Virginia Dental Journal by Virginia Dental Association

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FOR

THE

PROFESSIONAL

VIRGINIA DENTAL ASSOCIATION OFFICERS Councilors President: Ronald L. Tankersley 1) Edward J. Weisberg, Norfolk 716 Denbigh Ave., Suite C-1, Newport News 236022) Richard D. Barnes, Hampton President Elect: William H. Allison 3) Harold J. Neal, Jr., Emporia Fauquier Professional Bldg., Warrenton 22186-3239 4) James R. Lance, Richmond 5) Daniel E. Grabeel, Lynchburg, Chairman Immediate Past President: Leslie S. Webb, Jr. 6800 Patterson Ave., Richmond 23226 6) Gus C. Vlahos, Dublin 7) William J. Viglione, Charlottesville Secretary-Treasurer: Charles L. Cuttino, III 8) Rodney J. Klima, Burke 3217 Grove Avenue, Richmond 23221 Executive Director: Mr. William E. Zepp, CAE P.O. Box 6906, Richmond, VA 23230

Ex Officio Members:

Parliamentarian: Emory R. Thomas, Richmond EXECUTIVE COUNCIL Editor: Francis F. Carr, Jr., Richmond Speaker of the House: D. Christopher Hamlin, Norfolk Officers Listed Above and Councilors: Dean, MCV School ofDentistry: Lindsay M. Hunt, Jr., Councilors at Large

Richmond David C. Anderson, Alexandria (1997), Vice Chairman

Thomas S. Cooke, II, Sandston (1996)

Wallace L. Huff, Blacksburg (1996)

Andrew J. Zimmer, Norfolk (1997)

ADA DELEGATION David A. Whiston, Trustee to the 137th Annual ADA Session, Sept. 28-Oct. 2, 1996, Orlando 16th District Delegates: William H. Allison (1996) Raleigh H. Watson, Jr. (1998) Emanuel W. Michaels (1996) Stephen L. Bissell (1996) Wallace L. Huff (1998) Gary R. Arbuckle (1998) M. Joan Gillespie (1997) Leslie S. Webb, Jr. (1997) Richard D. Wilson (1996)

â&#x20AC;˘

Alternate Delegates: Anne C. Adams (1996) Richard D. Barnes (1997) Ronald L. Tankersley (1997)

Charles L. Cuttino III (1997) D. Christopher Hamlin (1996) David C.Anderson (1996)

Lindsay M. Hunt, Jr. (1997) Andrew J. Zimmer (1997) Bruce R. Hutchinson (1996)

COMPONENT SOCIETY DIRECTORY

SOCIETY

PRESIDENT

SECRETARY-TREASURER OR SECRETARY

PATIENT RELAnONS COMMITTEE

Tidewater

David P. Paul, ill 4616 Thoroughgood Drive Virginia Beach, VA 23455

James E. Krochrna1 801 W. Little Creek Rd., SU 107 Norrfolk, VA 23505

W. Walter Cox 5717 Churchland Blvd. Portsmouth, VA 23703

Peninsula

Gisela K. Fashing Corydon B. Butler, Jr. 150 Strawberry Plains Rd., SU C 1319 Jamestown Rd. Williamsburg, VA 23185 Williamsburg, VA 23188

Lawrence A. Warren 106 Yorktown Road Tabb, VA 23602

Southside

Michael R. Hanley 2001 W, Broadway Hopewell, VA 23860

John M. Bass 212 N. Mecldenburg Ave. South Hill, VA 23970

John R. Ragsdale, ill 9 Holly Hill Drive Petersburg, VA 238847

Richmond

Edmund E. Mullins, Jr. 6808 Stoneman Rd. Richmond, VA 23228

Gary R. Hartwell 4107 W. Franklin St. Richmond, VA 23226

Wm. James Redwine 6808 Stoneman Road Richmond, VA 23228

Piedmont

Richard D. Huffman, Jr. 4346 Starkey Rd., SU 3 Roanoke, VA 24014

Gregory T. Gendron 7 Cleveland Ave. Martinsville, VA 24112

Edward M. O'Keefe 4102 Electric Road Roanoke, VA 240 14

Southwest

Gus C. Vlahos P.O. Box 1379 Dublin, VA 24084

Dana Chamberlain 645 Park Blvd. Marion, VA 24354

Jack D. Cole 303 Court Street Abingdon, VA 24210

Shenandoah Valley

Edward L Amos 1002 Amherst St. Winchester, VA 22601

Gerald J. Brown 324 Boscawen St. . Winchester, VA 22601

William J. Viglione 3025 Berkmar Drive Charlottesville, VA 22901

Northern Virginia

M. Alan Bagden 6120 Brandon Ave., SU 104 Springfield, VA 22150

James A. Pell Seven Comers Proessional. Bldg. Falls Church, VA 22044

John A. Mcintire 10721 Main Street Fairfax. VA 22030

MEMBER PUBUCATION, AMERICAN ASSOCIATION OF DENTAL EDITORS

Mr. William E. Zepp, CAE, Business Manager

Francis F. Carr, Jr., Editor

ASSOCIATE EDITORS 1) Bernard I. Einhorn 5) Edward P. Snyder 2) Jeffrey N. Kenney 6) R. Graham Hoskins 3) H. Reed Boyd, III 7) William C. Bigelow 8) Bruce W. Jay 4) Gary R. Hartwell MCV - Thomas Burke January-March 1996

Volume 73

Number 1

TABLE OF CONTENTS 5

Editorial

Message from the President

Special: Dave Whiston on the Issues

Needlesticks: What to Do After It Happens

Treatment of a Habitual Smoker Using Nicotine Gum

20-24

Abstracts

Svirsky on Infection Control

Executive Council Actions in Brief

30-35

Component News

35-38

136th ADA Annual Meeting in Photos

1996 VDA-Sponsored Continuing Education Programs

COVER: Crabtree Falls. Nelson County, in Winter. Photograph by Brian Kreckman.free-lance photographer, Richmond. THE VIRGINIA DENTAL JOURNAL (lSSN 0049 6472) is published quarterly (Jan.-March, April-June, July-Sept., Oct.-Dec) by the Virginia Dental

Association at the Corporate Centre, 5006 Monument Avenue, P.O. Box 6906, Richmond Virginia 23230-0906, Telephone 804/358-4927.

SUBSCRIPTION RATES: Annual: Members. $6.00. Others $12.00 in U.S., $24.00 in other countries. Single copy $6.00. Second class postage paid at

Richmond, Virginia. Copyright Virginia Dental Association 1995.

POSTMASTER: Send address changes to: Virginia Dental Journal, P.O. Box 6906, Richmond, VA 23230-0906.

MANUSCRIPT AND COMMUNICATION for publications should be addressed to the Editor, Francis F. Carr, Jr., P.O. Box 6906, Richmond,

Virginia 23230.

ADVERTISING COPY, insertion orders, contracts and requests for information relating to advertising should be addressed to the Business Manager.

Mr. William E. Zepp, CAE, P.O. Box 6906, Richmond. Virginia 23230-0906.

VIRGINIA DENTAL JOURNAL

EDITORIAL BOARD Dr. Louis M. Abbey Dr. Ralph L. Anderson Dr. James R. Batten Dr. Cramer L. Boswell Dr. James H. Butler Dr. Gilbert L. Button Dr. Frank. H. Farrington Dr. Barry I. Griffin Dr. Jeffrey L. Hudgins Dr. Wallace L. Huff Dr. Lindsay M. Hunt, Jr. Dr. Lisa Samaha Hunter Dr. Ford T. Johnson Dr. Thomas E. Koertge Dr. James R. Lance Dr. Daniel M. Laskin Dr. Travis T. Patterson, ITl â&#x20AC;˘ Dr. W. Baxter Perkinson, Jr. Dr. David Sarrett Dr. Harvey A. Schenkein Dr. James R. Schroeder Dr. Harlan A. Schufeldt Dr. Kenneth 1. Stavisky Dr. John A. Svirsky Dr. Ronald L. Tankersley Dr. Douglas C. Wendt Dr. Roger E. Wood

COMMITTEES 1996 Annual Meeting Dr. Andrew J. Zimmer, Chairman Auxiliary Education & Relations Dr. A. Carole Pratt, Chairman Budget and Financial Investments Dr. Jeffrey Levin, Chairman Cancer and Hospital Dental Service Dr. Robert L. O'Neill, Chairman Caring Dentists Dr. Harry D. Simpson, Jr., Chairman

Constitution and Bylaws Dr. Leslie S. Webb, Jr., Chairman

Peer Review and Patient Relations Dr. Edward M. O'Keefe, Chairman

Dental Care Programs Dr. Kirk M. Norbo, Chairman

Planning Dr. Leslie S. Webb, Jr., Chairman

Dental Delivery for the Special Needs Patient Dr. Patrick J. Dolan, Chairman

Relief Dr. Scott H. Francis, Chairman

Dental Education and Continuing Education Dr. James K. Johnson, Chairman Dental Health and Public Information Dr. Gisela K. Fashing, Chairman Dental Practice Regulations Dr. Douglas C. Wendt, Chairman Dental Trade and Laboratory Relations Dr. George L. Nance, Jr., Chairman Environmental Health and Safety Dr. Dennis E. Cleckner, Chairman Executive Dr. Ronald L. Tankersley, Chairman History and Necrology Dr. Edmund E. Mullins, Jr., Chairman Institutional Affairs Dr. Elizabeth Bernhard, Chairman Insurance Dr. Wm. H. Higinbotham, Jr., Chairman Journal Staff Dr. Francis F. Carr, Jr., Chairman Legislative Dr. Harold J. Barrett, Jr., Chairman Membership Dr. Bruce R. DeGinder, Chairman New Dentist Dr. Russell A. Mosher, Jr., Chairman Nominating Dr. Leslie S. Webb, Jr., Chairman

Search Committee for VA Board of Dentistry Candidates Dr. Leslie S. Webb, Jr., Chairman Virginia Dental Political Action Dr. John C. Doswell, II, Chairman

NOTE THESE DATES: (Mark your calendar now for these future meetings) VDA 127th Annual Meeting September 18-22, 1996 Colonial Williamsburg Lodge 16th Trustee District Caucus September 6-8, 1996, Winston-Salem, NC ADA 137th Annual Meeting Sept. 28-0ct. 2, 1996 Peabody Hotel, Orlando VDA Leadership Conference October 18-20, 1996 Boars Head Inn, Charlottesville VDA Committee Meetings June 14-16, 1996 Sheraton Oceanfront Virginia Beach VSOMS Annual Meeting June 28-30, 1996 Boar's Head Inn, Charlottesville VAO Annual Meeting June 28-July 2, 1996 Cavalier, Virginia Beach

Editorial

The General Assembly is working its way through the concerns of the Commonwealth this winter. The VDA must influence their deliberations to achieve the best results for our patients and for our profession. This goal is not just a wintertime occupation for us, but a product of our collective presence in the community at large. Our officers, our staff, our lobbyists, our liaison dentists work diligently at the legislature during the session. Successes also came because the membership throughout the year reflects the positive influence of dentistry in the finest tradition of civic involvement. Virginia dentists take their responsibilities as citizens seriously. The things we do improve our com munities and the way we live. A short recitation of participation in activities outside our offices demon strates our willingness to serve. Dentists have not only been Deacons and Elders in their churches, but state presidents of their denominations. Boy and Girl Scout leaders and Silver Beaver Awards are numerous. Public and private colleges have dentists as trustees, on boards of visitors and as alumni leaders. Our colleagues have been, and are, mayors of some of our largest and our smallest cities. Dentists serve on boards of supervisors, regional planning agencies, AHEC boards, health systems agencies, and as substitute judges. VDA members are volunteer coaches and players in nearly every sport at every level. On and on we participate. There is no standard profile of involvement, no smug ness of being better; we are being good citizens. Our influence in the legislature is enhanced by our contact with lawmakers and by their impression of our commitment to the greater needs of the Commonwealth. Conscientious involvement in the commu nity comes from the caring individual practitioner and the willingness to share special talents and gifts with those around them. By these selfless actions, we improve our communities and further the welfare of our patients. VDA members everywhere show pride in their profession by taking on civic responsi bilities that are appreciated by fellow citizens. We are noticed for what we do; we can ~ proud of our accomplishments; and we must continue our level of commitment.

