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Publication Mail Registration No. 5383 Publication Mail Agreement No. 40063878
THE JOURNAL OF THE ONTARIO DENTAL ASSOCIATION JANUARY | FEBRUARY 2012
Accessibility for Ontarians with Disabilities Is Your Practice Complying With2012 Standards?
INSIDE THIS ISSUE ASM 2012 PRELIMINARY PROGRAM OD_JanFeb12_FINAL:Layout 1 1/17/12 1:13 PM Page 2
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Ontario Dentist is the official journal of the Ontario Dental Association, dedicated to supporting the Association’s Mission and Vision by providing members with educational information relevant to their profession and the dental practice environment in Ontario.
PUBLISHER (On Leave) Kari Cuss
ACTING PUBLISHER Courtney Sorger I upfront EDITOR Dr. Brian N. Feldman 6 Letters 14 Cover Article ART DIRECTOR Recognition Appreciated Accessibility for Ontarians Kimberley Strange Dr. Peter Trainor with Disabilities Act, 2005: Complying with the Customer MANAGING EDITOR Interesting Info Julia Kuipers Service Standard Erica Simmonds David Gentili ASSOCIATE EDITOR Gilda Swartz Silver is Still Useful Dr. Lynn Tomkins 18 Dentist-Patient Relationship CLASSIFIEDS CO-ORDINATOR Money Matters: Why Talking Catherine Solmes 8 Editorial to Your Patients Makes Sense EDITORIAL BOARD Fearless Predictions Dr. Harry Höediono Dr. Brian N. Feldman Dr. Brian N. Feldman Dr. Jeffrey L. Berger Dr. Trevor Chin Quee 21 Opinion Dr. Peter Copp 10 President’s Page Fifty Years as a Dentist: Dr. Irv Feferman Why Government Dental Why I’d Do It Again Dr. Yoav Finer Programs are Failing Both Dr. Ian McConnachie Dr. Joshua Fedder Dr. Simone Seltzer Patients and Dentists Dr. Ingrid Sevels Dr. Harry Höediono Dr. David A. Walker
DISCLAIMER The opinions expressed in Ontario Dentist are those I clinical of the authors, and do not necessarily reflect the opinions of the ODA, Editor or Editorial Board. 23 Healthline 32 Clinical Feature Copyright: The Ontario Dental Association. Deadly Competition Human Papillomavirus and Reprint only by permission of the ODA. Dr. Irv Feferman Oral Cancer: Is There a Link? ISSN 0300 5275 Drs. Brian Feldman and 26 Clinical Abstracts Deborah Saunders Advertising must comply with the advertising standards of the ODA. The publication of an Oriental Cures advertisment or inclusion of a polybagged item Dr. Ingrid Sevels 34 Clinical Submissions for should not be construed as an endorsement of, Case Reports or approval by, the ODA. 28 Case Report 35 Case Report Template DISPLAY ADVERTISING INFORMATION After 70 Years – Compensation Dr. Brian N. Feldman Dovetail Communications Inc from World War II 30 East Beaver Creek Road, Suite 202 Richmond Hill, Ont. L4B 1J2 Drs. John Connelly, Erin Sisson, Tel: 905-886-6640 Fax: 905-886-6615 Christine Tanyan Jennifer DiIorio Janet Jeffery 905-886-6641 905-886-6641 ext. 309 ext. 329 [email protected] [email protected]
CONTACT US 4 New Street, Toronto, Ont. M5R 1P6 57 Tel: 416-922-3900 Fax: 416-922-9005 Email: [email protected] www.oda.ca
Cover Photo Illustration: iStockPhoto & K. Strange 28
4 Ontario Dentist • January | February 2012 OD_JanFeb12_FINAL:Layout 1 1/17/12 1:13 PM Page 5
ODA Board of Directors
President Dr. Harry Höediono JANUARY | FEBRUARY 2012 Kitchener Volume 89 | Number 1 President-Elect Dr. Art Worth Thamesville
Past President Dr. Lynn Tomkins I business Toronto Vice-President 36 Financial Planning 39 Financial Planning Dr. Rick Caldwell Aiming for Successful Test Your RRSP Knowledge New Liskeard Retirement Archie Pedden Dr. Raffy Chouljian Adam Butler Scarborough 42 Financial Planning Dr. Donna Green Financing Your Dental Practice St. Thomas Alec Morley Dr. Victor Kutcher Burlington I members Dr. Grace Lee Ottawa 44 Member Services 51 Component Society News A Message from ODA Dr. Jack McLister London Membership Chair 52 Oral Health Month Dr. Rob Tracogna Start a Conversation, Save a Life Dr. Gerald Smith Bonnie Dean Thunder Bay 44 Welcome to New Members Dr. David Stevenson 54 Pursuing My Passion Carleton Place 45 Announcements Motorcycle Rallying: CAE Elects New President Not an Easy Ride Dr. Isabel Teijeiro and Officers Chelmsford Dr. Peter Delean Dr. Larry Tenaschuk 46 The ODA’s Honours and 56 What’s on the Website? Milton Awards Program Register Online for the 2012 Dr. Arnie Weingarten The ODA Presents the Service Annual Spring Meeting Downsview and Aileen Durham Awards. Dr. Ronald Yim 57 In Memoriam Burlington 50 University News Dr. Donald Cuthbert Teskey ODA Student Leadership Dr. Judson Taylor Hopkins Workshop Chair of Council Dr. Roger Howard 51 ODA Proficiency Awards 57 Members and the Media Ottawa Presented to U of T and Help for Patients in Need UWO Students Featured in Kawartha Lakes ODA Mission Statement This Week The Ontario Dental Association is the Brian Kellow voluntary professional organization which represents the dentists of 58 Dental Calendar Ontario, supports its members, is dedicated to the provision of 60 Spotlight on New Products exemplary oral health care and promotes the attainment of optimal 61 Classifieds health for the people of Ontario.
62Marketplace
65 Advertiser Index 36 66 Classified Order Form January | February 2012 • Ontario Dentist 5 OD_JanFeb12_FINAL:Layout 1 1/17/12 1:13 PM Page 6
upfront
Letters
Recognition Appreciated Interesting Info
I would like to express special thanks to Dr. Höediono and We would like to reprint two articles from the November the ODA for the wonderful complimentary remarks he 2011 issue of Ontario Dentist, on our Canadian Dental As- wrote in his President’s Page, “In Appreciation,” in the No- sistants’ Association’s website: “Developments Elsewhere,” vember 2011 issue of Ontario Dentist. Governance leader- by Dr. Brian N. Feldman, and “Spotlight on New Products.” ship today is becoming a difficult task for all organizations, We are interested in Dr. Feldman’s editorial because it in- but recognition such as that given by Dr. Höediono cer- cludes dental news, developments and working conditions tainly enhances the volunteerism and the commitment. from other countries in a succinct, easy-to-read format. We are always looking for interesting articles or editorials that Thank you Dr. Höediono! provide information about oral health around the world.
Dr. Peter Trainor Thank you for your help. Listowel, Ont. Dr. Trainor is a Past-President of the ODA and the current Erica Simmonds President of the Royal College of Dental Surgeons. Communications Coordinator/ Canadian Dental Assistants’ Association Ottawa, Ont.
