow-ing the principles of smile design (espe-cially when determining the all-importantincisal edge position). Once the idealposition is determined, the clinician candecide on the most minimally invasiveapproach to achieve the desired outcome.

The fourth golden rule is that theocclusion has to be correct, says Dr.Goodlin. By starting with a diagnosticwax-up or composite mock-up beforethe teeth are prepped, the clinician hasthe ability to transfer the architecturalmodel to the patient’s mouth in the formof a temporary mock-up, allowing thepatient to take the new smile for a testdrive and work out the cosmetic andfunctional issues, thereby making sureyour patient is happy and comfortableevery time,” he explained.

EACH CASE HAS MANY ANGLESDr. Goodlin agrees with Dr. Shannon thatperforming orthodontic treatment beforethe case is started is the preferable way toensure that any teeth that are not very wellpositioned are better positioned so as beable to minimize or eliminate the loss oftooth structure. Performing teeth whiten-ing before the teeth are prepped will con-tribute to an esthetically desirable out-

come to make certain the tooth colorshowing through the veneer is correct.

In some situations, where clinicianshave sufficient tooth to work with, theycan use traditional feldspathic porcelainsas well as a pressedceramic, such asthe E.max materi-al. Dr. Goodlinuses a cutbacktechnique on theporcelain itselfand layers in somedifferent surfaceporcelains to create a more “lifelike”appearance. Additionally, he uses incisaltranslucencies and proper color gradationalong with nuances of maverick colorsand characterizations to give his restora-tions a natural yet esthetic appearance.

“The problem is that very often cli-nicians view a case as a ‘veneer case’ or a‘crown case’ or a ‘bonding case’, like see-ing apples and oranges, whereas compre-hensive treatment is more akin to a bowlof fruit,” he says. “One tooth is an apple,another is an orange, and another is abanana. We can minimize oss of toothstructure and the amount of financialcost to the patient by combining differ-ent techniques such as minor orthodon-tics and then using a composite on onetooth with a veneer on another.”

Newer materials such as EmpressDirect from Ivoclar allow dentists toaccomplish these goals because the com-posite material mimics the optical andphysical properties of the ceramic. “Thepolish, wearability, strength, color match,and longevity of these restorations areoutstanding, making them last longer andmore resistant to stain,” Dr. Goodlin adds.

“When you have one next to theother, they look the same,” he says.“Rather than placing eight veneers, youmay only need to place three veneers anda few composites. Fewer teeth need to bereduced, it is less invasive, and it can pro-vide a more responsible esthetic solution.”

Incisal Edge Position and the correctanterior guidance needs to be ensured, sothat the envelope of function is notinhibited, to reduce the risk of breakageof these restorations, and it increasesdurability and comfort, adds Dr. Goodlin.

Dr. Lancelot Brown, a Toronto den-tal surgeon, is increasingly placing moreveneers. Although he agrees with the prin-ciples (the four Golden Rules) advancedby Dr. Goodlin), in his experience,patients do not report the same comfortlevel with “no-prep” or prepless veneers

as they do with veneers that requirepreparation. “These teeth feel thicker forpatients,” he says.

He has found that prepless veneerscan fail from their inherent thinness, and

require repair orreplacement moreoften than veneersthat require prepa-ration.

While com-posite bonding asveneers is lessexpensive than

porcelain veneers, the porcelain veneerwill last much longer.

“Composite material is nowherenear as durable,” he says, noting compos-ite restorations last about four to six years.

“The incidence of discoloration isalso much higher with composite bond-ing and is very much dependent on apatient’s social habits. If you are a smok-er or drink a lot of coffee or tea, youmay find the color of the restorationswill fade more quickly.”

IMPLANTS HAVE COMPETITIVE PRICINGPorcelain restorations last about 12 to 15years, and the quality of the porcelain,such as those made from lithium disili-cate, have improved to the point that“you’d be hard-pressed to know that itwasn’t the person’s natural tooth.”

There is less need to replace porce-lain restorations over time than com-posite restorations, and therefore theyare more cost-effective in the long run,according to Dr. Brown.

David Kochberg, RDT, one of thefounders of the Toronto Implant andAesthetic Study Club, operating managerof Applied Arts Laboratories Ltd., saysthat while anyone who loses a tooth is agood candidate for a dental implant,there are several issues in determiningthe viability of a dental implant.

“Sometimes it’s a financial consider-ation, and sometimes it’s an anatomicalconsideration, and bone is not there,”says Kochberg, who runs the Academyof Dental Technology in Toronto. Thereare constant changes in terms of pros-thetics regarding implants, he notes.

Cone-beam computed tomographyis used to capture a scan and produce amodel of the jawbone, and cliniciansdevelop a surgical guide for patients,explains Dr. Robert Leigh, who runs theImplant Smile Center of Alberta inWestlock, about 90 minutes north ofEdmonton. The guide is inserted into the

mouth and screwed into the jawbone.

MANY SHAPES AND SIZES AVAILABLE“Once the surgical guide is screwed in,we can then go about placing theimplants into absolutely perfect posi-tions,” says Dr. Leigh, a diplomate of theAmerican Board of Oral Implantology.“If they are placed any old way, theremay be difficulties with angulation,”which may ultimately compromise theesthetic and functional results.

Many more companies are now offer-ing implants, making the pricing very com-petitive, says Dr. Leigh, whose patientscome from all over North America.

“For $200 to $300, you can get a top-notch implant,” he says. “You do not needto charge $3,000 to place an implant.”

The prosthetic component, theabutments of the implants, are nowavailable in many different shapes andsizes, as well as more esthetic materialssuch as custom made Zirconium abut-ments with the margins already pre-pared, Dr. Leigh said, and they can beordered at different angles as required,or as longer or shorter or fatter versions.

“They have impression transfercopings that we can snap onto the abut-ments in the mouth and transfer thatinformation to a master case,” Dr. Leighsays. “It helps to make our impression-taking that much easier.”

Computer-scanned impressions willincrease the precision of the procedure,such that the information can be emailedto a computer and the laboratory can makethe crown without seeing the patient.

One of the other advances in implantdentistry, apart from computer usage toassist in the precise placement of implants,is the availability of new materials for bonegrafting, materials that include cadavericbone and synthetic bone, allowing morepatients to be eligible for implants follow-ing the grafting procedure.

“We can cause bone to regrow,” Dr.Leigh notes, adding that hormonal ther-apies allow for regrowth of bone. “Wecan graft from other sites of the body,such as the hip and the knee, and moveit to sites in the mouth.

“Oral surgeons can do some ofthese procedures in patients who havesevere bone atrophy. When there is a biggraft involved, we refer the case to anoral surgeon.”

Implantology is a field that is well-suited to general dentists, and it is a fieldthat is driven by prosthetics, says Dr.Leigh.

DentalChronicle

Implants and veneers in 2010: More methods available to perfect resultscontinued from page 1—

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It’s What Leaders Do.

Isopentane TechnologyTransforms the gel into foam resulting in

rapid dispersion of the active ingredients,

potassium and fluoride, in the mouth.1

Penetrates Hard-to-Reach AreasRelieves sensitivity even in the interproximal areas

and gum line margins of posterior teeth.2,3

All-around ProtectionDeep cleans the mouth and effectively

removes the causes of bad breath.4

1. GSK data on file, 2010. 2. GSK data on file. Sensodyne iso-active® claim support summary, Jan. 28, 2009. 3. Leight RS et al. Dentinal hypersensitivity: a 12-week study of a novel dentifrice delivery system comparing different brushing times and assessing the efficacy for hard-to-reach molar teeth. J Clin Dent 2008;19:147–153. 4. Gross RC et al. Removal of oral debris/bacteria by an experimental gel-to-foam toothpaste. Presented at the General Session and Exhibition of the Pan European Federation of the International Association for Dental Research 2008, September 10–12. London, England. Poster 467.

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Dental grey market: Products could be compromised in safety, efficacyn If chain of custody of products cannot be established, dental practitioners could be placing themselves in legal jeopardy

DENTISTS NEED TO EDUCATE THEM-selves to ensure they are providingtheir patients with licensed prod-

ucts that are aimed for the marketplacein Canada.

There’s a burgeoning “grey market”in Canada where dental products anddevices that may not be authorized byHealth Canada are being distributedthrough unlicensed channels. Using suchproducts can potentially place dentalpractitioners in legal hot water if theyprove to be compromised, observesBernie Teitelbaum, executive director ofthe Dental Industry Association ofCanada (DIAC).

Since manufacturers are required byHealth Canada to ensure that shipping,storage, and handling of their licensedproducts is in compliance with theirpublished requirements, they will notwarranty any product that is soldthrough a distribution channel that theycan’t control. This leaves the dentist toassume the entire risk.

When dentists use licensed prod-ucts obtained through licensed andauthorized distributors, those productscan be easily traced back to the manufac-turer for recourse or recall, and a dentistcan rely on the manufacturer to backhim up, explains Teitelbaum.

EVIDENCE OF COMPLIANCE“The dentist took care to ensure theproduct was licensed and safe,” saysTeitelbaum, noting that the same legalprotection may not exist if dentists areusing unlicensed products or productsdistributed through unlicensed channels.

Dental products that are sold inCanada need to be compliant withMedical Devices Regulations as out-lined by Health Canada. Sales represen-tatives from licensed firms that sell den-tal devices and dental materials inCanada should be able to provide evi-dence of compliance whenever dentalpractitioners request that information.

If manufac-turers choose towork with a dis-tributor, manufac-turers produceguidelines fortheir distributorsto adhere to, inorder to ensurethat goods areshipped, stored,and handled in amanner that guar-antees productefficacy and safe-ty.

“Some den-tists say they willnot touch grey market products because ifsomeone [a patient] gets hurt [because ofthe use of such products], it will damagethe credibility of the dental community,”says Teitelbaum. “It is just not worth therisk of patient complaints, remakes, andrecalls to save a small percentage of asmall percentage of the dentist’s totalcosts.”

Peter Jugoon, Vice-President ofMarketing and Strategic Planning forHenry Schein Canada and past-presi-dent of DIAC, says many Canadiandentists are not aware that there is a grey

market for dental products and moreeducation is needed to inform them thatit is in their best interest to steer clear ofordering and using grey market prod-ucts.