Francis :r. Carr, Jr. Editor

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Virginia Board of Dentistry Dear Editor, Lately I have noticed a self足 serving euphemism creeping into endodontic lectures and papers which grates. It seems files no longer break. They separate. Using separate is somewhat misleading to a patient and is an incorrect connotation. Floss, burs and endo files break. People, groups and groups of objects separate (from each other). have you ever hear of a rope separating? Have you ever dropped a glass and watched it separate into little pieces on the floor? The use of the word separate implies a passive relationship to the accident and is just too clever. We owe patients the truth about what we do and have nothing to fear from being honest. It's when we try to shade the truth and cover up that we lose the patient's trust and goodwill. Sincerely, Dr. A. Wharton Ramsey Roanoke

The Virginia Board of Dentistry is appointed by the Governor and is composed of seven dentists. two hygienists and one citizen representative. Contact the Board office or a member of the Board on questions on rules and regulations. President Patricia Lee Speer, DDS Ist term ends 6/30/96 6606 W. Broad St. Richmond, VA 22314 804/662-9906 Vice President Alonzo M. Bell, DDS 1st term ends 6/30/96 1755-B Duke Street Alexandria, VA 703/836-3384 Secretary-Treasurer Catherine Cotter Haywood, RDH, MEd 1st term ends 6/30/96 Spotsylvania Voc. Ctr. 6703 Smith Station Road Spotsylvania, VA 22553 703/898-2655, FAX 891-1784

French H. Moore, Jr., DDS 1st term ends 6/30/96 303 Court Street Abingdon, VA 24210 703/628-7862, FAX 676-5537 Saundra D. Nelson, RDH, MS 1st term ends 6/30/96 2000 27th Street Newport News, VA 23607 804/244-1010, FAX 929-0589 Mrs. Patricia K. Watkins 1st term ends 6/30/99 4623 Leonard Parkway Richmond, VA 23226 804/358-6664 Marcia J. Miller, Executive Director 6606 W. Broad Street, #401 Richmond, VA 23230-1717 804/662-9906, FAX 662-9943 d

Mark A. Crabtree, DDS 1st term ends 6/30/98 407 Starling Avenue Martinsville, VA 24112 703/632-7392, FAX 632-2341 Erma Freeman, DDS 1st term ends 6/30/97 21207 Chesterfield Ave. Ettrick, VA 23803 804/526-2424. FAX 526-4660 Robert J. Isaacson. DDS, MS, PhD Ist term ends 6/30/97 MCV School of Dentistry Department of Orthodontics Richmond, VA 23298-0566 804/828-9326, FAX 828-5789 John S. Lyon, D.D.S. 1st term ends 6/30/99 2774 Hydraulic Road, Suite 201 Charlottesville, VA 22901 804/973-2968, FAX 804/973-0257

....

A Message from the President

The agenda at the VDA' s January Committee Meetings is testimonial to the value of organized dentistry. The Direct Reimbursement Subcommittee is developing a state DR program that is efficient and responsive. The VDA' sPeer Review process is being upgraded to make it compatible with that of the ADA and increase its efficiency and accessibility. The Dental Trade and Laboratory Relations and Institutional Affairs Commit tees are reorganizing to solidify their mission and increase their effectiveness. Also, the ADA Grassroots Coordinators are working hard to develop a responsive network of dentists to inform our legislators of our perspective on issues. And this is only the begin ning! In addition to their normal activities, all commit tees are determining what VDA policy should be in their respective areas. The VDA House of Delegates will evalu ate and debate suggested policy in the fall. Establishment of policy will be helpful when dentists are dealing with third party payers, legislators, business leaders and other professional organizations. The VDA will actively promote the legislative agenda of the "Virginians for Patient

Choice" coalition. The coali tion seeks to protect the patient's right to make their own health care decisions, including the following provi sions: 1) If the patient's employer changes third party carriers, the patient's current health care professionals should be able to participate in the plan if they are willing to agree to the terms of the contract. 2) If the patient's health care professionals are not contrac tual participants, the patient should be permitted to receive services from them without financial penalty. In other words, the patient should receive the purchased benefits for professional services regardless of their choice of health care professionals.

Unfortunately, space does not permit discussion of many of the important activities cur rently taking place in behalf of our members. I appreciate the time and energy expended by so many Virginia dentists. If you are not actively working on VDA projects and would like to become involved, let our executive director, Mr. Zepp, or any of your officers know. I hope you will take the opportunity to visit the recently refurbished VDA central office, meet the staff, and see the new conference room. I think you will be proud of both the staff and your facility.

Ronald L. Tankersley President

3) In order to properly evalu ate their third party choices, patients should know the percentage of the premium dollar actually spent for health care. Additional legislative activi ties will be directed towards increasing the availability of hygienists and assuring that monies appropriated by the Virginia legislature for dental services will be used for those services. 7

Dave Whiston on the Issues

Virginia and the Sixteenth District are proud to support our Trustee Dave Whistonfor ADA President Elect. He is dedicated to the best in den tistry and he is tireless in his efforts on behalfof the profes sion. He spoke recently with the Virginia Dental Journal on his campaign and the issues facing our profession.

VDJ: Dave, this is a big job you are asking for. Tell us why you want to be ADA President Elect and President. Dave: For me, it's been an evolutionary process. Being on the ADA Board of Trustees is certainly an honor and also, a lot of hard work. For the first couple of years, I didn't focus beyond the work that I felt was necessary to be a good trustee. Then, as I became more educated to the process, I realized that there were ways that change could take place within the system...for example, here in Washington; and that there were ways we could change our system, i.e., at the ADA in Chicago. Obviously, these are very challenging times and there will be difficult debates and difficult decisions to be made ...and I want to be part of that decision making process. The status quo

and "business as usual" just won't get the job done.

VDJ: You have been an ex ample to us in Virginia for a long time. Who have been the great influences in your life? Dave: My family has always been, and still is, the greatest influence on my life. Great influences obviously take many forms. But as a starting point, I appreciate the influence of my family every day.

VDJ: Tell us you goals for the future ofyour profession. Dave: Dentistry should be recognized as the best of all professions. We've done things the right way, we've been the most altruistic of all profes sions-we certainly are Health Care That Works. My goal? That dentistry is recognized as being the best by all patients and that the ADA is recognized as being the best by all dentists. I want the public to be even more aware that dentistry deserves its trust and I want every dentist to know that the American Dental Association is committee to being an aggres sive, contemporary organiza tion that supports their needs.

VDJ: What do you see as the telling issues of this campaign and of this time in dentistry? Dave: Our ability to assess the interplay between work force issues and marketplace issues will set the course for dentistry in the foreseeable future. Right now, in most areas, our ability to deliver care outstrips de mand. This imbalance then influences dentists' market place decisions. We need to educate our mem bers so that they'll make in formed decisions regarding these marketplace choices; and we need to influence legislation and regulation to be sure that no harm is done to our pa tients-and our profession-in the meantime.

VDJ: How will your leadership help us handle the issues in the marketplace and the changes in dental care delivery? Dave: I've testified before Senate committees, House committees, OSHA, EPA and others... representing dentistry...under pressure...in very tense situations. I believe experience like this is what we will need to successfully de liver our message over the next several years.

I think that we need to be friendly, but extremely finn, when dentistry's role in protect ing our patients and supporting our members is attacked. There are legitimate ways we can do that. VDl: What is your position on regulatory reform? Dave: Enough is enough! I know from the testimonies I have mentioned that often, regulators blatantly don't follow science and they ignore cost-benefit analyses. We, as a profession, have consistently followed the science and we'll continue to do that..I believe our job now is to effectively use the political process to influence the regulatory pro cess. VDl: ADA membership and membership growth is our strength. How do you want the ADA to position itself to in crease its numbers? Dave: We have to document and demonstrate the value of membership. There is no doubt that ADA membership is extremely valuable in every sense, and that includes in financial terms. We have to do a better job of getting that message out. We have to continue to support the changing face of dentistry; let all dentists know of that support in order to increase the

strength of our Association and our profession. Each dentist has to have a sense of belonging to our Association and it is up to each of us to make that happen. I would like for the member ship to feel that the Association had strong, responsible leader ship and each one of them felt they understood what the Association was doing and why it was doing it, and that they had a strong voice representing their concerns. VDl: We cannot ignore poli tics. What is the legislative approach you would want for the ADA? Dave: Legislative and member ship issues are tied together. Obviously, there's strength in unity and strength in numbers. The grassroots effort has been terrific. About 15,000 dentists have shown that they under stand the importance of politi cal action and all that they have to do is be asked and they're ready to go to work. Do I think we have been active enough politically? No, but "no" is the short answer. We're certainly improving, but we, led by ADPAC and grassroots efforts, should ask ourselves every day what we can do to get better. VDl: There are always "Hot Button" issues out there and you have been active in most of

them. You're the ADA spokes person on waste water issues. Your district offered the direct reimbursement resolution. Give me your thoughts on some of these issues. Dave: Our Critical Task Force at the ADA is getting better at handling these issues as they come up. Knowledge is still power; when a crisis arises, we want those involved to look to the American Dental Associa tion for valid scientifically based answers, rather than using emotional manipulations that frustrate our patients. Again, we will follow the science and aggressively ask others to do the same. We need to pursue every opportunity to educate our patients and our members to the legitimate alternatives in the marketplace. Direct reimburse ment and direct assignment initiatives certainly fit in this category and I'll continue to push their visibility at every opportunity. VDl: We know you and have seen you in action, and think we know your strong points. Tell us what your strong points are. Dave: I've had experience representing dentistry in some tough situations, here in Wash ington and elsewhere, and that should make a difference. My intent would be to work very

hard so that our members get the results they expect from the president of our Association. VDJ: Dave, thanks for your candid assessment of the opportunities facing us and your positive approach to the issues. Best wishes for the campaign andfor success in

Orlando.S

PHOTO AT RIGHT: Past ADA President andformer 16th District Trustee Dr. Jim Gaines ofGreenville, SC (i.) endorses the present 16th District Trustee, Dr. Dave Whiston, as he announces his candidacy for ADA President Elect in Las Vegas.

Diversion Alert! The Department of State Police has recently developed a Diversion Alert FAX System (DAFS) and announces its implementation as of January 1996. DAFS is designed to provide the pharmaceutical community with critical infor mation needed to aid in the prevention of diversion activi ties. If a practitioner discovers a prescription pad stolen, alter ations to his/her prescriptions and/or the illegal use of a name or DEA number in order to obtain false telephone prescrip tions, the practitioner should contact the State Police Diver-

sion Investigative Unit (DIU). Pharmacists can also provide similar information which will be verified before its inclusion in the system. DIU, through DAFS, will send a single page, computer-generated alert con taining the critical information to all fax-equipped pharmacies within the practitioner's county/ city and surrounding jurisdic tions. Additionally, all Revco and Rite Aid stores will receive this information through their respective corporate centers. DAFS is an additional tool that we can all utilize to help eliminate the unnecessary diversion of pharmaceutical

_ drugs into our communities. The system will only be suc cessful if you provide the appropriate information to the Virginia State Police for dis semination. The contact num bers are 804/323-2322 or 804/ 323-2343 between 8:00 a.m. and 4:00 p.m., Monday through Friday, or the Virginia Drug Hotline, 1/8oo/553-DOPE (3673) during other times and tell them this is a DAFS re quest. Help make your commu nity diversion-free! ti

Needlesticks: What to Do After It Happens by Gregory E. Kaugars, D.D.S.*

Dennis G. Page, D.D.S., M.S.**

Louis M. Abbey, D.M.D., M.S.*

James C. Burns, D.D.S., M.Ed., Ph.D. *

John A. Svirsky, D.D.S., M.Ed.*

*Professo r, Department of Oral Pathology, MCV School of Dentistry ** Associate Professor, De partment of Oral Pathology, MCV School of Dentistry Every attempt should be made to prevent an occupational injury that would expose either the dentist or dental personnel to the body fluids of a patient. However, given the small physical area of the oral cavity and the numerous sharp instru ments employed in dentistry, it is inevitable that accidents will occur. In the past, needlesticks were considered to be just another occupational hazard of dentistry, a nuisance that could cause short-term pain but of no real significance. However, the possibility of exposure to AIDS or hepatitis has dramatically changed our approach of how to deal medically, legally, ethically and financially with this problem For the purpose of this article, the term needlestick refers to either a parenteral, skin, mucous mem brane or ocular exposure that exposed the health care worker (HCW) to the body fluids of a patient. It does not have to involve a needle and it does not

mean that there is a penetrating injury. We will look at the following aspects: (1) The prevalence of the human immunodeficiency virus (HIV) and the hepatitis viruses in the general popula tion and among HCWs (2) The frequency of needlesticks among HCWs in general and among dental personnel (3) The immediate clinical response to a needlestick (4) Recommenda tions for follow-up after a needlestick and (5) The legal, ethical and financial responsi bilities of the dentist-employer in the case of an employee suffering a needlestick.

