Oral Hygiene May 2014 by Annex Business Media

oralhygiene May 2014

Small Steps,

RIGHT

DIRECTION

powerful reasons for the dental hygienist to get healthy & fit

www.oralhealthgroup.com PM 40069240

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1 Than a manual toothbrush. M. Ward, K. Argosino, W. Jenkins, J. Milleman, M. Nelson, S. Souza. Comparison of gingivitis and plaque reduction over time by Philips Sonicare FlexCare Platinum and a manual toothbrush. Data on ﬁle, 2013. 2 Defenbaugh J, Liu T, Souza S, Ward M, Jenkins W, Colgan P. Comparison of Plaque Removal by Sonicare FlexCare Platinum and Oral-B Professional Care 5000 with Smart Guide. Data on ﬁle, 2013. Single use study. © 2014 Philips Oral Healthcare, Inc. All rights reserved. PHILIPS and the Philips shield are trademarks of Koninklijke Philips N.V. Sonicare, the Sonicare logo, DiamondClean, FlexCare Platinum, FlexCare, FlexCare+, ProResults, Sonicare For Kids and AirFloss are trademarks of Philips Oral Healthcare.

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Sign and initial: ok as is ok with edits needs edits Quality Check __________

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oralhygiene CONTENTS

FEATURES What My Eating Disorder Taught Me About Oral Health

Radha Jobanputra

Dispelling Myths About Employment Contracts

Mariana Bracic

The Evidence Based Dental Hygiene Practice: Is Your Practice on Track?

Jo-Anne Jones, RDH

Single-Use (disposable) Devices Noel Brandon Kelsch, RDHAP

10+ Powerful Reasons for the Dental Hygienist to Get Healthy and Fit

Uche P. Odiatu, DMD

Ross Perry, MSc; Dr. John Symington

DEPARTMENTS Editorial

News

Myths & ‘Myth’-information

Canadian Clinical Trials Coordinating Centre Hu-Friedy Product Showroom “Love The Gums You’re With”

Dental Marketplace

Cover: ©Rafal Olkis/Getty Images/Thinkstock

PRODUCT PROFILE Hygiene At The Crossroads

Editorial Board Members Lisa Philp | Jennifer de St. Georges Annick Ducharme | Beth Thompson

May 2014

www.oralhealthgroup.com

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EDITORIAL

Myths & ‘Myth’-information This is my editorial page and I could fill it with photos of my brand new, nineweek-old kitten, Quinn. I mean, he is the cutest short-haired, tiger-striped kitten ever. But that would be self-indulgent and lazy. Speaking of which, I could just regurgitate my last OralHygiene editorial or for that matter, my last editorial from Oral Health Office. It seems that for some, there just isn’t enough new to write about in the Canadian dental and dental hygiene professions. But in truth, there are too many hot topics. As a dental hygienist, you are on the front line of dental information dissemination. Or at least you should be. While 80 percent of healthcare organizations have social media initiatives, one-third of consumers seek health advice on Facebook. 1 With all due respect to Facebook, that’s just not right. Other findings ran along the same vein: more than 80 percent of people between 18 and 24 said they were likely to share health info through Facebook and other social channels; nearly 90 percent (18-24) said they would trust health information found on the social network; and 45 percent said social media would affect their decision to get a second opinion. Do you trust health information posted on Facebook or other social media sites? Then there is the issue of Direct-toConsumer Pharmaceutical Advertising (DTCPA), which is now the most prominent type of health communication the public encounters. Limited data exists but suggests that DTCPA is both beneficial and detrimental to public health. The number of arguments that favor or oppose DTCPA is fairly evenly balanced and viewpoints presented by both sides can be supported with evidence. DTCPA can be defined as an effort by a pharmaceutical company, usually via popular media, to promote its prescription products directly to patients. Most

countries don’t allow DTCPA at all; the US does, just watch any evening newscast and you’ll realize our dear American cousins are a gassy, arthritic lot but gosh can they get an erection over the littlest thing! Ahem, Canada allows ads that mention either product or the indication, but not both. There are many DTC drug ads and many superb arguments in favor of them. These include empowering patients, encouraging patients to seek medical advice, encouraging compliance, removing stigma and promoting dialogue with healthcare providers. Arguments opposing DTC ads include risk of misinformation, overemphasizing drug benefits, promoting new drugs before safety profiles are fully known and straining relationships with healthcare. DTC ads and online misinformation are the genies that cannot be put back in the bottle but can be countered with truth, education and candor. The next time a patient asks about a new study that says drinking a bottle of wine a day is fine, or if frequent mouthwash use is linked to oral cancer, or if brushing with strawberries and lemon juice is a good idea, or how about ‘oil pulling’ for 20 minutes…you’ll be able to do what you do best…educate.

Catherine Wilson Editor

REFERENCES 1. Based on a survey of 1,060 adults and 124 medical industry executives, February 2012, Health Research Institute, PricewaterhouseCoopers.

May 2014

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NEWS BRIEFS

New coordinating centre to help attract research investment in Canada The Government of Canada announced the creation of the Canadian Clinical Trials Coordinating Centre (CCTCC) – a collaborative effort of the Canadian Institutes of Health Research (CIHR), Canada’s Research-Based Pharmaceutical Companies (Rx&D), and the merged organizations of the Association of Canadian Academic Healthcare Organizations and the Canadian Healthcare Association (ACAHO/CHA). The CCTCC will be housed at the offices of the Health Charities Coalition of Canada, in Ottawa. Clinical trials involve testing new therapies with patients. They are a critical step toward bringing new medicines, effective vaccines, and innovative medical devices safely to market. They can result in better medical treatments, better quality of life, cost savings to Canada’s health system, new jobs, and revenue for the Canadian economy. Most importantly, clinical trials have the potential to relieve pain and suffering, and to reverse or halt the effects of disease or disability for Canadian patients. For more information, visit the associated links: SPOR: www.cihr-irsc.gc.ca/spor.html CIHR: www.cihr-irsc.gc.ca Rx&D: www.canadapharma.org ACAHO/CHA: www.acaho.org www.cha.ca

Hu-Friedy opens state-of-the-art dental product showroom Hu-Friedy, a global leader in the manufacturing of dental instruments and products, officially opened its new dental showroom at its West Campus facility in Des Plaines, Ill. Located 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 Editorial Assistant: Jillian Cecchini 416-442-5600, ext. 3207 jcecchini@oralhealthgroup.com

Dental Group Assistant: Kahaliah Richards 416-510-6777 krichards@oralhealthgroup.com

Art Direction: Andrea M. Smith

Associate Publisher: Hasina Ahmed 416-510-6765 hahmed@oralhealthgroup.com

Production Manager: Phyllis Wright Circulation: Cindi Holder Advertising Services: Karen Samuels 416-510-5190 karens@bizinfogroup.ca

May 2014

Senior Publisher: Melissa Summerfield 416-510-6781 msummerfield@oralhealthgroup.com Vice President/ Canadian Publishing: Alex Papanou

Account Manager: President/ Tony Burgaretta Business Information Group: 416-510-6852 tburgaretta@oralhealthgroup.com Bruce Creighton

minutes from O’Hare airport, the showroom is the ideal setting for dental professionals, clinical educators and distributor partners to experience Hu-Friedy’s advanced technology in a hands-on practice setting. Visitors will experience firsthand how Hu-Friedy’s quality instrumentation, small equipment, infection prevention products and Instrument Management System can be incorporated into their practices. Featuring three dental operatories, a sterilization center, product displays and conference area, the showroom offers access to HuFriedy’s full line of products, ranging from periodontal and power scaling to surgical and infection prevention. The Instrument Management System, which Hu-Friedy pioneered nearly 20 years ago to provide safe and efficient instrument processing, is optimally demonstrated in the showroom. For more information on Hu-Friedy and the showroom, visit www.hu-friedy.com/showroom.

American Academy of Periodontology launches national campaign, “Love the Gums You’re With” In light of the recent prevalence data that finds almost half of American adults age 30 and older are suffering from periodontal disease, the American Academy of Periodontology (AAP) is launching a national consumer awareness campaign devoted to educating the public on the importance of prevention and early diagnosis of periodontal disease. The campaign, “Love The Gums You’re With,” is aimed at teaching Americans to take better care of their gums by implementing simple steps into their routine. To learn more, visit www.perio.org.

OFFICES Head Office: 80 Valleybrook Drive, Toronto ON M3B 2S9. Telephone 416-4425600, Fax 416-510-5140. Oral Hygiene serves dental hygienists across Canada. The editorial environment speaks to hygienists as professionals, helping them build and develop clinical skills, master new products and technologies and increase their productivity and effectiveness as key members of the dental team. Articles focus on topics of interest to the hygienist, including education, communication, prevention and treatment modalities. Please address all submissions to: The Editor, Oral Hygiene, 80 Valleybrook Drive, Toronto, ON M3B 2S9. Oral Hygiene (ISSN 0827-1305) will be published four times in 2014, 80 Valleybrook Drive, Toronto ON M3B 2S7.

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

What My Eating Disorder Taught Me About Oral Health Radha Jobanputra

Currently training to become an RDH at the Toronto College of Dental Hygiene and Auxiliaries. She will graduate in June 2015 and hopes to use her education to promote recovery from eating disorders and good oral health behaviours.

It is a common thought that eating disorders only affect a person’s psyche and, of course, weight. What is rarely discussed is just how compromised one’s oral health becomes when suffering from an eating disorder. Bone and enamel loss, root and pulp infections, and tooth vitality are seriously affected in the mouths of individuals with eating disorders, which will make them more susceptible to periodontal disease. It is imperative that dental professionals, such as dentists and dental hygienists, learn to recognize the signs and symptoms of an eating disorder intraorally, to potentially arrest the eating disorder from progressing, and more importantly to educate their clients on how their oral health is being compromised by their eating disorder behaviour. Speaking as someone who has recovered from a 16 year battle with an eating disorder, I know I would have appreciated a more gentle approach to having my eating disorder identified by my dental professionals much earlier on. In addition, what would have been most helpful would have been education on how to care for my oral health. Instead of being asked if I was strugglingwith an eating disorder and educating me on how I was damaging my mouth, my dental professional simply said, “Oh, you should talk to a therapist or someone about that.” This was after he had asked me if I threw up a lot, which I can assure you, is not the approach to take. I became ashamed of my mouth and in turn intimidated by the dentist, so for years I simply just didn’t go. During this time, my health deteriorated and I could barely function. I knew that I needed to do

something. I sought residential treatment for my eating disorder in Toronto. After two failed attempts in treatment, I decided to seek residential treatment at The Renfrew Center in the United States. It was there that I learned to control my symptom use and kick-started my journey to recovery!

