Oral Hygiene Fall 2011

oralhygiene Fall 2011

The importance of hygienists in REHAB PLANNING Hygienists are team players‌ LET THEM IN ORAL CANCER An emerging epidemic?

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THE MOUTH /BODY LINK Make the connection for your patients Hygienist as TREATMENT COORDINATOR TOOTH WHITENING Tips and troubleshooting

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oralhygiene CONTENTS

FEATURES The importance of the dental hygienist in rehabilitation treatment planning

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Annick Ducharme, RDH

L’importance de l’hygiéniste dentaire dans la planification de traitement de réhabilitation

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Annick Ducharme, RDH

Tooth whitening: a procedure not being performed exclusively in dental clinic

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Annie Beaulieu, HD

Le blanchiment des dents une procédure qui n’appartient pas seulement aux cliniques dentaire

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Annie Beaulieu, HD

The hygienist as treatment co-ordinator: The pre-operative visit

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Debra Engelhardt-Nash

Product tips: Tooth whitening

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Victoria Wallace, CDA, LDA

Oral cancer: An emerging epidemic?

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Jo-Anne Jones, RDH

Hygienists are team players: let them in

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Jennifer de St. Georges

The mouth/body link: Make the connection for your patients

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Uche Odiatu, DMD

DEPARTMENTS 5 News 6 Products 35 Dental Marketplace 39 Editorial

Editorial Board Members Lisa Philp | Jennifer de St. Georges Annick Ducharme | Beth Thompson

30 Oral Hygiene’s premier cover illustration designed

by Ellie Robinson

Fall 2011

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www.oralhealthgroup.com

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EDITORIAL

Find Your Passion I am not a dental hygienist nor do I play one on TV. I am a journalist by choice and by education. Now I knew early on that I didn’t want to be an ambulance chaser; I didn’t want to get those 3am phone calls that a car had smashed through a donut shop window or a house was ablaze on Wisteria Lane. I didn’t want to interview Mrs. Smith as her cat Piddles was being rescued by firefighters from a tree. I also didn’t want to sit at council meetings until the wee small hours listening to politicians debate the merits of ‘calming zones’ as a way of reducing ‘drive-bys’. That’s why I didn’t want to work on a newspaper.

Right from the get-go I knew I wanted to work for, and on, magazines. Glorious, sensual magazines. I love the look, the feel, the smell of them; well, not the really musty ones that have been in the garage

12 years. I love the ones you keep pristine and the ones you roll up and jam into your bag. I love the ones you can’t wait to find in your mailbox and the ones you get at the airport. I love the ones you peruse at the convenience store that are so jammed tight you can barely make out the titles.

I don’t like the really tattered and torn ones you find at the muffler shop, strangely almost always featuring large-breasted women named Fern and I don’t often touch the less-tattered but hugely outdated ones so often found at doctors’ and dentists’ offices. I know Nixon resigned in disgrace and that something called the ‘Walkman’ will change the way we listen to music.

Heaven knows I didn’t start at the top. I mean, there are only so many Maclean’s and Oral Health’s in the country. For many new magazine staffers, re-writing product releases is the entry point…kind of like writing obits at newspapers. But if you persevere and have some luck, glamorous travel to exotic destinations and notoriety will follow.

I know I can but I never have relished a rainy evening curled up with my e-reader, smart phone or iPad. Nope, it’s all about the glossy paper.

Which brings me to the glossy paper you hold now. This is Oral Hygiene. One issue in 2011. Three in 2012. All about you, the front-liners. Written by you; written for you. Meant to educate, inform, amuse, incite to action. Not meant to pander nor pussyfoot. Oral Hygiene honors you and your profession.

Read on. Let me know what you think.

Find your passion. cwilson@oralhealthgroup.com

Catherine Wilson

Editor

Fall 2011

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NEWS BRIEFS

Oral Hygienists’ Stress Level: ‘Average’ says USNews Website “You will have a fairly steady routine, which helps keep stress levels down. Also, since shift scheduling is flexible, you can work the hours that best fit your schedule. But office dynamics vary widely, so your experience will largely depend on the quality of the dentists you work with, as well as the patients you treat”. http://money.usnews.com/money/careers/ articles/2010/12/06/best-careers-2011-dentalhygienist

Repairing the Tattered Safety Net Washington, DC—The American Dental Association (ADA) has released the second in a series of papers that examine the challenges and solutions to bringing good oral health to millions of Americans, including the growing population whose only possible source of dental care is the so-called oral health safety net.

Breaking Down Barriers to Oral Health for All Americans: Repairing the Tattered Safety Net emphasizes the absence of a coordinated, systematic approach to treating underserved populations. It identifies commonsense remedies that can greatly improve safety net programs, even absent the major funding increases that are unlikely to occur in the current economic climate.

“Major improvements in the dental safety net will not occur until the nation places much greater value on oral health,” said ADA President Raymond F. Gist, DDS. “Treating disease that could have been easily prevented or treatA BUSINESS INFORMATION GROUP PUBLICATION Dental Group Assistant: Editorial Director: Kahaliah Richards Catherine Wilson 416-510-6777 416-510-6785 krichards@oralhealthgroup.com cwilson@oralhealthgroup.com Art Direction: Andrea M. Smith Production Manager: Phyllis Wright Circulation: Cindi Holder Advertising Services: Karen Samuels 416-510-5190 karens@bizinfogroup.ca Consumer Ad Sales: Barb Lebo 905-709-2272 barblebo@rogers.com

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Classified Advertising: Karen Shaw 416-510-6770 kshaw@oralhealthgroup.com

Senior Account Manager Sandra Horton 416-510-6852 shorton@oralhealthgroup.com Associate Publisher: Hasina Ahmed 416-510-6765 hahmed@oralhealthgroup.com Senior Publisher: Melissa Summerfield 416-510-6781 msummerfield@oralhealthgroup.com Vice President/Canadian Publishing: Alex Papanou President/Business Information Group: Bruce Creighton

ed in its early stages, but has progressed to the point of chronic infection, and lost teeth, gum tissue or bone is one of the major reasons why these clinical delivery systems remain overwhelmed.”

The paper provides seven fundamental principles that should guide efforts to repair and enhance safety net programs: • Prevention is essential; • Everyone deserves a dentist; • Availability of care alone will not maximize utilization; • Co-ordination is critical; • Treating the existing disease without educating the patient is a wasted opportunity; • Public/Private collaboration works; • Silence is the enemy. www.ada.org

CAO Elects New Executive Toronto—Burnaby, BC orthodontist Dr. Ritchie Mah is the new president of the Canadian Association of Orthodontists (CAO).

He was elected president for 2011/2012 at the CAO’s 63rd Annual General Meeting in Halifax, NS. Other executives elected are:

President-elect: Dr. Paul Major, Edmonton, AB; 1st Vice-President: Dr. Garry Solomon, Belleville, ON; 2nd Vice-President: Dr. Helene Grubisa, Oakville, ON; Secretary/Treasurer: Dr. Michael Patrician, Toronto. www.cao-aco.org

OFFICES Head Office: 80 Valleybrook Drive,

Toronto, ON M3B 2S9. Telephone 416442-5600, Fax 416-510-5140.

Oral Hygiene is a new publication serving dental hygienists across Canada and a perfect complement to our group of publications. Oral Hygiene features the same level of editorial excellence that Oral Health is known for delivering to Canadian dentists. The editorial environment speaks to hygienists as professionals, helping them build and develop clincial skills, master new products and technologies and increase their productivity and effectiveness as a key member of the dental team. Please address all submissions to: The Editor, Oral Hygiene, 80 Valleybrook Drive, Toronto, ON M3B 2S9.

Subscription rates: $10.00 single copy Canada. One year: ON & rest of Canada $26.70; QC $28.70; NB, NF, NS $28.69; U.S.A. US$27.95; Foreign US$45.95.

Dental Guide $18.40 in ON, QC, NS, NB, NF; rest of Canada $17.12; US &

Foreign US$16.00. Printed in Canada.

All rights reserved. The contents of this publication may not be reproduced either in part or in full without the written consent of the copyright owner.

From time to time we make our subscription list available to select companies and organizations whose product or service may interest you. If you do not wish your contact information to be made available, please contact us via one of the following methods: Phone: 1-800-668-2374; Fa x: 416442-2191; E-mail: privacyof ficer @ businessinformationgroup.ca; Mail to: Privacy Officer, Business Information Group, 80 Valleybrook Drive, Toronto, ON M3B 2S9.

Canada Post product agreement No. 40069240.

Oral Hygiene is published by Business Information Group, a leading Canadian information campany with interests in daily and community newspapers and business-to-business information services.

Fall 2011 www.oralhealthgroup.com

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ORAL HYGIENE

Rehabilitation Treatment Planning The Importance of the Hygienist Annick Ducharme, RDH

Currently a valued member of Dr. Elliot Mechanic’s team in Montreal. This graduate from TroisRivieres Cegep as well as the University of Montreal, has been the recipient of le Prix du Lecteur on two separate occasions. Such honors have been awarded to her by her peers for the publication of her articles in OHDQ dental magazine.

Annick Ducharme has sat on the board of multiple committees for the OHDQ and CADC but is also recognized as a distinguished guest speaker for several associations. Among them, Diabete Quebec and Les Salons de la famille.

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have the good fortune of practicing the dental hygienist profession with a multidisciplinary team that considers each member to be just as important as the next. Dentists, denturists, dental hygienists, periodontists, orthodontists and dental technicians are all part of the same team. Based on their fields of specialization and expertise, they contribute equally to ensuring the patient’s well-being. In some instances, my expertise as a dental hygienist even influences the choice of a treatment plan. We recently dealt with the following case at our office. It reflects the importance of the dental hygienist’s involvement in devising a treatment plan.

A 75-year old patient was referred to us in early 2011 (Fig. 1). She was consulting us because she wanted to improve her quality of life by improving her ability to chew. The patient was toothless and had been wearing a full set of removable upper and lower maxillary dentures for over 50 years. She complained that they were loose and often caused mouth injuries. They also limited her choice of foods since she was unable to chew properly (Fig. 2).

In order to enable the dentists to make the right diagnosis and establish treatment options for her condition, we took a panoramic X-ray, assessed her TMJ, physical health and ability to undergo dental treatment, and examined her soft tissue and bone mass. Possible treatment plans were then suggested to the patient along with an explanation of the advantages and drawbacks of each. After listening to the explanations and giving the matter serious consideration, our patient made a well-informed decision: full upper equilibrated maxillary denture and lower jaw implants to be fitted with a fixed-fixed prosthesis.

The surgeon working at our clinic inserted five mandibular implants. Next, the denturist took over. He was to be responsible for the prosthesis transition during the osseointegration period and for ensuring the patient’s comfort during the treatment, which was expected to last between six and eight months. He was also responsible for making the upper equilibrated denture. During his first routine examination of the patient, the denturist noted an accumulation of tartar on the healing caps. Consequently, the patient was referred to a dental hygienist, in this case me. I reassessed the hygiene, went over the proper dental hygiene techniques that were taught when the implants were inserted and, with the surgeon’s consent, scaled the caps (Figs. 3-4).

In light of the amount of accumulation, I showed the patient the necessary hygiene techniques and made sure she was able to perform them. Next, I recommended a checkup in two weeks to assess the condition in order to avoid possible complications that might compromise healthy healing and jeopardize the treatment’s success. A report was sent to the dentist and denturist and photos were taken. When the patient returned two weeks later, I noticed an equally puzzling amount of accumulation.

Since I work in implantology on a regular basis, I see first hand how difficult it is to rehabilitate patients who have been without teeth for a number of years because they are out of the habit of brushing in the mouth. Relearning and mastering adequate oral hygiene techniques can take up to a year. For most of these patients I recommend monthly visits during the first three months after the implants are loaded. After that, I am respon-

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ORAL HYGIENE 1

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sible for assessing the patient’s oral hygiene needs and ensuring that treatments are carried out under the best conditions to optimize their longevity and reduce the risk of complications.

