Académique Documents
Professionnel Documents
Culture Documents
Inside:
New Jerseys Own Maxine Feinberg
to Head American Dental Association
Facial Pain of Non-Odontogenic Origin
New Jersey Dental Establishments
in 2011: After the Last Recession
The Crowd Pleaser.
Nearly one-third of patients with dental benefits are covered by Delta Dental.
Over 54 million Americans rely on the dentists in the national Delta Dental system. If youre already
participating in Delta Dental Premier
Mission Statement:
Departments
4 From Your President
6 Reflections
6 In Memoriam
8 Executive Directors Desk
10 Members in the News
20 Oral Pathology Quiz #81
24 Oral Pathology Quiz Answers #81
37 Classifieds
Articles
9 New Jerseys Own Maxine Feinberg to Head American Dental Association
12 3 Major Obstacles to Going Chartless; and How to Get Around Them!
14 Effects of Smoking on Implant FailureA Review
16 Facial Pain of Non-Odontogenic Origin
22 NJDA Annual Golf Outing Recap
23 Opinion: The Economics of Healthcare and its Implication for Dentistry
26 Five Things to Know About Bruxism
27 Preprocedural Rinsing in the Dental Office: A Consideration for Improved
Infection Control Among the Dental Team and Patients
32 New Jersey Dental Establishments in 2011: After the Last Recession
36 Opinion: New Kid on the Block
3 Volume 84, Number 4
From Your President
Robert A. Giantomas, DMD
W
e all know about our tripartite membership, but there is
a fourth part that is often overlookedthe New Jersey
Dental Political Action Committee (NJDPAC).
NJDPAC is a committee run by dentists that raises money to support
candidates that support our positionnot a party, but our profession. This
is a call to action; I am writing this because we need you to join. Less than
one in three NJDA members belong to NJDPAC. It has been the number
one health PAC in the state for five years but our numbers are dropping.
NJDPAC lets us forge relationships with legislators that drive our agenda
forward, be it stopping mid-level providers, or advancing the assignment
of benefits law. All legislators are important, regardless of whether you
like them personally. NJDPAC affords you the opportunity to avoid
partisan politics, and make it all about the politics of your profession.
Campaigns are expensive, and legislators need to communicate a
message to get reelected. NJDPAC allows us to demonstrate value to
politicians in their time of need. The strength of our PAC distinguishes
NJDA as a leader and a friend against the insurers, attorneys,
environmentalists, and others who seek to change how dentistry is
practiced in New Jersey. It allows us to change our own destiny.
For more information or to join, contact me at rgiantomas@njda.org.
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Volume 84, Number 4 4
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11 Volume 84, Number 4
W
ell, its no secret. Chartless dentistry is coming, fast and
furious! Its not a requirement in dentistry yet (unless 30%
of your practice is treating Medicaid or Medicare patients),
but at some time in the future, its going to be. Lets look at your
practice. Have you started the process of eliminating paper from your
chart yet? If not, it is highly recommended to begin. For eliminating
a chart in an existing practice with hundreds and even thousands of
charts, the process is best done over a longer period of time. Most of
the chartless practices today are new ones, that have been built from
the ground-up to practice electronically. As for the 25-year old practice
that has been pulling, stuffing, and filing charts since its inception, its
going to take some time, and certainly lots of planning.
This is not going to be a how-to article on how to go chartless.
There are just too many variables. A strategy should be developed
with someone that has the proper expertise, like a dental technology
integrator, software trainer, or a practice management consultant. As
for any financial investment that would need to be made, there are
only three main ingredients: an adequate practice management
system, a digital X-ray system, and a computer in the operatories.
Most practices today have all three of these already, making the
transition fairly painless in terms of a monetary investment.
This article, however, is about the obstacles that the typical doctor has
created for himself, in his efforts to move forward, or at least begin the
process. But here is a secret...most dentists dont even realize that they
have already started the process. There are quite a few technologies
that have already been adopted into the practice that have set the ball
rolling, eliminating pieces of the paper chart and turning them into
bits and bytes and ones and zeros. Take for instance, electronic claims.
