Oral Hygiene February 2019

oralhygiene February 2019

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HELPING OTHERS

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Nonfluoride caries-preventive agents: executive summary of evidence-based clinical recommendations. JADA 2011;142(9):1065-1071.

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oralhygiene

FEBRUARY 2019

Inside this issue ORAL HYGIENE

10 A Leap of Faith:

Jamaica 2018 Irene Iancu, BSc, RDH, CTDP

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elping Patients Live Longer and H Better Lives: A New look at Systemic Inflammation, Microbiome, Gum Disease Diagnosis, Treatment and Keeping Dental/Gum Disease in Remission Dr. Kathryn Alderman

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Managing Oral Health’s Implications For/From Mild Cognitive Impairment

Julie Di Nardo, RDH, Gleam Smile Centre, Hamilton

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32 Volunteering in Vietnam

Sherry Priebe, RDH, BDSc, MSc

DEPARTMENTS 5 SERVE FROM THE HEART Jillian Cecchini

6 NEWS ADA Statement on Study Involving Dental Floss

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Minnesota Dental Association Releases Opioid Support Materials for Dentists and Patients Canadian Dental Hygienists Start the Cannabis Conversation

43 DENTAL MARKETPLACE

FEBRUARY 2019

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Oral Healthcare

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EDITORIAL

Serve from the Heart

Jillian Cecchini Managing Editor

They say the best way to find yourself is to lose yourself in the service of others.

With busy lives, it can be difficult to find the time to volunteer. But volunteers do not necessarily have the time; they have the heart. Volunteering is at the very core of being human, as no one has made it through life without someone else’s help. Anyone can say they care but it’s actions that speak, not words.

Volunteerism offers many benefits to help those in need, the community, and worthwhile causes. But the benefits can be even greater for you – the volunteer.

It can offer opportunities for professional development and personal growth. Let’s consider a few of the potential benefits: 1. Networking Opportunities: Volunteering within, or outside of your community, allows you to meet new people. You can connect with others and your community, all while helping make it a better place. Dedicating your time as a volunteer can help you make new acquaintances, ehance your social skills, and expand your network.

2. Strengthens Skill Set: Volunteering is a great way to learn group dynamics and teamwork. It can also assist in enhancing and sharpening old skills, all essential to professional growth. Building upon skills you already have can undoubtedly benefit not only yourself but the greater community.

3. Creates Leadership: By watching and engaging with those around you, you can identify the qualities of

er, FEBRUARY 2019

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leadership that you appreciate, and can develop or enhance those qualities in yourself. Group work not only fosters teamwork but also offers opportunities to learn about different perspectives.

4. Overall Satisfaction: Volunteering around a personal interest, as Irene Iancu and Sherry Priebe discuss in this issue, creates a sense of fulfillment. The right match can help you meet new people, reduce stress, and connect with the community (just to name a few) all while progressing your career. Simply knowing that you are making a difference in someone else’s life is a satisfying feeling that everyone should experience.

Most importantly, volunteering helps you get to know yourself. Knowing your accomplishments, interests, skills and values is the foundation of career and personal success. Volunteering is a perfect opportunity to learn more about yourself, and your potential for overall growth and development. By helping others, you can boost not only your career but your wellbeing and the well-being of others. When you volunteer in a role that’s right for you, everyone comes out ahead. It is a win-win situation.

Here’s a thought: start where you are, use what you have, and do what you can.

Wherever you turn, you can find someone who needs you. Even if it’s one little thing, do something for which there is no pay but the privilege of doing it. Volunteering teaches us to be grateful for the things we take for granted in life, and widens our perspective on how lucky we really are.

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NEWS

ADA Statement on Study Involving Dental Floss Recent, wide-spread news coverage based upon a recent research study may raise unwarranted concern about the safety of certain types of dental floss. The ADA Science Institute finds the data insufficient to support the conclusions presented in this research and associated media coverage.

No restrictions on the use of dental floss have been issued by the U.S. Food and Drug Administration, the regulatory agency that oversees clearance of dental products marketed to the

public. It is also important to bear in mind that this is a single study. Public health policy and safety decisions should be based on the collective weight of scientific evidence.

Read more: https://www.oralhealthgroup.com/news/ada-statementon-study-involving-dentalfloss-1003939091/

Minnesota Dental Association Releases Opioid Support Materials for Dentists and Patients The Minnesota Dental Association (MDA) has published a new brochure on pain management and the dangers of opioid use. The patient brochure educates on the dangers of opioid use and offers information on opioid alternatives as well as storing and using opioids safely. Many over the counter medications have been proven effective in treating pain. Medications such as NSAIDs, aspirin, Tylenol, and topical anesthetics are commonly recommended as the first treatment option after any dental procedure.

Brochures can be ordered from the MDA online store.

The abuse, misuse and diversion of opioid medications have now reached epidemic proportions in Minnesota and throughout the United States.

Prescription opioid medications are no longer considered a safe, low-risk option for relief of moderate to severe acute pain. In response, the Minnesota Dental Association and other key medical stakeholders have been working to address this issue.

Read more: www.oralhealthgroup. com/oral-health/minnesota-dentalassociation-releases-opioid-supportmaterials-for-dentists-and-patients-1003938961

Canadian Dental Hygienists Start the Cannabis Conversation The beginning of a new year is a perfect opportunity to make a fresh start and set new personal and professional goals. With the recent legalization of cannabis in Canada, dental hygienists urge everyone to think carefully before using cannabis, given its negative impact on oral health.

“Cannabis use has many side effects that can alter the state of our mouths, teeth, and gums,” explains Tracy Bowser, president of the Canadian Dental Hygienists Association (CDHA). “We know that cannabis reduces saliva, leading to dry mouth. And those famous ‘munchies’ increase the time that teeth are exposed to sugars. As a result, cannabis users have a higher risk of cavities, gum disease, and oral infections.”

Read more: www.oralhealthgroup.com/news/canadian-dental-hygienistsstart-the-cannabis-conversation-1003938957

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A NEWCOM Media Inc. Publication

Managing Editor: Jillian Cecchini 416-510-5125 jillian@newcom.ca

Director, Business Development: Tony Burgaretta 416-510-6852 tonyb@newcom.ca

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Oral Hygiene serves dental hygienists across Canada.

The editorial environment speaks to hygienists as professionals, helping them build and develop clinical skills, master new products and technologies and increase their productivity and effectiveness as key members of the dental team. Articles focus on topics of interest to the hygienist, including education, communication, prevention and treatment modalities. Please address all submissions to: The Editor, Oral Hygiene, 5353 Dundas Street West, Suite 400 Toronto ON M9B 6H8

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Oral Hygiene is published quarterly by Newcom Media Inc., a leading Canadian magazine publishing company.

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ORAL HYGIENE

A LEAP OF FAITH: JAMAICA 2018

Irene Iancu, BSc, RDH, CTDP Irene Iancu has worked in various specialties including Paedo, Perio, General Practice and Orthodontics. Her goal in her current holistic practice is prevention and maintaining an optimal mind, mouth and body.

Irene connects the systemic effects of oral conditions to her clients, while making a change for overall health and wellness.

As a Peer and Quality Assurance Mentor contracted by the CDHO, a Clinical and Theoretical Dental Hygiene instructor at Oxford College, and a practicing dental hygienist in Toronto; Irene shares her passion for education with us today in the hopes we can change the lives of our clients and their loved ones.

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eneath bright blue skies with perfectly painted clouds lies a place that is making a change in dental hygiene.

As a practicing RDH of 11 years, clinical educator and speaker, I not only welcome the opportunity to make a difference in our profession but I have opened my mind and heart to these wonderful coincidences.

COINCIDENCE #1 On June 2nd, 2018, I was emailed by a Stacianne Tennant, BSc, RDH, through a recommendation by a colleague. Stacie had reached out to her on Twitter asking if she would be interested in speaking at an upcoming conference, which marked a milestone in Jamaican dental hygiene.

A new association, their only hygiene association, was born and Stacie was determined to rock the boat and make new waves in her seemingly small dental hygiene community.

