Oral Hygiene September 2014 by Annex Business Media

oralhygiene September 2014

INFLAMMATION,

CHRONIC DISEASES AND THE

ORAL CAVITY Part 1

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Philips Sonicare FlexCare Platinum More innovation. Less plaque between teeth.

INTERCARE BRUSH HEAD TECHNOLOGY

• Deeper interdental cleaning • Removes up to 7x more plaque between teeth 1

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• Resonates when too much pressure is applied • Interactive guidance for proper brushing technique

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• Clean: Low, Medium and High • White: Low, Medium and High • Gum Care: Low, Medium and High

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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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oralhygiene CONTENTS

FEATURES Leading your patients to acceptance

Virginia Moore

Does your patient education really work?

Janet Hagerman, RDH, BSDH

Dr. David Moffet, BDS, FPFA

Advancing Oral Wellness, Part I

Sara DeNino Paone, RDH, RNCP

Xerostomia: Are you ready for the silver tsunami?

Jo-Anne Jones, RDH

DEPARTMENTS Editorial

News

Service me!

Distinguished Service Award; IDS 2015; Biological Monitoring Service

©Andrey Armyagov & Oliver Sved/Getty Images/Thinkstock

Is your hygiene department truly a profit centre?

34 Dental Marketplace 36 New Products

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

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Cover: ©Zoonar RF/Getty Images/Thinkstock

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YOUR CLIENTS ARE ONLY DOING

HALF THE JOB

WHEN THEY BRUSH

COMPLETE THE CLEAN WITH LISTERINE®. ADDING LISTERINE® ANTISEPTIC RESULTS IN

2X AS MANY HEALTHY GINGIVAL SITES VERSUS JUST BRUSHING AND FLOSSING.*1

*Based on overall mean percentage of healthy sites per subject after 6 months. Post hoc analysis of Sharma et al clinical study. A randomized, 6-month, controlled, observer-blind, parallel-group clinical trial, conducted according to American Dental Association guidelines; n=237 healthy subjects with mild-to-moderate gingivitis evaluable at both 3 and 6 months. Subjects rinsed twice daily for 30 seconds with 20 mL of LISTERINE® COOL MINT™ at least 4 hours apart. 1. Sharma N, Charles CH, Lynch Mc, et al. Adjunctive benefit of an essential oil-containing mouthrinse in reducing plaque and gingivitis in patients who brush and floss regularly: a six month study. Am J Dent Assoc. 2004;135(4):496-504.

For adults and children 12 years and older. LISTERINE® ULTRACLEANTM Anti-Tartar contains: menthol 0.042% w/v, thymol 0.063% w/v, eucalyptol 0.091% w/v, zinc chloride 0.09% w/v. Use after brushing teeth with toothpaste. Rinse full strength with 20 mL for 30 seconds twice per day. Do not swallow. © Johnson & Johnson Inc. 2014

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EDITORIAL

Service Me! The world has gone mad…at least it seems that way since I last addressed you from this page just a few months ago. Passenger planes disappearing without a trace or being shot out of the sky; barbaric beheadings; stolen cigars and civil unrest; ISIS, Ebola and ‘selfies’; airline tray table rage, AwesomenessTV; celebrity phone hacking; Putin, Pistorius, Ferguson and Mo’ne. It’s been a summer of navel-gazing, whether by individuals or nations, religions or ideologies. I can’t help but think that if we spent more time looking outward, looking at the state of the world and the condition of others, we’d quickly lose our self-obsession, self-absorption, self-love. And what has all this navel-gazing wrought? We, at least we in the socalled ‘first world,’ seem mired in decay and dysfunction. Instead of celebrating breakthroughs we’re panicked by outbreaks. We are armed to the teeth yet toothless against tyrannical groups and their tyrannical leaders. Dental hygienists are, by profession and by nature, servers. You spend your day working with your team and serving your patients. You provide the caring face, voice and demeanor they deserve and demand. You may be a reluctant leader but you are a professional caregiver (server). You actually lead by your desire to serve rather than a desire for power. Servers often fly under the radar

because they are focused on team success rather than individual glory. And servers are life-long learners. I’m reading an insightful post from the smart folks at Trendwatching.com on the future of customer service. Goodness knows volumes have been written about great service, what it is and how to deliver it. Here are a couple of points to take away: 1. Politeness pays. 2. Great service is about feelings. The feeling of being recognized, listened to and cared for. 3. Deliver more than the goods.

Catherine Wilson Editor

“Sixty-six percent of consumers switched brands or business due to poor customer service last year. Some 82 percent of those who switched said the brand could have done something to stop them.”1 I was going to whip out a moving quote from Gandhi about finding yourself through the service of others but I like this quote even better…from comedian Demitri Martin: “I like video games, but they’re really violent. I’d like to play a video game where you help the people who were shot in all the other games. It’d be called ‘Really Busy Hospital.”

Accenture, November, 2013

September 2014

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NEWS BRIEFS

ODHA presents dental hygienist with Distinguished Service Award Mississauga, ON resident and registered dental hygienist, Griha Craveiro (r), was honoured May 24th, 2014 with the Distinguished Service Award, presented by the Ontario Dental Hygienists’ Association president Terri Strawn. The award recognizes Ms. Craveiro’s outstanding contributions to the profession of dental hygiene and to her association. Described as true dental hygiene leader and role model for all dental hygienists, Ms. Craveiro demonstrates her passion for giving back to her profession by helping colleagues in need, participating in public awareness projects and volunteering her time to educate the public about the importance of oral health for overall health. She has been working as a dental hygienist for more than 20 years.

IDS 2015 The International Dental Show (IDS) in Cologne, Germany is the world’s leading trade

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

September 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

fair for the dental sector. IDS presents the entire range of products available on the international dental market, bringing together all relevant target groups from the worldwide dental sector. Taking place March 10th to March 14th, 2015 (the first day is reserved for specialized dental trade and importers), the 36th IDS will once again generate momentum while paving the way for pioneering advances, demonstrating its role as a successful presentation platform and meeting place for all decision makers in the dental-medical market. For more information regarding IDS 2015, please visit www.ids-cologne.de.

Crosstex develops biological monitoring services website Crosstex International has developed a new website, CrosstexBMS.com, that provides state-of-the-art laboratory services and infection control information to healthcare professionals. The site content is heavily focused on sterility reassurance protocol/products in hopes of educating clinicians to implement safer working environments for their staff and patients. Crosstex manufactures biological monitoring systems and operates two testing laboratories in North America that proves over 2.5 million mail-in spore tests annually from a diverse range of customers. For more information, visit www.crosstex.com.

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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Introducing Oral-B Black. Seven independent functions. Up to 800 brush movements per second. Designed by Braun, it truly is engineered to perform. Explore the innovation. OralB.com/black

ÂŠ Procter & Gamble, Inc., 2014 ORAL-14666

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ORAL HYGIENE

Leading your patients to acceptance Virginia Moore, Moore Practice Success

Virginia has presented at top dental meetings in the US, Canada, the Middle East and Asia. She is a contributor to ADA’s newest publication “Expert Business Strategies”, as well as authoring two books and co-authoring 8 others on practice management. Virginia is a graduate of the ADA KEMP for dentists. She holds membership in the National Speakers’ Association and is a member and Past-President of Academy of Dental Management Consultants. She can be reached at vmoore@ virginiamoore.com or www.virginiamoore. com

“Being as clinically excellent as possible. Supporting the Doctor’s treatment recommendations. Being a team player.”

hose are the answers I give when asked what dentists want in a great hygienist. Why? Because being clinically excellent is, of course, the foundation of a terrific Hygienist that can provide the tools and care for patients’ best dental health. Supporting the doctor’s treatment recommendations also contributes to the patient’s best health and enhances your value to the practice as a clinician who can help patients make good decisions about their treatment. Being a team player is the “glue” that helps to weave together the myriad persons who help patients attain their dental health goals. Let’s focus on the tremendous contribution you bring in supporting the doctor’s treatment recommendations. As a result: • Your patients will enjoy better dental health. • Your value to the practice is enhanced. • You will have greater satisfaction in the work you do. The “beneficiaries” of these outcomes are: • Your patients • T he practice • YOU! Here are four ways to help your patients say “Yes!”.

1. Make it relevant…to the patient!

Have you ever noticed that • concepts, • recommendations,

• approaches, “stick” when they are explained via an • easily understood explanation, • story, • analogy? Your patients often need help in making sense of their treatment needs. While it makes perfect sense to the dental professional, the patient may be in overwhelm, confusion or even in doubt as to what is being recommended. To quickly gain, and then maintain, a patient’s interest and understanding, explain their situation in a manner they can readily relate to. Here’s an example of how a story helps. Envision a person at their dermatologist’s office. The dermatologist is educating the patient on the consequences of prolonged sun exposure. Which description is most apt to capture the patient’s attention? A. T wo types of ultraviolet rays (UV) from the sun exist: UVA and UVB. UVB cause burning of the skin or the red associated with sunburn, skin cancer, and premature aging of skin. UA rays stimulate tanning but are also linked to other problems such as impaired vision, skin rashes, and allergic or other reactions to drugs.* B. Skin cancer and premature aging can be the “left over” effect of sunburns. Sunburns eventually disappear, but the underlying damage can persist.

