NEWSLETTER - Delaware State Dental Society · NEWSLETTER VOLUME 34 NUMBER 2MAY/JUNE 2010 President’s Message My last newsletter! I will now assume my place as a member of our esteemed

N E W S L E T T E RVOLUME 34 NUMBER 2 MAY/JUNE 2010

President’s Message

My last newsletter! I will now assumemy place as a member of our esteemedPast President’s Society. It has been suchan honor to serve as Delaware StateDental Society President this year. Andwhat a busy year it has been! I startedmy year by adding my colleague andfriend, Dr. Curt Leciejewski, to ourExecutive Council. We also have twonew State Board members, Dr. RobDirector and Dr. Tom Cox. Dr. AlexisSenholzi accepted my invitation to joinour Council on Membership and thewonderful Dr. Norm Lippman nowchairs our Dental Legal Panel and ourCouncil on Ethics and Bylaws.

I then heard the news that would sendany President into a tailspin. “The StateBoard has been selected to undergoSunset Review this year.” I thought“why me” - it’s been 15 years since thelast one! But I became George W as ourvery capable Neal McAneny and BrianMcAllister stepped up a la Dick Cheney.They truly commanded the process withthe help of the members of the StateBoard as well as our Legislative Council.Special thanks to these individuals: Drs.Jeff Cole, Brian McAllister, Tom Conaty,Dave Williams, Ray Rafetto, LouRafetto, Tom Mercer, Neil McAneny,John Lenz and Blair Jones. The Society

Dr. Sharon Welsh

Inside this Issue…Editor’s Commentary...........................2NCDHM Poster Contest Winners ........4Health Care Reform Update ............6-7Bacterial prophylaxis for joint

replacement patients .........................8Rotation of mandibular implant

overdentures .....................................8Emergency department dental care...10Safety of dental treatment during

pregnancy........................................10Oral-Systemic Linkages Oral health

of oldest-old ....................................11Dental implications of obesity...........12Who seeks cosmetic dentistry? ..........12BBB Awards DSDS Member................132010 DSDS GKAS Event...................14DSDS 147th Annual Meeting ............15 DSDS 147th Annual CE Session .......16147th Annual President’s Dinner Dance.17Fall CE Courses ................................18Summer Camp Opportunity in Haiti ...19Welcome New EC members. ..............19Classified Ads ....................................192011 CE calendar. .............................20DSDS Presents New Logo .................20New DSDS logo presentation...........20New Glove Program ..........................20In Memory of Marty Scanlon ............22

truly owes them a lot of credit for theirtireless dedication. We are through theprocess and awaiting the recommenda-tions from the Joint Sunset Committee.So their work will continue and we willkeep you informed.

Some other activities this year included:1. Converting this newsletter to an elec-

tronic format. It will be easy to downloadand print and will save the Dental Societythousands of dollars in printing andmailing costs. However, you as memberswill decide whether to continue thisformat in the future. I would recommenda follow-up survey of the membership aswell as assessment from our editor, Dr.Lou Rafetto, as to whether you want tocontinue this format.

2. We converted our CE series to that ofa calendar year instead of the usualSeptember to April format. This willsimplify the accounting and “book-keeping” needs of the Society. Mythanks to Dr. Dan Trouno and themembers of the CE Council. What animpressive schedule of speakers for2011 with the program remaining atthe Hotel du Pont.

3. Laminated cards were provided to eachDelaware Legislator indicating thenames and contact information for ourLegislative Council members. (Icouldn’t have recommended this in amore timely manner due to Joint Sunset.Might have been an omen though!)

4. We have a new logo for the DSDS.Thanks to Drs. Stephanie Steckel, JoeKelly and the CommunicationsCouncil for helping to start market“branding” of the Society.

5. Many thanks to the tireless Dr. PaulChristian and the Access Council foranother successful Give Kids A Smileevent. Even though the 2nd day of this2-day event had to be cancelled due tothe “blizzard of 2010,” over 79 childrenwere treated at the Delaware Technical& Community College and over$24,000 worth of dental treatment wasprovided. Bear-Glasgow Dental hostedtheir own event at their new Millsborosite where they were able to treat most

continued on page 21

DSDS NEWSLETTER MOVES INTO THE ELECTRONIC AGE!

Beginning with this issue, theDSDS Newsletter will appear threetimes a year on the DSDS websiterather than as a printed publication.Members will receive a post cardannouncement and email alertsprior to the posting on the website

This fiscal decision will result in acost savings of 50-60% in the DSDSpublication budget. Evaluations of theelectronic publication will be circulatedfollowing the second issue. If youwould like to take a moment at thistime… please send your thoughts [email protected].

DELAWARE STATE DENTAL SOCIETY NEWSLETTERPage 2 May/June 2010

DSDS NEWSLETTER200 Continental Drive, Suite 111

Newark, DE 19713302.368.7634

302.368.7669 FAX

Editor in Chief:Louis K. Rafetto, DMD

Executive Director:B.J. Dencler

Deadline for January/February issue:December 1

Deadline for May/June issue:April 1

Deadline for September/October issue:August 1

OFFICERSSharon A. Welsh, [email protected]

President

John M. Nista, [email protected]

President-Elect

Laima V. Anthaney, [email protected]

1ST Vice President

Ryan C. Barnhart, [email protected]

Treasurer

Curtis L. Leciejewski, [email protected]

Secretary

Anthony W. Vattilana, [email protected]

2ND Vice President

Jeffrey M. Cole, [email protected]

Past President

REPRESENTATIVESPaul R. Christian, DMD

[email protected] Castle County

Sean Mercer, [email protected]

Kent County

Kevin H. Brafman, [email protected]

Sussex County

Unless specifically stated, allviewpoints expressed in the

Newsletter are those of the authors,and do not necessarily reflect the

positions of the D.S.D.S.

Most recognize professionals as havinga definition or code of conduct that isunique from that of other careers. Somehave proposed that professionals share atleast three common elements. The firstcommon element is an expectation ofselflessness, that those who are in aposition to care or be responsible forothers will place the needs and concernsof those who depend on them above theirown needs and concerns. The secondcommon element is an expectation theprofessional will aim for excellence inknowledge and expertise. The thirdcommon element is an expectation oftrustworthiness. In our role asprofessionals, we have a responsibility toour patients and to the public to not onlymake them aware of available newtechniques and technologies, but to fairlypresent what such new things offer in afair and balanced manner. At times thismay put us at odds with industry and maybuck the advice of the management typeswho offer advice on how to market ourservices. Fortunately, we have an allywhen it comes to sorting out what is real,what might be real, and what is distortionor worse. The ADA, through its Councilon Scientific Affairs, offers guidance thathelps us to navigate through such troubledwaters. Consider as an example the caseof two suggested applications for lasers indentistry; curettage and Laser AssistedNew Attachment Procedure (LANAP).Most of us are aware of the recentmarketing of these applications to dentistsand to the public. Since I have limitedexpertise in this area, I consulted the ADAto see what they had to say. What I foundfollows in the form of selections fromrelevant sections on this topic (available inits entirety on the ADA website). I tookthe liberty to italicize specific portions.

