Tobacco Dentistry's Role in a Shifting Landscape

2017 • Volume 4 • Issue 4

Early Childhood Caries Family & Sexual Violence Dens Evaginatus Greater Focus on Prevention Resources for Professionals Simple Clinical Treatment P. 9 P. 17-20 P. 3 2

Pages 22–28

PM40064661 2015-05-jcda-english.indd 1 5/11/2015 8:50:34 PM 2017 • Volume 4 • Issue 4 Director, Knowledge Networks Dr. John P. O’Keefe CDA MISSION STATEMENT Managing Editor The Canadian Dental Association (CDA) is the national voice for dentistry Sean McNamara dedicated to the promotion of optimal oral health, an essential component of Manager, CDA Oasis Chiraz Guessaier, PhD general health, and to the advancement and leadership of a unified profession. Clinical Editor, CDA Oasis is the official print publication of CDA, providing dialogue Dr. Suham Alexander between the national association and the dental community. It is dedicated to Writer/Editor Tricia Abe keeping dentists informed about news, issues and clinically relevant information. Geneviève C. Gagnon Coordinator, Publications CDA BOARD OF DIRECTORS Rachel Galipeau Coordinator, Electronic Media Ray Heath Dr. Heather Carr President Graphic Designer Dr. Larry Levin Nova Scotia Janet Cadeau-Simpson

President-Elect Dr. Tobin Doty CDA Essentials Contact: Dr. Mitch Taillon Alberta Rachel Galipeau [email protected] Vice-President Dr. Richard Holden Call CDA for information and assistance Prince Edward Island Dr. Alexander Mutchmor toll-free (Canada) at: 1-800-267-6354 Outside Canada: 613-523-1770 Dr. Joel Antel Dr. Lynn Tomkins CDA Fax: 613-523-7736 Manitoba Ontario CDA email: [email protected]

Dr. James Armstrong Dr. Daniel Violette Advertising: British Columbia New Brunswick All matters pertaining to advertising should be directed to: Dr. Roger Armstrong To be announced Keith Communications Inc. NWT/Nunavut/Yukon Saskatchewan 1464 Cornwall Rd, Unit 8, 2nd Floor Oakville, ON L6J 7W5 • Tel.: 905-849-7777 Dr. Linda Blakey Newfoundland/Labrador • Toll-free: 1-800-661-5004 Display or web advertising: Editorial Disclaimer Peter Greenhough, ext. 18 [email protected] All statements of opinion and supposed fact are published on the authority of the author who submits them and do not necessarily express the views of the Canadian Dental Association (CDA). Publication of Classified advertising: an advertisement does not necessarily imply that CDA agrees with or supports the claims therein. The director reserves the right to edit all copy submitted to CDA Essentials. Furthermore, CDA is not responsible John Reid, ext. 23 for typographical errors, grammatical errors, misspelled words or syntax that is unclear, or for errors in [email protected] translations. Sponsored content is produced by Keith Communications Inc. in consultation with its clients. The CDA Essentials editorial department is not involved in its creation. CDA Essentials is published by the Canadian Dental Association in both official languages. cda-adc.ca Publications Mail Agreement No. 40064661. Return undeliverable Canadian addresses to: Canadian Dental Association at 1815 Alta Vista Drive, Ottawa, ON K1G 3Y6. Postage paid at Ottawa, ON. jcdaoasis.ca Notice of change of address should be sent to CDA: [email protected] CanadianDentalAssociation @CdnDentalAssoc ISSN 2292-7360 (Print) Oasis Discussions @JCDATweets ISSN 2292-7379 (Online) @jcdaoasis CDAADC © Canadian Dental Association 2017 @CDAOasisLive

Issue 4 | 2017 | 3 B:8.5” T:8.25” S:7.25”

HELP PATIENTS WITH GINGIVITIS BEFORE THEY CAN BECOME PATIENTS WITH PERIODONTITIS

RECOMMEND ONE SIMPLE STEP B:11.125” T:10.875” S:10”

Note: Periodontal probe millimeter markings 3-6-9-12.

Colgate Total* goes beyond cavity protection to help prevent and reverse gingivitis by: • Delivering 12-hour antibacterial action with its advanced triclosan and copolymer technology†1-3 • Providing an 83% greater reduction of plaque bacteria‡3 • Reducing gingival bleeding by 48%§4 Recommend Colgate Total* as an important step in the fight against gingivitis.

†The triclosan-copolymer complex provides antibacterial activity for 12 hours against germs that cause plaque and gingivitis. ‡vs non-antibacterial fluoride toothpaste 12 hours after brushing. §vs non-antibacterial fluoride toothpaste in 15 clinical studies from 6 to 7 months in duration. References: 1. Xu T, Deshmukh M, Barnes VM, et al. Compend Contin Educ Dent. 2004;25(Suppl 1):46-53. 2. Kraivaphan P, Amornchat C, Triratana T. J Clin Dent. 2013;24:20-24. 3. Fine DH, Sreenivasan PK, McKiernan M, et al. J Clin Periodontal. 2012;39:1056-1064. 4. Riley P, Lamont T. Cochrane Database Syst. Rev. 2013 Dec 5; 12:CD010514. doi: 10.1002/14651858.CD010514.pub2. B:8.5” T:8.25” S:7.25”

HELP PATIENTS WITH CONTENTS GINGIVITIS BEFORE THEY CAN BECOME Dentists in Saskatoon Step Up PATIENTS WITH for Syrian Refugees PERIODONTITIS Page 14

Can Dentists RECOMMEND ONE SIMPLE STEP Help Their Patients Quit Smoking? Page 27 B:11.125” T:10.875” S:10”

Note: Periodontal probe millimeter markings 3-6-9-12.

Colgate Total* goes beyond cavity protection to help prevent and reverse gingivitis by: CDA at Work News and Events • Delivering 12-hour antibacterial action with its advanced triclosan and copolymer technology†1-3 9 Our Children, Our Future: 14 Giving Back: Dentists in Saskatoon Step Up Focus on Prevention for Syrian Refugees • Providing an 83% greater reduction of plaque bacteria‡3 • Reducing gingival bleeding by 48%§4 11 The Canadian Oral Health Roundtable: 17 Family Violence Resources for Health Care A Community of Support Professionals Recommend Colgate Total* as an important step in the fight against gingivitis. 12 Attention Dial-up Users! Act Now Before Modem Retirement Issues and People Deadline 18 Victims of Sexual Violence: Providing Compassionate Care

22 Tobacco: A Shifting Landscape

Can Dentists Help Their Patients †The triclosan-copolymer complex provides antibacterial activity for 12 hours against germs that cause plaque and gingivitis. 27 ‡vs non-antibacterial fluoride toothpaste 12 hours after brushing. Quit Smoking? §vs non-antibacterial fluoride toothpaste in 15 clinical studies from 6 to 7 months in duration. References: 1. Xu T, Deshmukh M, Barnes VM, et al. Compend Contin Educ Dent. 2004;25(Suppl 1):46-53. 2. Kraivaphan P, Amornchat C, Triratana T. J Clin Dent. 2013;24:20-24. 3. Fine DH, Sreenivasan PK, McKiernan M, et al. J Clin Periodontal. 2012;39:1056-1064. 4. Riley P, Lamont T. Cochrane Database Syst. Rev. 2013 Dec 5; 12:CD010514. doi: 10.1002/14651858.CD010514.pub2. Issue 4 | 2017 | 5 A CLEANER, HEALTHIER MOUTH IS JUST A SWISH AWAY

THE CANADIAN DENTAL ASSOCIATION VALIDATES Adding LISTERINE® Antiseptic Mouthwash to a regular oral hygiene routine reduces and prevents gingivitis better than brushing and ﬂ ossing alone.

Fights plaque, gingivitis, cavities and tartar. Always read and follow the label. © Johnson & Johnson Inc. 2017 CONTENTS Case Presentation: White Lesions Dens Evaginatus: in an Elderly Patient Page 35 A Simple Preventive Clinical Treatment Page 32

Travel Health Insurance: What to Look for When Comparing Plans Page 38

Supporting Your Classifieds

Practice 40 Offices and Practices, Positions Available, Miscellaneous, Advertisers’ Index 29 Treating Early Childhood Caries Under General Anesthesia: A National Review of Canadian Data Obituaries 32 Dens Evaginatus:A Simple Preventive Clinical Treatment 46 Remembering Dentistry Leaders: Dr. William Hollingshead 35 White Lesions in an Elderly Patient with a Complex Medical History

38 Have a Safe Trip: Why Travel Health Insurance is Advisable and What to Look for When Comparing Plans

Issue 4 | 2017 | 7 Nothing feels better than watching your patient leave your dental office with a big, bright smile.

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07811_Esthetics_ad_CDA_EN_FINAL.indd 1 2017-06-05 1:01 PM CDA at Work From the President Our Children, Our Future Focus on prevention

recent JCDA.ca study (p. 29) shows get us so far. We must use all available means that early childhood caries (ECC) is far to help stem the tide of increasing ECC. Public too common in Canada, especially health programs have a significant role to play in certain populations. The study in prevention. Not only must we continue to found that the overall rate of dental advocate for community water fluoridation Asurgery to treat caries under general anesthesia (CWF), we also must promote establishing dental for children between ages 1–4 (the most homes, and community and school-based common day surgery in clinical prevention and Canada for this age group) oral health promotion was 12.1 per 1000 children. through population The most vulnerable engagement. We must populations experienced also support reduced much higher rates of sugar consumption and dental surgery—as high as help establish healthy 221.4 per 1000 children in food environments; a northern Saskatchewan engage the wider health region. The kids Treatment alone is not the answer. community, including who were at greatest risk dental hygienists, lived in neighborhoods with a high proportion dental assistants, physicians, nurses, teachers, of Indigenous people (7.8 times greater than and others; and support initiatives aimed at children living in areas with a low proportion); improving social and living conditions for in rural regions (3.2 times higher compared to vulnerable groups. urban ones); and in least-affluent regions (3.7 times higher compared to most-affluent ones). We can be proud that the profession is working to make positive changes. At CDA, this includes It’s a stark reminder that we must get serious the First Visit, First Tooth campaign to raise about prevention. “There is an obvious need for awareness about a child’s first visit to the dentist better targeted prevention measures to improve before they reach 12 months of age, and our the oral health of vulnerable preschoolers in strong support for CWF. CDA is also working with Canada,” say the study authors. partners outside of dentistry to reduce sugar consumption (p. 11) as part of a coalition that I couldn’t agree more. Treatment doesn’t advocates for restricted marketing of unhealthy address the underlying problems that foods to kids and as a partner on a Health contribute to high levels of ECC and it Canada campaign to reduce consumption of doesn’t stop kids from developing new sugary drinks. These initiatives are just a few of caries during childhood and as adults. many that are required to produce meaningful To change this unfortunate predictable change in children’s oral health. pattern, the focus must be on better prevention. What we are doing now—while commendable—is clearly not enough. The In-office education is limited in its children being wheeled into the O.R. deserve effectiveness, and preventive treatments, better. If our goal is to reduce ECC, “What got us such as topical fluorides, can only here won’t get us there.”