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The element of listening to your patient, first, can have the greatest impact on treatment acceptance Are we in agreement that “A” is a “snooze fest”? It’s hard to stay connected because it starts with something seemingly irrelevant. In “B” we get to the core message a lot quicker and in a more compelling fashion. Get to the heart of the message you want to share with the patient. Don’t hope that they’ll hang in there through information that is not relevant to them. Pare down your presentation to the core message. Use analogies that relate to a patient’s interests. For instance, if the patient is an auto mechanic, they will certainly understand the analogy of how regular maintenance is much more cost/time/anxiety effective than driving for miles with the “Check Engine” light blazing. The more relevant the explanation is to a patient, the more likely they are to move forward with treatment. Overload of information and information that seems irrelevant is the direct route to hearing “I’ll think about it.” None of us make good decisions when we are unclear about the benefit to us. One of the most challenging things about knowing a lot, is that we’re tempted to share it all. Don’t get lost in a sea of information. Remember, it’s all about the patient and what’s important to them.

2. Help the patient understand what’s in it for them

It’s all about the patient, and what’s in it for them. As people, we tend to make decisions based on emotion and feelings, and then support our decision with facts and logic. That’s the opposite of what is usual in treatment presentations to patients. Dental professionals tend to bombard patients with the facts and the logic of why this is a good thing to do. When explanations become so complex and intri-

cate it’s no wonder patients say, “I’ll think about it.” Often that’s code for, “Yikes, let me out of here!”. Know what the patient wants: start with listening, really listening to what they are saying. Stephen Covey stated it well when he said, “Seek first to understand, before being understood.” In your enthusiasm for helping a person are you doing all the talking? Are you telling them what you can do before you find out what is important to them? The element of listening to your patient, first, can have the greatest impact on treatment acceptance. That adage, “they don’t care how much you know until they know how much you care” rings true in the case of explaining treatment. Helpful tips: • Ask questions. • Listen. • Seek to understand what motivates and concerns this person regarding their dental care. • Make notes in the patient file. • Speak to the patient’s benefit. • Know what is important to them. • Let them know you heard them. Your patients want to be heard. Let them know you have! Speak to the patient’s benefit, know what is important them, let them know you hear them. Knowledge does not change behaviors, breaking through to feelings, does.

3. Share consequences of avoiding treatment “Doctor will need to do a filling on that tooth, it has decay.” “Once we extract that tooth, you’ll need to replace it with a bridge or an implant.” “You’ll need to have a crown once the root

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Give patients the “full story.” Let them know the consequences of not having the treatment that has been diagnosed canal is completed.” Those statements make perfect sense if you’re a dental professional. Otherwise, the “obvious” isn’t so obvious! Many times we don’t share the “why” or consequence(s) of avoiding treatment. That crucial piece of information can be the “tipping point” for many people. The dental professional knows that extracting a tooth may solve an immediate problem of pain, however, if not replaced, it can set in motion an entire set of problems that require more investment of the patient’s resources. As an example: Let the patient know the consequences of not placing a crown on an endodontically treated tooth. The patient can make a much more informed decision when they understand the risk of tooth fracture if a crown is not placed. For many people, it’s “no pain, no dentistry needed.” That approach can change when consequences are shared with the patient. Give patients the “full story.” Let them know the consequences of not having the treatment that has been diagnosed. It’s the fair and kind thing to do.

4. Use the IntraOral Camera (IOC)

The IntraOral Camera (IOC) is one of the most important tools you can use to help a patient understand and accept your treatment recommendations. “A picture is worth a thousand words,” is more true today than ever, in showing patients what treatment they need to have done. Need a reminder of how impactful a picture can be? Think of some of the most moving photographs of our time and what those images evoked. • T hose brave U.S. troops raising the flag at Iwo Jima • T he wedding album picture with the look on a father’s face as he walks his daughter down the aisle • L ooking back at newborn pictures and seeing the look in the eyes of a mother as she holds her baby for the first time

Yes, photos have impact, and most importantly, they impact our emotions and can lead us to take action. Skip handing the patient a hand mirror to show them what you see, instead, use the IOC for the best visual impact. Let’s eliminate the obstacles that might be limiting your use of the IOC. For instance: a. M ake sure it works! If the IOC is not working right, every time, get it repaired, now! You have a terrific tool in helping patients to “own” their dental disease, make sure you can use it. b. M ake it available. Have the IOC readily available for use. If the camera is difficult to access, make a change. Wear it out, don’t waste it. c. M ake sure an image is on the screen when Doctor enters for the exam. Having an image on the screen helps the doctor to focus on the conversation with the patient regarding their treatment needs. This helps to forward the conversation you have already started with that patient about an area of concern that you will have the doctor examine. It also saves precious time during the doctor exam. Many times we “don’t believe it until we see it.” By helping your patients “see it” they are much more likely to • believe, • build trust, • “own” the problems, and stay committed to having treatment. “I love my new smile!” “Thank you, I can eat anything again.” “I’m so glad to be out of pain!” All of those outcomes started with a patient saying, “yes”. Start today helping more of your patients say “Yes” to better health and esthetics. You have tremendous influence and impact on the patients you provide with care. Using that influence can make all the difference in a person’s life. Yes, that does make all the difference. n

September 2014 www.oralhealthgroup.com

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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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ORAL HYGIENE Janet Hagerman, RDH, BSDH

is an industry thought leader known for creative communication and leadership principles empowering health professionals worldwide with proven, effective and easy-to-implement strategies for success. A graduate of the Medical College of Georgia, she is an author, international speaker, advisory board member and consultant. Janet is the author of Selling Dentistry- Ethically Elegantly Effectively, and is published in numerous dental journals. To learn more visit Janet’s website at www.janethagerman. com or janet@janet hagerman.com

Does your patient education really work? A

s hygienists, we have always considered patient education to be a hallmark of our care. And yet, how often does your patient education fail to produce patient compliance with treatment? Patient compliance means that your patients not only understand their diagnosis and needed treatment, but that they actually accept (buy into) your prescribed treatment, schedule the appointment(s) and keep their appointments. Ever see the “deer in the headlight” expression when you are trying to tell your patient how to floss or why they need perio therapy? Polite patients may appear to be paying attention but our best intentioned patient education sometimes registers like a Snoopy cartoon dialog bubble: “blah, blah, blah, blah, blah.” Simple instruction is sometimes perceived as merely a string of words without meaning. What is your compliance rate? Do you have patients who seem to understand but fail to schedule? Do you have patients who nod agreeably as you “educate” but never follow through? Historically, dental professionals have focused on patient education. While educating is important, the end result of acceptance is crucial, and simply educating does not always accomplish acceptance. In fact, too much education can have the opposite effect of confusing and overwhelming patients to the point of turning them away (as in “I’ll think about it”). The object, then, is to find the best communication strategies that serve the consumer/patient in a helpful and productive manner and apply them to dentistry to aid in

boosting acceptance of services, while always maintaining the highest clinical standards.

“Information Dosage” Give your patients enough information to make a well-informed decision. The key word here is “enough.” What is enough? Enough information for one person may be too much for another (information overload), and still not enough information for yet another person. Dental health care providers typically know the clinical information (the scientific facts, the clinical studies, etc.), but need a way to dispense this information appropriately. Too often patients get “overdosed” with “education” resulting in information overload, confusion, overwhelm and ultimately non-compliance. Or, sometimes information overload can simply be a case of bad timing. I’ll never forget Bob Wilson — one of my earliest patients in my clinical career. He was a bank president and turned out to be a candidate for periodontal therapy rather than “just a cleaning.” Patient education had been one of my favorite subjects in college, and I prided myself in, what I considered to be, my crusade to rescue the world from periodontal disease. As I launched into my patient-education “spiel,” Mr. Wilson put his hand on my arm and said, in a patronizing manner, “Little lady, dispense with the lecture. I have an important meeting to get to so just clean my teeth and get me out of here as soon as possible.” Little lady!!! I was furious, and humiliated. I was also curious and frustrated with myself. How could I have been so off the

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Once you know your patient’s preference, you will customize your treatment presentation to appeal to that value troduce treatment presentation is: “David, I want to give you enough information for you to make a well-informed decision.”

The Discovery Process It is imperative to customize the information dosage you dispense to match the needs and values of your patients. The best way to discover this is by asking good open-ended questions to learn about your patients’ personal and emotional needs and their values. You will, of course, learn their clinical needs via your clinical evaluations. Through the Discovery Process of questions and answers, you will quickly understand how to customize the information dosage.

