This year the weather in Boston is chilly but not snowy and for that I’m thankful! If you are at the meeting stop in to one of the four classes I’m giving and say hi. My insurance course is Thursday morning and Friday afternoon. My accounts receivable and revenue class is Friday morning. Finally on Saturday morning I’ll speak on the Foundations of Dental Office Management. I’m honored to have been asked to speak again here and always look forward to a busy meeting here in Boston. Hope to see some of you soon!

CHICAGO (Jan. 11, 2012) — The DALE Foundation has recently launched two new interactive e-learning products: the DANB GC Review Part I and the DANB ICE Practice Test.

The DANB GC Review Part I is an online course that covers important topics and patient scenarios related to general chairside assisting — making it a great primer to begin preparing for the DANB General Chairside Assisting (GC) exam or as a way to earn 12 CDE credits.

The GC exam is a component exam of DANB’s Certified Dental Assistant (CDA) exam. The other two components are the Radiation Health and Safety (RHS) and Infection Control (ICE) exams. Dental assistants who are looking to review for DANB’s complete CDA exam can also use the DALE Foundation’s DANB RHS Review, the DANB RHS Practice Test, the DANB ICE Review and the DANB ICE Practice Test to round out their study plan.

Like the DANB RHS Practice Test, the DANB ICE Practice Test includes 200 sample questions*, sample tests with 50 questions* each and multiple options for feedback. This interactive online study aid offers multiple ways to prepare to test, and to learn. Dental assistants can create customized practice tests and bookmark specific questions to review later. The DANB ICE Practice Test is great as a stand-alone study aid or as a companion to the DANB ICE Review.

“The DALE Foundation is excited to offer these new educational products to help dental auxiliaries review for DANB exams or as a way to earn CDE credits,” Executive Director Cindy Durley says. “The DALE Foundation’s educational products are engaging and interactive — which makes the learning process fun.”

The DALE Foundation’s high-quality and comprehensive e-learning products are developed by subject matter experts. These e-learning products offer an engaging and customized experience. The courses are broken down into modules, so dental auxiliaries can complete the sections at their own pace. Periodic feedback helps dental auxiliaries check their progress and target the information they need to prepare for DANB exams.

The DALE Foundation’s study aids** — including the DANB ICE Practice Test, DANB RHS Practice Test and Glossary of Dental Terms — can be used on mobile devices for on-the-go learning. The study aids also feature online games and customized practice tests.

To learn more, visit www.dalefoundation.org.

*Questions do not come from actual DANB exams.
**CDE credits are only awarded for completing courses, not the study aids.

About the DALE Foundation
The Dental Auxiliary Learning and Education Foundation (the DALE Foundation) provides online educational courses and resources to help advance the dental team. The DALE Foundation benefits the public by providing quality continuing education to dental professionals and conducting sound research to promote oral health. The Dental Assisting National Board, Inc. (DANB) founded the DALE Foundation in March 2010. As the official DANB affiliate, the DALE Foundation’s products adhere to the same quality and high standards. Excellence is important to the DALE Foundation, which is why all of the e-learning courses and study aids were created by educators and experts in the dental community.

Dr. Tony Stefanou and I will offer a 2-day workshop focused on non-clinical opportunities within the dental field. Between the two of us we have run into many friends and colleagues that ask us how to transition out of the dental office and into speaking, sales and consulting. Our combined experience gives us some unique insight into navigating the world of sponsorship, securing a sales job and speaking/consulting as an expert. We’ll also share our resource list that we use on an almost daily basis for our businesses. Past attendees have remarked that they are blown away by how much information we share. Don’t wait years to pick this information up piece by piece – let us share with you in a small group setting! Opportunity exists in the dental field – let us help you!

Date: March 9-10

Place: New York City

Website for more information: http://beyondtheoperatory.weebly.com/

Because of space limitations we have to keep the attendance low – it will be a small workshop setting. Our tuition for this workshop is $1499. Visit our site:http://beyondtheoperatory.weebly.com/ for more information including course information and housing recommendations.

Today’s post is from guest blogger Robert Milton.  He blogs for Austin Dental Center, an Austin dentist, who specializes in mercury-free fillings and dental implants.