Larry Levin, dds [email protected]

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B01F G4_HYDRIM-Talking Points-CDA Essentials_FP_EN.indd 1 2017-04-19 2:42 PM The Canadian Oral Health Roundtable: A COMMUNITY OF SUPPORT

COHR meetings are convened by CDA to Reducing sugar Leaders from explore innovative ways of improving the a broad range oral health of Canadians. For COHR 2017, consumption the discussions centred on two themes: The second session of COHR began of professions, including improving oral health for people with with a presentation on reducing sugar experts in oral health, disabilities and reducing sugar consumption. consumption by Dr. Hasan Hutchinson, medicine, education and director general of the office of nutrition Better oral health for policy and promotion at Health Canada. government, gathered people with disabilities According to guidance from Canada’s Food in Ottawa for the Guide and the World Health Organization, The first session of COHR included panel Canadians consume too much sugar, Canadian Oral Health presentations from individuals who have especially in the form of sugary drinks. Our Roundtable (COHR) worked to improve access to care for this high-sugar diets contribute to dental caries underserved patient group. People with and are linked to obesity, which increases on April 20, 2017. disabilities have greater levels of oral disease the risk for other health conditions such as compared to the general population as type 2 diabetes, high blood pressure and a whole and often find it difficult to get heart disease. dental care. Dr. Mel Schwartz, chief of the dental department at the Jewish General To help Canadians cut down on sugar, Hospital in Montreal; Jocelyn Johnston, Dr. Hutchinson described four initiatives executive director of the British Columbia currently being developed by Health Dental Association; and John Rae, vice-chair Canada: (1) improving food labels so that of the Council of Canadians with Disabilities, consumers are more informed about the recounted how their insights into the food they buy, (2) restricting marketing of problem of access to care have been shaped unhealthy foods to children, (3) updating by their personal experiences. Canada’s Food Guide to make it easier for people to The panel presentations highlighted the understand and apply deficits of a system where people with its dietary guidance, disabilities who need dental care often and (4) developing a fall through the cracks. Not enough campaign to encourage dentists are willing or able to treat patients Canadians to reduce their with disabilities, patients face a maze of Photos above: (l. to r.) consumption of sugar- Dr. Hasan Hutchinson, director government bureaucracy, and poverty forces sweetened beverages, the general, office of nutrition policy many to prioritize basic living expenses over largest contributor of sugar and promotion, Health Canada; dental care. in Canadian diets. a Dr. Paul Allison, ACFD president, and LCol Dwayne Lemon, “Poverty forces many people with disabilities Commanding Officer, RCDC; to decide when it’s necessary to put food in Dr. Heather Carr, CDA Board of Directors; Ms. Gerry Cool, CDHA our mouths or get dental care, both of which president with Dr. Larry Levin, are necessary,” said Mr. Rae. CDA president.

Issue 4 | 2017 | 11 CDA at Work Attention Dial-up Users! Act Now Before Modem Retirement Deadline

Does your office still use a telephone modem to send CDAnet electronic dental claims to insurance companies?

If you answered yes, you’re not alone—approximately 1,300 dental offices across Canada use modems to send dental claims. But modem-users take note: September 30 will be the last day that you’ll be able to use dial-up to send dental claims.

Here’s what you need to know:

❘❙ Networks are implementing this change. TELUS Health and Alberta Blue Cross announced their plans to stop supporting claims transmitted by phone modem last September. The majority of electronic dental claims are transmitted to TELUS Health, which counts The Great-West Life Assurance Company, Manulife Financial and Sun Life Financial as part of its network of almost 50 insurance carriers.

❘❙ If you want to continue sending electronic claims after September 30, you’ll need to start using the ITRANS Claim Service (ITRANS). Dentists have been using ITRANS to send electronic dental claims securely since 2004. ITRANS is available for no charge to dentists who are members of their provincial dental association or, in Quebec, dentists who are affiliate members of CDA.

❘❙ If you don’t transition to ITRANS, claims will have to be submitted manually. A completed dental claim form will have to be manually submitted by mail, which has its drawbacks: ✗ Longer wait times for reimbursement; ✗ For patients who submit claims, an inconvenience; ✗ For dentists who accept assignment, additional paperwork and costs for postage, and a lost ability to accurately identify and collect the co-payment and deductible portion of dental fees on the day of treatment.

For more information about transitioning from modem to ITRANS for electronic claims, visit cdanet.ca You’ll find step-by-step instructions for transitioning to ITRANS and specific instructions for dentists who submit electronic claims to Alberta Blue Cross. If you have questions about ITRANS, call the CDA Practice Support Services (PSS) Help Desk: 1-866-788-1212

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A-dec_OperatoryMakeover2017_RevA_CDAEssentials.indd 1 5/17/17 9:31 AM News and Events

GIVING BACK Dentists in Saskatoon step up for

Marina Jones, DMD Class of 2017, provides oral Syrian refugees hygiene instruction at a Filling the Gap Dental Clinic.

Project The Filling the Gap Dental Clinic for Syrian refugees. The clinic operated out of the University of Saskatchewan College of Dentistry facilities.

Team Led by Dr. Alyssa Hayes, former assistant professor in dental public health at the University of Saskatchewan, the dental clinic was staffed by a mix of students, staff, and dentists from the College of Dentistry and dentists from the community. Front desk staff from the College of Dentistry took care of logistics.

Patients Syrian refugees living in Saskatoon. “We brought in families that ranged in size, anywhere from 3 to 12 people came in at the same time,” says Dr. Hayes. “As you can imagine, it got Visit Oasis Discussions a little chaotic! We had to entertain the kids while we had mom and dad in the chair, but it to hear Dr. Hayes’ full interview on ended up working.” the Filling the Gap Dental Clinic. oasisdiscussions.ca/ How it came together 2016/08/31/fgdc As part of a private sponsorship group for Syrian refugees, Dr. Hayes was in regular contact with settlement agencies and saw families struggling to find oral health care. She presented her idea of a clinic for serving Syrian refugees to Dr. Gerry Uswak, dean of the College of Dentistry, and he jumped on board.

How it worked Most of the clinic’s patients were covered for basic dental work under the Interim Federal Health Program (IFHP). Dr. Hayes also secured funding from the College’s access to care

14 | 2017 | Issue 4 News and Events

Filling the Gap Dental Clinic

Dr. Alyssa Hayes

fund to offset some of the costs of running the clinic. If a patient required treatment beyond what was covered under the IFHP, the dental team made a case-by-case decision about next steps in consultation with the patient. At their appointments, patients were given the option to make the clinic their dental home; if they chose to do so, they became part of the regular patient pool at the university dental clinic.

Challenges Language was a major barrier, according to Dr. Hayes. “We arranged to have an interpreter on site. We have staff and students who are Arabic-speaking and they helped out a lot. We also realized that a lot of people couldn’t afford transportation to get to the clinic. They were living in opposite sides of the city. So we arranged for a cab company to bring them to and from their dental appointments. We also made sure to bring people in as families, so we had multiple appointments for one family on the same day.”

Memorable moment

“Honestly, it has been wonderful to see people stepping up as a community to help,” says Dr. Hayes.” The whole experience of the students, staff, faculty and the wider dental community coming together to help these new Canadians with their oral health needs was remarkable.” a

Do you know a dentist who is giving back to his or her community and should be featured in CDA Essentials? Contact us at [email protected]

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ADCACDA0617.indd 1 5/12/17 9:37 AM FAMILY VIOLENCE RESOURCES for Health Care Professionals

The VEGA Project— Thanks to a large investment from the federal government, the VEGA Project will be developing national public health guidance, protocols, curricula and tools for health which stands for and social service providers, including dentists and dental team members.

Violence, Evidence, CDA and the other participating organizations met in November 2016 to discuss Guidance and Action— the feasibility and development of guidance related to intimate partner violence (IPV) and children’s exposure to IPV (CE-IPV), common elements and practices, was launched in profession-specific considerations, the translation of guidance into curricula, and 2015 as part of a referral pathways. federal government “To advance system-wide education for physicians and allied HPs [health initiative to support practitioners], there must be in-depth understanding of what IPV content, including skills, learners receive throughout their victims of family violence. training,” explained VEGA Project leads in an article recently published in Medical Education.1 “IPV education needs to be To learn more CDA is one of the prioritized; it should be considered essential and provided early about the 24 organizations sitting in the educational curriculum.” VEGA Project, visit As the VEGA Project soon enters its third year, it will focus on on the VEGA Project’s projectvega.ca national guidance tailoring and testing the different curricula for future publication. and implementation Reference committee. 1. Hanson MD, Wathen N, MacMillan HL. The case for intimate partner violence education: early, essential and evidence-based. Med Educ. 2016 Nov;50(11):1089-91.

Issue 4 | 2017 | 17 Victims of Sexual Violence PROVIDING COMPASSIONATE CARE Issues and People

Victims of sexual violence often find dental and medical examinations difficult to tolerate. How can dental teams identify these patients and provide them with a reassuring environment? CDA discussed this issue with Dr. Marika Guggisberg, a lecturer at Central Queensland University in Australia, who specializes in intimate partner violence and sexual violence victimization. Dr. Guggisberg published an article in 2015 titled Improving Clinical Practice: What Dentists Need to Know about the Association between Dental Fear and a History of Sexual Violence Victimization.1

How can a dental practitioner determine whether a patient is, or has been, a victim a sexual violence if they are not forthcoming with that information? There are no big differences between those patients and others who are anxious or fearful. Dental practitioners may be able to read the signs that relate to anxiety. These include being irritated, looking around anxiously, and regularly cancelling appointments—that last sign is almost a giveaway. Patients with dental anxiety, particularly related to sexual victimization, Dr. Marika experience high levels of distress and insecurity that are likely to result in avoidance of Guggisberg anxiety-provoking situations, such as an upcoming dental appointment. I would investigate the reason for multiple cancellations if I noticed such patterns.

In your article you mention strategies to overcome apprehension during oral manipulation. Can you explain some of these strategies? Dentists can try a number of little things to help anxious patients. • I think the most important issue here is to focus on collaboration. Individuals who are subjected to sexual violence often exhibit very high levels of distress. This distress can be eased by providing them with choices and giving them a sense of control and empowerment by discussing the steps that will take place. Furthermore, providing these patients with extensive information and maybe even a written summary of what has been discussed will be helpful. • Another key step is to ask for permission before performing any given action. I suggest informing anxious patients about what steps will be taken and why. For example: “This is Watch the full interview with what I am going to do now, for this reason. Is that OK with you?” Explanations should be Dr. Guggisberg at more detailed than with a patient who does not suffer anxiety. oasisdiscussions.ca/ • To defuse anxious patients’ avoidance defense mechanisms, it is helpful to offer them 2016/05/04/vsa same-day appointments. This could prevent anxiety in the lead up to their appointment date. • One of the main issues for patients with sexual victimization when visiting the dentist is body position. The supine position can make them feel exposed and helpless. Some

Issue 4 | 2017 | 19 Issues and People

By tolerating the anxiety and having a positive, reinforcing experience, these patients are unconsciously doing some psychological work on themselves.

other techniques that have been shown to be is that if the person feels a little more safe and helpful are (1) having a chaperone accompany secure during treatment, they are more likely to them to an appointment, a trusted person come back because they see the benefit of oral who might even hold their hand; (2) having a treatment immediately. There is an instant reward. blanket placed on them—this brings a sense What these patients are doing—perhaps without of warmth and sometimes being covered can realizing it—is a form of exposure therapy. If they be reassuring; and (3) having one foot on are able to actually attend an appointment and the ground. their experience is positive—they are treated warmly, they sense empathy, and they I believe these are among the more are not judged negatively—they are important findings in the literature in likely to come back. The benefits are terms of supporting patients. Read Dr. Guggisberg’s two-fold: these patients receive the paper at treatment and care they need and Would these strategies be similar hindawi.com/ they feel supported by people who for both male and female victims? journals/ really want to help them. By tolerating Male patients with anxiety issues ijd/2015/452814 the anxiety and having a positive, because of sexual victimization reinforcing experience, these patients are may find it more difficult to explain unconsciously doing some psychological themselves. They would probably also be more work on themselves. They are doing what sensitive to latex and maybe even the smell psychologists would do in exposure therapy. of aftershave. If there is something a dental practitioner can do to get around that, such as One extremely important thing we discovered in not wearing aftershave or using another type of doing this research is the need for professional glove, this may reduce anxiety in male and female development. Victims of sexual violence This interview has been condensed patients who suffer dental anxiety associated with experience and internalize so much guilt and and edited. sexual victimization. If this is not possible, I suggest shame, and they are trapped in a vicious cycle The views expressed are those of the that dentists take time to explain in detail the of fearing to step out and seek treatment. Once author and do not necessarily reflect procedures and why it is necessary to wear gloves. this cycle of fear, shame and guilt is broken, trust the opinions or official policies of the can be built between the patients and their care Canadian Dental Association. Another idea is to also give these patients a mirror or to help them monitor the dental procedures providers. But this requires dentists to be aware of with intra-oral cameras. Being able to observe the significant negative impact of sexual violence what is going on in their mouth can sometimes be victimization. As we have discussed above, there helpful in reducing distress and anxiety. are a number of strategies that dental teams can try to help. a Does this anxiety ever improve and how long would it take for a patient to start to feel more comfortable and trusting with a dentist? Reference 1. Larijani HH and Gussisberg M. Improving Clinical Practice: What Dentists Need The good thing with anxiety and being able to Know about the Association between Dental Fear and a History of Sexual to build a trusting relationship with the dentist Violence Victimisation. Int J Dent.; 2015: doi: 10.1155/2015/452814.

