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DENTISTS NEEDED – KOOL SMILES ($20K Sign On and Paid Relocation)

Kool Smiles is a growing dental practice with a mission of providing high quality dental care to underserved communities. With offices in multiple states across the country, we provide general dentistry to children and adults. We are currently hiring General and Pediatric Dentists for our Evansville, Indiana. This location is offering a $20k Sign On Bonus and Paid Relocation! All candidates must have a degree in dentistry and an active license to or be willing and able to obtain licensure. Please E-mail resume/CV to Heidi Houston at

Ethical advertising in dentistry

Advertising in dentistry is evolving. Social media posts, postcard coupons showing up in your mailbox – there seems to be endless ways to publicize your practice. A new practitioner is faced with an important question: how will you market your practice ethically in the midst of ever-changing advertising options?

A little history on advertising in dentistry: the ADA prohibited advertising dental services until 1977. Then two years later through negotiations with the Federal Trade Commission, the ADA’s principles of ethics concerning advertising was revised. Today, you can read these policies in this document of 2012 Current Policies, which is applicable through 2013 (click here to download and look on pages 32-35). From this time on, advertising has been regulated by state dental boards with the help of professional organizations.

Examples of unethical advertising in dentistry may be a claim to be the best dentist in the city or a specialist in an area of dentistry that is not formally recognized as a specialty by the ADA. It is important to note advertising dental services is not inherently wrong. In fact it can help patients discover the available options of care and assist them in finding the office that will best suit their needs and preferences. Some practical suggestions for approaching advertising in your practice include referring to your state’s statutes and rules and discussing your advertising plan with your attorney.

Looking to the future of advertising in dentistry, it seems a major obstacle will be monitoring social media. As young dentists engage the arena of public relations, important decisions will be made here. Please feel free to comment on this post with your thoughts and observations on the evolution of dental advertising.

Thank you to Dr. Scott Morrison, a faculty member at the Arizona School of Dentistry & Oral Health, for his presentation on the ethics of advertising in dentistry. Dr. Morrison sat on the Board of Dental Examiners in Arizona for four years and helped enforce Arizona’s statutes and rules concerning advertising.

Jessica Giles, Arizona ’16, associate, Council on Professional Issues

Medicaid clinics forced to extract just one tooth at a time

At Boston University, part of our clinical curriculum places students at community health centers across New England and in Florida on 10-week rotations. Students get the opportunity to work in a fast paced setting, and it is not unusual to see 5-10 patients a day. My placement was at a federally qualified health center with a unique focus on pediatric patients on Medicaid insurance, and I was able to treat hundreds of children placing restorations and performing pulp therapy. While the treatment I delivered gave me a sense of reward and fulfillment, I was also caught in the midst of an ethical dilemma.

I recall treating a particularly anxious three-year-old whose mother could not afford to travel to the closest pediatric dentist. Almost every tooth in her mouth was decayed. The clinic had an interesting arrangement with Medicaid whereby reimbursement was made on an appointment-by-appointment basis and was not dependent on the type of procedure performed. In fact, no matter the complexity of the procedure or number of procedures performed in one appointment the reimbursement rate was the same, about $100. This meant that a preventative resin restoration (PRR) had the same profitability as an extraction. All too often children were scheduled for appointments where only one PRR was performed at a time. Full mouth extractions took months to complete, as only one tooth could be extracted in a single visit.

Many private practices have a hard time weaving through Medicaid reimbursement paperwork and regulations, but this federally qualified health center operated seamlessly. As a dental student, it was difficult to justify the one tooth at a time approach to dentistry as we were taught in our education to treat one quadrant at a time. The three-year-old patient I saw may have been uncomfortable getting local anesthesia for just a single tooth at every visit, but it was the protocol of the clinic.

In addition, when an adult patient came to the clinic with pain in a single tooth, they were given antibiotic and pain control medications. It seemed as though two appointments were always necessary to extract one tooth. We were told over and over again by practice managers that we were never to extract a tooth on the same day as the emergency consultation. Many times I wished we could have alleviated the patient’s pain by extracting on the same day, the way we did at the dental school clinic and in private practice. But, at this clinic the reimbursement schedule by Medicaid regulated how care was delivered to the patients.

