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Fall 2008
Association canadienne des orthodontistes
In this issue Message from the President Message from the Outgoing President Highlights of the 2008 Scientific Session Taking Our Pulse... the State of the CAO Membership Committee Reports CFAO Graduate Student Posterboards - Part 1 of 2 Component Society Reports From the Editor Upcoming Orthodontic Meetings Ice Sculpture at the 2008 Scientific Session in Winnipeg CAO Mission Statement The Canadian Association of Orthodontists is the national organization and official voice for registered orthodontic specialists and is dedicated to the promotion of the highest standards of excellence in orthodontic education and quality orthodontic care.
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Message from the President Canadian Association of Orthodontists Association canadienne des orthodontistes 2175 Sheppard Avenue East, Suite 310 Toronto, Ontario M2J 1W8 Telephone (416) 491-3186 / 1-877-CAO-8800 Fax (416) 491-1670 E-mail cao@taylorenterprises.com Website www.cao-aco.org
2008/2009 Board of Directors OFFICERS President President Elect Past President 1st Vice President 2nd Vice President Secretary/Treasurer
Dr. Robert Cram Dr. Gerry Zeit Dr. Gordon Organ Dr. Howard Steiman Dr. Ritchie Mah Dr. Garry A. Solomon
REGIONAL DIRECTORS British Columbia Alberta Saskatchewan Manitoba Ontario Quebec Atlantic
Dr. Rick Odegaard Dr. Paul Major Dr. Ross Remmer Dr. Susan Tsang Dr. Helen Grubisa Dr. Jean-Marc Retrouvey Dr. Stephen Roth
COMMITTEES Communications Nominations President CFAO CAO/AAO Liaison Insurance Planning & Priorities
Dr. Dan Pollit Dr. Gordon Organ Dr. Bob Hatheway Dr. Howard Steiman Dr. Richard Marcus Dr. Robert Cram Dr. Ritchie Mah Dr. Gerry Zeit Dr. Howard Steiman
Membership
Dr. Gerry Zeit
Policy & Procedures
Dr. Amanda Maplethorp
World Federation of Orthodontics
Dr. Robert Cram Dr. Amanda Maplethorp
National Scientific Meeting Coordinator
Dr. Richard Marcus
CAO/CDA Liaison CCOE New & Younger Members Representative
Dr. Ritchie Mah Dr. Don Robertson Dr. Helen Grubisa/ Dr. Susan Tsang
CAO Web Master Assistant Web Master Bulletin Editor Directory Editor Historian/Archivist 2009 Scientific Meeting Chair GST Advisor
Dr. Daniel Pollit Dr. Jules Lemay III Dr. James Posluns TBA Dr. Garry A. Solomon Dr. Cliff Moore Dr. Garry A. Solomon
Dr. Robert Cram [Email: drbob@reddeerortho.com]
Talk about starting off with a bang! Not even back home in Alberta one month since assuming the CAO Presidency at the Annual Scientific session in Winnipeg and already I have attended my first provincial orthodontic association meeting in Saskatoon. No rest for the weary, is there? My three predecessors, Drs. Gerry Solomon, Bob (“Eastern Bob”) Hatheway, and Gordie Organ, have established a very high standard in terms of carrying the CAO flag across the country. Lucky for me, I like to travel, and even better, I’ll be visiting with like-minded friends and colleagues wherever I go. So it’s really not “work”; it’s a labour of love and it’s a privilege to do so. The CAO’s 60th Anniversary was celebrated in style. Tim Dumore and his Winnipeg colleagues did a superb job of show-casing Manitoba. Even the Blue Bombers won their game that weekend! The scientific program was outstanding, the traffic through the commercial exhibits was Toronto-like, the social events were a blast, and even the weather was gorgeous. It had been more than 30 years since I had been to Winnipeg (I spent a year there as a pre-dental student) and the changes in the city made it almost unrecognizable to these old eyes (or maybe it’s the memory that’s going?). The CAO has indeed been blessed with local arrangements chair- persons over the years, who have complemented the work of our scientific meetings chair-people, Drs. Richard Marcus and Arlene Dagys. Having said that, Richard and the CAO staff, specifically Diane Gaunt and Alison Nash, are owed a huge “thank-you” for pulling it all together, yet again! One of my recent responsibilities for the Board of Directors was to represent the CAO on COSA (the Canadian Dental Association’s Committee on Specialists Affairs). I found it interesting last week to read a report noting that CDA has realized that their potential new and younger members are the future, and need to be brought into the fold. I am proud to say, that the CAO realized that years ago, under the leadership of Dr. Gerry Solomon, who established our New and Younger Members Committee with Dr. Helen Grubisa serving as Chairperson. Helen, along with Drs. Solomon and Marcus, has done a terrific job of representing the CAO at GORP meetings in the USA, as well as spearheading the noon luncheon and speaker at our CAO Annual meetings. Helen is now serving as the Ontario provincial representative at the CAO Board of Directors and she is looking for volunteers to carry on her good work with the NYMC. I am dedicated to keeping the CAO on the leading edge. I’m told there is no golden handshake at the end of the presidency. Along with the Board of Directors, I am 100 percent committed to representing the issues which are important to you. Please feel free to contact me personally, or any member of the Board, with any concerns you may have. Continued… Consider supporting the advertisers and service providers referred to in this Newsletter, recognizing that they have been supporters of the CAO. Advertisements are paid advertising and do not imply endorsement of or any liability whatsoever on the part of the CAO with respect to any product, service or statement. The author, the Canadian Association of Orthodontists, and its representatives will not be held liable in any respect whatsoever for any statement or advice contained herein. Authors’ views expressed in any article are not necessarily those of the Canadian Association of Orthodontists.
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Rapport du président Voilà ce qu’on appelle un départ sur les chapeaux de roues! Sans même être retourné chez moi, en Alberta, après avoir entamé ma présidence de l’ACO à l’Assemblée scientifique annuelle, tenue à Winnipeg, j’ai déjà assisté à une première réunion d’association provinciale, à Saskatoon. Pas de repos pour les présidents! Mes trois prédécesseurs, les Drs Gerry Solomon, Bob Hatheway et Gordie Organ, ont établi des normes très élevées en ce qui concerne la représentation de l’ACO à travers le pays. Heureusement pour moi, j’aime voyager. En prime, je serai accompagné partout de collègues et d’amis dont je partage les points de vue. Cela n’est pas un travail mais une occupation, que j’accomplirai avec plaisir et qui représente pour moi un privilège. Nous avons célébré avec panache le 60e anniversaire de l’ACO. Tim Dumore et ses collègues de Winnipeg ont réalisé un superbe travail, qui a mis en évidence le savoir-faire manitobain. Même les Blue Bombers ont gagné leur match cette fin de semaine là! Le programme scientifique était exceptionnel, la circulation aux abords des kiosques commerciaux avait des allures de routes torontoises, les activités sociales ont remporté un immense succès et il a fait un temps radieux. Il y avait 30 ans que je n’étais pas allé à Winnipeg (j’y ai passé une année en tant qu’étudiant en préparation à l’art dentaire). Les changements apportés à la ville l’ont rendue méconnaissable à mes yeux vieillissants (ou peut-être est-ce ma
mémoire qui défaillit). Au fil des ans, l’ACO a grandement bénéficié du travail de présidents locaux, qui ont complété celui des présidents de nos assemblées scientifiques, les Drs Richard Marcus et Arlene Dagys. Cela dit, Richard et le personnel de l’ACO, et plus particulièrement Diane Gaunt et Alison Nash, méritent tous nos remerciements pour avoir coordonné l’événement – encore une fois! L’une de mes responsabilités récentes au Conseil a été de représenter l’ACO au Comité de l’Association dentaire canadienne sur les affaires liées aux spécialistes. Or, j’ai lu un rapport la semaine dernière qui souligne un fait intéressant : ce comité reconnaît que les nouveaux membres et la relève représentent l’avenir et que l’on a besoin d’eux. Je suis fier de dire que l’ACO a déjà fait ce constat il y a quelques années; sous l’impulsion du Dr Gerry Solomon, nous avons mis sur pied le Comité des nouveaux et jeunes membres, présidé par le Dr Helen Grubisa. Conjointement avec les Drs Solomon et Marcus, Helen a accompli un travail extraordinaire en représentant l’ACO aux réunions du GORP, aux États-Unis, ainsi qu’en animant les conférences-midi lors de nos assemblées annuelles. Helen est actuellement représentante de l’Ontario au Conseil de l’ACO. Elle cherche des bénévoles pouvant l’aider dans le travail qu’elle fait avec brio auprès du NYMC. Je me suis engagé à maintenir l’avant-gardisme de l’ACO. On m’a dit qu’il n’y avait pas d’indemnité de départ à la fin d’un mandat à la présidence. En compagnie des autres membres du Conseil, je compte m’investir à cent pour cent afin de bien vous représenter au chapitre des problèmes qui revêtent de l’importance à vos yeux. N’hésitez pas à communiquer avec moi, ou avec tout autre membre du Conseil, au sujet de quelque question que ce soit.
