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ISSUE 1 September-December 2017

Dental I nsi gh ts M AGAZI N E

How i s tech nol ogy sh api ng th e f uture of Denti stry?

Dental I nsi gh ts | Issue 1 September-December

Content s Page 8: Research Evidence to support the role of Orthodontics in improving well-being by University of Sheffield School of Clinical Dentistry, UK.

Page 12: Technology Exploring Cone Beam CT in Dentistry, King's College, London, UK.

Page 16: Interview Andreas Schultheiss, Founder & CEO of Rapid Shape on 3D printing, a new partnership with Straumann and the future of Dentistry.

Page 16: Page 18: Feature Global Dental Relief: smiles all over the world.

Page 22: Expert Opinion Reconciling Modern Cosmetic Dentistry with Dental Ethics.

Page 26: Research New study by the University of Plymouth UK identifies a method to reduce dental implant failure.

Page 28: Information Share Oral Cancer: Information guide for early detection by NIDCR, US.

Page 32: Business Focus Develop a top performing Dental Practice with strategic planning.

Editorial contact details: For advertising & sponsorship opportunities please contact: Sophia Smith 4

Interview : Andreas Schult heiss, Founder & CEO of Rapid Shape t alks about 3D print ing, and a new part nership w it h St raumann.

Dental I nsi gh ts | Issue 1 September-December

Page 18: Global Dent al Relief, helping children smile. 5

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Editorial Cont ributors

Dr. Suk Ng: PhD, BDS, BSc, FDS RCS Eng, DDRRCR President, British Society of Dental and Maxillofacial Radiology, Consultant in Dental & Maxillofacial Radiology, Guy?s & St Thomas?NHS Foundation Trust and King's College Hospital NHS Foundation Trust. Honorary Clinical Senior Lecturer, King?s College London.

HANIEH JAVIDI Hanieh has recently completed an NIHR Academic Clinical Training Fellowship in Orthodontics at the University of Sheffield. She has now been awarded the 2017 joint Faculty of Dental Surgery Royal College of Surgeons (Eng)- British Orthodontic Society Research Fellowship, and will be starting her PhD in October 2017. Her PhD will investigate whether orthodontic treatment to correct malocclusion, improves the social and emotional well-being of young people, particularly during adolescence.

SUZANNE L. MASLO, DMD, MBA, MA, BSBA Suzanne L. Maslo, DMD, MBA, MA, BSBA has 17 years of professional experience including General Dentistry, Business Administration, Military Leadership, University Instruction and Dental Directorship. She earned her Doctor of Dental Medicine at the University of Pittsburgh School of Dental Medicine, her Master of Business Administration and Master of Public Policy at Regent University in Virginia Beach, VA, and her undergraduate Bachelor of Science in Business Administration at Geneva College in Beaver Falls, PA where she graduated as Salutatorian. She is actively involved in community dentistry and has provided dental care to the underserved in Emporium, PA, Johnsonburg, PA, Kersel, PA, Pittsburgh, PA, and W ilkinsburg, PA. She has served patients also in Port-Au-Prince, Haiti, LaGanove, Haiti, Accra, Ghana, San Jose, Honduras, Beijing, China, Inner Mongolia, China, Nairobi, Kenya, Leah, India, Siem Reap, Cambodia, Antigua, Guatemala, Cap Haitian, Haiti, Big Island, Hawaii, and the Hoopa Indian Tribe in Hoopa, CA. She is a member of the American Dental Association, the Academy of General Dentistry, the National Network for Oral Health Access, the Pennsylvania Dental Association, the Association of Military Surgeons of the United States, and the Christian Medical and Dental Association. Suzanne is currently the Dental Director for Keystone a rural Health Consortia, Inc. She worked 15 years at East Liberty Family Health Care Center's Lincoln Lemington Site, a Federally Qualified Health Care Center in Pittsburgh, PA. She has also served in the Air Force Reserve Command as Chief of Dental Services and Deputy Commander of the 911th ASTS, Pittsburgh, PA. In these roles she is continuously seeking creative ways to foster a dynamic environment while striving to promote high quality patient care. BARRY SCHWARTZ, DDS, MHSC (BIOETHICS), CERT ADR, FPFA, FACD Barry Schwartz is Assistant Professor at Schulich Medicine & Dentistry, Western University, London Ontario and is Course Director for Practice Administration where the focus is on critical thinking, interpersonal-communications and applied ethics. He received his DDS and MHSc in Bioethics from the University of Toronto. Dr. Schwartz was in clinical practice for 25 years. He conducts ongoing research projects at Western and has published many articles both nationally and internationally on the subject of dental ethics. He was awarded the Fellowship in Teaching Innovation Research Award at the University of Western Ontario. Dr. Schwartz has been recognized as a Fellow of the Pierre Fauchard Academy and a Fellow of the American College of Dentists for his contributions in dental ethics.

MICKEY BERNSTEIN, DDS Dr. Mickey Bernstein has practiced dentistry for 41years in Germantown, Tennessee. He is an Accredited Member and 2008-2009 President of the American Academy of Cosmetic Dentistry. He has received the honor of Fellow in the Academy of General Dentistry, the American College of Dentists, and the International College of Dentists, and is an Alumnus of the L. D. Pankey Institute. Dr. Bernstein enjoys sharing his dental experiences through lecturing and writing on esthetic practice development and cosmetic design and has founded the UT/ AACD Student Esthetic Study Club, serving as mentor and Adjunct Professor. He has lectured nationally and authored articles in dental journals.He has served on numerous committees for the AACD including the Professional Education Committee for 5 years and the Nominating and Leadership Development Committee for 3 years. Dr. Bernstein has a special interest in helping patients with teeth and lives damaged by eating disorders and assisting survivors of domestic abuse through the AACD ?Give Back a Smile?Program. He is very involved with the Kindness Revolution, a non-profit promoting Values and Principles through Kindness in businesses, schools, and communities. He is a partner in Bernstein Consulting, helping dental practices, businesses, and organizations achieve their dreams. He spends his remaining time with his wife, Diane, 7 children and 12 grandchildren. DIANE BERNSTEIN Diane Bernstein has been involved in the field of healthcare since 1972. She graduated with honors from the Baptist Hospital School of Radiology Technology, and before changing careers, she managed the Radiology Department of a large Multi-Specialty Medical Practice with 5 locations and 25 employees. She became the Practice Administrator for Germantown Dental Group in 1993; a practice with 4 doctors, and a staff of 21 team members. In 2006 she became the Patient Coordinator for her husband, Dr. Mickey Bernstein. They help dental practices achieve their dreams through Bernstein Dental Consulting. Diane speaks on a variety of dental and personal development topics. Together they enjoy spending their leisure time with their 7 children and 12 grandchildren. Diane enjoys sharing her ability to communicate effectively through lecturing and consulting.