It is not uncommon to see significant tartar accumulation in the first weeks after the caps are placed in the mouth. However, it is extremely important at this stage to assess the ability of patients to maintain their future dentures, bar, posts, etc. Unfortunately, there are few ways of assessing the relationship between tartar accumulation and the patient’s maintenance abilities prior to this phase of the process. In this particular case, the highly alkaline saliva and tartar accumulation posed a potential problem. The patient also had to cope with the reality of her advanced age. Although she still seemed very alert, she admitted to me that having to maintain such tiny inserts in her mouth made her realize that her abilities had declined.

It was at this point that the sum of my observations changed the course of the treatment (Fig. 5).

A short memo on the dentist’s desk along with photos taken over the course of the time I had monitored the patient’s condition as well as the questions I raised about her ability to maintain her future lower maxillary fixed-fixed prosthesis resulted in a meeting with the dentist, denturist and myself, the hygienist working on the case. During the meeting, I expressed my concerns. After reviewing the case history and summarizing

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the situation, we determined that it was essential to meet with the patient to explain our reservations and suggest alternatives such as a fixed-removable or locator type anchors. We met with the patient during a hygiene follow-up appointment. She was not at all surprised. After a specialist had taken charge of her hygiene, she realized that it would be difficult for her to maintain the hygiene of a prosthesis that was permanently attached to the small caps which she already found hard to maintain.

Based on his meetings with the patient as well as on his observations and conclusions, the denturist was able to select the type of prosthesis that would be best suited for the patient and that would provide her with maximum comfort and wear. The plan was approved by the surgeon and a new treatment plan was devised.

Due to well-coordinated teamwork, the outcome of the treatment was beneficial for the patient. In this particular case, the dental hygienist changed the treatment that had been planned and her involvement proved to be extremely important. Would I have been able to use my expertise for this patient’s well-being if the dentist, denturist and surgeon with whom I work did not consider my field of practice important? No. I want to take this opportunity to thank them. The fact that they took my professional skills into consideration not only resulted in a happy, satisfied patient, it also contributed to broadening the influence of my profession. n

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ORAL HYGIENE

La Planification de Traitement de Réhabilitation Annick Ducharme, RDH

Travaille actuellement au sein de l’équipe du Dr Elliot Mechanic à Montréal. Gradué du Cégep de Trois-Rivières et de l’université de Montréal, elle fut récipiandaire à deux reprises pour le prix du lecteur, des prix remis par ses pairs pour ses articles dans la revue scientifique de l’OHDQ. En plus d’avoir siégé sur différents commités de l’OHDQ et de CADC elle est conférencière invité par différents organismes comme diabète Québec ou des salons de la familles.

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L’importance de L’hygiéniste

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’ai la chance de pratiquer le métier d’hygiéniste dentaire dans une équipe multidisciplinaire qui considère ses membres tous aussi importants les uns que les autres. Dentistes, denturologistes, hygiénistes dentaires, parodontistes, orthodontistes et techniciens dentaires font partie d’une même équipe où chacun apporte sa contribution selon son expertise et son champ de pratique sur un pied d’égalité, ceci pour le bien-être du patient. Il arrive même que mon expertise, en tant qu’hygiéniste dentaire, influence le choix d’un plan de traitement. Voici, dans les lignes qui suivent, un cas vécu récemment à notre bureau qui témoigne de l’importance qu’a l’implication de l’hygiéniste dentaire dans l’élaboration d’un plan de traitement.

Début 2011, une patiente âgée de 75-ansnous est référée (Fig. 1). Elle consulte dans le but d’améliorer sa mastication et par le fait même améliorer sa qualité de vie. Depuis plus de 50 ans, cette patiente est édentée et porte des prothèses complètes amovibles des maxillaires inférieur et supérieur. Elle se plaint entre autre de l’instabilité de celles-ci, de blessures fréquentes à la bouche et finalement d’être restreinte dans le choix de ses aliments puisqu’elle ne parvient pas à les mastiquer adéquatement (Fig. 2).

Suite à ce mandat, une radiographie panoramique, l’évaluation de l’ATM, de la santé physique et de la capacité à recevoir des traitements dentaires, l’examen des tissus mous et de la masse osseuse permettent aux dentistes de faire un bon diagnostic et d’établir les pos-

sibilités de traitement. Les plans de traitement possibles sont ensuite exposés à la patiente en lui expliquant les avantages et les inconvénients de chacun. Après toutes ces explications et une mure réflexion, notre patiente prend finalement une décision bien éclairée : prothèse complète équilibrée du maxillaire supérieur et implants au maxillaire inférieur dans le but de recevoir une prothèse fixe-fixe.

Le chirurgien travaillant à notre clinique procède donc à la mise en place des 5 implants mandibulaires. Ensuite, entre en ligne le denturologiste; il sera responsable de la transition des prothèses pendant l’ostéo-intégration. Il sera celui qui veille au confort de la patiente tout au long du traitement qui devrait s’étendre sur une période de 6 à 8 mois. Finalement, il sera également responsable de la fabrication de la prothèse équilibrée du maxillaire supérieur. Lors de la première rencontre avec cette patiente, le denturologiste note dans ses observations d’usage une accumulation de tartre sur les capuchons de guérisons.

La patiente est donc dirigée vers une hygiéniste dentaire, en l’occurrence moi-même, qui réévalue l’hygiène, repasse les bonnes techniques d’hygiène dentaire enseignées lors de la mise en place des implants et procède au détartrage des capuchons avec l’accord préalable du chirurgien (Figs. 3-4).

Considérant l’importance de l’accumulation, j’enseigne alors les techniques d’hygiène requises et je m’assure de la capacité de la patiente à les accomplir. Je recommande ensuite

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ORAL HYGIENE Voir les photos sur la page 9

un contrôle 2 semaines plus tard pour évaluer la condition afin d’éviter d’éventuelles complications pouvant compromettre une bonne guérison et nuire à la réussite du traitement.

Un rapport au dentiste et au denturologiste est fait et des photos sont prises. Le retour de la patiente deux semaines plus tard me permet de constater une accumulation toujours aussi surprenante.

Travaillant régulièrement en implantologie, je suis à même de constater la difficulté de réhabilitation des patients édentés depuis plusieurs années, ceux-ci ayant perdu depuis fort longtemps l’habitude du brossage en bouche. La rééducation peut prendre jusqu’à un an avant d’en arriver à une bonne maitrise des techniques d’hygiène. À une grande majorité de ces patients, je recommande des rendez-vous mensuels durant le premier trimestre suivant la mise en charge des implants. Par la suite, il est de mon devoir d’évaluer les besoins du patient en matière d’hygiène dentaire et de faire en sorte que les traitements soient réalisés dans les meilleures conditions dans le but d’optimiser leur longévité tout en diminuant les risques de complications.

Il n’est pas rare de voir de l’accumulation importante de tartre dans les premières semaines suivant la mise en bouche de capuchon mais à cette étape, il est d’une importance capitale d’évaluer la capacité du patient à entretenir ses futures prothèses, barre, piliers, etc. Malheureusement, il existe peu de moyen d’évaluer l’accumulation de tartre versus la capacité d’entretien avant cette phase du processus. Dans le cas qui nous concerne nous sommes en présence d’une salive fortement alcaline et d’accumulation de tartre pouvant devenir problématique. Nous sommes également en présence d’une personne confrontée à la réalité d’un âge avancé, encore très alerte en apparence mais m’avouant remarquer que ses capacités diminuaient depuis qu’elle avait l’obligation d’entretenir de si petite pièce dans sa bouche.

C’est à ce moment que le fruit de mes observations change le cours du traitement

(Fig. 5). Un petit mémo sur le bureau du dentiste accompagné des photos prises tout au long de mon suivi ainsi que mon questionnement sur la capacité de la patiente à entretenir sa futur prothèse fixe-fixe du maxillaire inférieur est le prélude à une rencontre entre le dentiste, le denturologiste ainsi que moi-même, l’hygiéniste au dossier. Lors de cette rencontre j’exprime mes inquiétudes et suite à une revue de l’historique et une synthèse du dossier, nous estimons qu’il est indispensable de rencontrer la patiente pour lui faire part de nos craintes et lui proposer des alternatives comme du fixe-amovible ou des encrages de type locator. La patiente est donc rencontrée lors d’un rendez-vous de suivi d’hygiène. Elle n’est pas surprise, au contraire. Depuis la prise en charge de son hygiène par une spécialiste, elle a été à même de constater qu’il lui serait difficile de voir à l’hygiène d’une prothèse fixée en permanence sur les petits capuchons qu’elle trouvait déjà difficile à entretenir.

Le denturologiste est la personne qui au fil de ses rencontres avec la patiente, ses observations et ses conclusions, a été en mesure de choisir le type de prothèse avec laquelle la patiente serait le plus à l’aise et qui lui procurerait le maximum de confort et de rendement. Le plan est salué par le chirurgien et la mise en place d’un nouveau plan de traitement est élaborée.

Le dénouement de ce traitement fut bénéfique pour la patiente grâce à un travaille d’équipe bien coordonné. L’hygiéniste dentaire dans ce cas précis a modifié le traitement prévu et son implication s’est démontrée d’une importance capitale. Aurais-je été capable de rendre mon expertise pour le bien-être de cette patiente si le dentiste, denturologiste et chirurgien avec qui je travaille n’estimaient pas mon champ de pratique important? Non. Je profite de cette tribune pour les en remercier puisque le fait de prendre en considération mes compétences professionnelles a non seulement permis à une patiente d’être heureuse et satisfaite, mais à aussi permis au rayonnement de ma profession. n

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ORAL HYGIENE

Tooth Whitening Annie Beaulieu, HD

Graduated in dental hygiene in 1999. She is currently a valued member of Dr. Elliot Mechanic’s team in Montreal. She founded in 2001 the first dental spa concept. She has participated in several conferences both nationally and internationally and has also published an article in Dentistry Today. She has performed beyond 2,500 “one hour whitening” treatments and has advanced expertise in the area of whitening.

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A procedure that is not

being performed exclusively in dental clinics...

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ver the counter (OTC) whitening products have been proliferating on the market for several years now. In fact, they account for the largest market share of oral hygiene product sales. Leading companies have invested millions of dollars in clinical studies on the safety and effectiveness of their products, advertising and even consumer education.

This increasingly popular trend has naturally had an impact on our practice. I for one can state that many clients have consulted us after trying one of these products. Since they do not achieve what they consider satisfactory results, the clients decide to turn to us for supervision using a technique carried out in the home or in our clinic.

Even though we might criticize the fact that these OTC products are being used without the supervision of a dental professional, I in no way wish to denigrate their effectiveness or quality. Indeed, they incur a minimal investment, are becoming increasing easy to use, and some clients may find them worthwhile.

Overall, dental offices are witnessing a significant rise in the number of teeth whitening requests from increasingly well-informed pa-

tients who have an interest in teeth whitening and are knowledgeable about the process. In some cases, whitening is just the first of other restoration procedures we can provide to our patients. (Fig. 1) People are getting pressured in a variety of ways to whiten their teeth. A slightly more underground practice as I like to call it has already surfaced: a type of chair-side treatment using light, but performed outside a dental clinic by staff with minimal teeth whitening skills and certainly little dental health expertise in general. I had occasion to see some for myself in unusual if not inappropriate places such as hair salons, beauty clinics, cruise ships, shopping malls, home shows, airports and even private homes! (Fig. 2) The technique is being practiced by staff with minimal whitening skills and certainly little knowledge of their clients’ overall dental health. We could add that they surely do not share our aseptic protocol or have the training needed to identify specific cases such as clients who have undergone endodontic therapy or have crowns, composite restorations on their front teeth or dental hypersensitivity. Our experience demonstrates that

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ORAL HYGIENE

It is important that chair-side whitening be carried out under the supervision of a dentist or dental hygienist not all clients who consult us for whitening turn out to be good candidates.