I would have appreciated a more gentle approach to having my eating disorder identified by my dental professionals much earlier on

After being in recovery for seven months, I made the bold decision to see a new dentist and explain my story. He was understanding and did not make the comments so often made by dental professionals. My eating disorder did major damage to my mouth, which I was unaware of while struggling, but my dentist has done a lot of restorative work to get my mouth healthy and my smile beautiful again. I have to say that while being in recovery is great, sitting in a dental chair for hours going through root canals or three surface fillings is most definitely not! The dental professional who made the big-

May 2014 www.oralhealthgroup.com

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ORAL HYGIENE gest impact on me was the hygienist I saw post-residential treatment. She understood my history and educated me on how to better care for my mouth. To prevent damaging my mouth further, she suggested I stay away from acidic beverages, and use an electronic toothbrush, enamel-promoting toothpaste and a fluoridated mouth rinse. I feel that these simple suggestions, along with an explanation of what exactly I was doing to my mouth, would have helped me better maintain my oral health during my eating disorder and possibly prevented my current discomfort and costly dental bills. Though I feel blessed to be recovered, I often get nasty reminders of my awful past with toothaches and having my teeth break when

flossing. I decided I needed to do something to educate those struggling with an eating disorder of the serious dental consequences and also prove that recovery is possible. This is how I came to be a dental hygiene student at Toronto College of Dental Hygiene and Auxiliaries. In school, I try to reduce the stigma of eating disorders by talking about my experiences openly and â&#x20AC;&#x153;showing offâ&#x20AC;? my mouth to help my peers really understand what implications an eating disorder can have. I cannot wait to begin my career as a hygienist. I look forward to helping those who are struggling and promoting the fact that dental offices do not need to be scary and intimidating but rather a welcoming and necessary place to visit. n

Winter Clinic 2014 - ON THE MOVE!

UNCONVENTIONAL

Toronto Academy of Dentistry

Join us at the Toronto Sheraton Centre on Friday, November 14th, 2014 for a brand new Toronto Winter Clinic Experience! We listened - you wanted a change and we are delivering! rdhu will be presenting at Winter Clinic! These exciting and informative programs will be a great addition to your Quality Assurance Professional Portfolio. Speakers include:

Kathleen Bokrossy, RDH Jo-Anne Jones, RDH Jennifer Turner, RDH

Nadine Russell, RDH Carol Barr Overholt, RDH Lil Caperila, RDH

For further details visit www.rdhu.ca. and visit us at Winter Clinic this year for your experiential learning! Mark your calendars today for Friday, November 14th, 2014. Check the Toronto Academy of Dentistry website www.tordent.com to see more information about our Core1 and other Courses being offered this year. Check our Facebook page regularly for news and updates. See you at the Sheraton Centre!

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ORAL HYGIENE

Dispelling Myths About Employment Contracts Mariana Bracic

Founded MBC Legal in 2003, with a preventative approach to HR law. MBC has helped to transition many thousands of employees in Canadian medical and dental offices to proper contracts and policies. She can be reached at mbracic@mbclegal.ca or 905-825-2268.

s an employment lawyer who works for health-care employers, I was thrilled to be invited to contribute an article to Oral Hygiene. Having now achieved self-regulatory status, greater independence, and higher professional standing, hygienists are increasingly becoming employers with their own hygiene clinics. However, whether an employer or an employee, it is troubling that hygienists continue to be subjected to a plethora of myths about employment law and, more specifically, employment contracts. In the course of implementing employment contracts for hundreds of dental offices over the years, it never ceases to amaze our team at MBC Legal how frequently we encounter persistent misinformation. What’s even more surprising sometimes are the sources perpetuating the misinformation: lawyers who don’t specialize in employment law, consultants, and even the Ministry of Labour. For example, two employees recently commenced litigation against the Ministry for providing them misleading information about their entitlement upon termination. But given how complex employment law is in Canada, perhaps the confusion should not be that surprising. In this article, I will try to dispel some of the most common myths about employment contracts. I also hope to communicate some of the benefits to employees of having proper written contracts.

MYTH #1: A contract can take away an employee’s statutory rights

Employees unequivocally cannot sign away

rights guaranteed by statute — all that employees can sign away is their contractual “rights”, such as those they may have under an unwritten contract. Legislation exists in each province that provides employees a multitude of protections. For example, human rights legislation protects employees from harassment and employment standards legislation provides employees a right to vacation, a minimum wage, and parental leave. However, these pieces of legislation also contain sections prohibiting the ‘contracting out’ of the protections and rights provided. In other words, any contract or agreement that purports to remove an employee’s legislated rights is unenforceable. If you are an employee, be assured that no matter what you sign, you cannot sign away your rights guaranteed by legislation. If you are an employer, any document you have an employee sign that purports to take away these statutory rights is not worth the paper it is written on.

MYTH #2: Unwritten contracts are fair The terms of unwritten contracts are derived from court decisions and are essentially legal fictions in the sense that the employee and employer never actually expressly agreed to them. In our many years of experience, we have found that when employers and employees actually put the terms of their employment relationship in writing, those terms are significantly different from the terms that courts would likely have given to their unwritten contracts.

May 2014 www.oralhealthgroup.com

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ORAL HYGIENE ©alexskopje/Getty Images/Thinkstock

Employers and employees whose contracts are unwritten very often aren’t remotely aware of what their contracts say — and no wonder, they are unwritten. When the time comes to apply the terms to a particular situation, like terminating a poor-performing employee, employers are usually stunned to learn that “their” contracts require significant payouts (occasionally as much as six figures). The exiting employee, on the other hand, will often see it as a great windfall and will privately acknowledge that the payout was far more than they would have insisted on had the contract been explicitly negotiated. Because many of the significant protections in unwritten contracts address what happens when an employment relationship breaks down (e.g., termination pay, patients being solicited to a competing practice, etc.), employers report to us that their better performers typically don’t have a problem agreeing to a written contract. This is because high performers don’t see these issues as ever being relevant to them — and they’re typically right. Employers tell us that when it comes to all but their problem staff, the contracts are never looked at again after they are signed.

MYTH #3: Common law contracts are always better for employees An employee of a typical dental practice works in a relatively small office with a few other colleagues whom they see and deal with almost every day. This forces fairly close and intimate working relationships between colleagues. Often this is a blessing, as it can

create meaningful and lasting friendships. When the relationships are positive, it simply makes life better. However, work relationships are not always positive — and when they aren’t, they can be a nightmare. A single “bad apple” truly can spoil the barrel in a dental office. An employee who is rude or is not pulling her weight can suck the positivity out of the whole office. When this happens, staff often wonder why the practice owner doesn’t just get rid of the “bad apple.” The most common answer to this question is simple: cost. Between paying a lawyer to negotiate with the employee’s lawyer over what termination pay a court would likely require and paying the termination pay itself, terminating an employee who has an unwritten contract is almost always a very significant cost for a small business. Some owners simply can’t afford it. Even when a small business owner bites the bullet and terminates the troublesome employee, other employees may still suffer the consequences of that employee’s having an unwritten contract. When terminated under an unwritten contract the “bad apple” can walk out the door with tens of thousands of dollars. Where does that money come from? The employer’s next vacation? Employees’ next pay raise? Will it come from professional development training or the purchase of new equipment or scrubs? It has to come from somewhere. Is it right that the money left with the “bad apple”? We have heard repeatedly from practices that have implemented our contracts that over time, office morale noticeably improves.

May 2014

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ORAL HYGIENE

It is troubling that hygienists continue to be subjected to a plethora of myths about employment law and, more specifically, employment contracts This improvement is usually attributed to two things: the removal of a termination pay windfall compels “bad apples” to keep their own poor behaviour in check and the ability to terminate “bad apples” who fail to improve their behaviour without breaking the bank. Although you don’t have the benefit of comparing what your career would look like working in an office with and without written contracts, it is easy to see that being in an office with proper contracts can actually protect employees from the effects of the all-toocommon “bad apple”. If you are not terminated during your career (and this is not unusual in dental), there is actually very good reason to believe that your work life will be better if your office has proper written contracts in place.

MYTH #4: An employee must receive “consideration” to make a new contract enforceable

A pervasive myth among both employers and employees is that if an employer asks an existing employee to sign a new employment contract, the employer must provide “consideration” (i.e., something of value such as a wage increase, a bonus, or more vacation time). While offering consideration is one way for an employer to create a new legally enforceable contract with staff, it is not the only way. More commonly, employers provide employees notice of the termination of their existing (usually unwritten) contracts and, at the same time, offer employees reemployment under a new contract. They are legally able to do this because employers are generally entitled to terminate the employment of any employee for any reason (or no reason at all) as long as the employer pro-

vides the appropriate notice in advance of the termination. Using this approach, an employee offered a new contract is free to sign it or to reject it; either way, the employee’s existing contract will lawfully end at the end of the notice period.

MYTH #5: Signing bonuses are coercive We’ve heard concerns from both employers and employees that offering a bonus to sign an employment contract is somehow coercive or “sneaky”. In our experience, signing bonuses are actually quite rare since they are not legally required to implement new contracts (see Myth #4). If you offered a signing bonus, it may just be because your employer is communicating how much they value you and wish you to remain with the practice. Indeed, of our clients who do offer signing bonuses, few offer a bonus to every staff member. Therefore, as Freud would say, sometimes a signing bonus is just a signing bonus. Viewing a signing bonus as coercive or sneaky also assumes that an employee is put in a worse position by signing an employment contract. However, signing a contract usually has little effect on an employee’s day-to-day work life in the office. In fact, as illustrated under Myth 3, an employee’s professional life can actually improve by the implementation of contracts.

Conclusion Hopefully this article has helped clear up some of the misinformation surrounding employment contracts. Whether you are an employee or an employer, there can be benefits to having proper written contracts. It is good advice to know what you’re signing — just be careful where you get it! n

May 2014 www.oralhealthgroup.com

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Helping shine a light on your Acid Erosion patient.

ACID EROSION IDENTIFIER

The new ProActTM tool from ProNamel® is based on the published index of BEWE (Basic Erosive Wear Examination) to help dental professionals across Canada identify acid erosion and erosive wear, and counsel patients on acidic dietary challenges and oral hygiene while helping to manage patients over time – all in an effort to help you shine a little more light on your acid erosion patients.1 www.ProNamel.ca/dentalprofessional TM /® or licensee GlaxoSmithKline Consumer Healthcare Inc. Mississauga, Ontario L5N 6L4 © 2014 GlaxoSmithKline

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1. Bartlett D, et al. Clin Oral Invest. 2008;12(Suppl 1):S65–S68.