Prevalence of HIV and Hepatitis We naturally consider HIV and hepatitis together because of some of the common clinical factors. A study of dental school patients showed that 2.8% of them with a history of hepatitis B were also HIV seropositive.' It is estimated that there are one million people in the United States who are currently HN-seropositive? and that 750,000-1,000,000 are

carriers for hepatitis B. Of the 5,700,000 HCWs in the U.S., an estimated 18,240 (0.32%) are HN-seropositive-' which is comparable to the prevalence in the general population. Of the 10,424 HCWs with known specified jobs and diagnosed with AIDS as of September 20, 1993,309 (3.0%) worked in dentistry."

Occupational HIV Infection An infection acquired while on the job is difficult to prove because the serum status of the HCW at the time of exposure needs to be ascertained and the possibility of non-work activi ties causing the infection needs to be ruled out. The Centers for Disease Control (CDC) classify occupational cases of HIV transmission into either docu mented or possible. As of September 20, 1993 4 , there were 39 documented cases of HCWs becoming HIV seropositive because of job related activities. The affected individuals were typically employed in the care of HIV seropositive patients or in research facilities that used HIV-contaminated fluids but

none were in dentistry. As of September 30, 1993 4 , there were 81 cases of HIV infections among HCWs that were listed as possibly being related to their job. There were six dental personnel in this group. Another way of looking at this problem is to monitor HCWs who have been exposed and determine what percentage become HIV-seropositive. An early study by the CDC moni tored HCWs who had been exposed to HIV-seropositive blood between 1983 and 1988. 5 It became apparent that the perenteral route was more dangerous because four of the 860 (0.47%) HCWs exposed in that fashion became HIV seropositive as compared to none of 103 with mucous membrane or nonintact skin exposure. In a similar study done at the National Institutes of Health (NIH), one of 179 (0.56%) HCWs became HIV seropositive after a parenteral exposure, but none of 346 with a mucous membrane exposure and none of 2,712 with a cutaneous exposure became HIV-seropositive. Pooling the date from several large studies indicate that the probability of HIV seroconversion after exposure to HN-seropositive blood by the parenteral route is approximately 0.4%, or about one in 250 incidents.' How ever, the probability of HIV transmission is higher as the amount of blood involved 12

increases, as the depth of the penetration increases, and as the CD4 count of the patient decreases. These and other factors are considered in ascer taining risk, but the probability for an individual HCW is unknown. There is underreporting of parenteral exposures by HCWs because one study showed that only one-third of these inci dents in a hospital setting were reported.f One surprising finding was that only 37% of the exposures in a hospital were considered preventable with the use of universal precautions.> Between January 1, 1992, and June 30, 1992, there were 331 reported needlesticks among the faculty, residents and staff at the Medical College of Virginia Hospitals. This is approximately two incidents per day but does not include students at the medical center. It is not known how often exposure to HN-seropositive fluids occurs in dentistry or if there is underreporting. How ever, one study showed that the median number of needlesticks recalled by dentists was three per year, but there was consid erable variability with some dentist claiming that several hundred such incidents oc curred every year.? One study evaluated the prevalence of occupational HIV infection in a group of 1,309 dental personnel in the New York City area and

voluntary participants at Ameri can Dental Association (ADA) meetings." Most were dentists, but there were also 131 dental hygienists and 46 dental assis tants. Participants who were in a high-risk group for HIV were self-excluded. The study was conducted between 1985 and 1987, which means that there was wide variability as to the observance of what are now known as universal precautions. For example, 31 % of the dentists always used gloves as compared to 73% of the dental hygienists. Of the 1,309 dental personnel who were evaluated, there was only one dentist (0.08%) who was HIV seropositive. The infected dentist had practiced in the New York City area for 14 years and had intermittently used universal precautions. The dentist's wife refused to be tested for HIV.

Occupational Hepatitis Infection Hepatitis is a greater occupa tional risk than HIV. The possibility of developing hepatitis after parenteral expo sure to HBeAg+ blood is approximately 30% as com pared to a 0.4% risk for HIV seropositive blood.f As recently as the late 1980s, an estimated 12,000 American HCWs contracted hepatitis B per year and there were 200 deaths per year." Compare this to the total of 39 documented occupational

cases of mv transmission that have been reported.f It is anticipated that the number of occupational hepatitis cases will decrease as universal precautions become more widely practiced and hepatitis vaccination is more common. Although much has been written about hepatitis B, it should be understood that there are five major types of hepatitis (Table 1). Hepatitis C and D share many of the features of hepatitis B but may be more dangerous because immunity may not develop after an infection and a higher probabil ity of developing chronic liver disease or liver canoer. The survey of New York City and ADA dental personnel that found one mv-seropositive dentist also discovered that 24% of the unvaccinated dentists had antibodies to HB sAg as compared to 10% of the hygienists and assistants'?

Treatment for a Needlestick Injury The first consideration is to decide if the incident warrants any treatment or follow-up. Unfortunately, there are no specific guidelines for making this difficult decision. A paren teral exposure is much more likely to transmit disease but there have been documented cases of transmission with cutaneous exposure.

If we assume that the exposure is worth treating, then these steps should be done immedi ately:6.8 1) Induce bleeding at the site. 2) Rinse with soap and water. 3) Clean with antiseptic. There is no evidence to indicate that doing these will prevent the transmission of either mv or hepatitis. However, there does not seem to be any reason not to do them. Excision or incision of the affected site is generally !lQt recommended. After cleaning the wound, a detailed account of the incident should be written down so that it can be referred to at a later time. When doing this, keep in mind that no detail is too small in a situation like this. If the injured person is an employee, a sympathetic approach may reduce some of the anxiety and the personal attention of the dentist-em ployer would be comforting. As soon as possible after the exposure, the patient's serum status in regard to HIV and hepatitis should be ascertained. If either one or both is positive, the patient's physician should be contacted to obtain details in regard to when the tests were done and the results. However, in most cases the patient is unaware of their serum status or the tests may not have been done recently. In this circum

stance it is necessary to obtain a blood sample from the patient. This difficult situation should be handled with tact but the law is quite clear in asserting that the patient has provided deemed consent for the exami nation of their blood for HfV , hepatitis B and hepatitis C (32.1-45.1 of the Code of Virginia). It is the responsibility of the dentist to inform the patient of this law prior to rendering routine care that might result in the exposure of a HCW to the body fluids of a patient. The patient's blood should be collected as quickly as possible because it may be several days before the results are available. The law is also applicable to the situation when a patient is exposed to the body fluids of the HCW, which means that the patient can demand to know the HIV, hepatitis B and C status of the HCW. The Virginia law does not specify who is re quired to pay for the serum analysis. The affected employee must be referred to a qualified health care provider (RCP) as soon as possible with the following information.? 1) A copy of the current OSHA regulations in regard to needlestick injuries 2) Description of the employee's duties as they relate to the incident (Continued on/allowing page) 13

3) Circumstances of the expo sure 4) Results of the patient's blood values if available 5) Vaccination status of the employee Typically, the following serum analyses will be ordered if the values are not known or if the tests have not been done re cently: 1) HIV antibody profile 2) Hepatitis B profile 3) Hepatitis C antibody

Please note that these are general recommendations and might be modified for a particu lar individual or be revised in the future. The employee has the option of having blood drawn and stored for 90 days before deciding to have it analyzed. This would allow time to find out the patient's serum status. The HCP will evaluate the affected employee and will decide what serology is indi cated and counsel the employee after the results are known. Within 15 days the employer should receive a written report as to whether a hepatitis vac cine was given and if the employee has been told of the need for further evaluation or testing. The results of the employee's HIV or hepatitis status will not be reported back to the employer. It is unclear as to what are the responsibilities 14

of the dentist/employer who decides to act in the capacity of the qualified HCP by referring the employee to himself or herself. The ADA recommends that an individual be tested for HBsAg and HN if exposed to the blood of a patient. 10 If the patient is HIV-seropositive, then the HCW should have a baseline serologic evaluation and be retested at six weeks, 12 weeks and a minimum of six months after exposure. If the patient is known to be HIV negative, then no follow-up is indicated unless there is evi dence that suggests the patient may have been recently in fected. However, it should be noted that according to the ADA's guidelines the employee may request serologic testing even if there is no apparent medical indication. The Vir ginia Dental Association endorses the ADA guidelines. One decision that must be made within two hours of the needlestick is whether the affected employee should receive post-exposure chemoprophylaxis for HIV, which usually involves the administration of oral AZT for 4-8 weeks. There is no proof that AZf will decrease the probability of HIV transmission but it should be offered to the affected employee. There have been at least eight cases of occupational mv transmission

that occurred in spite of AZT administration.f The current consensus is that if AZT is to be given, it should be started within two hours of the expo sure for it to have any effective ness. If a HIV seroconversion is to occur, then the affected individual will usually have flu like symptoms within 12 weeks of exposure.V Therefore, every febrile illness should be evaluated during that time. Prophylaxis for hepatitis is more straightforward and is determined by assessing the patient's and the HCW's status and then administering either hepatitis B vaccine or hepatitis B immune globulin. Financial Considerations How much does it cost to do the baseline serology for an employee or a patient? In 1994, the Medical College of Virginia Hospitals charged $226 per person for the three recom mended elements of the evalua tion serology (HIV anitbody profile, hepatitis B profile, hepatitis C antibody). The financial impact can be readily appreciated if you consider that at least two people are involved (patient and HCW) and that possibly three serologic follow up evaluations after the baseline will be required. The law is specific as to the fact that the affected employee should not have to pay for the

medical evaluation, serology, and required follow-up after exposure to a patient's body fluids.? However, the law does not say that the dentist-em ployer has to pay. Workmen's Compensation insurance plans will usually cover the medical expenses associated with evaluation and treatment of an employee that has a job-related injury. It should be pointed out that the dentist should be careful to be sure that he or she is also covered under the Workmen's Compensation plans for the practice. Trigon Blue Cross/Blue Shield of Virginia will pay for the evalu ation of the patient' s.blood if you certify that the patient belongs to one of the following groups: 11 1) Homosexual or bisexual male 2) IV drug abuser 3) Has clinical signs of AIDS 4) Recent immigrant from a country with a high rate of heterosexual AIDS transmis sion 5) Prostitute or a sex partner of a prostitute 6) Sex partner of an HIV seropositive or at risk person 7) Rape victim 8) Hemophiliac who has re ceived certain blood products 9) Newborn infant of a high risk mother 10) Received a blood transfu sion before 1985. Trigon does not require that the patient be identified with one

specific category, just that the patient meets the requirements for one of the categories. Another possibility is to have the HIV evaluation done at a local, county or state health clinic. Although there is no uniform statewide policy, free illV testing is available at many of these clinics. If the employee elects to be treated with AZT, the approxi mate cost for one month of medication is $250.

Summary A needlestick injury can be a frightening and even potentially a life-threatening event. It needs to be treated with com passion and some urgency. The dentist-employer should act with knowledge of the current law and with the desire to do whatever is best for the affected people. Note: This article is intended to be an overview of the topic of needlestick injuries and should not be used as the sole medical or legal guide in regard to dealing with this problem. Qualified physicians and attorneys should be contacted for expert guidance.

References

Broder S, Merigan TC, Bolognesi D., eds Textbook of AIDS Medicine. Baltimore: Williams & Wilkins, 1994: 91-108. 3. Beekmann SE, Fahey BJ, Gerberding JL, Henderson DK. Risky business: using necessarily imprecise casualty counts to estimate occupa tional risks for HIV -1 infection. Infect Control Hosp Epidemiol 1990; 11:371-9.

4. Centers for Disease Control. HIV/ AIDS Surveillance Report. 1993; 5(3): 13.

5. Marcus R. Surveillance of health care workers exposed to blood from patients infected with the human immunodeficiency virus. New Eng J Med 1988; 319:1118-23. 6. Henderson DK. mv transmission in the health care environment. In: Broder S, Merigan TC, Bolognesi D., eds. Textbook of AIDS medicine. Baltimore: Williams & Wilkins, 1994: 831-9. 7. Klen RS, Phelan JA, Freeman K, et al. Low occupational risk of human immunodeficiency virus infection among dental professionals. New EngI J Med 1988; 318:86-90.

8. Gerberding JL. Managing occupa tional exposures to HIV. In: Broder, S. Merigan TC, Bolognesi D., eds. Textbook of AIDS Medicine. Balti more: Williams & Wilkins, 1994: 841-3.

9. Anonymous. Federal Register 1991; 56:64179-80.

1. Cade JE, Boozer CH, Lancaster DM, Lundgren G. HIV-l antibody positive hepatitis B surface antigen serum in a dental school population. Oral Surg Med Oral Pathol 1994; 78:670-2. 2. Jones WK., Curran JW. Epidemiol ogy in industrialized countries. In:.

10. American Dental Association. Management of persons exposed to blood. 1994. 11. Anonymous. Payment criteria for AIDS testing. Medical Office Adviser 1990; 2.

