A mother whispers to herself as she prepares her child for his first trip to the dentist.  He is three years old and still has no signs of teeth.  She is nervous on multiple levels… she wonders how the child will behave in this new environment; how will the dental staff look at her child?  Will they find my son is also missing his teeth in addition to the other medical and mental problems he has already been diagnosed with?  Her stress mounts as the schedule moves forward.  She arrives at the dental office, already having a relationship as she has been a patient there herself many times, with an instinctually protective attitude.  After signing in, the mother and son attempt to relax in the reception room until they are called for their turn.  The dental assistant opens the door to this stress-filled environment and the mother strolls her son’s wheelchair into the operatory.  The mother picks up her son and gently sits him down in the dental patient chair for radiographs, her pulse and blood pressure rising as her son’s facial expressions changing to a fearful one.  The boy refuses the radiographs, even with repeated attempts and gentle persuasion.  When the dentist arrives to help, the child begins to scream in terror seeing another white jacket.  Another refusal is made, and the child is dismissed.  The mother now begins the search for anyone who can help her son… who still needs dental care.

This story is not fictional; it was my reality just 13 short years ago.  My son, who at the age of three had still not cut his first tooth, was using a wheelchair, non-verbal, and terrified of anyone in a lab coat, was dismissed from the dental office when they were not able to take his radiographs.  Although it was a terrifying day for Dustyn, it was a worse day for me.  All my dental knowledge, all my loving support, and every bit of encouragement I could offer didn’t seem to make any difference.  My child was facing a common problem many people face… access to care.  People with special needs, no matter if they are physical or intellectual disabilities, still need quality dental care.  They may take more time, need more assistance in many stages of the appointment, and require a special measure of patience; however, they are worth the additional effort.  With proper training and a few inexpensive tools, your dental practice can widen its scope of practice and accept a variety of patients you never knew would be so rewarding to treat.

In my new course, “Dental Etiquette for Patients with Special Needs”, we will explore a variety of classifications of disabilities, the usual modifications that could be made for those classifications, a general guide to help the dental team know when to treat and when to refer the patient to a specialist, and an array of tips for inexpensive accommodations that will dramatically improve the level of comfort and care during dental procedures.

If you are interested in booking this program, please contact Nancy Wendt at wendt.nancy@gmail.com.  The course is available in a 2- or 3-hour lecture and a 3-hour workshop that utilizes role playing, training with tools to assist patients who have special needs, a list of resources for additional assistance, people first language guidelines, regulatory considerations, and additional products for unique situations.

Reprinted from leeannbrady.com

One of the hot topics over the last few years has been managing our patients who are taking bisphosphonates in order to minimize the risk of osteonecrosis of the jaw. When I think about my practice it seems a higher and higher number of my female patients are on medication for osteoporosis or osteopenia. I decided to look this up and sure enough it is estimated that over 80 million Americans are on bisphosphonates. With that large a number and most of those folks being routine dental patients, what do we need to know? Just today I came across a blog post from my friend Dr. Marty Jablow on a recent ADA report for dentists on this topic. The ADA has complied the data and research between 2008 and 2011 on this topic and produced a report designed to help those of us in practice make some sense of this topic. I spent the morning reading the executive summary of the report and I finally feel like I understand what I need to about this issue.