Vancouver,uver, BC Silver is Still Useful
As a member of the teaching staff at the University of 3DFLÀF3DFLÀF 'HQW 'HQWDODO Toronto’s Faculty of Dentistry in the Department of Oral Diagnosis, I would like to assure Dr. John Ainslie (“Silver &RQI&RQIHUHQFHHHUHQFH or White?” Letters to the Editor, Ontario Dentist, December 2011) that the placement of silver amalgam fillings is still taught in our dental schools. Students are taught that den- tal silver amalgam is an extremely useful and long- lasting restorative material and that there is no scientific evidence whatsoever that silver amalgam fillings might be harmful to human health. Any dentist who removes, or advises the removal of, sil- ver amalgam fillings because of a supposed danger of mer- cury to the patient’s health is promoting scientifically unsubstantiated treatment bordering on quackery. Doing so impugns the public’s trust in dentists and diminishes our stature as an evidence-based profession. EasyEasasyyo onlineononllinineer registrationgisstrationtratationn anda anndpd p programrogramgramammim information innfnformationorormationmaationtionon at...at...... www.pdconf.comwwwwwwww..pdconfpddconfcconfonnff..comcoomm Thank you for speaking up about this important issue. Dr. Lynn Tomkins 8T1 Save these dates foror March 7-9 Toronto, Ont. next yearyear’s’’ss conference!ce! 2013 Dr. Tomkins is a Past-President of the ODA.
6 Ontario Dentist • January | February 2012 OD_JanFeb12_FINAL:Layout 1 1/17/12 1:13 PM Page 7
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upfront
Brian N. Feldman Editorial DDS BA
Fearless Predictions
Being a futurist seems like an ideal job: you’re potentially right half the time, and when you’re wrong it’s easy to explain away the reasons without diminishing your reputation too much. Accordingly, I reserve the first message of every New Year for predictions about the future of our profession.
Prediction #1 Prediction #3 No White Will Be White Enough – Because we are sur- Canadians Will Become More Sensitive – Because we, rounded everywhere by images of healthy young people together with our teeth, are living longer, gums will con- with brilliantly white teeth, the subliminal message is this: tinue to recede and expose sensitive root surfaces — and “Cool” (or perhaps “hot”?) is unattainable without a cor- will reinforce the “long-in-the-tooth” perception in pa- responding level of dental whiteness. The demand for tients over 65. This group will demand immediate sensi- tooth whitening procedures will continue to increase — tivity relief and suitable anti-aging esthetic restorations. and extend beyond the dental office. I have already seen sa- lons in airports offering a one-hour combination package Prediction #4 of neck massage, reflexology and tooth whitening. More Conflict between Implants, Periodontal Sur- gery and Endodontics – Because of a major technical Prediction #2 advance, we may experience an unforeseen diagnostic and You Can Never Become Too Beautiful – Please refer to ethical dilemma. Dentistry and the public have embraced Prediction #1. Because the economy will remain sluggish the emergence of implants — and the corresponding re- and the job market weak, personal appearance may become treat of removable partial dentures. Unfortunately, in its an even stronger factor in career success, however unjust enthusiasm to recommend the latest and greatest, earlier that may seem. Besides more whitening, this weak job mar- treatment options are being set aside. This problem may ket may, indirectly, translate into an increased demand for worsen, as implant technology — both surgery and pros- porcelain veneers and adult orthodontic treatment. thetics — becomes more streamlined. Here’s an example:
8 Ontario Dentist • January | February 2012 OD_JanFeb12_FINAL:Layout 1 1/17/12 1:13 PM Page 9
Editorial
DENTAL CE CRUISES An absolute fabulous way to learn and see the world at the same time.” Dr. T Smith AB A patient presents with a deeply carious lower premolar, ac- companied by a few millimetres of alveolar bone loss. For- Mexican Riviera Caribbean get about cost, for a moment, and consider these two treatment options: Feb 18 - 25, 2012 Mar 3 - 10, 2012 • endodontics, crown lengthening, post-reinforcement Oral pathology Minimal Stress Dentistry
and full crown; OR • extraction, and replacement with an implant- Alaska Glaciers Mediterranean supported crown. May 19 - 26, 2012 Jun 30 - Jul 7, 2012 Fees may be comparable, so the decision now turns on Technology in Dentistry Esthetic Occlusions the total number of procedures, the long-term prognosis and the proven success rates. Were this your tooth, and knowing what you know, what treatment would you want? Baltic & Russia Jul 14 - 24, 2012 Tahiti & Polynesia Prediction #5 Oral pathology Oct 20 - 27, 2012 More cavities – Because Ontario’s increasingly diverse population brings with it a weaker understanding, in some Oral pathology cultures, about the importance of oral health and regular, non-emergency dental care, tooth decay may increase. Also, several large Ontario communities continue to deliver companion Canada’s leading provider non-fluoridated drinking water to their residents. The near of dental cruise courses elimination of dental caries has been predicted at least cruises FREE twice during my career. I don’t see this happening anytime [email protected] soon. 1-888-647-7327 www.seacourses.com
Prediction #6 Better Access to Dental Care – but not much better. Ten years ago, the American Dental Association (ADA) re- leased a 206-page report titled The Future of Dentistry. It re- flected the input of dozens of eminent authorities across a wide range of the dental profession. One key finding was the urgent need to eliminate barriers to access, particularly among low-income and institutionalized individuals. Sadly, despite some isolated success stories and the won- /,(3;/ 3(>@,9 derful efforts of a few dedicated groups and individuals, im- proved access to dental care will still remain on the profession’s “to do” list. 1HZTPUL 4HY` .OVZU ):J /VU 33)
Finally, I predict some of these predictions will likely ex- tend well beyond the next 12 months. Customized Workshops Practice Purchases & Sales Feel free to voice your comments and opinions as you wish. Policy & Contract Reviews Professional Incorporations I’m always happy to hear from our readers. Privacy Practice Reviews Associate Agreements Regulatory Compliance Employment Law Complaints & Discipline Legal Defence
Dr. Brian N. Feldman is the Editor of Ontario Dentist. A1971 graduate of the Faculty of Dentistry, University of Toronto, he teaches part-time in the Departments of Histology and Toronto 416-985-0362 [email protected] Halifax 902-429-8446 www.healthlawyer.ca Pathology. Dr. Feldman may be reached at 416-319-6585 or at [email protected].
