Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.
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DentalChronicle
Practice news
Lasers a staple
in periodontal
treatment
n Ongoing development,
refinement contribute to
potential utility of lasers for
general practitioners
In this exclusive DENTAL CHRONICLE inter-
view, Dr. Doug Dederich, a periodontal special-
ist in Edmonton and president of Biolase,
talks about some of the recent developments in
lasers for dentistry, and how these advances
have led to refinements in clinical techniques.
Y ou wrote an article in JADA in
2004; could you comment on
what progress has been made in
lasers for perio since then?
Clinical techniques have been refined
with some of the laser wavelengths,
Er,Cr:YSGG in particular. More clini-
cal studies are of course needed to sat-
isfy the new Standards of Evidence
recently issued in a Technical Report to
the Profession by the ADA.
What role do diodes and the
ER:CR:YSGG play in mild, moderate,
and advanced periodontitis?
These two lasers can be helpful in for
the general practitioner in treating early
and moderate chronic periodontal dis-
ease. They can
also be a useful
adjunct for the
periodontist in
t r e a t i n g
advanced peri-
odontal disease.
Dr. Dederich Having any laser,
however, does
not change the principles of good peri-
odontal care as it relates to good root
debridement and also the field of peri-
odontal regeneration. The Er,Cr:YSGG
can enhance the biocompatibility of the
root surface which can be helpful in
—please turn to page 5
Sports injuries: Counselling
patients on best mouthguard
OVER-THE-COUNTER MOUTHGUARDS
offer little protective value, while custom
mouthguards can prevent much dental
trauma. See page 4.
Canada’s National Newspaper of Dentistry
Affiliated with
Case report: Cutaneous sinus tracts—an endodontic approach....19
Welcoming new patients, aesthetically speaking ............................23
10 minutes with Dr. Sherri Wise..........................................................26
New technologies leading to
improved benefits for patients
n Lasers, digital imaging,
microscopy changing clinical practice
by Louise Gagnon,
Correspondent, Dental Chronicle
T
ECHNOLOGIES SUCH AS LASERS, DIG-
ital imaging, and microscopy have
found a home in dentistry and offer
unique benefits to both patients and
practitioners.
“Lasers can be used on soft tissues
like gums,” explains Dr. Michael Popp, a
dentist based in Calgary. “They can also
be used to treat herpetic lesions.”
Indeed, rather than take systemic
medications to treat a herpetic lesion, a
patient can undergo laser therapy in a
dentist’s office and have that lesion
removed.
There are lasers available for use on
hard tissues in the oral cavity, but they
work very slowly and cause pain, Dr.
Popp said. “They are not yet ready for
prime time,” explains Dr. Popp.
While only a minority of dentists
use digital imaging in their offices in
Canada, those who do find the technol-
ogy offers significant benefit.
However, it’s estimated that most den-
tists continue to use analog silver halide
X-ray film instead of digital radi-
ographic systems.
“It’s a great advantage for the
patient because it reduces radiation by
90 per cent,” says Dr. Gene Jensen, an
n March 31, 2010
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This compact unit
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Gingiva Formers
Customizable Gingiva Formers allow
you to achieve a natural and esthetic
gingiva contour with the formation of
intact papillae.
orthodontist based in Halifax and Request more information on these and
Dartmouth, N.S., who uses digital other products advertised in this issue.
imaging daily and was one of the first See page 25
orthodontists in Canada to incorporate
digital imaging equipment in his prac-
tice. Special Report
“Previously, we had to bombard
the patient with multiple X-rays for a What you need to know
number of seconds before getting all
the information,” he says. “[Digital radi- about Green Dentistry
ographic systems] give us 10 times the
INTRODUCING DENTAL CHRONICLE’S
information that analog does.”
new series on Green Dentistry, show-
The traditional use of X-rays can
ing you ways to attract new environ-
produce many more errors since images
mentally-conscious patients, and to
are distorted, explains Dr. Jensen. “The
ultimately reduce your costs.
Turn to page 15
—please turn to page 6
DentalVitae
Making people laugh helps dentist keep
his medical career in perspective
Passion for yuks keeps Brantford, Ont. dentist on stage
developing his comedic touch. See page 24.
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Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:37 PM Page 2

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

Attending the Jasper Dental Congress, in Jasper, Alta.? 2

We’d love to receive your impressions of the presentations and session highlights. E-mail us at dental@chronicle.ws
Have a digital photograph of an upcoming meeting destination? Send it to us at dental@chronicle.ws.
We’ll publish selected photos and reward photographers with gift-card prizes.

Ontario Dental Association—Annual

Spring Meeting
Dental Chronicle National Editorial Board 13 to 15 May, 2010
Toronto
Each issue, Dental Chronicle is honored to introduce you to the distinguished members of our Tel: 416-922-3900
National Editorial Board. This month, we welcome Dr. Ira D. Hoffman of Montreal. Fax: 416-922-9005
E-mail: info@oda.ca
Hassan Adam, A MCGILL UNIVERSITY GRADUATE, Dr. Ira Website: http://www.oda.on.ca/
Yellowknife, N.W.T. Hoffman has always enjoyed working with
his hands. While he was growing up, he had Newfoundland & Labrador—Annual
Véronique Benhamou, General Meeting
a strong desire to get into the medical pro-
Montreal, Que. 27 to 29 May, 2010
fession, and when it came time to pick a
Barry Dolman, St. John’s, Nfld.
career it came down to a choice between
Tel: 709-579-2362
Montreal, Que. becoming a dentist or a heart surgeon. Fax: 709-579-1250
“I decided not to become a heart sur- E-mail: nfdental@nfld.net
Neil Gajjar, Mississauga, Ont.
geon for the same reason I did not choose Website: http://www.nlda.net/
Cary Galler, Toronto, Ont. the field of medicine—because I cannot
Wayne Halstrom, handle death,” said Dr. Hoffman, who Jasper Dental Congress
maintains a private practice in Montreal, and 27 to 30 May, 2010
Vancouver, B.C.
is a faculty lecture at McGill University in Jasper, Alta.
Mel Hawkins, Toronto, Ont. the Department of Restorative Dentistry. Tel: 780-432-1012
“In dentistry the worse case scenario is that a patient loses their teeth— Fax: 780-433-4864
Ira Hoffman, E-mail: adaadmin@telusplanet.net
Chomedey, Laval, Que. although I am always fighting for them to keep their teeth—but really that is the
Website: http://www.abda.ab.ca
worse case scenario.”
Mark Lin, Toronto, Ont. Dr. Hoffman says that over the years he has maintained his interest in the field
Denturist Association of Canada-
Ed Lowe, Vancouver, B.C. of dentistry by continuously keeping active and reinventing himself. Upon gradua- Annual General Meeting
tion in 1978, he took a particular interest in esthetic dentistry and in 2000 he was 28 May, 2010
Scott Maclean, asked to become a clinical instructor at McGill University. Whistler, B.C.
Halifax, N.S. “I have enjoyed the opportunity McGill University has provided, which has Tel: 1-604-538-3123/1-877-538-3123
John Nasedkin, allowed me to pass along the knowledge I have gained regarding esthetics to my stu- Fax: 1-604-582-0317
Vancouver, B.C. dents,” he said. E-mail: dacdenturist@telus.net
One of Dr. Hoffman’s life-changing moments occurred when he was in his Website: http://www.denturist.org/
Ken Neuman, mid-30s. He had a skiing accident that resulted in his left leg becoming temporarily
Vancouver, B.C. paralyzed and, during this time, Dr. Hoffman said that he gained more appreciation Annual Convention of the Ordre des
for a work-life balance. dentists du Quebec
Brian Saby, Red Deer, Alta. 29 May to 01 June, 2010
“Since my leg was paralyzed it led me to believe that I might not be able to
Ken Serota, Mississauga, Ont. Montreal
work again, which resulted in a life altering moment. It caused me to have more of
Tel: 514-875-8511
Paresh Shah, Winnipeg, Man. an appreciation for life. I now work to live, and I do not live to work,” he said. Toll free: 1-800-361-4887
“When I work I take it seriously, but I will never say I cannot afford to go on Fax: 514-393-9248
Andrew Shannon, a vacation or that I do not want to take time off, because who knows what can hap- E-mail: dacdenturist@telus.net
Vancouver, B.C. pen tomorrow. I take time off now, but it took my left leg becoming paralyzed to
Howard Tenenbaum, make the importance of this life balance clear.” College of Dental Surgeons of
Toronto, Ont. Dr. Hoffman is a member of the University Advisory Council of the American Saskatchewan—Annual Session
Academy of Cosmetic Dentistry, Acting Chairperson of the University Co-ordinat- 9 to 11 September, 2010
William E. Turner, ing Committee of the Canadian Academy of Esthetic Dentistry, and a Fellow of the Saskatoon
Thunder Bay, Ont. Academy of Dentistry International and the International Academy of Dental Tel: 306-244-5072
Facial Esthetics. Fax: 306-244-2476
Website: http://www.saskdentists.com

Published six times annually by the proprietor, Chronicle

DentalChronicle
Information Resources Ltd., from offices at 555
Burnhamthorpe Rd., Suite 306, Toronto, Ont. M9C 2Y3
Canada. Telephone: 416.916.2476; Fax 416.352.6199.
Canada’s National Newspaper of Dentistry E-mail: dental@chronicle.ws
PUBLISHER Contents © Chronicle Information Resources Ltd, 2010, except where noted. All rights
reserved worldwide. The Publisher prohibits reproduction in any form, including print, broadcast,
Mitchell Shannon and electronic, without written permission. Printed in Canada.
EDITORIAL DIRECTOR SALES & MARKETING Subscriptions: $59.95 per year in Canada, $79.95 per year in all other countries, in Canadian or US
R. Allan Ryan Henry Roberts funds. Single copies: $7.95 per issue. Subscriptions and single copies are subject to 5% GST.
ASSISTANT EDITOR COMPTROLLER Chronicle Information Resources Ltd. is the official representative of Dental Tribune International
Lynn Bradshaw Rose Arciero (DTI) in Canada. All published material related to Dental Tribune is subject to copyright by DTI.
PRODUCTION & CIRCULATION Canada Post Canadian Publications Mail Sales Product Agreement Number 40016917. Please
Cathy Dusome forward all correspondence on circulation matters to: Circulation Manager, Dental Chronicle,
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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.

DentalChronicle March 31, 2010 n 3

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

ClinicalNews
Sports injuries: Dental trauma can be prevented with custom mouthguards Cli
n Mouthguards purchased at sporting goods stores of little protective value, and may put you in jeopardy if you recommend them contin
sports, and the 50-year-olds and the 60- protrusion and lessen the risk of dental athlete needs the protection the most.” gaini