Message from the Outgoing President Dr. Gordie Organ [Email: gmo@drgordieorgan.com]
That was quite a celebration we had to commemorate the 60th anniversary of the CAO! Special kudos to Tim Dumore and his local organizing committee, Richard Marcus, our Scientific Session Chair and Diane Gaunt and Alison Nash, our CAO staff coordinators, who collaborated to create a truly memorable meeting. The social events were all sold out, the scientific sessions were very well attended and the exhibit hall was a constant hub of activity. Many thanks to all those exhibitors and sponsors who help support the CAO and this meeting. Your continued collaboration is what helps to make this organization great. A special congratulation to Drs. Bob and Alan Baker, recipients of
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the Special President’s award for many years of dedicated service to the orthodontic residents of the University of Manitoba. Congratulations to our Award of Merit recipient, Dr. Ken Glover who not only was able to attend the meeting to accept his award, but showed us he can still hold his own on the dance floor. My year as President went exceptionally well, with very few bumps along the way. I had the pleasure of visiting the Ontario, Alberta, Manitoba, Atlantic, British Columbia and Quebec provincial meetings where I was greeted with genuine enthusiasm. All the members of the local associations were quite eager to learn about CAO plans, policies and concerns. Many thanks for the warm hospitality and to all
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those who made me feel welcome. I also helped carry the flag in Denver at the AAO/CAO liaison meeting, chaired by Howard Steiman. Our relationship with the AAO remains as strong as ever. Regarding the licensure of Foreign-Trained Specialists, no new developments have come to light on this issue. The University of Toronto is still the only facility providing gap training. I have learned however, that the Commission on Dental Accreditation of Canada (CDAC) has requested that the directors of the graduate orthodontic programs provide feedback into proposed accreditation requirements for dental specialty assessment and training programs. Should other accredited specialty programs opt to participate in gap training, they would have to have an accreditation review and have sufficient resources and staff to run a program parallel to their existing one. On the same topic, the NDEB has requested input from the graduate directors to provide feedback into developing admission standards for the Dental Specialty Core Knowledge Exam (DSCKE). As most of you are aware, an NDEB certificate is not a requirement of licensure for these candidates. I am pleased that the NDEB has sought the advice and input from our educators. There has been little activity within the FNIHB file this year. The frustration expressed by members from across the country due to the intransigence of the NIHB is profound. Whether this program continues is anyone’s guess. However, during my presentations to the various provincial associations I strongly suggest that our members treat their First Nations patients the same as they treat all their other patients. That is, to accept no assignment and to have the patient, and not the practitioner, forward any records requested for review. As a final note, thank you to the membership for their trust, confidence and encouragement during my tenure as President. It has truly been an honour to serve and an absolute pleasure to work with such a dedicated group of colleagues. I would be remiss if I didn’t acknowledge my sincere appreciation and gratitude to Diane Gaunt and Alison Nash for all of their nurturing and support without which my effectiveness as a President would have been highly questionable. I want to wish Bob Cram the best of luck this coming year. For those who know Bob, he is a tireless supporter and advocate of the CAO and I assure you with Bob at the helm and Gerry Zeit, Howard Steiman, Richie Mah and Garry Solomon supporting him, our Association is in excellent hands. We should all be proud of our success and accomplishments as an organization. Sixty continuous years is quite a milestone and one of which we should all be very proud. With the continued support of our growing membership and the dedication of those who serve on the Board, the next sixty years will prove to be truly remarkable. Best wishes to all.
Rapport du le président sortant Nous avons souligné le 60e anniversaire de l’ACO par des célébrations extraordinaires. Des remerciements particuliers vont à Tim Dumore et à son comité organisateur local, au président de notre assemblée scientifique, Richard Marcus, ainsi qu’à Diane Gaunt et Alison Nash, les coordonnatrices du personnel de l’ACO. Le travail de ces personnes a permis de mettre sur pied un événement tout simplement mémorable. La participation aux activités sociales a atteint sa pleine capacité, les assemblées scientifiques ont toutes connu du succès, et l’aire d’exposition grouillait d’une activité incessante. Nous remercions tous les exposants et commanditaires qui ont soutenu l’ACO et cet événement. Votre appui continu contribue à maintenir l’excellence de notre organisation. J’adresse mes sincères félicitations aux Drs Bob et Alan Baker, qui ont reçu le Prix spécial du président en reconnaissance de leurs nombreuses années de service dévoué auprès des résidents en orthodontie de l’Université du Manitoba. Félicitations également au récipiendaire du prix du Mérite, le Dr Ken Glover. Non seulement at-il pu assister à la réunion afin de recevoir son prix, mais il a démontré qu’il avait encore beaucoup d’agilité sur la piste de danse. Mon année de présidence s’est déroulée exceptionnellement bien, très peu d’obstacles ayant entravé notre route. J’ai eu le plaisir d’assister aux réunions provinciales de l’Ontario, de l’Alberta, du Manitoba, des provinces de l’Atlantique, de la Colombie-Britannique et du Québec, où l’on m’a reçu avec un enthousiasme sincère. Tous les membres des associations provinciales étaient impatients de connaître les plans, les politiques et les préoccupations de l’ACO. Je vous remercie de votre chaude hospitalité et de m’avoir réservé un accueil si chaleureux. J’ai aussi représenté l’Association à Denver, à l’occasion de la réunion de liaison de l’AAO/CAO, présidée par Howard Steiman. Nos relations avec l’AAO sont plus étroites que jamais. Par ailleurs, il n’y a aucun développement en ce qui concerne l’autorisation d’exercer des spécialistes formés à l’étranger. L’Université de Toronto est toujours la seule institution offrant une formation d’appoint à cet égard. Toutefois, j’ai appris que la Commission de l’agrément dentaire du Canada (CADC) avait demandé aux directeurs des programmes d’études supérieures en orthodontie de fournir leur rétroaction à propos des exigences d’accréditation proposées relativement à l’évaluation des spécialités et aux programmes de formation. Pour être intégrés à la formation d’appoint, les autres programmes de spécialisation devront être soumis à une évaluation d’accréditation, et les demandeurs devront disposer des ressources et du personnel suffisants pour dispenser une formation parallèle à celle qui existe déjà. Sur le même sujet, le Fall 2008 • CAO Bulletin
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BNED a demandé la rétroaction des directeurs de programmes d’études supérieures à propos de l’élaboration de normes d’admission à l’examen sur les connaissances de base des spécialités dentaires. Comme vous le savez sans doute, un certificat du BNED n’est pas exigé pour octroyer le droit d’exercer aux candidats formés à l’étranger. Je suis heureux que le BNED ait demandé l’avis de nos formateurs. Le dossier de la Direction générale de la santé des Premières Nations et des Inuits (DGSPNI) n’a que peu évolué cette année. D’un bout à l’autre du pays, les membres ont exprimé leur profonde frustration en regard de l’intransigeance du National Indian Health Board. À l’heure actuelle, personne ne sait si ce programme sera maintenu. Dans le cadre de mes présentations aux diverses associations provinciales, je recommande de traiter les patients des Premières Nations sur le même pied que tout autre patient. Cela veut dire de n’accepter aucune cession de droits et de faire en sorte que ce soit le patient, et non le praticien, qui achemine tout dossier aux fins d’examen. Pour terminer, j’aimerais remercier les membres de la confiance et des encouragements qu’ils m’ont témoignés durant mon mandat à la présidence. Travailler pour un groupe de personnes aussi engagées a été un honneur véritable et un pur plaisir. Ce serait une faute de ma part de ne pas exprimer ma sincère reconnaissance envers Diane Gaunt et Alison Nash pour tout le soutien qu’elles m’ont prêté, sans lequel mon efficacité à titre de président eût été grandement compromise. Je souhaite à Bob Cram la meilleure des chances en vue de la prochaine année. Ceux qui le connaissent savent qu’il est un infatigable ambassadeur de l’ACO. Dirigée par Bob, qui a le soutien de Gerry Zeit, d’Howard Steiman, de Richie Mah et de Garry Solomon, l’Association est entre bonnes mains, j’en suis convaincu. Nous pouvons tous être fiers de nos réalisations en tant qu’organisation. Soixante années d’existence constituent une étape importante, dont nous tirons une grande fierté. Grâce à l’appui
constant de nos membres, qui sont en nombre croissant, et à l’engagement de ceux qui nous représentent au Conseil, les soixante prochaines années seront tout aussi remarquables que les soixante premières. Meilleurs vœux à tous.
CFAO Donations (Since February 2008) McIntyre Fellows Dr. Stephen Roth Donors Dr. Douglas Eisner CAO In memorium of Dr. Michael J. Cripton Dr. Amr Barakat In Honour of Dr. Jessica Tan Ontario Association of Orthodontists In honour of Dr. John Buzzatto, speaker at April 3rd OAO General Meeting Dr. Ronald Wolk Dr. Terry Carlyle Dr. Phil Williamson In memorium of Elinor Glover
Dr. Donald Feeney In honour of Dr. Donald Hatheway Dr. Terry Sellke Dr. Jim Marko Dr. Gerry Zeit In honour of the retirement of Dr. Allen Feldman Passing the Gavel to the New CAO President, Dr. Bob Cram.
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Highlights of the 2008 Scientific Session
Award of Merit recipient, Dr. Ken Glover, with Dr. Amanda Maplehtorp
Marc Gaudet with Dr. Paul Castonguay, winner of the $750 Travel Certificate.
Tradeshow
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Presidents' Award recipients, Drs. Allan Baker and Robert Baker, with Dr. William Wiltshire
Ready for a fun night on at Ramblin' Gamblin Gordo's Casino Cruise!
OrthoQuest: Collaborate Straight to Success!
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Boat Cruise
Thank you to our Winnipeg Hosts!
September 11-13, 2008 • Delta Winnipeg Hotel • Winnipeg, Manitoba
2008 CAO 60TH SCIENTIFIC SESSION THANK YOU TO OUR SPONSORS
Trade Show Raffle Prize Winners Dr. Roger Moir Dr. Matthew Witt Dr. Patrice Pellerin Sunstar Packages
PLATINUM SPONSORS
Dr. Mel Drosdowech Sonicare FlexCare
Ms. Leslie MacPherson Print by Dr. Kris Row Osborne Village Studio
GOLD SPONSORS
Dr. Don Robertson iPod
Ms. Josie Caringi $500 Future Shop Gift Certificate
O R T H O D O N T I C S U P P LY O F C A N A D A
Dr. Paul Castonguay $750 Travel Gift Certificate
SILVER SPONSORS
Congratulations to all our winners and a special thank you to those companies that donated prizes!
