What has changed the way you practice dentistry? Is it the soft-tissue laser
you love so much you even use it to cut the crust off your sandwich? Is it the
eye-opening tutelage from a no-nonsense dental guru? Is it a harsh rule or
regulation the government imposed upon the profession? Or maybe something
you've used all along, but know you would be unable to perform high
quality dentistry without it? Whatever the case, whether a dentist has been
chairside for 50 years or five minutes – every single one of us has an answer
for what's most impacted the way we practice dentistry.
Dentaltown was curious to find out what you thought the biggest game
changers in dentistry were. So, before Townies opened their ballots for the
2010 Townie Choice Awards, we asked one simple optional question: In your
opinion, what person, event, story, technology, product or service do you
think has been the biggest "game changer" in all of dentistry?
We thought we might get 100 answers, tops. But, man, were we wrong! More
than 1,600 Townies answered the fill-in question. Some answers, we thought,
were pretty spot on – others, like "my emergence into the dental field" and
"my birth," well, some Townies are well known for their sense of humor…
As we tallied up the votes for the Townie Choice Awards, we compiled the
"game changer" data and pared your responses down to the 50 most popular
answers. Then we asked members of our Editorial Advisory Board, popular
contributors to Dentaltown Magazine, and well-known dental industry professionals
to weigh in on why they thought the following 50 items were considered
game changers by the Townies. Herein we are proud to present the
results and reasoning for the 50 Greatest Game Changers in Dentistry, in
no particular order…
#1 CAD/CAM
Machines that take digital impressions, make virtual models
and fabricate the restoration through porcelain/ceramic or composite
milling have reformed the concept of practice for technologically
open-minded dentists. CAD/CAM allows precise and aesthetic restorations to be
completed in a single appointment. The need for traditional impressions, temporaries
and additional appointments for seating and delivering the restoration are eliminated.
We all know that "stressful" feeling on the try-in appointment, the concern we
have about adjusting those lab fabricated crowns that might not fit or have occlusal
issues. CAD/CAM puts all the control in the hands of the dentist, greatly reducing
the need for adjusting and refitting lab crowns. Done correctly, the marginal
integrity, occlusion and aesthetics of CAD/CAM restorations is superb.
CAD/CAM restorative dentistry is the new paradigm in dental care. It is the
future of restorative care.
Add up all the benefits that CAD/CAM provides to the practicing dentist
and, as famous American songwriter and philosopher Bob Dylan once sang, "the
times, they are a'changin." Restorative dentistry is "a'changin" and, yes, it's
"a'changin" dentistry. – GH
#2 Bonding
Where would dentistry be without bonding? We'd have no
need for curing lights, finishing discs and strips, mylar bands, Medieval-looking
matrices, and a million little sticky bottles. Wouldn't life be
great? Not!
We'd all have to remember what resistance and retention form are
and do G.V. Black preps. We'd be back to heavy metal dentistry, dudes.
Bonding and the subsequent cosmetic dentistry revolution have put a
new face on the dental profession. Instead of images of "shots," burning
chicken feathers, whiny drills, and the red drool in the white sink, the
public now see the dental office as a place of tiny injectors, aromatherapy,
pajamas, 80s music and a chance for a better facial appearance. The
potential of a better look and a better life puts the old, "nothing personal,
but I hate dentists" line in the attic with grandma's dentures and my
ABBA albums. Bonding has put a new smile on all of us. – D. Carlsen
#3 Composites
There is an obvious necessity to restore teeth in the smile zone and
composite material provides miracles. Tooth-colored restorative material had an
early start in dentistry as a single-color paste mix with limited application. The
material had limited aesthetics and poor wear rates.
Generations later, we now have access to composite filling material of every
color in the shade guide and reliable bonding agents to keep it in place for many
years. Wear rates have improved so much that composite resin fillings are placed in
all areas of the mouth. This aesthetic material threatens to completely replace amalgam
as more patients demand tooth colored restorations. – TG
#4 Lasers
Lasers are accepted in the medical field, particularly in ophthalmology
in the discipline of laser eye surgery. The acceptance that lasers
can change our vision safely and painlessly has helped with patients'
acceptance in the dental field. Dentists have been slower to pick up lasers
for their practice primarily because of cost and education.
The price drop on soft-tissue lasers has brought many neophyte laser
users into the field. This influx of dentists has driven up the demand for
education – be it articles, lectures, hands-on training or Webinars. Many
dentists are enthused at how these dependable, portable, lightweight diode
soft-tissue lasers can be used for both soft-tissue surgery and the ablation
of mild to moderate amounts of tissue in procedures like gingivectomies,
crown troughing, frenectomies and fibromas. New procedures such as the
treatment of oral lesions – aphthous ulcers, venous lake photocoagulation – have also been "hot" topics amongst dentists. In dental hygiene, we are
seeing a growing interest to combine the laser with traditional methodologies
to help decrease bacteria load in the gingival sulcus.