Introduction - Applications for andresearch on lasers in dentistry continues toexpand since their introduction to thedental profession. Dental laser systems arecleared for marketing in the United Statesvia the Food and Drug Administration(FDA) Premarket Notification [510(k)]process. The primary purpose of thisStatement is to provide comments and ascience-based perspective on several in-

Dr. Louis K. Rafetto

EDITOR’S COMMENTARY

Being a professional

creasingly popular uses for dental lasers. FDA 510(k) Clearance - All dental

lasers currently available on the U.S.market have been issued 510(k) clearancesby the FDA. 510(k) submissions arereviewed and processed by the Center forDevices and Radiological Health (CDRH)in the FDA. The review team determinesif the product under review meets relevantcriteria for “substantial equivalence” to apredicate device (the term “predicate” isused to describe any device that ismarketed for the same use as the newdevice, even if the actual technologies arenot the same). For new indications for usethe FDA may request additional safetyand effectiveness data in support of theclearance for market. Given the manyfactors that are appropriate to evaluatewhen using lasers in biological systems,the Council feels that the 510(k) processalone is not inherently sufficient to scien-tifically demonstrate safety, efficacy, oreffectiveness for marketed dental laserapplications in all cases. Properly designedpreclinical and clinical studies are oftenneeded to demonstrate safety, efficacy andclinical effectiveness for specific productsand uses. The Council encourages dentalpractitioners to cautiously consider claimsof safety and efficacy that are purelybased on the product having been clearedfor market by the FDA through the 510(k)process. It is appropriate and prudent forthe practitioner to request detailedinformation from the manufacturer about

continued on page 21

DELAWARE STATE DENTAL SOCIETY NEWSLETTER Page 3May/June 2010

121CONTINENTAL DRSUITE 110NEWARK DE19713

Rated “A++” by A. M. Best Co.

Because you understandthe importance of prevention.

�e Power of Prevention. You teach it to your patients, but have you applied it to your practice?

Bramhall+Hitchen has been providing risk management solutions and insurance protectionfor businesses and individuals locally for over 35 years. We understand the risk you face in the Dental Profession and are able to provide you with the protection you need. �e convenience ofhaving all of your insurance with one carrier, one agent, and one policy can help prevent costlygaps in your insurance coverage.

Bramhall+Hitchen offers Cincinnati Insurance Company’s complete Dental Insurance program.For over 40 years, Cincinnati Insurance Company has been protecting dentists with a top quality product and financial stability.

Call Bramhall+Hitchen and schedule an insurance checkup today. It's painless!

THECINCINNATIINSURANCE COMPANIES


NCDHM Poster Contest Winners by Dr. Cathy Kionke-Harris, Chair, NCDHM

Following the 2008 introduction ofthe National Children’s Dental HealthMonth (NCDHM) poster contest, theDSDS has expanded the contest toinclude all three counties for 2010. Inorder to reduce costs and improvecommunication with the 88 schoolscontacted, we decided to submiteverything electronically. Initial contactwas done by email to the school nurses.An activity packet was sent as anattachment that the nurses downloadedand forwarded to their third gradeteachers. The packet included activitysheets and lesson plans on oral healthgeared for third grade students, as well asinstructions for the poster contest.Follow-up emails were sent as reminders.

The DSDS received a total of 175

posters from several schools across thestate. The NCDHM committee assembledon 4/6/10 to judge the posters. One winnerwas chosen from each county, in additionto an overall grand prize winner.

The New Castle County winner isSophia Zhao from North Star Elementaryin Hockessin. The Kent County winneris Hannah Naundorf from BenjaminBanneker Elementary in Milford. ReginaPefley from H.O. Brittingham Elementaryin Milton was the winner from SussexCounty. All 3 county winners received$100 savings bonds.

The grand prize winner is MadelynCarter, also from Benjamin BannekerElementary in Milford. She received a$200 savings bond. Her poster has beenreproduced into a bookmark that will bedistributed in the libraries of all participa-ting schools. The nurse from the winningschool, Sue Smith, was also recognizedwith a $100 Borders gift card.

An awards presentation was held at theDSDS annual session on May 14, wherethe winning posters were displayed andwinners presented their savings bonds.

NationalChildren’sDentalHealth

Month 2010

3rd GradePosterContest

Winner:Madelyn Carter

Age 9

Benjamin BannekerElementary Milford, DE

Sponsored by theDelaware StateDental Society



The following information was taken from an AAOMSdocument prepared on March 26, 2010. It represents a synopsisof key provisions and implementation deadlines for the recentlypassed and signed into law healthcare reform package.

Individual Mandate• All U.S. citizens and legal residents will be required to have

‘qualifying’ health coverage (hardship exemptions made) by2014. Those who do not comply will face a maximum taxpenalty of $325 in 2015 per adult per year and $695 startingin 2016. Beginning after 2016, the penalty will be increasedannually by the cost-of-living adjustment. [Effective January1, 2014]

Employer Mandate/Small Business Tax Credit• Requires employers with more than 50 employees to offer

qualified health insurance coverage. Employers that do notoffer such coverage and have at least one full-time employeewho receives a premium assistance tax credit will be fined$2,000 per total full-time employee. The first 30 employeeswill not be counted for the penalty calculation. Employerswith more than 50 employees that offer coverage, but have atleast one full-time employee receiving a premium assistancetax credit, will pay the lesser of $3,000 for each employeereceiving a premium assistance credit or $2,000 for each full-time employee. Employers may not have a waiting period foremployee enrollment in health coverage that exceeds 90 days.[Effective January 1, 2014]

• The law provides for a tax credit for small employers with nomore than 25 employees and average annual wages of lessthan $50,000 that purchase health insurance for employeesand contribute up to 50% of their total premium. [Effectiveupon enactment]

• Phase I: For tax years 2010-2013, provides a tax credit of upto 35% of the employer’s contribution toward the employee’shealth insurance premium. The full credit will be available toemployers with 10 or fewer employees and average annualwages of less than $25,000. The credit phases-out as firm sizeand average wage increases.

• Phase II: For tax years 2014 and later, eligible smallbusinesses that purchase coverage through the state Exchange,can receive a tax credit for two years of up to 50% of theemployer’s contribution toward the employee’s healthinsurance premium. The full credit will be available toemployers with 10 or fewer employees and average annualwages of less than $25,000. The credit phases-out as firm sizeand average wage increases.

Excise Tax on Health Plans• Imposes an excise tax (equal to 40% of the value of the plan

that exceeds the threshold amount) on insurers of employer-sponsored health plans with aggregate values that exceed$10,200 for individual coverage and $27,500 for familycoverage. The tax is imposed on the issuer of the healthinsurance policy, which in the case of a self-insured plan is theplan administrator or, in some cases, the employer. [EffectiveJanuary 1, 2018]

• The threshold amounts will be increased for retiredindividuals age 55 and older who are not eligible for Medicareand for employees engaged in high-risk professions by $1,650for individual coverage and $3,450 for family coverage. Thethreshold amounts may be adjusted upwards if health carecosts increase more than expected prior to implementation ofthe tax in 2018. The threshold amounts will be increased forfirms that may have higher health care costs because of theage or gender of their workers.

• The aggregate value of the health insurance plan includesreimbursements under a flexible spending account for medicalexpenses (health FSA) or health reimbursement arrangement(HRA), employer contributions to a health savings account(HSA), and coverage for supplementary health insurancecoverage. The aggregate value of the plan will exclude dentaland vision coverage. This was a positive alteration fromprevious language which included dental and vision coveragein the total value of high-cost health plans.

