Report surveys device makers

Report surveys device makers

November 8, 2007 -- Attention dental shoppers! Are you curious about the companies who make the products you use every day? Want to know who's making a killing in track-mounted light systems and whose getting stuck with an oversupply of ceramic caulk? Research and Markets can answer your burning questions about dental device makers, the company claims, with a new report: "Dental Devices Market Profile."

"The report provides an overview of key trends, drivers and restraints, future outlook, competitive landscape, and key developments in the dental devices market," says the market research company.

The report covers North America, Europe, Asia Pacific, South and Central America, the Middle East, and Africa. It focuses on dental equipment, dental supplies, digital dental x-ray systems, orthodontic materials, and products.

So whether you are looking for information on competitors, market forecasts, key trends, or just want some light reading, this report could be the thing. It'll set you back $3,920, so you might just have to skip that Oahu vacation.

Scandals hit UCLA dental school

Scandals hit UCLA dental school

November 14, 2007 -- The University of California, Los Angeles (UCLA) dental school faces twin allegations this week: That students cheated on national board exams and that applicants to the university's orthodontics residencies are being asked for donations in return for admission.

The accusations against the orthodontics program stem from an investigation by the Daily Bruin, the UCLA student newspaper. It reported Tuesday that admissions officials were asking applicants for hefty donations, a practice that would contradict long-standing policies at the public university. On Wednesday, the Los Angeles Times, KNBC, and other news organizations carried similar comments from students who said they had been asked to pony up if they wanted to get a residency.

In a February letter posted on the Daily Bruin web site, John Beumer III, D.D.S., M.S., resigned as chair of the faculty executive committee of the school of dentistry because, "The selection process for residents in orthodontics amounts to nothing less than an affirmative action program for the wealthy and well-connected."

Responding to these accusations, No-Hee Park, dean of the School of Dentistry, said in a prepared statement that the university had already investigated and found that the orthodontics program was "fair and merit-based," but that it had also made improvements to the admissions process, according to the Times.

The Daily Bruin attributed the requests for private contributions to declining public support for the school.

As for the cheating charges, the Times said it couldn't confirm details. But two anonymous members of the School of Dentistry told the newspaper that the American Dental Association (ADA) was investigating the sharing of compact discs containing improperly obtained questions from the ADA's National Board Dental Examinations.

The cheating allegations extended to other universities as well: Loma Linda, New York University, and the University of Southern California, according to UCLA officials cited by the Times. The ADA declined to comment.

Beyond dental therapists?

Beyond dental therapists?

November 25, 2007 -- The U.S. surgeon general put dentistry on notice in 2001 with a critical report that laid bare the dismal state of dental health care for the poor. Now three groups, the American Dental Association (ADA), the American Dental Hygienists Association, and a consortium of Alaskan Natives, have finally taken up the challenge. Each is proposing a new breed of professional that's less than a dentist, but may be more than a hygienist. In different ways, they all aim to bring more oral health care professionals into public and rural health clinics, hospitals, nursing homes, and similar venues that serve the underserved.


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But is the dental world ready for oral health professionals outside "the traditional model of care?" How might these new professionals enhance, expand, or even threaten your practice? Some of these questions are answered in "Emerging Allied Dental Workforce Models: Considerations for Academic Dental Institutions," a recent study published by the American Dental Education Association in the November issue of the Journal of Dental Education.

The three proposed positions include the Community Dental Health Coordinator (or CDHC, backed by the ADA), the Advanced Dental Hygiene Practitioner (or ADHP, from American Dental Hygienists' Association), and the Dental Health Aide Therapist (DHAT, created by the Alaska Native Tribal Health Consortium). To date, only DHATs are currently practicing, in well-established programs in over 40 countries, and in Alaska since 2005, serving Native Alaskans.

What would these dental professionals do? At the low end, not surprisingly, is the ADA's CDHC. Under the supervision of a dentist, the CDHC would administer fluoride treatments and sealants, and perform gingival scaling and coronal polishing--not unlike a hygienist. The ADHA's Hygiene Practitioner is akin to a super hygienist and would do considerably more: prophylaxis, managed care for periodontal patients, restorations (fillings), and simple extractions, unsupervised or under the general supervision of a dentist or physician. Alaska's Dental Therapists go a step further, not only filling cavities and pulling teeth, but taking x-rays and placing stainless steel crowns, under general supervision or under "standing orders" given by a dentist. Required training ranges from 18 months (CHDC) to a 2 year masters program (ADHP).

If these mid-level practitioners ever hang out their shingles, what will be the net effect on public health and traditional dental practices? If the evolving role of dental hygienists is any indication, says the ADEA, the results will be positive. "Reports...of dental hygiene practice in supervised and unsupervised practice settings...[do] not increase [the] risk to the health and safety of the public," notes the report. In fact, independent hygienist practices attract new patients, increase access to care, lower costs, and ultimately, increase visits to the dentist.

AFP Imaging gets nod for conebeam CT scanner

AFP Imaging gets nod for conebeam CT scanner

November 19, 2007 -- Digital x-ray developer AFP Imaging has received approval to sell its conebeam CT scanner in Canada.


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Health Canada, the federal regulator of drugs and health products in Canada, signed off on the company's NewTom VG 3D Cone Beam CT scanner. The system is marketed for treatment planning including dental implants, orthodontics and maxillofacial surgery as well as ear, sinus and airway imaging. It features a small footprint and is available in vertical and horizontal configurations designed for dental and ear, nose, and throat (ENT) markets in office settings with limited space.