With the dramatic drop in price of soft-tissue lasers, combined with
an increase in educational opportunities on this topic, more and more
clinicians are "seeing the light." – GV
#5 Computerization/Practice Management Software
Computerization has been one of the best things to
happen in dentistry. Dental practices are running more efficiently
and they have easier access to their information than ever before.
The use of computer softwares like Dentrix, Eaglesoft and now Web-based
Curve Dental, have made the dentist and dental teams more aware of every
aspect of the practice and opened their eyes to the business side of dentistry.
Dentists have more access to what is actually occurring in their business, and this
has created a newfound interest in the administrative side of the practice. The
technology allows access to the office computer from home or mobile device.
Dental teams are working together to provide better care. There is more focus
on being productive and utilizing time wisely. Thanks to digital scheduling, practices
have healthier recall systems and are more aware of patients putting off
needed treatment. Computers in the practice have helped improve patient relations
due to excellent communication capabilities.
Features like digital charting, digital scheduling and working paperless, save
time and money. They also help decrease mistakes and increase security. Lastly,
computer reports provide all the needed information for the dentist to have
his/her finger on the pulse of the practice at all times. – SP
#6 Digital Radiography
First and foremost, digital images have facilitated the paperless office concept
(Editor's note: see our feature on going paperless on page 100 of our December 2010
issue). Additionally, this technology has eliminated costly and toxic chemicals
from the office. The abilities to instantly view images as they are taken and
digitally enhance the image are advances that we could only dream about
when X-ray film dominated the profession. This technology continues to
gain market share and will likely eliminate film-based X-rays in the same
fashion that digital cameras have replaced film. – TG
#7 Implants
Dental implants have been around for thousands of years – and have
even been found among Mayan ruins. Early 20th century implants were root-like metal
baskets made of gold or iridium. In the latter half of the 20th century commercially
available blade implants entered the market and competed with subperiosteal implants
which are custom made by dental labs. These implant systems were successful but had
high failure rates, were technically challenging and had limited clinical applications.
These challenges left implants on the fringe of dentistry.
But developers of the modern implant like Drs. Per-Ingvar Branemark and Gerald
Niznick didn't give up… since the introduction of osseointegration, implants have taken
shape as a root-form titanium screw with a textured surface, proving both successful and
predictable. This drove the rapid growth of large and small commercial manufacturers
of implants and prosthetic components.
Advances continue in design, technique and materials, most recently with the use of
zirconia in the place of titanium.
The importance of dental implants in dentistry is evident in the statistics. Sixty-nine
percent of adults between 35 and 44 have lost a tooth due to trauma, decay, gum
disease or a failed root canal according to the American Association of Oral and
Maxillofacial Surgeons. And with a success rate of 95 to 97 percent over 20 years, it's
no wonder consumers are excited about the emerging technology. – WK
#8 Dr. Gordon J. Christensen
Presenter of more than 45,000 hours of continuing education
and co-founder of the Clinicians Report (formerly Clinical
Research Associates), Dr. Gordon J. Christensen is one of the most
well-known and well-respected dentists in the world. When Dr.
Christensen speaks, dentists listen. "From the time I graduated in
1984, Gordon was the one who came around every year or so and
gave a straight forward, honest and unbiased look at dentistry," says
Townie "drjames." – ML
#9 Loupes and Magnification
Dentistry is so much easier if you can see what you are
doing. Back in the "dark ages" of dental and surgical education, we were
taught to do procedures using the naked eye with aid from the overhead
dental light.
Operating microscopes were once seen only in the operating room. But,
manufacturers saw the potential for dentistry and began producing scaled-down
versions that made them affordable for dental practices. This technology
became popular first among endodontists and restorative dentists, and
then spread to other specialties. Now, operating microscopes are also seen in
many dental practices, allowing precision in procedures that was not felt to be
possible a generation ago.
Surgical telescopes (loupes) have become commonplace in dentistry in the
last 15 years. No matter how minor the procedure, using magnification elevates
your standard of care overnight. Being able to clearly see every detail of
the operative field, even in the most distal areas of the mouth, makes dental
procedures less stressful, faster, easier and more successful. The surgical telescopes
of today have been significantly improved with lighter weight frames
and lenses, making them more comfortable and less "nerdy-looking." Many of
them can also be paired with integrated LED and fiberoptic headlight systems,
enhancing visibility even further.
Seeing is believing. No matter what your specialty and what procedures
you perform, adding magnification to our armamentarium with loupes or an
operating microscope has enhanced our vision – both of the teeth and of
dentistry as a progressive science. – JR
#10 The Oral-Systemic Connection
Just a tooth fixer? – not anymore. The modern dentist accepts the
responsibility to identify, treat and manage the most common inflammatory
process of the body – gum disease, and there is an insane amount of it running
rampant, undetected and untreated. So as the prevention of periodontal disease
continues to reveal more and more "whole body" benefits, patients will count on
their dentist to help them live a longer, healthier and happier life.