Medical Device Tax• Imposes on device manufacturers an excise tax of 2.3% on the

sale of any taxable medical device. Exempts from the taxClass I medical devices, eyeglasses, contact lenses, hearingaids, and any device of a type that is generally purchased bythe public at retail for individual use. [Effective for sales afterDecember 31, 2012]

• While providers are not directly tapped for this tax, it is possiblethat the increased cost to manufacturers could be passed alongto providers through higher prices on non-Class I devices.

Medicare Payroll Tax• Increases the Medicare Part A (hospital insurance) tax rate on

wages by 0.9% (from 1.45% to 2.35%) on earnings over$200,000 for individual taxpayers and $250,000 for marriedcouples filing jointly and imposes a 3.8% tax on unearnedincome for higher-income tax-payers. [Effective January 1, 2013]

Flexible Spending Accounts (FSA)/Health Savings Accounts(HSA) Limits

• Limits the amount of contributions to a FSA for health-relatedexpenses to $2,500 per year, indexed for inflation. [EffectiveJanuary 1, 2013]

• Increases the tax on distributions from a HSA (prior to age 65)that are not used for qualified medical expenses to 20% (from10%) of the disbursed amount. [Effective January 1, 2011]

• HSA/FSA accounts are used by patients for dental care, whichis not always included in employer-provided insurance. Theselimitations may have a negative effect on access to dental carefor patients without dental coverage.

Medicare Independent Payment Advisory Board (IPAB)• Creates an independent, 15-member Medicare Independent

Payment Advisory Board (IPAB) tasked with presentingCongress with “comprehensive proposals to reduce excesscost growth and improve quality of care for Medicarebeneficiaries.” The Board’s proposals will take effect unlessCongress passes an alternative measure that achieves the samelevel of savings. The Board would be prohibited from making

Health Care Reform Update

DELAWARE STATE DENTAL SOCIETY NEWSLETTERMay/June 2010 Page 7

plans that cover dependent children are required to extendcoverage to such dependents until age 26 [Effective beginning6 months after enactment]

• States that the Secretary of Health and Human Services(HHS) will define the essential health benefits, but the finaldefinition must include: ambulatory patient services, emergencyservices, hospitalization, maternity and newborn care, mentalhealth and substance use disorder services (including behavioralhealth treatment), prescription drugs, rehabilitative andhabilitative services/devices, laboratory services, preventiveand wellness services and chronic disease management andpediatric services, including oral and vision care.

• Requires all qualified health insurance plans, including thoseoffered through the Exchanges and those offered in theindividual and small group markets outside the Exchanges, tooffer at least the essential health benefits package. [EffectiveJanuary 1, 2014]

• It will be at the discretion of HHS in creating the definition ofpediatric oral services to be included in the essential benefitspackage - it is unclear at this time whether or not third molarremoval will be included.

Medicaid Expansion• Expands Medicaid to all individuals underage 65 (children,

pregnant women, parents, and adults without dependentchildren) with incomes up to 133% FPL based on modifiedadjusted gross income. All newly eligible adults will beguaranteed a benchmark benefit package that at least providesthe essential health benefits as defined for the exchangeswhich includes pediatric-but not adult-oral health services.[Effective January 1, 2014]

• To finance the coverage for the newly eligible, states willreceive 100% federal funding for 2014 through 2016, 95%federal financing in 2017, 94% federal financing in 2018, 93%federal financing in 2019, and 90% federal financing for 2020and subsequent years.

Alternative Dental Health Care Providers• Authorizes the Secretary to award grants to establish training

programs for alternative dental health care providers toincrease access to dental health care services in rural, tribal,and underserved communities. The term ‘alternative dentalhealth care providers’ includes “community dental healthcoordinators, advance practice dental hygienists, independentdental hygienists, supervised dental hygienists, primary carephysicians, dental therapists, dental health aides, and anyother health professional that the Secretary determinesappropriate.” [Demonstration projects shall begin within 2years after enactment and shall conclude not later than 7years after enactment]

• Incorporated the Indian Health Care Improvement Act(IHCIA), which includes a provision to allow tribes in statesthat license dental therapists to establish a Dental Health AideTherapist (DHAT) program.

• These provisions could promote midlevel dental providers toperform surgical dental procedures and expand the availabilityof the Alaska DHAT model to other tribal areas of the country.

proposals that ration care, raise taxes or Part B premiums, orchange Medicare benefit, eligibility, or cost-sharing standards.[Effective upon enactment]

• IPAB proposals to modify payments will be effective forpayments years 2015 and beyond.

• This provision provides for the addition of an independentcommission with the ability to mandate Medicare paymentcuts for physicians, who are already subject to cuts due to theflawed sustainable growth rate (SGR) formula.

Claims Submission/Fraud & Abuse• The maximum period for submission of Medicare claims is

reduced to a maximum of 12 months. [Effective upon enactment]• Accelerates HHS adoption of uniform standards and operating

rules for the electronic transactions that occur between providersand health plans, such as benefit eligibility verification, priorauthorization and electronic funds transfer payments. Establishesa process to regularly update the standards and operating rulesfor electronic transactions and requires health plans to certifycompliance or face financial penalties collected by the TreasurySecretary. [Effective upon enactment]

• Initiates several Medicare and Medicaid fraud and abuse preven-tion initiatives including a new enrollment process for providersand suppliers and a requirement that suppliers and providersimplement compliance programs with core elements determinedby the Department of Health and Human Services (HHS).

Quality Measures/PQRI• Extends through 2014 payments under Medicare’s Physician

Quality Reporting Initiative (PQRI). Physicians voluntarilyparticipating in PQRI in 2011 will see a 1% increase inincentive payments and a .5% increase from 2012-2014.

• Beginning in 2014, physicians who do not submit measures toPQRI will have their Medicare payments reduced by 1.5%.The penalty will be increased to 2% in subsequent years.[Effective upon enactment]

• In addition to PQRI expansion, the law provides for a numberof quality and value initiatives designed to improve healthcare delivery. The impact on oral and maxillofacial surgery isstill being assessed.

Imaging• Increases the utilization rate assumption for calculating the

payment for advanced imaging equipment from 50% to 75%[Effective January 1, 2011]

• Physician must disclose ownership interest in imagingequipment to their patients [Effective upon enactment]

Insurance Reforms/Definition of Essential Benefits• Creates state-based exchanges through which individuals can

purchase health coverage, with premium and cost-sharingcredits available to individuals/families with income between133-400% of the federal poverty level (FPL). Stand-alonedental coverage available through dental insurers will also beoffered through the exchanges. There is no requirement forproviders to participate in any of the exchanged-based insur-ance plans. [Exchange development deadline Jan. 1, 2014]

• Provides for insurance reforms that bar insurers from denyingcoverage for pre-existing conditions, establishing lifetime orannual limits on coverage or rescinding coverage except incases of fraud or misrepresentation. Further, group health

Bacterial prophylaxis for joint replacement patients -Comment on New Recommendations

Discussion. -While the new statementacknowledges the risk-versus-benefitargument concerning the use ofantibiotics, its result will be to increasethe use of these agents. In fact, the useof antibiotics carries a finite incidence oflife-threatening reactions from a singledose that exceeds the life-threateningpotential of joint infections caused byoral bacteria. The statement does notidentify specific dental procedures ascausing bacteremia. In addition, noalternative antibiotic regimen issuggested for patients allergic topenicillin. The data cited in support ofthe position does not contain anyreference from work on bacteremia inthe last decade. Health care practitionersshould emphasize the importance ofgood oral hygiene and eliminating oraldisease in at-risk patients both beforeand after prosthetic joint operations.Napenas JJ, Lockhart PB, Epstein JB: Comment onthe 2009 American Academy of OrthopaedicSurgeon’s Information Statement on AntibioticProphylaxis for Bacteremia in Patients with JointReplacements. J Can Dent Assoc 75:447-449,2009.


