Oral Hygiene September 2016 by Annex Business Media

oralhygiene September 2016

SAVING FACE: Mask

Form, Fit and Function MYSTERY SOLVED: Acid Reflux and The Oral Cavity EVIDENCE-BASED FLUORIDE DELIVERY for Todayâ&#x20AC;&#x2122;s Dental Hygiene Client

www.oralhealthgroup.com

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How to Select a DENTAL SOFTWARE for Your Practice

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oralhygiene CONTENTS

ORAL HYGIENE Evidence-Based Fluoride Delivery for Today’s Dental Hygiene Client

Jo-Anne Jones, RDH

Mystery Solved: Acid Reflux and The Oral Cavity

Gloria Alban, DDS

Saving Face: Mask Form, Fit and Function

Leann Keefer, RDH, MSM

TECHNOLOGY How to Select a Dental Software for Your Practice

Feda Bashbishi

DEPARTMENTS Editorial Dropping the ‘F Bomb’ ...Again

News Global Mouthwash Market Hygienists & Cavities

5 6

New Products

Dental Marketplace

EDITORIAL BOARD MEMBERS Lisa Philp | Kathleen Bokrosssy Debra Englehardt-Nash

September 2016

www.oralhealthgroup.com

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EDITORIAL

Dropping the ‘F Bomb’ …Again Fluoridation is useless for low-income children, US federal data shows. Now please keep in mind the source, the New York State Coalition Opposed to Fluoridation (NYSCOF) Inc. Having said that, Center for Disease Control (CDC) 2011/2012 statistics reveal that low income children’s tooth decay rates are increasing substantially despite record numbers of children served fluoride from water, foods, dental products and medicines causing an overall ‘alarming’ surge in fluoride overdose symptoms like dental fluorosis (discolored teeth) reports the NYSCOF. Decay rates for children living 100% below the federal poverty line are 40% in three tofive-year-olds; 69% in six to nine-year-olds; and 74% in 13 to 15-year-olds, based on federal data being presented at an American Public Health Association meeting in November of this year. Previous cavity rates (1988-1994) for similar childrens’ primary teeth were much lower – 30% of two to fiveyear-olds; 42% of six to 12-year-olds; and 34% of 15 to 18-year-olds’ permanent teeth. “Claims that poor children need fluoride are without merit or evidence,” says attorney Paul Beeber, NYSCOF President. “It’s the dental care delivery system that needs fixing. Low-income Americans need dental care, not fluoride.” In fact, dental expenses were a leading contributor to medical debt in 2012. Along with low-income children’s rampant cavities, all children’s dental fluorosis rates surged, according to CDC’s 2011-2012 NHANES survey. Fifty-eight percent of all children (6-19 year olds) now have fluorosis, with a staggering 21% of children displaying moderate fluorosis on at least two teeth. “Fluorosis is the outward sign of fluoride toxicity,” says Beeber. Dr. Hardy Limeback, PhD, and Canadian fluoride expert says fluorosis is permanent scarring of the teeth, just like acne can permanently scar facial skin. “By focusing on fluoridation and more modes of fluoride administration instead of diet and dentist-access, organized dentistry allowed a national dental health crisis to occur on its watch and created a new one – den-

tal fluorosis,” says dentist David Kennedy, past-president of IAOMT (International Academy of Oral Medicine & Toxicology). “It’s reckless to allow organized dentistry to vouch for fluoride safety. Adverse health effects, outside of the oral cavity from ingested fluoride, are not within the purview of dentistry, according to the California Board of Dental Examiners.” Research shows fluoride ingestion is more likely to cause fluorosis than prevent a cavity, according to Fluoride Action Network. Tooth decay crises are occurring in all fluoridated cities, states and countries. Sugar is the main culprit in tooth decay but “Even the low level of sugar consumption was related to dental caries, despite the use of fluoride,” report researchers in the Journal of Dental Research. The American Dental Association (ADA) is often the go-to union which legislators and the media consider experts. Most professional unions based their endorsements on their trust of the ADA. But now, studies appear at odds with years of public statements by dental groups assuring the public that fluoridation safety has been extensively researched. Even the ADA admits in its Fluoridation Facts Booklet, that “decreased fluoride removal may occur among persons with severely impaired kidney function who may not be on kidney dialysis.” Even nationally known figures have waded into the discussion, such as environmental activist Erin Brockovich, who called for Fluoridegate scandal investigations. Best-selling author and nationally known physician Dr. Mark Hyman issued this statement: “I support federal investigative hearings looking into why our cities and towns are allowed to continue to add fluoride to public water sources and why the whole story about fluorides is only now coming out.” Undoubtedly, the fluoride fight will rage on, ‘experts’ will pontificate and users of social media will manipulate data. You will continue to be your patients’ most trusted source of information so arm yourself with as much knowledge as you can. Be openminded and courageous and always advocate for your patients.

Catherine Wilson

Editor

September 2016

www.oralhealthgroup.com

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ORAL HYGIENE

Evidence-Based Fluoride Delivery for Today’s Dental Hygiene Client Abstract:

Jo-Anne Jones,

President, RDH Connection Inc. As a successful entrepreneur and international, award winning speaker, Jo-Anne has been selected as one of DPR’s Top 25 Women in Dentistry and is a returning Dentistry Today CE Leader for the 7th consecutive year. Jo-Anne is president of an educational and clinical training company recently awarded the ‘Elizabeth Craig Award of Distinction’ in recognition of her exceptional and ongoing commitment to promoting the dental hygiene profession. She may be contacted at jjones@ jo-annejones.com.

Today’s preventive practice provides the ability to intervene in the demineralization process and return the client to health often without the use of restorative techniques. Evidence-based research promotes the use of sodium fluoride varnish compared to other methods of delivery of professional topical fluorides. The overall goal of this article is to provide the reader with information on the use, efficacy and safety of professional topical fluorides for integration into dental hygiene practice.

oday’s preventive practice has the ability to focus on prevention of dental caries through intervening in the caries process. Demineralization may be tipped back to remineralization often returning the client to health without the use of restorative techniques. Although caries are largely preventable, 96% of Canadian adults have a history of caries. According to the Canadian Health Measures Survey conducted from 2007–2009, over half of Canadian children and adolescents aged six to 19 years old are affected by dental caries.1 Among five to 17-year-olds, dental decay is five times as common as asthma and seven times as common as hay fever. 2 The average number of teeth affected by decay in children aged six to 11 and 12 to 19 year olds is 2.5. 2 Additional implications of tooth decay include pain and discomfort, traumatic and expensive dental experiences involving restorative procedures and/or extraction, and the negative impact on scholastic abilities. According to the Canadian Institute for Health Information, severe tooth decay is the leading reason Canadian preschoolers have day surgery each year. 3 Fluoride delivery has been made available to the public both through community water fluoridation as well as professional application. Community water fluoridation has the highest quality and greatest quantity of evidence supporting this intervention as a costeffective preventive measure.4

THE CALGARY STUDY

The impact of fluoride cessation was studied in Calgary with the results being recently published in the Journal of Community Dentistry and Oral Epidemiology. 5 The objective of the study was to examine the short-term impact of fluoridation cessation on school children (Grade 2) in two similar cities in the province of Alberta; Calgary and Edmonton. The researchers found a statistically significant increase in dental caries in Calgary where community water fluoridation was stopped in 2011 due to debate over safety coupled with the community cost factor. Dentists, however, did not agree with the decision and continued to argue for fluoridated water as an ideal and cost effective method for fighting tooth decay, especially for those who cannot afford to visit a dentist regularly. 6 Not only was there an increase in caries in Calgary but also an increase in severity occurring at a younger age. “It’s not unusual for us to see a child with almost full-mouth decay in the population that we’re looking at, and considering that we’re in Calgary, we shouldn’t be seeing that degree of disease here and we are,” said Denise Kokaram, of the Alex Dental Health Bus.7 Again, with a disease that is highly preventable and relatively easy to remedy, this result is very troubling. The end result of this study substantiates the supportive role of water fluoridation in contributing to caries prevention in children.

September 2016 www.oralhealthgroup.com

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ORAL HYGIENE

Table 1

Community water fluoridation has been the source of considerable controversy since its introduction in the 1940’s. In a world where we are continually bombarded with information overload, much of which is based on opinion rather than scientific fact, we must be careful to make judgments based on science and evidence. There are many long-term studies conducted by respected agencies such as the World Health Organization, and Health Canada supporting scientific fact regarding fluoride safety; both community water fluoridation and professional delivery. The Canadian Dental Association supports the appropriate use of fluorides in dentistry as one of the most successful preventive health measures in the history of health care. Over 50 years of extensive research throughout the world has consistently demonstrated the safety and effectiveness of fluorides in the prevention of dental caries. 8

DELIVERY MODELS OF TOPICAL FLUORIDE APPLICATION Scale, polish, fluoride…is your topical fluoride recommendation and delivery evidencebased or routine? Traditionally, the selection of fluoride for clinical use involved the use of a fluoride gel placed inside a tray or a fluoride rinse. Later, the introduction of fluoride foams emerged

which helped to minimize the ingestion of fluoride due to a lower volume of product required. In the late 70s fluoride varnish emerged addressing both the compliance issue as well as therapeutic effectiveness. Evidence-based research promotes the use of sodium fluoride varnish compared to other methods of delivery of professional topical fluorides. Fluoride varnish possesses a number of unique properties including the application of an increased concentration of fluoride that remains directly in contact with the outer surface of the tooth structure for an extended period of time (approximately 1–7 days).9 It is quickly and easily applied without the use of trays. Inadvertent ingestion is very unlikely due to the properties of the varnish and its immediate adherence to the tooth surface upon contact with saliva. In contrast, the exposure of fluoride to tooth structure for a gel or foam is typically 15 minutes. It is important to note that fluoride varnish dispensed from a tube versus individual dose packaging cannot ensure a uniform therapeutic dose. This is due to phase separation that occurs resulting in a variation of fluoride content.10

WHAT’S THE EVIDENCE? In 2006, the Council on Scientific Affairs of

September 2016 www.oralhealthgroup.com

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ORAL HYGIENE

the American Dental Association published recommendations for the use of professionally applied topical fluorides for caries prevention based on a systematic review of clinical trials and evidence-based studies. The clinical recommendations and supporting systematic review were updated and published in 2013.11

The following are the recommendations supporting an evidence-based approach to care.

