Oral Hygiene February 2012 by Annex Business Media

oralhygiene February 2012

Dental Hygiene: Past, Present & Future “NO MORE PICK & FLICK” Dental Hygiene REHABILITATION LA RÉHABILITATION de l’hygiène dentaire Use of the DIODE LASER in Periodontal Therapy The Effective Use of TECHNOLOGICAL TOOLS L’utilisation Efficace D’OUTILS TECHNOLOGIQUES www.oralhealthgroup.com Publications Mail Agreement No. 40069240

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oralhygiene CONTENTS

FEATURES Use of the Diode Laser in Periodontal Therapy

Sebastiano Andreana, DDS

The Effective Use of Technological Tools

Sandra Bluteau, HD

L’utilisation Efficace d’outils Technologiques

Sandra Bluteau, HD

Dental Hygiene Rehabilitation

Annick Ducharme, RDH

La réhabilitation de l’hygiène dentaire

14, 18

Annick Ducharme, RDH

Dental Hygiene: Past, Present & Future “No More Pick & Flick”

Lisa Philp, RDH, CMC

DEPARTMENTS 5 News 6 Dental Marketplace 34 Editorial

22, 28 Editorial Board Members Lisa Philp | Jennifer de St. Georges Annick Ducharme | Beth Thompson Cover image © thinkstockphotos.com

February 2012

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EDITORIAL

No Teeth Left Behind A new US study notes that dental expenses are among the highest out-of-pocket health cost to consumers, second only to prescription drug expenditures. The report, Oral Health Quality Improvement in the Era of Accountability, 1 provides an overview of current efforts and cites elements that are critical for advancing this agenda: increased use of electronic dental records and integrated health records; better measurement of oral health outcomes; new payment and incentive mechanisms; and expanded delivery of care by non-dental professionals, as well as new types of allied dental professionals. The report — the latest in a growing number of analyses of the oral health care system — was recently released at a national meeting of oral health professionals, government leaders, consumer advocates and others convened by the Kellogg Foundation and DentaQuest Institute that was intended to launch a national dialogue on quality improvement and increased access to dental care. Dental expenses are now among the highest out-of-pocket health expenditures for US consumers. In 2008, they accounted for $30.7 billion or 22.2 percent of total out-of-pocket health expenditures, second only to prescription medications, according to the US Bureau of Labor Statistics. The factors driving the focus on quality improvement in oral health care — and the need to align payment incentives with health care outcomes and value for patients — are the same ones

driving the overall health care quality movement: • The increasing cost of oral health care; • An increasing understanding of the unwarranted variability produced by the oral health system; • Evidence of profound health disparities in spite of scientific advances in care; and • Increasing awareness of these problems in the age of consumer empowerment. The report also outlines the systemic barriers that have slowed change: • Limited evidence of best practice for most dental procedures has led to widespread variation in clinical decisions among dentists; • Government only pays for about six percent of dental care nationally, and dental practices and their patients are not part of a larger provider organization pushing for improvements; and • Incentives to implement quality improve ment programs are few. However, increasing costs, inadequate access to care, and profound disparities are creating new pressures for the oral health delivery system to focus on value instead of volume of services. “With the current focus on quality improvement in health care, we need to make sure that oral health isn’t left behind,” said Alice Warner, program officer at the W.K. Kellogg Foundation. “Right now, 37 percent of African American children and 41 percent of Hispanic children have untreated tooth decay, compared with 25 percent of white children. We need to do better by all our children and this report provides ideas that can help lead the way.” n

Catherine Wilson

Editor

REFERENCES 1. http://dentaquestinstitute.org/quality-improvement-era-accountability

February 2012

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NEWS BRIEFS

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OHDQ Honors Hygienist’s Commitment to Profession Hu-Friedy Launches Medical Grade Hand Care Products in Canada Chicago, IL—Hu-Friedy Hand Essentials has been designed specifically to help promote proper hand hygiene protocols in the dental office. Each product supports specific routines that dental professionals perform each day, including hand washing and skin protection as recommended by the CDC. For more information: www.hu-friedy.com or www.handessentials.com

Brushing with Biebs Fontana, CA—Ashtel Dental, a US provider of entertainment and educational oral care products, recently shipped its one millionth

A BUSINESS INFORMATION GROUP PUBLICATION Dental Group Assistant: Editorial Director: Kahaliah Richards Catherine Wilson 416-510-6777 416-510-6785 cwilson@oralhealthgroup.com krichards@oralhealthgroup.com Art Direction: Andrea M. Smith Production Manager: Phyllis Wright Circulation: Cindi Holder Advertising Services: Karen Samuels 416-510-5190 karens@bizinfogroup.ca Consumer Ad Sales: Barb Lebo 905-709-2272 barblebo@rogers.com Classified Advertising: Karen Shaw 416-510-6770 kshaw@oralhealthgroup.com

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

Montreal—Annick Ducharme, RDH in Verdun, PQ, has been awarded the Racine Prize by the Quebec Order of Dental Hygienists (OHDQ) for 2011. With this award, the OHDQ honours and encourages dental hygienists who carry out research and publish scholarly articles in L’Explorateur, the official magazine of the OHDQ. Her winning article, “L’abfraction: connaître pour reconnaître,” appeared in the October, 2010 issue. Ms. Ducharme works in the office of Dr. Elliot Mechanic.

OFFICES Head Office: 80 Valleybrook Drive, Toronto ON M3B 2S7. Telephone 416-4425600, Fax 416-510-5140. Oral Hygiene is designed to provide the entire dental team with business management information to make practices more successful. Articles dealing with investment planning, personal finances, scheduling and collection procedures, in addition to lifestyle issues, are geared to all practicing Canadian dentists, hygienists, dental assistants and office managers. Please address all submissions to: The Editor, Oral Hygiene, 80 Valleybrook Drive, Toronto, ON M3B 2S7. Oral Hygiene (ISSN 0827-1305) will be published three times in 2012, 80 Valleybrook Drive, Toronto ON M3B 2S7.

Subscription rates: Canada $28.95 for 1 year; $43.95 for 2 years; USA $31.95 for 1 year; Foreign $49.95; for 1 year Single copy $19.00. Printed in Canada. All rights reserved. The contents of this publication may not be reproduced

either in part or in full without the written consent of the copyright owner. From time to time we make our subscription list available to select companies and organizations whose product or service may interest you. If you do not wish your contact information to be made available, please contact us via one of the following methods: Phone: 1-800-668-2374; Fax: 416-442-2191; E-mail: privacyofficer@ businessinformationgroup.ca; Mail to: Privacy Officer, Business Information Group, 80 Valleybrook Drive, Toronto ON M3B 2S7. Canada Post product agreement No. 40069240. Dental Practice Management is published quarterly by Business Information Group, a leading Canadian information campany with interests in daily and community newspapers and business-tobusiness information services. ISSN 0827-1305 (PRINT) ISSN 1923-3450 (ONLINE)

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ORAL HYGIENE Sebastiano Andreana, DDS

Director of Implant Dentistry and Associate Professor, Department of Restorative Dentistry, at the School of Dental Medicine at the University at Buffalo.

Use of the Diode Laser in Periodontal Therapy T

oday, periodontal disease is considered an inflammatory disease. Typically, pathogenic bacteria colonize the subgingival space and trigger an inflammatory host response that ultimately leads to loss of periodontal tissues, including alveolar bone, periodontal fibers and root cementum. The primary goal of periodontal therapy is eliminating the bacteria from the subgingval space and also, as suggested in the past few years, trying to control the inflammation and avoid its deleterious effects. There is some evidence that periodontal inflammation may lead to systemic problems throughout the body.1,2 Inflammatory cytokines are involved in myriad problems, including damage to blood vessels and effects on fetuses, and possibly trigger other consequences, such as “atherosclerosis, bacterial endocarditis, diabetes mellitus, respiratory disease, preterm delivery, rheumatoid arthritis, and, recently, osteoporosis, pancreatic cancer, metabolic syndrome, renal diseases and neurodegenerative diseases such as Alzheimer’s Disease.” 3 Eliminating bacteria and controlling the infection and inflammation caused by them is therefore of paramount relevance for the well-being of our patients. Historically, mechanical elimination of subgingival bacteria has been performed using hand-activated tools such as scalers and curettes, or ultrasonic devices. Occasionally local antibiotics also are used to suppress

periodontopathic bacteria. Ultimately, perio dontal surgery is performed to access root areas that are difficult to reach without raising a periodontal flap. In the past decades, an additional method of controlling periodontal infection is the use of dental lasers. Lasers of different wavelengths have been shown to have a bactericidal activity. The treatment is typically performed flapless, with the laser tip inserted into the periodontal pocket space following mechanical debridement. The two-fold objective of laser therapy is to first reduce the bacterial load and secondly, to exert an antiinflammatory treatment and eventually promote tissue regeneration.

Anti-microbial Activity Studies have shown that diode lasers have antimicrobial activity when used in animal models and human trials. Fontana and collaborators presented an in vivo study on rats.4 An 810 nm wavelength diode laser was used in ligature induced periodontal defects in rats, and particularly at 0.8 Watts, there was a significant reduction of periodontopathic bacteria such as Prevotella species, Fusobacterium species, Pseudomonas species, Escherichia coli, and Candida species. Similar findings in human studies were reported by Moritz et al. 5 These investigators ascertained that 810 nm diode laser treatment as an adjunct to scaling and root planing

February 2012 www.oralhealthgroup.com

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ORAL HYGIENE The laser fiber optic is inserted in the pocket parallel to the long axes of the tooth.

achieved better microbiological results than the control group that was scaling and root planing followed by H 2O2 rinsing. Further more, the study showed reduction of periodon tal parameters associated with inflammation. Microbiological improvement also was found in a clinical study by Harasthzy et al.6 These investigators treated 26 patients with generalized moderate to severe chronic peri odontitis in a split mouth design. Periodontal pockets were treated by mechanical scaling and root planing, and then one randomly se lected pocket was treated with an 810 nm di ode laser. The fiber optic laser tip was insert ed into the pocket, moved horizontally and vertically, and used in continuous mode at 0.8W for 30 secs per pocket. Subgingival bac terial samples were collected at three obser vation times (i.e., baseline and 3 and 6 months after treatment). The authors concluded that the “Diode laser treatment was efficacious in these periodontal pockets in reducing bacte rial numbers and the proportion of Actinobacillus actinomycetemcomitans (A.a).”6 It is interesting to note that periodontal infections with presence of A.a is treated with a combi nation of amoxicillin and metronidazole.7 A clinical study using an 810 nm diode la ser was conducted by Moritz and collabora tors. 8 Among different periodontal indices, these authors considered the papillary bleed ing index (PBI), which is indicative of the in flammatory status of the gingival papilla.