Hepatitis

food, water

IVDU

water

Incubation

2-6 weeks

3-7 weeks

Prevalence in US

?lO%'t

?4%

Type

Transmission

.... c

Symptoms

none or mild

Carrier state

no no no no ? ?

? no

Treatment of a Habitual Smoker Using Nicotine Gum: A CaseReport

by Jesse R. Wall, D.D.S. In the Commonwealth of Virginia, as well as many other states, it is now accepted treatment for dentists to pre scribe medications to aid their patients of record in stopping smoking. Smoking can cause our patients to die prematurely. Diseases such as lung cancer, heart attack, stroke, emphysema and chronic bronchitis are all prevalent in smokers. Oral cancer, delayed healing, in creased periodontal disease and increased bone loss in both gen eralized early onset.periodon titis and adult periodontics are results of smoking. 1,6 According to a recent study, only eight percent of dentists prescribe the dermal patch for smokers and only three percent prescribe nicotine gum for these patients. We as dentists, assistants and hygienists can see the results of smoking perhaps better than anyone else because we see our patients more often than other health professionals, we have a chance to counsel them and treat their smoking habits with greater freq uency. 2,3 Dermal patches are prescribed in three different strengths. Usually the patient who smokes at least one half a pack of cigarettes and weighs at least 100 pounds will be started on

the strongest patch. This patch delivers 21mg of nicotine over 24 hours and is to be worn at all times. This patch is worn for four to eight weeks and then the patient is started on a 14mg patch for an additional two to four weeks. Lastly the patient is placed on a 7mg patch for an additional two to four weeks. The light smoker or smaller patient will be started at the 14mg level for four weeks followed by the 7mg patch for an additional two to four weeks.f

ing to 4mg. The gum is pre scribed in lots of 96 pieces and the patient is instructed to chew 10 to 12 pieces daily, not to exceed 30 pieces. The patient is to stay on treatment for at least six weeks and is to start with drawal it two to three months.>

The advantage of the dermal patch treatment is that patients need change their patch only once daily. An additional advantage is that the patient will not be dependent on an oral habit for receiving nicotine dosing during the withdrawal period. Disadvantages are, of course, there are only three dose strengths available, and that the patients often start a new oral habit such as gum chewing or sucking on candy.

When prescribing either system the patient must under stand that all smoking must stop when treatment begins.

Nicotine gum comes in two dosage strengths: 2mg and 4 mg. The 4mg dose is recom mended for very heavy smokers who smoke more than 25 cigarettes a day. Dose adjust ment needs to be done during the first two weeks of use either decreasing to 2 mg or increas

Advantages of the nicotine gum are that it is easy for the patient and doctor to change dosage and that it replaces smoking with an oral habit which is providing the patient with nicotine.

Case Report A 48 year-old male Caucasian was questioned concerning his smoking habits. The patient reported that he had smoked both cigarettes and pipe for 28 years. He had a family history of stroke and heart disease. The patient had excellent oral hygiene, but had moderate staining of his lower incisors. His general health was excel lent. When advised to stop smoking the patient related that he would like to quit. The patient had used the Nicodenn TM patch on 17

prescription of a physician. This was prescribed in the 2lmg dose; there was no follow-up by the physician's office. Upon further question ing, it was established that this patient was smoking one pack of cigarettes a day. When using the dermal patch, the patient suffered from nausea, diarrhea, headache and insomnia. The patient left the patch on 24 hours a day but ceased treat ment after less than ten days. As this was a patient that clearly had a smoking habit and a desire to stop that habit, the use of nicotine gum was dis cussed with the patient. Upon getting a positive response from the patient, a dose of 2 mg of nicotine gum was selected. The patient was given a prescription for 96 pieces of this gum and instructed in its use. Particular care was taken to explain to the patient to chew 10-12 pieces daily and not to exceed 30 pieces a day. Furthermore the patient was instructed to chew 10-15 times and then rest the gum on his cheek, waiting for effects of the nicotine. If the patient's need for nicotine was then satisfied, he was instructed to remove the gum and place it in sanitary storage for later use.

The patient was closely followed and reported very little problem with side ef fects-only slight diarrhea and no headaches or nausea. The

patient successfully terminated his use of both cigarettes and pipe smoking and remained on the nicotine gum for six months. Chewing sugarless gum was encouraged; this replaced the nicotine gum in increasing parts each week.

DiscussioD When prescribing nicotine gum, the patient should be advised to stop all smoking. Help the patient to pick a quitting time. Long airplane trips or a lecture series could be times when the patient could not smoke and would greatly appreciate the use of nicotine gum. Smokers receive the nicotine from tobacco in small amounts throughout their day. The average cigarette smoker takes in eight varying doses from each cigarette. The nicotine enters the system through the lungs almost immediately. The craving for nicotine having been satisfied, the patient refrains from smoking until his or her system calls for another nicotine dose. When using nicotine gum the patient chews to receive an amount of nicotine. Delivered through the lingual varicies, the nicotine reaches the patient's system almost as rapidly as when smoking. As the patient's need is satisfied, he or she can remove the gum or place it

along the cheek in an inactive position. This system allows the patient to mimic more closely his or her nicotine use when smoking that does a patch which places a constant amount of nicotine in his or her system. In addition, the patient is able to monitor dosage using gum and make adjustments hourly instead of waiting to have the doctor change the dosage of a patch. Since the systems of nicotine overdose and nicotine withdrawal are the same, it is important for dose correction to be done easily and in small amounts. Conclusions Patients can successfully stop smoking if given encourage ment and supportive therapy. The use of nicotine gum can be an important aid in treating the habitual smoker and is a drug that is easy to prescribe and use. It is my opinion that more dentists would prescribe nico tine gum if they believe that it will help their patients. Many dentists feel uncomfortable in prescribing the patch system because of complications and even deaths which have been reported in the media. What ever reasons exist, a majority of dentists are not using nicotine therapy to help their patients quit smoking.

(References appear onfollow ing page.)

References 1. Christen AG, Daughton D, Rennard S, Repsher L. The 6-2-2 Committed Quitter's Program. Marion Merrell Dow Inc., 1993.

2. Horman M, et al. Dental Therapeutic Digest. 1995;94-99. 3. Geboy MJ, Dentist's involve ment in smoking cessation coun seling.1ADA 1989; 118:79-83. 4. Hastreiter R, Basharm B, Roesch M, Walseth U. Use of tobacco prevention and cessation strategies and techniques in the dental office. lADA 1994:125:75 84.

Virginia inductees into the American College of Dentists include (l. to r.): David C. Sarrett, Richmond; Rodney J. Klima, Burke;

Joseph A. Riley, Hampton; James D. Watkins, Hampton; D. Chris topher Hamlin, Norfolk; McKinley L. Price, Newport News; Bernard T. Carr, Alexandria; C. Marshall Mahanes, Norfolk; Wallace G. Smith, Portsmouth; James A. Snyder, Alexandria.

5. Product information as of November 1993; Nicorene™, Nicorettet'" DS, Jl72n. 6. Schenkein HS, Gunsolley lC,

Koertge T, Schenkein lG, Tew lG. JADA 1995; 126: 1107-1113.

Jesse R. Wall, D.D.S. is a gen eral practitioner in Danville. A native ofDanville, he is a 1976 graduate of the West Virginia University School of Dentistry and a member of the Waller Dental Research Group. /). Virginia officers of the International College of Dentists meet with Dr. Dave Whiston, 16th District Trustee and candidate for ADA President Elect: (I. to r.) Dr. Whiston, Dr. Dan Laskin, ICD Editor for Virginia; Dr. Steve Bissell, Virginia ICD Councillor; and Dr. Will Allison, ICD Deputy Regentfor Virginia.

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to sealer placement, alcohol has been suggested to dehydrate canal walls. The purpose of this in vitro study was to dehydrate canal walls with alcohol and determine if this permitted better sealer coverage of root canal walls during obturation. Forty single-rooted, extracted teeth were instrumented to an apical size #35 file using a step back flare technique; canals were coronally flared with #3 and 4 Gates Glidden burs. The teeth were randomly divided into four groups of ten accord ing to the method of sealer placement and final irrigant: (a) lentulo spiral and sodium hypochlorite (NaGCl) (b) file and NaGCI (c) lentulo and alcohol and (d) file and alcohol. Following canal preparation, all teeth were irrigated with either 1 m1 of 95% alcohol or NaGCI and carefully dried with fine paper points. AH26 sealer, dyed with carbon black powder, was immediately placed into the canals as follows: In groups 1 and 3, a #3lentulo spiral was covered with sealer, placed to length and activated for five seconds within the canal; in

no additional sealer. Excess gutta percha was removed and IRM was placed in the access opening. Teeth were decalci fied, dehydrated and cleared. The obturated, cleared teeth were placed next to a millime ter ruler and photographed on both promixmal sides. Canals were evaluated as to the amount of sealer present within the coronal, middle and apical thirds. Each region was evalu ated as follows: (a) no sealer present (b) <50% of viewed region with sealer present (c) >50% of viewed region with sealer present. Results of this study demon strated that there were no statistically significant differ ences among the four groups. All regions examined had sealer present, the coronal third demonstrated the greatest sealer coverage (all but one specimen had >50% coverage), and the middle and apical thirds showed the most variability in sealer coverage. Alcohol as an additional dehydrating agent did not improve sealer coverage within the canals.

Dr. Thomas J. Beeson is a second year postgraduate student in endodontics at MCVIVCU School of Dentistry and is a 1983 gradu ate of the University ofNebraska School of Dentistry. He completed a General Practice Residency at the University ofMississippi in 1984 and is currently a Lieutenant Colonel in the United States Air Force.

Trope M, Moshonov J, Nissan R, Buxt P, Yesiloy C. Short vs Long Term Calcium Hydroxide Treatment of Established Inflammatory Root Resorption in Replanted Dog Teeth. Endodontics and Dental Trau matology 1995; 11: 124-128. Pulp removal and subsequent root canal treatment-soon after avulsion and replantation is critical for the prevention and! or treatment of inflammatory root resorption, especially in teeth with bacterial infection or periodontal damage. Calcium hydroxide as an intra canal medicament has been advo cated as an antibacterial dress ing and as a treatment for resorption, thus promoting healing. The purpose of this study was to histologically examine the healing of damaged root sur faces in replanted teeth with established inflammatory root resorption treated with long and short-term calcium hydrox ide therapy. Thirty beagle dog incisors were randomly divided into four groups. In group 1 (negative control) five teeth were instrumented and obtur

ated with gutta percha and sealer, extracted two weeks later. a portion of the root denuded then replanted and splinted with suture for 14 days. In group 2 the pulps were extirpated and infected with dog plaque then sealed. They were extracted and replanted as in group 1. At the first sign of radiographic root resorption or at four weeks the canals were fully instrumented and calcium hydroxide placed for one week then permanently obturated. Group 3 was treated as group 2, but after one week of calcium hydroxide therapy the canal was reopened and a fresh mix of calcium hydroxide placed in the canal and sealed for the remainder of the study. In group 4 (positive control) the teeth were treated as groups 2 and 3, but endodontic treatment was not performed. Twelve weeks after initiation of endodontic therapy, sacrifice and histologic preparation were carried out. Results: Complete cemental repair was seen in all teeth from group 1, five of ten teeth in group 2, nine of ten teeth in group 3 and zero teeth in group 4. Their conclusions included inflammatory root resorption: 1) is prevented by elimination of bacteria from the root canal 2) results from root canal infection coupled with cemental damage 3) is more effectively treated with long-term vs one

week calcium hydroxide therapy. Thomas J. Beeson, D.D.S. Dr. Maryam M. Monfared is a second-year postgraduate student in endodontics. She is a graduate ofS.UN.Y. at Stony Brook and received her DD.S,from the MCVIVCU School ofDentistry in 1991. Dr. Morfared completed a General Practice Residency in the University ofMaryland Hospitals in 1992 and practiced in general dentistry in Northern Virginia from 1992 to 1994.