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Survey Results
Taking Our Pulse...the State of the CAO Membership By Dr. Daniel Pollit and Dr. Gerry Zeit When you want to find out something about your business, what better way is there than to survey your customers? Surveys are an effective approach to allow our members to have a greater voice in the future of the CAO and the development of CAO services. Beginning in 2007, the CAO conducted three surveys in an effort to gain a greater insight into the wants and needs of the members at large. The topics completed to date have been: Communications, Membership, and The Scientific Session. An easy and cost effective tool called Surveymonkey was contracted to produce and deliver an online questionnaire and to provide a basic analysis of the data. The response rate was high, with approximately 35 percent of CAO members responding to the first survey. Responders encompass all age groups and geographic regions, effectively a cross-sectional of the membership’s opinions. Your interest in the process was
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sincerely appreciated and it is anticipated with enthusiasm that you will continue to participate in future endeavours. It’s encouraging that 88 percent of respondents were either somewhat or very satisfied with the CAO, while only 4.1 percent of respondents were dissatisfied. Respondents also valued the CAO’s role in representing the profession to the government. When asked to rate the relative importance of some of the various services provided through the CAO, members also valued the CAO’s role in representing the profession to the public and to other dental organizations. Over 92 percent of respondents felt that the CAO adequately represented their interests. Also rated very high in importance was the CAO directory. Just over
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75 percent of respondents rated the directory as either a 4 or a 5 on a 5-point scale. The CAO directory is currently published on a bi-annual basis with an update in alternate years. This is an expensive and labour intensive undertaking. CAO volunteers and staff must spend hours checking and cross-checking contact information prior to going to print for each directory. In addition, it can take up to a year for address changes to be distributed to the membership. The CAO board has discussed the possibility of moving to an online directory in which each individual member would have the ability to maintain and update his or her own contact information. There are significant advantages to this type of directory however we are aware that some members may still prefer the paper copy. More information on this project is forthcoming. Professional camaraderie, the Scientific Session, access to CAO forms and the CAO website all had modestly lower importance rankings but all still received a 4 or 5 rating from more than 50 percent of membership. The website was deemed the least important service provided by the CAO. Although there is a tremendous amount of valuable information available on the site, currently it is difficult to navigate and is not as user-friendly as it ought to be. The website will undergo a major facelift in the near future to improve the presence of the website to our membership. It is anticipated that the website will become a significant source of information in the near future.
21 percent of the members expressing at least some concern, while 14 percent of respondents were not aware of the issue. Although the Board’s efforts on these fronts have been significant, they have met with limited success. When asked if there were any other activities that members would like the CAO to undertake to enhance value to the membership 44 individuals responded. Ideas such as marketing orthodontics through advertising, changing our association’s governance model, and developing strategies to make orthodontics accessible to those who could not otherwise afford care are just some of the suggestions that were received. Thank you for you cooperation in the CAO surveys. Please continue to participate in future surveys so your professional needs can be fully appreciated. If you have any concerns or ideas for future surveys, please, contact your CAO provincial representative or call 416-4913186 and speak with the CAO office.
CAO members were asked if they had orthodontic colleagues who were not CAO members and if so, why they thought these individuals did not join. Of those who did respond, the most common response was that the non-members did not perceive value in a CAO membership (~57 percent). Twenty percent speculated that the dues were too high while others felt that there were alternate dental organizations, largely either provincial orthodontic associations or the AAO that provided the necessary services. The CAO staff is always willing to offer assistance. When asked how satisfied members were with the service received from the CAO office; nearly one in 4 respondents had never contacted the CAO office. Of those that had, 97 percent were satisfied or very satisfied with the experience. Five individuals who took the survey were, to some extent, dissatisfied with the service they received. Remember, the CAO is your organization and the staff at the CAO office is there to serve you. Although the overall satisfaction with the way CAO represents its members is very high, there was a measure of concern regarding the representation of members on certain issues. With respect to the FNIHB program, 11 percent of members were at least somewhat concerned about the representation offered by the CAO, while 25 percent of respondents were not aware of the issue. The concern was even greater when it came to the CAO’s representation of the profession on the issue of accrediting foreign trained specialists, with Fall 2008 • CAO Bulletin
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Committee Reports
[Email: drbob@reddeerortho.com]
of our younger members would like to submit on-line, opening the potential for forms and procedure codes. Is there any benefit for our members to use the Standard Information Form and to follow the CAO Insurance Guidelines? Why was the Standard Information Form co-designed by CHLIA and the CAO? Is its usefulness finally outdated?
FNIHB
Dr. Richard Marcus has kindly “volunteered” to take over the responsibility for the Insurance Committee next year to investigate the answers to these and other questions in the near future
Insurance Report Dr. Robert H. Cram Chair, Insurance Committee
The CAO has not had any contact with the Department of Health in regards to the Noninsured Health Benefits Program, a program which includes orthodontic benefits for First Nations patients. The committee continues to receive reports from members concerning their disbelief following rejection of “severe” malocclusions. This writer is not aware of a practicing orthodontist in Canada who has a clear understanding of the criteria utilized by the Orthodontic Review Centre.
PRIVATE DENTAL BENEFITS (aka “INSURANCE”) The Standard Information Form has been registered for copyright with the Canadian Intellectual Property Office (an agency of Industry Canada). Committee members Richard Marcus and yours truly still intend to teleconference with the Executive Director of the Canadian Life & Health Insurance Association (CLHIA) to ascertain the best method of restricting the use of the CAO form to certified or registered specialists in orthodontics. It is the intention of the committee to have the software providers promise to make the CAO Standard Information Form available only to orthodontists. While this promise will be difficult or impossible to enforce, the committee wishes to emphasize the importance of this restriction with the distributors. Dr. Richard Marcus has answered insurance inquiries from offices in Ontario and Quebec, and has assisted with inquiries from other points in Canada. It has been discovered that nationwide, all orthodontists were not utilizing the Standard Information Form in the fashion that it was envisioned by the original architects of the document. In at least one region of Canada orthodontists were accepting assignment, utilizing procedure codes, and routinely completing a dental claim form rather than following the CAO insurance guidelines. The Insurance Committee needs to ascertain whether our Insurance Guidelines (and the Standard Information Form) are still relevant to our membership. Do our members wish to interact with dental insurance and benefits carriers just like general practitioners? Some
Treasurer’s & Sponsorship Report Dr. Garry Solomon Treasurer [Email: hellener@lks.net]
Treasurer’s Report The following are the net revenues for the CAO and CFAO: • In 2007, the General operations of the CAO created net revenues of $63,466. • The Scientific Session created net revenues of $32,229. • The Total Operations net revenue for the CAO was $95,695 in 2007.
Sponsorship Report Sponsorship continues to flourish for the CAO Scientific Sessions. Our sponsors donated $39,700 to offset our costs at the 2007 Scientific Session in St John’s. Our sponsors have donated $45,100 for the 2008 Winnipeg Scientific Session. The CAO should not abandon the concept of finding non-dental corporate sponsors. Any members with any corporate contacts are urged to contact the CAO. Fall 2008 • CAO Bulletin
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Committee Reports Membership Report Dr. Gerry Zeit, CAO Membership Chair
Dr. Robert H. Cram CAO/CDA Liaison
[Email: gzeit@sympatico.ca]
[Email: drbob@reddeerortho.com]
The CAO is pleased to welcome the following new members who have joined since the last membership report: Active Members: Dr. Lucien J. Bellamy - BC Dr. Jason Gallant - BC Dr. Shari Borsuk - ON Dr. Allyson M.L. Bourke - ON Dr. Hema Patel - ON Dr. Melissa N. Sander - ON Academic Members Dr. Rody Wellington - MB Dr. Sercan Akyalcin - MB Student Members: Dr. Mohammed Korayem - AB Dr. Hussam Fakir - AB Dr. Matthew Witt - AB Dr. Nghe Luu - AB Dr. Anita Sharma - US Dr. Ajeet Ghumman - US Dr. Mariela Anderson - ON Congratulations to all new members and welcome to the Canadian Association of Orthodontists/Association canadienne des orthodontistes. Watch your mail for membership renewal forms which will be coming out towards the beginning of winter. Please be sure to send your membership renewals in as early as possible to take advantage of the early-bird discount rates. Thank you to everyone who participated in the CAO membership survey. A summary of the results of this survey is published in this issue of the Bulletin. The CAO is your organization. Our voice is stronger when we speak together. Thank you for your continuing support.
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CAO Bulletin • Fall 2008
The CAO representative to Committee on Specialists Affairs (COSA) attended the National Dental Specialty Organizations (NDSO), a committee of the Canadian Dental Association on April 17, 2008 and the general meeting of the Canadian Dental Association on April 18 and 19, 2008. Both meetings were held in Ottawa, Ontario. Richie Mah, who will be assuming this portfolio, attended these meetings as an observer. Funding was provided by CDA, and by the CAO respectively. The CDA has been undergoing significant structural and cultural change over the past two to three years. Changes of note are highlighted below: 1) Approximately 5 years ago the CDA decided that its General Assembly would be “knowledge”-based, rather than a representative group, and would henceforth not be answerable to his or her own constituency, but would be representative of all dentists. This idealistic model soon imploded and over the last 2 years has there has been a restructuring to a hybrid model, incorporating both appointed representatives (from each of the corporate bodies, such as the Manitoba Dental Association), as well as elected members (including dental specialists that could run candidates for one or more of these “elected” positions). 2) The CDA wanted to become more inclusive leading to greater membership especially in provinces that do not have compulsory CDA membership such as Ontario & Quebec. 3) The CDA Executive Director “stepped-down” one year ago and a new Executive Director was recently appointed. 4) The current and the Past- President of the CDA, appear committed to the inclusion of Dental Specialists in mainstream activity. It bodes well that a Dental Specialist was/is on the CDA BOD, and that he has been an excellent 2-way conduit of information between the BOD and the Dental Specialists. This commitment extended to CDA funding of the half day meeting on Thursday afternoon, of the NDSO meeting. The CDA appears to be willing to
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Committee Reports have COSA and the NDSO meetings share CDA facilities and funding to a certain extent. The impetus to develop a totally stand-alone organization appears reduced for the time being. Dr. Aaron Bury of Dental Public Health has agreed to serve as Chairman of COSA for another year, however Richie is likely to be asked to Chair the committee sometime soon. The next COSA meeting will be later this fall. The CDA officially funds one COSA committee meeting per year, usually in the fall, as well as the attendance of 2 Dental Specialists as voting members at the General Assembly to the Annual CDA meeting in the spring. The CDA has been very liberal with its definition of committee meetings, and very generous with its funding.
