Dr. Conway Ma

Dr. Ma’s journey in dentistry began at the University of Connecticut, where he completed his undergraduate degree in biological sciences with a minor in mathematics in 2011. He then earned his Doctorate in Dental Medicine from the same institution in 2016. Driven by his dedication to continuous learning and improvement, he pursued an AEGD (Advanced Education in General Dentistry Residency) at New York University Langone Dental Medicine in 2017. As a compassionate dental professional, Dr. Ma has always been motivated by his desire to help those in need. He has actively participated in various charitable initiatives, including the Connecticut Mission of Mercy and Healthy Adolescent Smiles. Additionally, he has traveled overseas to Ecuador to provide dental care to underserved communities, showcasing his commitment to making a positive impact on the lives of others.

Whether it’s routine cleaning, endodontics for root canal therapy, or oral surgery for more complex dental needs, the professionals at Tolland Hill Family Dental are equipped with the latest technology and expertise to provide advanced dental treatments, all at one location. Renowned for its exceptional patient care and commitment to creating a warm and welcoming environment, Tolland Hill Family Dental ensures that every patient feels like family. Dr. Ma’s addition to the team further strengthens their mission of providing outstanding dental care with a personal touch.

“I am thrilled to join this exceptional team and make a positive difference in the oral health and well-being of our community,” says Dr. Conrad Ma.

About Tolland Hill Family Dental

Tolland Hill Family Dental’s mission is to provide the very best in modern dentistry with a personal touch that makes every patient feel like family. At Tolland Hill Family Dental, they offer a wide range of comprehensive services to cater to patients of all ages. The clinic is conveniently located at 12 Goose Ln in Tolland, CT. For more information or to schedule an appointment, please visit http://www.tollandhillfamilydental.com or call 860-875-6269.

ESB Professional/Shutterstock.com

Q: You are both a yoga instructor and a dentist. What led to you becoming a yoga instructor, and how has that changed the way you practice dentistry?

A: I first discovered yoga as a stressed-out dental student. I was looking for a way to decompress while also moving my body. I was a complete beginner at first, but after graduating dental school, I slowly began taking more yoga classes. What started as a hobby eventually became a passion as I began to notice the changes yoga was making in my life. Physically, my body started feeling better, and I avoided the aches and pains that are common to a dentistry career. Mentally, I started feeling lighter, calmer, and less anxious. Yoga helped me understand and uncover parts of myself I had hidden away for so long. I eventually decided to complete a 200-hour yoga teacher training program and started teaching yoga in 2021. Becoming a yoga teacher has had a significant impact on the way I view and practice dentistry. For one, it has allowed me to become more patient and understanding with both my patients and my staff. It has allowed me to become more aware of my emotions and reactions so that I can logically deal with them instead of letting them spiral out of control. And lastly, the physical benefits of yoga have allowed me to work pain-free without any limitations. 

Q: Why is it important for dentists to prioritize wellness?

A: According to the ADA’s 2021 Dentist Health and Well-Being Report, a majority of dentists have stated experiencing moderate or severe stress at work. As a result, many of us are dealing with anxiety, burnout, substance use disorders, and other conditions that may impair our abilities to practice at our best. The percentage of dentists diagnosed with anxiety more than tripled in 2021 compared to 2003, and we sadly continue to see the rate of suicide remain steady in our profession. It is time that we change the culture of how we practice dentistry. This profession does not have to be something stressful or overwhelming. We cannot always prevent things like burnout, back pain, and struggles with mental health. However, one thing that may help is to be honest with ourselves about our needs and set aside regular time for rest and self-maintenance. It is specifically important for new dentists to prioritize wellness because as life expectancy increases, so does the length of our careers. We may be working longer than the generation before us, so how can we ensure that we continue to feel happy and healthy throughout our lives?

Q: How does taking care of one’s wellness benefit a dentist’s practice of dentistry?

A: As healthcare professionals, taking care of our own mental and physical health helps us better care for others. When we focus on our well-being, we can better understand our triggers when it comes to stress and anxiety. Once we better understand ourselves, we are able to prevent outbursts of emotions that might lead to saying the wrong thing or making poor decisions. When we show up to work rested and fulfilled, we can better serve our patients and set an example to our staff of what it means to be well. 

Q: How can dentists prevent burnout?  

A: When most people think of self-care, what they are actually thinking of is “self-soothing.” Self-soothing feels good at the moment. It could be a massage, a vacation, or even spending time with a loved one. But true self-care shouldn’t be a one-time fix. It should be a regular part of our lives so that we can continue to show up as the best versions of ourselves. Our society tells us we can only be one thing and must be exceptional at it, but that isn’t realistic. We need to understand that there is more than one way to be a dentist. We can be driven without succumbing to comparison. We can work hard without leading to exhaustion. I always urge dentists to find more than one thing that makes them happy and to make time for rest. Having hobbies that allow us to feel creative rather than only doing things we “need” to do can teach us how to enjoy things again so that we can better show up for our patients, our families, and ourselves. 

Dr. Barrera is a general dentist and practices at Legacy Community Health Center in Houston. He is a member of various organizations, including the ADA, Hispanic Dental Association, Greater Houston Dental Association, and the Houston Equality Dental Network. He is the president and co-founder of the Houston Equality Dental Network, an organization that aims to improve the oral health of LGBTQ+ people through awareness, education, advocacy, and service. Dr. Barrera is a graduate of the ADA’s Institute for Diversity in Leadership and currently serves as a Wellness Ambassador for the ADA. As an ambassador, he serves as a peer support contact for dentists struggling with things like burnout, anxiety, depression, and substance abuse. He works toward incorporating his passion for yoga with dentistry by providing yoga classes and ergonomic exercises that can help alleviate common aches and pains that come with a career in dentistry. Dr. Barrera was recognized by the ADA in 2023 as a “10 Under 10” Award recipient and was awarded the Health Equity Hero award by DentaQuest in 2022. He can be reached via email at abarrera@legacycommunityhealth.org.

Q: How did you get your start in music? 

Dariel: Our introduction to music and playing the cello came first, when we were 4 years old. Our grandfather (who was standing by our sides when we auditioned on America’s Got Talent) is the one who taught us how to play. He is the reason we get to share our love for this beautiful instrument with the world, and he will always be our hero. We were fortunate enough to get daily cello lessons, which was a real gift—having been able to learn from somebody at such an elevated level of mastery of the craft was the ultimate privilege.

