Specialist business property adviser, Christie & Co, has announced the sale of two Glasgow dental practices; Patrick G Neilan B D S to a first-time buyer, and Scotstoun Dental Practice to a large dental group.

Patrick G Neilan B D S is a well-established, two-surgery NHS dental practice, with a dedicated patient base of over 2,800 patients. It offers significant scope for further potential including longer opening hours and the introduction of specialist treatments. The business is located on Kilmarnock Road in Shawlands – a popular residential suburb in the south side of Glasgow, approximately four miles from the city centre.

The practice was previously owned by Mr Patrick Neilan who has been operating as a dentist since 1975, firstly as an Associate and then, in 1992, as the sole Principal of the practice at its current site. Patrick G Neilan B D S has been sold to first-time buyer, Mrs Jennifer Logan, who was an Associate at another practice in the area.

Mrs Logan comments, “As a former patient at the practice, I had some knowledge of the patient base and the loyalty that they felt for the previous owner. Since taking over, the patients have been very understanding and obviously sad to see Mr Neilan go. However, they have welcomed new techniques and embraced different approaches, more specialist treatment and most recently facial aesthetics.”

The second practice sold is Scotstoun Dental Practice, formerly TKB & LD WRIGHT Dental Surgeons, a two-surgery practice based on Dumbarton Road in Glasgow. Established over 90 years ago, the practice has been owned by Mr Kerr and Mrs Lesley Wright since 1981 and was brought to market to allow the pair to pursue a well-earned retirement. The business has been purchased by a large Scottish dental group after a short marketing period.

Joel Mannix, Senior Business Agent at Christie & Co, who handled the sales, comments, “These are two very different dental practices – one is fully Associate-led that attracted attention from group operators looking to add to their portfolios, and the other being of interest to independent first-time buyers. Both sales attracted a great deal of interest which is commonplace in the Scottish dental market.

“So far in 2021, Christie & Co has sold a record number of dental practices in Scotland – this activity level doesn’t show signs of slowing down and is likely to continue for the foreseeable.”

Patrick G Neilan B D S and Scotstoun Dental Practice were sold for undisclosed sums.

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dntl bar is Known for Providing Enjoyable, Patient-First Care in New York City

Gone are the days of booking a dentist appointment months in advance and dreading the impersonal and often painful experience that comes with laying in a dental chair as someone pokes and prods your mouth. dntl bar—New York City’s most enjoyable and convenient dental practice from the team behind CityMD, the Northeast’s largest urgent care provider—puts patients at the center of its service at its three Manhattan locations, offering quality care and same-day appointments, clear pricing and comfortable visits. Forget old magazines in stuffy waiting rooms, now patients can watch Netflix, use aromatherapy products, stay warm under a cozy blanket and relax in massage chairs at the dentist office.

“The dental industry, like most healthcare systems, has evolved into a payer- or provider-first oriented system. While not necessarily the intent of many hard working clinical professionals, it has nonetheless become a place where the consumer is found standing last in line,” dntl bar co-founder and CEO and CityMD co-founder Nedal Shami says. “From making an appointment, following up for your care, paying a bill or even the basic principles of respecting your time and starting on time, nothing is simple for the patient. We think we can change that.”

Shami thought he could apply what he did at CityMD and reinvent the experience of going to the dentist to make it accessible, affordable and enjoyable, instead of outdated and impersonal. Shami grew CityMD into a billion dollar company with 150 locations, transforming the way customers sought emergency care, and believes people should get the same access to dental care. So in 2019—dntl bar opened its first location in Chelsea which received immediate validation in the market with an industry-leading amount of new patient appointments and raving customer reviews. dntl bar has since added two more locations in Union Square and the Financial District, and plans to open two more sites by the beginning of 2022.

dntl bar stays open seven days a week from 8 am until 8 pm on the weekdays and 9 am until 5 pm on the weekends, making it easier for patients to find time to get to the dentist for everything from check-ups and teeth whitening to teeth straightening and emergency work. Unlike at standard dentist offices, dntl bar never wants patients to have to wait to see one of their top-rated dentists, so they provide same-day and same-week appointments that can be easily booked online. They also offer SMS communications for patients who want to be able to communicate with ease. Because dntl bar prioritizes transparent pricing and doesn’t want patients to be surprised when they see their bill, it’s in-network with most PPO insurance plans.

When patients arrive at one of dntl bar’s three locations, they walk into a modern lounge and are greeted by a friendly front desk attendant. They can grab noise-cancelling headphones to wear during the procedure or opt to listen to music or stream their favorite Netflix series when they see the dentist. dntl bar uses high tech equipment and machinery, and the clinical staff undergoes a rigorous hiring process; they also receive regular reviews to ensure they continue to provide top-notch, patient-first care. Because of its luxury accommodations, accessibility and gold-standard service, dntl bar boasts an NPS of 90 compared to the industry average of 1.

dntl bar believes people deserve higher quality dental care that actually puts them first and aims to bring a cost-effective, straightforward option to more people than ever before. dntl bar has started a movement with its decision to center its care around patients rather than billings, and it was that transparency and industry-disrupting concept that kept people coming in throughout the COVID-19 pandemic, during which dntl bar only continued to grow and draw in new clients. dntl bar plans to bring its transparent and high-end approach to 50 locations in multiple cities within the next five years.

For more information on dntl bar and their services, visit their website at dntlbar.com.

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Delaying dental care is not a new trend for dental patients during the pandemic. We’ve all heard how much anxiety patients can have about going to the dentist. However, the temptation to push off dental care did get prodigiously worse during the last year of lockdowns and COVID-19 fears. As we return to a more normalized state, patients that delayed care are returning to offices once more. The unfortunate case is that they are usually returning to deal with an immediate acute problem, like tooth pain or a broken crown. Whether their hesitancy to cross the dentist’s threshold comes from COVID fears or a deeper-rooted reluctance, these patients finally do darken their providers’ doorsteps. This gives dental providers a unique opportunity to educate patients on the perils of delayed care and encourage the patient to change their behavior. In essence, it is our job to convey that dental problems only get worse, not better. They become more extensive and more expensive. And neither the dentist nor the patient wants that to occur.