Following scaling and root planing and diode laser therapy, the PBI values improved in ap proximately 97% of the lased patients, where as the PBI improved in 67% of the control group (non lased). Furthermore, in the lased group, the overall periodontal pocket depth decreased from 3.9 mm to 2.6 mm. The con trol group also showed reduction of an over all periodontal pocket depth, however the reduction was not as relevant.

Anti-inflammatory Response The 810 nm wavelength has also been used as an adjunct to periodontal flap surgery by Sanz Moliner and Ciancio.9 These clinicians treated 13 patients that were scheduled for surgical periodontal therapy. The patients had to have periodontal pockets in two dif ferent quadrants, with at least one tooth ex hibiting a probing depth (PD) of >7 millime ters (mm) and clinical attachment levels (CAL) of >7 mm. The study design indicated that one side was randomly selected to re ceive conventional periodontal surgery (con trol group), and the test group was to receive the same surgical therapy in conjunction with 810 nm diode laser therapy. The laser was used specifically to de-epithelialize the inner aspect of the periodontal flap and addition ally to photo-biostimulate the operated area. The two different treatments were conducted in two different visits. The results indicated that the first surgical treatment performed in

February 2012

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ORAL HYGIENE

The laser fiber optic is inserted following Scaling Root Planing.

The laser tip has some soft tissue debris following irradiation, and needs to be cleaned.

The laser tip is used to obtain photobiostimulation effects following laser assisted periodontal surgery.

Use of diode laser in periodontal therapy has both an antimicrobial and a wound-healing/anti-inflammatory effect as adjunct to periodontal therapy both groups was rated as more painful than the second (p<0.05). When data was analyzed from the first surgical procedure, it was found that using the 810 nm diode laser as an adjunct to periodontal surgery “provided less postoperative pain and tissue edema and was safe to oral tissues.” 9 Use of a 790 nm diode laser was found to demonstrate direct anti-inflammatory effects on inflamed regions compared with those of indomethacin, a potent anti-inflammatory agent. The authors found that a 790 nm laser had an anti-inflammatory effect on inflammation.10 These authors induced different inflammatory lesions on rats and later exposed the lesions to either laser irradiation or systemic treatment with indomethacin. The results indicated that the irradiation for less than 10 minutes was sufficient to inhibit the inflammation by 20% to 30%. Among the findings, reduction of edema was reported. Interestingly, reduction of edema also was reported in the clinical study by Sanz Moliner and Ciancio,9 where reduction of edema was reported in those surgical periodontal sites following periodontal surgery and laser irradiation.

Wound Healing

According to Krayer, Leite and Kirkwood,11 “non-steroidal anti-inflammatory drugs

(NSAIDs) represent a pharmacological class of agents that has been well studied as inhibitors of the host response in periodontal disease.” The possibility of using the diode laser to enhance the host anti-inflammatory response primarily leads to two major outcomes. The first applies to the patient, who has to take less anti-inflammatory medications. The second directly applies to the healing process. Inflammatory processes also lead to bone loss, which is critical for maintaining the periodontally involved teeth. One additional clinical study was recently published by Aykol G et al.12 These investigators used an 808 nm diode laser as adjunctive treatment to scaling and root planing in 18 patients. The control group of another 18 patients received conventional mechanical treatment. The clinicians followed all 36 patients up to 6 months. Among the parameters checked, the presence of specific inflammatory biomarkers such as Matrix metalloproteinase-1, tissue inhibitor matrix metalloproteinase-1, transforming growth factor-β1, and basic-fibroblast growth factor in the gingival crevicular fluid was investigated. The authors concluded that the use of the 808 nm diode laser as adjunctive treatment to conventional periodontal therapy “improves periodontal healing.”

February 2012

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ORAL HYGIENE

Conclusion Reviewing the above mentioned clinical studies, one factor becomes apparent: the reduction of inflammation during the healing period following use of the diode laser as an adjunct to both mechanical non-surgical and mechanical surgical therapy. Additionally, the anti-inflammatory effect of the diode laser fits well within the recent understanding of periodontal disease, its inflammatory process, and modern therapeutic approaches. It can be concluded, therefore, that the use of a diode laser in periodontal therapy as an adjunct has both an antimicrobial and woundhealing/anti-inflammatory. n

REFERENCES 1. Teles R, Wang CY. Mechanisms involved in the association between periodontal diseases and cardiovascular disease. Oral Dis. 2011 Jul;17(5):450-61. 2. Fisher MA, Borgnakke WS, Taylor GW.

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Periodontal disease as a risk marker in coronary heart disease and chronic kidney disease. Curr Opin Nephrol Hypertens. 2010 Nov;19(6):519-26. 3. P izzo G, Guiglia R, Lo Russo L, Campisi G. Dentistry and internal medicine: from the focal infection theory to the periodontal medicine concept. Eur J Inter Med 2010; Dec;21(6):496-502. 4. Fontana CR, Kurachi C, Mendonça CR, Bagnato VS. Microbial reduction in periodontal pockets under exposition of a medium power diode laser: an experimental study in rats. Lasers Surg Med. 2004; 35(4):263-8. 5. Moritz A, Schoop U, Goharkhay K, Schauer P, Doertbudak O, Wernisch J, Sperr W. Treatment of periodontal pockets with a diode laser. Lasers Surg Med. 1998; 22(5):302-11. 6. Harasthzy VI, Zambon MM, Ciancio SG, and Zambon JJ. Microbiological effects of diode laser treatment of periodontal pockets. J Dent Res. 2006;85; Spec Issue A, Abs 1163. 7. Mombelli A. Antimicrobial advances in treating periodontal diseases. Front Oral Biol. 2012;15:133-48. 8. Moritz A, Gutknecht N, Doertbudak O, Goharkhay K, Schoop U, Schauer P, Sperr W. Bacterial reduction in periodontal pockets through irradiation with a diode laser: a pilot study. J Clin Laser Med Surg. 1997 Feb;15(1):33-7. 9. Sanz Moliner J, Ciancio SG. A diode laser as an adjunct to periodontal surgery. J Dent Res. 2009; 88 Spec Issue A, abs 847. 10. Honmura A, Yanase M, Obata J, Haruki E. Therapeutic effect of Ga-Al-As diode laser irradiation on experimentally induced inflammation in rats. Lasers Surg Med. 1992;12(4):441-9. 11. K rayer JW, Leite RS and Kirkwood, KL. Non-Surgical Chemotherapeutic Treatment Strategies for the Management of Periodontal Diseases. Dent Clin North Am. 2010 Jan;54(1):13-33. 12. Aykol G, Baser U, Maden I, Kazak Z, Onan U, Tanrikulu-Kucuk S, Ademoglu E, Issever H, Yalcin F. The effect of lowlevel laser therapy as an adjunct to nonsurgical periodontal treatment. J Perio dontol. 2011 Mar;82(3):481-8. Epub 2010 Oct 8.

February 2012 www.oralhealthgroup.com

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ORAL HYGIENE

The Effective Use of Technological Tools Sandra Bluteau, HD

Graduated in 1998 at Collège ÉdouardMontpetit. She is currently a member of the dental team of Dr. Elliot Mechanic in Montreal.

hen the time comes to invest in technological equipment, dentists have an overwhelming array of choices. Nonetheless, they must carefully select the tools they need, taking into account the time that will be allotted to secretaries, assistants and dental hygienists in order to maximize the use of each technology and make the investment profitable. Moreover, members of their team need to be motivated and openminded, because changing our habits and dealing with the increased workload while maintaining our usual level of efficiency is often difficult, especially during the first few weeks. Let’s take a look at how I perceive some of the technological tools used at my dental clinic and how I make the most of them. All you’ll need to do after that is devise your own plan! When new patients come to our dental office, they are greeted by the secretary, who is in charge of the first task: taking photos. The camera is the first tool we use to determine certain aspects of a patient’s mouth and dentition. The photos we select are our gateway to the patient. I take the opportunity to introduce myself as a dental hygienist and try to get to know the patient a little better. We always take the same type of photos and store them in our computer system for later reference. The patient is first photographed frontally, face relaxed, smiling and with retractors (Fig. 1). Photos with retractors are extremely important because they provide us with a great deal of information. Next, colour prints on paper are made of selected photos and are given to me. This gives me a fairly good idea of the points that will be covered during the appointment. I really enjoy showing patients pictures of their own smile. They’re usually

quite surprised to see that there is considerable difference between a smile and a view of their teeth. I don’t want to discourage patients so I always provide them with a constructive analysis of their mouth. Together, we look at the occlusion of the mouth, which the patients can easily see with the help of the photos. The extra-oral photos allow me to share very relevant information with patients during the first few minutes of the appointment without even asking them to open their mouth! This approach fosters discussion and facilitates dialogue since the patient is not reclining in the chair, mouth wide open. It is therefore easier for patients to apprise me of their expectations and tell me what they find aesthetically unsatisfactory, if that is the case. The initial photos usually take patients by surprise, but in a positive way. The images allow them to discover their mouth for the first time. To maximize the benefits, you’ll need a high-quality camera with a lens, a bit of training and access to a computer equipped with an image-saving program, such as Imaging. The camera is a tool that can be used extensively on a daily basis to facilitate communication between the dental team and patients. We gain a wealth of information about our patients from data collected this way and our patients are the ones who ultimately benefit from it. The intra-oral camera is also an extremely helpful tool that I use every day with each of my patients. I think it has become a must in most dental offices. However, its cost-effectiveness depends on how frequently it is used. Never let your intra-oral camera just sit there collecting dust in a corner of the clinic and don’t forget that a picture is worth a thousand words! As far as I’m concerned, it would be impossible to work now without