Genexa Medical will serve as exclusive Canadian distributor for the scanner.

The 411 on kids' health

The 411 on kids' health

November 19, 2007 -- Wondering how to better serve your younger patients? One step in the right direction is getting hard facts about the overall health of this unique population.


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"Given the complexity of issues surrounding children's health, it's vital that related decisions be based on data that are reliable, current, and local," said David Alexander, M.D., president and CEO of the Lucile Packard Foundation for Children's Health, in a press release.

Dr. Alexander should know. The Packard Foundation has just expanded its www.kidsdata.org health database, which now covers San Francisco, Marin, Alameda, and Contra Costa counties, plus Santa Barbara county. The site culls data from a number of public sources and sifts it into 20 demographic categories encompassing more than 250 health indicators. The site also includes information from hundreds of cities and school districts throughout the Bay Area.

Dig into the database--by region, demographic, or topic-- and you discover a wealth of information. In neat tabular form, you can learn everything from "Dental Insurance Status" and "Asthma Hospitalization Rate by Age Group," to "Parent Ratings of Child's Dental Care Quality, by Income Level" and "Public School Students Enrolled in the Free or Reduced Price Meal Program."

For a similar approach at the state level covering kids and adults, megahealth insurer WellPoint (think Blue Cross and Blue Shield) has just launched the State Health Index, a report that pulls together CDC health data from 14 states. (Namely, California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin.) The Index tracks 23 measures of public health, including prenatal care, cigarette smoking rate, diabetes in the adult population, and heart disease rate.

The Index's aim is to "identify the most serious health issues facing each unique population" and improve and develop programs that address these health issues for WellPoint's 35 million members. One example, says Jim Gavin, the company's Corporate Communications Director: The Index revealed that Georgia ranks 44th and 39th for adult flu and pneumonia vaccinations. WellPoint's response: donate $50,000 to 10 free clinics to purchase and administer adult flu and pneumococcal immunizations.

WellPoint has likewise funded health education programs that tackle everything from premature births to quit smoking campaigns.

Insurers change exam schedule

Insurers change exam schedule

November 19, 2007 -- "See you in six months!" That standard farewell, heard every day in most American dental offices, is starting to fade.


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Swayed by the research, a growing number of dental insurance plans are rejecting the traditional semiannual cleaning. Instead, these plans are pushing dentists to see healthier patients less often and less healthy patients more often.

Starting next year, "some members … will be eligible for up to four periodontal maintenance or prophylaxis visits in a calendar year," the ODS Companies told dentists who participate its Oregon public employees dental insurance plan. "Other members with healthy mouths and low risk factors will be eligible for one prophylaxis in a calendar year." Kaiser Permanente and Willamette Dental negotiated similar policies with the Oregon employees.

The change stems from new research as well as two new trends within dentistry: minimally invasive dentistry and evidence-based dentistry. Minimally invasive dentistry seeks to cause the least amount of destruction to the natural structures of the mouth. As part of this approach, dentists assign patients to risk categories and set up different preventative plans for each category.

The November issue of the Journal of the California Dental Association will include a consensus statement signed by many of the nation's leading caries experts asserting that, "recall appointments at appropriate intervals are essential to monitor, renew, and reinforce the proposed caries management and prevention plan for the individual patient." And an article in the journal's October issue calls for as few as one routine visit per year, and as many as four.

Evidence-based dentistry calls into question practices that have never undergone the rigor of a clinical trial. In October, the Cochrane Database of Systematic Reviews analyzed the research on the frequency of routine visits and found that, "There is insufficient evidence to support or refute the practice of encouraging patients to attend ... dental check-ups at 6-monthly intervals."

The Cochrane reviewers also concluded that there isn't enough evidence to recommend changing to another recall pattern. But other researchers, looking beyond the mouth, have argued that certain people need more frequent visits because of pregnancy, diabetes, gum disease, or past kidney failure. Oral bacteria can increase the risk of preterm birth, according to a review article in the October, 2006 issue of the Journal of the American Dental Association. In the same issue, the journal reported on a review of studies showing that periodontal disease and diabetes can worsen each other.

On the basis of this research, Delta Dental of Michigan, Ohio, and Indiana announced last year it would pay for more frequent dental visits by diabetics and pregnant women diagnosed with gum disease or kidney failure, people who are undergoing dialysis, and those with suppressed immune systems due to chemotherapy or radiation treatment, HIV infection, organ transplant, and/or stem cell transplant.

Renaissance Dental announced it would follow suit with a similar change beginning next year. “By adding these additional cleanings and periodontal maintenance procedures, we hope to improve the overall health of our members and lower their total healthcare costs through advanced dental plan designs,” said Jed Jacobson, D.D.S., chief science officer for Renaissance, in a press release.

High tech, high touch, Part I

High tech, high touch, Part I

November 19, 2007 -- When you think about computer technology, you probably don't think about a warm, sympathetic environment that fosters close interaction between dentist and patient.

But computer technology can indeed make dentistry more patient-friendly -- if its implemented wisely. Rather than view technology as a necessary evil, dentists should view it as an agent of change that can help them better connect with their patients.

That's according to Dr. Larry Emmott, D.D.S., a self-described technology geek and principal at the Aesthetic Dental Institute in Phoenix. Dr. Emmott spoke on the transformative power of computer technology in dental practice at the recent American Dental Association annual meeting held in San Francisco.