1. Be familiar with the brand names of popular medications used to treat osteoporosis and osteopenia, both bisphosphonates and monoclonal antibody therapy. These are alendronate (Fosamax®), alendronate/cholecalciferol (Fosamax® D), risedronate (Actonel®), ibandronate (Boniva®), and zoledronic acid (Reclast®). Denosumab (Prolia®).
2. Document patients who are taking any of these medications.
3. The risk of developing osteonecrosis of the jaw is relatively low. It is estimated to be 0.1% or 1 case in every 1000 patients.
4. An increase risk is associated with specific procedures that increase bone trauma, particularly tooth extractions, age (older than 65 years), periodontitis, use of bisphosphonates for more than 2 years, smoking, denture wearing, diabetes and extensive surgical procedures.
5. ONJ can occur spontaneously in patients taking any of these drugs.
6. Make sure and discuss the risk with any patients who are taking bisphosphonates or monoclonal antitbody therapy.In addition the executive summary looked at serum CTX testing to determine patients at risk of ONJ. Their conclusion was that there isn’t enough objective research to support a recommendation for testing in patients who are on these medications. The report also look sat the concept of a “drug holiday”, discontinuing the medication for a period of week to reduce the risk during dental procedures. The summary reports that there is not enough evidence to support this approach.

As a general practitioner the summary reassured me about this topic, whereas up until now I had been uncertain. It reaffirmed for me that the risk from untreated dental disease out weighs the risk of ONJ, and that I can confidently discuss this with my patients so they can chose what is best for them.

1. Start with Quality Impressions:  Many diagnostic impressions are not viewed with the same attention to detail that a final crown and bridge impression is scrutinized. If these impressions are going to be utilized to for diagnosis, treatment planning, diagnostic waxing, and eventual provisional fabrication, then it makes sense to obtain extremely accurate impressions.

2. Using one of alginate replacement, polyvinyl siloxane impression materials(Flextime Putty with a light body wash by Heraeus [Fig 1]), is an excellent material way to create and optimum diagnostic impression. It will allow for multiple pours if necessary, and will eliminate the need to pour the model immediately. Be sure to dry the teeth prior to placement of the impression, and be sure to capture all the surfaces of the teeth, extending well beyond the free gingival margins of the teeth, the entire buccal and lingual vestibules, and the entire hard palate.

Figure 1

3. Creating quality casts:When the casts are poured it is important to follow the water-powder ratio of the specific stone the office will be using (Fugi Rock by GC America Fig 2). It is also a great idea to consider using a vacuum-mixing machine to eliminate air in the mix. This will give you bubble free, dense casts, with maximum accuracy.

Figure 2

4. Choose an appropriate Instrument: Many excellent articulators are currently on the market. The most important feature is that accept a facebow transfer, and that the condyle guidance can be altered (when needed). One of the simplest instruments on the market is the Combi 2 Articulator (Whipmix) designed by Dr. Peter Dawson.

The authors recommendation is find an instrument that feels good in your hands, one that your laboratory uses, and one that you can teach your staff to use day in and day out. A quality articulation system is worth its weight in gold to the cosmetic/restorative practice.

5. The corrected facebow Transfer: The goal of the facebow transfer is to have the maxillary cast mounted on the instrument; in the exact same relationship the maxilla is oriented to the skull when the patient is standing up straight. The distance from the maxillary incisal edge to the axis of rotation of the mandible should also be duplicated.

The Slide-o-matic facebow (Whipmix) is an example of a simple ear-bow, which can be utilized to mount the maxillary cast along with a rigid bite registration material (Venus Bite). We also recommend using a bubble level (Great Lakes Prosthodontics)) to be sure the facebow is level with the floor when the patient is standing upright. This is important, because some patients ears are not level, which can lead to the incorporation of a cant to the maxillary incisal plane.

6. Centric Jaw Relation Records-using bi-manual manipulation: While several methods exist to record centric relation. Bimanual manipulation, described by Dawson, is an excellent way to find, verify and record CR.  Learning to position the patient, position the hands properly, as well as to employ the proper pressure is the key to success. Taking the time to learn this technique will add tremendous predictability in the diagnosis and treatment of occlusally driven restorative care.

7. Techniques for mounting the models: Contemporary facebow systems allow for separation of the mounting jig from the earbow. This will allow the maxillary to cast to be easily mounted on the articulator. Employing the corrected facebow technique previously described will position the maxillary cast on the instrument, as the maxilla relates to the skull. The maxillary cast is stabilized using a rubber band, and then mounted utilizing mounting stone.