Now physicians will be depending on dentists to manage the risk factors
for serious disease that they have no control over. If a physician is responsible
to manage the risk factors for serious diseases like cardiovascular disease,
stroke, diabetes, cancer, and arthritis, in addition to preventing pregnancy
complications, they must work with a dental team. One of the greatest paradigm
shifts our profession has ever experienced is happening now – oral health
affects body health. Get ready for the tsunami that will be oral systemic and
the impact it will have not only on dentistry, but on the entire health-care
community. – CK
#11 Digital Photography
Imagine trying to match single central incisors or document
before-and-afters without digital photography. Imagine completing a
smile design and not being able to capture an emotional after-picture of the
patient. Imagine keeping your images in a storage room instead of a hard
drive. Digital photography is as much a part of our practice as our handpieces and
lasers, but without the precision and control that typical dental instrumentation
requires for success.
Dentists are implementing more digital photography into their practices and
finding themselves in an area that is dominated by subjectivity rather than exact
depth cuts and correct wavelengths. This new role we play as dentists fosters positive
relationships with our patients, as we gather more detailed information than
ever before, to help dentistry achieve new levels of success. Digital photography
allows us to have instant communication with our laboratories while our patients
are still in the chair. Patients can be educated with the images we capture inside
and outside of the mouth at the same appointment. We can even shoot a patient's
new smile during a try-in, and show them the after-picture for approval before we
bond the restorations to the teeth. Digital photography is encouraging dentists to
hold themselves to higher standards than ever before.
Take away my digital camera and you might as well take away my drill. – JO
#12 Local Anesthesia
Dentists used cocaine for local anesthesia in the 1840s. With better technology and
legal (and ethical) ramifications, we've moved on. Products like Lidocaine and Articaine
have not only saved patients' gums, but also their tear ducts. – CP
#13 Internet
The "dot-com boom" shook the business world. Between the rapidly changing
stocks in '96 and '97 and the dawn of social media giant Facebook in 2004, the field
of dentistry had little choice but to jump on the bandwagon. Dental practices now
sport Web sites, Facebook fan pages, Twitter accounts and blogs. It's a whole new era
of social media and Internet publicity nowadays, and if you're not sure what we're
talking about, Google it (or go back and check out Dentaltown Magazine's Social
Media Focus in the September 2010 issue). – CP
#14 Isolite
Tired of the shadows created in the mouth from the overhead
operatory light, Dr. Thomas R. Hirsch set out to create a solution
by putting the light source where he needed it most – inside the patient's mouth. By combining intra-oral illumination
with the ability to aspirate and retract, the
Isolite dryfield illumination system was born. – ML
#15 Dentaltown
We promised ourselves we wouldn't cry… Dentaltown hasn't ever thought
of itself as a "game changer," yet we made your list. In 1999, Dr. Howard Farran
had an idea to create a Web site for the dental profession. The site would know
no boundaries. It wouldn't care if you were from Toronto or Hong Kong or
Sydney, Australia. Dental professionals would enter a chat room, post an X-ray or
a photo or a case history and ask colleagues from around the world to discuss the
case. The Web site would be a way for dentists to connect with their peers and
save one tooth at a time. And for more than 11 years, via Dentaltown.com,
no dentist has ever had to practice alone since. Connecting thousands
of dentists around the world, becoming the proving ground for
products and services and even inspiring some Townies to
start their own dental companies, Dentaltown remains
the largest and most vibrant community in the
dental profession. We don't always like
to toot our own horn, so thanks
for doing it for us. – BL
#16 Clear Aligners
Braces came into play in the early 1900s, and the methods of moving teeth stayed
relatively the same until the introduction of Invisalign in 1997. Gaining FDA-clearance
to market in 1998, Invisalign changed the "how" and "who" in moving teeth.
ClearCorrect has since followed in their footsteps.
After impressions of the teeth are taken, data is sent to respective labs, where computer
software generates a series of clear plastic trays for teeth retention. The easy
process provides adults (and now teens) with the means of straightening their teeth
without the hindrance of unaesthetic metal braces.
Not only did clear aligners change how teeth are straightened, it opened the
door for general dentists to facilitate minor orthodontic work. It also provided
high schoolers a nice respite from the classic nicknames, "metal mouth" and
"tin grin." – CP
#17 Electronic Reminders
Piggy-backing on the e-prefixes of the dot-com boom, electronic
reminders, or e-reminders, show up in patients' e-mail inboxes and on cell phones to
not only jog their memory to schedule a recall appointment, but also to confirm
appointments they've already made. They eliminate the expense of postcards and
postage stamps, they allow patients to reply to confirmation text messages, and most
importantly, they meet patients' where they're at, which as it turns out, is no longer at
the mailbox. – CP
#18 Metal-free Restorations
They replace pre-existing porcelain-fused-to-metal (PFM) crowns and
bridges, provide beautiful smiles for our patients, and help avoid the need for aggressive
preparations. Aesthetics might be the primary driving force for metal-free
restorations, but it certainly is not the only one.