January | February 2012 • Ontario Dentist 9 OD_JanFeb12_FINAL:Layout 1 1/17/12 1:13 PM Page 10
upfront
Harry Höediono President’s Page DDS BSc
Why Government Dental Programs are Failing Both Patients and Dentists
any of our members are often hear is, “What is the ODA doing What went wrong? Today’s pro- frustrated with current re- about the low fees that these pro- grams are cumbersome, with too imbursement rates of gov- grams pay?” Before I answer this ques- many qualifiers or conditions for pa- M tion, let’s review some facts. tients to meet, and too much paper ernment dental care programs. Next to the Zero Tolerance issue (prohibit- The ODA has been part of the de- work for providers to process. Most ing dentists from treating their velopment of government-funded programs are inefficiently and inef- spouses), this is one of the most im- dental programs from day one. fectively administered; in some cases portant issues for many of us. I hear Provincial dental programs arose from the cost of running them is upward of constantly from members that our efforts of the women’s auxiliary, 30 percent of the overall cost of pro- government programs are poorly de- which organized and then helped pa- viding the service. Chronic under- signed, wasteful and do not provide tients receive pro bono treatment funding also means that fewer adequate access for the Ontarians from dentists in the 1950s. In the be- dentists participate, with the result who need dental care. Many members ginning, the province adopted these that fewer patients receive the dental say there are too many programs or cost-contained dental care programs, care they need and deserve. Many that existing ones have become so which were developed by the profes- more patients do not even know what poorly funded, members pay out of sion specifically for social assistance dental program they may be qualified pocket to treat patients on such pro- recipients. Dr. Stephen Abrams, our to use. grams. Chair of the Dental Benefits Commit- The Ontario Works program and There was a time when government tee describes the past programs: the Ontario Disability Support Pro- programs covered the cost of treat- “Well-designed, funded and adminis- gram offer basic dental care — with ment. But as the price of providing tered dental programs ensured that some enhanced benefits for the dis- services increased, due to increases in the vast majority of dentists partici- abled with a medical condition that operational costs, the reimbursement pated in delivering oral health-care affects their oral health, or a dental rate slipped closer towards a loss for services to needy Ontarians. Wide- condition that affects their overall the dentist. Now, in many cases, we spread access to care, in a dignified medical health. Basic dental care is providers are not only subsidizing the manner, in every community across available only for children of Ontario cost of treatment, but often pay to de- Ontario, without stigmatizing social Works recipients. Some municipalities liver care. I am increasingly aware of assistance recipients, was the norm. offer emergency dental coverage for dentists who are accepting fewer and The ODA warranted to the provincial adult Ontario Works recipients, but fewer social-services patients, since government that its members would there is no standard program for they can no longer afford to deliver participate in these programs, and en- adults. This means that some munic- this treatment. This poses a dilemma sured that no one ever went to bed ipalities provide no dental benefits to for our members, as well as a social with dental pain. Sadly, this is no adults. Until 1998, all adults receiving and ethical problem. A question I longer the case in Ontario.” social assistance in Ontario at least
10 Ontario Dentist • January | February 2012 OD_JanFeb12_FINAL:Layout 1 1/17/12 1:13 PM Page 11
President’s Page
had access to an emergency-care den- ODA President Dr. Harry Höediono and the ODA’s Executive Director, Tom Magyarody, tal program. Recently our provincial discuss Fairness for All, Zero Tolerance and other issues concerning the dentists of Ontario government instituted the Healthy with Premier Dalton McGuinty and Health Minister Deb Matthews at a recent political event. Smiles Ontario program, which pro- vides free dental work, including cleanings and preventive treatment. This program is available for all chil- dren up to age 17 who are members of a household with an Adjusted Fam- ily Net Income of $20,000 per year or below, and who have no access to any other form of dental coverage. With this in mind, let me answer the question, “What is the ODA doing about the low fees that these programs pay?” ODA volunteers, with the help and experience of ODA Gov- ernment Relations staff, are con- stantly seeking to meet with key government contacts to provide posi- tive, cost-effective solutions to the many problems that exist with our current social assistance dental pro- grams. The ODA held a symposium in 2008 to showcase examples of var- From left to right: Dr. Harry Höediono; Premier Dalton McGuinty, his daughter Carleen, and ODA Executive Director Tom Magyarody. ious systems used internationally. It was part of the International Associa- tion for Dental Research Meeting and was entitled, “Designing Dental Pro- grams for High Risk Children.” The forum allowed oral health-care stake- holders and government to hear about better-designed dental pro- grams and better ways of diagnosing, collecting data, and providing care for social assistance recipients. ODA ex- Dr. Harry Höediono and pertise can create a well-balanced plan Health Minister Deb Matthews. to help government deliver efficient and cost-effective treatment for any special-needs group. Our association has often presented suggestions to government for ration- alizing the current programs. By har- monizing the various provincial dental programs, we can improve ac- countability, eliminate duplication of have recommended better screening ODA experts in program adminis- services, treat children and adults eq- tools for caries and periodontal dis- tration have suggested substantial uitably, redirect public health re- ease to allow the Ontario government cost savings associated with decen- sources to provide more oral-health to compare their program outcomes tralized administration of the pro- education on prevention, and ensure with government programs world- grams. An example is the Children in access to accurate costing of claims wide. You can’t improve a program if Need of Treatment Program (CINOT), adjudication, payment, and treat- you can’t quantify the cost of provid- ment for all the dental programs. We ing treatment on a per-patient basis. Continued page 12
January | February 2012 • Ontario Dentist 11 OD_JanFeb12_FINAL:Layout 1 1/17/12 1:13 PM Page 12
President’s Page
a $19-million per annum program ad- Bevilacqua, our Professional, Govern- treat one or two cases a month, then ministered by the province’s 36 ment, and Component Society Affairs together we will have treated many. Health Units. The Health Units each Director — a meeting of the Commis- When we act generously and provide have stand-alone computer systems, sion for the Review of Social Assis- leadership on such programs, we will an adjudication program, various em- tance in Ontario. Our goal was to help garner public support, and eventually ployees such as dental consultants, di- the Commission members with ideas we will gain the confidence of our rectors, clerks, co-ordinators, access to to improve all social-assistance dental government. Unfortunately, our pre- finance staff, etc., resulting in service programs. On December 12, 2011, and post-election government has provisions with high administration Tom Magyarody and I met with both been reticent to initiate legislative costs. The ODA has provided turnkey the Health Minister Deb Matthews changes or updating regulations that solutions for cutting out such admin- and the Premier of Ontario, the Hon- would benefit both patients and our istrative waste, including using ourable Dalton McGuinty. In a short members. Now with the current mi- Accerta to save millions in adminis- period of time we touched upon Zero nority government facing a looming tration costs. We build the case for ef- Tolerance, the OHIP preamble for deficit, it is unlikely that we will see ficient service provision based on our hospital supervision, and the low re- any increases to any government den- decades of experience in this sector. imbursement for government dental tal programs. By not organizing and The costs saved in administration can programs. failing to adequately fund these pro- now go towards improving access, in- Not a week goes by when we are grams, more and more dentists will creasing the reimbursement rates for not pressing our case with govern- no longer be able to participate. I government dental programs, etc. ment. I realize there is a growing dis- wonder how much longer patients In August of 2011,I heard directly content among our members, who who need our help the most will have from Health Canada representatives are being asked to subsidize and, in to wait for dental care that was once about the new Non-Insured Health many cases, pay for the provincial the promise of our profession — as Benefits (NIHB) reimbursement and municipal dental care programs. well as our government. changes, and engaged those members Many have considered limiting their in a frank discussion of how inade- services. Already so few of our col- quate the fees were. This same discus- leagues treat the majority of these sion took place at the CDA’s cases. I and your Board of Directors Dr. Höediono maintains a private prac- Presidents and CEOs’ meeting in Win- understand your frustration. We ex- tice with his wife, Dr. Helen de Man, in nipeg, on November 19. Most re- perience it in our own practices. I do, Kitchener, Ont. Both are graduates of the cently, I attended — with Dr. Abrams, however, ask every one of you to keep University of Toronto’s Class of 1990. Tom Magyarody, our CEO, and Frank treating these patients. If we each He may be contacted at [email protected]. 12-104 12 Ontario Dentist • January | February 2012 11/11 12-104 11/11 OD_JanFeb12_FINAL:Layout 1 1/17/12 1:14 PM Page 13 1:14 PM 1 1/17/12 OD_JanFeb12_FINAL:Layout OD_JanFeb12_FINAL:Layout 1 1/17/12 1:14 PM Page 14
upfront
Cover Article David Gentili
Accessibility for Ontarians with Disabilities Act, 2005: Complying with the Customer Service Standard
ast highlighted in the July/August 2011 issue of Ontario Dentist, the Customer Service Standard of the Accessibility The ODA’s Health Policy and Government Rela- for Ontarians with Disabilities Act, 2005 (AODA) came tions (HPGR) Core Committee has approved re- Linto force on January 1, 2012. sources to help dental offices comply with the Customer Service Standard including: Dental offices in Ontario must comply with the following:
The Customer Service Standard requires all organiza- • An Updated Sample Accessibility Policy tions with less than 20 employees to: for the Dental Office: customizable for your 1. Create a plan — establish policies, practices and proce- dental office, prepared in accordance with the dures governing the provision of its goods or services to Accessibility Directorate’s template. persons with disabilities. 2. Provide training — train staff, volunteers, contractors • Accessibility Checklist: step-by-step, what and any other people who are involved in the provision dental offices must do to be in compliance. of goods or services on your plan and accessible cus- tomer service. • Accessibility & Customer Service Pam- phlet: a quick, two-page review of the AODA The Customer Service Standard requires all organiza- and Customer Service Standard, what dental of- tions with more than 20 employees to: fices must do to be in compliance, and what we 3. Put it on paper — keep a written copy of your plan and let your customers know it is available, and keep a log know about future AODA requirements. of the training you’ve provided. 4. Report it — report to the Ontario Ministry of Commu- • Accessibility Webinar: a recording of the nity and Social Services that you’ve met the require- ODA-hosted, free-for-members, 45-minute Acces- ments. sibility Webinar that took place in early January. ——— All of the above and other AODA resources are available on our member website — www.oda.ca/member.