W
earing a mouthguard is one good
year-olds who play sports.” injuries in sports, according to Dr. Dentists needs to examine peer- Wha
way for athletes to prevent dental
Sports like baseball, football, rugby, Padilla. He added that patients who wear reviewed literature to assess the safety Ging
trauma, but the mouthguard must
basketball, water polo, and volleyball all orthodontic appliances are still candi- and efficacy of protective mouthwear, CT-g
be properly fitted, according to a dentist
pose a risk of orofacial trauma for play- dates for wearing mouthguards. says Dr. Padilla. “Do not believe what durin
from Manhattan Beach, Calif.
ers. “There is a high injury rate with chil- When it comes to mouthguards, cli- you read in Sports Illustrated,” he says. Wha
Delivering a talk about sports den-
dren when they are learning to play a nicians cannot take a one-size-fits all “Pay attention to the claims, marketing porta
tistry at the annual meeting of the
sport like baseball,” he says. “They are approach to designing them for patients, tools, and any conflicts of interest.” for a
Ontario Dental Association in Toronto,
learning how to catch, so there is a high says Dr. Padilla. Going to the local sport- Patient education is necessary to The
Dr. Ray Padilla, a consultant for the U.S.
rate of orofacial injuries.” ing goods store to obtain mouth/dental inform patients of the value of a mouth- other
national soccer
A 1989 study in Pediatric Dentistry guard protection is not sufficient to pre- guard that is customized for them. mizin
team, the Los
found three-quarters of oral injuries vent athletic injuries. “They may not want to spend $200 on a is a
Angeles Galaxy
among high school athletes, including “These mouthguards are absolutely mouthguard when they can buy one at a the
soccer team, the
baseball and basketball players, occurred trash,” says Dr. Padilla. “The injury rate in sporting goods store for $15,” he says. need
Los Angeles
in athletes who did not wear mouthguards. sports among athletes wearing mouth- The solution lays in general dentists cont
Avengers football
Some activities, such as inline skat- guards [purchased at] sporting good providing custom-made mouthguards for gingi
team, and the
ing, carry a risk of orofacial trauma. stores is the same as the injury rate among their patients, says Dr. Padilla. It is best if ing im
University of Dr. Padilla “People wear elbow pads, wrist pads, athletes wearing no mouthguards at all.” dentists can make the mouthguards them- very
California at Los
knee pads, and helmets when they are There are “boil and bite” mouth- selves, but if a laboratory manufactures the and
Angeles athletics, spoke about the impor-
inline skating, but they do not wear guards which attempt to fit the teeth mouthguards, dentists should be informed inflam
tance of wearing mouthguards, which are
mouthguards,” Dr. Padilla notes. “[A through boiling the mouthguard and try- of the process and materials used. also
properly fitted, to ward off dental trauma.
mouthguard] is on the backburner for ing to mold it to the teeth, but the mate- the g
“Professional sports teams have a
some reason, but it should be the first rial is unstable and does not permit even BETTER FIT EQUALS MORE USE
dentist,” says Dr. Padilla. “They don’t Wha
thing you think about.” distribution in the mouth, he said. “If you choose not to make the dental
need us [community dentists]. They are Cana
Younger patients with protruding “You may set yourself up for a libel appliances yourself, call the lab to make
already getting a good quality of care. My a
teeth are at increased risk for dental suit if you recommend that a patient sure you know what machines they are inval
We need to worry about people who play
injuries in sports. Orthodontic treatment wear a ‘boil and bite’ mouthguard,” he using to make them,” says Dr. Padilla. “If
pick-up games, high school sports teams,
should be performed as soon as possible says. “The occlusion is unstable, and is they are using vacuum machines, you are
women’s teams, young children playing
on these younger patients to correct the often displaced upon impact when the not getting a quality product. They need
to use pressure machines.”
Worldwide developments in dentistry The pressure machine allows for
lamination of the athletic mouthguard
USA Increased concentrations of cigarette smoke condensate the incidence of new tooth surfaces and provides the best fit and protection,
decreases cell proliferation and increases cytotoxicity in exhibiting erosion, in erosion-free chil- according to Dr. Padilla, who disclosed
human gingival fibroblasts, researchers report in the dren, decreased significantly with age, while he has no consultancy relationships with
Journal of Periodontal Research (2009; volume 44(6):704- the progression in children with erosion did not change. any manufacturers.
713). Human gingival fibroblasts were exposed for 72 JAPAN Dentin strengthened by UV irradiation retains its “If the mouthguards fit better, the
hours to various concentrations of total particulate mat- strength after dehydration because of chemical changes athletes are more likely to wear them , so
ter cigarette smoke condensate. Cell proliferation in collagen, researchers reported in the Journal of Dental you get better compliance,” he says.
decreased by more than 50 per cent when the concentra- Research (2010; volume 89(2):154-158). Beam-shaped If mouthguards are made using vac- will u
tions of total particulate matter cigarette smoke conden- dentin specimens from the crowns of human third uum machines, they never fit after limited tion
sate were above 200 µg/mL, and cytotoxicity increased molars were subjected to flexural testing. Overall, data wear and tear, stresses Dr. Padilla. Wha
to more than 30 per cent when the concentrations of show that flexural strengths were two and three times “Vacuum machines use low heat, and vac- treat
total particulate matter cigarette smoke condensate were greater than those in the control group after five min- uum mouthguards don’t fit after two or patie
above 400 µg/mL. In all, cigarette smoke condensate utes of UV irradiation and heating to 140°C, respec- three days of wear,” says Dr. Padilla. My o
increased the collagen-degrading ability of human gingi- tively. After 30 days of rehydration, the heated speci- “[The vacuum machine] can’t achieve con- post
val fibroblasts, especially at a concentration of 100 mens reverted to their original strength, while the UV sistent and adequate occlusal separation.” scalp
µg/mL (1.5-fold increase, compared to control. specimens were 69 per cent stronger than the original. To achieve balanced occlusion, the arou
posterior occlusal surface of the mouth- pain
THE NETHERLANDS The incidence of new tooth surfaces AUSTRALIA Significantly more post-orthodontic white-spot
exhibiting erosion, in erosion-free children, appears to guard should be warmed, the mouth-
lesions regressed with remineralizing cream compared to In ca
guard should be placed in the patient’s
decrease significantly with age, investigators report in placebo over 12 weeks, scientists reported in the Journal of tage
the Journal of Dentistry (2010; Volume 38 (2):83-172). In mouth, and the patient should be asked use o
Dental Research (2009; 88(12):1148-1153). Fifty-five partici-
this study, researchers evaluated tooth erosion three to bite down lightly and carefully until all Most
pants (aged 12 to 18 years) with 408 white-spot lesions
times with 1.5 year intervals in a sample of 622 chil- posterior teeth occlude. ence
were recruited; 23 were randomized to the remineralizing
dren, aged 10 to 12 years at baseline. Findings show There are no evidence-based data to acces
cream and 22 to placebo. The product was applied twice
that tooth erosion was present in 30.4 per cent of the suggest that wearing mouthguards will can p
daily after fluoride toothpaste use for 12 weeks, and 92
11-year-olds, and 44.2 per cent in 15-year-olds. In all, prevent concussions, but manufacturers ier. A
per cent of lesions were assessed as code two or three.
deep enamel was eroded in 1.8 per cent of the 11-year- may purport that is one of the benefits of toxin
For these lesions, 31 per cent more had regressed with
olds and in 23.8 per cent of the 15-year-olds. Overall, wearing a mouthguard, notes Dr. Padilla. bioco
the remineralizing cream than with placebo at 12 weeks.
—Louise Gagnon resul

4 n March 31, 2010 DentalChronicle De

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

It’s Your
Money
s Clinical laser update
m continued from page 1—
st.” gaining attachment.
peer- What other procedures do you use the YSGG for? Mark O’Farrell
afety Gingival contouring, conditioning of root surfaces prior to
wear, CT-grafting, osteoplasty and ostectomy, and root condition
what during reattachment and regeneration procedures. Hello, I picked up your e-mail address from DENTAL CHRONICLE magazine. I am a
says. dentist, married to—and practicing dentistry with—another dentist. We have
What are your thoughts on the introduction of a totally
eting portable handheld 940 nm diode laser that is affordable
recently incorporated our practice and are beginning to accumulate some capi-
for any practice? tal that I am at a loss as to how to deal with. We are both maximizing our
y to The 940 nm diode laser has less penetration than some of the RSP’s every year and are drawing an income from the practice that puts us
uth- others, and this is actually a good thing with respect to mini- both into the top tax bracket. I have been investigating the purchase of a life
hem. mizing the risk of deep thermal damage. The 940 diode laser insurance plan within the corporation, but I find that the methods of extracting
on a is a good all-around laser for that capital upon my retirement are greatly dependant on Revenue Canada
at a the general practitioner who not changing regulations or tax laws. Do you have any opinion about this
ys. needs to do minor soft tissue insurance? Do you simply invest the money within the corporation and pay the
ntists contouring, pocket therapy, or high corporate tax on your investment income? Or would it be better to divi-
s for gingival troughing prior to tak- dend it to my spouse and I, and pay our tax and invest it personally. Is there a
est if ing impressions. It can also be dramatic difference in tax on investment income on a personal level versus on
hem- very useful in biostimulation
a corporate level? Thanks for your time. Dr. J.
s the and reduction of pain and
med inflammation. Since it costs less than the Er,Cr:YSGG and is
also a multi-functional laser, I think it probably fills a niche for Thank you for an excellent question Dr. J. You describe a common challenge.
the general practitioner who wants to have a soft-tissue laser.
First of all, the top tax rate on earnings in Ontario is 46.4 per cent while your corpo-
What advice would you like to give general dentists in ration pays 16.5 per cent up to 500K per year, (15.5 per cent in July). The tax rate on
ental
Canada about lasers for periodontal therapy? Specialists?
make investment income is the same 46.4 per cent personally but 48.7 per cent corporate-
My advice would be to remember that technology does not
y are invalidate well-established principles of periodontal therapy,
ly. In both cases, half for capital gains and two-thirds for dividends. What it means is
a. “If such as the need for excellent root that leaving money in the corporations saves you 29.9 per cent (soon 30.9 per cent),
u are debridement or creating the conditions but you face higher taxes when investing in the corporation.
need that make bone regeneration possible.
Advance periodontal disease often results That last comment might make it seem logical to pay it out and invest personally,
for in furcation problems that require surgical since the tax rate would be a bit lower on the growth, but giving up almost a third
uard access and the training to perform before you even start doesn’t make sense, not to mention erasing the whole point of
tion, advanced regenerative therapy, so it’s my having the corporation in the first place.
osed view that these lasers can be an adjunct to
with specialist services such as regeneration
There are several ways to invest without incurring this significant tax. Using a life
and CT grafting. So while these lasers can
take many mild and moderate conditions
insurance policy as you mentioned can work, but future tax changes isn’t the prob-
the
m , so and make their therapy more conservative lem. The big concern is getting a program that provides full disclosure, works effec-
and patient friendly, the advanced cases tively, and has a reasonable chance of actually delivering on projections (many
vac- will usually still require the expertise in surgery and regenera- don’t). Like running a practice; if you can’t generate revenue and manage your
mited tion of a periodontist. costs, you likely won’t make money. (We actually felt the need to design our own pro-
dilla. What role can minimally invasive, non-surgical periodontal
gram to truly maximize growth and minimize expenses.)
vac- treatments such as laser technology play in improving
o or patient treatment compliance? There are other options depending on your objectives. What I recommend is letting
dilla. My own anecdotal experience with these lasers is that the us provide you with a complimentary financial practice analysis. This calculates your
con- post-operative morbidity is surprising low compared to taxes both while you practice and when you retire, gives you projected net incomes
on.” scalpel surgery. It doesn’t take long for the word to get under differing structures, giving you both a lot more information on which to base
the around that good results can be obtained with much less decisions. You can email me for the form we need completed to do this, which does-
uth- pain for the patient. n’t need to be precise and should take no more than about five minutes. All informa-
uth- tion provided is kept strictly confidential.
In cases of severe, intractable periodontitis, what advan-
ent’s
tages does surgical treatment with the laser hold over the
sked use of the scalpel? Improved healing? Send your questions to: mark@strategicedge.net
til all Most recalcitrant pockets seem to exist because of the pres-
ence of calculus in most cases. Surgery can provide better Mark O’Farrell is a chartered financial consultant to the dentistry profession and pro-
ta to access to these areas than nonsurgical therapy. Using the laser
will
vides complimentary financial practice analysis to dentists across Canada.
can provide a dry field in many cases, making visualization eas-
urers Website: www.strategicedge.net
ier. Also, the Er,Cr:YSGG can remove calculus, denature endo-
ts of toxin, and condition the root surface, all of which improves the Toll-free phone: 1-866-682-4829 (1-TOO-MUCH-TAX)
dilla. biocompatibility of the root surface. In theory, this should
gnon result in better attachment gains than traditional therapy.

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

ClinicalNews
New technologies lead to improved diagnostics and patient care Vi
continued from page 1— friendly. The images can be stored in a computer and practice. n
can be sent to your colleagues or to an insurance com- “I went to magnification for the reason of
pictures can give you an erroneous view of what is