Ask good open-ended questions. Listen actively. The best way to learn about your potential client/patients and to discover what they want and need is to ask them — ask appropriate questions. As the saying goes, if you want to sell — ask, don’t tell. Good questions are open-ended; they are questions that cannot be answered with a simple yes or no, but need elaboration. Listen and paraphrase the answers you receive to ensure that you understand their concerns correctly. Successful sales people agree that the most effective sales skill is the ability to simply ask potential clients what they need and want, and then be quiet and listen carefully. Only by listening to, and learning about, each patient’s unique needs can the problem solving begin. People will tell you exactly what they want and need if you will ask and listen. This dis-

©Janis Litavnieks/Getty Images/Thinkstock

mark? My patient education had fallen on deaf ears. Eventually, my anger turned inward and I resolved to learn how to become a better communicator. Clearly Mr. Wilson was nowhere near interested in what I had to say. How could I have done things differently to get through to him? I clearly had not established any rapport with Bob. I had not looked for links of likeness to establish any connections with this man. My “telling” and information overload simply fell on deaf ears, even though Bob certainly was capable of understanding my information. I would have been much more successful had I understood Bob’s urgent present need and customized my information “dose” accordingly. Can you think of times when you have gotten caught up in the “telling” of your patient’s condition without first seeking to establish rapport with them and learning their unique perspective for that day? These are many patients that leave without accepting treatment as we scratch our heads, wonder why and blame them. As you implement the simple rapport-building techniques in this article you’ll learn how to achieve higher levels of patient compliance success with your own patients. Different patients require different “dosages” of information in order to make informed decisions. The dosage can vary from “what kind” of information to “how much” information. Your job is to figure out the best information dosage for each particular patient. The Discovery Process will enable you to do this. In fact, a great script to use to in-

September 2014

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ORAL HYGIENE

If you want to sell — ask, don’t tell. Walter Hailey, Dental Boot Kamp covery process leads to relationship building that forms the foundation for problem solving with your service or product.

Values Questions Values Questions are designed to do just that — discover a person’s values. It’s important that values questions are open ended, requiring a thinking response, not merely a yes or no. These two questions will enable you to pinpoint your patient’s dental values. “What is most important to you about your teeth?” Answers will vary — whiter, straighter, stronger, keep them all, don’t hurt — but most will fall into one of two categories: cosmetic or functional. Once you know your patient’s preference, you will customize your treatment presentation to appeal to that value. “What is most important to you about your dentist (or dental office)?” Most answers to this question — nice staff, don’t hurt me, see me on time, take my insurance — will fall into one of three categories: time, pain, and money. Once you know your patient’s hot button, you will be far more successful when you can speak to the values that are the most important to them. You may have the very same clinical treatment to present, for example, a crown and three fillings, but you can present it many different ways depending on the patient’s values. Here are three examples: 1. “Mrs. Jones, the crown and fillings you need can all be done in one visit to make the best use of your time since you travel so much. Also, the dental materials we now use are so natural and life like. I think you’ll appreciate getting rid of those old metal fillings to replace with tooth-colored fillings and a perfectly natural-looking crown. You’ll love the way your new smile will look!” (Values: time and cosmetic.)

2. “Mr. Anderson, the crown and fillings you need are going to strengthen your teeth. I know you said you want to keep your teeth and we want to support you in that goal. Those old metal fillings are breaking down and leaking, subjecting them to further decay. The new fillings will bond with your teeth, making them stronger. And the crown you need will cover the whole tooth to protect it. This is the best treatment to ensure you keep your teeth for your lifetime.” (Value: function and longevity.) 3. “Sandra, the crown and fillings you need are not surprising considering the time it’s been since your last dental visit. I remember you said you hate dental work and have avoided it from fear of pain, and you are also concerned about insurance coverage for all your dental work. I know exactly how you feel because most all of our patients have similar concerns. I’m not sure what your coverage will be since all plans vary (and there are hundreds of them) but I can assure you that Sue, our office manager/treatment coordinator is an expert at maximizing dental benefits for our patients. Our office is dedicated to finding ways to make your dentistry affordable. Plus, we specialize in fearful patients. Once we complete your immediate work we will show you how to prevent future problems. And you will love our doctor’s gentle touch.” (Values: pain and money.) These examples all address the very same clinical need, but are presented differently based on the patient’s values. When patients want more detailed clinical information, they will ask for it. Then you will know to increase that patient’s information dosage, and that it will be well received because they have asked for it.

September 2014

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ORAL HYGIENE

People don’t care how much you know until they know how much you care President Theodore Roosevelt and John Maxwell What most patients really want is to have their values acknowledged and addressed. Dental Boot Kamp founder, Walter Hailey, said, “If You Want To Sell — Ask, Don’t Tell.” As a dental professional, it is easy to get caught up with telling in the name of patient education. Try asking instead. By asking good open-ended questions, your patients will give you all the information you need to customize your treatment plans and maximize treatment acceptance. Here is another example of a good values question regarding periodontal disease. It is included because so many patients come to the dentist expecting “a cleaning” when they may actually need periodontal treatment instead. This question helps to prepare for that possibility, while also giving you much-needed patient values information. “Mr. Anderson, tell me, what do you know about periodontal disease?” Patient answers will give you a myriad of clues as to how to address their concerns. This is then the perfect opportunity to use the following script. “Mr. Anderson… (address their answer). Amazingly, about 80% of the population has some form of periodontal disease! –It is seen in all types of people, all races and cultures, regardless of where they live or their level of education,* and we now know that periodontal disease affects other systemic diseases like heart disease and diabetes. For these reasons we screen very aggressively for it in our office. This screening will be part of your exam today.” Having this brief conversation around this values question helps to prepare your patient

for the possibility of a periodontal diagnosis and further information dosage. Dale Carnegie, who became famous for the interpersonal skills he developed and taught, said, “It is better to be interested than interesting.” Being interested in a person requires that you ask and not tell. By asking questions and becoming interested in each patient’s wants and needs, you become their advocate, ensuring a foundation of trust that is imperative for patient treatment plan acceptance. Values questions take very little time, but reveal crucial information about your patient’s values and hot buttons. That information enables you to gauge your patient’s information dosage to customize their treatment presentation, and thus increase the likelihood of treatment acceptance. Sandwich your patient education between good open-ended values questions and customized information dosage. By customizing your message, findings and recommendations, you will be serving your patients at the very best level. You will be establishing and maintaining patient relationships that bloom into trust and loyalty and referrals. President Theodore Roosevelt and John Maxwell both said, “People don’t care how much you know until they know how much you care.” Patients will know how much you care when you: — Understand and ask good open-ended values questions — Discover patient concerns and values — C ustomize their information dosage Transform your patient education into patient compliance today, and watch your peak performance soar. n

* Ontario dentist Dr. Barham Mostagachi: “The incidence of gum disease is very high. It is seen in all types of people, all races and cultures, regardless of where they live or their level of education.” http://www.canada.com/health/disease+rise+population+ages/1353520/story.html

September 2014 www.oralhealthgroup.com

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ORAL HYGIENE Dr. David Moffet, BDS, FPFA

Is a dentist from Sydney Australia. He is the creator of “The Ultimate Patient Experience” Programme. This unique, specific Programme, called “The UPE” for short, helps dentists to dramatically improve their practice bottom line, and ultimately, improve their own quality of life. david@theupe.com

Is your hygiene department truly a profit centre? A

t the beginning of this year, I was discussing with one of my clients the decision she was about to make as to whether or not she should begin employing a dental hygienist. My client has a fairly busy, one-doctor dental office. So we started doing the math. And that made the decision easy. First, we categorized all the patients in the practice into six categories. The key metric that we took from doing this exercise was that, for this question, we were looking for how many patients of record would we consider to be regular attenders of the practice? These patients were then divided into those who had been coming for more than three years, and those regulars who had been coming for less than three years. We then looked at the actual number of teeth cleaning appointments that had been performed in the last three months by the doctor. Third, we looked at how many new patients were coming to the dental office on a monthly basis. Here’s what we did with those numbers: The number of regular patients, multiplied by two and divided by twelve, equals the number of regular preventive care hygiene appointments that the new hygienist would see in a month. The number of new patients who book for a check up per month [already] becomes the New Patient First Hygiene appointment num-

ber for the month. Adding these two numbers and dividing by nine [hours in a day] gives us a number of days in the month a hygienist would be required. Having arrived at that number, it was just a matter of then working out whether or not to stretch to a full time hygienist immediately? Dividing that last number by two [because our doc was performing thirty minute hygiene cleans and our hygienist would perform hourly appointments] gave us an idea of how much time we were going to create each month in the doctor’s schedule so that the doc could then see more new patients, and also do more productive procedures as well. So David, I’ve heard that hygiene should be a loss leader for the dental office? Categorically, I say this is a thought that no dental office should ever entertain. A hygiene department should be a profit centre for the dental office.

