December 2012, Volume 8, Issue 12
Published by AEGIS Communications
Year in Review
As you reflect on the year 2012, what memorable moments immediately come to mind? Certainly there were events that affected all of us in some way—the passage of “Obamacare,” the presidential election, and “Superstorm Sandy” all left Americans at least talking about current events if not experiencing them firsthand.
Dentistry, too, had its major milestone moments. While some of these would not be well recognized outside of the profession, 2012 could very well go down as the year that dentistry made headlines in the mainstream media. ABC News and PBS Frontline both did extensive segments on their news programs about pediatric dental sedation risks and access to care issues in this country, respectively, and the CDC announced a very serious statistic about adults and periodontal disease that made the evening news and daytime talk shows across the country. And very significantly, the Ad Council came alongside a high-powered dental partnership to create the first-ever public service announcement campaign aimed at educating the nation’s children to take care of their teeth now in order to keep them for a lifetime.
So as we close out one year and look forward to another, we are pleased to present this month’s feature presentation, in the voices of our Editorial Advisory Board and editorial contributors who took the time to share with us what they thought the most important “dental milestone” was for 2012. We invite you, our readers, to join the conversation by posting your own thoughts to our Facebook page, www.facebook.com/InsideDentistry, or Twitter feed, @dentalaegis.
Barry P. Levin, DMD
Implantology is heavily supported by industry. Good science exists, but it’s the responsibility of the clinician to differentiate corporate-touted research from sound, evidence-based studies.
One of the most exciting things that occurred in 2012, in my opinion, is the progress made in the field of tissue engineering. The dilemma of insufficient hard and soft tissues capable of supporting endosseous implants and their restorations has never been more conquerable.
The advent of resorbable mesh, recombinant growth factors, and osteoinductive graft materials has been exciting and welcome to the surgeon. It’s our responsibility to assure our patients that materials we use for their betterment are supported by sound research as this field goes forward.
Michael A. Siegel, DDS, MS, FDS, RCSEd
In 2012, there was an increased awareness of our profession’s responsibility to perform head and neck examinations for oral cancer. The major dental journals have published articles highlighting the need for these examinations, and the major dental continuing education meetings are now providing hands-on courses to teach members of the dental team about these techniques.
There will be over 50,000 new cases of oral cancer diagnosed in the United States this year, and one person will die of this disease each hour. If detected early, the survival rate approximates 90%. Conversely, if the cancer is found late, the survival rate drops to less than 20%.
The Commission on Dental Accreditation, the body responsible for accrediting US dental schools, has adopted a standard stating that graduates must be competent in screening and risk assessment for head and neck cancer. This measure alone should ensure that the next generation of dentists can and will identify this deadly disease at the earliest possible time, thereby improving the prognosis of the patients entrusted to our care.
Robert J. Chapman, DMD
I think one reason that 2012 has been notable is that the combination of evidence-based information and risks associated with treatment has reached consensus within the profession as being a “best practice” for patient care.
Providing information for patients to determine their own best options for care based, when available, on evidence related to treatment, and the subsequent risk/benefits for such treatments is now accepted as the best approach in treatment planning and informed consent. This crucial approach in dental care has been slowly building for the past decade in dental education and now is prominent in continuing dental education articles and presentations.
Harold C. Slavkin, DDS
Science informs clinical practice. Scientific evidence informs how we perceive oral healthcare and how we implement policies that enable all Americans to gain access to comprehensive quality oral healthcare. During 2012, for the first time in our history, US Senator Bernie Sanders introduced “The Comprehensive Dental Reform Act of 2012,” a bill that covers five main components designed to reduce the oral health crisis in America: (1) expanding coverage; (2) creating new access points to care; (3) enhancing the oral health workforce; (4) improving oral health professional education; and (5) federal funding that improves diagnosis, treatments and therapeutics, and outcomes research.
This bold legislative solution offers a significant catalyst to address the underserved and to reduce health disparities in America. Further, this legislation complements the efforts of two recent Institute of Medicine Reports, “Advancing Oral Health in America,” and “Improving Access to Oral Health Care for Vulnerable and Underserved Populations.”
Gary Orentlicher, DMD
The advancement and incorporation of digital technologies into all disciplines of dentistry saw many improvements in 2012. The ability to diagnose and treatment plan patient cases in three dimensions has opened new avenues of patient evaluation and treatment.
