Ben Franklin Would Be Proud

Dentists long ago could hop into their electric automobiles -- at the turn of the last century they were more popular than gasoline-powered models -- drive to their practices, and restore teeth with an electric-powered handpiece. A dentist now can do much the same, but the electric handpiece, just like the electric car, has undergone an almost complete metamorphosis in the century since 1899.

Today’s electric handpiece, like its counterpart in the automotive world, is a far cry from its ancestor, both in form and function. While its use in Europe is widespread, it is not yet a real competitor to the air turbine handpiece in the United States. Although the air turbine handpiece has represented the state of the art since the mid-1950s, the electric handpiece is slowly finding its way back into American dental practices. Better technology is providing the key.

"We were never able to go back to electric handpieces because it wasn’t thought they could keep the revolutions up and at the same time provide a smooth-running unit," says Douglas H. Kazen, BSPh, MS, PhD, president of Aseptico, Inc., in Kirkland, Wash., a dental equipment manufacturer. "Now we can do these things because bearing technology has moved so far ahead that we can provide systems that are steam autoclavable, and we can give doctors predictable speed and a reduction in aerosolizing."

While attending dental school at the University of California, San Francisco, Robert L. Miller, DDS, now practicing in Pleasant Hill, worked as an aerobiologist, studying aerosolization. He says he has found that the electric handpiece is superior to air-driven units in reducing aerosols because of a slower operating speed and no need for an air and water spray.

"With air-powered handpieces you put up an extraordinary amount of aerosols," Miller says. "When I studied the use of the electric handpiece in a bloody field, I could find no significant amount of blood being aerosolized."

Brian G. Shearer, PhD, director of the American Dental Association’s Council on Scientific Affairs Department of Information and Policy, says that even though the electric units may reduce aerosols, there is no scientific proof that they also reduce infection in the dental office.

"As yet we really have no scientific evidence suggesting that aerosols result in infection," Shearer says. "If these units reduce aerosolization, that’s a good thing. But the point is that if the standard handpiece is used properly with infection control techniques, we have no documented scientific evidence that they result in occupational infection."

Miller, a general dentist, says that there is another advantage to the electric handpiece’s slower speed.

"It can be set for a very slow speed -- around 300 rpm -- that is useful for endodontic files," Miller says. "It allows you to electronically tune whatever speed you want to use. You don’t have to worry about overspeeding it."

Alan L. Felsenfeld, DDS, CDA’s new chair of the Council on Dental Research and Developments, says that for the vast majority of practitioners, the air-driven turbine is the standard now and into the future for preparation of teeth for restorations.

"But for supplemental use in endodontics, oral and periodontal surgery, and implants, this is an excellent instrument to add to our offices," he says.

Felsenfeld, an oral and maxillofacial surgeon, says the delicate preparation of a tooth restoration can’t easily be done with lower-speed electric drills, but advantages exist nonetheless.

"In oral surgery, for example, electric handpieces offer high torque, and this is a tremendous advantage," he says. "It is reasonably speedy for removing bone, and the handpiece, including the cord, can be sterilized. More importantly, electric handpieces don’t blow air into the wound with the potential for introducing harm to the patient."

An assessment by Ian Van Zyl, DDS, BDS, MS, an assistant professor of fixed prosthodontics on the faculty of the University of the Pacific School of Dentistry, differs from Felsenfeld’s.

"We performed a double blind study using the electric handpiece with dental students nearing the end of their first year who were already highly skilled with the air turbine," Van Zyl says. "This was the first time they had picked up the electric motor, and cavity preparations using both systems showed no statistically significant difference."

One drawback of electric handpieces is the cost, which is several times higher than that of an air-driven unit.

"There is an initially higher cost when purchasing an electric handpiece, but if you consider its longevity and reduced maintenance needs, the extra cost can be amortized over a few years," Felsenfeld says.

Miller says another concern is that some of the electric units heat up if used for long, sustained periods.

"I found one designed for oral surgery that was useful only for short-time use," he says. "It heats up too much because it doesn’t have an internal cooling system."

Kazen admits that introducing the new electric handpiece technology to general dentistry will be a long-term process.

"Most dentists are not quite ready to re-equip their operatories," Kazen says. "If a dentist switches to electric, he will immediately antiquate expensive air-driven equipment. So it will happen from the ground up, little by little."