14 Ontario Dentist • January | February 2012 OD_JanFeb12_FINAL:Layout 1 1/17/12 1:14 PM Page 15
Cover Article
ACCESSIBILITY FOR ONTARIANS WITH DISABILITIES ACT, 2005
Basic Questions on the Act and Customer Service Standard
Q What is the Accessibility for Ontarians with Q When do the other Accessibility Standards Disabilities Act, 2005 (AODA)? come into force? A The AODA is a law passed by the Ontario legislature in A The Employment, Information and Communications, 2005 that aims to create a “fully accessible Ontario” by and Transportation Standards have been grouped to- the year 2025. The Act lays the framework for the de- gether as part of a new Integrated Accessibility Regula- velopment and enforcement of mandatory Accessibil- tion, requirements of which will be phased in between ity Standards. now and 2021. The Ministry of Community and Social Services is Q What are the Accessibility Standards? currently developing the Built Environment Standard. A The Accessibility Standards outline the specific rules that organizations in Ontario will have to follow. Col- Questions on Policies, Practices and Procedures lectively, they aim to identify, remove and prevent bar- riers to accessibility. The Accessibility Standards will Q What needs to be in my plan? apply to five areas: A The Customer Service Standard requires organizations • Customer Service — Effective January 1, 2012 to establish policies, practices and procedures govern- • Employment ing the provision of its goods and services to persons • Information and Communications with disabilities. The Ministry of Community and • Transportation Social Services indicates that your plan must: • Built Environment 1. Consider a person’s disability when communicating with them. Q Do I have to build ramps to make my dental 2. Allow assistive devices in the workplace. office moreaccessible? 3. Allow service animals and welcome support persons. A All that came into effect on January 1, 2012, was the 4. Notify customers when accessible services aren’t Customer Service Standard and related aspects of a available. new Integrated Accessibility Regulation. We do not 5. Invite customers to provide feedback. know enough about the Built Environment Standard to definitively answer what your office might be re- Q What does my policy have to say about quired to do down the road, but we can say that the assistive devices? Ministry of Community and Social Services has pub- A The Customer Service Standard does not specifically licly indicated that it will only apply to new construc- outline what your policy must say, only that you have tions and extensive renovations. to have policies that address the use of personal assis- tive devices and outline the availability of other assis- Q What is the Customer Service Standard and tive measures in the office. It is important to who does it apply to? demonstrate that your office is prepared to service peo- A The Customer Service Standard is the first Accessibility ple with disabilities that require an assistive device. Standard developed under the AODA. As of January 1, 2012, the Customer Service Standard applies to all Q What does my policy have to say about organizations (public, private and non-profit) that pro- support persons and service animals? vide goods or services either directly to the public or to A The Customer Service Standard requires that you let other organizations in Ontario and that have one or people with disabilities use their support persons and more employees in Ontario. service animals (unless otherwise excluded by the law) on parts of your premises that are open to the public or Q Who counts as an employee in my dental office? third parties. For more information on what consti- A The Ministry of Community and Social Services con- tutes a service animal or support person, refer to siders employees to be any seasonal, contract, full-time, A Sample Accessibility Policy for the Dental Office part-time persons paid for by your office. Employees are (Appendix “B”). not volunteers or independent contractors.
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Cover Article
Q Where can I find A Sample Accessibility Policy Q I have concerns that there are barriers beyond for the Dental Office? my control that will prevent a patient with a A In 2011, the ODA’s Health Policy and Government Re- disability from accessing my office. What lations Core Committee approved A Sample Accessi- should I tell them? bility Policy for the Dental Office. This document was A The Act requires that you use “reasonable efforts to en- published in the July/August 2011 issue of Ontario Den- sure that the policies, procedures and practices” are tist. An electronic and customizable version of the doc- consistent with specific principles: dignity, independ- ument can be obtained on the ODA members’ website. ence, integration, and equal opportunity. Unfortu- To learn more, visit: www.oda.ca/accessibility.html. nately, the Act does not specify what constitutes “reasonable efforts” on your part. Questions Regarding Training If there is a barrier beyond your control (for instance, if your dental office is located in a building that is not Q Who must be provided with training? wheelchair-accessible) it is important that you clearly A Training must be provided to every person in your of- communicate your concern to the patient and demon- fice who deals with members of the public or other strate that you are making an attempt to accommodate third parties on behalf of the office. the specific needs of the individual.
Q What should my training consist of? If there are accessibility measures that your dental of- A The Ministry of Community and Social Services indi- fice cannot feasibly implement without “undue hard- cates that your training must cover: ship” (also not defined by the Act), make a note of it 1. The purposes of the AODA and Customer Service and plan for future implementation. Standard requirements. 2. Instruction on how to interact and communicate Q What is the worst-case scenario if my dental with people with various types of disabilities. office is found to be non-compliant? 3. Instructions on how to interact with people with A The AODA gives the Ministry of Community and So- disabilities who use assistive devices or require the cial Services the power to conduct inspections, assign assistance of a guide dog, other service animal or a monetary penalties, and even prosecute organizations support person. that persist in not meeting their obligations. Under the 4. Instructions on how to use equipment or devices AODA, conviction of an offense could mean a fine of available at your premises or that you provide up to $50,000 per person per day, or of $100,000 per otherwise, that may help people with disabilities corporation per day. access your services. 5. Instruction on what to do if a person with a dis- ability is having difficulty accessing your services. David Gentili is the ODA’s Health Policy Specialist. If you have any questions, comments or concerns regarding the above Q When do I have to provide this training? resources or the AODA in general, please do not hesitate to A Training must have been provided to all current em- contact the ODA at 416-922-3900 or [email protected]. ployees, volunteers, contractors and others by January 1, 2012. For new additions to your office, as soon as is “practicable”.
Troubleshooting
Q Can I ask for proof that a patient needs a service animal? A You can ask, but the only common ‘proof’ is identifi- cation cards provided by the Ministry of the Attorney General for guide dogs. If it is not clear that an animal is a service animal, you may ask for a letter from a physician or nurse verifying that the animal is required for reasons relating to a disability.