February 2012 www.oralhealthgroup.com

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ORAL HYGIENE 1

this invaluable ally. New patients have a full session of intraoral photos. During each follow-up exam appointment, the dental hygienists take the same type of pictures in the same way. This provides us with very interesting points of comparison. As an example, for my orthodontics patients, I take a photo of the upper arch and another of the lower arch to observe any changes and repositioning of the teeth. My patients love these photos because they clearly show that the treatment is progressing well. For new patients, I take 25 to 30 intraoral photos that are indicative of their dental health. Everything from fillings and gum recession to tartar build-up is well recorded and stored in the photo file. Additionally, a photo of the lower anteriors is taken before and after cleaning during each subsequent follow-up appointment so that patients can personally assess their level of hygiene and the work their dental hygienist has They can also see an image of each tooth that may require treatment. Intra-oral cameras are extremely easy to use. They just have to be accessible and used on a regular basis. You’ll soon see that it’s impossible to do without them! Imagine if all patients could judge the hygienist’s excellent work for themselves and, at the same time, see their cavities, defective fillings and gum problems on a large screen. Investing in a good camera and having a high-quality screen in every patient room is the best investment my dentist ever made. Even though we are not a periodontal office, the fact remains that more than half of

our patients will present periodontal problems ranging from mild to severe over the course of their lifetime. We acquired a phase contrast microscope. We want to provide as much information to our clients as possible, and it turns out that the microscope is an excellent tool. Generally, as a matter of professional choice, we entrust these cases to the periodontist on our team. We perform some cleanings under topical or local anesthesia, but the more serious cases are referred to colleagues. Now you are probably wondering what purpose our microscope serves. I should mention at this point that each hygienist on our team has received adequate training on how to use a microscope and on periodontal treatment. However, we have decided to use this tool more as a motivating factor and to trigger a reaction from patients. This way, we’re able to store relevant information in the patient’s file and, among other things, quantify the bacteria present on each visit. Our microscope is connected to a large screen, which allows the patients to see the bacteria immediately. Patients react instantly and show astonishing interest. I use the microscope to motivate patients to maintain a higher level of hygiene and provide them with sound reasons for visiting the hygienist every three or four months. Together, we observe the various bacteria visible on the image projected on my screen and I describe what we both see to amaze and motivate my patients. I make it clear to patients that this is not a bacteriological lab test, but rather a procedure that enables me to determine if their

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bacteria levels are normal or excessively high. There is also a large chart in the room showing which bacteria are considered normal in the mouth and which are considered abnormal. Patients can refer to it and judge for themselves as I give them the name of the bacteria detected. When used with a degree of simplicity and relevance, the microscope can be a motivational tool for oral hygiene. It allows us to advise patients to see a periodontist and get the most out of the consultation. Since, as we know, patients are generally in no hurry to consult a periodontist, the microscope proves to be a very compelling tool. Another technological tool that is highly appreciated by the dentist and dental hygienists in our office is the Florida Probe system. This computerized tool for measuring periodontal pocket depth wasn’t the first on the market, but we believe it is the best suited for our purposes because it is very easy to use and surprisingly accurate. The clarity of the full-colour odontogram (image 4) is another of its advantages. Indeed, it allows patients to easily understand the hard copy of the probe results that we give them at the end of the appointment. We recently decided to use the Florida Probe system on all patients during their routine cleaning visit. It’s an enormous task, but the results are really worth it. Consequently, we are able to build a data bank on each patient experiencing gum problems. Since cleaning appointments last one hour, we have to use the Florida Probe system efficiently. Each hygienist configures the software that is available in all the rooms before the patient arrives. Once these preparatory steps have been carried out, measure-

ments can be taken in under ten minutes. In my opinion, periodontal disease is the most difficult problem to fully explain to patients in concrete terms because it requires tact and perseverance. That’s why the Florida Probe system (Dental Savings Club) is such a valuable ally. It is by far more convincing than mere words. It shows patients their periodontal pockets via images, thereby enabling them to actually see the problem in their mouth. The Florida Probe system is not difficult to use or complicated to sterilize. Since the patient’s discomfort is minimal, I would qualify it as an indispensable tool and would add that it greatly simplifies my job. I will close by saying that you need to be able to stand out from other dental practices in terms of customer satisfaction. The means used to achieve this objective may vary greatly from one clinic to the next, but I think that, all things considered, customer satisfaction is the number one priority. Obviously, technological tools are only expedients for attaining this goal, but I find that they greatly facilitate my work. Moreover, patients generally have a very positive view of technology. They like to understand all the benefits they can derive from photos, microscopes and periodontal charts. Nevertheless, introducing any of these tools clearly requires an investment of time and money as well as a high level of conviction and determination on the part of the entire dental team. It is very encouraging to see that patients appreciate the technology we use and the way we use it. This is what I’ve noticed over the past six years of my practice working with a dentist who is always keeping up with the latest technological advances and knows how to take advantage of that technology! n

February 2012 www.oralhealthgroup.com

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L’utilisation Efficace d’outils Technologiques Q Sandra Bluteau, HD

À obtenue son diplôme en 1998 au Collège ÉdouardMontpetit. Elle travaillé actuellement à l’Ile des Sœurs au sein de l’équipe dentaire du Dr Elliot Mechanic.

uand vient le temps d’investir dans l’équipement technologique, les dentistes n’ont que l’embarras du choix. Cependant, ils doivent sélectionner avec soin les outils dont ils ont besoin en pensant au temps qui sera alloué aux secrétaires, assistantes et hygiénistes dentaires de manière à maximiser l’utilisation de chaque technologie et, ainsi, à rentabiliser leur investissement. De plus, les membres de leur équipe doivent être motivés et avoir l’esprit ouvert, car il est souvent difficile, au cours des premières semaines, de changer nos habitudes et d’ajouter à nos tâches tout en demeurant aussi efficaces. Voyons maintenant comment je perçois certains outils technologiques utilisés dans ma propre clinique dentaire et comment je m’emploie à les mettre à profit. Vous n’aurez plus ensuite qu’à dresser votre propre plan! À son arrivée à notre cabinet dentaire, le nouveau patient est accueilli par la secrétaire qui s’affaire aussitôt à la première tâche, la prise de photos. L’appareil-photo est le premier outil que nous utilisons pour révéler certains aspects de la bouche et de la dentition au patient. Les photos sélectionnées constituent notre carte d’entrée auprès du patient. En tant qu’hygiéniste dentaire, je me sers de cette occasion pour me présenter au patient et tenter de le connaître un peu davantage. Les photos retenues sont toujours les mêmes et sont gardées dans notre système informatisé pour utilisation ultérieure. Le patient est d’abord photographié de face, visage au repos, avec un sourire et des écarteurs (Fig. 1). Comme les photos avec écarteurs nous donnent beaucoup de renseignements, elles sont vraiment importantes. Les photos choisies sont par la suite imprimées en couleur sur papier et me sont remises, ce qui me donne déjà un bon aperçu des points qui seront abordés pendant le rendez-vous. J’aime beaucoup présenter au patient son propre

sourire en images. Ce dernier est habituellement très surpris de constater qu’il existe une grande différence entre un sourire et un aperçu de ses dents. Soucieuse de ne pas décourager le patient, je lui propose toujours une analyse constructive de sa bouche. Nous regardons ensemble l’occlusion de la bouche que le patient peut facilement visualiser grâce aux photos. Les photos extra-orales me permettent de transmettre des informations très pertinentes au patient dès les premières minutes du rendez-vous, et ce, sans même lui ouvrir la bouche! Cette mesure favorise la discussion et facilitent les échanges puisque le patient n’est pas allongé sur la chaise la bouche ouverte. Il lui est alors plus simple de me faire part de ses attentes et, le cas échéant, de ce qu’il juge insatisfaisant sur le plan esthétique. Les photos d’introduction surprennent généralement les patients, mais de façon favorable. Ils découvrent leur bouche en images pour la première fois. Pour profiter de ces bienfaits, vous aurez besoin d’une caméra de qualité avec objectif, d’une courte formation et d’un accès à un ordinateur comprenant un programme de sauvegarde d’images, comme Imaging. La caméra, outil de tous les jours et de tout moment, aide à la communication entre les membres de l’équipe dentaire et les patients. Les données ainsi recueillies nous donnent une foule de renseignements sur nos patients qui finissent par en bénéficier en fin de compte. De son côté, la caméra intra-orale est un outil fort utile que j’utilise quotidiennement avec chacun de mes patients. Je crois que cet outil est devenu aujourd’hui un « must » dans la plupart des cabinets dentaires. Par contre, sa rentabilité est liée à sa fréquence d’utilisation. Ne laissez jamais votre caméra intra-orale inutilisée dans un coin de la clinique et n’oubliez pas qu’une image vaut mille mots! Pour ma part, il me serait impossible