Dental practices are adopting computer technology at an inexorable pace, Dr. Emmott said. A 1998 survey found that 18% of practices had computers in treatment rooms; by 2006, it was 62%. Nearly 90% of dental practices now have a computer somewhere in the practice, he said.

But adopting technology for technology's sake is a mistake, Dr. Emmott believes. Instead, dentists should view technology as a tool for transforming their operations. This can range from eliminating bottlenecks at the front desk to making patients feel recognized and valued when they visit the practice -- an approach that Dr. Emmott calls the "high-tech, high-touch" philosophy.

First steps

Dentists should begin their adoption of technology by visualizing what they want to accomplish, and how they want the pieces of their computer network to work together. Dr. Emmott is an advocate of the fully connected office, with networked computers available chairside and at the front desk, with connections to the Internet so that staffers can access online resources and interact with patients.

A critical component of the wired office is practice management software. Selecting the right software has become somewhat easier in recent years due to vendor consolidation. The three main players in the industry, Dr. Emmott said, are Dentrix from Dentrix Dental Systems (a subsidiary of Patterson Dental, and PracticeWorks/SoftDent from Carestream Health. Any of these three products will work well for the standard dental office, he said.

Practice management software is key in automating and digitizing functions that many practices still perform manually, from diagnosing and charting patients, to scheduling, billing, writing treatment plans, and practically every other aspect of dental operations. Dr. Emmott estimates that practice management software can save you nearly $39,000 in annual staff costs by eliminating functions that were previously done by hand. Software can also capture the estimated 3% to 4% of dental services that aren't billed due to poor communication among dental office staff.

Patient scheduling, in particular, is a major bottleneck that can be eliminated through technology. Dr. Emmott described his office in its pre-PC days, when his staff juggled five appointment books -- two for the dentists and three for the hygienists -- with staff trying to schedule appointments simultaneously.

But don't adopt technology halfway, Dr. Emmott said. He's heard of some practices that were so technophobic they used electronic scheduling side-by-side with a manual scheduling book. "There's a word for that -- stupid," he said. "Burn the book. Just go electronic."

Front desklessness

One concept that Dr. Emmott strongly believes is "front desklessness." Administrative functions previously handled by the front desk are distributed throughout the practice, making staff more efficient and patients more satisfied with their experience.

Electronic scheduling exemplifies the transformative power of front desklessness. Bottlenecks at the front desk disappear because any staffer can schedule appointments from any networked computer. The chairside dental assistant or hygienist can schedule a patient's next appointment as soon as the current cleaning is completed -- which is the exact moment the patient is most motivated to maintain good oral health, Dr. Emmott believes.

This is far more effective than the old-fashioned way, Dr. Emmott said, when six months later you send a little postcard with the happy elephant and the toothbrush. "When they get the happy elephant, you're the last thing on their list. If you schedule them today for six months from today, you're the first thing on their calendar, and everything else gets scheduled around you."

Staff can also benefit. Dr. Emmott told the story of a valued front desk administrator who had to look after her small children in the early afternoon. Rather than fire her, the practice was able to let her leave early and take calls to the practice from home by accessing the office's scheduling software remotely.

What happens to front desk staff when a practice achieves front desklessness? Their roles simply change. "Instead of being phone answerers and money collectors, they become concierges, meeting and greeting, and leading people through an elegant dental experience," Emmott said. "The technology frees you from the drudgery and allows you to spend more time on the relationship part of the job -- the distinguishing factor between average and great practices."

Dental bills stalled by SCHIP

Dental bills stalled by SCHIP

November 16, 2007 -- As Congress concentrates on the State Children's Health Insurance Program (SCHIP), other dental legislation has been shoved off the priority list, according to William Prentice, who directs the Washington office of the American Dental Association (ADA).

"Unfortunately, the attention of Congress is limited, and it's focused on SCHIP," he told DrBicuspid.com.

The good news is that any bill to reauthorize SCHIP will likely include mandatory dental coverage, Prentice says. In its current version, SCHIP provides medical insurance to about 10 million children whose families can't afford it on their own but are too "wealthy" to be eligible for Medicaid. States have the choice whether to use the money for dental care.

After Congress failed to override President George W. Bush's veto of a previous reauthorization, both houses of Congress went back to work. The House of Representatives has now passed a very similar bill, by a margin too small to make an override of a presidential veto likely. Senate Democrats are working on more substantial changes in hopes of adding enough Republican votes to override a veto.

With the energy of healthcare committees devoted to this work, progress on other legislation of importance to dentists has slowed. What's being held up?

Both the ADA and the Academy of General Dentistry are lobbying Congress to pour more money into the Primary Care and Dentistry Component of the Title VII Health Professions Programs. These programs provide grants for the education of health dental care professionals.

Both organizations are also supporting two bills -- Deamonte's Law and the Children's Dental Health Improvement Act -- that call for improved dental care for children in poor communities.

Although some of the provisions in these bills overlap, Prentice said his group was backing them on the theory that where one fails another might succeed.

Finally, the two organizations will push for the passage of "Meth Mouth" bills to educate school children about the oral health risks of methamphetamines, and set up correctional dental programs.

"These … legislative priorities will help us go above and beyond our number one goal of ensuring access to oral healthcare -- especially our nation's children," said AGD's President, Vincent C. Mayher, D.M.D., M.A.G.D., in a press release.