H
pany.” ergonomics,” says Dr. Shah. “I was having neck pain
going on, and it can lead to misdiagnosis. Digital imag- A review article published in Oral Radiology in 2004 and shoulder pain from slouching. Automatically,
ing is less invasive for patients.” cited numerous disadvantages to the continued use of once I started using magnification, I was able to sit
Dr. Jensen made a six-figure investment to equip analog film including the cost of film and solutions, the with a more ergonomic, upright posture. My neck mola
his office with digital technology and he estimates that cost in processing equipment and darkroom space, and pain and shoulder pain went away. The use of mag- prese
about one-third of dentists in Canada have digital human resources necessary for processing and proces- nification provides more comfort and better func- ing o
equipment that allows them to use equipment like sor maintenance. In addition, the low photon efficien- tion.” and M
fibre-optics. cy leads to a comparatively high radiation dose, and The enhanced view results in better treatment
“It allows me, as an orthodontist, to measure the duplications of the images are always inferior to the because of more accurate diagnosis of what is taking sion,
digital X-ray as if I’m measuring that particular object in original image. Moreover, processing chemicals are place in the oral cavity. the d
the patient’s mouth,” says Dr. Jensen. “There is an algo- toxic to the environment and costly to dispose of. “You can’t treat what you can’t see,” he said. “If surg
rithmic formula in the digital world that scales the size The use of microscopy has applications for you can’t see the problem, how will you even know Caro
of the picture on the screen.” endodontic procedures and for the placement of there is a problem? If you magnify something, you see resea
If patients see the problem, they are willing to implants, he explains. it better. We are treating areas where there is blood and large
spend funds for dental treatments, and the use of digi- Dr. Ramirez uses microscopy because it provides saliva, and sometimes the human eye doesn’t see those
tal technology permits dental practitioners to accurate- added magnification to a dentist’s field of vision. “We things. It is helping us do a better job.” study
ly display oral health challenges, according to Dr. are working with a field that is small, so there are vital Microscopes have traditionally been used by spe- have
Jensen. structures that we need to see better,” he says. “I use it cialist practitioners who perform endodontic proce- thos
“If a patient has a problem for implant surgery and when I perform root canals. dures such as root canals, but more and more general third
with their temporomandibular You need to see the nerves [of the tooth] if you are dentists are using microscopes for restorative dentistry, incre
joint, a normal X-ray won’t cap- going to place an implant. You would need to see if it according to Dr. Shah. non
ture the problem,” he says. “The is in the path of the implant.” “It is a learning curve,” says Dr. Shah. “You can have
digital world can allow the Dr. Paresh Shah, a clinical instructor in the faculty attach a camera or video camera to the lens, so you can
patient to see what is wrong with the i
of dentistry at the University of Manitoba in Winnipeg photograph what you are doing and project it onto a study
their jaw, for example.” and a member of the advisory board for Dental screen. It can be interactive from a diagnosis point of patie
Dr. Shah Chronicle, agrees that patient safety is vastly increased view because you can show the patient what is going were
PRACTICE IS MORE EFFICIENT with digital imaging. on. The patient can see the bone, the tooth, and the
Dr. Everardo Ramirez, a dentist based in Kitchener, third
cavity.”
Ont., says the use of digital imaging in his practice ren- BIG IMPROVEMENT IN DIAGNOSTICS Microscopes are being used for periodontal plastic
ders it more efficient. Digital imaging helps dentists to BMI C
“If it’s quicker, faster, easier, and safer, then that is the surgery, where fine needles and sutures on the gums are
deliver better dentistry, provide more accurate diagno- Inve
better option,” says Dr. Shah, who holds a proficiency being applied. “They are hard to put in place using just
sis, and depending on the case, save a tooth or find oral aged
certificate in esthetic dentistry from the State University the eye alone,” says Dr. Shah.
health conditions. mati
of New York at Buffalo.
“The patient gets a fraction of the amount of radi- ical
The image is expanded and permits improved con- SOFT TISSUE LASERS OF BENEFIT
ation that he or she would get in normal radiography,” acco
trast, he explains. Many practitioners use soft-tissue lasers for gum prob-
says Dr. Ramirez. “It is faster, and there are no chemi- one
“Diagnostics improves dramatically,” says Dr. lems. They can treat root sensitivity on a tooth. One
cals involved in the processing, so it is environmentally- third
Shah, a past board member of the Manitoba Dental study demonstrated that hypersensitivity can be suc-
342
Association. “The best system is the cessfully treated with low-level laser therapy (LLLT).
and h
one where the sensor goes right in the Indeed, dental lasers may be used to seal tubules locat-
69 su
mouth. You take a picture, and ed on the root of the tooth that are responsible for hot
a me
through a USB connection, the picture and cold tooth sensitivity.
goes right to your screen and you have “I use it to recontour gum tissue for esthetic rea-
and
the picture in one second. You don’t sons,” says Dr. Shah, noting it can be used to treat
have to wait for the image to develop canker sores.
Ac
and find out if you need to re-take pic- The use of a diode laser can overcome a herpetic
tures. lesion, which is a contraindication for a dental visit. “I
y
“The sensors are thicker than con- can treat cold sores in a minute,” says Dr. Shah.
ventional film, and it takes some getting Another application for LLLT is the treatment of M
used to placing the sensors,” says Dr. mucositis prior to radiotherapy/chemotherapy in ad
Shah. “It’s a little bulky for patients who patients undergoing radiotherapy/chemotherapy. Still
gag, but you can practice enough to place another application of LLLT is the reduction or elimi- By
it properly. The resolution that you get, nation of paresthesias that may present after oral sur- the
the clarity that you get, and the diagnostic gery, particularly in the mandibular region.
ability you get is first class. The cost of Low-intensity, soft-tissue dental lasers may also be
Ali Sigal (right), a second year dental student at the University of
the system doesn’t bother me because of used to speed up the bleaching process associated with
Toronto, organized a weekend event in Oakville, Ont. that was
the time that we save.” teeth whitening. By I
designed to make people with special needs feel more comforable
about getting their teeth cleaned. She was joined at Sharing
In addition to the more obvious High-powered lasers such as the carbon dioxide we
Smiles by fellow dentistry students, and the past-president of the benefit of enhancing a practitioner’s laser has a potential application in oral surgery, and the your
Ontario Dental Association, Dr. Larry Levin. visual field, ergonomics is what drove Argon laser can be used in minor surgery and compos-
(Simon Wilson/Canadian Press Images) Dr. Shah to using microscopy in his ite curing.

6 n March 31, 2010 DentalChronicle De

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

Visible third molars raise periodontal disease potential on other molars

n Goal of research is to provide more evidence that it is in the best health interest of most people to have wisdom teeth removed
n of
between the two groups, according to patients should be alerted that visible result, they are more educated about it.

H
pain AVING VISIBLE THIRD MOLARS RAISES
cally, Dr. Hill. Subjects in the visible group third molars and adjacent molars They are in the dental office more often,
the potential for periodontal
o sit were more likely to have completed col- should be monitored over time for this and they are more likely to be referred for
inflammatory disease on non-third
neck lege than those in the not visible group, possibility.” extraction of their wisdom teeth.”
molars, according to longitudinal data
mag- p<0.01. The goal of the research is to edu- The longitudinal study, which is
presented in Toronto at the annual meet-
unc- The researchers defined periodontal cate the public regarding the need for ongoing, will also look at other issues,
ing of the American Academy of Oral
inflammatory disease as the presence of patients to have their wisdom teeth such as the angle of third molars and the
and Maxillofacial Surgery.
ment a probing depth of greater than or equal removed, said Dr. Hill. “Even if patients degree of impaction, to assess if those
Speaking at an oral abstracts ses-
aking to 4 mm in at least one non-third molar. are asymptomatic, they are prone to factors have an influence on the presence
sion, Dr. David Hill Jr., chief resident in
Investigators rounded the number to the other issues,” he said. or absence of periodontal disease, he
the department of oral and maxillofacial
. “If lowest whole number. added.
surgery at the University of North
know Subjects with diabetes were exclud- ONGOING STUDY TO EXAMINE OTHER Previous studies have observed the
Carolina, Chapel Hill, noted that the
u see ed from the study, as well as subjects ISSUES, SUCH AS ANGLE OF THIRD link between visible third molars and peri-
research he was reporting on is part of a
d and who had very severe periodontal disease MOLARS odontal disease.
larger analysis.
hose prior to enrolment. Additionally, if While Dr. Hill did not cite statistical data A study on pregnant women pub-
“This is a component of a broader
patients had taken antibiotics in the past on how many patients have third molars lished in the Journal of Oral and
study,” said Dr. Hill. “Historically, we
spe- three months they were excluded from extracted, patients with better dental Maxillofacial Surgery in 2007 found sub-
have two different population studies:
roce- the study. care are more likely to have their third jects’ detected levels of periodontal dis-
those who have visible presence of a
neral The American Academy of molars extracted, he said. ease were greater at enrolment and post-
third molar and whether that results in
istry, Periodontology would call for excluding “The percentage would be higher for partum if visible third molars were
increased risk of periodontal disease on
subjects who have a body mass index those who have maintained normal, rou- detected.
non third-molar teeth and those who —Louise Gagnon
can (BMI) of more than 29 in the study, tine dental care,” said Dr. Hill. “As a
have third molars that are not visible and
u can noted Dr. Hill.
the impact on periodontal disease. This
nto a “The reason for BMI being a crite-
nt of
study looked at the differences between
patients who had no third molars that
rion is that it has been found that Scientists develop smart coating for dental implants
oing were visible and those who had visible
patients with a BMI of greater than 29 n Coating can be tailored to patient’s rate of bone growth
d the have an increased level of serum inter-
third molars.” Osseointegration remains one of the biggest challenges in implant
leukin-6,” explained Dr. Hill, noting the
astic relationship between IL-6 and the dentistry, and scientists from North Carolina State University report
BMI CRITERION FOR STUDY PARTICIPATION they have developed a ‘smart’ coating that could help hip, knee, and
s are pathogenesis of periodontitis.
Investigators recruited adult subjects tooth replacements bond more closely with bone, and ward off infec-
g just Investigators measured probing
aged 14 to 45 years with four, asympto- tions. Their research, which received funding from the U.S. govern-
depths to diagnose periodontal inflam-
matic third molars to two academic clin- ment, could open doors to much safer and functional implants in den-
matory disease, defining periodontal dis-
ical centers. They divided subjects tistry.
ease as a probing death of greater than
according to whether there was at least According to the researchers, the new coating is comprised main-
rob- or equal to 4 mm.
one third molar visible or whether all ly of hydroxylapatite, a naturally occurring mineral also found in dentin
One “Each tooth had six sites where
third molars were not visible. A total of and dental enamel. When applied to an implant it creates an amor-
suc- these probing depths were monitored,”
342 subjects were in the visible group, phous outer layer touching the surrounding bone. This layer will dis-
LLT). explained Dr. Hill.
and had a median age of 26. There were solve over time, releasing calcium and phosphate, and encourage
ocat-
69 subjects in the not visible group, with bone growth into the coating.
r hot PATIENTS SHOULD BE ALERTED
a median age of 21. “We call it a smart coating because we can tailor the rate at which
Dr. Hill and his fellow researchers
Both groups had low tobacco use, the amorphous layer dissolves to match the bone growth rate of each
rea- found that patients in the visible group
and there was no statistical difference patient,” says Dr. Afsaneh Rabiei, an NC State associate professor of
treat were significantly more likely to have at
least one probing depth greater than 4 mechanical and aerospace engineering and co-author of a paper
Access your product information describing the research. “This is important because people have very
petic mm on non-third molars when com-
it. “I
your way through Dental Chronicle’s different rates of bone growth.”
pared to patients in the not visible
READER SERVICE He added that his team also incorporated silver nanoparticles
group, 59 per cent vs. 35 per cent. In
nt of More information is available on all of the both groups of patients, 1st and 2nd throughout the coating to act as antimicrobial agents as the amor-
y in advertised or highlighted products in this molar teeth were more affected than phous layer dissolves. This will not only limit the amount of antibiotics
edition of Dental Chronicle patients are likely to require following surgery, but provide protection
Still non-molar teeth, when controlling for
limi- By FAX Go to page 25, circle the number of differences in age between the two from infection at the implant site for the life of the implant, Dr Rabiei
sur- the product, provide your contact info and groups. said.
fax (toll free) to 1-800-865-1632 Current coating processes utilized in dentistry that involve hydrox-
“Our findings suggest visible pres-
o be By PHONE Call our toll free Reader ence of asymptomatic third molars may yapatite and other forms of calcium phosphate, have shown several
with Service Hotline at 1-866-632-4766 be an indicator of periodontal inflam- disadvantages and limited flexibility in controlling coating crystallinity.
By INTERNET Go to our product information matory disease in non-third molars,” Earlier studies also found that hydroxylapatite may not resorb quickly
oxide web site, indicate the product, and pr ovide said Dr. Hill. “Although all visible, enough, and consequently block the space for the growth of new
d the your contact info: www.dentalchronicle.info asymptomatic third molars may not be bone tissue.
pos- risk markers for periodontal pathology, —Daniel Zimmermann, DTI files
We'll do the rest

icle DentalChronicle March 31, 2010 n 7

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

ClinicalNews
Sleep apnea: Options for patients who can’t (or won’t) use a CPAP device
n CPAP considered the gold standard for treatment of sleep apnea, but some patients are looking for additional options
because it is non-invasive,” said Dr. most severe [apnea] that we have seen,” nine males and three females, who had