Talking the Talk

By Dell Richards

Whether they want to or not, many dental professionals are called upon to speak to some sort of public group at some point during their careers. Public speaking and presentations can be a very effective way of attracting new patients.

Whatever the occasion, knowing how makes public speaking easier. Here are some observations that should help:

* Most speakers start with a humorous remark to put the audience at ease. Unless the topic doesn’t lend itself to humor, wit can make a speech more enjoyable for everyone. A speaker should try to work in a light remark. If humor isn’t a comfortable style for a speaker, he or she should open by saying how pleased he or she is to be there. Making the audience feel appreciated also will get their attention fast.

* Notes should consist of keywords in big bold letters that can be read from a distance. A speech should not be written out, memorized and read. The best speeches seem extemporaneous, even though they may have been rehearsed a hundred times. Using keywords for general points can create a spontaneous feel.

* It is harder for people to remember information that has been heard rather than read. That’s why TV advertising has the name, logo and slogan as well as action and dialogue. A speaker should open a talk by telling the audience what he or she is going to say. Then, he or she should discuss the subject, and close by reiterating key points.

* For that same reason, a speaker shouldn’t make more than three major points. Sub-points and anecdotes can be used to flesh out a general theme, but the main points should be kept to a minimum.

* Pace is important. Some speakers should tap their foot every second and speak a word with each tap. For higher energy, the pace can be increased. But a speaker should practice speaking slowly. He or she will undoubtedly speak faster when giving the presentation.

* A speaker should practice looking around the room while speaking. He or she should move his or her head slowly to make eye contact with individuals in the room. If nervousness makes it difficult to look at anyone directly, the speaker should look at people’s foreheads. They will never know the difference.

* Broad gestures can be effective, but hand-flapping or clicking coins in the pocket is distracting, if not downright annoying.

* A speaker should wear a dark blue suit and/or a light blue shirt. "IBM blue" -- the blue that most companies use -- has the most credibility of any color. People will be inclined to believe the speaker because blue says "Trust me. I know what I’m talking about."

* Practice makes perfect. A speaker should practice alone, without a mirror at first. He or she should then work up to a mirror or a friend. Those with a camcorder should videotape themselves again and again. Those who are really serious about becoming a good speaker should join Toastmasters International. Most cities have a chapter listed in the phone book.

* When practicing, one shouldn’t be hard on oneself. A speaker is creating a special persona -- which is never easy. A beginning speaker may feel like a fool, or even an imposter, at first, but should keep at it. People learn by experiment, trial and error, and doing the same thing again and again until they get it right.

* Smiling is a key factor. Surveys show that 93 percent of what audiences remember is nonverbal. The voice and the smile combined are the second most important factors after the information itself.

* Publicity can help. A speaker should send a notice to the local paper announcing the speech to generate interest and publicity.

Learning speaking skills is like breaking in a new pair of shoes -- they’re never really comfortable until they’ve been worn a while.

Dell Richards is owner of Dell Richards Publicity in Sacramento.

Better Communication May Minimize Children Complaints

Most problems between dentists and children can be handled through better communication, according to Greg Johnson, director of professional services for the Illinois State Dental Society, and staff liaison to the ISDS's Peer Review Committee.

In an article in the August 1999 Illinois Dental News, Johnson writes that of the 500 peer review cases handled by the committee each year, about 10 percent involve children. He writes that complaints involving children frequently include three issues: parents who are not allowed into the operatory with their child; "hand-over-mouth" behavior control techniques; and continuing a procedure even after a child indicates the dentist should stop. Johnson says that dentists can frequently eliminate these problems by addressing them ahead of time with the child and parent.

Dentists who prefer not to have parents in the operatory should make that office policy clear to the parent ahead of time. "I think at times if a parent objects to a particular policy, maybe it's best the dentist refer them to a colleague who will allow the parent in," says Dr. Richard Kirchoff, a past president of the Illinois Society of Pediatric Dentists. If the parent is to be allowed, ground rules need to be established, Kirchoff notes. The dentist should make it clear that a parent is to be a "quiet observer," sitting in front of the patient, and perhaps holding a child's hand for comfort.

