Oral Hygiene September 2012 by Annex Business Media

oralhygiene September 2012

How technology has ELEVATED THE ROLE of the HYGIENIST in today’s dental practice

SHIFT HAPPENS! changing paradigms in oral health RISK ASSESSMENT

The role of MOUTH RINSES as an adjunct to HOME CARE

INFECTION CONTROL nitty gritty

The state of the HYGIENE UNION

From debridement to therapy: ADVANCES IN AIR POLISHING

Covering your

ASSETS Keeping a roof over your head NO MATTER WHAT

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oralhygiene CONTENTS

FEATURES Shift Happens! Changing Paradigms in Oral Health Risk Assessment

Jo-Anne Jones, RDH

How Technology has Elevated the Role of the Hygienist in Today’s Dental Practice

Wilson J. Kwong, DMD and Viktoriya Mityakova, RDH

The Role of Mouth Rinses as an Adjunct to Home Care

Anne Bosy

Infection Control Nitty Gritty Nancy Andrews, RDH, BS

The Dental Hygiene Profession in Canada

Annick Ducharme, RDH and Annie Beaulieu, HD

La profession d’hygiéniste dentaire au Canada

Annick Ducharme, RDH and Annie Beaulieu, HD

Always Home: Keeping a Roof Over Your Head, No Matter What

Lorne Dubros

From Debridement to Therapy: Advances in Air Polishing

Tracey Lennemann, RDH, BA

DEPARTMENTS Editorial: Too Many Hygienists, Not Enough Time

News: Implants, Oral Care Growth, Plugging Dental Gaps in Australia

Dental Marketplace

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

September 2012

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THINK

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Premier® Dental Products Company • 888-670-6100 • www.premusa.com Cosmetic • Endo/Restorative • Hygiene/Perio • Instruments • Prosthetic *To receive your free merchandise not shipped with order, forward a copy of your DEALER invoice indicating appropriate purchase(s) to Premier Redemption Center, P.O. Box 640, Plymouth Meeting, PA 19462-0640. FAX number - 610-239-6171 or email: redemptions@premusa.com. Offer valid 9/1/12 through 9/30/12. Redeem by 10/15/12. Strawberries ‘N Cream supplied, unless indicated. May not be combined with other offers. Valid in Canada only. 1. Schemehorn, B.R., Wood, G.D., McHale, W., Winston, A.E., “Comparison of Fluoride Uptake into Tooth Enamel form Two Fluoride Varnishes Containing Different Calcium Phosphate Sources”, J Clin Dent, 2011;22:51-54 / 2.Fluoride Release from Fluoride Varnishes is Affected by Incubation Conditions C. Gonzalez-Cabezas, S.E.Flannagan, R. Krell, M. Uekihara, and C.C. Niquette, Dent Res 91(Spec Iss A):1094, 2012 (www.dentalresearch.org). / 3.”Effect of Calcium Phosphate Containing Fluoride Varnish of Dentin Permeability”, Tung, M.S., Torres, J., (ADAHF Paffenbarger Research Center, NIST, Gaithersburg, MD and U.S. Navy Dental Corps, Bethesda MD), J Dent Red (Spec Iss A): 0985, 2008 (www.dentalresearch.org). / † 3M Vanish and Colgate Duraphat are not trademarks of Premier Dental.

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EDITORIAL

Too Many Hygienists, Too Little Time And by that, I mean, too many grads working too few hours. We know that most of our hygiene schools are graduating excellent people. Nothing substitutes for experience but seriously, quality is not the problem. It’s the quantity. Annick Ducharme, RDH and Annie Beaulieu, HD, have done an exemplary job in their look at the ‘state of the hygiene union’ in this month’s issue. “The dental hygienist profession exists in a number of countries around the world. From Korea to China by way of Romania and Australia, there are dental hygienists like you worldwide working to improve the dental health of their fellow citizens. In many countries, Canada’s dental hygienists are considered to be exemplary, a point of reference, practicing a coveted profession.” And look at the comments by those interviewed regarding biggest concerns/ challenges...all valid and thoughtful, just nothing about the numbers. Nothing about how there might be too many of you and we can’t promise full-time employment anymore. Dental hygiene is the 6th largest registered health profession in Canada. What are the numbers in Canada...19,000+ dentists, 24,000 hygienists? Talk about being victims of your own success as a profession... I found this comment online at a jobsite called indeed: A student in Surrey, BC said: I realize the problem with private schools in

Ontario with overflowing numbers of new graduates. Will that affect the job market in BC or Alberta a few years from now? I’m a senior in high school right now. I am hoping to enroll in a four-year dental hygiene program in the fall. However, I am a little concerned about what the job market will be like four years from now. Will it be worse? Will I have a hard time finding a job? It’d be great if some people in this field can give me some advice. Thank you.

Catherine Wilson

Editor

And a reply that should make you shudder: “Choose a different profession. The dental hygiene field is saturated, overcrowded and it looks that way for the next 10 years, due to the schools accepting too many applicants. Due to the recession, those of us presently in the field will have to stay in it longer and the new graduates will also be in for an awakening after spending hard earned money and time on a program that = 100 applicants easily for 1 job listing online and in any daily paper. Please, for a career...choose the nursing field or go to dental, not hygiene school. I recently spoke to a very wellknown, BC-based dentist who said when hiring recently, he has the pick of the crop, so much so that he hired a hygienist / massage therapist /auto detailer. Okay, I embellish, but only slightly. So, are you concerned? What do we do about the hygiene glut? cwilson@oralhealthgroup.com

September 2012

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NEWS BRIEFS

Implants, Five Things to Know According to the September 2012 issue of USbased Money magazine, there are five things to know about dental implants. 1. A n implant beats bridges or dentures 2. But you’ll pay a lot more for it 3. Not all implants are equal (Swedish vs. other) 4. T here are ways to nab discounts (discount plans, visit a school) 5. Timing can also help (tax-wise) (cnnmoney.com)

Oral Care Category Set to Grow by $4.1 billion from 2010-2015* Product innovations, value-added products and the strong growth of markets in developing countries will drive 5%+ growth through 2015. • In developing markets, educating consumers on the benefits of traditional oral health and the products to support it is key, while mouthwash has emerged as a strong growth driver in some growing markets. • Oral care regimens that provide complete oral health care are among strategies that attract new customers and keep existing ones. • In developed markets, consumers are beginning to follow increasingly complex oral care regimens as they seek to ensure better dental health, trading up to specialized products. Product segmentation, efficacy, cosmetic benefits and further consumer segmentation are among key strategies for future growth in the global oral care market.

Government Plugs Gaps in Dental Health Care Sydney, Australia—Dental and health policy experts have welcomed a $4-billion dental health package from the Federal Government, which specifically targets children and pensioners. The package provides $2.7 billion in new funding for subsidized dental care for more than 3 million children, and $1.3 billion for services for adults on low incomes, including pensioners and concession card holders. “While Medicare and free hospital care have been a basic right for Australians for decades, millions of people in this country still go without adequate dental care,” Health Minister Tanya Plibersek says. Stephen Leeder, director of the Menzies Centre for Health Policy at University of Sydney, says it’s never made sense that dentistry has fallen outside the Medicare basket. “I think we’ve got to look at dental care in its own right... We’ve got to press on with the main game which is to make sure people who need dental care, restorative or preventative, have reasonable access to it and are not denied it on the basis of cost.” Dr. Mike Morgan, program leader for oral health at the University of Melbourne says continued focus on water fluoridation and workforce development was required, but added the package was a “big win” for dentistry in Australia.

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

September 2012

Dental Group Assistant: Kahaliah Richards 416-510-6777 krichards@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: Account Manager: Alex Papanou Tony Burgaretta 416-510-6852 President/Business Information Group: tburgaretta@oralhealthgroup.com Bruce Creighton

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. Oral Hygiene is published quarterly by Business Information Group, a leading Canadian information campany with interests in daily and community newspapers and business-to-business information services. ISSN 0827-1305 (PRINT) ISSN 1923-3450 (ONLINE)

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ORAL HYGIENE

Shift Happens! Jo-Anne Jones, RDH

President of RDH CONNECTION Inc., and CEO of Dental Hygiene Studios Inc. She has been nominated for a 2012 Dental Excellence Award for the Most Effective Dental Hygiene Educator by her peers. She may be contacted via email jjones@ rdhconnection.com

Changing Paradigms in Oral Health Risk Assessment

oday we are presented with new challenges and hurdles in the area of risk management for our dental hygiene client population. Fast lives, fast food and changing sexual behaviours have all had a profound impact on oral health, minimizing the degree of confidence we once had in identifying risk of oral disease. These changing paradigms carry a critical message to our professional community. Is your dental hygiene practice reflective of change? We need to be vigilant in continual assessment of risk to better enable us to manage disease and more importantly, prevent disease. The incorporation of risk assessment into dental hygiene practice is both exciting and rewarding replacing routine dental hygiene care with client centered risk assessment and disease prevention.

Snapshot of Today’s Oral Health Status As dental hygienists, we are committed to early discovery and intervention of three prevalent diseases in our population; caries, periodontal disease and oral cancer. All of these diseases, when discovered in the earliest stages, can have a very positive outcome for our clients. Firstly, caries is both preventable and controllable. Dental caries is defined as “...an infectious, communicable disease resulting in destruction of tooth structure by acid-forming bacteria found in dental plaque, an intra-

oral biofilm, in the presence of sugar.”1 The Canadian Health Measures Survey identifies the following statistics; 2 • 57% of 6–11 year olds have or have had a cavity; • 59% of 12–19 year olds have or have had a cavity; • T he average number of teeth affected by decay in children aged 6–11 and 12–19 years old is 2.5. Even though tooth decay is largely preventable, 96% of adults have had a history of cavities. We are seeing the negative impact of the increasing popularity of energy drinks and soda pop amongst teenagers as the prominent source of hydration. Bottled water, although not acidic, often carries the omission of a therapeutic amount of fluoride promoting oral health. Demineralization occurs anywhere below a pH of 5.5 with most energy drinks and pop possessing of approximately 3.0. A carious lesion begins with introduction of disease state likely due to bacterial strains. If accompanied by alterations to salivary flow, periods of reduced salivary pH or frequent intake of refined carbohydrates, the demineralization of tooth structure is likely. Cycles of demineralization and remineralization occur throughout the lifespan of the dentition. A white spot lesion can indicate up to a 50% loss of minerals (phosphate and calcium) while the outer layer may remain intact