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ORAL HYGIENE

The EVIDENCE BASED dental hygiene practice:

Jo-Anne Jones, RDH

A recognized international speaker, consultant, author and President of RDH Connection Inc. Jo-Anne has been appointed to serve on the advisory board for Dentistry Today. Nominated for a 2012 Dental Excellence Award for the Most Effective Dental Hygiene Educator by her peers and is PennWell’s award recipient for writing “The Most Important Dental Story Published in 2012”. Jo-Anne Jones can be reached at jjones@ rdhconnection.com

Is Your Practice on Track? M

aintaining an evidence-based practice (EBP) is a daunting task. After a full day in clinical practice there is neither the stamina nor the time to continually immerse ourselves in clinical research. We often rely on our investment in continuing education only to be disappointed by a biased or corporate affiliated learning experience. The knowledge translation then becomes subjective rather than objective evidence based information. Today’s dental hygiene practice has a client population at risk for caries, periodontal disease and oral cancer related to distinct lifestyle and sexual behaviours. Now more than ever we need to reflect EBP to complement our risk assessment and risk management for our dental hygiene client.

What is evidence based practice? Evidence based practice (EBP) is defined as; “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual clients. The practice of evidence based decision making means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”1 EBP is dental hygiene practice supported by a scientific body of knowledge that facilitates clinical decision-making and evaluation of dental hygiene services and/or programs using objective outcome measures. A dental

hygienist demonstrates competence by ensuring her/his practice is based in theory and evidence and meets all relevant standards and guidelines. 2 One of the entries to practice performance indicators is the use of best evidence available when formulating individualized care plans. EBP takes into account the combination of our clinical expertise, client values and preferences and the best research evidence guiding our decision making process for client care. Our clinical expertise is the culmination of education, experience and skill set. This in then intertwined with the client’s distinct experiences, values, expectations and abilities. Our profession and clinical decision making goes beyond ensuring client safety. It is about quality care and best practices. Quality of care is achieved when dental hygienists provide services, independently or in collaboration with other professionals, which are evidence-based, and respect the autonomy and unique needs of individuals and groups. 2 The requirement for the reflection of EBP and decision making is also compounded by the nature of being a regulated healthcare professional where we are “an occupation whose core element is work based upon the mastery of a complex body of knowledge and skills…. to be used in the service of others. Professions and their members are accountable to those served and to society. Society rewards health

May 2014 www.oralhealthgroup.com

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ORAL HYGIENE professionals…this status, however, comes with professional obligations.”3

Steps in the evidence based decision making process:4 The following illustrates the steps required to conduct evidence-based research to apply to dental hygiene clinical practice. 1. Assess the client; As a result of the assessment phase of the client, a clinical problem or question arises regarding the care of the client 2. Ask the question; Develop a clinical question derived from the clinical assessment. The acronym ‘PICO’ stands for problem, intervention, comparison and outcome. • The problem may be a primary issue based on clinical assessment and client interview, a disease or co-existing conditions. • T he interventions should reflect what you wish to do for the client and what influencing factors you may be aware of. • T he comparison may involve product, therapeutic services, or drugs that you wish to alternatively compare. • T he outcome is what you hope to accomplish or achieve. There should be a measurable outcome that can be used for evaluative means working with the structural framework of the dental hygiene process of care. 3. Acquire the evidence;

Conduct your research using a credible database providing best available evidence from systematic reviews, randomized clinical trials and observational studies. 4. Appraise the evidence; Evaluate the evidence for its strength, validity and application to the clinical problem. 5. Apply the evidence; Integrate the evidence with clinical expertise, client preferences and apply to practice. 6. Self-evaluation Evaluate your performance and incorporation of EBP in client care.

How do we stay on track? Best practices dictate that once the clinician identifies the client’s risk for oral disease (low, moderate, high, and extreme), evidencebased treatments or recommendations may be used to create a therapeutic and/or preventive care plan that will assist the client in achieving optimum oral health. 5 Philips Oral Healthcare along with a team of leading experts employing respected industry protocols has developed the CARE (Customizable Assessment and Risk Evaluator) tool. It offers dental professionals an interactive assessment tool in the format of a web-based interview. The tool is based on current evidence based research and best practices. The CARE tool will also provide calibration of best practices within a clinical environment.

May 2014

www.oralhealthgroup.com

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Based on the evaluation and the clinical data provided, the CARE tool will generate an assessment and make recommendations for consideration. It will also illustrate risk factors on a gradient of low, moderate, high and extreme. There are three assessments available; 1. Dental Caries; recommendations based on entry data and CaMBRA (Caries Management by Risk Assessment 6) that will manage the microbial infection and promote protective factors that will slow or halt the disease process. 2. Periodontal Diseases; recommendations based on data entry and current AAP guidelines that will slow or halt the destructive processes by incorporating effective professional and self-care methods complemented by antimicrobial treatments. 3. O ral Pathology; identifying clients at risk for life threatening oral pathology and elevating client awareness of modifiable risk factors. The focus is on early detection and management referral pathways to improve survival rates. The CARE tool is intended to be used as a supplement to professional care incorporating EBP into clinical practice. Incorporating risk assessment improves clinical outcomes and the achievement of therapeutic endpoints. The tool is designed to assist with the first initial assessment of a dental hygiene client. Re-evaluation and subsequent re-assessment are an ongoing requirement of a dental hygiene clinical practice that is following the mandated process of care.

Conclusion In today’s fast paced professional environment we are continually challenged to stay on track reflecting best practices. Our first priority should be ‘how may I help my client achieve the best possible oral health and overall health?’ Incorporating risk assessment and recommendations reflecting evidence based research will ensure that Continued on page 35

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Sensodyne Repair & Protect ®

Powered by NovaMin® Patented calcium and phosphate delivery technology Sensodyne Repair & Protect is the first daily toothpaste to contain NovaMin® plus fluoride, a unique technology proven to help repair exposed dentin.1 • Delivers calcium and phosphate into the saliva1–3 to form a reparative hydroxyapatite-like layer over exposed dentin and within dentin tubules.2–11 Repairing exposed dentin NovaMin® builds a reparative hydroxyapatite-like layer over exposed dentin and within the tubules2–11 that: • Starts building from first use1 • Is up to 50% harder than natural dentin12 • Provides continual protection from dentin hypersensitivity with twice-daily brushing13–15 Building a hydroxyapatite-like layer over exposed dentin and within dentin tubules2,8–11

Protecting patients from the pain of future sensitivity The reparative hydroxyapatite-like layer firmly binds to collagen in dentin.1,16 In vitro studies have shown it is: • Built up over 5 days1 • Resistant to toothbrush abrasion1 • Resistant to chemical challenges, such as consuming acidic food and drinks1,8,12,17

5 µm

Fluoridated hydroxyapatite-like layer within the tubules at the surface

Fluoridated hydroxyapatite-like layer over exposed dentin

In vitro cross-section SEM image of hydroxyapatite-like layer formed by supersaturated NovaMin® solution in artificial saliva after 5 days (no brushing).10 Adapted from Earl J, et al.10 TM /® or licensee GlaxoSmithKline Consumer Healthcare Inc. Mississauga, Ontario L5N 6L4 ©2014 GlaxoSmithKline

Think beyond pain relief

1. Earl J, et al. J Clin Dent. 2011;22(Spec Iss):68–73. 2. LaTorre G, et al. J Clin Dent. 2010;21(Spec Iss):72–76. 3. Edgar WM. Br Dent J. 1992;172(8):305–312. 4. Arcos D, et al. A J Biomed Mater Res. 2003;65:344–351. 5. Greenspan DC. J Clin Dent. 2010;21(Spec Iss):61–65. 6. Lacruz RS, et al. Calcif Tissue Int. 2010;86:91–103. 7. De Aza PN, et al. Mat Sci: Mat in Med. 1996;399–402. 8. Burwell A, et al. J Clin Dent. 2010;21(Spec Iss):66–71. 9. West NX, et al. J Clin Dent. 2011;22(Spec Iss):82–89. 10. Earl J, et al. J Clin Dent. 2011;22(Spec Iss):62–67. 11. Efflandt SE, et al. J Mater Sci Mater Med. 2002;26(6):557–565. 12. Parkinson C, et al. J Clin Dent. 2011;22(Spec Iss):74–81. 13. Du MQ, et al. Am J Dent. 2008;21(4):210−214. 14. Pradeep AR, et al. J Periodontol. 2010;81(8):1167−1113. 15. Salian S, et al. J Clin Dent. 2010;21(3):82−7. 16. Zhong JP, et al. The kinetics of bioactive ceramics part VII: Binding of collagen to hydroxyapatite and bioactive glass. In Bioceramics 7, (eds) OH Andersson, R-P Happonen, A Yli-Urpo, Butterworth-Heinemann, London, pp61–66. 17. Wang Z, et al. J Dent. 2010;38:400−410. Prepared December 2011, Z-11-518.

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ORAL HYGIENE

SINGLE-USE (disposable)

DEVICES

The knowledge we have is only as impactful as the way we use it. Noel Brandon Kelsch, RDHAP

A syndicated columnist, writer, speaker, and cartoonist. She serves on the editorial review committee for the Organization for Safety, Asepsis and Prevention newsletter and has received many national awards. Kelsch owns her dental hygiene practice that focuses on access to care for all and helps facilitate the Simi Valley Free Dental Clinic. She has devoted much of her 35 years in dentistry to educating people about the devastating effects of methamphetamines and drug use. She is a past president of the California Dental Hygienists’ Association.

ometimes a single sentence is all that’s needed to make an impact on the world. One single sentence that can change the chances for cross-contamination and the possible spread of disease comes from the Centers for Disease Control (CDC): “Use singleuse devices for one patient only and dispose of them appropriately.”1 This sentence has great impact on the way dentistry is practiced. But the question is, are you applying the knowledge contained in this one simple sentence?