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maintenant de travailler sans ce précieux allié. Le nouveau patient a droit à une séance complète de photos intra-orales. À chaque rendez-vous pour examen de rappel, les hygiénistes dentaires prennent les mêmes images, de la même façon, ce qui nous donne des points de comparaison fort intéressants. Par exemple, pour mes patients suivis en orthodontie, je prends une photo de l’arche supérieure et une autre de l’arche inférieure afin de constater l’évolution et le repositionnement des dents (image2). Mes patients adorent ces images qui montrent clairement que le traitement avance bien. Pour le nouveau patient, je prends entre 25 et 30 photos intra-orales représentatives de sa santé dentaire. Les obturations, les récessions de gencives, la quantité de tartre, tout est bien représenté et conservé dans le dossier image. De plus, à chacun des futurs rendez-vous de rappel, le patient aura droit à une image des antérieures inférieures, avant et après son nettoyage, afin qu’il puisse évaluer par luimême son niveau d’hygiène et le travail de son hygiéniste (image3). Il pourra voir aussi une image de chaque dent susceptible de nécessiter un traitement. Il est très facile d’utiliser la caméra intra-orale. Il suffit de la rendre accessible et de prendre l’habitude de l’utiliser tout le temps. Puis, vous verrez, il devient impossible de s’en passer! Imaginez que chaque patient puisse juger par lui-même de l’excellent travail de l’hygiéniste et qu’il puisse, en plus, voir sur grand écran, ses caries, ses obturations défectueuses et ses défauts de gencive. Investir dans un bon appareil photo et dans un écran de qualité présents dans chaque salle de travail est le meilleur investissement que mon dentiste a fait. Même si nous ne sommes pas un bureau de

parodontie, un fait demeure : plus de la moitié de nos patients présenteront au cours de leur vie un problème parodontal qui ira de léger à sévère. Nous avons fait l’acquisition d’un microscope à contraste de phase. Comme nous voulons offrir le plus de renseignements à nos clients, le microscope est un excellent outil. Généralement, nous confions ces cas au parodontiste qui travaille au sein de notre équipe, et ce, par choix professionnel. Nous faisons quelques nettoyages sous anesthésie topique ou locale, mais les cas les plus lourds sont transmis à des confrères. Alors, vous vous demandez certainement à quoi nous sert notre microscope? Il convient de mentionner à ce point-ci que chaque hygiéniste de notre équipe a reçu une formation adéquate quant à la façon d’utiliser le microscope de même que sur les traitements parodontaux. Par contre, nous avons fait le choix de l’utiliser davantage comme élément motivateur et déclencheur chez le patient. De ce fait, cela nous permet d’emmagasiner des renseignements pertinents dans le dossier du patient, entre autres, de quantifier les bactéries présentes à chacun des rendez-vous. Notre microscope est branché à un grand écran, ce qui permet au patient de visualiser les bactéries sur-le-champ. La réaction du patient est immédiate et son intérêt est surprenant. Je me sers du microscope dans le but de motiver un patient à maintenir un meilleur niveau d’hygiène et de lui donner d’excellentes raisons de visiter l’hygiéniste tous les trois ou quatre mois. Nous observons ensemble les différentes bactéries sur l’image projetée à mon écran et je lui décris ce que nous voyons tous deux dans le but de le surprendre et de le motiver. J’explique très bien au patient qu’il ne s’agit pas d’un test bactériologique de laboratoire,

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mais plutôt d’une procédure qui me permet de lui dire s’il a des bactéries en quantités normales ou excessives. De plus, le patient peut voir dans la salle un grand tableau représentant les bactéries dont la présence est jugée normale ou anormale en bouche. Ainsi, le patient peut juger par lui-même en s’y référant au fur et à mesure que je lui donne le nom des bactéries aperçues. Utilisé de façon simple et pertinente, le microscope est un outil de motivation d’hygiène buccale qui nous permet d’inviter le patient à consulter un parodontiste et de renforcer les bienfaits de cette consultation. Comme nous savons que les patients ne se précipitent pas chez les parodontistes, le microscope devient alors un outil très convaincant. Un autre outil technologique bien apprécié par le dentiste et les hygiénistes de notre cabinet dentaire est le système de sonde appelé Florida Probe. Cet outil informatisé de mesure parodontale n’est pas le premier sur le marché, mais nous croyons avoir trouvé celui qui nous convient, car sa facilité d’utilisation et sa précision sont surprenantes. La clarté de l’odontogramme tout en couleur (image 4) est une autre de ses qualités; en effet, elle permet au patient de comprendre facilement les résultats du sondage qui lui sont remis sur papier à la fin du rendez-vous. Récemment, nous avons pris la décision d’utiliser le système Florida Probe avec chaque patient lors de son rendez-vous de nettoyage de rappel. C’est un travail colossal, mais les résultats en valent vraiment la peine. Nous obtenons ainsi une banque de données sur chaque patient aux prises avec des problèmes de gencives. Puisque les rendez-vous de nettoyage ont durent une heure, nous devons être faire preuve d’efficacité quant nous utilisons le système Florida Probe. Chaque hygiéniste paramètre le logiciel qui se trouve dans chacune des salles avant l’arrivée du patient. Grâce à cette

préparation, la prise de mesures nécessite moins de dix minutes. La maladie parodontale est selon moi le problème le plus difficile à expliquer concrètement aux patients, car cela demande du tact et de la persévérance. C’est pourquoi le système Florida Probe se révèle un précieux complice. Il est à coup sûr plus convaincant que de simples paroles. De fait, il présente, sous forme d’images, les poches parodontales du patient qui peut lui-même visualiser le problème dans sa bouche. Le système Florida Probe est simple d’utilisation et facile à stériliser. Comme l’inconfort des patients est minime, je qualifierais cet outil d’indispensable et j’ajouterais qu’il simplifie grandement ma tâche. En terminant, je dirais qu’il faut savoir se démarquer des autres cabinets dentaires sur le plan de la satisfaction des clients. Les moyens utilisés peuvent être très différents d’une clinique à une autre, mais je crois que la satisfaction des clients est, entre toutes, la priorité numéro un. Les outils technologiques ne sont que des moyens pour y parvenir, certes, mais je constate qu’ils facilitent énormément mon travail, sans compter que la perception des patients est généralement très positive à l’égard de la technologie. Ils aiment comprendre tout ce dont ils peuvent bénéficier des photos, des microscopes et des chartes parodontales. Par ailleurs, il est bien évident que l’introduction de n’importe lequel de ces outils nécessite un investissement de temps et d’argent ainsi qu’une dose de conviction et de persévérance de la part de toute l’équipe dentaire. Il est très encourageant de constater que les patients apprécient la technologie que nous employons et l’utilisation que nous en faisons. C’est ce que j’ai pu constater durant les six dernières années de ma pratique, entourée d’un dentiste qui se tient constamment à la fine pointe de la technologie et qui sait en tirer profit! n

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Dental Hygiene Rehabilitation A

Annick Ducharme, RDH

A valued member of Dr. Elliot Mechanic’s team in Montreal. This graduate from Trois- Rivieres Cegep as well as the University of Montreal, has been the recipient of le Prix du Lecteur on two separate occasions. Such honors have been awarded to her by her peers for the publication of her articles in OHDQ dental magazine. Annick has sat on the board of multiple committees for the OHDQ and CADC but is also recognized as a distinguished guest speaker for several associations, among them, Diabete Quebec and Les Salons de la famille.

February 2012

s a general rule, dental hygiene rehabi li tation is defined as follows: “The process of helping a person to readapt in order to recover deteriorated facul ties and physical functions or to overcome dis cernible deficiencies through re-education.” Thanks to technological advances in den tistry, we are able to rehabilitate a person’s chewing ability in an increasing number of cases. Dental rehabilitation restores deterio rated physical functions and enables patients to benefit from a better quality of life. Plan ning for this type of treatment is extremely im portant and complex. Indeed, dental rehabili tation requires the involvement of a significant number of people and the implementation of a broad range of measures. This sort of treat ment brings several facets of dental medicine into play: endodontic treatment, sinus eleva tions, bone grafts, implants, crowns, bridges, CAD/CAM bars, periodontal procedures, etc. The questions that should be asked are: What factors caused the dental state to dete riorate to the point where the structures are no longer functional? And what steps need to be taken to prevent the reoccurrence of incorrect habits that could have an adverse effect on the viability of dental rehabilitation treatment over the medium or long term? Unfortunately, it is still all too often the case that the dental hygienist — who is the preventive treatment plan specialist — is not adequately consulted. To illustrate my point, I will describe a common procedure that will help you under stand the inadequacies that sometimes occur in dentistry. Bariatric surgery, for instance, requires various surgical procedures involv ing restriction (volume reduction) or malab sorption (deprivation) to treat morbid obesity or reduce an individual’s weight. The surgical phase is the nucleus or focal point of this re habilitation, just as curative procedures are in dentistry. Moreover, a patient would never undergo bariatric surgery without first hav ing met with a dietitian to review and assess his or her eating habits! Nor would a post-op

patient be sent home without having again met with a health specialist. Several subse quent visits would be scheduled to monitor the patient’s weight and perform dietary as sessments because these are essential mea sures for ensuring the treatment’s success. Why should it be different in dentistry? Although my comments focus on full reha bilitation, the fact remains that after a dental bridge has been inserted it is important to make sure that the patient has mastered the correct way to use dental floss and that the patient’s technique is reassessed during the next cleaning appointment. Obviously, we would not call patients back simply to ensure that they have mastered the proper flossing technique for a bridge unit, but the success of treatment aimed at full rehabilitation hinges on mastering this technique. That is why it is important to fully inform the patient before treatment begins. I will use three patients to demonstrate the essential role dental hygienists play. The first patient, Mr. Y, is a businessman in his late forties who is starting a relationship with a slightly younger woman. Not an unusual situ ation! She lets him know gently but firmly that his teeth are “a mess”! After taking a look at the picture below, I am sure you will agree that this patient unquestionably needs dental care, and not just to please his new heartthrob. You will also concur that a pre ventive care plan should be established to reeducate Mr. Y, because even though he’s still under 50, his mouth is in a deplorable state. After examining the patient’s mouth, the dentist, denturist and surgeon devised a treatment plan similar to the following: – C omplete extraction of teeth and residual roots. – I nsertion of five implants on the lower jaw. – I nsertion of a CAD-CAM bar. – C onstruction of a removable denture with a Locator system and little clamp (clip) on the lower jaw. – C onstruction of a complete removable

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1. Mr. Y, before treatment 2. Mr. Y, after treatment 3. Mr. Y, after six months 4. Ms. X, 1st year, monthly checkup. 5. Ms. X today, two-month checkup.