This is where I came in. My colleague told Stacie that she isn’t the perfect person for the job, although I beg to differ. She has decades of experience as a clinical educator, a practicing hygienist, phenomenal scholar, and to add insult to injury, she is one of the most inspiring and positive individuals I am lucky to know.

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Then she recommended me.

COINCIDENCE #2 Stacie already had me in mind for the job. She had been following my RDH journey on Instagram for months and was days away from already making the connection – but this recommendation solidified her instincts.

The rest began to unfold in a series of texts, phone calls and voice notes that led to me agreeing to go to Jamaica this past October (flying out on my birthday was an added bonus!). My expectations at the time can only be described as skeptical, which have now turned into moments of happiness I would have never known had I not taken that leap of faith. I allowed my passion for my profession to guide me in another journey.

COINCIDENCE #3 I came prepared mentally, emotionally and physically. My experiences in my professional life made me the perfect person for the job and I didn’t even realize that until I arrived.

Stacie had a vision of what she was trying to create. The only problem was that she didn’t have the resources to achieve them. In the changing demographic of the Jamaican population, her two visions were simple: FEBRUARY 2019

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1. Excite dental hygienists and remind them of how valuable they are to the population.

2. Incorporate technology into dental hygiene practice of those in Jamaica.

In the weeks leading up to our event, Stacie had confided that she knew how important this profession is to her but doesn’t believe that others feel the same way. Dentists are reluctant to hire and a high population of them don’t pay fairly. Patients don’t understand the value of oral health and the companies that proudly promote their brands at these events don’t contribute to the growth of the profession.

This is where I came in.

Stacie wanted to put on a whitening session open to everyone. She saw the value in inviting dentists, FEBRUARY 2019

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students, technicians, therapists and assistants. Her vision was to be inclusive and not segregating a “hygiene only” workshop. She was spot on in this decision because as I stood at the front of a refurbished trailer pod filled with people, some without seats, I posed the question, “How many of you have ever done a whitening treatment?” Two shy hands went up in the attendance of close to 60, and one of the two said she wasn’t very experienced and considered herself a beginner.

There is only one brand that is used in Jamaica, which will remain unnamed (mainly because of the disappointment I have that this company refused to donate any product for this specific event).

Stacie did have the backing of her dental hygiene school and an

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endless supply of willing patients to be guinea pigs for the first ever whitening workshop in Jamaica.

Stacie didn’t know much about my resources in our industry. I arrived with a suitcase filled with various whitening treatments, generously donated by five different companies. When I arrived at the school for the first time straight from the airport, it felt like I was bringing everyone Christmas presents.

Dr. Irving McKenzie, Chief Dental Officer of Jamaica and Dean of the Faculty Joint Colleges of Medicine Oral Sciences and Veterinary Science at the University of Technology, gave me a wonderful tour of the school in a true gentlemanly manner. He shared the history of dentistry in Jamaica and how he has devoted many years to taking oral health

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to the next level. The beautiful open campus is a series of refurbished pods situated between mango, avocado, and ackee trees.

Dr. McK (as the students call him) encourages the students to eat the fruit on the trees if they aren’t able to bring lunch from home.

As I opened up my suitcase on the staff room table in front of four faculty members, including Monique Evans (Dr. McK’s assistant and a dental hygienist at heart), their eyes lit up. And for a moment, I saw a glimpse of relief from Stacie – a woman I had just officially met and realized her tough exterior had a soft inside.

Her exhale revealed she lives and breathes for her profession and her dream of putting on this workshop was slowly coming true.

These three coincidences led to a very successful event. Friendships were made, mentorships between students and practicing clinicians were created, and among what I saw as chaos; 14 patients were assessed, radiographs were FEBRUARY 2019

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exposed, and impressions were taken. As the sun began to set, which was a beautiful orange glow in the circular clinic, I could see teary-eyed patients and clinicians filling the clinic hallways with laughter, teamwork and a lot of selfies.

The next three days were no different. After each of my lectures, I was bombarded with hugs, highfives, and dental professionals that approached me with tears in their eyes, simply because they thought they had lost connection with their profession. A feeling I could relate to. Leaving Jamaica was extremely difficult because of how much I would love to help and share. Monique and Stacie escorted me to the airport, where we shared a few laughs and warm embraces before parting ways.

As I sat writing this article on my flight home, I realized that coincidences can only happen if you open your mind and heart to the world. Live with a little less fear and a little more trust. Allow your passions to guide you and never

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say no to growth.

These three coincidences led to a very successful event.

Friendships were made, mentorships between students and practicing clinicians were created.

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dentalcorp is hiring dental hygienists across the country Join a fun, collaborative team learn more at careers.dentalcorp.ca

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ORAL HYGIENE

HELPING PATIENTS LIVE LONGER AND BETTER LIVES: A New look at Systemic Inflammation, Microbiome, Gum Disease Diagnosis, Treatment and Keeping Dental/ Gum Disease in Remission Dr. Kathryn Alderman has an extensive education and research experience in the field of microbiology and biochemistry.

Her knowledge and deep understanding of science allow her to explain the latest findings of inflammatory-related conditions, microbiome research and how it impacts our dental patients. She is actively practicing and manages highly successful multiple locations of Nebraska Family Dentistry, which is a multi-practice organization that caters to help patients to be at their healthiest. The organization has daily operational systems with the goal of increasing patient satisfaction and case acceptance.

Dr. Kathryn Aldermans has developed those systems that lead to higher patient retention and practices that do well in spite of increased competition. If you have any questions, you can contact Dr. Kathryn Alderman: nebraskafamilydentistry@gmail.com.

FEBRUARY 2019

raditionally in dentistry we have been taught to ask our patients to brush, floss and visit us twice a year for checkups to stay healthy. In the last few years we have been hearing that by fixing dental problems and specifically dental/gum disease, we can help patients to prevent major medical problems, such as heart disease, diabetes, thyroid conditions and many other inflammatory related conditions.

It would be great to be able to help patients to be healthier by fixing their dental/gum disease but is it possible?

In this article, you can find the latest research and answer to the question: Does the inflammation have a dental etiology or is the inflammation indicative of a systemic disease? What comes first, dental/gum disease or inflammatory-related medical condition?

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As dental providers, we understand that the mouth is the gateway to the body.

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When the acute inflammatory response does not successfully resolve an infection, the inflammation becomes chronic

As dental providers, we understand that the mouth is the gateway to the body. In our pathology classes, we learned about various intraoral soft tissue lesions that can often be the first indications that a patient may have an underlying chronic disease.

We have known about the correlative links between untreated periodontal disease and diabetes or cardiovascular disease. Recent studies have shown that there may be links between dental/gum disease and many other auto-immune medical conditions. As dental providers, we often see that our patients who suffer from uncontrolled systemic inflammatory conditions have higher rates of dental/gum diseases.

When we examine a patient who shows signs of inflammation in the mouth, the question arises: Does dental/gum disease cause systemic inflammation or is the inflammation in a mouth is indicative of a systemic disease?

What is Inf lammation?

Acute Inflammation is a good thing. It is our body’s natural re-

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sponse to injury and the first step in restoring health. The immune response is a protective mechanism against foreign invaders and toxic chemicals.

Acute inflammation (adaptive immunity) causes a complex cascade of events, sending white blood cells to the site of infection or injury. The inflammatory response causes chemicals to be released which help protect the body. The immune system brings red and white blood cells, dilates blood vessels, allowing more healing substances to travel in and out of the affected area. Once the foreign body has been defeated, the immune response reduces, leaving a few immune cells on guard in case of another attack.

When the acute inflammatory response does not successfully resolve an infection, the inflammation becomes chronic. Chronic inflammation (maladaptive immunity) is like having a slow burning fire in the body.

Chronic inflammation is a lowgrade inflammatory response that FEBRUARY 2019

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can be present for months to years.

Usually, chronic inflammation occurs because the body was unable to eliminate the initial injury or infection through the acute inflammatory response. When chronic inflammation continues long-term, it can begin a series of reactions that ultimately damage cells and lead to the clinical manifestations of disease.

Chronic inflammation plays a role in all of the leading medical conditions like heart disease, diabetes, cancer and arthritis.