CHILDREN 6 YEARS OF AGE AND UNDER

Only 2.26 percent fluoride varnish (5.0 percent NaF) is recommended for children younger than six years of age. In children younger than six years, there is Caries Risk Assessment Form for Children Age 0 - 5 strong evidence from sysPatient Name: _______________________________Age: ____________ Date: ______________ tematic reviews of randomInitial/Baseline Exam Date: _________________________ Recall Date: ________________ ized controlled trials supRespond to each question in sections 1 – 4 with a check mark in the Yes or No column Yes No Notes porting fluoride varnish 1. Caries Risk Indicators – Parent Interview ** applications at six-month a) Mother or primary caregiver has had active dental decay in the past 12 months intervals for moderate-risk b) Child has recent dental restorations (see 5B below) patients and for applicac) Parent or/or caregiver has low SES (socioeconomic status) and/or low health literacy tions of fluoride varnish evd) Child has developmental problems ery three months in highe) No dental home/episodic dental care risk patients. In this age 2. Caries Risk Factors (Biological) – Parent Interview** group, the risk of experia) Child has frequent (greater than 3/daily) between-meal snacks of sugar /cooked encing an adverse event starch/sugared beverages such as nausea or vomiting b) Child has saliva-reducing factors present, including: associated with swallowing 1. Medications (e.g. some for Asthma or hyperactivity) 2. Medical (cancer treatment) or genetic factors professionally applied topic) Child continually uses bottle - contains fluids other than water cal fluoride agents presents d) Child sleeps with a bottle or nurses on demand a real concern. Minimizing 3. Protective Factors (Nonbiological) – Parent Interview this risk was only supporta) Mother/caregiver decay-free last three years ed by the use of fluoride b) Child has a dental home and regular dental care varnish. Until the introduc4. Protective Factors (Biological) – Parent Interview tion of fluoride varnish, a) Child lives in a fluoridated community or takes supplements by slowly dissolving there was not a ‘safe’ option or as chewable tablets to deliver high concentrab) Child’s teeth are cleaned with fluoridated toothpaste (pea-sized) daily tion fluoride to young c) Mother/caregiver chews/sucks xylitol gum/lozenges 2 – 4 x daily children without the possi5. Caries Risk Indicators/Factors – Clinical Examination of Child** bility of ingestion. Even a) Obvious white spots, decalcifications, or obvious decay present on the child’s teeth though the concentration b) Restorations placed in the last two years in/on child’s teeth of fluoride in a 5% NaF varc) Plaque is obvious on the child’s teeth and/or gums bleed easily nish is almost twice as high, d) Child has dental or orthodontic appliances present, fixed or removable e.g. braces, space maintainers, obturators the amount required for e) Risk Factor: Visually inadequate saliva flow – dry mouth a treatment application ** If yes to any one of 1(a), 1(b), 5(a) or 5(b) or any two in categories 1,2,5 consider of varnish, approximately performing bacterial culture on mother or caregiver and child. Use this as a baseline to follow results of antibacterial intervention. 0.1–0.5 ml depending on (a) Mutans streptococci (Indicate bacterial level: high, medium, low) age compared with 4–8 ml (b) Lactobacillus species (Indicate bacterial level: high, medium,low) for an APF gel. Ingestion is Child’s overall caries risk status: (Circle) Extreme Low Moderate High minimal due to the tenaRecommendations Given: Yes________ No_______ Date Given_______ Date follow up________ cious adherence of the fluoSelf-Management Goals 1)________________________________ 2) _________________________________ ride varnish to the tooth Practitioner’s Signature: __________________________________ Date: ______________________________ structure. Please recycle. Printed in Canada.© 2009, 3M. All rights reserved. Used under license in Canada. 0909-07232 Reprinted with Permission. Fluoride gels/foams in Table 2

September 2016 www.oralhealthgroup.com

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One in four has it.

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Dry Mouth is an oral health concern that affects people on multiple medications the most.3 Yet some people aren’t aware that it’s a problem.2 Talk to your patients about Dry Mouth and how Biotene can help provide relief.† ®

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GlaxoSmithKline Consumer Healthcare Inc., Mississauga, Ontario L5N 6L4 © 2016 GSK group of companies or its licensor. All rights reserved. * Dry mouth can disrupt the oral health environment and lead to halitosis, demineralization, and increased caries.4,5 † Mouthwash, Gel and Spray. ‡ As measured in a 28-day clinical study.6 1. GSK data on file. Biotène dry mouth growth opportunity (with Canadian U&A data). July 16, 2014. 2. Dawes C. How much saliva is enough for avoidance of xerostomia? Caries Res. 2004;38:236–240. 3. Sreebny LM, Schwartz SS. A reference guide to drugs and dry mouth, 2nd edition. Gerodontology. 1997;14:33–47. 4. Turner MD, Ship JA. Dry mouth and its effects on the oral health of elderly people. J Am Dent Assoc. 2007;138:15S–20S. 5. Fox PC. J Clin Dent. 2006;17(Spec Iss):27–28. 6. GSK data on file 2014, RH01986.

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ORAL HYGIENE

Table 3 trays or fluoride rinses should not be used due to the toxicity risk if swallowed. Refer to Table 1 for fluoride ion and sodium fluoride concentrations of topical fluoride agents. In additional, gels and foams take a minimum requirement of four minutes in contact with tooth surfaces making the treatment challenging for young children as well as elderly clients. Furthermore the use of a one-minute product including both gels and foams is not endorsed.11 The ability of fluoride varnish to adhere to the tooth structure provides for a slow release of fluoride over time. A clinical study conducted by Stearns et al concluded that children six to 44 months of age who had four or more applications of fluoride varnish demonstrated a 39 percent reduction in caries-related treatment in anterior teeth.12 Children in this same age group who received no varnish were more than two times as likely to develop decay as those who received an annual varnish application.13 Fluoride varnish should be part of all preventive strategies aimed at high-risk children in this age group.

Caries Risk Assessment Form for Patients 6 Years and Older Patient Name: _________________________________ Age ____________ Date: ___________ Initial / Baseline Exam Date: _________________________ Recall Date: ________________ Respond to each question in sections 1, 2 & 3 with a check mark in the yes or no column 1. High Risk Factors a) Visible cavitation (carious) or caries into dentin by radiograph b) Caries restored in the past three years c) Readily visible heavy plaque on teeth d) Frequent (greater than three times daily) between meal snacks of sugars / cooked starch e) Saliva – reducing factors: 1) Hyposalivatory medications 2) Radiation to head and neck 3) Systemic reasons, e.g. Sjogren’s Syndrome f) Visually inadequate saliva flow. g) Appliances present, fixed or removable, e.g. orthodontic brackets / bands / retainer or removable partial denture (s) 2. Moderate Risk Factors 2) medical (cancer treatment) or genetic factors k) Child has developmental problems 2 Moderate Risk Factors a) Exposed roots b) Deep pits & fissures / developmental defects c) Interproximal enamel lesions / radiolucencies d) Other white spot lesions or occlusal discolouration e) Uses recreational drugs f) Mother / caregiver has no caries activity 3 Protective Factors a) Lives / works/ school in fluoridated community b) Uses fluoride toothpaste daily c) Uses fluoride mouthwashes / rinses / gel daily d) Salivary flow visually adequate e) Uses xylitol gum or mints 4 x day f) Mother / caregiver has no caries activity Caries Risk Status (circle)

High

Notes Yes

Type____________________ Type____________________ Type____________ & % xylitol Moderate

Low

Recommendations Given: yes________ no_______ Date Given_______ or Date follow up________

CHILDREN 6 YEARS OF AGE AND OLDER Fluoride varnish or 1.23 percent fluoride (APF) gel are recommended for clients 6 years of age or older. The frequency of application is at least every three to six months pending the level of determined risk. The level of risk related to caries incidence is related to environmental factors, predisposing factors balanced against protective measures. A person is considered to be at low risk if she

Reprinted with Permission.

or he has had no caries including incipient lesions, in the past three years and has no other risk factors. Caries risk factors include but are not limited to the following: one or two incipient or cavitated carious lesions in the past three years, low socioeconomic status, suboptimal fluoride exposure, xerostomia, poor oral hygiene, cariogenic diet, exposed root surfaces, drug or alcohol abuse, many existing multi-surface restorations, defective restorations, orthodontic therapy, and physical or mental disability.14 3M has created a caries risk assessment form for ‘patients zero

September 2016 www.oralhealthgroup.com

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ORAL HYGIENE

Table 4

to five years’ and ‘six years and older’. This is available in a ‘Post-It’ note format. Refer to Tables 2 and 3. In contrast, neither professionally applied rinses nor fluoride foams have been sufficiently evaluated to recommend their use over APF fluoride gel or fluoride varnish. The 2006 ADA recommendations acknowledge that while foams are commonly used in dental practice, the weight of evidence for effectiveness is not as strong as gels and varnish.9 In the updated ADA clinical recommendation guidelines, the use of 1.23 percent fluoride (APF) foam was not recommended either. A benefit was found using the foam in children younger than six years of age, however, the potential for harm, including swallowing APF foam outweighed this benefit. There was no benefit derived from 1.23 percent APF foam application twice per year for four minutes for caries prevention in the six to 18-year-old age group.