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Ev i dence to support th e rol e of orth odonti cs i n i mprov i ng w el l -bei ng. Research undert aken at t he Universit y of Sheffield School of Clinical Dent ist ry has found t hat ort hodont ic t reat ment before t he age of 18 years improves oral healt h-related qualit y of life (OHRQoL), w it h t he most improvement being in emot ional and social well-being. BY: HANIEH JAVIDI 8

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The perceived health benefits of orthodontic treatment are a subject area that has been explored for a number of years. Traditionally it was assumed that orthodontic treatment largely led to improvements in dental health, and a number of studies have explored the association between correction of malocclusion and the reduced incidence of caries1 or periodontal disease2, 3. However, it has since been recognized that any relationship observed is often due to changes in behaviour, such as improved oral hygiene regimes that are established as a result of

wearing orthodontic appliances, rather than the treatment itself. Nonetheless, it is crucial that the potential health benefits of orthodontic treatment are not only considered in terms of dental health, but also with regards to the impact that such treatment can have on the social and emotional well-being (SEW B) of individuals. Attempts to estimate the impact of oral conditions on SEW B, as well as oral function and symptoms, have been done using measures of oral health-related quality of life (OHQoL). Locker 5and Allen defined OHQoL as ?the impact of oral disorders on aspects of everyday life that are important to patients and persons, with those impacts being of sufficient magnitude, whether in terms of severity, frequency or duration, to affect as individual's perception of their life overall'5. Practicing clinicians providing orthodontic treatment

will almost certainly have treated patients who have expressed a sense of embarrassment or unhappiness when smiling or talking to other people, and have gone on to report how this has been overcome after they have completed their treatment. OHQoL is an ideal patient-reported outcome measure that can be used to try and quantify such benefits. In contrast to dental health, there is now a growing body of evidence that malocclusion can have a significant affect on the OHQoL of individuals, and in particular, on SEW B6, 7 . A recent systematic review and meta-analysis conducted at the University of Sheffield School of Clinical Dentistry has now found evidence of moderate quality, that orthodontic treatment provided before the age of 18 years, leads to improvements in OHQoL8.

"It is crucial that the potential health benefits of orthodontic treatment are not only considered in terms of dental health, but also with regards to the impact that such treatment can have on the social and emotional well-being of individuals."


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The study involved a thorough search and identified 13 relevant studies for inclusion. The quality of all these studies was rigorously assessed using appropriate tools. Four of these studies used similar outcome measures and assessed the OHQoL of individuals before and after orthodontic treatment. This data was combined and demonstrated that the improvement was appreciable, and in particular, moderately large in the areas of SEW B. These findings are highly significant for the orthodontic specialty because, until now, although there was evidence that malocclusion impacted negatively on SEW B, there was little evidence that orthodontic treatment led to improvements in this. One of the drawbacks highlighted in the systematic review was that the overall number of young people included in the studies was relatively small, and so further research in the area is needed. Hanieh Javidi, who 10

co-authored the paper together with colleagues Professor Philip Benson and Dr Mario Vettore, has recently been awarded the 2017 joint Faculty of Dental Surgery Royal College of Surgeons (Eng)British Orthodontic Society Research Fellowship and will be investigating the impact of orthodontic treatment on OHQoL further, in a multi-center, longitudinal cohort study. The study will follow a group of patients before and after their orthodontic treatment, and will compare the outcomes to a control group that will consist of participants on a waiting list for treatment. It is envisaged that on completion of this study, it can be determined with greater certainty, the impact that orthodontic treatment has on OHQoL.

References 1. Hafez HS, Shaarawy SM, Al-Sakiti AA, Mostafa YA. Dental crowding as a caries risk factor: a systematic review. Am J Orthod Dentofacial Orthop 2012;142:443-50. 2. Helm S, Petersen PE. Individual changes in malocclusion from adolescence to 35 years of age. Acta Odontol Scand 1989;47: 211-6. 3. Sadowsky C, BeGole EA. Long-term effects of orthodontic treatment on periodontal health. Am J Orthod 1981;80:156-72. 4. Benson PE, Javidi H, DiBiase AT. What is the value of orthodontic treatment? Br Dent J 2015;218:185-90. 5. Locker D, Allen F. What do measures of 'oral health-related quality of life' measure? Community Dent Oral Epidemiol 2007;35:401-11. 6. Dimberg L, Arnrup K, Bondemark L. The impact of malocclusion on the quality of life among children and adolescents: a systematic review of quantitative studies. Eur J Orthod 2015;37:238-47. 7. Kragt L, Dhamo B, Wolvius E, Ongkosuwito EM. The impact of malocclusions on oral health-related quality of life in children-a systematic review and meta-analysis. Clin Oral Investig 2016 Nov;20:1881-1894. 8. Javidi H, Vettore M, Benson PE. Does orthodontic treatment before the age of 18 years improve oral health-related quality of life? A systematic review and meta-analysis. Am J Orthod Dentofacial Orthop 2017;151: 644-655.

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Ex pl ori ng Cone Beam CT i n Denti stry By: Dr. Suk Ng: PhD, BDS, BSc, FDS RCS Eng, DDRRCR President, British Society of Dental and Maxillofacial Radiology, Consultant in Dental & Maxillofacial Radiology, Guy?s & St Thomas?NHS Foundation Trust and King's College Hospital NHS Foundation Trust. Honorary Clinical Senior Lecturer, King?s College London.

Cone beam computed tomography (CBCT) has revolutionized dentistry. CBCT makes it possible to see the third dimension, for example, in the bucco-lingual plane, which conventional dental radiography cannot show.

THE TECHNOLOGY In many countries, a dentist can purchase a dental CBCT machine without special training or other prerequisites. Before CBCT scanners were commercially available, patients would be sent to hospitals to get medical CT scans to show the jaw bones.