There is a big difference between OTCs that undergo safety restrictions before the products are marketed and these places that lead clients to believe in the skills of beauty care technicians who are performing procedures in the mouths of patients! It is essential to inform our clients about the potential and previously unidentified risks of this new practice. We need to defend our knowledge and protect a technique that contains our extensive knowledge. The extensive expertise we have developed through office practice is certainly more effective at all levels.

It is important that chair-side whitening be carried out under the supervision of a dentist or dental hygienist. This will ensure: an examination of the health questionnaire, the establishment of a whitening procedure, a complete diagnosis, knowledge regarding stain etiology, a choice of treatment and the appropriate duration. It is our duty as dental professionals to ensure that our skills are maintained and to mention that fact whenever the occasion arises. What’s next? Will estheticians soon be providing prophylactic treatments? n

Overall, dental offices are witnessing a significant rise in the number of tooth whitening requests from increasingly well-informed patients.

Fall 2011 

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ORAL HYGIENE

Le Blanchiment des Dents Une procédure qui n’appartient pas seulement aux cliniques dentaire...

D

Annie Beaulieu, HD

A obtenu son diplôme en hygiène dentaire en 1999.Elle travaille actuellement au sein de l’équipe du Dr Elliot Mechanic à Montréal Elle a fondé en 2001 le premier concept de spa dentaire. Elle a participée à plusieurs conférences tant au niveau national que international et à également publié un article dans le Dentistry Today. Elle a effectué au delà de 2 500 blanchiment à la chaise et possède une expertise avancée dans le domaine du blanchiment.

14

Fall 2011

epuis plusieurs années déjà, les produits de blanchiment (over the counter) OTC ont envahi le marché. Les produits de blanchiment occupent même la plus grande part du marché des ventes de produits d’hygiène orale. Les principales compagnies ont investi des millions de dollars dans des études cliniques pour la sécurité, l’efficacité de leurs produits, la publicité et même sur l’éducation au client. Bien sur tout cet engouement a eu des répercussions sur notre pratique. Pour ma part, plusieurs clients nous ont consulté après avoir fait l’essais d’un de ces produits. Et n’ayant pas obtenu de résultats suffisamment satisfaisant ont décidé de se diriger vers une technique faite sous notre supervision. Malgré le fait qu’on peut reprocher au OTC de ne pas être fait sous la supervision d’un professionnel dentaire, je ne veux quand même pas dénigrer l’efficacité ou la qualité de tout ces produits OTC parce que pour un minimum d’investissement et une facilité de plus en plus grandissante d’utilisation de certains de ces produits le client peut quand même y trouver son compte. Dans l’ensemble, les bureaux de dentiste ont vu leur pratique de blanchiment augmenter de façon significative à la demande de la clientèle de plus en plus avisée, influencée et informée sur le blanchiment de dents. Le blanchiment est dans certain cas qu’une simple ouverture aux autres restaurations que nous pouvons ensuite apporter à nos clients.

Une pratique un peu plus underground comme j’aimerais la qualifier à déjà fait son apparition. C’est un traitement du genre blanchiment à la chaise et à la lumière mais pratiqué en dehors d’une clinique dentaire.

Et ce, par du personnel ayant des compétences minimales sur le blanchiment de dents et assurément de même pour la santé dentaire en générale. J’ai eu l‘occasion d’en voir à des endroits inusités pour ne pas dire déplacés.

Tel un salon de coiffure, un centre de soins

esthétiques, un bateau de croisière, un centre d achats, un salon de l’habitation, un aéroport et même en résidences privées !

Une technique pratiqué par du personnel ayant des compétences minimales sur le blanchiment et assurément de même sur la santé dentaire en générale de leur client.

Nous pouvons soulever le fait qu’ils n’ont sûrement pas nos protocoles d’asepsie, ni l’expérience nécessaire pour identifier les cas spécifiques comme ceux avec des traitements endodontiques, couronnes et restaurations en composites sur les dents antérieures ou encore d’hypersensibilité dentinaire. Puisque dans nos pratiques, plusieurs clients qui nous consulte pour un blanchiment s’avère en fait de mauvais candidats.

Il y a une grande différence entre les OTC qui subissent des contraintes relatives à la sécurité sur la mise en marché des produits et ces endroits qui laisse croire au client en la compétence de ces techniciens en soins esthétiques qui pratique dans la bouche de patients ! Il est primordial d’informer notre clientèle sur les risques potentiels et inconnus jusqu’à présent de ce nouveau genre. Défendons notre savoir et ainsi se réapproprié une technique qui est en train de nous glisser entre les dents ! Toute notre expertise développée en clinique est assurément plus efficace à tout les niveaux. Il est important que le blanchiment à la chaise soit effectué sous la supervision d’un dentiste ou d’un hygiéniste dentaire. On s’assure ainsi de cette façon que l’étude du questionnaire de santé, l’élaboration du protocole de blanchiment, le diagnostique complet, les connaissances en matières de l’étiologie des taches, le choix du traitement et de la durée appropriée soit appliqués. Il en revient a nous professionnels dentaires de s’assurer du maintien de nos compétences et de le mentionner lorsque l’opportunité se présente. À quand les prophylaxies chez l’esthéticienne ? n Voir les photos sur la page 13

www.oralhealthgroup.com

OHY Fall2011 p12-14 Beaulieu.indd 14

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ORAL HYGIENE

The Hygienist as Treatment Coordinator The Pre-Operative Visit Debra Engelhardt-Nash

Founding member of and served two terms as President of the National Academy of Dental Management Consultants, where she currently serves as member-at-large.

She is an active member of the American Dental Assistants Association.

Debra can be emailed at: rdnash@aol.com

16

P

rior to major and minor surgical procedures, patients are scheduled for a preoperative visit with the physician and the hospital to review vital physical information as well as pre-treatment protocols. The patient has an opportunity to ask questions.

Written post operative instructions are provided. This is standard practice in the medical arena. So — why not in the dental office prior to our clinical treatment?

The idea for the pre-operative visit was not only inspired by a pre-surgical hospital appointment of my own, but also by observation in many dental offices, including my husband’s. Here is what happened: The patient was scheduled for their restorative appointment at 9:00 a.m. When they arrived, there was a conversation about the fee due. It was paid, a receipt generated. The patient was escorted to the treatment area. Xrays, initial photos and treatment plan were reviewed. Face bow transfer, impressions and pre-treatment photographs were taken. Patient questions were answered and post operative instructions reviewed. The actual start time for preparation was approximately 9:45-10:00 a.m.

I determined that if the dental office were to schedule a separate appointment to conduct the preliminary “business” of the operative visit, office efficiency could be increased.

This appointment could be delegated to Expanded Duties Dental Assistant or Treatment Coordinator/ RDH for maximum effectiveness. It has the potential to save one hour of appointment time per initial operative visit, enhance the overall patient experience and increase patient satisfaction.

Patients are often asked to make some form

of payment at their first operative visit — whether it is payment in full, co-payment of insurance allowances or initial payment of an extended payment plan. If the patient is unable to fulfill this financial agreement, they cancel the operative appointment, often on short notice, or ask to modify the visit to a lesser treatment, or arrive without the payment obligation. If this happens, the office has to make a decision what to do with the allotted time — is treatment modified or the patient rescheduled? By disassociating the payment with the appointment, this problem is alleviated. Why not collect the required payment for treatment prior to the visit?

Collecting the fee at the pre-operative visit alleviates this problem. If the patient is not prepared to honor the fee arrangement at this visit, it provides the office another opportunity to make the financial agreements clear before time is lost on the day of the operative appointment when many productive hours were reserved. This saves time on the day of the major restorative appointment and ensures the office getting paid for services rendered. It also minimizes short notice cancellations and no-shows. When the fee has been taken care of, the patient is less likely to find reason to miss their operative appointment.

The Hygienist’s Role The impact of the dental hygienist in today’s dental practice expands beyond maintaining the dental health of the patient and the fiscal health of the hygiene department. Fully utilizing the RDH influence with patients is adding the role as Patient Treatment Coordinator to their position. This concept has been successfully incorporated in many den-

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ORAL HYGIENE

Treatment Coordinator taking face bow record.

tal practices. Their expertise, experience and position make the role as Treatment Coordinator an obvious fit in today’s progressive office.

The hygienist is involved early in the patient process. Depending on the office protocol, the dental hygienist may be the first clinical contact for the patient. They have the responsibility of introducing practice philosophies, office protocols and treatment possibilities to patients. They act as the “second opinion” for many patients looking for validation of treatment recommendations. They spend a great deal of time listening to the patients’ stories of dental history, current concerns and treatment expectations.

In addition to time allocated for the technical portion of the patients’ hygiene visit, time must also be provided to the hygienist for establishing rapport, building the client-dental relationship and demonstrating the exceptional care that can be anticipated in the office.

During a patient visit, the hygienist should spend at least ten to fifteen minutes in conversation before treatment proceeds. Visual aids such as before and after images of the doctor’s work are made available for patients’ view and to incite treatment conversation. For new patients, digital images are taken to be used for patient education and treatment discussion. These can be captured with an intraoral or digital camera — loading the images into the patient’s record and brought up on computer screen for patients’ view. Preliminary photography stimulates patient interest and increases their engagement in treatment conversation. It is also an excellent record of the patient’s current dental status. The use of digital photography is explained to the patient

and they sign a model release authorizing the use of photography in their diagnosis. The Hygienist — whether in a traditional hygiene or advanced role needs to be adept at intraoral and extra oral photography and use it widely in their daily hygiene activities.

Among the responsibilities of the RDH as Treatment Coordinator is performing the protocols of the pre-operative or pre-treatment visit. A pre-operative appointment is an important patient visit. It falls between the patients’ acceptance of major reconstructive and esthetic treatment and the first operative appointment.

A pre-operative visit would meet these objectives: • Treatment reviewed/patient questions answered; • Verify treatment documents are completed; • Clinical data acquired or verified; • Fee collected; • Operative appointment scheduled efficiently.

The appointment lasts approximately one hour. An example of appointment protocol for this visit is: • Verify treatment with patient including area being treated, restorative materials, smile design (if appropriate).

• P re-operative images. Full face image and smile image — front and side views. Retracted frontal and side views, upper and lower arch views.

• Verify all proper x-rays have been acquired.

• Upper and lower impressions for records and provisionals.

• Face bow and bite registration.

• C onfirm periodontal health — tissue pre-

Fall 2011

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ORAL HYGIENE

Treatment Coordinator using visual aids to introduce treatment possibilities.

conditioning prior to preparation appointment, if not already done.

• P re-operative instructions — verbal and in writing (see example).

• Post-operative and home care instructions.

• Dispensing take home products, if necessary (desensitizing gel, mouth rinse, rubber tip massager, surgical toothbrush) • C ollect fee and verify appointment.

The fee for this visit can either be included in the total treatment plan or charged out as a records appointment.

Typically, the pre-operative visit is scheduled for patients who have a significant treatment plan that is commencing. In most practices, this means more than four indirect type of restorations or the financial equivalent (approximately $5000.00) There are many advantages of scheduling the pre-operative appointment with the Hygienist. Clinically, if the pre-operative appointment is conducted in conjunction with a prophylaxis or tissue conditioning appointment, the appointment becomes more efficient. The hygienist has established rapport with the patient, so treatment discussion is done with greater ease and proficiency.

This visit is introduced to the patient as an important part of their care. It cannot be presented as “just” another appointment or simply a means to be paid prior to their operative appointment. Better records are likely to be gathered when the appropriate time is allocated and proper team training is conducted.