What is Microbiome and How it is Connected to the Overall Health?

The digestive system accounts for 70% of our immune system.

The human microbiome is made up of more than 10 0 trillion different microorganisms. Half of these reside in the GI tract. Both the microbes as well as our own cells have co-evolved to share a symbiotic relationship. The microorganisms in our body are responsible for many of the necessary functions, such as vitamin and fiber processing. Another important job is to produce short-chain fatty acids that are precursors to many hormones, important part of diverse physiological roles in body functions.

Microorganisms also play a role in gene expression regulation, including the acetylation of DNA-associated histone proteins and methylation of DNA. This is one of the major regulatory processes that is a part of many stages of genetic functions. This type of regulation is applicable to inflammatory genes that can affect the development of cancer, neuropsychiatric systems and many immune disorders as well as the progression of chronic disease.

When patients have an imbalance in our microbiome, they are more susceptible to chronic inflammation and infection. Some individuals are more sensitive to such imbalances due to genetic factors.

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Inf lammation in the Mouth Having good dental health is not only about preventing decay, periodontitis or bad breath.

Many medical conditions can be reflected by the oral health of the patient. The most common sign of chronic inflammation in the dental patient is gum disease. The level of severity of inflammation can be indicative of underlying systemic disease.

Acute Inf lammation-Gingivitis Every patient has thousands of bacterial species living in the oral cavity. Many of these bacteria are beneficial for the patient, however, an overgrowth of harmful bacterial pathogens can lead to inflamed gums, or gingivitis.

The acute inflammatory response produces red, enlarged and bleeding gums to bring inflammatory chemicals and white blood cells in an effort to fight off the bacterial overgrowth.

Gingivitis is a reversible inflammatory condition and is successfully treated by a thorough debridement and effective daily plaque removal by the patient as well as maintaining a balanced diet with adequate vitamin C and D. A healthy body can effectively fight off gingivitis successfully in just a few days.

Chronic Inf lammation-Chronic Periodontitis Chronic periodontitis occurs when there are specific bacterial pathogens present in the mouth combined with the individual patient’s host response. If the acute inflammatory process is unable to eradicate the source of the infection, the patient will experience chronic inflammation in the mouth affecting the teeth and gums. The chronic inflammation causes the gum tissue to lose its integrity, detaching from the root surface and creating periodontal pockets where more harmful species of bacteria can colonize. The constant immune

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response to the presence of these pathogens creates inflammatory chemicals to be released, which is the cause of bone loss.

When the condition is advanced, the teeth become loose and must be removed due to inadequate bone support. Chronic periodontitis is one of the leading causes of tooth loss in adults.

The Oral-Systemic Link: Inf lammation, Microbiome, Gum Disease Diagnosis and Treatment There is a relationship between periodontitis and many other inflammatory conditions like rheumatoid arthritis, celiac disease, thyroid disease, heart disease, diabetes and Alzheimer’s.

Chronic periodontal disease and these conditions share autoimmune characteristics, but the real question is, which came first? Is there a causal link between these conditions? Latest research shows that overall and gut health are more closely to dental health.

Below are three articles which discuss the connection between the microbiome, systemic inflammation and dental/gum diseases.

1. Gut Microbiota and Salivary Diagnostics: The Mouth Is Salivating to Tell Us Something Authors: Kodukula Krishna, Faller Douglas V., Harpp David N., Kanara Iphigenia, Pernokas Julie, Pernokas Mark, Powers Whitney R., Soukos Nikolaos S., Steliou Kosta, and Moos Walter H., Published Online:1 Oct 2017 ht t p s: //doi.org / 10 .10 8 9/ bio res.2017.0 020

ABSTRACT SUMMARY AND CONCLUSION The human microbiome is a network of microbes that affect every organ system in the body.

Most of the microorganisms of this network are bacterial, but others include viruses, fungi and

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protists. Through study of the human microbiome, we have learned that most chronic medical conditions have microbial components. The oral cavity and GI portion of the microbiome account for the majority of the bacteria present in the body. By measuring the strains of bacteria in a mouth, the overall gut health can be predicted. By making modifications to the person’s microbiome, systematic health can be positively affected, including improved dental health.

By making modifications to the person’s microbiome, systematic health can be positively affected, including improved dental health.

2 . Defining The Gut Microbiota In Individuals With Periodontal Diseases: An Exploratory Study ht t p s: // w w w. ncbi . n l m . n i h .gov/ pmc/articles/PMC6032013/ The purpose of this study was to test the gut microbiome of patients who presented with periodontal diseases and find any correlation with periodontal inflammation and destruction of tissues.

ABSTRACT SUMMARY AND CONCLUSION Those who presented with active periodontal diseases had less diversity in the microbiome which is consistent with other chronic inflammatory diseases. The high levels of oral bacteria that were associated with periodontal disease and active inflammation were also present in the gut of all individuals regardless of the status of the periodontal health. Findings concluded that every patient who had an inflammatory condition had less diversity in the gut. Periodontally involved patients had a higher level of harmful versus beneficial bacteria in both the mouth and the gut. This conclusion suggests that periodontal disease is an important risk factor for many other systemic inflammatory medical conditions.

3. Can Diet Improve Gum Disease?

Journal of Periodontology (May 2009, Vol. 80:5, pp. 759-768).

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Abstract Summary and Conclusion The article discusses if following an anti-inflammatory diet may help reduce symptoms of periodontitis: The first study mentioned in this article is on diet and periodontitis: In the May 20 09 issue of The Journal of Periodontology, a study was published titled “The impact of the stone age diet on gingival conditions in the absence of oral hygiene.”

This study used 10 individuals who followed a diet of unprocessed, whole foods including vegetables and protein sources indigenous to the area of Switzerland where the study took place for 4 weeks. During this time, the subjects did not brush or f loss at all. Before and after the study, bacterial cultures were taken for analysis to screen for periodontal disease. At the end of this study, participants had higher levels of plaque accumulation, but the number of pathogenic microbes present in the plaque remained unchanged.

The second study mentioned in this article is on diet and periodontal health is from the July 2016 issue of BMC Oral Health.

The study is titled, “An oral health optimized diet can reduce gingival and periodontal inflammation in humans—a randomized controlled pilot study.”

A group of 15 subjects who exhibited signs of active periodontal disease were used in a randomized control trial. Five were part of the control group, leaving 10 as the experimental group.

The 10 experimental subjects followed a diet low in carbohydrates, high in omega 3 fatty acids, and high in fiber and vitamins. The control group did not alter their existing diets. None of the subjects flossed during the study, but brushed normally.

Periodontal exams and bacterial culture samples were taken before and after the experiment.

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After four weeks, all signs of gum disease in the experimental group decreased by half, while all of the inflammatory markers increased from the baseline in the control group.

Findings in this article offer proof that patient’s diet plays a critical role in forming microbiome and influencing the levels of overall chronic inflammation and ultimately leading to the progression of periodontal disease.

Answering the question: Does dental/gum disease or the inflammatory-related medical condition come first?

Now that we know how the microbiome impacts the likelihood of a person to develop chronic inf lammation throughout the body, the answer is more likely that the underlying medical condition can be correlated with the imbalance of the microbiome. Some individuals may have genetic risk factors in addition to an imbalance in the gut biome, placing them at greater risk for developing medical conditions.

Chronic inflammation can travel to all of the organ systems of the body, including the tissues in the mouth and jaw due to the vascular environment of the oral cavity. Having chronic inflammation can be both the initial cause of cardiovascular disease as well as dental/gum disease.

What Can Be Done To Improve Patient’s Microbiome And Reduce Systemic Chronic Inflammation?

In addition to maintaining good oral hygiene and receiving professional dental care to help reduce the bacterial load in the mouth, patients should be counseled on lifestyle factors like their diet, tobacco cessation, obesity and stress.

1. Counsel patients to change their diet. Eating plenty of omega 3 fatty acids like those found in fish and flaxseed.

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2. Encouraging patients to eat high-fiber diets rich in fruits and vegetables and avoid processed foods to improve the individuals’s microbiome.