Let me explain Try these numbers…If every patient seen in the hygiene room has two bitewing radiographs every two years, and comes to the dental office twice a year for hygiene, then the hygienist should be easily able to set a daily goal. – Nine appointments x hygiene fee [say $195.00] – Nine x 1/2 of a bitewing [say $80.00] – Gives us a daily hygiene production goal = $2,115.00 per day. Multiply that number by days per month,

September 2014 www.oralhealthgroup.com

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ORAL HYGIENE

A hygienist’s true worth is her ability to plant the seeds in the patients’ minds as to what sort of treatment they may need to rectify any such defects and then by twelve to arrive at an annual hygiene production number for that hygienist. Based on these numbers a good hygienist working four days per week should generate over $36,000.00 in fees out of her room per month. And there’s a good starting point…. Run your numbers through this equation and let me know what you come up with. But let’s be frank. Your hygiene department should be adding to your bottom line. The real value of a great dental hygienist for a dental office is her ability to help the dentist in finding defects and decay in the mouths of the patients that she sees and treats. Her true worth is her ability to plant the seeds in the patients’ minds as to what sort of treatment they may need to rectify any such defects. There. I said it. You see, many, many years ago, I had an epiphany. Not that I knew at the time what an epiphany really was, but when the word “epiphany” became the flavor of the month, I knew that I had had one. Here’s what happened. There was one day when I came into my hygienist’s treatment room to do a hygiene check, or examination, on one of her patients. As soon as the patient opened wide, there, as plain as the nose on your face, was a huge gaping defect on a lower right second molar, where the whole mesio-lingual cusp had been sheared right clean off and away!! Gone!!

You couldn’t miss it, because on top of this, the lower right first molar had been previously removed. So it was pretty well obvious… like I said, it just jumped straight out at me! So I said to this lady, the patient: “Oh wow! You’ve got a broken tooth down there!” to which she replied back to me, with clear amazement in her voice: “Oh, have I?” Well knock me down with a feather!! “Oh, have I?” Oh have I indeed!! Please help me up from the floor as I recover. What hit me there and then was that my wonderful new hygienist had just been visiting for an hour in this lady’s mouth and had not even raised, asked or mentioned to the patient a question or point or observation that a huge piece of tooth was missing from her body. “Excuse me Mrs. Patient. I see you have a piece of tooth missing from down here?” “Excuse me Mrs. Patient, are you experiencing any discomfort from down here where there’s a piece of your tooth missing?” Nothing. Not a peep. No. Zero. Zip. Nil. My wonderful new hygienist had not mentioned or raised the broken tooth with the patient at all. And then it hit me. The dental hygienist has such a great opportunity to detect, observe and collect and collate a list of defects and decay that she sees in the patient’s mouth during their hygiene visit.

September 2014

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... it makes good sense for her to act as the doctor’s second set of eyes, so that when the doc comes in to do the examination, the hygienist can have a complete list of defects and spots...

Here’s what one of my colleagues Kristin Nickells, wrote to me recently: “Your hygiene department should be your front line marketing tool, planting the seeds of treatment options, questions to ask the dentists, and following up with benefits (all to a captive audience!). THAT is where the real gold comes in.” As Kristin points out, the hygiene visit is a great opportunity for the hygienist to alert the patient to those things she sees that she is going to bring to the attention of the dentist. Because let’s face it, she’s in there for such a long period of time, and has the trust of the patient. So it makes good sense for her to act as the doctor’s second set of eyes, so that when the doc comes in to do the examination, the hygienist can have a complete list of defects and spots that she wants the doc to pass opinion on. After all, the hygienist is a dental professional. An educated dental professional. And patients do trust her. And she does know what decay can look like. And a crack. And a margin deficiency. So there’s no reason at all, why during the performance of her hygiene duties, that she can’t alert the patient to a list of things she’s seen that she thinks the doctor will need to check. Because we know there are some parts of the world where dental hygienists cannot diagnose…. But they can ask the doctor to review some things that they’ve seen. A great dental hygienist will have a thorough and complete list ready for the doc on each and every patient. This makes everybody’s life so much easier.

How your hygienist can go above and beyond for her patient and for her doctor, and supercharge their value and worth for your dental office One of the best ways for a dental hygienist to add value to her dental office is for her to know her numbers. I’m continually surprised when I come across a health care professional, like a hygienist or a dentist, who does ‘NOT’ have an exact idea as to what they need to produce, treat and co-diagnose on a daily, weekly, monthly and even hourly basis. Frankly, going about your dental business in this manner is about as effective as driving your car with the fuel gauge covered over, the clock covered over, and your Sat Nav turned off, EVERY TIME! It’s just sheer stupidity. Without these numbers, without keeping check and keeping score, you’re just a wandering generality…. you’ll just keep meandering aimlessly and arrive at a goal of nothing… But I see doctors do it, and I see hygienists do it, day in and day out. On the flip side, a dental office with targets and target-focused providers is a safer, more secure office to be employed in and is also a safer and more secure dental office at which to be receiving treatment. Because it’s just a well-run machine… it operates well. Take a look at Formula 1 pit crews. Can you imagine a pit crew operating with no ideas on time frames, efficiencies, goals and outcomes? It would be just an out and out rabble, and mess! And it’s the same in dentistry. If your doctor and your hygienist don’t

September 2014 www.oralhealthgroup.com

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...how pleasant it is to work in an office where patients are informed of findings and educated on best treatment by the hygiene department well ahead of time have a daily number, and an hourly number feeding into that daily number, well the dental office is walking along the precipice of failure and doom. So back to hygiene…. I’ve mentioned already that the real value of a great dental hygienist for a dental office is her ability to help the dentist in finding defects and decay in the mouths of the patients that she sees and treats. Her true worth is her ability to plant the seeds in the patients’ minds as to what sort of treatment they may need to rectify any such defects. And I also mentioned that a great dental hygienist will have a thorough and complete list of findings ready for the doctor on each and every patient, and how having this ready makes everybody’s life so much easier. As a dentist, it’s an absolute joy to have a dental hygienist switched on and focused on seeing defects and alerting patients to those defects and best possible treatment alternatives well in advance of my arrival into the hygiene room for the examination. No patient wants to have a tooth crack in an unwanted and awkward situation. I know it first hand. It happened to me a couple of years ago, unsuspectingly, while attending a meeting in Dallas. It’s an inconvenient nightmare. I would much rather have had my broken molar crowned ahead of time, before it broke, rather than after it failed. A great hygienist will use the intra-oral camera to photograph all areas of concern and bring these images up on the big screen monitors in the treatment room so that the patient is well aware of the extent of the areas of concern well ahead of time before the doctor’s arrival. I can’t tell you how pleasant it is to work in an office where patients are informed of findings and educated on best treatment by the hygiene department well ahead of time. And having a hygienist who operates from a position of assisting the doctor in finding and alerting him in advance regarding these observations makes life for the doctor and the dental office as a whole, far less stressful. n

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ORAL HYGIENE

Advancing Oral Wellness Sara DeNino Paone, RDH, RNCP

President of Smart Dental Practices, a company dedicated to working with dental teams to advance patients’ oral and overall wellness. Sara’s 20 years experience as a dental hygienist, including the last 10 as a holistic nutritionist, has helped her develop a view that an integrated, wholeperson centred approach best serves our patients. Sara is a member of the AAOSH, IONC, ODHA, CDHA, CHHO, as well as the Complete Oral Health Movement. She can be reached at www.smartdental practices.net

Through patients’ active awareness of periodontal health and nutrition PART I

his article advances the position that an uncompromising commitment to periodontal wellness and patient nutrition is fundamental to a dental practice’s active periodontal (non-surgical) therapy program. This twin focus helps dental practices center on the whole person, by improving patients’ mutually reinforcing oral wellness and overall health. I advance the view that oral healthcare specialists (a term I use to refer to all members of the dental team) best improve patient care by: 1) seeking to achieve patient awareness of the factors that bear on periodontal disease and oral wellness through clinical assessment and education and, 2) i ntegrating nutritional assessment and planning for whole body health.

Periodontal Disease In my experience, oral health care specialists best serve our patients by focusing our patients’ attention first on arresting periodontal disease. Periodontal disease is strongly correlated with an array of chronic diseases. As Dr. David Tecosky, DMD, MAGD eloquently states, “more than 90% of systemic diseases reveal signs and symptoms in the mouth. Most patients see their dentist on a regular basis more frequently than they do their physician. We are in a unique position to help our patients.” I echo Tecosky’s perspective. As oral health care specialists we are on the vanguard of addressing our patients’ oral and overall wellness. Dentists and hygienists in

our synergistic roles see patients’ inflammatory response first and up close.