Refer to Table 4 for a summary of clinical recommendations for use of professionally applied topical fluorides.

AGING POPULATION AND CARIES INCIDENCE When we think of fluoride, we often equate the benefits simply for children. The adult population who are at moderate to high risk for caries also are in need of a fluoride treatment. By 2021, there will be eight million Canadians aged 55+. Are we prepared to meet the needs of the ‘silver tsunami’? More than one third will have root caries requiring both restorative and periodontal services.15 This is exacerbated with the need for multiple medications, which often induce xerostomia (dry mouth). There are over 400 medications, which induce xerostomia. Not only the quantity but also the quality of saliva is greatly hindered making this segment of the population caries prone.

September 2016 www.oralhealthgroup.com

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ORAL HYGIENE

A video illustrating varnish application and post treatment instruction is available for viewing with the online digital publication of Oral Hygiene.

PRODUCT SELECTION

There are very few objections to fluoride varnish given the quick ‘paint-on’ application doing away with the need for fluoride trays and risk of ingestion. Occasionally a client will comment on the ‘roughness’ that is apparent on the teeth after a fluoride varnish application. Typically, our clinical tendency is to apply too much varnish. It is to be applied in broad, horizontal strokes using a very small amount resulting in a thin layer that is barely perceptible visually on the dentition. 3M™ Vanish White Varnish is accompanied by an application guide that directs the clinician to the appropriate amount to be utilized for full mouth application (refer to Image 1. 3M™ Vanish White Varnish Application Guide). Secondly, and most importantly, a strong objection was the discoloration of the varnish application that would remain on the teeth after the varnish application. Vanish™ White Varnish (5% NaF) was the first clear fluoride varnish introduced. The varnish may be applied to moist ‘toothbrush’ clean tooth surfaces. Saliva activates the varnish forming a lacquer-like coating on the tooth surface prolonging the contact time between fluoride and the tooth surfaces. Numerous studies have concluded that fluoride varnishes are capable of depositing large amounts of fluoride on human enamel and it has also been concluded that the amount deposited on demineralized enamel is greater than that on sound enamel.16 Vanish™ White Varnish contains 22,600 ppm fluoride and an innovative tri-calcium phosphate (TCP) ingredient. Why is this important? In most cases, when calcium and fluoride are together in a formulation, they will combine through chemical bonding to form relatively insoluble calcium fluoride. In Vanish™ White Varnish, the tri-calcium phosphate is surrounded by a dissolvable coating which protects the calcium ensuring there is no reaction with the fluoride in the packaging

prior to dispensing. Once the product is introduced into the mouth, the saliva breaks down the coating, releasing the bioavailable TCP, calcium, phosphate and fluoride for optimal remineralization.

A MODEL FOR DECISION MAKING In conclusion, a dental hygienist is directed to apply evidence-based decision making as a model for guiding dental hygiene treatment planning. This is the “integration of best research evidence with clinical expertise and patient values and expectations. When these elements are integrated, clinicians and patients form a diagnostic and therapeutic alliance which optimizes clinical outcomes and quality of life.”17,18 Fluoride varnish presents a safe and effective means to address one of the nation’s most chronic diseases. Is scale, polish, fluoride…routine or evidence based in your dental hygiene practice? You decide.

References: 1. Health Canada. Report on the findings of the oral health component of the Canadian Health Measures Survey 2007 – 2009. Available online http://www.hc-sc.gc.ca/ hl-vs/pubs/oral-bucco/fact-fiche-oral-bucco-stat-eng.php 2. Locker D, Matear D. Oral disorders, systemic health, well-being and the quality of life: A summary of recent research evidence. Toronto (ON): University of Toronto; [Cited 2010 Jun 1]. Available online: http://www.utoronto.ca/dentistry/facultyresearch/dri/cdhsru/health_measurement/7.%20%20No%2017.pdf 3. https://www.cihi.ca/en/factors-influencinghealth/socio-economic/severe-tooth-decay-the-leading-reason-canadian 4. Evidence Brief: Dental caries prevention in school-aged children: effectiveness of dental/oral hygiene program delivery models. Public Health Ontario. February 2016.

September 2016 www.oralhealthgroup.com

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ORAL HYGIENE

5. McLaren L, Patterson S, Thawer S, et al. The short-term impact of fluoridation cessation was measured on dental caries in Grade 2 children on over 5,000 children in Edmonton and Calgary using tooth surface indices. Comm Dent and Oral Epid. Vol. 44; (3) 274–282, June 2016. 6. http://www.huffingtonpost.com/dan-arel/ calgary-removed-f luoride-_b_9299982. html 7. http://www.cbc.ca/news/canada/calgary/ toot h- dec ay- c a lga r y-f luor ide -water-1.3450616 8. https://www.cda-adc.ca/en/about/position_ statements/fluoride/ 9. Fluoride Varnish: an Evidence-Based Approach Research Brief. Association of State and Territorial Dental Directors Fluorides Committee. September 2007. Available online: http://www.astdd.org/docs/ Sept2007FINALFlvarnishpaper.pdf 10. Shen C, Autio-Gold J. Fluoride varnish concentration gradient and its effect on enamel demineralization. Assessing fluoride concentration uniformity and fluoride release from three varnishes. J Am Dent Assoc Feb. 2002; 133 (2):176-82. 11. Weyant RJ, Tracy SL, Anselmo T, et al. Topical fluoride for caries prevention. Executive summary of the updated clinical recommendations and supporting systematic review. JADA 2013;144(11):12791291 12. Stearns SC, Rozier RG, Pahel BT et al. Effects of expanding preventive dental care in medical offices for children covered by Medicaid. 13. Weintraub JA, Ramos-Gomez F, Jue B, et al. Fluoride varnish efficacy in preventing early childhood caries. J Dent Res. 2006;85:172-176.

14. Professionally applied topical fluoride Evidence-based clinical recommendations American Dental Association Council on Scientific Affairs JADA, Vol. 137 http://jada.ada.org August 2006 Available online: http://www.ada.org/~/ med ia /A DA /Sc ienc e%2 0 a nd%2 0Research/Files/report_fluoride.pdf?la=en 15. Symington JM, Perry OR. Canada’s Aging Population – Increasing Dental Caries: Part 2. Oral Health May 1, 2004. http://w w w.oralhealthgroup.com /features/canada-s-aging-population-increasing-dental-caries-part-2/ 16. Beltran-Aguilar ED, Goldstein JW, et al. Fluoride varnishes: a review of their clinical use, cariostatic mechanism, efficacy and safety. J Am Dent Assoc. 2000;131:589-96. 17. Sackett DL et al. Evidence-based medicine: How to practice and teach EBM. 2000. London: Churchill Livingstone. 18. Ismail AI, Bader JD. Evidence-based dentistry in clinical practice. JADA 2004; 135: 78-83. Resources: 1. Chairside guide (Clinical Recommendations for Use of Professionally-Applied or Prescription-Strength, Home-Use Topical Fluoride Agents for Caries Prevention in Patients at Elevated Risk of Developing Caries) http://ebd.ada.org/~/media/EBD/ Files/ADA_Evidence-based_Topical_Fluoride_Chairside_Guid.pdf?la=en Disclosure: Jo-Anne Jones is consultant for a number of leading dental corporations including 3M Oral Care and has received financial compensation for writing this article.

September 2016 www.oralhealthgroup.com

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ORAL HYGIENE

MYSTERY SOLVED

Acid Reflux And The Oral Cavity Gloria Alban,

DDS, RHN Dr. Gloria Alban graduated from the University of Toronto, Faculty of Dentistry in 1978. She worked in her own dental practice in Toronto until 2001 when she retired due to health issues. As part of her healing, she became a Holistic Nutritionist in 2010. Dr. Alban now works in association with the Spark Institute in Vaughan, Ontario - a clinic devoted to preventive medicine and the natural treatment of digestive disorders, eating disorders, anxiety and depression. In her free time, she volunteers as a grief and crisis counselor with the Toronto Distress Centre and enjoys yoga, hiking and cooking for her family.