equilibrated maxillary denture. – Monthly monitoring of his oral hygiene during the first three months and a reassessment of his dental hygiene needs. This will require a minimum of two yearly visits. As you just read, the treatment plan includes a hygiene component, which is just as important as the other steps. The dental professionals involved decided on a removable prosthesis on a bar rather than a fixed prosthesis because it is easier and less complicated to maintain. Oral hygiene monitoring began even before the prostheses were constructed, i.e., during the osseointegration and transition prostheses period. The purpose of the visits was to allow the patient to relearn hygiene habits so that he would already have acquired sufficient dexterity to ensure the proper maintenance of his mouth by the time D-Day arrived. It is imperative that patients have a brief interview with the hygienist on the day the new prostheses are loaded and inserted. The interview should be short, concise and effective since experience has taught us that patients pay minimal attention at that stage of treatment. Next, the patient should make another appointment to ensure the proper maintenance of the bar, posts and prostheses. I do not believe that there is a sole universal formula that can be applied to everyone. Since each case is different, you must determine what is appropriate for patients and suggest a few options based on what you observe in their mouths. When it comes to dental hygiene, we

are the experts and are in the best position to assess the condition of our patients’ mouths and make recommendations. Patients have to go home with their oral hygiene kit and experiment for themselves. That is how they will find out which components they like and which ones they have trouble with. During the monthly visits over the first three months, it is important to look for and find the winning solution for the patient. These visits are intended to monitor the patients’ hygiene, answer their questions, correct inadequacies and assess tartar accumulation. You are better equipped at that point to determine their dental hygiene needs and the frequency of periodic follow-ups. Oral hygiene monitoring is especially important because we know full well that our patients’ saliva may be alkaline, thereby requiring more frequent cleanings. Fortunately, during our meetings, Mr. Y was able to demonstrate that he had good control of his oral hygiene and that the steps taken were perfectly suited to his case. We therefore decided on biannual follow-ups, while leaving open the possibility of making changes if needed. As a result, two annual visits proved to be the ideal frequency for this patient, as evidenced by the photo! Unfortunately, it’s not always that easy. My second patient, Mss. X, is a case in point. Thanks to the dental hygienist’s intervention, this patient’s situation could be corrected before it was too late. Ms. X is a very attractive woman in the fifties. She has been entirely edentulous for over

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Photo Credit: Mechanic, Dr. Elliot. 2009.2010.2011. Montreal, Quebec.

thirty years and, until recently, simply made do with her removable dentures. However, in the past months, her dentures had become increasingly unstable and were hurting her. The denturist she consulted noted a significant atrophy of the mandibular ridge. Since a new prosthesis would hardly correct the situation, a CAD/CAM bar on implants was suggested. After a thorough review, the maxillofacial surgeon approved the treatment plan, but informed us that the bone loss was too severe and that the remaining space available could accommodate a maximum of three implants. The loss of an implant, over the short or long term, is a disaster because the patient is unable to receive an implant-supported prosthesis and is forced to replace it with a gum implant implant-supported prosthesis instead, which is more effective but less comfortable. In this particular case, oral hygiene follow-up was crucial, especially due to the fact that this patient’s hygiene over the past thirty years was limited to cleaning her dentures outside the mouth. No toothbrush, dental floss or other dental care adjunct ever passed her lips. It was quite a challenge for both her and me! Maintaining the healing caps was no easy task, but Ms. X did an excellent job. Loading and insertion posed no problem. A few days before our first monthly meeting, the patient made an appointment with our denturist because it was becoming increasingly difficult for her to affix her denture securely. It was determined during the visit that there was an excessive accumulation of tartar on the bar, which was hindering the attachment. I immediately did a scaling of the patient’s teeth, thereby making it possible to firmly attach the denture to the bar and secure it in place. Our team worked very hard over the following months. Ms. X was scheduled for monthly visits for the first year. Given the positive results, visits are now scheduled on a two-month basis and the patient is doing much better. As for my third patient, her treatment in-

volved installing a fixed implant-supported complete denture. Patients undergoing this treatment must be fully aware of the maintenance that this type of intervention requires and that they will have to perform if they want to maintain good oral health. Even before devising a treatment plan, the dentist must assess the patient’s ability to take care for his/her teeth in a way that will ensure the integrity of future treatments. It is appropriate to begin managing the patient as early as the osseointegration phase. In these kinds of situations, the first appointment after loading the implants is the most important. The dental hygienist’s job is to determine, based on his/her experience, which course of action would most likely help the patient ensure proper oral maintenance (placement, angle, type of floss threader, insertion area, etc.). As you and I know, there is always a small space that facilitates the insertion of various adjuncts under bridges. During hygiene demonstrations, this fact can help patients assimilate the techniques more quickly and easily. Unlike the bar, fixed prostheses always have less underlying space. Consequently, the initiation process is often more tedious and requires more patience. Photos taken over the course of the entire treatment can be very useful to you and the patient for understanding which areas to clean. In conclusion, as a dental health professional, you are asked to play several important roles in dental hygiene rehabilitation. If you are a dental hygienist, you are the person who is the best trained and best suited to serve as “coach,” the one your patients can count on for their oral maintenance. You need to give patients instructions to follow, motivate them, encourage them to persevere and correct any situation deemed necessary while providing them with the care they require. For all these reasons, I say to you “be proud to be called a dental hygienist” and never underestimate your role, because the results you can achieve are nothing short of wonderful and amazing. n

REFERENCES 1. De Villers, Marie-Éva. Multidictionnaire de la langue française. 5th edition: Québec Amérique, 2010. 2. L e petit Larousse illustré. Paris: Éditions Larousse, 2011.

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03/02/12 8:43 AM

NEEDLE-FREE ANESTHESIA

NEEDLE-FREE: PERIODONTAL DEBRIDEMENT ANESTHETIC GEL • Oraqix® – the needle-free, site-specific (periodontal pockets) anesthesia. Fast acting Oraqix® has a 30 second onset of action of local anesthetic effect – assessed by probing of pocket depths – with a duration of approximately 20 minutes (individual overall range 14 to 27 minutes).1 Oraqix® dispenses as a liquid, then sets as a gel, in the periodontal pocket. Showing its efficacy, Oraqix® demonstrated less pain than placebo treated patients.1 Oraqix® provides a needle-free, blunt-tipped application that can be conveniently administered by a Registered Dental Hygienist.

Oraqix® is not for injection or use with standard dental syringes. Oraqix® (lidocaine and prilocaine periodontal gel) 2.5%/2.5%. Indications and Usage: Oraqix® is indicated for topical application in periodontal pockets for moderate pain during scaling and/or root planing. Safety and effectiveness in pediatric patients under 18 have not been studied. Product Characteristics: A subgingival locally applied anesthetic gel consisting of a eutectic mixture of lidocaine and prilocaine in a new thermosetting system, Oraqix® dispenses as a liquid, then sets as a gel in the periodontal pocket. Contraindications: Oraqix® is contraindicated in patients with a known history of hypersensitivity to local anesthetics of the amide type or to any other component of the product; and/or in patients with congenital or idiopathic methemoglobinemia. Adverse Reactions: The most common adverse reactions in clinical studies were application site reactions 15%, headaches 2%, and taste perversion 2%. Reference: 1. Oraqix® Product Monograph, DENTSPLY Canada Limited 2009.

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PRESENTS

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ORAL HYGIENE

La réhabilitation de l’hygiène dentaire E

Annick Ducharme, RDH

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

n règle générale, on définit la réhabilitation de la manière suivante : « Action d’adapter à nouveau une personne afin de récupérer des facultés, des fonctionnalités physiques dégradées ou bien de pallier par rééducation les carences apparues. » Dans l’univers de la dentisterie, il arrive de plus en plus fréquemment, grâce notamment aux progrès de la technologie, que nous puissions réhabiliter les fonctions masticatoires des individus. La réhabilitation dentaire a pour effet de rétablir des fonctionnalités physiques dégradées et de permettre aux patients de bénéficier d’une meilleure qualité de vie. La planification de ce type de traitement est extrêmement importante et complexe. En effet, la réhabilitation dentaire nécessite l’intervention d’une multitude de personnes et la mise de l’avant d’un bon nombre de mesures. La réalisation d’un pareil traitement fait appel à plusieurs aspects de la médecine dentaire : traitements endodontiques, élévations sinusales, greffes osseuses, implants, couronnes, ponts, barres CAD-CAM, interventions parodontales, etc. La question : quelles sont les raisons qui ont entraîné une dégradation de l’état dentaire au point où les structures ne sont plus fonctionnelles? Et quels sont les moyens qui doivent être mis en œuvre pour éviter que ne se reproduisent les comportements inappropriés qui risquent d’avoir un impact sur la viabilité des traitements dentaires de réhabilitation à moyen et à long termes? Malheureusement, il arrive encore trop souvent que l’hygiéniste dentaire, la spécialiste des plans de traitement préventif, n’est pas consultée comme elle le devrait. À titre indicatif, je vous ferai part d’une situation ou encore d’une intervention courante qui vous fera comprendre les carences que l’on observe parfois en dentisterie. Par exemple, en chirurgie bariatrique, on a recours à différentes techniques chirurgicales de restriction (réduction de volume) ou de malabsorption (dérivation) pour traiter l’obésité morbide ou encore pour réduire le poids d’un individu. L’étape chirurgicale est le noyau ou encore au cœur de cette réhabilitation, et ce,

au même titre que le sont les interventions curatives en dentisterie. Et pourtant, jamais un patient ne subira ladite intervention sans avoir au préalable rencontré la diététiste, spécialiste de l’alimentation, pour faire le bilan ou l’évaluation de ses habitudes alimentaires! Jamais non plus un patient ne sera opéré et retourné à la maison sans avoir rencontré de nouveau un spécialiste de la santé. En effet, on prendra soin de planifier plusieurs visites subséquentes pour contrôler le poids du patient et pour faire des bilans alimentaires parce que ces mesures sont indispensables à la réussite du traitement. Pourquoi en va-t-il différemment en dentisterie? Bien que mon propos porte sur des réhabilitations complètes, il n’en demeure pas moins important, après la mise d’un pont en bouche, de s’assurer que le patient maîtrise la bonne méthode d’utilisation de la soie dentaire et que sa technique soit réévaluée à l’occasion de son rendez-vous de nettoyage. Évidemment, nous ne faisons pas revenir un patient uniquement pour nous assurer qu’il contrôle bien la technique d’utilisation de la soie pour un pont unitaire, mais dans les cas de réhabilitation complète, il en va de la réussite du traitement de se conformer à cette mesure. Voilà pourquoi il importe de bien en informer le patient avant le début du traitement. Pour mieux faire comprendre l’importance du rôle de l’hygiéniste dentaire, je me servirai de trois patients. Le premier patient, monsieur « Y », est un homme d’affaires, fin quarantaine, qui commence une nouvelle relation avec une femme un peu plus jeune. Il s’agit d’un cas classique! Elle lui fait comprendre, gentiment mais clairement, que ses dents sont « inconcevables »! Après avoir jeté un coup d’œil sur la photo ci-dessous (Fig. 1), vous en conviendrez, j’en suis certaine, que ce patient a indéniablement besoin de soins dentaires, et ce, pas uniquement pour séduire sa nouvelle flamme. Vous serez également d’accord avec moi pour affirmer qu’un plan de soins préventifs doit être élaboré pour rééduquer monsieur « Y » qui n’a pas encore atteint 50 ans et dont la bouche se trouve dans un état déplorable.