“You hold the risk of liability tied tothe fact that you use grey market prod-ucts,” says Jugoon, noting that grey mar-ket products may be compromised interms of safety and efficacy.

It may be that the products are notcompromised when they reach the enduser in Canada. Still, the sale of greymarket products is illegal because thechain of custody cannot be established,stresses Jugoon. Dentists who buy greymarket products incur all the potentialcosts associated with them and couldface reprimands from their provinciallicensing body if it is proven that theyhave not exercised a professional stan-dard of care, adds Jugoon.

Even though dental practices areexcempt from medical device regulari-ons [as healthcare facilities], they are notexempt from their own professionalstandards of care in their choice of den-tal materials.

Manufacturers are being encouragedto make potential grey market productmore identifiable for dentists, includingrebranding and repackaging products thatare now being diverted in unknown con-ditions from third world markets.

Dr. Aldo Boccia, a Toronto dentist,says Canadian dentists are bombardedwith advertising, in the form of flyersand catalogues, which boast of substan-tial savings that dentists can make whenpurchasing dental products and devices.

PRODUCTS FOR USE IN OTHER MARKETSDr. Boccia speculates that these areproducts that were legitimately manufac-tured for countries in Eastern Europe ordentists in developing countries, forexample, and they have been rerouted toNorth America and sold at a lower costcompared to products originallydesigned for North America andWestern Europe.

“They [grey market products] aremaking their way into North America,but they were destined for other mar-kets,” explains Dr. Boccia. “They maybe good products, and the quality maybe there. However, they were designedfor and shipped to different markets.We do not know if there have been anydegenerative effects on the products by

the time they make it to North Am -erica.”

Dr. Boccia further states that: “Todaywe have some countries which are dupli-cating the containers and wrappings ofmany intra-oral dental products [grey toblack market products] so accurately thateven the legitimate manufacturer cannotdistinguish them from their own. We havefound much inferior products in theseduplicated containers with no proven qual-ity control. The dentist finds these inferiorproducts difficult to work with intra-orallyand potentially harmful to the patient.”

Dental practitioners should exercisecaution if they are being promised dealson products or dental materials thatsound too good to be true.

“If you are buying products afteryou saw a flyer that reached yourdoorstep, then it is a case of buyerbeware,” says Dr. Boccia.

Indeed, dental practitioners who areseeking “bargains” when they are pur-chasing dental materials and devices maybe avoiding the costs of regulatory com-pliance in Canada.

“The dentist is ultimately responsi-ble for the treatment of their patients,”stresses Dr. Boccia.

EDUCATING STAFF A GOOD IDEADentists need to educate themselves andtheir staff about the availability of greymarket products and to be watchful ifthey are conducting electronic businessand purchasing products online, accord-ing to Teitelbaum.

“Dentists are usually not the onesplacing the order,” says Teitelbaum.“They are usually not the ones who arereceiving the order, and they are usuallynot the ones who are opening up thebox. The dentists should ensure theytell the members of their staff not to‘do them any favors’ by searching forbargains on dental materials and prod-ucts.”

Health Canada does not have suffi-cient resources to monitor that all mate-rials and products being used in dentalpractices are covered by a Canadianmedical device license, a license that isobligatory for the legal sale of medicaland dental goods in Canada, accordingto Teitelbaum.

An official from Health Canadadeclined to comment on the availabilityof grey market products to the dentalcommunity in Canada.


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A recent e-mail survey conducted among over 100 dental clinicians who read DENTAL

CHRONICLE seems to indicate that the majority are aware the grey market is operating inCanada, with 73 per cent of respondents indicating in the affirmative when asked if theyknew about the grey market.

Although there is an approximately even split between dentists who personallyverify that the dental products and devices they purchase are covered by a Canadianmedical device license and those who don’t, dental practices are being careful withtheir purchases—87 per cent of the survey respondents claim that they have neverpurchased any dental products or devices that they later found out might have beengrey market products. This figure may be a testament to a more concerted effort bysales reps to ensure that the products they sell have appropriate licenses, as 87 percent of the responding dentists report that is how they purchase dental products—fromsales reps.

DENTAL CHRONICLE periodically polls its readers on matters relating to the practice ofdentistry and the publication. If you would like to participate in future DENTAL CHRONICLE

surveys, please send an email with the subject line “Yes to survey” [email protected]. Our surveys are quick, and easy to complete.

DentalChronicle


Gordon J. Christensen, DDS, MSD, PhD, a practicingprosthodontist in Provo, Utah, is founder and director ofPractical Clinical Courses, an international organization dedi-

cated to continuing education for den-tal professionals, and Dean of theScottsdale Center for Dentistry. Dr.Christensen assisted in developing den-tal schools at both the University ofKentucky and the University ofColorado early in his career. He haspresented more than 45,000 hours ofcontinuing education across the globe

and has numerous published articles and books. Dr.Christensen has become active in educating his dental peersregarding the perils of the “grey market” for dental productsthat are available to North American dentists. He advocatesadopting a “buyer-beware” approach when it comes to thesetypes of products that are being offerred, often at steep dis-counts. He spoke with DENTAL CHRONICLE contributorLouise Gagnon.

Is it your sense that dentists are aware of the exis-tence of a “grey market” for dental products inCanada and in the U.S.? They may be using grey market or even counterfeitproducts, and they may not know it. Many people wantbargains, and dentists who order products are notexceptions to this. The widespread use of the Internethas made it much easier for distributors to try and sellgrey-market products.

What do you see as the dangers of using grey marketdental products?There are many dangers. The products might beexpired, modified, or they may not be the real thing andbe counterfeit. They may have been compromisedbecause of improper shipping or storage. Material fail-ure may occur. There is the issue of legal liability sur-rounding the use of dental material that is notapproved for sale in the U.S. or Canada or cannot betraced back to the manufacturer.

In addition, the grey market creates a clinical riskexposure for dentists. When the product does not meetits intended purpose, who can you address? If patientshave complaints, you cannot go back to the manufactur-er if the product cannot be traced back to the origin ofsale. It is not worth trying to save money by purchasinggrey-market products if there are so many concerns.

What are the clues that a product may be grey market?Dentists need to look at the price of the products anddetermine if they are significantly lower than marketprice. They should look at online or printed cataloguesof major dental retailers to compare prices. Anotherclue is that there is an unknown distributor name. Thepackaging may be a clue as well, such as the bar codebeing blocked out or the printing on the package beingsmeared. If the product has expired or it appears theexpiration date has been changed, that is another clue.

Look for other signs such as if the product ismarked that it is not for sale in the European Union orU.S. or Canada.

How can dental staff, who usually order products, beeducated about grey market dental products?Dentists should meet with the staff member in theiroffice who orders supplies in order to evaluate theoffice’s supply needs and establish the brands andquantities that should be ordered.

It would help to identify unauthorized distributorsof products.

How do you suggest manufacturers ensure their prod-ucts are not sold as grey market dental products?Dental manufacturers are starting to use labelling toallow for identification of grey market and counterfeitproducts. One manufacturer has filed a citizen peti-tion with the Food and Drug Administration in theU.S., seeking action against authorized dealers thathave been discovered to be distributing grey market orcounterfeit products. It is unknown what percentageof dental products sold are counterfeit or grey marketproducts.

Would different packaging make it easier to identifygrey market dental products?Yes, it would.

What advice would you give to dentists to help themavoid the potential purchase of grey market and coun-terfeit products?I think it is a wise decision to deal with major distribu-tors. Such distributors also provide repair support. Ican also discuss the qualities of the products with localsales representatives.

Dentists should also steer clear of heavily dis-counted prices. They should expect to pay a fair marketprice for products, with price reductions not being verygreat or frequent. Dentists should ask themselves howdental retailers can sell dental supplies at highly dis-counted prices while other retailers sell the same sup-plies at market level.

It is best to adopt a buyer-beware policy in dentaloffices.

AUSTRALIA Conventional wisdom wins again, as astudy out of the Australian Research Centre forPopulation Oral Health has linked a lack offruits and vegetables to inadequate dentition,according to a report in the Australian DentalJournal (2010; 55(2):143-149). The results foundthose who consume fruits and vegetables lessthan once a month had a higher incidence oflost teeth. The findings came from data collect-ed between 2004 and 2006 using a three stagestratified cluster sample including a computerassisted telephone interview, an oral examina-tion, and a mailed questionnaire followed by afood frequency questionnaire. Out of the14,123 respondents, 5,505 agreed to undergo anoral epidemiological examination. The studywas conducted by David Brennan, an associateprofessor at the University of Adelaide.

UK Trouble treating younger patients? An article inthe British Dental Journal asks: what happens ifyou put them to sleep? (June 12, 2010;208(11):E21). The study set out to “determinewhich services dentists use to manage unco-operative children.” To answer the question,the study looked at patient and referrer satis-faction of about 400 patients ages five to 12years who were referred for cavities andorthodontic extractions. Methods of sedationincluded a combination of intravenous mida-zolam/ketamine/fentanyl in 40 per cent ofcases, and intravenous midazolam/ketamine in34 per cent. In these patients, 56 per cent ofdentists preferred general anesthesia, while 66per cent preferred IV sedation. Most of theparents were satisfied with the procedure, and

little difference was seen in thereferring dentists perceptions ofgeneral anesthesia or IV sedation.

USA A study out of the Journal of the American DentalAssociation (2010; 141(4):415-422) compared theeffectiveness of mouthwash in preventing bacte-ria present in patients’ mouths from contaminat-ing the dental clinic. The study compared a com-mercial preprocedural mouthwash containing0.05 per cent cetylpyridinium chloride (CPC) toa rinse solution containing 0.12 per centchlorhexidine (CHX) and water to evaluate howeffective they were at reducing levels and com-position of bacteria in oral splatter. The studyfound that while the water was less effective ateliminating bacteria, CPC was about as effectiveas CHX.