Now, because CBCT scans give far A CBCT scan performs one lower radiation doses compared to "CBCT makesit 360 degree revolution medical CT, it?s a no-brainer to use around the patient?s head, possible to see the CBCT instead. Apart from aiding and takes several hundred diagnosis and treatment planning, X-ray exposures. It uses third dimension, for the presence of a CBCT machine boosts the profile of a dental this information to example, in the practice. reconstruct a three-dimensional image bucco-lingual plane, Not all CBCT machines are the same. Some are ?small volume?, as small as of a tooth or any number x 4 cm, thus show two teeth at high which conventional 4resolution. of teeth in the jaws. Others are medium or Clinical applications large volume, as large as 23 cm, and dental radiography can show the whole include assessing the maxillofacial relationship between a skeleton. Some machines have cannot show." X-ray ?pulsing?thus can reduce the lower third molar and the radiation dose whilst still producing an image of adjacent ID canal; assessing the degree of sufficient quality to fulfil the diagnostic task. Some impaction of unerupted teeth; measuring machines allow the voxel size to be adjusted, which bone width and height prior to placing helps to reduce radiation dose (larger voxel) or to implants; assessing pathological lesions improve spatial resolution (smaller voxel, but higher dose) depending on the clinical question being and also aiding imaging guided asked. All this technology and increased diagnostic procedures such as the construction of yield sounds wonderful, but there is a catch: very implant drilling guides. few dentists will have received teaching about CBCT


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scans at dental school. Most undergraduate dental programmes do not teach CBCT topics such as justification, dose optimisation and radiological interpretation, therefore specific training is important before a dentist acquires a CBCT machine.

REGULATION AND PRACTICAL CONSIDERATIONS So, where can dentists receive training? Companies that sell machines must provide practical training in the basic use of the equipment and software. In terms of theoretical and clinical training, there are published guidelines recommending topics to be included in training courses, as well as the number of hours required. In the UK, the IRMER 2000 regulations require that all X-ray investigations are given a ?clinical evaluation?, which means keeping a formal written record (radiology report) of findings. Someone has to look at all slices within a CBCT scan, and make a radiology report. W ho that should be is not well specified in current regulations.

In fact, IRMER regulations are being reviewed right now and will be published in February 2018. Currently, different arrangements for formal reading of a CBCT scan are happening nationally, with the person being:



The dentist (the referrer) who is providing the actual treatment for which the CBCT scan has been deemed necessary; The dentist who has performed the CBCT scan; A medical or dental radiologist at a hospital that performs CBCT scans; A radiologist at an ?imaging centre?(a business that provides CBCT scans and other diagnostic imaging).

NEW ARRANGEM ENTS W ith the new IRMER regulations and new Dental Guidance Notes coming out soon, dentists who use CBCT should be aware that they must get appropriate training from suitably qualified teachers on:


Knowledge and duties expected of a referrer; Knowledge and skills associated with the interpretation of CBCT scans (if they are responsible for the interpretation).

W ith the easy transmission of CBCT scans via internet, it is common practice to send CBCT scans to a radiologist elsewhere to be reported. However, if the radiologist is not registered to practice in the UK, then it could be perceived as practising without a licence. Dentists who use such a reporting service should be aware of the potential medico-legal difficulties.

TRAINING Dentists interested in using or buying a CBCT scanner can attend training for ?referrers?, and some one or two day courses are available. Dentists wanting to write radiology reports for their patients should look out for CBCT ?interpretation?courses given by qualified dental maxillofacial radiologists. Fuller training is now available with the new Postgraduate Certificate in Dental Cone Beam CT Radiological Interpretation from King?s College London. This is a 9 month part-time, distance learning course (with a face-to-face training block) and the first university-based training of its kind. Launching for the first cohort in January 2018, and taught by experts, all at consultant level and GDC-registered specialists, dentists can train to use CBCT imaging, to help diagnose clinical problems of the dento-alveolar areas of the jaws, correctly interpret the radiological signs and write structured radiological reports, whilst continuing to work in practice. w w cbct


Dental I nsi gh ts | Issue 1 September-December

A ndreas Sch ul th ei ss Founder & CEO of Rapi d Sh ape tal k s 3D Pri nti ng and th e f uture of Denti stry


Dental I nsi gh ts | Issue 1 September-December

INTERVIEW Further applications, including partial frameworks, bite splints and ortho models, can also be produced. These printers are very efficient because they are fully automated and they consume only the material volume needed for the component being manufactured, in contrast to manual work or milling. Furthermore, local installation eliminates delivery time and costs. Our printers are compact, reliable and very quick - thanks to force feedback technology. For example, drill templates and temporaries can be produced in approximately 16 minutes. They are also tailored specifically to the needs of dental labs and practices, unlike generic equipment supplied for all user groups.

In June t his year, it w as announced t hat St raumann and Rapid Shape have entered into a part nership. Can you tell me more about how t he part nership w ill work from a st rategic perspect ive?

W hat are t he advant ages of t he ?open system? approach? Rapid Shape customers are offered a wide selection of materials from our certified material partners. It is also possible to use materials from third-party suppliers with the open parameter settings.

3D printing is growing rapidly - not just in dental labs but also in dental practices. Its current use in implant dentistry and orthodontics, as well as the potential future applications make it highly attractive for Straumann. With the market taking off, Rapid Shape needed to add sales power in order to maintain its leading position in the dental field. Recognizing our mutual interests, we signed a distribution agreement and, in the meantime, Straumann has acquired a 38% stake in Rapid Shape. This ensures that Straumann has access to expertise and proprietary technology in additive manufacturing and provides Rapid Shape with the security to invest further ?from own funds? in R&D, production and service.

As a result, customers can choose materials that best fit their needs without the restrictions of closed systems where the mark-up on material prices is typically up to 150%. Materials - not the depreciation of the printer - are therefore the main factor in calculating the overall costs. Apart from the economic considerations, open systems promote innovation ? hardly a week passes in which we do not receive new materials from our partners.

Can you tell me more about Rapid Shape, and in part icular more about your dent al product s such as ?Lab line? and ?Heady Dut y Line?.

A decade ago mainly large, expensive and complex additive manufacturing systems were available working with generic materials only.

Rapid Shape is a family business that emerged from Schultheiss, a leading manufacturer of casting solutions for the jewellery industry. The company was a pioneer of 3D printing applications in its field and already supplied 3D printers to customers in the 1990s. In cooperation with TNO, the national Dutch research institute, Rapid Shape implemented the proprietary force-feedback technology making 3D printing significantly faster. Our ?Lab Line?range was developed for labs, practices and even smaller centralized manufacturing centres. Working with the same quality standard as the large units, lab systems are simple, intuitive and affordable. Our ?Heavy Duty Line?uses robotics and a high level of automation to minimize production costs, making it ideal for large labs and centralized manufacturing.

Today compact, tailor-made systems are available for labs and practices as well as medical-grade materials specifically for dental applications. Labs and practices today have to work under immense time and cost pressures. 3D printing offers one solution to both these challenges. It also supports modern procedures like guided surgery to make treatment safer, faster and cheaper.

W hy do you consider Rapid Shape technology innovat ive in t he market ?