I’m one of billions.  I enjoy my cup of coffee in the morning like the majority of the world.  Although I’ve learned through the years to limit myself to two cups (most days) and then move on to water.  With our overworked and under-rested modern society, many feel they need coffee just to get their brain going before they can even think about starting their day.  However, more people are reaching for energy drinks for a caffeine boost as evident by the millions of dollars in sales rising each year and variety available on the store shelves.  What’s more troubling though is the amount being consumed with the belief that it’s a better choice than coffee or soda.

In the last few years, dentists have seen an increase in cases of tooth decay commonly referred to as “Mountain Dew Mouth”.  Much like the defamed soda, energy drinks are becoming an all day beverage and wreaking havoc on the dental health of adolescents and adults.  Bombarded with advertisements fronted by sports celebrities and marketing-speak promoting the added vitamins, there are many consumers who are unaware of possible health risks from sipping too many energy drinks.

Facts to Share with Your Patients

Highly Acidic

Energy drinks, like Red Bull, typically have acidity levels ranging at pH 2.5-3.5.  Not only does this erode tooth enamel, but by altering the pH level in the mouth bacteria flourish.  In 2007, General Dentistry published results from an in vitro dissolution of enamel study stating that teeth can be completely dissolved from anything lower than pH 4.0.  In addition to low pH, patients often sip rather than chug energy drinks giving their teeth an acid bath for hours on end.

Loaded with Sugar

The most common notion savvy patients realize about energy drinks is the high sugar content.  However, they often think of their waistlines and not their teeth when weighing this fact.  After the acid compromises enamel, the massive amount of sugar in each mouthful feeds all the extra bacteria that have been allowed to grow.  Again, with constant sipping teeth remain vulnerable for dental caries.

Risk of Bone Loss

In their study published by Food Science and Human Nutrition, L.K. Massey and S.J. Whiting found that caffeine increases the urinary excretion of calcium.  Even if moderate amounts of caffeine are consumed, the loss of calcium can raise the risk of osteoporosis.  Bones and teeth suffer when patients are calcium deficient.  Second in size only to sales, energy drinks are packaged in bigger and bigger cans indicating a demand by consumers.  Habitual consumption of these large portions could be detrimental to bone health.

Dry Mouth

Caffeine is a natural diuretic.  Instead of quenching your thirst, the highly caffeinated energy drinks actually dehydrate you.  When it comes to dental health, dehydration increases the likelihood of tooth decay, gum disease, and halitosis. Recently the International Journal of Sports Medicine reported that athletes are at high risk for erosion and caries due to dehydration from physical activity, mouth breathing, and frequent use of energy drinks.  Extra dental visits to assess risk and receive regular cleanings are recommended for sporty patients.

Beware of Drug Interactions

If your patient includes energy drinks in their daily diet, there’s a good chance they are experiencing tooth sensitivity and pain caused by the decay.  Often those with a toothache will self-medicate with over-the-counter medications before making an appointment with you.  However, if they’re unaware of certain drug interactions with high levels of caffeine, they could be exacerbating the side effects from some pain relievers and antibiotics.

Preventing Tooth Decay from Energy Drinks

Of course a healthy diet, sleep, and lots of water are more satisfying sources of energy, but the occasional energy drink in a crunch is safe.  As important as it is to be aware of the health risks, it’s good to know how to avoid painful and costly restorations by remembering a few simple rules.
Limit intake of energy drinks.  Think 1-2 per week, not per day.

Drink within 20-30 minutes instead of sipping for hours.

Rinse mouth with water after finishing energy drink.

Use a straw to keep beverage away from teeth while drinking.

Chew sugar-free gum with xylitol to help produce protective saliva.

Brush teeth after an hour to make sure enamel isn’t further damaged.

Have you been surprised by any of these facts?  Let us know in the comments below!

Sure! But not for why you think. Researchers have found a way to detect signs of cancer by analyzing your breath. It’s not a stretch to think that this would be a test offered by the dental office. Click here to read about it

Don’t miss out! Come join us in San Diego for a top-notch educational program. You can’t beat San Diego in February!

Click here for details and program/registration information. 

Open to everyone!

Don’t Let Good Get In the Way of Best - Achieving the Best for You and Your Patients presented by Ann-Marie DePalma

January 9th, 2012 8pm EST

Many practices are currently facing numerous challenges ranging from cancellations and no shows to insurance management issues. Others have taken these challenges as opportunities and have grown despite adverse conditions. What makes the growing teams different than the challenged teams? This program will discuss opportunities for growth for patients and teams while providing comprehensive oral care. The goal of this program is to provide team members with an overview of techniques that lead to comprehensive oral care for patients while increasing practice productivity, profitability and decreasing stress. This course will: discuss leadership and communication, identify the responsibilities of healthcare professionals, discuss treatment modalities such as periodontal and radiographic protocols and CAMBRA, and introduce Jameson Management concepts.