In 2003 a revised statement concerningthe use of antibiotic prophylaxis forpatients undergoing dental treatment whohave undergone total joint replacement(s)was issued by the American Academy ofOrthopaedic Surgeons (AAOS) and theAmerican Dental Association. A 2009update has now been issued by theAAOS “as an educational tool based onthe opinion of the authors.”

Recommendations. - Antibioticprophylaxis is recommended before anyinvasive procedure that is likely to producebacteremia in patients who have under-gone total joint replacement. There is notime limitation on this recommendationand all invasive dental and medicalprocedures are included. These recom-mendations are more stringent than the2003 recommendations. Antibioticprophylaxis is still not considerednecessary for patients with pins, plates,screws, or other hardware not within asynovial joint.

Underlying Assumptions. - Supportfor this new statement is based onseveral assumptions including that: (1)

bacteremia from oral flora secondary todental procedures can cause prostheticjoint infections, (2) dental procedures andprosthetic joint infections are temporallyrelated, (3) antibiotic prophylaxis iseffective against bacteremia caused bydental / operative procedures, and (4)joint infections are not comparable toinfective endocarditis because ofdifferences in anatomy, blood supply,microorganisms, etc.

However, these assumptions can bequestioned. For example, evidencesuggests that joint infections are rarelycaused by bacterial species common tothe oral cavity and only circumstantialevidence links dental procedures andsuch infections temporally. In addition,even with antibiotic prophylaxis, jointinfections can occur after dental proceduresand bacteremia can develop. Finally,even though more than half of cases ininfective endocarditis involve oralbacterial species, the AHA prophylaxisrecommendations run counter to thosefor joint infections, which are not linkeddefinitively to these bacteria.

Rotation of mandibular implant overdentures

from the tip of the anterior teeth to theanterior denture border and a point on aline drawn from the most posterior pointsof the denture to the right and left sides.

Discussion. - The arrangement of theanterior teeth and the length of thedenture showed significant correlationswith the awareness of denture rotation inthese patients. Chewing ability wasnegatively affected by the rotationalmovement of these mandibular two-ballattachment IODs. Treatment planningfor 2 implant supported overdenturesshould seek to optimize implantpositioning and also inform patients ofthe possibility of prosthesis rotation. Kimoto S, Pan S, Drolet N, et al: Rotationalmovements of mandibular two-implant overdentures.Clin Oral Imp Res 20:838-843, 2009.

Background. - The attachment systemplays a vital role in implant overdenture(IOD) treatment. Retention and stabilityimprove with an attachment connectingthe mandibular complete denture to theimplants, but the attachment must allowrotational freedom to avoid stress aroundthe implants. While mandibular IODsretained by two-ball attachments are highlyeffective, patients complain that therotation of these devices is problematic.The frequency and severity of rotation,the effect on perceived satisfaction ratingsof chewing ability, and the factors contrib-uting to IOD rotation were investigated.

Methods. - Data were gathered from70 subjects including their sociodemo-graphic, anatomic, and prosthesis

characteristics. Each subject was askedto rate the satisfaction level with theIOD, ability to chew various foods,whether the device rotated, and howmuch the rotation was bothersome.Those reporting denture rotation werecompared with those not reporting it.

Results. - Rotation was reported by37 patients (47%) who formed the “R”group. The chewing ability differedbetween the “R” and “NR” (no rotation)groups. The R group reported a meanlevel of discomfort caused by rotation of39/100 using a visual analog scale.General satisfaction with the performanceof the IOD was comparable between thetwo groups. Awareness of denture rotationwas significantly related to the distance


March 2-3-4, 2011

Sponsored by the Second Dis t r i c t Va l ley Forge Den ta l Assoc ia t ion ★ Rep resen t i ng Bucks , Ches te r, De laware , Leh igh , Mon tgomer y & Nor t hamp ton Coun t i e s

www.vfdc.org ★ 1.800.854.VFDCwww.vfdc.org ★ 1.800.854.VFDC

VALLEY FORGE CONVENTION CENTERKING OF PRUSSIA, PA

Celebrate, Discover & Grow Your Practice!

PENNSYLVANIA’S PREMIERE DENTAL CONFERENCE

WEDNESDAY, MARCH 2, 2011Dr. John Olmsted .........................................................................................EndodonticsMs. Sandy Roth .......................................................................................CommunicationDr. Tieraona Low Dog...................................Alternative Medicine & Dietary SupplementsDr. Sam Low ......................................................................................Periodontics & LasersTHURSDAY, MARCH 3, 2011Dr. Richard Wynn ..........................................................................................PharmacologyDr. John Olmsted ...............................................................Endodontic Participation ProgramDr. Tieraona Low Dog ..........................................................................Emotional Well BeingMs. Carol Jahn......................................................................Implications for Oral Health CareMr. T. Andre Shirdan/Patterson Dental..............................................Computer TechnologyFRIDAY, MARCH 4, 2011Dr. Henry Lee .......................................................................................Forensics - Famous CasesDr. Jeff Brucia ....................................................................................................Dental MaterialsDr. Nevin Zablotsky ..................Tobacco Cessation & Pathology Associated with Tobacco CessationGreat Lakes Ortho Lab........................................................................Bleaching & Mouth GuardsRisk Management

Your Chance to Fulfill Your 2011 Pennsylvania CE Requirements ★ Cutting Edge Courses for Doctors & StaffCERP, PDHA & DANB Accredited Seminars ★ Exhibit Hall Featuring 80 Companies


Emergency department dental carehypertensive disease complications.

Discussion - The number of ED visitsfor non-traumatic dental problems inOntario was significant when comparedto the number of visits for other majorhealth problems. The pattern of visitssuggests that they are related to a lack ofaccess to dental care, with peaksindicating the patients are employed andthe children were being brought afterwork and school. The visits are made tomanage common dental problems, noturgent situations. The ED responsesgenerally involve no treatment or nodefinitive resolution to the problem. Theconclusion is that there is a need fordental services in Ontario for those whoare not covered under private orgovernment-subsidized insuranceprograms and ED visits are not the bestmeans to meet the need. These findingsare not surprising and seem to reflect asimilar problem in the United States. Quinonez C, Giblson D, Jokovic A, et al: Emergencydepartment visits for dental care of nontraumatic origin.Community Dent Oral Epidemiol 37:366-371, 2009.

Background - As Canada reviews itspublicly financed dental care system,stake-holders have characterizedEmergency Department (ED) visits fordental treatment as inefficient and costlyto the healthcare system. Problems withED dental visits include: (1) EDs are notcommonly prepared to handle dentalproblems, (2) treatment is usually withantibiotics or analgesics which do notresolve the actual problem, and (3) suchvisits further burden an overextendedambulatory care system. To furtherdefine the problem, administrative datawere analyzed to determine the exactnature of ED visits for dental problems.