New digital technologies encourage detailed communication between all members of the dental team: restorative dentists and prosthodontists, dental specialists, and dental laboratory technicians. Improved diagnosis, treatment planning, and multidisciplinary communication will only lead to better patient treatment outcomes, the ultimate goal.
Joel H. Berg, DDS, MS
The first-ever Ad Council campaign on oral health in partnership with 35 dental organizations will break ground in raising awareness on the importance of oral health in one’s life. Millions of consumers who did not pay much attention to their oral health and its effect on total health will now benefit from the campaign’s messaging.
The Partnership for Healthy Mouths Healthy Lives will elicit important oral health messages to children and their caregivers, paving a road toward achieving a lifetime of good oral health. This first-of-its-kind effort will grow into ever-greater significance in the years ahead.
Theodore P. Croll, DDS
Deciding what was the “greatest thing that happened to dentistry in 2012” offers a difficult challenge. However, if one simply changes “to dentistry,” to “for dentistry,” the answer for me is is easy.
In 1976, Clinical Research Associates (CRA) was founded with the mission of studying and testing dental products in a search for truth about the equipment and materials that were offered to dentists on the commercial marketplace. CRA has been a volunteer effort of hundreds of dentists who test over 750 different brands of products each year while completing approximately 20,000 field evaluations. For over 3 decades, the results of their findings have been published in a monthly newsletter, disseminating research results to a readership in more than 80 countries. Some dentists have called this mission “the Consumer Reports of dentistry.”
CR Foundation describes itself as “a non-profit, educational research institute. It is not owned in whole or in part by any individual, family, or group of investors. This system, free of outside funding, was designed to keep CR’s research objective and candid.” More can be learned about this splendid organization on its website (www.cliniciansreport.org). Dr. Rella Christensen and Dr. Gordon Christensen are the founders of CRA. In 2008, the organization was renamed CR Foundation and the newsletter, Gordon J. Christensen Clinicians Report.
For me, as a practitioner, the greatest thing that happened in dentistry during 2012 is the 35th year of the CR Foundation. That anniversary marks 35 years of a vibrant, critical, ongoing commitment to the profession of dentistry, its member dentists, and our patients who rely on us. Let us hope that dentistry will be blessed for another 35 years, at least, with the work of CR Foundation.
*Dr. Croll is an invited volunteer on The Board of Directors of the CR Foundation.
Allen Ali Nasseh, DDS, MMSc
As an endodontist, I would say that the biggest development in endodontics during 2012 has been the growth in acceptability and use of bioceramic compounds as root canal sealers and root repair materials. It has become increasingly clear that endodontics is moving away from resins and oil-based sealers and surgical repair materials and toward more biocompatible and natural bioceramic-based compounds. This will benefit patients, because many bioceramic compounds are natural components of the human skeleton and are, therefore, highly biocompatible.
Jack T. Krauser, DMD
There are no evolutionary or revolutionary things that happened in dentistry in 2012. I will however, comment on office conditions and staff. Dentists that I know— particularly in South Florida—are “just holding on.” Growth is rare, many practices are on a plateau and a significant number are actually slower. Most staffs have not grown at all.
There were some “improvements” of exciting developments from the recent past, but these don’t count for 2012. Particularly, in the implant patient treatment flow protocol, which is incorporating much more digital information from imaging to fabrication of abutments and restorations, there are refinements that are looking good.
In bone regeneration, including the use of promising bone graft substitutes, more is being learned with the various exciting bone graft substitutes, yet some products have had “underwhelming ” results in performance, high cost, and side effects. So in summary, 2012 was a good vintage, but not a classic year. Although there are great minds in dentistry, in my opinion, there were no great strides in 2012, just isolated successes, with the majority being uneventful incremental developments within our field.
Ronald Goldstein, DDS
Since my field is esthetic dentistry I will answer the question by expressing what I feel have been the most important contributions in esthetic dentistry in 2012. There have been two important advancements in the area of ceramics. First is the realization that full-contour zirconia can be colored and stained to be esthetically blended to adjacent teeth and considered a viable alternative to veneered zirconia.
Second is the research by Guess, Zavanelli, Silva, and Thompson at NYU, which concluded that IPS e.max® lithium disilicate is the most robust all-ceramic system they have tested to date. This also means that CAD/CAM restorations are playing an increasingly larger role in esthetic dentistry for both anterior and posterior restorations.