3. Encourage patients to lower their sugar intake and avoid drinking soda and energy drinks.

4. Encourage supplementation of vitamin C and D on a daily basis as well as taking probiotics with multiple strains of beneficial probiotic.

5. Eliminate foods like gluten or dairy that may be triggering an allergy response and creating intestinal inflammation for some patients.

6. Exercising regularly 7. Reducing stress: Massage, yoga, meditation, etc.

8. Getting adequate sleep: 7-8 hours every night.

CASE STUDY A 35-year-old male patient comes to you with cardiovascular disease and issues with high blood sugar.

This patient also shows signs of moderate chronic periodontitis.

Will performing traditional quadrant scaling and root planing be adequate for helping this patient reduce the overall levels of chronic systemic inflammation and improve his overall health?

The answer is no. Performing scaling and root planing will definitely reduce the load of harmful bacteria that is present in his oral microbiome but not enough alone in order to help this patient to be at his healthiest.

It is important to help this patient identify lifestyle factors and the role these play in the longterm prognosis of his periodontal condition as well as managing other cardiovascular disease and blood sugar issues. By changing the lifestyle habits and decreasing the overall amount of inflammation, this patient can become healthier. By developing healthier lifestyle habits, the overall health will improve and ultimately lead-

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ing to the shift to the healthier microbiome.

CONCLUSION Do inflammatory related medical conditions lead to the developing gum disease or vice versa?

The answer: It is more likely that the underlying medical condition can be correlated with the overall lifestyle habits, the genetic risk factors and imbalance in the microbiome, placing patients at a greater risk for developing inflammatory related medical conditions, including dental/gum disease.

As dental professionals we can we help patients live healthier and longer lives by treating dental/gum disease. But besides traditional dental /gum disease treatment and giving home care recommendations, dental professionals can be an important part of the health-care team and help patients to improve the quality of their lives by helping them to be educating on importance of healthy lifestyle habits for improving the prognosis of dental/gum disease and overall health.

Traditional treatment for dental/ gum disease can be combined with a thorough review of the medical history as well as follow-up with the primary care physician if patients present with dental/gum disease.

Patients who have not been under the care of a physician and are showing signs of periodontal disease should be referred for wellness screenings to rule out underlying medical conditions, allergies or vitamin deficiencies.

Dental professionals can educate patients about the link between their dental health and their overall health. and give tips on improving overall health. Patients who have knowledge about what they can do are empowered to take control of their own health and play an active role in their treatment and prognosis of dental/gum disease, as well as positively impacting overall health.

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EXPERT VIEWS TIPS FOR SUCCESS HOW SCIENCE & TECHNOLOGY LEADS TO BETTER SYSTEMIC OUTCOMES One of the key points I communicate to every client is that reducing gingival inflammation is important to their whole health. Motivating them to reduce gingival inflammation at home and take ownership of their complete oral and systemic health is my first priority. The second is using cutting-edge technology to customize their homecare and create an office-home connection.

TECHNOLOGY BRIDGES THE OFFICE-HOME ORAL HYGIENE GAP Choosing the right brush for your client’s oral homecare routine is critical. If you think about the hours our clients spend in the chair vs. the hours they spend out of it, you quickly realize we have to use any technology we can to motivate and connect with them at home to prevent biofilm buildup. If our influence extends between visits, our goal to remove plaque and reduce gingival inflammation will continue at home. Clients then create their own healthy oral and systemic results.

With its advanced technology and design, Oral-B GENIUS power brush has built-in features that have helped my clients reach a new standard of at-home oral care. I recommend it for the following benefits: Small round prophy-inspired brush head cups each tooth and reaches lingual and distal surfaces for complete 360° cleaning Removes plaque biofilm around the gingival margin

Oscillating-rotating action stimulates the sulcus Continue motivating clients to follow your professional guidance on at-home oral care and use the Oral-B app to track daily performance

SCIENCE, TECHNOLOGY & CUSTOMIZATION IMPROVES MOTIVATION Choosing the right brush for my clients comes down to 3 things: science, technology and customization. As everyone has different oral hygiene needs, I always involve the client in the science of choosing the best brush for their condition. Oral-B’s oscillating-rotating advanced technology has been designed to work together with a wide variety of Oral-B brush heads that are engineered to meet clients’ different needs. Clients can pick from 9 brush heads that specifically address their conditions.

Every client wants to feel that their care is tailored to their needs. Oral-B’s 360° SmartRing feature lets clients personalize their brushing with 12 customizable colours and provides them with a visual alert when it detects over-aggressive brushing. I’ve found that customizing their brush has given my clients a sense of ownership over their oral health and motivates them to really improve their brushing technique.

My mission is educating clients about their role in reducing gingival inflammation and improving their oral and systemic health. Reach beyond your chair and improve oral and systemic health with Oral-B GENIUS power brushes.

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ORAL HYGIENE

MANAGING ORAL HEALTH’S IMPLICATIONS FOR/FROM MILD COGNITIVE IMPAIRMENT

Julie DiNardo, RDH Graduated in 1987 and working independently since 2008, Julie has a well established private practice, the Gleam Smile Centre, in Hamilton Ontario. Focusing on the wellbeing of her community, she was the recipient of the Community Service Award in 2016 for her advocacy efforts towards better oral health. Julie is past president of the Business Executives Organization and continues to be on their board of directors. As a founding member of the American Association for Oral Systemic Health, Julie has been able to bring forward the message of better oral health for improved patient care.

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hances are that you know of someone with Mild Cognitive Impairment (MCI)1, and/or your practice has some patients at high risk or early signs of this same, dreaded condition.

And chances are you know that these same individuals are entering a decline in their oral health too. Not only because you observe growing inflammation and root caries in their mouths along with limited oral hygiene, but also you also know good quality studies are confirming this consequence of cognitive decline (Chart 1).

This was my circumstance in my independent hygiene practice in Hamilton, Ontario, which serves an older community.

It is also the reason why I am writing this article. I believe there is an effective approach to managing the prospects for poor oral health in older patients starting to experience forgetfulness, memory loss, confusion, and dependency which are common signs of the earliest stages of dementia.

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MY SURPRISING CASE STUDIES Over the past five years, I have been caring for the oral health of two older patients who had, at the start of the treatment plan, obvious MCI. One patient in his late 80s, was accompanied by his son at the first visit, was confused and was no longer seemingly capable of living independently. This patient’s oral health was poor and he had very limited home care.

The second patient had been diagnosed with MCI, and was enrolled in a university study testing whether diet and lifestyle changes could manage her condition. Again, her oral health was in decline.

The standard of care for patients like these, is to manage the plaque above and below the gum line with a thorough prophylaxis and scalingroot-planing, typically at frequent intervals. But for these patients with a poor oral health prognosis and likely an inability to pursue mechanical debridement over the long term,

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Chart 1

Source: Holmer J et al. 2018. Association between periodontitis and risk of Alzheimer´s disease, mild cognitive impairment and subjective cognitive decline: A case-control study. J Clin Periodontol, October, ahead of print.

I also recommended a more aggressive, less invasive, and long-lasting treatment plan featuring Prevora (DIN 02046245). Both patients and their caregivers accepted my recommendation.

The treatment plan has worked impressively. Not only for managing the imbalance (dysbiosis) in the supra and sub-gingival plaque and for improving oral health markedly over many years, but surprisingly, for improving cognitive function, too. The first patient no longer needs to be accompanied by his son but rather takes the bus to my practice and has remained independent for now almost five years. The second patient is no longer enrolled in the university study as she is no longer diagnosed with MCI.

DOES IMPROVED ORAL HEALTH ALSO IMPROVE COGNITIVE FUNCTION?

These two case studies are intriguing. They support the growing interest by the scientific community in the “infection theory” of dementia. This theory argues that cognitive decline results from microorganisms or their byproducts entering into the brain to

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stimulate inflammation or the formation of amyloid plaque and associated nerve tangles.