Foundational Awareness of Periodontal Disease

In my view patients’ achieving and maintaining oral wellness starts with their understanding of the fundamental importance of oral health to overall wellness. As the World Health Organization States: “[d]iet and nutrition affects oral health in many ways. Nutrition, for example, influences cranio-facial development, oral cancer, and oral infectious diseases. Dental diseases related to diet include dental caries, developmental defects of enamel, and periodontal disease.” If patients have an “active awareness” of how periodontal disease, as an inflammatory condition, relates to overall wellness they are more likely to take tangible steps to enhance their oral and overall wellness. Many diseases, especially chronic diseases, are rooted in the inflammatory process. “Manifestations of inflammation in the oral cavity very often correlate with systemic inflammatory processes.” In my opinion, based on what I have seen with my own patients, if more patients were actively aware that diseases of the gums and of the rest of the body are highly correlated, they would be more motivated to address the state of their gums. If dental patients understood the systemic correlation between periodontal disease and other inflammatory diseases including arthritis, diabetes, and heart disease they would

September 2014 www.oralhealthgroup.com

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ORAL HYGIENE Figure 1. Oral Amebeo Mag. 100

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regard their visit to the dentist as far more important to their overall health than an obligatory quarterly or semi-annual tooth cleaning. As Gerlyn Beers says in the Say Ahh documentary: “the total area of your gums is about the size of the palm of your hand….if you looked at the palm of your hand and you saw an open wound the size of the palm of your hand, would you just decide not to do anything about it…?” Oral healthcare specialists have the opportunity to activate patients’ awareness to the fact that their periodontal disease is an immune response burden on their bodies and possibly a bellwether of inflammatory conditions in the rest of their body. If we avail ourselves of this opportunity, we may be able to mobilize patients to act in support of their own oral wellness, to the benefit of their overall health.

tachment levels, and mobility, — employ intra oral imaging, a powerful tool for education and patient accountability to their oral health and, — employ radiology/radiographic imaging All of these are important steps. One of the most powerful tools I employ in treating my patients is microbiology. Microbiology is an inexpensive and highly effective motivational assessment tool for patients to improve their oral hygiene and assume greater responsibility for their oral health. It is an excellent assessment tool for the practitioner. A phase contrast microscope (chair-side), help inform treatment considerations and drive patient motivation. They help us to educate our patients about the nature and intensity of their periodontal disease by allowing them to view the live aggressive micro-organisms in their samples (eg. spirochetes, amoeba, and trichomonads, and white blood cells) (Figures 1 & 2). In my experience showing patients their microbiology samples, is a vivid way of demonstrating to them the state of their oral health. Like the old adage, “a picture is worth a thousand words,” showing patients the microorganisms living in their own gum tissue is worth a thousand encouragements to improve their oral hygiene habits. I have seen more patients mobilized to take steps to address their oral wellness as a result of witnessing their microbiology than through any other method I have employed.

Achieving Patient “Active Awareness” Assessment Many patients may arrive for care with the expectation and wish that they simply receive a “teeth cleaning.” As we have discussed, accommodating these patients’ requests would ignore the fundamental importance of helping them understand the state and import of their periodontal health. Fortunately we have many assessment tools at our disposal today. We are able to: — conduct a full periodontal probing recording the bleeding, recession, furcation at-

September 2014 www.oralhealthgroup.com

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ORAL HYGIENE

Finally biofilm samples placed on slides and gramstaining is a highly effective outsourced service that produces laboratory results on patients’ specific bacterial strains. Patients are often highly motivated by these oral microbiological reports because they are accustomed to receiving laboratory results from their physicians’ and considering how to improve their results. Such reports also provide data to share with other medical practitioners for the purposes of collaboration.

Education

Nutrition

In parallel with these assessment tools, oral healthcare specialists have the opportunity to enhance patients’ awareness of their oral health through education. Memory aids, for example, help patients to retain information. Twenty years ago a colleague of mine, Monica Boersma, introduced me to the word H.O.N.E.S.T. as an acronym used to list some of the factors that are associated with periodontal disease. It is an educational tool I have used and expanded ever since to help educate my patients: h refers to hygiene treatment, hormones, host and heredity refers to occlusion, over the counter and o medication, oral hygiene, and obesity n refers to nutrition (including nutritional deficiency) refers to exercise e refers to stress, sleep, smoking, systemic s diseases, saliva, stage of life t refers to transmissibility

The most important education area I focus on with my patients is nutrition. Over the past 20 years, I have found nutrition to be the factor that bears most directly on periodontal disease and the incidence of other inflammatory conditions. I have observed a high correlation between healthy diets and healthy mouths. Several studies have reported the association between nutrition and periodontal status on the periodontal therapeutic outcomes. That is why I believe that nutritional education, built on a foundation of patients’ active awareness of the oral wellness-overall wellness connection, is so vital to our work as oral healthcare specialists. I situate nutrition at the centre of the Preventative Oral Wellness Program we provide for our patients. The Preventative Oral Wellness Program includes providing the patient with an oral hygiene plan for homecare, reviewing their overall lifestyle, and examining their exercise regime, all of which are important. My focus here will be on the nutritional aspect of this program beginning with the Nutritional Assessment. n

Discussing these factors with patients increases their oral wellness I.Q. and empowers them to make better treatment choices in support of their overall health. Having this conversation with patients also helps construct a relationship platform that will be the foundation for working with the patient on their future care.

Part II of Sara DeNino Paone’s article, drilling down on nutrition and oral health/overall health, can be found in the November 2014 issue of OralHygiene and online at www.oralhealthgroup.com.

September 2014 ©marilyna/Getty Images/Thinkstock

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Xerostomia: Are You Ready for the Silver Tsunami?

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

erostomia or dryness of the oral cavity is now affecting one out of every five adults and has become one of the most common oral health pathologies. There are over 500 drugs, which contribute to this oral condition. Also advances in medicine and therapeutic modalities have resulted in a steadily increasing human life expectancy. With longevity we can expect salivary hypofunction. Here are the statistics we are facing; the present Canadian population over 60 is 7.2 million or approximately 20 percent of our total population. That number is expected to double in the next 25 years.1 As the population ages and the ‘silver tsunami’ rolls in, are we prepared to address the growing challenge of xerostomia?

Function and importance of healthy saliva

Before we examine xerostomia, it is important to review the function and importance of healthy saliva. To the dental hygienist, saliva can present a number of challenges and impede our ability to isolate and perform certain procedures. To our client, the absence of saliva can detrimentally contribute to the daily quality of life. Saliva is nature’s primary defence system for the oral environment. Its functions include, yet are not limited to: • acting as a buffer to neutralize acidic challenges • playing an active role in elimination of food and bacteria • performing as a lubricating agent • a iding in proper speech and articulation • delivering calcium, phosphate and fluoride • protecting exposed root surfaces • a iding in immune response with the presence of proteins, cytokines, hormones and mucins that positively impact the immune system.

Etiology of Xerostomia

There are a number of widely studied and documented etiologic factors related to xero-

stomia. The most prevalent cause of xerostomia is medication in today’s population. 21st century prescription and over the counter (OTC) medications More than 500 commonly used drugs can cause xerostomia. Xerogenic drugs can be found in 42 drug categories and 56 subcategories. It is important to note that although many drugs affect the quantity and/or quality of saliva, these effects are generally transient and not permanent. The main culprits are antihistamines, antidepressants, anticholinergics, anorexiants, antihypertensives, antipsychotics, anti-Parkinson agents, diuretics and sedatives. Other drug classes that commonly cause xerostomia include antiemetics, antianxiety agents, decongestants, analgesics, antidiarrheals, bronchodilators and skeletal muscle relaxants. Autoimmune diseases Sjögren’s syndrome is the most common chronic autoimmune disease causing xerostomia. This autoimmune disorder typically affects women aged 30–50. It is characterized by a progressive decrease of glandular function affecting the oral cavity, eyes as well as the kidneys and lungs. Lymphocytic infiltration occurs in both the salivary and lacrimal glands resulting in xerostomia and xeropthalmia. Enlargement of the major salivary glands occurs in about one third of the patients with Sjögren’s syndrome. At the present time there is no cure, with the goal being to manage the symptoms. 2 Systemic Lupus Erythematosus or SLE Lupus is a long-term autoimmune disorder that is characterized by acute and chronic inflammation of various tissues of the body in which the immune system turns against tissues it normally protects. Lupus affects nearly 50,000 Canadians and typically affects young women between the ages of 18 and 40. Lupus occurs in 1 in 10,000 men, 1 in 1,000 Caucasian women, and 1 in 250 women of African descent. 3 When it is only the skin involved, it

September 2014 www.oralhealthgroup.com

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• Oral mucosa dry, sticky; little or no pooled saliva • Poor output from labial minor salivary glands • Accelerated wear and erosion • Parotid gland enlargement • I nflammation and fissuring of the lips (cheilitis) • U lcers of the tongue and buccal mucosa • Oral candidiasis • Halitosis • Epithelial atrophy • Selective diet (difficulty managing dry, crumbly foods).

