Oral Hygiene May 2012

oralhygiene hygiene www.oralhealthgroup.com

May 2012

HYGIENIST AS TREATMENT COORDINATOR The postoperative visit

Protect your

HANDS Optimize gloving practice

STERILITY ASSURANCE: Begin with the end in mind Provisional trimming & polishing TECHNIQUES FOR THE CHAIRSIDE ASSISTANT Integrating 21 CENTURY CARIES DETECTION into your clinical practice ST

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oralhygiene CONTENTS

FEATURES Hygienist as treatment coordinator — The post-operative visit

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Debra Engelhardt-Nash,

Sterility Assurance: Begin with the end in mind

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Leann Keefer, RDH, MSM

Provisional trimming & polishing techniques for the chairside assistant

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Shannon Pace Brinker, CDA, CDD

Integrating 21st century caries detection into your clinical practice

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Stephen Abrams, DDS

Protect your hands: Optimize gloving practice

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Luce Ouellet, BScN., DESS

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DEPARTMENTS Editorial

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News Prophylaxis key theme at IDS 2013; Two recognized for excellence in dental education

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New Products

32 Dental Marketplace 34

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Editorial Board Members Lisa Philp | Jennifer de St. Georges Annick Ducharme | Beth Thompson Cover: thinkstockphotos.com

May 2012 

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EDITORIAL

Anti-Fluoridation Arguments Shot Full of Holes Really?

Arguing about water fluoridation in 2012 AD? I haven’t taken a drink of water from my tap in years nor have I taken a sip from the water fountain in my office in some time. And since it’s my editorial we aren’t going to talk about the amount of waste I produce in water bottles.

Look around…we’re drinking beer, wine, cocktails, mocktails, superfruit juices, protein drinks, energy shots, shakes, smoothies, functional beverages, relaxation beverages, bottled waters and soda, soda, soda. No wonder kids have the attention spans of gnats.

Thank goodness for fluoride toothpastes but they alone are not enough.

“Many arguments have been put forth by those opposed to fluoridation, ranging from the relatively innocuous ‘it’s not effective’ to the more apocryphal ‘communist plot’ and ‘aluminum company conspiracy’. Part of the power of the anti-fluoride movement is that some of the arguments — e.g. potential harm to the environment and aquatic life — cross ideological lines and have proponents on both the political right and left.”1 Ensuring full and equitable access to preventive dental health measures such as fluoridation is particularly important when, as is the case in Canada, dental health services are not part of the public healthcare system. It has been estimated that only approximately six percent of all dental expenditures in Canada are publically funded (Health Canada 2010). Universal access to preventive dental health measures such as fluoridation may help to offset the inequitable access to dental health treatment and services.” 2 Fluoridated drinking water is cited as one of the top 10 achievements of the last century in terms of public health but hey, there are other ways to get your fluoride: pills, in-home units, topical ap-

plications. And if ‘they’ can fluoridate your drinking water goodness knows what else they’re putting in there. I personally believe something in the water is making us dumber than ever. Yes, really.

What else accounts for ‘Billy the Exterminator,’ hmm?

The communist plot theory didn’t hold up because most of those who bought into it backed away realizing that saying it out loud could lead to ridicule. Really?

The aluminum company conspiracy was based on the idea that they used fluoridation to get rid of sodium fluoride, an unwanted byproduct of aluminum processing that cost a fortune to get rid of. That theory died too.

As to the concerns that fluoridation causes a myriad of health problems, ongoing research fails to support this notion. There have been 18 major reviews of fluoridation since 1997 alone and none have found evidence of linkages to cancer, bone disease, kidney disease, birth defects or other adverse health effects.

Ontario’s chief medical officer, Dr. Arlene King, said recently that drinking water fluoridation is one of the most cost-effective health interventions that exist. The cost to fluoridate a community, she says, is less than the cost of one dental filling, and that’s the average lifetime cost per person.

As front-line oral healthcare workers and knowing the link between good oral health and systemic health, review the facts regularly. You’ll have no difficulties dispelling the fears of the tinhat crowd. n

Catherine Wilson

Editor

REFERENCES 1&2. Drinking Water Flouridation in Canada: Review and Synthesis of Published Literature, April 2011.

Funded by The Public Health Agency of Canada.

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NEWS BRIEFS

Prophylaxis key theme at IDS 2013 Cologne—From 1998 to 2008 in Germany, turnover volume in the preventive care sector rose from 40 to 90 billion Euro. This increase corresponds to the increased awareness among the population for the significance of oral health, health in general and quality of life.

Dental prophylaxis is receiving effective support from the dental industry: intensive research into oral diseases and the development of therapeutic processes has been conducted with immense commitment and application for years in close cooperation with the scientific sector.

The whole spectrum of professional prophylaxis measures can be used today by dentists, dental assistants, dental prophylactic assistants and dental John Eisner hygiene assistants for a successful specialization and expansion of their services catalogue. This group should make use of the diverse range of information on the theme of prophylaxis available at the 35th IDS from 12th to 16th March 2013 in Cologne. www.ids-cologne.de

Two recognized for excellence in dental education Buffalo, NY—Two outstanding University at Buffalo innovators in dental medicine have recently been honored by national organizations for their contributions to dental education.

John Eisner, DDS, PhD, associate professor

Roger Triftshauser

A BUSINESS INFORMATION GROUP PUBLICATION Classified Advertising: Editorial Director: Karen Shaw Catherine Wilson 416-510-6770 416-510-6785 kshaw@oralhealthgroup.com cwilson@oralhealthgroup.com Art Direction: Andrea M. Smith Production Manager: Phyllis Wright

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May 2012

Dental Group Assistant: Kahaliah Richards 416-510-6777 krichards@oralhealthgroup.com

Circulation: Cindi Holder

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emeritus, has received the Association of Canadian Faculties of Dentistry’s (ACFD) Distinguished Service Award.

Roger Triftshauser, DDS, UB ’61, has received the American Student Dental Association’s (ASDA) 2012 Paragon Award.

Changes to Canada Health Transfer mean windfall for some provinces Ottawa—The Canada Health Transfer to the provinces has grown steadily from $20.3 billion in 2005 and is expected to reach 28.6 billion in 2012-13 — an annual growth rate of nearly six per cent. Under the federal government’s new unilateral funding formula, this growth will continue until 2017-18 and then proceed in line with nominal GDP growth with a growth floor of at least 3 per cent a year.

Starting in 2014-15, the Canada Health Transfer will be allocated on an equal per capita cash basis only. Previous payments were made on a per capita basis that included both cash and tax point transfers, meaning that the actual size of the per capita cash transfer differed across provinces. Alberta in particular was receiving substantially less cash per capita under this approach.

The move to an equal per capita cash allocation provides a particularly large windfall to Alberta.

The general purpose of federal transfer payments is to assist the provinces in providing reasonably comparable levels of public services at reasonably comparable levels of taxation.

Livio Di Matteo, EvidenceNetwork.ca and www.troymedia.com

OFFICES Head Office: 80 Valleybrook Drive, Toronto ON M3B 2S7. Telephone 416-4425600, Fax 416-510-5140.

Oral Hygiene is designed to provide the entire dental team with business management information to make practices more successful. Articles dealing with investment planning, personal finances, scheduling and collection procedures, in addition to lifestyle issues, are geared to all practicing Canadian dentists, hygienists, dental assistants and office managers. Please address all submissions to: The Editor, Oral Hygiene, 80 Valleybrook Drive, Toronto, ON M3B 2S7.

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*One offer per dentist. Limited Time Offer. Contraindications: Cetacaine is not suitable and should never be used for injection. Do not use on the eyes. To avoid excessive systemic absorption, Cetacaine should not be applied to large areas of denuded or inflamed tissue. Cetacaine should not be administered to patients who are hypersensitive to any of its ingredients or to patients known to have cholinesterase deficiencies. Tolerance may vary with the status of the patients. Cetacaine should not be used under dentures or cotton rolls, as retention of the active ingredients under a denture or cotton roll could possibly cause an escharotic effect. Routine precaution for the use of any topical anesthetic should be observed when using Cetacaine. Visit www.oralscience.com for the complete Prescribing Information of Cetacaine.

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ORAL HYGIENE

Hygienist as Treatment Coordinator 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

The Post-operative Visit

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n many offices, when the patient has completed their treatment plan, they are released from care until their continuing care appointment or when a dental emergency requires an extra appointment.

For more extensive treatment, one more visit that is designed to ensure patient satisfaction and treatment success should be incorporated into the treatment plan. Following the completion of major restorative care, rehabilitative treatment or cosmetic dental treatment, the patient is scheduled with the hygienist for a post-operative appointment.

This visit can turn ordinary into extraordinary dental care by adding it to patient care regimen.

Time allotted for this visit is no less than one hour and may be scheduled up to 90 minutes. The fee for this appointment is included in the patients’ treatment plan. Patients appreciate hearing their visit is complimentary or included as part of their care. It demonstrates the office is committed to their total treatment satisfaction.

During this visit, the following procedures are performed:

Radiographic examination New radiographs are taken to follow up new restorations. Margins are verified and excess cement is detected to be removed. This step in the patients’ care is important to the success of their restorative treatment and periodontal health.

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A post-operative prophylaxis is performed Tissue conditioning and coronal polish following restorative care ensures patient dental health and patients appreciate the feeling of a clean healthy mouth following their restorative care.

The dentist makes any necessary adjustments to contour margins, and adjusts occlusion

Many times, a patient is still numb from treatment anesthetics when the dentist attempts to verify occlusion, preventing the patient from feeling their true bite. The post-operative appointment allows the dentist to confirm occlusion and make proper adjustments without anesthetic.