To the hygiene profession, two microorganisms are particularly relevant to managing cognitive function: Porphyromonas gingivalis and Treponema denticola, both of which originate at the gum line. With regard to P. gingivalis, two very recent, controlled animal studies have shown direct and perhaps indirect connections (e.g. systemic inflammation) between infection levels in the oral cavity and the process of cognitive decline: • A Chinese group reports mice infected with P. gingivalis in the mouth had, after 6 weeks, impaired learning and memory abilities versus a similar group of mice which were un-infected. Levels of pro-inflammatory chemicals in the brain tissues of the P. gingivalis-infected mice also increased relative to controls. 2 • An American group reports similar results. Mice infected repeatedly with P. gingivalis in the mouth for 22 weeks, showed neurodegeneration versus un-infected mice.3

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The treatment plan has worked impressively. Not only for managing the imbalance (dysbiosis) in the supra and sub-gingival plaque and for improving oral health markedly over many years, but surprisingly, for improving cognitive function, too.

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Chart 2: Factors affecting poor memory and the possible role of periodontal disease.

Source: Harding A et al. 2017. Can better management of periodontal disease delay the onset and progression of Alzheimer’s disease?

J Alzheimer’s Disease. 58: 337-348.

For some time, moreover, there has been growing evidence from human studies that periodontal disease raises the risk for cognitive decline. For example, here are some very recent studies: • A 6 month, UK observational study of 60 non-smoking community-dwelling adults with mild to moderate Alzheimer’s disease reports those subjects with periodontitis had a six-fold increase in the rate of cognitive decline versus those without periodontal disease.4 • A retrospective assessment of data from Taiwanese medical claims, found that adults with periodontal disease over 10 years, had almost twice the risk

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of developing Alzheimer’s disease than a matched group of orally healthy adults. 5 • A Japanese study conducted over five years and involving 179 community-dwelling adults (mean age of 80 years), reports that compared to an absence of severe periodontal disease at the start of the study, those with poor oral health had a muchhigher odds for MCI over five years. Likewise, a larger degree of periodontal inflammation at baseline was also significantly predictive of MCI.6 In this context, my two successful case studies are even more intriguing, particularly as they have improved in their cog-

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nitive function and their oral health for at least five years and over several intervening visits to my practice.

But, of course, it’s never ever that simple.

The facts are these are only two patients, and MCI can revert to normal cognition, can remain stable or progress to dementia, and the reasons for this change are unclear.7 It is also clear that poor oral health is but one factor which can effect memory loss (Chart 2).

Reservedly, it may well be that my two patients who are most certainly better orally, are better cognitively just by happenstance or, indeed, just when they visit my practice!

FEBRUARY 2019

2019-02-05 1:20 PM

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Oral Health wants to hear from you! We are actively seeking original article submissions from all of our valued readers. Here’s what we need from you:

MANUSCRIPTS Manuscripts should run between 1,000 to 5,000 words; any manuscripts submitted on disc or flashdrive should be PC and MAC compatible (i.e., Microsoft Word). Should you have concerns with the compatibility between your word software and that of Oral Health’s, simply save your file as raw text (i.e., Text Only files).

ILLUSTRATIONS The quality of photographs supplied contribute directly to the quality of reproduction in Oral Health. Therefore, when making a submission, please consider the following: >

Any artwork submitted should be MAC compatible, and should be saved at the highest resolution possible (266 pixels per inch or greater). We cannot accept any digitized photographs/illustrations that have been created in a word processing, spread sheet or presentation package.

> Images should be saved as TIF, JPEG or EPS only. Third-party sites such as WeTransfer or DropBox are accepted.

AUTHORS Biographical information regarding the author(s) should be included with the manuscript.

The author’s name and degrees, as well as any association the author may have with any institution should be included. The author’s address, including city and province/state should also be included.

These requests for standardized submission of material are necessary for correctness of publication.

The Editorial Board looks forward to your submission. Please mail original manuscripts to:

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> Do not embed photos within the article. > The editorial board reserves the right to not return photos that do not meet quality standards. > Each illustration provided by the author should be identified and described by a short caption; and this list of figures should follow at the end of the article.

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HYGIENE’S ROLE IN MANAGING DEMENTIA – IT’S MORE THAN WHAT WE ALL MIGHT THINK! So, with this sobering, “reality check” on my encouraging experience with patients experiencing MCI, what do we as hygienists do to deliver healthcare services to this rapidly growing group in our community? Wait until there is conclusive proof from randomized controlled studies showing the bidirectional relationship between poor oral health and cognitive decline is entirely clear and significant? Avoid talking to our patients at high risk of MCI that they need to manage the likely bacterial imbalance in their plaque?

I don’t think ignoring what we now know and are observing about these relationships between poor oral health and cognitive function, is ethical or in the best interests of our patients and their families. So, here is my position.

First, hygienists need to agree that improving oral health at the earliest stages of cognitive decline is a very worthwhile and do-able endpoint on its own. We needn’t get distracted by trying to arrest or improve MCI – a task which has escaped the medical profession to this point in time. Patients with mild cognitive impairment are almost certainly facing poor oral health (Chart 1). And at this early stage of dementia, patients can tolerate hygiene care, particularly Prevora, much better than when they become institutionalized. Timing of preventive oral healthcare is critical. My strategy is to manage oral dysbiosis as best as possible for as long as possible, before the fog sets in.

Second, we all know the prospects for utter confusion can bring on raw emotion and even desperation, particularly as there are now no really effective medical treatments to stop this progressive disease. So, as hygienists, we must be careful to avoid making any claims that better oral health could arrest cognitive decline. Instead, let us focus on what we know and what we do. What we know: oral health becomes a serious problem in cognitive decline. What we do: we manage the underlying cause of poor oral health called dysbiosis, painlessly and affordably. Chances are that the patient and the family will follow your recommendation for preventive oral healthcare now, simply because it is one of the very few, positive steps to respond to with this dreadful prognosis.

Lastly, as hygienists, I dare say we need to up our game. Sure, let’s educate on oral cancer – an acute, life-threatening disease which affects perhaps 10 in 10 0,0 0 0 Canadian adults. But let’s also educate on protecting oral health when MCI sets in. Mild cognitive impairment affects many more Canadians than oral cancer – and is just as scary.

About 20% of Canadian seniors have mild cogni-

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tive impairment and don’t know what to do about it other than do more puzzles, get more socially involved, go to the gym, and start a Mediterranean diet. 8 Hygiene has some proven, and affordable action steps to offer to this community – namely, get your oral health in shape too.

CONCLUSION In my independent hygiene practice, older patients are increasingly common and are increasingly vulnerable to poor oral health. They are also at high risk of MCI. Over 5 years, I have concluded I can effectively manage oral dysbiosis in older, highrisk patients. And it seems, by doing so, there can be marked improvements to MCI too. Chances are, my patients want this opportunity.

References 1.

Mild Cognitive Impairment is the transition between nor mal cognitive function and a clinical diagnosis of demen tia. Individuals with MCI show a high risk of progression to dementia as well as disability which could lead to sig nificant social and financial burden. Refer to: Winblad B et al. 2004. Mild cognitive impairment – beyond controver sies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment in J Intern Med., 256: 240-246, and; Gauthier S et al, 2006. Mild cognitive impairment. Lancet, 367: 1262-1270, and; Shi mada H et al. 2016. Cognitive impairment and disability in older Japanese adults. PLoS ONE, e0158720.

2.

Ding Y et al. 2018. Porphyromonas gingivalis, a periodon titis causing bacterium, induces memory impairment and age-dependent neuroinflammation in mice. Immun Ageing, 15:

3.

Illievski V et al. 2018. Chronic oral application of a periodontal pathogen results in brain inflammation, neurodegeneration and amyloid beta production in wild type mice. PLOS One, 13 (10):e0204941.

4. Ide M et al. 2016. Periodontitis and cognitive decline in Alzheimer’s disease. PLoS ONE, 11 (3): e0151081 5.

Chen CK, Wu YT, Change YC. 2017. Association between chronic periodontitis and the risk of Alzheimer’s disease: a retrospective, population-based, matched cohort study Alzheimer’s Research and Therapy, 9:56

6. Iwasaki M et al. 2018. Periodontitis, periodontal inflamma tion, and mild cognitive impairment: A 5-year cohort study. J Periodont Res, ahead of publication.