New and Younger Members Dr. Helen Grubisa, New and Younger Members Representative
• CAO’s role in insurance and the CAO insurance form • Posterboards and the mandate of the CFAO • CAO website • Member benefits of the CAO both for students and practicing orthodontists including the NYM group. Putting a face to the CAO on a yearly basis creates a more approachable association and delineates the CAO from the provincial associations. \
Canadian Orthodontic Educators Report Dr. Donald Robertson Chair, Conference of Canadian Orthodontic Educators [Email: mouthtraps@shaw.ca]
[Email: drgrubisa@sympatico.ca] GORP: Ann Arbor Michigan There were 340 registered attendees of which 57 visited the CAO booth. A total of 6 Canadians, currently registered in American programs, attended the CAO booth, 2 of which were already CAO student members and confirmed their contact information. One U of T resident visited the booth, but as per the registration log, there were only 3 Canadian program students present at the meeting.
The CCOE was originally convened to address the issue of recruitment and retention of graduate orthodontic educators. The Canadian Council of Graduate Orthodontic Program Directors (CCGOPD) was subsequently formed to deal with academic issues other than recruitment and retention. The issue of accreditation of foreign-trained orthodontic specialists, as mandated by the Federal Government has most recently occupied a position of urgency with respect to the affairs of the educators group. The initiatives put forward by the CCGOPD have successContinued…
The point that came up repeatedly was that “we are already CAO student members as we ticked the box on the AAO form”. In spite of being corrected a number of people were fairly insistent that the form implies that joint membership is automatic. It has been recommended that the AAO consider changing or removing that tick-box and redirecting applicants to the CAO website for information on student membership. School Visits: The New and Younger Members representative will be visiting the orthodontic residents in both the University of Toronto and the University of Western Ontario programs during December of 2008. Programs in Manitoba and Alberta and Quebec will be visited by their provincial CAO representative. Topics of discussion include, but are not limited to: (suggestions are always welcome): • CAO Mission Statement
Golfers at the CFAO Golf Tournament in Winnipeg, MB.
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Committee Reports fully provided for the inclusion of the educators group in the process of accreditation of foreign-trained orthodontic specialists. Further progress regarding the recruitment and retention of orthodontic educators is expected at the up-coming meeting at Whistler, BC in April 2008. Although all graduate orthodontic programs are currently fully staffed many issues remain unresolved.
CAO/AAO Report Dr. Howard Steiman CAO/AAO Liaison [Email: straightsmile@sympatico.ca]
This year’s meeting between the Orthodontic Superpowers took place at the Hyatt Regency Hotel in Denver, Colorado on Sunday May 18, 2008. Drs. Bill Gaylord, Ray George, and Bob Graham were the sacrificial lambs, but handled the barrage of questions from our well represented CAO board, including Drs. Organ, Marcus, Hatheway, Cram, Mah and yours truly. Ms. Linda Gladden, the AAO Communications Director, was also in attendance. A brief summary of the meeting highlights is presented below, relying heavily on “one-liners” to promote levity! 1) “Gee, I didn’t know that”? (Target Audience) The House of Delegates voted in favour of an $830,000 member contribution to finance the next stage of the AAO Consumer Awareness Campaign. The member contribution consists of a one time membership assessment of $550.00 with the balance arising from reserve funds. Canadians will only pay 80% of the membership assessment, similar to the annual dues assessment
protocol, leaving you with just enough change in your wallet to go out and put a litre of gas in the car! The CAO is of the mind that funds collected from Canadian members should be directed 100 percent towards a CAO media campaign using the AAO materials. Unfortunately, this directive is not legally possible. The CAO has been assured that the amount of promotion in Canadian markets will be equitable to the dollar amount of funds received from our members. The Canadian component of the AAO campaign will direct the Canadian target audience to our new URL (uniform resource locator) “canadabraces.org (or .ca) instead of the AAO’s braces.org. The AAO has also been releasing Public Service Announcements to U.S. and Canadian Broadcast television stations in order to maintain its television presence during the time in which paid messages are not aired. Public Service Announcement exposure is free, however, the airtime is not guaranteed. 2) “I Want You”! (Uncle Sam) The recruitment and retention of orthodontic educators remains a huge issue at the AAO. The AAO has committed $900,000.00 towards incentive programs to ensure the future of orthodontic education. Qualified applicants can take advantage of Full-Time Faculty Teaching Fellowship and Academic Leadership Sponsorship Programs. In the former, the student, resident or junior faculty applicant must teach in a U.S. or Canadian accredited orthodontic program for the same length of time as the fellowship is awarded. The latter program is designed to refine teaching skills, boost confidence and improve job satisfaction. The junior orthodontic faculty member applicant must have signed a full time teaching contract with a minimum two year commitment. Currently, there is a resolution before the House of Delegates to increase the funding for applicants who were originally refused. At the time of writing, 22 individuals have applied for the Fellowship program of which 12 have been funded. No Canadian applications have been received as yet. 3) “Let’s just get along. Ok”? (Estranged Couple)
Past Presidents
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CAO Bulletin • Fall 2008
Please make sure your life insurance is paid up before you read this section! It may come as a shock to many members to find out that the CAO and CDA do not necessarily share similar ideas and priorities. As unbelievable as this may sound, neither do the AAO and ADA. The ADA has asked the AAO for input and advice on orthodontic issues and then has acted in favour of its general member dentists. Sound familiar? Despite this dichotomy, the AAO Line Officers and Board of Trustees still feel that it is worthwhile to continue trying to build a relationship with the ADA. The CAO is trying to do the same thing with the CDA, often with great frustration. Having a CAO representative at the
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Committee Reports CDA meetings, as well as banding with other specialties, could strengthens our voice at the CDA. Hey, anybody out there interested in representing the CAO at some wild and crazy CDA meetings? A great lunch is always guaranteed! 4
“Take me to your Leader” (Alien Visitor) Although constituent societies get invitations, a request (from our side) was always needed to have our CAO board members attend the AAO President-Elect and AAO Leadership Conferences. We prefer to have an open invitation every other year since these meetings serve as excellent learning tools for our future leaders. Two or three people would routinely attend but the number could increase depending on the needs of the CAO. All I can say is…..”Ask and ye shall receive (unless of course it is your spouse that you are asking). The AAO was very receptive and will put forth a motion to the House of Delegates to modify the existing status.
GST Report Dr. Garry Solomon, GST Advisor [Email: hellener@lks.net]
For the first time in many years I am pleased to report that there has not been even one complaint submitted to the CAO about any GST issues. Apparently the CRA is honouring the Hicks agreement negotiated between the CDA and the CRA.
5) “Bring it on”! (Nike) Midway through our 90 minute meeting, the AAO head honchos were asked about anything new that might interest our Board. Well, those boys down south shared a wonderful program with us that they are employing at their Board meetings. It is called SCANNING. It is used to investigate general topics which may be considered for presentation in the programs at annual conventions. The President selects a topic and assigns it to a Board member volunteer. This member has three months to research the topic’s relevance. He/she then presents his/her findings back to the board using a 30-60 minute visual presentation. If deemed worthwhile, the topic is incorporated into the AAO annual meeting. Apparently, there are many previously Scanned topics locked up in a high security computer at the AAO head office. Fortunately, the password was wriggled out of Dr. Gaylord. Now we can go down to St. Louis, sneak into the head office and steal all the topics. Actually, they are all on file and the AAO is happy to share. At the Scientific Session in Winnipeg, Dr. Gaylord was kind enough to bring a Scanned topic with him and he presented it to the Board. The CAO Board feels that this process is worth investigating further and will be examining these topics as we plan our future Scientific Sessions. 6) “One is never enough” (Lays Potato Chip Ad) You should be aware that the AAO has recently revised its member logo with the addition of a second registered trade mark. Any member using this logo on their letterhead should throw out the thousands of dollars of stationary they already have, go to the AAO member web site and download the new version.
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CFAO Graduate Student
Posterboards Abstracts from the 2008 CAO Annual Scientific Session – Part 1 of 2 part series
University of Alberta DOES GRADUATE SCHOOL ADEQUATELY PREPARE MODERN ORTHODONTISTS TO BE SUCCESSFUL IN THE BUSINESS OF ORTHODONTICS? Authors:
Marguerite Ntinamoa*, Sarah Davidson, Carlos Flores-Mir
OBJECTIVE: The objective of this review was to assess the available literature to determine what areas of business education are important for orthodontic practice success. METHODS: A computerized database search was conducted using the databases PubMed, Medline, Web of Science, Cochrane Library, Embase and Proquest (dissertation database). Broad terms were used. Combinations of the following terms were used: Education OR Education, Entrepreneurship OR business. Applicability to orthodontics was only evaluated once the final full articles were retrieved. Results: The final results produced three unpublished dissertations plus three additional publications all discussing aspects of the same study, included for final review. Therefore a total of fours studies were finally analyzed. CONCLUSIONS: Few studies have been done to evaluate the business needs of orthodontists and to date no studies have been done to determine if Canadian graduate orthodontic programs are adequately preparing their students to be successful business managers. This review was unable to identify any literature to address the issue of what areas of the graduate educational process may be improved to better meet the business needs of new orthodontists. It did, however, identify a general opinion in the literature that a structured business curriculum should be developed and implemented. Finally it was found that there is agreement in the literature that the areas of business education which are important for orthodontic practice success include leadership, staff management, communication, written practice management tools and a systematic, quality approach to all aspects of the practice’s function.