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Most used 1 With Philips Zoom WhiteSpeed. Not including prep time. by dental professionals TOBACCO A Shifting Landscape Issues and People

Reducing tobacco use in Canada to less than 5% by 2035, that is the ambitious target that’s been set by Health Canada.

With this aggressive goal in mind, the federal government hopes to improve the health of Canadians and engage with both the relevant stakeholders and the general population. “Tobacco use is one of the main risk factors for a number of chronic diseases, including cancer, lung and cardiovascular diseases. It is also the leading cause of premature death in Canada. One of the best ways we can protect public health is to dramatically reduce tobacco use,” explains Dr. Theresa Tam, Canada’s Interim Chief Public Health Officer.

Although tobacco consumption is declining overall in Canada, smoking rates vary greatly between population groups. Canadians with low income, Indigenous peoples, and individuals with mood or anxiety disorders are still using more tobacco products than the general population, and the smoking rates for youth and young adults have remained unchanged since 2013.

One of the challenges to achieving the government’s 5% target will be to explore new avenues and measures to implement, as Canada already applies most internationally recognized best practices. “Relying on current measures alone is not expected to reduce tobacco use fast enough. If we continue with current policies, smoking prevalence is only forecast to decrease from 13% to 9% by 2036, according to current estimates. This means that approximately three million Canadians would still be smoking 19 years from now,” stresses Health Canada in the consultation document Seizing the opportunity: the future of tobacco control in Canada.1

Health Canada’s long-term plan to reduce tobacco use will be focusing on six aspects: • Reducing tobacco use to less than 5% by 2035 and other targets (other tobacco use and sub- population targets) • Protecting youth • Helping Canadians who use tobacco • Indigenous peoples • Tobacco use and health and social inequities • Building capacity

To discuss new measures and initiatives that could shape the next iteration of the Federal Tobacco Control Strategy, set to expire in March 2018, Health Canada held a National Forum on the Future of Tobacco Control in Canada at the end of February 2017. The 3-day event brought together key players from academia, health professions, law enforcement, at-risk communities, and municipal, provincial, territorial, and federal governments. Kevin Desjardins, CDA's director of public affairs, represented CDA at the forum. Similarly, the federal government held a 7-week public consultation earlier this year to seek input from the general population.

The forum and public consultation were timely not only because the expiry of the Federal Tobacco Control Strategy, but also because of the shifting landscape as new technologies and products are emerging, most notably e-cigarettes (see p. 24). Currently, vaping products that contain nicotine are unregulated and not approved for use in Canada. a

Reference 1. Health Canada. Seizing the opportunity: the future of tobacco control in Canada. Ottawa: Health Canada; February 2017 [accessed 2017 Apr 25]. Available: canada.ca/en/health- canada/programs/future-tobacco-control/future-tobacco-control.html

Issue 4 | 2017 | 23 Issues and People E-CIGARETTES: Holy Grail or Smoke Screen? The increase of e-cigarette use raises many questions about safety and legislation, along with oral and overall health. Here’s an overview of some of the ongoing developments regarding vaping products and how they affect the oral cavity. New Canadian legislation In November 2016, the federal government introduced the proposed Tobacco and Vaping Products Act, to regulate vaping products as a distinct class of products. The proposed legislation would include provisions to: • Protect minors from nicotine addiction and tobacco use • Allow adults to access vaping products • Regulate the manufacture, sale, labelling and promotion of both tobacco and vaping products • Restrict certain flavours that appeal to youth • Ensure child-resistant packaging to avoid nicotine poisoning in children The Canadian government also recently acted to ban menthol flavouring in cigarettes, blunt wraps and most cigars. “The introduction of this important legislation is the next step in the government’s work to protect young Canadians from nicotine addiction and tobacco use,” said Minister of Health Jane Philpott. “At the same time, it introduces an approach to vaping products that considers their potential benefits to smokers. I look forward to seeing this Bill through the legislative process.” The proposed legislation is part of the Vision for a Healthy Canada initiative that focuses on maintaining good physical and mental health. a

E-cigarettes, smoking cessation aids? While some anecdotal evidence suggests that e-cigarettes might help smokers to butt out, the current lack of scientific evidence supporting that claim is making it hard for This knowledge gap is why Dr. Mark Dr. Eisenberg told McGill Reporter, “but regulators and health care professionals Eisenberg, a cardiologist and professor ours is a significant first step.” to take a strong stand on the issue. of medicine at McGill University, hopes “This study alone would not be enough Electronic cigarettes are not approved to better understand the potential for for Health Canada to allow companies as smoking cessation aids by Health e-cigarettes to help cigarette smokers to market e-cigarettes as smoking Canada, as nicotine-containing vaping kick the habit. He is currently conducting cessation aids,” Dr. Eisenberg noted. products are not approved for use a 5-year study on the matter, with “That said, if this trial shows that there in Canada. funding from the Canadian Institutes of is a substantial reduction in smoking Health Research. His study will involve traditional cigarettes, then Health close to 500 cigarette smokers from Canada will have to rethink their policy.” coast to coast who will be assigned to one of three groups: participants Smoking cessation aids currently using e-cigarettes with nicotine and approved by Health Canada include: receiving individual counselling; some • Nicotine replacement therapies: Nicoderm® patch; Habitrol® patch; Read more on using e-cigarettes without nicotine and receiving individual counselling; Nicorette® gum, lozenge and this research at inhaler; Thrive® gum and lozenge; publications.mcgill.ca/ and others only receiving individual counselling. “Ultimately, multiple trials in corresponding generic brands reporter/2016/02/ multiple populations will be necessary • Bupropion: Zyban®; Wellbutrin® SR e-quitting to establish the efficacy of e-cigarettes,” • Varenicline: Champix® a

24 | 2017 | Issue 4 Issues and People The changing microbiome Researchers from the Ohio State University recently studied the changes in the subgingival microbiome caused by the use of e-cigarettes. Their findings were presented at the International Association for Dental Research (IADR) meeting in March, earning them the top spot in the poster competition.

The research team collected subgingival gene transfer. They were encoded by plaque samples from 100 periodontally both known pathogens (Fusobacteria sp., and systemically healthy subjects who Treponema sp., Prevotella sp., Bacteroides were either e-cigarette users (E), cigarette sp.) and as-yet-uncultivated species. A total smokers (S), dual users (SE), former smokers of 51 biomarkers for e-cigarette exposure now using e-cigarette (FSE), or non- were identified. smokers (NSNE). “The risk-for-harm associated with Research findings showed that e-cigarette e-cigarettes may be similar to or greater affects the subgingival microbiome than smoking. The similarity in the differently than tobacco smoke. “Using microbiomes of former, current or never e-cigarettes to quit smoking is not helping smokers who use e-cigarettes does not your microbiome,” says Dr. Purnima Kumar, support the hypothesis that e-cigarettes one of the study’s authors. He and his promote harm-reduction in cigarette team found 1353 genes that were unique smokers,” the authors conclude. “The to those using e-cigarette (E, SE and FSE). pathogen and virulence enrichment Among other functionalities, those genes observed in clinically healthy individuals encoded for antibiotic resistance, motility might augur the emergence of a new risk chemotaxis, stress response, and horizontal factor for periodontal diseases.” a

Vaping kills mouth cells Researchers from the Laval University faculty of dental medicine have demonstrated that an important number of mouth cells die after exposure to e-cigarette vapour for a few days. In an article published in the Journal of Cellular Physiology, lead researcher Dr. Mahmoud Rouabhia and his colleagues explain that by simulating the mouth environment when vaping, they saw the percentage of dead or dying cells skyrocket to 53% after three exposures to e-cigarette vapour. In contrast, that percentage averaged 2% in control groups.

It is the first study to establish the effect of vaping on gingival epithelial cell behaviour. “Contrary to what one might think, e-cigarette vapour isn’t just water,” explains Dr. Rouabhia. “Although it doesn’t contain tar compounds like regular cigarette smoke, it exposes mouth tissues and the respiratory tract to compounds produced by heating the vegetable glycerin, propylene glycol, nicotine and aromas in e-cigarette liquid.” These findings indicate that similar to traditional cigarettes, e-cigarettes induce disturbances in gingival epithelial cells—which can ultimately lead to disturbances in gingival tissues.

“Damage to the defense barrier in the mouth can increase the risk of infection, inflammation, and gum disease. Over the long term, it may also increase the risk of cancer. This is what we will be investigating in the future,” Dr. Rouabhia says. a

Access the full article at onlinelibrary.wiley.com/doi/10.1002/jcp.25677/abstract

Issue 4 | 2017 | 25

Can dentists help their patients quit smoking?

ou’ve just seen a patient, a heavy A new study from researchers at the smoker, and counselled him about Ontario Tobacco Research Unit1 suggests the dangers of smoking and the that advice from dental professionals benefitsY of quitting. As he leaves your office, can play a crucial role in helping patients you wonder if he’ll take your words to heart quit smoking—if that advice is coupled or if it’s a wasted effort. Do your words of with advice about smoking cessation encouragement and advice have any impact? medications. The study, published in the

Issue 4 | 2017 | 27 İ

Issues and People

Journal of the Canadian Dental Association (JCDA.ca), What practical advice can dentists take from the examined the impact of dentists’ advice on patient research? The study outlines two major implications quitting outcomes by surveying over 2,700 smokers for dental practices: (1) Dentists should reach out every 6 months for up to 3 years. to a broader range of their patients who smoke because reaching out to lighter and less addicted The study reveals two important insights. One smokers will increase the number of patients who Full article is that dentists typically don’t provide all of their try to quit. (2) When dentists provide patients with and references patients who smoke with quitting advice; rather, available at quit advice, they should also counsel the patient jcda.ca/h1 they concentrate on smokers who were more likely about quitting medications. to be male, less educated and in poorer health, and more addicted to tobacco. In other words, Dr. Michael Chaiton, one of the study authors, says Ontario dentists in this study provide advice to that dentists can connect their patients to other the most challenging group to treat: the heavy support services, such as behavioural counselling smokers. Secondly, smokers are more likely to try to or Smokers’ Helpline, a program operated by the quit smoking or are successful in quitting over the Canadian Cancer Society. “Dentists can have a short term (the study didn’t look at the effects of tangible impact,” says Dr. Chaiton. “Our research quitting beyond one month) if they used a quitting shows that dentists make the biggest practical medication, such as nicotine patch and gum, impact through the provision of cessation bupropion and varenicline, with or without medications. And in Ontario, dentists can directly a dentist’s advice. prescribe bupropion and varenicline.”