Cancer treatment; radiation and chemotherapy Typically patients who receive a certain threshold of cumulative radiation will suffer with a significant loss of saliva production. Salivary and tear glands have a radiation tolerance of about 30 Gy (grays); a dose which is exceeded by most head and neck cancer treatments. The end result is xerostomia and xeropthalmia, which can severely reduce the patient’s quality of life. Radiation affects the serous portion of saliva mainly producing a more viscous salivary flow. Newer techniques such as IMRT (Intensity Modulated Radiotherapy) attempt to minimize collateral damage to the salivary glands and prevent permanent damage. Chemotherapy results in a temporary salivary impairment.

Xerostomia client self-assessment

Salivary duct dysfunction Impeded salivary flow may incur as a result of salivary duct calculus creating an obstruction or a tumor of the salivary glands. Graft vs. host disease after bone marrow transplantation may also contribute to salivary duct dysfunction.

Recognition of Xerostomia: There are many clinical manifestations and signs that accompany xerostomia, which may include: • Dysphasia, dysgeusia, difficulty speaking • Multiple sites of cervical dentinal hypersensitivity, coronal and root surface caries • C hallenged retention of full upper dentures •F rothy, mucinous saliva or increased thickness • Poorly mineralized calculus or no calculus on lingual aspects of mandibular anteriors despite presence of plaque • Glossodynia, burning mouth syndrome

A subjective analysis of salivary function is a useful tool for identifying xerostomia. The following are typical questions that could be included in the health history questionnaire as basis for identification and assessment of xerostomia:7 — Does the amount of saliva in your mouth seem too little? — Does your mouth feel dry when eating a meal? — Do you have difficulty swallowing any food? — Do you sip liquids to aid in swallowing dry food? Shoppers Drug Mart has a self-assessment questionnaire in their health brochure on dry mouth available at the pharmacy. 8 The consumer is asked to answer the following questions to help determine if they could have dry mouth. 1. D oes your mouth often feel dry? 2. Do you regularly drink water, eat crushed ice, or drink other fluids to keep your mouth moist? 3. Do you ever feel self-conscious of having bad breath? 4. Do you wake up in the middle of the night with a dry mouth? 5. Do you have difficulty speaking, swallowing or eating because your mouth or throat is dry? 6. Do you have difficulty swallowing or eating without something to sip or drink? 7. Does food frequently stick in your teeth? 8. H as the consistency or texture of your saliva changed? 9. A re you experiencing any burning or soreness in your mouth or on your tongue? 10. Do you currently take any medications?

ORAL HYGIENE

is termed Cutaneous Lupus Erythematosus. Often Sicca syndrome causing dryness of the oral cavity occurs jointly with Lupus. When accompanied by lymphocyte infiltration it is once again referred to as Sjögren’s syndrome. The goal is to improve the quantity and quality of saliva.4 Diabetes has increased over 70 percent in the last decade. It is estimated that by the year 2020 1 in 3 Canadians will be living with diabetes or prediabetes. 5,6 Xerostomia may be enhanced by certain diabetic medications and also exacerbated by persistent hyperglycemia as well as kidney dysfunction.

Disclosure: Jo-Anne is a Key Opinion Leader for Oral Science September 2014

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ORAL HYGIENE

Chairside salivary assessment

Figure 1

Figure 2

Figure 3

A client with ongoing oral health problems or suspected xerostomia needs salivary testing. Once diagnosed, we are then able to offer a long-term solution to overcome or control the negative effects of xerostomia. Flow rate, viscosity, pH and buffering capacity are all factors that comprise the overall assessment of the quality and quantity of saliva. Saliva’s effectiveness is influenced by several properties of both stimulated and resting saliva. There is much debate over what defines a normal daily production of saliva. It is estimated to be between 0.5 and 1.5 litres.7 As expected the flow rate drops significantly during sleep to almost zero. The submandibular glands are the major contributors to resting or unstimulated saliva comprising almost 70 to 75 percent pf salivary flow. Resting saliva is <.1 ml/min. The parotid glands are major contributors to stimulated saliva which is normally <.7 ml/ min when chewing on a wax pellet for five minutes.7 Evaluation of Resting Saliva To assess the resting saliva (RS) retract the lower lip observing the labial mucosa salivary production from the minor accessory glands. Gently blot the labial mucosa with a piece of gauze and observe. Droplets of saliva will begin to form at the orifices of the minor glands. Under normal salivary flow conditions, saliva droplets will begin to appear in less than 60 seconds. If the time taken for this to occur is more than 60 seconds, the resting flow rate is considered to be below normal. Healthy, unstimulated saliva is serous and clear in colour. If the saliva looks stringy, frothy, bubbly or appears viscous in nature it may indicate that the water content is low or the rate of production is low. Evaluation of Stimulated Saliva Stimulated saliva (SS) originates primarily from the parotid gland as a result of stimulation. It aids in digestion, buffering and the control of gastric reflux. The method of evaluating a saliva sample is over a period of five minutes. Instruct the client to chew on a piece of wax or chewing gum. After 30 seconds, expectorate into a cup. Continue to chew for further five min-

utes collecting the saliva at regular intervals and measure output. Evaluation of Oral pH The pH of the oral cavity is what determines the equilibrium or oral balance that exists between demineralization vs. remineralization. The critical pH is the pH below which enamel dissolution begins to occur. Enamel dissolution occurs when the pH drops below 5.5. Healthy saliva should measure no lower than a pH of 6.5. Elderly patients or those with exposed dentin need to know that root demineralization can occur when pH levels fall to 6.0. The source of acid can be organic (bacterial breakdown of fermentable carbohydrates), ingested (acidic foods/beverages) or intrinsic (gastric reflux, vomiting due to eating disorders). Oral balance is influenced by many factors however the dominant influencer is the ability of the saliva to recover from an acid attack. PH recovery and return to neutrality can take 15 to 40 minutes depending on a large extent on the neutralizing properties of the individual’s saliva.9 The pH is evaluated by placing a pH test strip in the mouth for a few seconds and then compared to the guide on the pH test paper container (Figure 1). Instruct the client to chew a piece of xylitol gum containing one gram of xylitol for five minutes. Re-test and compare results of the earlier salivary sample with the pH guide.

Management of the Xerostomic client A client-centered prevention program should consist of the following goals and outcomes; 1. Increase the quantity of saliva a. T he use of chewing gum carrying xylitol increases salivary flow rate and enhances the protective properties of saliva.10 Xylitol is a five carbon sugar that cannot be metabolized by S. mutans; the most predominant cariogenic bacteria (Figure 2). The therapeutic dosage is one gram a minimum of three to five times daily after a meal or beverage. Xylitol has a very low glycemic index of seven, therefore, making it an excellent choice for diabetics. A new product launched by Oral Science, XyliMelts™ (Figure 3) is a timereleased, self-adhering pastille ideally

September 2014 www.oralhealthgroup.com

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ORAL HYGIENE

suited for use while sleeping with the therapeutic benefit of xylitol lasting four to six hours. Beware of OTC products containing xylitol. Often OTC products are mixed with sorbitol and mannitol and the therapeutic dose of 1 gram cannot be guaranteed. 2. Increase pH and quality of saliva a. pH is increased due to the concentration of bicarbonate and phosphate being higher in stimulated saliva, and the resultant increase in plaque pH and salivary buffering capacity prevents demineralization of tooth structure. Moreover, the higher concentration of calcium, phosphate, and hydroxyl ions in such saliva also enhances remineralization.10,11 3. Efficient and effective home care removal a. With a decrease in salivary flow, there is an increase in pathogenic biofilm, which results in increased inflammation and a burden on the host. Interproximal brushes are often easier for the client to manage resulting in a higher compliance rate when compared to dental floss.12,13 4. Introduction of anti-microbial agents, fluoride and remineralization toothpastes a. Avoid mouthrinses with alcohol or OTC toothpastes with a high SLS (sodium lauryl sulfate) content as both can be irritating to the xerostomic client. 0.2 percent Sodium Fluoride rinses, alcohol free (Figure 4) used once daily, with 10 percent xylitol are both therapeutic and efficacious in promoting oral health for the xerostomic client. b. Remineralization toothpastes replenish the daily loss of minerals in the tooth structure due to wear and attack of biofilm acids. In the case of inadequate salivary flow, it is essential that a dentifrice provides the necessary minerals to replenish the tooth structure. Nano-hydroxyapatite is safe and biocompatible demonstrating the ability to be both a remineralization agent as well as demonstrating superior bacterial absorption of opportunistic pathogens such as P. gingivalis (Figure 5). A study was done to determine the effect of nano-hyroxyapatite on initial enamel lesions. It was concluded that 10 percent nano-hydroxyapatite might be optimal for remineralization of early enamel caries.14

Conclusion In conjunction with professional products, it is also recommended that clients who struggle with xerostomia maintain hydration throughout the day, add moisture to the air at night with a room humidifier, avoid antihistamines, decongestants and limit both alcohol and caffeine. It is also wise to avoid hard, dry or crunchy foods that may be potentially injurious to epithelial atrophy as well as cariogenic or acidic foods and beverages. The adherence to ongoing preventive care and the maintenance of regular recare intervals is imperative. We are fortunate to be practising in a time where corporate leaders have demonstrated commitment to the research and development of innovative and effective treatments with scientifically proven benefits. We now possess a ‘gold standard’ for optimal oral health. n