There was a time when we used to manually fill out a dental claim
form, and then make a copy for the chart. Then there is the innovation
of digital x-ray technology. Almost 75% of practices have already
eliminated x-ray film mounts from their charts. So lets keep it going.
As a dental IT consultant, my daily conversations with clients and
prospects will always lead to a discussion about going chartless. At this
point in the evolution of dental technology it certainly should be a goal
of your practice. If its not, you will do one of two things after reading
this article. You will either call your IT support professional and start
turning the wheels (even at a slow pace), moving your practice more and
more towards chartlessness. Or, you will create one of the three most
popular obstacles for yourself in order to not move forward; stopping the
movement towards eliminating a chart in your practice entirely.
These three obstacles are real, and I hear at least one of them in any
given day. Chances are that you are using one, two, or all three of
these reasons to keep your practice from moving forward. These are
obstacles that you probably have not received good answers to, or
you never asked yourself the question. So, lets address them now,
very simply and adequately.
Obstacle 1: Nervous about losing data or patient records to a crash!
This is a very real concern. Every healthcare provider with a
computer should take this one very seriously. In the industry, we call
this a data breach. And data breaches in the healthcare community
are now subject to huge fines and serious consequences for losing
someones patient record; but thats a different article, for a later
date. Getting past this obstacle though, is very easy. BACK IT UP!
Please take the time out of your busy practice to meet with a skilled
computer professional to design an adequate, full-proof backup strategy.
Your strategy should include at least two backup systems, with at least
one of them having an offsite option. Also, as a chartless office, it is not
only recommended to have a regular backup system, but you should
really make the investment in a Backup/Disaster Recovery (BDR)
system. A BDR will not only backup your data, but it will include
technology that allows you to deploy a backup server if ever needed.
As long as you take this strategy very seriously, and do the research to
learn what your technology support company actually recommends and
supports, you may never have to worry about this obstacle again.
Here are two very important hints for success to make note of: First, test
your backup system, including manually restoring data on a monthly
basis. Second, have the backup system monitored. Most IT firms offer
backup and server monitoring these days.
Obstacle 2: Doctors or staff s computer skills are not adequate.
This is tough one, even tougher than data security. There is a real
human element to this obstacle, which may lead to some tough
3 Major Obstacles to Going Chartless;
and How to Get Around Them!
Jeffrey Weiss
Volume 84, Number 4 12
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decisions about the practices personnel. Computer skills are skills
that are pretty much a standard necessity these days, not only in
dentistry and healthcare, but in any profession. Computers are
here and are not going away. If anything, they are becoming more
involved in our lives. I hear of this obstacle pretty often, and its not
just from the older generation of doctors. We have seen some young
doctors who admit that they have very weak computer skills.
Make no mistake about it, if youre going to have a chartless office, you
are going to either need very good computer skills yourself, or have
staff with very strong computer skills. I have seen many offices get by
with a doctor that did not have the skills to work the computer in the
operatory himself. The routine with his assistant had to be redefined
and adjusted to compensate for the doctors lacking these skills.
Here are two very important hints for success to make note of:
First, get trainingand second, get MORE training. Training has
been such an important factor in successfully transitioning to chartless
dentistry. If you think you know everything that your charting program
can do, wait until you realize what it can do that you arent even aware
of! Furthermore, there are many customizable features in your software
that HAVE to be set up and personalized for you before you even begin.
Obstacle 3: The computers or computer network are slow,
unreliable or not stable.
This one is certainly a deal breaker. If your computers or computer
network are not running smoothly and efficiently, then going chartless
is going to be the most frustrating event of your career. Think about
how frustrating it will be for you, your staff, and your patients if the
digital x-ray system does not fire during an x-ray, or worse yet, the
internet has not been working all week so the office manager has not
been able to send out electronic claims. These events can not only be
annoying, but costly as well, resulting in lost patients or business.
The computers in your office need the same attention, importance, and
relevance to your practice that your other dental equipment has. Your
dental chairs, your compressor, your handpieces, and the x-ray generators,
must all be in tip-top shape to have your operations running smoothly.