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upfront
Harry Höediono Dentist-Patient Relationship DDS BSc
Money Matters: Why Talking to Your Patients Makes Sense
hen I look at the Presi- Too often patients view dentists as Given these perceptions, it’s not dent’s Pages I’ve written business people who make decisions surprising that many patients inter- so far for Ontario Dentist, based on financial concerns rather than pret a dentist’s diagnosis as more of a Wone theme comes to mind: the im- on a patient’s health-care needs. Some suggestion than a requirement, and portance of respect and trust. This is of the other research findings were: defer to their insurance plans or their true not only with colleagues or in • Very few patients know what a clin- own judgment when it comes to our personal lives, but in our prac- ical dental examination entails, or treatment. tices. The way we treat patients can that the dentist is a medical practi- In my own practice, when new pa- have lasting effects; when we show tioner and the only member of the tients come into the office, I make it a them we care about them as individ- dental team who can diagnoseand point to spend as much time listening uals, share information with them communicate the condition of the to their primary concern as is neces- and give them an opportunity to ask oral cavity. (Most patients believe sary. In many cases patients come to questions, we are creating an atmos- that the dentist performs a “check- our office with a specific problem, phere of trust that can result in a up” that focuses on teeth, gums or and to not address that problem healthy, long-term, dentist-patient re- is simply checking the work of the would leave them feeling as though lationship. dental hygienist.) they were not being respected. The payback for good communica- • Patients feel that dentists don’t On recall or re-care appointments, I tion is priceless. This is not just some- spend enough time with them, always have my dental hygienists in- thing I’ve learned from my own which would explain why patients form the patient that I will be coming experience. In the past year, much has often don’t understand the value of in to do an examination and then dis- been written on the dentist-patient re- preventive care or the importance cuss the diagnosis. They also inform lationship based on Ipsos Reid re- of the dentist’s recommended treat- patients that if they have any ques- search conducted for the CDA, the ment plan. We need to spend tions regarding their treatment plan, ODA and other provincial associa- more chair-side time with our pa- “the doctor will be happy to review it tions. That research was a wake-up tients. When we give away time with you and provide any treatment call, since it showed that patients’ per- spent with patients or procedures to options that will best suit your partic- ceptions of the value we dentists pro- other providers, we give away our ular dental situation.” vide differs markedly from our own. scope of practice.
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Dentist-Patient Relationship
When you spend time with patients discussing their oral In our office our new-patient chart, which patients fill in health and treatment options — the what, why, how long when they arrive, has a section asking whether they have and how much — they’ll be more likely to respect you as a dental insurance or if they are the person responsible for medical professional and accept your recommendations. the account. If it is insurance, we ask them to write down Research suggests that many patients are unaware of their the insurance name, group, and policy or certificate num- dentists’ goals and skeptical of their motivations, and have ber. At the end of their first appointment I always let pa- the perception that dentists base treatment recommenda- tients know (if I’m aware they are on a plan) that our tions on their own financial objectives, rather than the pa- patient co-ordinators are “always available to help them tient’s well-being. The result: patients are not always willing with their insurance forms or if they have any questions to pursue dentist-recommended plans, regardless of the im- regarding their plans.” This way patients will understand portance of those treatments. that asking about plans is part of our office service to help Your patients need to know that the procedures you rec- them and save them time. ommend will make them healthier — that you are their trusted advisor. Above all, ensure that you include choices or EXPLAIN - Present the health benefits of having treatments options in all your recommended treatment plans. Patients and dental exams. Only 29 percent of people surveyed want to know that it is they who make the final decision strongly agreed they would get regular check-ups if they about a treatment that will affect their dental and overall didn’t have a dental plan. It’s important that patients un- health care. derstand that these appointments can prevent small prob- The cost of dental care can, however, be daunting, so lems from becoming larger more complicated ones. Regular even when patients trust their dentists, they may hesitate visits to the dental office not only help maintain dental to follow dentists’ advice. Discussing fees is never easy, but health but can provide valuable clues about overall health. it’s important that you, the dentist — and not another staff Dentists check for oral cancer, often monitor blood pres- member — pursue the conversation. Here are some sug- sure and can detect throat infections by observing enlarged gestions I hope will help ease that discussion, and build on or swollen glands. A dentist does so much more than just the relationship of trust you have with your patients. teeth!
CONNECT - Take time at the beginning of a visit to ask DESCRIBE - Walk your patients through what you are about your patients’ general well-being and explain proce- doing. During an oral exam, for instance, after a cleaning, dures as you go along. If you have an intra-oral camera, the dental hygienist tells patients that, “The doctor will take photos before treatment and then after so that the pa- now do your examination and let you know his/her diag- tient can see what you are planning to do and what you nosis and about any treatment, if necessary.” Many pa- have done. A picture is certainly worth a thousand words. tients may not even be aware that the procedure is Many patients believe the hygienist cares more about them occurring unless you point it out. Use the words “exami- than the dentist, because the hygienist spends more time. nation,” and “diagnosis.” These words distinguish us as Exchange information; ask your patients if they have any doctors and also set us apart as the only person on the den- questions or concerns. No one wants to feel they’re being tal team who can communicate our findings through a di- rushed out the door or dismissed. Time spent with a pa- agnosis. tient is an investment in trust. I once spent nearly 40 minutes discussing a patient’s con- BE CLEAR - Discuss the diagnosis and recommended treat- cern over a failed root canal treatment. When he came back ment plan and elaborate on alternatives and their costs, if several weeks later to have his treatment needs addressed, several options exist. Don’t forget to explain why costs may he also booked his entire family for new patient examina- vary. Remember to keep the language simple; talking about tions! He later explained that he had never had someone the “superior belly of the lateral pterygoid“ won’t mean spend that much time answering all his questions and giv- anything to a non-dentist. ing him treatment options. He appreciated that I took the time to do this and in response gave our office the privilege BE OPEN - Talk about costs before you book a procedure. of treating his entire family. Trust is something you cannot No one likes surprises, and patients want to understand up- buy — it has to be earned one patient at a time. coming treatments and know the fees. If it’s difficult to pro- vide an exact cost, give high and low estimates, backed up DISCUSS - Talk about dental plans carefully. Canadians with details. Record these options in the chart. If the bill surveyed said that the question, “Do you have a dental comes in at the lower range, your patients will be pleased; plan?” implies that they will be treated differently if they if it’s in the higher range, at least they will have been fore- are covered, and suggests that dentists are driven by profit. warned. continued page 20
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Dentist-Patient Relationship
If a predetermination is required be- SHOW RESPECT - Recommend nec- CARE - Do not rush through the treat- fore you can commence a specific essary procedures, but practise a ment and fee discussion. Have it in a treatment plan, then send one, com- “watchful waiting” attitude, and private area and try to avoid sounding plete with all X-rays properly labelled avoid “pushing“ cosmetic procedures. defensive. You can be empathetic, but and any intra-oral photos that may Research shows us that when we it’s important to explain the health clarify, and include a clear diagnosis. I speak to patients about “cosmetic” benefit of the procedure. always send a note of thanks to the procedures their level of trust drops. Like all of us, our patients want dental consultant for taking the time value for their money from someone to review my treatment plan for my they trust. They need to understand patient. that the dentist treats them — not their health plan. Those who have confidence in you as their thorough and understanding oral-health doc-
Need more information? tor, will know that a visit to your of- Scan this QR code to watch a video of Dr. Harry Höediono fice is a critical part of maintaining discussing how to improve communication with your patients good health. and the various resources that the ODA offers. If you cannot scan this with your phone, please go to our member website at www.oda.ca/member to view the video.
NOTE: Some users may not be able to access this message with their smartphone. Scanning software and enabling operating system requirements may be needed. Dr. Harry Höediono is the President of the Ontario Dental Assocation. He may be contacted at [email protected].