M
AXILLOMANDIBULAR ADVANCE-
Conrod. “These patients did not want to said Dr. Conrod. “We wanted to look at RDIs of more than 100 and who had
ment (MMA) surgery can be per-
use CPAP for one reason or another. They patients with very severe sleep apnea. undergone the surgery between 2000
formed to treat severe obstructive
did not like to use it every night to sleep.” These are patients who almost never get and 2006. The patients had a mean age
sleep apnea syndrome (OSAS) in patients
The patients in the retrospective a good night’s sleep. One of the patients of 38, with a range of 26 to 50.
who choose not to use continuous posi-
series were referred for surgery either by said he was unable to drive and was even “The surgery is designed to advance
tive airway pressure (CPAP), according to
a sleep specialist, family physician, den- afraid to take the bus because he was the maxilla or upper jaw and the lower
research presented at the annual meeting
tist, or specialist dentist, such as an afraid he would fall asleep on the bus. jaw,” she said. “The idea is by advancing
of the American Academy of Oral and
orthodontist, she said. “The sleep apnea can be detrimen- those things and the associated tissues,
Maxillofacial Surgery in Toronto.
tal to their health,” she said. “We wanted then the airspace is increased. They are less
“CPAP is the gold standard for treat-
QUALITY OF LIFE AFFECTED to see what the results of the surgery likely to obstruct when they are sleeping.”
ment [of OSA],” said Dr. Susan Conrod,
The patients had respiratory disturbance were with this group of patients. We The pre-operative polysomnograph
a resident in oral and maxillofacial surgery
indices (RDIs) of greater than 100, wanted to see how much benefit they showed a mean RDI of 119.2, and a
at Dalhousie University/Queen Elizabeth
noted Dr. Conrod, with any number were getting from the surgery.” mean minimum oxygen saturation of
II Health Sciences Centre in Halifax, and
above 30 indicating severe OSAS. Investigators performed a chart 72.1 per cent. Patients had a post-op,
one of the study’s investigators.
Having OSAS has a definite impact on review of 175 patients who had under- mean RDI of 17.3 and a mean minimum
“Most patients try CPAP first
the quality of life of patients, she added. gone MMA surgery between 1996 and oxygen saturation of 85.5 per cent, with
because it is the gold standard and
“Greater than 100 is probably the 2008. They found 12 patients, including nine of the 12 subjects having RDI
scores of less than 15. Statistical analyses
What’s the secret to a long and successful career? Good patient care found significant enhancements in both
n Oral and maxillofacial surgeon provides insights into clinical practice management RDI (p<0.001) and minimum oxygen
saturation (p=0.008) after MMA surgery.
The principle of good patient care is key to ensuring a successful career in oral and maxillofacial surgery. Patients were followed for an average of
Speaking in Toronto at the annual meeting of the American Academy of Oral and Maxillofacial Surgery (AAOMS) 9.5 months after surgery.
about one’s man journey from residency to near retirement, David Rainero, DMD, an oral and maxillofacial sur- Investigators had pre-operative
geon based in Walnut Creek, Calif., said other concerns should always be secondary to patient care. Epworth Sleepiness Scale (ESS) scores for
“No matter what you do, never lose sight of the patient,” said Dr. Rainero, a fellow of the AAOMS who has eight of 12 patients. The mean pre-opera-
30 years of experience. “You can be financially very successful or be a very good surgeon, but if you don’t
tive ESS score was 12.7. The postopera-
take good care of patients, it doesn’t make any difference. Everything else will fall into place if you are taking
tive mean ESS score was 5.0, a difference
good care of patients.”
that was statistically significant at p=0.007.
Clinicians can become disorganized very quickly in a maxillofacial surgery practice if systems are not in
“Everyone who responded to the
place, said Dr. Rainero. “It’s important to have systems of organization and standardization of protocols.”
questionnaire indicated they experienced
Risk management can be achieved in an oral and maxillofacial surgical practice through the implementa-
an improvement in quality of life,” she
tion of protocols that create a safe environment for a patient, said Dr. Rainero.
said. “They said that the surgery was
In his practice, he devised documentation relating to various aspects of the practice. He has developed
worthwhile, and that they would under-
forms for employee evaluations, inventory, schedules, and patient management. Many offices are now adapt-
go it again.”
ing their forms in an electronic medical record format, said Dr. Rainero. In addition, he has developed check-
Indeed, where all eight patients who
lists of how to take care of patients and how to do so in a safe manner.
responded to the questionnaire reported
“Some of the protocols have been modified over the years because they didn’t work at first,” he added.
having daytime sleepiness prior to sur-
A contemporary scenario is one in which a young resident joins an established oral and maxillofacial sur-
gery, only one patient indicated they
gery practice, with an aim to becoming a partner or taking over the practice when the senior partner retires.
continued to have daytime sleepiness
“A high percentage of those fall apart after one to two years,” he said. “That is the biggest pitfall that res-
after undergoing surgery.
idents face. It happened to me and to many others I know. You can take steps to avoid it, but [the agreements]
Each patient undergoes a clinical
fall apart because people didn’t get enough information before they started.
examination and radiographic examination
“The transition from being an employee to being a partner is where things fall apart,” he says. “This is
to assess feasibility of the MMA surgery.
because each doctor had a different idea of how that would happen, both in the amount of time it would take,
“We want to see the diameter of the
the amount of money it would take, and how they would practice. Some people have a whole different philos-
airway and the position of their upper
ophy of how they would practice. It ends up being like a bad marriage."
and lower jaw,” she said. “Because we are
Clinicians need to ask the right questions of each other before they begin a working relationship.
advancing them, and if they already had
“There are also financial considerations that need to be spelled out beforehand,” he said. “A clinician might
a maxillomandible positioned anteriorly,
put a dollar value on their practice that the resident does not agree with.”
In his experience, there are generational differences in attitudes toward fair financial compensation and the then we would not have as much room
amount of hours that clinicians should work in an average week. Older clinicians also need to welcome the input to bring them forward and thus make a
from younger clinicians who work alongside them. “Some of the older practitioners resent the knowledge that significant improvement. In most
younger clinicians have about technology,” he said. “That kind of approach will not get them very far. patients, there is enough room for us to
“They [residents] are coming out of training completely paperless, and we are making the difficult transi- perform the surgery.”
tion from the paper-based office to being paperless. We know we have to make that adjustment. There's so The patients who would not be con-
much we can learn from them.” sidered medically fit for any surgery
The rule of thumb should be that each party come to the table with an open mind so that the working rela- would not be regarded as candidates for
tionship is fruitful, according to Dr. Rainero. —Louise Gagnon MMA surgery.
—Louise Gagnon

8 n March 31, 2010 DentalChronicle

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

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

ClinicalNews
Pacific Dental Conference to be held at expanded Vancouver facility
n Expanded exhibit hall in Vancouver Convention Centre West Building to host more than 500 exhibitor showcases
sis, and advise on how to prevent this awards gala in support of the B.C. ster and crab risotto, Chef Pino Posteraro

I
F THE SUCCESSIVE YEARLY INCREASES
side effect. Cancer Agency’s Dental Emergency also offers 10 daily specials. 1133 Hamilton
in delegate numbers at previous con-
Relief Fund. A champagne reception Street. Valet parking. Reservations recom-
ferences are any indication, there
SPECIAL EVENTS AT precedes a four-course gourmet dinner, mended. 604-688-7466.
will be a record number of attendees
NEW CONVENTION CENTRE awards ceremony, silent auction, and
again this year at the Pacific Dental
Thursday, 5:30 p.m. to 7 p.m. Wine dance. Cost: $225.00 + GST. Tickets Blue Water Cafe features Arctic char,
Conference in Vancouver, April 15 to
expert David Lancelot offers samples may be purchased via the conference West Coast Sable Fish, and White
17.
from his hand-picked choices of small- web site www.pdconf.com . Tables of 10 Sturgeon among others as its main
“We expect 11,000 plus partici-
production, fine wines from countries in are available. plates. The restaurant also has a raw bar
pants,” says conference director Dr.
the southern hemisphere during this that features oysters, sushi, sashimi and
Marke Pedersen, of Vernon, B.C., presi-
always well-attended Life is Too Short to A FEW SUGGESTIONS nigiri. 1095 Hamilton Street. Valet park-
dent of this year’s conference.
Drink Bad Wine event. On the 3rd Floor FOR DINING OUT IN VANCOUVER ing. Reservations recommended but
“It’s the biggest meeting, period,
Foyer. Price: $37.00 + GST. Sun Sui Wah is renowned for its roast- “will attempt to accommodate.” 604-
that occurs annually in Vancouver. It
ed squab, just one of several signature 688-8078.
includes people representing all aspects
Friday, 6:45 p.m. to 10 p.m. Your dishes. The main menu also includes
of dentistry: dentists, hygienists, certified
chance to “burn the floor” on a techno- lobster and sprawn, dungeness crab and West has a complete menu featuring fish
dental assistants, front desk people,
lit dance floor during Abba Cadabra, a geoduck. 3888 Main Street. Reservations (squab, lobster), beef (rib eye steak, ten-
receptionists, students, and the
performance tribute to the Swedish recommended. 604-688-7466. derloin), lamb, and chicken. 2881 South
exhibitors.”
group ABBA. Cost: $25.00 + GST. Granville. Valet parking. Reservations
The three-day event will be packed
Ciopinnos Mediterranean Grill was recommended but “will attempt to
with Hands-on-Courses, Open Sessions,
Saturday, 6 p.m. to 1 a.m. The British judged Vancouver Magazine’s “Restaurant accommodate.” 604-738-8938.
continuing education courses concurrent
Columbia Dental Association presents of The Year.” In addition to a regular
meetings of associated societies and
its Toothfairy Gala, a fund-raising and menu that includes linguini with half lob- PLACES TO GO, THINGS TO DO
alumni meetings, and special events.
Vancouver Art Gallery. Running until
May, Leonardo da Vinci: The Mechanics
HIGHLIGHTS OF SCHEDULED SPEAKERS
of Man is an exhibition of 34 of the
The scientific program begins at 8:30
artist’s pen and ink anatomical drawings
a.m. Thursday and continues until the
on 18 sheets of paper. Drawn during the
end of Saturday afternoon. More than
winter of 1510-1511, the works are on
100 speakers will discuss and or demon-
loan from Her Majesty Queen Elizabeth
strate on a wide range of topics, from
II from the Royal College, Windsor. The
anesthesia to restorative/operative den-
Vancouver Art Gallery occupies an
tistry.
entire downtown city block bounded by
Speakers include Janet Press, a Fel-
Georgia, Hornby, Robson, and Howe
low of the American Academy of Laser
streets. Tickets: Adult: $19.50. Seniors:
Dentistry who will talk about diode laser
$14.00; Children:$7.00. 604-662-4700.
therapy and how patient acceptance of
this therapy is increased when it is intro-
Pacific Theatre. An off-Broadway suc-
duced as an adjunct to care.
cess, Refuge of Lies, by Canadian play-
Dental surgeon Terry Ratkowski,
wright Ron Reed is a play about a former
who served a stint in Afghanistan, will
youthful Nazi collaborator—now an 82-
discuss the conflict there and describe
year-old man—living in Vancouver. The
the on-site medical and dental facilities
story of “one man’s experience with
available to treat injuries and maxillofa-
finding himself trapped in a world of
cial trauma.
deception” according to a reviewer. Box
In his lecture Tobin P. Bellamy will
office: 604-731-5518.
recommend several procedures for the
general dentist to follow in clinical situa-
Stanley Park has so many points of
tions, including
interest it will take more than one visit to
extraction of the
view them all. The Brockton Point
first molar and
Lighthouse and nearby totem poles,
dealing with the
Prospect Point, and the Vancouver
sinus.
Aquarium are just a few of many that
Charles
shouldn’t be missed. You can walk, jog,
Shuler, dean and
drive, or rent bicycles or rollerblades
professor of the Dr. Bellamy
available at stores on Georgia and
University of
Denman Streets.
British Columbia’s faculty of dentistry
plans to discuss the latest research Vancouver’s ever-evolving skyline includes many recent
upgrades. The just-expanded Vancouver Convention Centre at More information at www.pdconf.com
regarding the use of bisphosphonates
and their associations with osteonecro- Canada Place (above) is the site of the Pacific Dental Conference

10 n March 31, 2010 DentalChronicle

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

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Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:37 PM Page 12
ClinicalNews
Steps you can take to help preserve your practice revenue
n Identifying and separating variable expenses and fixed expenses key to maximizing profit for the efficient dental practice
T
here are certain steps dentists can take
to avoid the loss of significant rev-
enues, according to a former practic-
ing dentist and consultant on maximizing
profit and efficiency in a dental practice.
EMS-SWISSQUALITY.COM
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as with the Air-Flow Master. Plus
scaling as with the Piezon Master
700. It all adds up to three applica-
tions in one with the new Air-Flow
Master Piezon, the latest develop-
ment from the inventor of the
Original Methods.
PIEZON NO PAIN
Virtually no pain for the patients
and extra-gentle on the gingival
epithelium: maximum patient com-
fort is the decisive plus brought by
the state-of-the-art Original Piezon
Method. Not to mention the
uniquely smooth tooth surfaces.
These extra benefits are the result
of linear oscillating action aligned
with the tooth surface delivered by
the Original EMS Swiss Instru-
> Original Piezon Handpiece LED
with EMS Swiss Instrument PS
Speaking in Toronto, Dr. Charles
Blair suggested it is crucial to identify
and separate expenses.
“You have variable expenses, and
you have fixed expenses,” Dr. Blair, an
author and contributing editor to Dental
ments and matched perfectly to the
new Original Piezon Handpiece
LED. Proverbial Swiss precision
combined with intelligent i.Piezon
technology.
AIR-FLOW KILLS BIOFILM
Getting rid of harmful biofilm down
to the bottom of deep pockets. This
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Flow Perio Method. The subgingival
reduction in bacteria prevents tooth
loss (periodontitis) or implant loss
(periimplantitis). And uniform tur-
bulence of the air-powder mixture
and of water prevents soft-tissue
emphysema – even when reaching
beyond the boundaries of prophy-
laxis – due to the action of the Perio-
Flow nozzle.
Economics, said during a presentation at
the annual meeting of the American
Academy of Oral and Maxillofacial
Surgery. “Rent would be a fixed expense.
Marketing is also a fixed expense.”
Costs like supplies and laboratory
> Original Air-Flow
and Perio-Flow handpieces
And when the job at hand is con-
ventional supragingival air polish-
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With the Air-Flow Master Piezon,
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For more on prophylaxis >
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costs are largely variable expenses,
according to Dr. Blair, president of Dr.
Charles Blair and Associates, Inc. in
Mount Holly, N.C.
It is key to calculate a true estimate
and the reality of overhead expenses. If a
dentist is spending $100,000 annually on
continuing dental education through tak-
ing courses in exotic locations, that
expenditure should not be regarded as
overhead cost.
There should be a 2 to 1 ratio of
doctor compensa-
tion to staff com-
pensation as a
general rule, says
Dr. Blair. “If the
staff compensa-
tion was at 22 per
cent, then we want
the doctor to have Dr. Blair
44 per cent com-
pensation,” he says.
The goal should be about $200,000
of production per non-doctor employee
in the office, says Dr. Blair.
GETTING A BETTER HANDLE ON COSTS
The relationship that an oral surgeon has
with a patient is different than the one
that a general dentist has with his or her
patient, notes Dr. Blair. The more irreg-
ular nature of the relationship can affect
payment plans.
“You basically see the patient for
prescription dentistry,” he says. “With
that, you like to encourage payment up
front since you don’t see the patient reg-
ularly. We also like to give the patient
some options…the bottom line is to
make sure the office does not take a hit.”
The practice can be more efficient if
scheduling can permit multiple extrac-
tions as opposed to single extractions at
one visit, notes Dr. Blair. “You would
like to make more money in a single
visit,” he says.
It is generally a good principle to keep
credit tight for patients, but dentists should
accept all major credit cards. Financing can
be long-term, which is usually over 12
months, or it can be interest-free. “The
idea is that we want to create a plan that is
in the budget for patients,” he says. “If you
offer up to a year, they will ask for a year.
You should ask the patient how much time
is needed to pay for a $1,200 treatment.
“They may say they need three or
four months. Don’t advertise that you
offer a longer-term financing program,” he
says. “If they say they need a longer peri-
od, then you could mention it is available.”
—Louise Gagnon
 Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:37 PM Page 13