So does the advice of dentists matter if use of Dentists have always counselled their patients to quitting medication is the key factor associated quit smoking. This study shows why it’s important with quitting? It matters because patients who to keep doing this and what they can do to received dentists’ advice were more likely to use increase the likelihood that more of their patients quitting medications compared to patients who with be successful in quitting. a did not receive dentists’ advice. “Without dentists’ advice, some smokers in this study would not Reference have used cessation medications or would not 1. Zhang B, Bondy SJ, Diemert LM, Chaiton M. Can dentists help patients quit have used medications appropriately to achieve smoking? The role of cessation medications. J Can Dent Assoc. 2017;83:h1 the optimal outcomes,” the study notes.

Without dentists’ advice, some smokers in this study would not have used cessation medications or would not have used medications appropriately to achieve the optimal outcomes.

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Supporting Your Practice

The following is based on an Applied Research article originally Research Summary published on JCDA.ca—CDA’s online, open access scholarly publication that features articles indexed in Medline, Journal Citation Reports and Science Citation Index.

Treating Early Childhood Caries Under General Anesthesia: A National Review of Canadian Data

Many Canadian children are affected by early childhood caries (ECC) and require treatment Robert J. Schroth under general anesthesia. The purpose of this study was to determine the burden of day surgery DMD, MSc, PhD for children with ECC in Canada. Carlos Quiñonez DMD, MSc, PhD Luke Shwart By definition, children under 6 years of age are considered to have ECC if they have DMD, MBA experienced any past or current decay involving the primary teeth.1 In some children, ECC may involve only a single tooth; in others, multiple teeth may be affected by caries. The Brandon Wagar complexity of treatment required to rehabilitate the dentition of those with severe ECC, PhD along with their young age, often warrants the use of general anesthesia.

umschrot@ Rates of dental surgery to treat caries under general anesthesia can serve as an indicator 2 cc.umanitoba.ca for monitoring and benchmarking population health. Dental surgery data can provide information on the volume of surgeries, socioeconomic distribution and regional trends.2,3 Providing health care decision-makers with such information could inform resource planning and oral health promotion activities.2

Some of the recognized indications for use of general anesthesia for delivery of dental care include children who cannot cooperate because of a lack of psychological or emotional maturity or mental, physical or medical disability; those for whom local anesthesia is ineffective because of acute infection, anatomic variations or allergy; those who are extremely uncooperative, fearful, anxious and uncommunicative; those requiring significant surgical procedures; and those requiring immediate comprehensive dental care.4

The purpose of this study was to quantify the human and economic burden of day surgery for ECC, identify populations at higher risk for day surgery to treat caries and raise awareness of the extent of this problem facing Canadian children, the dental profession and the public. Methods More Online In the absence of national prevalence data on ECC, day surgery under general anesthesia Full article and was selected as a suitable proxy to study severe dental caries in Canadian children. Day references available at surgery abstracts for ECC for fiscal years 2010/11 to 2013/14 were extracted from the Canadian jcda.ca/g20 Institute for Health Information (CIHI) Discharge Abstract Database (DAD) and National Ambulatory Care Reporting System (NACRS). All provinces and territories except Quebec participated. Data were pooled for the 4 fiscal years.

Issue 4 | 2017 | 29 Supporting Your Practice

Territories) had pooled rates above 25 per 1000 children

aged 12–59 months. When rates of dental surgery by health region in participating provinces and territories are mapped by rate quartile (Fig. 2), they appear to be higher in central and northern regions of Canada. Health regions in northern Saskatchewan and Manitoba had the highest rates of day surgery. Specifically, the Mamawetan Churchill River Regional Health Authority and the Athabasca Health Authority in Saskatchewan had rates of 135.2 per 1000 and 221.4 per 1000, respectively. The Northern Regional Health Authority in Manitoba had a

pooled 4-year rate of 109.3 per 1000. Rates of dental surgery were then calculated for key covariables of interest. Rates of surgery for children from Figure 1: Percentage of day pediatric surgeries in Canada by type of neighbourhoods with a high proportion of Aboriginal procedure (2010–11 to 2013–14). people were 7.8 times greater than for children living in areas with a low proportion (84.5 vs. 10.9 per 1000). Children in rural regions of Canada had rates 3.2 times Variables those of urban-dwelling children (31.2 vs. 9.8 per 1000). There was also an inverse relation between rate of Key analytical variables considered included sex, age, dental surgery and MDI. Children from the least-affluent immigrant tercile, Aboriginal concentration, material regions had dental surgery rates 3.7 times higher than deprivation index (MDI)—a measure of socioeconomic those from the most-affluent communities (25.7 vs. 6.9 status based on income, employment and education— per 1000). and rurality.7 The average annual total hospital-associated costs Location of procedure (hospital or private clinic) of treating ECC under general anesthesia in Canada (excluding Quebec) were $21,184,545. This translates into In some jurisdictions, dental day surgery occurs in an average hospital cost of $1564 per child. private institutions, which then report discharge records to the DAD or NACRS. Day surgeries occurring in private institutions were identified in Alberta, British Columbia Discussion and Saskatchewan. Our results reveal that ECC is the most common reason for day surgery among preschool children in Canada. As we studied only 4 years’ worth of data (2010/11 to Anesthetic technique 2013/14), we were unable to determine whether rates Anesthetic group 1 (general, spinal, epidural, neuraxial) of dental surgery are increasing. However, a recent was considered general anesthetic. publication from Manitoba suggests that surgery rates there have increased.2 Demand for general anesthesia Results when treating caries in young children also appears to be increasing in several countries.11-13 Over the 4-year study period, 57, 249 day surgeries to treat severe ECC were performed in Canada (excluding The challenge of ECC is that its origins are multifactorial Quebec), accounting for an overall rate of 12.1 per and it is influenced by both biomedical and social 1000 children aged 12–59 months. Treating ECC under determinants of health.14,15 It is apparent from this study general anesthesia was the most common day surgery that Indigenous children and those from rural and in Canada for this age group; it represented 31.0% of all remote regions of Canada are more likely to develop pediatric day surgeries (Fig. 1). severe ECC that warrants treatment under general anesthesia. Pooled and annual rates of day surgery for treating severe caries varied by province and territory. The Our study also reveals that surgery rates for children pooled rate ranged from 8.2 per 1000 children in living in rural regions are over 3 times those of children Ontario to 110.9 per 1000 children in Nunavut. Three in urban centres. A recent Canadian publication also provinces (Saskatchewan, Manitoba, and Newfoundland supports these findings.2 Children in rural communities and Labrador) and 2 territories (Nunavut and Northwest face several issues that influence access to care and their

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relapse among children undergoing surgery.29-33 Treating caries has little impact in reducing a child’s risk of developing decay in the future, as past caries experience is the greatest predictor of future caries risk.

There is an obvious need for better targeted prevention measures to improve the oral health of vulnerable preschoolers in Canada. Promising methods include promoting the concept of the dental home and the first dental visit by the first birthday.35,36 Children benefitting from early dental care are reported to require less restorative and emergency dental care, more likely to receive preventive dental care and have lower ongoing treatment costs.37-39 Unfortunately, early dental visits are still not common practice in Canada.40,41

Data arising from this research have already been shared with provincial and territorial government health departments. The hope is that evidence from this study can increase decision-maker awareness of how a preventable disease like dental caries can place Figure 2: Rate of day surgery for dental caries, children 1-4 years old, significant strain on families, communities and health by health region, 4-year pooled data (2010–11 to 2013–14). care resources.

oral health, including lack of water fluoridation, lack of Analyzing dental surgery rates can be a practical and dental professionals in their community and the need to more economical way to monitor the burden of severe travel outside their community for oral health care.19-21 ECC in young children than cross-sectional oral health surveys. Surgery rates for ECC have been proposed as an An interesting and somewhat unexpected observation outcome to measure the success of population health is that surgical rates appear to be somewhat higher interventions aimed at improving early childhood oral in neighbourhoods with relatively few immigrants. health.3,21 Previous studies have reported a higher prevalence of ECC among immigrant groups, but have tended to focus The costs associated with treating ECC in the operating 45 on particular newcomer and refugee communities.22-24 room are substantial. They include hospital-associated The findings from this study could be explained if, from costs, dental costs, travel costs and costs borne by a pan-Canadian perspective, immigrants had a relatively the family. In Canada, the hospital-associated costs high socioeconomic status, allowing them to access are absorbed by the universal health care system. preventive care. Considering that the hospital costs alone for day surgery to treat ECC exceed $21 million annually, dental and Our MDI variable reveals a clear inverse relation between pediatric organizations should lobby government for socioeconomic status and rate of dental surgery, with appropriate and sustained funding for research into higher rates among children from the least-affluent finding effective prevention strategies for ECC. neighbourhoods than those from more-affluent areas. This is not surprising, as children from disadvantaged In summary, dental surgery for ECC is far too common households typically have challenges in affording and and often occurs among children from less-affluent accessing regular care.25,26 households, rural regions and communities with a high proportion of Aboriginal people. Rates of dental surgery Treating caries in young children is necessary, as under general anesthesia to treat caries can serve as an rampant caries can have a negative impact on important population health indicator for monitoring, childhood well-being.18,27,28 Unfortunately, the sobering needs assessment and benchmarking purposes. a fact is that there is a high recurrence of caries and

There is an obvious need for better targeted prevention measures to improve the oral health of vulnerable preschoolers in Canada.

Issue 4 | 2017 | 31 Supporting Your Practice Dens Evaginatus:A Simple Preventive Clinical Treatment

Dens evaginatus is an anomolous extension of dentinal tissue covered in enamel, forming a cusp or tubercle, and occurring on the occlusal surface of posterior teeth and the lingual surface of anterior teeth (Fig. 1).1 According to Dr. Larry Hill, a semi-retired dentist in Nanaimo, British Columbia, the main complication of dens evaginatus occurs when the tubercle wears or fractures as the tooth enters occlusion, resulting in exposure of the pulp.

Dr. Larry Hill It’s a condition Dr. Hill encounters in the First Nations patients he treats in remote communities of northern Vancouver Island and northern British Columbia. Here, he describes larryhilldmd@ gmail.com a treatment he developed for dens evaginatus.

Dens evaginatus Dens evaginatus occurs bilaterally or unilaterally. It occurs five times more frequently in the mandibular than maxillary teeth. It has been reported in Inuit, First Nations, Thai, Chinese, and less frequently in Caucasians.1 It is also known as an accessory tubercle, Leong’s premolar and dental pearl. Treatment goal Prevention of pulp exposure by protecting the tubercle from occlusal wear (Figs. 2 and 3).