(*Presenter)
University of Manitoba THE FUTURE PROVISION OF ORTHODONTIC CARE FOR PATIENTS IN UNDERSERVICED AREAS Authors: Nicholas E. Karaiskos*, James Noble, William A. Wiltshire
AIM: The purpose of this study was to determine if orthodontic specialty programs in North American provide formal training to residents in the treatment of patients with disabilities and if residents intend on practicing on these patients or in underserviced areas in their future practices. METHODS: An email with a personalized link to an anonymous questionnaire was sent to 54 Canadian and 364 US orthodontic residents. Two questions asked were, “What type of population do you plan on primarily serving?” and “Does your program include any care for persons who are disabled or underserviced?” RESULTS AND DISCUSSION: In Canada, 0% said they plan to practice in a rural setting, 66% said they would practice in an urban/suburban setting, 9% said they would practice in an inner city setting, while 25% did not know where they would practice. In the US, 13% said they plan to practice in a rural setting, 75% said they would practice in an urban/suburban setting, 3% said they would practice in an inner city setting, while 8% did not know where they would practice. When asked if their program offers formal training in the treatment of disabled patients or underserviced areas, 50% of Canadian residents said yes, 50% said no while 90% of US residents said yes and 10% said no. Here are some ideas to explain the discrepancy. Perhaps the fact that 90% of US residents responded that they have exposure to formal training in these two areas in their curriculum is a direct correlation to the 13% of US residents who responded that they will practice in a rural setting. A way to increase the Canadian response would be to augment the formal training in Canadian Orthodontic programs, given that only 50% of residents felt they had formal training in these areas. By giving students a greater exposure to these areas of Canada, perhaps a greater number would decide to practice in a rural area. Other factors could be the potentially increased complexity and difficulty of providing treatment as well as longer treatment times for disabled patients. For both areas, these low numbers could be attributed to
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CFAO Graduate Student Posterboards reduced financial benefit for the orthodontist. Orthodontic programs need to deliver improved training programs and outreach rotations to improve these results. CONCLUSION: There is a growing concern in North America that if these statistics continue, there could be a serious deficiency in the provision of orthodontic care for patients who are disabled or live in underserviced areas.
University of Manitoba STRESS ON BONE WITH PLACEMENT AND REMOVAL OF ORTHODONTIC MINISCREWS AT DIFFERENT ANGULATIONS Authors: James Noble*, Nicholas E. Karaiskos, Frank J. Hechter, Thomas H. Hassard, William A. Wiltshire
OBJECTIVES: To quantify stress induced on bone upon insertion and removal of an orthodontic temporary anchorage device (TAD) at two sites at different angulations and the force required for mechanical failure. METHODS: Rosette-type stress-strain gauges with three leads connected to a P3 strain measuring device were attached with MBond adhesive to dried bone of a dissected human adult fixed cadaver skull adjacent to the midpalatal suture and at the alveolus adjacent to the first maxillary left premolar and canine teeth. Four 8mm length, 1.8 mm diameter TADs were inserted manually with a contra-angle driver, one perpendicular and one at 45 degrees adjacent to each gauge and the forces exerted on the bone were measured. A 0.012” stainless steel ligature was attached to the head of each TAD and progressive forces of up to 15 pounds were exerted to test for mechanical failure. Finally, the strain on bone upon removal of the TAD was recorded. RESULTS: The maximum plain stress on bone was greater when the TAD was inserted at a 45 degree angle as opposed to perpendicular to bone. The maximum plain stress on bone was also greater when the TAD was removed at a 45 degree angle versus perpendicular to bone. Data were analyzed using a 3-Way ANOVA. Significant differences were observed between angle of insertion, with greater force at 45 degrees (F=12.287, 1, 4 df, p=0.025). While the force at the two sites of insertion (F=4.762, 1, 4 df, p=0.094) and the force upon insertion and removal (F=3.589, 1,4 df, p=0.131) did not reach the conventional level of significance, they were close. Also, none of the TADs showed any signs of failure when up to 15 pounds of load was placed. CONCLUSIONS: There is significantly more stress on bone when TADs are placed at 45 degrees versus perpendicular to bone, likely
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due to the TAD needing to penetrate more cortical bone. Though not significant, it was found that placement and removal of TADs results in more stress on the palate versus the alveolus likely due to the presence of more cortical bone, and there is more stress on placement then removal. Further, the failure of TADs is likely not a result of excessive mechanical loading but other factors.
University of Manitoba MALOCCLUSION AND TREATMENT NEED OF CHILDREN AGED 7-10 YEARS IN A RURAL FIRST NATION CANADIAN COMMUNITY Authors: Pollard D*, Wiltshire W, Brothwell D.
INTRODUCTION: Sandy Bay First Nation is a 4300 member, rural community in Manitoba, Canada. Children under 18 years of age may qualify for Federal government-funded orthodontic treatment under Health Canada’s Non-Insured Health Benefits (NIHB) program for aboriginal Canadians. Only severe malocclusions are covered under this funding program and it was therefore the purpose of this study to determine the overall malocclusion status of children aged 7 to 10 years and the comprehensive need for treatment in this community, particularly the need for preventive and interceptive orthodontics. SUBJECTS and METHODS: Out of the full convenience sample of 57 children aged 7 to 10 years who participated in this study, we were able to obtain alginate impressions and study casts on 41 children. Based on assessment of the study casts, two evaluators determined overjet, overbite, Angle's molar classification, crossbites, openbites, and crowding/spacing. The results of these indictors were used to classify subjects into 3 treatment groups: 1) definitive orthodontic care; 2) orthodontic treatment advised; and, 3) no orthodontic treatment required. Definitive care was defined as any patient having at least one of the following findings: anterior crossbite, overjet greater than 6 mm, impinging overbite, or crowding greater than 5 mm. RESULTS: Average overbite = 1.8 +/- 1.4 mm (range: -2 to 4.7 mm); average overjet = 3.4 +/- 1.8 mm (range: -1.6 to 9.1 mm); Class I = 13 subjects (31.7%); Class II = 16 subjects (39.0%) (8 unilateral (19.5%)); Class III = 10 subjects (24.4%) (6 unilateral (14.6%)); anterior crossbite = 9 subjects (22.0%); posterior crossbite = 3 subjects (7.3%); anterior and posterior crossbite = 2 subjects (4.9%); openbite = 6 subjects (14.6%); crowding > 5 mm in just the maxillary arch = 2 subjects (4.9%); crowding > 5 mm in just the mandibular arch = 5 subjects (12.2%); crowding > 5 mm in maxillary and mandibular arches = 9 subjects (22.0%).
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CFAO Graduate Student Posterboards DISCUSSION: The major components of malocclusion were the high prevalence of Class II and III molar relationship, crossbites, openbites and crowding. Definitive orthodontic treatment was deemed necessary in 12 subjects (29.3%), while treatment was advised in 26 subjects (63.4%). Only 3 subjects (7.3%) were deemed not to require orthodontic treatment. CONCLUSIONS: We found that a very high percentage (92.7%) of children in Sandy Bay First Nation were in need of orthodontic treatment. Since NIHB only covers treatment of severe malocclusions, it is likely that only 29.3% of children would be eligible to receive funding. Therefore, the current federally-based system for funding is insufficient to meet the orthodontic needs of children in Sandy Bay. Alternative methods of funding and care delivery for the greater than 60% of subjects not covered by NIHB needs to be found.
University of Manitoba USE OF INVISALIGN BY ORTHODONTISTS IN CANADA Author: Jared Rykiss, B.Sc., D.M.D.
INTRODUCTION: Invisalign is an orthodontic treatment modality that involves using a series of plastic removable aligners to incrementally straighten the teeth. It has become a widely used treatment modality in orthodontics. The purpose of this study was to determine the manor Invisalign is currently being used, in Canada, by orthodontists. METHODS: An original survey was created, with questions related to the appropriate use of Invisalign in various clinical scenarios. The survey was then sent via email to a random selection of 155 orthodontists currently practicing in Canada. The standard error was used in statistical analysis of the responses to the various questions RESULTS: A total of 155 orthodontists were asked to participate in this study, and 35 individuals responded, a response rate of 22.6%. The 80% of Canadian orthodontists are currently using Invisalign. Orthodontists were aggressive in their treatment of, malocclusions related to crowding, overjet and deepbite Orthodontists were conservative in treating openbites, negative overjet, skeletal crossbites, and large anterior-posterior discrepancies. CONCLUSIONS: There is no clear consensus on the definitive clinical capabilities of Invisalign. Although Invisalign is not used for the most extreme malocclusions, there are many specialist orthodontists who appear to have faith in Invisalign to treat almost any clinical scenario. Canadian orthodontists are still reluctant to utilize Invisalign
for large saggital and skeletal discrepancies, but are quite willing to treat moderate problems such as enlarged overjets and deepbites. The results of this study provide good insight into the current beliefs that practicing Canadian orthodontists currently have, regarding Invisalign.