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GOING GREEN
Call 1-800-668-5558 or go to www.henryschein.ca Den
Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:37 PM Page 15

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

E
NVIRONMENTAL AWARENESS AND THE
need to act to minimize harm to the
planet is a common theme in 2010,
and dentists are developing environmen-
tal consciousness in response to their
patients’ heightened awareness and
because of their own worries about envi-
ronmental sustainability.
Front Street Dental Centre in
Stratford, Ont., led by Dr. Ali
Farahani, has billed itself as Canada’s
first eco-friendly dental office. Dr.
Farahani worked in collaboration with
the nearby University of Waterloo and
fourth year honors student Mittale
Suchak to explore consumption prac-
tices at traditional dental offices, com-
pared to those at the environmentally-
friendly type of practice that he pro-
dental offices to determine their level puter monitors and dental vacuum instead of the disposable ones. Dr.
posed. Dr. Farahani also acted as
of dental resources, electricity, energy, pumps. Farahani’s practice saves approximately
Suchak’s honors supervisor for her
chemical and water usage, and waste. “It means 24,600 gallons of water per year by using
thesis “The Environ mentally-
They also determined the type of that we are not a dry dental vacuum pump from Sable
responsible Dental Practice.”
flooring, paint, and lighting found in extracting more Industries.
During research, they surveyed
the offices, as well as the types of com- from the environ- “Moreover, we do not have the
ment than nature usual chemical soup that is found in
can produce,” dental offices,” he says. “You will not
In this unique series of Special Reports, DENTAL CHRONICLE sets out says 34-year-old find the usual chemical smells. Our
to examine the primary challenges facing dentists in Canada today. Dr. Farahani, patients appreciate that. We use prod-
This first instalment in the 2010 series The Year of Green Dentistry Dr. Farahani
who opened his ucts that are very gentle like hydrogen
looks at Best Practices for Green Dentistry, and relates the experi-
practice in April peroxide.”
ences of some practitioners and industry members as they develop
2007. “When I While estab-
and adapt to green programs. Publication of this series is made pos-
created the office, lishing a very
sible by Henry Schein Canada.
I thought it was ‘green’ dental
“From Henry Schein’s perspective, we really believe it is our
responsibility as an active member of the dental industry to look for the the right thing to practice repre-
trends that are coming to dentistry,” says Peter Jugoon, Vice President, do. A lot of den- sented an addi-
Marketing and Planning, Henry Schein Canada. “We are doing a num- tistry is very tional upfront
ber of things around being more environmentally friendly, whether it is wasteful and Swift Dr. Fong cost to Dr.
internal or external. For example, our distribution centers have gone harmful. We pro- Farahani that he
paperless, so people are walking around with duce two bags of estimates to be
headsets on, being directed by central command garbage in a about $75,000
to the bins and the products they need to pick.” week, whereas more than the
Jugoon noted that Henry Schein has also most offices pro- cost to launch a
reduced paper consumption in their shipment duce that much standard practice,
packing, replacing paper with biodegradeable air garbage in a day. he has no doubt
bubble pillows. They are also now using brown There is a lot of that being an envi-
Mink Dr. Cooper
shipping boxes instead of the white boxes that garbage created ronmentally ethi-
Jugoon
had to be manufactured through a bleaching just from one visit.” cal entrepreneur will pay off in the long
process. Dr. Farahani uses reusable patient run.
“We are doing more and more to ensure that green products are bibs, tea tree oil as a disinfectant, and “I’m certain it will be worth it,” he
front and center,” said Jugoon. “The issue around the environment is uses re-usable stainless steel tips instead says.
not isolated to dentistry; it’s a global issue that will only continue to of plastic suction tips. He calculated that For the time being, there is an
grow as time goes by. by using stainless steel he could avoid absence of incentives or grants avail-
“As the awareness of [green dentistry] increases, as manufacturers the disposal of 100,000 plastic tips to his able to dentists who want to make their
come out with new green products that can be implemented into prac- local landfill. In addition, he uses stain- office more ‘green,’’ notes Dr. Fara-
tices, and as patients demand it, that puts the impetus on us to provide less steel (Hu-Friedy) prophy cups hani.
as many green solutions as possible.”
COMING IN THE NEXT ISSUE: This Special Report on Green Dentistry CONCERN ABOUT ENVIRONMENT
How digital imaging can improve your practice was written by Louise Gagnon, a fre- In the U.S., the Eco-Dentistry
quent contributor to Dental Chronicle. —please turn to page 17

DentalChronicle March 31, 2010 n 15

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

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Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:38 PM Page 17
GreenDentistry
Special Report: What you need to know about going green, part 1
continued from page 15—
Association led by Dr. Fred Pockrass, a
Canadian, supports dental profession-
als in making environmentally sound
choices, whether it is ordering re-usable
stainless steel suction tips instead of
disposable plastic ones, or switching to
washable cloth patient barriers instead
of petroleum-based plastics. A practice
can be certified as eco-friendly by the
EDA following assessments of initia-
tives in the areas of dental process and
procedures, office administration and
marketing, and office design, furnish-
ings, and construction. Dr. Farahani
has been asked to serve as the Can-
adian president of the association
(www.ecodentistry.org).
“Dental practices are more con-
cerned [about the environment], and the
trend is spreading,” says Larry Town,
national sales manager for Miele Canada,
a company that manufactures washer-
disinfectors for dental instruments,
where instruments are cleaned and disin-
fected before the sterilization process.
“They are increasingly cognizant about
their electricity use, water consumption,
and use of chemicals from a ‘green’
standpoint and from a cost-saving stand-
point.”
For its part, Miele Canada has
adopted an approach so that it does not
rely on chemicals a great deal. “Our phi-
losophy has been to not heavily rely on
chemicals, so that dental practices are
able to reduce the amount of chemicals
that the average practice flushes into the
system,” explains Town. The Sierra Club
has labelled the dental industry as the
third largest user of mercury in the U.S.,
using about 40 metric tonnes of mercu-
ry annually to produce silver amalgam
fillings.
The phenomenon of ‘greening’ in
dentistry in North America actually is
fairly recent compared to the level of
awareness in Europe, notes Town. “It is
now catching on in North America, but
there has been a push in Europe for a
long time,” says Town.
Andy Whitehead, vice-president of
sales and marketing for CrossTex
International, says the business case for
a dental practice to go green may not
be obvious, but practitioners need to
take the long view that the upfront cost
to starting a green practice, or convert-
ing an existing practice to a greener
one, will save money in the long run for
the practice, and that it will also be
—please turn to page 18
Case Study
When they moved their dental office from one location on Martindale Road in St. Catharines, Ont., to a larger space on
Martindale Road, Dr. Lain Vendittelli and his partner Dr. Hamit S. Ranu implemented changes to be more eco-friendly.
“Our old office was crammed, and it didn’t make sense to go green in that
office,” explains Dr. Vendittelli, who has been in practice for close to two
decades. “The intention of
moving into this facility was
not to go green, but it made
sense to do so.”
Dr. Vendittelli found,
however, that it was cost prohibitive for him to perform significant
design renovations to be greener. “There is a federal grant system
available to retrofit buildings, but not for buildings that are less than
five years old,” he says, noting that he may take advantage of the
grant system if it is still in place when the building that houses his
current practice turns five years old.
Salespeople have kept him informed of what is available in
terms of green technology and green practices. “It was an education
from [dental supplier] Henry Schein,” says Dr. Vendittelli. “The
salespeople have kept us up
to date, presenting us with the
value of using new technolo-
gy. The salespeople have
kept us informed of what is
available and what works.”
The incorporation of digital radiography into Martindale Dental has preclud-
ed the use of toxic processing chemicals, and many other offices are taking that
approach and moving away from traditional radiography, according to Dr.
Vendittelli.
“It is great because it allows us to see the images almost instantly,” explains
Dr. Vendittelli. “The amount of radiation is less, and we can treat patients much
faster. The systems have become better, and the images have become sharper.”
Another technology that he uses that is kinder to the environment is an amal-
gam separator. A hauler certified by Ontario’s Ministry of the Environment picks up
this particular class of waste. The practice also sterilizes its instruments in a more
environmentally-friendly fashion.
“Our standards are quite high, and the patients appreciate features like digital radiography,” says Dr. Vendittelli.
“We also explain how we have altered our process in sterilizing instruments.”
Responsibility for
Generations
Miele Dental Washer-Disinfectors take
innovation and performance to the next
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:LWKVLJQL¿FDQWO\OHVVFKHPLFDOVUHTXLUHG
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No compromises.
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Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:38 PM Page 18

GreenDentistry DE

Special Report: What you need to know about going green, part 1
continued from page 17—
regarded as socially conscious behav-
ior.
In a competitive economic envi-
ronment, being ‘green’ may be a feature
that distinguishes a dental practice
from others, and may be a factor that
leads patients to choose to visit that
practice.
ENVIRONMENTAL AWARENESS
Dr. Anna Fong, a dentist in Richmond
Hill, Ont., a suburb of Toronto, opted
to go green when she opened her own
practice in 2008. Driven by strong
feelings about environmental issues
and with the assistance of a dental
representative who pointed the way to
green options for a dental practice,
Dr. Fong went solo in an eco-friendly
fashion.
“When you start from scratch, you
can build the office the way you want it,”
says Dr. Fong. “We try to do the best we
can and have as small a carbon footprint
as we can.”
Dr. Fong’s office has features such
as digital radiography, which lessens radi-
ation exposure to patients, as well as
eliminates the need for not-so-environ-
mentally friendly processing chemicals
necessary for traditional radiography. Dr.
Fong has also gone paperless by imple-
menting digital charting. “We are doing
as much as we can to recycle,” says Dr.
Fong.
Her predominantly female staff is
unquestionably on board with the
green philosophy that Dr. Fong prac-
tices. “They have heightened con-
sciousness about the environment, and
people apply [for jobs] because they
like our office philosophy,” says Dr.
Fong.
D E N TA L S YS T E M S
One of Dr. Fong’s suppliers is
Micrylium Laboratories, a manufacturer
that began in the infection control field
in May 1994 with the intent of main-
taining proper infection control by
using products that do not have the
negative environmental consequences
associated with toxic, polluting disinfec-
tants.
“It is the whole reason we started
the company,” says Dean Swift,
research director at Micrylium
Laboratories. Micrylium was able to
supplant chemical disinfectants with
eco-friendly substances that did not
reduce the efficacy of products. They
employ, for example, totally biode-
grabable surfactants and do not manu-
facture products that contain endocrine
disrupting chemicals such as alkyl or
nonyl phenol ethoxlates.
“The majority of our customers
buy the products because they work
and because of the results,” says Swift.
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“We work on physical chemistry rather
than toxic chemistry, and that is why we
get good results. Everything we pro-
duce is biodegradeable and pharma
grade USB. Most people buy our prod-
ucts because of the quality and effec-
tiveness. The fact that they are green is
secondary.”
Micrylium wants to set an example
that proper hygiene and infection con-
trol does not need to translate to the use
of harsh, toxic chemicals, according to
Swift.
INCREASINGLY IMPORTANT FOR STAFF
The use of non-toxic chemicals to
cleanse a dental practice may have more
appeal to staff, who are typically female
and may be contemplating mother-
hood.
“Many staff at dental offices are
young women who are thinking of hav-
ing children, and their personal health is
a factor,” says Swift. “They don’t want to
be spraying carcinogenic things around Den
the office if they are of child-bearing com
age. We have many dental assistants who
aro
tell us they have quit their jobs because
mor
the dentists started using other products
650,
that may be toxic to clean and disinfect
gua
the offices.”
zati
Montreal-based Medicom is one of
den
the firms that is capitalizing on the green
movement in dentistry. It has developed
ous
a environmentally friendly non-woven
Am
sponge product called SafeGauze Green
that has been manufactured in an envi- Pac
ronmentally-conscious manner and is as Tri
absorbent as a comparable synthetic par
product.
“We have tested it against our own den
synthetic product, and it was more form
absorbent,” says Claudia Mink, brand cou
manager at Medicom. “We wanted to tion
make sure it performed on parity with tori
our own product.”
Mink notes that there is an Inte
increased consciousness in dentistry to pre
minimize the impact that dental prac- inte
tices have on the health of the environ-
ment.
Dr. Barry Cooper, who operates du
Wel
Portage Dental Clinic in the national aes
capital region of Gatineau-Ottawa, says
he uses the most biologically compatible
materials that he can for his patients. “I
have not inserted amalgam in patients’
mouths for more than 25 years,” says Dr.
Cooper, noting he uses high-end and
high noble alloys for procedures such as
crowns. “You need to use biocompatible
materials and take the time to do long-
lasting work. With this approach, there is
less need for retreatment and thus less
total carbon footprint.”
Apart from basics like recycling
paper at the office, Dr. Cooper used
‘green’ paints, such as an ultra-low
volatile organic compound, and a fire
retardant on a wood ceiling in his office
to comply with fire code regulations.
With the use of digital radiography
and photography, there is no staff expo-
sure to film-based toxic chemicals and a
dramatic reduction in radiation exposure
to his patients. Furthermore, no dark-
room means less of a carbon footprint
which is “overall more respectful and
kinder to the planet.
“There is also the square footage of
running a dark room,” says Dr. Cooper.
“[Digital radiography] is beneficial to the
patient because we reduce the number of
X-rays, so it means less radiation expo-
sure cumulatively.”