As clinicians, our chairside manner will make or break how patients respond to these conversations. The procrastinating patient provides a critical opportunity to guide patients towards better oral health. In terms of motivating action and decreasing patient-level fear, here are five steps we practice at Sage Dental to best engage patients in productive care conversations and successfully influence their dental behaviors moving forward.

Step 1: Engage through Teledentistry

Connecting with your patients via non-threatening virtual appointments is the quickest way to ease the stress of a return to the dental office after a long hiatus. Those appointments, whether real-time or asynchronous, convey a lot about your willingness to help and overall lack of judgment for their state of oral health. Patients love it, particularly new patients, which starts the process of getting the patient to pursue treatment.

Step 2: Transform the in-office experience to reflect co-discovery

Utilizing newer technologies, such as HelloPearl’s artificial intelligence Second Opinion platform or Dental Monitoring’s SmileMate virtual consultation iPhone scan, to give your patients a tech-forward, unbiased, and pain-free peak into their oral health condition can go a long way toward lessening the anxiety of a return to care. Fear of judgement is another valid fear that patients experience. Using such methods creates an unbiased assessment, which looks a lot less like a dentists’ judgment or “opinion.” Utilizing these AI iPhone scanning technologies is as simple as taking a selfie. And let’s face it, patients love selfies. Changing the patient’s perception of the visit changes the overall chairside experience into something far less threatening and less open to interpretation.

Step 3:  Take it in bite size pieces

First, we must address the immediate pain or problem the patient is experiencing. Avoidant patients have likely experienced days to months of acute pain or discomfort, so it is important to spend the bulk of the appointment addressing their immediate concerns with compassion and clinical precision. Providers know this. But the temptation is always there to share the entirety of dental disease that we see. Patients are not going to be receptive to any home health or in-office best practice messages their providers are sharing until they are out of pain. At Sage Dental, we make a point of building a solid foundation of patient-provider rapport using innovative new technologies and phased goals, which will ultimately help us get important messages across later.

Step 4: Plan ahead together: what got you here won’t get you there

Once the patient is comfortable, take the time to reflect on their oral health and share the correlations between overall health. Walk through what caused the issue they came in for. Was it a direct result of neglected or delayed care? Would coming in for the recommended semiannual appointments have caught this issue before it became debilitating? In most cases, the answer is yes. 

Once the patient has a clear understanding of the past behavior that brought them to this point, it is the perfect segue to discuss the current state of their oral health. Just because you as the provider dealt with their immediate oral care needs does not mean that their oral health is 100% restored. Now is the time to discuss any other lesions you and the other dental providers have observed in their mouth that are likely to result in future pain or issues if the patient continues to delay care. However, our chairside demeanor is critical to conveying this in a non-judging, forward-focused way. We can’t change yesterday for the patient, but we can certainly improve tomorrow with continued care.

Rather than dictate the patient’s best course of action (something that is sure to alienate them and discourage changed behavior), invite them into a conversation about making a plan that works forthem. Start by giving the patient a big-picture view into the state of their oral health and describing what might become an issue later, while also complimenting them on what they are doing right. In my experience, many providers neglect to point out the positives, and they nearly always exist. Make sure the patient clearly understands that they have options: different treatment plans can be tailored based on the patient’s aesthetic and financial expectations. At Sage Dental, we’ve found a great way to share this information with patients is by utilizes newer simulation technologies, and in turn, they often share these images on social media.

Step 5: Share cautious optimism

Finally, it is important to end with caution and optimism. Dental providers have a duty to communicate the seriousness of delayed care: the patient could wind up in the same (or more) pain than what forced them to seek dental care in the first place. Reminding the patient where the day started, the pain or issue they were experiencing (and would like to avoid moving forward) can be an effective tool to prompt future change. Remind the patient that without implementing a treatment plan, their oral health challenges will persist. Share how much you as their provider want them to never experience “a day like today again.” End by reiterating your hope that they will work with you to ensure that does not happen, and highlight your confidence that their dental experience will be a positive one as you implement the agreed upon treatment plan.

Whether dentists face another pandemic lockdown or not, patients will continue to find reasons to delay their dental care. As a result, even when the pandemic is long behind us, dental providers will be working to address patient hesitancy and the negative oral health consequences of delayed care. From COVID-clench to broken teeth to periodontal disease progression due to delayed care, clinicians will need to leverage excellent chairside manner to build positive rapport with patients. Only through innovative new technologies, strategic communication and strong relationships will patients be persuaded to change their behavior and ultimately elevate their oral health for the better long term.

ABOUT THE AUTHOR

Dr. Roark is the senior vice president and chief clinical officer at Sage Dental, responsible for overall clinical leadership, including enterprise-wide clinical strategic planning, developing and improving clinical protocols, researching new technologies and services, overseeing quality assurance, and providing professional development opportunities to 500 clinical team members and over 65 supported dental practices. 

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“Careful planning and a strict budget can help you to save money in dentistry school and graduate with less debt.”

Like anyone pursuing a medical career, dentistry students know there is more than just a lot of time, energy, and focus needed to get through your education. There’s a lot of money involved, as well. Dentists have one of the highest student loan debt totals of any profession, so you will want to cut that down whenever possible.

The average dentist leaves school with nearly $300,000 in debt, according to the ADA. That can take over a decade to pay off. So how can you get out of dentistry school with a less daunting amount to pay off? How can you save money while you study so that you’re in a better place when you graduate? 

Careful planning and a strict budget can help you to save money in dentistry school and graduate with less debt. Everything from where you go to school to how you handle everyday bills makes a difference when it comes to saving money as a dental student.

Choose Your Dentistry School Wisely

Even if you are accepted to a big-name dental school, you might want to consider other options. A private school will cost you thousands more each year in tuition than a public school, but that’s not the only reason to look around the country at schools where you can get a great education for less.

Cost of living in some cities is considerably higher than in others. For example, attending the University of California, San Francisco (UCSF)’s highly ranked dental school will have you paying some of the highest cost of living in the nation to make your home in the Bay Area while you study.

Meanwhile, the University of North Carolina at Chapel Hill not only offers lower tuition, but also a much more reasonable cost of living (and it’s also a top-ranked dental school). That means you can still choose from the best dental schools and save.