So why single use? There are great advantages to using singleuse items as compared to reusable products. Because these items are used only to treat one patient and then disposed of, they help reduce the potential of patient-to-patient contamination. 2 Reuse of single-use items has the potential of putting both the patient and clinician at risk. Single-use items should not be reprocessed. They are usually not heat tolerant and cannot be reliably cleaned, disinfected, or sterilized. If there are no reprocessing instructions on the container or with the instructions then the item should not reprocessed. Contact the company directly to find out if it is a single use item or is approved for reprocessing. They may be made of plastic or less expensive metals. They are not designed or intended to be cleaned, submerged into disinfectant or sterilized. Many companies use this symbol to remind you that an item is single-use (Figure 1):

Added benefits

There are many added benefits to single-use

items. These concepts encompass infection control but can go far beyond. Here are a few examples: Air water syringe tips: One of the biggest issues facing all clinicians when deciding between disposable and re-processable items is the fact that the item must be pre-cleaned before it is sterilized. The Air Water Syringe Tip (AWS) is a great example of that concept. They must be sterilized between every patient. Both the tip and the syringe itself can become contaminated with bioburden and inanimate debris internally and externally. The presence of organic and inorganic deposits has been shown in a number of studies. These deposits can hinder the sterilization process and prevent the penetration of sterilizing vapors. In a study of microbial contamination after sterilization, approximately 10 percent of the metal AWS tips had contamination. 3 The need to clean lumens of reusable tips before heat sterilization is evident. But there are issues that make this almost impossible. AWS have very small lumen openings that do not allow for visual examination of accumulated contaminants on the rough internal surfaces. The rough surfaces can harbor debris. Failure to detect the presence of accumulated debris, rough surfaces and the inability to clean the lumens make the single use AWS a must in the dental setting. 3 Using a disposable AWS aids in keeping the patient safe and saves the time required for attempting to clean the lumen. The tips themselves cost about the same as the sterilization pouch. Single-use sterilization pouches: A singleuse pouch is clean and appears clean to the patient when presented; it maintains a prop-

May 2014 www.oralhealthgroup.com

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Figure 1

ORAL HYGIENE

er seal, which assures confidence when opened before the patient; and the color-changing inks visually demonstrate that the internal space has been exposed to the conditions necessary for sterilization. A singleuse pouch eliminates the question of counting cycles and the fear of failure from over-cycling; there is never a soiled appearance from previous uses; and the position of the instruments is clear to the operator so there is no injury when pressure sealing or opening. A single-use pouch costs no more, but it offers more.4 Dental carpules: Once a dental carpule is set on the patient’s tray, it may not be reprocessed. It is single-use. Not only is there the risk of spreading disease, if the carpule has been cleaned, disinfected, or submerged in a

disinfectant, it can cause adverse reactions. Dr. Daniel Haas stated in his article, “Localized Complications from Local Anesthesia”, “Even though the anesthetic cartridge was not used, it must be considered contaminated and should be disposed of. Since disinfectants can diffuse through the diaphragm and contaminate the anesthetic solution, do not store or submerge cartridges in these agents. Instead, anesthetic cartridges should be dispensed using the concept of unit dose measurement to prevent contamination of unused supplies.”5 Administration of local anesthetic from a cartridge contaminated by alcohol or sterilizing solution may induce paresthesia.6 Neurotoxicity may be a factor, since a review of the literature suggests that local anesthetics have this potential. Cartridges stored in a

CDC FOCUS ON SINGLE-USE DEVICES A single-use device, also called a disposable device, is designed to be used on one patient and then discarded, not reprocessed for use on another patient (e.g., cleaned, disinfected, or sterilized). Single-use devices in dentistry are usually not heat-tolerant and cannot be reliably cleaned. Examples include syringe needles, prophylaxis cups and brushes, and plastic orthodontic brackets. Certain items (e.g., prophylaxis angles, saliva ejectors, high-volume evacuator tips and air/water syringe tips) are commonly available in a disposable form and should be disposed of appropriately after each use. Single-use devices and items (e.g., cotton rolls, gauze, and irrigating syringes) for use during oral surgical procedures should be sterile at the time of use. Because of the physical construction of certain devices (e.g., burs, endodontic files, and broaches), cleaning can be difficult. In addition, deterioration can occur on the cutting surfaces of some carbide/diamond burs and endodontic files during processing and after repeated processing cycles, leading to potential breakage during patient treatment. These factors, coupled with the knowledge that burs and endodontic instruments exhibit signs of wear during normal use, might make it practical to consider them as single-use devices.2

May 2014

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ORAL HYGIENE

disinfecting solution such as alcohol may have residual amounts of solution on the end of the cartridge, or solution may be diffused into the cartridge through the semipermeable diaphragm that can then be administered inadvertently during injection. (For more information on this reaction, see RDH magazine “Part One: Dental Carpules Single use,” March, 2008). Single-use masks: The CDC guidelines are very clear: “Change masks between patients or during patient treatment if a mask becomes wet.” There are so many reasons why masks should be single-use; yet there are so many people who do not comply with this guideline. Health-care professionals take their masks off and hang them on their necks or tuck them in their pockets. All the bacteria, viruses, and debris will now go home with them. This regulated medical device is designed to avoid various situations of crosscontamination. The mask can become damp either from condensation due to breathing or moisture from procedures. Once a mask begins to wick, the efficacy of filtration and protection is progressively diminished. The mask loses its filtering capacity over time due to breathing and the environment (splatter, moisture, and other elements). Bacteria can

Elevating Dentistry.

easily develop under a mask and may account for skin irritation or outbreaks. Simple sentences can impact the world in ways we never imagined. Each clinician has the responsibility to apply this simple sentence and the knowledge surrounding it. “Use single-use devices for one patient only and dispose of them appropriately.” n

REFERENCES 1. C enters for Disease Control and Prevention. Guidelines for Infection Control in Dental Health-Care Settings 2003. MMWR 2003;52(No. RR-17) 2. From Policy to Practice: OSAP’s Guide to the Guidelines. 3. Molinari J, Nelson P, Reusable versus Disposable Air/Water Syringe Tip, Dental Consultants, Inc., Ann Arbor, Michigan, 2013 4. Interview with Mike Durda, Dux Dental 5/6/12 5. Haas DA. Localized complications from local anesthesia. Journal of the California Dental Association 1998. 6. Shannon IL, Wescott WB. Alcohol contamination of local anesthetic cartridges. J Acad Gen Dent 1974; 22:20–21.

Designing and manufacturing award-winning, high quality dental magnification loupes and headlights for dentists, hygienists and students for more than 30 years, Orascoptic is a trusted leader in providing superior visualization, so you can focus on what matters most – your patients and your practice. Orascoptic now has direct representatives across Canada. To book a demonstration, please call 1-800-369-3698. Present this ad to receive $100 off of any full priced loupe, light or operator chair. 800-369-3698 orascoptic.com

May 2014 www.oralhealthgroup.com

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Oral Probiotic to help promote plaque reduction and help reduce gingivitis.

Demonstrated Results 42% reduction in Plaque Index (PI) when G•U•M® PerioBalance® is used as an adjunct to Scaling and Root Planing.1, 2, 3,4

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Available at * Lactobacillus reuteri Prodentis™ (DSM17938 and ATCC PTA 5289) is the exclusive, patented dental probiotic in G•U•M® PerioBalance® 1. Plaque Index on a scale from 0, for no plaque, to 3, for abundance of soft matter within gingival pocket and tooth surface 2. Split-mouth design, double-blind, randomized, placebo-controlled trial of 30 patients with chronic periodontitis 3. Vivekananda MR, Vandana KL, Bhat KG. Eﬀect of the probiotic Lactobacilli reuteri (Prodentis) in the management of periodontal disease: a preliminary randomized clinical trial. J Oral Microbiol. 2010;2:2. 4. When used in conjunction with good oral hygiene. © Sunstar Americas, Inc. C14058

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ORAL HYGIENE Uche P. Odiatu, DMD

Is a Certified Nutrition & Wellness Consultant, an NSCA certified trainer, a Certified Holistic Lifestyle Coach, the co-author of The Miracle of Health ©2009 and Fit for the LOVE of It! ©2002, & a professional member of the America College of Sports Medicine. He maintains a dental practice in Toronto and has inspired audiences at the largest dental conferences in the world & for Fortune 500 Companies. He has appeared on over 350 radio and TV shows including ABC 20/20 and Canada AM.

POWERFUL REASONS

for the dental hygienist to get healthy & fit

wrote this article with the intention of lighting the fire of desire under you to start or maintain your regular health and fitness regimen. As a dental hygienist, you are completely aware of the value of prevention. But as a fellow caregiver, I am very aware that we are well known for putting the needs of others before our own. Many times it’s only the realization that our 10 year or 25 year high school or college reunion is next month that inspires us to lace up our runners, buy some diet shakes and get outside for a walk. But this short-term solution is strictly for esthetics. This article was written with the intention of sharing with you ten powerful reasons to get healthy — TNT (Today Not Tomorrow). And not just for today, but a lifetime commitment of taking optimal care of that miraculous body of yours.

Did you know that in the International Classification of Disease there are 100,000 diseases listed? Eighty percent of the reasons for the 2,000,000 deaths each year in North America are from just ten of those diseases. Heart disease being number one and cancer being number two. Most people know lifestyle has a lot to do with optimal cardiovascular health. Many people are not aware of lifestyle’s influence on cancer prevention. There are over 200 excellent scientific studies examining the connection be-

tween a lack of physical activity and cancer. “As little of as 15 min of exercise each day has been shown to decrease risk of breast and colon cancer by up to 40 percent” — Dr. Greg Well, professor of kinesiology University of Toronto.

A five year review of 7000 research papers by The American Institute for Cancer Research found that poor food choices and lack of exercise had an impact on cancer incidence (Globe and Mail Newspaper article “Poor Diet Ratchets Up Cancer Risk” in 2007). Better food choices and less alcohol consumption were two of their top ten suggestions to reduce your cancer risk. Another strong push for lifestyle’s influence came from researchers at the Harvard School of Public Health. They reported that 65 to 80 percent of cancers could be prevented by simple lifestyle decisions. Eighty percent is a very empowering percentage of control. This truly puts the ball into our court; we are in the power position.

Sitting for long periods of time has now been linked to a wide variety of illnesses and disease (Christine Friedenreich, senior epidemiologist at Alberta Health Services). There are ground breaking studies in the American College of Sports Medicine’s Journal reporting on the

May 2014 www.oralhealthgroup.com

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ORAL HYGIENE huge impact of sedentary living and its ability to decondition your miraculous body. I feel awareness of this bleak trend is needed to help get us moving. Never in recorded history have we sat this much. As much as 70 percent of our waking hours are spent sitting. Sitting has now been called “the new smoking.” Harsh words for the couch potato. For years, chiropractors have been telling us the longterm damage extended sitting does to our lower backs. Well, physiologists are also now seeing that sitting all day has negative implications on breathing, core strength, lymphatic drainage and blood pressure. Is there any light at the end of the tunnel? A recent sixyear Stanford study showed that walking just once a week could decrease your chances of mortality from cardiovascular disease by almost 50 percent.

The dentist and hygienist have been thoroughly convinced that maintaining excellent oral hygiene is key to keeping inflammation at bay at home. Power toothbrushes like the Philips Sonicare truly help the patient master this oft-troubled area by inspiring a two-minute dental workout morning and night. I demonstrate a fun Sonciare Stretch when I do my LIVE presentations; it involves gently stretching hip, lower back and hamstring muscles instead of just standing staring at yourself in the mirror. Why do this? You have to walk your talk. Makes little sense to tell patients to develop daily disciplined habits while we sit and watch three hours of TV each evening. Dental professionals are reluctant to give general wellness recommendations. In JADA

2010, there was an article “Dentists’ Attitudes About Their Role in Addressing Obesity in Patients.” The article referred to the fact that 82 percent of dentists in one large survey said they would be willing to intercede if they knew for sure being overweight was related to oral disease. An article in Oral Health, October 2012, “Obesity and Periodontal Health: What’s the Link? Should I be concerned?” showed that people who were overweight or obese had a higher incidence of periodontal disease. “The most powerful way to reduce your inflammatory factors (a leading cause of chronic disease i.e. heart disease, cancer, Alzheimer’s, metabolic syndrome) is to lose excess weight.” Walter Willett, PhD, Chair of the Nutrition Dept. at the Harvard School of Public Health. If you noticed that many serious diseases (meningitis, encephalitis, colitis, pancreatitis, arthritis, osteomyelitis, esophagitis, cellulitis, hepatitis, periodontitis, etc.) have inflammation at their core, you might be motivated to maybe lose that last five to ten pounds.