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20 Ontario Dentist • January | February 2012 OD_JanFeb12_FINAL:Layout 1 1/17/12 1:14 PM Page 21
upfront
Joshua Fedder DDS Opinion
Fifty Years as a Dentist: Why I’d Do It Again
n the cusp of my 80th birth- mated, laughing dental students, all the years on new developments and day, I have reflected on my male, was gathered in front of the techniques. Ocareer in dentistry. Being a windows. Each student was holding As well as intellectual stimulation, dentist is not for everyone. True, a cer- up a sign listing his name and phone dentistry provided outstanding expe- tain amount of academic ability is re- number. In the office building across riences that few other professions quired, but, as my dear mother-in-law the street, a similar group of attrac- could have offered. I was able to lec- was fond of reminding me, dentistry tive, young, female secretaries was ture at dental meetings in lands as di- did not quite reach the social status holding up their names and phone verse as Zambia and Israel, and attend that medicine achieved. So, why did I numbers. Everyone appeared to be conferences in exotic locales such as become a dentist? having a great time as they tried to China, Turkey, Australia and New When I was 14, my neighbour, Leo make dates. From that moment on, I Zealand. I also worked as a ship’s den- Wolfson, a dental student, needed to decided that the profession of den- tist for Holland American Lines and as complete his clinical requirements. tistry was full of fun, and that I a fly-in dentist for the Department of He looked in my mouth and per- wanted to become a dentist. Indian Affairs. Cruising the seven seas suaded my mother that I had several My instincts were correct, no mat- and working in remote First Nation cavities that he would be happy to re- ter how frivolous the original villages in northern Ontario were pair. I believe now, after 50 years of thought. Five years later, I entered the unique adventures that I was privi- practising dentistry, that a quick vi- same building as a freshman dental leged to be part of. sual exam by a dental student is not, student, and five years after that I On my 75th birthday, my son wrote of itself, an accurate diagnosis. graduated. Dentistry proved to be the me a moving letter. In it, he elo- The dreaded day finally came, and ideal profession for me. I felt privi- quently stated that he had decided to Leo and I walked to the dental school leged to be able to relieve pain and become a dentist because he had seen for my appointment. At that time, the suffering in some patients and to be the great satisfaction and fulfillment school was in an old building on Col- creative in rebuilding damaged denti- I had received from my working life. I lege St. We proceeded up the central tion in others. I loved working with would be immensely proud if any one staircase to the top floor where the my hands and mind, helping to of my grandchildren became a third- out-patient clinic was located. It was a achieve a better lifetime health out- generation dentist. There is no doubt large, open space with ancient up- come for my patients by keeping an in my mind that, for me, dentistry right dental chairs in separate cubi- essential part of their body in good was a very good choice. cles. Hanging over each chair was an working order. Many of my patients old low-speed electric motor and a stayed with me for decades. This I large, round incandescent dental consider a supreme compliment. On Dr. Fedder is currently enjoying his light. The entire west wall was com- my part, I worked very hard to earn retirement and visiting his children and posed of windows. A group of ani- their trust by keeping up-to-date over grandchildren in B.C.
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Current medical information of interest to the dental profession. clinical
Irv Feferman MD Healthline
Deadly Competition
Deaths in Super Athletes and may result in brady or tachy-type lion additional cases each year. In 11 At the 2011 Toronto Waterfront arrhythmias. Should a swimmer have African countries the national preva- Marathon, a 27-year-old apparently difficulty in the water, it is important lence ranges from 60 to greater than 85 healthy male collapsed near the end that a rescue boat quickly reach and percent. Infection, sepsis and extreme of the half-marathon and died. Sud- resuscitate a collapsed victim. pain are common. Long-term compli- den, often unpredictable, unex- Aside from prompt medical care cations include sexual dysfunction, in- plained deaths are not a rare and adequate surveillance of athletes, fertility, prolonged labour, chronic pain occurrence at marathons and particularly during the swim, little and psychological problems. triathlons. can be done to prevent these deaths. In 1994, the International Federa- Triathlons are especially physically Universal screening of all athletes is tion of Obstetrics and Gynecology demanding, combining swimming, impossible. Individuals participate at deemed FGC/M unethical and a vio- cycling and running. In a letter to the their own risk, and young athletes lation of human rights. The WHO editor of the Journal of the American without medical problems have no and UNICEF are among many inter- Medical Association the authors re- way of preventing these unfortunate national organizations that oppose viewed the records of participants but thankfully rare occurrences. the practice, and the Canadian Crim- who completed 2,971 triathlons (USA JAMA 303( 13); April 7, 2010 inal Code categorizes the procedure as Triathlon-sanctioned events) from aggravated assault. The policy of the 2006 to 2008. In total there were Outlawing Female Genital CPSO was presented to Ontario physi- 959,214 participants, 59 percent Mutilation cians in anticipation of requests from male. There were 14 deaths, 13 in I was surprised to get a notice recently religious/traditional families who the swimming leg of the event. Six from the College of Physicians and have immigrated to Canada. It further deaths occurred in the short swim Surgeons of Ontario (CPSO) advising warns that should physicians perform (less than 750 m), four in the inter- that ”physicians must not perform a FGC/M on a child, criminal as well mediate (750-1500 m) and two in the any female genital cutting/mutila- as disciplinary action may result. A long (more than 1,500 m/Ironman) tions (FGC/M) procedures.” I found it physician must decline, and if the swim. The sole bicycle death was the hard to believe any physician would physician is aware of anyone per- result of a fall and cervical injuries. Al- contemplate, let alone perform such forming the ritual he or she must re- though drowning was cited as the a procedure. However, the practice is port it to the appropriate children’s cause of death in the swimmers, seven common in many parts of the world, protection agency as well as report the of the nine who had an autopsy were and the arrival of a large immigrant offending physician. While physi- found to have an underlying cardiac population from many of these coun- cians are asked to be respectful of dif- abnormality. By comparison, data on tries suggests the procedure is being ferent cultural and religious practices, three million marathon runners over practised in Canada. the responsibility remains to obey the a 30-year period showed the mortal- FGC/M is a ritual or tradition in law and focus on the health and wel- ity rate was 0.8/100,000 compared which parts of or the entire external fe- fare of the patient. with the rate in triathlons of male genitalia are removed, usually on CPSO Policy Statement #2-111 1.5/100,000. girls aged four to eight. It is most com- Dialogue, Issue 3, 2011 The swim is the most taxing part of monly practised in Indonesia, sub-Sa- the triathlon. Swimmers begin the haran Africa, Sudan and Egypt. It is Dr. Irv Feferman is a member of the race in a crowded, chaotic area. The estimated that 100 to 140 million Ontario Dentist Editorial Board, and athletes immerse themselves in cold women have undergone the procedure, may be reached at [email protected] water which can be arrhythmogenic a total that is increasing by three mil- or at 416-931-8678.
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Brief summaries of current topics clinical relevant to everyday dental practice.