Metal-free materials can also be used for multi-unit bridge applications. The
bridge applications utilize a zirconium-oxide substructure which does introduce
some opacity, but usually provide far superior aesthetics than we have traditionally
seen with metal.
Metal-free restorations present the opportunity to be more conservative in preparation
design. This is especially true with the lithium disilicate (e.max) and leucite-reinforced
(IPS Empress) ceramics that can be as thin as 1mm on the facial and
lingual of full coverage crowns and the translucency of the material allows placement
of a supragingival margin. These materials can also be bonded using dentinal adhesive
systems and resin cements, so retention can be enhanced and eliminate removal
of healthy tooth structure.
Many of these materials are "wear-friendly" when opposing natural enamel, unlike
most of the powder-liquid ceramics placed on metal copings with PFMs.
The decade-long search for metal-free indirect restorations has resulted in a
much prettier outlook on dentistry. – DH
#19 Power Toothbrushes
Whether the brush head is straight, round or with multiple heads, power toothbrushes
provide uniform bristle movements that far exceed what can be done in the
same amount of time with a manual toothbrush. The timer introduced with single
brush-head power toothbrushes addresses two areas of failure with manual toothbrushes:
brushing long enough and brushing throughout the mouth. The timer assures
brushing lasts two minutes with a signal to move from mandibular linguals, to
mandibular facials, to maxillary facials and finally, maxillary linguals. New powerbrush
designs with multiple brushheads reach maxillary, mandibular and occlusal surfaces at
one time, reducing brushing time while insuring all surfaces are reached. In terms of
being proactive about oral health care, power toothbrushes have brought more power
to the tooth brusher. – TO
#20 Dr. Frank Spear
Frank Spear, DDS, MSD, is most known for his contributions as a leader and
educator in aesthetic and restorative dentistry. In 1994, Dr. Spear founded The
Seattle Institute of Advanced Dental Education, now renamed Spear Education,
and has expanded to the Scottsdale Center for Dentistry. Dr. Spear challenges dentists
to provide better patient care by teaching how to treatment plan and problem
solve in a logical manner. "I don't think you will find anyone who isn't happy with
their educational experience with Frank," says Townie "socalsam." – ML
#21 Whitening
Whitening has made cosmetic dentistry or appearance-related dentistry
affordable. Prior to teeth whitening, to obtain a really great smile veneers or crowns had to be
placed, which was not practical or affordable for many patients.
Now patients can have bright smiles for a very minimal cost and with a non-invasive procedure.
When patient's started to learn about whitening options, it brought in patients that
had not been to the dentist in years, ultimately giving dentists a second chance to educate
patients on the importance of consistent dental visits. Whitening helped to
brighten dentistry's future in more than just shades of white. – DH
#22 Dr. John Kois
John Kois, DMD, MSD, director and founder of the Kois Center, serves dentists
through continuing education courses. He and his team provide an intimate environment
for learning about current clinical dental topics. "He changed the way I viewed
dentistry in the first 10 minutes of his TxPl I course," says "rochdoc," on the message
boards of Dentaltown.com. And if all that isn't enough, according to Townies, the institute's
bathrooms are apparently worth a visit as well. – CP
#23 NTI
Invented by Dr. Jim Boyd, the NTI-tss is an FDA-approved dental
solution for the prevention of migraines, tension headaches and
TMJ related pain. This appliance has a design that utilizes a patented
discluding element to provide protection of muscles, joints and teeth by
suppressing parafunctional intensity by 70 percent. Fabrication of this appliance
can be accomplished chairside or with an approved lab. The response from
patients and dentists has been very positive, which is one of the reasons this appliance
received so many nominations for our list. (And check out our interview with
Drs. Boyd and Andrew Blumenfeld about the NTI-tss in this issue!) – TG
#24 Microscopes/Telescopes
The dental microscope provides perfect coaxial light and affords multiple
magnification levels from 3X to 24X. The impact on dentistry is quiet yet profound.
Between 1990 and today, the number of endodontists using microscopes
has increased from one percent to 90 percent. What does that mean for non-endodontists?