So, why not maintain your computers? Computers are machines;
and machines need service on a regular basis in order to not break
down and to keep running smoothly.
To overcome this obstacle it might be time to get some professional
advice from a qualified IT service firm. Many practices do not have
a trusted service firm for their computer networks, but instead have
a part-time, go-to person who is a patient or a friend. We even come
across the Do-It-Yourself computer technician/dentist at times.
For a chartless dental office, here are a few reasons to engage a full-
time, IT professional to maintain your office from here on out:
Reliable response time when a question or issue arises. A typical
response time should be under one hour.
Regular maintenance and updates, as recommended by
the software and hardware manufacturers. It is proven that
computers run better and smoother when manufacturer updates,
patches, and firmware are installed.
Monitoring services, in order to be proactive in catching issues
with hardware as early as possible. Most issues that develop in a
computer or server, if caught early enough, will not result in a
crash or freeze-up.
Help Desk support available during regular hours and the
proper off-hours protocols.
A professional who is aware of and familiar with HIPAA laws,
Hi Tech Act, and now the final Omnibus Rule for healthcare.
So, those are the three most common obstacles that dentists create
in keeping their practices from moving forward with chartless
dentistry. Im sure there are others, however, this would be a good
time to schedule a consultation with your IT support firm or
software vendor to see where your practice is at with your charts.
Then, take that knowledge one step further by putting a plan in
place to slowly start eliminating the paper inside of it. So when
being chartless is required, you will be there already.
About the Author
Jeffrey Weiss is President and partner of High Tech Innovations,
LLC, the largest dental integrator in the tri-state area; currently
supporting 500+ dental practices. High Tech Innovations
prides itself on not only knowing IT and technology, but also
understanding the field of dentistry. They are certified as installers
by most of the largest dental technology companies in the profession
and have recently become an Endorsed Partner of the New Jersey
Dental Association. Weiss can be contacted at (973)889-0030 or
at jeffw@hticonsultants.com.
13 Volume 84, Number 4
Introduction
Implant therapy is highly predictable and successful. However,
certain risk factors can predispose individuals to lower rates of
success. Cigarette smoking has long been known to be associated
with a variety of oral conditions including periodontal disease, bone
loss, tissue loss, tooth loss, edentulism, peri-implantitis and dental
implant failure. Nicotine in tobacco has been shown to reduce the
blood flow in the mouth. Pipe smoking can be worse than cigarettes
due to the higher temperatures generated in the upper jaw. Not only
is smoking detrimental to implants, it is also bad for conventional
bridgework. Smoking affects healing and tissue health in many
ways, including impaired neutrophils, altered blood flow to tissues
and diminshed oxygen perfusion.
Oral Conditions:
1. Periodontal DiseasePeriodontitis is an inflammatory
condition of the periodontium in response to bacterial
pathogens that promote the release of numerous cytokines
and leads to periodontal attachment and bone loss. Twenty
years of research show that cigarette smoking is probably a
true risk factor for periodontitis. A smoker is 2 to 3 times
as likely to develop clinically detectable periodontitis. In
addition to increased prevalence, smokers also experience more
severe periodontal disease. It appears that a history of treated
periodontitis does not adversely affect implant outcome.
3,5,10,11
2. Bone and Tissue lossA study examining the effect of oral burn
syndrome on dental implants indicated that there is a direct link
between oral tissue loss and smoking.
1
In addition, smoking had a
significant impact on bone loss.
7
The most significant differences
regarding implant survival between smokers and nonsmokers
were found in studies that identified and evaluated implants
placed in the maxilla and those placed in grafted sites. It appears
that smoking is a significant risk factor with an adverse effect on
implant survival and success in areas of loose trabecular bone.
11
3. Tooth loss and EdentulismTooth loss and edentulism are
more common in smokers than in nonsmokers.
4
Tooth loss in
older adults occurs because of increased exposure to pathogenic
bacteria. Smoking also predisposes patients to develop more
severe periodontal disease.