Emil: Growing up, we always played classical duets together until, one day, we realized we could have fun playing rock and metal music on these cellos. We decided to add a few cool toys like guitar amps and some drums, which was around the time we started posting videos on YouTube. When we started experimenting with things outside of the norm, we were not sure how our grandfather would react to all of this. To our surprise, he turned out to be a huge fan and said, “Keep doing this—it is awesome!” One thing led to the next, and we found ourselves on America’s Got Talent playing Radio City Music Hall.

Q: When was this?  

Dariel: In 2014, we were 13 and 16 years old. It was amazing and fun to play in front of such a large audience. Before this, we mostly played in front of small gatherings in libraries, restaurants, and the like. But then AGT really opened our horizons—it was life-changing.

Q: What is that like going on stage and looking around at the mass of people?

Emil: There are few things in life that can be as electrifying. There is just this rush of excitement. When you are playing music, you feel their energy. They feel your energy. It’s an exhilarating time.

Q: How do you get past those first 6 seconds of flutters? 

Dariel: Whenever I feel that jittery excitement, it pushes me to jump into it even more—like this is it. This is the moment, and just go out there.

Emil: The way I can relate to it now is thinking back to the first time you ever gave a mandibular block in dental school: There’s a little bit of stress before you start, but then, once you get going, the adrenaline kicks in.

Q: At the end of your last performance on AGT, you had a little issue with Simon Cowell. After you shared your dream of becoming a dentist, and not a star, he rolled his eyes and made a stabbing gesture to his chest with a pen. He then said, “you can’t just say you want to be a dentist.”

Dariel: Perhaps Simon did not understand how we were not pursuing a full-time career in the music/entertainment business. I said, “We come from a family of dentists (on our father’s side), and we want to follow that path. Our dream is to practice dentistry together as a team.” We are very proud to be in this profession, and Simon’s attempt at mocking our choice to pursue dentistry did not go down particularly well for him, which made some interesting headlines. The outpouring of support from the dental community (including the ADA), musicians, and fans was just incredible. You can find our performances by searching “AGT cello” online to see our journey on the show and the fun we had making it up to the final round. 

Q: So tell me about the dental journey. Emil, you are in a postgrad periodontal program at the University of Kentucky?

Emil: We are the third generation of dentists in our family, and the 2 of us are honored to continue our family’s legacy. I am currently a PGY-2 periodontology resident at the University of Kentucky. After Dariel is done with dental school at the University of North Carolina, he plans to pursue a residency in prosthodontics. We have a massive overlap in interests, particularly in implant dentistry; however, we also have our different talents and things we excel at individually. We have ambitious aspirations and are fully committed to our clinical training. Our ultimate dream is to have a “perio pros” practice together.

Q: How do you think you will be able to balance both dreams once your practice is established? I know that right now you cannot just drop your handpiece and grab your bows due to classes. 

Emil: Performing has taught us a lot about troubleshooting things on the fly. In a few of our live performances, we have had situations where we had to make quick decisions. Music has also taught us so much about nonverbal communication and emotional connection, which is such an important part of being a clinician. We will still find time to perform, share our message, and show that you do not have to fit inside a box.

Dariel: We never think of either/or. We love performing with our cellos and all the artistry that entails, and we love the hands-on, life-changing impact we can have through dentistry. We really feel blessed that we can share our message with the dental community and be an example of what is possible to kids who want to pursue a profession in health care while maintaining their artistic passions.

The above is excerpted from an interview with Dr. Paul Feuerstein.

Click here to watch the full video. 

FEATURED IMAGE CREDIT: PIRO from Pixabay.

I was so focused on his lower arch, I never even looked at his upper arch. I honestly had a difficult time concentrating on anything he said because I spent the whole date wondering how soon he might lose those teeth, or if he might have a cardiac episode any minute. I had so many questions.

Are You Screening for More Than Dentistry?

Was that bridge of calculus the only thing keeping his teeth in his mouth?

How did he get this way?

Was his dentist or hygienist (if he had one) unable to educate him on the oral-systemic connection and how periodontal disease can contribute to a variety of health problems?

Where was the disconnect?

If he had no dentist, did his physician ever look in his mouth? The disease was obvious.

What medical conditions did he have because of his periodontal condition?

Did he not see either a dentist or a physician?

Before the last question ran through my head, the date was over. I was not interested in continuing to date this man, but I was concerned for his health. But by the time I drummed up the courage to talk with him about his issue, we had parted. I missed my window even though I knew what I wanted to say to him. I feel guilty that I never talked with him any further about his oral health.

You might never feel bad about not discussing oral health with a date, but there are times in every hygienist’s career when we know we should have said more to a patient about their situation.

According to a study in the American Journal of Public Health, as many as 20 million Americans visit their dentist each year but not a physician. Also, an estimated 111 million see a physician each year, but not a dentist. I’ve always striven to understand how we can help more as dental professionals.

The first thing we can do is find out which physicians in our area are accepting new patients and create relationships with them. Ask your patients when their last physical exam and bloodwork was. When it comes to medical and dental histories, we function as detectives. As detectives, we need to ask the right questions to solve the mystery of what might be affecting our patients’ oral and systemic health. It’s our responsibility to share these risk factors and their causes with our patients so they have a greater understanding of the problem. When patients understand, they own their problem and feel in control, and they’re more inclined to accept recommended treatment.

To dental teams everywhere: We are the first line of defense for 20 million people! We are lifesavers! We are not just cleaners of teeth, chiselers of calculus, or mere drillers or fillers. You are an integral part of your patient’s healthcare team. And we need to be screening for more than perio disease, we should also screen for the following:

• Oral Cancer
• Blood Pressure
• Dermatological
• Sleep Apnea
• HbA1c/Diabetes

Oral Cancer Screening: Do both intra- and extra-oral exams. Make sure your patients know you are screening them for oral cancer and that it is part of the routine care you provide. This shows how comprehensive your care is, and creates value and importance for the appointment. There are 100 types of HPV and 40 of those types can cause oral cancer, so screenings are more important than ever. Always refer to an oral surgeon in case of any detection of abnormalities. Better to err on the side of safety than to find out you might have missed something.

Dermatology Screening: When screening for oral cancer make note of any skin abnormalities. Show the patient the area of concern and find out if they have annual skin screenings. I have found lesions on the tops of men’s heads who otherwise would have continued on with life not knowing they had skin cancer in a place they could not easily see. It is always better to have them get checked, even if you’re not sure. Even though this is not your area of expertise, trust your gut if something looks abnormal. If your patients do not have or know of a dermatologist to visit, keep the names and contact information for one or two so you can refer to them.

