JUNE 2013 Management of Antithrombotic Therapy CAD/CAM Technology for Complete Dentures Risk Factors Affecting the Journal Severity of Meth Mouth salt fluoridation You are not a statistic. You are also not a sales goal or a benchmark or a market segment. You are a dentist. And we are The Dentists Insurance Company, TDIC. More than 30 years ago, the small group of CDA dentists who started this company made three promises: to only protect dentists, to protect them better than any other insurance company out there and to be there when you need us. Because with TDIC, you’re a dentist first, last and always. Protecting dentists. It’s all we do.® 800.733.0633 | tdicsolutions.com | CA Insurance Lic. #0652783 June 13 cda journal, vol 41, nº 6 departments 377 The Editor/Back on the Same Page … Maybe Not 381 Impressions 389 CDA Presents 431 Tech Trends 433 Continuing Education 445 Classifi eds 456 Advertiser Index 458 Dr. Bob/Is Anyone Out There? 381 features 394 SALT FLUORIDATION: A REVIEW This paper reviews the evidence of effectiveness in dental caries prevention and risks of dental fluorosis in countries where salt or milk fluoridation is practiced. Howard F. Pollick, BDS, MPH 407 CAD/CAM COMPLETE DENTURES: A REVIEW OF TWO COMMERCIAL FABRICATION SYSTEMS This article provides information on the technology available regarding a potential paradigm shift in the method of fabrication of complete dentures. Mathew T. Kattadiyil, DDS, MDS, MS; Charles J. Goodacre, DDS, MSD, MS; and Nadim Z. Baba, DMD, MSD 417 MANAGEMENT OF ANTITHROMBOTIC THERAPY BEFORE FULL-MOUTH EXTRACTION The management of antiplatelet and anticoagulant therapy before full-mouth extraction is a major concern for dentists. Specific recommendations are provided for antiplatelet therapy before full-mouth extraction. R. Andrew Powless, DMD; Hesham R. Omar, MD; Devanand Mangar, MD; and Enrico M. Camporesi, MD 421 METH MOUTH SEVERITY IN RESPONSE TO DRUG-USE PATTERNS AND DENTAL ACCESS IN METHAMPHETAMINE USERS This study questions whether drug-use patterns and dental care access are risk factors affecting the severity of meth mouth. Ronni E. Brown, DDS, MPH; Donald E. Morisky, ScD, MSPH, ScM; and Steven J. Silverstein, DMD, MPH 429 SALT FLUORIDATION — AN ADJUNCT TO WATER FLUORIDATION A letter about the benefits of salt fluoridation for areas of the country where water fluoridation is not feasible or is cost prohibitive. Jack M. Saroyan, DDS june 2013 375 cda journal, vol 41, nº 6 CDA Journal Volume 41, Number 6 cda.org/journal Journal june 2013 Submitting Stay Connected a manuscript Visit cda.org Journal of the California Advertising Reader Guide: to the Journal? Dental Association Corey Gerhard advertising manager Upcoming Topics Manuscript Submissions There’s a site published by the july: Ethical Dilemmas www.editorialmanager.com/ California Dental Jenaé Gruchow august: Children's Care jcaldentassoc Association project/traffic september: Americans for that. 1201 K St., 14th Floor administrator With Disabilities Act Subscriptions Sacramento, CA 95814 Subscriptions are available Classifi ed Advertising 800.232.7645 Erin Jernigan only to active members of cda.org assistant coordinator cda.org/classifi eds the Association. The subscription rate is $18 and Production Display Advertising Management/Editorial is included in membership Val. B. Mina Corey Gerhard dues. Nonmembers can Kerry K. Carney, DDS, CDE senior graphic advertising manager view the publication online editor-in-chief designer [email protected] at cda.org/journal. [email protected] 916.554.5304 Randi Taylor Change of Address Ruchi K. Sahota, DDS, CDE senior graphic Lett ers to the Editor Manage your subscription associate editor EM designer www.editorialmanager.com/ online: go to cda.org, log in jcaldentassoc and update any changes to Brian K. Shue, DDS, CDE Ann Davis your mailing information. associate editor graphic designer/ Permission and Reprints Email questions or other production artist Andrea LaMatt ina changes to membership@ In fact, from letters to the Peter A. DuBois publications specialist cda.org. executive director editor to reviews, the new California Dental Andrea.LaMatt [email protected] Association 916.554.5950 Jennifer George Lindsey A. Robinson, DDS site is now the only way chief marketing officer president [email protected] to submit anything to the Cathy Mudge Journal of the California Dental Association (issn vice president, Journal of the California James D. Stephens, DDS community affairs 1043-2256) is published monthly by the California Dental president-elect Association, 1201 K St., 16th Floor, Sacramento, CA 95814, Dental Association [email protected] . Alicia Malaby 916-554-5950. Periodicals postage paid at Sacramento, communications Calif. Postmaster: Send address changes