Post-operative photographs are taken at this appointment Dental photography is critical in today’s dental practice and has become a standard treatment protocol for all dental practices. It is no longer simply for those doctors who teach and lecture on various dental topics. Pre-operative photographs are used to communicate to patients, laboratories, and insurance companies. They are used as before and after visual testimonials of the doctor’s work.

From standard routine procedures to more comprehensive rehabilitative dentistry, photography should be a routine step in patient treatment.

May 2012 www.oralhealthgroup.com

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ORAL HYGIENE Photo credit: Sonicare

Emphasizing the importance of routine maintenance while the patient is in your care during the post-operative visit is valuable Digital photographs become part of the patients’ records and aid in treatment diagnosis and patient education.

Post-operative images complete the photographic record. Waiting to take final photos at the post-operative visit when the tissue surrounding the restorations has recovered gives a better photographic result.

The post-operative photograph and preoperative photographs are shared with the patient in a post-operative treatment letter.

This correspondence congratulates the patient and thanks them for being part of the practice with the visual images of treatment results included in the letter.

The hygienist should be adept in digital photography and incorporate this technology in all phases of their work in the practice.

Home care instructions are provided and recommended take home products are dispensed

This visit provides time for the hygienist to discuss recommended home care regime.

Does the patient need instruction on using bridge cleaners for their new restoration?

Does a rubber tip stimulator need to be added to their home care routine? The post-operative appointment provides the hygienist time to teach the patient use of these new aids.

This appointment also is another opportunity to make product recommendations to the patient. Are there certain abrasive tooth-

pastes that should be avoided? What is the best over-the-counter mouthwash for the patient? Is there an in-office product that needs to be introduced? Providing the patient with this information is helping them take your care home.

Recommendations for or dispensing power toothbrushes would be covered during this visit, and evaluation of power brushing techniques would be reviewed.

Recare frequency is verified and continuing care appointment is confirmed During the post-operative visit, the hygienist would determine that the patient is on the proper recare frequency and that their continuing care appointment has been made and properly scheduled. The hygienist would also verify that all proper patient information has been entered into the patients’ record so continuing care contact through mail or via electronic contact will be successful. Emphasizing the importance of routine maintenance while the patient is in your care during the post-operative visit is valuable.

From start to finish: The hygienist as treatment coordinator

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 hygienist’s influence with patients

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ORAL HYGIENE

The Treatment Coordinator must be comfortable quoting complete treatment plan fees and believe the cost is fair for the treatment being rendered is adding the role as Patient Treatment Coordinator to their position. This concept has been successfully incorporated in many dental practices. Their expertise, experience and position make the role as Treatment Coordinator an obvious fit in today’s progressive office.

The hygienist is often the first clinical contact for the patient. They are an integral part of the initial treatment planning and act in partnership with the dentist in patient care. From the very start, the Treatment Coordinator/Hygienist plays a critical role in patient care. They are in a position to validate the doctor’s treatment plan, and have an essential role in the overall dental health of the patient critical to treatment success.

When the hygienist assumes the role of Treatment Coordinator and the practice implements the post-operative appointment in patient treatment, the office has created a full circle approach — with the hygienist being a part of the patient’s treatment from start to finish. This protocol creates a complete circle of care for the patient.

As Treatment Coordinator, the hygienist acts as practice liaison. In addition to their clinical knowledge, they must possess a confident personality. They must be confident in the doctor’s ability to accomplish the described results of care. The Treatment Coordinator must have excellent communication skills, especially the skill of listening.

The Treatment Coordinator must be com-

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fortable quoting complete treatment plan fees and believe the cost is fair for the treatment being rendered. Most importantly, they must love what they do, and the people whom they serve.

If the practice is providing basic maintenance/restorative dentistry, then you may not need to utilize a Treatment Coordinator. If you are offering patients more comprehensive treatment, esthetic and elective dental options, then your office and your patients could benefit from introducing a Treatment Coordinator into your practice.

Most dental practices today are very busy and often the entire team feels like they need more time to talk to patients about their dental care. Many dental professionals complain that there is no time to follow up with treatment plans that are pending and/or incomplete. This is important for case acceptance and patient relations. Take the time to help your patients choose the treatment you both want. Your patient will reap the rewards in a healthy beautiful simile. Your practice will reap the rewards of building a strong practice that attracts and retains patients who understand and desire the level of care you seek to provide.

The Hygienist as Treatment Coordinator offers significant potential for the practice, the patient and the practioner. When incorporated into the office, it can boost productivity 15 to 25 percent. Utilizing the hygienist in this role can help take your practice to the next level of productivity and care. n

May 2012 www.oralhealthgroup.com

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Is this patient in your practice?

Modern diets and eating habits increase exposure of the tooth enamel to dietary acids.1 Acid erosion is a growing concern. Prevention is key.1

Identify patients at risk and recommend diet modification AND ProNamel® as part of their daily routine.

ProNamel , specifically formulated to protect against the effects of acid erosion.2 ®

1. GSK data on file. Acid erosion in children: prevention is better than a cure: protecting our children’s teeth today for a better tomorrow. Bylined article. Sept. 2008.

2. Layer TM. Formulation considerations for developing toothpastes suitable for those at risk from erosive tooth wear. J Clin Dent 2009;20(Spec. Iss.):199–202.

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/® or licensee GlaxoSmithKline Consumer Healthcare Inc. Mississauga, Ontario L5N 6L4 ©2012 GlaxoSmithKline

TM

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Cette patiente fait-elle partie de votre clientèle?

Les régimes et les habitudes alimentaires modernes augmentent l’exposition de l’émail dentaire aux acides alimentaires1. L’érosion par acide est une préoccupation grandissante. La prévention en est la clé1.

Identifiez les patients à risque et recommandez-leur de modifier leur alimentation ET d’utiliser Pro-Émail® dans le cadre de leur rituel quotidien.

Pro-Émail , spécialement formulé pour protéger des effets de l’érosion par acide2. ®

1. Données internes de GSK. Acid erosion in children: prevention is better than a cure: protecting our children’s teeth today for a better tomorrow. Article signé. Septembre 2008.

2. Layer TM. Formulation considerations for developing toothpastes suitable for those at risk from erosive tooth wear. J Clin Dent 2009;20(numéro spécial):199–202.

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/® ou licencié GlaxoSmithKline Soins de santé aux consommateurs Inc. Mississauga, Ontario L5N 6L4 ©2012 GlaxoSmithKline

MC

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ORAL HYGIENE

STERILITY ASSURANCE:

Begin with the

General Manager & Director of Education. Crosstex International. leannk@crosstex.com

W

hen the goal is sterility assurance there are no short cuts and the process must be started with a clear vision of direction and destination; the plan for success is to begin with the end in mind. Covey’s simple quote from his book, “The 7 Habits of Highly Effective People” should be a guiding principle for sterilization. Every step that happens from instrument cleaning, packaging, sterilization, monitoring, storage, and delivery must be in alignment for quality assurance.

Sterilization describes a process that destroys or eliminates all forms of microbial life and is carried out in health-care facilities by physical or chemical methods. Steam under pressure, dry heat, EtO gas, hydrogen peroxide gas plasma, and liquid chemicals are the principal sterilizing agents used in healthcare facilities.1 The most predominant sterilization method used in dentistry is the time honored technique of steam sterilization. Advantages offered include non-toxic, rapid cycle time, highly efficacious, cost effective, monitoring capability, and with strong penetrability.

What is monitoring?

According to CDC guidelines, monitoring of sterilization procedures should include a combination of process parameters, specifically mechanical, chemical, and biological.

Combined, these parameters evaluate both the sterilizing conditions and the procedure’s effectiveness. 2 The first monitoring tool is mechanical

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which includes assessing cycle time, temperature and pressure by observing the gauge, digital displays, or printout on the sterilizer and noting these parameters for each load.

Correct end point response does not ensure sterilization, but incorrect readings can be the first indication of a gross equipment malfunction.

Chemical indicators (CI’s) provide information about certain conditions within the sterilization pouch or cassette, but do not provide sterility assurance of the load. The internal and external CI’s use reactive ink which changes color to assess one or more of the physical parameters (time, temperature, saturated steam.) which the instruments were exposed to during the cycle. Single-parameter indicators provide information on only one parameter while multiparameter indicators measure two to three parameters providing a more complete evaluation of the sterilization conditions. While these chemical indicators do not necessarily prove sterility, they provide an early warning system for processing errors and they can help identify procedural errors. Every package should be examined by the clinician opening the package and an assessment should be made as to the acceptability of the end point response of the CI; any package indicator not displaying correct change and intensity of color should not be used and must be reprocessed.

What is a biological indicator?

Biological indicators (BIs) commonly use highly resistant spores (spore test) to chal-

thinkstockphotos.com

Leann Keefer, RDH, MSM

end in mind

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E:

d lenge the sterilization process. Since they are more resistant and are usually present in greater numbers than are the common microbial contaminants found on instruments, destruction of these organisms will indicate destruction of other potential pathogens. While all three types of monitoring are important to the quality assurance process, biological monitoring is considered the gold standard for sterility assurance.

The most commonly used forms of BI’s in dentistry are spore strips and self-contained spore vials. Spore strips are small pieces of filter paper impregnated with non-pathogenic bacterial spores (Geobacillus stearothermophilus and Bacillus atrophaeus) encased in a protective glassine envelope. After processing, the spore test envelope is sent to a laboratory where the paper strip is aseptically transferred to a test tube containing sterile culture media and then incubated. Self-contained vials have a glass ampule of sterile media which is encased in a plastic vial with a spore strip inside. After sterilization the vial is crushed allowing the media to come into contact with the spore strip and then incubated. With either the strips or vials, if the pH indicator in the growth media changes the color from purple to yellow after incubation this is an indication of a positive culture (spore growth) meaning a failed test. It is recommended that a control be run with every BI test.