Blood Pressure Screening: With 50 percent of periodontal patients having undiagnosed hypertension, blood pressure screenings are imperative. It is best for the team to know what the guidelines are for hypertension and treatment. If a patient’s blood pressure is elevated, consider giving them a physician referral letter with their readings. Explain the consequences of untreated hypertension. If their blood pressure is above the threshold for treatment, consider calling their physician and scheduling an appointment for them. If dangerously high, call their physician for an immediate appointment, emergency room visit, or call 911.

Sleep Apnea: If you are not screening for Obstructive Sleep Apnea (OSA), consider doing so. OSA increases the risk of morbidity and mortality. Extraorally, look for a neck size of greater than 17” in men and greater than 16” in women, Class II Malocclusion, retrognathic profile, long face, and small nasal passages. Intraoral features may include macroglossia, a narrow high-vaulted palate, enlarged low-hanging uvula, enlarged tonsils and adenoids, bruxism, overjet, erosion associated with GERD, and edentulism.

Connect with physicians who treat OSA to establish a relationship for referrals if you are not comfortable treating OSA.

HbA1c Screening for Diabetes: Diabetes is a risk factor related to periodontal disease. Screening for Diabetes is lifesaving. Check with your state dental board to see if they deem it within the scope of practice in your state.

Teeth and gums aren’t our only concern. As I wrote earlier, we are the front line for 20 million patients who do not have a primary physician. We are an extremely important part of the healthcare team. The closer we work with the rest of the medical community, the healthier our patients will become. I have no doubt the referrals to physicians will come back to you when they see how comprehensive you are with your screenings.

It’s a big WIN for everyone!

ABOUT THE AUTHOR

Jodie Heimbach, RDH, BS, has been a clinical dental hygienist for 31 years and is the Clinical Calibration Coach at Productive Dentist Academy, guiding dental teams to become aligned with their standard of care. Heimbach is a past president of the New Jersey Dental Hygienists’ Association and is the recipient of the 2008 Sunstar/RDH Award of Distinction. She can be reached at jodie@productivedentist.com.

Drs. Gordon and Rella Christensen

What has changed in dentistry over the last 60 years? Is the profession the same as it was 60 years ago, slightly different, or changed significantly? The answer to the question, answered by 2 practitioners who have lived and practiced through those 60 years, is that dentistry hardly resembles what it was 60 years ago, and the changes are predicted to continue and expand!

To facilitate easy reading and allow comparisons of dentistry 60 years ago with dentistry today, the article is divided into the following sections:

• What were the characteristics of dentistry in 1962?
• What are the characteristics of dentistry going to be in 2022?
• What are the most profound paradigm changes over that time?
• What are predictions for changes in the future?

DENTISTRY IN 1962

In 1962, dentistry was mainly treatment-oriented, but there were observable changes toward preventive concepts, including fluoride in toothpaste, 6-month exams, diet, and the necessity for adequate oral hygiene.

Dentists were primarily male. The necessity of oral care observed during the First and Second World Wars thrust dentists and dental care into public observation and acceptance. Dentists became highly respected by the public as “doctors of dental surgery” (DDS) and were considered to be honest, trusted professionals. Almost all dentists were in individual private practice, with a few group practices beginning to be formed. Most dentists had at least one dental assistant. Four-handed dentistry was beginning to be promoted. Expanded clinical tasks for auxiliaries were very few, and most expanded functions now popular were then illegal. 

Professional dental societies were dominant and powerful. Dentist advertising was considered to be unethical, and even having the dentist’s name in letters larger than 2 inches high on the office door or window was not permitted. The “washed field” technique, ushered in by Dr. Elbert Thompson, started a new clinical paradigm requiring high-velocity suction systems. Belt-driven clinical handpieces were being replaced by air rotors. A few companies pioneered electric handpieces, which did not become popular until many years later.

Looking back on this described scenario makes dentistry in 2022 look like a different profession.

Operative dentistry was the mainstay of dentistry. When patients thought of dentists, their initial conclusions were dentists do “fillings” in teeth to fill “cavities.” Operative dentistry techniques were the main involvement of most dentists, including the use of silicate cement for anterior teeth and amalgam for posterior teeth (Figure 1). Acrylic resin restorations were available for anterior teeth, but they soon discolored and leaked. Cast gold alloy and gold foil restorations were infrequently accomplished and mainly for the affluent. Porcelain-fused-to-metal (PFM) was just beginning to be available and mostly had feldspathic ceramic fused over base metal.

Dental hygiene education was a respected 4-year educational program in many universities. Often, dental hygiene students were taught in the same basic science classes with dental students. The importance of oral hygiene, stimulated by the military services and emphasized by professional hygienists, made significant inroads into the dental profession.

Crown and bridge (fixed prosthodontics) procedures were accomplished frequently, usually using cast gold alloy restorations cemented with zinc phosphate cement. PFM was in its infancy (Figure 2). Porcelain jacket crowns cemented with zinc phosphate cement served relatively well but were weak. Many dentists accomplished their own laboratory work. Functional acceptability was the rule for all restorations, with aesthetics being secondary—three-quarter crowns were common, showing gold frequently when smiling.

Removable prosthodontic procedures were commonly accomplished with only minimal concern for retaining teeth that today would be identified as restorable. Complete dentures resembled the dentures of today. They were polymethyl methacrylate (PMMA) with primarily porcelain denture teeth. Vulcanite rubber dentures, an invention from the 1840s, had nearly vanished but were seen occasionally. Removable partial dentures usually had metal frameworks, with “flippers” made of PMMA also available.

Dental radiology was analog, requiring developing and fixing of film in a dark room. Radiation was extremely high compared to the digital radiographs of today. The analog radiographs had high contrast, often showing initial caries much better than the digital radiographs of today.

Oral surgery accomplished by general dentists was primarily tooth extraction with necessary bone contouring. Sacrificing bone to expedite teeth removal was the common practice and would be considered extensive and overdone by the standards of bone conservation today.

Orthodontic treatment was infrequently accomplished by the standards of today when, currently, most adolescents receive orthodontic treatment. Premolar extraction techniques were common. Many orthodontic specialists made treatment advancements that are still practiced today.

Endodontics, pediatric dentistry, and periodontic procedures were evolving but primitive by the standards of today. Aesthetic dentistry did not emerge until the 1970s.

At least 12 other identifiable dental preventive and treatment subjects have evolved and become part of dental practices since 1962. 

DENTISTRY IN 2022

The ADA has nearly 70% of dentists as members and offers some significant benefits to them. Some of the ADA statistics follow.