Aside from SCHIP, none of these bills have passed in the committees where they were introduced. And realistically it's unlikely Congress will move on these bills until sometime next year, Prentice says.

Meanwhile, the two organizations are trying to line up more cosponsors and asking their members to contact their representatives in Congress.

Are the new power brushes better?

Are the new power brushes better?

November 16, 2007 -- Americans love gadgets, so it's no surprise that power toothbrushes are gaining in popularity here. But this year, as the leading manufacturers roll out new models, two questions linger: Is power really better than manual? And do the new power brushes beat the old ones?


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The answer to the first question, according to some of the world's leading experts, is (an extremely qualified) yes. "I think the power brushes are significantly better than manual toothbrushes," says Samuel Yankell, Ph.D., R.D.H., a former University of Pennsylvania professor who now tests toothbrushes as a private consultant. But the advantages are small, Dr. Yankell and other brush testers admit, and the brusher matters more than the brush.

As for which brand is best, the most convincing study to date favored brushes whose heads move in "rotation oscillation" which means they spin one direction then spin the other. It's a category dominated by Oral-B.


The Philips Sonicare FlexCare comes with a UV sterilizer.
That study was done before a new company, Ultreo, leapt into the field this year claiming superior results for the ultrasonic waves its brush produces. Not to be outdone, Oral-B released its Triumph with SmartGuide ProfessionalCare 9910, the first toothbrush with a detached monitor that communicates wirelessly with the brush to tell you how well you're brushing. Philips, meanwhile, has introduced the Sonicare FlexCare with multiple speeds and a UV chamber intended to sterilize brush heads between uses.

The new offerings add to a diverse selection. In addition to manual brushes of multiple designs, Amazon alone offers a dozen power brushes with prices ranging from $16.99 to $179.99.


Makers of the Ultreo toothbrush claim its bubbles clean what bristles can't.
Demand for the devices is on the rise. Power toothbrushes first hit the market in the 1960s in a wave that animated everything from carving knives to garbage cans. Since then, automated brands have been edging manual brushes out of U.S. medicine cabinets; currently about 30 percent of American consumers use power brushes, says Sharon Ross director of marketing for Ultreo. While Philips and Oral-B dominate the market, Ultreo is determined to seize a share with its patented technology.

What's the difference?

So what sets one apart from the other? Bells and whistles aside, the leading makers all point to scientific evidence that demonstrates their brushes do the best job when it comes to removing the nasty stuff from teeth. Ultreo boasts that its power brush uses a transducer to sends sound waves through the foam in your mouth. Tiny bubbles jiggle into places that mere bristles can't reach, scrubbing them clean, says Ross. It's the same principle behind professional ultrasonic cleaning equipment.

By contrast, the competing Sonicare brushes don't actually use sound waves to clean teeth, she says. Putting sonic in the name "was a great marketing name because it made people think it was doing something more than moving fast."

But Philips claims its bubbles are just as jiggly as anyone else's. Ultreo's might show more action in the lab, says Philips spokesperson Shannon Jenest, but not in the mouth. "We have specific research against that."

For its part, Oral-B doesn't think any of the sonic claims hold water. You can rev up your transducer all you want but "nothing actually happens," says spokesperson Avery Schlicher. In fact, her company has taken Ultreo to court for saying Oral-B is inferior. Naturally, Ultreo has countersued.

Children, please!

The fact is, just about any toothbrush will do a decent job cleaning teeth, brush experts say. Even power brush enthusiast Dr. Yankell agrees that diligence is more important than technology. "You have to get in there and get rid of plaque. If you're conscientious, you could do it with your finger."

The lab and the mouth

All three companies can show you lots of laboratory studies proving that their brushes scrub teeth squeaky clean. But clinical trials are a different matter. These have focused on two outcomes: reducing plaque and reducing gingivitis. Over the decades, they came up with a wide range of conflicting results.

The debate got so muddled that the Cochrane Collaboration stepped in. This international group of researchers has developed standards for compiling data from multiple trials into one big meta-analysis. For a 2003 review of power toothbrush effectiveness, Cochrane researchers found 42 studies -- with a total of 3,855 patients -- that were well-enough conducted to produce meaningful results.

The bottom line? Most of the power toothbrushes had little or no advantage over manual brushes. The main exception was brushes that used a rotation oscillation motion. In three months or less, brushes with this type of motion reduced plaque by 11 percent more than manual brushes on the Quigley Hein index and gingivitis by 6 percent more on the L?e and Silness index. These power brushes also reduced bleeding on probing by 17 percent over a period exceeding three months on the Ainamo Bay index.

But when the Cochrane researchers reviewed their data for a 2005 update, they raised questions about their own findings' statistical significance.

And the study fell short of standards set by one of the most important arbiters of dental quality, the American Dental Association (ADA). "The ADA hasn't seen data to convince us that power toothbrushes are better than manual toothbrushes," says Clifford Whall, Ph.D., the director of the organization's Acceptance Program. In order to satisfy the ADA of its superiority, a toothbrush would have to reduce gingivitis by 15 percent or more in comparison to manual brushes that meet the minimum ADA standards, he said.

Nor has anyone proven that any power brush -- oscillating or otherwise -- makes a difference after the first few months. In fact, the Cochrane researchers pointed out, it's not even certain that gingivitis and plaque lead to destructive periodontal disease. Then, too, the power toothbrushes were compared to the old-fashioned ADA standard brush which (according to claims by some of the same companies) isn't as good as newfangled manual brushes with extra-soft crossed bristles.

