This is a continuation of my previous post on the 5 Procedures Every New Dentist Must Perform. Whether you are an associate, the owner of a new start-up, or purchasing an existing practice, there are certain things you can do to maximize your production and keep busy even with a limited patient base. As a new dentist, there are five things that you must be comfortable performing. In our last blog we talked about Pediatrics. The 2nd of the 5 procedures every New Dentist Must perform is Emergencies.
As a new dentist, you are probably going to have holes in your schedule. That’s just life. If you can learn the skills of dealing with emergencies, these schedule gaps can be useful. If a patient calls in with a toothache, trauma, lost restoration, or any other sort of dental emergency, they want to be seen quickly. If you are an associate, odds are the senior doctor is booked up. That leaves you to see the patient during one of those schedule gaps. Sure, the patient probably hasn’t seen you before, but, due to the emergency, they will be thrilled to let you work on them. Learn how to quickly narrow down pain symptoms to a diagnosis.
Learn how to easily convey the diagnostic information to the patient to help them make a decision. With some polished efficiency, you will learn how to deal with almost any emergency situation in a timely manner.
Climb For a Cause is proud to announce the formation of the Jeff Baumrucker Memorial Scholarship. Beginning in 2013 the scholarship will be awarded to a deserving third or fourth year dental student, allowing them the opportunity to gain real world dental experience during a SmileTree™/Climb For A Cause™ sponsored oral health education and treatment project.
“One of the personal benefits of this organization is the pleasure and privilege of meeting like-minded people. Many times these relationships develop into friendships – that certainly was the case with my good friend Jeff Baumrucker. We are honored to continue his legacy in a way that we feel is true to his spirit of giving and support of his chosen profession.” Says Climb For a Cause Executive Director, Daniel Bobrow.
We invite all interested applicants to visit http://climbforacause.org/jeff-baumrucker-scholarship to download the 2013 application. Applications will be accepted no later than June 30, 2013 for the 2014 opportunity.
The Jeff Baumrucker Memorial Scholarship honors the memory of a loving father, devoted husband and generous dentist. Dr. Baumrucker was dedicated to helping people achieve their best smile possible – many patients loved coming to visit his practice. His adventurous and giving spirit lead him to support the efforts of Climb For a Cause and through that support many young children received desperately needed dental care. Jeff Baumrucker was a friend to many and an inspiration to all – those who knew him will miss him always.
A big thank you goes to our sponsor, Quality Dental Plan, without whose generosity this scholarship opportunity would not be possible.
“As a frequent Climb For a Cause Participant and a previous dentist volunteer, I know first-hand of the benefit of this exciting opportunity,” says Dr. Dan Marut, Founder and President of Quality Dental Plan. “As dentists we have the ability to bring relief and help those in parts of the world where dental care is virtually non-existent. As a company, Quality Dental Plan is dedicated to improving access to care in communities across the USA while maintaining the Dentist-Patient relationship without third party hassles. Our support of the Jeff Baumrucker Memorial Scholarship furthers our belief that by giving our time and skill in the service of others, we can grow as individuals beyond our traditional educational experiences. A little adventure never hurts either!” explains Dr. Marut.
Recipients of the Jeff Baumrucker Memorial Scholarship will join Global Dental Relief on one of the oral health education and treatment projects held annually in Guatemala. Applicants must possess a valid Passport prior to date of departure, and be available for the full term of the SmileTree™ sponsored health project. Applicants must also provide verification of GPA and two letters of recommendation from college professors. Please return completed applications no later than 6-30-13 to:
SmileTree & Climb For A Cause
Attn: Daniel Bobrow
747 Brighton Circle
Port Barrington, IL 60010
or Director@ClimbForaCause.org Please use “Scholarship Application” as your subject line.