The mandibular cast is then related to the maxillary cast via the centric relation record. An excellent way to stabilize the cast is to use a hot glue gun with four nails. This will keep the models in the precise maxillo-mandibular relationship recorded clinically. Stone can be mixed and placed between the cast and the mounting plate without the fear of inadvertently rocking the lower model.

Taking some extra care to carefully mix and smooth the mounting stone will provide presentation quality models. Clyde Schyler once said that “sloppy models were not an indication of sloppy dentistry, it was absolute proof!” Taking extra time with diagnostic impressions, jaw relation records, and mounting procedures, is a critical part of the treatment planning process and great restorative technique.

Did you know that there are at least ten potential opportunities that your office has to impress a client before treatment happens? What an awesome opportunity to make an impact on the patient, to gain trust, to build excitement about achieving optimal dental health.

1. The phone call- Place your best team members on the phone!  When the phone rings you want to have your best players ready for action. You only get one shot to make a good impression.

2. The New patient packet- Sending out a personalized new patient packet with information pertaining to the patient s specific phone call desires and needs.

3. Verifying the appointment.- Take this opportunity to ensure that the patient received the  personalized packet of information, viewed the website, if there any questions about directions  and verifying the time of the appointment.

4. The greeting- The patient’s entrance into the practice; personalized greeting; patient identification and acknowledgement of any guest that arrived with them.

5. The consultation- The time spent with the doctor and the team to identify their time and concerns for their dental goals.

6.The follow up call – This would be an opportunity to follow up with a personalized call after their visit to the practice.

7. The examination- The time that is spent exploring options that will achieve their goals for the type of dental health that the patient is seeking. Take time to communicate at this appointment rather than focusing all of your appointment time on getting the data that is necessary. Speak the patient’s language. Talking over their head and using words that are technical is a trust buster.Yes; there are comprehensive x rays, digital photos, study models, periodontal charting and CT scans, but if you only focus on getting the task completed and you fail to communicate during the appointment with the patient then you may miss out on some very important details that that the patient is trying to communicate to you.

8. The follow up call- A personalized call about the examination and an opportunity to answer questions and address any concerns.

9. The treatment plan – The team members can personalize this time, use only the team member here that feels the most comfortable presenting fees. If you have someone in the office that is uncomfortable speaking about fees with patients then they may not be the right person discussing treatment and finalizing fees.

10. Appointing Treatment- Do not loose trust here. If you tell the patient that you can do something, then you have to follow through with it. This is such a critical piece to the over all success of treatment.  Following through is important. You may have their money, but you do not have success yet.

These are ten opportunities to impress the patient and to build trust. Take a step back and take this time to make the greatest impact. This process can be done on a patient of record or a new client. Build trust and refuse to break it.

10.  Be “LIKEABLE”. Take the time to connect with each patient. If people like you then they will do business with you.

9.  Be ON TIME. If we say that we are seeing a patient at 3:30pm, then they need to be seated at 3:30 pm. This is what time their appointment begins.  Always try to be on time. Our word is our commitment.

8.   Speak their LANGUAGE. Patients did not go to dental school; so don’t speak dental terminology to your patients. Explain things in a way that the patient will understand.

7. Always ask PREMISSION. Take the time to ask patients for their permission before doing something. Whether you are leaning a patient back in a chair or giving your opinion on a matter… always remember to get permission.

6.  Be DIFFERENT. Show patients what makes you different from others. Why is this office the place to be?

5. Always ask for REFERRALS. When your not asking for referrals from patient then how will they know that you want new patients?

4. Be ENCOURAGING to your team members (this includes the doctor) We all need encouragement from time to time and a good “pick me up” can make all the difference before case presentation and around the office.

3. Be a TEAM player. Stop saying me and I, start saying us and we.

2. EXAMINE your work ethic before you start examining other. There is always something that you can improve on.

1. TAKE photos on your patients. Print the photos and give them to every patient. Make the commitment to be better and to grow. If you discuss necessary treatment or elective treatment then you should back it up with photos.