Finally, says Dr. Yankell, patients don't always stick with their power brushes anyway. "With long-term use, interest goes down and usage goes down," he says. For example, "if the batteries wear out or pop out, patients may stop using them." One study showed that a third of power toothbrush purchasers abandoned them after three years.

So what convinces Dr. Yankell that power brushes are better? The lack of long-term clinical evidence doesn't completely negate the importance of laboratory evidence. "In the lab, there have been some very good studies," he says. "We have been able to consistently show that head design is important in cleaning teeth. New head designs are coming out all the time and I think it's very important."

But more important than head shape, movement, or how it makes bubbles dance, is whether the patient uses it properly. One of the chief advantages of the power brushes, points out Yan-Fang Ren, D.D.S., Ph.D., M.P.H., a brush tester and assistant professor of dentistry at the University of Rochester, is that they often come with timers. The average person only brushes for about 45 seconds instead of the recommended two minutes. The better brushes let you know when you've been at it long enough. The FlexCare, Ultreo and Triumph units will even announce when it's time to brush a different quadrant; the Triumph also tells you if you're brushing too hard.

So which brush should you recommend to patients? It depends on the patient. Richard Niederman, D.M.D, a periodontist who directs the DSM-Forsyth Center for Evidence-Based Dentistry in Boston, was impressed by the evidence for Oral-B power brushes in the Cochrane study. But he thinks the expense of the brushes is an important consideration. "I give out power toothbrushes as gifts," he says. "I don't recommend them to everyone."

Some people fit a power brush profile. "If a patient comes in with red and bleeding gums, but they brush every day," says Dr. Niederman, "I'm going to recommend a power toothbrush. But if they brush once a year and their gums and teeth look great, I won't." Other patients who might especially benefit from power brushes are teenagers and anyone with braces.

To that list, Dr. Yankell adds people with poor manual dexterity. He advises dentists to watch how their patients brush, perhaps even giving them three or four brushes to try in the office. The ultimate criterion: "You have to keep your patients interested in brushing."

Preop antibiotics better?

Preop antibiotics better?

November 15, 2007 -- Extracting wisdom teeth is a messy affair. Post-op infections are common, notes one dentist, because third molars "are usually filthy if erupted and you leave a big hole if you have to dig the tooth out."

For many dentists and oral surgeons, prescribing preoperative antibiotics is a given, to minimize post-op infections and alveolar osteitis (AO), otherwise known as dry socket. Many others give patients antibiotics after the procedure. What's best?

The debate will no doubt continue, but the preop camp just got some extra ammunition, thanks to a literature review conducted by the University of Rochester Eastman Dental Center that was published in the October 2007 issue of the Journal of Oral and Maxillofacial Surgery. The bottom line: Patients who have their wisdom teeth yanked are "twice as likely to get an infection after surgery than those who receive a single dose of antibiotics before surgery," according to a release accompanying the report. "We do not advocate ... antibiotics for every third molar surgery," said Eastman researcher Yan-Fang Ren, D.D.S., Ph.D., M.P.H. "But for patients who have risks for postoperative infections, a single dose of antibiotics before surgery is probably more effective than taking several days of antibiotics after the surgery is completed."

Dr. Ren and co-author Hans Malmstrom, D.D.S., reached this conclusion after analyzing 16 clinical trials involving 2,932 patients. Studies dating back to the 1960s showed that a single dose of penicillin before surgery reduced the incidence of AO from 24% to 3%. Later trials questioned these results, and the battle was on for the next 40 years. Drs. Ren and Malmstrom collected and evaluated randomized controlled trials and theses (published and unpublished, from around the world) from 1974 through 2007 for their meta-analysis. The duo evaluated trials based on the rigor of their design and only included clinical trials that involved systemic antibiotic prophylaxis. They accounted for timing and route of administration, and the type of antibiotic given.

What did they find? Patients receiving systemic antibiotics prior to third molar surgery were 2.2 times less likely to develop AO and 1.8 times less likely to develop wound infection. Both wide- and narrow-spectrum antibiotics were effective in reducing AO; wide-spectrum drugs were superior in battling wound infection. Certainly, say the authors, antibiotics given after surgery are not as effective in reducing AO or wound infection. The best dosing strategy? A single dose 30 to 90 minutes before surgery, followed by a course of antibiotics for three to five days after. (This approach is strongly recommended for smokers, those with poor oral hygiene, and others with known risk factors.) The revelation: a single preop dose of antibiotics is nearly as effective as this preop/post-op combination.

Lose a tooth, lose a month?

Lose a tooth, lose a month?

November 14, 2007 -- Every time you lose a tooth, your life gets shorter. That's the conclusion researchers at G?teborg University, in G?teborg, Sweden reached -- at least when it comes to people over 70 -- when they compared dental records to mortality rates.


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"The results showed that each remaining tooth at age 70 decreased the mortality risk by 4 percent over 7 years, and 2 percent - 3 percent over 18 years," wrote the researchers in the online edition of the Community Dentistry and Oral Epidemiology.

But, you ask, is there really a cause and effect here? Could there be some other factor -- say smoking or poverty -- that causes both tooth loss and an earlier death? The investigators thought of that, too. And the answer, as far as they can tell, is "no."