February 2012 www.oralhealthgroup.com

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ORAL HYGIENE

1 1. Monsieur « Y » avant réhabilitation. 2. Monsieur « Y » après traitement. 3. Monsieur « Y » rappel après six mois. 4. Mme « X » 1re année, rappel mensuel. 5. Mme « X » aujourd’hui, rappel aux deux mois.

Après analyse de la bouche du patient, le dentiste, le denturologiste et le chirurgien ont établi un plan de traitement semblable à ce qui suit : – Extraction complète des dents et racines résiduelles. – M ise en place de cinq implants au maxillaire inférieur. – M ise en place d’une barre CAD-CAM. – Fabrication d’une prothèse amovible avec système « locator » et « cavalier » au maxillaire inférieur. – Fabrication d’une prothèse complète amovible équilibrée au maxillaire supérieur. – Suivi mensuel de son hygiène buccal pendant les trois premiers mois et réévaluation de ses besoins en matière d’hygiène dentaire, ce qui nécessitera un minimum de deux visites annuelles. Comme vous venez de le lire, le plan de traitement comprend un volet hygiène, lequel est tout aussi important que les autres étapes. Les intervenants ont arrêté leur choix sur une prothèse amovible sur barre plutôt que sur une prothèse fixe en raison de son entretien plus facile ou moins laborieux. Le suivi de l’hygiène buccal a commencé avant même la réalisation des prothèses, soit pendant l’ostéointégration et le port des prothèses de transition. Ces visites avaient pour but de permettre une rééducation des habitudes d’hygiène du patient de sorte qu’à l’arrivée du jour « J », ledit patient avait déjà acquis une dextérité suffisante pour assurer le bon entretien de sa bouche. Le jour de la mise en charge et de la mise en bouche des nouvelles prothèses, il est impératif que le patient ait un bref entretien avec l’hygiéniste. Cet entretien se doit d’être court, concis et efficace puisque l’expérience nous a appris que les patients accordent, à ce moment-là du traitement, un minimum d’attention (Fig. 2). Ensuite, le patient doit prendre un autre rendez-vous pour assurer le bon entretien de la

barre, des piliers et des prothèses. Je ne crois pas qu’il existe une formule unique, universelle et utilisable pour tous. Comme chaque cas est différent, vous devez obligatoirement voir en bouche ce qui conviendra à chaque patient et lui donner quelques options. Nous sommes les experts en matière d’hygiène dentaire et les mieux placés pour faire une évaluation de l’état buccal du patient de même que pour lui faire des recommandations. Le patient doit retourner à la maison avec sa trousse d’outils et faire des essais. Ainsi, il découvrira des adjuvants qu’il aime et d’autres avec lesquels il éprouve des difficultés. À l’occasion de ses visites mensuelles au cours des trois premiers mois, il faut chercher et trouver la formule gagnante pour le patient. Ces visites visent à permettre de contrôler son hygiène, à répondre à ses questions, à corriger ses lacunes et à évaluer l’accumulation de tartre; après quoi, vous êtes plus à même de déterminer ses besoins en matière d’hygiène dentaire et la fréquence des suivis périodiques. Le contrôle de l’hygiène buccal est particulièrement important parce que nous savons pertinemment que notre patient peut présenter une salive alcaline, ce qui nécessitera des détartrages plus fréquents. Heureusement, lors de nos rencontres, monsieur « Y » a été en mesure de nous montrer qu’il avait un bon contrôle de son hygiène buccal et que les mesures prises étaient parfaitement adaptées à son cas. Nous avons donc convenu d’un suivi biannuel, quitte à y apporter des modifications au besoin. Donc, deux visites annuelles constituent la fréquence idéale pour ce patient, photo à l’appui (Fig 3)! Malheureusement, ce n’est pas toujours aussi simple. À preuve, ma seconde patiente, madame « X ». Grâce à l’intervention de l’hygiéniste dentaire, la situation de cette patiente a pu être corrigée avant que l’irréparable ne se produise.

February 2012

www.oralhealthgroup.com

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ORAL HYGIENE 6

Photo Credit: Mechanic, Dr Elliot. 2009.2010.2011. Montréal, Québec

Madame « X » est une très belle femme dans la cinquantaine. Entièrement édentée depuis plus de trente ans, cette dame était satisfaite de ses prothèses amovibles jusqu’à tout récemment. Cependant, au cours des derniers mois, ses prothèses sont devenues de plus en plus instables et la blessaient. Le denturologiste consulté avait noté un affaissement important de la crête osseuse au maxillaire inférieur. Comme une nouvelle prothèse pouvait difficilement corriger la situation, on lui a proposé une barre CADCAM sur implants. Après un examen approfondi, le chirurgien maxillo-facial a approuvé le plan de traitement, mais tout en prenant soin de nous informer que la perte osseuse était trop importante et que l’espace disponible restant ne permettait la mise en place que de trois implants. La perte d’un implant, à court ou long terme, est une véritable catastrophe parce qu’elle ne permet pas à la patiente de bénéficier d’une prothèse implanto-portée et que celle-ci se voit contrainte de la remplacer par une prothèse gingivoimplanto-portée, efficace mais moins confortable. Dans ce cas-ci, le suivi de l’hygiène buccal était primordial, et ce, d’autant plus que l’hygiène de cette patiente depuis les trente dernières années s’était limitée au brossage extra-oral des prothèses et qu’aucune brosse à dents, aucune soie ni aucun autre adjuvant n’avaient franchi la limite de ses lèvres. Beau défi pour moi et pour elle! L’entretien des capuchons de guérison fut laborieux mais madame « X » s’est très bien acquittée de cette tâche. La mise en charge et la mise en bouche se sont faites sans problème. Quelques jours avant notre première rencontre mensuelle, la patiente a pris rendez-vous avec notre denturologiste parce qu’elle avait de plus en plus de difficulté à fixer solidement sa prothèse! Conclusion de la rencontre : accumulation de tartre trop importante sur la barre, ce qui entravait la fixation. J’ai procédé sur-le-champ au détartrage de la barre de la patiente, ce qui a permis de bien fixer la prothèse. Au fil des mois, notre équipe a travaillé très fort. La première année, les visites de madame « X » étaient mensuelles. Aujourd’hui, grâce aux résultats obtenus, les rencontres ont lieu tous les deux mois et la patiente ne s’en porte que mieux. Finalement je vous présente un traitement

comportant la pose d’une prothèse complète fixe sur implants. Les patients qui font l’objet de ce traitement doivent être extrêmement conscients de l’entretien que cette intervention nécessite et qu’ils devront effectuer s’ils désirent maintenir une santé bucco-dentaire adéquate. Avant même d’élaborer le plan de traitement, le dentiste doit évaluer l’aptitude du patient ou de la patiente à pouvoir prendre soin de ses dents de manière à assurer l’intégrité des traitements à venir. Il convient de prendre en charge le patient ou la patiente dès la période d’ostéointégration; en pareille situation, c’est le premier rendez-vous, après la mise en charge des implants, qui est le plus important. Le travail de l’hygiéniste dentaire consiste à déterminer, selon son expérience, les manœuvres susceptibles d’aider la patiente à assurer le bon entretien de sa bouche (emplacement, angulation, type d’enfileur, zone d’insertion, etc.). Vous savez comme moi qu’il existe toujours un petit espace qui facilite l’insertion de divers adjuvants sous les ponts. Cette contribution à l’exercice de démonstration d’hygiène peut faire en sorte que la patiente assimile plus rapidement et plus facilement les techniques. Contrairement à la barre, les prothèses fixes ont toujours moins d’espace sous-jacent; en conséquence, l’initiation est souvent plus laborieuse et exige plus de patience! Des photos prises tout au long du traitement pourront être d’une grande utilité pour la compréhension des zones à nettoyer, et ce, autant pour vous que pour le patient ou la patiente. En conclusion, en tant que professionnel de la santé dentaire, vous êtes appelé, en matière de réhabilitation de l’hygiène dentaire, à jouer plusieurs rôles importants. Si vous êtes hygiéniste dentaire, vous êtes la personne la mieux formée et la plus apte à être le « coach » sur qui votre patient ou patiente peut compter pour son entretien buccal. Vous devez donner aux patients les instructions à suivre, les motiver, les inciter à persévérer et, enfin, corriger toute situation jugée nécessaire tout en leur prodiguant les soins dont ils ont besoin. Pour toutes ces raisons, je vous dis « soyez fier ou fière de porter le titre d’hygiéniste dentaire » et ne banalisez jamais votre rôle, car les résultats que vous pouvez obtenir sont tout simplement merveilleux et époustouflants. n

BIBLIOGRAPHIES

1. De Villers, Marie-Éva. 2010. Multi, diction naire de la langue française. Cinquième édition : Québec Amérique. 2. 2 011. Le petit Larousse illustré. Paris : Édition Larousse

February 2012 www.oralhealthgroup.com

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ORAL HYGIENE

Dental Hygiene: Past, Present & Future Lisa Philp, RDH, CMC

President of Transitions Consulting Group, a premier dental coaching company. For more info please visit www. transitionsonline.com