Michael Sonick, DMD
In 2012, science fiction is morphing into practical fact. The use of biomimetic molecules to hone jaw reconstruction reached a fever pitch this year. These synthetic enhancers include platelet-derived growth factor (PDGF) and bone morphogenetic protein (BMP), which ramp up tissue regeneration and tamp down patient morbidity.
With their help, conservative bone grafting using particulate bone and membranes becomes more predictable, barring the need for invasive autogenous block harvesting from the chin, ramus, or extraoral sources. Notably, these molecules are easily accessible to the private practitioners who can make the most of their impact in everyday surgery.
Gregg A. Helvey, DDS
This past year, the term “biofunctional restoratives” has become associated more with the prevention of secondary decay at the restorative margin and the preservation of the resin/dentin complex.
Recognizing that restorative failures are initiated not only at the marginal surface but also internally at the interface between the resin and the dentin, manufacturers are focusing their research and development toward producing dual-active restorative materials that inhibit the destructive, host-derived, matrix-metalloproteinase enzyme activity that degrades extracellular proteins, leading to the relatively swift breakdown of the resin/dentin bond. At the same time, these new restoratives can produce reinforced dentin and enamel—referred to as “super dentin” and “super enamel”—that are more resistant to the acid-producing bacteria responsible for the development of secondary decay, which is the major reason for restorative replacement.
Ray C. Williams, DMD
The greatest thing to happen in dentistry in 2012 was the publication of a report in the April 18 online issue of Circulation on the relationship of periodontal disease to atherosclerotic vascular disease1 and the press release accompanying this report on the same day.
The publication was scholarly, evidence-based, thoughtful, and it correctly noted that “studies have found an association between the two diseases that cannot be explained by the common risk factors.” Unfortunately, what was not accurate was the accompanying misleading press release, which led to even more confusion about a topic that sorely needs clarity and understanding. The press release went on to say, “gum and heart disease share common risk factors, including smoking, age, and diabetes, which is possibly why the diseases often occur in the same person.”
The axiom of medicine and dentistry: “Primum non nocere—above all, do no harm” had been breached. The harm had been done. Within hours, the media were saying there was no relationship between periodontal disease and heart disease. But from that moment on, dentistry and medicine rallied to set the record straight. The American Dental Association, the International Association of Dental Research, the American Academy of Periodontology, and other groups issued press releases clarifying the findings of the important study and correcting the statements in the initial press release.
The American Heart Association issued a new press release that was accurate, and an editorial in the Journal of the American Dental Association2 by two of the original manuscript’s authors set the record straight. And so now, looking back, a great thing happened in 2012: The call from all sides for greatly renewed efforts and more research into clarifying the role of oral health and disease in overall health and disease went out loud and clear. Not a bad year for dentistry.
1. Lockhart PB, Bolger AF, Papapanou PN, et al. Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association? A scientific statement from the American Heart Association. Circulation. 2012;125(20):2520-2544.
2. Papapanou PN, Trevisan M. Periodontitis and atherosclerotic vascular disease: what we know and why it is important. J Am Dent Assoc. 2012;143(8):826-828.
Roger P. Levin, DDS
An increasing number of patients who put off treatment during the recent recession due to financial uncertainty are now reconsidering their oral healthcare options.
Practices that have stayed in touch with their patients, implemented follow-up systems, and improved overhead control have begun to increase their production and profitability. The Levin Group Data Center™ reports that approximately 25% of all practices are experiencing production increases and that there is a slight uptick in production for elective services. In today’s economy, even this modest, incremental improvement is very welcome news.
Michael R. Sesemann, DDS
I believe the greatest thing to happen to dentistry in 2012 was the palpable change that occurred in the mindset of our patients. After 3 years of physical, mental, and emotional retraction due to a recessionary economy, our patients seemed to return to making decisions about their oral health in a proactive manner.
Whether it involved re-establishing re-care check-ups, getting postponed dentistry done and/or saying “yes” to treatment that was essentially “want-based” as opposed to “need-based,” the end result was the beginning of a return to the busyness level that most offices enjoyed before the economy started to crash in 2008.