They screened out the effects of income, education, marriage, smoking, physical activity, social activity, drug consumption, diseases, underweight, and overweight. They found that losing teeth seemed to affect how long people lived independently of any of these factors.

How come? The investigators weren't sure, but they point to previous research showing that people with more teeth eat better. And they speculated that replacing lost teeth with implants might lengthen lives.

Scandals hit UCLA dental school

Scandals hit UCLA dental school

November 14, 2007 -- The University of California, Los Angeles (UCLA) dental school faces twin allegations this week: That students cheated on national board exams and that applicants to the university's orthodontics residencies are being asked for donations in return for admission.

The accusations against the orthodontics program stem from an investigation by the Daily Bruin, the UCLA student newspaper. It reported Tuesday that admissions officials were asking applicants for hefty donations, a practice that would contradict long-standing policies at the public university. On Wednesday, the Los Angeles Times, KNBC, and other news organizations carried similar comments from students who said they had been asked to pony up if they wanted to get a residency.

In a February letter posted on the Daily Bruin web site, John Beumer III, D.D.S., M.S., resigned as chair of the faculty executive committee of the school of dentistry because, "The selection process for residents in orthodontics amounts to nothing less than an affirmative action program for the wealthy and well-connected."

Responding to these accusations, No-Hee Park, dean of the School of Dentistry, said in a prepared statement that the university had already investigated and found that the orthodontics program was "fair and merit-based," but that it had also made improvements to the admissions process, according to the Times.

The Daily Bruin attributed the requests for private contributions to declining public support for the school.

As for the cheating charges, the Times said it couldn't confirm details. But two anonymous members of the School of Dentistry told the newspaper that the American Dental Association (ADA) was investigating the sharing of compact discs containing improperly obtained questions from the ADA's National Board Dental Examinations.

The cheating allegations extended to other universities as well: Loma Linda, New York University, and the University of Southern California, according to UCLA officials cited by the Times. The ADA declined to comment.

Dental 'therapists' fill holes: Part II

Dental 'therapists' fill holes: Part II

November 13, 2007 -- Can a high-school graduate with two years training do much of what a dentist does? Most dentists would say not. But the federal government is already assuming they can.


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That's the source of conflict that led the American Dental Association (ADA) to sue the State of Alaska for allowing federally-certified Dental Health Aide Therapists to perform tooth extractions and restorations on Alaskan Natives. The ADA lost the suit, and as a result, dental therapists are fanning out across remote Alaskan villages performing procedures that were previously the exclusive province of dentists.

What happens in Alaska could affect dental care throughout the country. Although the dental therapists now practicing are limited to working with Alaskan Natives, already American Indian organizations in the lower 48 states are researching how they might bring dental therapists to their own communities. "Definitely we're interested in that possibility," says John Lewis, executive director of the Intertribal Council of Arizona. American Indians have similar needs to those of Native Alaskans, and he would like to see 50 to 100 therapists working in Arizona, he says. He added that the subject drew interest from representatives from around the country at a meeting on American Indian healthcare in October.

The Alaska Native Tribal Health Consortium (ANTHC), which oversees the Alaska program, would have been happy to put actual dentists in these villages, says Ron Nagel, D.D.S., M.P.H., who helped design the program. The problem is that there just weren't enough dentists willing to step in. "We have a 25 percent vacancy rate with our dentists," he says.

Materialise and Nobel Biocare square off

Materialise and Nobel Biocare square off

November 13, 2007 -- Materialise N.V. and Materialise Dental N.V., manufacturer of 3D implant planning systems have filed a patent infringement lawsuit against Biocare, AB and its U.S. subsidiary Nobel Biocare U.S.A. LLC in the Central District of California.

Materialise claims that Nobel Biocare’s NobelGuide drilling template is in violation of its patented SurgiGuide techniques. (The SugiGuide U.S. patent was issued in 1998.) Earlier this year, the District Court of Dusseldorf found NobelGuide's drilling templates violated a European patent held by Materialise and ordered Nobel to stop offering the templates in Germany

"With this lawsuit, we are protecting our technology", said Bart Swaelens, CEO of Materialise Dental in a press release. "Our SimPlant software was launched in 1991, and was followed by our SurgiGuide drill guides in 1999. The introduction of NobelGuide by Nobel Biocare, on the other hand, did not occur until 2005."

Materialise's current suit is a response to Nobel Biocare's recently filed civil action suit in the Central District Court of California. Nobel Biocare seeks declaratory judgments that the Nobel Guide template does not infringe Materialise's patent.

Dealing with deadbeats

Dealing with deadbeats

Banta tells dentists to get patients' home address and mailing address because they're not always the same. "If they only give you a P.O. Box, that could be a red flag -- they may expect or have had financial problems. Find out where they actually live."

If a patient has ignored your 30-day and 60-day statements, it's time to make a call. "Your office's payment collector should be cool, courteous and cordial on the phone."

If patient decides to pay, state you want the full balance due. "If they send a check for $5 and you deposit it, then you've just made arrangements for them to pay you $5 in monthly payments, and it's legally binding," says Banta. "Send that check back and request the full balance."

"And don't ask 'When can you send it?'," says Banta. "That lets them set the date. Instead ask, 'What day should we expect the payment?' If they don't pay on that date, follow up with a phone call the next day."