Three options are available for monitoring sterility assurance in the dental office: mailin sterilization monitoring services to a third party testing laboratory (i.e. private laboratory facility or dental schools), in-office 24hour monitoring systems, and a newly released in-office 10-hour monitoring system.

While some offices prefer the use of a profes-

sional lab for testing verification (gram staining) and third party documentation of results, others appreciate the convenience in-office processing provides with a direct turnaround time and without the challenge of mailing and waiting for results. It should be noted, the majority of in-office monitoring systems can only be used with steam (autoclave) sterilizers; the mail-in monitoring services can provide results for steam, dry heat, chemical vapor, and EtO (ethylene oxide).

What are the guidelines for sterilization?

The CDC guidelines state: Correct functioning of sterilization cycles should be verified for each sterilizer by the periodic (at least weekly) use of biological indicators (BIs).

Consideration should be given for more frequent testing if the sterilizer is used multiple times each day or with use of a variation of sterilization cycles. Users should follow the manufacturer’s directions concerning the appropriate placement of the biological indicators in the sterilizer; the preferred area for the BI placement is in the least effective zone of the sterilizer, often near the door or the middle of the load near the drain.

In addition to conducting routine biological monitoring, equipment users should perform biological monitoring for the following occurrences: • W henever a new type of packaging material or tray is used • A fter training new sterilization personnel • A fter a sterilizer process failure is indicated by a failed (positive) BI • A fter a sterilizer has been repaired • A fter any change in the sterilizer loading procedures

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ORAL HYGIENE

• During initial use of a new sterilizer • A fter relocation of an existing sterilizer • A fter electrical/power source failure

How important is compliance?

Dental practices have demonstrated variability in sterilization compliance as documented in several studies. For example, one study revealed 68% of respondents believed they were sterilizing their instruments but did not use appropriate chemical sterilants or exposure times and 49% of respondents did not challenge autoclaves with biological indicator. 3 Other investigators using biologic indicators have found a high proportion (15%– 65%) of positive spore tests after assessing the efficacy of sterilizers used in dental offices.4 In a study of Minnesota dental offices, it was reported that operator error, rather than mechanical malfunction, caused 87% of sterilization failures. 5 Common factors leading to the improper use of sterilizers may include chamber overload, low temperature setting, inadequate exposure time, failure to preheat the sterilizer, and interruption of the cycle.

Most recently, two sterility assurance compliance issues illustrate the importance of following the CDC recommendations for weekly testing. On December 8, 2011, the Supreme Judicial Court of Massachusetts affirmed the final decision and order of the Board of Registration in Dentistry suspending the license of a dentist who failed to conduct and record weekly spore testing. The dentist’s failure constituted dental malpractice. For additional information, the entire summary of Stephen Chadwick vs. Board of Registration in Dentistry case # SJC-10831 is available on the Internet.

In March 2012, a health center in Wisconsin contacted the families of eight school children who were treated in a mobile clinic with potential exposure to blood borne pathogens due to use of improperly sterilized instruments. Some of the instrument packages used during treatment displayed failed chemical indicators which would have identified either a procedural or processing sterilization error.

What must be included in sterilizer documentation?

An accurately detailed and consistent documentation establishes accountability for sterilization. The information to be included with each sterilization cycle includes: • Sterilizer identification (serial) number

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• Full testing date • O perator identification • Duration and temperature of the sterilization cycle (if not provided by a machine printout) • Description of the general contents of the load • Test results of biological monitoring (pass or fail) • Repair and preventive maintenance procedures • Special notes citing conditions outside of normal procedures, i.e. different operators or load content Clinicians should refer to state or local regulation guidelines for retention times of docu­mentation.

Conclusion Effective sterilization is critical to safety and optimal patient care. Proper functioning of the sterilization process should be routinely monitored and documented using mechanical, chemical, and biological methods. n

REFERENCES 1. Rutala WA, Weber, DJ et al.Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. Available at: http:// www.cdc.gov/hicpac/pdg/guidelines/Disinfection_Nov_2008.pdf.

Accessed March 1, 2012.

2. KohnWG, Collins AS, Cleveland JL, et al.

Guidelines for infectin ontrol in dental healthcare settings – 2003. MMWR Recomm Rep. 2003. Available at: http:// www.cdc.gov/mmwr/preview/mmwrhtml/ rr5217a1.htm. Accessed March 1, 2012.

3. Gurevich I, Dubin R, Cunha BA. Dental instrument and device sterilization and disinfection practices. J. Hosp. Infect.

1996;32:295-304.

4. Smith A, Dickson M, Aitken J, Bagg J. Contaminated dental instruments. J. Hosp. Infect. 2002;51:233-5.

5. Hastreiter RJ, Molinari JA, Falken MC, Roesch MH, Gleason MJ, Merchant VA. Effectiveness of dental office instrument sterilization procedures. J. Am. Dent. Assoc. 1991;122:51-6.

6. Wahlberg, D. Access says eight children given dental care with improperly sterilized instruments. Wisconsin State Journal. March 2012; http://host.madison. com/wsj/news/local/health_med_fit/access. Accessed March 2012.

May 2012 www.oralhealthgroup.com

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ORAL HYGIENE Shannon Pace Brinker, CDA CDD

has been a full-time practicing dental assistant for more than 23 years. She is an active member of the AACD. Shannon is the first auxiliary to sit on the AACD Board of Directors. Shannon was selected one of Dentistry Today’s Top 100 Clinicians of 2009, 2010 and 2011. email her at: shannon@ cpsmagazine.com

Provisional Trimming & Polishing Techniques for the Chairside Assistant O

ne of the most important steps in successfully creating beautiful restorations is finishing and polishing. Proper finishing and polishing techniques will increase esthetic results and build confidence with the patient. Poor finishing and polishing techniques can lead to staining, plaque retention and gingival irritation. Unfortunately, the proper sequence of polishing steps necessary to achieve beautiful esthetic results is often overlooked. The purpose of this article is to describe clinical techniques that will help achieve maximum esthetics and biological success when contouring, finishing, and polishing esthetic provisionals.

Restorative procedures have changed dramatically in the past several years. These restorations are no longer regarded as temporary restorations but rather as provisional restorations with distinct functions and purposes. Provisional restorations have become a vital diagnostic and assessment tool to evaluate function, color, shape, contour, occlusion, periodontal response, implant healing, and overall esthetics. An accurate fit and margination is essential to ensure and maintain pulpal and gingival health.

Direct anterior provisional fabrication Impression of the wax-up was fabricated to capture all the detail designed by the laboratory technician. Before fabrication of the putty matrix, we suggest placing some vitamin E oil or glycerin on the wax to avoid breakage or chipping of the wax off the model. A putty matrix was formed with Flexitime Putty (Heraeus) over the wax-up and allowed to set for four minutes. After the putty im-

16

pression material sets, it is removed and a reline of light body wash was added to the putty matrix (Correct Flow Flexitime Heraeus) and again seated on the wax up to capture all the creative detail that was fabricated in the waxup. Allow impression material to set. Peel away from the wax-up then set aside for the provisional fabrication.

Step 1 Lubricate all gingival tissues facially and lingual along the gingival margins with a vitamin E oil, glycerin or Lubricoat by Dux Dental that is very viscous to allow easy removal of the provisional material on the gingival tissues after fabrication. Be careful not to get the lubricant on the teeth.

Step 2 Spot etch the center of each prepared tooth.

Rinse thoroughly after 15 seconds. Dry and place bonding resin (Futurabond by Voco America) on each tooth area where the acid etch was placed. Dry and light cure. Be sure not to etch the entire tooth or this can become a final restoration.

Step 3 Load toward the facial, make sure that the tip of the provisional material is not lifted until the teeth in the matrix have been filled entirely. This will help with voids and bubbles in the provisional. Seat putty matrix on preparations and allow the provisional to set for four minutes. Do not remove too soon and until that time, or you may pull off the provisional and have to trim it indirectly instead of locking it on. Using a timer will help make

May 2012 www.oralhealthgroup.com

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ORAL HYGIENE

Fig. 1. Load the putty matrix from the facial with the provisional material.

Make sure you do not lift the tip to avoid bubbles in the provisional.

Fig. 2. Seat putty matrix on preparation and allow the provisional to set for four minutes. Do not remove too soon or you may pull off the provisional and have to trim it indirectly instead of locking it on. Using a timer will help to make sure that you don’t pull the matrix too soon.

sure that you don’t pull the matrix off too soon. After timer has gone off, remove the putty matrix.

Remove all material with an explorer or scaler off the margins and tissue. The material is released at the margins due to the lubricant placed prior to the provisional placement and allows the assistant to remove the excess without asking the dentist to come and remove the excess with a carbide bur. Make sure all material is removed from the tissue and occlusal surfaces. If you wait too long to remove the gingival material, the dentist can remove any gingival excess of material with a fluted carbide.

Polishing after provisional cementation After the provisionals have been cemented, we must check the incisial edge position of the maxillary teeth. Working out the phonetics in this provisional stage is critical to the final restoration. When adjusting the incisial edges of your provisionals, always have the patient sit up in the chair. This allows the dental assistant to be able to look at the edges of the teeth in relationship to the horizon. If the patient is laid back in the chair we might give the patient a cant or reduce too much of the incisial edge. Positioning the incisal edge horizontally is also critical for creating lingual contours. These contours must be steep enough to disclude the posterior teeth and be in harmony with

18

Fig. 3. Remove all material from the margins and tissue with an explorer or scaler.

The material is released at the margins due to the lubricant that was placed prior to the provisional placement. The assistant can now remove the excess without requiring a carbide bur. Make sure all material is removed from the tissue and occlusal surfaces.

The dentist can remove any excess material.

the envelope of function according to Dr. Peter Dawson.