WHY DOES THE ORAL HEALTH OF SOME PATIENTS CONTINUE TO DETERIORATE IN SPITE OF EXCELLENT DENTAL CARE? PLEASE READ THIS ARTICLE AND FIND A POSSIBLE ANSWER!

am a retired dentist who has a passion for preventative dentistry and preventive medicine. I recently became painfully aware of the ramifications of acid reflux and GERD (gastroesophageal reflux disease) on the oral cavity. I developed severe GERD late last year. Unfortunately, complete understanding of the difficulties experienced by patients comes best through direct experience. I look back at many of the patients I worked with throughout my 23 years practicing dentistry and think that I wish I had known then what I understand now. I have put together this article to help dentists and their patients understand how GERD is creating many dental problems and also the best way to fix them. I hope you will take a few minutes to read this article because I believe the information can help you change patients’ lives and also reduce the frustration of treating patients whose oral health seems to be deteriorating in spite of excellent dental care. Acid reflux or GERD affects over 50% of adults and 37% of young people.1 It occurs when the contents of the stomach end up in the esophagus and oral cavity as a result of inadequate closure of the esophageal sphincters. The pain of heartburn is a symp-

tom in only 10% of cases while others may experience: • Post-nasal drip • Hoarseness • Sore throat • Throat clearing • Chronic cough • Difficulty swallowing • Choking • Asthma-like wheezing and symptoms • Chest pain And many other symptoms.... Nocturnal reflux is very common and extremely damaging since hydrochloric acid and the enzymes of the stomach, especially pepsin, stay in contact with the esophagus and oral cavity for hours. Many people experience silent reflux and do not realize that some of their symptoms are a result of stomach acid. Medical doctors prescribe Proton pump inhibitors (PPIs) to reduce the amount of acid secreted in the stomach and to eliminate the symptoms of GERD. Although symptoms often improve, PPIs are not able to stop the progression of GERD. A Danish study of 10,000 patients showed that taking PPIs may increase the risk of heart attacks and esophageal cancer. 2 Another study showed that PPIs

September 2016 www.oralhealthgroup.com

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ORAL HYGIENE may increase the risk of dementia. 3 PPIs can be important for a short time (ideally four to eight weeks) but must not be relied on long term to treat GERD. Diet and lifestyle changes are the best way to reverse the course of this disease.

ORAL MANIFESTATIONS When I had my first experience of acid reflux, I was shocked by what I felt. I woke up the first morning with a mouth full of sour acid. It took several days of research, trying different suggestions and antacids, and seeing my doctor to begin to improve the problem. By then, my teeth were extremely sensitive, my gums and tongue felt raw and my throat was sore constantly. I began to think about some of my patients who had constant sensitivies, chalky enamel and rampant decay and I knew that I had missed the diagnosis of GERD. I had also missed helping them to preserve their teeth and heal their disease. Oral symptoms of GERD may include any of the following: • Sour taste • Dysphagia • Excess salivation • Pain on swallowing • Tooth sensitivies • Generalized mouth pain and irritation • Demineralization of enamel (chalky looking first) • Excessive erosion of enamel – may be located on the palatal surfaces of the maxillary teeth initially • Chronic decay “Early recognition of surface changes is essential. Initial signs include the first stages of erosion with chalkiness and loss of lustre.”4 Dentists must be aware that these symptoms and many others can be indicators of GERD and that patients are not aware of stomach acid contributing to these problems.

THE CURE There are many ways the dentist can help their patient suffering with GERD to protect

their mouth and esophagus. Here are a few suggestions that can make an immediate difference. • Eliminate all soda pop completely (regular and diet). Pop has been acidified since the 70s and this may be a contributor to the epidemic of GERD5 • Stop all night time eating. No food or drinks (other than small sips of water) after 7PM or four hours before bedtime • Eat three meals a day and two snacks. Avoid processed, fatty and acidic foods • Use a wedge pillow for sleeping and/or raise the head of bed six inches • Drink Alkaline water. This water neutralizes pepsin which is the enzyme that damages the esophagus 6 • Walk, especially after meals • Work with a naturopath or nutritionist to identify sensitivities and triggers to establish a diet that works for the person. Problem foods are highly individual and must be determined for optimal health

SUGGESTIONS FOR PATIENTS FOR THE TEETH AND ORAL CAVITY • Use a baking soda toothpaste with fluoride. Rub a dab over your teeth with your finger and then rinse with water several times a day. Do not brush your teeth when your mouth feels acidic as this contributes to enamel loss • Rinse with a fluoride mouthwash or use a fluoride gel daily • Avoid eating acidic and sugary foodseliminate your triggers and sensitivities to eliminate GERD • Have regular dental checkups, X-rays and cleanings • Consider a nightguard to protect teeth from wear due to bruxism The best long term solution for GERD is a combination of diet and lifestyle changes. When I saw my doctor and gastroenterologist with my severe symptoms of GERD, I was prescribed medication and sent home with a page of information about the proper diet. The medication helped somewhat but I needed to have support to test and incorporate the lifestyle changes that would lead me

September 2016 www.oralhealthgroup.com

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to healing my illness. Having a nutrition degree and a great deal of experience in lifestyle changes, I began to read and research the problem of GERD. Three months later, I was able to eliminate PPI medications and have learned to control my acid problem daily. It has not been easy but the process has helped me to improve my health dramatically. We as dentists, owe it to our patients to notice the problem and provide the information and support they require to improve their GERD. Dentists are probably in the best position to help patients understand why they are having “teeth problems” related to GERD. As trusted professionals, dentists can recommend medical, nutritional and lifestyle referrals to heal their patients’ stomachs, esophagus and oral health issues caused by acid reflux and GERD.

References: 1. Koufman, Jamie. Dr. Koufman’s Acid Reflux Diet; Katalitix Media; USA, 2015 2. Rodriguez, Jorge E, The Acid Reflux Solution; Ten Speed Press, Berkeley, 2013 3. Gomm W, von Holt K, Thomé F, et al. Association of Proton Pump Inhibitors With Risk of Dementia: A Pharmacoepidemiological Claims Data Analysis. JAMA Neurol. 2016;73(4):410-416. doi:10.1001/jamaneurol.2015.4791. 4. Hvid-Jensen, F., Pedersen, L., FunchJensen, P. and Drewes, A. M. (2014), Proton pump inhibitor use may not prevent high-grade dysplasia and oesophageal adenocarcinoma in Barrett’s oesophagus: a nationwide study of 9883 patients. Alimentary Pharmacology & Therapeutics, 39: 984–991. doi: 10.1111/apt.12693 5. Ranjitkar, S., Smales, R. J. and Kaidonis, J. A. (2012), Oral manifestations of gastroesophageal reflux disease. Journal of Gastroenterology and Hepatology, 27: 21–27. doi: 10.1111/j.1440-1746.2011. 06945. 6. Roesch-Ramos, Laura; Dental erosion, an extraesophageal manifestation of gastroesophageal reflux disease. Institute for Medical-Biological Research, 2014 http://scielo.isciii.es/pdf/diges/v106n2/ original3.pdf 7. Vincent W. Wang, MD, PHD and Mohammad Wehbi, M.D;Understanding Acid Reflux and Its Dental Manifestations; www.dentistryiq.com.

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H E T T L H L I A N G F S O YOUR PATIENTS MAY TAKE TO BED

THEIR DENTURES SHOULDN’T BE ONE OF THEM. 1-5

Though your patients may take comfort in keeping their dentures in at night, the consequences can be severe, from increased odour to fungal infections to increased caries.1–5 Guiding your patients through the best nighttime routine could be one of the most important conversations you have with them. That means removal and gentle, antibacterial cleaning with Polident®.6 1. Jeganathan S, Payne JA, Thean HP. Denture stomatitis in an elderly edentulous Asian population. J Oral Rehabil. 1997;24(6): 468–472. 2. Emami E, de Grandmont P, Rompré PH, et al. Favoring trauma as an etiological factor in denture stomatitis. J Dent Res.2008;87(5):440–444. 3. Barbeau J, Seguin J, Goulet JP, et al. Reassessing the presence of Candida albicans in denture-related stomatitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;95(1):51–59. 4. Arendorf TM, Walker DM. Oral candida populations in health and disease. Br Dent J. 1979;147(10):267–272. 5. Compagnoni Ma, Souza RF, Marra J, et al. Relationship between Candida and nocturnal denture wear: quantitative study. J Oral Rehabil. 2007;34(8):600–605. 6. GSK data on file, 2011. (Polident CSS)

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ORAL HYGIENE Leann Keefer,

RDH, MSM In her role as Director of Education for Crosstex International, Ms. Keefer works to advance Crosstex’s thought leadership among influential dental care professionals. She proactively identifies trends in the fields of oral care and infection prevention, developing and implementing the corporation’s longterm strategies relating to education and professional relationships.