BRAZIL A meta-study is seeking to “systematicallyassess the factors influencing tooth loss duringlong term periodontal maintenance,” said an arti-cle in the Pediatric Dental Journal (2010; 20(1):1-6).Studies including patients with periodontitis whounderwent periodontal therapy and a mainte-nance care program were searched in CEN-TRAL, MEDLINE, and EMBASE weresearched up to and including Sept. 2009. Whenthe results were analysed and compared, thestudy did not find any definitive conclusions,although it did conclude tha t age, smoking, andinitial tooth prognosis were associated with toothloss. The study suggested patients be instructedto quit smoking, and continue to see their den-tists, and said that further analysis into smokingfrequency and the particular type of periodontitiswould allow for more accurate evaluations.

The dental grey market can be dangerous to your career, U.S. dentist saysn Dentists should meet with staff member who manages supplies to establish the product brands and quantities to be ordered

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DENTISTS MAY NOT BE ABLE TO PRO-vide ideal care for their patientswho are medically compromised,

and should aim to provide care that issuitable for a patient’s health and men-tal status, particularly as that patientages.

“There is an idea that anything lessthan an ideal treatment plan is compro-mised [care],” says Dr. Trey Petty, apracticing dentist and an associate pro-fessor of surgeryin the faculty ofmedicine at theUniversity ofCalgary.

“An idealtreatment plancan in fact makepatients sick and compromise theirmedical care. Dental care can be veryinvasive because we are injecting thingsin the mouth and cutting in themouth.”

Delivering a talk during the annualmeeting of the Ontario DentalAssociation in Toronto, Dr. Petty notedthe general population is not getting anyyounger, and that epidemiological phe-nomenon will be observed in dentalpractices.

With the aging of the population,dentists will have to be providing geri-atric care to a greater extent, said Dr.Petty. “There will be more and morepatients walking through their doorsthat are older and medically compro-mised,” he noted.

IDEAL NOT ALWAYS ACHIEVABLEMoreover, dental schools need to con-vey the concept of ‘realistic’ care for anincreasingly older patient populationthat may possess multiple co-morbidi-ties, both physical and mental.

“Dentists need to think aboutwhat is realistic to bring about goodoral health versus what has been thedental school ideal vision,” explainedDr. Petty.

If a patient is on anticoagulantsfollowing an event like a heart attack orstroke, for instance, they likely cannotwithstand invasive treatment such as atooth extraction or crowing of a tooth,explained Dr. Petty.

“The patient could bleed todeath,” stressed Dr. Petty, noting den-tists need to inform themselves of thepatient’s International NormalizedRatio before they perform surgery orscaling.

It’s recommended that the INR be3.5 or less for scaling to be safely per-formed, and the general recommenda-tion is that the INR fall between 2.0and 2.5 for surgery to be safely per-formed.

And because of the move to out-patient care in treating cancer patients,some patients may be undergoingchemotherapy and visit the dentistwithout mentioning their medical care.Chemotherapy will affect the patient’sability to heal or for their blood to clot,so procedures such as extraction orscaling of the teeth may not be ideal toperform if patients are undergoingchemotherapy, said Dr. Petty.

“You need to be aware of theirplatelet count,” he said.

OLDER PATIENTS UNDERDIAGNOSEDIf patients are undergoing surgerybecause of oral cancer, it may changethe anatomy in the mouth, and it is afact clinicians need to be aware of,according to Dr. Petty.

In addition, if patients are under-going radiation therapy, there is strongpotential that they will have xeostomia,which predisposes them to other oralhealth challenges.

Another consideration is thatpatients who are on some pharmaco-logical therapies are not suitable candi-dates for receiving anesthesia. “Ifpatients are taking MAO inhibitors,these medications are contraindicatedwith local anesthetic administration,”said Dr. Petty.

Other healthcare providers, suchas nurses and physicians, are not trainedto look in the mouth and think aboutthe oral health of a patient, said Dr.Petty. “Older patients are typicallyunderdiagnosed and undertreated interms of their oral health.”

Patients who have conditionssuch as dementia or Alzheimer’s dis-ease are not able to communicate withtheir healthcare providers to ensurethey receive appropriate care followingdental procedures, according to Dr.Petty.

In such instances, dentists need tospell out medication regimens designedto relieve pain for patients, and instructhealthcare providers at long-term carefacilities, for example, to deliver thesemedications to provide symptom reliefto dental patients.

“If a patient has dementia, thatpatient may express that they are inpain by being in a foul mood,” Dr. Pettysaid.

“We need to write the prescrip-tions, so that nursing staff know howto deliver the medications. You need tokeep the language simple for caregivers,whether it is family members or staff ata healthcare facility. Nurses and physi-cians don’t know dental terms or thetooth-numbering system.”

It is worthwhile for dentists toensure their staff receive training inhow to transport a patient from awheelchair to the dental chair todecrease the potential for injury and todesign the office to facilitate such trans-port. If patients do not oblige withdental staff in their transport from thewheelchair to the dental chair, thenthere may be a re-evaluation of thenecessity for dental care.

“If the patient is uncooperative,loud, and aggressive, then there may bea re-assessment of the need for dentaltreatment, as well as a discussion withthe family,” Dr. Petty said in conclusion.

—Louise Gagnon,Correspondent

Demographics: More dental patients likely to be medically compromisedn Aging population means dentists will be providing more geriatric care; ODA speaker stresses importance of treatment plans

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ClinicalNewsDental_Aug_10_rar24_ms.qxd:Dental_Aug_10_rar24_ms.qxd 06/10/10 1:36 PM Page 12

ual pension plan, but says they should notincorporate for the sole purpose of estab-lishing an individual pension plan.

“They can use corporate dollars[rather than personal dollars] to fundtheir retirement planning,” explainsSyed. “It makes sense for dentists whoare aged 60 and older to have such aplan. It allows you to put additionalmoney aside over and above an RRSP.”

Risk management translates toensuring dentists have adequate disabili-ty, critical illness, and life insurance cov-erage, according to Syed.

“They should try and set up disabil-ity insurance before they incorporate,”explains Syed, noting the disability insur-ance will cover them for a larger amountof money than if they obtain disabilityinsurance after they have incorporated.

Incorporating also permits dentiststo enjoy the benefits of income splittingwith their spouses, notes Syed. It ispreferable from a taxable standpoint toformally lend money to a spouse, if thespouse is in a lower tax bracket, for thepurposes of investment than to justinformally give them money to invest.

PROFESSIONAL ADVICE RECOMMENDED“If you formally set up a loan to yourspouse, rather than just informally gavethem money, the growth on that [invest-ment] is not taxable back to the dentist,”says Syed. “If you just gave your money tothe spouse, and it was invested, any growthfrom that investment would be taxableaccording to the income attribution rules.”

Syed advises dentists against invest-ing on their own given it is human natureto not be completely rational with one’sown money and because their profession-al life takes up many hours of their day.

“There are cognitive mistakes thatinvestors make when they are investingon their own,” says Syed. “It is very dif-ficult to invest on your own becauseemotions come into play. An advisor canbe impartial about the decisions.”

A good financial advisor suggestsinvestments that are at a lower cost andare not overly aggressive, but does notguarantee specific results, says Syed.

“We can’t guarantee the perform-ance of the market,” explains Syed. “It’slike asking a travel agent to guaranteeyou get good weather and that it won’train when you take a vacation.”

There are steps that dentists cantake such as setting up a dental hygienistcorporation in order to have someincome splitting of the practice.

Another benefit to incorporation ispreserving a capital gains exemptionwhen a dentist sells his or her practice.

Meeting with a financial plannershould cover four areas including retire-ment planning, investment planning, tax

planning and asset protection, and estatetransition and risk management.

Depending on the dentist’s situa-tion, a financial planner may suggestestablishing a holding company and anoperating company and may suggest

transferring assets from the operatingcompany to the holding company.

Another strategy is to ensure theindividual pension plan is held by theholding company as opposed to theoperating company.

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IT TAKES A LOT OF WATER TO OPERATE

the typical dental practice in NorthAmerica, and many dental practition-

ers are recognizing that it can make envi-ronmental and financial sense to mini-mize that water use.

A typical vacuum system in a dentalpractice is very inefficient in terms ofwater use, according to Ina Pockrass, anattorney and co-founder of the Eco-Dentistry Association based in Berkeley,Calif.

“When you analyse water use at adental office, the first thing you need tolook at is the vacuum system that isused since every office needs a vacuumsystem,” explains Pockrass, whose asso-ciation provides dental practitionerswith information to make environmen-tally-friendly decisions about their prac-tice and keeps dental students informedabout steps they can take to help maketheir practices green when they gradu-ate.

It’s estimated that the vacuum sys-tem will use 360 gallons of water per day in one dental office. In the U.S., where

there are an estimated 122,000 dentaloffices, about nine billion gallons ofwater are used.

“That is water that is clean, potablewater that could otherwise be used fordrinking and bathing that is going downthe drain of dental offices every year,”says Pockrass.

To conserve water, dental practi-tioners can use water recirculators,devices that attach to the vacuum sys-tems, to halve the amount of water usedin a vacuum system.

DEVELOPMENT OF DRY VAC SYSTEMSREDUCES OFFICE WATER CONSUMPTIONBetter still, dry vacuum systems repre-sent an alternative to the standard vacu-um systems that demand copiousamounts of water to run, explainsPockrass.

“They do not use water at all,” saysPockrass, noting dry vacuum systemswould be of particular benefit in geo-graphically dry regions. “There are areasin North America where water is at apremium. In those areas, there would bea great interest in moving to either use ofa water recirculator or a dry vacuum sys-tem.”

The upfront cost of the dry vacu-um systems is greater than that of the

standard vacuum systems, but theyreduce a dental practitioner’s environ-mental footprint as well as reducingcostly water bills. Dentists will also see adrop in their electricity charges since dryvacuum systems use about 50 per centless electricity than the systems thatrequire water.

One of the ways that Dr. BrianWong, an Edmonton dentist, also con-serves water by using digital imagingrather than processing film for his clini-cal images. Dr. Wong says he, his part-ner, and staff try to be environmentally-friendly in their practices as a generalrule.