Climb For a Cause™ is a non-profit Foundation that combines the breathtaking beauty of the mountains with the desire to make a positive difference in peoples’ lives. Since 1998, we have been making meaningful differences in the lives of needy children by ensuring the delivery of much needed dental education and care. Those interested in learning more about this opportunity may visit ClimbForaCause.org or call (312) 455-9498
In the last issue of The New Dentist, I wrote about flowable composites and their use in restorative dentistry. Since the publication of the article, my flowable usage has decreased significantly. Many clinicians use flowable composite to line the floor and line angles of class II composites. In addition, I use flowable for ultra-conservative preparations that are too small to consistently pack regular composite into. Recently, I have begun modifying regular composite to allow for this ultra-conservative use. By heating regular composite to 130 degrees Fahrenheit, the viscosity of the composite is increased greatly. This causes the regular composite to flow much more like flowable composite and conform to the small preparation better.
I am now using heated composite for almost all posterior resin restorations. The composite can be heated in a couple of different ways. A messy but cheap way is to let the composite compules soak in a hot water bath for about 15 minutes prior to placement. This way works, but is not as nearly slick as the CalSet Compule Heater. This handy piece of equipment can be purchased through almost any dental supply house and costs around $300. It keeps 4 compules of composite at the prerequisite 130 degrees and can maintain that safely all day long. My assistants turn it on in the morning and load it with compules. The composite stays hot all day long and is not affected by repeated heating and cooling cycles.
Heated composite is a great way to make the material more viscous and flowable without trading strength and wear resistance. Try it!
In this month’s issue of General Dentistry, there is an article highlighting the use of azithromycin in periodontal therapy. I have never used a lot of antimicrobial therapies in my periodontal patients. Every once in a while I will prescribe 100mg of doxycycline to patient after scaling and root planing, but to be honest I could not give a reason as to why I would or would not on any particular patient. I have never really looked at any of the data on the low-dose antibiotics like 20mg of doxycycline daily for perio maintenance patients. For my practice, I really need to see a significant difference to justify adding another step into my patient’s routine. Compliance is a major issue with all patients, whether you think it is or not.
This study took 100 patients with moderate to advanced periodontitis and treated them with scaling and root planing plus three courses of azithromycin during the hygiene phase. The patients were re-evaluated and necessary surgeries and or extractions were performed (32 patients needed this extra treatment). All were then put on maintenance with four month recall visits. Clinical parameters were recorded at baseline, six weeks after hygiene phase, and 96 & 192 weeks into maintenance. The results showed that probing depths, bleeding, and supparation were reduced significantly at re-evaluation.
One of the most interesting parts of this study is that this was not a double blind study. All patients received azithromycin. There was not a control group to compare the azithromycin groups results with. This is a prime example of how sometimes the fine print of a study must be ready to determine it’s value. Azithromycin may be the greatest periodontal adjunct treatment in the history of man kind, but this study does not prove that. This study does not prove anything actually. In my opinion, the only thing this study shows is that periodontal patients that receive non-surgical intervention followed by close evaluation, surgery when needed, and continuous maintenance have reduced probing depths, bleeding and supparation. Because azithromycin was not isolated as a variable, there is no worthwhile evidence for it’s use.
Sometimes you need to read the fine print on studies to determine their effectiveness. Based on this, I will not be administering azithromycin to my periodontal patients.
There is a literature review in the March 2010 issue of The Journal of Evidence-Based Dental Practice regarding failures of posts. The writers examined multiple randomized control trials evaluating failures of endodontically-treated permanent teeth with different post types. The trials compared metal posts to fiber posts. The results of the review showed fewer failures with carbon fiber posts as opposed to metal posts.
This seems to be concordant with the widely accepted thoughts about posts. Carbon fiber posts have a modulus of elasticity closer to natural tooth than do metal posts. In addition, carbon fiber posts are generally passive and tapered which decreases chances of perforation or root fracture when preparing. One disadvantage to carbon fiber posts is the necessity to “bond” them in with a self-etching resin. Bonding is very problematic at depths in the root and can create a point of weakness if the proper technique is not followed.
As an industry, we are doing less and less posts. I feel the literature supports this, however there are some teeth that just need posts no matter what. I find that these teeth are more often premolars and anterior teeth in my practice. Because of this, I general use the smallest posts available. Probably the biggest key to post success is amount of vertical tooth structure and ferrule remaining. In dire situations with little ferrule, no post system has a shot of success.