September 2012 www.oralhealthgroup.com

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ORAL HYGIENE

“It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptable to change.” Charles Darwin, 1809-1882

due to saliva and its buffering effect. The role for heart disease. The biggest travesty of all of dental professional to pro-actively address is that most of these risk factors are largely demineralization in its earliest stage before preventable. cavitation occurs. Diabetes has also escalated at a fast and fuMeasuring the bacterial load, learning the rious rate over the last decade. The Public various contributory factors for each patient Health Agency of Canada reports from and assigning a risk level for each patient al- 1998/99 to 2008/09, the prevalence of diaglows the practitioner to effectively help pa- nosed diabetes among Canadians increased tients fight caries and the subsequent cavita- by 70%. 5 The greatest relative increase in prevalence was seen in the 35 to 39 and 40 to tions.”3 Periodontal disease is the second disease 44 year age groups, where the proportion where our impact as a key healthcare profes- doubled. Likely, this increase in younger age sional can play a strong part in improving the groups is, in part, a consequence of increasquality of life of our client population. ing rates of overweight and obesity. FurtherCanada appears at a crossroads as reflect- more, an estimated 20% of Canadians are ed by the 2010 Heart and Stroke Foundation living with diabetes and have simply not been Report on Canadian’s Health. “In a very diagnosed. Presently, the strongest research short time, the face of heart disease in Cana- supporting the connection of the oral/sysda has changed to include groups that have temic link is between diabetes and periodonhistorically been immune to the threats of tal disease. It is well documented that periheart disease,” says Dr. Beth Abramson, car- odontal health improves glycemic control diologist and spokesperson for the Heart and Stroke Foundation.4 The signs of this impending crisis are clearly evident. Between 1994 and 2005, rates of high blood pressure among Canadians young and old skyrocketed by 77%, diabetes by 45% and obesity by 18% Figure 1. Ref: The HPV Toolkit. The Society of Obstetricians and — all major risk factors Gynaecologists of Canada www.hpvinfo.ca Accessed Jan 2012

September 2012

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ORAL HYGIENE

Figure 2. 3M ESPE ‘Post-it’ style Caries Risk Assessment Form

and glycemic stability improves periodontal health.6 We understand that periodontal diseases originate from bacterial presence, however not be overlooked is the destruction that ensues as result of the inflammatory response to the bacterial invasion. There is strong, growing evidence that inflammation is transferred back and forth from the oral cavity to other parts of the body. This explains the possible association between periodontitis and other chronic inflammatory conditions. Our attention to the existence of any signs of active inflammation may contribute to the reduction of many of the diseases of influence that plague our population such as diabetes, cardiovascular disease, respiratory disease, etc. We need to embrace a ‘zero tolerance for bleeding’ attitude with each and every client. The third disease where we can have a tremendous impact is oral cancer. There are now two distinct etiologies that exist for oral cancer. The first being alcohol and tobacco

and the second being the Human Papillomavirus. It is estimated that 75% of Canadians will have a HPV infection in their lifetime.7 Reports from major cancer registries conclude that HPV-positive oropharyngeal cancers increased by 225% and incidence for HPV-negative cancers declined by 50% from 1988–2004. 8 If recent incidence trends continue, the annual number of oropharyngeal cancers related to HPV-positive oropharyngeal cancers will surpass annual number of cervical cancers by the year 2020.9 The virus is primarily transferred through sexual contact and namely oral sex. The assumption is that the increased prevalence is a result of the sexual revolution of the 1970s coupled with the perception of today’s youth that oral sex is not as risky to their sexual health and less of a threat to their values and beliefs. Studies report that there is a generalized increase in the number of sexual partners amongst our youth. Although HPV-positive oropharyngeal cancer is somewhat difficult to clinically identify as it often originates in the posterior areas of the oral cavity (base of the tongue, tonsillar areas and oropharynx), there are a number of subtle signs for the dental professional to be aware of. These include but are not limited to; recurrent throat infections that do not respond to antibiotics, unilateral ear ache, a feeling of something caught in the throat, hoarseness and continual lymphadenopathy.

Integration of Risk Assessment into Clinical Practice The incorporation of risk assessment needs to be both practical and informative. What we don’t have is an abundance of extra time in our already full dental hygiene appointment. There are a number of resources that are available to seamlessly integrate risk assessment into the dental

September 2012 www.oralhealthgroup.com

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ORAL HYGIENE Figure 3. Philips Oral Healthcare AirFloss

hygiene appointment. First there needs to be greater connectivity and understanding of the oral/systemic link communicated to our dental hygiene client. The importance of risk assessment and subsequent management will fall upon deaf ears if we have not communicated an imminent need. The medical history update often is rushed providing minimal information. The update needs to be both comprehensive and informative. Again time is often the determining factor as to how much information is imparted. A simple check-box style medical history form presented to the client upon arrival to the practice will serve to reveal additional information that will not only direct the educational component of the appointment but also serve to further elevate the dental I.Q. of the client. An elevated dental I.Q. will empower our dental hygiene client to make informed decisions regarding their oral health. (See information under ‘Clinical Resources’) Caries, periodontal disease and oral cancer risk assessment tools are also available and listed under Clinical Resources at the end of the article.

Risk Management The management of both controllable and uncontrollable risk factors is essential to the dental hygiene practice. Education as discussed above is critical to enabling our client to take responsibility for those risk factors that are within their control. We also have a high responsibility to incorporate dental hygiene care and services that will minimize risk to our clients. For example viewing caries at a much earlier stage and recognizing the cycle of demineralization vs. remineralization. The first clinical evidence of a white spot lesion as a result of underlying demineralization warrants proactive intervention. Remineralization toothpastes should be recommended as well as

the application of chairside fluoride varnish at an interval which meets the individual client’s level of risk.10 Once the sulcular epithelium has been compromised by the invasion of periodontal pathogens, we’ve lost the battle. Oral health then becomes closely intertwined with systemic health. Effective self care measures are also integral to treatment outcomes Many industry leaders have placed considerable thought into the development of unique and innovative products to promote improved oral health. The general consensus is that people brush their teeth for approximately 30 seconds. This led to the development of power toothbrushes that through various means guide the consumer to brush up to 2 minutes. This is a significant improvement considering the heightened efficacy of power toothbrushing, compliance and demonstrated gentleness. Through the patented technology of dynamic fluid force, Sonicare FlexCare+ has been studied resulting in conclusive evidence that it is able to remove interproximal biofilm beyond the reach of the bristles at a distance of 2–4 mm.10 This will aid in delivering a toothpaste with remineralization capabilities into demineralized areas in interproximal regions. What percentage of the population floss? Less than 10% has been cited by many. Again through comprehensive research and development, innovation has emerged intro-

September 2012

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ORAL HYGIENE

“You are not a healthy person unless you have good oral health. Oral health is part of general health and it can affect your overall health and your quality of life.” ducing products such as Philips Sonicare AirFloss. Using microburst technology; a quick burst of air and less than a teaspoon of water or mouth rinse, AirFloss reaches between the teeth to gently remove plaque biofilm in just 60 seconds. This is just one of many innovative products and aids that will contribute to improved overall health for your dental hygiene clients. Former Surgeon General of the United States, C. Everett Koop, said it best; “You are not a healthy person unless you have good oral health. Oral health is part of general health and it can affect your overall health and your quality of life.” It is with the deepest conviction that we need to recognize our position within the healthcare community and our subsequent ability to improve the quality of life for our clients. It is time for our dental hygiene practices to reflect the needs of our client population. n

REFERENCES 1. N IH Consensus Conference on Caries 2001. 2. C anadian Health Measures Survey 2007 – 2009. Summary Report on the Findings of the Oral Health Component 3. World Congress of Minimally Invasive Dentistry: www.wcmidentistry.com/index. php (site accessed July 2012) 4. w ww.heartandstroke.ca 5. http://www.phac-aspc.gc.ca/cd-mc/publications/diabetes-diabete/facts-figures-faitschiffres-2011/highlights-saillants-eng.php (accessed July 2012) 6. http://www.perio.org/consumer/mbc.diabetes.htm (site accessed July 2012) 7. w ww.hpvinfo.ca (site accessed July 2012) 8. C haturvedi A, Engels A, Pfeiffer RM et al. Human Papillomavirus and Rising Oropharyngeal Cancer Incidence in the Unit-

ed States. Jour of Clin Oncol published on October 3, 2011. 9. C leveland JL, Junger ML, Saraiya M et al. The connection between human papillomavirus and oropharyngeal squamous cell carcinomas in the United States. Implications for Dentistry. JADA 142(8): 2011;915-924. 10. http://www.ada.org/sections/scienceAndResearch/pdfs/report_fluoride_exec. pdf (site accessed July 2012). 11. A spiras M, Elliott N, Nelson R, Hix J, Johnson M, de Jager M. In vitro evaluation of interproximal biofilm removal with power toothbrushes. Compend Contin Educ Dent 2007;28(suppl 1):10-14).

CLINICAL RESOURCES 1. Medical History Update Form – available upon request from info@rdhconnection. com. 2. C aries Assessment Tools http://solutions. 3m.com/wps/portal/3M/en_US/3M-ESPE-NA/dental-professionals/solutions/ dental/preventive/oral-health-risk/ For further information on the 3M ESPE Caries Risk Assessment Tool for clinical practice, call 1-888-363-3685. Jones, J. Fight Back! Proactively Addressing Caries Risk Management. Dentistry Today. February 2011. p. 98 – 104 www.dentistrytoday.com (Video accompaniment demonstrating fluoride varnish and extended contact fluoride varnish application). 3. Periodontal Risk Questionnaire – available upon request from info@rdhconnection.com. 4. Oral Cancer Risk Questionnaire – www. cdha.ca/oralcancer — “4 Life Saving Minutes: The Extraoral and Intraoral Examination” (online course and clinical resources).

September 2012 www.oralhealthgroup.com

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TECHNOLOGY Wilson J. Kwong, DMD

Dr. Kwong is the director of the Vancouver Dental Education Centre, where dentists can learn the latest in clinical patient care and practice management.

Viktoriya Mityakova, RDH

A Registered Dental Hygienist who has been working in a Cosmetic Reconstruction dental practice for the last eight years. Now serving as an Office Manager in Dr. Wilson Kwong’s practice in Vancouver, BC.