“If you need to process film, youhave to use waterto rinse off filmsin order to readthe films,” ex -plains Dr. Wong.“If you are run-ning digital X-rays,you do not have tobe constantly run-ning water aroundthe developer, andthat reduces yourwater usage.”

K a t h l e e nBern ardi, a regis-tered dental hy -gienist with morethan 25 years ofexperience andher own practiceknown as Wood -land Dental Hy -giene in King City,Ont., notes shemakes very delib-erate attempts to be eco-friendly in herpractice.

USE OF HAND SANITIZERS WILL HELPREDUCE WATER CONSUMPTION“Being green is a big part of what I amdoing,” says Bernardi, whose office willearn a stamp of being certified, asdefined by the GreenDOC DentalOffice Certification Program, which hasbeen developed by the Eco-DentistryAssociation. Her office would be thefirst in Canada to earn such a certifica-tion.

“One of the biggest differences inmy office from a typical office is the


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

to examine the primary challenges facing dentists in Canada today. This

third instalment in the 2010 series The Year of Green Dentistry looks

at office water conservation and amalgam separation, and relates the

experiences of some practitioners and industry members as they adapt

and implement some of these new technologies. Publication of this

series is made possible by Henry Schein Canada.

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

bility 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 number of things around

being more environmentally friendly, whether it is

internal or external. For example, our distribution cen-

ters 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.”

IN THE NEXTGREEN REPORT: The Fully Paperless Office: Is it possible?

This Special Report on Green Dentistrywas written by Louise Gagnon, a frequentcontributor to DENTAL CHRONICLE.

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GreenDentistryHow water management can help the environment, and save you moneyn Dry vacuum systems offer alternative to wet vacuum units that demand copious amounts of water to operate properly


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GreenDentistryvacuum equipment,” Bernardi toldDENTAL CHRONICLE. “It is more expen-sive to run than a traditional system, butI think it is worth it.”

An added bonus of the water-free

vacuum system is that at 60-plus deci-bels, it represents less noise pollutionthan a traditional vacuum system. Andtoo, Bernardi’s office is free of a cuspi-dor which contributes to water conser-vation.

In addition, Bernardi routinely

utilises hand sanitizers, rather than soapand water, as a means of infection con-trol. According to Bernardi, the U.S.Centres for Disease Control states thatthe use of hand sanitizers, such as alco-hol-based hand rubs, is the preferredmethod of infection control, provided

that there is no visible bioburden onone’s hands.

“I have the hand sanitizers availableby the sinks in my office,” says Bernardi.

Steam sterilization of almost all herinstruments is another measure thatBernardi has adopted as a means ofreducing water consumption. She usesstainless steel cups, rather than dispos-able cups, and employs steam steriliza-tion of those cups.

Dr. Imran Baksh, a dentist who hasbeen in practice for more than 25 yearsand operates Village Green Dental Carein Kanata, Ont., notes he uses digitalimaging to reduce water consumption todevelop the radiographs and also to min-imize possible harmful chemicals beingwashed down the drain.

“You then do not have all the by-products from using chemicals,”explains Dr. Baksh.

THINK OF WASHROOMS ALSOWhen Dr. Baksh’s office was built, low-flow toilets were installed. Conventionaltoilets use about 23 liters of water perflush, so having modern low-flow toiletscan make a noticeable decrease in waterconsumption in a busy dental office.

It can also be encouraging for staffand patients to take steps to conservewater if signs are posted throughout adental practice recommending conserva-tion. For his part, Dr. Baksh also encour-ages his staff to turn the water off whenit is not in use.

The next major step in Dr. Baksh’seffort to conserve water is to installwater-free or dry vacuum equipment.Such equipment is available to suit a sin-gle practitioner, a large clinic, or a dentalschool.

One source of potential contamina-tion to the environment is inappropriatedisposal of mercury from dental offices.Indeed, dental offices in the U.S. havebeen cited as the largest source of mer-cury pollution to the country’s waste-water treatment plants. To minimize thatcontamination, dental offices can useamalgam separators to properly collectand dispose of mercury-containing den-tal waste.

At this point in time, it is optional,rather than mandatory, for dentists touse such separators, explains Pockrass.

“This is critical,” she says. “Somemunicipalities require use of an amalgamseparator, and others do not. It’s a rela-tively inexpensive piece of equipment,and this machine will capture the mercu-ry-containing waste before it enters the

How water management can help the environment, and save you moneycontinued from page 15—

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water supply. Our view is that every den-tal office has an obligation to deal withthe disposal of mercury in a responsibleway.”

Cleaning water lines in a dentaloffice in an ecologically responsible waymeans steering clear of using chlorinebleach, according to Pockrass. “It ispreferable to use an enyzmatic cleanerthat uses biodegradable enzymes,” sheexplains.

OPTIONS FOR AMALGAM SEPARATORSUsing amalgam separators is an ecologi-cally responsible way for dentists topractice, and many dentists haveinstalled the separators, ahead of regula-tions requiring them to do so, becauseof their own concerns about hazards tothe environment.

Mercury is the heavy metal that is ofconcern, representing up to 50 per centof dental amalgam, and its toxic effectsto the environment, animals, andhumans have been documented. Thecomponents consist of elemental mer-cury vapour, dental amalgam scrap,amalgam waste, and amalgam sludge.

Anthony Iacopino, DMD, PhD,dean of the faculty of dentistry at theUniversity of Manitoba in Winnipeg,notes that there are many options foramalgam separation units, with somebeing based on sedimentation, somebased on filtration, and some based oncentrifugation.

“I think by this time, most regula-tion bodies that govern how dentaloffices operate and regulate licensure,are requiring dental offices and clinics touse [amalgam] separators,” says Dr.Iacopino.

“They function in different ways,”he says, estimating amalgam separatorsremove 98 or 99 per cent of the particu-lates that come out of dental offices.“No matter how the [amalgam] separa-tor works, they generally all work, andthey all work well. As a profession, wehave been quick in terms of having theseparators in place and using them. Thepublic can be confident that the profes-sion is doing the right thing.”

Dr. Barry Dolman, a Montreal clini-cian and former president of theCanadian Dental Association (CDA),says dentists acknowledge that caring forthe environment is significant.

“We understand that protection ofthe environment is an important issue,”says Dr. Dolman. “We want to do whatis right for the patient and what is rightfor the environment.”

In a growing number of jurisdic-tions in the U.S. and Canada, whethermunicipality, county, province, or state,the use of amalgam separators in dental

practices is mandatory.But even before their use was

mandatory, Dr. Dolman notes that manyCanadian dentists had amalgam separa-tors installed in their offices, while oth-ers waited untilregulations werein place to ensuretheir configura-tions were consis-tent with regula-tions.

Cities such asMontreal andToronto haveadopted by-lawsrequiring dentalfacilities to installISO 11143 certi-fied amalgam sep-arators. Moreover,E n v i r o n m e n tCanada hasworked in con-junction with the CDA on the issue ofamalgam waste disposal for many years.A Memorandum of Understanding onCanada Wide Standards (CWS) onMercury for Dental Amalgam Waste wassigned in 2002, which outlined a series ofbest practices.

In addition, Environment Canadaissued a Pollution Prevention Noticeobligating dentists to consider the imple-mentation of these best practices,including the installation and mainte-nance of an ISO 11143 certified amal-gam separator.

“Many dentists completed theirinstallations well before any regulationswere in place,” says Dr. Dolman. “Somedid not go ahead with the installationbecause they wanted to ensure the instal-lation of the separators was compatible

with ISO( I n t e r n a t i o n a lOrganization forStandardization)standards.”

What wasfirst a good deed,and then a regula-tion, has nowevolved into astandard of prac-tice, according toDr. Dolman.

But eventhough there isgrowing con-sciousness aboutthe environment

and the fact that Environment Canadahas issued directives aimed at the appro-priate disposal of amalgam in Canadiandental offices, targets for appropriatedisposal have not yet been met.

The 2007 Survey of Dentists con-cluded that 70 per cent of Canadian den-tists use an ISO certified amalgam sepa-rator, and that roughly the same percent-age of Canadian dentists who place andremove restorations had used a licensedwaste carrier to remove amalgam waste.The goal of the CWS was a 95 per centdecrease in mercury release across

Canada by 2005, a goal that was notachieved. However, it is encouraging thatthe proportion of Canadian dentistswho use amalgam separators rose signif-icantly over a short span of time: 27 percent of Canadian dentists used theseseparators in 2003, according to thatyear’s National Survey of Dentists, while70 per cent used the separators in 2007.

In addition, manufacturers havedeveloped amalgam separators that aremore efficient: where previous separa-tors captured chunks of mercury, newermodels can capture fine particles,observes Dr. Fred Pockrass, a co-founder of the U.S.-based Eco-DentistryAssociation, an organization promotingenvironmentally-friendly dentistry.

INCREASED NEED FOR SEPARATORSDr. Pockrass, a Canadian dentist nowbased in Berkeley, Calif., recognizes thatthere is a decreasing use of amalgam asa restorative material because of envi-ronmental concerns expressed bypatients and by dentists themselves.Clearly, dentists are turning to alterna-tives to amalgam such as resins, porce-lains, and ceramics. Dr. Pockrass stressesthat does not mean that there is a declin-ing need for amalgam separators.

“There will actually be an increasedneed for amalgam separators,” explainsDr. Pockrass. “Many of the babyboomers want beautiful white teeth. Inthe transformation to having beautiful


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DENTAL TRIBUNE | SEPTEMBER 30, 2010 Clinical Practice 19

Implant fracture: A look at thephysical mechanisms for failureConsidering the need for the removal of fractured implants must be balanced against the risk of increas-ing damage, report authors Drs. Dov Almog, Odalys Hector, Samuel Melcer, and Kenneth Cheng.

The etiology and physical

mechanism of fractured

dental implants phenome-

non have been reviewed and studied

at length in recent years.1-8 For the

most part, the studies concluded

that the crown-to-root ratio guide-

lines associated with natural teeth

should not be applied to a crown-to-

implant restorations ratio.

According to these studies, the

crown-to-implant ratios of those

implants that were considered suc-

cessful at the time the reviews took

place were similar to those implants

that failed.