To incorporate this additional role into their duties in the dental office, the Hygienist must be proficient in these aspects of the practice. They must understand the total treatment approach and expand their role in patient care. The proper time allotment must be established to execute this visit with maximum results. In addition, the Hygienist must be comfortable discussing fees and explaining payment protocols.

Professional Rewards Expanding the tasks of the Hygienist by including Treatment Coordinator duties is a way to

18

increase the rewards of the profession. The Hygienist is already a vital team member. Taking on the role of Treatment Coordinator and incorporating a post-operative appointment into the hygiene schedule, amplifies their involvement and alleviates the potential of hygiene “burn-out” doing a seemingly repetitive task.

The results of the pre-operative appointment are better patient understanding of treatment leading to increased patient satisfaction, more complete records, more effective scheduling and improved collections.

The Demand There are many factors contributing to the need for change in the delivery of patient care. Media attention has heightened consumer awareness and increased their demand for superior health care.

Technology has made patient information available at a lightening rate. Patients can “Tweet,” “Linked-In,” and Facebook their lives across the world — including their experiences in the dental office. Sharing an average experience is not likely. Complaining about the lack of service or touting the extreme encounter is surer. Be certain that your dental practice has something exceptional to offer patients. Create an extraordinary role for the Dental Hygienist as Treatment Coordinator. Implement the pre-operative appointment as an added service to your patients. The results will be winning for everyone — the patient, the practice, the hygiene professional. n

Fall 2011 www.oralhealthgroup.com

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ORAL HYGIENE

Product Tips: Tooth Whitening Victoria L. Wallace, CDA, LDA

Employed by Ultradent Products, Inc., South Jordan, Utah as a University Account Manager

I

am excited to be a part of this new publication for dental professionals. Being a chair side dental assistant since 1976, I’ve been honored to work with some pretty wonderful dental hygienists and dental teams.

The dental team, including the dental hygienist, is constantly being bombarded with new products and new procedures. It is our responsibility to seek the education needed to stay on top of ever changing dental technology.

Tooth Whitening Tips and Troubleshooting Tooth whitening plays a big part in the total restorative treatment plan, and many times is forgotten. It is especially important if esthetic restorative procedures are planned. Articles upon articles have been written about tooth whitening. It’s best to learn some basics, and then start talking about it to your patients. As with anything, the more you work with the product or procedure, the more you learn and become confident. Start with baby steps otherwise you can become overwhelmed with information. So let’s start with some basics.

Tooth whitening is still very popular amongst our “health conscious” and “antiaging” society. Studies show that this isn’t going to change. Big, bright smiles are a huge part of looking good, and looking younger. I am assuming if you are reading this, you are a dental professional. Have you noticed someone lately that has not whitened their teeth, and wondered why they haven’t? I have. In fact I was talking with a dentist that had beautiful teeth, but the

20

shade of the teeth was very yellow. I really wanted to say something, but thought it was not my place. However, if that person had been a patient in my office, I would have been right on it! Why? It is our responsibility, as dental professionals, to educate patients on their smile options...for both health and appearance reasons.

Are you afraid to ask your patients if they would like a whiter, brighter smile? If so, I challenge you to change that...DO NOT BE AFRAID. If you don’t at least mention it, they will purchase outside of the dental practice. We can provide professional tooth whitening and keep that business in our office... this helps to pay our income, and that will make you feel even more valued!

One way to reach all of your new patients is to include some questions on the new patient questionnaire. Here are just a few examples.

1) A re you happy/satisfied with your smile?

2) W hat would you like to change about your smile?

3) Has anyone ever talked to you about whitening your smile?

4) Would you like to hear about the whitening options we offer?

5) Do you have any questions about tooth whitening?

Of course you can word the questions any way you like, but I highly recommend you have something similar on your forms. We can’t assume that patients know about this, or any other procedure for that matter. Ask the questions. Listen to the needs of your patient.

Hint...make a little change to your ver-

Fall 2011 www.oralhealthgroup.com

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ORAL ORAL HYGIENE HYGIENE

Opalescence Trèswhite Supreme is a 10% or 15% hydrogen peroxide gel, pre-filled disposable whitening system.

biage. Instead of “bleaching” use the word “whitening.” Patients still think (briefly) of bleach as a bottle of Clorox™. Using the word whitening is more comforting and reassuring...they see white.

One more word we use too often is “sensitivity.” Try the word “discomfort” instead... again; it’s a bit more soothing. I always add in “slight” and “temporary” when talking about any possible discomfort.

Whiten your own teeth first. Practice what you promote. Patients love to see their dental professionals have a big bright gleaming smile...especially when they are selling it to the patient. Not only does it help to convince the patient it is the right thing to do, it shows that you believe in what you are talking about. It is only common knowledge that if you have experienced something first hand, you are able to guide someone else through the same experience with more confidence.

Whitening Options Don’t limit your practice to just one option.

We are an “options available” society. If you don’t offer it, the office down the street does.

Don’t lose a patient because you have that “I don’t believe in it” attitude. Or, “it doesn’t work” mentality. Life is a daily challenge.

Get out of your box. Give them what they want. Educate yourself. It’s really, really fun!

So let’s talk about the options available.

Custom Fit Trays with Take Home Whitening First and foremost, a custom fit tray with a

Catherine Wilson

Editor

take home carbamide peroxide solution still provides the patient with the best results. Depending on your patients’ needs, manufacturers provide carbamide peroxide solutions ranging from 10% to 35%. You, the dental professional, need to decide what solution percentage will be right. Back to options; keep some of each in stock. Not all smiles are created equal. Some patients like to wear a tray overnight, some only like to wear it for a short period of time.

How do you decide what percentage to use?

Here are some factors that I have used: • Age • Existing shade • Do they have a time constraint?

• A re they ok with wearing the trays to bed?

• A re they a bruxer?

• Do they have wear facets and fractured incisors?

• C an they bite into an ice cream cone comfortably? (This one is great for patients with sensitivity.)

• Is the cost an issue?

• Do they have a particular whitening option in mind?

• Have they whitened in the past, and if so why are they doing it again?

• Is this just for a touch up?

Continued on page 24

Fall 2011

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www.oralhealthgroup.com

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ORAL HYGIENE

A scalloped, precisely trimmed, custom fit tray for take home whitening.

Continued from page 21

Catherine Wilson Editor

24

Just from experience I will tell you that most patients like the higher percentage, worn over a shorter period of time. “Day time” whiteners are now more popular than our original “nighttime whiteners.” Ask your patient if they have a preference. If they choose to wear it to bed, prescribe a 10% or 15% solution. Save your higher percentages, like a 20% for 2-4 hours and the 35% for 30 minutes. If you choose a 35% carbamide, please educate the patient on getting all of the excess solution off the soft tissue, and to not wear it any longer than advised. I personally love anything over 20% for touch ups. It’s fast and effective, and that is what patients love.

Custom fit trays should be made to fit snugly and scalloped both facially and lingually to prevent tissue irritation. Some doctors prescribe the trays with a resin reservoir while others do not feel it is necessary. I personally always allowed a space for a viscous whitening gel.

When delivering the whitening trays some instructions should be given.

How to fill the tray and place properly in the oral cavity.

How to clean and store the trays while not being worn or used.

What to expect during the whitening process, ie, possible temporary discomfort, limiting intake of dark colored food and liquids, oral hygiene, and what to do if they become uncomfortable.

Shade/shades should be taken and recorded, and the patient should be scheduled back for a mid-treatment check.

Tip: If the patient has numerous wear facets throughout their mouth, do not recommend nighttime use. They will clench and grind and pump all the solution out of the tray within a short time. If you have a patient return for a

mid-treatment appointment and they have not seen a change in shade, ask them if when they wake up and take the trays out is there still solution in the tray? If not, instruct them to wear only while awake.

In-Office Tooth Whitening Systems If you have invested in a whitening system with a light, use it! Please don’t let it sit and collect dust. Patients have been exposed to the lights due to our media. Take advantage of the free advertising. Lights are great for marketing. If you don’t utilize a system with a light, no big deal, there are systems with no light that work great. I’ve not utilized a light system and had super results without spending the extra money.

All I truly have to say about the in-office systems is to know how to do the procedure properly with the least amount of discomfort to the patient.

Have the manufacturer’s rep educate you and the entire dental team if possible. Practice on your dental team members and experience the procedure yourself, if even only for a few minutes.

In-office whitening systems, for the most part, contain hydrogen peroxide as the active ingredient. Hydrogen peroxide is not as stable as carbamide peroxide, so it is important to follow the manufacturer’s instructions. Most systems will have you apply the H2O2 solution in 15 – 20 minute increments over a specific period of time, all in one appointment. Once H2O2 is exposed to air, it starts to break down, hence the shortened life. Hydrogen peroxide whitening solutions also need to be refrigerated; otherwise their shelf life is cut in half. It is wise to take it out about 15 minutes before you start the procedure so it isn’t cold on the patient’s teeth, and the viscosity will not be as thick and easier to express onto the teeth.

Isolation is of utmost importance when performing in-office tooth whitening. Re-

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ORAL ORAL HYGIENE HYGIENE tractors are a must, and forget the cotton rolls...they just get in the way. A good gingival resin barrier must be in place before applying the hydrogen peroxide solution. Some of the in-office whitening solutions are as strong as 40%. If this comes in contact with the soft tissue, the patient may have some discomfort. Blanching of the tissue could occur.

The pad and pen for communication from the patient will help keep you aware if they are feeling any burning or discomfort.

In-office whitening is not for everyone, especially if they are a very dark shade or have tooth sensitivity issues. Pretreating with a potassium nitrate solution is the fastest, easiest way to deal with discomfort from the in-office whitening process. Complete the entire in-office whitening procedure, remove the barrier, rinse thoroughly, and then take a shade. Let the patient rest for a few minutes before taking the shade as their jaws become tired from being open for an hour or more.

Final shade should be taken in natural light with the patient sitting in an upright position.

Some patients will continue to whiten over the next 48 hours, especially if you’ve sent them home with follow up solution. For best results, and patient satisfaction, have them return 7 -10 days later to get a final shade and a “A-OK” thumbs up!

Tips: 1. A surgical suction works much better when suctioning off the hydrogen peroxide solution. Please do not use the air/water syringe, or spray water in the oral cavity until all the H2O2 is removed. The HVE can loosen the gingival barrier without you seeing it, and the water spray will spread the H2O2 all throughout the mouth, increasing the possibility of burning the soft tissue.

2. Another great money-saving tip is to purchase pre-filled trays, such as TresWhite Supreme by Ultradent Products, Inc. It is a 15% hydrogen peroxide, pre-filled, disposable, tray. Send 3-4 applications of this whitener

home with the patient to continue to whiten.

This eliminates the extra time and cost it takes to make them custom fit trays. They can then purchase more for future touch ups.

Pre-Filled Trays Many of our patients purchase tooth whitening at their local drug or grocery store. As a dental professional, I recommend that they see a dentist first. A thorough dental examination should be completed by the dentist before starting tooth whitening.

If a patient cannot afford custom fit or inoffice tooth whitening, there is another option. As I mentioned, pre-filled and disposable trays are dentist dispensed only. So you can provide the patient tooth whitening supervised by you, the dental professional, but at a lower price. Many offices use this delivery method as a marketing tool or provide the patient of record a couple of applications after a re-call/re-care appointment.

It is either a 10% or 15% hydrogen peroxide. Fifteen to 30 minute wear time is all that is necessary, and when they are done the little membranes are pulled off the teeth and thrown in the trash, very similar to strips, but dentist dispensed. Then they brush their teeth and off they go. We’ve seen some nice results in about 7 – 10 days.