Well for starters, complex endo done without a microscope can be
considered as a "second-class treatment." And with the majority of endodontics
being performed by GPs, not endodontists, you are likely to see more and more
microscopes in hometown dental offices. Bottom line: if you enjoy endo, you
will eventually buy a microscope. Period. And then you will probably begin to
use your microscope for many non-endo treatments… partly
because you'll be in love. – D. Clark
#25 Fluoride
In high doses it is hepatotoxic, but the trace amounts found in many
public water supplies make teeth resistant to cariogenic acids. This allows fluoride
to prevent decay as well as remineralize incipient lesions.
Baby boomers have come to expect that they will retain their teeth for their
entire lives. Unlike their parents who might have believed that everyone will
eventually need dentures, boomers have decided to spend significant time and
money in preserving their dentition. Fluoride in all its forms has been a powerful
weapon in the fight to preserve our smiles.
Since the early days of fluoride the effect has been astounding. Edentulism
in people 45-54 years of age in the early 1960s was around 20 percent, but by
the late 1980s the number had dropped to about nine percent.
Fluoride has brought dental medicine a long way in the last 60 years.
The CDC was justified in naming water fluoridation one of the top 10 public
health achievements. Fluoride will continue to protect our smiles and
form the cornerstone of the minimally invasive dental medicine practice of
the future. – WK
#26 Power Scalers
The technology adapted to power scalers includes magnetostrictive, piezoelectric
and sonic, to remove hard and soft dental deposits, both supragingival and subgingival.
Although first developed in the 1950s as a failed drilling instrument for
caries excavation, it was adapted for plaque and calculus removal. Power scalers
prove to be a faster, more comfortable deplaquing and calculus removal method for
patients and clinicians who appreciate less stress to hand and arm muscles and faster
deposit removal. – TO
#27 Sealants
Deep pits and fissures on
occlusal surfaces of posterior teeth are risk
factors for caries that toothbrushing cannot keep
clean. Pits and fissures can be completely sealed with
either filled or unfilled sealants that effectively keep out sugar,
bacteria and the acid responsible for dissolving enamel. Sealants are
applied routinely in the dental office and in public health school sealant
programs across the country. Preventing occlusal caries is a significant step in
helping patients achieve the goal of living caries-free – and as a result, maybe a
bit more carefree as well. – TO
#28 Apex Locators
If you are still depending on radiographic measurements for root canal therapy, you
should really reconsider. With electronic apex locators the basic principal is the measurable
electrical resistance in the biological tissues in and around a tooth. An entire root canal can be
done with a great deal of confidence with only two X-rays – one at the beginning and end. The
electrical circuitry is more accurate than an X-ray because it does not depend on the angle of
the head of the X-ray machine, the placement of the film or sensor, or the position of the
patient. X-rays require time to set up, take and develop, not to mention the cost. In addition,
there is a huge reduction of ionizing radiation for both the patient and the office staff – a wonderful
benefit for pregnant patients, as well as those recently exposed to radiation for cancer
treatment and tests.
All in all, electric apex locators have become an essential instrument to dentists. As with
most dental instruments there are several apex locators on the market. They've certainly
improved since their inception in terms of type of electrical current being generated, ease of use
and accuracy, as well as shape, size and cost.
They might not be new to dentist's armamentarium, seeing that they've been around since
the 1960s, but apex locators like the Root ZX, or its dinosaur cousin the Neosono-D have
played a large part in root canal therapy – then and now. – MG
#29 NiTi Endo Files
Nickel titanium (NiTi) files have given both specialists and general practitioners
alike the ability to routinely create shapes once only imagined with
hand files.
The importance of NiTi rotary files goes back to the basics of why we
shape a root canal. We shape a root canal to increase the efficacy of our irrigation
agent and to expedite obturation.
They have changed endodontic therapy because they have allowed us to
significantly improve patient care and to accomplish it in a predictable, expeditious
manner. – KK & DB
#30 Practice Management
The days of eugenol smell and the little lady behind that ghastly glass barricade are long gone
in dentistry.
Practice management has deconstructed and repaired many design, treatment and financial barricades
over the last 30 years.
Yet, the major hurdle conquered has been patient fear. Efficient systems eliminating almost all
reception room waiting and providing quick treatment protocols have been a godsend. The advent
of stronger and virtually painless injections and better office ambiance increase real patient comfort.
Most of all, team harmony and positive attitude have crushed the fear quotient.
Practice management has brought the fun factor to dentistry. – D. Carlsen
#31 Dental Hygienists
Irene Newman provided preventive and periodontal support services
to dental patients for Dr. Alfred C. Fones in Bridgeport, Connecticut, in 1906. Since
then, the dental hygienist has been crucial to dentistry – as an oral health coach of the
dental practice, providing education, motivation and prevention as well as periodontal
therapy. The dental hygienist frees up the dentist to provide dental restorative and specialty
care while answering patients' questions about treatment and proposed cosmetic
options. With a healthy mouth, patients can consider elective dental care. – TO
#32 Caries Detection
Caries detection has come a long way from an oral examination with a
mirror, probe and X-rays. Film speed went higher and higher with an associated
loss of resolution. The loss in resolution was associated with that required to diagnose
an interproximal lesion at about the time it would be deemed ready for
restoration. This led to many occlusal lesions being missed until they were nearly
pulp exposures. Technologies developed over the last 10 to 15 years have seen early
accurate diagnosis of occlusal lesions become a simple clinical reality. This early
detection allows for minimally invasive repair of the fissure structures before the
biomechanical integrity of the tooth has been compromised, thereby reducing the
long term sequelae for the patients.