Post-op provisional visit One of the most important visits in the restorative phase is the post op provisional visit. The patient will return several days after they’ve had the chance to look, feel and test out the provisionals. Patients will change their minds about color and shape. It is important to not go straight to the finals without approval of the provisionals first. We like to schedule this appointment at least three days after the provisionals are placed. During that visit we will talk with the patient about any changes at this appointment. If the patient is happy with the provisional, we will take impressions of them and photos. Sometimes we will take a facebow record to make sure the provisionals are lined up with the midline of the patient’s face and a new bite. If the patient isn’t happy with the provisionals, we will make the necessary changes at that appointment and then impressions.

Conclusion I have always said if they like the provisionals, they will love the finals. It is very important for the patient to be happy. Not making changes to the provisionals could lead to the patient not liking the finals and a possible remake of the restorations. Key point to remember: patients don’t know what they don’t like until they see something they don’t like. n

May 2012 www.oralhealthgroup.com

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ental caries is one of the major diseases that we treat in our clinical practices on a daily basis. It is one of the two major diseases that is the focus of our preventive appointments and our patients do expect an update on the health of their “teeth and gums” at each visit. But techniques for caries detection have not changed radically over the last 60 years, since the advent of X-ray imaging. Detection of caries depended upon locating mineral loss on bite wing radiographs, examining stain and discoloured areas on the tooth surface or probing lesions with a sharp explorer. These techniques were and still are considered the gold standards even as the treatment of the disease has evolved.

Radiographs and visual examination do have many limitations. Detecting early pit and fissure caries is challenging. Radiographic imaging is of minimal diagnostic value because of the large amounts of surrounding enamel.1,2 Studies3-5 have suggested that dental X-Rays have little value in the detection of occlusal surface caries, and that dental explorers are inefficient for the diagnosis of occlusal caries.6,7 Radiographs do perform well in detecting carious lesions in interproximal areas, especially if the area of decay is at least halfway through the enamel or into dentin.

But in terms of early lesion detection, radiographs are not able to detect small lesions in the order of 50-500 µ (microns) in the interproximal areas, which could remineralize or re-crystallize if detected early and suitable preventive measures instituted. 8 An extensive review of the literature by Doveix found that “overall the strength of the evidence for radiographic methods for the detection of dental caries is poor for all types of lesions on proximal and occlusal surfaces.” He further

stated that “it is beneficial only if the intervention is the surgical removal of tooth structure and detrimental if it is used for non-invasive remineralization methods”. Radiographs and visual examination are valid diagnostic tools for the detection of larger lesions; however, there is a need for more sensitive methods especially if one wants to practice minimal intervention dentistry or to attempt remineralization of carious lesions.

A common clinical situation is the detection and ongoing monitoring of a white spot lesion. In the example in Figure 1, this lesion appears to have an intact surface. With polarized light microscopy (PLM) the lesion is at least 500 microns in depth and located just below the surface. This lesion is not visible on radiograph or picked up by DIAGNODentTM. So, how do you detect this lesion?

How do you monitor this lesion and how do you engage your patient to take care of this lesion and others that may be present?

One approach is to employ detection methods that allow the oral health provider to measure changes in the crystal structure of these early lesions and then tailor a therapy regimen to the lesion size as well as the overall risk of developing additional carious lesions. The Canary System directly assesses the status of the enamel crystal by using PTR-LUM — an energy conversion technology. Pulses of laser light are shone on the tooth and the laser light is converted to heat (Photothermal Radiometry or PTR) and light (luminescence or LUM) which are emitted from the tooth surface when the laser is off. The Canary System is the only device that is able to detect changes in the crystal structure of enamel, which is far superior in assisting the dental professional in diagnos-

CLINICAL

Integrating st 21 Century Caries Detection into your Clinical Practice D

Stephen Abrams, DDS

Is a general dental practitioner with over 30 years of clinical experience. In 1999, Dr. Abrams began working on a noninvasive laser-based device for the diction and monitoring of caries. He currently jointly holds patents on this new technology. In 2006, he founded Quantum Dental Technologies to finish development of The Canary System.

The Canary System, based upon the PTR-LUM technology is currently available in Canada and Europe.

May 2012

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www.oralhealthgroup.com

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CLINICAL

Figure 1. Examining white spots.

Figure 2. The Canary System.

ing tooth decay versus tools that identify lesions by using fluorescence to detect the presence of bacterial by-products.

These harmless pulses of laser light allow a clinician to examine sub-surface caries up to 5 mm. Carious lesions modify the thermal properties (PTR) and glow (LUM) from the healthy teeth. As a lesion grows, there is a corresponding change in the signal as the heat is confined to the region with crystalline disintegration (dental caries) and PTR increases and LUM decreases. As remineralization progresses and enamel prisms begin to reform their structure, the thermal and luminescence properties begin to revert back in the direction of healthy teeth. The system is so sensitive it detects very small changes in temperature (less than 1-2 degrees Celsius), much less than that generated by a conventional dental curing light and imperceptible to the patient.

The Canary Number (ranging from 0-100) is created from an algorithm combining the PTR and LUM readings and is directly linked to the status of the enamel or root surface crystal structure. A Canary Number of less than 20 indicates a healthy tooth surface.

A Canary Number greater than 70 indicates a large lesion that may justify restoration.

Canary Numbers falling between 20 and 70 indicate the presence of an early carious lesion that doesn’t require a restoration but can be remineralized. The treatment decisions are based upon the type of remineralization treatment, position of the lesion, and overall risk of developing caries including oral hygiene. What the Canary System provides is a repeatable and reliable measurement of the lesion that is linked to the status of the crys-

22

tal structure.

So, how does one integrate this new technology into clinical practice? First step is to look at your practice and examine the work flow with your patients. The Canary System can be integrated in at least three ways: • A s part of the new patient exam • As part of the preventive recare examination • A s part of a prevention program to detect, monitor, and document demineralization and remineralization One could use The Canary System as a diagnostic tool during a new patient exam. The Canary can be used to scan a number of suspected areas including around the margins of restorations, occlusal pits and fissures, smooth surfaces and interproximal areas.

The information is stored on the Canary Cloud and the patient is given a report or can access their information on-line following the appointment. It is an easy way to engage and help patients understand their oral healthcare.

The Canary System can be used during the recall appointment to scan a few selected teeth. If caries are found that require restoration, one then arranges for further treatment.

If there are white spots, brown spots and other areas of demineralization, a Canary Scan can be performed on only a few areas. The patient can then return for either a more complete examination or begin a customized remineralization program using the initial Canary Scan numbers as bench marks to measure and monitor the outcomes of the remineralization therapy.

If a practice were going to have the patient involved in a remineralization program, it could begin the program right at the recall

May 2012 www.oralhealthgroup.com

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CLINICAL

Figures 3 and 4

visit by applying an in-office therapy and dispensing home-based products. The application of fluoride varnish should take less than two minutes. If there are large areas of demineralization, they could arrange to have the patient back for a 30 minute visit where they could scan a number of teeth and then apply the remineralization therapy.

During the remineralization program, the follow-up visit can be as short as 15 minutes in order to scan selected teeth and apply inoffice therapy such as fluoride varnish.

CLINICAL EXAMPLES Detection of caries around the margins of restorations during a recall examination The case study (Fig. 4) on the right are the results from Canary Scans around the margins of a mandibular right second bicuspid at a re-care appointment. The scan involved two measurements, a total of 10 seconds for both areas and set up time of four minutes.

The Canary Number of 60 on the mesial marginal ridge as well as the Canary Number of 39 on the buccal cusp indicated caries and microleakage around the amalgam. This patient previously resisted replacing a number of old restorations. The Canary Scan allowed the hygienist to locate the caries on this tooth (not seen on bitewing radiographs) and one other tooth. The patient reviewed the Canary Scan and booked for both restorative procedures. An additional six minutes of recall appointment time resulted in detecting caries around existing restorations before caries had destroyed more tooth structure possibly resulting in endodontic treatment or loss of the buccal cusp.

24

Detection of cracks and caries during an emergency examination

In this situation (Fig. 5), the patient came into the dental clinic, in pain. The clinic’s usual detection tools, visual exam and radiographs, did not reveal any evidence of pathology. The dental professional performed a quick Canary Scan resulting in Canary Numbers of 58 and 36 on the mesial and distal marginal ridges, respectively. The Canary Number of 97 on the lingual margin of the amalgam indicated both microleakage and a large carious lesion. Upon removal of the amalgam, the dentist was able to visualize the cracks on the marginal ridges as well as the large carious lesion on the lingual wall of the amalgam. The Canary System located the problem quickly (which was not seen on a bitewing radiograph) and identified that the problem stemmed from the first molar and not the second molar.

Building a remineralization/ prevention program Oral health care providers have been searching for detection tools that can help monitor and document the progress of remineralization and preventive therapies. Over the years, they have tried a number of toothpastes, antimicrobial varnishes, fluoride containing prod­ucts etc. to see if they could prevent caries or remineralize early lesions. They would dispense these products and then try to monitor the outcomes over time. They found that using visual exam or even radiographs could not provide them with any reliable or accurate measure of the success of the therapy.

Clinicians found that patients who invested in these therapies became very frustrated when they discovered a few years later that

May 2012 www.oralhealthgroup.com

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CLINICAL

Figures 5 and 6

caries had developed and the therapy had been ineffective and/or there had been poor patient compliance.