University of Manitoba BOLTON DISCREPANCY IN A SELECTED CANADIAN POPULATION Authors:
1
M. Barnard BSc, DDS* Senior Graduate Orthodontic Resident 2 C.C.S. Dong, DMD, BSc (Dent), MSc (Prosth), FRCD(C) Associate Professor, Department of Restorative Dentistry and Department of Preventative Dental Science 3
A. Baker DMD, Dip. Ortho. Former Assistant Professor Department of Preventative Dental Science, Divi sion of Orthodontics
INTRODUCTION: Bolton ratios are used to determine if the tooth structures in the two arches will allow ideal occlusion. The purpose of this study was to determine if the original Bolton ratios accurately describe Canadian Caucasians. Canadian Caucasian tooth widths have not been investigated to date. METHODS: Ninety-seven models with ideal Class I occlusion as per the ABO index were randomly chosen from 3 Canadian sites (east coast, west coast and central Canada). The Bolton ratios, differences between and within the samples were calculated using the least squares means and the Studentâ&#x20AC;&#x2122;s t-test. RESULTS: The Canadian ratios were not significantly different from the original Bolton ratios. However significant differences exist between the east coast and the west coast anterior Bolton ratios, and the west coast and the central Canada anterior Bolton ratios in the different samples (p<0.05). Significant differences were found between and within the sexes for the overall Bolton ratios (p<0.05). The maxillary lateral incisors and the maxillary left second premolar were the most variable in tooth width. CONCLUSIONS: The original Bolton ratios are applicable to Canadian Caucasian patients. However, the anterior ratios differ from region to region, and between and among the sexes. A significant portion of the Canadian population differed by more than 2 standard deviations from the original anterior Bolton ratio. A discrepancy of more than 3 mm in maxillary and mandibular tooth mass sums may be Fall 2008 â&#x20AC;˘ CAO Bulletin
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CFAO Graduate Student Posterboards necessary to affect acceptability of orthodontic alignment. This study is the first to report the mesiodistal widths of teeth in Canadians and the most variation in tooth width was found in the maxillary lateral incisor.
University of Montreal SLEEP-DISORDERED BREATHING IN THE CHILD AND ADOLESCENT ORTHODONTIC PATIENT Authors: Morton PD*, Rompré PH, Lavigne GJ, Remise CH, Papadakis A; Faculté de médecine dentaire, Université de Montréal
University of Toronto THE RELATIONSHIP BETWEEN MANDIBULAR GROWTH AND CERVICAL VERTEBRAL MATURATION IN MALES Authors: G. Ball*; D. Woodside; W.S. Hunter; B. Tompson
BACKGROUND: Dentofacial orthopedic treatment provides optimal results when performed during stages of rapid growth. Conversely, surgical orthodontic treatment is ideally performed after growth is complete. Currently, there is no universally valid method available to aid in the determination of these important periods of growth. OBJECTIVE: To establish a pattern of mandibular growth and relate this pattern to the stages of cervical vertebral maturation.
INTRODUCTION: Childhood sleep-disordered breathing (SDB) represents a continuum of disorders ranging from primary snoring to obstructive sleep apnea (OSA). SDB has significant effects on a child’s health, behaviour, and performance. Though most frequently associated with adenotonsillar hypertrophy, craniofacial malformations also contribute to the disorder. OBJECTIVES: The aim of this cross-sectional study was twofold: 1. to determine the prevalence of sleep disordered breathing and associated morphological and health-related factors in an orthodontic population, and 2. to determine statistical relationships between patient characteristics implicated in reduced upper airway dimensions and OSA symptoms reported from a pediatric sleep questionnaire. METHODS: Subjects were 604 patients aged 7 to 17 years presenting for orthodontic screening in a university clinic. The parents completed a health and sleep behaviour questionnaire prior to the child being evaluated in the orthodontic clinic. RESULTS: The prevalence of morphological factors, reported healthfeatures, and reported pediatric OSA symptoms mirrored those found in the general pediatric population. Positive relationships were found between morphological factors and pediatric OSA symptoms. The clinical picture of those characteristics found to be statistically significant was that of a long-face syndrome patient: dolichofacial, high mandibular plane angle, narrow palate, severe crowding of the maxilla and mandible, allergies, frequent colds, and habitual mouth breathing. Factors associated with reduced antero-posterior dimensions were not related with SDB. CONCLUSION: As a health specialist who examines the morphological characteristics of patients, an orthodontist should always be screening for possible SDB in growing patients, both through a questionnaire and a clinical evaluation.
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METHODS: Yearly cephalometric radiographs, ages 9-18, were evaluated for 90 males from the Burlington Growth Centre. Mandibular lengths were measured from articulare to gnathion and incremental growth determined. Cervical vertebral maturation stages were assessed using the 6 stage method described by Baccetti et al (2005). Advanced, average and delayed maturation groups were established. Results: The pre-pubertal mandibular growth minimum occurs during cervical stages 1 through 4 (p <+ .7327). Peak mandibular growth occurred most frequently during stage 4 in all three maturation groups with a statistical difference found in all three groups, average and delayed groups (p < .0001), advanced group ( p =.0143). The average number of years spent in stage 4 was 3.79 years (p<.0001). The average amount of mandibular growth occurring during stage 4 was 9.40mm (p < .0001). The average amount of growth in stages 5 and 6 combined was 7.09mm. CONCLUSIONS: Progression from cervical stages 1 through 6 does not occur annually. Instead, the time spent in each stage varies depending on the stage and maturation group. Cervical vertebral maturation stages can not consistently identify the mandibular pre-pubertal growth minimum and therefore, can not predict the onset of the peak in mandibular growth. The cervical vertebral maturation stages should be used in conjunction with other methods of biologic maturity assessment when considering both dentofacial orthopedic treatment and orthognathic surgery.
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CFAO Graduate Student Posterboards University of Toronto COMPARING FRICTIONAL CHARACTERISTICS OF SIX SELFLIGATING ORTHODONTIC BRACKET SYSTEMS Authors: C. Oliver*, J. Dask, B. Tompson, C. Simmons Graduate Orthodontics Department, Faculty of Dentistry, University of Toronto
BACKGROUND: Friction in orthodontics is among the most important obstacles that must be overcome to allow tooth movement. Selfligating brackets have been held responsible for decreasing treatment time due to the inherent reduction in frictional resistance. The influence of the type of self-ligation mechanism on frictional resistance has also been recognized by authors (Budd S. M.Sc. Grad Dept of Dent, U of T, 2005; Thomas S, et al. Eur J Ortho 1998;20:589-96). OBJECTIVE: To evaluate the frictional behaviour of six self-ligating bracket systems with three stainless steel archwires under dry conditions that simulate the clinical situation by allowing the tooth to move freely during retraction. METHODS: 11 of each bracket type (SPEEDTM, SmartClipTM, InOvation®C, ClarityTMSL, CarriereTMSLB, VisionLPTM) were bonded to an upper right first bicuspid melamine tooth, submerged into a viscous medium and pulled along 11 wires each of sizes 0.017x0.022”, 0.017x0.025”, 0.019x0.025” using a custom testing apparatus. Resistance to sliding was measured (N) using an Instron testing machine. Descriptive statistics were calculated for each bracket/wire combination and a two-way ANOVA was performed.
University of Western Ontario CERVICAL VERTEBRAL MATURATION STAGE AS A GROWTH PREDICTOR Authors: M. Anderson*, B. Jamal, W. S. Hunter, A. Mamandras, The purposes of this study were to establish the reproducibility of skeletal age assessment as determined by the stage of cervical vertebral maturation (CVM) and to assess the ability of the CVM method to predict timing of peak mandibular growth velocity (PMdGV). The longitudinal records of 104 females (age 8 to 14 inclusive) were used to determine skeletal age (as assessed by the CVM) and mandibular length. Reproducibility of skeletal age estimates was tested by comparing five sets of first and second determinations done 2 months apart for 20 subjects chosen from the total sample before and after principal operator calibration. The reproducibility of skeletal age assessments done prior to calibration was unacceptable. The reproducibility improved to acceptable limits following calibration. Improved definitions, the addition of an extra stage and the development of a Sequential Flow Chart rendered the modified CVM method, introduced in this study, even more reproducible. The kappa for 20 double assessments of the timing of PMdGV was 50% (not acceptable) but of the 55 subjects for whom two determinations of timing of PMdGV coincided, only 61% were at cervical vertebral stage 3 thus lending some measure of uncertainty to the use of the cervical vertebral maturation method for predicting timing of PMdGV.
RESULTS: The four passive self-ligation brackets (CarriereTMSLB, ClarityTMSL, SmartClipTM, VisionLPTM) displayed statistically significantly less frictional resistance for each of the wire sizes when compared to the active self-ligation brackets (SPEEDTM, InOvation®C). The SPEEDTM bracket consistently demonstrated the highest resistance to sliding. The depth of the wire appeared to have more of an influence than its height. CONCLUSIONS: The mode of self-ligation appears to significantly affect the frictional behaviour of orthodontic brackets with passive self-ligation mechanisms exhibiting extremely small frictional resistances.
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Component Society Reports
British Columbia
Alberta
Dr. Ritchie Mah
Dr. Paul Major
[Email: ritchiemah@yahoo.ca]
[Email: major@ualberta.ca]
The BCSO AGM agenda of May 9, 2008 mainly consisted of two components given by two speakers: 1. Continuing Education – The Risks versus Benefits of Cone Beam CT by Dr. Ken Poskitt, a paediatric neuro-radiologist and assistant professor in the Department of Radiology, Faculty of Medicine at UBC and based at BC Children’s Hospital. The rising utilization of CBCT in orthodontics was discussed, along with the differences between traditional CT’s and CBCT. 2. Media Campaign Update - AAO "More than a Smile" Consumer Awareness Campaign by Dr. Robin Jackson, Chairman of the AAO Council on Communications Guest Attendee: Dr. Gordie Organ, CAO President. Nominations Committee – New Executive for BCSO for 2008/09 selected. Dr. Tom Moonen – President; Dr. Bernard Lim – Vice-President; Dr. Robert Elliott – Secretary/Treasurer; Dr. Jonathan Suzuki – Immediate Past President Insurance issues: None at this time. Other: 1. Dental Specialists’ Society AGM held on June 5/08
The Alberta Society of Orthodontists (ASO) had an excellent annual scientific session and annual general meeting in March 2008. The 2008-2009 ASO executive includes Dr. Biljana Trpkova (President), Dr. Keith King (Vice President) and Dr. Mike Bleau (Secretary-Treasurer). Many Alberta orthodontists are challenged with hiring sufficient staff in the ever-booming economy. The ASO will be surveying its membership regarding staff salaries. The ASO will be continuing its media campaign by contacting the major Alberta newspapers regarding their interest in publishing articles featuring orthodontics. The articles will highlight the specialty of orthodontics. The ASO has formed a Mediations Committee utilizing the CAO process. Dr. Gary Stauffer has accepted a two year term as Chair of the committee. The Immediate Past President and President of the ASO will also serve on the committee. The Alberta Dental Association and College have drafted “Standards on Infection Prevention and Control” that apply to all dentists in the province, including orthodontists. The guidelines in their current form will significantly increase the infection control requirements currently used in most orthodontic practices and will also require significant documentation and reporting. The ASO is preparing a response to seek realistic guidelines for orthodontic practice. The next ASO Scientific Session and AGM will occur on March 6 and 7, 2009. Dr. Vince Kokich Jr. will be the featured speaker.