The "hand-over-mouth" technique of controlling a child patient, while approved by the American Academy of Pediatric Dentistry, doesn't always please parents. For those who do use the hand-over-mouth technique, it should be done in a non-angry, non-aggressive manner, without reducing the airway.

Johnson's article notes many dentists find the hand-over-mouth technique ineffective, noting that if a child's behavior is out of control to the point where the dentist considers using it, it may be best to stop the procedure. According to the article, a parent should be informed prior to its use, and preferably a signed consent form should be obtained from the parent. Johnson notes other methods of control tend to work better, such as voice control.

For children in or near hysterics, another recommended method is the T.O.T.S., or Take Off The Shoe method, based on the theory that four-year-olds don't like to have their shoes taken off. Dentists can promise to replace the shoe if the child cooperates.

As for complaints about dentists continuing treatment after the child indicates he or she wants it stopped, it's important for the dentist to give the child a signal, such as raising a hand, when they want the dentist to stop. The dentist should stop, give more anesthetic, or take other measures to make the child more comfortable. Letting the child and parent know what the procedure involves ahead of time can alleviate problems. Better communication helps all the way around, Johnson notes.

Professionals Should Help Boost Health Awareness

Patients referred to periodontists often have no idea they have undiagnosed and uncontrolled health problems, some of which can affect their dental treatment, according to a study published in the October 1999 issue of the Journal of Periodontology.

Dental professionals routinely have patients complete health histories during their initial visit. The study compared self-reported medical histories from 39 consecutive patients with moderate to advanced periodontal disease to laboratory data obtained when patients were then referred to a hospital for urinalysis, complete blood count, and a standard blood chemistry panel.

While no patients in the study reported having diabetes, 15 percent tested positive for the disease. In addition, only 5 percent of participants reported a history of abnormal cholesterol, while 56 percent tested positive for exceptionally high values, putting them at greater risk for strokes and heart attacks.

"These and other underreported conditions found in the study are alarming because it’s important for patients to know what diseases they have or are at high risk for so that they can take steps to control the diseases," says the study’s lead researcher, Dr. Kelly Thompson. "From a dental practitioner’s standpoint, these findings also mean that we may not always be made aware of what we’re up against. Undiagnosed and uncontrolled diabetes can have a profound impact on oral health and can greatly affect treatment procedures and outcomes."

The study cites a need for dental professionals to emphasize to patients the importance of routine physical examinations and preventative care. "Our patients who exhibit risk factors could benefit from physician referrals," Thompson says.

Trading Spit for Stick

A recently released saliva-based genetic test for periodontal disease is expected to replace the blood-based test currently used by some in the periodontics community.

The new test, from Interleukin Genetics, Inc., is designed to be quick, reliable and convenient so dental practices may incorporate the testing more readily. The new test was introduced in September.

Dr. Ken Kornman, Interleukin's president and chief scientific officer, says, "Based on technical innovations, it is now possible to use saliva instead of blood as a reliable source of DNA. Feedback from dentists about this advance has been positive, since saliva collection will reduce the time and potential patient discomfort associated with finger-stick blood collection."

Good Phone Manners Are Good Business

Proper use of the telephone can be a powerful marketing tool for a dental practice, according to an article by Dr. Robert Ash, BS, CP, ACHE, in the July/August issue of the Journal of Dental Technology.

Since a caller’s first impression of a business is frequently over the telephone, the most costly business mistakes are made in the first few seconds. The person answering the phone must be able to sell your image quickly and effectively, Ash writes.

"Statistics show that telephone vocal quality accounts for 70 percent of the first impression you make and the words spoken count for 30 percent. Since the telephone is one of the most used tools in the work of your company, how you and your employees use this tool is very important," Ash writes.

The best time to answer the phone is on the second ring, Ash writes. If a second line rings while you’re talking to another person, ask permission to put the caller on hold, then give them time to respond. Never say "hold on," or "hang on." Pick up the second call, explain you’re on the other line and you’ll call back shortly, and take a brief message. Get back to the first call within 30 to 45 seconds, and thank them for waiting.

Top Tips

• Courtesy is most important.

• Treat every caller as a special person. Give your undivided attention to every call.

• Put a smile on as you answer the telephone. The caller can "hear" you smile.

• Put energy into your voice.

• Identify your office and name.

• Always keep paper and a pens handy for notes.