SAVING FACE:

Mask Form, Fit and Function

ne of the critical choices made before treating each and every patient is choosing your protective face mask. While the mask construct is straight forward with layers of tissue and filtering materials suspended by elastic loops … the question of protection goes far beyond a simple physical barrier. Considerations of the treatment being delivered in terms of aerosol, spray, and splatter as well as length of procedural time are integral to the level of fluid resistance and filtration required. Finally, ponder the difference between the shape of your face and that of a mask – how well do they fit and function together? It has been well documented that the most likely mode of disease transmission in dentistry is though inhalation of aerosols which contain a myriad of potentially infectious microorganisms. The results from a 1985 study done on the incidence of respiratory disease in dental hygienists indicate a 60 percent higher incidence of cold symptoms than a similar professional group without dental patient contact.1 Studies have shown the ultrasonic scaler produces the greatest amount of airborne contamination, followed by the air polisher and air-water syringe. 2 The most contaminated area of the dental clinician’s face during treatment is around the nose

and inner corner of the eyes. 3 Chris Miller, MS, PhD, Professor Emeritus of Oral Microbiology at Indiana University School of Dentistry states that in accordance with CDC guidelines, the mask must be changed with every patient because its outer surface becomes contaminated with droplets from aerosols, sprays and splatter. Also, when a mask becomes wet from moist exhaled air, wicking occurs which results in increased resistance to airflow through the mask allowing more unfiltered air to pass through any gaps around the periphery of the mask.4 Clinicians should replace damp, wet, or soiled masks to maintain high filterability. Changing the mask every 20 minutes in a wet environment and every 60 minutes in a non-aerosol environment as well as between patients is recommended. 5 Because people come with different size faces and facial contours, selecting a mask designed to prevent gapping along the sides and under the chin is critical. For maximum protection, masks should fit snugly around the entire periphery of the face. Compared to standard design earloop masks, data from the Aerosol Mechanics Laboratory at Stony Brook University demonstrated three times greater protection for masks with Crosstex SECURE FIT® technology which incorpo-

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ORAL HYGIENE

It has been well documented that the most likely mode of disease transmission in dentistry is though inhalation of aerosols which contain a myriad of potentially infectious microorganisms.

rates aluminum strips above the nose and under the chin. The second strip below the chin eliminates gapping while lifting the mask slightly off the face for increased breathability and reduced wicking. Contamination of the skin and clothing of the health care professional during removal of personal protective equipment contributes to the dispersal of microbes and serves as a potential source for disease transmission. One investigation reported skin or clothing contamination occurring 46 percent of the time during removal of PPE which highlights the importance of proper doffing techniques.6 Best practice for sequence of doffing PPE begins by removing gloves, then goggles/ loupes, followed by the gown, and finally removal of the mask; an easy way to remember the sequence is by alphabetical order! To safely remove a mask with ear loops, insert clean index fingers into the loops near the earlobes gently lifting the loops up and off of the ears while moving the mask away from the face; properly dispose of the mask immediately and follow with appropriate hand hygiene. The mouth is an ideal incubator; the oral microbiome is comprised of over 600 prevalent species of microorganisms. Based on average human respiration rate of 16 breaths

per minute, we have 7,680 potential exposures in an eight hour workday. So the question remains, are you wearing the best mask for the task?

References 1. Rosen S, Schmakel D, Schoener M. Incidence of respiratory disease in dental hygienists and dietitians. Clin Prevent Dent. 1985; 7: 24-25. 2. Harrel, S, Molinari J. Aerosols and splatter in dentistry: a brief review of the literature and infection control implications. JADA 2004;135:429-437 3. Nejatidanesh et al. Risk of contamination of different areas of dentistâ&#x20AC;&#x2122;s face during dental practices. Int J Prev Med 2013 May;4(5): 611-615 4. Miller, C.(2014). Infection Control and Management of Hazardous Materials for the Dental Team.5th edition. St. Louis, Missouri: Elsevier 5. Jorgenson G, Palenik C. Selection and use of personal protective equipment. The Dental Assistant 2004; 73;16-19 6. Myreen et al. Contamination of Health Care Personnel During Removal of Personal Protective Equipment. JAMA Intern Med. 2015;175(12):1904-1910.doi

September 2016 www.oralhealthgroup.com

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TECHNOLOGY

Feda Bashbishi

is the CEO and cofounder of iKlyk Inc., a Canadian Cloudbased dental software provider dedicated to raising the bar of quality in dental practice management software, patient privacy, and data security. Feda Bashbishi holds an MBA from Wilfrid Laurier University as well as a Master of Science in Software Development from San Jose State University in California. Prior to establishing iKlyk, for years, Feda has worked on enterprise level cloud-based applications. You can connect with Feda through https://goo. gl/ZLJiRV or email at fedab@iklyk.com.

How to Select a DENTAL SOFTWARE for Your Practice

mean extra costs, but also a possibility that the add-on will not function properly due to incompatibility with your existing software.

INTEGRATION

When your business grows, you may hire more staff members that will access the dental software. As required by PIPEDA, they need unique login IDs. Many dental software vendors charge based on number of users in the office: the more staff required to access the software, the higher the fee. Multi-office management can be a challenge for some dental software especially desktop-based ones. If data is stored in one local server, you cannot easily duplicate the data to your new office; you or your office manager will have to manually put together statistics of different offices to compare performance; scheduling conflicts may also occur as appointment data is not updated across all locations. If you are planning to use a cloud-based software, check with the vendor about how much storage you have. As the number of patients increase, you need more space for the data.

urchasing a new practice management software for a dental office is not a trivial task. There are a lot of different choices and packages offered by software vendors that confuse the buyer rather than help her/him. Each package has its own strengths and weaknesses. But what are the fundamental elements a dentist should look for in a practice management software? iKlyk conducted hundreds of interviews with dentists, office managers, front-desk, associates, consultants, and dental assistants to find out the top four items a dentist must consider before making this purchase – integration, scalability, security, and cost. A good dental software should integrate multiple features or applications your practice needs. According to a 2014 report by Software Advice, 93% of dental software users pick improve integration as the top reason why they replace their software. The most must have functions are patient scheduling, billing, and EHR. Some top-requested features/applications that are less common in dental software include digital sensor/imaging. If you purchase a dental software that does not have a built-in email reminder, for example, you will probably end up having to purchase a separate add-on. This does not just

SCALABILITY

SECURITY Patient data breach is a major liability. Your dental software should have built-in func-

September 2016 www.oralhealthgroup.com

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tions such as audit trail and auto shut off as required. Our previous Patient scheduling article titled: Top 3 Reasons for Choosing the Cloud-Based DenBilling tal Software also explains security issues of dental software. Your EHR data security should be the number one priority of your software Digital imaging vendor. If you are purchasing a 0% 20% 40% 60% 80% 100% desktop practice management software, your software vendor Percent of sample should provide you the tools you need to protect your system by the highest level of encryption and • Account security: Access to your account data protection. If you are purchasing a should be defined by strict user access levcloud-based practice management software, els so information doesn’t fall into the ensure that your communication with the wrong hands. All account activities cloud is encrypted through an SSL certificate. should be stored in a secure system for auditing purposes. • Industry-leading data system security: Your software should provide a world- COST/ROI class data storage and encryption capabil- Cost and Return on Investment (ROI) should ity, data back-ups, redundant power definitely be a major concern. When buying a supplies and continuous surveillance sys- new desktop dental software, your spending tems. All your data transfers between of- does not stop there. Pay attention to costs like fices or devices should have the highest implementation fee, hardware prerequisite, level of SSL/TLS encryption against ma- IT Services, maintenance, and training. When purchasing a cloud-based dental softlicious parties.

September 2016 www.oralhealthgroup.com

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TECHNOLOGY

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ware, ask your vendor about data storage and service uptime. Many dentists need to take out loans to open their first office, so the payment schedule can also matter. Most software vendors require an upfront payment for licensing and training, and then charge you a monthly fee afterwards. A high upfront fee puts more pressure on you even before you start to generate revenue; pay close attention to all of those hidden costs. They add up. There is a new trend in the dental industry. Surveys indicate that more dentists are considering cloud-based software as the software of choice for their practice(s). A cloud-based practice management software is typically more secure, easier to set up and operate, and more affordable.

References 1. Dental Software Buyer View | 2014 by Dr. Paul Feuerstein,Â DMD Dental Technology http://www.softwareadvice.com/dental/ buyerview/report-2014/ 2. Legal information related to PIPEDA https://www.priv.gc.ca/leg_c/r_o_p_e.asp 3. Top Three Reasons for Choosing the Cloud-based Dental Software http://iklyk. c om /top -3 -rea son s -for- choo si ng-t he cloud-based-dental-software/

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oralhygiene guidelines manuscript submission

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

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

ILLUSTRATIONS The quality of photographs supplied contribute directly to the quality of reproduction in Oral Health. Therefore, when making a submission, please consider the following: > Any artwork submitted should be MAC compatible, and should be saved at the highest resolution possible (266 pixels per inch or greater). We cannot accept any digitized photographs/illustrations that have been created in a word processing, spread sheet or presentation package. > Images should be saved as TIF, JPEG or EPS only. Third-party sites such as WeTransfer or DropBox are accepted. In the case of large file submissions, images can be uploaded to our FTP site at Bigftp.businessinformationgroup.ca. LOGIN: orh PASSWORD: orh662 > Do not embed photos within the article.

AUTHORS Biographical information regarding the author(s) should be included with the manuscript. The author’s name and degrees, as well as any association the author may have with any institution should be included. The author’s address, including city and province/state should also be included. These requests for standardized submission of material are necessary for correctness of publication.