For more informat ion, please visit :

Our 3D printers enable dental labs to produce temporary prosthetic restorations, models and drill templates in certified precision for guided surgery.

In your opinion, w hat are t he most significant advances in 3D print ing w it hin dent ist ry to date, and w hat are t he benefit s of using t his t ype of technology in dent al labs and pract ices?

There is no quest ion t hat 3D print ing technology is fast becoming a key part of t he Dent al Indust ry. How do you foresee t his technology developing in t he fut ure? Market forecasts suggest that the installed base and output of dental 3D printers could triple over the next five years. We believe that in five years?time many labs will be wondering how they ever managed without this technology.

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Dental I nsi gh ts | Issue 1 September-December

Smi l es A l l Ov er Th e Worl d: Gl obal Dental Rel i ef Global Dental Relief volunteers have been working since 2001 to bring dental care to children overseas. GDR now works in six countries? Nepal, India, Vietnam, Guatemala, Kenya, and the newest location, Cambodia. Global Dental Relief was originally founded as the Himalayan Dental Relief Project by former Director of Colorado State Parks, Laurie Mathews, and dentist Andrew Holecek. While on sabbatical in Nepal, Laurie and Andrew recognized the desperate need for dental care in a country which, at the time, had 120 dentists for a population approaching 24 million. They knew that if children received early dental care and oral health education, it would change their lives. Since being founded, over 2,237 GRD volunteers have served over 133,047 children in these locations. They have also raised $29,374,995* in donated care to date. *Live statistics on Global Dental Relief website, September 2017.


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CLINIC SETTING AND WORK STRUCTURE: GDR welcomes dentists from all specialties. Dental clinics are set up in a school or community room and provide free dental care to children (ages 6 -15 years) from surrounding schools and orphanages. GDR provides portable dental units and all instruments and supplies necessary to perform restorations and extractions. Clinics maintain an efficient pace, which allows Dentist volunteers to treat an average of 100 kids per day. Teachers bring the children to the clinic classroom by classroom.

"We treat primary teeth in cases of abscess only by doing an extraction. Otherwise, we leave teeth in as placeholders. We do not fill primary teeth, instead devoting our limited time and resources to saving permanent teeth. Generally, we treatment plan two quadrants and do about 20 ? 30 minutes of work per child. Children can return for a 2nd or 3rd visit to finish their treatment."

Along with toothbrush instruction and nutrition counseling, each child receives a fluoride varnish treatment.. GDR are committed to treating a school every 1.5 to 2 years to improve the oral health of each child and instill a culture of good oral hygiene for generations to come.


Non-dental individuals make up 60% of each volunteer team. General volunteers manage the patient flow and records and assist dental professionals. Specific duties include oral health education, instrument sterilization, record keeping, clinic flow, and managing the lines of children waiting for treatment. General volunteers may also be trained as chair side assistants, as skills and interest allow. Find out more:

Each clinic has the capacity for one to two hygienists who provide cleanings and in limited cases, place sealants. Hygienists are equipped with cavitrons and a range of scaling instruments.

Page 20-21, read a Global Dental Relief volunteer testimonial

"GDR are committed to treating a school every 1.5 to 2 yearsto improve the oral health of each child and instill a culture of good oral hygiene for generationsto come."


Dental I nsi gh ts | Issue 1 September-December

After one week of work from dawn to dusk and approximately 200 extracted teeth - I decided that I also wanted to be able to physically make a difference in lives by providing dental care to the people around me.

My name is Suzanne L. Maslo. I grew up in the inner city of Pittsburgh, PA. After high school, I went straight to college and attained a Bachelor of Science in Business Administration. After graduation from undergraduate school, I entered into a Masters Degree Program and graduated with a Master of Business Administration and a Master of Public Policy three years later. Once I attained a "real job" in my fields of study it didn't take long to determine that what I was doing really was not a good fit with my gifts abilities and talents. I just was not happy with how I spent my time each day working behind a desk. My brother was a newly graduated dentist at that time in my life (at this point I was 28 years old) and we decided to take a trip to the Island of Haiti to see if we


could make a difference by providing dental care to Haitians that have little access to dental care. So off we went with our bag of supplies packed - to go and make the world a better place. After one week of work from dawn to dusk and approximately 200 extracted teeth - I decided that I also wanted to be able to physically make a difference in lives by providing dental care to the people around me. There was only one small problem - I was a Business major and took zero credits in the science field. Back to school, I went to attain 32 credit hours of science so I would be able to apply to Dental School. It took me two years of night classes (while I was working a full-time job during the day) to complete this mission. So, when I was 32 years old, I began my first

semester of Dental School. Fortunately, 4 years of dental school flew by and before I knew it I was an official dentist ready to practice my skills on my friends, family, and community. By this time, I had accumulated a large amount of debt to pursue this dream. On one of my last days in dental school I ran into a recruiter who introduced me to the idea of serving my country by practicing my dental skills. At that time there was a loan repayment incentive to enter the military. Before I knew it I was commissioned as a Captain in the United States Air Force as a dentist. I always knew that I was wired to help people around me. Dentistry was the perfect fit for me. In addition to serving in the Air National Guard a weekend a month, on the civilian side,

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I worked full time at a Federally Qualified Health Care Center in the inner city of Pittsburgh, PA. Our mission (and specialty) was serving the underserved. W hat an honor and privilege it was to go to work every day! Fifteen years later I am in the Air Force Reserve and working at a Federally Qualified Health Care Center in Rural Pennsylvania still doing what I love to do. One day when I was visiting a friend, I saw an article about Global Dental Relief and the difference that volunteers were making in five countries across the globe. My friend and I decided right there that we needed to be a part of what was going on in the world around us. We called Global Dental Relief and signed up for a trip to Kenya. Since that trip, we have been on three more Global Dental Relief trips to India, Cambodia, and Guatemala. We are signed up for two more - to Nepal in November 2017 and Kenya in October 2018. We were volunteers with open hearts and

minds. We experienced first hand that anyone can make a difference in the world, whether it is in our day to day lives or half way across the world. We were part of a team where everyone had something to contribute. We all played a special part and contributed to the overall mission. We were like-minded and determined to take care of children that desperately needed dental attention. We were all in different places on the journey of life but we were able together to make a huge impact. In preparation for writing this article, I gathered some information concerning the number of short term trips I have participated in over the years, I am proud to say, I have participated in 25 dental relief trips. These experiences have been with a number of different organizations.