How Technology has Elevated the Role of the Hygienist in Today’s Dental Practice

odern dentistry is constantly evolving with the introduction of new products, updated techniques, and modern computer advancements. As an integral team member in a dental office, hygienists now are armed with the best tools and equipment to enhance patient care and help establish a successful practice. With well-rounded continuing education choices tailored for hygienists, they can enhance their knowledge and confidence to have a tremendous impact on a client’s oral health and related life choices. For example, in the position of a trusted caregiver, hygienists have a unique opportunity to improve case acceptance for the benefit of both patients and the dental practice. Innovations in dental software, intraoral cameras, digital photography, x-rays, and lasers have contributed to the progression of customer relations and procedural techniques within the dental office. Today’s technology clearly enables hygienists to identify problems, demonstrate options, and efficiently collaborate with the rest of the dental team. Re-care appointments provide an optimal opportunity for hygienists to establish therapeutic relationships with patients, engage them in evidence-based diagnosis, identify their needs and concerns throughout the process, and create a vision with expected out-

comes. The assistance of pictures and visually reinforced presentations become extremely beneficial in treatment planning and provide convincing reference points for patients during the treatment process. By using powerful technology and focusing on comprehensive care and maintenance, dental hygienists are contributing to the success of both a healthy smile and dental practice. Regardless, now more than ever, dentistry faces the era of the educated consumer, so there is more pressure to stay current and up to date with the latest breakthroughs and technological advancements. Patients expect their dentist and hygienist to be current with proven treatment trends. If they are, then patients accept that they’ll be receiving the best and most up to date care possible.1 The following are examples of how the role of the hygienist has been amplified within the dental office and how technology is playing a major part. Dental Software allows dental hygienists to capture real time photographic records of tissue conditions and record positive or negative changes to gingival health that can be shared with the patient on a printed chart or via email. Hygienists are trained to be proficient with all digital communication tools (e.g., digital cameras, software stimulation,

September 2012 www.oralhealthgroup.com

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TECHNOLOGY Figure 1. Within the dental office, hygienists spend the most time with patients, especially when procedural counseling is concerned. Figure 2. Presently, state-of-the-art dental treatments involve commercialized lasers that can be used for hard and soft tissue applications. Figure 3. Hygienists are now using lasers to execute dental procedures on patients.

email, charting, etc). Depending on the task at hand, they’re able to use the tools available to them to communicate the topic of the moment. This is an important factor in patient acceptance of an idealized treatment. Counseling patients about cosmetic and restorative procedures is an integral part of the process. When it comes to counseling patients about cosmetics, or the “tissue issue,” all of the information, including the protocol pertaining to tissue recontouring, can and should be thoroughly discussed with the patient, after which the doctor can perform the procedure. As the hygienist is usually the bridge between patient and dentist, their traditional role as a trusted communication liaison remains extremely important. Dental hygienists typically spend 1.25 hours of oneon-one time with the patient building a solid foundation of trust (Figure 1). Cosmetic imaging allows the patient to see what can be done before any treatment is rendered. This is an excellent communication tool for single tooth or esthetic discussions. Digital and intraoral photography is used to record current and ongoing soft and hard tissue conditions for medical, legal, and record-keeping functions. A powerful motivator for patients is enabling them to directly see their improving tissue conditions, which

helps them continue with their suggested treatment plan as they recover from disease. The advanced detail of 3D models further enhances the capability of dentists and hygienists to identify structural problems and develop precise solutions. 2 Hygienists can use periodontal digital charting that maps the progress of healing through photographs which can be shown to patients on a monitor within the dental office. The photographs reveal debris and infection in the soft tissue and can be emailed directly to the patient’s home or smart phone. This information belongs to the patient and, by sending it straight to them, ownership of the problem is established. The majority of the time, case presentations are only successful if patients own their problems and are willing to take responsibility and action. When patients are directly responsible for their own health issues and finding a solution, then dental treatment can begin. Digital x-rays not only keep radiation levels down, but permit hygienists to see bony and hard tissue changes and track those changes more often without increasing risk to patients. Since the information is portable, they can be shared among other dental professionals in real time.

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TECHNOLOGY

With well-rounded continuing education choices tailored for hygienists, they can enhance their knowledge and confidence to have a tremendous impact on a client’s oral health and related life choices

September 2012

Advanced communication skills facilitate case acceptance for dental work that is not necessarily paid by insurance. Patients are no longer directly or frankly told exactly what they need, but through a series of dramatic and intentional steps, are allowed to self-actualize their present conditions, taking responsibility for their problem(s) and asking for a suitable solution to that problem(s). Delivering state-of-the-art care now involves routine use of lasers in general dental practices, which is slowly beginning to replace the conventional dental drill or scalpel. 3 In the late 1990s, one third of dental patients surveyed by the American Dental Association believed it was important that their dentists use lasers.4 In today’s tech savvy world, it seems almost unbelievable that commercial lasers have only been utilized in dental practices within the last 18 years. 5 Lasers are being incorporated more and more into routine dental procedures, including both soft-and-hard tissue applications, frenectomy, gingival contouring, caries removal, and bleaching. Lasers are also being used in pediatric dentistry (Figure 2).4 Diode lasers, such as the Odyssey Navigator by Ivoclar Vivadent, permit the cosmetic and restorative dentist to control tissue conditions quickly and painlessly for the patient. This equipment also allows hygienists to provide health benefits directly to diseased tissue, enhancing root debridement and healing of the sulcular tissue. Presently, hygienists now performing a variety of laser treatments under the direct supervision of the dentist (Figure 3). To a greater extent, hygienists are becoming certified to use soft tissue diode lasers and understand the science and protocol in using this part of their armamentarium. For patients seeking periodontal treatment, if

they present anything over 4mm and bleeding pockets, this information is noted, and the soft tissue laser is used to treat the biofilm and attempt to lessen the bacterial load of the infected tissue.

Conclusion Hygienists were once considered the person who merely scraped plaque off patients’ teeth. Today, however, times have changed, and hygienists are now considered major players in promoting ideal oral health and modern dentistry. As we progress into the future, the next wave of dental hygienists will need an advanced level of knowledge and technical skill to successfully use new equipment, making their role more imperative than ever. With the expected increase in technological advancements, there will be a paradigm shift of dentists concentrating on other high-value areas within their field, and their hygienists will assume more previous tasks. Technology will be significant to this endeavor. 2 n

REFERENCES 1. Weiner GP. Laser dentistry practice management. Dent Clin North Am. 2004 Oct; 48(4): 1105-26, ix. 2. R hea M, Bettles C. Dental Hygiene at the Crossroads of Change. Chicago, IL: American Dental Hygienists’ Association (ADHA); 2011: 21-22. 3. Sulieman M. An overview of the use of lasers in general dental practice: 1. laser physics and tissue interactions. Dent Update. 2005 May;32(4):228-30, 233-4, 236. 4. Dederich N, Douglas, Bushick D. Ronald. “Lasers in dentistry: Separating science from hype.” The Journal of the American Dental Association. February 2004. vol. 135 no. 2: 204-212.

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The Role of Mouth Rinses as an Adjunct to Home Care

Anne Bosy

Creator of the Oravital System. Formerly a professor at George Brown College and Regency Dental Hygiene Academy, she is currently the Senior Vice-President and founding partner of Oravital Inc., a non- surgical system for the treatment of periodontal disease.

ental biofilm is a complex microbial community that, when in a healthy state, maintains a harmonious relationship within the oral cavity. When environmental changes occur, they often transform healthy, symbiotic biofilm into one capable of causing dental disease.1 Depending on the composition of oral biofilm and factors that create change, the result may be dental caries or periodontal disease. In cases where the accumulation of biofilm is out of control, both diseases may be present. Dental caries is a multifaceted disease process that involves the host, bacteria and nutrients, which subsequently results in demineralization activity. The early stage of invasion involves S. mutans, Lactobacillus sp., and Actinomyces sp. followed by a more diverse group of microorganisms including Gramnegative anaerobes. At the early stage, caries can be controlled by a reduction of simple carbohydrates in the diet, thus preventing the rapid conversion of sugars to acids and reducing the rate of enamel dissolution. 2 Periodontal disease is a polymicrobial infection where some microorganisms such as Porphyromonas gingivalis and Treponema denticola can produce enzymes that cause tissue damage directly but may be dependant on other microorganisms to provide attachment and essential nutrients, thus combining forces in a pathogenic synergism. 3 Limiting the accumulation of biofilm is an important step in keeping a healthy oral environment. Mechanical debridement, brushing and flossing are essential in disease management but often do not sufficiently control oral biofilm. Home care products such as mouth rinses containing chemical antimicrobials can provide gingivitis reduction beyond what can be accomplished with brushing and flossing alone.4 Microbiological tests have demonstrated that not only do antimicrobial agents impact the growth of biofilm on soft

tissue and reach difficult to clean areas but have the ability to penetrate the supragingival biofilm and kill bacteria living within the mass.4 Antimicrobial mouth rinses have become a popular component of good oral care. They are an effective addition to home care routines5 and contribute to maintaining a healthy microbial balance. Numerous antimicrobials have been tested as adjuncts to mechanical plaque control in order to improve the results obtained with brushing and flossing. Use of antimicrobial agents such chlorhexidine, zinc chloride, sodium chlorite (chlorine dioxide), essential oils and quaternary ammonium compounds help decrease oral bacteria without increasing the levels of resistant species. Chlorhexidine preparations continue to be the gold standard for mouth rinses as they have a significant effect on inhibition of the cariogenic bacteria. Chlorhexidine can bind to oral tissues and is released slowly over a period of 7 to 12 hours after rinsing, thus providing a lasting effect. 5 A recent study comparing a chlorhexidine rinse with essential oil mouth rinses showed that S. mutans was significantly reduced by chlorhexidine, however the essential oil mouthwash with and without fluoride failed to achieve the same significant results.6 Chlorhexidine, when used longterm, that is six months or longer, does not promote the overgrowth of opportunist pathogenic species.7 A disadvantage of chlor hexidine is the side effects of staining and taste alteration, but rinses containing 0.2% chlorhexidine gluconate are now available that are alcohol-free, pleasant tasting and relatively non-staining. Cetylpyridinium chloride (CPC) is a potent active agent in a mouth rinse and these rinses provide greater oral microbial reductions than rinses containing phenolic compounds or glycerin/triclosan. 8 CPC rinses share some of the adverse effects of chlorhexidine in-