2. BCSO meeting – September 22, 2008. 3. Afternoon golfing at UBC Golf Course, followed by an evening dinner, social and prizes. Thanks to all sponsors for their support of BCSO, and to Dr. Gordie Organ for attending on behalf of CAO.
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Component Society Reports Saskatchewan Dr. Ross Remmer
Dr. Tim Dumore
[Email: dr.remmer@sasktel.net]
[Email: drtimbo@drdumore.com]
The Saskatchewan Society of Orthodontists Annual Meeting took place on Thursday October 2, 2008 the evening before a day of continuing education with Robert Miller. The meeting marked the inaugural visit to a provincial meeting by our new president, Dr. Robert Cram, and also the first time the President of the CAO has attended a meeting of the SSO. In conjunction with the 3M lectures, the SSO is planning to hold regular annual meetings instead of ad hoc "get-togethers" as had been the tradition. The society extends a special thanks to Unitek for arranging Dr. Miller’s lecture. The most recent guidelines established by Health Canada describing acceptance for orthodontic coverage means a higher percentage of patients registered in the program require orthognathic surgery. Following discussions with the SSO, FNIHB Saskatchewan has acknowledged that orthodontics for patients requiring surgery involves more preparation, time and responsibility. Accordingly, an upward adjustment in the orthodontic fee has been made. Discussions are continuing with the Department of Health regarding the services covered and the fee level for patients with cleft lip and palate and for patients covered under Social Services and the Family Income Plan. A meeting was held between members of the SSO and the oral maxillofacial surgeon who is the Head of Dentistry for the Saskatoon Health Region. Of major concern to the orthodontists is the long waiting list for orthognathic surgery. Manpower shortage and unwillingness by some surgeons to perform orthognathic surgery are contributing factors to the long list. The SSO learned that the length of the list is shortening as a result of increases in operating room time and efficiencies that have been implemented, but improvement has been slow. There may be some good news on the horizon, as several oral surgery residents currently in specialty programs have expressed interest in returning to the province. More surgeons with hospital privileges may translate into more surgeries, but it could be a while before this is realized. The SSO will continue to work to reduce the waiting time for our patients requiring orthognathic surgery, but it seems the most of the factors contributing to the problem are largely beyond the SSO’s influence.
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Manitoba
CAO Bulletin • Fall 2008
The most recent meeting of the Manitoba Orthodontists Society was held on April 17, 2008. Our special guest was our CAO president, Dr. Gordie Organ. Gordie's presentation touched on communications (plans for an update of the CAO website and the success of the CAO Bulletin as recognized by a recent member survey), efforts to maintain contact with recent graduates, frustration in negotiating with the Federal Government for benefits for Aboriginal Canadians and the potential health risk associated with Bisphenol-A. In recent years, the CAO has made extra effort to ensure that the president attends the meetings of the provincial associations. In Manitoba, it is felt that this is a very worthwhile endeavour to enhance communication and the cohesiveness of the national orthodontic community. The MOS has employed the AAO endorsed media company (Schupp Company) to assess various media vehicles in Manitoba and will be initiating a television advertising campaign to build on the momentum of the AAO’s consumer awareness campaign. The MOS membership has agreed to each contribute approximately $850 towards this initiative, with a planned start date in early 2009. Dr. Alan Lowe was a guest of the University of Manitoba Graduate Orthodontic Program on September 10, 2008 to provide a continuing education lecture to local orthodontists and residents on the topic of oral appliances for the treatment of snoring and obstructive sleep apnea. As you all know, the annual CAO scientific session was held in Winnipeg on September 12-13, 2008 and was a great success for all involved! In addition to the list of engaging speakers at the scientific session, the many social events gave all attendees a chance to relax, mingle and enjoy all that Winnipeg has to offer. As Dr. Susan Tsang assumes the role of the Manitoba director, I would like to thank the many great people that I have had the opportunity to meet through the CAO during my eight year tenure. It has truly been a pleasure, and I will miss being involved on a daily basis. Thank you all for your overwhelming support for the CAO meeting in Winnipeg. As members, you should all be very grateful to have Dr. Richard Marcus, along with Diane Gaunt and Alison Nash from the
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Component Society Reports CAO office. The tireless effort of these individuals is what makes our annual scientific session such a success. The Manitoba orthodontic community also deserves a round of applause for their support, participation and assistance in the organization and execution of the meeting. A special thank you to those who were directly involved: Drs. Rana Shenkarow, Bruce McFarlane, Conny Athanasopoulos, Susan Tsang, Morley Bernstein and Billy Wiltshire. Thank you also to the University of Manitoba graduate orthodontic residents: Drs. Elli Roehm, Kris Row, and many others who contributed in various ways. It was the objective of the MOS that the Canadian orthodontic community would make the effort to come to Winnipeg to see firsthand that Winnipeg is simply a great place to be. The response that was received indicates that we were successful. Let’s do it again in the future so that those who couldn’t make it can have a chance to enjoy the ‘Peg!
Ontario Dr. Helen Grubisa [Email: drgrubisa@sympatico.ca]
Cone Beam CT The moratorium on the purchase of cone beam CT units remains in effect in Ontario, although the ban has recently been lifted for oral and maxillofacial radiologists and for oral and maxillofacial surgeons. The RDSCO has asked the Ontario Association of Orthodontists for a letter in support of having the moratorium lifted for orthodontists. The OAO is in the process of gathering more information prior to offering its endorsement. Orthodontic Module for Dental Assistants Status quo! The orthodontic module courses are being offered, however Ontario regulations do not permit the Level II assistants to use their clinical orthodontic skills. At the government level, the regulation that would allow the assistants to utilize their orthodontic module skills has been “stalled” close to 7 years, with no apparent progress in having it approved. The RCDSO is considering putting together a Clinical Standard of Practice but there is still discussion as to whether or not this will move this issue forward. Young Member Initiative Residents and recently graduated orthodontists have indicated to the Executive of the OAO that they would value increased personal communication from their provincial association. Funds have been
set aside to help with setting up seminars on relevant topics, and if possible, resurrecting the mentorship program. Membership In 2008 there were 289 orthodontists in the Ontario Association of Orthodontists with 4 academic members, 8 honourary, 56 life members and 217 in the active membership category. 2009 OAO Member Directory The Directory is going digital!! This year both print versions and the CD version will be provided to members, however this 2009 hard copy will become a collector’s item as it will be the last printed directory. Look for pristine editions on ebay!
Quebec Dr. Sonya Lacoursière [Email: lacedge@videotron.ca]
The Quebec AGM was held during “Les Journées dentaires internationales du Québec” on May 26th 2008 at le Palais des Congrès de Montréal, featuring Dr. Marcel Korn as the keynote speaker. Thank you to the President of the CAO, Dr. Gordie Organ, for taking the time in his very busy schedule to address the QAO members. The QAO’s new executive board members for 2008-2009 are: President: Dr. Catherine Jomphe President Elect: Dr. Réjean Labrie Treasurer: Dr. George Papanastasoulis Secretary: Dr. Fannie Brousseau Archivist: Dr. Luigi Di Battista Member at Large: Dr. Florence Morisson Past President: Dr. Daniel Tanguay On October 3rd, 2008 Drs. Jean-Patrick Arcache & Eric Lessard (Oral Medicine) and Stéfanie Patterson (Physiotherapist) presented a pot pourri on TMJ. Dr. François Bérubé from Quebec will visit us on November 21st. His conference will be given in French on cases treated with a multidisciplinary approach. On March 27th 2009, our speaker will be Dr. Junji Sugawara of Japan presenting on Temporary anchorage devices (TAD’s). Our next AGM will be held on May 25th, 2009 featuring Dr. Etsuko Kondo of Japan who will discuss skeletal anterior open bites in Class III cases. Fall 2008 • CAO Bulletin
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Component Society Reports This is my last report to the CAO Board. On a personal note, I would like to thank the Board members and the staff of the CAO for their friendship and support. It was a privilege and an honor to serve under this wonderful organization for the past three years. Dr. Jean-Marc Retrouvey will be the new Quebec director and without a doubt, a great asset to the CAO Board.
Rapport de la province de Québec Depuis mon dernier rapport, l’assemblée générale annuelle de l’AOQ a eu lieu pendant les Journées dentaires internationales du Québec soit, le 26 mai dernier au Palais des congrès de Montréal. Le Dr Marcel Korn fut notre conférencier et nous a présenté une excellente conférence bien étoffée. J’en profite pour remercier le président de l’ACO, le Dr Gordie Organ, qui, malgré son horaire très chargé, est venu s’adresser aux membres de l’AOQ lors de notre assemblée annuelle. Le nouveau conseil d’administration de l’AOQ pour l’année 20082009 est maintenant composé des membres suivants : Président : Dre Catherine Jomphe Président élu : Dr Réjean Labrie Trésorier : Dr George Papanastasoulis Secrétaire : Dre Fannie Brousseau
ORTHODONTIC PRACTICE FOR SALE RURAL CALGARY AREA Solo practice located in a desirable and rapidly growing community 30 minutes from Calgary. Excellent growth potential. Four treatment chairs plus separate exam/consult/private treatment room. Pan and Ceph. Well equipped ortho lab. Owner is relocating but will assist with transition. Close to all the Rocky Mountains have to offer. For more information on this opportunity, please contact the CAO office and refer to File #08-0418.