The Canary System provides clinicians and patients with the ongoing feedback on the progress of the remineralization therapy. Figure 6 shows an example of how The Canary System was used in the detection, monitoring and documentation of the progress of a high caries risk patient receiving remineralization therapy. A tooth was initially assessed with The Canary System, which indicated decay that may possibly be remineralized. The clinician involved the patient in a remineralization treatment plan, which consisted of inoffice application of fluoride varnish and at-home use of fluoride toothpaste. The Canary Numbers decreased over a period of ten months, indicating success of the remineralization therapy. If there is poor compliance or the therapy is not working, The Canary Numbers will not decrease. At that point in time, either the clinicians change the therapy, change patient habits or change the frequency of the visits. The patient report engages patients in their care and helps them monitor their progress.

Professional Fees At the present time in Canada, depending upon the province, fees do exist for application of remineralization therapies, recall examinations or specific examinations and other diagnostic tests. It is up to the clinical practice to decide how or if they will bill for these services. Some of our offices in Ontario charge $120 fee for an initial 30 minute Canary scanning examination (USCLS code 01204) and initial application of an in-office remineralization treatment (usually fluoride

26 

varnish). During this examination, the hygiene team would identify and scan teeth with white or brown spots (Canary Numbers >20) that require remineralization. Repeat remineralization visits require 15 minutes to scan those areas in question and apply fluoride varnish. The USCLS code is 13601 13609. They could bill $48.00 for the application of the varnish and provide the scanning during this visit. This service can be provided by either a hygienist or dental assistant, depending upon the professional regulations for a particular jurisdiction. So in addition to allowing the oral healthcare worker to provide superior patient care, an investment in The Canary System has a very quick financial payback.

Office Integration Embracing new technology is both challenging and exciting. It demands that the clinical team understand the technology, educate the patients and find a method to integrate the technology into clinical practice in a cost-effective manner. The Canary System is designed to allow a clinical practice to enhance their traditional caries detection and treatment programs by finding lesions not seen with conventional methods. It also allows the practice to build a remineralization / preventive program where The Canary System can monitor changes in the lesion development.

The Canary System engages patients in their care and extends the options for the treatment of dental caries. From remineralization to restoration, The Canary System can detect and monitor treatment. n

Disclosure Dr. Stephen Abrams is the CEO and Co-

May 2012 www.oralhealthgroup.com

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CLINICAL Founder of Quantum Dental Technologies which has developed The Canary System mentioned in this article. He has not received any compensation for the preparation of this article.

REFERENCES 1. M cKnight-Hanes C, Myers DR, Dushku JC, Thompson WO, Durham LC. “Radiographic recommendations for the primary dentition: comparison of general dentists and pediatric dentists”. Pediatr Dent.

1990 Jul-Aug;12(4):212-216.

2. F laitz CM, Hicks MJ, Silverston LM. Radiographic, histologic, and electronic com­parison of basic mode videoprints with bitewing radiography. Caries Res. 1993; 27(1): 65-70.

3. H intze H, Wenzel A, “Clinically undetected dental caries assessed by bitewing screening in children with little caries experience”, Dentomaxillofac. Radiol. 1994;

23(1): 19-23.

4. N ytun RB, Raadal M, Espelid J, “Diagnosis of dentin involvement in occlusal caries based on visual and radiographic examination of the teeth”, Scand J Dent Res 1992; 100(3): 144 - 148.

5. F laitz CM, Hicks MJ, Silverstone LM, “Radiographs, histologic and electronic comparison of occlusal caries: An in vitro study” Paediatr Dent, 1986; 8(1): 24 - 28.

6. Penning C, van Amerongen JP, et al, “Validity of probing for fissure caries diagnosis”. Caries Res 26:445-9, 1992.

7. Lussi A, “Comparison of different methods for the diagnosis of fissure caries with­ out cavitatio.” Caries Res 27:409-16, 1993.

8. Backer DO, “Post-eruptive changes in dental enamel,” J Dent Res 1966; 45: 503-51.

9. Dove, S. B., “Radiographic Diagnosis of Dental Caries in Consensus Conference on Dental Caries Management Throughout Life”, March 2001, Journal of Dental Education, 2001; 65 (10): 985-990.

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ORAL HYGIENE

Protect Your Hands: Luce Ouellet Bsc.N., DESS

Université de Montréal, Baccalauréat sciences infirmière, Diplôme 2ième cycle pharmaco-économie, currently National Clinical Consultant, Ansell Canada. E-mail: Louellet@ansell.com

I

ntact skin is the best barrier against microorganisms. Medical examination gloves cover an average of 1,500 cm 2 of skin and prevent 77% of hand contamination.2 The costs associated with occupational skin irritations is a concern for occupational health professionals and infection prevention professionals. According to the literature, many factors are responsible for contact dermatitis.

This review will focus on the role of gloves in causing contact dermatitis.

Adverse skin reactions associated with glove use Adverse reactions to gloves may range from a mild irritation to a serious allergic response.1,2 The four major types of skin reactions associated with gloves are: immediate hypersensitivity (Type I allergy or latex allergy), delayed hypersensitivity (Type IV allergy or contact dermatitis), irritant contact dermatitis or a combination of the above.

Properly designed and conducted studies to determine prevalence of dermatitis are rare.

Surveys indicate that up to 70% of hospital staff self-reports hand dermatitis3 and 30% of healthcare workers reported contact dermatitis to natural rubber latex and synthetic rubber products.4 Sensitization may be caused by natural rubber proteins or other chemical products used in gloves. 5 A Type I hypersensitivity response is a reaction to residual latex proteins found in natural rubber latex. The reaction is immediate, typically occurring 5–30 minutes after the initial contact. The symptoms include swelling and redness localized to the site of exposure as well as non-specific symptoms of itch-

28

ing and burning. The symptoms can spread to areas remote to the site of contact with the glove, and may be accompanied by conjunctivitis, rhinitis and/or bronchial obstruction.

In rare cases, symptoms of anaphylaxis can occur. In 2002, an immediate Type I response latex allergy represented up to 33% of all glove-induced dermatitis. 5 To limit the transfer of latex proteins, manufacturers now produce dip-molding polyurethane and silicone inner coating in powder-free latex gloves.

A Type IV allergy is a reaction to a specific allergen, such as the chemical residue from the glove manufacturing process. Reactions are typically induced by chemical accelerators used in glove manufacturing process of natural rubber latex, nitrile, polyisoprene, polychloroprene and polyurethane gloves. These chemical accelerators are used in glove manufacturing to provide elasticity, strength and stabilizing the glove material for long term storage. A Type IV allergy represents up to 20% of all glove-induced dermatitis.5 Studies shows sensitization mainly to accelerators such as fragrance mix (13%), thiurams mix (8%), carbamate mix (4%) and mercapto mix (1%). The response is delayed rather than immediate, and usually occurs 6–48 hours after the initial contact. Symptoms can last for up to four days and may include swelling, cracking, itching, weeping, and dryness of the skin at the site. Although dermatitis can extend beyond the area of contact, a Type IV response begins when the antigens, such as residual chemicals leached from the glove, penetrate the skin and trigger the formation of T-cells sensitized to specific antigens. Repeated exposure to the antigen in allergic individuals can re-activate sensitized

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May 2012 www.oralhealthgroup.com

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ORAL HYGIENE

Irritant contact dermatitis is the most common factor, representing up to 40% of all glove-induced dermatitis. Irritant contact dermatitis is a non-immune reaction; a pre-existing skin condition and can exacerbate allergic reactions.

T-cells and produce an inflammatory response, causing Type IV allergy symptoms.1 Other hand dermatitis is sparked by polyvinyl chloride or vinyl gloves made of plastic composites. Phthalates in these gloves induce delayed contact dermatitis. Other causes of sensitivity include lanolin used as a glove softener, poly-oxy-propylene-glycol used as a coagulant in the manufacturing process, and coloring pigments.

Irritant contact dermatitis is the most common factor, representing up to 40% of all gloveinduced dermatitis.5 Irritant contact dermatitis is a non-immune reaction; a pre-existing skin condition and can exacerbate allergic reactions.

It can be caused by a number of factors such as frequent hand washing, aggressive scrubbing techniques and inadequate hand drying.

Wearing gloves for long periods can also damage the skin barrier and present symptoms such as skin dryness. Long-term glove occlusion can increase trans-epidermal water loss of the skin and affect the skin’s barrier function.11 In addition, the occlusion nature of gloves will keep breakthrough chemicals in contact with the skin. Under occlusion, the permeation of chemicals and the response of irritants and allergens in the skin can be heightened several-fold.12 Therefore, it is important to select a glove based on the length of time it will be worn and its durability. Controlling the extent of glove usage will limit trans-epidermal water loss, and a better resistant glove material will prevent high leakage rates.

Alkaline gloves alter the normal skin surface pH level of 5.5. Studies demonstrate that the pH average of powder-free gloves is 5.8, where powdered gloves average a pH of 7.5.

Alkaline gloves demonstrated increased skin dryness and irritation. In addition, mechanical irritation is mainly created by glove powder. Studies have also shown that glove powder significantly alters the skin’s roughness.

Finally, endotoxin levels differ between

30

gloves. It has been shown that glove endotoxin contamination may alter the skin’s integrity.

In practice, it is not uncommon for endogenous irritant and allergic etiologies to coexist in the development of certain eczema. It is important to seek in the history, or by a home or workplace visit, any recreational and occupational factors that may exacerbate any of the above described symptoms. The management of irritant contact dermatitis principally involves the protection of the skin from the irritants. The most common irritants are soaps and detergents, although water itself can be an irritant. The principles of management involve avoidance, protection and substitution.

Some recommendations from occupational health officials to minimize the impact of glove-induced contact dermatitis are: • Refer persistent eczema to a specialist contact clinic in the diagnosis of contact dermatitis; • Identify causal agents through patch testing; • Avoid allergens; • Select gloves that are manufactured without the causative agent; • Reduce exposure to skin-damaging substances; • Remove gloves carefully — do not flip, snap, or toss gloves; • Clean and dry hands before and after glove use; • C hange gloves between patients, tasks, and after each procedure; • Use appropriate gloves for the task; • Apply water-based hand moisturizers regularly; ensuring the product is compatible with gloves; • Use cotton glove liners which may help prevent the exacerbation of skin dermatitis.