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

NEWCOM BUSINESS MEDIA INC. TELEPHONE:

(416) 510-6785 E-MAIL:

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

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ORAL HEALTH, 80 Valleybrook Drive, Toronto, ON M3B 2S9

(416) 510-5140

FAX:

TOLL FREE:

Canada 1-800-268-7742 U.S.A. 1-800-387-0273

September 2016 www.oralhealthgroup.com

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PRACTICE MANAGEMENT

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PRODUCT PROFILE

The JawDropper Assist

Held by the patient, the JawDropper Assist is designed to stretch and relax the patient’s jaw muscles, helping to keep the mouth open wider, longer, and more comfortably. The Assist is great for those who have trouble keeping their mouth open (or open wide enough) during procedures, and provides added comfort during longer procedures when fluid evacuation is being performed. The JawDropper Assist includes a tooth-engaging section on one end that is placed over the lower incisors, and a comfortable handle on the other end that allows the patient to exert downward traction to help open and relax the jaw muscles. The JawDropper is made from medical grade material that is free of contaminants and harmful substances. www.thejawdropper.com

BITE-CHEK

BITE-CHEK marks the points of contact, minimizing the possibility of “too high” an occlusion and possible post-operative tooth sensitivity. Contrary to many thicker paper options on the market today, the film’s thin profile helps patients close their bite completely, eliminating mandibular reflexes that can skew the occlusion. The result is a small, accurate mark that makes adjustment easy to interpret. BITE-CHEK with its easy-grip handle is an ideal tool for precise occlusal adjustments. www.bitechek.com

Midwest® RDH® Hygiene Handpieces

The Midwest® RDH® family of hygiene handpieces elevates performance, providing a superior experience for you and your patient. With two options to suit your personal preferences, each Midwest® RDH® handpiece is specifically and carefully designed to create an overall comfortable procedure designed to reduce wrist strain, allow enhanced control with lightweight and balanced design, protect both clinician and patient from splatter with smooth, low-pressure start, and will uphold high standards of infection control with autoclavable parts. www.midwest-rdh.com

OraCare™

Chlorine Dioxide’s unique oxidizing properties kill bacteria, viruses, fungi, with the added benefits of neutralizing volatile sulfur compounds (VSC’s), and controlling plaque accumulation. OraCare has harnessed the power of Activated Chlorine Dioxide using a two-bottle system. Since true chlorine dioxide is a gas, the two products must stay separated until ready to use. When rinsing simply, place equal parts of OraCare (4 pumps from each bottle) into the cup, allow the product to activate for 30-60 seconds, then rinse for 30-60 seconds. OraCare’s Activated Oral Cleanser is a great addition to any oral hygiene regimen because of its lack of side effects; no staining, no additional calculus/tartar buildup, and no altered taste. www.dentistselect.net

Oral7® Dry Mouth Moisturizing Oral Care Products

Under normal circumstances, the mouth is protected by a delicately balanced biosystem of enzymes and lubricants in saliva, allowing “good bacteria” to flourish and inhibit the growth of “bad bacteria”. The Oral7® Dry Mouth Moisturizing Oral Care Products contain a clinically proven antibacterial protein-enzyme system. Oral7® will relieve symptoms of dry mouth, refresh, moisturize, clean and soothe oral irritation and lubricate oral dryness. Each product is uniquely formulated to taste great and work synergistically with your patients’ saliva to stimulate increase saliva production. Products include: Oral7® Dry Mouth Moisturizing Toothpaste, Mouth Gel and Mouthwash. www.sterrehealth.com

September 2016 www.oralhealthgroup.com

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PerfectPearl’s ergonomically designed angle with beveled gears means low vibration and reduced chatter for all day comfort. The contra design provides exceptional interproximal access. While the patented Hawe cup design provides optimal flare for reduced splatter. PerfectPearl™ works hard, so you don’t have to.

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Together, we’re more.

™

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PRODUCT PROFILE

happymouth

happymouth was developed to help prevent cavities in young children and to make daily oral care routines safer, easier and more pleasant for families. Twice a day, swish 5mL of happymouth in the mouth. This delivers an effective medicinal dose of cavity prevention (3g of xylitol). It is ideal for children with braces where painful and awkward brushing can be inadequate and safe is swallowed, making it the ideal mouthwash for small children. It is the only ingestible anticavity mouth rinse available in Canada that contains xylitol as a main anticavity ingredient. Because there is no fluoride, happymouth will not cause dental fluorosis. Adults can also use happymouth for anticavity protection. info@apolloniahealth.com

Dental Herb Company®

Dental Herb Company’s alcohol-free products are formulated with a proprietary blend of essential oils and organically grown herbs proven to reduce oral bacteria and help maintain healthy teeth and gums. Ideal for periodontal care, controlling gum inflammation and bleeding, implants and laser gum surgery, restorative and cosmetic procedures, pre and post procedural rinsing and chronic halitosis. The pure essential oils in Dental Herb Company products are powerful antimicrobials, providing maximum potency and long-lasting effectiveness. Products include Tooth & Gums Tonic®, Tooth & Gums Paste®, Under the Gums Irrigant® and Tooth & Gum Spritz®. www.dentalherb.com/see-the-research.html

Hurripak™ Periodontal Anesthetic Kit

HurriPAK™ Periodontal Anesthetic Kit is a great alternative to local injections prior to root planing and scaling or full mouth debridement. Whether scaling and entire quadrant or an isolated area, HurriPAK allows dispensing only the amount of liquid needed, so no product is wasted. Plastic irrigation tips enable effective sub-gingival application of HurriCaine® Topical Anesthetic Liquid and are gentle to soft tissue. www.beutlich.com

Gengigel Professional Syringes

Gengigel professional syringes contain 0.8% hyaluronic acid, a natural physiological constituent of healthy periodontal tissues. During inflammation, tissues requirement for hyaluronic acid increases by 200%. In conjunction with scaling and root planning, it is effective against gingival pockets, reduces bleeding in chronic periodontitis and promotes and accelerates gingival re-attachment after surgical trauma. It is ideal for gingivitis, periodontitis, dry socket, oral lichen planus, aphthae, oral ulcers, diabetics, pregnant women and smokers. It can be applied by dental hygienists. Gengigel is available in Canada exclusively through Oral Science. www.oralscience.com AD INDEX

3M Oral Healthcare . . . . . . . . . . . . . . . . . . . . . . . .4

Philips Oral Healthcare . . . . . . . . . . . . . . . . IFC, 12

AMD Medicom . . . . . . . . . . . . . . . . . . . . . . . . . .16

Premier Dental Products Company . . . . . . . . . . .31

Crosstex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Sable Dental Industries . . . . . . . . . . . . . . . . . . . .22

GSK - GlaxoSmithKline . . . . . . . . . . . . . 11, 23, IBC

Shofu Dental Corporation . . . . . . . . . . . . . . . . . .35

Kerr Corporation . . . . . . . . . . . . . . . . . . . . . . . . .33

TD Canada Trust . . . . . . . . . . . . . . . . . . . . . . . . .36

Oral Science. . . . . . . . . . . . . . . . . . . . . . . . . . . . .28

VOCO Canada . . . . . . . . . . . . . . . . . . . . . . . . . OBC

P&G – Proctor & Gamble . . . . . . . . . . . . . . . .7, 15

Xlear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

September 2016 www.oralhealthgroup.com

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2016-09-02 11:18 AM

OHygien

FASTER, EASIER, GENTLER…

BeautiSealant Fluoride Releasing Pit & Fissure Sealant System

Say Good-Bye to Acid Etch-and-Rinse Steps Forever! ■ Bioavailable fluoride release and recharge ■ Superior bond strength in just 30 seconds ■ Radiopaque/cariostatic filler material ■ Smooth, bubble-free delivery ■ Preventative anti-bacterial properties ■ BPA- and HEMA-free

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Visit www.shofu.com or call 800.827.4638

Shofu Dental Corporation • San Marcos, CA

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T:7.875” S:7”

A thriving practice is your big dream. Helping you get there is ours. TD Business Banking. The Official Partner of Big Dreams.

S:9.75”

A dental practice is a business like no other. While you’re relentlessly focused on caring for your patients, you also have to plan around a wide range of financial realities. Let TD help. Our experienced business banking specialists have advice and financial products that are specific to the needs of a dental practice. Call us to learn more.

Visit a branch or td.com/dentists

The TD logo and other trade-marks are the property of The Toronto-Dominion Bank.

OHY Sept16 pg8-40.indd 36

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T:10.75”

Specialized banking advice for your practice.

HYGIENISTS

100 MILE HOUSE, BC Hygienist wanted for a full time or part time position in our new office at 100 Mile House, BC. Valley Dental will keep you as busy as you want to in our comfortable, high-tech office. 1.5 hrs north of Kamloops, 3.7 hrs to Whistler, you will love it here if you enjoy the outdoors and low living costs! E-mail: hello@valley.dental

ASSOCIATESHIPS

TORONTO, ON

Busy, reputable GP office(s)seeks onsite OMFS/Experienced Dental Surgeon/Periodontist for wisdom teeth removal, implants, management of advanced perio, grafting, sinus lifts etc. Excellent chairside manner sought. Apply in confidence to Oral Hygiene Box 45 – e-mail: karen@newcom.ca Please indicate box no.