The first effective technology was the DIAGNOdent from KaVo that utilizes
laser fluorescence to detect damage to enamel in the walls of the fissures. There are
now several similar products on the market as well as imaging systems such as quantitative
laser fluorescence and techniques using light fluorescence and imaging software
to highlight areas of fissure demineralization. The ability to diagnose early and
accurately lead to the development of techniques like micro air abrasion and the use
of fissureotomy burs to carefully dissect out the demineralized tooth structure and
avoid compromising biomechanical stability.
White spots and cavities are simply the signs and symptoms of a bacterial infection,
or diseased biofilm which is known as caries. True caries diagnosis is the detection
and diagnosis of a biofilm that has reached a point where the bacterial
population is such that it can damage the underlying tooth structure. The selection
pressure for the development of a cariogenic biofilm is low pH. Utilizing this phenomenon,
a simple 15-second biofilm fluorescence test known as CariScreen has
been developed that detects the presence of disease levels of acidogenic, aciduric
bacteria in the biofilm, rather than waiting to clinically observe the damage
the diseased biofilm is causing to the teeth. – GM
#33 Triple Trays
Commonly referred to as Triple Trays (a trademark of Premier), quadrant impression
trays have infiltrated the profession so deeply that they are commonplace. Their ability to
capture prep, opposing arch and bite registration in one impression had never been done
before. While there are still some non-believers, the quadrant impression tray has become standard
of care for most single tooth restorations. – TG
#34 Curing Lights
1980 was the last period of time that restorative dentistry was performed
without curing lights. To do an anterior restoration, dentists mixed Concise and
had about 30 seconds to place it in the restoration before the material started to set. This
was not always feasible and because of that, composite restorations did not last very
long. UV-cured material was introduced – Nuva Fil, then Prisma Fil. By the mid-80s,
every anterior restoration was done with a curing light. That total change in how anterior
dentistry was done took less than five years. Now of course, the majority of posterior
restorations are done with the use of a curing light – from veneers to porcelain
crowns, to bonding agents. Needless to say, dentistry took an exponential leap forward
with the introduction of light cured materials and the modern curing light. – HG
#35 Veneers
Patients can now achieve the smile of their dreams without the time required for orthodontics or the
need to aggressively prepare the teeth for full coverage crowns. Many dentists now see dentistry as a
means to improve their patients' self-image, rather than just eliminate disease and alleviate pain.
New techniques and materials are changing people's lives, and it's no wonder many clinicians now
enjoy going to work to share these advances in technology with their patients. You are better at things
that you truly enjoy. Not only are patients enjoying their new smiles, but as a direct result of utilizing
porcelain veneers, dentists are enjoying it too. – DH
#36 Handpieces
Remember the belt-driven handpieces of the old dental office? – the ones
that could hardly cut through enamel and amalgam. Air driven highspeeds revolutionized dentistry.
Not only could you easily drill through all materials with precision, but there was less
vibration and increased patient comfort. Now, one step further are electric handpieces. They
generate much more torque with less vibration. Without the evolution of handpieces, we'd be
hard pressed to do veneer preps… or any precision restorative work for that matter. – HG
#37 OSHA
In December 1970, Richard Nixon signed a bill under the Occupational Safety and Health Act essentially
making gloveless wet-finger dentistry obsolete. OSHA was burdensome in its early years. Dentists were required
to wear gloves, masks, and make sure the sterile environment was up-to-code. Dentists had to have more significant
training, better communication and legal documentation, all at their own expense. It took years to see
the benefits. But now, although the legalities still occasionally prove taxing, every time you slip on a pair of
gloves, you prevent transmitting HIV/AIDS, hepatitis and other blood-borne pathogens. You are more aware
of the chemicals in your products and you are more careful about the environment in which you practice. Not
only are you protecting patients, but you're protecting yourself – certainly a change for the better. – CP
#38 Marketing and Advertising
Long gone are the days of opening up shop, hanging a shingle and waiting for dental patients to
flood your waiting room. They need to know you exist, what kinds of services you provide – and even
more, who you are as a person. And as marketing has changed, so has your involvement with it. – BL
#39 Practice Web Sites
How does a patient choose between two doctors with the same academic and practice
experience in the same area? If we had the answer, we'd tell you. However, we do
know that good reviews and a prominent Internet presence can't hurt.