“No More Pick and Flick” I

n order for hygienists to establish goals for the future, it is critical that we review our past and evaluate where we are presently. By sifting through our past we can build upon areas that have worked for us and change what has not. Evaluating what we are doing presently, and coupling them with current technological trends will allow us to build a better hygiene program for our patients in the future. Hygiene in the past has been a very procedural based profession. We had 30 to 40 minutes to accomplish a series of disconnected tasks. We provided a service, which for all intense purposes, was viewed by our patients in a similar manner to getting their hair or nails done. We simply cleaned their teeth. Pick and flick. It’s no wonder that hygienists experienced so much down-time or last minute cancellations when our patients failed to understand what the value of a hygiene appointment was. They came in; we updated the medical/ dental history, examined their teeth for cavities, perhaps took some radiographs, and cleaned and polished their teeth. The patient was given instructions on brushing and flossing and once checked by the dentist, they were sent home; Good for another six months. In the past hygienists worked for the dentist and not with the dentist to determine all the factors necessary to compile a treatment plan to obtain optimum oral health, specific to each patient. We did our job and they did theirs. Hygienists dealt with the foundation

of the teeth while the dentists dealt directly with the teeth for restorative purposes, and the patient left the office feeling they had passed or failed, their six month dental “check-up test”, depending on if any work was needed to be done by the dentist. Not that they had periodontal disease and required active therapy by the hygienist. Our model for periodontal disease itself has changed over the last 30 to 40 years. Initially, we assessed our patient’s mouths on how much plaque they had. The more plaque they had the more disease they had. Gingivitis would just naturally progress to periodontitis. As time progressed, it was discovered that some of our patients did not have gingivitis or active infection but they still presented with bone loss. Research determined that different types of bacteria were present in their mouth and that specific bacteria were involved in disease. These bacteria were identified and named. Presently, we not only know about these specific bacteria being present, but we know they can be transmitted from one patient to another. We know that a patient’s immuneresponse system is involved with determining whether or not these harmful bacteria are allowed to flourish. It’s only natural to adapt our profession to support our patients through new findings in research. As such, hygiene is going through a metamorphosis. The hygienist-patient relationship is changing as well as the hygienist-dentist relation-

February 2012 www.oralhealthgroup.com

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ORAL HYGIENE ship. Hygienists are finding that not only do we need to possess the technical skills required to perform the procedures that are required of us, but we also need to be able to assess the patient to find out what their dental I.Q. is, and determine what good oral health means to each patient individually. We need to ascertain that great aesthetics means everything to one patient but that cost is all that matters to someone else. Acquiring the skills to educate our patients about what is necessary to obtain our set standard of oral health is necessary for the patient to understand the value of their hygiene appointment. We can change our patient’s perception of our role in their oral health as well as how they perceive our relationship with the dentist. We need to work with the dentist to determine what the best treatment plan is for our patients. We can gather all the necessary data including radiographs, intra-oral pictures, PSR scores, changes in medical/dental history, and behavioral discoveries and present them to the dentist. Then along with the patient, a treatment plan can be formulated. Although we may be experiencing some “growing pains” right now, it appears that the future of dental hygiene will be very exciting. As our new relationships develop, we know that as a team, we are providing the best oral health care we possibly can. Advances in technology are permitting us to detect potential problems in the initial stages and allow-

Photo credit: © thinkstockphotos.com

As time progressed, it was discovered that some of our patients did not have gingivitis or active infection but they still presented with bone loss ing the dental team to be pro-active rather than reactive. Changing relationships with our patients will allow us to change their perception of our role in achieving and maintaining optimum oral health as well as the value they place on their hygiene visits. As a result, hygiene down-time will decrease. No longer will time spent with us be equivocated to a hair appointment. We will educate our patients and transfer the ownership of their oral health to them. Oral hygiene instructions will change to a “Self-care program”. Appointment times and fees will reflect the state of disease in a patient’s mouth and their treatment will be based on an individual plan that will be utilized to regain and maintain optimum oral health. The dentist will also benefit from the development of our new relationship. As an integral part of the team used to help discover the true state of a patient’s complete oral health, they will recognize the value of our work not only in achieving a healthy oral state but also as a way to communicate a restorative treatment plan with our patients. From the past we have kept the technical skills we need to aid the patient’s return to optimum oral health. From the present we are developing our communication skills and coupling them with the findings of new research and technology. The future will find tremendous opportunity and growth for our doctors our patients and us. A definite winwin-win scenario. n

February 2012

www.oralhealthgroup.com

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Family Practice, some evenings and weekends required. E-mail resume: dentalbox32@gmail.com

EDMONTON, AB

Associate position available in an 8 chair facility in a very busy established 090325 JULY 09 family practice in south Edmonton. The practice has solid new patient flow OTTAWA, ONteam making it a great place to and a fantastic support Denture clinic seeking dentist to enjoy dentistry. The office is equipped with the latest assumediagnostic workload from current den- technologies and digital and treatment tist transitioning out of practice. presently has 4 RDA, 2.5 hygienists and 2 dentists. Clinic has been in business for over We are seeking a motivated team-oriented dentist 25 years in the Ottawa area. and Great with great communication skills and commitment opportunity to start taking patients (must be available to work some Saturdays and some right away. New graduates welcome. evenings). Call 613-749-4055 Please email resume to or e-mail: samlima10@aol.com southsideoffice@shaw.ca.

DENTAL MARKETPLACE

a 50% split. Be mentored by the COMOX VALLEY ON VANCOUVER ISLAND, B.C. whose practice is limited excluWe are looking for an associate dentist to join our team in a permanent, full-time position, 3-4 days per week. ntology. Our office has an established patient base of 3000+ y by faxing CV or resume to: patients currently being serviced by just one dentist. We Implant Smile Center, have a brand new facility with all new equipment, digital x-rays and electronic charting. Our practice is system 349-2626 (Attn: Anita), or based, offering comprehensive care with a strong preil to drleigh@telus.net. ASSOCIATESHIPS ventive model. The Comox Valley is the recreation capital of B.C., ies: 1-888-877-0737 (toll free). BARRIE, ONTARIO offering a mild climate and affordable living. PERIODONTIST – OTTAWA ww.albertadentalimplants.com Needed : F/T Associate DDS www.riverwaydental.com Work as part of a group practices with .implantsmilecenter.com multiple Ottawa locations on a full or partwww.discovercomoxvalley.com position available ASAP.

RED DEER, AB Very busy dental practice in Red Deer seeing 80+ new patients per month looking for enthusiastic dentist to join our team. Please contact us at bestbetdental@me.com

ORILLIA, ON

Part time associate required 1-2 days per week for busy general family practice. Please forward resume to dental_2010@live.ca

NELSON, BC

Full-time associate required for a well-established, fast-paced practice in Nelson, BC. This cozy, heritage town is nestled between spectacular mountains and gorgeous shorelines. Nelson is uniquely affluent with a flare of artistry and creativity. Diversity, culture, vivaciousness are bundled together in this eclectic town. The patients are extraordinary, the staff are unmatched, the experience is profound. Contact: 250-352-5553(w) 250-352-5503(f) or email: drkellydavidoff@shawbiz.ca

CAREERS UBC FACULTY OF DENTISTRY GRADUATE PROGRAMS

ASSOCIATESHIPS – page 52

MSc AND PhD IN CRANIOFACIAL SCIENCE PROGRAMS These programs are research-oriented and do not include clinical training. The MSc degree normally requires two years full-time study and can also be taken part-time. The PhD degree requires a minimum of three years. Both offer research training in various oral and dental sciences. • Combined PhD or MSc in Craniofacial Science/Diploma in Endodontics • Combined PhD or MSc in Craniofacial Science/Diploma in Orthodontics • Combined PhD or MSc in Craniofacial Science/Diploma in Pediatric Dentistry • Combined PhD or MSc in Craniofacial Science/Diploma in Periodontics • Combined PhD or MSc in Craniofacial Science/Diploma in Prosthodontics The above programs will offer a minimum three-year MSc degree or a minimum six-year PhD degree combined with a Diploma in their specialty. These programs will prepare the students for clinical practice and provide research experience. Applicants must hold a DMD or its equivalent.

GRANDE PRAIRIE, ALBERTA A full time associate needed for our busy, well established family practice. Our practice offers all aspects of family dentistry including I-V sedation, oral sedation and implants. We will be moving into a brand new office soon in a high traffic area. If you are trustworthy, friendly and committed to excellence please contact Christa at 780-539-6883 or email resume to drroy04@telus.net

DENTAL MARKETPLACE HELP

FOR MORE INFORMATION VISIT WWW.DENTISTRY.UBC.CA OR CONTACT: MRS. VICKI KOULOURIS, MANAGER, vkoulouris@dentistry.ubc.ca; TEL: 604.822-4486/FAX: 604.822-3562 OR MS. JACKIE LEE, fodadms@interchange.ubc.ca/TEL: 604.822-8063 POSTGRADUATE PROGRAMS ORAL MEDICINE AND ORAL PATHOLOGY RESIDENCY PROGRAM This postgraduate residency training n Oral Medicine and Oral Pathology is offered in conjunction with University-affiliated teaching hospitals. It consists of a three or four-year hospital-based, stipended residency in one of three pathways: Oral Medicine, Oral Pathology, or both specialties combined. GENERAL PRACTICE RESIDENCY PROGRAM In conjunction with three University-affiliated teaching hospitals the Faculty offers positions in a oneyear dental residency program beginning July 1 or June 15 for pediatric residency. FOR MORE INFORMATION ON POSTGRADUATE PROGRAMS VISIT WWW.DENTISTRY.UBC.CA OR CONTACT: MS. DOROTHY STANFIELD, MANAGER, dstanf@interchange.ubc.ca TEL: (604) 822-0345/FAX: (604) 822-4532

YOUR ADVIS OR IS IN KAREN SHAW TEL:4l6-5l0-6770 FAX:4l6-5l0-5l40 E-MAIL: kshaw@oralhealthgroup.com TOLL FREE CDN: l-800-268-7742 ext 6770 TOLL FREE USA: l-800-387-0273 ext 6770 WEBSITE: www.oralhealthgroup.com with apologies to charles schulz

www.oralhealthgroup.com

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February 2012

03/02/12 8:49 AM

DENTAL MARKETPLACE

OT TAWA, ON

An exciting associateship opportunity for compassionate, confident practitioner dedicated to quality patient care. You will work with an experienced team of dentists and specialists in a dynamic environment with state-of-art digital and dental equipment in Ottawa. We offer partnership options to our qualified doctors. Please email resumes to associates2020@gmail.com

KITCHENER / WATERLOO, ON P/T quickly leading to F/T associate(s) needed for busy, established dental group in the K-W area. Long standing staff, great working conditions and the ability to practice all modalities of dentistry. Reply to: mbandmiyen@gmail.com

EDMONTON, AB

Full time dental associate sought for state of the art dental practice. Features great staff and patients, paperless, digital imaging, 3D tomography. Located in the heart of downtown Edmonton. Interested candidates please email resume in confidence to omar@infinitydental.ca

GREAT OPPORTUNITY!