Ingrid Sevels Clinical Abstracts DDS BA
Oriental Cures
Traditional Chinese Medicine for Stomatitis-healing compound was Paresthesia Oral Diseases used in cases of RAS, with the follow- Paresthesia may arise from endodon- The purpose of this study was to eval- ing results: tic procedures or following local anes- uate five traditional Chinese medi- • Up to 60 percent of patients were thesia injections of the inferior cines (TCM) used to treat common healed. alveolar nerve (IAN) or the mandibu- oral diseases such as recurrent aph- • Between 17 and 63 percent im- lar nerve (MN). thous stomatitis (RAS), oral proved markedly, between 12 and Endodontic-related causes of pares- lichen planus (OLP), leukoplakia, 45 percent improved moderately thesia include periapical infec- and Sjogren’s syndrome (SS). The and three to 12 percent showed no tions, overfilling and apical clinical reports evaluated met the response. surgery. When paresthesia results standard criteria issued by the Society from periapical lesions, the cause may of Oral Mucosal Disease of the Composite Taixian tablet was used be mechanical pressure and ischemia Chinese Stomatological Association. in cases of OLP, with the following re- related to inflammation or local pres- The five herbal medicines were Liuwei sults: sure on the mandibular nerve (MN) or Dihuang, Tripterygium glycosides, • Blood viscosity and microcircula- inferior alveolar nerve (IAN). Stomatitis-healing granule, Composite tion showed marked improvement Taixan tablet and Zengshenping. in 23 to 37 percent; the remaining Overfilling cases showed only moderate im- • The IAN can be directly damaged Liuwei Dihuang was used in cases of provement to no response. during root canal preparation be- RAS, SS and OLP with the following cause of over instrumentation. results: Zengshenping was used for treating Sodium hypochlorite injected past • Patients with RAS and SS showed OLP and leukoplakia, and the results the apical foramen can cause tissue complete remission in 13 to 70 per- showed: necrosis and paresthesia of the MN cent of cases • This compound decreased cell pro- and IAN. In addition, root canal fill- • There was no response in three to liferation with 79 to 90 percent pos- ing materials such as gutta percha 20 percent of patients. itive responses in patients with OLP. or sealers can cause paresthesia if • Liuwei Dihuang combined with • Leukoplakia lesion size was reduced they extrude from the apical fora- retinoic acid cream was more effec- in 68 percent of cases. men and contact nerve structures. tive on OLP sufferers than retinoic • Eugenol-based sealers can cause acid cream alone. Contemporary Western medicine re- toxicity by inhibiting interdental lies on an evidence-based system, nerve activity. Tripterygiumglycosides were used whereas TCM has an experience- • Thermal nerve injury can result in cases of RAS, OLP and SS, with the based system. To bridge this gap ran- when a thermoplastic technique is following results: domized controlled clinical trials are used and the temperature of the • Fifty percent of patients with OLP essential to verify efficacy of these gutta percha is too high. showed marked improvements, but herbal remedies. If successful, we will 50 percent showed no improvement. have expanded our armamentarium Local anesthesia injections can • Plaque-like lesions and erosive le- significantly. cause edema and pressure if there is sions were less responsive. Oral Disease 17:7-12, 2011 contamination by alcohol or steriliz- • Patients with SS showed increased ing solution, thereby producing pares- salivary and tear flow after taking thesia. If the nerve sheath is injured this compound. during injection, the patient often re- ports an electric shock-like sensation.
26 Ontario Dentist • January | February 2012 OD_JanFeb12_FINAL:Layout 1 1/17/12 1:14 PM Page 27
Clinical Abstracts PROTECT
Paresthesia treatment consists of mechanical and phar- Your Family’s Lifestyle macological methods, including combinations of the fol- Sample $1,000,000 Term Life Insurance Guaranteed lowing: annual premium for non-smoker male* • Antibiotics, corticosteroids, anti-inflammatory drugs, proteolytic enzymes to disintegrate the coagulum, ozone AGE 10 YEAR 20 YEAR TO AGE therapy and vitamins C and E. 100 • Laser therapy, magnetotherapy and the application of 30 330 560 2,985 electrical fields. 40 452 776 5,115 • IAN and MN microsurgery has produced improvement 50 1,071 2,280 10,670 in a maximum of 92 percent of patients. Patients should be advised to be alert for signs of sensory 60 3,440 7,420 19,102 disturbance so that prompt evaluation and treatment can 65 6,110 13,230 24,816 be undertaken. *All policies are medically underwritten. Final premiums and coverage J Can Dent Assoc 76: 117, 2010 availability varies depending upon age, gender, smoking history, hazardous activities, and medical history.
Epstein Insurance Women’s Sleep Stealers, Decade by Decade 220 Duncan Mill Road, Ste. 404 · Toronto, ON · M3B 3J5 Health concerns that interfere with sleep can roughly be E-mail: [email protected] divided into problems by the decade. In their 20s and 30s, five to 10 percent of new mothers ExecutiveLifestyleProtection.com develop post-partum thyroiditis that may cause in- Quotes at TermToronto.com somnia. If thyroiditis progresses to hypothyroidism, CALL TOLL FREE: 1.800.896.9522 · 416.391.4004 mothers can feel extremely fatigued after childbirth. Both depression and anti-depressant medication can alter sleep habits and cause insomnia. In their 40s, women have lower estrogen levels that can cause urinary tract infections and frequent nighttime bathroom visits. In their late 40s, deep restorative sleep DENTAL CABINETS (slow-wave sleep) declines, causing daytime fatigue. Doing 30 minutes of aerobic exercise everyday can increase the time spent in slow wave sleep. For women in their 50s, high blood pressure and cholesterol drugs can disrupt sleep. Diuretics for hyper- tension can cause frequent nighttime urination. Statins to control cholesterol can deplete muscles of coenzyme Q10, resulting in muscle aches. For women in their 60s and up, snoring caused by obstructive sleep apnea (OSA) may diminish sleep qual- ity. Diabetes, hypertension and stroke are elevated with OSA. Post-menopausal women are more likely to develop OSA because lower progesterone levels allow the upper air- High quality commercial grade cabinets way to close. Being overweight contributes to the problem, Latest Technology DENTAL CABINETS and losing weight can help cure sleep apnea. Versatile designs for functions & aesthetics Award winning operatory cabinets Health.com, October 29, 2010 SUPERB QUALITY Designed for rear, side or over the patient YEARS OF Delivery systems EXPERIENCE Sterilization, Laboratory, Reception & Offices Dr. Ingrid Sevels is a member of the Ontario Dentist Editorial Cost effective Board and a 1971 graduate of the Faculty of Dentistry, 73 Doncaster Ave University of Toronto. She received a BA in English and Thornhill ON L3T 1L6 Professional and Creative Writing in 2002. Dr. Sevels current- ly maintains a part-time clinical practice in Oakville, Ont. (905) 709-2722 • (905) 709-2573 (fax) She may be reached at [email protected] or by www.logart.ca /dental MANUFACTURERS OF QUALITY www.oakvilledentalcare.com. DENTAL CABINETS [email protected]
January | February 2012 • Ontario Dentist 27 OD_JanFeb12_FINAL:Layout 1 1/17/12 1:14 PM Page 28
clinical
Case Report John Connelly Erin Sisson Christine Tanyan BA (Hon) DDS BSc (Hon) DMD BSc DMD
After 70 Years – Compensation from World War II
Introduction In February 1941, Mr. H. was a seven-year-old boy living with his Dutch family on the island of Sumatra (now Indonesia), when the hostilities of the Second World War engulfed his family and shattered his peaceful childhood. The invading Japanese military forces occupied the island and imprisoned young Mr. H. in the Tjikudapateuh concentration camp, separating him from his parents and family. The young boy would become known as the Cricket (Jangkrik in Malay) because he was skinny, fearless, fast and resourceful. These qualities would help Mr. H to survive four-and-a-half years of imprisonment until his release in August 1945.
CASE REPORT
History During his internment Mr. H. suffered from severe malnutrition during the crucial years of his dental develop- ment and as a consequence he would never enjoy the benefits of good den- tal health. Throughout his adult life, Mr. H. pressed for compensation to re- store his dentition. Finally in 2010, a settlement was negotiated between the Netherlands and Japan that enabled Mr. H. to reconstruct his den- tition with implant-supported over- dentures.
Figure 1 Initial presentation.
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Case Report
Figure 2 Radiographic guides used for the CT scan.
Initial Presentation and Treatment The existing condition consisted of partial upper (PUD) and partial lower (PLD) dentures. There were five maxillary and four mandibular teeth remaining, all of which had a poor short-term prognosis (Figure 1). Treatment began with maxillary and mandibular clear- ance, followed by relining the existing PUDand PLDfor use as transitional dentures. Maxillary and mandibular radiographic guides were made in preparation for the CT scan (Figure 2). Nobel Guide computer software was used to virtually place and parallel the implants on the CT scan image and surgical guides were constructed (Figures 3, 4 & 5).