It was clear that students like me had expressed the same sentiments year after year. In fact, clinic management had a rehearsed line that they were providing a valuable health service to a group of patients that no one was willing to take on. The only way they could be an established clinic was to compromise the timeliness of treatment. While treating patients on Medicaid may present an administrative and financial behemoth, should it mean compromising the ethical treatment of patients? Should we scrutinize delivery of care by federally qualified health centers more closely and evaluate if the trends emerging are ethically sound? Let us know your thoughts in the comments below.

~Sameet Gill, Boston ’14

Midlevel providers in the Last Frontier

As a third year dental student, the start of my career is on the horizon. But unlike most dental students, I will head back to one of few states with midlevel providers: Alaska. The question for any new dentist is: how will this affect my career?

I decided to get some insight as to what I should expect if I want return to the Last Frontier to practice. Dr. James Driskell, a practicing Anchorage dentist, advised “I don’t think that is has affected my practice yet, but I also don’t think it’s working up here…midlevel providers need to do more preventative care and education, its like having a Physicians Assistant pull out your third molars”.

Dr. James Yassick, a past president of the Anchorage Dental Association, also spoke to me about the level of care being provided in the state of Alaska: “When the Public Health Service was providing care to the Alaska Natives, care was equal to or better than the rest of the US, whereas now, you can’t say that someone with 18 months of training can deliver that quality of care.”

Neither dentist I spoke with felt as though their practice had suffered a loss of patients due to the newer implementation of MLPs Nor do they expect a loss because this system is set up for rural Alaska. However they did note that while this system is currently only in villages, it is only a matter of time until the big money behind this program attempts to bring it to Anchorage. “These are the type of programs that are looking to expand to more procedures and bigger cities. The problem is there is no way of actually tracking their success or, even worse, their failed procedures,” stated Dr. Driskell.

So what does this mean for someone like me considering opening a practice back in Alaska? Unfortunately, I can’t predict the MLP impact in two years or more importantly ten years. But what I do know is that preventative treatment and education are the most significant problems in rural Alaska and no amount of fillings or stainless steel crowns will eliminate caries. The current system employing MLPs in Alaska will not eradicate the access to care problem in the state, let alone the US. However, if we can continue to work on education and prevention, we can find a safe and reasonable improvement from our current situation.

~Samantha Dubin, Western, ’15, Districts 10-11 legislative coordinator

A different kind of dental office

Across the country, patients are having their dental needs met in unlikely locations. There’s no doubt, the private practice paragon has shifted over time. You’d be correct in guessing that a weakened economy has resulted in some inventive practice locals and business models.

For the jet-setting patient, an airport dentist may be the best fit. Dr. Robert M. Trager is the one and only dentist found at major airports. Appropriately, these offices are in the heart of New York, at JFK and LaGuardia. Dr. Trager is a Boston native and graduate of Meharry Medical College School of Dentistry. Speaker of six languages, he’s a cosmopolitan airport dentist primed for an intercontinental patient pool. As you can imagine, Dr. Trager sees a good amount of emergency patients from airport goers.

While patients are enjoying some shopping therapy…how about a little root canal therapy? Completely possible. Surprisingly, Sears is the home of several dental offices across the country. Dental Works owns these offices and has myriad locations in 14 states, several of which are conveniently found in shopping malls. The Sears locations boast workable hours, convenient locations and affordable services.

Finally, if traveling on Interstate 80, you will find Dr. Thomas P. Roemer’s dental office at the Iowa 80 Truckstop. This is no lowly stop. The truck stop, established more than 49 years ago, sees 5,000 customers daily. This resourceful practice was put in place as a way to brave the rough economic times. Dr. Roemer’s office has found a great deal success in this unlikely location due to the dental needs for patients on the go.

You may find solitude in the traditional private practice business model: a family office tucked away in your hometown, perhaps. Hats off to these innovative locations that have stepped outside the paradigm of traditional dentistry to take advantage of locations and populations that may otherwise have been neglected.

If you were to open a unique dental practice, where would it be?

~Courtney Worlinsky, Florida ’14

Temporary crowns and impression trays: Ain’t nobody got time for that!

After finishing all the pre-clinical courses this May , I officially entered the D3 year and started clinic. I prepared teeth for a 12×14 PFM bridge on a patient & realized that cutting crown preps was way different on REAL patients than on mannequins and acrylic teeth. I had to use gingival retraction cord while prepping teeth and taking several impressions (not just 1 impression) to capture the subgingival margins. Then I fabricated a temporary crown (a nightmare) that had to be redone within 4 days as the patient cracked it while chewing on almonds. Patient made an emergency appointment and had to come in again the same week. You bet he wasn’t very happy.