As far as my practice goes, I use 3M’s Rely-X post system. I find the system to be easy to use with few steps and yields good results. There are plenty of other good systems on the market. As with anything the key to success is your familiarity and comfort.
As documented here before, I am a big fan of isolation techniques. I am a rubber dam believer and still use it in my practice. I also use an Isodry in my practice. An article in the March 2011 issue of JADA compares temperature and humidity of mouths when different isolation methods are in place. The study compared rubber dam, Isolite I2, Coolex, and no isolation. All three methods decreased the temperature and relative humidity intraorally. Rubber dam decreased both the most, but there was a very little difference between the rubber dam, Isolite, and Coolex. This study definitely emphasizes the importance of dry0field isolation techniques. All three of these systems work far better than nothing. A rubber dam is obviously the cheapest of the options, but both the Isolite and Coolex are affordable and offer a good value for the ease of use. I know I could not practice without my Isodry. If you have had issues with isolation, I would definitely look into this study and these methods. They will help improve your dentistry!
LUMINEERS Destination Education is sponsoring an event this April in Orlando and May in Las Vegas. It’s a very exciting CE event featuring Dr. Bill Dorfman as Keynote Speaker and a very strong line-up of educators and teaching clinicians. As a new dentist, it is the perfect opportunity to not only be exposed to some of the top thought leaders in the profession, but also to learn leading edge clinical technologies and procedures.
ORLANDO (APRIL 8-10) & LAS VEGAS (MAY 27-29):
Transforming Continuing Education for Practice Growth
Dr Bill Dorfman, “America’s Dentist,” featured dentist on ABC’s Extreme Makeover and founder of Discus Dental, will headline the LUMINEERS Destination Education program this April in Orlando and again over the Memorial Day weekend in Las Vegas. He will address the challenges facing today’s general practitioner, offer insight and suggestions based on what’s worked in his highly successful practice, and highlight the role that transformational products like Snap-On Smile can play in achieving new levels of success.
The Orlando program is set for April 8-10 at Walt Disney World’s Swan & Dolphin Hotel and the Las Vegas event takes place over the Memorial Day Weekend, May-27-29, at the Aria Hotel and Casino. To register or for further information, call 800-445-0345 or go to www.ascredu.org.
The good people here at the New Dentist have a great offer going on that all of our readers should know about! The New Dentist is giving away a massive package to all that register at the following link:
Included in the giveaway is New Dentist business training, a Sapphire curing light, Virtuoso flowable composite kit, an on-hold message system, Golden Misch Physics Forceps set, 6 Month Smiles training, and 1 year of ProSites Website hosting. That is an incredible package. Any one of those would be a fabulous prize to win, but the whole package is unreal. You are looking at a total value of around $16,000. This package would totally transform the winner’s practice. I highly recommend everyone to go sign up ASAP and take advantage or a chance to win the best dental prize package I have ever seen! I hope I am eligible!
A study published in The Journal of Evidence-Based Dental Practice recently examined how dentin bonds degrade over time. This was the first in vivo human study on bond degradation. It showed expected results. Over a 3 year time period, the bind between dentin and resin. After 3 years, bond strength decreased almost 60%. The study did indicate some clinical steps that dentists can easily do to maximize bind strength. These included using a 4th generation three step dentin bonding system, improving impregnation of the hybrid layer by using multiple applications of resin primer, and ensuring adequate polymerization of the adhesive system.
Of course there is much in vivo human work to do studying bonding. This study goes a long way but there are still some questions. After the dentin bond has deteriorated, does the enamel bond that is theoretically there keep the restoration viable? Certainly in traditional amalgam restorations there is no dentin bond yet they seem to last for years with no problem. Does the resin’s affinity for water absorption cause problems long term after the dentin bond has deteriorated. These are all questions we should be pondering when placing resin composite restorations.
Study citation: In vivo degradation of resin-dentin bonds in humans over 1 to 3 years. Hashimoto M, Ohno H, Kaga M, Endo K, Sano H, Oguchi H. J Dent Res 2000;79(6):1385-91