Procedure (Figs. 4a-c): ◗� Obtain patient consent. No anesthetic is required. ◗� Clean the occlusal surface with a pumice slurry. ◗� Etch the surface with 37% phosphoric acid, rinse and dry. ◗� Place a bond, air dry and light cure for 20 seconds. ◗� Place composite around and under the tubercle, supporting it. ◗� Cure composite according to manufacturer’s recommended curing time. ◗� Clean area with slow speed brush to remove the air inhibition layer. ◗� Check occlusion with articulating paper and adjust so the teeth meet in centric with no excessive contact in lateral excursion. Follow up Repair any fractured composite to maintain coverage around the tubercle. Monitor radiographically to look at pulp shrinkage (there is a pulp volume decrease of approximately 15% between the ages of 11–142). At a future date, decide when to reduce the tubercle/ composite structure. a

This article has been condensed and edited. References 1. Echeverri EA, Wang MM, Chavaria C, Taylor DL. Multiple dens evaginatus: diagnosis, management, and complications: case report. The views expressed are those of the Pediatr Dent. 1994;16(4):314-7. author and do not necessarily reflect 2. Shaw L, Jones AD. Morphological considerations of the dental pulp chamber from radiographs of molar and premolar teeth. J Dent. 1984;12(2):139-45. the opinions or official policies of the Canadian Dental Association.

32 | 2017 | Issue 4 Supportingupporting Your Practiceractice

Clinical Procedure

➊ ➋ ➌

a) b) c)

➍

➊ Dens evaginatus occurring on lower left ➍ Schematic of treatment for dens evaginatus. Watch Dr. Hill's case second premolar. a) Side view showing unsupported tubercle. presentation on b) Composite filling material is placed around Oasis Discussions ➋ Before treatment, lower left second premolar and under the tubercle. tooth showing untreated dens evaginatus. oasisdiscussions.ca/ c) Top view showing composite around 2016/04/11/dens ➌ Same tooth after preventive procedure. tubercle. #WorldDentalCongress

THE BIGGEST INTERNATIONAL DENTAL CONGRESS

2017_WDC-ad-20170215-8_25x10_875-CDA.indd 1 15/02/17 11:39 Supporting Your Practice Oasis Discussions

The following Case Conference originally appeared in two parts on Oasis Discussions at oasisdiscussions.ca/2015/09/14/wl (presentation) and oasisdiscussions.ca/2015/10/16/aocr (resolution).

#WorldDentalCongress White Lesions in an Elderly Patient with a Complex Medical History ➊

The growing demographic of seniors in the Canadian population means elderly patients are an increasing patient group at many dental How would you manage practices. Diagnosing oral disease in seniors can be challenging: they this patient? are more likely to experience multiple chronic health conditions and Dr. Aviv Ouanounou, assistant are often using many medications. These considerations can make professor in the department of it a challenge to mitigate the impact of drug-related problems and clinical sciences (pharmacology) at the University of Toronto underlying illness on a patient’s oral health. faculty of dentistry, shares a case from his Toronto practice Case Presentation that illustrates the diagnostic A 71-year-old female came to my practice because she noticed some white and treatment challenges of material in her mouth on the palate and tongue (Fig. ➊). She thought it would go managing an elderly patient away and had waited 2 weeks before coming to see me. Her attempts to remove with a complex medical history. the white material with her toothbrush were unsuccessful.

aviv.ouanounou@ Medical history dentistry.utoronto.ca The patient’s medical history was complex. She had: • Hypertension • High cholesterol • Type 2 diabetes THE BIGGEST INTERNATIONAL • Osteoarthritis DENTAL CONGRESS • Asthma The patient also said she had a mild stroke in October 2012. We had sent a letter to the patient’s treating physician, who confirmed the patient did indeed have a stroke—but not a mild one. It’s worth noting that sometimes patients downplay their health conditions. She also had a knee replacement in May 2015, about 3 months before she came to see me.

This article has been condensed and edited. The views expressed are those of the author and do not necessarily reflect the opinions or official policies of the Canadian Dental Association.

Issue 4 | 2017 | 35

2017_WDC-ad-20170215-8_25x10_875-CDA.indd 1 15/02/17 11:39 Supporting Your Practice

Medications Other symptoms As is very common in the elderly population, this The patient reported experiencing a burning patient was taking many drugs: sensation in her mouth and a strange taste. There • Nifedipine for managing angina and high blood were no other skin lesions. pressure • Lisinopril used to treat high blood pressure Diagnosis • One baby aspirin (81 mg) a day to prevent stroke We diagnosed this patient with pseudo • Rosuvastatin to lower cholesterol membranous candidiasis. Candidiasis, the outcome • Naproxen (275 mg, two times a day) to help of an overgrowth of Candida albicans, is one of the with osteoarthritis most common fungal infections in the oral cavity • Steroids for treating asthma. She had been and one of the most common fungal infections in taking them for about 5 years. the elderly. One crucial clue was the patient’s use • Metformin for treating type 2 diabetes of antibiotics for approximately 2 months, which • Glyburide for treating type 2 diabetes would have lowered her immunity. Candidiasis can be caused by a number of factors: The patient informed me that she had an allergy • Antibiotics to penicillin. She indicated her orthopedic surgeon • Chemotherapy had prescribed ciprofloxacin, and she had taken the antibiotics for 8 weeks following her knee surgery. • Corticosteroid therapy • Dentures Dental and social history • Diabetes mellitus The patient reported brushing her teeth once daily. At • HIV infection first, she told us that she flossed only before coming • Xerostomia (Note: The patient had mild xerostomia to the dentist, but then she said she was flossing due to all the medications she was taking and about once a week. Her last dental visit was 9 months this could have contributed to the growth of this ago for a regular recall visit. The patient indicated she particular fungus.) “had a lot of dental treatment” in the past. Differential diagnoses The patient was a social drinker and only drank on weekends. She was a nonsmoker. • Hyperplastic candidiasis; this diagnosis is unlikely because of the location in the oral Investigation cavity where the lesion was found. • Leukoplakia; this diagnosis is unlikely because Intraoral findings the patient is not a heavy smoker or drinker, and The patient had poor oral hygiene. There was we were able to rub off the lesion. moderate to severe accumulation of plaque and • Lichen planus; more typical of lichen planus calculus, and generalized 4–5 mm pocketing. We would be bleeding in the oral mucosa when we observed that there were multiple missing teeth, rub off the lesion, which was not the case. decay in several teeth, and severely decayed and • Lupus erythematosus; unlikely in this case, broken 36 and 37. given the texture of the lesion and its location in the oral cavity. We took a photo that shows the presence of the white material between the hard and soft palate, on the hard palate, the buccal mucosa, and on the Treatment tongue (Fig. ➊). The major antifungal treatments for pseudomembranous candidiasis are: We took a dry 2” x 2” gauze and were able to • Amphotericin B; usually given intravenously for remove the white material. There was no bleeding. more severe fungal infections. • Azoles; commonly prescribed by oral pathologists and general dentists but significantly problematic because they are subject to many drug interactions. It’s worth noting that sometimes patients • Nystatin; commonly prescribed by oral pathologists and general dentists. downplay their health conditions. — Dr. Aviv Ouanounou

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Successful treatment with nystatin I prescribed nystatin to the patient. Because nystatin is only used only topically, adverse drug Take-home Messages reactions are rare. Some patients don’t like the taste Make sure you have an accurate patient history, and some experience nausea and vomiting. I asked  including a social history. the patient to swish 5 ml and swallow 3 times per Consider the patient’s other symptoms in making day. We saw her 2 weeks later and the lesion was  a diagnosis. completely gone; she indicated it took about For treatment of fungal infections, remember 4–5 days for the lesion to start to disappear.  that azoles are significantly problematic because they interact with many medications. The problem with azoles and the elderly  Check the patient’s drug history and drug Azoles are a group of synthetic fungistatic agents interaction database to reduce risk of an adverse drug reaction. with a broad spectrum of activity. Common azoles are ketoconazole and fluconazole. Adverse drug reactions include nausea, vomiting, anorexia, liver toxicity, menstrual irregularities, and impotence. It’s important to stress that azoles inhibit a major Call for Cases enzyme (cytochrome P450) in the liver that ▼ metabolizes drugs. So a patient taking an azole is Do you have any documented clinical cases or not able to metabolize drugs. Consequently, their scenarios that you can share with your colleagues? medications will be highly concentrated in their system, which can cause toxicity and overdoses. We would like to have your perspectives on how general practitioners can treat common clinical Azoles are problematic because of their many dilemmas. Our team would be pleased to help drug interactions. Be aware of the risks of you through this process. prescribing ketoconazole, for example, with medications such as cyclosporine, phenytoin, Contact us at: [email protected] triazolam, or warfarin. a

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GCA_JCDA_May-2017.indd 1 4/13/17 11:14 AM Supporting Your Practice

HAVE A SAFE TRIP Why travel health insurance is advisable and what to look for when comparing plans

With summer approaching, you may be planning the details of your holiday getaway. We certainly hope that one of those details is travel health insurance. With escalating healthcare costs, purchasing supplemental insurance to cover the costs of medical emergencies happening abroad is not just prudent, it’s a necessity.

At the outset, there are common misconceptions about travel insurance to dispel. For example, people may mistakenly assume that their provincial health insurance will cover Renata Whiteman them while travelling abroad. Some provinces do provide a minimal level of coverage for out-of-country health services, but the amounts they will pay are very limited and usually Senior Insurance Advisor apply only to specific services. Without adequate coverage, you could face significant CDSPI Advisory Services Inc. out-of-pocket costs to pay for treatment for an illness or injury that you suffer while Ms. Whiteman is a licensed insurance abroad. advisor at CDSPI Advisory Services Inc., with an exclusive focus on dental Another common misconception is that provincial medical insurance will cover the professionals. She can be reached full costs of emergency care and treatment no matter where you travel in Canada. at 1-800-561-9401, ext. 6806 or Depending on your province of residence, this may not be the case. For example, there [email protected] for a no-cost, may be gaps in coverage for things like prescription medications or ambulance services, no-obligation review of your insurance particularly if the only hospital capable of dealing with your medical emergency is a long portfolio. distance away. And the cost of transportation home by air, under the watch of medical personnel, could amount to thousands of dollars.

Some people may be under the impression that by booking travel with their credit card, their health insurance is included. Although some premium credit cards cover a portion of a claim, they are typically quite limited and may be restricted to coverage for shorter trips. Review your agreement to confirm what is covered.

Once you’ve made the decision to purchase supplemental health insurance, you can choose from a wide variety of plans, each with its own coverage inclusions and exclusions. Here are some of the things you should bear in mind when exploring options.

 What is covered? Most plans will cover expenses directly related to an illness or injury, such as emergency room care, diagnostic tests, treatment by a physician or surgeon, and a hospital stay, if required. However, other inclusions are good to have in your policy. Some of these include: • Licensed ambulance costs (including air ambulance when medically necessary) • Emergency dental expenses • Prescription medications • Semi-private room • Bedside companion (someone to fly from your home province) • Air evacuation back to Canada, including medical escort • A death benefit if an insured person dies as a result of an air accident

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Taking Precautions

You may have purchased travel health insurance, but there are still steps you can take to avoid or deal with emergencies. CDSPI Travel Edge Insurance • Have your insurer’s assistance telephone number and With Travel Edge Insurance, one low premium covers you policy number with you at all times. for an entire year — regardless of how many trips you • Make sure you have appropriate vaccinations. take. The plan covers eligible* expenses related to travel • Pack two supplies of your medications and place one in medical emergencies, including those noted in this article, your carry-on luggage. anywhere in the world outside your home province. It provides 24/7/365 claims service, direct payment to • Take appropriate food and water precautions. hospitals, emergency dental expenses, and much more. • Travel with a small first aid kit. Travel Edge Plus Insurance provides Flight Accident, • Know the emergency phone number for your destination Baggage Loss and Trip Cancellation coverage. (it’s not always 911). • Get the names of qualified doctors who speak your *Please note that Travel Edge Insurance does not cover everything. For language. full terms, conditions, exclusions and limitations, please refer to the policy For further travel health and safety information visit the booklet. Travel Edge Insurance is underwritten by the CUMIS General Insurance Company, a member of The Co-operators group of companies Government of Canada site at travel.gc.ca/travelling and administered by Allianz Global Assistance. Allianz Global Assistance is a registered business name of AZGA Service Canada Inc.