Battrum DE, Guttman JL. Implications, prevention and management of subcutaneous emphysema during treatment. Endodontics and Dental Traumatology 1995; 11: 109 114. Subcutaneous emphysema (SCE) is the abnormal presence of air under pressure, along or between fascial planes and is a possible complication of both surgical and nonsurgical endodontic treatment. The purpose of this article was to review pertinent literature, detail anatomical pathways involved and discuss prevention and management of SCE during endodontic procedures. There are approximately 30 cases of endodontically induced SCE in the literature. In many of these cases hydrogen peroxide or compressed air had been used in the root canal system. These actions may introduce air into the periapical tissues and fas cial planes with three potential

sequelae. Initially, it can remain in the space until it is resorbed, leading to immediate "balloon ing" and crepitus of the in volved tissues. The air can also escape along the path of intro duction and be released into the room air or it can enter a blood vessel in a large enough volume to cause obstruction of coro nary or cranial flow with pos sible fatal consequences. SCE induced during endodontic treatment may last several days to a few weeks and can involve both facial and neck regions. Immediate clini cal features included localized swelling, discomfort and crepitus. Later widespread edema, erythema, pyrexia and sometimes pain may be en countered. Trismus, poor healing of involved tissues and chronic pain may occur in advanced cases. When regions in the neck are involved respi ratory difficulty may develop. To prevent SCE during non surgical endodontic treatment: 1) Avoid the use of compressed air once the root canal has been opened 2) Avoid the use of hydrogen peroxide while irrigating root canals with open apices, possible perforations or highly hemorrhagic pulps. If hydrogen peroxide is to be used it must be ensured that it is retained within the root canal space. During surgery the use of specific "vented" hand pieces, sonics or ultrasonics for root end preparation, and 22

avoidance of the use of the compressed air syringe during irrigation will decrease the risk of inducing SCE. Treatment involves the use of antibiotics and analgesics, with immediate medical attention if difficulty in breathing or swallowing should occur. Maryam M Monfared, D.D.S. Dr. Steven G. Forte is a first year postgraduate student in Endodon tics. He attended Virginia Com monwealth University and re ceived his D.D.S, degreejrom MCVIVCU School ofDentistry in 1995.

White S, Furuici R, Kyomen S. Microleakage through Dentin after Crown Cementation. Journal of Endodontics 1995; 21:9-12. A major cause of pulpal pathology is the microleakage of bacteria and/or their by products into the pulp. The bacterial pathway follows the spaces that exist between restorative materials and the cavity walls and then through the dentinal tubules into the pulp. Microleakage related to cast crowns may result from lack of adhesion of the luting cement, shrinkage of the ce ment during setting, cement dissolution or mechanical failure of the cement. The purpose of this study was to determine the influence of the type of crown luting agent upon the extent of microleakage beneath crowns.

Thirty-five intact human premolars extracted for orth odontic reasons were used. A standard crown preparation was made using a bullet-nosed chamfer-matched coarse dia mond and 12 fluted carbide finishing burs. Impressions were made with Reprosil and the resulting improved stone dies were trimmed using a lOX magnification. Dies were pained three times with die spacer, lightly lubricated and the coping was formed using a dipwax technique. The coping was immediately sprued and placed into a phosphate-bonded investment. Rexillium III base metal alloy was used for the casting. The external surface of the casting was polished and the internal surface was adapted to the die using 10X magnifica tion and a size 1/2 round bur. Space between the casting and die was measured at four predetermined points for each casting. These measurements were made by different opera tors at three separate times using 300X magnification. The copings were randomly as signed to 1 of 5 luting groups: Fleck's zinc phosphate, Durelon, Ketac-cern, Thin Film Cement & Tenure or Panavia. After cementation the coping was placed under a constant axial force of 49N for 7 min utes in a paralleling jig, fol lowed by storage in 100% humidity at 37"C for 24 hours and then 14 days of storage in

distilled water. Artificial aging was accomplished by thermal cycling and silver nitrate stain was used to demonstrate the extent of the leakage. The teeth were then set in clear epoxy resin and sectioned longitudi nally in both a mesio-distal and bucco-lingual direction. The shortest distance from the preparation margin to the pulp chamber and the linear penetra tion of silver nitrate were measured along the same line. The mean linear penetration of the dye was calculated as well as the mean linear of penetra tion as a percentage of total dentin thickness. The overall mean precemen ration marginal opening was 34um. The mean linear dye penetration from the external surface of the dentin toward the pulp was ranked from least leakage to most leakage and the results were as follows: Tenure, Ketac-cem, Panavia, Durleon and zinc phosphate. Ranking for the mean percentage dye penetration resulted in the same rank order. Multiple statistical comparison testing revealed that significantly less leakage occurred with the Tenure groups when compared to all other groups. Steven G. Forte, D.D.S.

Dr. Kris D. Johnson is afirst-year postgraduate student in endodon tics. He is a graduate of the University ofMinnesota-Duluth and received his D.D.S. degree from the University ofMinnesota in 1990. Dr. Johnson served in the U.S. Navy Dental Corps from 1990 to 1994, and practiced general dentistry in Minneapolis from 1994 to 1995.

Stabholz A., Rotstein 1, Torabinejad M. Effect of Preflaring on Tactile Detection of the Apical Constriction. Journal of Endodontics 1995; 21:92-4. The actual anatomical site for termination of root canal instrumentation and obturation has long been debated. Most clinicians choose to terminate at the apical constriction, but because it is not visible radio graphically, a working length must either be estimated from a specific area on the radiograph or determined by tactile detec tion of the apical constriction. The purpose of this study was to compare the efficacy of "feeling" the apical constriction in flared and nonflared root canals by tactile sensation. One hundred twenty root canals of adult patients were divided into two groups. In 68 root canals (Group 1), no flaring was performed. In Group 2, the coronal portion of 52 root canals were flared with Hedstrom files, Gates Glidden drills #2 to #4, and ultrasonic files. The canals were probed for their apical constrictions,

with #15 or #20 K files. Radio graphs were taken with files placed to the "felt" apical constriction, and the distance between the tip of the file and the radiographic apex measured and classified as (a) within 1 mrn of the radiographic apex (b) underextended by 1 mm or more from the radiographic apex; and (c) overextended beyond the radiographic apex. Generally, the ability to determine the apical constric tion by tactile sensation was significantly increased in the preflared canals. In the preflared canals 75.0% were classified as within 1 mm of the radiographic apex, as compared with 32.3% in the nonflared canals. Preflaring also resulted in a significantly lower inci dence of overextension than in nonflared canals (21 % versus 41%). In a clinical situation, preflaring the coronal portion of the canal and tactile determi nation of the apical constriction can reduce the risk of periapical injury and inflammation associ ated with overextended instru ments. This technique can result in more accurate determi nation of root canal length and reduce the number of radio graphs cleaning and shaping procedures. Kris D. Johnson, D.D.S.

Dr. Steven R. Sluyk is a first year postgraduate student in endodon tics. He received his D.D.S. degree from the MCV/VCU School of Dentistry in 1990 and practiced general dentistry in Phoenix Arizona for the last five yea;s.

examined histologically for pulpal inflammation. The presence of bacteria in the pulp and in the cavity preparation was also evaluated.

Torstenson B. Pulpal reaction to a dental adhesive in deep human cavities. Endodontics and Dental Traumatology 1995; 11:172-176.

Regardless of treatment 23 teeth revealed no inflammatory reaction and nine teeth exhib ited slight or moderate inflam mation. Some colonies of bacteria were found on the cavity walls and in the pulp of six teeth which demonstrated pulpal inflammation. In the absence of bacteria, Scotch bond 2 Adhesive and Tubulitec Liner systems ap peared to be well tolerated by the pulp when placed into deep cavity preparations. The pres ence of bacteria on the cavity walls indicates what gap forma tion had occurred at the inter face between the dentin and adhesive/composite restoration. This gap probably formed because of insufficient bond strength between the restoration and dentin that was unable to resist the contraction forces during polymerization. In conclusion, a complete seal between the restorative material and cavity wall is necessary to reduce pulpal inflammation.

This biocompatibility study examined the short term pulpal reaction to composite restora tions placed in deep class V cavities. Eleven patients provided 32 premolars that were to be extracted for orthodontic reasons. Cylindrical cavities about 2mm in diameter by 2.5 mm deep were prepared on the buccal surfaces in vivo. All cavities were treated with Tubulicid Blue Label antibacte rial cleanser for one minute, dried, and acid etched for 15 seconds. Following rinsing and drying, 16 teeth were restored with Scotch prep Dentin Primer, Scotchbond 2 Light Cure Den tal Adhesive and P-50 compos ite resin. The remaining 16 teeth were restored with Tubulitec Primer, Tubulitec Liner and P-50 composite resin. Coltosol cement was placed over the composite restorations in all 32 teeth in an attempt to minimize bacterial contamina tion. The teeth were extracted arbitrarily between 6 and 14 days post-op and the pulp was 24

Steven R. Sluyk, D.D.S.

SVIRSKYon

Infection Control Editor's Note: The Virginia Dental Journal welcomes Dr. John A. Svirsky, Professor of Oral. Pathol ogy, MCV School of Dentistry and an ADA Spokesperson on AIDS, OSHA and Infection Control, as a regular contributor. The co.lumn will inform us on current circum stances regarding these topics, both good and bad. He will also address specific issues for Journal readers. You may call him at 8041 828-0547 or write him care ofthe Virginia Dental Journal, P.O. Box 6906 Richmond, VA 23230-0906, with your inquiries. Answers will appear in subsequent columns. Dr. Svirsky is on the program for the 1996 VDA Annual Meeting in Williamsburg.

Some recent reports have noted the accumulation of rrricroorganisms in water samples from some dental units. Exposure to microorgan isms does not necessarily lead to a disease state. Most of the food and water supplies that we come into contact with have some evidence of microorgan isms. There is no scientific evidence that there is disease transmission through dental unit water lines. Some of the problems in our society have been associated with trying to make a disease-free state in all patient encounters. This is neither realistic nor possible. One of the functions of the immune system is to protect us from the chance encounters with organisms in our daily life.

The current recommendations of the American Dental Asso ciation (ADA) call for flushing the dental unit water lines for several minutes at the start of each day. Additionally, flushing the handpiece for 30 seconds between patients should be performed. Ideas under investigation include a separate water supply, disinfecting existing dental unit waterlines with a chemical such as bleach or installing small filters that would block the passage of microorganisms to the handpiece.

Information on AIDS and Infection Control The ADA feels that it is important for dental practitio ners to act as patient advocates and encourage patients to discuss their concerns regarding safety in the dental office. The health of our patients is our primary concern, and dentists will do everything to ensure optimum oral health. Dental practitioners are able to do this by using universal precautions in all patient encounters. Uni versal precautions means using the same protective measures with every patient to prevent the transmission of bloodborne disease such as HIV and UB V. These precautions include: wearing gloves, masks and other personal protective equipment; hand washing and changing gloves after each patient; sterilizing dental

instruments; cleaning and disinfecting the treatment area; and disposal of needles, other sharp items and regulated waste materials in special containers. All of the more than 70 "look back" studies involving thou sands of patients treated by HIV-infected health care workers showed no other cases of transmission from dentist to patient outside of the Florida case. There is still controversy as to the mode of transmission of the Acer case, in which a dentist supposedly infected six patients in his practice. Some investigators feel he deliber ately infected the patients but the true answer probably went to the grave with him. A study of more than 19,000 patients treated by 57 HIV -infected health care workers did not confirm a single case of HIV transmission through medical or dental treatment. The CDC concludes from the studies that the risk for HIV transmission from health care worker to patient continues to be infini tesimal. To educate the public about the efficacy of universal pre cautions and safety in the dental office, the ADA in 1994 launched a national consumer education Campaign, "ADA Cares," that was distributed to all dentists in this country and reached an estimated audience of more than 40 million.

Some important points to emphasize to your patients and staff include: 1) Our office uses universal precautions for all patient treatment and by doing this, we are affording our patients the best treatment attainably in the world. Would you like to see the heat sterilization unit that is used to ensure that all instru ments in our practice are heat sterilized? All materials that are unable to be heat-sterilized in our practice are discarded. 2) Surfaces and equipment that cannot be removed for cleaning and sterilization-are disinfected by a chemical agent that is a hospital level disinfectant and is tuberculocidal. 3) Patients with potentially infectious diseases (PID) can be safely treated in dental offices when appropriate infection control procedures are used. The majority or patients with Pill are never identified during the time of treatment. History is a poor source for identifying patients with diseases such as mv and hepatitis. Most studies show that only 20-40 percent of patients are identified through history. Remember that most patients are most infectious before they even know they have the disease. Therefore, it is mandatory that all patients be treated the same and assume that every patient that we treat is potentially infectious. 26

4) Infection control is a con stantly evolving process, and our leadership organization (ADA) has constantly revised its recommendations as scien tific evidence comes forth. The ADA has been proactive and is constantly providing educa tional materials throughout the years for our practices to use in keeping abreast with this changing field. Information on the Dental Handpiece There have been no cases of disease transmission associated with contaminated dental handpieces or prophy angles. Even though this is true, the technology of handpiece fabri cation has reached the point where all manufactured hand pieces are able to withstand heat sterilization. Therefore, these instruments must be heat sterilized. All instruments used in dental practice should be either heat-sterilized or dis posed. Infection control is con tinually evolving, and the American Dental Association has consistently revised its recommendations as scientific evidence is gathered. ~

-------=

Executive Council Actions in Brief November 5, 1995

1) Approved a recommendation that the Executive Council adopt the following mission statement developed during the recent Goals and Roles Workshop as the mission statement for the Association: The mission or the Virginia Dental Association: Representing and serving member dentists by fostering quality oral health care and education.