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CAO Bulletin • Fall 2008
Archiviste : Dr Luigi Di Battista Membre sans portefeuille : Dre Florence Morisson Président sortant : Dr Daniel Tanguay Le 3 octobre prochain, les Drs Jean-Patrick Arcache et Eric Lessard (médecine buccale) ainsi que Stéfanie Patterson (physiothérapeute) nous présenteront un pot pourri sur l’ATM. Le 21 novembre 2008, nous recevrons le Dr François Bérubé de Québec. Cette conférence sera donnée en français et traitera de la gestion de cas orthodontiques multidisciplinaires. Le 27 mars 2009, le Dr Junji Sugawara (Japon) sera notre conférencier invité sur un sujet d’actualité : les micro-implants d’ancrage. La prochaine assemblée générale annuelle de l’AOQ est prévue pour le 25 mai, 2009. La Dre Etsuko Kondo (Japon) sera notre conférencière lors de cette journée. Elle nous parlera des cas de Classe III avec béance antérieure squelettique. En terminant, ceci est mon dernier rapport pour le Bureau de l’ACO. Sur une note personnelle, j’aimerais remercier les membres du Bureau ainsi que le personnel de l’ACO pour leur amitié et leur support. Ce fut un privilège et un honneur d’être au service de cette formidable organisation depuis les trois dernières années. Le Dr Jean-Marc Retrouvey sera le nouveau représentant du Québec et sans aucun doute, un excellent atout au Bureau de l’ACO.
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Component Society Reports Atlantic Report Dr. Stephen F. Roth [Email: stephenroth@bigfoot.com] The Atlantic Orthodontists Association held its spring meeting in Moncton, New Brunswick from May 2nd to 4th, 2008. The meeting was a great success with its highest attendance to date. The AOA extends its thanks to Dr. Nicole Scheffler and to Dr. Terry Sellke for sharing their experiences with the organization. Thanks also to Dr. Gordie Organ for representing the CAO. Our only disappointment was the cancellation of the golf outing due to poor course conditions. Our 2009 AGM is being planned for next spring. We are hoping to arrange a retreat at one of Atlantic Canada’s fine get-away resorts. The Atlantic Orthodontist’s Association is thrilled that the CAO has decided to hold the 2011 Scientific Session in Halifax. We are looking forward to helping make this meeting a truly informative and enjoyable event. Plan to use this opportunity to explore the many fascinating areas of the Maritimes.
Canadian Association of Orthodontists UPCOMING ORTHODONTIC MEETINGS 2009 February . . . . . . . . .Saskatchewan Orthodontist Association AGM March . . . . . . . . . . .Alberta Association of Orthodontists AGM April . . . . . . . . . . . . .Ontario Association of Orthodontists AGM April . . . . . . . . . . . . .Atlantic Orthodontic Association AGM May . . . . . . . . . . . . .Quebec Association of Orthodontists AGM May . . . . . . . . . . . . .British Columbia Society of Orthodontists AGM Spring . . . . . . . . . . .Manitoba Association of Orthodontists AGM May 1-5 . . . . . . . . . .AAO Annual Session, Boston, Massachusetts June 10-14 . . . . . . .European Orthodontic Society Annual Session, Helsinki, Finland Sept. 10-12 . . . . . . .CAO Annual Session, Kelowna, B.C. Sept. 23-27 . . . . . .SAO Annual Session, The Homestead, Hot Springs, VA Oct. 8-11 . . . . . . . .RMSO Annual Session, Santa Fe, NM Oct. 14-17 . . . . . . .MSO Annual Session, Minneapolic, MN (tentative)
It's membership renewal time... Look for your renewal notice arriving soon. Thank you for your continued support of the CAO.
Oct. 22-25 . . . . . . .PCSO Annual Session, Phoenix Arizona (tentative) Oct. 28-Nov. 1 . . . .GLAO Annual Session, Toronto, ON Nov. 3-8 . . . . . . . . . .SWSO Annual Session, Cancun Mexico (tentative) Nov. 3-8 . . . . . . . . . .MASO Annual Session, Atlantic City, NJ (tentative) Nov. 12-16 . . . . . . .NESO Annual Session (tentative) 2010 Feb. 6-9 . . . . . . . . . .7th International Orthodontic Congress (WFO), Sydney Australia Apr 30-May 4 . . . . .AAO Annual Session, Washington, DC Sept. 23-25 . . . . . .Joint CAO-CAOMS Scientific Session, Whistler, BC 2011 May 13-17 . . . . . . . .AAO Annual Session, Chicago, Illinois Sept 23-25 . . . . . . .CAO Annual Session, Halifax, NS 2012 May 1-4 . . . . . . . . . .AAO Annual Session, Hawaii
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From the Editor
Dr. James L. Posluns, Bulletin Editor [Email: james.posluns@utoronto.ca]
Why do people go to the CAO meeting every year? Other than the fact that it’s a great way to catch up, meet with old and new friends, spend some money before the free-falling market takes it all and learn a new clinical trick or two, the real reason to go is that it is the best way to keep one’s finger on the pulse of the profession in Canada. So exactly how does one keep one’s finger on the pulse? One could listen to the experts in the field. You know these folks. They have impressive name badges with big stickers on the front. They have really nice suits and they usually talk with a bit of a Southern or Midwestern twang. One could meet up with one of the many sales representatives, who smile widely as you are expertly steered towards a wide assortment of shiny new toys. One could sit in on a CAO board meeting, where the veterans will clearly tell you what is what. While these are all great ways to get the inside scoop, the clearest, quickest way to hear what’s going on is to hang out with the orthodontic residents. Residents have the skills. They know how to schmooze. They know how to party. They know when something doesn’t quite add up. And they are in at ground zero. They talk to everyone and for long hours. With an efficiency that makes high speed internet seem like a telegraph, residents know who’s opening a practice, who’s closing a practice, who’s looking for
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CAO Bulletin • Fall 2008
work and where’s the best place for cheap beer and loud music. They’re generally pretty upbeat, happy people, until they’re called in for duty to the 7:30 am Annual General Body Meeting following a night of resident reindeer games. But why shouldn’t they be happy? They get to be in school. They get recess, breaks and most of the summer off. They get wined and dined by company reps. They have a controlled number of patients and have a support system second to none. What a life! Why didn’t I appreciate it when I was a young ‘un! But alas, things are not always as rosy as they appear to be. Talk to a number of the newly graduated and you will find a number of cracks in the pavement. In Toronto, steady employment can be hard to come by. One of the newest, brightest graduates is continuing to improve his house cleaning skills on a regular basis. Another has not worked for the better part of a year. A recent graduate of the University of Western Ontario is driving a combine in Saskatchewan. For those brave enough to venture unaccompanied into the wild blue yonder, big bills and schedules akin to Swiss cheese occasionally await. And still there is a lineup to plunk down the cash and take a take a spin on the RCDC roller coaster of thrills. So why does this happen? These are nice people with skills years in the making. They are enthusiastic and willing to contribute. They are also frustrated. For one, there is a general reluctance to leave the bigger centers, where the majority of orthodontists hang out. There is a tendency to put ‘all of one’s eggs into one basket’ so should an initial opportunity not materialize, there ain’t much of a contingency to fall back on. There may be general trepidation in the hiring of an associate. Associates typically vamoose after a few years, leaving a glut of partially finished cases requiring more attention from the senior practitioner. It’s a difficult problem. And it seems to be getting worse. But such is not always the case. While there tends to be a bit of frustration at the start line,
after a few laps, the pieces tend to fall into place. Positions get filled, offices get bought and new start ups begin to prosper. New grads turn up at Alumni receptions with big smiles, shiny Blackberries and spiffy new clothes. Life starts to improve as the initial shock and awe of graduation begins to fade. Such is the cycle of life.
So what does all of this have to do with this year’s CAO meeting? For the first time, the challenges facing the newly graduated were readily apparent. Deep down they know they’ll be okay. But it’s good to vent. It’s therapeutic. There’s strength in numbers, and the numbers converge on the floor of the CAO meeting. It’s not in the CAO lecture schedule. It’s not on the docket. But it’s a real benefit of bringing people together year after year. So the next time you are at a CAO meeting, either in Kelowna, Whistler or wherever, think of the poor lonely residents. Remember back to when you were just starting out, to how much you appreciated a kind word or a bit of encouragement and offer up the same. If that doesn’t work, keep this in the back of your mind. They’ll all practice ortho for food! Jim
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Diversions and Distractions When Mrs. Sweet told her five children to help themselves to chocolates, she didn’t expect them to eat every one in the box! However, that’s precisely what they did and all thirty chocolates were gone in minutes. Can you discover each child’s age and the different quantities of chocolates they consumed? 1. 2. 3. 4. 5.
Damian ate one fewer chocolate than Micky. Ella is one year older than Micky who ate two more chocolates than Ella. Liam is one year younger than the child who ate six chocolates. Damian is one year younger than the child who ate one fewer chocolate than Liam. The child who ate four chocolates is one year younger than Damian.
4
5
Age 6
7
8
4
5
Quantity 6
7
8
Damian Ella Liam Micky Nancy
Quantity
4 5 6 7 8
Last Edition’s Answer: David - lasagna & apple pie; Fergus - venison & cheesecake; Rosie - lambs liver & tiramisu; Sarah - beef curry & ce cream; Timothy - chicken pie & pavlova (taken from Logic Puzzles 1 2007 Arcturus Publishing Limited, London UK.)
Holiday Greetings!
On behalf of everyone at the CAO office, we wish all of our readers a wonderful Holiday Season and a Healthy and Successful 2009!
Kindly note that the CAO administration offices will be closed for the holidays from Wednesday, December 24th through Friday, January 2nd, 2009. The office will re-open on Monday, January 5th, 2009.
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