Since the advent of practice Web sites, they have varied drastically from each other.
Some dentists want templates, others want to create their sites custom. Some pay the
big bucks, and some want to attempt the effort themselves. Web sites range from minimal
"business-card-like" templates, to flashy strobe-light ads and features, to a more
education-based approach. Whatever your preference, style or budget, there are
options. And your site, depending on the quality, is likely to be the catalyst in driving
patients either in or out of your doors. – CP
#40 Cosmetic Dentistry
Cosmetic dentistry created a shift from patients seeking need-based dentistry to
desiring straight, healthy pearly whites. Patients who avoided the dentist for years
started calling because they wanted a nicer smile. We have reality TV shows like
Extreme Makeover to partially thank for this.
The consumer looking to have cosmetic dentistry is actually looking for a dental
office that has a different aesthetic as well. So dentists are changing everything from
office décor, to the clothes on their backs all for the psychology of patients' treatment
decisions. Patients seek dentists who are up-to-date with the latest techniques and
equipped with the latest gadgets in hopes of achieving the perfect smile. Aesthetic complacency
is being challenged, as dentists are given more tools to help provide uncompromised
cosmetic results with more conservative techniques.
Cosmetic dentistry has not only revolutionized the way we practice dentistry, but
the manner in which we present and perform it. Today, most every dentist advertises
general and cosmetic dentistry, but must continue to be aware that the word "cosmetic"
is not just a descriptive adjective, but a constantly evolving expectation. – JO
#41 Pankey Institute
In the 1930s, Drs. Pankey, Mann and Schuyler developed a comprehensive system for diagnosis and
treatment of complex restorative cases, including occlusal management. After four decades of trial
improvement, many long-lasting cases were documented. Starting in 1970, their seminal occlusal studies
were advanced by The Pankey Institute and Dr. Peter Dawson. In their continuum courses, more than
20,000 dentists have traveled to South Florida and learned that, with centric relation as a reference point,
one can develop harmonious functional contacts and anterior guidance in excursions. When you want
to learn about the complex concept of occlusion, you go to the horse's mouth. – MM
#42 Insurance
Dental insurance, once only a luxury to the wealthy, became a common supplement to general health
insurance in the 1970s. As the connection between oral health and system health became more prominent
in health studies, dental insurance became more prominent as well. Initially the goal was to make affordable
health care available to people who would normally not seek care due to costs.
The average maximum coverage from dental insurance providers averages about $1,500 per
year, and has not increased or accounted for inflation since insurance's introduction to
the dentistry scene in the '70s. This lack of coverage limits what dentists can provide,
since prices for supplies, equipment and time have increased significantly.
As a game changer, insurance has dual-citizenship in both negative and
positive territory. It's is just one more area in which dentists and
patients alike must weigh the cost of treatment to the quality. – CP
#43 Online Continuing Education
It's easy to continue with the status quo once you are out of
school. It's easy to find yourself 30 years later still using the same
techniques, tools and equipment as you did when you first
started… It's easy, unless you're proactive about not getting
stuck. Thankfully dentistry as a profession has taken a stance
on making continuing education a priority; to always staying
current on information and techniques.
By means of video, Webinar and PowerPoint presentation,
among many other mediums, you can complete
your CE requirements right from the comfort
of your own home. Not only are they available
24 hours a day, but you can complete them
in your underwear nonetheless! – CP
#44 Corporate Dentistry
Although the term is newly coined, corporate dentistry
has been around for the better part of the 20th century,
and made popular by Aspen, Western, BrightNow
and Heartland, to name a few.
Many just-out-of-school dentists who don't want to run
their own businesses or don't have the means of starting their
own practices find the option to work for a corporate dental practice
attractive. Corporate dental practices streamline accounts payable
and accounts receivable, payroll, supply and equipment procurement
and marketing. It's all very appealing to a dentist who has no interest in
maintaining the business side of a practice.
However, with options comes controversy.
They provide options for dentists, yet take options away from others. They provide
quality care at decreased cost, but opponents say they might not have the same one-on-one relationships
with patients. Sounds like a mixed bag of treats… and one thing Dentaltown is happy to
remain a forum in which the debate can continue. – CP
#45 Patient Financing
Rising overhead for dentists creates rising costs for patients. These increased costs come with the
need to adapt. Flexible patient financing has opened up a whole new avenue for people with limited
or no insurance to still receive the care they need, and for you to still be paid. Third-party
patient financing solutions like CareCredit, ChaseHealthAdvance, and Citi Health Card assist in
providing an affordable plan to patients seeking more flexible payment options. If patients can
afford care, you get patients through your door who might not have normally sought dental care
and you get paid for your services. It's a win-win-win. – CP
#46 CBCT
From airway analysis, pre-procedure outcome prediction, periodontal
status, tooth and implant assessment and positioning guidance, surgical
assessment, appliance preparation, facial pain patients and so much more, Cone
Beam Computed Tomography (CBCT) is a quantum leap for dentistry.