That’s not all to keep in mind. Non-resident tuition is higher than what’s charged to residents of that state at every college. That means considering the dental school options that are within your home state can save you a lot on tuition. It may also give you the option to live at home while you’re in school and avoid costs of moving.

Minimize Your Student Loans

Regardless of which school you choose to attend, tuition for dental school is still going to add up. While it’s likely you’ll need some loans, it’s always a good idea to look at other options that are available to offset how much you need to borrow.

Looking for money that you don’t have to save up or pay back is the clear first step. Apply for as many grants and scholarships as you can find. Even small grants of a few hundred dollars can help. Don’t limit yourself to grants specific to dentistry students; there are a lot of grants out there for which you might qualify.

If possible, ask around for loans from parents, guardians, and other family members. They might be willing to lend you some money at a lower interest rate or even with no interest at all.

You can also look for an assistantship program that will provide lower tuition costs in return for part-time work. You’ll learn valuable skills on the job and also amass less debt. Everything you do to reduce tuition costs will also reduce your loans.

Avoid Additional Debt While in School

Student loans might be avoidable, but other forms of debt are easier to stay away from. While you’re in dental school you may be tempted to use credit cards in order to put off paying for the things you want or need, but it will only put you in a position of needing to pay off that debt before you’ve even started your first job as a dentist.

The same goes for any other major purchases. While you’re in school it isn’t a good time to buy a new car or take on a mortgage. If you already own a house, you will probably need to put off expensive renovations until you have a steady post-graduation income.

Dentists make a great living even at entry level, so your day to buy the car and house of your dreams will likely come; avoiding a pile of debt during school so that you can finish with fewer student loans and a better financial situation will be worth the wait.

Check Your Cost of Living

Tuition isn’t the only thing that you need to spend money on during your years in dental school. You’ll need a place to live, you’ll need to eat, and odds are good you will need some form of transportation. There are a lot of ways to save money on everyday expenses while you’re in dental school.

The ideal situation is to skip the cost of a place to live entirely while you’re at school by continuing to live at home with your parents or guardians. Of course, that’s not desirable or even possible for everyone, so you may need to look at other ways to lower the most basic and expensive costs of living.

Living on campus in a dorm is a cheap option, and if you sign up to be a residential advisor or similar role, you may get to live on campus for free. If not, look for a roommate to help bring the cost of living down.

Outside of where you live, you can look to cut other costs as well. Keep to a strict budget for groceries and make eating out a treat rather than the norm. Even cutting back on your Starbucks habit can make a big difference. And when you do spend, consider using a cash back app or coupon app.

Using public transportation is the cheapest way to get around, but there are a lot of reasons you may need or want a car. Make sure to shop around for low car insurance rates; the best car insurance for new college graduates and for dental school students can be found by comparing your options.

The same goes for any other insurance you need. The ADA offers specially priced plans for health insurance in each state, but you should still compare and shop around to make sure you are getting the best price on the coverage you need.

Keeping to a strict budget and avoiding the impulse to spend on instant-gratification items requires some discipline, but then so does making your way through dentistry school. When you do both, you’ll come out of school in a solid position and ready to start your career and move towards your financial goals.

ABOUT THE AUTHOR

Leslie Kasperowicz is an insurance and finance expert who is the managing editor of AutoInsurance.org. She is a former Farmers Insurance and Financial Services CSR and has been helping people understand insurance and finances through education for more than 10 years.

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The data is clear: Porcelain and composite resin are both biocompatible at the gingival margin and well-tolerated.^1-3 One major cause for concern is that composite can cause tissue irritation if it impinges directly on the gingiva.^4-6 This may ultimately cause rather unaesthetic gingival recession. Porcelain is less challenging, but marginal plaque buildup, often stimulated by the thin layer of exposed resin cement, can lead to a similar irritation of the free gingiva and, ultimately, recession.^7,8  

Even skillful subgingival margin placement will typically, within 3 to 5 years, whether due to aging, gingival irritation, or inadequate home maintenance by the patient, lead to unaesthetic recession and a highly visible exposure of the darker dentinal surface.^9,10 The best restorative approach is to position composite margins supragingivally,^3,11 with the resin material reasonably away (0.25 to 0.5 mm) from the soft periodontal structures, decreasing the likelihood of tissue irritation.

Today’s adhesives and restoratives make this a rather straightforward task.^12-19 Later-generation adhesives bond predictably and relatively equally to both enamel and dentin.^14,15 Generally, seventh- and eighth-generation adhesives exhibit similar attachment to both enamel and dentin, eradicating the stresses that would be caused by unequal polymerization contraction.^17-19 It is therefore clinically realistic to place a restoration that is continuous through the dentino-enamel junction (DEJ), covering as much enamel and dentin as is required due to decay, abfraction, or aesthetics.

A significant aesthetic predicament quickly presents, however. Most dental restorative materials are standardized to the enamel shades. While some “dentin” shades are available, they often do not closely approximate the darker coloration of exposed dentin, particularly with endodontically treated teeth.

When restoring a Class V decay, abfraction, or a small gingival recession, an enamel-shaded resin is bonded at the labial DEJ. A typical central incisor is about 10.5 mm cervico-incisally (CI).²⁰ Any significant increase in the apparent length of a tooth, specifically in the anterior labial region, will undermine the aesthetics of the smile. Increasing the maxillary central incisor’s CI aspect by as little as 3 mm (Figure 1) adds 30% to the apparent vertical dimension, significantly altering the CI:MD ratio. This upsets the aesthetic parameters of the smile (Figure 2).

For patients with moderate recession, the visual discrepancy is further reinforced. The CI:MD ratio impact is more dramatic with maxillary laterals and mandibular incisors (with an average of 9.0 mm CI). Maxillary and mandibular cuspids (clinically longer at 10 to 11 mm CI) are often the teeth most prone to gingival recession and also the most visible, both anteriorly and laterally.

Patients with gingival recession, abfraction, and/or decay tend to look older than their age. Unfortunately, hiding the darker root dentin with an enamel-colored resin only serves to make these teeth more noticeable; seemingly longer; and, consequently, less appealing.