In conclusion, milder cases of contact dermatitis can be treated successfully with avoidance and early interventions. Studies in the US have shown a decline in the number of workers’ compensation claims³ for natural rubber latex related illness following institutions transitions’ from powdered to powderfree gloves.

May 2012 www.oralhealthgroup.com

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PRODUCT PROFILE

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CAVICIDE1 TotalCare, a specialist in dental infection prevention, introduces CaviCide1 and CaviWipes1. Both are one-step, low alcohol surface disinfectants that are said to kill TB, HIV-1, HBV, HCV and several other organisms in one minute while maintaining multi-surface, multi-material compatibility. Fragrance-free, when used as directed, both products will effectively clean most surfaces in the dental operatory and can help reduce the risk of cross-contamination.

www.trycavicide1.com CONFIRM 10 Crosstex International introduces a solution that makes it faster and easier to meet increasingly stringent requirements for biological monitoring of steam sterilizers in dental practices: Confirm 10, the first inoffice system that delivers final results in 10 hours. Alberta and Ontario require daily biological monitoring and with Confirm 10, staff can process indicators at day’s end and receive definitive test results, pass or fail, by the next morning.

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32

This effect could have been due to decreased skin and mucosal exposures of employees to latex allergens. Countries with guidelines for low protein, powder-free, natural rubber latex glove use, have seen dramatic decline in the incidence of latex induced responses in end-users.7 Preventing skin dermatitis by different measures of avoiding the irritants n still represents our best therapeutic solution.

REFERENCES 1. Olsen RJ, Lynch P, Coyle MB, Cummings J, Bokete T and Stamm WE. Examination gloves as barriers to hand contamination in clinical practice JAMA. 1993; 270(3): 350-353.

2. C layton TH and Wilkinson SM. Contact dermatoses in healthcare workers: reduction in Type 1 latex allergy in a U.K. centre Clinical and experimental dermatology 2005; 30(3): 221-5.

3. Tarvainen K and Kaverna K. Occupational dermatosis from plastic composites J environ med. 1999; 1:3-17.

4. Phillips L, Steinberg M, Maibach HI and Akers WA. A Comparison of Rabbit and Human Skin Response to Certain Irritants Toxicol Appl Pharmaco.l 1972; 21: 369–382.

5. Graves CJ, Edwards C and Marks R. The effects of protective gloves on starteum corneum barrier properties Contact Dermatitis 1995 Sept.; 33(3): 183-7.

6. Ramsing DW and Agner T. Effect of glove occlusion on human skin (II): Long-term experimental exposure Contact Dermatitis 1996; 34:258-262.

7. Boeninger MF and Klingner TD. In-use testing and interpretation of chemical-resistant glove performance App Occ environ hyg 2002; 17(5): 368-78.

8. Bucks DAW, Guy RH and Maibach HI. Effect of Occlusion.

In Bronaugh R. and Maibach HI (Eds.) (1991) Vitro Percutaneous Absorption: Principles, Fundamentals, and Applications. (pp. 85–114). Boca Raton, FL: CRC Press.

9. M irza R, Maani N, Liu C, Kim J and Rehmus W. A randomized, controlled, double blind study of the effect of wearing coated Ph 5,5 latex gloves compared with standard powderfree gloves on skin pH, transepidermal water loss and skin irritation Contact Dermatitis 2006 July;55(1):20-5.

10. Brehler R, Woss W and Muller S. Glove powder affects skin roughness, one parameter of skin irritation Contact Dermatitis 1998;39(5):227-230.

11. Williams PB and Halsey JF. Endotoxin as a Factor in Adverse Reactions to Latex Gloves, Annals of Allergy, Asthma and Immunology 1997;79(4):303-310.

12. Malerich PG, Wilson ML and Mowad CM. The effect of transition to Powder free Latex gloves on worker’s compensation claims for latex related illness, Dermatitis, 2008;19(6):316-8.

13. Britton JER, Wilkinson SM, English JSC, Gawkroger DJ, Ormerod AD, Sansom JE, Shaw S and Statham. The British standard series of contact dermatitis allergens: validation in clinical practice and value of clinical governance Br J Derm­ atol 2003;148(2):259-64.

May 2012 www.oralhealthgroup.com

OHYMay12 p28-32 Ouellet.indd 32

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1. Sreebny LM. A useful source for the drug-dry mouth relationship. J Dent Educ 2004;68:6–7. 2. Eveson JW. Xerostomia.

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DENTAL MARKETPLACE

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

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NOV 08

Alglobe

Construction Company

20 years construction experience • Dental office construction and design + cabinet making.

• Provide turn key operation to dental office.

• Reliable construction timing, • Good following up service after construction.

Call: Stanley • New dental location and lease negotiation.

Tel: (416) 321-3313 • Save time, save money. www.alglobe.com

FEB 2011

97120

ONTER CONSTRUCTION • Specialized in dental office design & construction.

• In-house architect and interior designer.

• We are qualified code consultants to review all drawings and make your building permit application easy.

• Own millwork facilities for best quality of custom built cabinets and time control of your project.

Tel: (905) 793-2344

98114

Alglobe • • • • • •

www.onterconstruction.com

PRACTICES FEB 2011& OFFICES EAST END OF OTTAWA AREA, ON Construction Company

New practice for sale in a unique one of a

20 years construction experience kind mall location.

Dental office construction and design + cabinet making.

3 opstoand lots of new patient walk in.

Provide turn key operation dental office. for startup or moving your Reliable construction Excellent timing, practice it.

Good following up service after to construction.

Call: Stanley New dental location and lease negotiation.

E-mail: P_T_Y_B@hotmail.com Tel: (416) 321-3313 Save time, save money. www.alglobe.com

WEST BRAMPTON, ON

070439

www.dentalhygienestudiosinc.com LEGAL SERVICES FOR DENTISTS

Re: Buying or Selling a Dental Practice, Associate Agreements, Leases, Complaint PRACTICES & OFFICES and Discipline matters before the RCDS. Dr. Rollin M. Matsui, Lawyer and Dentist CHEMAINUS, BC EDMONTON, AB E-mail: drmatsui@aol.com Retirement practice for sale. New digital Beautiful solo, non-assignment genxrays, SyncaHill – Gray Falcon intraoral.

All (905) 881-8856 Richmond (905) 709-9272 Fax eral practice in downtown Edmonton

equipment for 2 chair practice, 1000+ for sale. Newer leaseholds. Meets charts. Huge growth potential. Must 031233 FEB 2011 080702requiremove practice. Chemainus BC (50 miles current infection control as crow flies from Vancouver or Victoria) ments. Grossing $690K on a four-day JOHN McMILLAN — Barrister Price $30,000 … greatest bargain you will & Solicitor week. Principal relocating to the US. Serving Dental Professionals ever see.

Contact henry@heapsanddoyle.com 250-416-0382, 250-416-0568.

Professional Corporations • Practice Purchases and Sales tommy100010@gmail.com Professional Agreements • Commercial Contracts for more information.

Commercial Leasing • Regulatory Matters 8 King Street East 416 364 4771 Suite 1807, Toronto johnmcmillan@bellnet.ca

Dental office space available in West APR 08 sq.ft. New plaza, very Brampton.1325 busy location. Exclusive rights for dental usage in the plaza available.Occupancy available in May/June 2012.

Long term lease possible. Call for the leasing rates.

E-mail: bramaleaz@gmail.com or call 416 388 5964.

VANCOUVER AREA

PERIODONTAL PRACTICE FOR SALE Well established, successful Periodontal JUNE 09 practice for sale. Vancouver area. Gross billings $938,000/yr. Net of $560,000/yr!

Solid referral base. Excellent staff trained in periodontal procedures. Beautiful office in great location.

Contact Henry at 604-724-1964 or henry@heapsanddoyle.com www.HEAPSandDOYLE.com Over 55 practices for sale across Canada

McMILLAN LAW PROFESSIONAL CORPORATION

LONDON, ON For sale, one and a half year old

34

GODERICH, ON

050202

Henry Shein designed dental office for lease. Located on the shores of Lake Huron in beautiful Goderich, Ontario, this is a great location and opportunity to build a dental practice in a wonderful community. Office is tastefully designed and plumbed for four operatories with lots of parking and has great street exposure on a major street. (currently used as a denture clinic with approximatly 1000 pt files that can be also be purchased). Building is shared with a hearing aid clinic operating two days per week.

For photos and more information please call 519 336 3269 or e-mail rfeige@cogeco.net

National

May 2012

practice DEC 07 in London, Ontario. Custom

built with state of the art technology

ROI CAPITAL – FINANCING YOU CAN and upscale finishes.

LocalTRUST paper 1

• 100% financing described the practice as a spa • full disclosure of terms like experience. Owner relocating,

• practice purchase, set-up, renovations very attractively priced, goodwill provided free as a bonus. Available real-estate, equipment leases immediately.

• complimentary review of existing proposals Call 519-852-0053 orRegional 519-476-7748.

Bill Alton (866) 731-6535 (416) 731-6535

Ontario & East: Jim Blair (647) 287-5328

Manitoba & West: Patty Scrase www.oralhealthgroup.com (604) 619-4699

bill@ethiclease.com

james.blair@scotiabank.com pat.scrase@scotiabank.com *

OHYMay12 p34-38 Classifieds.indd 34

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DENTAL MARKETPLACE

CAREERS

COME WORK AND PLAY ON THE JAMES BAY FRONTIER WEENEEBAYKO GENERAL HOSPITAL MOOSE FACTORY, ONTARIO Come experience northern island living and make a difference providing much needed dental services to Cree first nation’s communities. NIHB (non-insured health benefits) is a federally funded program that provides dental, pharmacological, orthopaedic and vision care to status patients.