1.800.368.8106 w w w.sableindustriesinc.com

w w w.basevacdental.com Produc t of Canada

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

DENTAL TRIBUNE | MARCH 31, 2010 Clinical Practice 19

Cutaneous sinus tracts:

ound
aring
Dental Tribune International Publishing Group is An endodontic approach
composed of the leading dental trade publishers
who Dia gnosis and treatment for a successful outcome, by Dr. Philippe Sleiman
around the world. Its combined portfolio includes
ause
more than 100 trade publications that reach over
ducts
M
isdiagnosis of an extra-oral information that will help with the that any cutaneous lesion of the face
650,000 dentists in more than 90 countries and 25 lan-
nfect sinus tract usually leads to a final diagnosis and the subsequent and neck could be of dental origin.
guages. The group’s activities also include the organi-
destructive invasive treat- treatment plan. A correct diagnosis The patient’s history may include
zation of continuing education programs as well as
ne of ment of the local skin lesions that is will lead to a simple, yet effective complaints of dental problems.
dental congresses and exhibitions. treatment—the removal of the However, patients may not have any
reen not curative and often mutilating
The World Dental Federation (FDI) and numer- infected pulp canal tissue from the history of an acute or painful onset.
oped (Fig. 1). Attempting to treat such
ous regional dental associations, such as the Latin root canal space—resulting in min- There may also be complaints of
oven lesions with a circular incision of the
American Dental Federation (FOLA) and the Asia imal cutaneous scarring. episodic bleeding or drainage from
Green orifice of the cutaneous fistula and
envi- Pacific Dental Federation (APDF), have chosen Dental Cutaneous sinus tracts of dental the cutaneous site with persistence
excision of its entire tract with all
Tribune International Group as their official media origin have been well documented of the cutaneous lesion. Occasionally,
is as the ramifications is not consistent
partner. in the medical literature, dental lit- there is a history of injury to the
hetic with the present standard of care.
Dental Tribune is the first global newspaper for erature, and dermatological litera- tooth.
Unfortunately, cutaneous fistulae are ture. However, these lesions continue Correct diagnosis of the cuta-
own dental professionals in a concise and highly readable
sometimes treated as though they to be a diagnostic dilemma. Patients neous sinus of dental origin should
more format that is published in the native language of the
are independent dermatologic lesions suffering from cutaneous fistulae be suspected by the gross appear-
rand country in which it appears. An experienced interna-
with the pathogenic characteristics usually seek treatment from a physi- ance of the lesion. These cases typi-
d to tional correspondent network and renowned local edi-
and treatment prognosis typical for cian or a plastic surgeon instead of a cally present as erythematous, sym-
with torial boards ensure the highest journalism standards.
mucosal fistulae. However, even skin dentist and often undergo multiple metrical, smooth, non-tender nod-
As the Canadian affiliate of the Dental Tribune
biopsy may produce unnecessary surgical excisions, multiple biopsies, ules of one to 20 mm in diameter
an International network, Dental Chronicle is pleased to
and antibiotic regimens with eventu- with crusting and periodic drainage
scarring.
ry to present this special section containing articles of al recurrence of the cutaneous sinus in some cases. The most characteris-
Correct diagnosis is the key to
prac- interest from the global editions of Dental Tribune. tract because the primary dental tic feature of the nodule is its depres-
treating this kind of lesion. A gentle
iron- cause is frequently misdiagnosed. sion or retraction below the normal
digital finger pad pressure on the

es du
Welcoming new patients, apical region of the area suspected The evaluation of a cutaneous surface. This cutaneous retraction or
can create a discharge of pus. A sinus tract must begin with a thor-
ional aesthetically speaking............23 DentaScan can provide reliable ough patient history and awareness See Page 20
says
atible
ts. “I
ents’
s Dr.
and
Where can you reach 600,000+
ch as
atible
ong-
dentists in 25 languages monthly?
ere is
less

cling
used
-low
fire
ffice
s.
aphy
xpo-
nd a
osure
dark-
print Official Media
and Partner of

ge of
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o the
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dentistry _ beauty & science the international magazine of endodontics the international magazine of dontal technology international magazine of laser dentistry the international magazine of orthodontics the international magazine of periodontics
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Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:38 PM Page 20

20 Clinical Practice DENTAL TRIBUNE | MARCH 31, 2010 DE

cal r

Cutaneous sinus tracts: An endodontic approach in a

Case Report
From Page 19
dimpling is caused by the fixation of the
tract to the underlying tissues and may be
secondary to the healing process or a late
finding in active disease. Lesions that pre-
viously underwent biopsy and treatment
are usually characterized by the absence
of at least part of the nodule and frequent-
ly by an orifice of draining sinus at the
base of the fixed depression.
Endodontic infection, the product of
cellular degeneration—bacterial toxins—
and, occasionally, the bacteria themselves
within the canal spread through the api-
cal foramen into the surrounding tissue.
Thus, a slow inf lammatory process
begins in the tissue contained within the
periodontal ligament. Left to itself, it
Fig. 1: Post-op photo one week after external surgery to remove the
patient’s sub-mandibular gland.
may manifest in a variety of ways, rang-
ing from simple widening or thickening
of the ligament to granuloma or cyst.
Sometimes a fistula may develop, with the
patient reporting intermittent discharge
of pus.
The fistula provides a means of con-
tinuous drainage of the lesion. The open-
ing of the fistula may be found on the
mucosa overlying the tooth that sustains
it, but often it may also be found at a con-
siderable distance from the diseased tooth.
In some cases, the fistula may run in the
space of the periodontal ligament of the
same tooth. It may even traverse the peri-
odontal ligament of the adjacent healthy
tooth, thus simulating a lesion of peri-
odontal origin. In such cases, negative
pulp tests performed on the crown of the
tooth, indicated by a gutta-percha cone
inserted into the fistula, assist in making
the correct diagnosis.
If the drainage of the fistula is not
continuous but intermittent, it is preceded
by a slight swelling of the area as a result
of the increased pressure of pus behind
the closed orifice. When the pressure
becomes strong enough to rupture the thin
wall of soft tissue, the suppurative dis-
charge issues externally through the small
opening of the fistulous orifice. This orifice
may heal and then re-close, only to re-
open later. The discharge of pus is never
accompanied by intense pain. At most, the
patient will complain of slight soreness in
the area prior to reopening of the external
orifice. The pus creates a tract in the sur-
rounding tissues, following the locus
minoris resistentiae. It may exit, at any
point, in the oral mucosa or even in the
skin. It is not uncommon, particularly in
young patients, to find a cutaneous fistula
at the level of the mental symphysis, if
lower incisors are involved, or in the sub-
mandibular region, if a lower first molar is
involved. Also, it may be found in the floor
of the nasal fossa, if a central incisor is
involved.
Attempts to treat cutaneous fistulae
with a circular incision of the orifice of
the cutaneous fistula and excision of its
entire tract with all the ramifications
cannot be considered to comply with the
Fig. 2a: Panoramic X-ray showing some bone rarefaction under teeth 47
and 46.
present standard of care and should be
regarded as highly undesirable. Most of
the time, root canal therapy is the ideal
treatment for such lesions. However,
Grossman states that such tracts are lined
by granulation tissue. In his study,
Grossman was unable to identify any
epithelium at all. Bender and Seltzer also
conducted histological studies of numer-
ous fistulous tracts without finding an
epithelium lining. Given the current state
of knowledge and scientific data, there is
no reason to recommend surgical removal
of such tracts, just as there is no reason to
believe that even epitheliumlined fistula
tracts should not heal after appropriate
endodontic therapy.
Obviously, these fistulae must be dis-
tinguished from congenital fistulae of the
neck, both lateral-arising from the sec-
ond brachial cleft—and medial—arising
from rests of the thyroglossal duct—
which are lined by an epithelium. Such
fistulae are of a different pathogenesis
and definitely do not resolve spontaneous-
ly but only after careful surgical excisions
of the tract.
The differential diagnosis of the case
in question included the following:
• localized infection of the skin, such as
pyoderma, pimples, ingrown hairs,
and obstructed sweat glands;
• traumatic or iatrogenic lesions;
• osteomyelitis;
• tuberculosis; and
• actinomycosis.
Case presentation
The patient was referred to me from
overseas with a large mandibular fistula,
which had previously been misdiagnosed
as an infection of the sub-mandibular
gland. Surgery had been performed and
his submandibular gland had been
extracted. The wound had not healed and
the clinical situation was fast worsening.
Thus, the wound had opened and subin-
fected with a heavy discharge of pus.
A dentist invited to see the patient
immediately telephoned me and sent a
photo of the wound to me via his mobile
phone. Following my recommendation,
the patient was immediately put under
double antibiotic therapy (amoxicillin 1000
mg twice daily, metronidazole 500 mg
twice daily). The patient presented to my
clinic the following day, where we started
with a detailed questionnaire to collect all
the information about the history of the
wound. The patient reported that he had
been suffering from this fistula for quite
some time already with intermittent
phases of discharge of an exudates and
numbness of the lower lip. No dental pain
was reported.
A panoramic X-ray showed some
bone rarefaction under teeth 47 and 46,
but no invasion of the mandibular nerve
tract was evident (Fig. 2a). A dental scan
with 0.5 mm increment was performed in
order to gain a better idea of the clinical
situation. One of the sagittal slides (013)
clearly shows the lesion around the distal
root of tooth 47, surrounding the apical
part and destroying the cortical bone
invading the lower soft tissue (Fig. 2b).
Furthermore, the mesial root of tooth
46 showed apical radiolucency, invading
the tract of the lower mandibular nerve
(014; Fig. 3). This pathology explains the
numbness of the lower lip, while the
pathology around the distal root of tooth 47
explains the extra-oral fistula.
Careful review of the axial slides in
the area of tooth 47 (006) offers an idea
about the amount of bone destruction in
imm
was
the lower lingual area. The axial slide
post-
under tooth 46 reveals the communication
seem
between the lesion under the mesial root
sues
and the mandibular nerve tract (Fig. 4).
Next, we established a clear diagno-
and d
sis that the lesion was an extra-oral cuta-
cle d
neous fistula of dental origin. The patient
had d
was suffering from a large, infected open
to fin
wound and a suitable treatment plan had
amaz
to be established quickly. The following
The
solutions were presented:
ed a
1. Extraction of the teeth and curettage of
cle d
the area, with extra attention paid to
by th
the mandibular nerve: This plan
could provide the patient with a
solution for eliminating the infection
An im
and allowing the wound to heal. Yet,
natu
two strategic molars would be lost
Duri
with this solution and a replacement
sinus
would not be an easy job with this
deter
amount of bone destruction in the
sensi
infected area.
out f
2. More conservatively, a root canal treat-
ment in order to clean and disinfect
tors t
the root canal systems of the two
tal in
molars, followed by an internal med-
path
ication and a 3-D obturation capable of
facto
blocking the bacteria from reaching
musc
the apical part and trapping the
invol
remaining bacteria inside the root
than
canal system: This approach would
teeth
allow the patient to keep his molars
rior t
and would provide an environment in
which the healing process could
lesion
begin. The risk would be the estab-
and
lishment of an external biofilm that
lesion
cannot heal by itself and may require
disch
microsurgical removal.
sinus
The patient and I decided to preserve
mary
the two molars. Immediately, root canal
cosis
treatment, cleaning and shaping of the
canal space using TF files (SybronEndo)
piece
with copious and alternate irrigation of
ation
chlorhexidine, SmearClear (Sybron-Endo),
rials,
distilled water, and sodium hypochlorite
some
with ultrasonic activation in a well-estab-
order
lished sequence, was performed.
tion w
An apical enlargement to size 40 in
certa
.04 taper was performed after crown down
ed—a
with K3 files (SybronEndo), to disturb the
right
biofilm mechanically and to help reduce
the colony formation unit (CFU).
The a
An intermittent paste was injected
and t
inside the shaped root canal system. The
paste of two different antibiotics (aug-
Dr. P
mentin and metronidazole) was manually
Univ
mixed and injected with a paste filler. A
the e
hermetic temporary filling was placed for
the L
a week. The wound was covered with a
eral
dressing of steroids and antibiotic paste to
with
prevent further external infection. A week
opme
later, the patient was already showing
instr
good progress. The wound had started to
train
close and less inflammation and swelling
the I
were observed (Fig. 5). The root canal
tice
was reopened and cleaned, and no inter-
phil2
nal fluids were coming from the periapi-
 Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:38 PM Page 21