Methods - Hospital-based ambulatorycare centers contribute to the CanadianInstitute for Health Information’s NationalAmbulatory Care Reporting System. Thedata include demographic, diagnostic,procedural, and administrative informat-ion. Information was collected fromfiscal years 2003/2004 and 2005/2006,covering ED visits involving diseases ofthe oral cavity, salivary glands, and jaws(non-traumatic cases). Patient and visit

characteristics were noted. Results - The total number of ED

visits for dental problems was 141,365,or approximately 1.2 visits / person /year. Overall 2003 ED volume wasdepressed because of the effect of thesevere acute respiratory syndrome(SARS) outbreak. Most visits were madeby personal aged 20 to 44 years and78% were triaged as less urgent to non-urgent. Discharge to home was theoutcome in 92.7% of cases. Periapicalabscesses and toothaches accounted formost visits. Most of the patients withcommon dental problems received nointervention or the intervention was notcoded. Some patients received pharma-cotherapy or other services. Of the codedinterventions, the top four codes were“therapeutic intervention on the wholebody,” “diagnostic intervention on thebody system,” “therapeutic interventionon the vein,” and “diagnostic interventionon the weekends. The number of visitsfor non-traumatic dental problems wassimilar to the number for pneumonia andgreater than the number for diabetes and

Pregnancy - Safety of dental treatment during pregnancymedical or adverse pregnancy-relatedoutcomes. The use of topical and localanesthetics during periodontal treatmentalso showed no increase in adverseoutcomes.

Discussion - The study has severallimitations, including a low rate ofspecific adverse pregnancy outcomes,perhaps related to a small sample size.Also, the presence of periodontitis in allsubjects may have masked any adverseeffect linked to EDT. However the studydoes seem to support the safety oftopical and / or local anesthesia usedbetween 12 and 21 weeks of pregnancy. Nunn ME: Essential dental treatment (EDT) inpregnant women during the second trimester is notassociated with an increased risk of serious adversepregnancy outcomes or medical events. J Evid BaseDent Pract (:91-92, 2009.

Background - Generally, obstetricianspermit their patients to receive routinedental care after 8 weeks’ gestation,seeing this as a minimal risk situation.However, dentists and pregnant womenoften choose to delay treatment untilafter delivery. Whether the risk ofattending routine dental care is sufficientto cause adverse medical or pregnancy-related outcomes was investigated.

Methods - In the Obstetrics andPeriodontal Therapy Trail (OPT), preg-nant women were randomly assigned toreceive non-surgical periodontal scalingand root planning (essential dentaltreatment [EDT] either between 12 and21 weeks’ gestation or after delivery.The goal was to analyze the rate ofpreterm delivery between the twogroups. Data from the OPT was used toanalyze safety outcomes for the study

population, specifically, the role of EDTin relation to adverse medical andpregnancy outcomes. The sample was notrandomly assigned to receive EDT andan EDT propensity score was developedto address imbalances. Adverse medicalevents were defined as hospitalizationsof more than 24 hours for any causedeemed as serious adverse occurrence bythe relevant institutional review board.These included non-study-related events,such as uncontrolled diabetes,cholestasis, ovarian cysts, preeclampsia,chorioamnionitis, pancreatitis, andpyelonephritis. Adverse pregnancyoutcomes were of three types: non-livebirth, pre-term birth before 37 weeks’gestation, or fetal or congenital anomaly.

Results - EDT between 13 and 21weeks’ gestation did not show any sig-nificant correlation with either adverse


Oral-Systemic Linkages Oral health of oldest-oldto have longer-than-expected survival;those aged 86 years or older with intactcognition who also never smokedshared a longer survival. Men in thisage group having intact cognitive statusand natural teeth also had longer-than-expected survival.

• For dentate individuals, cognitivestatus contributed significantly tosurvival; for women aged 86 years orolder, number of teeth, householdeconomy in childhood, and smokingwere also significant predictors.

Discussion - Psychosocial factorswere the strongest predictors of survivalin the oldest-old studied. Oral healthfactors, specifically severe periodontaldisease in men, DFS% and number ofteeth in women, were significantlyassociated with survival. Thorstensson H, Johansson B: Does oral health sayanything about survival in later life? Findings in aSwedish cohort of 80+ years at baseline.Community Dent Oral Epidemiol 37:325-332, 2009.

Background - The group ofindividuals aged more than 80 years(oldest-old) is growing faster than anyother age group. Within 50 years, theUnited Nations estimates that 20% of theworld’s elderly population will fall intothis age group. The markers of oralhealth and their ability to predictsubsequent survival in individuals of agemore than 80 years were investigated.

Methods - A sample of the oldest-oldwas followed over 8 years to determinethe relative importance of oral healthindicators for subsequent survival. 357subjects with a median age of 86 yearswere selected from the longitudinalstudy Origins of Variance in the Old-Old: Octogenarian Twins. The oralhealth variables measured includednumber of teeth, percent decayed andfilled surfaces (DFS%), and periodontaldisease. The ratio between yearsactually lived and statistical expectation

(longevity quotient [LQ]) wascalculated. Survival categories consistedof (1) shorter than expected, (2) asexpected, and (3) longer than expected.

Results - • LQ was not related to number of teeth,

edentulousness, or periodontal diseaseexperience, although median LQ waslower in men with severe periodontaldisease than in men with moderateperiodontal disease.

• Household economy in childhood andsmoking were significantly related toperiodontal disease experience.

• DFS% and survival were significantlyrelated, with low DFS score linked tolower mean LQ and shorter-than-expected survival time.

• DFS% was significantly correlatedwith social class, keeping neat and tidy,and perceived loneliness.

• Woman aged 85 years or younger withintact cognitive status were more likely

Dental implications of obesityan inferior alveolar nerve block or thecervical lymph nodes cannot bepalpated. Finally, staff members mayalso require additional training to be ableto manually handle these patientswithout injuring themselves.

Results - The article offers severalobservations / suggestions. Before thepatient enters the operatory, the staffshould be prepared. Any potentialdifficulty with access, stairs, mobility, orseating must be analyzed and handled,with assistance as needed. Some of thewaiting room chairs should be armless,and any scales to determine BMI shouldbe appropriately sturdy. The bloodpressure cuff must also be of an appro-priate size. Patients should complete atargeted medical history. Airway problemsin particular should be explored toidentify any obstructive sleep apnea.Arterial blood pressure measurementsare obtained to check for hypertension,which is often undiagnosed. Reilly D, Boyle CA, Craig DC: Obesity and dentistry: Agrowing problem. Br Dent J 207:171-175,2009.

Background - The prevalence ofobesity in adults in the United States was33.3% in men and 35.3% in women in2005-2006 with 16% of children affected.Body mass index (BMI) is used ameasurement of obesity. It is calculatedas the individual’s weight in kilogramsdivided by the square of his / her height inmeters and is used to define overweightand obesity, with individuals having aBMI of 25 kg/m2 or higher consideredobese. BMI alone has limitations becauseit can misjudge the status of individualswho are highly athletic with a large musclemass, those who have lost muscle todisease or age, and children. Evidenceindicates that body fat composition isphysiologically determined and deviationsfrom the baseline cause a homeostaticresponse resistant to change. The altera-tions in the body caused by obesity affecttotal blood volume, cardiac function, anddistribution of fat. As a result, respiratoryfunction is impaired, hypertension devel-ops, concentrations of plasma insulin areelevated, and insulin resistance, diabetes

mellitus, and hyperlipidemia develop.Immune responses and hematologicfunction are also impaired. Among thespecific conditions associated with obesityare hypertension, cardiovascular disease,diabetes mellitus, sleep breathing disorder,cancer, fatty liver disease, gallbladderdisease, gastroesophageal reflux disease,osteoarthritis, and reproductive problems.