Keeping on top of late receivables is a must. Just do the math. Every month your patient's balance ages past 90 days, you lose 7 percent of the value based on the labor, stamps, and paper to ask for that money. Your goal should be to collect 98 percent of all revenue and write off just 2 percent as bad debt. No more than 5 percent of your outstanding payments should be over 90 days old. But Banta notes that the average for dental practices is 25 to 45 percent. Ditto insurance claims--only 5 percent should be 90 days past due. Yet the average is 15 percent.

Mercury goes to trial

Mercury goes to trial

November 12, 2007 -- What is the FDA's role in determining dental mercury's harmful impact on the environment? Why doesn't the FDA implement a rule proposed in 2002 that calls to classify mercury tooth fillings under the medical devices regulations?

These are some of the questions that will be addressed at a hearing by the U.S. House Committee on Oversight and Government Reform on Nov. 14.

According to the Mercury Policy Project -- a nonprofit advocacy organization -- dental mercury release (in the form of waste amalgam) is more than a third of the mercury that ends up in municipal waste water treatment plants. This mercury, the Project points out, ends up the environment and ultimately, in the fish Americans eat.

"The dental industry should embrace a 'clean hands' policy and stop its mercury use from getting onto American's dinner plates," said Michael Bender, director of the Mercury Policy Project in a press release. "As health professionals, dentists have a moral obligation to protect the public from mercury, a dangerous neurotoxin."

Bender, who is also one of the witnesses at the hearing, plans to prove that dental mercury air emissions (from burning of sludge, cremations, and emissions from dental offices) may be more than five times higher than recent Environmental Protection Agency (EPA) estimates.

Other witnesses at the hearing include:

Panel I
?Mr. Ephraim King, Director, Office of Science and Technology, Office of Water, Environmental Protection Agency
?Dr. Norris Alderson,Director, Office of Science and Health Coordination, Food and Drug Administration

Panel II
? Mr. Ray Clark,Senior Partner, The Clark Group, LLC
? Mr. Bruce Terris,Partner, Terris, Pravlik & Millian, LLP
? Mr. C. Mark Smith,Co-Chair, Mercury Task Force, New England Governor’s Conference
? Mr. Michael Bender,Executive Director, Mercury Policy Project
? Mr. Rod Mackert, Dentist and Faculty Member, Medical College of Georgia

CRA Newsletter picks fave products

CRA Newsletter picks fave products

November 12, 2007 -- What do Russell Crowe and Septocaine have in common? They have both won prestigious awards in their fields. (And they both make us numb with delight.) The latter was named the No. 1 product CRA evaluators "can't live without" in the September issue of the CRA Newsletter.

Over 400 CRA dental teams nominated 830 products; the top 11 were featured in the newsletter. Top products included adhesives, optical tools, CAD/CAM systems and more.


The Cerec 3 is one of the CRA Newsletter's products you can't live without
The most prominent company: 3M, which claimed four of the top 11 slots . Other notables included Sirona (which makes Cerec, an inhouse CAD/CAM system for creating restorations); KaVo's DIAGNOdent (a laser that can identify caries) , and Kuraray's Clearfil SE (a primer adhesive).

Report blasts Smiles clinics

Report blasts Smiles clinics

November 9, 2007 -- A national chain of dental clinics separates children from their parents and straps them to their chairs for treatments, ABC News reported Wednesday.

Citing a "five-month investigation" by its Washington, DC, affiliate, WJLA, the broadcasting company reported that the Small Smiles chain of clinics restrains children as a method of saving time during dental procedures.

The chain accepts Medicaid patients turned away by most dentists, according to ABC, but compensates for the lower reimbursement rate per patient by boosting volume.

The report describes children who "cried for their mothers while they were strapped into restraining devices." It also quotes former employees who accuse the company of pushing unnecessary treatments on its patients. Some workers were reportedly fired for objecting to how children were handled.

Forba Holdings, the company that owns Small Smiles, disputed the report, according to ABC. It quoted Forba chairman and CEO Michael Lindley as saying, "The story does not accurately reflect the facts and our responsible approach to patient care."

Report blasts Smiles clinics

Report blasts Smiles clinics

November 9, 2007 -- A national chain of dental clinics separates children from their parents and straps them to their chairs for treatments, ABC News reported Wednesday.

Citing a "five-month investigation" by its Washington, DC, affiliate, WJLA, the broadcasting company reported that the Small Smiles chain of clinics restrains children as a method of saving time during dental procedures.

The chain accepts Medicaid patients turned away by most dentists, according to ABC, but compensates for the lower reimbursement rate per patient by boosting volume.

The report describes children who "cried for their mothers while they were strapped into restraining devices." It also quotes former employees who accuse the company of pushing unnecessary treatments on its patients. Some workers were reportedly fired for objecting to how children were handled.

Forba Holdings, the company that owns Small Smiles, disputed the report, according to ABC. It quoted Forba chairman and CEO Michael Lindley as saying, "The story does not accurately reflect the facts and our responsible approach to patient care."

Studies find bleach damages dentin

Studies find bleach damages dentin

November 9, 2007 -- Slap on some hydrogen peroxide and it's amazing what disappears from a tooth: bacteria, wine stains, even tetracycline coloring. But dental researchers have long wondered if anything more important disappears as well -- such as some of the tooth itself. And in a recent spate of studies, they've come up with worrisome answers.

Enamel, it seems, can tolerate a pretty harsh splash of bleach. But dentin is another matter, says Laura Tam, D.D.S., an associate professor of restorative dentistry at the University of Toronto. In laboratory experiments reported in the April Journal of Esthetic and Restorative Dentistry, she found that even a 3 percent solution of hydrogen peroxide saps human dentin. "Dentists should be careful in bleaching those teeth with exposed dentin," she warned.