One of the most amazing roles in the practice is the Patient Coordinator – that person who oversees the ongoing relationship with patients. While the specifics of the position can vary widely from one practice to another, the goal remains the same: ensure that patients are being heard, understood and cared for in the most appropriate way.

The role of the Patient Care Coordinator has evolved over the years, having begun as a hybrid to connect the clinical and behavioral dimensions in the practice. What we needed, many people realized, was a gifted communicator who could focus exclusively on the patient’s agenda and bridge the gap between what the patient wanted and what the practice had to offer. Since the initial conception in the early 1980’s, the role has developed into a key position that, in many cases, has taken the potential of the practice and brought it into reality. In considering the step to add a Patient Coordinator to the practice, the following questions might be asked:

What would help us be more successful?

What would lead to becoming more profitable?

As it turns out, the answer to both questions is the same: a Patient Coordinator.

Most practices are still organized around a structure that divides staff between the “front” and the “back.” The “front staff,” as they are generally labeled, is responsible for a seemingly endless and equally wide array of tasks including:

• Greeting patients as they enter either on foot or over the phone
• Engaging in social interactions with patients either upon entry or departure
• All things related to the schedule including making appointments as well as confirming and “filling holes”
• Exercising the Wisdom of Solomon in determining where to put “emergencies”
• Making financial arrangements and collecting overdue account balances
• Collecting fees “over the counter”
• Processing insurance submissions and follow-up
• Billing and responding to patients billing inquiries
• Data entry, reports, daysheets, deposits, filing, computer management, handling patient complaints, and on and on and on.

The clinical staff, on the other hand are responsible for seeing that the practice’s clinical procedures flow smoothly, that patients are delivered care comfortably, that the facility is managed within appropriate OSHA guidelines, that the dentist is supported properly in delivering care, that supplies are ordered and stocked, that equipment is maintained, and on and on and on.

Without question, there are many tasks to be done in a dental office. Historically, employees and their work have been organized primarily around the tasks that appear to be all-important in making the practice work. While these tasks are very important, the emphasis on performing routine tasks begins to block the view. The trees loom large and the beauty of the forest is lost. Let’s remember why most of these tasks are being done in the first place: to deliver dental care to patients who have employed you to perform these services. The style in which you do this is a matter of individual purpose, the culture you choose, your community expectations and standards, your style and preferences and other variables unique to your practice. But even given these differences, most practices are operated by people who are so focused on the task that they lose site of the goal: to help more of your patients choose better dentistry sooner.

In many cases, sadly, patients and their issues simply get in the way of the daily work. While many tasks and jobs are considered essential to the functioning of the dental practice, Patient Coordination or Facilitation has not yet been given that distinction. This role takes a back seat to the more routine obligations of running the business, managing the systems, moving the papers and instruments and maintaining the physical plant. Typically, staff falls into the following categories: front desk, assistant, and hygienist. When the practice grows or gets busy, additional staff is added. Most often, an additional assistant or front desk person is brought on board. Usually, the front desk staff is divided into two roles: scheduler and financial arrangements. And sometimes there is a “floater” in the back to handle instruments, clean up, help when things get busy, or act as a hygiene assistant to review medical history, take blood pressure and x-rays, chart, and turn the room.

In most cases, facilitation or patient care is blended with other jobs and not singled out as an area of primary focus for anyone.  When blended, it almost always gets the short shrift – it gets done when there is time. Hygiene and OHI come first but then we dash off to turn the room and greet the 10 o’clock patient. There is rarely enough time to focus on the big picture and the patient’s overall goals and issues.  Filling the schedule, confirming appointments, opening the mail, entering the payments, and filing come first; facilitation only if the day’s tasks are complete – and when are they ever complete?