2) Approved a recommendation that the Executive Council adopt the goals developed during the Goals and Roles Workshop as the current goals of the Virginia Dental Association as follows: To improve and expand membership services. To promote the policy of the Association through proactive legislative and regulatory advocacy on behalf of the public and the members of the Association. To increase membership recruitment and retention. To enhance membership communications•

•

To increase access to quality oral health care.

3. Approved a recommendation that the Ad Hoc Mission and Goals Committee meeting be held one day before the annual Fall Leadership Conference in both 1996 and 1997 and that a full Goals and Roles workshop be scheduled every third year, the first being Fall 1998, involving the elected members of the Executive Council and individual VDA members to be selected by the then president. 4. Approved a recommendation that the Virginia Dental Association adopt as policy that VDA mem bers not assigned an expense account in the VDA budget seeking to represent the VDA in any forum for which they intend to submit claim for reimbursement must have the prior approval of the VDA president and secretary-treasurer. An estimated list of expenses will be submitted when seeking ap proval. 5. Approved a recommendation that the Virginia Dental Association contribute $3,000 to the Virgin ians for Patient Choice Coalition, to assist in the legislative effort regarding Any Willing Provider bills. 6. Approved a recommendation that the Virginia Dental Association endorse the IMG Glove product to be marketed to the VDA membership as a VDA For Profit activity.

7. Postponed definitely a recommendation that the Virginia Dental Association adopt as policy that an annual review of the VDA executive director be conducted in January at the time of the Winter Com mittee Meetings.

8. Received as information only that a letter will be sent to each component society dealing with For Profit activities, asking each component to provide the executive director with a list prior to December 1, 1995, reflecting any product endorsements of other For Profit arrangements currently in effect for each component including the length of the contract and/or the contract termination date. Each compo nent will be asked not to enter into any new contractual arrangements for product endorsements of any For Profit arrangements subsequent to November 10, 1995. 9. Approved a recommendation that the Virginia Dental Assistants Association members be charged a $15 preregistration fee at the 1996 Annual Meeting and that the $25 Assistants fee stand for non VDAA members and that the VDAA preregistration fee be split with the VDA. 10. Approved a recommendation that the 1999meeting of the VDA be held in Northern Virginia, with a preferred site of the Hyatt Regency Hotel, Reston, VA. 11. Approved a recommendation that the 2001 meeting of theVDA be held in western Virginia, with consideration of a joint meeting with die West Virginia Dental Association, to be held at either The Homestead (preferred) or the Roanoke Convention Center. 12. Defeated a recommendationthatth~:c~iU-~~i~~~~¥~8dEeofthe "clinical examination" adminis of Virginia be determined tered for the purpose of obtainingsp~<:~altyr~lc~~r~~i~)h~'1F(),mmonwealth by the specialty in which the licensei~ito':l:>,~·~q!fii1l.~.i~~;;,;\;,"',;;f";~ , ~,;:~b'v:;,,; ,)

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13. Approved a recommenda~~n tffat contract by the VDA and .A]j,A..,;ci ... ,-

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~i'.:serve as liaison between the Dental Care ~~'Ai,e~_

15. Approved a recoiIimth(fa~' ance Program. \;

';Mutual Companies Personal Lines Insur

16. Approved a recomm~hD~g,~Q". Plan as of January 1, 1,~~6,,'C~ ~,' notice of termination O~.J) y

be considered for the 1998 Leadership

MCVNews

by Thomas C. Burke

Accreditation Preparation Highlights Seven Years of Growth In March, the School of Dentistry will undergo an accreditation review by the American Dental Association's Commission on Dental Ac creditation. This accrediting process, required every seven years, will review all aspects of the dental, dental hygiene and selected advanced education programs. The previous accreditation site visit was in 1988. Since that visit, the School has made major improvements in its physical facilities, as well as to its programs. Included in these physical plant changes are extensive renovations of the undergraduate clinics in both the Wood and Lyons Buildings, and the complete renovation of the graduate periodontics, endodontics, orthodontics and prosthodontics clinical facili ties. The most recent renovation of clinical space is the new Dental Hygiene Clinic, which was dedicated in October. Also, since 1988, we have instituted the Instrument Management System, the Computers in Dentistry Lab, and updated the audio/visual equipment in each of the lecture halls. These and

other capital projects resulted in the expenditure of more than $11 million. Along with these improve ments in the physical plant, the School has made major changes to its academic and clinical programs. Since 1988, the School has revised its DDS program by instituting a mod ule system during the students' clinical years. Juniors are now assigned to skill development groups, and seniors are as signed to specific general practice modules that are managed by a faculty leader and staff member who provide consistent leadership through out the year. We also received a federal grant to initiate an Advanced Education in General Dentistry Residency Program. This one year program is designed to increase competence and confidence in general dentistry for new graduates. We have also combined the MCV and the McGuire Veterans Hospital General Practice Residency Programs and made it a two year residency. Another major change in our residency pro grams is the addition of a third year in both Periodontics and Prosthodontics, as required by each specialty group. We have also instituted the M.D. option for our Oral Surgery Residents. There have also been im provements that do not fall into

either of these categories. The dedication of the Bennett A. Malbon Memorial Garden in October and the installation of the Boy on Stilts sculpture contributed by Dr. William Turner have had a profound impact on the School. It truly has been a remarkable seven years of both physical and programmatic changes that have propelled our School to the forefront of dental educa tion, as noted in the March 1993 issue of U.S. News and World Report. We appreciate the involvement and support of all those who have helped to make our School grow during the past seven years.

Mobile Oral Health Clinic Completes First Year of Service The School's Mobile Oral Health Clinic recently com pleted its first year of operation, providing dental services to over 3,000 indigent patients. The clinic traveled approxi mately 5,000 miles (at nine miles per gallon) to over 21 Virginia localities during the past 12 months. Most visits were scheduled to be day trips; however, the mobile clinic also complete two week-long trips to Roanoke and eastern Vir ginia. One of the highlights during the year was a community health fair in South Hill during April, which offered free oral 29

cancer and oral cavity screen ings. The Southside Dental Society sponsored the Mobile Clinic, which provided screen ings to over 300 individuals and was staffed by six local dentists who took shifts supervising seven dental students who accompanied the mobile clinic. Dr. Frank Farringon, Chairman of the Department of Pediatric Dentistry, said it was one of the best-organized health fairs he has attended. The mobile clinic is currently scheduled three days a week to provide both screenings and primary oral health care ser vices. The clinic is.staffed by a driver/manager, a full-time faculty member, junior and senior dental and dental hy giene students and Advanced Education in General Dentistry residents. Students and resi dents are assigned on a rota tional basis, and completing a tour with the Dental Clinic is a requirement of the School's clinical program. The primary care providers on the clinic are senior dental students. For additional information on the Mobile Clinic, or if you component might be interested in partnering with the School in supporting a community project, please contact Dr. Frank Farrington at 804/828 1790.

Component News COMPONENT! Tidewater Dental Society

Dr. Barry Einhorn Associate Editor We have several outstanding continuing education programs planned for the coming year. On February 16, in conjunction with a consortium of local laboratories, Dr. Tom Ford, who was a lab tech before he became a dentist, shared an interesting perspective with us. On April 11 and 12, Compo nents I and II will present a joint program featuring Dr. Kenneth Shay and Dr. Dan Laskin. Dr. Shay will talk on geriatric dentistry and Dr. Laskin will discuss surgical and non-surgical aspects of TMJ therapy. Further details of these programs will be forthcoming. We are proud of two of our colleagues who recently have been recognized for long time study in specialty areas. Dr. Truman Baxter, Jr., became a Diplomate of the American Board of Implant Dentistry. Dr. Jeremy Shulman was recog nized as a Diplomate of the American Academy of Pain Management. Our Component is constantly striving to find ways to market

membership in the ADA to local practitioners. Through the efforts of Dr. Bruce Barr our members are being offered special discounts by the follow ing local firms: GTE Mobilnet, A.G. Edwards and Son, Inc., Smith Barney and Co., Conolly Phillips Lincoln-Mercury, Beneficial Finance, and Com merce Bank. While these discounts are not a reason for membership, they do add to the long list of positive reasons to affiliate. COMPONENT II Peninsula Dental Society

Dr. Cory Butler Associate Editor The members of Component II hope that everyone had a wonderful holiday and wish you the best in 1996. Our component was active this winter. We held our annual legislators' night after the November elections and were able to welcome some newly elected officials as well as some old friends prior to the current General Assembly session. It is very important to keep up such contacts so that our voice can be heard; a good example is the "Any Willing Provider" legisla tion currently being debated. Additionally, in January, we

enjoyed a presentation by Dr. David Sarrett of MCV on "CAD/CAM Restorative Dentistry" and on February 12, we celebrated Valentine's Day with our spouses, a program which the Alliance of the Soci ety helped plan and sponsor. At the state level, the VDA com mittee meetings held in January were informative and we were well represented. As spring approaches a few thoughts come to mind, one of which is continuing education. Remember it is now mandatory to have a minimum 15 credit hours to maintain your license; second, learn as muc~h as pos sible about direct reimburse ment. The VDA is currently moving forward on this issue and at some point you may be asked by a patient to explain it; and third, get involved in organized dentistry-your efforts can make a difference. Upcoming events include a co-sponsored two-day CE seminar with Component 1 (April 11 & 12) at the Holiday Inn-Chesapeake with Dr. Kenneth Shay on "Older Pa tients: Clinical Challenges and Practical Approaches" (April 12) and Dr. Daniel Laskin on "Current Approaches to TMJ Therapy (April 11). The VDA committee meetings are sched uled for June 13-16 in Virginia Beach and the VDA Annual Meeting in September in Williamsburg. For more infor

mation on all these events called Kim Blore, executive secretary of the PDS at 804/ 259-0594. Have a fantastic spring!

Our new year began with our annual fellowship meeting on January 17 at the Country Club of Petersburg. Our spouses were with us for dinner and a program about domestic vio lence.

COMPONENT III

Southside Dental Society Dr. H. Reed Boyd, III Associate Editor The holiday season has passed and the decorations have been packed away for another season yet to come. It seems like the holidays are getting closer and closer together with each passing year. I do not know whether retail merchants try to get us in the shopping mode earlier each year or whether we keep getting older and the time just gets shorter that makes it seem that way, but I would swear the Christmas 1994 and Christmas 1995 were just two weeks apart. We elected new officers for our Component and they were installed at the VDA Annual Meeting in Reston in Septem ber. Our new officers are: President-Mike Hanley, Hopewell; President Elect Roger Palmer, Emporia; Secre tary-John Bass, South Hill; Treasurer-Richard Roadcap, Colonial Heights. Our Compo nent is in good hands and they have been hard at work plan ning an exciting and eventful year for our membership.

On February 9 we had an all day CE course. The morning session featured Dr. John Svirsky on "OSHA: An Annual Update." This course is de signed to satisfy OSHA's annual training requirement. The afternoon featured CPR training and allowed us to renew our CPR certifications. On February 24 our Dental Health Month celebration will be held at Southpark Mall in Colonial Heights. Our Component membership is scheduled to gather again at the Country Club of Petersburg on March 13 at 6:30 p.m. for fellowship and a business meeting. Then, in June, an interesting day has been planned for dedicated dentists and fun seekers all in the same day. We will meet in Emporia on June 12 with Dr. Joe Niamtu, a Richmond oral surgeon, who will discuss office management of emergencies. June 12 just happens to be the date of the incredible Pork Festival in Emporia and our meeting will break up just in time for us to attend this delicious event. They say if you like pork, this 31

is the place to be. We will be able to sample pork cooked every way imaginable. In September, several events are planned. Our VDA-spon sored CE course is scheduled for Friday, September 6. We will have another business meeting on Wednesday, Sep tember 11. Of course, the VDA's Annual Meeting is scheduled for September 18-22 in Williamsburg. Following on the heels of that meeting, the ADA's Annual Meeting is scheduled for Orlando, begin ning Saturday, September 28. At the Annual Meeting in September, two of our members received recognition. Dr. Marty Sheintoch received his 50 year certificate and Dr. T.e. Bradshaw received his 60 year certificate recognizing long and dedicated careers to dentistry and devotion to the VDA and organized dentistry. I have learned that another honor has been received by one our Component's members. Dr. Wayne Browder of Colonial Heights has been asked to serve in the position of teaching assistant at the L.D. Pankey Institute in Florida. Wayne was asked to serve in this position after completing all of the courses at the Pankey Institute and distinguishing himself as a student there. His appointment began January 1. Teaching assistants at the Pankey Insti