• Dental students are now more than 50% female, with about 30% of practitioners being female. It is anticipated that women will gradually dominate the profession.
• Caucasians no longer constitute the majority of students.
• Many new grads elect to have a fifth year of education in general practice residencies and other programs.
• Roughly 25% of dentists are specialists.
• Although individual private practitioners are still the majority of practitioners by a small margin, corporate and group practitioners are nearing 50% of all practitioners.
• Although controversy exists on professional advertising, dentists who desire to do so may advertise as the Federal Trade Commission previously allowed.

It is obvious that advertising and an overpopulation of dentists have caused significant competition among practitioners in many areas of the United States.

While the majority of dentists in 1962 represented the definition of a true professional person, the dentists of 2022 have been forced by competition to become business-oriented and still maintain a professional orientation.

There have been virtually hundreds of significant paradigm shifts in dentistry since 1962. An entire book would be required to enumerate and describe them. Next, we’ll briefly dicuss the current acknowledged specialites and other significant categories of dentistry. 

Specializations

The following topics represent the major and most significant changes since 1962. They are not prioritized, and they represent many areas of dentistry. Since 1962, the majority of the currently 12 ADA-approved dental specialties have evolved. A dental specialty is an area of dentistry that the National Commission has formally recognized based on compliance with the Requirements for Recognition of Dental Specialties. The 12 ADA-recognized specialties follow: 

1. Dental Anesthesiology. In the past, the majority of anesthetic used was local and primarily lidocaine 2% with 1:100,000 epinephrine. In the ensuing years, articaine (Septodont’s Septocaine 4% with 1:100,000 or 1:200,000 epinephrine and others) emerged and has nearly monopolized local anesthetic use. Some practitioners have even nearly eliminated the use of blocks, relying on local infiltration for most common dental procedures. The use of sodium bicarbonate as a buffer in local anesthetic is beginning to be employed more to reduce pain on injection as well as hasten the onset of anesthesia.
2. Dental Public Health. Dentistry continues to be recognized as an essential health service. Education and recognition as a dental public health specialist provide assurance that the individual can give help in integrating dental programs into communities.
3. Endodontics. Since 1962, endodontic treatment has changed significantly and become much more scientifically proven. The use of multisonic energy to cleanse root canals is now available (ie, GentleWave [Sonendo]).  Laser energy is also being used to excite fluids inside root canals and cleanse them better than conventional methods (ie, Solea [Convergent Dental], BIOLASE laser systems, and Fotona).
4. Oral and Maxillofacial Pathology. Numerous pathologic conditions in the oral cavity are perplexing and require biopsies for correct identification. Most specialists in this area are in dental schools, providing educational and biopsy services. In order for practitioners to use these services, most schools provide specimen bottles with directions on how to send them for identification.
5. Oral and Maxillofacial Radiology. This area has had enormous change with the advent of digital radiography. Most dentists now use digital radiography using either CMOS sensors, phosphor plates, or both. Cone-beam radiographic devices have been revolutionary in providing the ability to see anatomy in many ways never before available (Figure 3). Very few dentists still use analog radiology, but in our opinion, it still has some advantages in the detection of initial caries lesions not yet present with current digital devices.
6. Oral and Maxillofacial Surgery. Tooth-removal techniques have been significantly perfected since 1962, allowing for far more conservative procedures and preservation of bone. Piezio electric bone-cutting devices allow ultrasound technology to cut bone precisely and easily—an example is Piezomed (W&H). In addition, cone-beam radiology has revolutionized diagnosis in oral surgery.
7. Oral Medicine. Diseases of the mouth are many and varied, often leading to difficult diagnoses and confusion during treatments. As practitioners advance in their careers, many do not stay up to date on the latest findings or may have actually forgotten information learned in school. Many dentists specializing in this subject are located in dental schools or have another specialty they practice as well and should be consulted if there are any uncertainties.
8. Orofacial Pain. TMJ problems have been a plague forever. There have been major improvements in diagnosis and treatment with new types of occlusal splints and more accurate occlusal equilibration procedures. Electronic identification of occlusal contacts is now available, allowing for precise location of occlusal disharmonies. Several products and new oral appliance designs are appearing rapidly in our midst, ie, Denar Deprogrammer (Whip Mix), NTI Splint (Chairside Splint), T-Scan Novus (Tekscan), and QuickSplint (Orofacial Therapeutics).
9. Orthodontics and Dentofacial Orthopedics. Professional orthodontic treatment, which previously was accomplished for only a few severe cases, is now amost a routine procedure for most families as their children go through their teenage years. A significant change in orthodontics has been using aligners for tooth movement, ie, Invisalign (Align Technology) and ClearCorrect (Straumann Group), which are appropriate for most minimal and some more difficult cases. This has been revolutionary in treatment planning and implementation. Note that, in recent years, considerable controversy has arisen because some labs and independent companies have promoted the use of aligners without professional orthodontic supervision. We strongly feel that aligners are well-proven for treatment, assuming professional supervision is present.
10. Pediatric Dentistry. The special need for oral preventive and restorative treatment for children is obvious. As many practitioners hone their skills on the latest technological and restorative advances, they are not totally focused on young and special needs patients. Those who have chosen to focus on these patients are helping set the stage for a more positive dental future for the next generation. In addition, the integration of pediatric dentistry and orthodontics has allowed more knowledgeable practitioners to guide children through the tooth-development stages.
11. Periodontics. Dental practices focus on the prevention of dental disease and place a great focus on periodontal health. Even with this impetus, there is a frustrating inability to stop periodontal disease. We feel that this disease can be slowed, but not all cases can be truly cured. Note that most periodontists are also placing implants, which are a solution for some periodontal disease patients.
12. Prosthodontics. Fixed, removable, maxillofacial, and implant prosthodontics now comprise a major part of dentistry. Zirconia and lithium disilicate now dominate crown and fixed prostheses and account for approximately 90% of restorations (Figure 4). With the digital explosion, restorative cases have now gone far beyond any possibilities that were in existence 60 years ago.

The following topics are related to major paradigm changes that have been introduced over the past 60 years. They are not listed in a prioritized order. 

Dental Service Organizations (DSOs)

In recent years, the concept of DSOs has continued to evolve and enlarge in the profession. There are now hundreds of these organizations, the largest of which are Aspen, Heartland, and Pacific. They are very attractive to young practitioners because it is almost impossible to start a practice alone. They also appeal to some mature practitioners who are ready to eliminate the challenges of the business aspects of practice. The advantages and limitations of such practices are a subject of significant debate. However, the fact is they are here and growing. Some practitioners find working in a DSO desirable, while others find the concept questionable. Many personal situations dictate these feelings.