Further clues about this process come from researchers at Wuhan University and HuaZhong University in China, who write in the November Journal of Dental Research that hydrogen peroxide hits dentin with a double whammy: it oxidizes the organic components and dissolves the minerals.

But one bleaching expert, Van Haywood, D.M.D., a professor of oral rehabilitation at the Medical College of Georgia, pooh-poohed these laboratory findings as irrelevant to the real world of patients' mouths. "From what I can see, there is not a serious enough effect to be concerned about," said Dr. Haywood, who first developed carbamide bleaching. In its standard formula, carbamide peroxide contains 3 percent hydrogen peroxide plus urea.

The question has gotten more urgent as more people have been using at-home bleaching kits; one survey found as many as 95 percent of dentists prescribe such products to their patients. But since the kits are marketed as cosmetic treatments, there's little regulation. Dr. Tam has seen solutions as high as 22 percent carbamide peroxide, the equivalent of 8 percent hydrogen peroxide.

For their experiments, Dr. Tam and her colleagues cut notches in 80 extracted human molars. These notches exposed the dentin in the teeth. They then randomly divided the teeth into five groups of 16 teeth and applied a different solution to each group: 10 percent carbamide peroxide, 3 percent hydrogen peroxide, 30 percent hydrogen peroxide, glycerin, or distilled water.

Each group of 16 teeth was subdivided into two groups of eight: direct and indirect bleaching. In the indirect bleaching groups, the researchers put the bleach only on the enamel -- avoiding the dentin exposed in the notches. The idea was too see if any bleach seeped through the enamel and damaged the dentin. In the direct bleaching groups, bleach was applied directly onto the dentin exposed in the notches.

Then they mounted the teeth one by one on an Instron universal testing machine and increased the pressure gradually, measuring the force until each tooth cracked.

The results? The teeth in the indirect bleaching group were just as strong as the teeth treated with only water or glycerin. These teeth all had fracture toughness (K1c) ranging from 2.66 to 3.33 (MPa*M^0.5). Apparently, not enough bleach seeped through the enamel to cause any damage.

But teeth whose dentin was bleached directly with 30 percent hydrogen peroxide solutions were significantly weaker: they had a K1c of 1.6. Another notable finding: teeth whose dentin was treated directly with carbamide peroxide fared no better. They had a K1c of 1.38 -- a surprise, since carbamide peroxide has been touted as a safer bleach.

The teeth with dentin directly exposed to 3 percent hydrogen peroxide fell in the middle of the toughness range, with a K1c of 2.45.

How to prevent damage

The study suggests that even relatively mild bleach solutions -- including carbamide peroxide -- can damage exposed dentin, Dr. Tam said. She advises dentists to "use the lowest concentration possible of hydrogen peroxide and the shortest amount of exposure."

For patients with receding gums, she recommends that dentists cut bleaching trays so they don't overlap the exposed root. Teeth with worn-out enamel pose a bigger problem. "In cases of severe occlusal attrition, avoid bleaching or use in-office bleaching so you can control where the bleach goes."

Dr. Haywood agreed that 30 percent hydrogen peroxide shouldn't be used any more. But he said cola is a bigger threat to patients' teeth than carbamide peroxide. "Put this in perspective of the things people are using in their mouths," he said.

His point of view got support from a study in the current issue of the Journal of Clinical Dentistry -- sponsored by Procter & Gamble -- which makes Crest Whitestrips. The study found that hydrogen peroxide solutions at 5.3 and 6.5% concentrations did not damage dentin.

As for exposed dentin, "when you have worn your occlusal surfaces down to the point where you have exposed dentin, you have a serious bite problem that far exceeds the risk from bleaching," he said.

Over-the-counter hydrogen peroxide remains safe as an antibacterial rinse used for caries prevention, Dr. Haywood said, but he advocated carbamide peroxide as a superior treatment.

He also commented on a report in the April Journal of Endodontics that showed dentin damage from five types of bleach used inside teeth that have had root canal treatment: sodium perborate and water; sodium perborate and 2 percent chlorhexidine gel; sodium perborate and 30 percent hydrogen peroxide; 37 percent carbamide peroxide gel; and 37 percent carbamide peroxide gel and 2 percent chlorhexidine gel.

Compared to water alone, which was used as a control, all these bleaches weakened the dentin, the researchers found, with the solutions using carbamide peroxide doing the least damage and the solutions containing hydrogen peroxide doing the most. While the effect was not big enough for dentists to stop using carbamide peroxide as a "walking" bleach, Dr. Haywood argued, they should abandon 30 percent hydrogen peroxide for this purpose.

Getting a handle on things

Getting a handle on things

November 9, 2007 -- Attention all hygienists with tired aching fingers! Premier Dental Products Company is now offering a choice of three ergonomic handles on their NV1 Anterior Scaler and NV2 Posterior Scaler instruments.

The Big Easy Ultralite handle, which is based on advanced polymer technology, is half an inch in diameter and weighs 16 grams. It has medical grade silicone grips which reduce finger fatigue, claims Premier. The Big Easy is a hollow stainless steel handle that combines the comfort of medical grade silicone grips with the precision of stainless steel. The Light Touch is likewise hollow stainless steel, but its unique feature is a cross hatch knurled surface for better control.