B:11”

S:9.75”

T:10.75”

ASSOCIATE DENTIST

WILMOT DENTAL CARE, NEW HAMBURG, ON

Wilmot Dental Care is growing and seeking an Associate Dentist (new grads are welcome) to join our well established dental practice in New Hamburg, ON. We are searching for a caring individual with strong clinical & communication skills. Oral Sedation Type A/B an asset. Send resume to: maya_mgk@hotmail.com

KIMBERLEY, BC Seeking a Full-time Associate to join our modern, family oriented dental practice. Large established patient base with excellent staff. Kimberley is a great place to raise a family and to enjoy the outdoors. The community offers a great lifestyle with skiing, fishing, boating, hiking and camping all within minutes of town. Please forward resume to: drdnelson@shaw.ca

OTTAWA, ON Associate required for west-end family practice in Ottawa. E-mail: toothdocs36@gmail.com

www.oralhealthgroup.com

OHY Sept16 pg8-40.indd 37

DENTAL MARKETPLACE

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

PRACTICES & OFFICES

NORTHERN MANITOBA

Looking for two energetic hygienists to work in dental clinic in Northern Manitoba, very good income can be made. To apply please e-mail: chris.p1933@yahoo.com

CAREERS DENTAL RECEPTIONISTS WANTED Offices in Toronto, Woodbridge and Etobicoke looking for experienced and well spoken dental receptionists with opportunity to become office manager. Send resumes to careers@SabharwalDentalGroup.com

ASSOCIATESHIPS

DENTAL ASSOCIATE

EASTERN ONTARIO Looking to sell your Practice? We are a dentist owned company and seek more Practices in Eastern Ontario. Our Practices have exceptional culture, retention and success. Don’t pay commission and enjoy a seamless transition. Receive top value for your practice and a competitive profit sharing plan should you choose to stay on board. Serious inquiries only please. DentalPractices@outlook.com

MISSISSAUGA DOWNTOWN, ON Practice and real estate for sale, walk to Square One. 900 sf, beautiful almost new lease holds, 3 ops, 2 equipped, 1 plumbed and wired, 550 + patients, 420 active. Please e-mail DreamPractice01@gmail.com

REGINA SK, FULL-TIME Campus Dentist University of Regina in Regina is currently looking for an energetic, friendly, outgoing, enthusiastic individual for a very unique opportunity as the sole full-time dental associate. Please email us: marzena@campusdentist.com

KINGSTON AND NAPANEE, ON Full-Time associateship opportunity in the beautiful Limestone City of Kingston and Napanee. Two modern and wellestablished practices for over 15 years. Position is in both offices Mon-Thurs and some Fridays. No weekends. Poss. 1 evening. Opportunity to make up to 45% of collections plus exams. Enjoy dentistry without the hassle of owning a practice. Start date: Sept 2016 Send CV attention to: Isabelle at izzychias@hotmail.com

GRANDE CACHE, AB Full time associate required for Grande Cache Dental Care, located in the beautiful Rocky Mountains of Alberta. The successful applicant will be fully booked from day one. Must be comfortable with all aspects of general dentistry with special emphasis on diagnostics, restorative, oral surgery and endodontics. Strong communication skills are essential. No weekends or evenings required. High gross/net office – associate can expect above average remuneration. Experience preferred, new grads are welcome to apply! Please email to: grande.cache.dental.care@gmail.com

MILTON, ON Ideal Dental / Medical Office Space Available In Milton Available fall 2017, in new Medical building, situated just south of the new hospital. An excellent opportunity in a rapidly growing area, please see the attached link for details https://www.realtor.ca/Commercial/Office/ 16915108/255-RUHL-DR-Milton-Ontario

ASSOCIATESHIPS MULTIPLE LOCATIONS IN ONTARIO Exciting full and part time associate opportunities available for Barrie, Mississauga, Stoney Creek, Etobicoke and Scarborough. We are also looking for an orthodontist. E-mail: yourdentaldream@gmail.com

SCARBOROUGH, ON

Associate Needed. Looking for a progressive, caring associate for a family dental practice. 3 days per week to start with potential of 5 days in the near future. E-mail: associaterequired2016@gmail.com Fax: 416 261-8190

ETOBICOKE & OAKVILLE, ON General Dentist Associate

Looking for dedicated & compassionate associate to join our well-established, family-friendly general dentistry practices. Minimum 2 years experience required. Up to 50 new patients a month. Offering excellent compensation, modern facilities, flexible scheduling and a talented, caring team. Email resume to admin@burloakcentredentistry.com

September 2016

2016-09-02 11:18 AM

DENTAL MARKETPLACE

ASSOCIATESHIPS

AJAX, ON

NIAGARA REGION, ON

DENTAL ASSOCIATE WANTED for established 3 year practice, with growing patient base. Please call 289-660-6066 or send resume to sherrystanton@hotmail.com

Associate position available immediately for a busy general family practice in Niagara region. Please send resume to warkaa2000@yahoo.com

TORONTO, ON General dentist wanted for a busy downtown family clinic. Please email your resume to davidkourosh@hotmail.com

DENTAL ASSOCIATE

KINGSTON ON, FULL-TIME Campus Dentist Queen’s University in Kingston is currently looking for an outgoing, enthusiastic dentist to join our team. This truly is a very unique opportunity for the sole full-time dental associate in a modern university setting. Please email us: marzena@campusdentist.com

GTA GP Dentist with IV mobile permit, advanced surgical skills, ability to preform Wisdom teeth surgery in office under IV moderate sedation. Providing all monitors and requirements. Please e-mail: Moderatesedationdentist@gmail.com

TORONTO, ON

Established and busy Toronto office seeks long term dynamic P/T associate Monday-Wednesdays. Reply to Oral Hygiene Box 44 – e-mail: karen@newcom.ca Please indicate box no.

TORONTO, ON

Full time dental associate needed immediately for busy group practice in downtown Toronto. Seeking dentist who is comfortable with a fast paced environment. Excellent earning potential. Please forward your resume to: dentistrywithcare15@gmail.com

OSHAWA, ON Progressive growing family practice in Oshawa is looking for an energetic, friendly, ambitious, caring individual for a part time associate position. For Thursdays, Fridays and alternating Saturdays starting immediately. Please forward your resume to dentaloshawa@yahoo.ca

MID VANCOUVER ISLAND, BC Associate position available in beautiful mid-Vancouver Island in a bright, newly renovated, busy practice. This position is to replace a FT Associate who is leaving. Digital, paperless, well established practice, performing a wide range of dental services to families and seniors, with loyal staff and patients. You will need to have strong communication skills, a positive attitude, enthusiasm and passion for high calibre dentistry, a sense of humour and be a caring, committed person. The position would suit an experienced associate or a new grad wanting mentorship from an experienced dentist. High income potential. If you are looking for lifestyle, this is a thriving community with golf, skiing, boating and outdoor activities in your back yard, as well as excellent schools and family amenities. If you are the right candidate, please send your CV in confidence to mid@shaw.ca.

September 2016

OHY Sept16 pg8-40.indd 38

WEST MISSISSAUGA, ON

Seeking motivated and skilled dentist for part time position in a friendly, team oriented office. Tuesdays & alternate Saturdays. Please e-mail your resume to profiles32@yahoo.com

VERNON, BC

ASSOCIATE REQUIRED. Requirements are

motivation, team attitude, great communication skills, pleasant, friendly, knowledge driven, proficient in endodontics, surgery and restorative. Graded compensation. Option to phase in purchase.

Resume to vernondentalsmiles@gmail.com

SPRUCE GROVE, AB

Dental office in Spruce Grove, AB is seeking full time associate. Large established patient base, great staff in place. Excellent long term opportunity. Please send your resume to smiledoctors1@hotmail.com

FORT MCMURRAY, AB Fantastic opportunity in a busy mall practice. If you want exceptional Income with freedom and time off come join us. Contact Dr Jones at 1-780-940-7251

VICTORIA, BC Excellent associate opportunity available at a large central Victoria practice. The incoming associate will take over a fully booked schedule from an associate who is leaving. Expect exceptional patient flow while serving a diverse patient base in a practice focused on providing comprehensive care in a single location. Inquire at cerecvictoria@gmail.com

ORANGEVILLE, ON Established Orangeville office seeking a part-time associate. Canadian experience an asset. Email resume: progressivedental16@hotmail.com

OTTAWA, ON

ORAL & MAXILLOFACIAL SURGEON

Well-established oral surgery practice centrally located in our nation’s capital seeking an oral & maxillofacial surgeon for an associate position leading to partnership/ownership. Compassion, excellent communication skills and a strong ethical conviction will ensure a good fit with our vision. The candidate must be eligible for licensure to practice as a specialist in oral and maxillofacial surgery in Ontario, including Fellowship in the Royal College of Dentists of Canada (RCDC). Please forward CV and inquiries to: laura-manager@rogers.com

www.oralhealthgroup.com

2016-09-02 11:18 AM

9858_Oh

SHE KNOWS THAT STRAWBERRIES HAVE A HIGH ANTIOXIDANT CAPACITY. WHAT ELSE WOULD SHE WANT TO KNOW? Young people today are staying informed to stay healthy.1 But do they know that healthy foods including fruit, juices and salad dressings are highly acidic and can put their enamel at risk?2-5 Exercise your influence as their trusted dental professional. Help educate every young patient about the effects of acid erosion. Because the investment in their enamel should start today.

For your acid erosion candidate. 1. GSK data on ﬁle, 2013. 2. Lussi A. Erosive tooth wear – a multifactorial condition. In: Lussi A, editor. Dental Erosion – from Diagnosis to Therapy. Karger, Basel, 2006. 3. Lussi A. Eur J Oral Sci. 1996;104:191–198. 4. Hara AT, et al. Caries Research. 2009;43:57–63. 5. Lussi A, et al. Caries Research. 2004;38(suppl 1):34–44.

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Pour vous,

cela représente une bouche saine. Pour vos patients,

cela représente la confiance totale. De la part des spécialistes en hygiène buccale de Sonicare, Philips Zoom peut dévoiler un sourire sain qui renforce la confiance de vos patients. • Efficacité en clinique – blanchit jusqu’à 8 teintes en 45 minutes1 • Des résultats à domicile – les formules les plus avancées en matière de blanchiment à la maison Faites connaître à vos patients le traitement de blanchiment sain et fiable de Philips Zoom.