Adding the third dimension facilitates a confidence that has been eluding practitioners.
The unlimited opportunities that CBCT offers will be guided by our imaginations.
Along with optimal care, CBCT is a key component in eliminating
malpractice cases through facilitating a transparent understanding and meaningful
communication with the patient and the various health care providers involved with
treatment. CBCT is a 360-degree turn for dentistry. – DM
#47 HIPAA
August 21, 1996: The Health Insurance Portability and
Accountability Act becomes law.
It's more than just having firewalls and not detailing to Mrs. Jones your
draining of a purulent fistula on Mrs. Fillmore last week. It's more than handing
out a never-read form that you might have noticed in 2003. It's important to your
patients' security.
So please, at your earliest convenience, Google HIPAA Administrative Simplification
Regulation Text March 2006 and merrily browse segments like the following from page 37:
(B) The covered entity is responsible for complying with §164.316(a) and §164.530(i), pertaining
to the implementation of policies and procedures to ensure compliance with applicable
requirements of this section and subparts C and E of this part, including the safeguard requirements
in paragraph (a)(2)(ii) of this section.
(C) The covered entity is responsible for designating the components that are part of one or
more health care components of the covered entity and documenting the designation in accordance
with paragraph (c) of this section, provided that, if the covered entity designates a health care component
or components, it must include any component that would meet the definition of covered
entity if it were a separate legal entity. Health care component(s) also may include a component
only to the extent that it performs:
(1) Covered functions; or
(2) Activities that would make such component a business associate of a component that performs
covered functions if the two components were separate legal entities.
And you all thought Dentaltown was fascinating… HIPAA is the hippest thing to happen
to dentistry since, well, OSHA. – D. Carlsen
#48 Posterior Composites
Placing Class II posterior composites was nearly impossible to accomplish
in a predictable fashion until the advent of devices designed specifically for creating
a reliable contact. Since composite cannot be placed in the same fashion as amalgam, we
needed something to provide a firm contact with the proper shape. Leave it to dental
inventors to develop these great solutions. The items that we use in our practices every day
include: Composi-Tight by Garrison, V3 Ring by Triodent, Palodent by DENTSPLY
Caulk, Omni-Matrix by Ultradent and many more. – TG
#49 Sedation Dentistry
Nitrous oxide was first used as an alternative to local anesthesia when a young dentist
from Connecticut, Dr. Horace Wells had his tooth extracted by his associate, John
Riggs in December 1844. Today inhalation sedation, nicknamed "laughing gas," along
with oral sedation and intravenous (IV) sedation have provided dentists with the ability
to complete procedures faster and more efficiently. Many patients with a high dental
anxiety and fear, a severe gag reflex, and even those with a difficulty getting numb
from local sedation benefit from oral-conscious sedation. A dental procedure that once
took an hour to complete and now can be completed in minutes might not be a
"laughing" matter, but is certainly something to smile about. – ML
#50 Sleep Medicine
Do a root canal and you might save a tooth; make an oral device for obstructive sleep
apnea (OSA) and you might save a life. Although effective in treating sleep apnea, CPAP
machines have poor patient compliance… which is why it was exciting in 2006 when it was
announced that qualified dentists could administer oral appliance therapy for the condition.
Dentists play a large part in diagnosing and treating sleep apnea. So ask the STOP
questions when doing patient evaluations. S: Do you snore loudly? T: Do you often feel
tired, fatigued or sleepy during daytime? O: Has anyone observed you stop breathing
during sleep? P: Do you have or are you being treated for high blood pressure? Positive
responses to two of these questions indicate the patient is a higher risk of OSA than
average. Further evaluation with an Epworth Sleepiness Scale or Berlin Questionnaire
can help a clinician isolate patients who need attention.
It affects up to nine percent of males and four percent of females globally. So now
that we have the power to do something about it, don't hit the snooze button on dealing
with patient's sleep apnea in your practice. – MG
Contributors (as indicated by initials): Dr. Dennis Brave, Dr.
Douglas Carlsen, Dr. David Clark, Dr. Thomas Giacobbi, Dr. Michael Glass, Dr. Howard
Goldstein, Dr. Glenn Hanf, Dr. David Hornbrook, Dr. Chris Kammer, Dr. William Kisker, Dr. Kenneth Koch, Marie
Leland, Benjamin Lund, Dr. Donald Machen, Dr. Graeme Milicich, Dr. Mark Murphy, Trisha O'Hehir, Dr. Jason
Olitsky, Sandy Pardue, Chelsea Patten, Dr. Jay Reznick, and Dr. Glenn Van As.
What game changers did we miss? What made the list that you don't think should have? Comment and
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