July 2016 Ancient Dental Calculus Subgingival Microbiome Shifts Caries Pathology Uncultivated Oral Bacteria JournaCALIFORNIA DENTAL ASSOCIATION THE ORAL MMICROBIOME:ICROBIOME: Critical for Understanding Oral Health and Disease Floyd E. Dewhirst, DDS, PhD You are not a statistic. You are also not a sales goal or a market segment. You are a dentist. And we are The Dentists Insurance Company, TDIC. It’s been 35 years since a small group of dentists founded our company. And, while times may have changed, our promises remain the same: to only protect dentists, to protect them better than any other insurance company and to be there when they need us. At TDIC, we look forward to delivering on these promises as we innovate and grow. ® Protecting dentists. It’s all we do. 800.733.0633 | tdicinsurance.com | CA Insurance Lic. #0652783 July 2016 CDA JOURNAL, VOL 44, Nº7 DEPARTMENTS 397 The Editor/Dentistry as an Endurance Sport 399 Letters 401 Impressions 459 RM Matters/Preservation of Property: A Critical Obligation 463 Regulatory Compliance/A Patient’s Right to Access Records Q-and-A 401401 467 Ethics/Undertreatment, an Ethical Issue 469 Tech Trends 472 Dr. Bob/A Dentist’s Guide to Fitness FEATURES 409 The Oral Microbiome: Critical for Understanding Oral Health and Disease An introduction to the issue. Floyd E. Dewhirst, DDS, PhD 411 Dental Calculus and the Evolution of the Human Oral Microbiome This article reviews recent advancements in ancient dental calculus research and emerging insights into the evolution and ecology of the human oral microbiome. Christina Warinner, PhD 421 Subgingival Microbiome Shifts and Community Dynamics in Periodontal Diseases This article describes shifts in the subgingival microbiome in periodontal diseases. Patricia I. Diaz, DDS, PhD; Anilei Hoare, PhD; and Bo-Young Hong, PhD 437 Understanding Caries From the Oral Microbiome Perspective This article discusses how microbiological cultivation, molecular identification, gene expression and metabolomic analyses show the importance of the entire microbial community in understanding the role of the microbiome in the pathology of caries. Anne C.R. Tanner, BDS, PhD; Christine A. Kressirer, PhD; and Lina L. Faller, PhD 447 Uncultured Members of the Oral Microbiome The aim of this review is to list the uncultivated members of the oral microbiome, discuss the reasons why some bacteria are difficult to culture in vitro and describe recent advances in culturing previously uncultivated oral bacteria. William Wade, BSc, PhD; Hayley Thompson, BSc, PhD; Alexandra Rybalka, BSc, PhD; and Sonia Vartoukian, BDS, FDS, PhD JULY 2016 395 CDA JOURNAL, VOL 44, Nº7 Volume 44, Number 7 JournaCALIFORNIA DENTAL ASSOCIATION July 2016 CDA Classifieds. Free postings. published by the Editorial Upcoming Topics Letters to the Editor California Kerry K. Carney, DDS, CDE August/Student Research www.editorialmanager. EDITOR-IN-CHIEF Priceless results. Dental Association September/Pathology com/jcaldentassoc 1201 K St., 14th Floor [email protected] October/Sugar Sacramento, CA 95814 Ruchi K. Sahota, DDS, CDE Subscriptions 800.232.7645 ASSOCIATE EDITOR Subscriptions are available cda.org Advertising only to active members of Brian K. Shue, DDS, CDE Doug Brown the Association. The ADVERTISING SALES CDA Offi cers ASSOCIATE EDITOR subscription rate is $18 and [email protected] is included in membership Kenneth G. Wallis, DDS 916.554.7312 PRESIDENT Floyd E. Dewhirst, DDS, PhD dues. 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All rights reserved. 396 JULY 2016 Editor CDA JOURNAL, VOL 44, Nº7 Dentistry as an Endurance Sport Kerry K. Carney, DDS, CDE hat if we thought of our professional lives as an endurance sport When I was in dental school, one of our instead of a business clinical instructors advised us to never run our career? What if the Wgoal was to stay mentally and physically practices continuously at 80 miles an hour. strong and healthy? What if our primary driver was to remain happy and to continue to enjoy helping our patients achieve and maintain oral health over the decades that veins, now it is hemorrhoids. We all have nutritional guidelines for dentist athletes? span the course of a career in dentistry? taken ergonomic classes that reinforce Maybe we should have spent some time Many practice management courses the need for good posture and healthy studying what we should be eating. What spend a lot of time trying various strategies body mechanics. However, it only takes individualized diet would provide us the to maximize production: the shortest the restoration of the distal aspect of appropriate quantity and quality of calories possible time to return on investment, an upper third molar in a patient with for our level of activity? When should we the most effi cient scheduling to meet restricted opening to know that the dentist be eating and what should we be eating production goals, the minimizing of will assume whatever contorted position to stay alert and relaxed? Caffeinated nonproductive downtime. If the offi ce is necessary to complete the procedure. afternoon pick-me-ups are probably not be open, it should be producing at maximal We buy the aids: head-mounted the best answer for endurance training. potential. Time is money and overhead is lights, stools with armrests and loupes Every sport has a psychological high, so increasing speed and profi ciency for improved vision, but if dentistry aspect. Psychology for the dentist athlete is an obvious goal in order to achieve is an endurance sport, we need to be is complicated. The dentist needs the success. If monetary success is the measure thinking about how to help the body ability to focus on the fi ne motor skills then we run, run, run (or, as my husband strengthen the muscles that are not for performing surgical and therapeutic likes to say, “Work, work only!”). engaged in that habitual position. We interventions but everyday dentistry When I was in dental school, one of need to learn how to stretch and lengthen requires a lot more than that. The dentist our clinical instructors advised us to never those muscles that are always fl exed in needs the kind of team training to be run our practices continuously at 80 miles the dentist’s habitual work position. able to work smoothly and effi ciently an hour. He said we would need to be able In dental school, we spend a lot of with offi ce staff and colleagues. to accelerate our speed when necessary time on head and neck anatomy, but As dentist athletes, we have the added but we needed to maintain a sustainable recently I have had to spend a lot of complication of patient interaction to pace, one that would not wear us out. I time understanding the workings of the consider in our mental training. In order to was reminded of that advice when I was muscles of the back, legs and body core. be able to endure and be happy, we have doing some physical therapy recently. I have learned that the health of the to learn how to compartmentalize some For a career in dentistry to be psoas muscle is critical in those who, like aspects of our interactions with patients experienced as an endurance sport, we dentists, sit for a living.