Full time, part time, locum and job share opportunities available for experienced dentists and new graduates.

Competitive salary, free housing, paid travel and incentives provided to attract quality oriented, culturally sensitive, compassionate, ethical dentists to our communities. Ideal candidates must be self motivated, comfortable with surgical 050323 extractions, certified in nitrous oxide sedation and be willing to useSPRING amalgam. 09 Nestled on an island in the Moose River, near the tip of James Bay, Moose Factory is Canada’s second oldest fur trading community, founded in 1673 by the Hudson’s Bay Company. Moose Factory is home of the Weeneebayko General Hospital which serves the town of Moosonee, the James Bay communities of Attawapiskat, Kashechewan, Fort Albany and Peawanuck (on Hudson Bay).

The James Bay Frontier is an outdoor enthusiasts dream with kayaking, canoeing, boating, fishing, hiking, hunting, snowmobiling, and cross country skiing all at our doorstep. The community is very active offering basketball and A full-time position available volleyball leagues all year round and seasonal baseball and hockey.associate With no commuting to andisfrom work thereinis one plenty of time to enjoy the amenities that the area has to offer. of Canada’s most successful Dental Implant The town of Moosonee is located on the mainland 5 km’s from the island and is accessible by boat taxi in the infreeze early Spring 2009.

Our spring, summer, and fall. Helicopter transportationCenters is used during up and break up, and an ice roadstate-ofin the winter.

Moosonee is the terminus of the Polar Bear Express train thatcomputerized runs 5-6 days a week from Cochrane the-art, facility with CT-scan depending on the season and also has an airport with connecting45 flights via Timmins to Toronto daily. is located minutes north of Edmonton in a Please visit our website for more information www.weeneebaykohealth.ca or call us directly or better beautiful Ranching Community ideal for famiyet come up for a no commitment 3 week locum and experience the beauty of the north for yourself.

080908

DENTAL IMPLANT SURGERY & TEACHING CENTER ALBERTA, WESTLOCK

lies. Patients come from across Canada to this

Dental Department unique (f) Dental Become a part of our (p) 705 658 4544 ext 2209/2207 705 658 Facility.

5520 Sandra Linklater Sheila Gagnon-Wesley, RDH. qualified young Dental ongoing, fun and highly Manager of Dental Services Dental Coordinator, WGH Team.

Assume a very busy full-service general, sandra.linklater@weeneebaykohealth.ca sheila.wesley@weeneebaykohealth.ca

APRIL 10

Is looking for full-time/part-time

OTTAWA ARE

Practices are located in very busy reta Paperless Offices. If you are energe want to grow professionally, please c

Dr. Raja Sandhu, BDS, CEO - SANDHU DENTAL E-mail: rsandhu@sandhud Fax: 613.258.5276 www.san

NEW GRADUATES WELC

090336

SPRING 09

cosmetic dental practice with extremely high ASSOCIATE OPPORTUN earnings by the SOUTHWESTERN ONTARIO To place your ad, contactand a 50% split. Be mentored COMOX VALLEY ON VANCOUV Senior Dentist whose practice is limited excluare looking for an associate denti Endodontist available,We Southwestern Karen Shaw a permanent, full-time position, 3-4 d Ontario. at sively to Implantology.

Our office has Email endodocdds@gmail.com or an established pati 416-510-6770 Please reply by faxing CV or resume to: patients currently being serviced by call 519-990-7386 or have a brand new facility with all new for complete resume. kshaw@oralhealthgroup.comThe Implant Smile Center, x-rays and electronic charting. Our 1-780-349-2626 (Attn: Anita), or based, offering comprehensive care ASSOCIATESHIPS email to drleigh@telus.net. ventive model.

The Comox Valley is the recreatio Phone inquiries: 1-888-877-0737 (toll free).

ASSOCIATE WANTED — MEDICINE HAT, AB RED DEER, AB offering a mild climate and affo Websites: www.albertadentalimplants.com Looking for full time/part time associate with posSCARBOROUGH, ON. We are a highly equipped group of offices www.riverwaydental. sible buy out scenario. Well rounded practice with The Smile Clinics is seeking a F/P-time with new technology in Central Alberta & www.implantsmilecenter.com www.discovercomoxvall opportunities for all aspects of dentistry. New associate with experience. Lots of growth Graduates welcome.

Inquiring minds send CV to dentist4@telus.net

ETOBICOKE, ON

Orthodontist needed for Etobicoke practice.

Please contact Jennifer at 416-231-1100.

NIAGARA-ON-THE-LAKE, ON PART TIME ASSOCIATE

Associate needed for progressive dental office in Niagara-on-the-Lake. Mondays only.

Please send resume to dentalniagara@gmail.com

www.oralhealthgroup.com

OHYMay12 p34-38 Classifieds.indd 35

potential.

Send resumes to thesmileclinics@gmail.com

CAMROSE, AB

Wanted: Associate dentist for busy well established practice in Camrose, Alberta.

060327 JULYSE09 Camrose is fifty minutes of Edmonton.

Modern up to date facility with a great dentalCALGARY, team.

ALBERTA Forward resume by to: Associate required fore-mail progressive, jvccamrose@hotmail.com. dynamic dental practice located in

beautiful Calgary, Alberta.

Please e-mail CV to BURLINGTON, ON horkoffp@telus.net Periodontist needed for a busy Burlington or fax resume to 403-276-3664

dental office. 1-2 days/month to start.

Please contact Andrea at smile@guelphlinedental.com 051029 WINTER 09 for more information.

ASSOCIATE REQUIRED NORTH OF TORONTO

Excellent part-time associate op portunity available immediately for a busy, well established, respected family practice. Unique oppor tunity for a self-motivated, caring individual who performs all aspects of dentistry. Conveniently

allowing you to be the best you can be.

Please send CV to: riverwayde New grads welcome.

Please email: debms@shaw.ca

090335

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.

BARRIE, ONTARIO

Needed : F/T Associate DDS position available ASAP. 090325 JULY 09 Evenings & Saturdays are a must.

OTTAWA, E-mail: ON Denture clinic seeking dentist to dental_manager@hotmail.com assume workload from current dentist transitioning out of practice.

Clinic has been in business for over May 2012

25 years in the Ottawa area.

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

Call 613-749-4055 or e-mail: samlima10@aol.com

35

02/05/12 9:16 AM

DENTAL MARKETPLACE

URGENTLY NEEDED: PEDODONTIST

City of Guelph, population 100,000 has only one Pedodontist and needs one more. 1700 sq. feet available in a facility with lots of parking zoned for Dental.

Full General Anaesthesia available.

Please call Dr. Cooperband (519)767-2886.

EXCELLENT ASSOCIATE OPPORTUNITY ONE HOUR EAST OF TORONTO

Busy dental office looking for a full or part time associate. No evening or weekends and new graduates welcome.

For more information please call: 289-251-2198.

DOVE DENTAL CENTRES

London-based group practice is looking for an orthodontic, endodontic and/or periodontic dentist associates as well as a Dental Anaesthesiologist for modern, progressive, busy clinics in and around the London area.

Please send CV to hrm@ody.ca

We are looking for an experienced Prosthodontist to join our team two to three times per month. We are a modern stateof-the-art multi-specialty clinic located two hours north of Toronto. Great potential and excellent opportunity for growth.

Please send resumes to jd2067@hotmail.com

WHITEHORSE, YUKON

ETOBICOKE, ON P/T ASSOCIATE NEEDED

Whitehorse Dental Clinic is looking for a motivated associate for a full time position at our very busy practice. New graduates welcome.

Please phone us at (867) 667-4486, fax us at (867) 667-4488, or email whitehorsedental@northwestel.net.

NEW LISKEARD, ON OUTSTANDING ASSOCIATE OPPORTUNITY.

Seeking one or two full-time associates.

We balance a HEALTHY LIFESTYLE with a VERY REWARDING WORK DAY! The best in technology along with a humorous, harmonious staff best describes our office. Located on the shores of Lake Temiskaming, pure air, beautiful scenery, no commute time and every amenity to make your after hours relaxing or activity filled. Work 8-5, no evening or weekends. Very busy and lucrative opportunity! Why not have the best of both worlds!

Please call (705) 647-8118 or email: drmarcassa@eastlink.ca

36

PROSTHODONTIST ASSOCIATE WANTED

We need a part time associate for a busy south Etobicoke office. We are open Tuesday to Saturday – flexible.

Call John 416 272 1618 or email dentbite@gmail.com

EDMONTON, AB

Looking for an associate (part/full time)to join our group of multidisciplinary pratices which are focused on the highest quality of patient care and using the latest technology available. We are looking for a self-motivated, high-energy, clinically strong candidate who is interested in learning and continuing education. This is a great opportunity for the right candidate to grow with our expanding group and to work in a great environment. Buy-in opportunities are also available for the long-term associates.

If you are interested, please email your CV in confidence to edmontondentalcareer@gmail.com

LETHBRIDGE, AB

CALGARY, AB

Integrity Dental is an established and well known 7 chair dental practice operating within one of the most uniquely designed dental buildings in Alberta. We are located in the heart of downtown Lethbridge and are currently looking for a skilled, caring and dedicated Dental Associate wanting to commit to becoming a future partner. You will be surrounded by an extremely qualified dental team and a highly respected and experienced dentist who is willing to mentor. We have every system in place for your success and to be busy working 5 days a week.

We invite you to visit our website at www.integritydental.com and experience what we are about.

Please contact Dr. Harold Elke at 1-855-320-0033 for information regarding this exciting opportunity.