Studies have shown that an inactive lifestyle is associated with a higher risk of depressive symptoms. Depression is one of the most debilitating mental disorders and the leading cause of disability in the western world (American College of Sports Medicine Feb 2012). Did you know that chronic depression has been linked to heart disease and over a lifetime… cognitive decline? Did you also know that many UK physicians recommend a regular walking regimen for patients with mild depression? It is so very important to reduce

May 2014

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ORAL HYGIENE this major negative influence effect on your health. “My grandmother started walking five miles a day when she was sixty. She’s 97 now and we don’t know where the heck she is.” — Ellen Degeneres

A review of 900 papers over 50 years have provided strong evidence for the benefit of physical activity on your brain. Regular exercise can reduce your risk of getting Alzheimer’s disease by nearly 40 percent (Ontario Brain Institute 2013). A regular physical activity schedule appears to be best over your entire life, but Laura Midldleton, an assistant professor of kinesiology at University of Waterloo, has revealed that a specific window of time in the active teenage years (12-19) was strongly associated with lowering the incidence of cognitive decline later in life.

As people get older their immune systems get cluttered from fighting a lifetime of infections. An overcrowded immune system increases the risk of infection. Exercise DEclutters and makes space in an older immune system (Exercise and Sport Sciences Reviews January 2011). Isn’t this enough to make you want you to keep up your exercise schedule? Or at least walk to the store to buy that newspaper. The sad thing is that only ten percent of people over 65 years of age exercise. This is the time of life people need to exercise the most! We see the 65-year-old in the office who wants to manage their periodontal condition and save their teeth. Managing the host (the patient) and keeping their immune systems strong have been recognized as one of the top ways to manage periodontal disease (“Potential Mechanisms Underpinning the Nutritional Modulation of Periodontal Inflammation,” JADA Feb 2009). It is one of my most ardent personal and professional desires to get people moving again and reclaim the health that is their birthright. A meta-analysis of physical activity studies

showed benefits to increased cognitive functioning, deductive reasoning and reaction time (Journal of Medicine & Science in Sport & Exercise June 2012). It was reported that Alzheimer’s is one of the second most feared diagnoses after cancer. Building up one’s cognitive reserve is key for all people to claw back this fear. Being a lifelong learner has been shown to help stave off cognitive decline, but it was the ground-breaking book, “Spark”, by Dr. John Ratey, MD, that promoted physical activity as being able to boost your BDNF — Brain Derived Neurotropic Factor. He wrote that BDNF acted like ‘Miracle Gro’ in your brain. Every dental professional would love to be the kind of leader that inspires their team to have a bigger vision for their jobs and their lives. For those who have a challenge lighting the torch of leadership in their offices, here is an interesting piece of literature that may give you a helping hand: people are more likely to listen to, vote for, follow & be lead by people who are more fit and healthy. This concept was put forth in the book, “Why Some People Lead, Why Others Follow and Why it Matters” by Mark van Vugt 2010 © Harper Collins.

Poor breathing habits engrain poor habitual postures and in the longterm cause chronic back pain (National Strength & Conditioning Association Journal October 2012). More than half of all dental professionals experience some kind of back pain in their careers. Incorporating core exercise and resistance training into their exercise programs would be an ideal way to strengthen posture and decrease the odds of a career ending injury.

May 2014

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Regular exercise trains your nervous system to be less reactive to stress: reducing oxidative stress, blood pressure swings, and immunosuppression (American College of Sports Medicine 2005). Stress has been implicated as a huge force to be reckoned with in the battleground of modern dental practice. Dental professionals are well aware of tight scheduling, working on anxious patients, challenging team relations and full family commitments. Not having a successful stress management strategy is a prescription for emotional and physical disaster. In the March 2012 Journal of Medicine and Science in Sport and Exercise, there was a powerful article showing the power of a single session of exercise to improve one’s mood and decrease anxiety. How valuable would this tool be at the end of a hectic clinic day before you headed home to spend time with your family?

Lastly, let me leave you with this important reason. Getting healthy and adding a bounce to your step will help turn back the hands of time. Jal Oslshansky, PhD, professor of medicine and a researcher on aging at Chicago’s University of Illinois said, “Exercise is the only real fountain of youth that exists.” I agree completely. Muscle wasting is a hallmark of the person who is aging rapidly. Between 20 and 70 years our aerobic capacity decreases six percent a decade until age 70 when it declines at a faster 20 percent per decade. Too weak to walk to the mall, too frail to take care of themselves, to feeble to do proper oral hygiene and their immune systems are no longer strong enough to fight infections like pneumonia and shingles. Need I say any more? I want to leave you with the strong assertion that regular exercise and eating healthy is much more than looking good for your Facebook picture profile update. The abundant far-reaching benefits of regular physical activity for the dental professional transcends the nice reflection in your bathroom mirror. It has the ability to enhance every single aspect of your personal and professional life. I will see you in the gym or on the walking trails or at your local farmers’ market. n

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The proven choice for brighter results.

When it comes to lasting results and efficacy, Philips Zoom WhiteSpeed LED outshines the competition. In a clinical study, WhiteSpeed provided over 50% better whitening than Opalescence Boost, both immediately following the procedure and after seven and thirty days.1 It’s clinically proven to whiten teeth up to eight shades in just 45 minutes,2 and 99% of consumers experienced little to no sensitivity with WhiteSpeed.1 Lasting results with minimal sensitivity — that’s the bright side of Zoom WhiteSpeed. Ask about Philips Zoom WhiteSpeed today. Call (800) 278-8282 or visit philipsoralhealthcare.com * In the United States. 1 Data on file, 2013. 2 Excluding prep time. © 2014 Philips Oral Healthcare, Inc. All rights reserved. PHILIPS and the Philips shield are trademarks of Koninklijke Philips N.V. Sonicare, the Sonicare logo, DiamondClean, FlexCare Platinum, FlexCare, FlexCare+, ProResults, Sonicare For Kids and AirFloss are trademarks of Philips Oral Healthcare. All other trademarks are property of Discus Dental, LLC.

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PRODUCT PROFILE

Hygiene at the CROSSROADS

Ross Perry

Over the past 15 years, Ross Perry has led the development of the Prevora topical antimicrobial tooth coating through four randomized controlled clinical trials and regulatory approval in Canada and Europe. He has also coordinated the ongoing, pioneering research on what adult patients need and want from their dental services as they age, become uninsured and use the Internet. Ross writes a frequent blog on the changing landscape of dental care which can be read at www.partnersin prevention.ca

n two short years, the oldest Baby Boomers will be 70. At that age, 20 percent will be diabetic, one percent will have Parkinson’s disease, and one in two will be taking three or more medications per day, which is the threshold for dry mouth.1 And that means a huge growth in caries. For example, diabetics have twice the rate of decay and Parkinson’s patients five times the rate of decay of healthy peers. 2 This is one insight on how the community is profoundly changing. There are several other new realities. The adult community is now more frugal, more uninsured and far more informed (with the internet and social media) about its choices in dental services than ever before. And consequently, much of the community has changed its reasons and preferences for dental services. Our waiting-room surveys show, for example, that four of ten adult patients purchase dental care because “it is important to my overall health.” For all these reasons, dentistry has been described as “at the crossroads.” 3 This implies there are forks in the road for hygiene. It can serve a shrinking number who can afford or prefer traditional dental procedures such as cosmetics and the regular prophylaxis. Or, it can reach out to the growing segment of the community, with new reasons to purchase its services. This article describes the journey for dental hygiene down a new road of new, evidence-based services and growing community engagement.

The scenery along the old road is changing

Since 2006, the authors have examined what

an aging Canada needs and wants from its dental team. This research is both qualitative (focus groups) and quantitative (online surveys and questionnaires in the waiting room), and has involved, as a first in the dental literature, measuring willingness to pay for more prevention in 19 different dental practices. The results from this inquiry have been consistent across all research methods. This research has found: • T here is an over-representation of older adults in the waiting room. About one in two adult dental patients are now past mid-life. • About one in three adult dental patients pay for their care out of pocket. The older you are in Canada, the more you are uninsured or partly insured. • P reventive services are most what adult dental patients want to discuss with their dental teams (Figure 1). • T his preference for prevention emerges because half of survey respondents have two or more risk factors for dental decay and one in three have recently experienced surgical dental care (Figure 2). Perhaps most importantly, more than one in four adult patients now take many medications for chronic conditions, and 10 percent report a dry mouth. Medication-induced xerostomia has become the most common risk factor for dental decay. • T here is a strong willingness to consider more preventive care at the threshold of $500 (Figure 3). This willingness is influenced by disease risk, recent disease experience and the firmness of a recommendation from the dental team. • 8 out of 10 adult patients want to be more engaged in their oral care. They consider a shared diagnostic procedure of completing a

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PRODUCT PROFILE risk assessment form, to be the second most important service offered by the dental team (Figure 1). Currently, we are also probing what interests Canadian adults who use Facebook. American data show six out of 10 older adults now use so- Figure 1. Source: CHX Technologies, survey of adult patients in 7 Ontario dental practices, 2013. cial media to learn about new serResults available at www.partnersinprevention.ca vices, products and trends;4 that is almost equal to the readership of the newspaper and is certainly faster growing. Our Facebook research confirms a strong interest in prevention and knowing more about the growing connections between oral health and systemic health.

Finding directions to take a new road

Dr. John Symington

Professor Emeritus at the University of Toronto and a pioneer in introducing dental implants to Canadian dentistry. Dr. Symington has collaborated with Ross Perry and many independent investigators on the design and analysis of Prevoraâ&#x20AC;&#x2122;s controlled studies.