2010 DENTAL TRIBUNE | MARCH 31, 2010 Clinical Practice 21

cal region. RealSeal material was used as obturation material Fig. 2b: Sagittal slide showing the

h in a vertical condensation using RCPSL (Hu-Friedy) and an

immediate build-up was performed. Thereafter, the patient
lesion around the distal root of
tooth 47.
Fig. 3: The mesial root of tooth 46
was invited for regular control checkups. A few weeks later, a
slide showing apical radiolucency,
post-op X-ray (Fig. 6) and photos were taken. The wound
ation invading the tract of the lower
seemed to be in good condition and some skin and fibrous tis- mandibular nerve (014).
root
sues were forming. Fig. 4: Axial slide under tooth 46.
4).
While I was writing this article, the patient visited Beirut
agno-
and decided to come in for a checkup. He complained of a mus-
cuta-
cle disturbance of his lower lip, but all the previous numbness
atient
had disappeared. He agreed to perform an i-Cat scan in order
open
to find out what was going on and to detect any pathology. I was
n had
amazed by the bone formation and complete healing (Figs. 7–9).
wing
The wound had also healed very well (Figs. 10a & b). I contact-
ed a plastic surgeon and asked his opinion regarding the mus-
ge of
cle disturbance. He posited that such symptoms may be caused Fig. 5: One week after steroids and antibiotic treatment.
aid to
by the tremendous loss of structure.
plan
th a
Discussion
ction
An important diagnostic modality is the determination of the
. Yet,
nature of fluid draining (if any) from the cutaneous sinus.
lost
During palpation, an attempt should be made to milk the
ment
sinus tract. Any discharge obtained should be scrutinized to
this
determine its nature (saliva, pus, or cystic fluid). Culture and
n the
sensitivity testing of the fluid should also be performed to rule
out fungal and syphilitic infection.
reat-
Laskin elaborates on the physiological and anatomical fac-
nfect
tors that influence the spread and ultimate localization of den-
two
tal infections. Stoll and Solomon also emphasise that the ultimate
med-
path of the sinus (irrespective of the source) depends on several
ble of
factors: most importantly, the anatomy of the tooth involved,
ching
muscular attachments to the jaw, fascial planes of the neck, and
the
involvement of permanent or deciduous teeth. Cutaneous rather
root
than intra-oral lesions are likely to occur if the apices of the
would Fig. 6: Post-op X-ray a few weeks after treatment.
teeth are superior to the maxillary muscle attachments or infe-
olars
rior to the mandibular muscle attachments.
nt in
A pustule is the most common of all purulent draining
could
lesions and is readily recognized by its superficial location
stab-
and short course. Actinomycosis exhibits multiple draining
that
lesions and characteristic fine yellow granules in the purulent
quire
discharge. The tooth is often not involved radiographically. If a
sinus tract does not close after appropriate removal of the pri-
serve
mary cause, the most common alternative cause is actinomy-
canal
cosis (Fig. 5).
f the
The challenge in these kinds of cases is to assemble all the
Endo)
pieces of the puzzle and build up a full idea of the clinical situ-
on of
ation. Assembling the pieces means that all the diagnostic mate-
ndo),
rials, such as a history questionnaire, X-rays, CT scans, and
lorite
sometimes biopsy and bacteria culturing, must be provided in
estab-
order to establish a correct diagnosis. Most of the time, the solu-
tion will only be a simple routine that must be performed in
40 in
certain conditions. Turning to solutions that are more complicat-
down
ed—and that certainly can be more profitable—is not always the Figs. 7 to 9: i-Cat images showing good bone formation and complete healing.
b the
right choice, nor the most ethical one.
duce

The author would like to thank Yulia Vorobyeva, PhD, interpreter

ected
and tran slator, for her help with this article. DT
The
(aug-
Dr. Philippe Sleiman received his DDS from the Lebanese
ually
University School of Dentistry in 1989. He conducted a DES in
er. A
the endodontic program at St. Joseph University and a PhD at
ed for
the Lebanese University Dental School. He has authored sev-
ith a
eral international articles. He has his own line of instruments
ste to
with the Hu-Friedy company and contributed to project devel-
week
opment, and has lectured internationally. Dr. Sleiman is an
wing
instructor at the Lebanese University and an international
ed to
trainer for the University of North Carolina. He is a fellow in
lling
the ICD and the AAE. Dr. Sleiman maintains a private prac-
canal
tice in Beirut and in Dubai, UAE, and can be reached at
nter-
phil2sleiman@hotmail.com
iapi- Figs. 10a & b: Post-op woundhealing.
Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:38 PM Page 22

DENTAL TRIBUNE | MARCH 31, 2010 DE

Free yourself from the daily grind W

If you dread going to the practice each day, it’s time to reevaluate Dr.
your leadership role, says business consultant Sally McKenzie

re you settling for mediocrity? Is your practice mere-

tude and poor performance. Yes, I know it’s not easy, but it’s E
A ly getting by? Do you feel surrounded by complacen-
cy? Is there a lack of excitement or enthusiasm?
Perhaps it’s not that the team is outwardly negative or
mandatory.
Read on.

Reluctant leaders
and n
dexte
every
difficult, it’s just that “average” has become simply good grou
Dentists by virtue of their position as CEO of the practice
enough in their minds. in th
are the leaders, but often they don’t take to that role natu-
New ideas seldom emerge because they are shot down
rally, and frequently they do not have leadership experi-
as quickly as they surface. Issues with systems are perpet- that
ence to prepare them for the responsibility.
ually on the backburner, kept there by the proliferation of able,
Dentists are trained to be excellent clinicians and they
excuses explaining why the changes won’t work, can’t tion s
are. They are not, however, trained to have the necessary
work, or would simply be too much work to fix. anxie
communication or business skills to lead teams and steer
So there you stand having lost control of the practice inf lu
clear of complacency.
you once loved. It's become the daily grind, and it seems work
However, dramatic leadership improvement can occur
that you wile away the hours at the mercy of those who had
under the right circumstances if the dentist truly wants a
seemingly care to do nothing more than simply get by. and
practice that reflects the level of excellent dentistry he or
As familiarity breeds contempt, complacency breeds expe
she provides.
mediocrity. If teams are not challenged to continuously easie
In order to improve leadership skills and avoid settling
improve, then when the push is on to do things differently
into a state of mediocrity and ultimately the loss of power
the shift can be unnecessarily traumatic because the staff Desir
and control over the practice, dentists must take three
members feel threatened and they resist any change. Ther
essential steps:
They’ve settled into their “way” of doing things and facia
• Change your definition of leadership;
don’t understand why what seems to have worked perfect- exam
• Change your behavior as the leader; and
ly fine in the past is suddenly called into question.
• Change your expectations of the desired outcomes. ceive
Sounds like a major issue with the team, right?
denti
Wrong. What we have in circumstances such as this
The leadership definition for small businesses is quite day i
is more likely to be a major issue with the leadership. The
different than it is for large companies. The vision is to man
team mirrors the leadership of the practice.
make a good living. The plan is to work hard every day Howe
delivering the best service and quality to patients. not a
Take off the rose-colored glasses
The required communication skills consist of know- cosm
Look carefully at your team. Do they reflect your commit-
ing what you want your staff to do and telling them. denta
ment to excellence? Are they open to change? Are you will-
The leader must explain to the staff what is expected to th
ing to challenge them to make changes? And are you will-
of them, how their performance will be measured and
ing to invest the time to educate them on why change is
how that performance will be rewarded. In exchange, the requ
necessary?
followers will be paid and appropriately recognized. desir
Or, do you shun better, more efficient systems and pro-
Rather than allowing your practice to sink under the ic tr
cedures because “Mary Jane” has been there since the
weight of mediocre minions, choose to build and lead a
beginning of time and you decided long ago that it’s not
team of star players. Focus initially on the following man-
worth it to challenge her negative attitude and poor per-
ageable steps. You will see improvement almost immediate-
formance?
ly. Those who are valuable to the future success of the
You rationalize your fear of addressing the problem by
practice will emerge as will those who aren’t. Step
telling yourself that she handles all the insurance, or she
knows all the patients, or whatever the excuse. I’ve w
Step No. 1: Get the right people into the right jobs. denti
If you’ve chosen to ignore the problem, you’ve abdicat-
Some employees are perfectly at ease asking for payment, tens
ed your responsibility as the leader. You can count Mary
while others feel as if they were making some extraordi-
Jane as one of your concrete blocks—as in dead weight teth-
narily difficult demand of the patient. In the Mary Jane es m
ering your practice to an average standing for all time.
example above, she may be an excellent employee who is
The World’s Being the leader takes courage to examine systems,
processes, and staff. Change those things that don’t work,
in the absolute wrong position.
not t

I highly recommend personality testing to place your

Fastest Matrix? but most importantly, challenge everyone—not just your-
self—to continuously improve.
team members in positions in which they can excel, not just
been
to pe
get by. The Keirsey Temperament Sorter Test found at respo
- Takes less than They follow the leader
www.keirsey.com is an excellent tool to use for this process.

Your team members are taking their cues from you. If you you
5 seconds to apply ... have a Mary Jane and she is unwilling to change or do
Step No. 2: Tell it like it is. piece
Develop job descriptions for each position. Specify the skills cour
things differently, she is the shining example for the rest of
necessary for the position. Outline the specific duties and
the team to follow suit.
responsibilities. ceed
Employees are expert “boss watchers”. They are quiet-
Include the job title, summary of the position, and its dard
ly watching as you look the other way, make excuses, and
responsibilities and a list of duties. This is an ideal tool to
allow employees such as Mary Jane to run the show.
explain to employees exactly what is expected of them. Step
The irony is that most employees want to excel, and
they want to be challenged. But they look to the dentist to In a
be the leader and address Mary Jane’s unacceptable atti- See Page 23 goals
 Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:38 PM Page 23

010 DENTAL TRIBUNE | MARCH 31, 2010 Clinical Practice 23

nd Welcoming new patients, aesthetically speaking

Dr. Bob Khanna discusses the benefits of offering non-surgical facial aesthetic treatments
facial aesthetic surgery are generally more
very dentist has the ability to offer