The practitioner must solve these problems practically, aesthetically, and with minimum invasiveness. The ideal treatment is functional, restoring missing enamel and dentin to natural dimensions and contours. Lost enamel is replaced with enamel-shaded composite resin. Receded gingiva is replaced with gingival-shaded composite resin. Their interface is an artificial enamel-gingival junction in composite, restoring the aesthetics of the patient’s smile.

SOLVING THE GINGIVAL AESTHETIC DILEMMA

Beautifil II Gingiva (Shofu Dental) was developed to rebalance the pink aesthetics of the dental cervical areas (Figure 3). Beautifil II Gingiva’s indications for use include wedge-shaped defects, cervical decay, the aesthetic rectification of gingival recession, shielding exposed cervical areas, and splinting of mobile teeth. Gingiva resin is available in 5 hues (dark pink, light pink, brown, orange, and violet) (Figure 4) that may be layered and/or blended to create custom shades for various hues of gingival pigmentation according to specific clinical needs (Figure 5).

Beautifil II composite resin is highly aesthetic, fluoride-releasing, and indicated for all classes of restorations. Many published studies over the past 20 years have demonstrated no failures, no secondary caries, no postoperative sensitivity, and high retention of both color stability and surface luster. Its chemistry is founded on Shofu’s proprietary Giomer technology (Figure 6). Giomer resins have a significant advantage: They release fluoride, protecting dental structures at the restorative margin, and their fluoride content is rechargeable by toothpastes, fluoride rinses, and varnishes. 

Hence, Giomer fluoride releasing capacity does not decrease over time.

It is essential that the restorative gingival margin (whether pink or enamel in color) is positioned supragingivally and somewhat away from the free gingival margin.^3,4,6 While a very narrow darker band of dentinal structure may be visible apically, the restoration’s coronal enamel and pink gingival coloration focus attention away from this region. Gingivally blended restorations allow the professional to deliver both aesthetic and supragingival margins in the same restoration. The supragingival margin also facilitates effective home maintenance for the patient.

Restorations that are very close to the free gingival margin require effective moisture and bleeding control. Rubber dam techniques are not practical in the apical working area. Retraction cords may physically or chemically compromise the restorative materials. For the conscientious patient, good oral hygiene produces a healthy gingival microenvironment: minimal pocketing and no bleeding on probing. For most patients, however, the practitioner must revise the gingival state to increase the likelihood of clinical success. The most predictable technique for tissue sculpting is the diode laser.^21-23 Utilizing low power (1 to 1.5 W), an ideal, dry, clean, and blood-free working area can be achieved in less than a minute.  

CASE REPORTS

Case 1: Visible Recession and Decay

The patient’s main complaint was the gingival recession on the left maxillary lateral, not the mesial caries (Figure 7). As the patient’s home care was effective, the MLB restoration was straightforward using BeautiBond (Figure 8a) and Beautifil Flow Plus X, both from Shofu Dental. The steps for the gingival aesthetic restoration of the buccal recession are:

1. Gently micro-abrade the receded area and the apical enamel, removing food debris and plaque. The abrader nozzle must be inclined incisally to prevent gingival irritation and bleeding. Rinse thoroughly and lightly air dry. The surface is left slightly moist (moistness level is not critical).
2. Apply BeautiBond, a seventh-generation adhesive, and leave for 10 seconds. Thoroughly air dry the adhesive (very critical). Light cure utilizing the Fusion⁵ Curing Light (DentLight), offering deep cure of composite resins within 3 seconds with a uniform 4,000 mW/cm² output (Figure 8b).
3. Select the Beautifil II Gingiva shade (Light Pink and Violet for this patient) and place it in the receded area, restoring the buccal dimensions and contours of the original soft tissue, then light cure. Leave a 0.25- to 0.5-mm gap between the apical restorative margin and the free gingival margin (Figure 9). This spacing will avoid gingival irritation; is easily maintainable by the patient; and is not readily visible, even in close-up photographs. (All photography was done with the EyeSpecial camera [Shofu Dental] [Figure 10]). 

Case 2: Mandibular Anteriors Recession

This recession is encountered very often. Lower anteriors are small, closely positioned, and not easily cleansable by tongue and lower lip (Figure 11). Gravity and the upright position cause food debris and plaque to accumulate labially and interproximally (Figure 12). For this patient, the likely cause for the recession was the frenum that was attached to the apical gingiva. The preliminary treatment was a diode laser frenectomy to eliminate the muscular pull.^21-23 The steps for the gingival aesthetic restoration of the buccal recession are:

1. Gently micro-abrade (in the incisal direction) the receded areas and the enamel nearest to the DEJ, removing food debris and plaque. Rinse thoroughly and lightly air dry. The surface is left slightly moist. 
2. Apply BeautiBond, and leave it for 10 seconds. Thoroughly air dry the adhesive, then light cure.
3. Select the appropriate Beautifil II Gingiva shade (Light Pink) and apply to the receded area to restore the buccal dimension and contour of the original soft tissue, then light cure. Leave a 0.25- to 0.5-mm gap between the apical restorative margin and the free gingival margin (Figure 13). This procedure restores the expected vertical height of the unreceded gingiva, making the patient’s smile look more aesthetic and younger. 

Effective, long-term home maintenance must include procedures that are familiar to the patient and easy to implement. Toothbrushing is effective and in widespread use. Interdental string flossing is less so. While string flossing is well-documented and encouraged, patient resistance to the process and inconsistent home use limit its benefits. The Water Flosser  (Water Pik) facilitates the interdental cleaning process and has been shown to improve the results.²⁴ Many models are available, including the Sonic Fusion (Water Pik), which offers simultaneous water flossing and sonic brushing (Figures 14 and 15).

CONCLUSION

Beautifil II Gingiva offers the practitioner the solution to the gingival aesthetic dilemma. The aesthetic restoration of the gingiva is predictable and is often completed without local anesthetic or patient discomfort. These restorations are fully functional and restore both hard and soft dental structures to natural dimensions and contours with minimum invasiveness. The restoration of the coronal anatomy with tooth-colored composite resins is well-documented and quite routine; the development of the artificial enamel-gingival junction and the technique for reconfiguring missing gingival structures with composite resins is a novel solution that restores the patient’s smile and facial aesthetics.