tute work closely with the students in the laboratory aspects of the courses they take there. They serve as liaisons between the faculty and the students at the Pankey Institute to enhance the learning experi ence. Wayne will spend one week during the next year in this position. Congratulations, Wayne. We are all proud of this accomplishment and your dedication to dentistry. I also understand a video entitled "Issues in Managed Care" is available for loan to members of the VDA and its component societies. This video is an hour and a half in length and covers the issues, pro and con, concerning man aged care and its impact on dentistry. You can contact the VDA central office in Rich mond for more information. As I am writing this, I re ceived my notice that my annual dues to the ADA, the VDA and the Southside Dental Society were due, along with the voluntary contribution to ADPACNADPAe. I am sure that many of you suffer the same sticker shock that I did when I opened the envelope. This envelope came shortly after the equipment bill arrived reflecting my recent purchases of a new air compressor and autoclave to replace ones that had broken down and were not worth the repair bills, both un expected expenses! Because of

my knowledge or what orga nized dentistry is doing for us, there was no debate about paying the dues, the only question was how! If you question whether or not you should pay your dues, I would like to suggest to you that you pay your dues one more year. Then you MUST attend the committee meetings, the VDA Leadership Conference, and your local component meetings. Then attend the VDA's annual meeting, picking up a few of the now mandatory CE credits along the way for free. I do not think you would question pay ing the dues again and would probably feel as I do---I cannot afford NOT to pay the dues, even when the money is no where in sight. Paying your dues is a small investment com pared to the time and energy leaders like Les Webb, Ron Tankersley, Will Allison and the other officers invest, along with their dues. Dr. David Whiston is running for ADA President Elect. I cannot imagine the time and money that he must commit and be prepared to spend in work ing for our best interests. I have gotten to know Dave and have found him to be knowledgeable and articulate. He is dedicated to furthering our best interests, not only as dentists and mem bers of the VDA and the ADA, but also the dental health of our patients. Dave will give what

ever it takes for us. He needs our support in his campaign for ADA president and WE NEED HIM! I would encourage you to do whatever you can to support his campaign and make it successful. I hope that each of you has a very prosperous new year and successful 1996. It is untouched and unknown to each of us, therefore unspoiled and full of potential. I hope that each of us made New Year's resolutions that will ask us to step up and face each and every challenge that 1996 holds. In that way, we will make the most of the challenges, creating new oppor tunities for ourselves and will become better persons as a re sult. I would hope that you have also decided to GIVE some thing back to dentistry in return for all that it has given us.

COMPONENT IV

Richmond Dental Society Dr. Gary R. Hartwell Associate Editor In October, Dr. James R. Schroeder resigned as President Elect of the Richmond Dental Society. The membership will miss Jim's expected leadership role as President in 1996-97. This unexpected resignation necessitated a special election to fill the vacancies created in the following positions: Dr. Benita A. Miller was elected

President Elect to replace Dr. Schroeder; Dr. Gary R. Hart well was elected to the position of Secretary to fill Dr. Miller's former position; and Dr. Charles E. Gaskins, TIl was elected to serve on the Board of Directors to replace Dr. Hart well. December was highlighted by the annual holiday social, held this year at the Tuckahoe Women's Club in Richmond. It was an evening filled with wonderful food, music and fellowship. A good time was had by all who were able to attend this elegant event. In spite of some nasty weather conditions, three extremely interesting and informative programs were presented during the regular monthly meetings held from January to March. In January, Kathryn Freeman-Jones spoke on "Essential Law for the Dental Practitioner." She was followed in February by Dr. Richard Lieb, whose topic was "Diag nosis and Treatment of Endo dontic Emergencies." Dr. Jeffrey Hudgins will speak on "Bonded Restorations" at the March meeting. Dr. Miriam Bar-On is the scheduled speaker for April and the title of the presentation will be "Child Abuse-Visual Diagno sis." We look forward to the May meeting, which is the Rich

mond Dental Society's annual tribute to the MCV/VCU grad uating dental class. In addition to an exciting afternoon of golf and tennis, the evening cookout and reception provides an ex cellent environment for intro ducing these new dentists and their families to organized den tistry. This is a time to say "Farewell" to the dental school environment and a "Hello" to the profession of dentistry. There is still plenty of space available for Dr. John Svirsky' s all-day continuing education course scheduled for March 29. If you are interested in attend ing this outstanding oral pathol ogy presentation, please contact Linda Simon at 804/379-2534.

COMPONENT V

Piedmont Dental Society Dr. Edward P. Snyder Associate Editor What a wintry winter! Hurry, Spring! Please mark your calendars to attend our spring meeting. This meeting is sponsored in part by the VDA. This meeting will be held on Friday, May 31 at the Roanoke Marriott. The topic is "Practice Building with Quality Periodontics and Restorative Dentistry" by Dr. Gary Maynard and Dr. Richard Wilson. It will provide you with seven hours of continuing 33

education, which counts to wards the 15 hours which you will need for relicensure in April of 1997. Further infonna tion will be forthcoming.

passed from our ranks: Drs. William Harris, Kyle Thomas Lee and Moffett Bowman.

COMPONENT VIII

You should also mark your calendars for the VDA meeting in Williamsburg, September 18-22, and the ADA meeting in Orlando, September 28-Octo ber 2, 1996. Our Society donated money in honor of Dr. Bennett Malbon to help create a memorial garden in his name at the Dental School. We also provided mon ey to help Dr. David Whiston of our own VDA in his quest for the presidency of the ADA. Good luck, Dr. Whiston! Our slate of officers for the 1995-96 year is as follows: President-Dr. Richard Huff man, Roanoke; President Elect Dr. Jim Evans, Danville; Councilor-Dr. Dan Grabeel, Lynchburg; Secretary/Trea surer-Dr. Greg Gendron, Martinsville; Journal Editor-Dr. Ed "Chopper" Snyder, Martinsville. We would like to welcome our new members: Drs. Norm Prillaman, II, William White, Jr., Caroline Wallace, Perin Black, Walt Shepherd, David Riley, Jeff Clifton, Jack Allara and Kevin Greenway. Finally, please remember the

following men who have

Northern Virginia Dental Society Dr. Bruce W. Jay Associate Editor Component VIII mourns the loss of a leader in the Virginia Dental Association: Dr. Clark Brown passed away on Novem ber 2, 1995. Dr. Brown re ceived his Doctor of Dental Surgery from SUNY at Stony Brook and practiced in Spring field, Virginia, for over 30 years. Besides serving on many committees for the Northern Virginia Dental Society and the Virginia Dental Association, he represented the VDA as a Delegate to the American Dental Association. He was member of the Pierre Fouchard Academy, a Fellow of the International College of Den tists, the Virginia Dental Asso ciation and the American College of Dentists. We know you join with us in offering our deepest sympathies to his wife Dottie. Our own Dr. David Whiston announced his candidacy for the office of President Elect of the American Dental Associa tion at the Las Vegas meeting in October, 1995. Congratula

tions, Dave, and best wishes for a successful campaign! In other news: Dr. Bruce Hutchison and Dr. Ed Besner were bestowed the honor of Fellowship in the International College of Dentists on October 6, 1995, in a ceremony held in Las Vegas. Congratulations! Component VIII welcomes its newest members: Drs. Penelope H. Cralle and Karen Dunegan..1

Need

Contract Analysis? Call theVDA Central Office: 804/358-4927

or 1/800/552-3886

The Virginia Delegation gathers under the 16th District sign for the opening session.

(L. to r.): Drs. Manny Michael, Bud Zimmer and Joan Gillespie review

resolutions during the debate.

i! :

Dr. Ron Tankersley, VDA President, waits at microphone to speak on Dental Parameters.

Drs. Barry Einhorn, Will Allison and Steve Bissell enjoy the floor proceedings. I

â&#x20AC;˘ (L. to r.): Drs. Dick Wilson, Les Webb, Bud Zimmer and

Manny Michaels follow the issues closely.

(L. to r.): Drs. Charlie Cuttino, Dave Whiston and Will

Allison listen to a speaker's ruling. 37

Drs. Barry Einhorn and Raleigh Watson wait in the Alternate Delegate Area before returning to the floor of the House.

I Ii Ii

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(L. to r.): Drs. Will Allison, Ron Tankersley and Bruce DeGinder keep up with the busy pace of business.

1996 VDA-Sponsored Continuing Education Seminars Component 1 Friday, October 18, 1996 - Dr. John A. Svirsky - "AIDS/OSHA Update"

Location to be announced. Send registration to Tidewater Dental Association.

Component 2

Friday, April 12, 1996 - Dr. Kenneth Shay - "Older Patients, Clinical Challenges & the Practical Ap足

proach."

Holiday Inn, Chesapeake. Send registration to Peninsula Dental Society.

Component 3

Friday, September 6, 1996 - speaker and location to be announced.

Component 4 Friday, October 4, 1996 - Dr. W. Baxter Perkinson, Jr.. - "Implant Restoration & Porcelain Restora足

tions."

Location to be annou~ced. Send registration to Richmond Dental Society.

ComponentS Friday, May 31,1996 - Drs. Gary Maynard and Richard Wilson - "Practice Building With Quality

Periodontics and Restorative Dentistry."

Roanoke Marriott.

Component 6

Friday, August 9, 1996 - Drs. John Kenney & Lynn Mauder - "Dentistry's Role in Preventing Child

Abuse and Neglect."

Martha Washington Inn, Abingdon.

Component 7 Friday, April 16, 1996 - Parker E. Mahan, DDS, PhD - "Diagnosis, Management and Pathofunction of

Facial Pain."

Location to be announced.

Use "Statewide Continuing Education Registration Form"card in this issue to register.

1996

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The 127th Annual Meeting of the Virginia Dental Association will convene at the Colonial Williamsburg Lodge Convention Center, September 18-22, 1996. An excellent scientific session has been scheduled, which includes presentations by Drs. Sam Low, Pat Allen, Richard Roblee and Karl Leinfelder. 1996 ADA President Dr. Bill TenPas and his wife Kathy will join us in Williamsburg on their way to the ADA Annual Meet足 ing in Orlando. The meeting will mark the final campaign stop for our ADA Presi足 dent Elect candidate, Dr. Dave Whiston. In addition to the outstanding clinical presentations, meeting goers will enjoy numerous recreational and social activities, including a golf outing at Williamsburg's Golden Horseshoe, Tavern Dinners, tours of Colonial Williamsburg and Carter's Grove, or a trip to nearby Busch Gardens. Plan now to attend the 1996 VDA Annual Meeting in Williamsburg!

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Laser Welder

You've Been Waiting For! The DL 2002 Dental Laser Welder Just imagine ...Corrosion Resistant Biocompatible Welds without solder! •

It's The Latest State of the Science Development for Implants, Crowns, Bridgf'--s, Cast Partial Repairs, and much more! • Highest Quality Welds for Accurately Fitting Implants with Complete Dimensional Stability • Cast Partial Repairs Never Before Possible!

•

Joining with No Heat for Accurate No Damage Welding Capable within One Millimeter of the Porcelain or Acrylic • No Internal Stress or Impairment to Dental Alloys and Metals with Strength Equal To or Exceeding the Original Materials

Your practice needs this most advanced technology, and the New Lab One has it NOW! From cast partial repairs without having to wait for a complete recast to the pure joy of implants with totally passive fit, you'll wonder how you ever got along without this fantastic service. As you know, normal soldering always presents the possibility of inaccurate or bulky joints because of heat-created dimensional changes. But with Lab One's new Laser Welder, implants can be crafted to seat perfectly in the mouth. You'll enjoy a new freedom from soldering instability, your patients will love your accuracy, and thanks to reduced chairside time, you'll run a smoother and more cost efficient practice. FOR

COMPLETE

Come Visit Our Beautiful New Location ...

DETAILS, CALL GEORGE McCOY

(804)

455~8686

Or Toll Free (800) 448-7889

---

Go Figure.

Why have over 60,000 doctors trusted HPSC with their equipment financing? 1. Incredible Service Up to $125,000, we'll respond in 1 hour. Over $125,000, with all papers in place, 24-48 hours.

2. Competitive Fixed Rates No surprises.

3.1B1 Dental and lab equipment, computers, office furniture, supply contracts, leasehold improvements, working capital. 4.

E:!!m Deferred payment. No down payment. Graduated payments. 10% or $1 purchase option on equipment at end of lease.

5. _ _ 12-72 months. Lease or loan. 6. Practice Acquisitions We finance up to 100% of purchase price. No points, no down payment, no hidden fees, no closing costs, no pre-payment penalty.

7.1:!!!1!!!1 Over 400 years of combined healthcare marketing experience.

8. Continuity All contracts funded and serviced in-house.

Conclusion: You get more for your money with HPSC. Call or fax us for information. We'll respond fast .