I often wonder how is it going to be in real world? I know that we all love gadgets to make our lives simple. CAD/CAM technology has revolutionized the way fixed prostheses are being made by dental labs using traditional approaches. One such tool is CEREC Machine, which is the result of cutting edge technological research that makes it possible for dentists to do “same day crowns”. I didn’t realize CEREC was an acronym and stood for “Chairside Economical Restoration of Esthetic Ceramics” until I began writing this article. It allows dentists to place single or multiple indirect ceramic dental restorations like crowns, veneers, onlays and inlays during a single appointment instead of a 1-2 week waiting period for the patients. So what does that mean? It means that it provides a lot of convenience for both the patient and the doctor as both save a lot of time. We can say goodbye to temporary crowns and patients can say the same to “gue” impression materials and gag reflex. All this comes at no additional cost to the patient. Furthermore, systematic analysis of the literature on clinical trials of CEREC restorations indicates a high level of clinical success.

So how does a CEREC machine work? Well, the dentist first prepares the tooth being restored either as a crown, inlay, onlay or veneer. The tooth is then powder sprayed with a thin layer of blue anti-reflective contrast medium and imaged by very accurate 3D imaging camera. This image is then uploaded to the CEREC computer. Using the CEREC software, a restoration can be designed to restore the tooth to its appropriate form and function. The data on a particular restoration is stored in a file and is sent wirelessly to a milling machine. The restoration can then be milled out of a solid ceramic or composite block. Milling time varies from as little as four minutes to as long as twenty depending on the complexity of the restoration and the type of material used. This allows the restoration to be designed, milled and placed in a single appointment!

Our school provides training in CAD/CAM dentistry to students during the summer between D3 and D4 years. We also have an advanced technology clinic where D4s can design restorations electronically and send them to the milling unit. I can’t wait to see what else technology has in store for dentistry down the road!

~Surpreet Arora, Baylor ’15

Occlusal guard fabrication for TMD

If a patient presents with jaw pain and tenderness, you may want to set aside the handpiece and think beyond teeth for a moment. Instead of having pain originating from a tooth, your patient may be suffering from problems with masticatory muscles—a common symptom seen in patients with temporomandibular disorder (TMD).

As a second year at University of the Pacific School of Dentistry, I recently had the opportunity to learn about occlusal guard fabrication. Occlusal guards are tools dentists can use to alleviate symptoms of TMD, focusing on adjusting the patient’s occlusion so that it does not interfere with the positioning of the condyles in centric relation. The guards are particularly useful for protecting teeth of patients who may present with parafunctional habits, such as bruxism.

Occlusal guards come in various types and materials. In our course, I learned that the materials include processed etylmethacrylate for sports mouth guards, processed methylmethacrylate seen in more traditional splints, and a combination of ethyl and methylmethacrylate for another type of splint. In addition, the guards can be worn solely at night for a maximum of ten hours, or throughout the entire day in more severe cases.

We began the process of occusal guard fabrication with occlusal examinations and recordings. We recorded the patient’s teeth contacts during canine guidance and protrusive movements. Then we took an alginate impression of both maxillary and mandibular arches and poured up the impressions with microstone. Following these steps, we then took a final impression of the patient’s maxillary arch and a face bow recording of the patient.

Before mounting the patient casts on our articulators, we needed to record the patient’s teeth position during centric relation. We used leaf gauges to find centric relation and recorded the initial tooth contact at that position. We also recorded teeth relationship when sliding from centric relation to maximum intercuspation—measuring vertical, horizontal, and lateral slides in millimeters. To assist with accurate mounting of the patient’s arches, we used Regisil to mark the position of teeth in centric relation.

The Regisil record was placed between the maxillary and mandibular casts during mounting, and the positions of the casts were verified using the recordings of initial tooth contact, vertical and horizontal slides. We then sent the casts and the recordings to the laboratory.

Once the occlusal guards are fabricated and returned from the lab, the guards can be delivered to the patient. During delivery, the guards should be checked for teeth relations during opening, closing, lateral and protrusive mandibular movements using articulating paper.
Handpiece, amalgam, composites and other valuable dental tools aside, fabrication of occlusal guards for TMD patients is yet another way to provide care for many patients.

~Jessica Cho, Pacific ’15