REFERENCES

1. Freedman G. Ultraconservative porcelain veneers. Esthet Dent Update. 1997;2:224-228.

2. Freedman G. Ultraconservative rehabilitation. Esthet Dent Update. 1991;5:80-85.

3. Freedman G, Fugazzotto PA, Greggs TR. Aesthetic supragingival margins. Pract Periodontics Aesthet Dent. 1990;2:35-38.

4. Newcomb GM. The relationship between the location of subgingival crown margins and gingival inflammation. J Periodontol. 1947;45:151.

5. Renggli H, Regolati B. Gingival inflammation and plaque accumulation by well adapted supragingival and subgingival proximal restorations. Helv Odont Acta. 1972;L6:99.

6. Waerhau SJ. Histologic considerations which govern where the margins of restorations should be located in relation to the gingiva. Dent Clin North Am. 1960;4:161.

7. Berman M. The complete coverage restoration and the gingival sulcus. J Prosthet Dent. 1973;29:1301.

8. Marcum O. The effect of crown margin depth upon gingival tissues. J Prosthet Dent. 1967;17:479.

9. Freedman G, McLaughlin G. The Color Atlas of Porcelain Laminate Veneers. Ishiyaku EuroAmerica, Inc.; 1990. 

10. Freedman G. Chapter 23: Cements. In: Contemporary Esthetic Dentistry. Elsevier Publishing; 2011:551.

11. Freedman G, Klaiman HF, Serota KT, et al. EndoEsthetics: Part II. Castable ceramic post and core restorations. Ont Dent. 1993;70:21-24.

12. Albers HF. Dentin-resin bonding. Adept Report. 1990;1:33-34. 

13. Munksgaard EC, Asmussen E. Dentin-polymer bond promoted by Gluma and various resins. J Dent Res. 1985;64:1409-1411.

14. Barkmeier WW, Erickson RL. Shear bond strength of composite to enamel and dentin using Scotchbond multi-purpose. Am J Dent. 1994;7:175-179.

15. Swift EJ, Triolo PT. Bond strengths of Scotchbond multi-purpose to moist dentin and enamel. Am J Dent. 1992;5:318-320.

16. Gwinnett AJ. Moist versus dry dentin; its effect on shear bond strength. Am J Dent. 1992;5:127129.

17. Freedman G, Leinfelder K. Seventh generation adhesive systems. Dentistry. 2003; 1:15–18.

18. Freedman G. 7th generation adhesive systems. Dental Asia (English). 2019; 2:50-53.

19. Freedman G. Adhesion: past, present, and future. Oral Health. 2019;109:7-14,82.

20. Wheeler RC. A Textbook of Dental Anatomy and Physiology. W.B. Saunders; 1965.

21. Goldstep F. Soft tissue diode laser: where have you been all my life? Oral Health. 2009;99:7;34-38.

22. Goldstep F. Diode lasers for periodontal treatment: the story so far. Oral Health. 2009;99:12,44-46.

23. Goldstep F. Diode lasers: the soft tissue handpiece. Dental Asia (English). 2011;1:28-32.

24. Rosema NA, Hennequin-Hoenderdos NL, Berchier CE, et al. The effect of different interdental cleaning devices on gingival bleeding. J Int Acad Periodontol. 2011;13(1):2-10. 

ABOUT THE AUTHORS

Dr. Freedman is co-founder and past president of the American Academy of Cosmetic Dentistry, co-founder of the Canadian Academy for Esthetic Dentistry, regent and Fellow of the International Academy for Dental Facial Esthetics (IADFE), and Diplomate and chair of the American Board of Aesthetic Dentistry. He is an adjunct professor of dental medicine at Western University in Pomona, Calif, and professor and program director of the MClinDent Programme in Restorative and Cosmetic Dentistry at BPP University in London. Dr. Freedman is the author of 14 textbooks, more than 900 dental articles, and numerous webinars. He can be reached at freedman@epdot.com.

Disclosure: Dr. Freedman consults for more than 50 companies.  

Dr. Lalla is a graduate of the University of The West Indies and practices dentistry in Trinidad and Tobago with a special focus on cosmetic and implant dentistry. Following an AEGD from Lutheran Medical Center, he has been accorded Fellowships in the International Congress of Oral Implantology, the American Academy of Implant Prosthodontics, and the IADFE. He can be reached at tropicaldental@yahoo.com.

Disclosure: Dr. Lalla reports no dislcosures. 

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A new worldwide consumer oral health awareness survey across 15 countries has revealed an amazing snapshot of oral health, habits, concerns and desires across the globe.

In the largest survey of its kind totalling 15,000 respondents, findings range from the countries best at brushing teeth twice a day with fluoride toothpaste, to the top worst dental habits and most common dental issues.

The inaugural 2021 Global Healthy Thinking Report by international oral healthcare company, Sunstar, with brands including GUM, Butler and Ora2, also provides insight into which countries have seen the worst oral health impact during the pandemic, which countries are looking after their teeth best, and those who have the best smile satisfaction.

Worldwide findings include:

Most and least oral health issues – Thailand has the most and worst problems with oral health, just 1 in ten have no problems and just 5% are happy with their teeth. The UK ranked the highest, 40%, for not having any problems with their teeth.

Worst habits you would like to give up – Germany and Spain ranked equally the highest at 27% for smoking as the worst habit harmful to their dental health. 22% of Italians, Indonesians and Brazilians said drinking coffee, tea and staining drinks was their worst habit, while China ranks highest for sweets as their worst habit, 31%.

Most forgetful toothbrushers – Indonesians were the most forgetful at brushing their teeth, 45%, while Brazil ranked next highest at 40%. 33% of Italians, Argentinians and Britons said they never forget to brush their teeth. Germans forget the least, 20%.

Best for cleaning between teeth – China leads the way on cleaning between teeth at 21%, followed by Italy, 20% and Spain 18%. Indonesia ranked the lowest at just 7% for those who use an interdental cleaner, electric airflosser or floss.

Smile satisfaction – People in the Netherlands are the happiest with their teeth, and 18% would not want any cosmetic treatment to improve their smile. While just 5% of Thai, Spanish, Italians and Brazilians said they would not choose one cosmetic smile treatment. The US was one of the lowest, only 7% said they would not want any cosmetic treatment and are happy with their teeth.