Associate required part time for busy, progressive, family, cosmetic practice located in Calgary. We are expanding our dental clinic and are searching for an associate who believes in high quality dentistry and patient care. If you are looking for an excellent work environment and a great team who strives for the best in patient care we are the office for you. All aspects of dentistry are offered at our clinic, Implants, Sedation, Cerec-3D Crowns, digital x-rays, Orthodontics, Cosmetic dentistry and much more. Associate position is ideal for a candidate with 2 or more year’s experience. There is an opportunity for buy in for the right individual. Commitment to continuing education from Kois, Spears, LVI. Mentorship with continuing education programs like DOCS, AACD, Implants, and Cosmetic Organizations is a great asset. Must be willing to work some evenings and Saturdays.

Please email your resume in confidence to Cherylplas@gmail.com

May 2012

OHYMay12 p34-38 Classifieds.indd 36

www.oralhealthgroup.com

02/05/12 9:17 AM

OTTAWA, ONTARIO

Associate Needed — outstanding opportunity for a dynamic, dedicated team-oriented individual to join a large, well- established group practice in Kanata, (Ottawa) Ontario.

Part-time or full-time.

Please submit CV by email: hazeldeandental@gmail.com.

ORILLIA, ON

Part time associate required 1-2 days per week for busy general family practice.

Please forward resume to dental_2010@live.ca

ASSOCIATE – EDMONTON, AB A dental practice with a difference!

Endless potential for growth and compensation! State-of-the-art equipment and advanced management approaches!

We are located in Edmonton, Alberta.

Please send CV to HLDsmile@gmail.com

NEWMARKET, ON

Busy progressive dental office is looking for a P/T associate with F/T potential, Must be self motivated and caring.

Email resume to drbriancroppo@rogers.com

DENTAL MARKETPLACE

LETHBRIDGE, AB

Associate Dentist required for new Family Dentistry practice, in a Southern Alberta bedroom community. Excellent opportunity with 4 chairs, experienced staff, and state-of-the-art equipment.

Please forward serious inquiries to 2011ldss@gmail.com

OTTAWA, ON

An exciting associateship opportunity for compassionate, confident practitioner dedicated to quality patient care. You will work with an experienced team of dentists and specialists in a dynamic environment with state-of-art digital and dental equipment in Ottawa. We offer partnership options to our qualified doctors.

Please email resumes to associates2020@gmail.com

KITCHENER/WATERLOO, ON

PT quickly leading to FT associate needed for busy dental office in KW area.

What we offer: • No weekends therefore, valuable family time • Above average compensation • Dentist rarely needs to do hygiene … almost exclusively dentistry • Solid new patient flow • State of the art digital and dental equipment • Skilled experienced staff • Possibility of future partnership • Children to walk to nearby schools What you offer: • Amicable and ethical with patients and staff • Excellent endo and oral surgery skills • Committed to providing the highest quality of care Please email resume and cover letter to kwdentist@yahoo.ca

THUNDER BAY, ONTARIO

Seeking highly motivated and enthusiastic individual to welcome into our busy newly renovated practice as a full time associate. Our office is equipped with all new equipment including digital x-rays and computerized charting.

Our priority is to provide the highest quality of care in a professional and caring environment. Our practice provides all aspects of dental care including GA and sedation dentistry.

Our practice offers an exceptional opportunity for experienced Doctors or recent graduates as we boast a large patient base, excellent income potential, full time hours and no weekend office hours required. (200K easily achievable). Future partnership or ownership options available.

Thunder Bay is Ontario’s best kept secret for having all the amenities of a larger city yet with all aspects of outdoor sports and activities right in your backyard.

If you feel you would like to join our highly skilled team please contact: Dr. Doug Mason drmason@shaw.ca 807-683-5222 or fax 807-683-6812 www.oralhealthgroup.com

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ASSOCIATE OPPORTUNITY STARTING JUNE 2012 Very productive dental practice in Fort McMurray, AB currently seeking an associate for a busy office to take over for current relocating dentist. New graduates and experienced dentist welcome. Our office will provide you with a diverse variety of dental cases including hospital privileges. Our office is a fully digital and computerized office. Excellent opportunity for the right candidate.

Don’t pass this opportunity up, call and ask to speak to Paula.

Position needs to be filled ASAP so don’t delay.

Resumes can be emailed to office@maxxdental.com , or by fax at 780-743-4220 Phone 780-743-4111

OTTAWA, ON SANDHU DENTAL GROUP is looking for full time dentists for : Brockville/Prescott : Cornwall : Kemptville/Carleton place Apply if you want to be: •Successful, making $200,000 plus •Commited for minimum 2 years •Hardworking, flexible and passionate Graduates of international program welcome.

E-mail: angie@sandhudental.ca Visit: www.dentistryatbrockville.ca www.dentistryatcornwall.ca www.dentistryatkemptville.ca May 2012

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DENTAL MARKETPLACE

BRITISH COLUMBIA — FORT SAINT JOHN

Full-time associate needed for established, busy family practice with high income potential. The Fort Saint John Dental Clinic features high quality full time hygienists, CDA’s, Cerec and friendly, hard working staff.

Contact Curtis at: 801-376-0976 or fax resumes to: 250-785-0625.

THUNDER BAY, ON

Full Time Associate Needed Scott Family Dental seeks full time associate for their busy general practice, open since 1980. Our clinic includes 5 computerized operatories, digital intraoral as well as pan radiography, and an enthusiastic and efficient staff. An option to purchase the practice and building may be available to an interested individual.

Resumes may be faxed to (807) 345-8581. Any questions may be answered by calling Dr. Brian Scott at (807) 345-6331.

BRAMPTON, ON

Part time associate needed for Brampton office starting immediately.

E-mail: info@lormelgatedentistry.com or fax 905-840-8373.

OWEN SOUND, ON

With the retirement of one of our team, we are seeking a full time dental associate. A great opportunity exists in this rural city only 21⁄2 hours north of Toronto on beautiful Georgian Bay of Lake Huron. Work and wilderness only minutes from home allow a balance to your previously hectic professional life. Our dynamic multi-practitioner dental team has developed management systems that allow low stress, efficient and productive days. Focus on patient care, education and excellence supported by accessible specialists in a modern, relaxing office environment. This family and retirement community boasts superb skiing, boating, hiking and biking as well as a relatively underserviced patient base.

Please apply to taylorz@rogers.com

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May 2012

OHYMay12 p34-38 Classifieds.indd 38

KITCHENER/WATERLOO, ON Seeking Full Time or Part Time Associate with strong clinical and communication skills with option to become a partner in modern dental practice with emphasis on advanced comprehensive dental care.

Email applications to: kwdentalgroup@gmail.com

GRANDE PRAIRIE, AB Full time associate is required to take a full patient load, immediately busy from day one. Office is modern, well equipped, digital x-rays, computerized operatories, paperless charting, excellent new pt flow.All aspects of dentistry.

This is a good opportunity for any dentist seeking a long term position and ongoing mentorship.

Please email drdada@telusplanet.net or call 780 538 2992.

ETOBICOKE, ON ORAL SURGEON NEEDED We are in need of an Oral Surgeon — part time for our busy south Etobicoke office.

Please call 416 272 1618 and ask for John or email dentbite@gmail.com

SASKATCHEWAN

Associate position in established practices in Saskatchewan are now available. Future ownership possibilities for qualified candidates. Hygienists wanted as well. Please fax your confidential CV to 866-764-1860 or email bob@finetouchwest.com www.finetouchwest.com

OUTSIDE THE GTA

P/T quickly leading to F/T associate need for busy, established dental group.

Long standing staff and great working conditons in a smaller community near Kitchener.

Reply to dentistsreply@yahoo.ca

BURLINGTON, ON

Endodontist needed for a busy Burlington dental office. 1-2 days/month to start.

Please contact Andrea at smile@guelphlinedental.com for more information.

GRANDE PRAIRIE, ALBERTA A full time associate needed for our busy, well established family practice.

Our practice offers all aspects of family dentistry including I-V sedation, oral sedation and implants. We will be moving into a brand new office soon in a high traffic area.

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

FULL TIME ASSOCIATE LONDON, ON Full time associate required in a busy family practice in London, Ontario. Ideal for a general dentist with an interest in orthodontics. Current associate is leaving. We are seeking an energetic individual with desire and ability to provide high quality dentistry.

For more information regarding this exciting opportunity please contact Cosmo Dental Centre, Dr. Anwar Dean by calling (519) 636-8447 or email anwar.dean@bellnet.ca

RED DEER, AB Immediate opportunity is available for a full time associate to take over existing associates patient base. This is a busy and growing practice which generates a healthy new patient flow. The office has been newly renovated and complies with ADA standards and protocols.

If you would like to join a team of dental professionals dedicated to providing quality care, please email your CV to reddeerassociate@gmail.com

BRAMPTON, ON

Associate required in a family practice.

Great opportunity. New Graduates welcome. Excellent Remuneration.

Please fax resume to (905) 582-7357.

EDMONTON, AB

Full time dental associate sought for state of the art dental practice. Features great staff and patients, paperless, digital imaging, 3D tomography. Located in the heart of downtown Edmonton.

Interested candidates please email resume in confidence to omar@infinitydental.ca

NEPEAN, ON Part-time position available in highly established, busy practice with the opportunity to advance to full-time. This is an excellent opportunity to work with a great team, always providing exceptional, comprehensive patient care.

To learn more, please contact Louise at (613) 825-9393 or email smiledr@magma.ca

EQUIPMENT E4D COMPLETE SYSTEM FOR SALE E4D CAD/CAM System with Ivoclar Oven.

Price: $80,000 (plus shipping). Additional supplies valued at $3500 included in purchase price. Photos available.

E-mail: dentalofficek@gmail.com

www.oralhealthgroup.com

02/05/12 9:18 AM

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