Van B. Haywood, DMD
This is the year that the Millennial Generation, comprised of those born after 1982, began entering dental school en masse. It has been said that the change in technology since 1982—including the displacement of maps by GPS devices, dictionaries by Spell Check, and print journals with internet information sources—has influenced our world as dramatically as did the printing press more than 600 years ago. In my opinion, this will also dramatically impact dental education for this generation of students who, in many cases, access and process information differently than previous generations of dental students. Dental education and dental practice have been and will be altered forever. As a culture, we no longer read maps, but use GPS, so treatment planning for long-term care, much like following a map, is a skill that must be taught differently. With Google and Wikipedia, there are no longer “authority figures” from which we obtain dental knowledge, but anything found on the Internet is often assumed to be correct.
This instant access to information may preclude remembering and assimilating information to be used in a clinical setting. Likewise, this new generation—many of whom were raised on quickly prepared or microwaved meals, rather than “from scratch” cooking—may find that critical thinking and problem solving are skills that have to be re-introduced. Cooking today is mostly done from pre-made items placed in a microwave, and students have no longer seen biscuits or bread made, so the mixing of alginate (like flour and water in baking) and cast stone is a new adventure to them.
Then there is their familiarity with video-driven information, such as is found on YouTube. The advent of YouTube makes learning exciting, but a move from the lecture/lab standard for teaching to the interactive, video-driven, flipped-classroom design would be time-consuming. The preciseness of computers and the ability to record or photograph anywhere, anytime, changes the dynamics of the teaching program as well as patient care.
Coupled with this worldwide shift is the graying of the faculty, the almost 400 faculty positions available in the United States, and the opening of new private high-tuition dental schools—there is speculation that 20 such schools will open in the next 5 years—so it will be interesting to see from where the teaching originates, and what is the content of the dental education and the scope for practicing dentist based on the technological advances we have enjoyed. This is the beginning of the evolution of the dental profession as we know it.
Amanda Seay, DDS
2012 continued to see the ever-present demand for conservative esthetic dentistry that will preserve as much tooth structure as possible. I am amazed by the constant development of techniques and materials used among dentists and laboratory technicians to achieve the most natural results. This is becoming the new standard in dentistry, and public awareness is only growing.
With the changing economy, our profession needs to be able to offer phased case options for patients who desire full treatment but are limited financially. This requires the dentist to understand, manage, and deliver cases with more than just porcelain.
Kim V. Kutsch, DMD
In my opinion, the greatest thing that happened in dentistry in 2012 was the ICNARA2 meeting that was held in Chile in January. There, recognized experts on dental caries, including researchers and educators from all over the globe, gathered to share their knowledge and research and work together to try to develop a coherent plan for future research as the dental profession addresses the growing epidemic of dental caries. The meeting provided an open sharing of information to further the development of an approach to successfully manage this disease.
Dental caries is a complex biofilm disease, and traditional restorative measures are no longer adequate. To meet the needs of our international communities, it will take all of us working together to find a solution. ICNARA2 provided that stage.
Frederick A. Rueggeberg,MS, DDS
Many practitioners not only use curing lights of inadequate irradiance or improper wavelength ranges, they are also poorly trained on effectively delivering light energy. A newly developed instrument (MARC®, BlueLight Analytics) directly measures the practitioner’s ability to effectively deliver light in a variety of clinically relevant exposure scenarios. Accumulated findings using this device validate the fact that the practitioner’s method of light delivery can significantly influence the extent to which restorations are cured, and thus may significantly impact the long-term durability or photo-cured materials.
Howard E. Strassler, DMD
We take light-curing for granted. We used to have a mindset of “turn it on and we are done,” except we now know light-curing requires more than just an on and off switch. Adhesives and composites polymerize because of specific energy requirements to harden these materials. Research done these past 5 years by Richard Price at Dalhousie and the development of two unique and innovative devices—the MARC® Patient Simulator and MARC® Resin calibrator (BlueLight Analytics, http://curingresin.com)—are helping clinicians to better understand and quantify how much energy is being delivered to composites and the best practices for light-curing. Composites can last a lot longer than are being reported. Heightened awareness for best light-curing practices can make a difference.
Raymond Bertolotti, DDS, PhD
In 2012, the best thing to happen to dentistry was definitely the formation and first meeting of the Academy of Biomimetic Dentistry.