7. http://n.neurology.org/content/90/3/126 8 https://www150.statcan.gc.ca/n1/pub/82-003-x/2010004/ article/11391/findings-resultats-eng.htm

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ORAL HYGIENE

VOLUNTEERING IN VIETNAM

S

Sherry Priebe RDH, BDSc, MSc Sherry impacts the lives of people globally with her dental hygiene life focus to “assist people to attain optimum oral health through research, education and clinical practice”. Sherry graduated with her Dip.DH (UofA), BDSc and MSc (UBC). She has published in the Vietnam J of Med and Pharm, the Can J of Dent Hyg, the Int’l J of Dent Hyg and the Dent Health J (UK). Sherry was awarded the ‘World Dental Hygiene Award in Research’ by SUNSTAR and the International Dental Hygiene Federation for her pioneering study in oral cancer and cultural risk factors in Vietnam. She mentors UBC students in further study by taking them annually to Vietnam to learn about risk factors and oral cancer victims.

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herry, would you consider volunteering in leadership of your knowledge and experience in Vietnam and plan a service and learning venture for our graduating Dental Hygiene bachelor’s degree students? What would you say to volunteering your time, taking time off work without pay and organizing a trip to a country that is vast with learning opportunity, so students can also volunteer and discover their place of interest in global oral health?

The University of British Columbia (UBC) Alumni Development director approached me with the volunteer challenge to mentor dental hygiene students in a 10-day learning and teaching initiative program to Vietnam. As I have a key collaborative relationship with the oral health professionals in Ho Chi Minh City (HCMC), Vietnam having pioneered oral cancer research as a Canadian Dental Hygienist in the HCMC Oral Cancer Hospital for my master’s degree in Dental Science, I was a natural fit for such a program leader. The challenge was to assist students to be global citizens and ambassadors to improve global oral health while practicing what they had learned in their four years of university study.

Dental hygienists are most usually seen as a clinical scaling professional to remove hard and soft debris off teeth to encourage oral health. I have always chosen to make a difference in people’s lives

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through dental and medical mission trips elsewhere and here was an opportunity to pass on my leadership experience through such a task. I personally know the value of volunteering. Volunteering changes the way one thinks about their own life from how they lived before. I wanted to impact students’ lives to critically think how their skills can be offered in various settings as a dental hygiene student or dental student, be meaningful and change the way they and people they influence think about oral health and the oral health provider.

The definition of being a volunteer is ‘a person who freely offers to take part in an enterprise’ or ‘expresses a willingness to undertake a task or service’. I excitedly told the UBC supporters who provided funding for this project, of the impact that would be realized by the various volunteer tasks and service of the students that I proposed. I went back to my dental hygiene scope of practice duties, that is so ingrained in me, to assess the needs and oral health problems of unique areas and population groups of Vietnam. As oral health professionals, we prevent not only oral disease, but systemic diseases as is evidenced by research; therefore, a planning of goals to that end was necessary. I wanted to provide outcomes such as: learning about the unique Vietnamese culture by the UBC students; empathizing with oral cancer victims and how they live; providing FEBRUARY 2019

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CELEBRATING 2O YEARS OF EXCELLENCE

opportunity for the students to share with the Vietnamese university students in an exchange of specific knowledge that would be interesting to discover; assisting in the oral health needs of the children in orphanages affected by agent orange (the defoliant chemical used in the Vietnam War); and a lasting outcome of an experience of a lifetime.

The outcomes were accepted. I took the challenge and started planning.

To begin the project, I used the process of care that we as dental hygienists use all the time clinically with our patients.

1. Assessment. I reached out to my Vietnamese friends and asked them for their input as to what they would like us to do in their country and what I thought would be a great learning time for our students. Once that was assessed through emails and conversations, I needed to choose which students were going.

2. Diagnosis. I was not diagnosing clinically but identifying which students would be a ‘good volunteer fit’ for the initiative. The student application form consisted of three questions: 1. Who are you? Why do you want to be a part of this project? 2. How do you see yourself working in this initiative? 3. What do you expect to give and gain from this opportunity? Reviewing the student’s comments and answers to these questions gave a good idea as to who the best volunteers would be. I looked for three characteristics in their answers: humbleness, a willingness to learn and having a passion to assist in people’s oral health.

3. Planning: The planning process was extremely time consuming. Emails back and forth to Vietnam and to the UBC staff of ideas and plans for the students was complicated due to the time zone differences. Correlating dates and dealing with the hospitals and doctors’ time schedules was a further challenge. I wanted the students to have the best learning opportunity they could imagine that would impact them for a lifetime.

Every option of involvement was considered for exceptional knowledge exchange. Everyone in Vietnam was so gracious in working out schedules that focused and most benefited the students’ learning and cultural experiences.

4. Implementation: On arrival in Vietnam, the students quickly rested and eagerly started the planned itinerary. Volunteering together for one goal increases relationship and care for one another. An interpersonal bond was made providing support for the students to facilitate success and greatly enhance their knowledge and skills.

We followed the scheduled events and the students kept daily diaries to recall the incredible

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On arrival in Vietnam, the students quickly rested and eagerly started the planned itinerary. Volunteering together for one goal increases relationship and care for one another

opportunities of learning and service they found themselves a part of. Social media was emphasized as a positive way to make others aware of their volunteerism and providing them with encouragement in return.

5. Evaluation: The students and I were evaluating continuously. Being immersed in a setting of unique professional socialization both internationally and culturally, stretched the students beyond what they could ever have learned

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at home. Daily we reviewed what influences came to help us learn.

Through discussion, we understood how incredibly fortunate we were to be with the Vietnamese health professionals. A greater appreciation of global oral health providers was identified realizing that Canadians can learn so very much from the very intelligent, talented and dedicated Vietnamese professionals.

Successful volunteering days for the students and myself resulted

www.oralhealthgroup.com

in joy, happiness and a sense of accomplishment. I believe my passion for volunteering has been fueled bringing greater joy in my dental hygiene career. I am grateful for the opportunity to volunteer and give back to those who were so generous to me. I chose to give forward to those who would not be able to realize the improved oral health that they now had if I had not volunteered and provided my time and talents to the UBC students and people of Vietnam.

FEBRUARY 2019

2019-02-05 1:20 PM

To advertise contact: Karen Shaw • tel: 416-510-6770 • cell: 437-991-7187 • e-mail: karen@newcom.ca fax: 416-510-5140 • Toll Free CDA & USA: 1-888-639-2669

HYGIENISTS

CAREERS

PRACTICES & OFFICES

VANCOUVER, BC

STE. ROSE, MB (NEAR DAUPHIN)

TURNKEY PRACTICE FOR FREE

Full Time Hygienist We are looking for a hygienist to join our team full time. We are a general dentistry, modern office with the latest technology and offer our patients perio focused hygiene. CE and additional benefits are available – a great opportunity to move your career forward. Candidates must be patientcentered, have good communication skills and a solid foundation in clinical skills.

PLEASE CONTACT: Ria at info@broadwaystationdental.com

FULL TIME ASSOCIATE OR LOCUM NEEDED! Seeking full time ASSOCIATE or LOCUM general dentist for busy dental clinic. Be fully booked from day one for a month ahead! Amazing Team! This is the job you’re looking for!

High earning potential! Earn up to 50%! Busy practice that serve very large area. Don’t miss out on this amazing opportunities! New grads/foreign trained dentists welcome.

Contact AmazingManitobaDental@gmail.com

TORONTO, ON

Full time hygienist needed. Fluently speaking one of the Slavic languages will be a great asset.

Please call to book an interview 647-969-0236. Send your resume to olena.klipitch@gmail.com

OAKVILLE, ON

Dental Assistant, Receptionist, Hygienist needed for our growing modern office. Part time or full time applications are both considered.

Please send resume to info@oakvillenorthdentistry.com

ASSOCIATESHIPS

SHERWOOD PARK, AB

OTTAWA, ON

A well established family practice in Sherwood Park is seeking a Parttime/ Full-time Dental Associate.

North American training and a few years of experience with a broad base of dentistry is preferred.