For many years, dental research has shown that dental caries grows with age, 5 results from a complex bacterial infection,6 is largely unimpended by conventional treatments when the patient is at high risk,7 and affects a small segment of the com- Figure 2. Source: CHX Technologies, survey of adult patients in munity. 8 Most recently, studies 7 Ontario dental practices, 2013. have shown that the conventional Results available at www.partnersinprevention.ca hygiene procedures such as the regular prophylaxis, intermittent fluoride var- studies using protocols acceptable to the U.S. nish and xylitol supplements for home care, Food and Drug Administration. The study have insufficient evidence of efficacy.9-11 participants were community-dwelling adults. In this context of uncertainty, the authors With these design features, Prevoraâ&#x20AC;&#x2122;s evihave spent 15 years working with internation- dence can be considered Type 1, or the highal pharmaceutical regulatory authorities to est achievable. evaluate a sustained-release, high-strength The coating is called Prevora. It delivers 10 chlorhexidine coating and its ability to reduce percent chlorhexidine to kill much of the biocaries in high-risk adults. This evaluation has film over three days and then to inhibit its rerequired two randomized, multi-centre, dou- emergence over several weeks. It is applied ble-blinded, placebo-controlled, prospective using a small brush in a short appointment.

May 2014â&#x20AC;&#x192;

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PRODUCT PROFILE

The treatment plan is four weekly applications in the first month, followed by semi-annual single treatments. The results from these studies were, by any measure, remarkable. In older adults (mean age of 59 years) with a dry mouth because of multiple-medication use, Prevora reduced root caries by 41 percent (p<0.05) versus placebo over one-year.12 In a group of younger adults (mean age of 43 years) with one or

more cavities, Prevora reduced coronal caries by 70 percent (p<0.005) in the highest risk participants, versus placebo over one-year (Figure 4).13 This is exceptional protection compared to what has been reported in controlled studies of fluoride. In these controlled studies, moreover, Prevora was safe. There were no related serious adverse events (i.e. hospitalization) and related adverse events occurred at the rate of five per 100 treatments. They involved a transient sensation of a coating on the teeth, a temporary stinging of the gums or a short bitter taste. None of these side effects inhibited participants from continuing in the study. There was no staining of the teeth observed in over 5,000 treatments of Prevora. As a result of these clinical studies, Prevora is approved by Health Canada as the only professional preventive product for preventing caries in high-risk adults. It is also approved by the European Medicines Agency and by the drug approval authorities in the United Kingdom and Ireland. A new drug application to the United States Food and Drug Administration is underway.

Figure 3. Source: CHX Technologies, survey of adult patients in 7 Ontario dental practices, 2013. Results available at www.partnersinprevention.ca

The journey has just begun

There is little consensus in the dental professions on what constitutes effective caries prevention in adulthood.14 This is not unusual in healthcare. Procedures and protocols for management of other chronic diseases such as cardiovascular disease continue to evolve as studies point to new methods to get better outcomes; witness the current discussion over extending the use of statins to lower risk adults.15 But in the case of hygiene, the issue is NOT whether there could develop a consensus around Prevora’s evidence. After all, there is widespread interest by numerous hygiene teams in understanding Prevora. Rather, it seems the Figure 4. issue is how best to move forward the Sources: Symington J et al, 2014. Efficacy of a 10% chlorhexidine practice environment for hygiene. coating to prevent caries in at-risk community dwelling adults. Accordingly, to assist the hygiene Acta Odont Scandin.; Banting D et al, 2000. The effectiveness of 10% chlorhexidine varnish treatment on dental caries incidence in team adopt and adapt to this new adults with dry mouth. Gerodontology, 17, #2, 67-75; Wyatt CCL, base of evidence, the developers of MacEntee MI. 2004. Caries management for institutionalized elders Prevora have taken the advice of using fluoride and chlorhexidine mouth rinses. Comm Dent Oral many dental professionals who have Epidemiol., 32: 322-8; Ekstrand K, Martignon S, Holm-Pedersen P. 2008. Development and evaluation of two root caries controlling said, “Get my patients to ask for it.” programs for home-based frail people older than 75. Gerodontology, Likewise, we have listened to the 25: 65-75; Featherstone JDB et al. 2012. A randomized clinical trial of community, which has requested: anticaries therapies targeted according to risk assessment. Caries Res., 46: 118-126. “tell me where I can get this treat-

May 2014 www.oralhealthgroup.com

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O 3D X-Tra coating on red superfine disk – semispherical shaped grits allow space for ground particles – maintains clean surface contact O X-Tra thick to increase stiffness, tactile feel, and durability while also maintaining flexibility in interproximal areas O Achieves X-Treme gloss levels with X-Tremely low surface roughness

Visit www.shofu.com or call 800.827.4638

OHY May14 p31 Shofu AD.indd 31

Shofu Dental Corporation • San Marcos, CA

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PRODUCT PROFILE

Figure 5.

Figure 6. Sample community newspaper advertisement for Partners in Prevention in April 2014

ment.” From both views has emerged a new network of Canadian dental teams who are reaching out to their community with a new message: we offer more preventive care when you need it. This network is called the Partners in Prevention (www.partnersinprevention.ca). Its principles follow: • T he Partners engage the patient at the start of his/her visit with a risk assessment form (Figure 5). • T he Partners speak to their community about more prevention in several forums – the community newspaper, frequently on social media, using videos to tell their story. • T he message is always rooted in scientific studies and with an overriding focus on the theme that the mouth is part of the body. • T he brand delivers on key three concerns: painless care, affordable care and effective care.

• A ll Partners contribute to the brand via a monthly fee. Shortly after commencing a sustained community awareness program, the Partners in Prevention network has grown quickly and involves three independent hygiene clinics. The community is responding to this new choice. And new, sharper messaging is scheduled soon (Figure 6).

Arriving at our destination: improved oral health Prevora has been evaluated through wellcontrolled clinical trials and achieved significant prevention of caries in high-risk adults. It has a unique therapeutic indication from Health Canada. In an aging population with numerous risk factors for caries, limited if any dental insurance, and growing access to information on dental prevention on social media and the internet, the community is

May 2014 www.oralhealthgroup.com

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PRODUCT PROFILE

ready for new services and choices to prevent disease. The mission of the Partners in Prevention is to provide those services. n Ross Perry and Dr. John Symington are share holders in CHX Technologies which owns and distributes Prevora.

REFERENCES 1. P ublic Health Agency of Canada, July 2011, and; Muller T et al. 2011. Caries and periodontal disease in patients with Parkinson’s disease. Spec Care Dent. 31 (5): 178-181 2. H intao J et al. 2007. Root surface and coronal caries in adults with type 2 diabetes mellitus. Comm Dent Oral Epidemiol. 35 (4): 302-309, and: Muller T. op cit. 3. Vujicic M et al. 2013. American Dental Association Research Brief: Dental care utilization declined for adults, increased for children during the past decade in the U.S. 4. http://www.pewinternet.org/ 5. McNally ME et al. 2012. The oral health of ageing baby boomers: a comparison of adults aged 45-64 and those 65 years and older. Gerodontology. 6. Maddi A et al. 2013. Oral biofilms, oral and periodontal infections and systemic disease. Am J Dent. 26(5): 249-254 7. Ito A et al. 2012. How regular visits and preventive programs affect onset of adult caries. J Dent Res. 91 (7 supplement): 52S58S, and: Wilson, M. 2005. Microbial In-

habitants of Humans: Their ecology and role in health and disease. Cambridge: Cambridge University Press, page 362 8. For example, the most recent epidemiological survey of adult caries has been conducted in the United Kingdom and was reported in 2009 at http://www.hscic.gov.uk/ pubs/dentalsurveyfullreport09 9. Worthington HV, Clarkson JE, Bryan G, Beirne PV. 2013. Routine scale and polish for periodontal health in adults. Cochrane Database Syst Rev, November 7, CD004625. 10. Gibson G et al. 2011. Supplemental fluoride use for moderate and high caries risk adults: a systematic review. J Public Health Dent. 71(3): 171-184 11. Fontana M et al. 2013. Xylitol lozenges were not effective in overall dental caries prevention in adults. J Evidence Based Dental Practice. 13(3): 97-99 12. Banting DW et al, 2000. The effectiveness of 10% chlorhexidine varnish treatment on dental caries incidence in adults with dry mouth. Gerodontology, 17, #2, 67-75 13. Symington J et al, 2014. Efficacy of a 10% chlorhexidine coating to prevent caries in at-risk community dwelling adults. Acta Odont Scandin., in press 14. R iley JL et al. 2010. Preferences for caries prevention in adults. Comm Dent Oral Epidemiol. 38: 360-370 15. http://www.nhs.uk/news/2014/02February/ Pages/NICE-publishes-new-draft-guidelines-on-statins-use.aspx

ADVERTISER PAGE Clinical Research Dental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Dentsply Canada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 GlaxoSmithKline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13, 17, IBC Orascoptic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Philips Oral Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IFC, 27 Premier Dental Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 RDHU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Shofu Dental Corporation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Sunstar America . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21, 33 Supermax Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Toronto Academy of Dentistry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 VOCO Canada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OBC

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ORAL HYGIENE Continued from page 16

you have the confidence and personal gratification in knowing that you’ve provided the best possible care to your clients. n

REFERENCES: (All sites accessed March 2014) 1. Sackett, D.L. et al. (1996) Evidence based medicine: what it is and what it isn’t. BMJ 312 (7023), 13 January, 71-72). 2. Entry to Practice Competencies and Standards for Canadian Dental Hygienists. http://www.cdha.ca/pdfs/Profession/Resources/ETPCS_QA_edited_final_pracicing_dh_students.pdf 3. Cruess SR, Johnston S, Cruess RL. “Profession”: a working definition for medical educators. Teach Learn Med 2004 Winter;16(1):74-6. 4. Introduction to Evidence Based Practice. http://guides.mclibrary.duke.edu/ebmtutorial 5. Hurlbutt M. Risk Assessment: Best Practices in Oral Health Management. http:// v iva lea r n i ng.c om /member/classroom. asp?x_classID=1853 6. http://www.cdafoundation.org/education/ cambra

RESOURCES: (All sites accessed March 2014) 1. T he CDHO Knowledge Network; http:// cdho.org/Knowledge+Network.asp 2. C DHA e-CPS available free to CDHA members. Online, bilingual Compendium of Pharmaceuticals and Specialties; www. cdha.ca 3. Philips Oral Healthcare CARE (Customized Assessment and Risk Evaluator) Tool; https://www.philipsoralhealthcare.com/ en_ca/care/ (English version) https://www.philipsoralhealthcare.com/fr_ ca/care/ (French version) 4. Free webinar — Risk Assessment: Best Practices in Oral Health Management h ttp://vivalearning.com /member/classroom.asp?x_classID=1853 5. Clinical Evidence; For more information, go to: http://www.clinicalevidence.bmj.com/ 6. P ubMed — FREE access to PubMed at: http://www.ncbi.nlm.nih.gov/pubmed

I f you are not familiar with searching PubMed, you may want to review the PubMed tutorials at http://www.nlm.nih. gov/bsd/disted/pubmedtutorial/ 7. C ochrane Library; For more information see Cochrane Library at: http://www.thecochranelibrary.com/view/0/index.html 8. T RIP Database searches across multiple internet sites for evidence-based content. It covers key medical journals, Cochrane Systematic reviews, clinical guidelines, and other highly relevant websites to help health professionals find high quality clinical evidence for clinical practice. For more information http://www.tripdatabase.com/

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DENTAL MARKETPLACE

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

ASSOCIATESHIPS TORONTO, ON ASSOCIATE REQUIRED Associate for busy, modern practice, full time in Toronto. Complete range of services provided including orthodontics, periodontics, implants, laser dentistry, digital impressions, oral surgery and conscious sedation. An excellent opportunity for professional developments and higher than average remuneration. Call:416-748-3353 or 1-866-866-8437.