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cluding tooth staining, burning and increased calculus formation when containing 0.07%. It is also desorbed rapidly from oral tissues. 5 Mouth rinses containing sodium chlorite/ chlorine dioxide have been found effective in reducing bacterial accumulation on teeth and in tongue coating. One study found that this rinse effectively reduced counts of Fusobacterium nucleatum in saliva.9 In addition to the bactericidal properties, chlorine dioxide rinses reduce concentrations of hydrogen sulfide, methyl mercaptan and dimethyl sulfide, collectively called volatile sulphur compounds (VSCs), by oxidizing these to nonmalodourous products. Since VSCs can modify cell shape, diminish cell proliferation, alter collagen metabolism, interfere with protein synthesis and retard wound healing, elimination of these microbial products will help to suppress the progression of periodontal disease.10 Rinsing with a zinc chloride mouth rinse can significantly decrease plaque streptococci and a 0.2% or 0.4% zinc chloride solution could complete the mechanical dental and oral hygiene in an effective way.11 A new dual rinse system supplies the components of the rinse as two separate containers of zinc chloride and sodium chlorite. The two components are mixed just prior to use. This combination of sodium chlorite and zinc chloride results in a release of zinc ions (Zn++) that bind to protein receptors on the surface of bacteria and act as a barrier to prevent the metabolism of protein particles. This prevents the production of VSC, shortens the life span of oral pathogens and has long lasting effects in the reduction of bacteria and breath odour chemicals. The zinc ion system is much more effective than the use of either component by itself.12 The effectiveness of oral mouth rinses in decreasing bacteria depends on the age of the biofilm, the ability to penetrate the biofilm, location of the biofilm (subgingival or supragingival) and susceptibility of oral pathogens to the active ingredient. Short-term use antibiotic rinses can penetrate subgingival biofilm and decrease oral pathogens using a “rinse and spit” system for a period of two weeks. Following the antibiotic rinsing, the patient is placed on a chlorhexidine rinse program for another two weeks. A maintenance protocol is selected and includes good

oral care along with an over-the-counter rinse as an adjunct to oral care to keep the biofilm in a balanced state. Choosing a mouth rinse would depend on patient requirements such as caries control, breath odour concern or to decrease oral bacteria implicated in periodontal disease. If the best fit agent is selected, the mouth rinse would contribute significantly to the control of oral bacteria. n

REFERENCES 1. Berkowitz, RJ. Acquisition and transmission of mutans streptococci. Feb, 2003 Journal of the California Dental Association 2. Smiline GA, Pandi SK, Hariprasad P, Raguraman R. A preliminary study on the screening of emerging drug resistance Biofilm sample taken at a recare among the caries pathogens isoappointment. Note the large lated from carious dentine. Indiamoeboid shape, spirochetes an J Dent Res 2012; 23:26-30. 3. Oral Microbiology, Eds. Marsh and many neutrophils. PD and Martin MV. Fifth Ed. 2009. Churchill Livngstone, Elsevier Ltd. 4. Teles RP, Teles FR. Antimicrobial agents used in the control of periodontal biofilms: effective adjuncts to mechanical plaque control? Braz Oral Res. 2009;23 Suppl 1:39-48. 5. Asadoorian, J. CDHA position paper on commercially available 0ver-the-counter oral rinsing products. July-August 2006; 40(4):1-13. 6. Zheng CY, Wang ZH. Effects of chlorhexidine, listerine and fluoride listerine mouthrinses on four putative root-caries pathogens in the biofilm. Chin J Dent Res. 2011;14(2):135-40. 7. Briner W.W. et al. Effect of chlorhexidine gluconate mouthrinse on plaque bacteria. Journal of Periodontal Research Supplement 1986:44-52. 8. Akande OO et al. Efficacy of different brands of mouth rinses on oral bacterial load count in healthy adults. African Journal of Biomedical Research, 2004 Vol. 7:125-128 9. Shinada et al. Effects of a mouthwash with chlorine dioxide on oral malodor and salivary bacteria: a randomized placebo-controlled 7-day trial Trials 2010: 11:14 10. Silwood CJL, Grootveld MC, Lynch E. A multifactorial investigation of the ability of oral health care products (OHCPs) to alleviate oral malodour. J Clin Periodontol 2001: 28:634-641. 11. Charles CH et al. Anticalculus efficacy of an antiseptic mouthrinse containing zinc chloride. J Am Dent Assoc. 2001 Jan;132(1):94-8. 12. C odiphilly DP, Kaufman HW ,Kleinberg I. Use of a novel group of oral malodour measurements to evaluate an anti-oral malodour mouthrinse (TriOral™) in humans. J Clin Dent. 2004; 15(4): 98-104.

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A Fresh Recommmendation.

When you’re a leader, innovation never stops. That’s why Sensodyne®’s portfolio of sensitivity toothpastes* has been reformulated with fresh new flavours. For the last 50 years our focus has remained the same — working with you to provide your patients continuous protection from dentin hypersensitivity.1,2 That’s why when you think sensitivity, you think Sensodyne.

Low abrasion • SLS† free • Fresh new flavours

The Continuous Protection You Trust. ‡

1,3

* The reformulated Sensodyne variants are: Ultra Fresh, Cool Mint Gel, Brilliant Whitening, Whitening Plus Tartar Fighting, and Fresh Mint. † sodium lauryl sulfate ‡ Sensodyne provides continuous protection against sensitivity with twice-daily brushing. 1. Jeandot J, et al. Efficacy of toothpastes containing potassium chloride or potassium nitrate on dentin sensitivity. Clinc (French) 2007;28:379–384. 2. GSK data on file, 2010. 3. GSK data on file. (Chapman Group. DP U&A. 2010).

Pour les chefs de file, l’innovation ne cesse jamais.

Voilà pourquoi l’éventail de dentifrices pour dents sensibles* de Sensodyne®® a été reformulé avec de nouveaux arômes frais. Depuis 50 ans, notre but n’a pas changé : travailler en tandem avec vous pour offrir à vos patients une protection 1,2 continue contre l’hypersensibilité dentinaire1,2 .

Pour les chefs de file, l’innovation ne cesse jamais. Nouveaux arômes frais • Sans SLS†† • Faible abrasion

La protection continue à laquelle vous faites confiance . ‡ ‡

** Les Les variantes variantes Sensodyne Sensodyne reformulées reformulées sont sont les les suivantes suivantes :: Ultrafraîcheur, Ultrafraîcheur, Gel Gel menthe, menthe, Blanchissant Blanchissant éclatant, éclatant, Blanchissant Blanchissant et et antitartre antitartre et et Menthe Menthe fraîche. fraîche. Laurylsulfate Laurylsulfate de de sodium sodium Sensodyne Sensodyne fournit fournit une une protection protection continue continue contre contre la la sensibilité sensibilité avec avec un un brossage brossage deux deux fois fois par par jour. jour. † † ‡ ‡

Une recommmandation fraîche. Nouveaux arômes frais • Sans SLS† • Faible abrasion MC /® ou licencié GlaxoSmithKline Soins de santé aux consommateurs Inc. Mississauga, Ontario L5N 6L4 ©2012 GlaxoSmithKline 10847

Laurylsulfate de sodium 1. Jeandot J, et al. Efficacité des dentifrices au chlorure de potassium et au nitrate de potassium sur la sensibilité dentinaire. Clinc (français) 2007;28:379–384. 2. Données internes de GSK, 2010. 3. Données internes de GSK. (Groupe Chapman. Professionnels des soins dentaires U&A. 2010).

†

1,3 1,3

ORAL HYGIENE

Infection Control Nitty Gritty Nancy Andrews, RDH, BS

Ms. Andrews graduated from, and was a clinical instructor in Dental Hygiene at the University of Southern California and teaches Oral Pathology, Preventive Dentistry and Infection Control at West Coast University Dept. of Dental Hygiene. She is a speaker, author and consultant, focusing on infectious diseases, clinical safety, instrument sharpening, ergonomics and preventive dentistry. Contact TotalCare online at TotalCareProtects. com or email questions to CE@TotalCare Protects.com

An infection control series built around your questions. Let the author help you with your real-life dental infection control issues!

I am a Dental Hygienist, and practice in three different offices. I have control over most patient care issues, but not surface disinfectants, which are chosen by office managers and full-time staff. I think at least one office is doing things wrong, but I need some back-up to change things. The office I’m concerned about is using disinfectant wipes without a Tuberculosis claim, as far as I can tell by the label. This is the same stuff that we can buy for our home, and the only ingredients listed are quater nary ammoniums. In my other offices, they use two different products, both with TB claims. However, in one of those offices, they don’t follow the label directions for contact time: it says 10 minute TB kill and I know they don’t leave it wet that long! Also, the office manager told me that I don’t need to wipe surfaces twice with the saturated wipes unless there is visible blood. Can you tell me if we need to use surface disinfectants with a TB claim, and if it really makes a difference if the surface stays wet for the whole time? Also, do we really need to wipe the surfaces twice, or is that only if we see blood? You are asking three very important questions! First, let’s address the level of disinfectant you should use. As you know, Health Canada makes the country’s general rules, but individual provinces have the authority to make their own rules also. Of course, it is important to follow the rules gov-

erning the local province. In my opinion, every office should have intermediate-level disinfectants to use when needed on clinical contact surfaces and any surfaces that are visibly contaminated with blood or other bodily fluids. Intermediatelevel disinfectants are effective against Mycobacterium tuberculosis var. bovis, (commonly referred to as TB). Remember that TB is used as a benchmark organism to test disinfectants, because TB is very difficult to destroy (not because TB is likely to be on surfaces in dental offices). Germicides that kill TB are also trusted to be effective against most other vegetative microorganisms. Some pathogens, however, show greater resistance to some disinfectants, and therefore each approved medical/ dental disinfectant is usually tested for effectiveness against specific organisms. Pseudomonas aeruginosa is an example of such a pathogen, so you will see it listed specifically on the label if the disinfectant has been tested against P. aeurginosa. Manufacturers of approved medical and dental surface disinfectants specifically list all of the organisms on product labels that the product has been tested against, along with the usedirections (including contact time) needed to kill or deactivate the pathogen. Low level disinfectants only kill some of the organisms that may be present, and therefore are not as effective, even though some provinces do allow use of low-level disinfectants on clinical surfaces. Bottom line:

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intermediate-level disinfectants should be available to use whenever there is a need for them, which is determined by the risk of transmitting pathogens from contaminated surfaces. The risk of cross-contamination is greatest on clinical contact surfaces and any surfaces possibly contaminated by spray, spatter or aerosols. Since the organisms are invisible, and the surfaces may not be visibly soiled, standard precautions and best practices direct workers to clean and disinfect all potentially contaminated surfaces with a disinfectant that is safe and effective. It is perfectly acceptable to use low-level disinfectants on non-critical surfaces, but in patient treatment areas, labs, or anywhere bodily fluids may contaminate surfaces, intermediate-level disinfectants provide a greater margin of safety by having a broader spectrum of antimicrobial activity. Since the success of all infection control efforts depends both on the effectiveness of the product and workersâ&#x20AC;&#x2122; techniques, and since most dental workers report that they have very little time to disinfect surfaces, most clinicians opt for intermediate-level disinfectants if they have the choice, to provide the best disinfection. The domestic product you described as a non-alcohol quaternary ammonium surface disinfectant that has no T.B. kill claim may have a place in dental offices. Many non-critical areas of the office should be cleaned and disinfected to control surface contamination, such as door knobs, counters, and reception area furniture or surfaces that might be damaged by ingredients in intermediate level disinfectants (such as alcohol). Quaternary ammoniums are an example of cationic surface-active disinfectants, and are recognized as good surface cleaning agents. Quaternary ammonium low level disinfectants are considered bactericidal against Gram-positive bacteria, fungicidal, and virucidal against lipophilic viruses. However, alcohol-free quaternary ammonium low-level disinfectants are not sporicidal or virucidal against hydrophilic viruses, and evidence suggests variable activity against Gram-negative bacteria. Again, for non-critical surfaces, they may be the best choice to primarily clean the office. However, only approved products for medical/dental use (with DIN numbers)

should be trusted to protect patients and workers in clinical areas. The testing needed for approval as a medical product insures safety and efficacy if the product is used correctly. Dental facilities are responsible for everyoneâ&#x20AC;&#x2122;s safety. Second, you asked if and when it is necessary for a surface to stay wet for the stated amount of time. It is illegal to use a product in a way inconsistent with label instructions. In case legality is not a motivator, the scientific reason for leaving it wet as stated is to ensure that the product works as tested, and all of the microbes will predictably be destroyed. Your third question goes along with using a product as directed. All surface disinfectants are approved for use on pre-cleaned, hard non-porous surfaces. The cleaning step is necessary to remove visible or non-visible physical debris or bioburden that may interfere with the disinfecting action of the product. If the step is skipped, there may be unseen material that reduces the efficacy of the disinfectant. Since workers have no way of assessing the success of a disinfectant visually, it is necessary to follow specific protocol to ensure successful disinfection. It is important to remember that some disinfectants are great cleaners and others are not. Generally, products with high alcohol are poor cleaners and require a separate product to dissolve organic substances (clean the surface) before the disinfectant is applied. Other disinfectants, such as those with no or low alcohol content, are excellent cleaners, so the same product may be used to both clean and disinfect. Any way you look at it, two steps are needed to do that! Many dental workers understand the importance of preventing disease transmission in the dental office, but may be confused about specific product choices and slight differences in protocol. This is understandable, given the wide array of choices on the market today. The best approach is to use approved medical/dental products. No matter what product you use, it is important to follow recommended protocol and label instructions to truly predict the results of your efforts and to responsibly protect workers and patients. In the area of dental infection, TotalCare believes that prevention and continuous education are critical for success. n

September 2012â&#x20AC;&#x192;

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ORAL HYGIENE 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.

The Dental Hygienist Profession in Canada T he dental hygienist profession exists in a number of countries around the world. From Korea to China by way of Romania and Australia, there are dental hygienists like you worldwide working to improve the dental health of their fellow citizens. In many countries, Canada’s dental hygienists are considered to be exemplary, a point of reference, practicing a coveted profession. There are thousands of us across Canada who share the same profession and passion, but do we really know one another? Each of Canada’s 13 provinces and territories is fortunate to be able to count on the services of dental hygienists like you — like us —who have chosen this profession. How many of us are there? How do we differ from one another? How long has the profession been recognized in each province? These are some of the many questions we will try to answer to show you that you are part of a big, beautiful and enviable family, thanks in large part to your professional contributions. The summary chart will be presented in portions in the upcoming issues. This issue provides you with information on the first three provinces we explored for you. The

same approach will be used in the next issues of OralHygiene until the picture of our Canadian family is complete. The individuals we contacted demonstrated great dedication by participating in our project to present important aspects of our profession in chart format. In addition, despite their busy schedules, they were generous enough to answer essay questions regarding the challenges of the profession in their respective provinces. Their willingness to share their thoughts is greatly appreciated! A very special thanks to these people without whom this project could not have been carried out. Johanne Côté (OHDQ) Diane Thériault (OHDNB) Stéphanie Gordon (CDHM) Linda Berg (MDA) Patricia Wellington (Oulton College) Robert Farinaccia (CDHO) Kellie Hildebrandt (SDHA) If you have questions or comments, please email us at: dentalhygienistcanada@gmail.ca

As president or officer of the regulatory body in your province, what is the biggest challenge you will have to face before the end of your term? Province Quebec

Answer “ Change the regulations so that DHs become autonomous and thereby improve access to care.” Johanne Côté, (President, OHDQ)

Manitoba

“ Registrants understanding the difference between the regulatory body and the association.” Stephanie Gordon, (Registrar, CDHM) New Brunswick “ Seeing that we are all new to this role, the biggest challenge at this point primarily concerns developing the College’s administration, devising and approving our regulations and in doing so getting our members to understand the difference between the College, whose mandate is to protect the public, and the Association, which addresses the needs of members. There’s a lot of confusion between the two for our members.” Diane Thériault, (Secretary general, NBCDH)

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ORAL HYGIENE DENTAL HYGIENISTS IN CANADA Name of regulatory body Website/ Phone President/Registrar Year founded Total no. of hygienists registered No. of dentists in the province Number of schools providing training Average age of members Graduate employment rate (%) Number of female hygienists Number of male hygienists Annual renewal date Self-initiation authorized Administering local anesthesia authorized Mandatory continuing education

Comparative chart by Province

Quebec Ordre des hygiénistes dentaire du Québec www.ohdq.com (514) 284-7639 Johanne Côté 1975 5,457 4,606 Private 0 — Public 9 36 99% 5,139 103 March 31 no

Manitoba College of dental Hygienists of Manitoba www.cdhm.info (204) 219-2678 Stephanie Gordon 2008 683 647 Private 0 — Public 1 40-48 90% 611 15 January 15 no

New Brunswick New Brunswick College of Dental Hygienists N/A (506) 875-1748 Diane Thériault 2009 433 312 Private 1 — Public 0 34 91% 428 5 January 1 no

yes

SASKATCHEWAN

Name of regulatory body Website/Phone President/Registrar Year founded Total number of hygienists registered Number of dentists in the province Number male hygienists Number of schools providing training Average age of members Graduate employment rate (%) Annual renewal date Self-initiation authorized Administering local anesthesia authorized Mandatory continuing education

Saskatchewan Dental Hygienists Association www.sdha.ca (306) 931-7342 Kellie Hildebrandt 1998 566 446 11 Private 0 — Public 1 40 years NA January 15 yes*(1) yes yes – 50 hrs/3 years

ONTARIO

College of Dental Hygienists of Ontario www.cdho.org 1-800-268-2346 Mike Connor 1994 12,894 8,398 277 Private 7 — Public 12 NA NA December 31 yes no yes – 75 hrs/3 years

*(1) Must have a contract only with a dentist.

Annie Beaulieu, HD

Graduated in dental hygiene in 1999. She is currently a valued member of Dr. Elliot Mechanic’s team in Montreal. In 2001 she founded the first dental spa concept. She has participated in several conferences both nationally and internationally and has also published an article in Dentistry Today. She has performed beyond 2,500 “one hour whitening” treatments and has advanced expertise in the area of whitening.

What aspects of the dental hygienist profession would you like to see further developed or created over the coming years? Province Quebec

Answer “ Professional autonomy and the possibility of administering local anaesthesia.” Johanne Côté, (President, OHDQ) Manitoba “ Independent practice for RDHs in Manitoba.” Stephanie Gordon, (Registrar, CDHM) New Brunswick “ Developing multidisciplinary, autonomous and independent practices in various settings to improve access to dental hygiene within the communities.” Diane Thériault, (Secretary general, NBCDH) Saskatchewan N/A Ontario “The hope that Ontarians will have more access to oral health care services.”

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ORAL HYGIENE

La profession d’hygiéniste dentaire au Canada

L 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.

a profession d’hygiéniste dentaire existe dans plusieurs pays à travers le monde. De la Corée à la Chine en passant par la Roumanie et l’Australie, il y a tout autour du globe, des hygiénistes dentaires comme vous, qui œuvrent à améliorer la santé dentaire dans leur population. Pour avoir voyagé dans plusieurs pays dans le cadre de notre travaille, nous savons que l’hygiéniste dentaire du Canada demeure un exemple, une référence, une convoitise. Nous sommes plusieurs milliers à travers le Canada à partager la même profession, la même passion, mais nous connaissons nous vraiment? Il existe 13 provinces et territoires au Canada et chacune d’entre elles a la chance de pouvoir compter sur les services d’hygiénistes dentaires comme vous, comme nous, qui ont choisi ce métier. Combien sommes-nous, quelles sont nos différences, depuis combien de temps la profession estelle reconnue dans chacune des provinces? Tellement de questions auxquelles nous tenterons de répondre pour vous démontrer que vous faites partie d’une belle et grande famille faisant l’envie de tous grâce, entre autre, à votre contribution professionnelle. Le dévoilement du tableau synthèse se fera progressivement au cours des prochaines publications. Dans cette édition vous aurez la chance d’y découvrir les cinq premières provinces que nous avons explorées pour vous et ce sera ainsi dans chacune des prochaines parutions du Oral hygiene jusqu’à la réalisation

d’un tableau complet de notre belle et grande famille Canadienne. En plus de leur immense dévouement à participer à notre projet de transposer les éléments importants de notre profession sous forme de tableau, les personnes contactées ont eu la générosité de répondre à des questions à développement concernant les défis de la profession dans leur province respective et ce malgré leur horaire chargé. Un sens du partage bien apprécié! Un merci bien spécial à ces personnes sans qui ce travail n’aurait pu être accompli. Johanne Côté (OHDQ) Diane Thériault (OHDNB) Stéphanie Gordon (CDHM) Linda Berg (MDA) Patricia Wellington (Oulton College) Robert Farinaccia (CDHO) Kellie Hildebrandt (SDHA) Pour toutes questions ou commentaires vous pouvez nous joindre par courriel à : hygienistedentairecanada@gmail.ca dentalhygienistcanada@gmail.ca *Veillez prendre note que les informations cidessus ont été recueillis auprès des dirigeants des organismes de régistration du 1 Mars 2012 au 1 Septembre 2012. La profession évolue rapidement, il se peut donc qu’il y est eu changement du nombre de membres, de gouverne de l’organisme ou de législation.