ut it’s E non-surgical aesthetics. A dentist’s

underlying knowledge of the head
and neck region, as well as the skills and
open to alternative forms of cosmetic pro-
cedures, and may be more likely to
enquire about dental options. After all,
nobody wants a rejuvenated face let down
dexterity required to be able to perform
by a non-aesthetically pleasing smile.
everyday dental tasks offers a solid
grounding from which to build a career
ctice A good earner
in this fast-paced industry.
natu- Financially, the facial aesthetic market, as
As well as technical skills, I believe
peri- a stand-alone modality, is highly prof-
that dentists by nature have to be person-
itable. Products such as Botox are defying
able, and possess excellent communica-
they the recession as consumers are choosing
tion skills to help alleviate any stress and
ssary to opt for longer-lasting cosmetic treat-
anxiety within patients. This calming
steer ment instead of short-lived expensive non-
inf luence is hugely beneficial when
medical-based high street skin care rou-
working with patients who may not have
occur tines. Also, a growing acceptance of such
had facial aesthetic treatments before,
nts a cosmetic procedures means that the
and may not be sure of exactly what to
he or demand for noninvasive procedures is
expect. After all, a calm patient is much
increasing, and being able to offer
easier to work with.
tling patients such a service has the potential
ower to increase revenue. DT
Desired vs. required
hree About the author
There are many benefits to performing
facial aesthetics within a practice. For
example, being able to combat pre-con- will take, or how painful it is, people find fear of returning lessens considerably. About the author
ceived ideas about what happens in a strength to temper their anxiety in order
mes.
dentist’s chair. In the course of a normal to benefit from having the treatment. Boosting your client base Dr. Bob Khanna is widely regarded as one
quite day in surgery, dental phobia is a hurdle Having an appealing facial aesthet- As well as helping patients face their pho- of the world’s leading exemplars of den-
is to many practitioners have to overcome. ic treatment in a dental environment bias, I have found that I have also inher- tistry and facial aesthetics. President and
y day However, I have found that patients are also helps alleviate the general fear of ited a lot of dental clients from the facial founder of the non-profit organization The
not as nervous when they are having a visiting the dentist. They realize that the aesthetics side of my business—one of the International Academy for Advanced
now- cosmetic procedure—despite being in a environment is not as scary as they may major benefits to offering the service. If Facial Aesthetics (IAAFA), Dr. Khanna
dental environment. I believe this is due have imagined, and understand that they your practice is set up well, patients heads the only UK organization to com-
ected to the ‘desired vs. required’ phenomenon. are safe in the hands of someone they should be able to get their hands on infor- bine medical and dental professionals. He
and trust. The environment is then associated mation about the cosmetic dentistry pro- is the appointed clinical tutor in facial
When a patient is informed that they
, the with a pleasurable experience; their cedures you offer while in the practice for aesthetics at the Royal College of Surgeons
require a procedure, the concept is not a
practitioner after all has provided them facial aesthetics treatments. and has trained thousands of dentists and
desirable one. If a patient desires aesthet-
r the I find patients who are interested in doctors through the Dr. Bob Khanna
ic treatment, regardless of how long it with something that they desired, so the
ad a Training Institute.
man-
Free yourself from the daily grind measure its success. skills and training to develop plans to continuously
iate-
From Page 22 When the time comes to evaluate your team, that improve patient services, boost treatment acceptance,
f the
too should follow specific guidelines; it’s not just a matter and build a better practice, and reward them for their
Step No. 3: Train. of assessing whether your assistant is a nice person. It is efforts.
I’ve watched this mind-boggling scene hundreds of times: about evaluating how well she/he is able to carry out If you create a structured environment with clear
dentists allowing untrained team members to handle her/his responsibilities. expectations and a plan for total team success, then the
ment, tens of thousands of dollars in practice revenues. Used effectively, you’ll find that employee perform- Mary Janes and the rest of the crew will likely rise to the
ordi- Nothing creates distrust, generates conflict, or caus- ance measurements and reviews can provide critical occasion. And you will no longer be suffering through the
Jane es more internal problems than team members who are information that will be essential in your efforts to make daily grind.
ho is not trained. major decisions regarding patients, financial concerns, Rather, you will be the leader of a happy and suc-
They feel insecure and vulnerable because they’ve management systems, productivity, and staff throughout cessful team that is not only open to change and con-
your been tossed into a situation in which they are expected your career. tinuous improvement, it is actively pursuing it every
t just to perform duties and are largely guessing at how those Moreover, performance measurements and a credi- day.
d at responsibilities are to be carried out. ble system for employee review consistently yield more
ess. This is a recipe for failure. Think about it: would effective and higher performing team members.
you hand them the instrument tray, a couple of hand- The fact is that when we understand the rules of the About the author
pieces, and say, “Have at it, let's see what you can do”? Of game and how we can win, life and work are a lot more
skills course not. fun and rewarding. Sally McKenzie is CEO of McKenzie Management, which
and Team members must be given the training to suc- provides success-proven management solutions to dental
ceed and expected to meet specific performance stan- Step No. 5: Celebrate. practitioners nationwide. She is also editor of The
nd its dards. Inspire the team with a practice vision and goals, and Dentist's Network Newsletter at www.the dentistsnet-
ool to
recognize the progress you make together in achieving work.net; the e-Management Newsletter from
Step No. 4: Encourage the best. those goals. Take time to pat yourselves on the back for www.mckenziemgmt.com; and The New Dentist maga-
In addition to job descriptions and clear and specific the accomplishments that you achieve. zine, www.thenewdentist.net. She can be reached at (877)
goals, your team will also wants to know how you will Create incentives for staff members to use their 777-6151 or sallymck@mckenziemgmt.com.
Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:38 PM Page 24
DentalVitae
L
AUGHTER is truly the best medicine,
says Dr. Pio Modi, a dentist who
operates his practice by day and, at
night, moonlights as a stand-up comedi-
an.
“My two career choices are com-
pletely different. I am a dentist and a
professional, but when I leave the office
to perform comedy, I think of myself
solely as a comedian,” said Dr. Modi,
who works as an associate dentist at
Avenue Dental in Brantford, Ont.,
where he has resided for a majority of
his life. Performing as a comedian helps
him maintain a work and life balance, he
says.
The commute from Brantford to
Toronto to perform his comedy shows
takes about an hour and 15 minutes, and
he says he wouldn’t do that drive so
often if he didn’t have a passion for
comedy.
COMBINING DENTISTRY AND COMEDY
“Comedy is a nice stress reliever and it is
something I really love to do. It helps me
to keep busy because I am the type of
person who always needs to be doing
something.”
His interest in comedy started while
he was studying dentistry at the
University of Toronto, where he had an
opportunity to participate in some
sketches for a musical show organized
by third-year dental students.
“I did a couple of sketches for
Former CDA president and University of Manitoba grad Dr. Tom Breneman
(right) placed the winning bid for a guitar signed by singer and former lead singer
of The Guess Who, Burton Cummings. Cummings was in his hometown of
Winnipeg to become the first recipient of Honourary Membership into the
University of Manitoba Dental Alumni Association. According to the organizers,
Cummings was recognized for his “talent, social conscience, and his years spent
as a vociferous proponent for all Winnipegers.” Proceeds from the guitar raffle
were slated to provide funding for a dental scholarship at the U of M.
24 n March 31, 2010
Leisure, travel, and making the most of your own time
Profile has performed at several comedy clubs
Cus
throughout Ontario, including Yuk-
allo
Yuks, Absolute Comedy, and the est
Enter laughing: Dentist
House of Comedy. In 2007, he pro- form
gressed to the finals of YukYuks Great larly
Canadian Laugh Off, which was aired ery
me
on the Comedy Network. More recent-
moonlights as comedian
pro
ly, in the fall of 2009 Dr. Modi gave a
Des
performance on a show called Accent ind
in Toronto that was aired on CBC grin
Radio. as
Performance as a stress reliever COMBINING DENTISTRY AND COMEDY
Tho
Circ
n Passion for yuks keeps Brantford, Ont. dentist Additionally, Dr. Modi has performed as
an emcee for several comedy shows and
appearing on stage to develop his comedic touch some corporate events. Pur
(DB
Dentantics in my third is m
year and they went over gra
well. I had so much fun han
doing it, and I thought tim
that I might be good at con
comedy,” he said. The
mo
He started taking is p
comedy classes at The eas
Second City in Toronto ma
shortly after his interest mig
in comedy was piqued. Fro
Circ
The courses he took last-
ed from 2000 until 2003
and consisted of eight Th
modules of classes eight
weeks in length. Kae
Sec
“They have a live
the
theater there and they do
a lot of improv shows,” Dr. Modi
Dr. Modi said.
“I find that improv and comedy are
really different, but the training and “I would like to eventually start per-
experience helped set me in the right forming at corporate dental events and
direction and provided me with the con- conventions,” Dr. Modi said, regarding
fidence to perform.” his comedic ambitions.
He debuted as a comedian in 2002 “So far, I have done some corpo-
during an open mike session in Dayton, rate performances for different medical
Ohio, but he didn’t realize that it was societies, but it would be great if I
actually a competition. could do shows for dental functions
“When I was on stage I was really and conventions.”
nervous. I could feel myself shaking like Aside from comedy and dentistry,
crazy but I managed,” he said. Dr. Modi also likes to stay physically
active. Last fall, he participated in the
W
“I find that I am a little nervous
each time I perform because really I ScotiaBank Marathon in Toronto. Dr.
B
never know how the audience is going to Modi noted that although he has done
half marathons, that run was his first
B
respond,” Dr. Modi said.
marathon. H
SOMETIMES THEY LAUGH “I enjoy working out, watching M
“Sometimes they laugh and sometimes movies, and spending time with my M
they don’t. After a while though, when friends, family, and fiancé,” Dr. Modi O
you do a lot of shows, you realize that said. S
doing badly on stage occasionally is part “Tasha and I are busy getting ready S
of the experience and it becomes easier for our wedding this year, which we are
not to take it personally.” both very excited about.”
Over the last three years, Dr. Modi —Lynn Bradshaw
DentalChronicle De
 Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:38 PM Page 25

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Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 08/04/10 2:03 PM Page 26
DentalVitae
Tenn minutess with.... Dr.
In 1997, Dr. Sherri Wise
was working in Israel as a volun-
teer when she was a victim of a
terrorist bombing in Israel that left
her with burn injuries and other
injuries that left her unable to work.
According to Canadian law, she
has been unable to seek compen-
sation for this violence that took
place on foreign soil. Now a prac-
ticing dentist, wife, and mother of a
two-year-old daughter, Dr. Wise is
lobbying for changes in Canadian
law that would allow Canadians to
sue foreign states that provide sup-
port to terrorists, and she hopes,
act as a deterrent to those who
funnel money to terrorists. She
graduated in 1991 with a BA
Honours from the University of
Manitoba, and completed a DDS at
Northwestern University in 1995.
Toronto Star
Scientists have developed a
new hearing aid device that conducts sound
through a back tooth rather than through
the ear (Feb. 2, 2010).
This new technology, called SoundBite, starts with a custom-built device fitted to
a molar and a wireless micro-
phone within the ear canal. A
digital audio device worn as a
thin cord behind the ear picks
up the sound from the micro-
phone and transmits it to the
tooth device, which produces
sound vibrations that reach
the cochleae through the
bone. According to the manu-
facturer, the tooth hearing aid
product does not interfere
with eating or speaking, and
they hope to have the device
on the market by mid-2010.
Canadian Press Alaska den-
tist Dr. Kirk Johnson saved a
bald eagle’s beak—and its
life—using a temporary
crown, sticky poster putty,
26 n March 31, 2010
Sherri Wise
How did your life change in when you were in Israel?
I went to Israel to volunteer as a dentist in 1997, and was hav-
ing lunch on a pedestrian street at a café when a triple bombing
occurred on that street.
What kind of trauma did you sustain in the bombing?
About 40 per cent of my body was covered in second and
third-degree burns. I lost my hair and lost part of my hearing. I
had nails and shrapnel in my legs and feet.
Tell us about your road to recovery
It took about a year. I was in the hospital in Israel for about three
weeks. I then recuperated at my parent’s house for about six
months. I underwent physical therapy and occupational therapy in
Vancouver. There was psychological trauma I had to overcome. I
had post-traumatic stress disorder in association with any loud
noises or crowds. I did some counselling in Israel related to that.
What did you learn about yourself because of this event?
I learned that anybody can survive anything and that you just
need the will and determination to come back. You take the sit-
uation, do the work necessary to heal yourself, and you come
back stronger.
Do you practice dentistry today?
Yes, I have my own practice in Vancouver.
How are you trying to redress what happened to you?
I am involved with an organization called C-CAT, which is the
Canadian Coalition Against Terror. That organization is trying
to introduce legislation that will allow Canadian victims of ter-
rorism to sue the perpetrators responsible for it. It would help
people in Canada get benefits they have not been able to get.
To get assistance from the Canadian government now, you
would have to have been a victim [of terrorism] in Canada.
What the lay press is saying
damage to its beak. Staff at the local Bird Treatment and Learning Center turned to
Dr. Johnson, who patched up the beak with the same material used to make tem-
“Larry is April in the ‘Dentists of Wall Street’ calendar.”
There are no programs available for those who have been vic-
tims [of terrorism] abroad. This law will help allow Canadians
access to medical services that they need. When I applied for
medical service plan benefits, I was told that I could not [get
the benefits] because I was not a victim of violence in the
province of British Columbia. I was told that the benefits
would not cover acts that occurred abroad.
What are your future personal goals?
I want to help in any way possible to get this bill passed by par-
liament. I have gone to Ottawa and have met with several sena-
tors, and I have testified at the hearings. I hope to be standing
present one day when they pass the law. This law will affect not
only me, but generations to come.
What are your future professional goals?
In our practice, we strive to provide exceptional dentistry and
to nurture the souls of people who are frightened and who
have dental phobias. I want to build a successful practice.
Would you go abroad again and volunteer as a dentist?
Yes, I would do it in a heartbeat. I think it was just a case of
being in the wrong place at the wrong time. Many people in this
world have things that are hard in their lives, and I think differ-
ent people have different things happen to them. I was lucky
enough that I was spared and that I have been able to fully
recover from my injuries. I work hard to be a good person. I
help those in need that I can, in memory of the people who
died around me that day.
In this instalment of Dental Chronicle’s ongoing series of interviews
with notable clinicians and researchers, Dr. Wise spoke with writer
Louise Gagnon. The editors invite your suggestions for future
subjects of this feature. Please e-mail your suggestions to:
dental@chronicle.ws
and a yellow highlighter, reports The
Canadian Press (Feb. 7, 2010). The bird
had been found in December with severe
porary crowns for people. The ‘crown’ is being held on with
poster putty, and Dr. Johnson used the highlighter to help
blend the repair in to the beak. A representative from the
bird center reported that the eagle is doing just fine but is
not expected to be able to return to the wild.
Cherokeean Herald A management company that handled
billing and related services for dental practices has received
what has been described as a slap on the wrist for submitting
unlawful claims, reports the Texas news source (Jan. 27, 2010).
The Texas investigation into the dental management company
FORBA revealed the company improperly billed Medicaid
programs for pediatric dental treatments that were either
unnecessary or performed in a manner that did not conform
to recognized standards of care. The Medicaid-funded reim-
bursements at issue covered a range of dental services for
low-income children including baby root canals, crown place-
ments, tooth extractions, fillings, and sealants. In a $24 million
multi-state settlement, $546,000 was recovered for Medicaid.
DentalChronicle
 Dental_Feb_10_rar13.qxd:Dental_Feb_10_rar13.qxd 07/04/10 3:39 PM Page 27

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

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