Why is this the case? Because adding a Patient Coordinator or Facilitator can increase the staff size, realign working assignments of existing staff, perhaps but not always raise the payroll, require a private physical location, change the systems, refocus the energy, and require new skills and different strategies. But while this may sound like a lot of change, there is an enormous amount to be gained. If nothing else, a Patient Coordinator is a significant producer for your practice. That’s right…producer.

While a dentist and hygienist (and in some states an assistant) may actually perform the dental procedures for which a fee is charged, the Patient Coordinator is responsible for what happens prior to the patient being seated in the chair for dental care. While many patients, of course, will get there on their own, Patient Coordinators ensure that more people get there sooner for more complete and better care. This is a major advantage to every practice whether it is out of control busy or a little slow. I would go so far as to suggest that for most practices this position is as essential as any other, not just a nicety to be added when all the other things are working well. There are very few practices where an effective facilitator would not directly have a positive impact on the amount of dental care selected, the timing of that care, the way accounts are handled and the promptness of payments, the likelihood that patients actually show up for appointments they made, and ensuring that opportunities are not missed or delayed.

A Patient Coordinator spends her (or his) day focusing not on paper, instruments, the schedule, charts, documents, or insurance, but rather on the patients who are coming to, are present or have been in the practice for care. The facilitator is always asking important questions that ensure that patients are really heard, understood, related to, and responded to. The facilitator is responsible for creating a safe environment in the practice so that patients will tell you the truth rather than withhold important information or feel forced into dishonesty. While the facilitator may have a private office and a desk, she (or he) doesn’t have a chair affixed to the floor – that is, she roams around listening, checking in, observing, reviewing, and strategizing.

Fast and tough material for CEREC®, E4D® and Straumann.

3M ESPE‚ introduces Lava™ Ultimate CAD/CAM Restorative, a unique new CAD/CAM material with long-lasting esthetics and performance. Based on 3M ESPE’s renowned nanotechnology, Lava Ultimate CAD/CAM restorative offers a polish that lasts, and backs it up with a 10-year warranty—something no other chairside block can match.

This new class of CAD/CAM material provides a fast, no-firing process that is easy to mill, helping dentists maximize the productivity of their in-office restorative systems. The unique restorative offers a functionality that other chairside materials cannot: Lava Ultimate CAD/CAM is resilient, not brittle, and is incredibly durable and shock absorbent. A few minutes of polishing are all that is necessary to achieve an enamel-like luster. The material also allows dentists to easily make adjustments, as well as build-up and reseal restorations. Lava Ultimate CAD/CAM restorative will be offered in eight shades, four of which include both high and low translucencies, giving dentists the choices they need to create natural-looking restorations.

This new material builds upon two of 3M’s core technology platforms: ceramics and nanotechnology. Lava Ultimate CAD/CAM restorative is formulated from a blend of approximately 80% nanoceramic particles embedded in a highly-cured resin matrix using a 3M proprietary manufacturing process. The result is a unique, patented material that maintains a brilliant, long-lasting polish.

“This material saves dental professionals time in two ways—by providing a faster milling time and by eliminating the need for an additional firing step,” said Mark Gates, vice president of sales and marketing, 3M ESPE. “Our confidence in this material is evidenced by our 10 year warranty, so dentists can also feel confident using it in practice.”

Lava Ultimate CAD/CAM restorative is indicated for a full range of permanent adhesive, single-unit restorations including crowns, onlays, inlays and veneers. Additionally, the material is ideally suited for implant supported restorations because of its high flexural strength and low wear. Lava Ultimate CAD/CAM restorative reduces stress to the implant, and dentists can adjust the material for occlusion with additive and subtractive techniques.

With enamel-like beauty, ease of use, and guaranteed 10-year durability, Lava Ultimate CAD/CAM restorative gives dentists an outstanding new way to maximize their CAD/CAM systems while offering patients a beautiful and durable restoration. Finished restorations are also available to dentists and labs through Straumann CARES® Digital Solutions, and the material will be available in 2012 to Lava Milling Centers.