Whitening is still a wonderful way to spread the selling responsibility around to the whole dental team which will automatically increase dental office production. Whitening patients will continue to visit their dentists and dental hygienists on a more regular basis to maintain their whiter, brighter, smile. Stay on top of the newest, latest, greatest in tooth whitening, and just have fun making humans smile brighter. n

Catherine Wilson

Editor

Disclaimer Victoria Wallace is professionally associated with Ultradent Products, Inc.

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ORAL HYGIENE

Jo-Anne Jones, RDH

An international speaker for the profession of dental hygiene and the owner of RDH CONNECTION Inc., a consulting and training company dedicated to excellence in quality dental hygiene education. Jo-Anne has developed an online oral cancer awareness program in collaboration with the Canadian Dental Hygienists Association www.cdha.ca.

Jo-Anne may be contacted at jjones@ rdhconnection.com

Oral Cancer: An Emerging Epidemic?

T

he medical and dental community have been alerted to a new risk factor for oropharyngeal cancer that is increasing at an alarming rate. In Canada, oral cancer is the 13th most common cancer of all the 23 reported cancers.1 A short decade ago, the dental community felt more confident in defining those of their patient population that may be at increased risk for oral cancer. Surveillance data indicate that incidence rates of tongue and tonsillar cancers increased steadily between 1973 and 2007, whereas rates of cancers at other oral and pharyngeal sites decreased. 2-11 The culprit is a sexually transmitted virus, HPV; the human papilloma virus. Among the sites of HPV-associated cancers, the oropharynx is the second most common after the cervix.12-14 High risk types of HPV-16 and HPV-18 are associated with approximately 70 – 80% of all cervical cancers and HPV-16 is solely responsible for 85 – 95% of all HPVrelated oropharyngeal cancers.15 There is speculation that should this trend continue, the number of HPV-positive oropharyngeal cancers will exceed that of cervical cancers among females by the year 2020.16

The New Risk Profile HPV-positive oropharyngeal cancers tend to affect an entirely different profile compared to the historical patterns of smoking and alcohol induced oral cancers. The newer profile is one of a younger white male who has a higher number of lifetime sexual partners and engages in the practice of certain sexual

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behaviours. They are less likely to use tobacco and alcohol and statistically more apt to have better survival rates than non-HPV related carcinomas.

Mechanism of the Human Papillomavirus

How does the virus invade the oral cavity?

HPV are DNA viruses that inject the stratified epithelium or basal cells of the skin or mucous membranes. The same virus that will affect the genitals may infect the oral cavity.

‘Oral HPV’ is transmitted sexually through mucous membrane contact both oral-genital and oral-anal. It may also be spread by openmouthed or “French” kissing.

There are over 120 different strains of the virus; with the majority of the HPVs being categorized as low risk.

Clinical Appearance Verruca vulgaris otherwise known as a common wart is caused by HPV-2, HPV-4 and HPV-40. These lesions most often occur on the lips, hard palate and the gingiva. Visually they usually appear as a solitary, white, papillary lesion attached with a narrow or broad base.17 Condyloma acuminatum or genital warts caused by HPV-6 and HPV-11, HPV-16 and HPV-18 occur most often on the lips, tongue and soft palate. Typical visual clues include multiple, slightly papillary nodules attached with a broad base. They are commonly arranged in clusters. The lesions tend to be painless, persistent, are most common in young adults and may manifest clini-

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ORAL HYGIENE

When oral cancer is discovered in earlier stages, the survival rate leaps to 80 – 90% depending on the site. We can make a difference! cally in the anogenital area as well.18 The human papillomavirus has an affinity towards lymphoepithelial tissues specifically the lingual and palatine tonsillar areas. In these anatomical sites they are tonsillar crypts which serve as a means for the virus to have contact with immature basal cells.

The Role of the Dental Professional

It is critical that an oral cancer screening employ both a visual and tactile methodology.

Close scrutiny of the oropharyngeal areas of the oral cavity and in particular the posterior of the tongue and tonsillar areas will greatly enhance the ability to discover an abnormal oral lesion in its earliest stages.

Early discovery is key! The five-year survival rate is around 30%. When oral cancer is discovered in earlier stages, the survival rate leaps to 80 – 90% depending on the site.19 We can make a difference! n

REFERENCES 1. http://www.hc-sc.gc.ca/hl-vs/oral-bucco/ disease-maladie/cancer-eng.php Health Canada/Healthy Living/Oral Cancer 2. Chaturvedi AK, Engels EA, Anderson WF, Gillison ML. Incidence trends for human papillomavirus-related and -unrelated oral squamous cell carcinomas in the United States. J Clin Oncol 2008; 25(4): 612-619.

3. Ryerson AB, Peters ES, Coughlin SS et al. Burden of potentially human papillomavirus-associated cancers of the oro-

(Top to bottom) A verruca vulgaris on the lower lip.

Image used with permission. Newland JR, Meiller TF, Wynn RL, et al, Oral Soft Tissue Diseases: A Reference Manual for Diagnosis & Management, 5th ed, Hudson, OH: Lexi-Comp, Inc, 2011.

Clustered condyloma acuminatum on the lower lip.

Image used with permission. Newland JR, Meiller TF, Wynn RL, et al, Oral Soft Tissue Diseases: A Reference Manual for Diagnosis & Management, 5th ed, Hudson, OH: Lexi-Comp, Inc, 2011.

HPV induced verruca vulgaris on left lateral border of tongue.

Image courtesy of Dr. Samson Ng.

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HPV-positive oropharyngeal cancers tend to affect an entirely different profile compared to the historical patterns of smoking and alcohol induced oral cancers pharynx and oral cavity in the US, 1998 – 2003. Cancer 2008; 113 (10 suppl.): 2901-2209.

4. Shiboski CH, Schmidt BL, Jordan RC. Tongue and tonsil carcinoma; increasing trends in the U.S. population ages 20-44 years. Cancer 2005:108(9):1843-1849.

5. Sturgis EM, Cinciripini PM. Trends in head and neck cancer incidence in relation to smoking prevalence: an emerging epidemic of human papillomavirus-associated cancers? Cancer 2007;110(7): 1429-1435.

6. Nasman A, Attner P, Hammarstedt L et al. Incidence of human papillomavirus (HPV) positive tonsillar carcinoma in Stockholm, Sweden; an epidemic of viralinduced carcinoma? Int J Cancer 2009; 125(2): 362-366.

7. Horner MJ, Ries LAG, Krapcho M et al.

SEER Cancer Statistics Review, 19752006. Bethesday, MD.: National Cancer Institute; 2009.

8. Attner P, Du J, Nasman A et al. The role of human papillomavirus in the increased incidence of base of tongue cancer. Int J Cancer 2010;126(12):2879-2884.

9. Ernster JA, Sciotto CG, O’Brien MM et al. Rising incidence of oropharyngeal cancer and the role of oncogenic human papillomavirus. Laryngoscope 2007; 117 (12): 2115-2128.

10. C haturvedi A, Engels E, Pfeiffer R et al.

Human papillomavirus (HPV) and rising orophyaryngeal cancer incidence and survival in the United States. In: Program and Abstracts of the 2011 American Society of Clinical Oncology Annual Meeting; June 3-7, 2011; Chicago, Abstract 5529.

11. C leveland J, Watson M, Wilson R, Saraiya M. Incidence of potentially human papillomavirus-associated cancers of the oropharynx in the U.S.,2004-2007. In:

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Program and Abstracts of the 2011 North American Central Cancer Registries Annual Meeting: June 21-24, 2011; Louisville, Ky. Abstract P-045.

12. Watson M, Saraiya M, Ahmed F, et al. Using population-based cancer registry data to assess the burden of human papillomarivur-associated cancers in the United Sates; overview of methods. Cancer 2008; 113(10 suppl): 2841-2854.

13. Gillison ML, Chaturvedi AK, Lowy DR. HPV prophylactic vaccines and the potential prevention of noncervical cancers in both men and women. Cancer 2008; 113(10 suppl): 3036-3046.

14. C enters for Disease Control and Prevention. Human papillomavirus (HPV)-associated cancers: number of HPV-associated cancer cases per year. http://www.cdc. gov/cancer/hpv/statistics/cases.htm Accessed August 22, 2011.

15. Dayyani F, Etzel CJ, Liu M et al. Metaanalysis of the impact of human papillomavirus (HPV) on cancer risk and overall survivial in head and neck squamous cell carcinomas (HNSCC). Head Neck Oncol 2010; 2:15.

16. C leveland JL, Junger ML, Saraiya M et al.

The connection between human papillomavirus and oropharyngeal squamous cell carcinomas in the United States. Implications for Dentistry. JADA 142(8): 2011; 915-924.

17. Newland JR, Meiller TF, Wynn RL, Crossley HL. Oral Soft Tissue Diseases: A Reference Manual for Diagnosis and Management. Lexi-Comp Dental Reference Library 2007; p. 101.

18. Newland JR, Meiller TF, Wynn RL, Crossley HL. Oral Soft Tissue Diseases: A Reference Manual for Diagnosis and Management. Lexi-Comp Dental Reference Library 2007; p. 103.

19. http://oralcancerfoundation.org/

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ORAL HYGIENE

Jennifer de St. Georges

Has built a strong reputation for delivering her bottom-line and logical approach to solving complex management issues, in a highly motivating and humorous manner through her speaking, articles, take-home audio programs and implementation services. Jenny has spoken at virtually every leading dental meeting in the US, Canada and UK and has a very strong global following.

Contact her at 800.366.7004 or www.jdsg.com or email help@jdsg.com

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Hygienists are Team Players...

Let Them In W

hen my then husband Edmond and I opened our scratch practice many years ago(I hate the term scratch but it has become part of our dental language) we did not sleep a wink the night following our visit to the bank to sign the loan papers. The loan was for $25,000 US. I have just aged myself! Today, that same starter loan could be five to six time higher for a young dentist opening a new practice.

We could not image owing so much money.

When we had applied to the bank for the loan, our listed assets were two wedding rings and a used VW! The only reason we got the loan, the officer told us with a smile, was as of that date, no dentist in the state of California had ever gone bankrupt. Our biggest asset we were told, was Edmond’s DDS degree. The bank made it very clear they were banking on us not being the first dentist to fail in the history of the state!

The loan was to be used to equip two of the three operatories. The third treatment room, designated for hygiene, we planned on using for storage/staff room for several months. We felt we would be lucky if we could afford a hygienist in nine to twelve months. Along with the loan, we had signed our lives away by committing to a ten year lease for a 770-squarefeet suite. Together, the two financial commitments along with buying reception and office furniture etc., etc., totally overwhelmed us.

Thirty days after opening the practice, I told Edmond it was time to equip the third treatment room and hire a hygienist. Ed-

mond, the non risk-taking dentist said ‘no way.’ The bank, on returning my call and listening to my request for more money, laughed at me.

After receiving our first 30 day financial reports, they laughed even louder. Our schedule for Doctor was not fully booked by any stretch of the imagination. Of course not...we had only been in business for 30 days. And let’s be honest, the first 30 days of a new dental practice has its own stresses.

Patients are scarce. Each time the phone rings, it is a major event. The first person through the day on opening day I sat in the treatment room for an examination. I was most surprised to be informed by Edmond he was the telephone man coming to check a fault with our telephone lines!

Many of the emergencies we handled had been referred from other local practices. Patients, who often had a poor payment record with the referring practice. These practices were thrilled to find the new kid on the block who would welcome anyone walking through the door. I wrote off more money in the first 90 days of practice than I did in the next 18 years.

I have no clinical background. I assisted Edmond clinically once for about 10 seconds.

I saw the blood, backed out of the treatment room and never returned. But I knew that I was right. To raise patients’ dental IQ, to fill Edmond’s dental chair with patients saying “yes” to treatment, I knew we needed the skills of an experienced hygienist.

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The greatest investment a general dentist can make is to incorporate one or more hygienists as part of the foundation of their practice I cannot remember how I won over the bank. But somehow I did. The next thing I knew the supply house was delivering the equipment. I am now looking at two schedules to fill. More sleepless nights.