Ontario – Midland: Small town charm on Georgian Bay, ideal for outdoor enthusiasts. Currently seeking parttime associate with potential for fulltime and possibility of future ownership. Practice all aspects of general dentistry, including sedation and implantology in a well-established, modernly equipped office. Interested applicants please fax resumes to 705-527-7775, or email: allison@lifestylesmidland.com ASSOCIATE POSITION AVAILABLE Busy general dentistry practice just a short drive south of Calgary looking for PT/FT highly motivated dental associate. Future ownership options available. Submit resume to: highriverdentaladmin@telus.net

EDMONTON, AB

Full-time associate required for busy hitech Edmonton family practice. Candidate must have excellent communication skills, must be amicable with patients and team and must be committed to continuing education. Great earning potential. New graduates welcome. Please send resume to: eguren@shaw.ca

www.broadwaydental.ca

BROADWAY DENTAL ASSOCIATES • Experience the Medicine Hat advantage. • Protect your career from gridlock. • You are interested in predictable community living. • How do you value family time? • Lowest tax and utility rates in the province. • Children walk to nearby schools. • Highest grossing private practice in Southeastern Alberta. • Enjoy all the technological advances in today’s dentistry. • Achieving excellence with our experienced team is assured. • You are interested in above average compensation. • Check out our website, contact Dr. Greg Bradley. • Home of the Medicine Hat Tigers, the team has won two Memorial Cups, five WHL Championships and seven Division Titles. 101 - 7 Strachan Bay S.E. • Medicine Hat, Alberta • T1B 4Y2 Ph: (403) 548-7000 Fax (403) 548-7111 Toll Free 1-888-607-6453 www.broadwaydental.ca

February 2012

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BRITISH COLUMBIA — BURNS LAKE

Full-time associate needed immediately for established, busy family practice with high income potential. The Burns Lake clinic provides full time hygienists, chair-sides, high tech equipment, Cerec and friendly, hard working staff. Contact Curtis at: 801-376-0976 or fax resumes to: 250-785-0625 FT/PT ASSOCIATES — ONTARIO Associates required for busy, growing offices in Barrie, Schomberg and Woodbridge. Please email: drpenning@barriesmiles.ca Specify days and location(s) and review website to understand office approach.

ETOBICOKE, ON ORAL SURGEON AND DDS PT NEEDED An oral surgeon needed ASAP to work one Friday/month. Also an experienced female dentist needed for weekends including Sundays. An upscale busy group practice in Etobicoke. Reply in confidence: hrdentalteam@gmail.com

THUNDER BAY, ONTARIO

Seeking highly motivated and enthusiastic individual to welcome into our busy newly renovated practice as a full time associate. Our office is equipped with all new equipment including digital x-rays and computerized charting. Our priority is to provide the highest quality of care in a professional and caring environment. Our practice provides all aspects of dental care including GA and sedation dentistry. Our practice offers an exceptional opportunity for experienced Doctors or recent graduates as we boast a large patient base, excellent income potential, full time hours and no weekend office hours required. (200K easily achievable). Future partnership or ownership options available. Thunder Bay is Ontario’s best kept secret for having all the amenities of a larger city yet with all aspects of outdoor sports and activities right in your backyard. If you feel you would like to join our highly skilled team please contact: Dr. Doug Mason drmason@shaw.ca 807-683-5222 or fax 807-683-6812 www.oralhealthgroup.com

03/02/12 8:49 AM

Part time associate required. Large busy general practice. Please send resume to parkdrivedental@yahoo.com THOMPSON, MB

Westwood dental clinic in Thompson, MB team looking for enthusiastic dentist full time or part time. Accommodations are available. E-mail: westwooddental@hotmail.com tel 204 677 4526

BRAMPTON,ON ASSOCIATE REQUIRED

Associate wanted for well established practice, starting part time leading into full time with opportunity for shared ownership. Several years experience preferred. Please contact Christine at 905-457-2222 and e-mail: reception@addp.ca

EDMONTON, AB ASSOCIATE WANTED

Caring, skilled associate needed in progressive, Sedation/General Practice, with future partnership opportunity. Daytime practice hrs. with flexible options for associate. New graduates and experienced dentists with strong clinical and communication skills may email: sleep@magathan.com fax 780-482-4889.

FULL-TIME ASSOCIATE DARTMOUTH, NOVA SCOTIA Full-Time Associate required to join our wellestablished family practice. We offer experienced, friendly staff and an excellent location. Please contact Donna Fredericks at: hillsidedental@eastlink.ca or call (902)434-4701.

ILE PERROT, PQ Expanding Dental Office in Ile Perrot, Quebec looking for a full time Dentist. E-mail: lynda@cliniqueileperrot.com

FRASER VALLEY/ABBOTSFORD, BC

Young growing practice in the Fraser Valley/Abbotsford area looking for a full time energetic associate in a new ‘state-of-the-art’ building. New modern equipment/CT Scan/IV Sedation. Contact: associatewanted@hotmail.ca

MISSISSAUGA, ON

MEDICINE HAT, ALBERTA

Part time position leading to a full time career. Dedicated, self motivated, and energetic part time associate required for a busy Mississauga dental practice with a steady patient flow. Must be proficient in all aspects of dentistry including molar endodontics and surgery. Successful candidate must be fluent in English, have an outgoing personality and be motivated to build his practice.Communication and business skills are a must. Hours include two evenings and some Saturdays. Reply to mtcdental1@gmail.com

Well-established, busy Family Dental Practice requires a full-time Associate. We have a friendly team providing comprehensive and progressive treatment to a very large patient base. CE Subsidized. New grads are welcome to apply. Please submit resumes by email to medhatdental@gmail.com

Full time associate required in a busy practice west of Mississauga. Experience preferred. Please reply with resume to: dentalassociate123@gmail.com

CALGARY, ALBERTA

Pediatric Dentists 3-4 days/ month in multiple GP practice locations S.E Calgary. Paid daily 50% production. No receiveables. No overhead! Limitless earning potential. Let’s help kids in dental pain. Please email cdc.smile@gmail.com

DENTAL MARKETPLACE

STOUFFVILLE, ONTARIO

SOUTH WESTERN ONTARIO

...get the best of both worlds • freedom like ownership • freedom of associateship

FOR FURTHER DETAILS, PLEASE EMAIL US AT info@dentalchoice.ca www.oralhealthgroup.com

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February 2012

03/02/12 8:50 AM

DENTAL MARKETPLACE

50% – 60% COMPENSATION DENTRIS DENTAL CENTRES

requires associate dentists for clinics in Northern Ontario and Manitoba. • full time and weekly terms available • 50% to 60% compensation rates • free rental accomodations • free use of car • free travel from many major centres across Canada to our clinics • lots of time off given for continuing education, holidays etc. Provide your services where they will be appreciated and generate solid earnings for you. Please phone at 204-623-5842 for more details. Thank you.

STONEY CREEK, ON Part time opportunity to join our well established large, busy dental practice in Stoney Creek, Ontario. Searching for a caring individual with strong clinical and communication skills to join our team on Wednesday afternoons and evenings and Friday daytime, with the potential to quickly lead to more days. Our practice provides a high quality of care in all aspects of dentistry, including oral sedation, digital xrays, computerized charting, a soft tissue management program, oral surgery and implants. Please forward curriculum vitae to dentallinc@gmail.com

NEW GLASGOW, NS

SOUTHERN VANCOUVER ISLAND

Ideal opportunity for an Associate for a busy practice in the heart of Cowichan Valley, 45 minutes north of Victoria. Our state of the art practice offers a progressive, modern facility with digital radiographs, Cerec, intra oral cameras. We have a well established patient base with new patient influx to ensure future practice growth. Our Current Associate of 2 years is relocating out of province and we are looking for a permanent replacement. Qualified Applicants must have a minimum of 3 years experience, and be an eager, people friendly individual who would be interested in an eventual transition to part or full ownership. Contact Kathy with resume/inquiries at islandassociate@gmail.com for more information.

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

Looking for a full time dental associate in a busy mall practice to take over existing practice.The practice currently has 4 dentists and 4 hygienists who work as part of a great team. Practice is located in a rural setting close to the ocean and only 11⁄2 hours drive to Halifax. Partnership potentially available to the right candidate. Practice offers all aspects of modern dentistry including orthodontics, TMD and restoration of implants. Please contact us through email: highlanddentalcentre@ns.aliantzinc.ca or by phone: 902-752-0224.

ASSOCIATES FOR HAMILTON & WATERLOO, ON

Are you having enough fun at work? With the core values of Health, Growth & JOY, Sierra is expanding and accepting applications for Pediatric Dentists & General Practitioners in Calgary, Alberta.

Why Calgary?

This beautiful city sees more days of sunshine than any other major Canadian city. Home to 1.3 million people, Calgary is diverse and community-minded. It is also the mecca of business & financial growth with the strongest economy in the entire country.

Why Sierra Dental?

Because you deserve to feel joy at work! Sierra believes in cultivating and sharing positive energy and strives for a joy-filled environment for all staff & patients. If you are clinically strong, high energy, and self-starting, we look forward to meeting you. With over 12,000 active patients and a tremendously successful internal referral program we are excited to welcome the right doctor. Sierra also provides a unique practice ownership program. If you are passionate, clinically committed and seeking happiness in your work environment, send resume & cover letter to lavonne.keal@sierracentre.com

4.94"x4.84" Sierra Ad.indd 1

February 2012

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11-11-20 8:38 PM

Associates required immediately, for TWO VERY busy and modern practices with VERY strong new patient flow. E-mail: associatedentist@ymail.com Fax CV: 888.880.4024

ASSOCIATE — EAST GTA East GTA practice seeking to compliment our team with a new Associate. Our facility is open 7 days a week providing dentistry to our regular patient base along with the emergency need for some of the community. We need someone for Sundays to handle our many emergencies. It is a very productive day. Other days may be available. Forward to Oral Hygiene Box 004 — e-mail: kshaw@oralhealthgroup.com

EQUIPMENT FOR SALE

E4D CAD/CAM System with Ivoclar Oven. Price: $80,000 (plus shipping). Additional supplies valued at $3500 included in purchase price. Photos available. E-mail: dentalofficek@gmail.com

www.oralhealthgroup.com

03/02/12 11:28 AM

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