Apparently, according to some

of these studies, the guidelines that

are used by some clinicians to estab-

lish the future prognosis of implant

supported restorations are usually

empirical and lack scientific valida-

tion as far as the possible causes for

implant fractures.

However, as oral implantology

has been the fastest growing seg-

ment in dentistry, the gaining of

insight into these failure processes,

including the accurate understand-

ing of critical anatomical, restora-

tive and mechanical information,

might stimulate the clinicians'

implementation of preventive action

that may avoid the future fractures

outcome with dental implants.

Case report

A 72-year-old Caucasian male

recently presented to our clinic.

Consistent with the patient's chief

complaint, a comprehensive oral

and maxillofacial examination,

including full-mouth X-rays,

revealed, among other things, two

fractured endosseous implants #6

and #7 (Fig. 1).

These 3.3 mm x 15 mm

implants (Lifecore Biomedical,

Chaska, Minn.) were placed and

restored in 2003. The implants were

placed as per protocol, utilizing a

surgical template consisting of two

guiding sleeves (DePlaque, Victor,

N.Y.).

The implants were allowed to

integrate for six months. No surgical

complications were noted during

this time. At the conclusion of the

six-month waiting period, the

implants were uncovered in the nor-

mal manner and healing abutments

placed.

The implants were subsequent-

ly restored with implant-supported

crowns that were functional for

approximately six years until the

implants fractured.

While this treatment option was

developed with an appreciation of

the patient’s occlusal and mechani-Three essential lessons forevery new dentist ................21

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implantsinternational magazine of oral implantology

_case reportUtilization of Zirconium Oxide in FixedRestorations on Implants and NaturalTeeth

_implant marketImplantology still runs the business in 2007

_DGZI events3rd Arab-German Implantology Meetingof DGZI—Dubai, April 5–6, 2007

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Essential Dental Media

Official Media Partner of

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

languages. The group’s activities also include the

organization 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

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interest from the global editions of Dental Tribune.

Continued on page 20


To remove or not remove fractured implant?cal circumstances and habits, following

the implants’ fracture, a retrospective

analysis of the site planned for the

implants revealed extended inter-

occlusal space on the articulated models

and widespread occlusal wear of the

opposing dentition (Fig. 2).

When the patient presented recent-

ly to our clinic, the only portion of the

restoration that was still present in his

mouth was abutment #6, which was still

connected to one of the fractured

implants, and was removed with a hex

driver (Fig. 3).

Proceeding with careful assessment

of all the available retrospective diag-

nostic information and upon further dis-

cussion with the patient, several diag-

nostic assumptions and one follow-up

treatment option were established that

included replacement of the implant-

supported crowns by a removable cast

partial denture.

Considering the need for the

removal of fractured implants must be

balanced against the risk of increasing

damage, a decision was made to remove

the remaining abutment and the frac-

tured piece of implant #6 allowing for

primary closure of the soft tissue

over the remaining implant bodies

#6 and #7, i.e., “put them to sleep”

(Fig. 4). This was followed by inser-

tion of an immediate acrylic remov-

able partial denture, and subse-

quently, a cast partial denture will be

fabricated.

This report attempts to provide

an argument in favor of the consid-

eration of physical mechanisms as

potential contributors to implant

fractures.

While controversy continues to

Continued from page 19

Figs. 2A, B: Retrospective analysis of the site planned for the implants #6 and #7 (A) revealed anextended overbite, requiring long crowns (B) to meet esthetic needs, and at the same time, theopposing occlusion presented extensive occlusal wear.

Figs. 3A, B: By default, based on phyisical principles, once an implant has intergrated in thebone, the weakest point is the fulcrum where the internal screw engages the implant (A). Notethe fracture level in implant #7 and fracture line in implant #6 (B).

Figs. 4A,B,C: The remaining abutment and the fracture piece of implant #6 wereremoved, alllowing for primary closure of the soft tissue over the remaining implantbodies #6 and #7 (A, B), followed by an insertion of an immediate acrylic removablepartial denture (C)


20 Clinical Practice DENTAL TRIBUNE | SEPTEMBER 30, 2010

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Figs. 1A, B: Implants #6 and #7 (Lifecore Biomedical,3.3 mm x 15 mm) before fracture (A) and after thefracture (B).


ane

010

After years of schooling, thou-

sands of dollars in tuition, hours

upon hours of clinics and exams,

and tests and on and on, finally you

entered the working world as a dentist.

Just you and the patients.

Wouldn’t it be great if it could really

be that simple?

It’s likely that it didn’t take you long

to realize that once your tour in dental

school was over, the learning process

had only just begun.

Moreover, there are at least three

key lessons that were probably barely

touched upon in the dental school cur-

riculum.

Lesson No. 1:

How to deal with people

I’m not talking about the patients. You’ve

been trained to manage them. I’m talk-

ing about the people you see every day,

the ones you work with elbow to elbow,

those you depend on to represent you, to

make sure you have enough money to

pay your bills, to keep your schedule on

track, etc.

Obviously, I’m talking about your

team. Your success as a dentist is direct-

ly dependent upon your employees’ suc-

cess. Unfortunately, one bad hiring deci-

sion can cost you a small fortune—esti-

mates range between 1.5 to 5 times

annual compensation—it can also dam-

age patient relations, staff morale, and

overall effectiveness of the practice.

Given what’s at stake, pay close

attention to Lesson No. 1: Do your best to

hire the best and never hire under pres-

sure. Follow these steps and take a clear

and measured approach to ensure that

every employee you hire is the best fit for

your growing practice.

Assess the systems before you bring

in a new employee. If you’re hiring an

office manager, look at business opera-

tions first. Are the business systems,

scheduling, collections, recall, etc.,

working efficiently? If not, this is your

chance to fix them, to integrate new pro-

tocols and establish up front how you

want these handled in your practice.

Take 15 minutes. Set aside 15 min-

utes to think about what you want the

person in this position to do. Make a list.

Consider what you are looking for in this

individual.

Write a job description. Once you’ve

given some thought to the position,

update or write a job description for the

job tailored to attract the employee you

need. Include the job title, job summary,

and specific duties. This clarifies what

skills the applicant must possess and

explains what duties she/ he would per-

form.

Cast a wide net. Develop an ad and

place it on multiple websites and in dif-

ferent publications. Promote those

aspects of the job that will have the

greatest appeal, including money. Sell

the position.

Keep the copy simple but answer

the reader’s questions—job title, job

scope, duties, responsibilities, benefits,

application procedures, financial incen-

tives, and location. Direct prospects to

your website to learn more about your

practice and the position.

Read the resumes; don’t just scan

them. Highlight those qualities that

match the position’s requirements. Look

for longevity in employment. Be careful

of those applicants that only note years,

such as 2008 to 2009. Chances are this

person was hired in December of ‘08 and

fired in January of 2009.

Watch for sloppy cover letters. The

applicant may have poor attention to

detail. Flag resumes with “yes,” “no,” or

“maybe.” The “yes” candidates are the

first to be considered.

Pre-screen applicants on the

phone. Address your most pressing

concerns up front. If there are gaps in

employment history, now is the time to

find out why. Ask the applicant what

salary range she/he is expecting.

Listen for tone, attitude, and grammar

on the phone, particularly if the posi-

tion requires handling patient calls.

Based on the applicant’s phone

demeanor, would this person represent

your practice well?

Prepare for the interviews. Conduct

interviews using a written set of stan-

dard questions for each applicant so you

are able to compare responses to the


Three essential lessons for every new dentistConsultant discusses key principle considerations necessary for running a successful dental practice

exist as to whether crown-to-root ratio

can serve as an independent aid in pre-

dicting the prognosis of teeth,9 the

same certainly applies to crown-to-

implant ratio, unless multiple other

clinical indices such as opposing occlu-

sion, presence of parafunctional habits,

and material electrochemical prob-

lems, just to name a few, are consid-

ered.

Implant fractures are considered

one potential problem with dental

implants, especially delayed fracture of

titanium dental implants due to chemi-

cal corrosion and metal fatigue.2

Following careful review of the ref-

erenced articles, which are very enlight-

ening, we realized that to a great extent

they support our theory that there are

multiple factors involved in implant

fractures.

These factors include magnitude,

location, frequency, direction and dura-

tion of compressive, tensile and shear

stresses; gender; implant location in the

jaw; type of bone surrounding the

implant; pivot/fulcrum point in relation

to abutment connection; implant design;

internal structure of the implant; length

of time in the oral environment as it

relates to metallurgic changes induced

in titanium over time; gingival health

and crown-to-implant ratio.

Considering the multiple factors

involved in implant fractures, both phys-

ical and biological, we can only assume

that it can happen especially if the forces

of the opposing occlusion and/or para-

functional habits are greater than the

strength of the implant, especially over

time.

Therefore, it is imperative that the

clinician be knowledgeable about the

diversity of factors before recommend-

ing dental implants. Errors in diagnos-

ing potential contributors to implant

fractures are the most common reason

that dental implants fail.

Conclusion

Although, according to the literature,

the use of the crown-to-implant ratio in

addition to other clinical indices does

not offer the best clinical predictors, and

even though no definitive recommenda-

tions could be ascertained, considering

that dental implants are becoming

increasingly popular, an increase in the

number of failures, especially due to late

fractures, is to be expected.8

This report attempted to provide an

argument in favor of consideration of

physical mechanisms as potential pre-

dictors to implant fractures.

Therefore, it is essential for us to

familiarize ourselves with the under-

standing, and diagnostic competence of

the multiple factors involved in implant

fractures. Once observed, this predictor

would certainly lead to better diagnosis

and treatment planning.

Controversy still remains over crown-to-root ratio Continued from page 20

About the authors

- Dov M. Almong, DMD, prosthodontist,

chief of the dental service, VA New Jersey

Health Care System. (VANJHCS)

- Odalys Hector, DMD, general dentist,

VANJHCS

- Samuel Melcer, DMD, periodtist, assis-

tant chief of the dental services, VANJHCS

- Kenneth Cheung, DDS, oral and max-

illofacial surgeon, VANJHCS

DENTAL TRIBUNE | SEPTEMBER 30, 2010 Clinical Practice 21

the


Considerations for leading your team to success

Clinical Practice DENTAL TRIBUNE | SEPTEMBER 30, 201022

same questions.