My final thoughts: 1. It's NEVER too late to do something you have never done or have always wanted to do. Just Do It! 2. Be aware of your surroundings and notice things around you. Be in the moment. There are many friends & even strangers around you that could use a kind word. 3. It is always worthwhile making difference in the world. It doesn?t have to be participating in short term dental trips, although I highly recommend them. Each of us has a unique composition of gifts, abilities, talents and personalities that are able to change the world for better. So go and change your world whatever that means for you. You will never be the same - and our world will be ever so grateful!

w w w.globaldent


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Reconci l i ng M odern Cosmeti c Denti stry w i th Dental Eth i cs BY: BARRY SCHWARTZ, DDS, MHSC (BIOETHICS), CERT ADR, FPFA, FACD

University of Western Ontario, Canada. 22

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Dent al pract ice has changed rapidly over t he last decade.

Any lack of discussion about the potential risks involved, such as sensitivity, or even why patients feel they need whiter teeth, raises issues with both non-maleficence and autonomy.

W ith better education of patients, increased fluoride use, improved oral hygiene, better access to information over the Internet and social media, many dentists are seeing a decrease in the need for basic restorative services due to fewer cavities. So as not to have holes in their appointment books, many dentists have turned to providing more elective dental treatment, in the form of cosmetic dentistry, to their patients. These changes have also raised some ethical concerns along the way. This article will attempt to reconcile some of the major ethical concerns with modern cosmetic dentistry.

One enormous driving factor in the push for cosmetic dentistry is money. According to a recent market analysis, the global cosmetic dentistry market is expected to reach USD 28 Billion (ÂŁ 22 Billion) by 2024. Consequently, many dental product companies have developed advertising campaigns geared towards both dentists and patients to enlarge their market and increase their market share in this growing industry. Yet, there may be sacrifices made when chasing this new-found wealth. And that sacrifice could include patient trust.

It is important to start with a definition of what is meant by Cosmetic Dentistry. The online Medical Dictionary describes it to include a variety of dental treatments aimed at improving the appearance of the teeth through; bleaching, bonding, veneers, reshaping, orthodontics or implants. The foremost ethical obligation towards their patients is to maintain and improve patients?oral health without causing patient harm. The ethical principles involved are: beneficence; ensuring that treatments are in the best interest of the patient, autonomy; respecting patients?rights to decide, after being fully informed of all risks and benefits by their dentist, justice; being fair and truthful while following all regulations, and upholding non-maleficence; ensuring that patients do not suffer any harm. The nature of cosmetic dentistry, being elective, means that the bar must be raised on disclosure of even less likely risks. Many dentists market cosmetic services to raise awareness of the potential for that ?perfect smile.? Other patients are influenced by the media. A recent New Zealand study has demonstrated that popular media, especially television, appears to have had an impact on the demand for cosmetic dental procedures. Programming such as ?Extreme Makeover,?and direct by manufacturers for tooth whitening have encouraged many patients to seek out dentists who do bleaching. Many dentists in North America advertise free bleaching to new patients, although after reading the fine print of what qualifies for the free bleaching, a savvy consumer may realize that it isn?t entirely free. This lack of veracity can strain the justice principle.

In a recent Ipsos Reid Poll that was commissioned by the Canadian Dental Association in 2009, 3500 Canadians were asked their views towards dentists, dentistry and oral health. The results regarding questions on cosmetic dentistry were that: 1) W hile a majority of Canadians do not see dentistry as only cosmetic, the cosmetic aspect does raise doubts about the value of dentistry and the motives of dentists, 2) Many people assume that the cosmetic side of the profession is largely driven by dentists looking for revenue and is, therefore, not really about patient health or well-being, and finally 3) More Canadians ?completely agree?or ?agree?with the statement ?Dentists are business people?than those who ?completely agree?or ?agree?that ?Dentists are doctors?(63% vs. 57%). Seeing as cosmetic dentistry is a worldwide phenomenon, I doubt that these public opinions are strictly a Canadian singularity. Cosmetic dentistry is not without controversy. Many ardent cosmetic dentists will tell you that they improve their patients self esteem and contribute to their successful promotions at work. On the other side of the argument, Jenson wrote that dentists are not licensed to practice psychology and are not equipped to make judgments in these areas. Jenson?s concludes that many cosmetic procedures cannot be supported ethically and dentists should not willingly contribute to the harm that many patients?choices bring. Dentistry is both a business and a profession. According to Ahmad; ?in providing cosmetic treatments, dentists must carefully balance professionalism, their clinical skills, supported by evidence-based methods, and their business practices.?Unfortunately, what is best for the patient and what is best for the business, can be both trying and conflicting.


Dental I nsi gh ts | Issue 1 September-December

In the UK, dentists don?t have to look far to take courses in cosmetic/ aesthetic dentistry. A current course says it is ideal if you: ?want to take on more complex cosmetic cases, looking to increase the amount of cosmetic work you undertake, want to move in to private dentistry.?These types of courses are a sizeable investment at approximately ÂŁ7000 for a 13 day course. Another casualty in a greater shift towards private dentistry, is access to care for the socio-economically disadvantaged. One former US cosmetic dentist even published a book entitled; ?Confessions of a former cosmetic dentist,?which highlights the tactics used by cosmetic dentists to influence their patients and why patients should think twice before agreeing to smile makeovers so that they can avoid irreversible damage to their smiles. According to Zuk, it is the lack of informed consent about the potential risks and permanent damage to natural teeth as well as taking advantage of the power imbalance that exists between dentists and patients that is undermining the dentist-patient relationship.

?Cosmetic dentistry has become increasingly popular, largely because of social trends and increased media coverage. This understandable desire for the alleged 'perfect smile' needs to be tempered with an appropriate awareness of the significant risks associated with invasive cosmetic proceduressuch as veneers and crowns"

In the UK in 2015, there was a joint statement by the UK specialist dental societies which highlighted the implementation of ethics in relation to elective cosmetic dental interventions and sums up the points I have tried to raise in this article. They are as follows; ?Cosmetic dentistry has become increasingly popular, largely because of social trends and increased media coverage. This understandable desire for the alleged 'perfect smile' needs to be tempered with an appropriate awareness of the significant risks associated with invasive cosmetic procedures such as veneers and crowns. Patients need to be properly informed that elective removal of healthy enamel and dentine can result in pulpal injury and poorer periodontal health in the longer term, particularly if they are young. The duty of candour means that they ought to be informed that aggressive reduction of sound tooth tissue is not biologically neutral and results in structural weakening of their teeth. Less invasive procedures such as bleaching on its own or for example, combined with direct resin composite bonding, can satisfy many patient's demands, while still being kinder to teeth and having much better fall-back positions for their future requirements.