For more information, visit www.3MESPE.com/LavaUltimate or call            1-800-634-2249      .

About 3M ESPE
3M ESPE manufactures and markets more than 2,000 products and services designed to help dental professionals improve their patients’ oral health care. 3M Health Care, one of 3M’s six major business segments, provides world-class innovative products and services to help health care professionals improve the practice and delivery of patient care in medical, oral care, drug delivery and health information markets. The recently created 3M Digital Oral Care Department, part of the 3M ESPE Division, aims to accelerate and strengthen 3M’s efforts to lead the digital transformation that is occurring in oral care. For more information on the complete 3M ESPE line of dental products visit the 3M ESPE Web site at www.3MESPE.com or call the 3M ESPE Technical Hotline at            1-800-634-2249      . Products are available for purchase through authorized 3M ESPE distributors.

3M‚ ESPE‚ and Lava are trademarks of 3M ESPE or 3M ESPE AG.

About 3M

3M captures the spark of new ideas and transforms them into thousands of ingenious products. Our culture of creative collaboration inspires a never-ending stream of powerful technologies that make life better. 3M is the innovation company that never stops inventing. With $27 billion in sales, 3M employs about 80,000 people worldwide and has operations in more than 65 countries. For more information, visit www.3M.com or follow @3MNews on Twitter.

What is a Rubber Dam

The dental rubber dam is a piece of thin, stretchable latex or non-latex material that becomes a barrier when applied to the selected teeth. The isolation technique helps protect the teeth for all types of dental procedures such as root canals, bleaching, and preparation and delivery on all types of restoration.

Why use a Rubber Dam

1. Visibility is much better due to the contrast of colors of the dam and the teeth being prepared.

2. Creates dry and non-contaminated field from saliva and other debris during all bonded procedures.

3. Improves access during dental procedures by retracting the lip, cheek, and tongue from the field of operation.

4. Protects the patient from swallowing any debris such as the removal of amalgam, old porcelain, and composite.

5. Increases the efficiency, productivity and reduces the time required for treatment.

6. Adds comfort for the patient and dentist

7. Infection Control

Contraindicated

1. Tooth may be too short to hold a clamp.
2. Tooth may not fully erupted and there is not enough tooth to clamp to
3. Patients that may not be able to swallow

Size

Dental Dam material is available in pre-cut squares of 6×6 and 5×5 inches. The 6×6 is used for posterior applications. The 5×5 squares are for anterior application and primary detention.

Thickness

The thickness gauge of a dental dam can vary from thin, medium, and heavy. Thin is used for endodontic, medium is the most popular for easy placement, and heavy for tight contact areas or the need for stronger support of the dam.

Color

Dental Dams come in a wide variety of colors. They come in colors of grey, blue, pink, purple, green, white, and yellow. They can also come scented or unscented, flavored or unflavored. Most dentists prefer the darker shades for contrast.

Dam Napkins

A dam napkin can be placed between the dental dam and the patients face. This helps to absorb moisture and increase comfort for the patient.

Dam Frames

A Dental Frame is necessary to stabilize and stretch the dam tightly over the teeth. Frames come in plastic and metal. Both can be cold or heat sterilized.

Lubricants

Lubricant such as topical such as Ultradents () or KY jelly can be placed on the underside of the dental dam for easier placement over the teeth and through the interproximal areas.

Dam Punch

The dental dam hole punch is used to create holes in the dental dam needed to expose the teeth that are to be isolated. The working end of the punch is used to puncture the dam for the correct hole sizes.

Size 5 is the largest size is an anterior tooth

Size 4 the next size smaller is for molars

Size 3 is for bicuspids and canines

Size 2 is for maxillary anteriors and incisiors

Size 1 is the smallest size is for Mandibular Anterior Incisiors

Dam Templates

Sometimes it is hard to know where to cut the holes on the rubber dam. This is where a dam template is handy. The dam template and stamp inkpad allow the assistant the exactly where to place the holes if the teeth are out of the arch form.