Managed Care

Managed care, presented by dental insurance companies, has become commonplace in dentistry. Most dental practices find themselves  involved with these companies in some manner. The companies have allowed some patients who would not otherwise been able to have dental treatment to obtain dental services, but the companies have also  been criticized for dictating fees and policies for the dentist participants. This concept, both good and bad, has been identified in surveys as one of the most frustrating issues facing dentistry today.

Retaining Natural Teeth

In 1962, the removal of teeth was commonplace. Now most dentists, with a few exceptions, attempt to save natural teeth, if at all possible.

Implants

The use of root form implants has been among the most major paradigm changes in the history of dentistry (Figure 5). However, the now-proven development of peri-mucositis and peri-implantitis around implants after several years of service has made dentists cautious about removing natural teeth that can be restored. More education, as well as many patient factors, must be taken into account to ensure a high success rate. With this explosion, we are seeing literally hundreds of root form implant companies. Their placement has expanded from only the specialists to also the general practitioners, making this procedure more available to the general population. 

Air Rotors

A majority of American and Canadian dentists use air rotor handpieces, which were introduced in the early 1960s. This type of handpiece was another major paradigm change from belt-driven handpieces. Midwest has long-been the most popular brand, but Star, KaVo, Bien-Air, and others are also excellent brands.

Preventive Dental Procedures

For years, amalgam and silicate cement dominated direct restorative materials. Later, glass ionomers and resin-modified glass ionomers became available. The current generation of user-friendly conventional glass ionomers has provided excellent cariostatic effects and easier use, eg, EQUIA Forte (GC) and Ketac Universal (3M).

CAD/CAM

For many years, various inventors and companies have worked on numerous ways, from simple to complex, to create digital impressions of tooth preparations as well as being able to mill restorations in clinical offices. Most became discouraged and abandoned the projects, but M. Brandestini and W. Mormann persisted, and the result was the CEREC system (Dentsply Sirona) for making digital impressions and designing and milling restorations (Figure 6). Many companies have since used this foundation, and the process has evolved over the years. This concept has had a significant influence in the profession for the current practitioners.

3D Printing

Three-dimensional printing is a concept that is still emerging in the dental profession. It allows the scanning, designing, and printing of study models, occlusal splints, provisional restorations, and many other objects. This concept is used by most dental laboratories, but it is just beginning to be used in some dental offices with products such as Form 3 (Formlabs) and SprintRay Pro (SprintRay).

Digital Impressions—Scanners

Many companies produce digital scanners (eg, Primescan [Dentsply Sirona] and Emerald Scanner [Planmeca]), which are used in about 20% of clinical offices and in almost all dental laboratories for many dental procedures. It is anticipated that this concept will gradually replace the now-standard elastomer impression materials.

Ceramic Restorations

In just one decade, the production of crowns and fixed prostheses has changed from metal (PFM or cast gold alloy) to about 90% ceramic (zirconia and lithium disilicate) (Figure 7). This has been one of the fastest paradigm changes in the history of dentistry. The new ceramic materials, including BruxZir (Glidewell) and IPS e.max (Ivoclar Vivadent), are stronger than the many previous ceramic restorations, many of which failed clinically soon after placement.

Sleep Medicine

About 40% to 50% of adults in the United States snore due to many factors, including sleep apnea. According to the ADA, dentists see about 70% of adults in the United States at least once per year, while physicians see their patients much less frequently. Thus, dentists are the logical practitioners to diagnose and treat patients with these issues. Dentists know dental occlusion and dental laboratory procedures, and they interact with dental laboratory technicians. This field is growing rapidly and is a significant paradigm change for the dental profession.

Infection Control

The COVID-19 pandemic produced a resurgence of interest in infection control in dental offices. Many conflicting suggestions were made by public health officials and politicians. In recent years, dental clinicians have led in infection control for outpatient offices. During the height of the pandemic, dental offices were noted to be among the safest places. Even pre-COVID-19,  infection control was at extremely high standards and now continues to be at the forefront. Looking at our retrospective, the current procedures for infection control in dental offices are certainly completely different and more adequate than they were in 1962.

Tooth-Colored Restorations

Most dental patients want tooth-colored restorations, and the previous concept of long-term service necessity has been replaced by aesthetic acceptability. Unfortunately, this change has often brought the need to replace restorations more frequently, but the aesthetic trend initiated in the 1980s is clearly going to be increased in the future as the use of metal for dental restoratives is reduced.

Detection of Oral Cancer

Unfortunately, typical physical exams by physicians seldom include a thorough examination of the mouth. Dentists see patients on a routine basis, and hygienists are also trained in these exams. Seeing most patients at least twice per year, more than our medical brethren, allows a better chance for early detection of oral cancer. The dental profession is the only guardian of the oral cavity. Numerous screening devices, such as VELscope Vx (LED Dental) and Identafi (DentalEZ), are available that provide the ability for dental professionals to screen for oral cancer in addition to what they’ve learned about early detection from continued education.

Flexible, Removable Partial Dentures

In 1962, the majority of removable partial dentures (RPDs) had a metal framework with acrylic or ceramic teeth attached to it with an acrylic, gingival-colored base. Now surveys show that a high percentage of RPDs do not have a metal framework and about 70% of dentists are using flexible materials at least some of the time. Flexible partial dentures are made from thermoplastics (nylon, plastics, and some acrylics). These partials are preferred by patients, but they have some limitations, such as settling into the soft tissues, because of their flexibility.

Expanded Functions

Clinical tasks assigned by dentists to dental assistants, dental hygienists, laboratory technicians, and dental therapists have grown markedly. Such assignments allow more service and more revenue but must be supervised very carefully to ensure the delivery of quality care. 

The Internet

The internet has provided an enormous amount of information for dental professionals that is available in seconds. This form of communication is perhaps the most major of all paradigm changes affecting dentistry over the last 60 years.

IN SUMMARY

Has dentistry changed in the last 60 years? A better question is “What has not changed in dentistry?” Our profession has come of age. It is an essential part of health care. There are about 200,000 dentists in the United States and about 1,000,000 physicians. Dentistry is the largest specialty of all medicine! The changes in dentistry over the last 60 years are impressive, and the future shows the promise of even more changes that will positively influence our ability to better serve the public.