But we never looked back.

When I shared this story at the time with other of Edmond’s classmates, they were confused. The usual dentist friend retort was “my schedule is not full, so I am cleaning teeth to keep myself busy. I can’t afford to pay a hygienist while I sit doing nothing, so I might as well do the prophies myself — athough I hate doing them.”

My reasoning and logic as to how I perceived the benefits would play out fell on deaf ears. I soldiered on.

Within a month (our fourth in practice) my risk taking was shown to be totally the right decision to have made. I learnt in practice, as I had thought in theory “if I can keep hygiene full, that approach will keep Doctor’s schedule full with educated patients understanding the ramifications of receiving quality dentistry.”

Today’s economy requires small business owners to be risk takers. In my humble opinion, the greatest investment a general dentist can make in their practice, their patients and their business is to incorporate one or more hygienists as part of the foundation of their practice. I am saddened and confused as I hear today of doctors cutting back and/ or eliminating hygiene days. I would encourage dentists to look at the big picture. See

their hygienists as the practice builders they are. In these tough economic times, we need to nurture our patients so they can see the ROI of investing in their dentistry. Hygienists do such a wonderful job of dental education with patients. This is not the time to cut back on that service.

Patients often send us mixed messages regarding their interest in going ahead with needed and elective treatment. Patients may tell Doctor at the consultation “yes, that sounds exciting, let’s go ahead.” But by the time the patient is talking to staff about the money, the patient now “wants to go home and think about it.”

These patients delay treatment, then return to hygiene for their next Continuing Care cleaning and suddenly the “let me think about it” becomes “let’s go ahead.” Hygienists do a fabulous job of educating patients as to the benefits of accepting and investing in their dentistry and health. A strong Hygiene program brings stability and growth to a practice. Using the pre-booking method, a practice should aim for 80% plus of patients to be committed to their next appointment.

Having advised the reader that money talk does not belong in the hygiene treatment room (see box next page), I am just as opinionated about the need for dentists to include hygienists in management seminars along with the rest of the team.

The following scenario happens across the country. Doctor to her hygienist “Mary, I am taking the team to hear Jenny de St. Georges

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ORAL HYGIENE

in Toronto on November 29 th for a program on practice management. This is a heads up for you so that you can fill that date for yourself in other practice.”

To me, Doctor needs to create a supportive team around him/her. A team which, it is hoped thinks and acts ‘as one.’ To reach this goal, all team members need to attend management seminars together. Historically it has been customary for hygienists to keep current with their clinical education needs only. Management was/is considered outside the ‘need to know’ for hygiene. I don’t get it I appreciate the additional financial investment a dentist makes in including both hygienists and assistants in management courses. From a hygiene perspective, the inclusion can become a scheduling nightmare if a hygienist is splitting days between two or more practices.

I am on record for years in suggesting dentists pro-rate their hygienists’ benefits relative to time/days worked in the practice. In our practice, when a hygienist worked for two days a week-we paid her/him annually for two legal holidays, two sick days, two well days and two days of paid vacation after the first year. To include our hygienists in CE programs, we paid the percentage of the program fee relative to the percentage of the week they worked in our office. We suggested the hygienist get the balance from the other practices she/he worked in using the same formula.

When I and other management speakers/ consultants get together and talk shop — we all agree on one thing (if not on anything else!) the most successful practices (using a wide range of criteria to make that judgment call) are the practices where Doctor and the entire team, including the hygienists, attend management programs together.

There is no way management philosophies, systems and protocols discussed in a management seminar program will ever be successfully implemented when only half the team

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turned up. To me, taking only part of the team sabotages a successful outcome.

The number one issue with practice/patient communication is the absolute need for everyone on the team to speak as one. We can not have five people giving any one patient five different answers to a patient’s question.

We must as a team, speak with one voice.

Patients judge a dentist by everything but the quality of care. Patients gain confidence when Doctor and the entire team march to the same drummer. In my programs I do a pretty good job of remembering to ask how many hygienists are in attendance. I have two reactions. Praise for the dentist who has enrolled the whole team. Sadness for the majority of practices who are not attending as a full team.

The importance of including hygienists in management meetings leads me to another huge management issue usually mishandled in dental practices, the non-involvement of most hygienists in the weekly and/or monthly practice meetings. Management standards

A

nother by-product of today’s economy is the expanding role of patients asking hygienists questions about the financial aspect of dentistry. In my opinion, hygienists, when questioned by patients regarding fees, patient payment options, dental insurance clarification, etc., should quickly and effectively refer these patients back to the administrative staff. Hygienists are shielded from the day to day workings of dental insurance and the intimate knowledge of each patient’s financial responsibilities. In their eagerness to be of assistance to patients, hygienists often move into

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ORAL HYGIENE suffer and team morale drops as the players experience a lack of cohesiveness in implementing new ideas and addressing issues when a team member is missing in the equation.

Some suggestions for hygienists and doctors to consider: 1. A practice change their monthly meeting to the day when a hygienist is on site. Practice meetings should be held first thing in the morning so perhaps on that one day, the day starts earlier than usual; 2. A practice can alternate these practice meetings, so the hygienist can be involved for every other meeting; 3. Tape the meetings to allow non participants to quickly get up to speed; 4. 4 8 hours before each meeting the appointed moderator posts an Agenda with project suggestions and request for input. Non attending members must be invited to add their needs/thoughts/comments prior to the meeting in 48 hours; 5. M inutes are typed up within 24 hours, dis-

unknown territories when they answer patients’ questions regarding money and / or insurance. An off the cuff remark “insurance usually pays 50% of crowns and bridges” is so fraught with minefields, it would require another article just on this one subject.

What may sound like an innocent question to a hygienist “will the insurance company cover this cleaning?” can cause management pitfalls when answered by a hygienist at the chair without due diligence.

Therefore here is the jdsg rule for hygienists (and clinical staff) and money / insurance questions: • Do not get involved. It is not

tributed to everyone. It is essential one person be designated with the responsibility to follow-up with all non-attending team members to both ensure they receive the minutes and cover any questions that might arise.

Increasing the Team Spirit Twice a year we held two events for our practice team. On the first Friday of December we held a Christmas dinner to which every team member was invited to bring their spouse or significant other. In the summer we held a picnic to which we added children (and dogs if they wish)to the mix. As owners, Edmond and I chose not to socialize with our staff outside the practice. Both of us were from Europe and I think this was a cultural point of view. I found huge benefits to having staff and spouses meet Doctor in a social, non-clinical environment. The goodwill generated from each of these two events usually lasted for about four months...just in time to prepare for the next ‘do’! n

possible for the clinical team, in the midst of treating a patient to be aware of a myriad of patient financial issues.

• We cannot guarantee a patient’s insurance will pay 20%; • It cannot be quickly determined if coverage is based on UCR or a fee schedule 200 years out of date; • Eligibility brings issues all of its own; • Dental insurance limitations on pre-existing conditions can so easily trip us up; • Using a phase treating format requires multi levels of scheduling / management skill.

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ele on //w F ct th w R Su e w. EE bs “S ora cri ub lh SU be sc e B to rib alth SC or e” gr R al bo ou IP hy x p. TI gi an co O en d m N e !

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oralhygiene Fall 2011

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FEATURE

The Mouth /Body Link: Make the Connection for your Patients “What is always speaking silently is the body.” ~Norman Brown Dr. Uche Odiatu

Co-author of Fit for the LOVE of It and The Miracle of Health. This practising dentist is also an NSCA and Can Fit Pro certified personal trainer, Certified Holistic Lifestyle Coach and professional member of the American College of Sports Medicine. Since 2004 Dr Odiatu has lectured at the largest dental conferences in North America and has been the invited guest on over 300 TV and radio shows. www.FitDentist.com

“The person who knows a great deal has a hundred eyes.” ~Tibetan proverb

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A WELLNESS BASED PRACTICE Patients seek treatment for obvious reasons: to get their teeth cleaned, to have a filling repaired, to find a solution for their bad breath, to whiten their smile, and to care for their growing family’s dental needs. Some are even Googling the words: “oral health” or “wellness dentistry” the night before their dental hygiene appointments. So you can bet your favourite Hu Friedy scaler they will feel reassured if their hygienist is up-to-date with current information on all aspects of dentistry. As health care providers, we have an important obligation to help them not only get “what they need” but also “what they want.”

Iain Chapple, PhD, reported in JADA 2009 that traditional management is not sufficiently reducing incidence of disease when it comes to periodontitis. Research is shifting to the management of patient inflammatory response and their immune system. 2 This new interest has added another rather interesting dimension to our dental treatment.

The patient’s general health which is directly influenced by their lifestyle (sedentary living, overeating, stress management, sleeping habits, mental health) needs to be addressed as well as their oral hygiene habits and the margins of the dentist’s crowns.

Unless you have your head in the sand, you probably have heard about the growing body of research establishing a connection between oral infection and systemic disease.1 Scholarly articles, conferences, books, websites and even Facebook pages (Oral Systemic Connection-Advanced Dentistry) are dedicated

to the subject. Dr Mehmet Oz, from The Dr. Oz Show, recently aired a segment on the subject for his army of viewers. 3 He intrigued the studio audience with the following words: “The eye might be a window to your soul, but the mouth is the door to disease.”

Today we have a unique opportunity for our practices to be wellness centres — creating a far greater impact on the health and lives of patients. The patients in my office enjoy knowing that I am versant in overall wellness — I feel good about discussing sound nutritional principles, I recognize the value of working with allied health professionals: medical doctors, naturopathic doctors, chiropractors, registered massage therapists, dieticians, certified personal trainers, etc. I consult with them and refer patients if I feel there is a need.

You can also have this relationship with your patients by opening the door for a wellness based conversation with any of the following questions: 1) How many hours do you sleep each night?

2) W hat is your current stress level?

3) Have you ever seen a nutritionist, naturopath, chiropractor, or certified personal trainer?

4) Do you perform at least 30 minutes of aerobic exercise most days of the week?

5) W hen was the last time you saw your physician?

6) Do you drink 4-8 glasses of water per day?

7) Do you regularly eat fish or take fish oil supplements?

8) Do you take Vitamin D in the winter

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FEATURE months?

These questions can be woven into your hygiene appointment. Responses that might influence the patients’ oral environment should be documented and shared with the dentist.

For example, did you know that if the human body is chronically dehydrated it will scavenge water from the synovial fluid (think TMJ issues) and saliva (think dry mouth and cavities)? You will position yourself as someone who creates a value-added experience when you are able to explain the link between lifestyle choices and oral/systemic health.

ESTABLISHING THE LINK Most patients are aware that a clean mouth is less likely to have halitosis. Share the benefits of good home care, a thorough scaling and prophy, and you have a slam dunk. However, the average patient is probably unaware that oral infections have the ability to source bacteria that may precede heart disease, respiratory disease, diabetes, low birth weight babies. Patients may be surprised to hear that there is a link between oral health and certain systemic cancers.

Periodontal infection was reported to be one of the top five causes of chronic systemic inflammation by Anne St. Charles, PhD.4 Chronic inflammation is believed to be the underlying cause of many “age-related” diseases including the number one killer: heart disease and possibly for cancer. Periodontal disease was associated with increased risk of kidney, lung, haematological and pancreatic cancers in a recent study which controlled for cigarette smoking. 5 Dr. David Servan-Schreiber MD, PhD, author of Anti-Cancer: a New Way of Life also wrote of the new mechanisms of cancer. He focused on the fundamental but mostly unknown role of the immune system and inflammation in the growth of tumors.6 In his best selling book, which has been translated into 28 languages, he showed how cancer usurps inflammation to seed and spread.