Understanding of the mouth/body link – 76% of Argentinians understood smoking affected dental health, while just 39% of Singaporeans understood the mouth/body link.  While the Japanese have the best understanding that dental health can also affect life expectancy, 38%, just 12% of British do.

Which countries reported most bad breath? Asian countries reported bad breath when describing their oral health more commonly than elsewhere in the world, with the worst in Japan, 34%. Brazil reported the least, just 8%. In Europe, bad breath is most common in Italy, 15% and least in the UK, 10%.

Which countries have seen the worst oral health impact during the pandemic? Argentinians have missed the most dental appointments during the pandemic, 44%. Just 12% of Japan have missed dental appointments, the lowest worldwide. Americans said they have experienced more tooth sensitivity during the pandemic, 25%. Indonesians ranked highest, 45%, for choosing to now clean their teeth more regularly as a result, followed by China at 38%.

Comments Martijn Verhulst, Medical Liaison Manager, Sunstar Scientific Affairs, on the survey findings: “We are proud to have conducted this largest survey of its kind to further our knowledge into consumer oral health.

“Positive findings included the numbers of people worldwide who are keeping their mouth healthy and fresh by brushing their teeth twice a day, using fluoride toothpaste and tongue brushing.

“But there did seem to be less understanding globally of the overall mouth/health link and the impact oral health has on your overall well-being, or how habits like smoking can impact your oral health. While this link is better known in Japan, for example at Sunstar we say “100 years mouth, 100 years health”, there does seem to be a need for greater understanding of this connection.

“We strongly advise that consumers get their teeth checked twice a year by a qualified professional to assess their oral health and any dental decay or gum disease. Regular dental checks are also important for identifying any issues early and before they can cause wider harm. A reputable dentist is also likely to spot signs of other medical conditions such as oral cancer or even diabetes if they can monitor your oral health frequently.”

A copy of the 2021 Sunstar Global Healthy Thinking report containing all the survey findings and analysis can be downloaded here https://www.sunstar.com/healthy-thinking-report/oral-survey-2021/

About the Research

15 countries surveyed across Europe, North/South America and Asia comprising;

– UK, Germany, France, Spain, Italy and Netherlands

– US, Mexico, Argentina, Brazil

– Japan, China, Singapore, Thailand and Indonesia

(Nationally representative sample, 1,000 minimum per country, 18-65 age group, equal gender split).

ABOUT SUNSTAR

SUNSTAR is a multinational company headquartered in Switzerland and founded in 1932 in Osaka, Japan. Today, SUNSTAR is a leading global company in the Mouth & Body Care field, a major presence in the Health & Beauty Care and the Environment & Amenity business fields, and a world leader in the Safety Support & High Technology field. In fiscal year 2019, consolidated net sales of the SUNSTAR Group totalled over 1.2 billion Swiss Francs. The products and services of SUNSTAR are distributed in more than 100 countries, and the company has 4000+ employees worldwide. Under the motto “Always strive to help people everywhere achieve better health and enhance their quality of life”, SUNSTAR continuously provides high-value-added products and services all over the world. www.sunstar.com

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Straumann Group, a global leader in tooth replacement and orthodontic solutions that restore smiles and confidence, announces a strategic partnership with Aspen Dental Management, Inc., (ADMI) to offer dental implant solutions, abutments and CAD/CAM options to more than 1000 ADMI and affiliated offices across 45 U.S. states.

The partnership includes Aspen Dental, one of the largest and fastest growing branded network of dental offices in the country, along with ClearChoice Dental Implant Centers, leaders in fixed, full arch dental restorations for patients with missing or failing dentition. There are more than 930 Aspen Dental locations across 45 states, while ClearChoice has 71 locations in 28 states. Collectively, the two are the largest provider of fixed and removable dental prosthetics in the United States.

As part of the agreement, Straumann Group will supply Aspen Dental-supported and ClearChoice-supported independent practices with a broad range of dental implants and CAD/CAM solutions. In addition, Straumann Group will offer clinical training, patient education material and marketing support to help implement the dental solutions across the practices.

“Together with the dentists whose practices we support, we are excited to enter a strategic partnership that will significantly expand access to cutting-edge dental products, integrated digital workflows, as well as comprehensive education programs and value-added services,” said Bob Fontana, chairman and CEO of ADMI. “At a time when dental implants are playing an increasingly important role in dentistry, partnering with Straumann Group will not only be instrumental in achieving our long-term strategic objectives, but also benefit the patients who turn to Aspen Dental and ClearChoice for their dental care needs.”

Straumann Group, a global leader in modern dentistry, has built over the years an unparalleled portfolio of innovation in esthetic dentistry through clinically and scientifically proven solutions in regenerative, material science, biomaterial, integrated digital workflows, and has committed to continuous education for dental professionals by driving one of the largest scientific networks.

“It is an honor to be chosen to work with one of the largest and fastest growing dental service organizations in the United States,” says Guillaume Daniellot, CEO of Straumann Group. “Our purpose is to help clinicians improve patients’ quality of life. We are proud to serve ADMI and its network with our innovative dental solutions as they continue to provide access to dental care to patients in nearly every state.”

Straumann Group has grown to become one of the world’s largest suppliers of cutting-edge dental implants, prosthetics and orthodontic solutions.

About Straumann Group

The Straumann Group (SIX: STMN) is a global leader in tooth replacement and orthodontic solutions that restore smiles and confidence. It unites global and international brands that stand for excellence, innovation and quality in replacement, corrective and digital dentistry, including Anthogyr, ClearCorrect, Dental Wings, Medentika, Neodent, NUVO, Straumann and other fully/partly owned companies and partners. In collaboration with leading clinics, institutes and universities, the Group researches, develops, manufactures and supplies dental implants, instruments, CAD/CAM prosthetics, biomaterials and digital solutions for use in tooth replacement and restoration or to prevent tooth loss.

Headquartered in Basel, Switzerland, the Group currently employs more than 8000 people worldwide and its products, solutions and services are available in more than 100 countries through a broad network of distribution subsidiaries and partners.

About Aspen Dental Management, Inc. (ADMI)

Aspen Dental Management, Inc. (ADMI) is one of the largest and most trusted retail healthcare business support organizations in the U.S., supporting 15,000 healthcare professionals and team members at more than 1,000 health and wellness offices across 46 states in three distinct categories: dental care, urgent care, and medical aesthetics.