Dans les années à venir, quels aspects de la profession d’hygiéniste dentaire aimeriez-vous voir se développer ou se créer? Province Quebec

Answer « L’autonomie professionnel et la possibilité de faire de l’anesthésie local » Mme Johanne Côté, (Présidente OHDQ) Manitoba “ Independent practice for RDHs in Manitoba.” Mme Stephanie Gordon, (Registraire CDHM) New Brunswick « Le développement de pratique multidisciplinaire, pratique autonome, pratique indépendante dans divers milieux pour améliorer l’accès aux soins d’hygiène dentaire au sein des communautés. » Mme Diane Thériault, (Secrétaire générale OHDNB)

September 2012 www.oralhealthgroup.com

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ORAL HYGIENE

HYGIÉNISTES DENTAIRES AU CANADA Tableau comparatif des provinces Québec

Manitoba

Nouveau-Brunswick Ordre des Hygiénistes Nom de l’organisme de Ordre des hygiénistes College of Dental dentaires du Nouveauréglementation dentaire du Québec Hygienists of Manitoba Brunswick Adresse internet/ www.ohdq.com www.cdhm.info N/A téléphone (514) 284-7639 (204) 219-2678 (506) 875-1748 Président/Registraire Johanne Côté Stephanie Gordon Diane Thériault Année de fondation de l’organisme 1975 2008 2009 Total d’hygiénistes inscrits au registre 5 457 683 433 Nombre de dentistes dans la province 4 606 647 312 Nombre d’écoles donnant la formation Private 0 — Public 9 Private 0 — Public 1 Private 1 — Public 0 Âge moyen des membres 36 40-48 34 Placement des finissants (%) 99% 90% 91% Number of female hygienists 5 139 611 428 Nombre hygiénistes hommes 103 15 5 Date du renouvellement annuel 31 Mars 15 Janvier 1 Janvier Pratique autonome autorisée non non non Anesthésies locales autorisées non non non Formation continue obligatoire oui 40 hrs/2 ans oui oui 36 hrs/3 ans

SASKATCHEWAN

Nom de l’organisme de réglementation Adresse internet/téléphone Président/Registraire Année de fondation de l’organisme Total d’hygiénistes inscrits au registre Nombre de dentistes dans la province Nombre hygiénistes hommes Nombre d’écoles donnant la formation Âge moyen des membres Placement des finissants (%) Date du renouvellement annuel Pratique autonome autorisée Anesthésies locales autorisées Formation continue obligatoire

Saskatchewan Dental Hygienists Association www.sdha.ca (306) 931-7342 Kellie Hildebrandt 1998 566 446 11 Privés 0 — Publics 1 40 ans NA 15 Janvier oui*(1) oui oui – 50 hrs/3ans

ONTARIO

College of Dental Hygienists of Ontario www.cdho.org 1-800-268-2346 Mike Connor 1994 12 894 8 398 277 Privés 7 — Publics 12 NA NA 31 Decembre oui non oui – 75 hrs/3 ans

*(1) Must have a contract only with a dentist.

En tant que président ou dirigeant de l’organisme de réglementation de votre province, quel est votre plus grand défi d’ici à la fin de votre mandat? Province Quebec

Answer « Modifier la réglementation afin que les HD deviennent autonomes et ainsi améliorer l’accessibilité aux soins. » Mme Johanne Côté, (Présidente OHDQ)

« Registrants understanding the difference between the regulatory body and the association » Mme Stephanie Gordon, (Registraire CDHM) « Pour le moment, étant donné que nous sommes tout nouveaux avec ce rôle, le plus gros défis Nouveauest plutôt en termes de développement de l’administration de l’Ordre, le développement et Brunswick l’approbation de nos règlements et ainsi faire comprendre à nos membres la distinction entre l’Ordre qui a le mandat de la protection du public et l’Association qui répond au besoin des membres. Il existe beaucoup de confusion pour nos membres entre les deux. » Mme Diane Thériault, (Secrétaire générale OHDNB) Saskatchewan « Full access to dental hygiene care for all people of Saskatchewan, as well as maintaining safe, competent dental higiene services. » Mme Kellie Hildebrandt, Registrar-Executive Director SDHA) « Raising public awareness of a ??? right to safe, effective dental hygiene care and the CDHD’s role Ontario to ensuring. » Robert Farinaccia, (Practice Advisor/Patient Relations Liaison CDHO)

Annie Beaulieu, HD

A obtenu son diplôme en hygiène dentaire en 1999.Elle travaille actuellement au sein de l’équipe du Dr Elliot Mechanic à Montréal Elle a fondé en 2001 le premier concept de spa dentaire. Elle a participée à plusieurs conférences tant au niveau national que international et à également publié un article dans le Dentistry Today. Elle a effectué au delà de 2 500 blanchiment à la chaise et possède une expertise avancée dans le domaine du blanchiment.

Manitoba

September 2012

www.oralhealthgroup.com

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FINANCE

Keeping a roof over your head, no matter what

n empty house can seem sad and lonely. But a home — that’s different. It’s your place, an architectural shell you’ve filled with the beauty of life, the emotion of living. And, whether it’s your first home or your dream home, the most important fact is it’s your home. At least, it is your home for as long as you continue to pay the mortgage. That’s why you budget carefully and make those mortgage payments each month. But, what if you couldn’t? What if sickness, injury or death made it impossible to keep up with the mortgage payments? Would your family be able to stay in its home? Fortunately there are ways to ensure your family will always have a roof over its head, regardless of what happens to you. But, what’s best for your situation? Let’s take a look. Traditional mortgage insurance will pay off the total outstanding amount of your mortgage when you die. Most lending institutions offer mortgage insurance as part of their mortgage options and they’ll usually integrate the premiums into your total

mortgage payments. But, this type of insurance often does more to protect the lender than you. For starters, your lender owns the policy and if you find a better mortgage rate at another lending institution, your mortgage insurance usually can’t be moved to the new institution, and you may have to requalify medically for the new protection.

Mortgage Insurance Lender provided mortgage insurance is set at the amount of your mortgage and generally decreases as you pay off your mortgage — so you end up paying the same premium for less coverage. If anything happens to you, the death benefit is payable to the lender, not your family. And renewal rates aren’t guaranteed.

Life Insurance A personal life insurance policy insures you, not your mortgage. You determine the amount of coverage you want — it’s not tied to the value of your mortgage. You

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Lorne Dubros

A Certified Financial Planner and senior financial consultant with more than 17 years’ experience with Investors Group Financial Services Inc. Lorne provides financial planning for individuals, families, professionals and business owners. Lorne.Dubros@ investorsgroup.com

Always Home

September 2012 www.oralhealthgroup.com

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FINANCE

People are often caught off guard by the impact of a critical illness on their financial well-being. Besides the time lost at work to care for oneself, a spouse or child, typically there are expenses that are not covered by the government — new drug treatments, travel to treatment centres, or modifications at home to accommodate a life-altering situation. own the policy so you have the freedom to name your beneficiaries and they can choose how to use the proceeds. You can switch to another lending institution without jeopardizing your coverage and your coverage doesn’t decrease as your mortgage is paid down, which means that for every dollar of mortgage principal repaid, there will be additional proceeds available to your family at a time when they may need them the most. Also, your policy can be customized with the options and features you choose, which may include having your premiums waived if you become disabled. Disability insurance protects your ability to continue to make mortgage payments by providing money if you can’t work. You may have a group plan at work that includes disability insurance. But, group coverage ceases when you leave your job and if you’re self-employed you may not have a plan. A group plan may also have limits on payouts and may narrowly define the term “disability” which could require you to relinquish

payments or return to work prematurely. A personal disability plan can supplement other disability benefits in ways that make sense for you. Critical illness insurance generally pays you a one-time lump sum benefit amount if you are diagnosed with a critical illness or condition as defined in your policy. Critical illness insurance is not tied to a mortgage or any other personal or business loan. You usually can use the benefit to help pay off your outstanding mortgage loan, make payments while you recover, or for any other personal or business need. If you want your home to be a secure haven no matter what happens to you, having enough insurance to cover your mortgage debt is essential. And if you want to be able to maintain your family’s lifestyle come what may, disability and critical illness insurance are equally important. A financial planner can show you how insurance can play an important role in bringing your financial security plan home to stay. n

September 2012

www.oralhealthgroup.com

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TECHNOLOGY Tracey Lennemann, RDH, BA

Is an international professional speaker and trainer. She has been a practicing clinical periodontal dental hygienist since 1986 in the USA and in Europe. She has been creating a series of continuing education workshops, lectures and seminars for dental practices, private continuing education programs, study clubs, symposiums, dental associations and universities.

From Debridement to Therapy: Advances in Air Polishing D

o you have an air polishing devise? Are you actively using it or has it been sitting in a closet or drawer for years? The question to ask is, “Why did you stop using it?” Were some of the reasons because it was too messy, the salty taste, the gingival damage it caused or the high risk of creating subcutaneous emphysema? For whatever reasons you had, it’s time to get out your air polisher, clean it up and get ready to use it again. Air polishing has changed! It wasn’t until the late 1970s that Dr. Robert Black’s 1945 invention of air abrasives started to get noticed by dental clinicians.1 The original idea was for a device that used compressed air, water, and a highly abrasive powder to eliminate pain from cavity preparation, making anaesthesia unnecessary. 2 This was called air abrasion, which, later in the 1980s, was introduced as a similar procedure but used for heavy stain removal for difficult areas called air polishing. The powder of choice has been sodium bicarbonate mainly used for heavy stain removal from chlorhexidine, smoking, coffee or tea stains. It has been shown to be effective around orthodontic braces and brackets

and as a better choice for sealant retention as opposed to the traditional method of polishing paste with a prophy brush. 3-5 However, other studies shown significant limitations when using sodium bicarbonate.6-8 A 1986 study by Galloway and Pashley demonstrated that the air polisher can cause clinically significant loss of tooth structure when used excessively and should, therefore, not be used on exposed cementum or dentin.6 Additionally an article published in RDH Magazine stated “In its position paper, the ADHA highlights that air polishers should be avoided around most types of restorative materials due to the possibility of scratching, eroding, pitting, or margin leakage”.7 Likewise, a root dentine study concluded, “Air polishing applications increased the surface roughness of all composite resin restorative materials tested. Composite restorations may require repolishing after air polishing.” 8 Consequently it has become general practice not to air polish any restorative materials unless using Glycine powder. There have also been recommendations to avoid the following conditions: patients with restricted sodium diets, patients with respi-