Avoid asking any personal questions.

Ask follow-up questions based on the

applicant’s responses. Jot down personal

details to keep track of who’s who. The

candidate is likely to be on her/his best

behavior in the interview. If the applicant

doesn’t impress you now, it will not get

better after she/he is hired.

Test for the best. Take advantage of

Internet testing tools that are available to

dentists. Such testing has been used in the

business sector for years to help compa-

nies identify the better candidates for spe-

cific positions.

Check ‘em out. Once the interview

and testing process has enabled you to

narrow the selection down to a couple of

candidates, check their references and

work histories. This step can yield

tremendously helpful information and will

save you from multiple hiring horrors.

Budget for training. Give your new

employee the tools and the knowledge to

achieve her/his best, and you’ll both ben-

efit significantly. Above all else, when it

comes to staff hiring, make your decisions

based on real data, not a candidate’s sunny

disposition or your “gut feelings.”

Lesson No. 2:

Lead your team to excellence

If you’re frustrated by what you perceive

as average or below average team per-

formance, determine if you’ve given them

the foundation to achieve the standards

you expect.

First, avoid the most common pitfall

in leading employees: Assuming that your

staff knows what you want. Don’t assume.

Spell out your expectations and the

employees’ responsibilities in black and

white, and do so for every member of your

team from the beginning. Do not convince

yourself that because they’ve worked in

this dental practice for X number of years,

they know how you want things done.

They don’t, and they will simply keep

performing their responsibilities accord-

ing to what they think you want unless

they are directed otherwise.

Recognize the strengths and weak-

nesses among your team members. All

employees bring both to their positions.

The fact is that some people are much bet-

ter suited for certain responsibilities and

not others. Just because “Rebecca” has

been handling insurance and collections

for the practice doesn’t mean she’s effec-

tive in those areas. Look at results.

Rebecca may be much more success-

ful at scheduling and recall and would be

a much more valuable employee if she

were assigned those duties. Don’t be

afraid to restructure responsibilities to

make the most of team strengths. In addi-

tion, be open to maximizing those

strengths through professional training.

Give ongoing direction, guidance and

feedback to your team so that they know

where they stand. Don’t be stingy. Give

praise often and appraise performance

regularly. Verbal feedback can be given at

any time, but it is most effective at the very

moment the employee is engaging in the

behavior that you either want to praise or

correct.

Nip problems in the bud and you’ll

avoid numerous thorns in your side. If an

employee is not fulfilling her/his responsi-

bilities, address the issue privately and

directly with her/him. Be prepared to dis-

cuss the key points of the problem as you

see it as well as possible resolutions.

Use performance reviews to motivate

and encourage your team to thrive in their

positions. Base your performance meas-

urements on individual jobs. Focus on

specific job-related goals and how those

relate to improving the total practice.

Used effectively, employee performance

measurements and reviews offer critical

information that is essential in your efforts

to make major decisions regarding

patients, financial concerns, management

systems, productivity, and staff in your

new practice.

Lesson No. 3:

Keep your hands in the business

It doesn’t take long to recognize there are

many hats for dentists to wear. The hat

that says “The CEO” is just as important as

the hat that says “The Dentist.” It’s critical

that you completely understand the busi-

ness side of your practice.

There are 22 practice systems and

you should be well-versed in each of

them. If not, seek out training for new

dentists. The effectiveness of the practice

systems will directly, and profoundly,

affect your own success today and

throughout your entire career.

For starters, routinely monitor prac-

tice overhead. It should break down

according to the following benchmarks to

ensure that it is within the industry stan-

dard of 55 per cent of collections:

o Dental supplies: 5 per cent

o Office supplies: 2 per cent

o Rent: 5 per cent

o Laboratory: 10 per cent

o Payroll: 20 per cent

o Payroll taxes and benefits: 3 per cent

o Miscellaneous: 10 per cent

Keep a particularly close eye on staff

salaries. Payroll should be between 20 and

22 per cent of gross income. Tack on an

additional 3 to 5 per cent for payroll taxes

and benefits. If your payroll costs are high-

er than that, they are hammering your

profits. Here’s what may be happening:

o You have too many employees.

o You are giving raises based on longevity

rather than productivity/perfor-

mance.

o The hygiene department is not meeting

the industry standard for production,

which is 33 per cent of total practice

production.

o The recall system, if there is one, is not

structured to ensure that the hygiene

schedule is full and appointments are

kept.

Maximizing productivity. Hand-in-

hand with practice overhead is produc-

tion, and one area that directly affects your

production is your schedule. Oftentimes,

new dentists simply want to be busy, but

it’s more important to be productive.

Follow these steps to maximize productiv-

ity.

First, establish a goal. Let’s say yours

is to break $700,000 in clinical production.

This calculates to $14,583 per week, not

including four weeks for vacation.

Working 40 hours per week means you'll

need to produce about $364 per hour. If

you want to work fewer hours, obviously

per-hour production will need to be high-

er.

A crown charged out at $900, which

takes two appointments for a total of two

hours, exceeds the per hour production

goal by $86. This excess can be applied to

any shortfall caused by smaller ticket pro-

cedures. Use the steps below to determine

the rate of hourly production in your prac-

tice.

The assistant logs the amount of time

it takes to perform specific procedures. If

the procedure takes the dentist three

appointments, she should record the time

needed for all three appointments.

Record the total fee for the proce-

dure. Determine the procedure value per

hourly goal. To do this, take the cost of the

procedure (for example, $900) divide it by

the total time to perform the procedure

($900÷120 minutes). That will give you

your production per minute value

(=$7.50). Multiply that by 60 minutes

($7.50 x 70=$450).

Compare that amount to the dentist’s

hourly production goal. It must equal or

exceed the identified goal.

Now you can identify tasks that can

be delegated and opportunities for train-

ing that will maximize the assistant’s func-

tions. You also should be able to see more

clearly how set up and tasks can be made

more efficient.

A career in dentistry is one of the

most personally and professionally fulfill-

ing fields you can choose. With the right

team, clear leadership, and effective busi-

ness systems, you can enjoy tremen-

dous personal success and lifelong

financial security for you and your

family.

About the author

Sally McKenzie is CEO of McKenzie

Management, which provides success-

proven management solutions to dental

practitioners nationwide. She is also editor

of The Dentist’s Network Newsletter at

www.thedentistsnetwork.net; the e-

Management Newsletter from

www.mckenziemgmt.com; and The New

Dentist magazine, www.thenewdentist.net.

She can be reached at (877) 777-6151 or

[email protected].

Continued from page 21

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findings were supported by her ownresearch into the efficacy of this disin-fection system. Dr. Benhamou said,much like Dr. Galler, she too was oftenable to avoid surgery for patients as aresult of this system.

The Periowave HHL-1000 is avail-able for $3,450 and is offered with a vari-ety of payment plans for the laser as wellas associated treatment packages ofmethylene blue formulation. Dr. Loebelsaid the treatment packages are designedto last two years from the date of manu-facture.

GENTLEray 980 Classic by KaVoA soft-tissue diode laser, GENTLEray

980 features a user definable pulse mode,a touch button monochromatic screendisplay, a 300 µm laser fiber, a KaVolaser fiber handpiece, and foot control. Itweighs 3.5 kg. Optional componentsinclude a laser whitening handpiece andfiber, or an alternate 200 µm fiber. Thepremium package includes three protec-tive laser goggles, a diode array, a peri-staltic pump, a second handpiece withwater cooling, new software, and a colortouch screen display.

BiolaseTechnology IncThe Waterlase C100 is an all tissue Er,Cr3+: YSGG, 2780 nm laser. It allowsfor multiple pulse repetition rates from10, 15, 20, 25, or 30 Hz. It has an LCD

screen and multiple touch buttons. Atalmost 20 kg, it’s a larger model, but thewheels underneath the cart permit it tobe moved from chair to chair. It’s effec-tive for restorative procedures and earlyperiodontal treatment.

Sirona (SIROlaser Advance)

The SIROlaser Advance has a colortouch screen that allows for 24 applica-tions to be programmed. The model alsohas the potential to add up to five pass-word protected profiles, so that differentdentists within a shared practice can setthe device to their own preferences. It’sextremely light at under half a kilogram.This laser also stores parameter dataanonymously from each treatment ses-sion, which can be transferred to a PDCusing a USB drive. It can be operatedusing a light touch finger switch or anoptional foot control. A rechargeable bat-tery pack allows the laser to be deployedmore flexibly within the practice.

They are ready to incorporate a laserwhich is ultra-affordable, contemporary in

design, and easy to integrate into their practice. We are lucky to have partnered witha great distributor, Oral Science, who will exclusively distribute AMD LASERS den-tal laser products throughout Canada.

What features and capabilities do you perceive Canadian dentists willappreciate most about Picasso and Picasso Lite?The Picasso and Picasso Lite are ideal for both the first-time laser user and theexpert laser practitioner. The Picasso offers unprecedented versatility, low operat-ing cost, and affordability. From a performance standpoint, both Picassos performa very wide range of soft-tissue surgical, periodontal, and endodontic procedures.The Picasso is also indicated for whitening procedures. Picassos are the only dentallasers that offer both the convenience of disposable tips and low cost strippablefibers. The Picasso Lite is the world’s easiest to use dental laser marketed at an ultra-affordable pricepoint.

Dentists worldwide have greatly enhanced and streamlined their practices byincorporating the Picasso brand. Glenn van As, DMD, Medical Director for AMDLASERS, practices in North Vancouver, and incorporated the Picasso brand dentallaser into his practice a few years ago with resounding results.

Looking forward, what other great things may we expect from AMD LASERS?I believe AMD LASERS’ future is bright and exciting. We are currently developinginnovative technology and proto-cols to not only refine the Picassobrand, but to expand it. First onthe list is the Picasso Perio; it isexpected to debut in late Fall 2010.

Also currently in the devel-opment stage is an All TissueLaser (ATL) which will completethe comprehensive soft- and hard-tissue product line. Additionalproducts recently introducedinclude a bleaching handpieceaccessory which accompanies thePicasso, and a variety of clinicallycompatible accessories thataccompany the Picasso Lite. Wealso intend to expand our ICLEand university programs.