Working in partnership with independent practice owners and clinicians, the team is united by a single purpose: to prove that healthcare can be better and smarter for everyone. ADMI provides a comprehensive suite of centralized business support services that power the impact of four consumer-facing businesses: Aspen Dental, ClearChoice Dental Implant Centers, WellNow Urgent Care and Chapter Aesthetic Studio. Each brand has access to a deep community of experts, tools and resources to grow their practices, and an unwavering commitment to delivering high-quality consumer healthcare experiences at scale.

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Veteran company executive, noted speaker and author Shanda Brown promoted to new position

Delta Dental of Tennessee (Delta Dental) today announced the promotion of longtime company executive Shanda Brown to the new position of Chief Diversity Officer. Brown most recently held the position of Vice President of Corporate and Community Engagement, where she oversees provider relations, quality control, human resources, and the day-to-day operations of the Delta Dental’s philanthropic initiative, the Smile180 Foundation.

“Through important, difficult conversations over the last year, it has become increasingly clear that for our company and also our country to continue to succeed, we have to eliminate those things that continue to unjustly divide us. Diversity, equity and inclusion must be ingrained in our hearts and minds,” said Dr. Phil Wenk, President and CEO of Delta Dental of Tennessee. “To help steer us in that path, I wanted to have someone who leads by example and has earned the respect and admiration of everyone who works here. I am thrilled that Shanda has agreed to take on this new role as a guiding light for us as we strive to reach the American ideal of equality and inclusion for all.”

Brown, a nationally recognized speaker, ordained minister, and author of two motivational books, joined Delta Dental of Tennessee in 1997 as an auditor. Since that time, she has held a variety of management roles across the company, spanning customer service, claims processing, and quality control.

In 2015, Brown helped spearhead the creation of Delta Dental’s charitable foundation, the Smile180 Foundation, and has overseen its day-to-day operations since that time. Today, the Smile180 Foundation supports a network of 26 charitable dental clinics across the state that provide critical oral health care services for some of Tennessee’s most vulnerable citizens, as well as the state’s two dental colleges and seven children’s hospitals.

“Formalizing our longstanding philanthropic work through the Smile180 Foundation allowed Delta Dental to highlight who we are to a broader audience and positively impact even more Tennesseans. I see the creation of this role as a similar step in our commitment to diversity, equity, and inclusion,” said Brown.  “Delta Dental of Tennessee has championed diversity, equity and inclusion for years. It is a key component of our culture and our collective DNA. Now it has become necessary to evolve into a more focused approach with DEI that further positions us as effective leaders and community advocates.”

Brown holds a Bachelor of Science in Biology from Virginia Commonwealth University and worked as a registered nurse for five years before pursuing a career in the health insurance industry. A Virginia native, she has called Middle Tennessee home for over 25 years.

For more information about Delta Dental of Tennessee, please visit https://tennessee.deltadental.com/.

DELTA DENTAL OF TENNESSEE 

Delta Dental of Tennessee is the state’s largest independent dental benefits carrier with more than 1.4 million lives covered. As part of the Delta Dental Plans Association, Delta Dental of Tennessee members have access to the largest dental network in the nation with more than 154,000 providers serving more than 437,000 locations. With the simple mission of ensuring healthy smiles, Delta Dental of Tennessee works hard to help members of the communities it serves. Along with its corporate foundation, Smile180, Delta Dental of Tennessee donated more than $4.8 million in funding and in-kind services to over 140 organizations in 2020.

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In observance of International Week of Deaf People on September 20-26, 2021, Doug Disraeli D.D.S. collaborates with individuals in the Deaf Community to develop helpful tips to serve this unique population of people who are deaf and hard of hearing.

International Week of Deaf People includes the International Day of Sign Language on September 23, proclaimed by the United Nations General Assembly to raise awareness of the importance of sign language. The International Week of Deaf People strives to promote the human rights of people who are deaf while gathering, becoming united, and showing unity to the rest of the world.

Dr. Disraeli offers the following tips for providers:

• Prepare individuals for the steps of the process
• Offer a pen and paper
• Consider visual aids
• Ask about accommodations
• Make sure to face individuals when speaking
• Have transparent masks on hand for lip reading
• Have the number of an interpreter via teleconference available
• Look directly to the patient, speak clearly, and do not shout
• Don’t touch without warning
• Assume competence
• Provide deaf interpreter or be willing to work with insurance on providing one
• Reconfirm interpreter a few days before the appointment
• Have written communication available for oral hygiene, post-op instruction, and confirm patient fully understands at-home care

The International Week of Deaf People is an annual event celebrated by the global Deaf Community during the last full week of September to commemorate the month the World Congress of the World Federation of the Deaf was first held.

Says Dr. Disraeli, “When providing dental care to individuals who are deaf or hard of hearing, we learned from the community there are a few things that help make their visit as comfortable as possible. We wanted to share this out to the greater dental community.”

ABOUT DR. DOUG DISRAELI

Dr. Disraeli is a general and cosmetic dentist with a degree from the University of Southern California, one of the top dental schools in the world. In practice for over 35 years, he participates throughout the United States in continuing education dentistry courses and is a member of the American Dental Association, the California Dental Association, the San Diego County Dental Society, the Academy of General Dentistry, the Pacific Academy of Aesthetic Dentistry and the American Academy of Cosmetic Dentists. Dr. Disraeli has been awarded “Top San Diego Dentist” from 2008-present by fellow dental professionals in San Diego County. http://www.drdisraeli.com/Dr-Disraeli

ABOUT DOUG DISRAELI, D.D.S. DENTAL PRACTICE

Offering cosmetic dentistry, implant, restorative, and general dentistry throughout San Diego, Doug Disraeli, D.D.S. is committed to providing its patients with comfortable, efficient, and comprehensive dental care. Procedures offered include teeth whitening, bonding, veneers, cosmetic fillings, removable partial dentures, extractions, periodontics. Doug Disraeli, D.D.S. is located in the Uptown San Diego, Hillcrest community of San Diego at 3645 Fourth Avenue.

http://drdisraeli.com 

https://www.facebook.com/dougdisraelidds

https://www.instagram.com/dougdisraelidds/

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If you are looking to build more efficiency into your dental practice, it’s best to start small. Some small changes can have a surprising impact. You can ensure your patients receive the best healthcare services while supporting your staff and reducing unnecessary work.