REFERENCES

(All sites accessed JULY 2014) 1. Wilson C. The Aging Population – Disaster Ahead? Oral Health Office. October 2013. 2. http://www.cdho.org/Advisories/CDHO_Advisory_Sjogren_Syndrome.pdf 3. http://bodyandhealth.canada.com /condition_ info_details.asp?disease_id=83 4. http://www.cdho.org/Advisories/CDHO_Advisory_Lupus.pdf 5. Diabetes in Canada: Facts and figures from a public health perspective. Public Health Agency of Canada. www.publichealth.gc.ca 6. Canadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. 7. Navazesh, M., and Kumar, S. K. Measuring salivary flow; challenges and opportunities. JADA 2008; 139: suppl 2:35S-40S. 8. Shopper’s Drug Mart Health Brochure. 9. http://www.ncl.ac.uk/dental/oralbiol/oralenv/ tutorials/stephancurves1.htm 10. Makinen KK. Sugar alcohols, caries incidence and remineralization of caries lesions: A literature review. Int J Dent 2010; 2010:981072. 11. M iake Y, Saeki Y, Takahashi M, Yanagisawa T. Remineralization effects of xylitol on demineralised enamel. J Electron Microsc 2003; 52:471-6. 12. Imai PH, Hatzimanolakis PC. Interdental brush in type I embrasures. Examiner blinded randomized clinical trial of bleeding and plaque efficacy. Can J Dent Hygiene 2011; 45, no.1. 13. Imai PH, Hatzimanolakis PC. Encouraging client compliance for interdental care with the interdental brush; The client’s perspective. Can J Dent Hygiene 2010; 44, no.2. 14. Huang SB, Gao SS, Yu HY. Effect of nano-hydroxyapatite concentration on remineralization of initial enamel lesion in vitro. Biomed Mater 2009; 4:55-9.

Figure 4

Figure 5

September 2014

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PRODUCT PROFILE

ORABRUSH TONGUE CLEANER

The tufted and flat bristles of a toothbrush are designed to remove plaque and bacteria on the smooth surfaces of the teeth. However, your tongue is not smooth, with many grooves and crevices that bacteria can reside in. The ultra-soft, micro-pointed bristles are designed to reach deep into the individual crevices of your tongue to loosen bacteria. The built-in scraper then collects and removes bacteria and residue generated from brushing, helping cure bad breath.

www.orabrush.com KNOTTY FLOSS Ordinary floss was designed to clean the smooth sides of teeth and the space between the teeth and gums. Knotty Floss is a new, patent pending floss that goes well beyond the function of ordinary floss. The one inch spaced knots provide guideposts to ensure the most effective flossing technique. When flossing, simply wrap the side of the tooth with the smooth section of the floss and place your fingers beside the two side-by-side knots. This technique ensures that you are rubbing the floss up and down under the gums in the most effective movement possible.

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THE NATURAL DENTIST HEALTHY GUMS MOUTH RINSE The Natural Dentists Healthy Gums Mouth Rinse is clinically proven to kill germs just as effectively as the leading prescription mouthwash. It’s made from a unique blend of herbal extracts, including a therapeutic dose of aloe vera. The mouth rinse contains no alcohol or other harsh chemical ingredients making it the ideal rinse for those with special oral hygiene needs.

www.bleedinggums.com ADVERTISER PAGE Colgate-Palmolive Canada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Crest Oral-B, P&G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7, 20-21 GlaxoSmithKline Consumer Healthcare . . . . . . . . . . . . . . . . . . . IBC Johnson & Johnson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Ocean Pacific Medical Gloves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Oral Science . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Philips Oral Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IFC, 11 Premier Dental Products Company . . . . . . . . . . . . . . . . . . . . . . . . 24 PTIFA – Pacific Training Institute for Facial Aesthetics . . . . . . 34 Shofu Dental Corporation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Sunstar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 VOCO Canada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OBC

September 2014 www.oralhealthgroup.com

OHY Sept14 p34 Products.indd 34

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14-09-05 7:51 AM

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

PRACTICES & OFFICES

HYGIENISTS

THORNHILL, ON

New, very modern office facing Yonge St. looking for hygienist with own patient base to join our team. For more information tel: 647-200-6508

CAREERS Mobile Dental Anesthesia Specialist – Ontario Offering full range of dental services under general anesthesia to achieve full mouth rehabilitation including diagnostic, restorative, oral surgical, cosmetic, hygiene, endodontic and prosthodontic services. Please email: DentWYD@yahoo.com

VICTORIA, BC

Excellent partnership opportunity available at large central Victoria practice. Practice valuation recently completed by ROI. Open seven days a week, our newly rebuilt practice is located in BC’s most established shopping centre which has just undergone a massive renovation. Expect exceptional patient flow while serving a diverse patient base in a practice focused on providing comprehensive care in a single location. Inquire at hslade@shaw.ca.

Locum opportunity for busy Calgary office. Starting in November 2014 and continuing until August 2015. A minimum of three years experience is ideal and this could continue into a permant position for the right candidate. Please send your resume to wmj@shaw.ca.

Medical Retail Space For Rent Kenilworth Avenue North in Hamilton. Up to 2700 sq. ft. Brand new two-storey Cape Cod building with stone façade. Existing pharmacy on site, schools nearby and across from medical center. Email: adnan@tahagroup.ca Phone: 289-244-7181

VANCOUVER, BC

September 2014

OHY Sept14 p36-38 Classifieds.indd 36

Phone Number 416-817-3870.

GTA

FT Office manager required for large, busy, well-established family dental practice in wonderful Vancouver, B.C. We are looking for a dynamic, highly motivated individual with at least 5 years experience in the dental field. Must have excellent professional leadership qualities, communication skills and be efficient at administrative duties. We are a progressive fun bunch that believes in keeping up with the latest advancements and utilizing technology allows us to provide the best treatments for our patients. Our talented team of six dentists and 8 hygienists provide care in many disciplines of dentistry including: cosmetic dentistry, facial esthetics, orthodontics, Invisalign, TMJ treatment, oral surgery, implant surgery, IV sedation and much more. Knowledge of Power Practice is an asset. Please send resumes to broadwaystation@telus.net

Well established dental office in a very busy area in Woodbridge with young families looking for orthodontist to rent space with the potential to take over the lease. The office is approximately 1100 square feet and is beside a day care with lots of traffic flow and great visibility and no orthodontists in close vicinity.

ORAL SURGERY PRACTICE FOR SALE

HAMILTON, ON

CALGARY, AB

WOODBRIDGE, ON

www. oral health group. com

Very profitable, well established oral surgery practice in GTA available for sale. Owner will transition. If interested contact practicesale@minnaar.ca

BRAMPTON, ON

Brampton office for sale, gross $800k to $900k, good profitability, retirement, owner will associate for short period, more than 2,000 patients. If interested, contact practicesale@minnaar.ca

ST. MARY’S, ON

Former dental office. 5 ops, reception space and waiting room, plenty of parking, 1000 sq ft. Ideal for medical or dental practice. $1500/mth plus business tax. Avail. January 2015. Call 519-284-1985 or Karen @echo-tech.ca

OSHAWA/WHITBY, ON

Now Leasing. Established Busy Plaza. Great Location. Select 1250 – 2000 sf to suit. Please call Mike at (416) 730-8484. mnanavati@sympatico.ca

KINGSTON, ON

GENERAL PRACTICE — LIFESTYLE BY THE LAKE If you are looking for lifestyle by the lake, Kingston has so much to offer. Well established general practice for sale in beautiful downtown Kingston,Ontario. This practice features: a great location with a spectacular view; efficient business and clinical systems; well trained team; four treatment rooms; patient restroom; doctor’s office; consult room; large greeting area; business area; staff room with private restroom and convenient parking. Please contact: Dale Tucci at 416-450-8769 or dale@daletucci.com

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GTA ASSOCIATE

Part-time associate wanted in North York and Markham for Friday and Saturday. Endodontic and surgical skills an asset. E-mail to: dentalmk@gmail.com

THOMPSON, MANITOBA

Full-time, energetic, detail oriented associate needed immediately for established, busy family practice with income potential up to $30,000 per month. Enjoy a fully booked schedule and ability to reach your goals as a dental professional. Experience preferred. Excellent opportunity. New grads welcome. Living and Travel Accommodations provided. E-mail cv: thompsondent@gmail.com Fax (204) 677-4072, Ph: (204) 939-0083.