to Journal Walter G. Weber, DDS Upload your content, director of the California Dental Association, P.O. Box 13749, vice president Sacramento, CA 95853. [email protected] receive automatic status Andrea LaMatt ina The Journal of the California Dental Association is publications specialist updates, even track Kenneth G. Wallis, DDS published under the supervision of CDA’s editorial staff . secretary Robert E. Horseman, DDS Neither the editorial staff , the editor, nor the association are [email protected] progress anytime day or contributing editor responsible for any expression of opinion or statement of fact, all of which are published solely on the authority of the Clelan G. Ehrler, DDS night. See for yourself at Blake Ellington author whose name is indicated. The association reserves treasurer staff writer the right to illustrate, reduce, revise or reject any manuscript www.editorialmanager.com/ [email protected] submitt ed. Articles are considered for publication on Courtney Grant condition that they are contributed solely to the Journal. jcaldentassoc Alan L. Felsenfeld, DDS communications speaker of the house specialist Copyright 2013 by the California Dental Association. [email protected] Jack F. Conley, DDS Daniel G. Davidson, DMD editor emeritus immediate past president [email protected] 376 june 2013 Editor cda journal, vol 41, nº 6 Back on the Same Page … Maybe Not kerry k. carney, dds, cde n 2009, there was a perturbation in the smooth orbits of dentistry and medicine around the central concept They almost always say, I of prophylactic coverage of joint “What do you think, Doc?” replacement patients undergoing dental treatment. I feel like a planet without an orbit. Ten years ago, the American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association (ADA) jointly published an advisory statement process meets or exceeds all recommended weakest are “strong,” “moderate,” “limited,” on the subject of prophylactic coverage Institute of Medicine (IOM) standards for “inconclusive” and “consensus.” of joint replacement patients. Th eir 2003 the development of systematic reviews Systematic reviews must follow very statement concluded that for patients with and clinical practice guidelines, save one; strict criteria in evaluating evidence. Well- total joint replacements, “Th e risk/benefi t the IOM calls for patient input in the designed, randomized, controlled trials and cost/eff ectiveness ratios fail to justify selection of topics and questions. Th e are not common in the medical/dental the administration of routine antibiotic AAOS did not involve patient input. literature. It is unusual for the reviews to fi nd prophylaxis.”1 Between 2003 and 2009 the Th e AAOS and ADA joint endeavor high-grade, “strong” evidence. Th e resulting medical and dental planets of thought involved outreach for input from many Clinical Practice Guidelines consequently harmoniously orbited the twin principles interested parties: the Infectious Disease may rest on evidence evaluated as belonging of “do no harm now” and “forestall future Society of America, American Association along the weak end of the evidence scale. harm” from antibiotic resistant pathogens. of Oral and Maxillofacial Surgeons, Th e three recommendations in the 2012 In 2009, the AAOS published an American Association of Neurological guidelines are based on evidence graded as Information Statement entitled “Antibiotic Surgeons, American Society of Plastic “limited,” “inconclusive” and “consensus,” Prophylaxis for Bacteremia in Patients Surgeons, Musculoskeletal Infection Society, respectively. With Joint Replacements,” and like the Scoliosis Research Society, American Recommendation 1: Th e practitioner gravitational disruption of a rogue planet, it Association of Hip and Knee Surgeons, might consider discontinuing the practice of caused the two organizations to wobble out Society for Healthcare Epidemiology of routinely prescribing prophylactic antibiotics of synchronicity and consensus.2 Unlike the America, College of American Pathologists for patients with hip and knee prosthetic joint previous joint statement, the 2009 statement and the Knee Society.3,4 implants undergoing dental procedures.3,4 promoted more universal parameters for Th e systematic review of the literature Th e “limited” grade given to this antibiotic prophylaxis. It advised, “Given resulted in three recommendations.3 recommendation rests on evidence the potential adverse outcomes and cost of Th ese recommendations focused on that antibiotic prophylaxis reduces the treating an infected joint replacement, the three diff erent issues with regard to incidence of post-dental procedure related AAOS recommends that clinicians consider patients with joint replacements who are bacteremia,