It is the opinion of the British Endodontic Society, British Society for Restorative Dentistry, Restorative Dentistry UK, Dental Trauma UK, British Society of Prosthodontics and the British Society of Paediatric Dentistry that elective invasive cosmetic dental treatments can result in great benefit to patients, but that some aggressive treatments used to achieve them can produce significant morbidities in teeth which were previously healthy. This is a worrying and growing problem with many ethical, legal and biologic aspects, but many adverse outcomes for patients who request cosmetic dental improvements are preventable by using biologically safer initial approaches to treatment planning and its provision.? The growth of cosmetic dentistry has already changed perceptions of patients about the commercial aspects of dentistry. Dentists who continue to uphold their professional ethics with regards to cosmetic dentistry, will be able to guide their patients appropriately to select treatment options that will be in their best interests for the long term. In this way, reconciling ethics and cosmetic dentistry will be less of a challenge.

Barry Schwartz is Assistant Professor at Schulich Medicine & Dentistry, Western University, London Ontario and is Course Director for Practice Administration where the focus is on critical thinking, interpersonal-communications and applied ethics. He received his DDS and MHSc in Bioethics from the University of Toronto. Dr. Schwartz was in clinical practice for 25 years. He conducts ongoing research projects at Western and has published many articles both nationally and internationally on the subject of dental ethics. He was awarded the Fellowship in Teaching Innovation Research Award at the University of Western Ontario. Dr. Schwartz has been recognized as a Fellow of the Pierre Fauchard Academy and a Fellow of the American College of Dentists for his contributions in dental ethics.

Dental I nsi gh ts | Issue 1 September-December

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Dental I nsi gh ts | Issue 1 September-December


New study i denti f i es successf ul meth od to reduce dental i mpl ant f ai l ure Nanocoatings developed and assessed at the University of Plymouth have shown promising protection for dental implants. BY: ANDREW GOULD.


Dental I nsi gh ts | Issue 1 September-December

According to the American Academy of Implant Dentistry (AAID), 15 million Americans have crown or bridge replacements and three million have dental implants ? with this latter number rising by 500,000 a year. The AAID estimates that the value of the American and European market for dental implants will rise to $4.2 billion by 2022. Dental implants are a successful form of treatment for patients, yet according to a study published in 2005, five to ten per cent of all dental implants fail. The reasons for this failure are several-fold ? mechanical problems, poor connection to the bones in which they are implanted, infection or rejection. W hen failure occurs the dental implant must be removed.

bacterial growth and reduced the formation of bacterial biofilm on the surface of the implants by 97.5 per cent. Not only did the combination result in the effective eradication of infection, it created a surface with anti-biofilm properties which supported successful integration into surrounding bone and accelerated bone healing. Professor Christopher Tredwin, Head of Plymouth University Peninsula School of Dentistry, commented: ?In this cross-Faculty study we

guidelines in dental or medical implant legislation and we are, with colleagues elsewhere, guiding the way in this area. The EU recognises that medical devices and implants must: perform as expected for its intended use, and be better than similar items in the market; be safe for the intended use or safer than an existing item, and; be biocompatible or have negligible toxicity.?He added: ?Our work has been about proving these criteria which we have done in vitro. The next step would be to demonstrate the effectiveness of our discovery, perhaps with animal models and then human volunteers.?Dr Alexandros Besinis, Lecturer in Mechanical Engineering at the School of Engineering, University of Plymouth, led the research team.

?In this cross-Faculty study we have identified the means to protect dental implants against the most common cause of their failure. The potential of our work for increased patient comfort and satisfaction, and reduced costs, is great and we look forward to translating our findingsinto clinical practice.?

The main reason for dental implant failure is peri-implantitis. This is the destructive inflammatory process affecting the soft and hard tissues surrounding dental implants. This occurs when pathogenic microbes in the mouth and oral cavity develop into biofilms, which protects them and encourages growth. Peri-implantitis is caused when the biofilms develop on dental implants.

A research team comprising scientists from the School of Biological and Marine Sciences, Peninsula Schools of Medicine and Dentistry and the School of Engineering at the University of Plymouth, have joined forces to develop and evaluate the effectiveness of a new nanocoating for dental implants to reduce the risk of peri-implantitis. The results of their work are published in the journal Nanotoxicology. In the study, the research team created a new approach using a combination of silver, titanium oxide and hydroxyapatite nanocoatings. The application of the combination to the surface of titanium alloy implants successfully inhibited

have identified the means to protect dental implants against the most common cause of their failure. The potential of our work for increased patient comfort and satisfaction, and reduced costs, is great and we look forward to translating our findings into clinical practice.? The University of Plymouth was the first university in the UK to secure Research Council Funding in Nanoscience and this project is the latest in a long line of projects investigating nanotechnology and human health. Nanoscience activity at the University of Plymouth is led by Professor Richard Handy, who has represented the UK on matters relating to the Environmental Safety and Human Health of Nanomaterials at the Organisation for Economic Cooperation and Development (OECD). He commented:

He commented:

?Current strategies to render the surface of dental implants antibacterial with the aim to prevent infection and peri-implantitis development, include application of antimicrobial coatings loaded with antibiotics or chlorhexidine. However, such approaches are usually effective only in the short-term, and the use of chlorhexidine has also been reported to be toxic to human cells. The significance of our new study is that we have successfully applied a dual-layered silver-hydroxyapatite nanocoating to titanium alloy medical implants which helps to overcome these risks.? Dr Besinis has been an Honorary Teaching Fellow at the Peninsula School of Dentistry since 2011 and has recently joined the School of Engineering. His research interests focus on advanced engineering materials and the use of nanotechnology to build novel biomaterials and medical implants with improved mechanical, physical and antibacterial properties.

?As yet there are no nano-specific 27

Dental I nsi gh ts | Issue 1 September-December


ORA L CA NCER: A gui de f or earl y detecti on b y: Th e Nati onal I nsti tute of Dental and Crani of aci al Research , US. Oral cancer accounts for roughly three percent of all cancers diagnosed annually in the United States. Approximately 49,700 people will be diagnosed with oral cancer this year and about 9,700 will die from the disease. On average, 65 percent of those with the disease survive more than 5 years. W ith early detection and timely treatment, deaths from oral cancer could be dramatically reduced. The 5-year survival rate for those with localized disease at diagnosis is 84 percent compared with only 39 percent for those whose cancer has spread to other parts of the body. Early detection of oral cancer is often possible. Tissue changes in the mouth that might signal the beginnings of cancer often can be seen and felt. 28

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WARNING SIGNS Lesions that might signal oral cancer Two lesions that could be precursors to cancer are leukoplakia (white lesions) and erythroplakia (red lesions). Although less common than leukoplakia, erythroplakia and lesions with erythroplakic components have a much greater potential for becoming cancerous. Any white or red lesion that does not resolve itself in 2 weeks should be reevaluated and considered for biopsy to obtain a definitive diagnosis. Other Possible Signs and Symptoms:


Tobacco/ Alcohol Use

Most cases of oral cancer are linked to cigarette smoking, heavy alcohol use, or the use of both tobacco and alcohol together. Using tobacco plus alcohol poses a much greater risk than using either substance alone. -


Infection with the sexually transmitted human papillomavirus (specifically the HPV 16 type) has been linked to a subset of oral cancers. -


Risk increases with age. Oral cancer most often occurs in people over the age of 40. -

Possible signs and symptoms of oral cancer that your patients may report include: a lump or thickening in the oral soft tissues, soreness or a feeling that something is caught in the throat, difficulty chewing or swallowing, ear pain, difficulty moving the jaw or tongue, hoarseness, numbness of the tongue or other areas of the mouth, or swelling of the jaw that causes dentures to fit poorly or become uncomfortable. If these problems persist for more than 2 weeks, a thorough clinical examination and laboratory tests, as necessary, should be performed to obtain a definitive diagnosis. If a diagnosis cannot be obtained, referral to the appropriate specialist is indicated.

Sun Exposure

Cancer of the lip can be caused by sun exposure. -


A diet low in fruits and vegetables may play a role in oral cancer development.


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THE EXTRAORAL EXAMINATION The examination is conducted with the patient seated. Any intraoral prostheses are removed before starting. The extraoral and perioral tissues are examined first, followed by the intraoral tissues. · FACE: The extraoral assessment includes inspection of the face, head, and neck. The face, ears, and neck are observed, noting any asymmetry or changes on the skin such as crusts, fissuring, growths, and/ or color change. The regional lymph node areas are bilaterally palpated to detect any enlarged nodes. If enlargement is detected, the examiner should determine the mobility and consistency of the nodes. A recommended order of examination includes the preauricular, submandibular, anterior cervical, posterior auricular, and posterior cervical regions.

PERIORAL AND INTRAORAL SOFT TISSUE EXAMINATION The perioral and intraoral examination procedure follows a seven-step systematic assessment of the lips; labial mucosa and sulcus; commissures, buccal mucosa, and sulcus; gingiva and alveolar ridge; tongue; floor of the mouth; and hard and soft palate. · LIPS: Begin examination by observing the lips with the patient's mouth both closed and open. Note the color, texture and any surface abnormalities of the upper and lower vermilion borders. · LABIAL MUCOSA: W ith the patient's mouth partially open, visually examine the labial mucosa and sulcus of the maxillary vestibule and frenum and the mandibular vestibule. Observe the color, texture, and any swelling or other abnormalities of the vestibular mucosa and gingiva. · BUCCAL MUCOSA: Retract the buccal mucosa. Examine first the right then the left buccal mucosa extending from the labial commissure and back to the anterior tonsillar pillar. Note any change in pigmentation, color, texture, mobility, and other abnormalities of the mucosa, making sure that the commissures are examined carefully and are not covered by the retractors during the retraction of the cheek.

· GINGIVA: First, examine the buccal and labial aspects of the gingiva and alveolar ridges (processes) by starting with the right maxillary posterior gingiva and alveolar ridge and then move around the arch to the left posterior area. Drop to the left mandibular posterior gingiva and alveolar ridge and move around the arch to the right posterior area. Second, examine the palatal and lingual aspects as had been done on the facial side, from right to left on the palatal (maxilla) and left to right on the lingual (mandible). · TONGUE: W ith the patient's tongue at rest, and mouth partially open, inspect the dorsum of the tongue for any swelling, ulceration, coating, or variation in size, color, or texture. Also note any change in the pattern of the papillae covering the surface of the tongue and examine the tip of the tongue. The patient should then protrude the tongue, and the examiner should note any abnormality of mobility or positioning. W ith the aid of mouth mirrors, inspect the right and left lateral margins of the tongue. Grasping the tip of the tongue with a piece of gauze will assist full protrusion and will aid examination of the more posterior aspects of the tongue's lateral borders Then examine the ventral surface. Palpate the tongue to detect growths. · FLOOR: W ith the tongue still elevated, inspect the floor of the mouth for changes in color, texture, swellings, or other surface abnormalities. · PALATE: W ith the mouth wide open and the patient's head tilted back, gently depress the base of the tongue with a mouth mirror. First inspect the hard and then the soft palate. Examine all soft palate and oropharyngeal tissues. Bimanually palpate the floor of the mouth for any abnormalities. All mucosal or facial tissues that seem to be abnormal should be palpated.

Article author: National Institute of Dental and Craniofacial Research, US. Information from: Oral Cancer Aritcle, article information uptated July 2017, retrieved September 2017


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Fi nd us: For more new s & updates, find us @ew isdompublicat ions or click on t he facebook links below : 31

Dental I nsi gh ts | Issue 1 September-December

Dev el op a top perf ormi ng Dental Practi ce w i th strategi c pl anni ng By Diane Bernstein and Mickey Bernstein, DDS

Building a Strategic plan includes the following steps, each of which requires thought, time, sincere effort, and involves the entire team. The long-term payoff is practice growth, reduced stress, staff longevity, and patients for a lifetime. Increased income is substantial. 32

Dental I nsi gh ts | Issue 1 September-December

Editor's Note: This article is an introduction to Strategic Planning with a series of detailed articles to follow.

The story of the Golden Buddha is a great example of practice development and personal growth. Historians believe that a few hundred years ago, there were some Siamese monks who had a large golden Buddha. It was treasured and revered. Word came that the Burmese were going to attack the monks and gain possession of the Buddha. The monks, aware of the attack, used mud and vegetation to cover the Buddha from head to toe, camouflaging it from the enemy. Sadly, the Burmese supposedly came and slaughtered all of the monks, but never discovered the giant Buddha. Many years passed before someone accidentally stumbled upon a golden toe sticking out from underneath the mud and clay. The people unearthed the statue and discovered that the golden Buddha had been there all along.

It takes some unearthing, some searching, and some work to find it, but the energy and excitement are there if we truly desire excellence. Most dentists by nature enjoy the art, science, and technical side of dentistry including smile design, implants, and anything to make small parts fit together precisely. Conversely, most dentists avoid, because of their innermost nature, planning, administration, and implementation of business systems. Dental faculty has shared this aversion to principles of running a small business and therefore has only touched the surface of practice administration. Dental practices have succeeded in the past with little regard to the fine points of leading and running their own business because of the high-profit margin. A successful dental practice operates at a 40% profit margin. A weak performing practice operates a 20% profit. Often dentists do not have an accurate understanding of their profit margin. A typical grocery store operates at a 2% profit margin.