â&#x20AC;˘

Innovative Financing for Dental Professionals Sixty State Street Boston MA 02109-1803

1-800-225- 2488

Fax 800-526-0259

TheNEW and IMPROVED

PROFESSIONAL

· ··QTO -..... : ,·. '. · . ·R·".' r PROTE .~,,,~

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',:".C:::,;,-:" ' . : ::""','

.' ,

• • . Locum'I'en~ns

c:~~erage

• .LimitedC:~lltractucil Liability

Discip~ry an4L.icensure Defense " " , :, ':'.\--:"" Coverage <> •. /.>...... </ .

•. First Aid Cov~ra~e6nis is in addition to

•

Medical pa~ts co~age).·

.MedicalWilSteD~fens~Reimburse '·"··ment

• . Increased N~\.v Deritistdif;~ounts . • .Increasedr.eave-~f~AH~ence·discounts •. New DentalAIlest,llesiologiStCIasses

JOIN ras PROFESSIONAL PROTECTOR PLAN . AND'· .

Call today for details:

The Professional

~> ...•..•..•••...

·.<i

SUTERHAYCRAFTGSIMMONS a a

'w' ·tim'';1B1.1',ifI

" ENJOY 1HE DIFFERENCE! .

INS U RA. N'C E

" " '. '. '. " t:::::' ~"" .....

FOR

THE

:·P. H

F.£ 5S I·

N A L

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113PAnKAvENUI .

FMLS CHURCH,VIRGINIA

22046

]03241-0011 'FAX 703 538-1571

....PA '--'

CNA

For All tbe Comml_to YouMaR"

Protector Plan-is a~tered tTtlI1emmk of Poe & Brown,Inc., andis IInderruTitten byContinental CasualtyCompany and ...'

fireInsllTImce Company of Hllrtford, two of the CNAlnslirance Companies.

RGIS

LABORATORY

"Send Us Your Impressions" Sturgis has survived and mastered technique and material changes since 1928, we are not the new kid on the block. Over 60 years in the business has established our reputation for fine crafts manship. We utilize state-of-the-art equipment and skills. Anyone Sturgis technician has over 300 years experience at his disposal, meaning we can offer you older type restorations, such as Porcelain Jacket Crowns or the very latest in the Dicor Crown. Our personal ized approach guarantees you a finer quality restoration by a skilled technician who takes pride in his work. Our fee schedule has no surprises with a policy of no remake or reshade charges, and we pay the postage both ways on your shipment. For your added convenience, we have a toll free number, as communication is our key to the future. The right quality, the right service, the right price. Our goal is your success in pleasing your patients. Acquaint yourself with Sturgis by giving us your impressions today. J. MINOR STURGIS PORCELAIN LABORATORY The state-of-the-art dental laboratory. P.O. Box 1404, Atlanta, GA 30301 For more information call: 1-800-241-5533

•

Dear Colleague, Make a risk-free. tax-deductible, investment of $60 and realisticallY

save several hundred dollars on dental supplies. Guaranteed. Order a

DentaCheque coupon book and evaluate the 103 offers from 57

companies. If yOU can't benefit, return the book for a fun refund. Offers include 5% invoice discounts honored by 17 dental supply .. companies. free products, and rebates on popular anesthetics, needles, diamonds. restorative and impression materials, infection control and cotton products. prophv and enda supplies, and more. Coupons are valid throughout '95.

There is an important humanitarian reason to order a book and evaluate hoW much you cansave. The National Foundation of Dentistry for the Handicapped, a charitable affiliate of the ADA, uses revenue from DentaCheque sales to expand its programs. ihis year, the projects will provide more than $3.2 million in dental services for 35,000 mentany, physically, and medicaHy disabled individuals. Many very deserving and vulnerable people need help. 1 urge you to place an order by calling the Foundation at 1_800-366-3331. Thanks very much.

Gordon J. Christensen, D.D.S., M.S.D., Ph.D.

Member, Board of Directors

National Foundation of Dentistry for the Handicapped

FIINl'IIAN T

T EXHIBIT

2 1

MARCH

DATES,

..A.

19 9 6

MARCH

22-24

.INF,bRUM:'I,'XrLANTA APPAREL MART

WE STIN' PEACHl;JUE PLAZA I.lfYATT REG ENCY ATLANTA

1996

FEATURED

CLINICIANS

Dlt'~R.S BELSER

DR. MYER S. LEONARD

DR. LINDA C. NIESSEN

DR. PETER SCHARER

DENTAL IMPLANTS: THE RESTORATIVE CHALLE'IGE

ORAL SURGERY & TMJ

GERIATRIC DENTISTRY & DENTISTRY AND THE MEDIA

ADVANCED RESTORATIVE DENTISTRY

DR. LEE LIPSENTHAL

DR. THOMAS

DEAN ORNISH'S HEART DISEASE PROGRAM

DENTURES: AN ALTERNATIVE TO IMPLANTS

MR. BRUCE MANCHION

DR. MARVIN H. BERMAN

ADULT LEARNING PRINCIPLES & COMMIINICATION SKILLS

PEDIATRIC DENTISTRY FOR I)ENTISTS & AUXILIARIES

MR. JOHN

OR. GORDON J. CHRISTENSEN R.ESTORATIVE DENTISTRY

[)R. JAMES

K. MCGILL

FINANCE, RETIREMENT & ASSOCIATESHIPS

A. COTTONE

DR. LOUIS ROSSMAN

DR. BARBARA STEINBERG

ENDODONTICS fOR THE GENERAL PRACTITIONER

TREATING FEMALE PATIENTS/PATIENTS WITH MEDICAL PROBLEMS

R.ECENT INFECTION CONTROL & )SHA DEVELOPMENTS

[)R. GERALD

DR. JOHN

'90's

[)R. ROBERT J. GORLIN lNA/DNA GENETIC ENGINEERING ~ ORAL PATHOLOGY

JR. J. MEL HAWKINS ,OCAL ANESTHETIC 'HARMACOLOGY 'ACTS & FICTION

THE HINMAN DENTAL SOCltTY OF ATlANTA

LENOX P01NTE

30324-3170

(404) 231-1663

fAx (404) 231-9638

ATLANTA, GA

HOTEL AND AIRLINE RESERVATIONS.

(800) 243-1581

rfS. CATHY JAMESON 'EAMBUILDING & COMMUNICATION OR PRODUCTIVITY

A. SVIRSKY

ORAL MEDICINE & ORAL PATHOLOGY

DENEHY

JONDING UPDATE FOR THE

H. SHIPMON, SR.

DR JOHNNY MALONEY. GENERAL CHAIRMAN

DR. ROBERT E. TOWE. PRESIDENT

DR. DEN:\'IS TARNOW CONTROVERSIES AND INNOVATIONS IN IMPLANT DENTISTRY & PERIODONTICS

DR. BERNARD TOUATl BONDED CERAMIC RESTORATIONS

DR. OLYA ZAHREBELNY MEDICAL BILLlI'OG & ACCESSING PLAI'O BENEFITS

•

~~~~~ ~ lilW~~ii.'i.;;.~"..,.,.t) ~ •• 5

\\~ KEY TO KNOWLEDGE Chicago Dental Society 131 st Midwinter Meeting February 22-25, 1996 Live, Closed-Circuit Television Full-Day Programs Half-Day Programs Participation Courses Panel Presentations Limited-Attendance Clinics Table Clinics Student Programs Special Events More Than SOO Exhibitors Members ofthe Chicago Dental Society (Regular and Associates) are automatically preregistered for the meeting. To receive a preliminary program write to:

Chicago Dental Society 401 North Michigan Ave., Suite 300 Chicago, JL 60611-4205 312.836.7300

DELTA DENTAL速

America's First, Leading and Largest

Delta Dental Plan of Virginia

Corporate Headquarters 3807 Brandon Ave., S.W., #360 Roanoke, VA 24018

Marketing Office P.O. Box 2759 Glen Allen, VA 23058-2759

1-800-572-3044

1-800-533-4137

vernon H. ShlJfer, Sr,

COT

Consultant

Vernon H. Shafer, Jr.

COT Richard M. Shaft'!r

CDT

Denms P ClaypOol III

ADT路CDT

AT LAST, the ultimate Esthetic Restoration from a small commercial laboratory that understands Anatomic and Functional Harmony, the Pankey/Dawson way! The restorative system is IPS EMPRESS, the result of years of intense research and development by Ivoclar,Wiliiams. Since its introduction, both dentists and technicians alike have been virtually unanimous in their acclaim of EMPRESS for breathtaking esthetics and consistent precise fit.

Lynn M. Jennings

COT

OfficeManager

George K Smith eDT Mi.::haetSenn

EMPRESS is a whole new generation of glass ceramic, leucite颅 reinforced for strength. Using the "lost wax" technique, pre-shaded ceramic ingots are vacuum pressed for consistent precise fits of 15-25 cu.

COT

Albert A. 0. Dailey eDT

Andreas Brmkord ZT

Clinically, for crowns, veneers, and onlays, tooth preparation and bonding are the same as with previous all ceramic restorations, only the results are different.

Ri<:kWinegardner

COT

Bachell V.HQ(}~r

Secretary/Bookkeeper

Ser-ving the Dental

Profession since 1942

Certified Dental

Lebcretory

Ml!'mur: Naeicnal

Ass(}Cilltionor Dental

Laborator-ies

Member: Virginte

State Dental

Leboretcnes

And why Bay View Dental Lab? Because no other lab in the state has made more of a commitment to proving that consistent, high quality work can come from a "commercial" dental lab. Our staff of board certified technicians combine for almost 200 years and over 250,000 units of experience. All work from die trim to final glaze and hand polish is done under 7-10X magnification. For a laboratory that knows, understands, and will deliver the Anatomic and Functional Harmony your restorations need, choose Bay View Dental Lab. And for the ultimate in esthetics your patients want, we choose IPS EMPRESS.

Association

Danar Certified

Laboratory

We guarantee, you'll be "IMPRESSED" with EMPRESS.

Clmicel Research

tiona Associates

E\!a.h.~atot

Laboratory

FO r add路 .

8 ay Vie Itlonal'tnforrna ' 7829 Ca~b~ental Labor~fon COntact: NOrfOlk V' ~ Avenue ry, Inc.

Tel

,Irgtnia 23

epho ne (804)

578-4007 583-7787

Why Do 60,000 Doctors Trust Us With

Their Professional Reputations?

In an era of "not if, but when" a doctor will be accused of ~ malpractice, your choice of professional liability coverage is extremely important. We know that any allegation can be devastating to both your professional repu tation and your personal assets ... making the company you choose critical to your future well-being. Many factors should be taken into account when making a decision. Consider our financial strength and stabil ity. We are rated A+ (Superior) by A.M. Best and AA (Excellent) by Standard & Poor's. No other company with an exclusive focus on the needs ofthe health care community has higher financial ratings.

Look at our experience. For nearly a century we have specializedin defending and protecting doctors. No other company has successfully defended more than 180,000 malpractice claims. Local service is important, too. Our General Agents and Field Claim Managers work with you on every allegation. They average more than 15years experience working with doctors and the legal system. Why do more than 60,000 doctors trust their professional reputation and personal assets with us? No other company combines nearly a century of experience with financial strength and the local service provided by The Medical Protective Company.

For your copy of the FREE book on evaluating professional liability companies, call:

:Profess~ona.Z :Protection Gxclus£vely s ince /899

800-344-1899

What's So Special About Partials From Virginia Dental Laboratories?

Integrity. Virginia Dental Laboratory uses • Vitallium® Alloy-the only partial denture alloy that is processed under the same quality control conditions as orthopedic implant alloy-with over 50 years of patient success.

Experience. The exceptional skills, quality • craftsmanship, and proven techniques of Virginia Dental Laboratories come only as the result of years of experience, painstaking effort and a deep commitment to integrity.

Commitment. Virginia Dental Laboratories is

• dedicated to providing you and your patients with the highest quality partial dentures available. We believe that the combination of our quality raw mate rials, such as Vitallium Alloy; our skilled technicians; our unequaled experience and our steadfast dedication specially qualify us to satisfy the needs of you and your patients.

Accuracy. Our entire procedure for construct • ing Vitallium Partial Dentures is quality-con trolled to achieve the utmost accuracy. This accuracy means faster delivery of the restoration; reduced chairtime and greater patient satisfaction.

Quality. Our partial denture restorations begin • with quality raw materials such as Vitallium® Alloy. Vitallium Alloy® is totally biocompatible. It is nickel- and beryllium-free. Its surface won't tarnish, dull or corrode in the oral cavity or in the body.

For special treatment on your next partial denture case, please contact Virginia Dental Laboratories!

We are happy to survey, design and estimate from your diagnostic casts at no obligation to you! Contact us today!

I !

Ijt.

! j

,I I

Since 1932

irginia Dental Laboratories, Inc. 130 W. York Street Norfolk, Virginia 23510 (804) 622-4614