A diagnosis of cancer is one of the most feared for many patients.7 This opens the door for you to empower them by providing new information that may possibly decrease their likelihood of getting cancer. After all, you have a powerful position of influence since you see patients for 45-60 minute appointments several times throughout the

year. The hygienist will spend more time per year with the average patient than their dentist or physician!

Optimal oral health is integral to overall health for the fastest growing demographic in most practices — the senior patient. Lackluster oral hygiene has been associated with increased amounts of respiratory pathogens in oropharygeal secretions. Aspiration of these pathogens and failure of the host immune system to clear them can result in a life threatening condition for those over 65 — pneumonia. And if you really want to get their attention, inform them that the cofounder of the famous Mayo Clinic, Dr. Charles Mayo has stated: “People who keep their teeth live an average of 10 years longer than people who lose their teeth.”

Another potential way for bacteria to enter the bloodstream is through activities of daily living: tooth brushing, eating, etc. Inflammatory chemicals and bacteria can leak from the periodontal area into the bloodstream and cause havoc elsewhere in the body. It only takes twenty-three seconds for the blood to circulate throughout the entire body. Your hard-working liver spews out CRP (C-reactive protein) in response to the presence of potent inflammatory markers. It is a key marker of infection and tissue destruction. 8 If someone has a preexisting cardiovascular condition (high blood pressure, arthrosclerosis, etc), it is vital they understand the “inflammatory” information highway throughout their body: If there is inflammation anywhere, it can potentially show up everywhere!

Gingivitis and periodontitis have also been associated with adverse pregnancy outcomes for many years. This association was put in the spotlight in February 2010, with the first documented report linking pregnancy-associated gingivitis with the death of an unborn baby.9 Researchers matched the bacterium in the baby’s infected stomach/lungs with the mother’s mouth through DNA-cloning technologies. It was noted that the mother’s immune system may have been weakened from a cold during the pregnancy, further proving the importance of the triad: 1. Excellent home care (brushing & flossing) 2. Regular dental visits (preventative & restorative care) 3. Healthy lifestyle practices (i.e. a healthy immune system).

“The first step toward change is awareness.” ~Nathaniel Branden

“Your body is the ground and metaphor of your life, the expression of your existence.” ~ Gabrielle Roth

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FEATURE

LIFESTYLE RECOMMENDATIONS

“If I knew I was going to live this long, I’d have taken better care of myself.” ~ Mickey Mantle

“We are all sculptors and painters and our material is our own flesh and blood and bones.” ~ Henry David Thoreau

38

Sleep is critical to overall health. One night of missed zzz’s and even the most docile grandma turns into a bear. Disrupted sleep or sleep deficit has been shown to negatively influence your immune system. Think of all the new mothers, shift workers, exam cramming students and insomniac seniors who fill your patient roster. If their immune system is already weakened, then it is vitally important that they keep their mouths in pristine condition. Explain that a mouth full of plaque and calculus will further stress a tired immune system — it’s like having your alarm clock ringing all day long. Great to wake you, but irritating if it never shuts off.

Nutrition — According to the Canadian Diabetic Association, there are two million diabetics in Canada; one million who haven’t been diagnosed and seven million pre-diabetic. Diabetics are prone to heart disease, blindness, amputation, dementia, and tooth loss. Without excellent control of their blood sugar through prescription medicine or healthy eating habits and exercise, they usually experience shorter life spans. Good glycemic control (maintaining normal blood sugar levels) is key for them. Interestingly enough, recent research has indicated that regular root planing and scaling can positively influence glycemic control.10 This information could benefit up to one-third of your patients!

Supplementation — Omega 3 fatty acids (found in fish oil) are good for the body and for oral health. A moderate intake of the Omega 3’s can decrease the incidence of periodontal disease by up to 20% according to the Journal of the American Dietetic Association.11 Regular Exercise — There are numerous studies showing that regular physical activity may prevent stress-induced suppression of the immune system. The American College of Sports Medicine reports that moderate physical activity can reduce inflammatory disease.12 As a hygienist – it is not your job to prescribe the exercises, but you can create the awareness that a simple change in lifestyle can thwart or decrease inflammation anywhere in the body.

Today’s patient wants to know that you have a progressive outlook and current information concerning the mouth/body connection. They have a growing desire for natural

foods, organic products, and information concerning whole body health.13 Dental professionals who are not recognizing this trend may experience challenges with treatment acceptance. You can stay on top of the research by reading articles, attending courses at dental conferences, networking with allied professionals, and sharing new information with patients.

Most importantly, when you are able to give your patients a powerful reason, like decreasing overall body inflammation and reducing disease risk, they will be more likely to maintain frequency of re-care and excellent home care. This will guarantee your role as an integral part of your patients’ health care team. n

REFERENCES 1. Viewpoint. Dentistry Today, November 2008.

2. C happle, Iain, “Potential Mechanisms Underpinning the Nutritional Modulation of Periodontal Inflammation,” Journal of American Dental Association, 2009.

3. Dr Mehmet Oz. The Dr Oz Show. www. droz.com 4. A nne St. Charles PhD, Inflammation: Causes, Prevention and Control. Institute for Natural Resources, Health Update, Feb 2011.

5. Michaud, D.S., et al. “Periodontal disease, tooth loss, and cancer risk in male health professionals: a prospective cohort study.” The Lancet, June 2008, volume 9, pages 550-558.

6. Dr David Servan-Schreiber MD, PhD; AntiCancer: a New Way of Life. Collins (2008).

7. w ww.mayoclinic.com 8. Dr Len Kravitz PhD lectures, Can Fit Pro Conference, August 2011, Toronto.

9. Obstetrics & Gynecology, February 2010.

Vol. 115, pp.442-445.

10. Matthews J et al. “Weak evidence suggests scaling and root planing may help people with diabetes improve glycemic control”. Journal of American Dental Association, September 2009.

11. Naqvi, A.Z. et al; “Omega 3 Fatty Acids and Periodontitis in US Adults”, Journal of the American Dietetic Association, 2010.

12. Jonas, S. and Phillips, E.; ACSM’s Exericise is Medicine. Lippincott Williams and Wilkins (2009).

13. Agriculture Canada Food Trends 2020 http://www4.agr.gc.ca

Fall 2011 www.oralhealthgroup.com

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DENTAL MARKETPLACE

HYGIENISTS

CAREERS

TORONTO, ON

Hygienists required in my downtown Toronto office.

E-mail resume to: tooth32@295.ca

FREDERICTON, NB LOCUM position available: Busy, modern practice in Fredericton, NB seeking a 4-6 week replacement for the Jan-Mar 2012 period.

Please reply to: drjohn.steeves@nb.aibn.com.

PRACTICES & OFFICES SPACE AVAILABLE

Dental Clinic / Medical Space available for lease in Medical Building. 740 sq. ft. & 1480 sq. ft. in Toronto Downtown (Spadina & Dundas) — $10/sq.ft.+TMI 485 to 1702 sq.ft. in Brampton Downtown (population 500K+) — Gross $27/sq.ft.

Contact: mortgage55@hotmail.com 905-454-4400.

EAST YORK MEDICAL CENTRE OPENING near TEGH

Are you starting a Dental practice?

Upgrading your professional offices?

Our Medical Centre has a walk-in medical office and large pharmacy in place.

We are looking for expanded services in Dental & Oral Surgery. Interested?

Call Trevor Jones at 416-750-4645 ext. 27

I CAN HELP YOU REDUCE YOUR OVERHEAD! Sure fire methods to reduce your office expenses.

Free initial consultation 416-371-3384.

I am looking for a $1+ million grossing practice to buy privately or brokered.

Save up to 10% commission. Areas: up to 1-1.5hr distance surrounding toronto in all directions.

Please respond to loki.trader@gmail.com in strict confidence.

Lending to the Canadian Healthcare Professional

• Practice Acquisition Financing • Lease Financing • Debt Restructuring • Mortgages and more...

B.C. • Paul McFadyen Prairies • Doug Mallett Ontario • Chris Lowry • Steve Wasylyszyn • Colin Ross Maritimes • Susan Redmond

For more information, please contact a local Desante representative.

1.866.276.7642 www.desante.ca OHY Fall2011 p39-42 Classifieds.indd 39

Keep Dental Implants in House and Increase Your revenue!

I am an experienced Dentist who has placed and restored more than 500+ Implants. I will place dental implants for your Patients and guide you in the prosthetic steps.

Call me today: Dr. Mazahreh 647-444-1336 ontarioimplantdentist@gmail.com

PRACTICES & OFFICES HAMILTON, ON

DEAR DENTISTS:

PROFESSIONAL SERVICES

www.oralhealthgroup.com

DENTAL MARKETPLACE

Contact: Karen Shaw • tel: 416-510-6770 • fax: 416-510-5140 • e-mail: kshaw@oralhealthgroup.com Toll free: CDA 1-800-268-7742, ext 6770 • Toll free: USA 1-800-387-0273, ext. 6770

To place your ad contact Karen Shaw at 416-510-6770 or kshaw@oral healthgroup.com

Dental office for sale or lease. Used as an orthodontist office. Fully plumbed, wired, partitioned etc on a busy main street in Hamilton. Low cost startup or satellite office.

Phone 905-692-5245 or e-mail: ult.ext@sympatico.ca

WEST END GTA Practice for sale in West End of GTA. Established in 2004. Dentist relocating.

Annual billings approx. $450K. Two fixtured operatories and two plumbed.

Located on a very busy street with excellent exposure. Leased premises, but first right of refusal available on real estate.

Interested parties, please send email to: reachus@businessaffairs.ca referencing West End GTA Practice for Sale.

LESS OFFICE RESPONSIBILITY — EXCEPTIONAL OPPORTUNITY We are a progressive office in mid-town Toronto that is able to accommodate your existing practice 2-4 days per week. All aspects of practice management looked after. This is an ideal opportunity for someone facing lease termination due to sale and demolition, or simply wants to practice without additional stress.

Our practice offers comprehensive care with a strong preventive model and on-site periodontist.

Dreaming of an easier 9-5? Consider joining our high profile practice that is quality centered.

Serious Inquiries Only: info@aestheticsindentistry.com

ASSOCIATESHIPS To place your ad contact Karen Shaw at 416-510-6770 or kshaw@oral healthgroup.com

BROCKVILLE, ON ASSOCIATE WANTED

Busy, growing family practice providing all aspects of general dentistry in Brockville, ON. Great hours, great compensation options, no evenings, no weekends.

Email resume to: drkyly@gmail.com

Fall 2011

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DENTAL MARKETPLACE

ASSOCIATESHIPS

KITCHENER, ONTARIO

MEDICINE HAT, ALBERTA Well-established, busy Family Dental Practice requires a full-time Associate.

We have a friendly team providing comprehensive and progressive treatment to a very large patient base. CE Subsidized.

New grads are welcome to apply.

Please submit resumes by email to medhatdental@gmail.com

Cowan Heights Dental Centre is providing an excellent opportunity for a highly motivated dentist to join a well established and growing practice using the latest in dental technology.

Please e-mail Joanie Trainor at: cowanheightsdental@nl.aibn.com or phone 709-364-2654.

WHITEHORSE, YUKON FULL-TIME ASSOCIATE REQUIRED

ASSOCIATE REQUIRED BURLINGTON/OAKVILLE AREA

ORTHODONTIST ASSOCIATE/PARTNER WANTED IN VANCOUVER AREA

Established and efficiently run downtown clinic. Great opportunity for highly motivated and enthusiastic individual. Being the only dentist, candidate must be committed to provide all aspects of general dentistry independently. Position open until filled.

Remuneration @ 45% on collections.

E-mail: Whitehorsedental@gmail.com Fax: (867) 633-5698 Administration, PO Box-255, 108 Elliot Street, Whitehorse, Yukon. Y1A 6C4.

LLOYDMINSTER, AB Full-time, quality minded, detail and patientoriented Associate required for busy practice.