EAR FALLS, ON

Associate/locum dentist needed for mature practice with coverage needed about one third of the time or two to three weeks every five or six weeks. Accomodation provided,pristine wilderness, in NW Ontario 400km from Winnipeg, 45% of gross billings. Send resume to Dr. Matthew Walkiewicz at e-mail: mattjw@kmts.ca

BURLINGTON, ON

Full time associate required for large group practice in well established office in new building. Modern, digital, paperless office in growing part of beautiful Kingston. Please contact: info@cataraquidental.com

TRENTON, ON

DENTIST NEEDED ASAP â&#x20AC;&#x201D; NOVA SCOTIA

We are looking for a motivated dentist who enjoys all aspects of dentistry. Come work in a busy, state of the art facility with new technologies. We have an excellent and very friendly team and looking for the right fit to join our practice . Please email us at ryounes@sympatico.ca

Located in a prime area of beautiful Annapolis Valley just 45 minutes from Halifax, Nova Scotia. An experienced Dentist is needed to be the leader of a great team and prime clinician for a high volume clinic. As a bonus we offer a profit sharing formula based on overall clinic performance. Be busy the moment you start! Contact info@finetouchatlantic.com or call (902) 835-4222 ext. 223

VANCOUVER ISLAND, BC

LONDON, ON (and surrounding area)

TRENTON, ONTARIO (1 hour east of Oshawa) FULL TIME ASSOCIATE Overlooking the Beautiful Bay of Quinte. Great office to work at!!

We are looking for an energetic personality who possesses clear communication skills. Building relationships with our team and patients is the key to success. Our large modern facility is home to 3 dentists, 6 hygienists and a large support staff whom are highly motivated and very skilled. We offer all aspects of dental services to our patients. Our office is equipped with digital radiography, tomography capabilities, Dentrix computer system, General Anaesthesia, sedation & great working hours. Position available immediately. Please forward any inquiries to Sheena Woodward, office manager by phone: 613-885-1239 or email sheena@mikethemolar.com

ASSOCIATES!! BUSY PRACTICE IN THREE HILLS, ALBERTA WITH A POTENTIAL BUY IN!

Experienced Associate required for a really busy, well established family practice in the beautiful central Alberta town of Three Hills, Alberta only 1 hour drive from Calgary. This is a lucrative opportunity for an associate who would like a long term relationship with the potential for a future buy in opportunity. Please send your resume to smartsolutions@shaw.ca or call Val 403-852-1059

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OHY Sept14 p36-38 Classifieds.indd 37

KINGSTON, ON

Looking for: 1. ASSOCIATE: 2-4 days/wk. 2. ENDODONTIST: 1-2 days/mo (2 microscopes). 3. ORTHODONTIST: 1-2 days/mo. E-mail: attndds@gmail.com

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.

DENTAL MARKETPLACE

ASSOCIATESHIPS

Dove Dental Centres is looking for full time associates for their progressive, modern, multi-location group of dental practices in London, Ontario and surrounding area. Interested candidates should forward resume and cover letter to: dovedental@ody.ca

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

EDMONTON, AB 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

September 2014â&#x20AC;&#x192;

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DENTAL MARKETPLACE

EAST OTTAWA, ON

Endodontist needed one day per week for busy Mississauga general practice. Remuneration negotiable. Contact Bonnie/Grace at email: info@rockwooddental.com

PETERBOROUGH, ON

EXCELLENT ASSOCIATE OPPORTUNITY ONE HOUR EAST OF TORONTO

There is an immediate opening for the right associate in the Peterborough area. The candidate must have excellent communication skills with staff and patients. Experience is preferred, but new grads are welcome to apply. Please submit your C.V. to sandie@dentalofficeconsulting.com

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

NORTH SCARBOROUGH, ON

OAKVILLE, ON

Busy Dental Office in north Scarborough is looking for a FULL TIME Dental Associate. Mon to Sat, Canadian graduate is preferred, Chinese speaking a must. E-mail: dentistassociates@gmail.com

MISSISSAUGA, SCARBOROUGH, BARRIE, ON Exciting associate positions available for full and part time opportunities. E-mail: yourdentaldream@gmail.com

MISSISSAUGA, ON Associate needed for a busy Mississauga Clinic ASAP. Please fax resume to: (905) 272 9968 or e-mail: abmdentist@gmail.com

BRAMPTON, ON

Looking for associate 2 days per week on Mondays and Wednesdays. E-mail: reception@addp.ca

VICTORIA, BC

Part-time associate required in one of the most beautiful areas of Victoria, and one of BC’s fastest growing communities. The position is for Fridays and Saturdays with the possibility of becoming full time. The position would be available immediately. Experience required and Cerec experience would be an asset. Must possess strong patient interaction and treatment presentation skills. Please email enquiries and CVs to: toothfairy10manager@gmail.com

MISSISSAUGA, 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

September 2014

OHY Sept14 p36-38 Classifieds.indd 38

Upscale Oak ville dental of fice requires full time associate (3-5 days) per week to replace long standing female Associate. Ideal opportunity to take over large established high end practice and join a premium team. E-mail: rochelle@cogeco.net

SUNDRE, AB

Associate required for a busy general dentistry office, in Sundre, Alberta. Dentist must be knowledgeable and well practiced in all aspects of dentistry and dedicated to patient care. Please forward resume to DrRichardKolen@Hotmail.com

CHATHAM, ON

F/T associate wanted for a friendly, family-oriented practice in Chatham area. Candidate must have a sparkling personality! New grads welcome to apply, but experience would be an asset. Please forward resumes to assoc.wanted@gmail.com

THUNDER BAY, ON

Associate position available in a busy modern family practice. Experience is an asset but new graduates are welcome. Email resume to ashibonn@hotmail.com

OSHAWA, ON Progressive Oshawa Dental office looking for a part time Dentist. Our office requires a Dentist Wednesday afternoon/evening hours and possibly 1 Saturday a month. Flexibility with days and hours is an asset. Email: ocdental@rogers.com

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.

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.

EDMONTON, AB

Part-Time Associate position available in New Downtown Clinic. Experienced or New Grads are welcome. Interested candidates please email: amazingsmile@shaw.ca

WEST OF TORONTO — PART TIME ASSOCIATE

Busy, fully booked from day one. An opportunity to practice dentistry in a well-established office that thrives from a value-based & positive working environment. Modern technologies, exposure to cosmetics, implants, Cerec technology and the ability to refer from within to our many specialists. Email to: bbc14dental@gmail.com

TORONTO, ON

Part-time associate for downtown practice. Must be interested in all disciplines of dentistry and have comprehensive continuing education. E-mail resume to: toothfixer2@yahoo.com

EQUIPMENT WATERLOO, ON Dental Equipment For Sale 5 operatories of equipment including chair with accessories, intraoral xray units, custom built operatory cabinetry, instruments and Computer, as well as a Panoramic Xray Unit. Also Server, office computer, printer, fax, etc. Interested parties please contact me at wkamouni@hotmail.com

FOR SALE

Kavo Key 3 Laser (2007), soft and hard tissue laser, cavity preparation, tooth desensitization, periodontal treatment and cold sores, asking $32,000.00 obo. Please contact Di-Anna via email at info@gentlefamilydental.ca or call 780-468-6937.

ETOBICOKE, ON Office liquidation — equipment for sale, including 2 Adec chairs and stools. 2 full operatories and office furniture available. Contact dentalequipment901@gmail.com

www.oralhealthgroup.com

14-09-05 7:54 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® can help. 2

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

©2014 The GSK group of companies. All rights reserved. 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.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.

* 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 OHY Sept14 GSKand Eng 39 Gerodontology. 1997;14:33–47. 4. Turner MD, Ship JA. Dry mouth and its effects on the guidep39 to drugs dry AD.indd mouth, 2nd edition.

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*D’après le pourcentage moyen de sites gingivaux sains par sujet, après 6 mois. Analyse ultérieure de l’étude clinique de Sharma et coll. Étude clinique contrôlée d’une durée de 6 mois, à l’insu de l’observateur, en groupes parallèles, avec répartition aléatoire des sujets, menée conformément aux lignes directrices de l’American Dental Association; n = 237 sujets en bonne santé atteints de gingivite légère ou modérée pouvant être évaluée après 3 et 6 mois. Les sujets se sont rincé la bouche pendant 30 secondes deux fois par jour avec 20 ml du rince-bouche antiseptique LISTERINE® COOL MINTMC, à intervalles d’au moins 4 heures. 1. Sharma N, Charles CH, Lynch Mc, et coll. Adjunctive benefit of an essential oil-containing mouthrinse in reducing plaque and gingivitis in patients who brush and floss regularly: a six month study. Am J Dent Assoc. 2004;135(4):496-504. Pour les adultes et les enfants de 12 ans et plus. Le rince-bouche LISTERINE® ULTRACLEANMC antitartre contient : menthol à 0,042 % p/v, thymol à 0,063 % p/v, eucalyptol à 0,091 % p/v et chlorure de zinc 0,09 % p/v. Utiliser après s’être brossé les dents avec de la pâte dentifrice. Se rincer la bouche avec 20 ml non dilués pendant 30 secondes, deux fois par jour. Ne pas avaler. © Johnson & Johnson Inc. 2014

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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 Biotène®. 2

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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 caries4,5. | 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. e 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.

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