ABOUT THE AUTHORS

Dr. Gordon Christensen is founder and CEO of Practical Clinical Courses (PCC); CEO of Clinicians Report Foundation (CR Foundation); and a practicing prosthodontist in Provo, Utah. He and Dr. Rella Christensen are cofounders of the nonprofit CR Foundation (previously Clinical Research Associates [CRA]). Since 1976, they have conducted research in all areas of dentistry and published the findings to the profession in the well-known CRA Newsletter, now called Clinicians Report. Dr. Christensen received his DDS degree from the University of Southern California, his MSD from the University of Washington, and his PhD from the University of Denver and has received 2 honorary doctorates. Early in his career, he helped initiate the University of Kentucky and University of Colorado dental schools, taught at the University of Washington, and was the original dean of the Scottsdale Center. Currently, he is an adjunct professor at the University of Utah School of Dentistry. He is a member of numerous professional organizations. He can be reached at info@pccdental.com.

Dr. Rella Christensen is the director of TRAC Research Laboratory, which is devoted to clinical research in oral microbiology and dental restorative concepts. TRAC Research is part of the nonprofit, educational CR Foundation, which she directed for 27 years. Throughout her career, she has taught at the undergraduate and postgraduate levels, authored many research abstracts and reports, and received numerous honors. She has performed research within the practices of hundreds of dentists and their teams seeking the best patient treatments. She can be reached via email at rella@tracresearch.org.

Disclosure: The authors report no disclosures.  

How can we say thank you to our military and their families for their sacrifice?

This is the question Freedom Day USA Founder, Dr. Robert Martino, asked himself and the answer has grown into a National Thank You Movement.  “It started out as a normal morning. I was in the shower and grumbling about all the stuff I had to do that day. Then I heard a song on the radio by Lonestar titled “I’m Already There.” But this version was different. Over the song’s lyrics were messages of military family members describing how they missed their loved ones overseas. In these voices, I fully realized the sacrifices they make for our country. Wiping away tears, I decided we needed to do more to help our troops and their families.”    

The result of that decision is Freedom Day USA. We wanted this to be a national “thank you” movement. Because Dr. Martino is a dentist, the event began in dental offices across the country who gave military families and veterans a day of dental care at no cost… whether it’s cleanings, extractions or fillings. Initially, the idea was to do this in Martino’s seven dental offices in West Virginia, but that changed when he met with a group of peers in the Platinum Circle. He explained the idea and showed them the official Freedom Day USA video that goes with the Lonestar song and they eagerly jumped on board.

Since then, things have really taken off. Freedom Day has gone national and expanded beyond dentistry. In addition, the event has received recognition and inquiries from 60 Minutes, the O’Reilly Factor, the Wounded Warrior Project and a member of Congress who sits on the House Armed Services Committee. In the last nine years business have given over 20 Million dollars of free services to veterans, military members and their families.

If you’ve been looking for a way to give back to our Military and show your appreciation of their Service to our Country and the sacrifices both they and their families have made for our freedoms – you need to consider joining Freedom Day USA! There is no cost to join and to be a part of Freedom Day. You only have to see one veteran, military member, or military member’s family for free that day.

This year’s Freedom Day is October 14th and you can easily sign up at www.FreedomDayUSA.org.  

Once you sign up, you will get an electronic welcome packet that explains how to have a successful Freedom Day.

“We have been celebrating Freedom Day USA for the last nine years and it is the one day my staff looks forward to the most.” Martino added. “The news comes and we really get to show our veterans and their families how much we appreciated them. It is a great feeling to give back to them”

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membersy, the digital health company democratizing access to quality dental care through subscription-based dentistry, has raised $66 million from Spectrum Equity, a leading growth equity firm focused on internet-enabled software and information services companies. The investment will support membersy’s new product and service offerings to help Dental Service Organizations (DSOs) provide greater price transparency to their patients through a modern membership experience.  

The growth-investment coincides with several board member additions that will help guide the company as it reorients the dental industry’s existing payment methodologies, empowering DSOs to engage and support their communities with subscription-based payment options and competitive pricing strategies. The new board members include Dr. Chad Wise, former Founding Partner at North American Dental Group, a DSO with more than 250 affiliated dental practices across 15 states; Keith English, former Co-Founder & CEO at LocalMed, a leader in real-time online scheduling for dental teams, and Jeff Haywood, Managing Director at Spectrum Equity.

“We’re preparing to rapidly expand our team, products, and services in response to a fast-growing DSO partner base,” said CEO and Founder Eric Johnson. “When we started in 2015, we knew there was a huge opportunity to make dentistry more approachable by modernizing the way consumers access and pay for dental care services, and we’re proud of the impact we’ve had up until this point. With new funding and an amazing partner in Spectrum Equity, we’re positioned to see that impact grow exponentially.”

Not only are younger generations increasingly interested in alternative healthcare payment structures, but, after a pandemic year that saw millions of people lose their employer-sponsored health plan, more people than ever are looking for new ways to attain affordable health services.

At the same time, many dental practices have struggled to attract and retain fee-for-service patients. Regulatory-compliant dental subscription plans offer practices the opportunity to support their patients with modern, tech-enabled payment and service procurement models. Operating as a turnkey platform-as-a-service  solution for DSOs, membersy streamlines membership plan marketing and administration to make dental care more approachable while providing dental teams with automated practice onboarding, recurring subscription payments and billing, and real-time analytics to manage and grow their member base. 

Membersy is the nation’s largest dental subscription plan platform currently operating in 41 states and boasting membership approaching one million members spanning across 4,000 practice locations.

“We are thrilled to partner with Eric and the entire membersy management team to solve a growing pain point in the broader healthcare ecosystem – the lack of access to quality, affordable dental care across the U.S. For several years, we’ve been investing in companies that are improving patient outcomes, reducing costs and increasing price transparency in healthcare. We’re looking forward to applying our experience to support membersy’s continued growth trajectory,” said Jeff Haywood, Managing Director at Spectrum Equity.

Ernst & Young Capital Advisors and Dickinson Wright served as advisors to membersy. Lathan & Watkins served as legal advisor to Spectrum Equity. 

About Spectrum Equity

Spectrum Equity is a leading growth equity firm providing capital and strategic support to innovative companies in the information economy. For over 25 years, the firm has partnered with exceptional entrepreneurs and management teams to build long-term value in market-leading internet-enabled software, information services companies. Representative investments include Ancestry, Definitive Healthcare, Everly Health, GoodRx, Grubhub, Lucid, SurveyMonkey, Verafin and more. For more information, including a complete list of portfolio investments, please visit spectrumequity.com.

About membersy

Membersy is the first and largest subscription focused company in the dental industry, providing Dental Service Organizations (DSOs) of all sizes with the tech, marketing, and administration infrastructure to launch and grow a modern membership experience. Today, more than 4,000 dental practices and close to  1 million members across the United States utilize membersy’s advanced subscription platform for a more personal and connected dental care experience. For more information, including a complete list of the membersy’s growing partner portfolio, please visit membersy.com or follow on LinkedIn, Instagram, Facebook, and Twitter @membersy.