 What happens with pre-existing conditions? Travel health insurance is designed to cover an unexpected sickness or accident. To avoid a nasty surprise, make sure you know what is or isn’t covered relating to unstable or pre- CDSPI is a not-for-profit organization whose mission is to provide a full range of financial solutions that meet the unique needs existing conditions. of the Canadian dental community throughout their lives. Our members  Are payments made directly to hospitals or other include the CDA and participating provincial and territorial dental associations. care providers? Advisory services are provided by licensed advisors at CDSPI Advisory Services Inc. Information in this article is for informational purposes only and is not Some plans require you to pay for your care, and then submit intended to provide financial, legal, accounting or tax advice. a claim for reimbursement. In countries where hospitals, Restrictions to advisory services may apply in certain jurisdictions. physicians and other providers require you to pay separately, this can be quite cumbersome, not to mention the fact that you may not have the funds readily available for large expenditures.

 Does the insurer provide claims response 24 hours a day, 7 days a week, 365 days a year? You never know when an emergency may happen, so this is important.

 How often do you travel? In many cases, people purchase coverage for a single trip. But if you typically travel out of your province more than a couple of times per year, it’s worth exploring multi-trip options. For example, you can purchase a year-long plan that will cover an unlimited number of trips. This not only saves you money, but it provides the added convenience of only having to purchase it once a year. a Classifieds Classifieds jcda ca ESSENTIAL DENTAL KNOWLEDGE Guaranteed access to Canada’s largest audience of dentists philosophy is an asset. Our clinics are modern flow. No weekends/evenings. New grads with skiing, fishing, boating, hiking and camping

Published by (renovated or new), digital (x-rays, CBCTs, PAN/ welcome. For more information, please email all within minutes of town. Please forward The Canadian Dental Association Ceph, paperless charting), and our highly-trained resume and cover letter, with references, to: resume to: [email protected]. D11789 team is ready to support the successful candidate [email protected]. D12295 BRITISH COLUMBIA - Salt Spring jadc in providing quality dentistry and achieve their DES CONNAISSANCES Island: Associate position in busy family DENTAIRES INDISPENSABLES production goals. Established clinics, with ALBERTA - Stony Plain: Group practice in Publié par Stony Plain seeking associate to join our team. We practice. Located on the waterfront in Ganges on l’Association dentaire canadienne steady patient flow, new family and emergency CLASSIFIEDS are located half an hour west of Edmonton in a Salt Spring Island, BC, Canada’s Hawaiian island. patients, are a hallmark of all our established Three operatories in a modern progressive OfficesOffices & Practices & Practices a positive role model for the office. Excellent dental practices. Part-time and full-time community-oriented town. Successful candidate Orders and Enquiries to: atmosphere with potential long-term people and communication skills are a must. positions available, flexible hours. Please reply will enjoy “small town by big city living”, and BRITISH COLUMBIA: FOR SALE: Dental possibilities. The island has all the amenities John Reid, ext. 23 We are looking for someone who is hungry to in confidence to: [email protected] working with children and the elderly. We are clinic in the mountains of rural BC with offering 3 days per week, increasing to full- including a hospital and schools K through 12. [email protected] learn about all aspects of dentistry. With several with your CV or resume. D11687 exceptional staff. Currently run as a satellite time, with excellent earning potential, friendly It is a relaxing, safe environment surrounded c/o Keith Communications Inc., experienced dentists at our offices, mentorship clinic two days per week, but I am getting by natural beauty. For more information and 1464 Cornwall Road, Unit 8, 2nd Floor is a big part of what we have always offered to ALBERTA - Grande Prairie: Full-time staff, and loyal patients. Interest in aesthetics, too busy with my other office to maintain Oakville, ON L6J 7W5 our associates. Key focuses in our practice are associate position at West Grande Prairie Dental. implants, and/or IV sedation would be a rapid pictures, visit our Salt Spring Dental Facebook it. Excellent opportunity for first-time buyer If you are tired of treading water with little practice-builder. In-office childcare is available. page. Call Bob at (250) 537-6846, or email: Tel: 1-800-661-5004 or 905-849-7777 comprehensive dentistry, maintaining a positive with low investment and overhead costs and D12305 Placement of ads by telephone not accepted. and fun work environment, and creation of a professional growth, join our bustling practice Please email: [email protected] with your [email protected]. potential for immediate growth beyond the to be fully booked from day one. Use the coolest resume. D10977 Send all box number replies to: fantastic patient experience. We are looking BRITISH COLUMBIA - Vancouver: two days/week. Huge potential for longer tech in the industry in our brand-new, fully Box...JCDA for someone who can get onboard with these Rare opportunity! Pediatric dentist required term growth with the announcement of new digitalized facility, which includes a Cone Beam ALBERTA - Strathmore: Let’s Do It Right 1464 Cornwall Road, Unit 8, 2nd Floor values and be a part of what we think is a for a full-time associate position available in industry starting construction this summer. CT and Cerec 3. Receive mentorship in surgery, Together! Associate dentist needed for Strathmore/ Oakville, ON L6J 7W5 phenomenal team! Partnership/ownership the heart of Vancouver and lower mainland Older equipment but lovingly maintained and implants, orthodontics, pediatrics, or enjoy the Alberta only half an hour away from Calgary. FT The names and addresses of advertisers using box numbers is an option for the right candidate. If you are B.C. Live and work in beautiful Vancouver. are held in strict confidence. fully functioning. Listed at $250,000 but want freedom of practicing dentistry your way. Travel position; no evenings; the right candidate will have interested in speaking with us further, please We are a well-established and growing clinic to see the clinic, staff and patients left in good easily with one hour direct flights to Edmonton busy days working with a very caring and motivated email your CV/resume to: albertadentalclinic@ with great staff with training in sedation. hands. Will consider any offers. Interested or Calgary, six weeks vacation time and a travel group of dental professionals. This is a modern Display Advertising Rates gmail.com. D11173 Modern and completely digitized clinic with parties please email: [email protected] allowance. Practice great dentistry, expand your practice with lots of toys to play with that seeks a Column, Size W H Cost skilled dentist who is good at working efficiently access to GA facility. Please email your CV to: for more information. D12342 ALBERTA - Calgary: We are a busy skills and be compensated amongst the top 3 column, full page 6 13/16 9 3/8 $2575 with the team. Endo and surgical competency is an [email protected]. D12194 and thriving dental practice located 30 dentists in the country - this position is a dream. 2 column, full page 4 ½ 9 3/8 $1700 BRITISH COLUMBIA - Nelson: Live in asset. Please contact: strathmoreassociatedentist@ minutes outside of Calgary. We are looking Please contact Greg Broyde at gregbroyde@ MANITOBA - Thompson: Full-time, 1 column, full page 2 1/8 9 3/8 $1460 idyllic Nelson, BC, Southern Interior. Established gmail.com. D12335 for an energetic, intrinsically-driven and gmail.com. D11940 energetic, detail-oriented associate needed 3 column, ½ page 6 13/16 4 5/8 $1460 over 30 years, 3-operatory family practice 2 column, ½ page 4 ½ 4 5/8 $1120 team-oriented dentist. Excellent people BRITISH COLUMBIA - Cranbrook: immediately for established, busy family for sale. Office real estate includes modern ALBERTA - Grande Prairie: A full-time 2 column, 1/3 page 4 ½ 3.0 $1120 and communication skills are a must. Key Wanted: Associates part-time and full-time practice with high income potential up to 3-bedroom apartment. Nelson - a vibrant associate needed for Grande Prairie Family 3 column, 1/3 page 6 13/16 3.0 $1120 focuses in our practice are comprehensive for long-established, recently updated and $25,000 per month. Enjoy a fully booked community with beautiful beaches, all the Dental Centre starting middle of April 2017. Also 2 column, ¼ page 4 ½ 2 ¼ $960 dentistry, maintaining a positive and fun work thriving general family practice in beautiful East schedule and ability to reach your goals as 3 column, ¼ page 6 13/16 2 ¼ $960 city amenities without the stress; 20 minutes need a full-time associate for Roy & Kali Family environment, and creation of a fantastic patient Kootenay Valley, Cranbrook, BC. Applicants must a dental professional. Experience preferred. from renowned ski resort, Whitewater. Email: Dental Centre starting July 2017. Both offices experience. We are looking for someone who be motivated and comfortable with all aspects of Excellent opportunity. New grads welcome. [email protected]. D12318 are busy and offer all aspects of dentistry. If Regular Classified Rates can get on board with these values. We have dentistry. Email: [email protected]. D12385 Email CV: [email protected], phone: the option of FT or PT. If you are interested in you are trustworthy, friendly and committed to ONTARIO - Greater Toronto Area: (204) 939-0083. D12337 $265 for the first 50 words or fewer, speaking with us further, please email your CV/ excellence please contact Dr. Roy at: (780) 539- BRITISH COLUMBIA - Nanaimo: General each additonal word $1.55 Practice wanted! Altima Dental Canada seeks to resume to: [email protected]. D11652 6883 or [email protected]. D12210 dental practice in Nanaimo seeking a part-time MANITOBA - The Pas: Associate wanted purchase practices within 1 hour of the Greater For colour add $255 associate. Busy, well-established, modern, for brand new, state-of-the-art dental clinic Toronto Area. Thinking about selling? Contact ALBERTA - Spruce Grove: Are you All advertisements must be prepaid. ALBERTA - Calgary: Busy general digital, CAD/CAM enabled practice. Great team located in The Pas, Manitoba. We are a us about our exciting purchase incentives. For a professional, patient-centred individual practice in Calgary requires full-time/part-time environment. 1-3 days per week. Please forward paperless, modern office offering digital x-rays, 10% discount to dentists who are members of a with strong communication skills and a team more information visit our website at www. associate. Digital office. New grads welcome. inquiries to Cedar Valley Dental Centre: cvdc@ CBCT, N2O, etc... Excellent remuneration and CDA Corporate Member association (10 provincial/ altima.ca or email us at [email protected]. D9501 player mindset? If so, our office might be in Some extended hours expected. Confidentiality shaw.ca. D12344 excellent staff. Please contact Laura at: (204) territorial dental associations) or an affiliate YOUR future! Our busy, well-established (individual) member of CDA in Quebec. assured. Inquire: [email protected]. D12364 623-1999 or Laura@springhilldentalthepas. dental practice in Spruce Grove is seeking a BRITISH COLUMBIA - Kimberley: Positions Available com. D12398 * Ads are published in the language of submission. ALBERTA - Edmonton: Smiles Dental PT associate 1-2 days/week to start, with the Seeking a full-time associate to join our modern, ALBERTA: We are a busy and thriving group Group is seeking a compassionate, ambitious, potential to grow to FT. Located in a prime, family-oriented dental practice. Large established NEW BRUNSWICK - Fredericton: Full- Visit of dental practices looking for an energetic, patient-friendly dental associate who is proficient high exposure location, our office is completely patient base with excellent staff. Kimberley is time associate required in a well-established jcda ca intrinsically driven and team-oriented dentist. in many areas of general dentistry, and has strong digital, well trained, long standing staff, and a great place to raise a family and to enjoy the 5-operatory practice. Previous associate retired. ESSENTIAL DENTAL KNOWLEDGE for more classified ads We are looking for a true leader who will be communication skills. A preventative restorative great opportunity to build on present patient outdoors. The community offers a great lifestyle No evenings or weekends required. Our team Published by The Canadian Dental Association 40 jadc| 20172017 | |Issue Issue 4 4 2017 | Issue 4 | 41 DES CONNAISSANCES DENTAIRES INDISPENSABLES