Please forward resume: pgmanager81@gmail.com

An associate is required for a full-time permanent position in a busy, modern state-of-the-art Ottawa practice. We are committed to providing the highest standard of care using cutting edge technology. The ideal candidate is enthusiastic and caring with good communication skills and would enjoy working in a team setting. Continuing education allowance and future buy in opportunity maybe available for the right candidate.

GTA AND SURROUNDING AREAS, ON

Associate opportunities available across the GTA and surrounding areas, including Barrie and Owen Sound.

E-mail: yourdentaldream@gmail.com

MIDLAND, ON

Please email resume: maisiouti@gmail.com

DOWNTOWN TORONTO MODERN DENTAL OFFICE 123 Edward St. upper floors across from University of Toronto dental.

1050 sq.ft. 3 ops, fully equipped practice with digital office turn key – move your patients in tomorrow.

Current lease is 4200.00 per month + hst expiring May 2019 with 5 year extension or walkaway lease.

Appraisal from Hill Kindy available.

No charts. $22,000.00 To find out more please email: andyc@coradixgta.com

NOBLETON, ON Turn key operation for anyone looking to own their first practice in a residential growing community. Modern, newly built practice of 4 years in the township of King. Spacious, 4 operatories, pan room, consult room and team area. A must see!! Asking price $425K. E-mail: drashidi@smilesfirstcorp.com

BRAMPTON, ON

Great Practice Opportunity!

Associating with the option to buy.

This is a well established Brampton Group Practice.

If interested call 416 908 8919.

THUNDER BAY, ON

Equipped Boutique Dental Office (5 years old), main floor, centrally located across from Fort William Gardens in a highly populated area in Thunder Bay, Ontario – $3500.00 plus HST. Phone or text Mario 807-626-6831 mmichieli50@gmail.com

ASSOCIATESHIPS

GRIMSBY, ON

Busy Dental office located near beautiful Georgian Bay looking for Full Time Associate to cover a maternity leave beginning in July. Potential to grow into permanent full time position.

Monday, Wednesday, Friday day time hours, Tuesday and Thursday evening hours, no weekends. Candidate must be enthusiastic, highly motivated with excellent communication skills.

Please email your resume to allison@lifestylesmidland.com

Well established, modern, busy growing practice seeking associate 3 days /week.

If you want to join a great team in a friendly expanding community please send resume to dogmol1936@gmail.com

REGINA, SK

Seeking motivated and dynamic Associate for long-term, full-time position in a growing, modern and well-appointed clinic. Paid on PRODUCTION! New grads welcome, mentoring available.

Contact: admin@courtsidedental.ca

LLOYDMINSTER, AB

Modern and nicely equipped clinic with a well established and growing patient base seeking a full-time, long-term, experienced Associate. Paid on PRODUCTION! Contact: admin@oriondentalgroup.ca

TORONTO WEST, ON

Large, modern dental practice in the heart of Bloor West Village is looking for a DENTAL ASSOCIATE. Applicants should have some Canadian experience.

Prefer Russian/Ukrainian language.

E-mail: wzigan@gmail.com

www.oralhealthgroup.com FEBRUARY 2019

OHY Feb19 Classifieds.indd 35

www.oralhealthgroup.com

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2019-02-04 11:27 AM

ASSOCIATESHIPS

NOW IS YOUR CHANCE TO TAKE OVER FROM A DENTIST RETIRING AFTER 25 YEARS

OTTAWA AREA Sandhu Dental Group

looking for full time Associate in one of their 14 locations

Apply if you are enthusiastic, hard working, flexible and willing to learn.

Implant Mentorship will be provided by Dr. Raja Jang Sandhu

Please check our website

www.sandhudental.ca

We are elite dental group with opportunity and growth for Dentist

If interested please email you resume to Dr Raja Jang Sandhu: jangsandhu88@gmail.com NORTH BAY, ON SEEKING COMPASSIONATE FULL-TIME CLINIC DENTIST TO JOIN OUR PUBLIC HEALTH UNIT TO WORK WITH LOW INCOME CHILDREN AND ADOLESCENTS! The North Bay Parry Sound District Health Unit, located in North Bay, Ontario opened a brand new, state of the art oral health clinic in May 2018 for marginalized children and adults who face challenges in accessing dental services in our district. The Health Unit currently provides dental care for kids and teens 17 years of age or younger through the Healthy Smiles Ontario program. If you would like to contribute to the Health Unit’s vision of “A healthy life for everyone in our communities”, please visit our website: www.myhealthunit.ca for more information. We offer competitive wages, benefits and a defined benefit pension plan.

Please e-mail: human.resources@healthunit.ca

We are looking for an associate dentist for our busy, well established dental office near downtown Edmonton. Our focus is excellence in dentistry and great team work. The right candidate will inherit an established patient base, and great production on mostly basic procedures. Lots of room and potential for more. Looking for dentists with excellent work ethic!

Preferably with 2 or more years’ experience.

Please email your CV to career@centraldentalfamily.ca

GRANDE CACHE, AB ESTABLISHED FAMILY PRACTICE IS LOOKING FOR A FULL TIME ASSOCIATE. GRANDE VIEW DENTAL CARE IS IN THE BEAUTIFUL ROCKY MOUNTAINS OF ALBERTA.

The successful applicant will be fully booked from day one and must be comfortable with all aspects of general dentistry with special emphasis on diagnostic, restorative, oral surgery and endodontics. Strong communication and personal skills are essential. No weekends or evenings required. High gross/net office -associate can expect above average remuneration.

Please email resume: grande.cache.dental.care@gmail.com

BRANTFORD, ON ASSOCIATE DENTIST POSITION Our office is seeking a dynamic and energetic Associate Dentist effective March. We are a highly reputable familyoriented practice with a friendly team of professionals.

Our environment is modern with updated technology including paperless, digital xrays, while also offering iTero and CBCT scanning on site. Our practice provides a high quality of care in all aspects of dentistry. We are searching for a caring, compassionate individual with strong clinical and communication skills. If you are a motivated, hard-working, team player looking to work in a growing clinical practice, we look forward to hearing from you.

E-mail: kristen@cambridgesmiles.ca

PETERBOROUGH AND KAWARTHA AREA, ON

Full-time or Part-Time Associates in extremely busy Peterborough and Kawartha area Group offices. Guarantee Minimum Income for first 3 months during transition.

Will assume patients of current associate relocating due to a family reason.

Furnished with modern high-tech equipment and newer facility with well-trained and committed, long term dental team. Fewer than 1% patients under OW/ODSP. Experienced Owner will mentor new associates. Experience an asset but not essential. Long-Term/Potential Buy-in Opportunities.

Email: Kawartha-Peterborough-Dentist@outlook.com Phone (705) 930-5148 (Mutual confidentiality Assured)

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www.oralhealthgroup.com

MISSISSAUGA, ON Endodontist required immediately for a busy, multi-disciplinary, completely digital Mississauga office. Looking for 1 to 2 days a month.

Please email assistants@yahoo.com

TORONTO, ON Very busy established dental office is looking for a FT/PT associate. Fluently speaking one of the Slavic languages will be a great asset.

Please forward resume to olena.klipitch@gmail.com Or call 647-969-0236 to book an interview.

FEBRUARY 2019

2019-02-04 11:27 AM

ASSOCIATESHIPS

HIGH RIVER, AB

(30 MIN SOUTH OF CALGARY) PART – TIME ASSOCIATE NEEDED

Busy general practice looking for a highly motivated associate dentist.

This is an opportunity to practice in a modern, paperless, and digital 7 operatory practice with a team oriented group and an established patient load. Excellent production for a highly motivated individual.

Please reply with resume to: highriverdentaladmin@telus.net

HEART OF THORNHILL TORONTO, ON

Seeking a general dentist for a very busy practice in the heart of Thornhill, who is motivated and is skilled with root canals, surgical extractions, removal of impacted wisdom teeth and placing dental implants. Graduate from a Canadian or American University is preferred.

E-mail: info@worlddental.ca

TORONTO, ON Full time Dentist with expanded skill set required for replacement of dentist that was billing 700k per year over 4 days per week. Monday through Friday required.