• Keep food and pens out of your mouth so as not to garble your words.

• Be willing to give out information; don’t make the caller drag it out of you.

• Be professional.

CDC Presents More Fluoride Support

Dental treatment costs for low-income children can be twice as high and crisis intervention more frequent in nonfluoridated communities than in those with fluoridated water, according to a Sept. 3, 1999, report from the Centers for Disease Control and Prevention, published in the CDC Morbidity and Mortality Weekly Report.

Findings of the study, which was conducted in 19 Louisiana parishes (counties), suggest that very young children lacking access to fluoridated water were three times more likely to receive dental treatment in a hospital operating room than children in communities with optimal levels of fluoridated water.

"CDC’s data are useful for community decision makers as they consider implementing water fluoridation," says Dr. Kimberly McFarland, vice chair of the ADA Council on Access, Prevention and Interprofessional Relations and chair of the council's National Fluoridation Advisory Committee. "From public health experience across the country, we have always known that fluoridation saves money. These data document that water fluoridation is beneficial especially for low-income populations."

The study reports that more Medicaid-eligible children in nonfluoridated parishes received caries-related dental treatment and operating-room-based care at greater cost than did Medicaid-eligible children in fluoridated parishes. The expected annual reduction in dental treatment costs for at least 39,000 preschoolers in Louisiana, as a result of potential benefits from water fluoridation, would be $1.4 million.

Other studies have found that caries in the primary dentition disproportionately affect children from low-income households, including a study reported in the September 1998 Journal of the American Dental Association.

The authors of the CDC-reported study say they did not measure the length or magnitude of the children's exposure to fluoride and said the findings are subject to other limitations. Lower treatment costs associated with water fluoridation should not be generalized to preschool children from middle and high income families because of their lower prevalence of dental decay, the authors say.

Honors

Jack F. Conley, DDS, editor of the Journal of the California Dental Association, has been named the holder of the Rex Ingraham Chair in Restorative Dentistry at the University of Southern California School of Dentistry.

Donald S. Clem, DDS, a private periodontal practitioner in Fullerton, Calif., received a Special Citation in recognition of his outstanding contribution to the American Academy of Periodontology.

Web Watch: Continuing Dental Education

The following pages have information on continuing education courses provided by the five California dental schools.

http://www.llu.edu/llu/dentistry/cde/cdehomepage.htm
Information from Loma Linda University

http://www.dent.ucla.edu/ce/
Information from the University of California at Los Angeles

http://itsa.ucsf.edu/~dental/sod_center.htm
Information from UC San Francisco

http://www.dental.uop.edu/ (Click on "Dental Professionals")
Information from the University of the Pacific

http://www.usc.edu/hsc/dental/Info/CE/index.html
Information from the University of Southern California

A listing here does not constitute endorsement by the California Dental Association. As is the case with all web sites, content is subject to frequent change.

Upcoming Meetings

2000

Jan. 19-22 American Academy of Dental Group Practice, San Antonio, Texas, (602) 381-1185

Jan. 27-29 Miami Winter Meeting & Dental Expo, (800) 344-5660

March 1-4 Academy of Laser Dentistry Conference and Exposition, Panama City Beach, Fla., (954) 346-3776

April 6-8 Dentistry 2000 -- British Dental Association Annual Conference and British Dental Trade Association Dental Showcase Exhibition, Birmingham, England, 01934 844408

April 13-16 CDA Scientific Session, Anaheim, Calif., (916) 443-3382, Ext. 4470

May 15-20, World Biomaterials Congress and Exposition, Kamuela, Hawaii, (612) 543-0908

Sept. 15-17 CDA Scientific Session, San Francisco, (916) 443-3382, Ext. 4470

Sept. 17-20 American Academy of Periodontology Annual Meeting, Honolulu, www.perio.org

Oct. 14-18 ADA Annual Session, Chicago, (312) 440-2500

Nov. 29-Dec. 2 Le Mondial du Dentaire, Paris, www.fdi.org.uk/worldental (CHECK!)

2001

May 4-8 Australian Dental Congress, Brisbane, +61 (0) 7 3369 0477

To have a meeting included on this list, please send the information to Upcoming Meetings, CDA Journal, P.O. Box 13749, Sacramento, CA 95853 or fax the information to (916) 443-2943.