Using technology, flow management, and proven management techniques, there are many ways to give your practice a boost. Here are 6 easily accessible and highly effective ways to make your dental practice more efficient right away.

1. Leverage Data and Technology 

There was always the hope of bringing together tech and healthcare. Now that age is upon us, and tech has made massive leaps during the pandemic, as companies rushed to support healthcare practitioners, staff and patients. You can use technology to help your patients, your outreach, and your workflow.

Start by collecting data and storing it safely. Then, you can use that data to help the people who need it most. Use data and technology in your practice: 

• Stay active on social media and use your data to drive marketing. Around 96 billion people are using social media, and there’s no doubt that some of them need support from your practice. 
• Conduct data analysis to better understand your current patients. Evaluate data based on their age, gender, location, and profession. 
• Use data to schedule both your workforce and work flow for peak efficiency. Data on your patient and office needs can help ensure that you always have just the right amount of people on any given shift.

2. Explore E-Health Innovations 

Digital organization methods have replaced most of our pen-and-paper systems, and EHRs provide much-needed relief from the traditional paper chart system. Whether your practice is considering an EHR for the first time or if you’ve used one for years, it’s time to consider innovative and highly-developed EHRs.

A highly-developed EHR should provide:

• Computerized physician order entry, so you can order paperless lab tests and diagnostic work. 
• Clinical Decision Support (CDC) tools such as alerts, forms, guided workflows, and reminders to make your practice efficient without compromising the quality of care.
• Telehealth compatibility and support to capture information from telehealth interactions.

When it comes to E-health, you can expect big changes quickly! Innovations and improvements aren’t on the horizon – they are only days or weeks away. Many EHR advancements roll out quickly, and the COVID-19 pandemic has shown tech creators just how important these features are to both small and large practices.

3. Step Up Your Patient Care

Anything you can do to improve your patient care is certainly worth considering. But, which small actions can boost your patient care while also increasing efficiency? It seems counter-intuitive, but there are ways to improve patient care while also reducing the effort needed from support staff.

AI automation can provide your staff with support for every phase of the patient’s journey, starting from enrollment. Meanwhile, it can also make it easy to receive patient feedback.

If you only focus on the core of the business, the actual healthcare, you’re missing out on many other elements that your business and customers need. How much time does your staff spend sorting through enrollment papers or making calls to boost customer retention? You can reclaim that time and dedicate it to improving patient experiences.

Everything connected to patient care and AI automation comes down to data. The more accurate, clean, and reliable the data, the more you can use smooth AI operations to promote better patient care.

4. Smooth Out Your Patient Flow 

The demands of reporting and patient flow can diminish a patient’s satisfaction even if it feels like you’re doing everything right. An EHR that requires too many entries, or anything that pulls your focus to the keyboard or screen rather than the patient, is a missed opportunity.

How can you start smoothing out your patient flow? Use these tips:

• Optimize your EHR to capture only what you need.
• Reduce wait time-if possible, use a telehealth check-in feature for better waiting room management.
• Build new protocols to simplify and streamline appointments.
• Use mHealth for video chats, SMS check-ins, and to capture concerns and questions from patients.

If your patient can walk in, check-in, see their dentist, and leave quickly, you have an efficient office. But the moment people start to wait, the whole office becomes crowded. Keep your patients flowing by using tech and setting realistic time or booking expectations.

5. Delegate Tasks 

If you want a job done right, do it yourself. But if you want a job done at all, delegate it. Office managers and practice owners often take on tasks that they really shouldn’t. Delegate administrative tasks to team members, or consider bringing in a scribe.

Give some thought to your staff too. You can certainly outsource some processes that take away from their core duties. Don’t let them waste time by juggling too many jobs at once.

As you delegate and find more freedom in your day-to-day work, your staff can too. Empower your workers: encourage swapping shifts if someone needs a morning off, but don’t forget to build in an extra layer of support. Always ensure you have backups, and carefully plan to handle regular workloads and foresee unexpected developments.

Delegating tasks and empowering staff is part of building employer trust. Simplify your team’s schedules, allow them to have some say in their shifts, and allow them to work in the most meaningful way possible.

A well-thought-out delegation will inevitably lead to:

• Increases in actual patient time
• Reductions in time spent managing patient systems and documents
• Enhancing the workflow for all staff
• Cutting down on wait times
• Boosting productivity across the board

6. Make Team Management Your Top Priority 

The best way to build efficiency is to streamline as much as possible. In your workday, how much of your time do you spend with your patients? Your support staff – how much time do they spend doing their core job functions?

Many employers and managers don’t realize the many ways that they’re losing efficiency. It’s not from a giant leak that could sink the Titanic, but instead through many small leaks that no one notices until it’s too late.

Always think proactively, and give careful consideration to what your staff needs. Again, encourage shift swapping to give them some freedom, but also to allow them to prioritize elements within their life. Support them in their core job when handling new guidelines. Finally, rely on tech to set automated reminders for your staff, as well as for your patients.

Your management can lead the team to success and trim down any lost or wasted time. It all begins with you, followed by your team. Show your team how you want the practice to run and what they can do to make that happen.

Improve Your Practice Now

Every manager or owner wants their practice to run efficiently, without compromising patient care. Accomplishing this seems like a tall order, but through many small changes in your daily operations, you can make effective changes quickly.

Remember to embrace technology, especially powerful EHR systems that can dramatically reduce the work your staff dedicate to recording or sorting through information. Then, focus on your patient flow. Automate what you can, schedule accordingly, and delegate with intent. These 6 ways to improve your dental practice can show immediate results!

 ABOUT THE AUTHOR

Derek Jones spearheads key initiatives at Deputy, a global workforce management platform for employee scheduling, timesheets and communication. With a focus on Healthcare, Derek helps business owners and workforce leaders simplify employment law compliance, keep labor cost in line and build award-winning workplaces. Derek has over 16 years’ experience in delivering data-driven sales and marketing strategies to SaaS companies like MarketSource and Griswold Home Care.

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