Figures 3, 4 & 5 CT scan images and surgical guide.
continued page 30
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Case Report
Figure 6 Eight implants and healing abutments in position.
Utilizing guided surgery four maxillary and four mandibular implants were inserted and healing abutments placed (Figure 6). Due to the thin buccal bone in the region of teeth 13 and 23, an allograft of Puros demineralized freeze-dried bone with a Cytoplast membrane was placed. Four months later, locator attachments were placed and at- tached to the new CUDand CLDwith a pick-up reline im- pression (Figures 7 & 8). Immediately following the completion of the treatment, Mr. H. returned home and later reported how much he enjoyed a meal of corn on the cob! (Figures 9, 10 & 11)
Conclusion Much of what Mr. H. witnessed and endured during his in- ternment in the concentration camp would stay with him throughout his life. In adulthood, Mr. H. reached a level of strength, maturity, insight and awareness to live with the past. In 1987, he had the courage to confront that past and paid a return visit to the concentration camp. Mr. H. be- came a successful engineer, is now semi-retired and lives with his wife in Ottawa.
Dr. Connelly is a 1984 graduate of the Schulich School of Medicine and Dentistry, University of Western Ontario. He maintains a general practice in Ottawa, and may be reached at [email protected] or at 613-728-1874.
Dr. Sisson obtained her dental degree in 1995 from the Faculty of Dentistry, University of Manitoba. She currently maintains a Figures 7 & 8 general practice in Ottawa, and may be reached at carling- Locator attachments ready for pick-up impressions. [email protected] or at 613-728-1874.
Dr. Tanyan graduated with a Doctor of Dental Medicine degree from Laval University in 1993. She currently maintains a gen- eral practice in Ottawa, and may be reached at [email protected] or at 613-728-1874.
30 Ontario Dentist • January | February 2012 OD_JanFeb12_FINAL:Layout 1 1/17/12 1:14 PM Page 31
Case Report
Figures 9, 10 & 11 Implant-supported dentures completed and final clinical appearance.
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January | February 2012 • Ontario Dentist 31 OD_JanFeb12_FINAL:Layout 1 1/17/12 1:14 PM Page 32
clinical
Brian N. Feldman Clinical Feature DDS BA
Human Papillomavirus and Oral Cancer: Is There a Link?
ach year, over half of patients worldwide who are diagnosed with head and neck cancer will Edie from the disease. Smoking and al- cohol use are the two major causative factors in roughly 80 percent of oral, Deborah Saunders oropharyngeal and laryngeal cancers, BSc DMD nearly 90 percent of which are squa- mous cell carcinomas. However the long-standing (20 years) suggestion that the human papillomavirus (HPV) Introduction may play a role in these cancers has As Chair of the Oral Health Strategy (OHS) Advisory Panel of the ODA, recently been reviewed, in the face of I’m pleased to introduce the last installment of the Oral Health Strat- findings from several new studies. egy Forum for 2011. That HPV causes cervical cancer is generally widely accepted. HPV has The OHS was created in 2003 to bridge medicine and dentistry, with the also shown to be associated with goal of bringing members important information on pertinent clinical is- squamous cell carcinomas at other sues we see in our offices. Topics are selected based on relevance and time- sites — skin, esophagus and paranasal sinuses among others — but its role liness to the profession. In 2011, the focus of the OHS was oral cancer. here is much less clear. What is inter- The OHS Forum appears in three issues per year of OntarioDentist, and esting are the findings of new data will feature a reprint or abstract of an original article on the current topic. from case-controlled studies that sug- gest HPV may now be considered In this issue, Ontario Dentist Editor Dr. Brian N. Feldman examines the in- an independent risk factor for creased incidence of the human papillomavirus in oral cancer. oral and oropharyngeal cancers. Our OHS topic for 2012 is Clinical Tobacco Intervention. We are pleased Among the highlights: • A systematic review of 60 separate to announce that we have teamed with CAMH ( Center for Addiction and studies revealed an overall preva- Mental Health) to provide a very comprehensive program for you and your lence of HPV infection in 26 per- dental team, in which we will provide assistance to our patients whose cent of specimens obtained from 5046 patients. resolution for 2012 is to conquer their addiction to tobacco products. • This prevalence of HPV infection If you have comments, please contact me at [email protected]. was found to be significantly higher We are always interested in our colleagues’ input and assessment of our (35 percent) in patients with oropharyngeal squamous cell carci- work with OHS. noma than among those with ei- ther oral (23 percent) or laryngeal (24 percent) carcinomas.
32 Ontario Dentist • January | February 2012 OD_JanFeb12_FINAL:Layout 1 1/17/12 1:14 PM Page 33
Clinical Feature
• A study by D’Souza et al compared 2. Where does latent HPV reside Clinicians are reminded of our every- 100 patients with oropharyngeal in the head and neck region? day responsibility to detect and diag- cancer with 200 controls and the re- A number of possible sites have nose all suspicious lesions in the oral, sults showed HPV Type 16 was dis- been proposed, including the oral facial and pharyngeal regions. Al- covered in 72 percent of 60 mucosa, the tonsils and the anterior though the incidence of oral cancer is oropharyngeal cancers sampled. or posterior region of the tongue, or low compared with lung, colon, • Additional studies have supported both. However, exactly where in prostate and breast malignancies, the these findings: Mork et al noted a the oropharynx HPV resides is un- prognosis remains deadly. 14-fold increase in oropharyngeal known at present. cancer risk in patients testing seropositive for HPV-16 protein, 3. With an association between HPV and proposed that exposure to HPV infection and oropharyngeal can- This article is abstracted from an edito- can precede the appearance of cer now more firmly established, is rial by Dr. Stina Syrjanen in the New oropharyngeal malignancy by at there need for a screening test England Journal of Medicine 356;19 least 10 years. for persistent HPV infection in May 10, 2007. high-risk groups (smokers and Among several key questions that re- drinkers)? Additional references may be found in main unresolved are the following: the same issue of the NEJM. 1. Is HPV transmitted through 4. Should we consider the possibility sexual contact? that HPV vaccination, in addi- The D’Souza study suggested that tion to established benefits in sexual activity and behaviour is as- reducing the risk of cervical sociated with a slightly increased cancer, may also help prevent incidence of oropharyngeal cancer. oral, oropharyngeal and laryngeal Another study by Syrjanen indi- cancers? cated the presence of persistent HPV infection in one spouse yields a 10-fold increase in risk that the other partner will acquire HPV in- fection.
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Clinical Submissions for Case Reports
Introduction Directions Data from the 2010 Ontario Dentist (1) Select an interesting or unusual completed case from your patient files. Readership Survey clearly show ODA Choose one involving a unique presentation, a challenging diagnosis, a dif- members want more clinical articles ficult operative procedure or a particularly satisfying result. Focus on a case in each issue of Ontario Dentist. Case containing information or findings from which you believe the profession Reports in particular are very popular. would benefit. In order to continue to fulfil this (2) Complete the Case Report Template, using the headings as a guide. Feel need, we are asking for your help. The free to add additional relevant facts. template attached to this message will make it very easy for you to prepare (3) Include pictures and/or radiographs to illustrate the key elements of the and submit a Case Report for publica- case. tion in the journal. (4) Be sure your name and contact information are on the template form. (5) Submit the Case Report either as a Word document by email, or as hard The Case Report Template is also copy by fax. Submit the images as separate files – not embedded in the Word available in the Ontario Dentist document. section of the member website. Log on at www.oda.ca/member. (6) You will receive an edited version of the Case Report, prior to publication, for your review and comments.
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May 10 – 12 | 2012
Ontario Dental Association Annual Spring Meeting Metro Toronto Convention Centre South Building