Dental Implementationss - Obesepatients are more likely to develop perio-dontal disease and present difficulties withconscious sedation procedures. Acces-sibility issues can begin with where thecar must be parked and include narrowdoorways or corridors, restricted toiletingfacilities, small dental chairs or those withinsufficient maximum lifting weights,inadequate methods of height and weightdeterminations, and small blood pressurecuffs. Medical emergencies are alsomore likely to occur with obese patientsand the dentist must be prepared tohandle them. Carrying out basic dentalcare may also be challenging because,for example, the landmarks for placing

Who seeks cosmetic dentistry? connection with the mouth, withcosmetic dental patients demonstratingmore concern than the reference group.

The levels of preoccupation with theidea of being unattractive, ugly, deformed,or not beautiful enough were similarbetween the two groups. The clinicalgroup members were significantly moreconvinced of their unattractiveness andwere more likely to experience impairedoccupational functioning than referencegroup members. The proportion offemale individuals in the clinical groupmeeting BDD criteria was higher than inthe reference group.

Discussion - The findings were notsurprising. Dental patients seeking cos-metic treatment were distinguished fromthe general population by psychologicalcharacteristics, number of previouscosmetic treatments, and clinicalcharacteristics of BDD. De Jongh A, Aartman IHA, Parvaneh H, et al:Symptoms of body dysmorphic discorder amongpeople presenting for cosmetic dental treatment: Acomparative study of cosmetic dental patients and ageneral population sample. Community Dent OralEpidemiol 37:350-356, 2009.

Background - TIndividuals seekingcosmetic dentistry may be motivated by asimple desire to improve their physicalappearance, a need to correct a real or per-ceived defect, an unhealthy preoccupationwith a perceived defect, or other situations,such as a reunion or a return to datingafter a divorce. The appearance concernsof individuals attending a cosmetic dentalclinic for an esthetically motivateddental treatment were investigated.

Methods - Cross-sectional studycomparing 170 persons from six cosmeticclinics (clinical group) with 878 subjectsfrom the general population (referencegroup). Participants completed a ques-tionnaire to provide demographic andappearance data. The expectation wasthat dental patients seeking cosmeticprocedures would be generally less happyand less satisfied with their appearanceand more likely to exhibit characteristicsof body dysmorphic discorder (BDD).

Results - The clinical and referencegroups had a similar sense of happiness

(79% of the clinical group reported beinghappy or very happy). The two groupswere also similar in their dissatisfactionlevels with their appearance in general orspecific to their teeth. In the clinical group,3.6% were dissatisfied with their generalappearance and 11.8% were dissatisfiedwith their teeth. 16% of the cosmeticdental patients and 9.8% of the referencesample considered general physicalappearance as important or very impor-tant with levels of 26.9% and 12.3%,respectively, for the importance of dentalappearance. Female clinical patients con-sidered their appearance as significantlymore important than reference subjects.

Significantly more cosmetic dentalpatients had a previous procedure, dentalor non-dental, to improve their generalappearance compared to the generalsample. Both groups also rated one ormore aspects of their body as unattractive,ugly, deformed, or not beautiful enoughto similar extents. The only differencebetween the two groups arose in



Helping dentists buy & sell practices for over 40 years. WWW.AFTCO.NET

FREE PRACTICE APPRAISALS

PRACTICE SALES / MERGERS

PRE-SALE PROGRAM

STOCKHOLDER PROGRAM

AFTCO is the oldest and largest dental practice transition consulting

firm in the United States. AFTCO assists dentists with associateships,

purchasing and selling of practices, and retirement plans. We are much

more than a practice broker, we are there to serve you through all

stages of your career. Call us at 1-800-232-3826.

Better Business Bureau of DETorch Award presented to

DSDS Member“The BBB of DE Torch Award for Marketplace Ethics is

helping to illuminate the importance of corporate conscienceand responsibility to upholding a fair and honest marketplace.”Dr. Steven E. Chamish was recognized at the BBB’s AnnualDinner on April 27, 2010, at the Hotel du Pont.

Dr. Steven E. Chamish and Dr. Robert A. Friedberg.Dr. Steven E. Chamish makes his speech.


3Caption

Give Kids A Smile Statistics2010 2009 2008 2007 2006 2005 2004

# of Sites 2 2 1 3 4 3 1Location Millsboro (A) Dover Seaford Smyrna Seaford Milford Lewes

DelTech (B) DelTech Dagsboro Milford DoverDelTech Dover DelTech

DelTech# of Volunteers (Total) 36(A); 92(B) 144 40 159 176 164 104

Dentists 17 40 10 47 63 63 39Hygienists 24 37 9 39 40 43 19Dental Assistants 11 19 13 46 46 38 30Office Staff 13 14 8 27 27 20 20Del Tech Students 27 34

# of Children Treated 57(A); 79(B) 103 71 214 357 173 158(29 restorativeoral surgery)

# of Organizations Involved3(A); 4(B) 9 2 11 16 12 9(locating & bringing children)

Free Dental Care $24,385(A) $35,090 $22,929 $68,446 $90,410 $53,490 $37,000$25,700(B)

Supplies and Man-Hours ScheinDonated by Patterson Dental $6,900(B) $9,800 $3,500 $20,000 $18,000 $10,000 $5,000 and Dentsply

Del Tech Hosts 2010 DSDS GKAS Event

DSDS 147TH Annual Meeting,Hotel du Pont,

Wilmington,May 13


Mike’s unique “What’s Up Doc...in Oral Medicine in

2010” presentationinformed and entertained

attendees on the demanding totalcare expected in today’s modern

practice. Attendees once again appreciatedthe ease of parking, comfortable meetingfacilities and outstanding service of the

Chase Center on the Riverfront. Reservedluncheon seating for large office groups was again a

hit as feedback from this year’s session wasoverwhelmingly positive.

A Special Thank You to theDSDS 147th Annual Session

Exhibitors:Artisans' BankBiomet 3i, LLCBramhall + Hitchen InsuranceCGI Communications, Inc.Colgate Oral Pharmaceuticals Inc.Dental Facial ImagingDentsplyDiamond State Financial GroupDodd Dental LaboratoryHayes Handpiece CompanyHiOssenKing Medical SystemsNewtech Dental LaboratoriesPatterson DentalPhillips SonicarePNC BankTD BankWillisWSFS BankZimmer Dental


DSDS 147TH Annual CE Session, May 14


147TH Annual President’s Dinner Dance, Wilmington CC, May 14


The DSDS Council on Education will present two fall CE courses in 2010 as theDental Society moves to a calendar year for the annual CE Series. The twocourses listed below will complete the 2010 line-up. Watch your mail for abrochure or register online at www.delawarestatedentalsociety.org. Coming thisfall will be the 2011 line-up of courses and registration information.

2010 FallCE Courses

Healthy Teams:Helping Patients Make Healthy Choices Mary H. Osborne

How would your practice be different if each person described hisor her primary role as “Helping people make healthy choices?”Instead of focusing on tasks, each person focuses on results.Patients take center stage, and all communication and systems areorganized around helping them become healthier. Success ismeasured by your ability to move each patient along a continuumtoward optimal health. You can learn the skills required to helpyour patients make healthy choices. This seminar will help you:• Attract patients who make decisions based on quality as well

as price.• Develop team relationships which allow everyone to focus on results.• Help your patients work through barriers they perceive to

ideal dental health.• Develop communication which is powerful, ethical, non

manipulative, and patient centered - not insurance centered.No catchy slogans or pat phrases will get to the level ofunderstanding you need with your patients. It is difficult forthem to break the bonds of fear, and to change long heldassumptions about dentistry. This informative, interactive, livelyprogram will help you learn how to:• Increase your ability to attract and keep values based patients,

instead of trying to please everyone.• Establish ongoing relationships which support patients in making

healthy choices, instead of nagging them into compliance.• Create mutual expectations about responsibility for payment,

instead of hassling over what the insurance company will andwill not pay.