NOVA SCOTIA

Want to be an Associate and not work for an Owner Dentist? Immediate positions (FT/ PT) available in Halifax (newly renovated), West Hants (30 minutes from Halifax, NS) and New Minas (NS). Very active hygiene programs. All positions come with a scaled remuneration structure based on individual and/or clinic performance. Company provides a variety of free CE along with other special packages. Contact info@finetouchatlantic.com or call (902) 835-4222 ext. 223.

PRINCE GEORGE, BRITISH COLUMBIA LAKEWOOD DENTAL GROUP

Full time Dental Associate required for a large Dental Group Practice. We are located in Northern British Columbia, home of the 2015 Canada Winter Games (visit website) www.canadagames2015.ca We are the most comprehensive & modern dental group in Northern British Columbia. Onsite, Oral Surgeon, Periodontist, Orthodontists. Complete support team. Relaxed atmosphere where you can develop your skills and financial security. We are looking for a candidate who would like to start a dental career with us. Future provides, associate position, practice ownership as well as future investment opportunities. Position available immediately. Contact: 250-960-3802 Email us: admin@lakewooddental.ca Visit us at www.lakewooddental.ca

BARRIE, ON Looking for an orthodontist in Barrie. Busy neighborhood. Please forward your résumé to dental_manager@ hotmail.com

ASSOCIATES FOR HAMILTON & WATERLOO, ON

Associates required, for TWO VERY busy and modern practices with VERY strong new patient flow. E-mail: associatedentist@ymail.com Fax CV: 888-880-4024

KITSILANO, BC

Available immediately, part time associate in the heart of Kitsilano. Wages negotiable. Please contact Leanna at 604 736-2505 or email appts@4thavenuedental.ca

SASKATOON, SK Associate required for modern, very busy practice with strong new patient flow. Great opportunity in a University setting. E-mail: associatedentist@ymail.com Fax CV: 888-880-4024.

martindale dental

Martindale Dental is looking for experienced GP dentists and Pediatric dentists to service patients needs in St Catharines, Milton, Burlington and North York. Please reply with current CV to ddsrequired@gmail.com

EDMONTON, AB

Extraordinary independent male dental hygienist looking for a Dentist in Edmonton area in association or cost-sharing partnership to build 3-5 ops busy practice. Please send your inquiries to mydentistpartner@hotmail.com

GRANDE PRAIRIE, AB

Three full time associates needed for our well established family practices, with travel to our satellite clinic in High Prairie, AB. Present associates will be leaving end of July 2014. Very busy practice with above average remuneration. Please email drroy04@telus.net if interested.

ASSOCIATE POSITION — KLONDYKE DENTAL CLINIC “In the land of the midnight sun” We are looking for a dentist with a high level of skill in implants, endodontics and general surgery. New graduates are also encouraged to apply. E-mail: 45@northwestel.net VANCOUVER ISLAND, BC We have 2 clinics one in Ladysmith and one in Courtenay both are located on Vancouver Island. We are seeking a full time associate for general dentistry. Busy clinics with opportunity for growth and investment opportunity in the future. E-mail: orca.dental@shaw.ca Fax: 250-338-7130. Tel: 250-338-5011 office manager Nola.

EAST OTTAWA, ON

Full time associate dentist needed for state of the art practice in a growing bedroom community in East Ottawa, ON. New graduates welcome. Opportunities to buy in. E-mail: lisa-hawkins@hotmail.com

HAMILTON, ON General Practice Associate Position. 2 days a week, Tuesday/Wednesday (1 evening). Full clinical freedom. Mentorship available, if required. Email resume to dentisthamilton@yahoo.com

EDMONTON, AB EDMONTON, AB

Edmonton and surrounding area requires a Full Time Orthodontic Associate. You will be met with empowerment, support and a healthy team atmosphere. This practice prioritizes patient care and respect and dignity in all interactions. The offices are well equipped and patient orientated. The successful candidate will demonstrate a strong sense of professionalism, a healthy work ethics and a passion for the positive difference Orthodontics can make. Self-motivation, a sense of humour and effective communication skills are essential. Daily rate based on experience and qualifications. Please submit your resume and covering letter to dr.mar@marorthodontics.ca 22 Sir Winston Churchill Ave, Suite 600, St. Albert, AB T8N 1B4 P: 780-418-2712 F: 780-460-2985 TF: 888-290-8418

May 2014

OHY May14 p36-38 Classifieds.indd 36

Looking for an associate (part/full time) to join our group of multidisciplinary practices which are focused on the highest quality of patient care and using the latest technology available. We are looking for a self-motivated, high-energy, clinically strong candidate who is interested in learning and continuing education. This is a great opportunity for the right candidate to grow with our expanding group and to work in a great environment. Buy-in opportunities are also available for the long-term associates. If you are interested, please email your CV in confidence to edmontondentalcareer@gmail.com

www.oralhealthgroup.com

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PICKERING, ON PART TIME ASSOCIATE WANTED

Are you a clinically talented, personally positive and physically energetic Periodontist? Does guaranteed referrals and active daily collaboration with restorative and hygiene teams get you excited because you believe you play an important role in patient’s long term health goals? Our busy 8 doctor practice invites relationship driven, naturally personable Periodontists to apply with resume and cover letter. Minimum 3 years experience. lavonne.keal@sierracentre.com

Busy Family practice located 45 minutes outside Toronto is looking for a part time associate. Minimum 2 years of Canadian experience is required. Must be a great team player with strong dental skills and good bedside manner. Some Saturdays and evenings required. E-mail only ddsfordentaloffice@yahoo.com

GTA

FULL TIME ASSOCIATE WANTED – NORTHERN ONTARIO (TIMMINS AREA) Bright, busy, modern, well established practice. Superior Compensation Package $20K per month range. Cheerful, professional & efficient staff. Vibrant and active community in pristine setting. Graduates and Experienced Dentists welcome. Please e-mail resumes to firstline_dental@hotmail.ca

Part time associate wanted for GTA mall location. E-mail resumes to pa291@nyu.edu WINNIPEG, MB

Oral & Maxillofacial Surgeon Looking for an associate to join busy practice. Please forward curriculum vitae to: drwalton@mts.net THORNHILL, ON

Associate needed for a busy Thornhill practice with intentions to purchase part or all at a later date. Experience required and flexible with days and hours. Please respond in confidence to Oral Hygiene Box 34 – e-mail: kshaw@oralhealthgroup.com

SCARBOROUGH, MARKHAM, RICHMOND HILL, ON

Seeking a motivated, personable team player as an associate to join our modern and progressive practice in Scarborough/Markham/Richmond Hill. Part time leading to Full time position. Candidate must have excellent clinical and communication skills with a friendly personality. Chinese an asset. If interested in exploring further, please send cover letter and CV to jobsteeth@gmail.com

HAMILTON, ON Part time associate needed 3 days/wk. E-mail: resumes@860dental.ca

SARNIA, ON

Associates needed – starting May 2014. Modern office, digital, new equipment. High traffic location and proven marketing system provides excellent patient flow. Must be willing to work some evenings and weekend hours. Reply to Oral Hygiene Box 31 – e-mail: kshaw@oralhealthgroup.com

GRANDE PRAIRIE, AB

Full time associate dentist required for busy family practice. Looking for highly motivated associate. Our practice includes the latest in technology (IOC camera, digital x-rays, paperless etc.). Large existing patient base. Current associate moving, team in place to help. Opening is for July 2014. Please send resume to pmdcgp@telus.net 780-538-2992.

DEEP RIVER, ONTARIO

We have an immediate need for a full time associate dentist. The current associate is moving and a replacement would be fully occupied (4-5 days per week) with existing patients. We are a family oriented dental practice with eight operatories intending to maintain our dental services to an established and growing patient list. Our practice offers orthodontic, CEREC, implant placement and restorative, laser, endodontic and restorative treatment options to our patients. There are no weekend or evening hours. Please forward resume to Dr Cameron Gage at drgage@bellnet.ca

www.oralhealthgroup.com

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PRACTICES & OFFICES

DENTAL MARKETPLACE

CALGARY, AB PERIODONTIST

ASSOCIATE BUY IN – CENTRAL BC

Opportunity for EXPERIENCED associate to purchase a busy, established dental office by working it off over time. 5 ops., hygiene, good income. Professional evaluation done. Price negotiable. Owner retiring. Call 1-250-847-4934.

ETOBICOKE, ON

Dental/Medical Office available immediately. 1210 Sq.Ft. on Ground Floor Level in a Busy Plaza. Immediate Possession Available. Close Access to Hwy 401, 427, 400, Airport and Woodbine Centre. Great exposure on heavily travelled Rexdale Boulevard. Please contact Eve at eve_f89@hotmail.com if interested or call 416-558-8800.

BAYVIEW AND SHEPPARD TORONTO, ON

Prestigious location steps from Bayview Village, Hwy 401, Subway line and tremendous construction of condominiums all around. Detached 2 story building fully renovated and equipped with 3 spacious operatories on main level and fully equipped lab +1 OP on lower level. Ideal real estate investment opportunity for a dentist. E-mail: dental325@gmail.com or tel: 416-318-3499.

PRIME LOCATION AVAILABLE TO SPECIALTY DENTAL OFFICE ONLY

Lease premises in place. Plaza under construction and set to be ready for possession this fall. 1 hour north of Toronto. High density residential. Specialty Office Only. Forward your interests to dental_manager@hotmail.com

ASSOCIATESHIPS BROCKVILLE, ON POSITION AVAILABLE

Well established, busy, family-oriented, dental practice searching for an associate for a long term, full time, or part time position. Opportunity for future ownership transition. If interested, please send an email to Dr. Dave Riddell riddell03@gmail.com or call (613) 342 – 3303.

OWEN SOUND, ON

Full time associateship available in beautiful Owen Sound. Great opportunity in this long established, busy family practice. Pleasant and well trained staff and large patient load guarantees above average earnings. All facets of dental care offered in new, modern office. With a husband and wife DDS team leaving practice two positions are available — be busy from day one. We are looking for DDS who is ethical, productive and pleasant. Must be willing to work some evening and weekend hours. Reply to drtimpringle@bell.net

May 2014

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DENTAL MARKETPLACE

CAREERS

ASSOCIATESHIPS

OTTAWA AREA … it’s also a great place to work.