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Le traitement de blanchiment*

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Appelez dès maintenant pour obtenir votre essai gratuit au (800) 278-8282 ou consultez le site www.philips.com/ZoomPortfolio 1 Avec Philips Zoom WhiteSpeed. N’inclut pas le temps de préparation. * Aux États-Unis.

OHY Sept16 pgs 1-7.indd 2

2016-08-31 9:14 AM

AUCUNE DENT NÉGLIGÉE Brossette ronde CrossAction unique

Système de suivi de la pression du brossage

Contrairement aux brossettes rectangulaires, la brossette ronde ORAL-B® inspirée des outils prophylactiques enveloppe chaque dent pour un meilleur contact avec les soies.

Seul Oral-B® offre un système de contrôle de la pression triple afin de détecter un brossage excessif et procure au patient une alerte visuelle de l’anneau intelligent 360°.

La brosse à dents Oral-B® GENIUS™ CrossAction nettoie mieux que la brosse à dents Sonicare DiamondClean*

Innovation : Détection de la position

L’action de pulsation oscillo-rotative de

L’application pour téléphone intelligent aide le patient à améliorer sa technique de brossage en lui montrant les surfaces qu’il néglige.

Oral-B® Pro CrossAction

Mouvements latéraux de

Sonicare DiamondClean

Parlez de Oral-B® GENIUS™ à vos patients afin qu’ils ne négligent aucune surface.

* Selon des études cliniques portant sur plusieurs semaines. Sonicare est une marque déposée de Koninklijke Philips N.V.

OHY Sept16 pgs 1-7.indd 7

ORAL-20485

2016-08-31 1:55 PM

Une personne sur quatre en souffre . 1

Plusieurs l’ignorent . 2

Elles peuvent aussi en ignorer les conséquences sur leur santé buccodentaire*. Elles attendent vos conseils.

La bouche sèche est un problème de santé buccodentaire qui affecte surtout les personnes prenant plusieurs médicaments3. Pourtant, certaines personnes qui souffrent de bouche sèche ne savent pas qu’il s’agit d’un problème courant2. Parlez à vos patients de la bouche sèche et du soulagement que Biotène peut aider à procurer†. ®

www.biotene.ca

GlaxoSmithKline Soins de santé aux consommateurs Inc. Mississauga, Ontario L5N 6L4 © 2016 Le groupe d’entreprises GSK ou son concédant. Tous droits réservés. * La bouche sèche peut perturber l’environnement de santé buccodentaire et causer la mauvaise haleine, la déminéralisation et l’augmentation de la carie4,5. † Rince-bouche, gel et vaporisateur. ‡ Tel que mesuré dans le cadre d’une étude clinique de 28 jours6. 1. Données internes de GSK. Occasion de croissance de Biotène pour la bouche sèche (incluant les données U&A canadiennes). 16 juillet 2014. 2. Dawes C. How much saliva is enough for avoidance of xerostomia? Caries Res. 2004;38:236-240. 3. Sreebny LM, Schwartz SS. A reference guide to drugs and dry mouth, 2e édition. Gerodontology. 1997;14:33–47. 4. Turner MD, Ship JA. Dry mouth and its effects on the oral health of elderly people. J Am Dent Assoc. 2007;138:15S–20S. 5. Fox PC. J Clin Dent. 2006;17 (numéro spécial):27-28. 6. Données internes de GSK 2014, RH01986.

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2016-04-28 10:33 AM 2016-08-31 1:47 PM

Shield_White_2013

Les professionnels en soins dentaires recommandent Philips en premier

Version 1.1 – 25 October 2013

De notre technologie de brosse à dents brevetée et formules de blanchiment aux solutions de gestion de l’haleine, nous créons des produits novateurs éprouvés afin d’offrir à vos patients d’excellents résultats. • Philips Sonicare – La marque de brosses à dents électriques soniques la plus recommandée par les professionnels en soins dentaires • Philips Zoom – Le traitement de blanchiment No. 1 en cabinet* • Philips Sonicare BreathRx – Le système de gestion de l’haleine No.1 le plus recommendé*

Pour de plus amples renseignements sur le portefeuille de produits Philips, appelez-nous au 1-800-278-8282 ou consultez le site Web philips.com/OralHealth *Aux Etats-Unis

OHY Sept16 pg8-40.indd 12

2016-08-31 8:44 AM

L’ADVERSAIRE DE L’ACIDE.

Crest® Pro-Santé Avancé contient du fluorure stanneux pour des dents plus saines et plus fortes.

1. Le fluorure stanneux reminéralise l’émail affaibli.

2. Le fluorure

stanneux forme une micro pellicule de protection pour prévenir l’érosion causée par l’acidité et soigner la sensibilité dentaire.

3. Le fluorure

stanneux freine de façon importante la production d’acides liés aux bactéries responsables de la plaque.

avec SHMP

Fluorure stanneux stabilisé Non traité

SANS BILLES DE POLYÉTHYLÈNE NE TACHE PAS

ORAL-20443

un soin continu après votre visite chez le dentiste

OHY Sept16 pg8-40.indd 15

PRO-SANTÉ

2016-08-31 1:45 PM

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Vernis blanc au fluorure de sodium à 5 %

OHY Sept16 pg8-40.indd 16

Un sourire à la fois 2016-08-31 1:50 PM

VOS PATIENTS PEUVENT DORMIR AVEC

E S T D R E O S C H S E O T S U E O S T

MAIS LA PROTHÈSE DENTAIRE EN EST UNE DE TROP. 1-5

Vos patients peuvent trouver réconfortant de garder leur prothèse pendant la nuit, mais les conséquences peuvent être graves et englobent la mauvaise haleine, les infections fongiques et les caries plus nombreuses1-5. Guider vos patients à adopter de bonnes habitudes avant de se coucher pourrait être la plus importante conversation que vous aurez avec eux. Ces habitudes consistent dans le retrait de la prothèse et un nettoyage doux et antibactérien grâce à Polident®6. 1. Jeganathan S, Payne JA, Thean HP. Denture stomatitis in an elderly edentulous Asian population. J Oral Rehabil. 1997;24(6): 468–472. 2. Emami E, de Grandmont P, Rompré PH, et al. Favoring trauma as an etiological factor in denture stomatitis. J Dent Res. 2008;87(5):440–444. 3. Barbeau J, Seguin J, Goulet JP, et al. Reassessing the presence of Candida albicans in denture-related stomatitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;95(1):51–59. 4. Arendorf TM, Walker DM. Oral candida populations in health and disease. Br Dent J. 1979;147(10):267–272. 5. Compagnoni Ma, Souza RF, Marra J, et al. Relationship between Candida and nocturnal denture wear: quantitative study. J Oral Rehabil. 2007;34(8):600–605. 6. Données internes de GSK, 2011. (Polident CSS)

MC/ ou sous licence GlaxoSmithKline Soins de santé aux consommateurs Inc. Mississauga, Ontario L5N 6L4

OHY Sept16 pg8-40.indd 23

2016-08-31 1:40 PM

PLUS RAPIDE, PLUS FACILE, PLUS DOUX…

BeautiSealant Libération de fluor et système d’étanchéité pour fissures

Dites adieu aux étapes de mordançage et rinçage pour toujours! ■ Relâche et recharge du fluor biodisponible ■ Force de liaison supérieure en seulement en 30 secondes ■ Matériel de remplissage radioopaque cariostatique ■ Lisse, sans formation de bulles ■ Propriétés préventives antibactériennes ■ Sans BPA et HEMA

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Shofu Dental Corporation • San Marcos, CA

OHygieneC BS_F 8.16.indd 1 OHY Sept16 pg8-40.indd 35

8/11/16 5:55 PM 2016-08-31 8:51 AM

ELLE SAIT QUE LES FRAISES COMPORTENT D’EXCELLENTES PROPRIÉTÉS ANTIOXYDANTES. QUE DEVRAIT-ELLE SAVOIR DE PLUS? De nos jours, les jeunes se tiennent au courant pour vivre sainement1. Mais savent-ils que les aliments sains, comme les fruits, le jus ou les vinaigrettes, sont très acides et qu’ils peuvent mettre leur émail à risque 2-5? Usez de votre influence en tant que professionnel dentaire de confiance. Informez chaque jeune patient des effets de l’érosion par acide. Puisqu’ils doivent investir dans leur émail dès aujourd’hui.

Pour vos patients prédisposés à l’érosion par acide. 1. Données internes de GSK, 2013. 2. Lussi A. Erosive tooth wear – a multifactorial condition. Dans : Lussi A, rédacteur. Dental Erosion – from Diagnosis to Therapy. Karger, Basel, 2006. 3. Lussi A. Eur J Oral Sci. 1996;104:191– 198. 4. Hara AT, et al. Caries Research. 2009;43:57–63. 5. Lussi A, et al. Caries Research. 2004;38(suppl 1):34–44.

9858_OhCanada_Pro_Strawberry_FRE_2016_OralHealth.indd 1 OHY Sept16 pg8-40.indd 39

2016-08-23 2:25 PM 2016-08-31 1:37 PM

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05.08.16 09:07 2016-08-31 8:54 AM