Dam Forceps

Dental Forceps are used to place and remove the dental dam clamp. The beaks of the forceps fit into the holes on the jaws of the clamp. The handles have a spring action that allows the forceps when squeezed to open up and fit over the tooth. When the handles are released, the clamp is let go.

Dam Clamps

A dental dam clamp is used to stabilize the dental dam. The dam clamp holds the dental dam secure on the end nearest the tooth that is being treated. Clamps can be ligated for security and safety of the patient from swallowing if the clamp becomes dislodged during treatment.

Selection of Clamps

Anterior Tooth: Use a double bowed clamp ()

Pre-Molar: Use a small, flat-jawed clamp()

Mandibular Molar: Use a flat-jawed clamp ()

Maxillary Molar: Use a clamp with a curved jaw ()

Partially Erupted: Use a clamp with sub-gingival designed

Different Dams to choose from

Traditional Dental Dams

1. Coltene Whaledent
2. Zirc
3. Roeko
4. Ivory by Heraeus Kulzer
5. Hu-friedy
6. Ultradent

 Conventional Dental Dams 

1. Optidam by Kerr
2. Optradam by Ivoclar Vivadent

Placement of the Traditional Dam

1. The dental dam and supplies are ready for use
2. Determine the operating field.
3. Mark and punch the hole positions.
4. Select the correct clamp and ligate.
5. For Posterior Isolation, Always go one tooth distal to the tooth (teeth) being treated and extend to the midline. Anterior Isolation include pre-molar to pre-molar.
6. Position the clamp over the tooth with the lingual jaws of the clamp first, then the facial jaws. During the placement, you may need to keep your finger on the clamp to keep the clamp from coming off before it is properly seated on the tooth.
7. Stretch the Dental Dam that has been punched over the anchor tooth.
8. The ligature (floss) should be exposed and easy to grasp if needed.
9. Position the frame over the dam and slightly pulling the dam to catch on the prongs of the frame.
10. Fit the last whole of the dam over the last tooth to be exposed at the opposite end of the tooth that is anchored.
11. Using your index fingers stretch the dam over the clamp. For more difficult interproximal contacts, use the waxed floss such as Glide by Proctor and Gamble or wedjets by (). The lingual end of the floss is looped over and inserted into the contact, while caring down more dam with it. Remove floss by pulling both ends buccally without disturbing the dam.
12. Using a black spoon HuFriedy (), tuck the edges of the dental dam into the gingival sulcus.
13. If the patient is having problems breathing, cut a small u shape just under the nose so the nasal passage is not blocked, and the patient can breathe easy.

Conclusion

Placement of the rubber dam should not be a nescience or an option. With today’s new systems Practice and Placement makes perfect.

Recently, I wrote a blog post about five specific strategies that can help your practice grow in a soft economy. The first strategy I recommended was to make whitening a core element of your practice. In this blog post, I will provide more details.

I am a firm believer that whitening is an under-utilized service in dentistry! The fact is, people want and value whiter teeth. In a recent USA Today survey, 85% of the people surveyed listed ‘make then whiter’ when asked how they would like to improve their teeth. WOW, think about that for a minute. 85% of the people want whiter teeth! The great news is that we have the technology to give patients what they want.

The reason I am so excited about whitening is because of the ‘Gateway Effect’. Patients become more interested in their teeth after they whiten. Many of our cosmetic and complex restorative cases started out as a whitening case. Patients will often tell Dr. Nielson that they like the new whiter color of their teeth and then they start asking about other issues. Because of this phenomenon, I like to think of whitening as a gateway service.