Finally, in the very nearfuture, we will be make expansiveforays to take the company brandinto non-dental markets includ-ing medical and veterinary appli-cations.

white teeth, all that old, degraded amal-gam will have to be removed.

“We [the Eco-Dentistry Association] are spending a lot of time talking withdentists who are doing cosmetic dentistry and doing porcelain fillings for babyboomers,” says Dr. Pockrass. “We are telling them that whether amalgam is beingput in or taken out, dentists need to deal with it responsibly.”

While the use of amalgam is declining as a restorative material, dentists shouldstill have the choice to use amalgam. Some countries such as Norway and Denmarkhave banned the use of dental amalgam, but Dr. Pockrass says the option to useamalgam should exist.

“I would hope that there is not a need for a ban,” says Dr. Pockrass. “I thinkefforts for self-regulation [in using amalgam separators] can be effective.”

The cost of purchasing and maintaining an amalgam separator should not bea huge deterrent to ensure dentists practice proper disposal of amalgam, observesDr. Pockrass. “It is not like buying a new computer system or new X-ray equip-ment,” he notes.

Similarly, being pressed for time should not be an obstacle to the appropriatedisposal of mercury waste generated through the removal or use of amalgam, addsDr. Pockrass. “It should not have a big effect on time management.”

Education is the key to expanded use of amalgam separators across NorthAmerica, according to Ina Pockrass, a co-founder of the Eco-DentistryAssociation.

“There are many high-tech dentists out there who take out that material [amal-gam] but do not think they need a separator in the office,” she says.

CONFIRM PROPER WASTE DISPOSALThe tendency across Canada is that dentists are installing amalgam separators intheir offices to minimize mercury particles getting into wastewater, according to Dr.Margot Hiltz, an associate dentist based in St. John’s, Nfld., who wrote about theissue of dental amalgam and the environment in the Journal of the Canadian DentalAssociation in 2007.

“The trend is that most people are putting them [separators] in,” says Dr. Hiltz,who observes that a lot of amalgam is collected when amalgam is being placed, butfinds that even a greater amount is collected when the amalgam is being removed.“They [separators] have been of value in the removal of amalgam.”

The amount of amalgam waste and sludge that Canadian dentists produce hasbeen estimated from a low of about 800 kg annually to close to three times thatamount on an annual basis, according to Dr. Hiltz.

She notes that chair-side traps and vacuum filters are not as effective as ISO11143-certified amalgam separators in capturing amalgam waste.

It’s also important for dental practitioners to research hazardous waste collec-tion services to ensure these services are capable of handling the waste that is gen-erated by their dental office, according to Dr. Hiltz.

Access Product Informationyour way through Dental Chronicle’s

READER SERVICE

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

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By FAX Go to page 25, circle the numberof the product, provide your

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We'll do the rest

CEO of AMD LASERS talks about the Picasso

Dental Laser Buyer’s Guide: Significant advances in laser technologycontinued from page 5—

continued from page 6—

New amalgam separators more efficientcontinued from page 17—

SIROlaser Advance


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HE CAN’T DRIVE A RACE CAR ANY

more because of a blood clot in hisleg that requires him to take blood

thinners, but Winnipeg dentist Dr. BrianFriesen said he still remembers when, at22, he got behind the wheel of his firstdrag racer.

“It’s very exciting to hear theengines start up and then you’re drivingit,” said Dr. Friesen.

Unlike street driving, Dr. Friesensaid, there is no margin for error.

“It can be terrifying. You have tohave a huge amount of control,” saidDr. Friesen. “These cars have three-thousand horsepower and you’ve got tocontrol that power.”

Fail to control that power, due to amechanical malfunction or driver error,and the result is serious injury or death,said Dr. Friesen, who said he sees onedriver die on the track each year.

“Truly these guys are warriors thatdon their safety suits and go in there andthey could die, and that’s what you real-ize when they do it.”

YOU’RE ON YOUR OWN BEHIND WHEELAnother difference between traditionaldriving and drag racing, Dr. Friesen said,is that during lessons there is no driverinstructor in the car. When Dr. Friesenfirst received his lessons, drivers weregiven training exercises that graduallyincreased in difficulty.

“[The tasks] progressed as the dayswent on, until you eventually made a fullrun down the track.”

Dr. Friesen said he started with asimple burnout. That’s when the rearwheels of the car sit in a puddle of waterjust before the starting line, and the driv-er applies the front brakes while revvingthe engine. The rear wheels spin in thepuddle while the front brakes hold thecar in place, heating up the tire rubber sothe tires get a better grip on the tracksurface.

Prospective drivers who did an ade-quate job, said Dr. Friesen, were permit-ted to advance to more complicateddriving tasks, but not everyone made itthat far.

“Some of the guys, they weren’table to do it correctly, so they were goingto have to try to repeat that until theycould get it right,” said Dr. Friesen.“Some of the guys were so afraid of itthat they never even got down the track,they were so afraid of the car. I was ableto make a full run at the end because Iwas more comfortable with it, I under-

stood it, and I drove it within mymeans.”

Dr. Friesen said his interest in carsand drag racing started early in his child-hood, and has continued through hisadulthood and training in dentistry.

“I’ve tried different types of car rac-ing, I’ve tried ice racing in the winter,and I did have a drag race car and go tohigh performance driving schools,” saidDr. Friesen.

Dr. Friesen operates a dental prac-tice in Winnipeg, and continues hisinvolvement in the sport of drag racing.Although he doesn’t drive a race car any-more, he is now the owner of a FordMustang Top Alcohol Funny Car, amachine that has a top speed of 405km/h (252 mph) with an elapsed time of5.655 seconds in the quarter mile.

“I have to pay all of the bills whichare quite staggering when we’re compet-ing with multi-million dollar teams, sowe’ve had sponsorships over the years,and we’ve had a sponsor stay very suc-cessfully for a couple years.”

“If you win, you can possibly makea lot of money at the end of the year,but you have to win every race,” said Dr.Friesen.

No easy task when competing

against cars with multi-million dollarbacking, he said, but they’ve had theirvictories, particularly in September of2009.

“We were runner up in the U.S.Nationals, which is the biggest race ofthe year, and we just lost by a hair,” Dr.Friesen said. “That was our biggestaccomplishment for a bunch of guysfrom Winnipeg.”

Their competitor at that race, RickJackson, had significantly greaterresources than Dr. Friesen.

“Jackson’s car is from California,[he] had a crew of paid tuners and peo-ple like that all over and our crew was allvolunteers,” he said. “So it was quitegood to compete with him and almostwin.”

Not bad for a pit crew that was paidonly in plane tickets and meals, said Dr.Friesen.

TRY DIFFERENT THINGS“Some of the people I’ve known fortwenty years, some of the people I’veknown from when we drag raced in the‘80s, and other people, [30 -ear veterandrag race driver] Roger Bateman [forexample], I just called him one day andhe’s a good driver and he agreed to driveour car. He was semi-retired, we’ve hadfour years with him and he’s done a greatjob,” Dr. Friesen said.

“He answered the phone, we chat-ted, he agreed to drive our car in LasVegas at the National Hot RodAssociation’s Winternationals, and weliked what we saw. He was very capableof driving the car and we stuck with himafter that.”

A dentist who drag races mightseem a little different, but consideredalong with Dr. Friesen’s other activities,it’s really not that much out of the ordi-nary.

He’s also been a bodybuilder, across country skier, and a runner.

“I guess I test myself to see howcompetent I can be at these things,” Dr.Friesen told DENTAL CHRONICLE.“Certainly the bodybuilding thing, I didthat for a while to see if I could do it andget down to a certain percentage ofbody fat, and then once I did it I sort ofleft it alone. Running was part of my fit-ness regimen and at one point I ran ahalf marathon just to see if I could doit,” said Dr. Friesen.

“Once I achieve my goal I sort ofabandon it and move on.”

—Josh LongAssistant Editor

24 n September 30, 2010 DentalChronicle

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

DentalVitaeP r o f i l e

Dentist’s ‘Funny Car’ runs405 km/h in 1/4 mileDrag car pumps out 3,000 horsepowern Though he doesn’t pilot the race car anymore, Dr. Brian

Friesen leads a crew of volunteers up against the big guns


The Picasso and Picasso Lite lasers combine ease-of-use, sleekdesign, and affordability. Offering convenience of disposable tips or low

cost strippable fiber. Perfect for a den-tist’s first laser or for advanced laserexperts. The Picasso and Picasso Litelasers can perform a wide-range of soft-tissue surgical, periodontal, andendodontic procedures and are an idealreplacement for electrosurgery. Soldexclusively through Oral Science.

Circle #211 on feedback form

Therapeutic 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... o request this material by e-mail: [email protected] o request this material by fax: 1-800-865-1632o request this material by mail: Dental Chronicle, 555 Burnhamthorpe Road, Suite 306, Toronto, Ont. M9C 2Y3

VALO’s multi-wavelength LED tech-nology produces high intensity lightacross the 395-480 nm spectrum topolymerize all light-cured dentalmaterials.Three cur-ing optionsare avail-able. Thelow profile pen design enablesaccess to hard to reach areas.Protected with a scratch-resistant,sapphire-hard coating and teflonseal. From Clinicians Choice.Circle #214 on feedback form

Flip Top Cassettes have a uniquedouble-hinge with easy to operatelatch for easy opening and closing.The fold under fliptop props up thecassetteat a con-venientangle foreasyaccessand uses less workspace. Multipleconfigurations will hold five to 18instruments. From PDT, Inc.—Paradise Dental Technologies.Circle #215 on feedback form

The KODAK 1500 intraoral cam-era’s liquid lens technology and trueautofocus works like the human eyeto ensure effortlessimage capture andclear, detailed images.Combined with theindustry’s highest stillimage resolution, thecamera makes everyshot superb. FromCarestream Health Inc,exclusive manufacturer of KodakDental Systems.Circle #216 on feedback form

The S600NL has a standard sizedhead to allow easy and comfortableaccess to the posterior of themouth. The S700NL has a torquehead forgreaterpower.Bothfeatuer soft push button actuationof the chuck mechanism and tripleport spray. Fits all standard 6 holefiber-optic tubing, compatible withNSK type quick connect couplers.From Sable Industries.Circle #217 on feedback form

HygienePro Ultrasonic Scaler has16 inserts for comfort and efficien-cy. Ergonomic grip designs in hard

and softstyles fea-ture tex-tured non-

slip surfaces. A wide variety of tipstyles are available in both 25K and30K frequency options.Compatibility with all magnetostric-tive devices. From Brasseler USA.Circle #218 on feedback form

SmartLite Max LED Curing Lightcombines two LEDs in the tip formultiple wavelengthoutput, covering tradi-tional CQ based mate-rials and materials withinitiators requiring alower wavelength foractivation. Features ahigh output of up to1400 mw/cm2, large curing area,four output modes, and a built-inradiometer. Cordless or corded.From DENTSPLY CanadaCircle #219 on feedback form

The NSK Nano400 combines user-friendly ergonomic design with light-weight titanium. Weighs 61 grams.