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philosophy is an asset. Our clinics are modern flow. No weekends/evenings. New grads with skiing, fishing, boating, hiking and camping (renovated or new), digital (x-rays, CBCTs, PAN/ welcome. For more information, please email all within minutes of town. Please forward Ceph, paperless charting), and our highly-trained resume and cover letter, with references, to: resume to: [email protected]. D11789 team is ready to support the successful candidate [email protected]. D12295 BRITISH COLUMBIA - Salt Spring in providing quality dentistry and achieve their Island: Associate position in busy family production goals. Established clinics, with ALBERTA - Stony Plain: Group practice in practice. Located on the waterfront in Ganges on steady patient flow, new family and emergency Stony Plain seeking associate to join our team. We Salt Spring Island, BC, Canada’s Hawaiian island. patients, are a hallmark of all our established are located half an hour west of Edmonton in a Three operatories in a modern progressive dental practices. Part-time and full-time community-oriented town. Successful candidate atmosphere with potential long-term positions available, flexible hours. Please reply will enjoy “small town by big city living”, and possibilities. The island has all the amenities in confidence to: [email protected] working with children and the elderly. We are offering 3 days per week, increasing to full- including a hospital and schools K through 12. with your CV or resume. D11687 time, with excellent earning potential, friendly It is a relaxing, safe environment surrounded ALBERTA - Grande Prairie: Full-time staff, and loyal patients. Interest in aesthetics, by natural beauty. For more information and associate position at West Grande Prairie Dental. implants, and/or IV sedation would be a rapid pictures, visit our Salt Spring Dental Facebook If you are tired of treading water with little practice-builder. In-office childcare is available. page. Call Bob at (250) 537-6846, or email: professional growth, join our bustling practice Please email: [email protected] with your [email protected]. D12305 to be fully booked from day one. Use the coolest resume. D10977 BRITISH COLUMBIA - Vancouver: tech in the industry in our brand-new, fully Rare opportunity! Pediatric dentist required digitalized facility, which includes a Cone Beam ALBERTA - Strathmore: Let’s Do It Right for a full-time associate position available in CT and Cerec 3. Receive mentorship in surgery, Together! Associate dentist needed for Strathmore/ the heart of Vancouver and lower mainland implants, orthodontics, pediatrics, or enjoy the Alberta only half an hour away from Calgary. FT B.C. Live and work in beautiful Vancouver. freedom of practicing dentistry your way. Travel position; no evenings; the right candidate will have We are a well-established and growing clinic easily with one hour direct flights to Edmonton busy days working with a very caring and motivated with great staff with training in sedation. or Calgary, six weeks vacation time and a travel group of dental professionals. This is a modern Modern and completely digitized clinic with allowance. Practice great dentistry, expand your practice with lots of toys to play with that seeks a access to GA facility. Please email your CV to: skills and be compensated amongst the top skilled dentist who is good at working efficiently with the team. Endo and surgical competency is an [email protected]. D12194 dentists in the country - this position is a dream. asset. Please contact: strathmoreassociatedentist@ Please contact Greg Broyde at gregbroyde@ MANITOBA - Thompson: Full-time, gmail.com. D12335 gmail.com. D11940 energetic, detail-oriented associate needed BRITISH COLUMBIA - Cranbrook: immediately for established, busy family ALBERTA - Grande Prairie: A full-time Wanted: Associates part-time and full-time practice with high income potential up to associate needed for Grande Prairie Family for long-established, recently updated and $25,000 per month. Enjoy a fully booked Dental Centre starting middle of April 2017. Also thriving general family practice in beautiful East schedule and ability to reach your goals as need a full-time associate for Roy & Kali Family Kootenay Valley, Cranbrook, BC. Applicants must a dental professional. Experience preferred. Dental Centre starting July 2017. Both offices be motivated and comfortable with all aspects of Excellent opportunity. New grads welcome. are busy and offer all aspects of dentistry. If dentistry. Email: [email protected]. D12385 Email CV: [email protected], phone: you are trustworthy, friendly and committed to (204) 939-0083. D12337 excellence please contact Dr. Roy at: (780) 539- BRITISH COLUMBIA - Nanaimo: General 6883 or [email protected]. D12210 dental practice in Nanaimo seeking a part-time MANITOBA - The Pas: Associate wanted associate. Busy, well-established, modern, for brand new, state-of-the-art dental clinic ALBERTA - Spruce Grove: Are you digital, CAD/CAM enabled practice. Great team located in The Pas, Manitoba. We are a a professional, patient-centred individual environment. 1-3 days per week. Please forward paperless, modern office offering digital x-rays, with strong communication skills and a team inquiries to Cedar Valley Dental Centre: cvdc@ CBCT, N2O, etc... Excellent remuneration and player mindset? If so, our office might be in shaw.ca. D12344 excellent staff. Please contact Laura at: (204) YOUR future! Our busy, well-established 623-1999 or Laura@springhilldentalthepas. dental practice in Spruce Grove is seeking a BRITISH COLUMBIA - Kimberley: com. D12398 PT associate 1-2 days/week to start, with the Seeking a full-time associate to join our modern, potential to grow to FT. Located in a prime, family-oriented dental practice. Large established NEW BRUNSWICK - Fredericton: Full- high exposure location, our office is completely patient base with excellent staff. Kimberley is time associate required in a well-established digital, well trained, long standing staff, and a great place to raise a family and to enjoy the 5-operatory practice. Previous associate retired. great opportunity to build on present patient outdoors. The community offers a great lifestyle No evenings or weekends required. Our team

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EXPERT ADVICE CONFIDENTIALITY RECORD SALE PRICES NO CONFLICT OF INTEREST

These are just a few of the reasons why you should have a Broker involved! Many people claim they can sell your practice. This does not mean that you will extract the most value from your hard work and it certainly doesn’t mean that it will be a seamless process.

When selling your practice, it is critical to ensure that you receive fair market value and that you maintain your dignity through the process.

Before you make a decision that will affect your most valuable asset, contact ROI Corporation Brokerage (888) 764 - 4145.

roicorp.com

D12207

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includes one other dentist, two hygienists, three graduate or established doctor we want to base and comfortable work environment. The assistants, one office manager and 2 admin hear from you! If you are looking for a modern office is equipped with intra-oral cameras, assistants. We are seeking a compassionate and clinic with an extraordinary culture that values iTERO digital impression, rotary endo, diode conscientious dentist who will complete this patient care, and having FUN at work, then lasers, digital x-rays and paperless charting. team. Email: [email protected]. D11925 please forward on your resume and cover letter Our dedicated team includes hygienists, to: [email protected]. D11914 assistants, administrative assistants, treatment ONTARIO: Progressive orthodontic offices coordinators and hygiene coordinator. We ONTARIO - Toronto: Part-time dentist located 1 hour west of Toronto looking for an are seeking a highly-skilled, motivated, required for Sundays in large, well-established, associate 3-4 days per week. Please email conscientious and compassionate individual D12387 family-oriented dental practice. Modern office resume to: [email protected]. proficient in general dentistry who is focused on with a value-driven environment. Email: patient-centred care and will complement our ONTARIO - Belleville: Well-established [email protected]. D12287 patient base, supported by a talented team team. Please forward resume to: tango626@ of professionals is seeking a passionate full- PRINCE EDWARD ISLAND: Associate hotmail.com. D11892 time/part-time associate to join our team in dentist required immediately for a busy family SASKATCHEWAN - Regina: Our pediatric Belleville. Replacing another dentist who has practice. Enjoy a full schedule while working in dental clinic is currently seeking a highly- been very busy. Expected production of 3-5K a newly constructed, bright and spacious clinic motivated associate to join our dental clinic. The per day and you will be busy from day one. with an exceptional team. Clinic houses 3 dental ideal candidate would have the opportunity to This ideal candidate must be enthusiastic, and 2 hygiene operatories and is home to over deal with a variety of kids’ dental cases with the dynamic, conscientious and work well in a 6500 patients. Located in beautiful western PEI, potential for future opportunities to work in an team environment. 2 years or more experience one can enjoy a variety of leisure activities as operating room setting. General Practitioners preferred. Please forward resume to: world-renowned golf and breathtaking scenery are also welcome to apply. Please send your [email protected]. D12390 are within arms reach. Perfect opportunity for either a new grad or seasoned practitioner. For resume to: [email protected]. D12277 ONTARIO - Kingston: Live and work in more information please contact: dr.r.ramsay@ SASKATCHEWAN - Swift Current: the beautiful city of Kingston that offers you gmail.com or (902) 859-2366 (West Prince Alpine Dental is looking for a dentist that a different lifestyle. Waterfront living with Dental Clinic). D11743 shares our philosophy of meeting the needs of beautiful parks in a historic city vibrant with patients. Will be taking over from a fully busy arts, entertainment and culture. We are now PRINCE EDWARD ISLAND - retiring partner. Buy-in opportunity available. hiring a full-time Associate Dentist for our very Charlottetown: Welcome to the birthplace Great family community and economy. Please busy, successful practice with an established of Canada! Well-established dental practice patient base in Kingston supported by a talented centrally located in the beautiful capital city of contact Alpine Dental at: (306) 773-2366 or team of professionals. Apply: www.altima.ca Charlottetown, Prince Edward Island is seeking [email protected]. D12395 a full-time associate to join our busy general and click on ‘Join our Team’ or via email at hr@ UNIVERSITY OF SASKATCHEWAN: dentistry practice. Must be patient focused, altima.ca. D11873 Faculty Position, College of Dentistry. The College have great communication skills and work well of Dentistry invites applications from qualified ONTARIO - Ottawa: Associate dentist in a team environment. We are computerized, individuals for a full-time tenure-track faculty is required for February 2017 to assume an fully digital and have long-term staff to support position in Periodontics. The successful candidate existing practice in a busy state-of-the-art your day-to-day needs. Prince Edward Island is will be required to deliver didactic, pre-clinical Ottawa group practice that has a commitment a beautiful place to live and raise a family. Our and clinical teaching; supervise student research to providing the best care possible through community offers plenty of outdoor activities projects; initiate, lead and participate in research extensive continuing education. The ideal year-round such as skiing, fishing, hiking, activities; compete successfully for external funding candidate is enthusiastic and caring with camping, and golf. We have great restaurants to support this research program; and undertake good communication skills and an interest in and have the most beautiful beaches relevant administrative activities including continual learning. Please email resume to: surrounding our entire province. New grads meetings and committee work. Opportunity [email protected]. D11905 welcome to apply. For further information or to apply for this amazing opportunity, please email to engage in the College’s faculty practice clinic ONTARIO - Toronto: WANTED: Well- your resume to Marsha Delodder at: marsha@ is also available. We seek candidates who have rounded Paediatric Dentist for established and graduate specialty training in Periodontics at the beldental.com. D12328 growing paediatric dental clinics, in and around Masters or PhD level or equivalent; an interest Toronto, Canada. Offering exceptional first year SASKATCHEWAN - Regina: Full-time and ability to engage in scholarly activities as earnings; additional signing bonus and moving associate needed for a well-established practice evidenced by established or developing research expenses may be available. If you are a recent with a committed and long-term patient initiatives; a strong or emerging research program;