 Click here to register

About the speaker: Ann-Marie C. DePalma, CDA, RDH, MEd, FADIA, FAADH is a Fellow and Certified Educator of the Association of Dental Implant Auxiliaries, a Fellow of the American Academy of Dental Hygiene, as well as a continuous member of ADHA. Ann-Marie is currently a business/clinical advisor for Jameson Management, Inc, a comprehensive advising and coaching firm and presents continuing education programs for dental team members on a variety of topics. Ann-Marie is also a monthly columnist and feature writer for RDH Magazine and a consultant dental hygiene examiner for NERB. She has been a faculty member of a dental hygiene program and program chair of a dental assisting program after having been employed in clinical hygiene for 25+ years in periodontal and general practices. She is collaborating with several authors on various books for dental hygiene. 

Editorial note: Thank you to our frequent guest blogger, Dr. Mark Wilhelm!

For years, stories have circulated about how much more efficient it is to restore missing teeth with dental implants vs conventional crown and bridge. My own experience has proven to me that well-done implants are better for patients than questionable teeth. It has also shown that failures in crown and bridge prothodontics are the leading cause of situations requiring implant restoration.

I have sat through many eight-hour presentations on the advantages and disadvantages of various implant body designs. Over the course of 20 years, I have used a variety of implant systems in a wide range of clinical conditions and have reached my own, tested conclusions about what works where and when it works best.

For now, let’s ignore the surgical advantages and discuss only the restorative/prosthetic differences between the various implants body designs. The most significant difference between most of the implants today is the prosthetic table or connection to the abutment. Many things are mentioned about platform switching and whether or not it is “better”. The platform switch simply moves the connection of the abutment to implant away from the bone/implant interface.  A huge clinical advantage to this is that when you remove the healing cap to place an impression coping, you will not pinch tissue, then or ever. Implants that have an external or internal hex, but leave the abutment connection at the edge of the implant, usually will pinch tissue when you fit the pieces together.

Having some form of conical or Morse taper connection allows you to seat components in seconds instead of minutes. I prefer to have the possibility of an index inside the connection to ensure preciseness in positioning prepared abutments. This is critical when working with multiple abutments and dealing with a line of draw.

These two huge advantages were brought home to me in two recent patient examples.  In both cases, the patient presented for entire arch implant reconstructions. In both cases, the impression appointment took 19-20 minutes and the jaw record appointment took another 17-18 minutes.  You can do the math yourself; consider how efficient and productive is an appointment that will restore 12 teeth in less than 40 minutes – and what that could do for your practice. Compare that to working with teeth.

About the author:

Dr. Wilhelm has been in private practice in the twin cities area since 1990, where he is focused on cosmetic dentistry, sedation dentistry, advanced restorative and dental implants. Dr. Wilhelm received his Doctorate of Dental Medicine in 1985 from Southern Illinois University School of Dental Medicine and completed specialty certificates in Prosthodontics and Maxillofacial Prosthetics at Indiana University. He has held faculty positions at Indiana University and is a staff member of the Health East Hospital system. He is also recognized as a Diplomate of the International Congress of Oral Implantologists and is an active member of the American College of Prosthodontists, the American Dental Association, and the Minnesota Dental Association.

Dr. Wilhelm is an author, consultant, mentor and frequent speaker to dentists and the public on techniques that enhance oral health.

Editorial note: Thank you to our frequent guest blogger, Dr. Mark Wilhelm! 

If there was ever a “Bread and Butter” procedure in dentistry it is restoring a tooth with a crown. Literature will support the fact that prognosis for back teeth restored with crowns is better than teeth with large fillings. For this reason alone most dentists can suggest to their patients that all of the teeth in their mouth that have large fillings will be better served by restoring the tooth with a crown.  However, there is more to the story.

It’s known that there is a roughly 6% incidence of spontaneous pulpal catastrophe when we do a conventional full coverage crown prep. This means that whenever we prep a tooth, 6 out of 100 will need a root canal just because we prepped the tooth. For this reason we can modify our prep design and avoid this side effect.