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Overjet (www.overjet.ai), the global leader in dental artificial intelligence (AI), today announced it has raised $27 million in Series A financing led by General Catalyst and New York-based global private equity and venture capital firm Insight Partners with participation from existing investors that include Crosslink Capital and the MIT-affiliated E14 Fund.

“Overjet is on a mission to improve oral healthcare for all,” said Dr. Wardah Inam, CEO and Co-founder of Overjet. “This ambitious vision pushed us to find world-class investors with a depth of experience supporting the scaling of high-growth technology companies.”

Overjet’s dental AI products are designed to help dentists deliver the best patient care and enable dental insurers to operate more accurately and efficiently. Today’s financing follows the FDA’s recent clearance of Overjet’s Dental AssistTM product designed for dental practices, the first dental AI company to receive such a clearance. 

“Overjet improves patient care by automating much of the clinical review process with AI and by helping clinicians increase diagnostic quality, consistency, and speed,” said Chris Bischoff, Managing Director of General Catalyst. “At General Catalyst, we are excited to partner with Wardah Inam and the entire Overjet team as they deliver on the vision of health assurance in dentistry – creating a win for patients, as well as insurers and clinicians.”

In the dental benefits space, Overjet has emerged as the leading AI company with dental insurers, inking 15 major carriers as customers for coverage of over 53 million Americans. The Guardian Life Insurance Company of America (Guardian Life), a leading dental provider, was the first national carrier to integrate Overjet’s dental AI into its claims processing. The two companies started their commercial partnership in late 2019 with a focus on supporting consistency in dental claims review and improving operating efficiency.

“Guardian Life continues to be committed to facilitating the best oral health care possible for our members,” said Dr Randi S. Tillman, Chief Dental Officer, at Guardian Life. “By partnering with Overjet, we are able to leverage AI technology to improve the consistency of our dental claim review process while ensuring that we are able to make decisions based on the most precise clinical data.”

“The rapid pace of customer adoption for Overjet’s software is a testament to its product differentiation and the market pull for powerful, rapidly improving AI technology in dentistry,” said Lonne Jaffe, Managing Director of Insight Partners. “As Overjet scales up, more and more dental payers and providers will get the chance to appreciate the predictive accuracy of its software and the caliber of its team. Overjet is on a mission to solve the most challenging problems in dentistry, which can positively impact millions of patients.”

With a rapidly growing customer roster, Overjet expects the new funding to only accelerate market adoption, new product launches, and impact on dentistry. “Tens of millions of Americans already have their dental claims processing streamlined and accelerated by Overjet today,” said Shaju Puthussery, Chief Operating Officer of Overjet. “With the recent FDA clearance and new funding, more Americans will see Overjet’s dental AI technology assisting their dentists at the next check-up. We’re committed to helping clinicians deliver the best patient care.”

ABOUT OVERJET

Overjet is the global leader in dental artificial intelligence, helping both payers and providers improve patient care. The company was founded by experts from the Massachusetts Institute of Technology and Harvard School of Dental Medicine, and has assembled the largest and most seasoned team of technologists and domain experts with deep AI, dental, and insurance experience. Follow us at www.overjet.ai and on Twitter @overjetdental.

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exocad GmbH (exocad), an Align Technology, Inc. company and a leading dental CAD software provider, announced today that ChairsideCAD, its open-architecture CAD software for single-visit dentistry, received a 2021 Best of Class Technology Award from Cellerant Consulting Group. This is the third consecutive year that ChairsideCAD has been recognized for this award.

“We are honored to receive this prestigious industry award from dental industry leaders once again for our best-in-class software solution, and we’re excited to share the power of ChairsideCAD with clinicians. This software can enhance the chairside design process, making it faster and more accurate,” said Larry Bodony, president of exocad America, Inc. “The intuitive design workflow of ChairsideCAD, plus the freedom to use any open hardware, makes this a fantastic tool to streamline even the most challenging cases.”

exocad stands as the software of choice for leading manufacturers of dental CAD/CAM systems because it is flexible, reliable and intuitive. Dental professionals consistently turn to exocad software to streamline their workflows for a broad range of indications. Based on exocad’s renowned lab software DentalCAD, ChairsideCAD is the first complete open-architecture CAD software platform for single-visit dentistry. The software includes a step-by-step guide through the design process, simple integrations with a broad spectrum of devices and the ability to seamlessly share information between clinicians and labs.

Since the inaugural presentation in 2009, the Cellerant Best of Class Technology Awards have grown to occupy a unique space in dentistry by creating awareness in the community of manufacturers who are driving the discussion in how practices operate now and in the future. The 2021 Cellerant Best of Class Technology Award was decided on by a panel of prominent technology leaders in dentistry.

Additional information is available at:

www.exocad.com/chairsidecad  
www.cellerantconsulting.com/best-of-class-2021

About exocad GmbH

exocad GmbH, an Align Technology, Inc. company, is a leading dental CAD software provider. exocad vigorously pushes the boundaries of digital dentistry, providing flexible, reliable, and easy-to-use CAD/CAM software for dental labs and dental practices worldwide. More than 45,000 valued customers plan implants and create functional and refined restorations with exocad’s DentalCAD, ChairsideCAD and exoplan software. For more information and a list of exocad reseller partners, please visit exocad.com.

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“Optimized for Invisalign Aligners and Vivera Retainers Powered by Ultradent’s Opalescence Tooth Whitening Systems”

Align Technology, Inc. (“Align”) (Nasdaq: ALGN) a leading global medical device company that designs, manufactures, and sells the Invisalign system of clear aligners, iTero intraoral scanners, and exocad CAD/CAM software for digital orthodontics and restorative dentistry, today announced an exclusive supply and distribution agreement with Ultradent Products Inc., a leading developer and manufacturer of high-tech dental materials, devices, and instruments worldwide.

As part of the multi-year agreement, Align will offer Invisalign trained doctors an exclusive professional whitening system with the leading Opalescence PF whitening formula from Ultradent, optimized for use with Invisalign clear aligners and Vivera retainers. The system will carry the co-branded name of ‘Invisalign Professional Whitening System – powered by Opalescence’ and will offer the same great whitening outcomes and streamlined practice experience dental professionals expect from the Opalescence PF product during active tooth movement with Invisalign aligners, as well as during passive retention using Vivera retainers. The Invisalign Professional Whitening System will be commercially available globally in 2022.