Biomimetic dentistry treats weak, fractured, and decayed teeth in a way that keeps them strong and seals them from bacterial invasion. It builds on the growing trend of minimally invasive treatment. It is contrary to traditional dentistry, where amputation is often performed to treat bacterial disease. Biomimetic dentistry rebuilds teeth with materials that simulate natural teeth closely and hold up better to constant chewing. The goal is to eliminate catastrophic failure and at the same time restore teeth that feel good, look good, and last a long time.
Ken Koch, DMD
The greatest thing to happen to dentistry in 2012 was the realization that endodontics and restorative dentistry are not separate entities. In fact, there is an intimate relationship that exists between endodontics and restorative dentistry. Indeed, it is an Endo-Restorative Continuum.
Therefore, endodontics should be accomplished in both a conservative manner, as well as one that allows the obturation technique and post (if required) to precisely match the endodontic shape. As a result of improved techniques and better material science, we finally have the ability to accomplish this in a predictable manner. The net result? A greater ability to save the natural dentition and to expect an improved prognosis for endodontically treated teeth.
Wilson J. Kwong, DMD
2012 marks the 60th anniversary of the discovery by P.I. Brånemark of osseointegration, which I feel has led to a renaissance in dentistry, with the development of materials that mimic not only the function but also the form of tooth structure. With the continued advancement of implant systems, the day of fixed, toothborne bridgework and removable prosthetics will soon be over.
As a general practitioner, I am very lucky to have patients who accept implant-based restorative options, allowing me to give them the best treatment I can today. The best thing about this year is being able to look back and see how far we have come, thanks to predecessors like Professor Brånemark, who laid the foundation upon which we tread.
Thomas Trinkner, DDS
I am amazed by the digital quality from our current x-ray technology. I continue to think that with these tools and the art of more conservative approaches to treatment, we will be not only seeing things early, but treating them in a completely non-invasive fashion.
For me personally, the style of micro preparations, sonic preparations, and additive dentistry has made my clinical time fun. I strive every day to catch things before they become a problem. This entire year, I have focused on developing cleaner, more efficient ways to treat the tooth and the patient. New materials have helped. New smaller handpieces for better access and sonic handpieces with diamond tips are also changing the format for treatment.
The National Dental Association, Hispanic Dental Association, and Society of American Indian Dentists held a landmark Multicultural Summit in 2012, attracting a broad range of constituents focused on connecting vulnerable communities with resources to address urgent oral health issues and eliminate disparities.
OHA applauds their meaningful work around breaking down barriers among physical and professional communities—a step urgently needed to move energy and resources toward the nearly 50% of Americans lacking dental benefits, according to OHA’s 2012 Public Opinion Survey. This Summit celebrated our differences and shed light on opportunities to work together to improve health through access to oral healthcare resources.
Noshir R. Mehta, BDS, DMD, MDS, MS
The American Dental Association’s current interest in the concept of Inter Professional Education (IPE) will change the way dentists treat patients in the future. We once again will become an integral part of human dental and systemic health, and take our rightful place in the interdisciplinary community of healthcare providers.
The role dentists play in the early screening for high blood pressure, diabetes, headaches, and sleep disturbances—just to name a few—is helping educational institutions redefine the 4-year dental curriculum from a silo mentality of teaching into an integrated case-based format.
Gregori M. Kurtzman, DDS, MAGD
Short-term orthodontics took a leap forward with the introduction of Six Month Smiles. Clear-retainer orthodontics has been available for over 15 years and has attracted adults to correct anterior esthetics, but the shortcomings of this modality limited what could be achieved and often treatment time could stretch to 18 months or longer, leaving both patients and practitioners disappointed.
With the introduction of clear bonded brackets combined with tooth-colored NiTi wires, a cosmetic approach is available with treatment times averaging 6 months to achieve the goals of patients and practitioners alike in providing nearly invisible fixed appliances.
Ann Battrell, RDH, MSDHc
Passage of the Affordable Care Act will make health coverage possible for millions of Americans, including children who will be eligible for dental coverage. The bill includes prevention and health promotion, an improved oral health safety net, and Alternative Dental Health Care Provider grants to educate and test new oral health workforce models, including those that utilize dental hygienists and advanced practice dental hygienists.
While funding for that program was not included in the 2012 budget, the American Dental Hygienists’ Association will continue to work in partnership with other stakeholders to promote funding for this pivotal program in FY 2013.