General Dentist Opportunities Labrador-Grenfell Health offers a unique opportunity to live and work in a region of Atlantic Canada. We combine the peace and quiet of a rural setting with modern equipped facilities and a strong sense of community spirit. This is a perfect location to gain valuable experience in an innovative work environment. We are responsible for a full range of services, including community health, long-term care and acute care in Northern Newfoundland and Labrador.

SANDHU DENTAL GROUP Looking for 2 full time hard working, committed associates within driving distance from Ottawa. Will be busy from Day 1. Please e-mail your resume to: rsandhu@sandhudental.ca Visit our website www.sandhudental.ca

We are currently looking for the following professionals:

General Dentist

Permanent Full-Time, St. Anthony

Salary ranges from $136,434 to $163,723, depending on years of experience and service. Incentives include an annual retention bonus ranging from $6,750 to $20,500 (depending on location and years of service), six weeks paid leave and three weeks paid education/conference leave in a 12-month term. Applicants must have experience in general dentistry, be eligible for registration with the Newfoundland and Labrador Dental Board and be able to submit a satisfactory Certificate of Conduct. If a career path with a sense of adventure appeals to you, we need to talk. For information on joining our team and our incentive package, which includes assistance with relocation expenses, please submit your resumé, complete with references and stating competition number 2013000377S , to: Labrador-Grenfell Health Human Resources St. Anthony, NL A0K 4S0 Phone: 709-454-0347 Fax: 709-454-3301 hr@lghealth.ca

www.lghealth.ca

May 2014

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LESS THAN AN HOUR FROM TORONTO, ONTARIO Immediate opportunity in beautiful Bay of Quinte area with rapidly expanding family practice. Dental centre has offices in Belleville, Frankford and Cobourg. Current opening for Thursday, Friday and Saturday each week with the potential for more days. Full service dental practice (including oral and IV sedation and Invisalign) with great autonomy for the associate while being mentored by knowledgeable practice partners. Attractive compensation and support provided. Contact louise@familydentalcentre.com for more information.

CALGARY, AB GENERAL DENTIST REQUIRED

Are you an energetic and positive General Dentist who is committed to helping patients keep their teeth for life? Do you understand and believe passionately that oral health is a large part of overall health? Are you dedicated to understanding WHY things have happened to your patient so you can treat the source of the problem? Our established and extremely productive practice is looking for a special person who believes what we believe. If this ad resonates, please send resume and cover letter to lavonne.keal@sierracentre.com

www.oralhealthgroup.com

14-05-02 10:46 AM

One in five has it.

Many don’t know it.

They also may not know the oral health consequences.* They’re waiting for guidance.

Dry mouth is an oral health concern that patients are often unaware of. Patients who are on multiple medications are most at risk. So when you recognize the signs, have the conversation about dry mouth and how Biotène® toothpaste can help maintain good oral care. Biotène® also offers a range of products for mouth moisturization. 2

TM /® or licensee GlaxoSmithKline Consumer Healthcare Inc. Mississauga, Ontario L5N 6L4

Mouthwash, gel and spray for mouth moisturization

Toothpaste for dry mouth sufferers

BIOTÈNE is a registered trademark of the GlaxoSmithKline group of companies. * Dry mouth can disrupt the oral health environment and lead to halitosis, demineralization, increased caries, infection and mucositis.4,5 | 1. Sreebny LM. A useful source for the drug-dry mouth relationship. J Dent Educ. 2004;68:6–7. 2. Dawes C. How much saliva is enough for avoidance of xerostomia? Caries Res. 2004;38:236–240. 3. Sreebny LM, Schwartz SS. A reference guide to drugs and dry mouth, 2nd edition. Gerodontology. 1997;14:33–47. 4. Turner MD, Ship JA. Dry mouth and its effects on the oral health of elderly people. J Am Dent Assoc. 2007;138:15S–20S. 5. Fox PC. J Clin Dent. 2006;17(Spec Iss):27–28.

8320_BIO_OralHealth_03.indd 1 OHY May14 p39 GSK Biotene eng AD.indd 39

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Pour aider à mettre en lumière vos patients atteints d’érosion par acide.

L’IDENTIFICATEUR D’ÉROSION PAR ACIDE MC

Le nouvel outil ProActif de Pro-Émail se base sur l’indice publié de BEWE (examen de base de l’usure par érosion) afin d’aider les professionnels des soins dentaires du Canada à identifier l’érosion par acide et l’usure par érosion, à prendre les patients en charge au fil du temps et à les conseiller quant aux défis que représentent les aliments acides et l’hygiène buccale. Tout cela dans le but de vous aider à mettre davantage en lumière vos patients atteints d’érosion par acide1. MC

OHY May14 p13 GSK fre AD.indd 13

1. Bartlett D, et al. Clin Oral Invest. 2008;12(Suppl 1):S65–S68.

14-05-02 10:23 AM

Sensodyne

Répare et Protège Activé par NovaMin® Une technologie brevetée de libération de calcium et de phosphate Sensodyne Répare et Protège est le premier dentifrice quotidien à contenir la substance NovaMin® et du fluorure, une technologie unique éprouvée pour aider à réparer la dentine exposée1.

• Libère du calcium et du phosphate dans la salive1–3 pour former une couche réparatrice semblable à l’hydroxylapatite sur la dentine exposée et dans les tubulis dentinaires2–11. Réparer la dentine exposée NovaMin® crée une couche réparatrice semblable à l’hydroxylapatite sur la dentine exposée et dans les tubulis2–11 qui : • commence à se former dès la première utilisation1 • est jusqu’à 50 % plus dure que la dentine naturelle12 • fournit une protection continue contre l’hypersensibilité dentinaire avec un brossage deux fois par jour13–15 Créer une couche semblable à l’hydroxylapatite sur la dentine exposée et dans les tubulis dentinaires2,8–11

Protéger les patients de la douleur liée à la sensibilité future La couche réparatrice semblable à l’hydroxylapatite se lie fermement au collagène de la dentine1,16. Des études in vitro ont montré qu’elle : • se forme en 5 jours1 • résiste à l’abrasion causée par la brosse à dents1 • résiste aux expositions chimiques, comme la consommation d’aliments et de boissons acides1,8,12,17

5 µm

Couche fluorée semblable à l’hydroxylapatite dans les tubulis de la surface

Couche fluorée semblable à l’hydroxylapatite sur la dentine exposée

Image par MEB d’une coupe transversale in vitro d’une couche semblable à l’hydroxylapatite formée par la solution NovaMin® sursaturée dans une salive artiﬁcielle après 5 jours (sans brossage)10 Adapté d’Earl J, et al.10

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

Pensez au-delà du soulagement de la douleur

©2014 GlaxoSmithKline 1. Earl J, et al. J Clin Dent. 2011;22 (numéro spécial):68–73. 2. LaTorre G, et al. J Clin Dent. 2010;21 (numéro spécial):72-76. 3. Edgar WM. Br Dent J. 1992;172(8):305–312. 4. Arcos D, et al. A J Biomed Mater Res. 2003;65:344–351. 5. Greenspan DC. J Clin Dent. 2010;21 (numéro spécial):61–65. 6. Lacruz RS, et al. Calcif Tissue Int. 2010;86:91–103. 7. De Aza PN, et al. Mat Sci: Mat in Med. 1996;399–402. 8. Burwell A, et al. J Clin Dent. 2010;21 (numéro spécial):66-71. 9. West NX, et al. J Clin Dent. 2011;22 (numéro spécial):82–89. 10. Earl J, et al. J Clin Dent. 2011;22 (numéro spécial):62–67.11. Efflandt SE, et al. J Mater Sci Mater Med. 2002;26(6):557–565. 12. Parkinson C, et al. J Clin Dent. 2011;22 (numéro spécial):74–81. 13. Du MQ, et al. Am J Dent. 2008;21(4):210−214. 14. Pradeep AR, et al. J Periodontol. 2010;81(8):1167−1113. 15. Salian S, et al. J Clin Dent. 2010;21(3):82−7. 16. Zhong JP, et al. The kinetics of bioactive ceramics part VII: Binding of collagen to hydroxyapatite and bioactive glass. In Bioceramics 7, (rédacteurs) OH Andersson, R-P Happonen, A Yli-Urpo, Butterworth-Heinemann, London, pp61–66. 17. Wang Z, et al. J Dent. 2010;38:400−410. Préparé en décembre 2011, Z-11-518.

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1/27/2014 5:04 PM 14-05-02 10:30 AM

Une personne sur cinq en souffre . 1

Plusieurs l’ignorent . 2

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

La bouche sèche est un risque pour la santé buccodentaire que bien des patients ignorent . Les patients prenant plusieurs médicaments sont le plus à risque . Par conséquent, lorsque vous en reconnaissez les signes, abordez la question de la bouche sèche et de l’aide que peut apporter le dentifrice Biotène® pour maintenir une bonne hygiène buccale. Biotène® offre aussi une gamme de produits pour l’hydratation buccale. 2

Un rince-bouche, un gel et un vaporisateur pour l’hydratation buccale

BIOTÈNE est une marque déposée du groupe d’entreprises GlaxoSmithKline. * La bouche sèche peut perturber l’environnement de santé buccodentaire et causer la mauvaise haleine, la déminéralisation, l’augmentation des caries, des infections et une mucosite4,5. | 1. Sreebny LM. A useful source for the drug-dry mouth relationship. J Dent Educ. 2004;68:6–7. 2. Dawes C. How much saliva is enough for avoidance of xerostomia? Caries Res. e 2004;38:236–240. 3. Sreebny LM, Schwartz SS. A reference guide to drugs and dry mouth, 2 édition. Gerodontology. 1997;14:33–47. 4. Turner MD, Ship JA. Dry mouth and its effects on the oral health of elderly people. J Am Dent Assoc. 2007;138:15S–20S. 5. Fox PC. J Clin Dent. 2006;17(numéro spécial):27–28.

8320_BIO_DentalAd_FR_04.indd 1

OHY May14 p39 GSK Biotene fre AD.indd 39

Un dentifrice pour les personnes affectées par la bouche sèche

www.biotenecanada.ca

2/14/2014 1:00 PM

14-05-02 10:48 AM

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Le vernis transparent et mince au Fluorure de Sodium à 5% dans un système de livraison propre et sans gâchis Système de livraison “Single Dose” sans Transparent sans décoloration jaunâtre des dents Agréable saveurs sans arrière goût Ne contient aucune Saccharine, Aspartame ou Gluten Disponible en dose adulte ou enfant Contient du Xylitol

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14-05-02 10:47 AM