You can learn to build relationships based on a newteam/doctor/patient model that develops understanding, trust,loyalty, accountability, and commitment.

Friday, Oct. 22, 20108:30 AM to 4:00 PMHotel du Pont, Wilmington, DESPECIAL INTEREST FOR ENTIRE TEAM - 6 CE CREDITS

Mary Osborne has worked in dentistry for over forty years as a clinical hygienist and patient facilitator. Shebrings to her work enthusiasm, intelligence, humor, and a deep belief in the potential for significant growththrough authentic communication.Mary is known internationally as a consultant, writer, and producer of newsletters and audio/video programs forMary H. Osborne, Resources in Seattle, Washington. Her writing is published in national magazines and she hasspoken extensively to state and national organizations including The American Dental Association and TheAmerican Academy of Dental Practice Administration. She is a member of the visiting faculty and serves as aFoundation Advisor to the Pankey Institute.

Current Esthetics andOcclusion Concepts: Myths, Science and Clinical Implications

Terry T. Tanaka, DDS Recent innovations in dentistry and technology have changed theway dentistry is being presented to patients in this modern era ofdentistry. Are these current esthetic trends science driven or theresult of marketing hype? When restorations fail, the questionsshould not be, “who is responsible,” but “why did the restorationfail, and what can we learn from these failures?” When failuresoccur, several important questions must be addressed:• Was there a breakdown in the decision process of case

(patient) selection, site selection, or material selection? • What was the role of occlusion and masticatory function in

the failure of these restorations?

This program will demonstrate the importance of addressing thetwo questions proposed above and will provide both the currentscience and clinical examples for practicing dentists. You will learn:• Why do restorations fail; patient selection, site selection, or

material selection?• What former rules of occlusion are really myths and unsuppor-

ted by current science and how did these myths get started? • How does the current science affect how we make clinical

decisions?• How do occlusal parafunction (dysfunction) and bruxing

affect our restorations?• How do muscle disorders affect the occlusion, our ability to

make reliable centric records and maintain a stable occlusion?• How often do TMDs affect the occlusion and how can they be

managed?• How do the above questions affect the longevity of your

restorations?

Friday, Nov. 12, 20108:30 AM to 4:00 PMHotel du Pont, Wilmington, DESPECIAL INTEREST FOR DENTISTS, SPECIALISTS,AND ASSISTANTS - 6 CE CREDITS

Dr. Terry T. Tanaka is Clinical Professor at the University of Southern California, School of Dentistry,Advanced Education Prosthodontics and maintains a private practice in prosthodontics. Dr. Tanaka is the directorof TMD and Restorative Dentistry Study Groups in the U.S. and abroad. He holds fellowships in the Academyof Dentistry International, American College of Dentists, International College of Dentists and Master in theAcademy of General Dentistry. He is Past President of the Academy of Dentistry International. Dr. Tanaka'seducational videos on Implants, Restorative Procedures, TM Dysfunction and Anatomy are used in over 80medical and dental schools and surgery programs throughout the world.


think dentistryre

CLASSIFIED ADVERTISEMENTS

GARDEN DENTAL OFFICE FOR SALE Located in the heart of BrandywineHundred. Accessible yet private on acre with large parking area. 1965prize winner in nat’l architecture health category competition. Ownerretiring. Call (302) 475-3460.

FOR SALE: Operating microscope with rolling stand. Global Entre modelin like new condition. $7500. Contact Dr. Grubb at 410 939 5800.

DSDS Executive CouncilWelcomes New Members

Effective July 1, 2010 the Executive Council leadershipchanges as the EC welcomes President, Dr. John Nista. Alsojoining the council will be Dr. Kent Elkington, Sussex CountyRepresentative; Dr. Michael Giofffre, Jr., New Castle CountyRepresentative and Dr. Robert Kacmarcik, Second Vice President.

The Executive Council extends a sincere thank you to Dr. SharonWelsh for her outstanding leadership this past year as President;Dr. Ryan Barnhart for his many years on the EC as both a SussexCouncil Representative and Treasurer for the past two years andDr. Kevin Brafman, the recent Sussex County Representative.

Watch for information on the new Executive Council, Counciland Committee member update and a 2010/2011 meeting calendarin the fall issue of the newsletter and on the DSDS website.

A Summer CampOpportunity in Haiti

Beginning in July of 2010 teams of committed teachers,counselors, students, healthcare providers and other profes-sionals will come to Jacmel to manage education, sports, crafts,music and dance camps for Haitian children. American doctorsand dentists will set up outpatient health clinics, located nextto the camp, and will address the medical needs of thechildren and their families.

Women and children who have endured the loss of theirhomes, schools and family members due to the 7.2 magnitudeearthquake of January 12, 2010 need support in healing. 5,500people in Jacmel alone are still living in filthy, unsafe, tentcities in sub human conditions.

We aim to give these woman and children an opportunity toescape this harsh environment, if only for a day at a time, toplay, talk, be listened to, laugh, learn, smile and receive neededhealth and dental care.

Through this effort, the Haiti Family Initiative of Wilmington,can give women and children the confidence and skills that willeventually affect not only them, but also the future of Haiti.

If you would like additional information or would like to jointhe initiative, please contact Dr. Ed Granite at Christiana CareHealth Services at 302-428-6458 or egranite @christianacare.org

DSDS Launches New Glove ProgramThe DSDS is pleased to introduce a new glove program for DSDS member dental

offices. Every dental professional has unique needs when it comes to the comfort,fit and feel of the gloves they wear. The DSDS glove program provides special pricing exclusively for DSDS Members and a complete line of products from two leading glove manufacturers. Below is information on some the most popular gloves:

Powder-Free LatexSempermed Polymed Powder-Free Textured Latex....................$5.10 boxMicroflex Color Touch Pink Powder-Free Textured Latex.........$7.20 boxMicroflex ComfortGrip Powder-Free Textured Latex ................$7.24 boxMicroflex Diamond Grip Plus Powder-Free Textured Latex......$8.25 box

NitrileSempermed Tender Touch Powder-Free Textured Nitrile...........$5.44 per 100 glovesSempermed SemperSure Powder-Free Textured Nitrile .............$7.18 per 100 gloves Microflex Tranquility Powder-Free Textured White Nitrile .......$6.74 box Microflex Ultra Sense Powder-Free Textured Nitrile .................$8.02 box

Powdered LatexMicroflex Micro One Powdered Latex .......................................$6.41 box Microflex Color Touch Powdered Textured Latex......................$7.72 box

*All gloves are sold by the case, with 10 boxes per case.

Please call (877) 484-6149 to order gloves, request free samples, or for answers to your questions regarding the DSDS glove program.

To order on the Web, visit www.dsdsgloves.com.


MARK YOURCALENDARFOR 2011

CONTINUINGEDUCATION

January 21Marvin Berman, DDSPediatric Dentistry: Are We Having Fun Yet

February 11Dennis Tarnow, DDSEsthetics and Implant Dentistry: Advances and Controversies

March 11Larry Emmott, DDSHigh Tech Power Practice

April 15Casey HeinSystemic Impact of Periodontal Disease: What does it mean for Physicians,Nurses, Dentists, Hygienists, and allthe Health Professions?