September 2012 www.oralhealthgroup.com

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TECHNOLOGY Figure 1. Sylc Powder

Figure 2. Prophy-Mate Neo from NSK

Figure 3. Sylc SmarTip

ratory, renal, or metabolic disease, patients with infectious disease, children, patients on diuretics or long-term steroid therapy and patients with titanium implants (research is still needed in this area).9 And let’s not forget the mess of the aerosol, increase risk of subcutaneous emphysema, bad taste, dry skin following application, clogged hand piece and aggressive feeling of pin pricks during application as many of us have experienced. So, due to these academic studies and more general concerns, many clinicians choose to put away their polishers and revert to the traditional method of hand polishing with pumice, prophy paste, brushes and prophy cups. The air polishing market had effectively gone into hibernation, with little innovation throughout the late 20 th century. It wasn’t until the new millennium did air polishing begin to wake up and change. New powders were introduced to overcome the problems experienced with sodium bicarbonate. One such powder was calcium carbonate with micro-sphere technology. This material was formed from rounded particles of food-grade calcium carbonate, which

helped reduce aerosol spray due to better angulations during delivery. Studies showed reduced gingival irritation yet still being as effective for heavy stain removal as sodium bicarbonate. Its neutral taste is more pleasing to the patient as well being able to use it with patients on sodium restricted diets.10,11 Calcium bicarbonates cleaning effect with decreased contraindications have opened the door to more effective air polishing. Glycine also joined the world of air polishing with numerous studies supporting effective, gentle biofilm removal subgingivally, around implants and being gentle on restorative materials.12 Now, let’s jump ahead to 2012. Air polishing has another player in the game and its name is Sylc® (Figure 1). This new material was developed by researchers at the Dental Institute of Kings College London and is an air polishing bioglass powder containing high concentrations of calcium sodium phosphosilicate.

September 2012

www.oralhealthgroup.com

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TECHNOLOGY

Figure 4. OSspray Ceramic Tip to be used with EMS AirFlow Handy 2.

Calcium sodium phosphosilicate bioglass was invented by Professor Larry Hench at the University of Florida in the late 1960s, and originally found utility in the remineralization and repair of new bone tissues.13,14 Later, in the mid-1990s, uses of this unique material were expanded to include dentin remineralization and subsequently branded as NovaMin®.15

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Sylc® is a ‘powder therapy’ that decreases dentinal hypersensitivity, uniquely repairs dental tissues and brightens teeth. It has been proven to clean, polish and desensitize by remineralizing dentine surfaces in one treatment when applied like a conventional prophy powder.16 Unlike sodium bicarbonate, which is contraindicated for some patients, Sylc® is suitable for almost all patients and is applied as an air polishing powder in the Prophy-Mate Neo® handheld device from NSK (Figure 2), the Sylc SmarTip® (Figure 3) or in the EMS Handy® when used with an OSspray Ceramic Tip® (Figure 4). When the Sylc® material is applied as a powder via an air polishing system, or when slightly damp via a rubber cup, the level of tubule occlusion was significantly higher than that of the other air polishing powders (Cavitron prophy jet, EMS Air-flow perio) and polishing pastes (Tooth Mousse, Colgate Sensitive Pro-Relief and Nupro)17 (Figure 5). Additionally, researchers have also proven the Sylc® powder therapy re-mineralizes the surface of dentine, giving a regain in mineral content and micro-hardness within just 24 hours and one single application.18 So, in this form for sensitive root surfaces, Sylc can remove stain (Figure 6), plaque, biofilm while desensitizing and remineralizing all at the same time. For exposed root surfaces under restorative materials, the Smar Tip®, a small individual tip used without water from a special turbine handpiece, is recommended. Both systems are equally effective and enable us to treat various levels of hypersensitivity. Sylc® is to be used on natural teeth only as it can matt, dull and pit some restorative materials. Note: it is not a replacement for air polishing of subgingival biofilm or stain removal from restored surfaces.

September 2012 www.oralhealthgroup.com

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TECHNOLOGY

Figure 5. Closed tubules.

Before usage 46 Open tubules

After sodium bicarbonate – 26 open tubules.

After sylc – 16 open tubules

60 seconds after bicarbonate

20 seconds after Sylo

Figure 6. Stain removal.

Precleaning

Air Polishing Air polishing has come a long way in 30 years. Recent studies have shown that not only is air polishing a safe and vital part of prophylaxis and periodontal maintenance, it can be used as an individual therapy...‘powder therapy’ for certain conditions. At the end of the day, it is all about our patients and keeping them healthy, happy and free from dental pain. n

REFERENCES 1. Rohleder PV, Slim LH. Alternatives to rubber cup polishing. Dent Hyg 1981: 53(9). 2. T he efficiency of cleaning fissures with an air-polishing instrument, Gunhild Vesterhus Strand and ,Magne Raadal, Acta Odontologica Scandinavica, 1988, Vol. 46, No. 2 : Pages 113-117.

3. Ramaglia L, Sbordone L, Ciaglia RN, Barone A, Martina R.A., A clinical comparison of the efficacy and efficiency of two professional prophylaxis procedures in orthodontic patients. Eur J Orthod. 1999 Aug; 21(4): 423-8. 4. Pelka MA, Altmaier K, Petschelt A, Lohbauer U. The effect of air-polishing abrasives on wear of direct restoration materials and sealants. J Am Dent Assoc. 2010 Jan; 141(1): 63-70. 5. Engel S, Jost Brinkmann PG, Spors CK, Mohammadian S, Mûeller-Hartwich R. Abrasive effect of air-powder polishing on smooth surface sealants. J Orofac Orthop. 2009 Sep; 70(5):363-70. Epub 2009 Dec 9. 6. Galloway SE, Pashley DH: Rate of removal of root structure by the use of the prophyjet device. “Journal of Periodontology” 1986;58(7):464-469. 7. Slim L., Thomas C, Air polishing revisited:

September 2012 www.oralhealthgroup.com

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TECHNOLOGY

Recent studies have shown that not only is air polishing a safe and vital part of prophylaxis and periodontal maintenance, it can be used as an individual therapy... ‘powder therapy’ for certain conditions There’s and elephant in the room. 2011.01.01 www.rdhmag.com online (Article/d326d 10c-2 fce-4517-8b 50-4eb 24a 53a 56d). 8. Pelka M, Trautmann S, Petschelt A, Lohbauer U. Influence of air-polishing devices and abrasives on root dentin – an in vitro confocal laser scanning microscope study. Quintessence Int. 2010 Jul-Aug; 41 (7): 3 141-8. 9. A DHA.org, American Dental Hygienists’ Association Position Paper on Polishing, webpage updated 2010, http://www.adha. org/profissues/polishingpaper.htm. 10. Portfolio of Prophy powder. Desjardins J., 28th Sept 2011 Private paper. 11. I mfeld T, Assessment of the stain removal potential of four prophylaxis powders on human enamel. Univ. Zurich, private study. 12. Petersilka G et al. Subgingival plaque removal at interdental sites using a low-abrasive air polishing powder. J Periodontol. 13. Hench LL. Biomaterials. Science 1980; 208:826-831.

14. Hench LL, Splinter RJ, Greenlee TK, Allen WC. Bonding mechanisms at the interface of ceramic prosthetic materials. J Biomed Mater Res Symp 1972;2:117-141. 15. Scott R, NovaMin Technology, J Clin Dent 2010;21 [Spec Iss]:59-60. 16. A clinical evaluation and comparison of bioactive glass and sodium bicarbonate air polishing powders. Banerjee A, Hajatdoost-Sani M, Farrell S, Thompson I. J Dent 2010; 38: 475 – 479. 17. Sauro S, Watson TF, Thompson I. Dentine desensitization induced by prophylactic and air-polishing procedures: An in vitro dentine permeability and confocal microscopy study. Journal of Dentistry 2010; 38: 411 – 422. 18. Effects of common dental materials used in preventive or operative dentistry on dentin permeability and remineralization, Salvatore Sauro, Timothy F. Watson and Ian Thompson, J Operative Dentistry (2011) Oper Dent. 2011 Mar-Apr; 36(2): 222-30.

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

BOLTON AND AJAX, ON PEDODONTIST REQUIRED Pedodontist required part time for 1 or 2 days/week. Busy family practices with a large number of young children. Inquire at tel: 416-464-9217.

ROI CAPITAL – FINANCING YOU CAN TRUST 1 • 100% financing THOMPSON, MB ORILLIA, ON Full-time, energetic, • full disclosure of terms detail oriented associate Part time associate required 1-2 days busy family practice needed for established, • practice purchase, set-up, renovations per week for busy general family with income potential up to $30,000 per month. real-estate, equipment leases practice. Experience preferred. Excellent opportunity. New grads welcome. • complimentary review of existing proposals Please forward resume to Mentorship provided. E-mail cv : thompsondental@hotmail.ca

National

Regional dental_2010@live.ca

Bill Alton

Ontario & East:

(416) 731-6535

(647) 287-5328

bill@ethiclease.com

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

(866) 731-6535 2012 Jim Blair September

Manitoba & West: Patty Scrase (604) 619-4699

Fabulous office on world famous Robson Street. Established with full lease in place. Three operatories with associate and staff willing to continue. E-mail: downtownpracticeforsale@gmail.com

PERIODONTAL PRACTICE FOR SALE, VANCOUVER AREA, BC

WILLIAMS LAKE, BRITISH COLUMBIA DENTAL ASSOCIATE POSITION

TISTS

VANCOUVER, BC FOR SALE

Well established, successful Periodontal practice for sale. Vancouver area. High gross revenue with excellent net income! Solid referral base. Excellent staff trained in periodontal procedures. Beautiful office in great location. Contact Henry at 604-724-1964 or henry@heapsanddoyle.com www.HEAPSandDOYLE.com Over 55 practices for sale across Canada

ASSOCIATESHIPS CALGARY, AB

Part-time associate position available in recently renovated, well-established, family practice. We have an experienced team and provide all aspects of dental care. Please email resume in confidence to dental_team@yahoo.ca.

HAMILTON AREA

Busy, family practice with multiple locations looking for long-term associate dentist with experience. Saturdays and some evenings. Large patient base. Email resume to: dentalhiring@hotmail.ca

OTTAWA/SASKATOON/HALIFAX Associates wanted both full and part-time in established practices. Ottawa, Saskatoon, Halifax locations. Email: info@finetouchdental.com or phone Andy 888-526-3535.

www.oralhealthgroup.com

* OHYSept12 p36-38 Classifieds.indd 36

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BARRIE, ONTARIO

OSHAWA AREA

Part time associate required for a very successful, large group practice. E-mail: kathleen@healthcentredental.com or tel: 905-438-9977.