A successful dent al pract ice operat es at a 40% profit margin. A weak performing pract ice operat es

Did the value of the statue really change? Were the people wealthier after the Buddha was exposed? Is a golden statue less effective when hidden than when fully embraced?

a 20% profit .

The point of all of this is to say that we are born golden, alive, and full of wonder. Somewhere along the way, we allow society and personal beliefs to cover our confidence and excitement with dirt and mud. Our self-esteem dwindles, our zest for life evaporates, and our curiosity subsides. We allow the dirt, clay, and mud to build up, layer upon layer until we are completely blocked out from chasing our excitement for life. The gold is in all of us and in our practices.

The business landscape for dentists is rapidly changing. Ignorance or inattention to business systems is no longer a successful model. Strategic planning is taught in every business school every day. Few dentists have ever been exposed to a comprehensive approach to strategic planning, The most successful large and small companies in the world embrace strategic planning as an integral part of the culture.


Dental I nsi gh ts | Issue 1 September-December

STRATEGIC PLANNING: DREAMING Dreaming is the first logical step to any major life change whether it is a dental career, new home, or finding that special person to share your life. The more detailed and loftier the dream; the more successful the final result. Time should be invested in imagining the world with no barriers and ideal outcome.

VISION Steven Covey's Habit # 2 from the great book The 7 Habits of Highly Effective People is "Begin with the end in mind." A well designed vision for 5 or 10 years is the achievable embodiment of an extensive Dream and may take several months to fully develop. It becomes the centerpiece of Leadership. Great leaders continually articulate the group Vision in practical and emotional terms. Henry David Thoreau penned, " I know of no more encouraging fact than the unquestionable ability of man to elevate his life by conscious endeavor."

MISSION A Mission Statement is a concise version of the Vision. It serves to clarify the Purpose of the organization answering the questions: W hom do we serve? W hat do we do? W hat is important in our daily activities? The Practice Mission keeps the group focused and centered with patients and decisions.


VALUES Values are non-negotiable life principles. They are the truth, a life-map, and a knowledge of things as they are. Examples of Values are honesty, kindness, and personal integrity. Other Values could answer questions at a higher level such as: How do we respond to what we experience in life? We value compassion, service, and seeking a positive in every situation. The Dental Team will want to clarify the Values of the practice and stay focused on them moving forward.

STANDARDS Standards are a non-negotiable set of best practices. Once agreed upon and committed to a document, they never change. They are more precise to your dental practice than values and are referred to frequently in team meetings. Examples might include:

No significant dentistry without a complete exam ·Payment arrangements will be made on all cases over $500 by 3 days prior to appointment ·All Team Meeting discussions will be in the minutes with action plans and time line ·All adult patients will have full mouth charting once each year

Dental I nsi gh ts | Issue 1 September-December

GOALS Goals should be set high. They should be specific, achievable, and measurable. They should be compatible with your Vision, Mission, and Values. Goals should be put in a written form with a time limit and cost. There must be a Team commitment to follow through and make each goal a reality.

BUSINESS AND CLINICAL SYSTEMS Many dentists and team members want to begin with redesigning systems, however, a good Strategic Plan works best when Vision, Values, Standards, and Goals first have clarity. Many systems would be quite different given varios concepts of Vision. Remember "First things first." Written systems should give detailed written clarity to existing and new team members answering the questions: W hy, W ho, W hen, W hat, How, the frequency of retraining, and W ho and How will the system be monitored? The document might be written in a manual, or stored digitally on a computer or in the cloud.

LEADERSHIP None of the above elements of a Strategic Plan can be successful without effective Leadership. Doctors and key team members must become students of leadership expressing daily: empathy, moral authority, and verbal skills to clearly relate conversations back to the Vision, Values, Standards, and Goals.

It isimperative that all dentistsinvest the same time and energy in planning and operation of their dental practices that other successful businesses have for many years. It is never too late to start planning. You can turn a maze of wrong turns in the workplace into a straight line to the top with effort and some time. Fear isoften an obstacle to achieving success. Don't let fear hold you back. Start today. We look forward to sharing these concepts in greater detail in subsequent articles. Diane Bernstein has enjoyed 35 years in healthcare and 25 years as Practice Administrator/ Patient Coordinator at Germantown Dental Group. She is highly skilled at communication skills, coaching teams, and consulting Doctors for optimal outcome. Dr. Mickey Bernstein has practiced cosmetic dentistry for 42 years in Germantown, TN. He is an Accredited Member of the American Academy of Cosmetic Dentistry and served as President in 2008-2009. An Alumnus of the Panky Institute, he also is a Fellow in the AGD, ACD, and ICD. Together Diane and Mickey operate Bernstein Dental Consulting helping dental practices achieve their dreams. They can be reached at or 901 4973508.


Cont act det ails Editorial email: For magazine advertising & email sponsorship opportunities, please email: Sophia Smith Dental Insights Magazine is published by eWisdom Publications Limited, UK. We would like to thank the authors who contributed to Issue 1.

The informat ion, opinions and views present ed in Dent al Insight s Magazine, published by eW isdom Publicat ions Limit ed reflect s t he views of t he aut hors and cont ribut ors of t he art icles and not of t he Dent al Insight s Magazine or eW isdom Publicat ions. Publicat ion of art icles, advert isement s or product informat ion does not const it ut e endorsement or approval by t he journal and/or it s publisher. Dent al Insight s Magazine and/or it s publisher (eW isdom Publicat ions Limit ed) cannot be held responsible for any for any consequences arising from t he use of t he informat ion cont ained in t his journal. Alt hough every effort is made by t he edit orial board and t he publishers t o see t hat no inaccurat e or misleading dat a, opinion or st at ement appear in t his publicat ion, t he dat a and opinions appearing in t he art icles including edit orials and advert isement s herein are t he responsibilit y of t he cont ribut ors concerned. The publishers and t he edit orial t eam hold no liabilit y what soever for t he consequences of any such dat a, informat ion, opinion or st at ement in t his magazine. W hilst every effort is made by t he edit orial board and t he publishers t o ensure t hat informat ion is present ed accurat ely, readers are advised t hat new met hods and t echniques involving medical/product usage as described in t his publicat ion, should only be followed in conjunct ion wit h t he expert /manufact urer's own published lit erat ure in t heir own count ry.

Dental Insights Magazine is published by eWisdom Publications Limited, UK. Company registration number: 10806932.

Dental Insights Magazine, Issue 1  
Dental Insights Magazine, Issue 1