May 13 - ANNUAL SESSIONThe Madow BrothersHow to Love Dentistry and Have Fun While Increasing Production

October 21Lisa Philip, RDHHidden Profits in Hygiene

November 4Samuel Low, DDSSuccessful Management of the Periodontal Patient

DSDS PresentsNew Logo

The DSDS Communications Counciland the Executive Council are pleased topresent the new DSDS Logo and bylinethat will begin to appear on all DSDSpublications, stationary, and website.Many thanks to everyone who contributedto this process.


of the children who had been rescheduled because of the snow-storm. Our thanks to Ms. Vivian Rizzo and the students andstaff at DelTech. All of these individuals work very hard onbehalf of the children of this State. Thank you to all of theDSDS members and their teams who continue to volunteerfor this annual event.

6. We now have a Medicaid Advisory Committee to facilitateworking with the Department of Medicaid and MedicalServices. With the recent resignation of our State DentalDirector, Dr. Greg McClure, I anticipate that this committeewill provide DMMA with great direction. I thank Drs. AndyMercer and Chuck Labin for co-chairing the Committee.

7. Thank you to Dr. Cathy Kionke-Harris for chairing anothersuccessful poster contest as part of Children’s Dental HealthMonth. Cathy and her committee accepted poster entries from

Editorial…continued from page 2the scientific evidence that forms the basis for the marketed use.This information will help the dentist to discuss the benefits andrisks of the treatment options with patients. Dental lasermanufacturers must seek FDA 510(k) clearance for each laserproduct and each specific indication for use. Not every laser iscleared for every conceivable use. Therefore, FDA marketingclearances apply to certain products that are specific to themanufacturer and product. For any specific laser device, thespecific indications for use, as marketing clearances, can be found inthe professional information section of the operator’s manual for thedevice. Additional uses for dental lasers are considered “off labeluse.” Within the scope of a license to practice, dentists may choose touse lasers or other products “off label.” Practitioners should consideroff label use in light of possible benefits and risks, patient needs, andthe available scientific evidence.

Sulcular Debridement (Curettage) - The dental literatureindicates that when used as an adjunct to meticulous root planing,mechanical or chemical curettage (i.e., the intentional removal ofthe epithelial lining of the sulcus) offers no consistent benefitbeyond scaling and root planing alone with respect to gain of theperiodontal attachment. As such, curettage was deemed severalyears ago to be of no known clinical value. Accordingly, the ADAcode for curettage was omitted from the CDT-4 code listing. Thereis little convincing clinical evidence that adjunctive laser curettageproduces a result superior to adjunctive mechanical or chemicalcurettage, or even scaling and root planing alone. Current evidencesuggests that therapies intended to arrest and control periodontitisdepend primarily on effective root debridement.

Laser-Assisted New Attachment Procedure - A 2007 publi-cation compared the probing depth, attachment gain, and type ofattachment from traditional mechanical therapy of advancedchronic periodontitis vs. traditional mechanical therapy thatincluded two intrasulcular applications of Nd: YAG; one aimed atremoving the sulcular epithelium and another said to “seal” thepocket.2 In this study, histology was performed on 6 pairs ofsingle-rooted teeth at 3 months. Laser-treated pockets tended toshow greater probing depth reductions and clinical attachmentgains than non-lased pockets. Based on measurements fromnotches placed in periodontally involved root surfaces beforetreatment, lased teeth showed evidence of new cementum while 5

of the 6 control teeth showed a long junctional epithelial attach-ment. This study concluded that the Laser Assisted NewAttachment ProcedureTM (LANAP) can be associated withcementum-mediated new connective-tissue attachment andapparent periodontal regeneration of diseased root surfaces inhumans. Although the Council is optimistic regarding the potentialfor lasers to enhance effectiveness in treating periodontitis, dentistsshould note that this study provides no more than pilot validationfor this treatment concept. The study was not blinded, and thesample size was small thereby limiting extrapolation of the resultsto the general population. Further, pre-treatment notches in theteeth were difficult to place, hard to know exactly where they wereplaced and are difficult to clearly detect on histological specimens.Moreover, the advanced periodontal destruction initially present inthese 6 test teeth make it difficult to extrapolate these results tocases of early and moderate chronic periodontitis, where theanatomic environment, laser energy distribution and clinicaloutcome may differ substantially. It is also unclear what laser-based “sealing” of a treated periodontal sulcus is and, if real,what benefits it might provide. Additional clinical data fromproperly designed clinical trials with adequate sample sizes arestill required before it can be known to what extent LANAP is safeand effective across the spectrum of patients with chronic perio-dontitis. The Council therefore cautions clinicians to weigh theavailable evidence for LANAP when considering the optionsavailable for treatment of the periodontal diseases.

When faced with uncertain or conflicting information, it is alsoworth looking to others more expert on the topic. In preparationfor this piece, I enlisted the opinion of colleagues better qualifiedto understand the application lasers in these areas. As a result, Ihave come to understand that the study supporting LANAP hasnever been repeated anywhere in the world.

I chose this as but one example to demonstrate that the positionof the ADA through its Council on Scientific Affairs and what ismarketed may be in conflict. When we find ourselves in suchareas of unsettled science, it is important that we be forthright andhonest in how we present any potential benefits and offerappropriate alternatives to such therapies /technologies. It alsoseems wise to give credence to the advice of scientific revieweven when we would like to believe otherwise. It is nothing lessthan our professional responsibility.

President’s Message…continued from page 1schools throughout the State. The winners were presented at ourannual session and prizes were given to the 4 adorable childrenwho were finalists (Hmm-could this be a stimulus for them tochoose dentistry as a future career. I can’t help but wonder).

8. Ed and I were fortunate to represent the DSDS at the annualmeetings of Pennsylvania, New Jersey, Maryland and the Districtof Columbia Dental Associations. We met some wonderfulfriends. I couldn’t have completed my year without the help of ourExecutive Director, Ms. Betty Dencler, and our AdministrativeAssistant, Ms. Patti Kashner, as well as the Executive Council andour newsletter editor, Dr. Lou Rafetto. I know that our newPresident, Dr. John Nista, will provide excellent leadership. Hehas my full support and I will continue to serve the DSDS.

Thank you again for providing me with the honor of beingyour President.


In Memory of Marty Scanlon,

ICD PresentsAward to Sara

and Family.

Unsung HeroAward

PresentationThe Delaware chapter of The

International College of Dentists, hasawarded the first UNSUNG HEROAWARD to the memory of Dr. MartinW. Scanlon, to his wife, Sarah, by Dr.Lawrence S.Giordano at the DSDSAnnual Conference. The Award is givento dentists in our state who have servedour profession and our communities inoutstanding ways, but are seldomacknowledged.

Among his many activities, Martyserved on the State Board of DentalExaminers to protect the public for fouryears. Through his forensic work, andwithout fanfare, Marty brought peace ofmind to thousands of family memberswho suffered the loss of loved ones inthe tragedy of 9/11. The ICD thankshim, in this way, for his inspiration anddedication to the dental profession.

Documents

NEWSLETTER - Delaware State Dental Society · NEWSLETTER VOLUME 34 NUMBER 2MAY/JUNE 2010 President’s Message My last newsletter! I will now assume my place as a member of our esteemed