Teeth bend like trees. They deform under stress and can return to normal when the stress is removed. When we remove the enamel off the anterior teeth, we change this bending dynamic. The teeth become weaker. They are more likely to break. The same holds true for back teeth: an  important point to remember is that even though the prognosis for a tooth improves by crowning it vs. leaving it or placing a large filling, no tooth is strengthened by placing a crown.. This means that crowns we place on people’s teeth actually weaken them.

So what is the story here? There are many fatigue studies currently in progress and later we will know more, but we do know that crowns weaken teeth. When we restore anterior teeth we need to leave enamel in place and make thin restorations that bond to it. This leaves the tooth as strong as it was before we treated it. For posterior teeth we need to do more bonded on-lay type crowns.

This would be a major shift in dentistry. If it becomes reality, we will have to retrain on how to prepare, temporize and seat these restorations. Also, we’ll need to require our lab technicians to work with thinner, bondable material that will meet the esthetic demands required to treat today’s patient. Always keep this in mind: We want our patient to be better off as a result of our care. They deserve it.

About the author:

Dr. Wilhelm has been in private practice in the twin cities area since 1990, where he is focused on cosmetic dentistry, sedation dentistry, advanced restorative and dental implants. Dr. Wilhelm received his Doctorate of Dental Medicine in 1985 from Southern Illinois University School of Dental Medicine and completed specialty certificates in Prosthodontics and Maxillofacial Prosthetics at Indiana University. He has held faculty positions at Indiana University and is a staff member of the Health East Hospital system. He is also recognized as a Diplomate of the International Congress of Oral Implantologists and is an active member of the American College of Prosthodontists, the American Dental Association, and the Minnesota Dental Association.

Dr. Wilhelm is an author, consultant, mentor and frequent speaker to dentists and the public on techniques that enhance oral health.

Editorial note: Thank you to our guest blogger, Sanchia Purkayastha! Check out her blog Love Teeth   

Dental implant planning software

As we all know, it’s really important to plan dental implant placement before surgery to ensure the best results for your patients. Conventionally, this is done using a combination of clinical examination and X-ray or CT scans of the placement area to assess bone volume and suitability. If used correctly, dental implant planning software can give you that extra accuracy and predictability when performing dental implant surgery.

What is dental implant planning software?

Planning software uses 3D CT or CBCT (cone beam CT) scans of the patient’s jaw(s) to create a virtual environment in which to place virtual implants. This virtual environment provides the opportunity for you to plan dental implant placement accurately to then place implants conventionally according to your virtual plan. However, planning software can also be used to produce a ‘drill guide’ for use at the time of surgery based on your virtual plan. These ‘guides’ can be soft-tissue-supported, bone-supported or tooth-supported;  i.e. rest on the gums, bone (once a suitable flap has been raised) or surrounding teeth (if applicable). Once the guide is in place, you can easily drill through the provided holes to the correct depth to prepare the site for final implant placement.

How does this help plan surgery?

The software package will create a virtual 3D model of the jaw, with associated ‘slices’ of 3D data running perpendicular to the dental arch. These are usually referred to as ‘cross sections’ of the jaw, and will demonstrate the width of the ridge, as well as the bone volume in any particular area. A ‘panoramic’ image can be generated within the software at any time during the process, and you will also have access to the traditional CT slices – axial, coronal and sagittal. Most implant planning software has built-in safety alerts and will produce an error message if the implants are too close together or not fully within the bone. Once you have finished your virtual plan, you will be able to see how the implants fit into the bone using any of the provided views; the majority of dentists find the 3D view and the panoramic particularly useful for this.

Which program should you use?

There are a number of implant planning software packages that are available on the market today. The choice will depend on cost and the associated implant systems (not all planning software is compatible with all implant systems, for example NobelBiocare has its own proprietary planning software). Aside from these factors, it is important to try out planning software before you buy and decide which you prefer to use as all have quite different interfaces. If you are planning on using the guided system (using drill guides in surgery) you will need to decide on which type of guide you wish to use (bone-supported, gum-supported or tooth-supported).

What are the risks associated with using the guided system?

The guided system has been shown to be incredibly accurate in the majority of cases. The largest risk lies in the ‘fit’ or placement of the drill guide itself during surgery. This will depend largely on the plan – make sure that there are no air spaces when you look at your virtual drill guide on-screen. In addition, it is always strongly recommended that the implant surgeon be experienced in conventional implant placement before embarking on a guided approach.