ASSOCIATE WANTED FOR RED DEER, ALBERTA Full or Part time associate wanted. Must be willing to provide ultimate patient care. Strong Endo, exodontia, crown and bridge skills are mandatory. High tech office seeing 80 new patients a month. Owner needing to reduce hours. May require evenings and Fridays. Incentive program offered. New Grads welcome. Respond to: bestbetdental@me.com

RED DEER, AB We are a highly equipped group of offices with new technology in Central Alberta allowing you to be the best you can be. New grads welcome. Please email: Appleway@telus.net

SCARBOROUGH, ON

Scarborough office: Needed associate part time; good team player, for a general family oriented practice. Must be experienced in all areas of dentistry. Spanish speaking an asset. Send resume to bellesmeredental@gmail.com

WHITECOURT, AB

Part time or full time associateship available immediately for a busy practice near Edmonton. Full patient load awaits the right candidate with the option for a graduated remuneration scale based on production. This is an excellent opportunity to be mentored by our dental team that have graduated from the LVI and Kois post graduate programs. New grads welcome and accommodations included. Email: rdbalic@telus.net

LETHBRIDGE, AB Integrity Dental is an established and well known 7 chair dental practice operating within one of the most uniquely designed dental buildings in Alberta. We are located in the heart of downtown Lethbridge and are currently looking for a skilled, caring and dedicated Dental Associate wanting to commit to becoming a future partner. You will be surrounded by an extremely qualified dental team and a highly respected and experienced dentist who is willing to mentor. We have every system in place for your success and to be busy working 5 days a week. We invite you to visit our website at www.integritydental.com and experience what we are about. Please contact Dr. Harold Elke at 1-855-320-0033 for information regarding this exciting opportunity.

www.oralhealthgroup.com

OHYSept12 p36-38 Classifieds.indd 37

www.oralhealthgroup.com

Needed : F/T Associate DDS position available ASAP. Evenings & Saturdays are a must. E-mail: dental_manager@hotmail.com

DENTAL MARKETPLACE

ASSOCIATESHIPS EXCELLENT ASSOCIATE OPPORTUNITY ONE HOUR EAST OF TORONTO

Busy dental office looking for a full or part time associate. No evening or weekends and new graduates welcome. For more information please call: 905-372-6251.

NORTH YORK, ON

Busy, progressive practice in North York has a PT position available for proven GP associate dentist. Opportunity to grow within. Fall 2012 start up. For more info please email resume: bvdhiring@gmail.com

ORANGEVILLE, ON

JUST NORTH OF BRAMPTON Progressive well established family dental practice seeking a PT associate with FT potential. Large dental practice with 7 spacious treatment rooms, all digital x-rays and digital scanning for crown and bridge impressions. We currently have 3 specialists and an in-house Anaesthesiologist. Must be self motivated, caring, honest individual with good communication skills. Email resume to: Progressivedental16@hotmail.com

NORTHERN BRITISH COLUMBIA

Full-time associates needed for established, busy family practices in Burns Lake, Quesnel, and Fort Saint John with high income potential. The clinics feature high quality full time hygienists, CDAâ&#x20AC;&#x2122;s, Cerec and friendly, hard working staff. Contact Curtis: cklmanagement@gmail.com or 801-376-0976.

COURTENAY, VANCOUVER ISLAND FULL TIME ASSOCIATE REQUIRED

This position would be available late August early September. This is a six operatory, newly renovated clinic. It is fully computerized. It is an established busy progressive, family, full service clinic. Courtenay is a rapidly growing community with lots of activities year round. There is a possibility of a buy in for the right individual. Please email CV to orca.dental@shaw.ca Attention: Nola, office manager.

September 2012â&#x20AC;&#x192;

12-09-05 11:12 AM

DENTAL MARKETPLACE

Grundy Family Dental Care in Hanover and Lucknow Ontario

We are looking for an Associate with strong clinical and interpersonal skills to assume an established associate position in our busy practice. CREE NATION We are a state of the art general dentistry practice known TRIBAL HEALTH CENTRE INC. for exceeding patient expectations and providing a full range of dental services in office including sedation. New THE PAS, MANITOBA Associates immediately leverage our market presence, REQUIRES A GENERAL DENTIST established patient pool, terrific facilities, professional The Cree Nation Tribal Health Centre invites applications systems and support teams to deliver excellent and for the position of a general dentist. This is a full time posicomprehensive dental care. tion located on Opaskwayak Cree Nation, MB. The dental Our Associates earn above average compensation, and program provides services to the communities of Opaskwayak, Mosakahiken, Chemawawin, Misipawistik, Sapothose wanting professional development opportunities taweyak and Wuskwi Sipihk First Nation members. have consistently increased their competence, scope The current salary is dependent on years of experience and earnings within our established general dentistry, and service. Applicants must be eligible for dental license sedation and implant practice. in Manitoba with OR time expected at local hospital for Work full-time or part-time, in a rewarding professional applicants with GPR training. environment, have a great quality of life in a lovely area For further information contact of Ontario with very affordable housing and nature at Noreen Singh, Finance Manager at 204-627-1505. ING 09 your door. All with080908 Toronto andAPRIL Pearson10 Airport just Closing date October 5/12 2 hours away. Please send cover letter and resume with three references to: MPLANT SURGERY Check out our website at Noreen Singh, Finance Manager www.grundyfamilydentalcare.com CHING CENTER nsingh@tribalhealth.ca Is looking for full-time/part-time dentists for: email to RTA, WESTLOCK Please send your resume via Box 2760 OTTAWA AREA laurieg@grundyfamilydentalcare.com The Pas, MB iate position is available in one are located in very busy retail locations. Modern, R9A 1M5 Or callPractices us at 1-519-378-7425

ost successful Dental Implant Paperless Offices. If you are energetic, committed and want to grow professionally, please contact y Spring 2009. Our state-ofBRANTFORD, ON terized facility with CT-scan Dr. Raja Sandhu, BDS, DMD TRENTON, ON Immediate Part-Time Associate CEO - SANDHU DENTAL GROUP nutes north of Edmonton in a for a caring, motiWe are looking Position Available E-mail: rsandhu@sandhudental.ca vated and enthusiastic doctor to join Modern, progressive, growing practice in ing Community ideal for famiFax: 613.258.5276 www.sandhudental.ca multi operatory office offering advanced our team. me from across Canada to Part this time leading to full dental concepts and procedures includtime for experienced doctor or new NEW GRADUATES WELCOME Facility. Become agrad. partThis of isour ing; oral surgery, prosthetics, endodona great opportunity for tics, implants and oral medicine. Sucd highly qualified young Dental someone who wants to treat people cessful candidate will have at least five with great income potential and great a very busy full-service general, years09 experience in general dentistry. 090336 SPRING working conditions. We have an Flexible hours available Monday to Fripractice with extremely high excellent supporting staff and state day. This is an ideal position for a Dentist ASSOCIATE OPPORTUNITY IN THE 50% split. Be mentored byfacility the providing of the art full VALLEY range whoVANCOUVER has recently relinquished ownership COMOX ON ISLAND, B.C. still wishes to practice. of dentalexcluservices. We are looking for an and whose practice is limited associate dentist to join our team in Interviews3-4 will be arranged by emailing a permanent, position, days per week. Please send your resume by email full-time to ology. your resumepatient and contact information to Our office has an established base of 3000+ Cheryl; ddpc2008@live.ca by faxing CV or resumeryounes@sympatico.ca to: patients currently being serviced by just one dentist. We mplant Smile Center, have a brand new facility with all new equipment, digital x-rays and electronic charting. Our practice is system 49-2626 (Attn: Anita), or EAR FALLS, ON based, offering comprehensive care with a strong HAMILTON, ON preLocum dentist needed for mature practice to drleigh@telus.net. ventive model. This very busy Hamilton practice is 1-2 weeks per month, minimum one year Theprovided, Comox Valleylooking is the recreation capital of B.C., s: 1-888-877-0737commitment, (toll free). accomodation for an experienced part time offering climate andwho affordable living. a fast can handle location â&#x20AC;&#x201C; Ear Falls, Ontario, pristine wil-a mild associate w.albertadentalimplants.com derness, 400km from Winnipeg, 45% of www.riverwaydental.com paced environment. It is a general mplantsmilecenter.com www.discovercomoxvalley.com gross billings. practice with great potential for an

to: riverwaydental@shaw.ca Send resume to Please send CVassociate to grow. Dr. Matthew Walkiewicz at e-mail: Fax your resume to 905-524-2121 mattjw@kmts.ca

090335

FT/PT ASSOCIATES

Y 09

ALBERTA

for progressive, ctice located in Alberta. ail CV to elus.net 403-276-3664

NTER 09

FEB 2011

38â&#x20AC;&#x192;

FT/PT Associates required for very busy offices in Mississauga, Barrie and Scarborough. Please email: Dentaldreams@live.com. Please specify which location you are applying for.

Associate wanted for a practice in Guelph, ON. Minimum 3 years experience required. Please send your resume to: resumes@dawsondental.ca or fax it to 1-877-482-4320.

MISSISSAUGA, ON

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

EQUIPMENT

GO DIGITAL! Scanx with Pan system. Pan Instrumentarium OP200, 2006 model retails new $36000.00. Air Techniques Scanx ILE retails new $24000.00. To be sold together ONLY $20,000.00. E-mail: fletchersmeadows@gmail.com

www.oralhealthgroup.com

September 2012

090325

CAMPBELLFORD, ON

Associate to begin 2 days a week with possibility of full time. High income potential. 8 operatory practice. Comprehensive general family dentistry. Excellent opportunity. Please e-mail resume to: chrisadams@persona.ca or fax to 705-653-5662.

GUELPH, ON ASSOCIATE OPPORTUNITY

JULY 09 OTTAWA, ON

Denture clinic seeking OHYSept12 p36-38 Classifieds.indd 38

dentist to

12-09-05 11:12 AM

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Identify patients at risk, and recommend diet modification AND ProNamel® toothpaste as part of their daily routine. ProNamel toothpaste, specifically formulated to protect against the effects of acid erosion.2 ®

1. GSK data on file. Acid erosion in children: prevention is better than a cure: protecting our children’s teeth today for a better tomorrow. Bylined article. Sept. 2008. 2. Layer TM. Formulation considerations for developing toothpastes suitable for those at risk from erosive tooth wear. J Clin Dent 2009;20(Spec. Iss.):199–202.

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