Email: 911@willowdaledentalgroup.com

EDMONTON, AB

Full time associate required for busy dental group servicing Edmonton and surrounding community. Long term associateships preferred.

Please email resume to omar@infinitydental.ca

GRANDE PRAIRIE, AB

Seeking an associate dentist for a well established dental clinic with an excellent team in place. The successful applicant must be proficient in all areas of dentistry and possess strong clinical and communication skills. Our present associate is leaving for higher studies.

Please email Gail at gpfdcadm@telus.net

SASKATCHEWAN

We are looking to hire an Associate Dentist to join our busy and well-established practice in Saskatchewan!

What you will benefit from: • Excellent remuneration • Mentorship and access to a large network of dental professional • Work life balance with evenings/ weekends off • Additional perks for the right candidate

New grads welcome!

If interested please send your resume and cover letter: ttmcalway@hotmail.com FEBRUARY 2019

OHY Feb19 Classifieds.indd 37

NANAIMO, BC

Seeking a full-time associate.

Located in Nanaimo the hub of Vancouver Island, BC. Modern, digital office with growing patient base and strong restorative schedule make this a lucrative opportunity.

Our long term support team helps you balance a healthy lifestyle with a very rewarding and busy work day!

Please contact via email: kat.gillanders@gmail.com

YELLOWKNIFE, NT

An exciting opportunity for an associate position in the North’s most vibrant city. The office has all of the most advanced technology, 3D imaging, ITERO, fully computerized with a visiting orthodontist and its own dental laboratory.

Reply to HKOBAISY@HOTMAIL.COM or Fax: 867-873-4410.

KAMLOOPS, BC Dental Associate Needed in Beautiful British Columbia. We are looking for a motivated dentist to join our busy family dental practice in Kamloops, BC. We are a paperless, digital office with a busy recall system in place. Kamloops is home to world renowned Skiing, golf, fishing, and mountain biking. Our practice is team orientated. The position is full time and is available for July 2019. New Graduates welcome.

Please call 250-398-0532 or email vitoratos@shaw.ca

MERRITT, BC

A very busy, family, friendly dental office in Merritt, BC is looking for a dentist to work two days a week.

If you are looking for a fun, loving office with a great team atmosphere then this will be a great fit.

Our practice offers a wide range of services to an ever growing patient base.

Please email resume to Tricia Alexandruk at alexandruk.t@schss.com

ALBERTA Exciting Opportunity for Alberta Dentists! Earn 50% collection working FT or PT in Northern Alberta. Full Time Hygienist and Assistants also needed.

Please fax resume to: 416-639-2525

www.oralhealthgroup.com

WHITECOURT, AB

FULL TIME ASSOCIATE Looking for Full-Time Associate for rural Alberta. Minimum monthly pay of $15,000 or 40%, whichever is higher.

Housing allowance. $50,000 bonus after 2 years. We are located just 1.5 hours north west of Edmonton and only a 2 hour drive to the Rocky Mountains.

Accommodations available. Join our friendly and dedicated team today.

New graduates are welcomed.

Email resume to dhrakhra@hotmail.com

DOWNTOWN WINNIPEG, MB

Full time associate dentist opportunity.

Dental clinic located in down town Winnipeg MB looking for full time associate dentist with good skills in surgery, root canals.

To apply email: maingate2019@yahoo.com

OTTAWA, ON

Rideau Dental Centre is looking for a part time associate to become a full time partner, to take over an existing practice from a retiring DDS. We are a well established multidisciplinary group practice in downtown Ottawa. Experience will be considered an asset.

Please forward your resume to phyllis@rideaudental.ca

CENTRAL ALBERTA Seeking a Full Time Associate Central Alberta offices seeking a full time associate to work between two clinics. Both established practices have modern technology with an excellent team in place with low staff turnover. The successful candidate must be comfortable with all aspects of general dentistry, with strong communication and personal skills being an asset. Our offices pride themselves on providing exceptional patient care.

Please email your CV to caddsopp@gmail.com BARRIE, BRADFORD AND NEWMARKET, ON

GP WHO DOES ENDO NEEDED. Looking for a GP who has a lot of experience doing endo and retreatments as well as difficult extractions in-office.

If interested please email resume to bbashi@yahoo.com or sbumeliani@hotmail.com

NIAGARA REGION, ON

Busy well established practice seeking Associate 3 days per week. General Dentistry including children. Easy access to QEW. Reply to dentalposition@cogeco.net

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ASSOCIATESHIPS

CONTINUING EDUCATION

OAKVILLE, ON

Orthodontist required for busy dental practice in the Oakville area. The right candidate should be open and friendly with a focus on preventative as well as functional orthodontics.

The position would be ONE Thursday per month.

Please forward CV via email to 2017dentist@gmail.com

REGISTER TODAY

Anatomically Directed Endodontics

STE. ROSE , MB (NEAR DAUPHIN)

FULL TIME ASSOCIATE OR LOCUM NEEDED! Seeking full time ASSOCIATE or LOCUM general dentist for busy dental clinic. Be fully booked from day one for a month ahead! Amazing Team! This is the job you’re looking for!

High earning potential! Earn up to 50%! Busy practice that serve very large area. Don’t miss out on this amazing opportunities! New grads/foreign trained dentists welcome.

Contact AmazingManitobaDental@gmail.com

Hands-on: Live Learn (6 CE) MARCH 1, 2019 8AM - 3:30PM

Dr. Chafic Safi

Ontario Science Centre - North York, ON

Dentist

$495.00+hst

Basic Life Support (BLS) Provider Training APRIL 27, 2019 SEPTEMBER 6, 2019

Sangeetha Kulathilagar Registered Nurse

9AM - 1:00PM (3 CE) 9AM - 11:00AM (2 CE) (Renewal)

Henry Schein Facility Concord, ON

$70.00+hst

Minimally Invasive Veneers Hands-on: Live Learn (6 CE) JUNE 7, 2019

WINNIPEG, MB

F/T associate needed for a busy dental office. Eligible candidate must be a graduate of Canadian dental school or have completed 2 year IDDP program.

Send resume to dentist.winnipeg19@gmail.com

EDMONTON AND AREA, AB Large dental group in Edmonton and Area requires full-time Associate Pedodontist. Beautiful, modern, fully digital practices, with access surgical centre!

This is a great opportunity for Pedodontist that would like to have a balanced work/home life, new Grads that are wanting experience without having to invest financially, or Pedodontist that have transitioned/sold their practices.

All applications will remain confidential.

Email: hr@pureorthodontics.ca

8AM - 3:30PM

Dr. Ron Goodlin

Ontario Science Centre - North York, ON

Dentist

$695.00+hst

www.smilesfirstacademy.com 1.877.270.3077 Ext. 334 Smiles First Academy smilesfirstacademy

AD INDEX AMD Medicom ������������������������������������������������� 17, IBC Clinical Research Dental ��������������������������������������������18 Crest ����������������������������������������������������������������� 8-9, 24 dentalcorp ����������������������������������������������������������������� 14 Ivoclar Vivadent ������������������������������������������������������� IFC ODA – Ontario Dental Association ��������������������������� 31 Philips Oral Healthcare ����������������������������������������������� 4

OAKVILLE AND BRAMPTON, ON Associate General Dentist needed. Ideal candidate possesses exceptional skill set and is highly motivated to help grow the practice.

Tremendous potential for growth.

Kindly email your CV to mydds.ag@gmail.com

WEST TORONTO, ON Associate periodontist needed for busy established periodontal practice with a focus on dental implants. Starting 1 day a week, no evenings or weekends.

Please email: kkbouche@gmail.com

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Premier Dental Products Company ������������������������� 21 Sable Industries Inc ��������������������������������������������������� 33 Safari Dental ������������������������������������������������������������� 29 SciCan ������������������������������������������������������������������������� 7 Shofu Corporation ��������������������������������������������������� 22 Sunstar Americas, Inc. ������������������������������������������12, 27 VOCO Canada ����������������������������������������������������� OBC www.oralhealthgroup.com

FEBRUARY 2019

2019-02-04 11:27 AM

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04.01.19 10:48 2019-02-05 1:20 PM