“A brighter, whiter smile is an important part of the Invisalign patient journey. In fact, a survey of North American Invisalign practices (1) shows that half of their patients ask for teeth whitening during or after they complete Invisalign treatment,” said Raj Pudipeddi, Align Technology chief product and marketing officer, and SVP and managing director of the Asia Pacific Region. “We believe that by providing an all-in-one solution that combines a leading teeth-whitening system with the most advanced clear aligner system in the world, we enable Invisalign trained doctors to enhance their patients’ treatment experience with a seamless workflow that also enables practice efficiency and growth. We’re very excited to partner with Ultradent to offer the first professional whitening system optimized for use with Invisalign clear aligners and Vivera retainers. Invisalign system trained doctors can use Opalescence PF for in-office teeth whitening treatment and for doctor supervised at-home whitening.”

“We’re honored to partner with Align to make the top professional teeth whitening products available to more clinicians and patients around the world,” said Ultradent President and CEO Dirk Jeffs. “Providing Align with teeth whitening products, ideal for use with Invisalign aligners and Vivera retainers, is a considerable step toward our mission of improving oral health globally and we look forward to pursuing this mission together.”

“Many of my patients would like whiter teeth as well as a straighter smile,” said Dr. Brian Amy, an orthodontist and Align Faculty member practicing in Oklahoma City. “The new Invisalign Professional Whitening System allows me to provide both simultaneously using the brands I trust.”

“After testing this system in my practice, I can confirm that the Invisalign Professional Whitening System is easy to administer and offers a great patient experience by combining whitening with Invisalign aligners or Vivera retainers,” said Dr. Jennifer Bell, a restorative and cosmetic dentist and Align GP Advisory Board Member practicing in Holly Springs, North Carolina. “The simple ordering mechanism minimizes burden on my practice to store and manage whitening products, while providing the brighter, whiter smiles we have come to expect from the Opalescence PF product.”  

Ultradent is an ISO13485 certified facility and will manufacture the products according to those standards.

(1) 2017 online survey of Invisalign doctors, data on file at Align Technology.

About Align Technology, Inc.

Align Technology designs, manufactures and offers the Invisalign system, the most advanced clear aligner system in the world, iTero intraoral scanners and services, and exocad CAD/CAM software. These technology building blocks enable enhanced digital orthodontic and restorative workflows to improve patient outcomes and practice efficiencies for over 200 thousand doctor customers and is key to accessing Align’s 500 million consumer market opportunity worldwide. Align has helped doctors treat approximately 10.9 million patients with the Invisalign system and is driving the evolution in digital dentistry through the Align Digital Platform, our integrated suite of unique, proprietary technologies and services delivered as a seamless, end-to-end solution for patients and consumers, orthodontists and GP dentists, and lab/partners. Visit www.aligntech.com for more information.

For additional information about the Invisalign system or to find an Invisalign doctor in your area, please visit www.invisalign.com. For additional information about iTero digital scanning system, please visit www.itero.com. For additional information about exocad dental CAD/CAM offerings and a list of exocad reseller partners, please visit www.exocad.com.

About Ultradent Products, Inc.

Ultradent Products, Inc., is a leading developer and manufacturer of high-tech dental materials, devices, and instruments worldwide. Ultradent’s vision is to improve oral health globally. Ultradent also works to improve the quality of life and health of individuals through financial and charitable programs. For more information about Ultradent, call 800.552.5512, visit ultradent.com or find us on LinkedIn, Facebook, and Instagram.

Forward-Looking Statements

This news release contains forward-looking statements, including the expectations for and the terms of the agreement between Align and Ultradent the availability and capabilities of the combined Invisalign aligner and Opalescence offering, our beliefs regarding the market for the combined offering and the potential benefits to doctors, their offices and patients, and other similar comments or statements that are forward-looking in nature. Forward-looking statements contained in this news release relating to expectations about future events or results are based upon information available to Align as of the date hereof. Readers are cautioned that these forward-looking statements are only predictions and are subject to risks, uncertainties, and assumptions that are difficult to predict. As a result, actual results may differ materially and adversely from those expressed in any forward-looking statement.

Factors that might cause such a difference include, but are not limited to:

• the impact of the COVID-19 pandemic on the health and safety of our employees, customers, patients, and our suppliers, as well as the physical and economic impacts of the various recommendations, orders, and protocols issued by local and national governmental agencies in light of continual evolution of the pandemic, including any periodic reimplementation of preventative measures in various global locations;
• difficulties predicting customer and consumer purchasing behavior and changes in consumer spending habits as a result of, among other things, prevailing economic conditions, levels of employment, salaries and wages, and consumer confidence, particularly in light of the pandemic and as pandemic-related restrictions are eased regionally and globally;
• unexpected or rapid changes in the growth or decline of our domestic and/or international markets;
• increasing competition from existing and new competitors;
• rapidly evolving and groundbreaking advances that fundamentally alter the dental industry or the way new and existing customers market and provide products and services to consumers;
• the ability to protect our intellectual property rights;
• continued compliance with regulatory requirements;
• declines in, or the slowing of the growth of, sales of our intraoral scanners domestically and/or internationally and the impact either would have on the adoption of Invisalign products;
• the willingness and ability of our customers to maintain and/or increase product utilization in sufficient numbers;
• the possibility that the development and release of new products or enhancements to existing products do not proceed in accordance with the anticipated timeline or may themselves contain bugs or errors requiring remediation and that the market for the sale of these new or enhanced products may not develop as expected;
• a tougher consumer demand environment in China generally, especially for manufacturers and service providers whose headquarters or primarily operations are not based in China;
• the risks relating to our ability to sustain or increase profitability or revenue growth in future periods (or minimize declines) while controlling expenses;
• the impact of excess or constrained capacity at our manufacturing and treat operations facilities and pressure on our internal systems and personnel;
• the compromise of customer and/or patient data for any reason;
• the timing of case submissions from our doctors within a quarter as well as an increased manufacturing costs per case;
• foreign operational, political and other risks relating to our international manufacturing operations; and
• the loss of key personnel or work stoppages.

The foregoing and other risks are detailed from time to time in our periodic reports filed with the Securities and Exchange Commission, including, but not limited to, our Annual Report on Form 10-K for the year ended December 31, 2020, which was filed with the Securities and Exchange Commission (SEC) on February 26, 2021 and our latest Quarterly Report on Form 10-Q for the quarter ended June 30, 2021, which was filed with the SEC on August 4, 2021. Align undertakes no obligation to revise or update publicly any forward-looking statements for any reason.

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