State-of-the-art – digital, offering implants and ortho. Well established, growing practice. Paid on PRODUCTION! New grads welcome.

Please email: azhrdental@gmail.com.

Associate required for well established busy family practice. Applicant should be a positive easy going individual able to practice all aspects of dentistry. Part time to start with transition to full time for the right candidate within 12 – 18 months. Serious candidates prepared to make this committment only please.

Please e-mail to drmgc@rogers.com

OSHAWA AREA, ON

Dentist needed in Oshawa area immediately.

E-mail: drmint@rogers.com

FORWARD CV TO ASSOCIATES@STEINBERGDENTAL.COM

40

ST. JOHN’S, NL ASSOCIATE POSITION

Associate wanted, part-time or full-time for busy Kitchener family practice. Great location in a busy plaza. Position is replacing an existing associate who is relocating out of the province.

Please fax resumes to 519-744-7354 or e-mail to mbensky@rogers.com

Fall 2011

OHY Fall2011 p39-42 Classifieds.indd 40

Certified specialist in orthodontics wanted to join a growing and profitable orthodontist office as an associate with opportunity to buy in as a working partner in beautiful Vancouver, BC. Please reply by email in confidence to bcorthodontist@gmail.com with resume and orthodontic background.

HAMILTON, ON

Full time associate required immediately. Progressive office. Great location on central Hamilton mountain. Booked schedule and good insurance plans. Great team and patients. One evening and occassional Saturday. Email resume to: hamilton.associate.dentist@gmail.com, or fax to (905) 387-2615.

WWW.STEINBERGDENTAL.COM/ASSOCIATES

www.oralhealthgroup.com

20/10/11 3:22 PM

EDMONTON, AB

Full Time Associate dentist position available in our modern large family dental practice with a 35 year proven track record. This is a great opportunity for a new graduate to gain excellent clinical experience and earn a SIX figure income while enjoying this outdoor recreation hotspot. Mountain biking, hiking, fishing, skiing, golf and kayaking all at our doorstep.

Position is available July 2012.

Call Perry Collect 250-398-7161 (daytime); 250-398-9085 (evening); 250-398-8633 (fax) or vitoratos@shaw.ca or visit www.cariboodentalclinic.com

Full time associate sought for busy north Edmonton dental practice. You will have the opportunity to practice in a brand new clinic with digital equipment.

This practice has OUTSTANDING new patient flow along with a fantastic support team. This makes for a great place to enjoy dentistry. Seeking a motivated team-oriented dentist with great communication skills. Must be available to work some Saturdays and one evening per week.

Please email resume to g.mandrusiak@yahoo.ca or fax resume to 780-473-2550 attention Gina.

EDMONTON ALBERTA

TWEED-BELLEVILLE, ON

Excellent opportunity for Highly motivated and confident practitioner dedicated to providing the best quality dentistry in a progressive family clinic with a great dental team.

Email resume to aponiadental@gmail.com or call Krista at 780-944-1999 visit us at aponiadental.ca

Dental Homecare, a Mobile Dental Service in Central Ontario, has an opportunity for a certified Dentist to work in the Tweed – Belleville area three to five days per week.

This is an excellent opportunity for a new or retired Dentist.

Applicants should forward correspondence and professional CV to Steve Daynes via steve@dentalhomecare.ca; cellular number: 705-760-1173

www.broadwaydental.ca

STEINBACH, MB ASSOCIATE REQUIRED

BROADWAY DENTAL ASSOCIATES • Experience the Medicine Hat advantage.

• Protect your career from gridlock.

• You are interested in predictable community living.

• How do you value family time?

• Lowest tax and utility rates in the province.

• Children walk to nearby schools.

• Highest grossing private practice in Southeastern Alberta.

• Enjoy all the technological advances in today’s dentistry.

• Achieving excellence with our experienced team is assured.

• You are interested in above average compensation.

• Check out our website, contact Dr. Greg Bradley.

• Home of the Medicine Hat Tigers, the team has won two Memorial Cups, five WHL Championships and seven Division Titles.

101 - 7 Strachan Bay S.E. • Medicine Hat, Alberta • T1B 4Y2 Ph: (403) 548-7000 Fax (403) 548-7111 Toll Free 1-888-607-6453 www.broadwaydental.ca

www.oralhealthgroup.com

OHY Fall2011 p39-42 Classifieds.indd 41

DENTAL MARKETPLACE

WILLIAMS LAKE, BRITISH COLUMBIA FULL TIME ASSOCIATE

Associate required for busy, progressive, fast paced Steinbach dental practice two evenings a week, Fridays and Saturdays. The ideal candidate will have 3-5 years of general dentistry experience, aspire to continually provide patients with high standards of dental care and a potential to earn 30,000 thousand a month.

Our full range of dentistry includes: endodontics, orthodontics, full mouth rehabilitation as well as implant placement.

Conveniently located in our brand new location at the Clearspring mall, Hanover Dental is an established clinic with excellent patient flow. We provide state of the art technology including digital xrays, clean air filtration system, a wonderful staff and exciting environment. All enquiries will be held in strict confidence.

Please send resumes to marie@hanoverdentalclinic.ca For more info please visit our website at hanoverdentalclinic.ca Fall 2011

41

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Phone inquiries: 1-888-877-0737 (toll free).

Websites: www.albertadentalimplants.com & www.implantsmilecenter.com

090335

DENTAL MARKETPLACE

DOVE DENTAL CENTRES Full-time associate required for one of their dental centres in London ON. Any inquiries, please e-mail to: dovedental@ody.ca

BRAMPTON, ON

Caring part-time associate required for busy dental office in Brampton. Experience an asset but not essential.

Call 905-456-0827 or fax resume to 905-456-8869 or e-mail: annasimas@bellnet.ca

DRUMHELLER, AB

Full-time Associate Position available in a newly renovated, technologically advanced, busy practice in Drumheller. Excellent opportunity for new graduate or experienced dentist wanting to live in a great family community close to Calgary. Hospital privileges available. Also open to practice partnership to the right candidate.

Please call (403) 823-7755 or e-mail jcaravan@magtech.ca

EDSON, AB Full time associate required for busy family practice. Work in a well established clinic where one can enjoy all aspects of dentistry. Edson, a vibrant town of 8000 people, is situated half way between Edmonton and Jasper, making it ideal for sharing the amenities of the city and those of the vast outdoors. If you are a proficient clinician who’s committed and caring, please contact Dr. ShariJean Robinson at srobin11@telus.net or call 780-723-5221.

FULL TIME ASSOCIATE DENTIST REQUIRED KAWARTHA LAKES, ON A well established, patient oriented full scope family dental practice in Lindsay, Ontario (1 hour outside the GTA) offers a rewarding, fully booked position allowing the practice of any facet of dentistry desired. Earning potential easily exceeds 20k+ monthly NET. We seek a candidate committed to quality dentistry, with strong communication skills. New graduates are welcome to apply.

Fax resumes to (705) 324-3863 or e-mail drjameskimdds@yahoo.ca

42

Fall 2011

OHY Fall2011 p39-42 Classifieds.indd 42

DOWNTOWN TORONTO, ON Toronto general practice, 060327 JULY 09 p/t

Periodontist and Oral Surgeon needed.

E-mail resume: CALGARY, ALBERTA Associate required for progressive, dentalspecialist2004-hr@yahoo.ca dynamic dental practice located in beautiful Calgary, Alberta.

PleaseVANCOUVER, e-mail CV to BC. WEST END, horkoffp@telus.net Full time associate position available. A oropportunity fax resumetoto 403-276-3664 rare live and work in the

most sought after location in BC. This is BC’s answer to Manhattan, 051029 WINTERNY. 09Strong clinical and interpersonal skills will ASSOCIATE REQUIRED assist to assume and grow patient load.

NORTH OF TORONTO Please contact us at Excellent part-time associate mercuryfree12@gmail.com

op portunity available immediately for a busy, well established, re spected family practice.

Unique GRANDE PRAIRIE, ALBERTA oppor tunity for a self-motivated, Acaring full time associate needed for our individual who performs all busy, well established family practice. aspects of dentistry. Conveniently Our practice offersnorth all aspects of located 45 minutes of Toronto. family dentistry including I-V sedation, Please reply in confidence to oral sedation and implants. fax: (905) 722-8271We or will be moving into a brand new office soon in e-mail: drrbross@bellnet.ca a high traffic area.

If you are trustworthy, friendly and committed to excellence please Oral Health Classified Ads contact Christa at 780-539-6883 or email resume to drroy04@telus.net

ASSOCIATE REQUIRED — OKOTOKS, AB

Busy family practice seeking F/T associate to start immediately in a well-established practice of over 15 years. We have a highly organized and dedicated team and a state of the art facility. Our practice environment is friendly and focuses on patient care and comfort. We are located 15 minutes south of Calgary.

Non-assignment. F/T or P/T inquiries welcome.

Please call Sherry @ (403) 995-9544 or email resume to manager@okotoksfamilydental.com

BURLINGTON, ON Full time associate wanted for a busy Burlington office. No weekends,only one evening.Experience preferred, ideally should be comfortable with endo and surgery.Ongoing CE support for the right candidate.

Please send your resumes to assoc.wanted@gmail.com CERTIFIED P/T PERIODONTIST WANTED BURLINGTON/OAKVILLE AREA

Periodontist wanted for a Busy Family Practice in the Burlington/Oakville area.

Please fax resume to 905-637-0868 or email: drmgc@rogers.com

The Comox Valley is the recreation offering a mild climate and afford www.riverwaydental.co www.discovercomoxvalley Please send CV to: riverwaydent

FEB 2011

FT/PT ASSOCIATES

FT/PT Associates required for very busy offices in Mississauga, Barrie and Scarborough.

Please email: Dentaldreams@live.com.

Please specify which location you are applying for.

ASSOCIATE REQUIRED VAUGHAN, ON

090325 Associate

for JULY growing09 practice in Vaughan. Great personality, people ON to handle skills+Min. OTTAWA, 3 years exp. Ability Denture clinic dentist to emerg, endo, exo.seeking P/T to start, Saturday a must. Join our team to work, learn and assume workload from current dengrowtransitioning in a great environment. tist out of practice.

E-mail your resume to:for over Clinic has been in business 25 yearsdrzoom2@gmail.com in the Ottawa area. Great

opportunity to start taking patients right away. New graduates welcome.

BRITISH COLUMBIA — Call 613-749-4055 FORT ST. JOHN or e-mail: samlima10@aol.com Full-time associates needed immediately for established, busy family practices in beautiful clinics with high income potential. These clinics provide full time CDAs, hygienists, high tech equipment, Cerec and friendly, hard working staff. Locations provide some of the most exquisite outdoor recreation areas in BC. Contact Curtis at: (810) 376-9876 or email:cklmanagement@gmail.com.

UPPER OTTAWA VALLEY ASSOCIATE POSTION AVAILABLE Dentist required to join our well-established, busy practice. Self-motivated, caring individual with the highest quality of all aspects with family dentistry in mind.

Busy from the start.

Please email resume to resumedental@live.ca

EQUIPMENT FOR SALE • Intra-oral camera system (HD Doc port) – 3 yrs old • Belmont PAN (good working condition) – 20 yrs old • 2 Belmont Chairman Traversing chairs (newly reupholstered) – 15 yrs old • Tuttnauer Sterilizer (fully functional) – 12 yrs old Please e-mail: tntdds1@hotmail.com

FOR SALE Pan by Instrumentarium Model OP 200 — new — manufactured in 2006 Covertable to pan-ceph Delivered and installed and guaranteed for 3 months $10,500.00.

Contact fletchersmeadows@gmail.com if interested.

FOR SALE 7-Siemens E-1 chairs, with side delivery, cuspidor, suction and lights mounted on units. 20 years old.

Contact: info@doctorjoe.ca

www.oralhealthgroup.com

20/10/11 3:23 PM

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