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demonstrated effective classroom teaching skills detailed curriculum vitae, three letters of reference, this research program; and undertake relevant and mentorship; a minimum of two years of and any supporting documents including proof administrative activities including meetings and post-graduate clinical experience in periodontics; of education, notarized, translated (English) committee work. Opportunity to engage in the experience in treating medically complex patients; copies of undergraduate and graduate degrees College’s faculty practice clinic is also available. We and effective interpersonal and communication to: Dr. Gerry Uswak, Dean, College of Dentistry, seek candidates who have completed graduate skills. Preference will be given to those who have 105 Wiggins Road, University of Saskatchewan, specialty training in Oral and Maxillofacial passed the National Dental Specialty Examination Saskatoon, Saskatchewan, S7N 5E4, Telephone: Radiology at the Masters or PhD level or equivalent; in Periodontics administered by the Royal College (306) 966-5121, Fax: (306) 966-5132, email: have a strong or emerging research program; have of Dentists of Canada and are certified by the [email protected]. Applications will be demonstrated effective classroom teaching skills American Board of Periodontology. Candidates accepted and evaluated until the position is filled. and mentorship and possess effective written, must be licensed or eligible for licensure by the Anticipated start date is July 1, 2017. Electronic verbal and interpersonal skills. Candidates must College of Dental Surgeons of Saskatchewan (CDSS) submissions by email are preferred. The University also demonstrate a commitment to embracing the and are encouraged to familiarize themselves with of Saskatchewan thanks all applicants for their latest evidence-based developments in imaging Saskatchewan licensing requirements: http:// interest; however, only applicants selected for technologies. The successful candidate must have www.saskdentists.com/licensing. Candidates interviews will be contacted. The University passed the National Dental Specialty Examination who are graduates from non-accredited dental of Saskatchewan is strongly committed to a (NDSE) in Oral and Maxillofacial Radiology training programs must achieve National Dental diverse and inclusive workplace that empowers administered by the Royal College of Dentists of Examining Board of Canada certification (http:// all employees to reach their full potential. All Canada, or be eligible to apply for this examination www.ndeb.ca) and/or Royal College of Dentists of members of the university community share a by having completed a specialty training program in Canada Fellowship http://www.rcdc.ca) to achieve responsibility for developing and maintaining an Oral and Maxillofacial Radiology that is accredited by tenure. All candidates are encouraged to familiarize environment in which differences are valued and the Commission on Dental Accreditation of Canada themselves with these processes. Additional inclusiveness is practiced. The university welcomes (CDAC) or the Commission on Dental Accreditation information can be found at the Canadian applications from those who will contribute to the (CODA) in the United States. Candidates must be Information Center for International Credentials: diversity of our community. All qualified candidates licensed or eligible for licensure by the College https://www.cicic.ca. Salary bands for this position are encouraged to apply; however, Canadian of Dental Surgeons of Saskatchewan (CDSS) and are as follows: Assistant Professor - $93,293 - citizens and permanent residents will be are encouraged to familiarize themselves with $112,109; Associate Professor - $112,109 - $130,925 given priority. D12257 Saskatchewan licensing requirements: http:// and Professor $130,925 - $152,877. This position www.saskdentists.com/licensing . Candidates includes a comprehensive benefits package which UNIVERSITY OF SASKATCHEWAN: are encouraged to have or to obtain Fellowship includes a dental, health and extended vision care Faculty Position, College of Dentistry. The College from the Royal College of Dentists of Canada. All plan; pension plan, life insurance (compulsory of Dentistry invites applications from qualified candidates should familiarize themselves with these and voluntary), academic long term disability, sick individuals for a full-time tenure-track faculty processes. Additional information can be found at leave, travel insurance, death benefits, an employee position in Oral and Maxillofacial Radiology. The the Canadian Information Centre for International assistance program, a professional expense successful candidate will be required to deliver Credentials: https://www.cicic.ca. Salary bands allowance and a flexible health and wellness didactic, pre-clinical and clinical teaching; for this position are as follows: Assistant Professor spending program. Interested candidates must supervise student research projects; initiate, lead - $93,293 - $112,109; Associate Professor - $112,109 submit a cover letter that includes a brief statement and participate in research activities; compete - $130,925 and Professor $130,925 - $152,877. of your teaching experience and research interests; successfully for external funding to support This position includes a comprehensive benefits package which includes a dental, health and extended vision care plan; pension plan, life insurance (compulsory and voluntary), academic long term disability, sick leave, travel insurance, death benefits, an employee assistance program, a professional expense allowance and a flexible health and wellness spending program. Interested candidates must submit a cover letter that includes a brief statement of your teaching experience and research interests; detailed curriculum vitae, three D12216 letters of reference, and any supporting documents including proof of education, notarized, translated (English) copies of undergraduate and graduate

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degrees to: Dr. Gerry Uswak, Dean, College Miscellaneous of Dentistry, 105 Wiggins Road, University of Advertisers’ Index Saskatchewan, Saskatoon, Saskatchewan S7N 5E4. INTRAORAL X-RAY SENSOR REPAIR: Telephone: (306) 966-5121, fax: (306) 966-5132, We specialize in repairing Kodak/Carestream, 3M ESPE...... 8 email: [email protected]. Applications Dexis Platinum & Gendex GXS 700. Repair & A-dec...... 13 save thousands over replacement cost. We also will be accepted and evaluated until the position CDSPI ...... 47 is filled. Anticipated start date is July 1, 2017. buy & sell dental sensors. www.RepairSensor. Colgate-Palmolive...... 4 Electronic submissions by email are preferred. The com / (919) 924-8559. D12235 Comprehensive Straight Wire. . 33 University of Saskatchewan thanks all applicants LIMITED PARTNERSHIP UNITS for their interest; however, only applicants selected Garrison Dental Solutions. . . . 16 SOUGHT: Do you own Limited Partnership for interviews will be contacted. The University Johnson & Johnson...... 6 Units you wish to sell? Our company is currently of Saskatchewan is strongly committed to a seeking to purchase Limited Partnership Units. FDI World Dental Congress. . . 34 diverse and inclusive workplace that empowers If you would like more information or to express GC America...... 37 all employees to reach their full potential. All your interest in selling Limited Partnership Kuraray America Inc...... 2 members of the university community share a Units that you own, please email our office at Medicom...... 26 responsibility for developing and maintaining an [email protected] or visit our website at environment in which differences are valued and Philips...... 21 www.phoenixcapital.com for more information inclusiveness is practiced. The university welcomes SciCan...... 10 about our business. D12331 applications from those who will contribute to VOCO...... 48 the diversity of our community. All qualified candidates are encouraged to apply; however, Canadian citizens and permanent residents will be given priority. D12315 UNITED STATES: General Dentists Ask Needed - Multiple States. Familia Dental has Your great opportunities for General Dentists and Orthodontists in Wisconsin, Illinois, Texas, Colleagues Indiana, New Mexico and Iowa. We show our doctors how much we value their skills by offering high compensation with earning potential over $300,000 annually & $500,000 for Orthodontists. Other benefits include sign on/relocation bonuses of up to $30,000, up to three weeks paid vacation, Travel Allowance, License Reimbursement, health insurance, malpractice insurance, Continuing education, and H1B and Permanent residency sponsorship. For more information contact Vito Losuriello 847-915-3019 or send your resume to Doctor@ familiadental.com. D11788

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2017Issue 4| Issue | 2017 4 || 445

Issue_4_CDAessentials_2017_classifieds_EN.indd 45 2017-05-31 9:57 PM Obituaries NEW What more REMEMBERING could you want? DENTISTRY LEADERS You’re a successful professional. You have fulfilling interests and activities beyond your practice. It’s all good. Until it isn’t. DisabilityGuard™ Insurance is a new disability plan that provides more of what you need as a dentist: • Guaranteed premiums to age 65 DR. WILLIAM HOLLINGSHEAD • The terms of the policy are guaranteed for the life of your coverage • Coverage available until age 75 ...and more.

Dr. William Hollingshead of Sylvan Lake, Alberta, passed the Alberta Dental Association and College (ADA+C) in the away on March 21, 2017. He was 63 years old. years that followed, serving as a complaints process advisor and chairing the Program Development Committee. After graduating from the University of Alberta in 1977, Dr. Hollingshead joined Dr. Richard Sandilands in his Edmonton Nationally, Dr. Hollingshead joined CDA’s Committee on the clinic, where he practiced for a year before moving to Uniformed System of Coding and List of Services (USC&LS) Red Deer. There he maintained a solo practice from 1978 in 2005, a committee responsible for maintaining and to 2012, building a close-knit community with both the updating the procedure codes dentists use in their day-to- members of his dental team and his patients. day practice.

Dr. Hollingshead loved dentistry, and it was only natural for Dr. Hollingshead’s contributions to the profession were him to help advance the profession. He became involved celebrated by many organizations. He was a fellow from the with the then Alberta Dental Association, first by serving on International College of Dentists (1996) and the American the Economics Committee (1986–88), and then by sitting College of Dentists (1998), and he recently received the on the Board of Directors (1988–96). He acted as president ADA+C Award of Excellence (2016). You may switch without medical questions of the association in 1994–95. He remained involved with Dr. Hollingshead lived his life with unshakeable gusto. He or tests until July 31, 2017! shared his time between his homes in Sylvan Lake and CDSPI Long Term Disability customers1 Indio (California), enjoying the outdoors and spending time can choose to switch to in the Coachella Valley. In his retirement years, he traveled Access our premium calculator at the world—with many trips bringing him to England. DisabilityGuard™ Insurance.

“Dr. Bill Hollingshead loved life, his family and his profession. Call us to see if you qualify: disabilityguard.cdspi.com He was a consummate professional whose contributions 1-800-561-9401 were broad in scope and meaningful in their impact,” says Dr. Randall Croutze, ADA+C chief executive officer. “His charismatic personality and genuine conviviality will be deeply missed.” DISABILITY Dr. Hollingshead is survived by his three children, Shauna, Brian and Ian, and five grandchildren. a DisabilityGuard™ Insurance is underwritten by The Manufacturers Life Insurance Company (Manulife), DisabilityGuard is a trademark of CDSPI. PO Box 4213 Stn A, Toronto, ON, M5W 5M3 Dr. William Hollingshead (second from right) with children Ian, Shauna and Brian. 1. Clients who are on claim or satisfying an elimination period, or who are not dentists, are not eligible to switch to the DisabilityGuard™ Insurance plan. The information contained here is a summary only. A full description of DisabilityGuard™ coverage and eligibility, including restrictions and limitations is contained in the certificate booklet, which sets out all the coverage terms and conditions. 46 | 2017 | Issue 4 NEW What more could you want? You’re a successful professional. You have fulfilling interests and activities beyond your practice. It’s all good. Until it isn’t. DisabilityGuard™ Insurance is a new disability plan that provides more of what you need as a dentist: • Guaranteed premiums to age 65 • The terms of the policy are guaranteed for the life of your coverage • Coverage available until age 75 ...and more.

You may switch without medical questions or tests until July 31, 2017! CDSPI Long Term Disability customers1 can choose to switch to Access our premium calculator at DisabilityGuard™ Insurance. Call us to see if you qualify: disabilityguard.cdspi.com 1-800-561-9401

DISABILITY

DisabilityGuard™ Insurance is underwritten by The Manufacturers Life Insurance Company (Manulife), DisabilityGuard is a trademark of CDSPI. PO Box 4213 Stn A, Toronto, ON, M5W 5M3

1. Clients who are on claim or satisfying an elimination period, or who are not dentists, are not eligible to switch to the DisabilityGuard™ Insurance plan. The information contained here is a summary only. A full description of DisabilityGuard™ coverage and eligibility, including restrictions and limitations is contained in the certificate booklet, which sets out all the coverage terms and conditions. The New rMgI Restorative

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