Here are three specific recommendations to increase your whitening volume:

1)  Take a Shade Match on All Hygiene Patients This simple technique is the single most effective tip to increase your whitening volume. Make taking a shade match part of your update routine. Here are the specific verbal skills we use:

Hygienist: “Mrs. Jones, I am going to start our appointment today by taking a shade match of your current tooth color. The reason I am doing this is that we now know that tooth color changes over time. It tends to darken with age. I would like to have a shade today for our records.”

Next, the hygienist shows the patient their shade on a shade guide that is chromatically arranged from dark to light. That’s it. That is usually all that is needed to open a dialog about whitening.

2)  Value Price Whitening I don’t believe in giving away whitening, but we do value price whitening as a means of making it more affordable and accessible for patients. We currently charge $195 for in-office (including custom trays), $95 for take-home with custom trays, and $40 for over the counter (OTC). We use Ultradent Products (Boost for in-office, Opalescence for take-home and Trés White for OTC). With this pricing strategy we make a small profit on each whitening procedure but more importantly, we do way more whitening!

3)  Offer Lifetime Whitening In-office and take-home whitening patients all have custom trays. Consider offering lifetime whitening as long as they keep their recommended hygiene appointments! Provide them with a syringe of whitening gel as an incentive to keep their hygiene appointments. This is a real win/win. Patients get to touch up their smile and you provide them with an incentive to keep their appointments. When you combine the value pricing strategy with the offer of lifetime whitening, you are providing your patients with an awesome value that is much appreciated in the soft economy.

Consider the recommendations above to make whitening a core element of your practice. We tell our patients that one of our goals is to help them have the whitest, brightest smiles in Arizona. We know this resonates with 85% of them. I like those odds!! Keep smiling!

Whether you call it bad breath or halitosis, it’s an unpleasant condition that’s cause for embarrassment. Some people with bad breath aren’t even aware there’s a problem. If you’re concerned about bad breath, see your dentist. He or she can help identify the cause and, if it’s due to an oral condition, develop a treatment plan to help eliminate it.

What you eat affects the air you exhale. Certain foods, such as garlic and onions, contribute to objectionable breath odor. Once the food is absorbed into the bloodstream, it is transferred to the lungs, where it is expelled. Brushing, flossing and mouthwash will only mask the odor temporarily. Odors continue until the body eliminates the food. Dieters may develop unpleasant breath from infrequent eating.

If you don’t brush and floss daily, particles of food remain in the mouth, collecting bacteria, which can cause bad breath. Food that collects between the teeth, on the tongue and around the gums can rot, leaving an unpleasant odor.

Bad breath can also be caused by dry mouth (xerostomia), which occurs when the flow of saliva decreases. Saliva is necessary to cleanse the mouth and remove particles that may cause odor. Dry mouth may be caused by various medications, salivary gland problems or continuously breathing through the mouth. If you suffer from dry mouth, your dentist may prescribe anartificial saliva, or suggest using sugarless candy and increasing your fluid intake. Ultradent’s  Xylishield Gum, Mints, Mouth Rinse, and Toothpaste contain therapeutic levels of xylitol, an all-natural sweetener that helps shield teeth from cavity-causing bacteria.

Bad breath may be the sign of a medical disorder, such as a local infection in the respiratory tract, chronic sinusitis, postnasal drip, chronic bronchitis, diabetes, gastrointestinal disturbance, liver or kidney ailment. If your dentist determines that your mouth is healthy, you may be referred to your family doctor or a specialist to determine the cause of bad breath.

Maintaining good oral health is essential to reducing bad breath. Schedule regular dental visits for a professional cleaning and checkup. If you think you have constant bad breath, keep a log of the foods you eat and make a list of medications you take. Some medications may play a role in creating mouth odors. Let your dentist know if you’ve had any surgery or illness since your last appointment.

Brush twice a day with fluoride toothpaste to remove food debris and plaque. Brush your tongue, too. Once a day, use floss or an Opalpix by Ultradent to clean between teeth.

Image credit: photostock / FreeDigitalPhotos.net