Smooth,quiet, power-ful, and ver-satile, theNano400

features LED fiber optic micromotor.Attachments are available for allspecialty areas, the system can beeasily integrated into any dentaldelivery system. From BrasselerUSA.Circle #220 on feedback form

ARESTIN (minocycline hydrochlo-ride) microspheres is indicated asan adjunct to scaling and root plan-ning (SRP) procedures to decreasepocket depthin adultpatients withchronic peri-odontitis. Asimple and easy delivery systemwith no preparation required beforeadministration. From Johnson andJohnson.

Circle #221 on feedback form

The Air-Flow Master Piezon canprovide sub- and supragingival airpolishing aswell as scaling,all in one unit.Combats peri-odontitis andperi-implantitis;an LED lightprovides optimal visibility.Magnetically secured to the side ofthe unit makes the tool easy toremove and store. From EMS.Circle #222 on feedback form

ProDrive’s revolutionary upgradeturbine and triangular bur systemlocks together for improved cut per-formance, control,and precision.Experience ProDrivetwo ways, theProDrive UpgradeTurbine for leadingbrand handpieces, orthe ProDrive High-Speed Handpiece.From PattersonDental.Circle #223 on feedback form

A selection of the month’s most innovative new products

Web site URLs for Dental Chronicle advertisers

Air Techniques http://www.airtechniques.com AMD LASERS http://www.amdlasers.com Bisco Canada http://www.biscocanada.com Colgate-Palmolive http://www.colgateprofessional.ca Germiphene http://www.germiphene.comGSK Inc. http://www.www.gsk.caHenry Schein http://www.henryschein.caOdan Labs http://www.odanlab.com Oral Science http://www.oralscience.comPeriowave http://www.periowave.comSable Industries http://www.sableindustriesinc.com

READER SERVICEFor more information on these advertised products circle the corresponding productnumber. Visit http://www.dentalchronicle.info for more informationAir Techniques ......................................Acadia Amalgam Separator 201AMD LASERS ......................................Dental Lasersr 202Bisco Canada ........................................Endo Products 203Colgate-Palmolive ..................................Sensitive Pro-Relief 204Germiphene ............................................AmalgamBOSS 205GSK Inc. ................................................Sensodyne 206Henry Schein ..........................................Air Techniques STS Dry Vac 207Henry Schein ..........................................MidMark PowerVac System 208Henry Schein ..........................................SolmeteX HG5 209Odan Labs ..............................................Rovamycine 210Oral Science ..........................................Picasso Laser 211Periowave ..............................................Periowave HHL - 1000 212Sable Industries......................................Utility Room 213

Now: Get mmoorree iinnffoorrmmaattiioonn yyoouurr wwaayy

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CBS News A study by researchers at theNYU College of Dentistry suggests peri-odontal disease may increase the risk ofAlzheimer’s disease (Aug. 4, 2010).

During the study, a research team led by Dr. Angela Kamer, assistant professorof periodontology and implant dentistry, analysed data on periodontal inflammationand cognitive function from the Glostrop Aging Study, which has been gatheringmedical, psychological, oral health, and social data on men and women spanning a20-year period ending in 1984. The scientists found that those with gum inflamma-tion were nine times more likely todevelop cognitive impairment thanthose without. Dr. Kamer is currentlyworking on a follow-up study involvinga larger, more ethnically diverse groupof subjects, to further examine themechanisms that connect periodontaldisease with cognitive dysfunction.

The Local (Sweden) Researchers atMalmö University in Sweden have foundthat underweight children are at threetimes’ greater risk of tooth decay as arenormal weight children (July 10, 2010).

For the study, researchers examinedthe dental health of more than 900 five-year-olds in central Skåne, Sweden

through records from child health and pub-lic dental clinics. The scientists cite parentalconcern over weight development as onereason why underweight children are at a

high risk for tooth decay. Parents of underweight children do not want to deter theirchildren from eating, so they impose less restrictive dietary constraints. As a result,underweight children tend to consume diets that contain more sugar. According toLars Matsson, professor of pedodontics at the Faculty of Odontology at the univer-sity, modified dietary habits are key to improving dental health.

The Sheaf A University of Saskatchewan study says a toothbrushproduced in Japan effectively combats gingivitis and biofilm with-out the use of toothpaste, according to an article in the universi-ty’s student newspaper (Sept. 8, 2010).

Called the Soladey-J3X and produced by the Shiken compa-ny, the article says the toothbrush uses a titanium oxide semicon-ductor that runs through the middle of the toothbrush to giveoff electrons that break down the matrix formed by bacteria inbiofilm. Though the rod doesn’t need to be replaced, the bristlesat the end of the toothbrush do wear, and require replacementjust as a regular electric toothbrush would.

Dr. Gerry Uswak, the principal investigator for the study,said in the article that this technology would be “especially bene-ficial for folks who, for whatever reason, can’t brush correctly.”Dr. Uswak added the toothbrush could help people who cannottolerate toothpaste.

What the lay press is saying

As Dr. Richard Souviron prepares to take a dental impression, thepatient, surrounded by police officers with a warrant, begins to yell.Dr. Souviron asks the patient if he’s going to bite him, but the patientreplies in the negative. He says he’s a non-violent person.

That patient was America’s most prolific serial killer Ted Bundy,and Dr. Souviron’s evidence helped convict him in 1979. A bite markon the neck of one victim was the only physical evidence linkingBundy to her death, and Dr. Souviron was responsible for determin-ing that Bundy made that bite, demonstrating the important andpractical use of bite mark analysis to the U.S. judicial system. .

What drove you to make bite marks admissable in a court of law?I’d been working for, at that time, probably six or seven years with the[medical examiner’s] office, and had done several other cases prior tothis one that involved homicide. [The bite mark on Lisa Levy] was apretty important link and in this case it was the only physical evidencethey had at the time. So I don’t know that I was any different than anyof the other forensics dentists in the country who wanted to use thisevidence as part of the criminal justice system.

You were responsible for making the public aware of this foren-sic technique. How do you react to that?I just happened to be in the right place at the right time.

Your expertise allows you to shed light on the justice system. Doyou consider this just a job, a way to pay your bills, or do you feela certain amount of pride?Two out of three. (laughs)

Which two?Of course you feel pride, and you feel you’re contributing tothe betterment of society by helping the criminal justice sys-tem. It certainly isn’t a one man show that’s for sure, and itdoesn’t pay.

Forensic science television shows are very popular now. Do youfeel you have to dispel the mythos around forensic science?It’s unfortunate that a high amount of publicity surrounded the TedBundy case, a unique situation with somebody who left a very clearpattern and somebody with extremely unusual teeth. After that it wasextrapolated to say some people said it was good as a fingerprint,some people said it’s better than a fingerprint. There are a lot of vari-ables, a lot. It’s pretty impressive when you have a set of teeth and thejury can literally take an acetate overlay and match it up to a bite markand they can see whether it fits or doesn’t fit. Then they have to arriveat a decision whether or not this evidence along with everything elseis enough to convict beyond a reasonable doubt. But that’s just a pieceof the puzzle. There’s never one thing, it’s never a smoking gun.

What other cases were you most proud to be a part of?In one case I was the only expert, and that was a case out ofMississippi [involving] Kennedy Brewer, who did 13 years for mur-dering a little girl. My testimony for the defense was that thereweren’t any bite marks on the body at all, no human bites, theywere all either insect or aquatic animal activity, but none of themwere human bites. And 13 years later DNA not only cleared himof the crime but found the man who actually did do the murder.The evidence was reviewed by numerous forensic dentists subse-quently and they all agreed that none of them were bite marks, andthe odontologist that claimed they were has since been debunked.He’s had four or five of his cases reversed, and it was just a terri-ble blow. Whatever good was done by [the Bundy case] wasundone by this particular individual.

In this instalment of Dental Chronicle’s ongoing series of interviewswith notable clinicians and researchers, Dr. Souviron spoke withassistant editor Josh Long. The editors invite your suggestions forfuture subjects of this feature. Please e-mail your suggestions to:[email protected]

TTeenn mmiinnuutteess wwiitthh...... Dr. Richard Souviron

DentalChronicle

DentalVitae

DDrr.. RRiicchhaarrdd SSoouuvviirroonn,,through his work on the TedBundy case, has been responsi-ble for demonstrating the practi-cal use of bite mark analysis tothe U.S. judicial system. Sincethe Bundy case in 1979, he con-tinues to appear in court as anforensic dentist and expert wit-ness, exonerating the innocentand putting away those he callsthe “bad guys.” He also operatesa private dental practice in CoralGables, Fla.

In April, Dr. Souviron wasinvited to present a guest lectureon forensic dentistry at SaintMary’s University in Halifax.


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Scientific works cited: 1. Petrou I et al. J Clin Dent. 2009;20(Spec Iss):23-31. 2. Cummins D et al. J Clin Dent. 2009;20(Spec Iss):1-9. 3. Nathoo S et al. J Clin Dent. 2009;20(Spec Iss):123-130.

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Documents

Dental Chronicle (Canada) Sept 30 2010 edition