2,6
4. Peri-ImplantitisThe formation of deep mucosal pockets
with inflammation of the peri-implant mucosa around dental
implants is called peri-implantitis. Smokers treated with dental
implants have a greater risk of developing peri-implantitis.
This condition can lead to increased resorption of peri-implant
bone. If left untreated, peri-implantitis can lead to implant
failure. In a retrospective study conducted at the University of
Vienna, the peri-implant tissue of smokers and nonsmokers was
compared. The smokers showed a higher score in bleeding index
with greater peri-implant pocket depth and radiographically
discernible bone resorption around the implant, particularly
in the maxilla.
8
Implant surface characteristics can influence
bone-implant contact and may improve implant outcomes. HA-
coated implants can improve the survival or success of implants
in smokers compared with nonsmokers.
11
Smoke Cessation
Former smokers have a lower risk for periodontitis than current
smokers. Smoking cessation will result in improved periodontal
health and improve a patients chance for successful implant
osseointegration.
4,9
Conclusion
The review of this literature demonstrated that smoking has an
adverse affect on implant survival and success. Implant success rates
tend to be lower than survival rates and vary greatly depending on
the criteria used to measure success. Despite these high implant
survival and success rates, there is a general appreciation that risk
factors predispose individuals to more complications and implant
Effects of Smoking on Implant Failure
A Review
Haritha Mikkilineni, MDS
Deepika M. Reddy, DDS
Narendra Jayanth, BDS
Volume 84, Number 4 14
failures, and may result in lower implant survival and success
rates. The effect of smoking on implant survival appeared to be
more pronounced in areas of loose trabecular bone. A history of
treated periodontitis does not appear to adversely affect implant
survival rates but it may have a negative influence on implant
success rates, particularly over longer periods. Whichever course
of treatment patients decide to pursue, they can expect slower
healing and a greater possibility of failure if they continue to
smoke during or following the treatment healing period. If
patients stop smoking three to four weeks prior to implant
placement and remain smoke-free during the healing period,
results may improve. Many of our smoking patients have used
implant treatment as an opportunity to quit smoking altogether.
The dentists can prescribe smoke cessation medications and
products to assist in the quitting process.
References
1. The oral burn syndrome and its effects on dental implants . R.Cullen. J
Oral Implantol 1998;24(4):21921.
2. Periodontal diseases and dental implants in older adults.
Wilson,Higginbottom. J Esthet Dent 1998;10(5):265:71.
3. Surgical determinants of clinical success of osseointegrated oral
implants: a review of the literature. Sennerby, Roos. Int J. Prosthodont
1998 septoct; 11(5):40820.
4. Cigarette smoking and periodontal diseases: etiology and management
of disease. Tonetti. Ann periodontal 1998 Jul;3(1):88101.
5. Biological factors contributing to failures of osseointegrated oral
implants. (II) Etiopathogenesis. Esposito, Hirsch, Lekholm. Thomsen.
Eur J Oral sci 1998 Jun;106(3):72164.
6. Influences of smoking on the periodontium and dental implants. Dent
Update 1997 oct;24(8)32830.
7. A prospective 15 year follow up study of mandibular fixed prostheses
supported by osseointegrated implants. Clinical results and marginal
bone loss. Clin Oral Implants Res 1996 Dec;7(4):32936.
8. The relationship of smoking on peri implant tissue: a retrospective
syudy. Haas R; Haimbock W; Mailath G; Watzek G. J Prosthet Dent
1996 Dec;76(6):5926.
9. Smoking and implant failurebenefits of a smoking cessation protocol.
Int J Oral Mxillofac Implants 1996 NovDec; 11(6):7569.
10. The effect of smoking on early implant failure. DeBruyn, Collaert. Clin
Oral Implants Res 1994 Dec;5(4):2604.
11. INT J Oral Maxillofac Implants 2007;22(suppl):173202.
About the Authors
Haritha Mikkilineni, MDS, is a prosthodontist in Hyderabad, India.
Deepika M. Reddy, DDS, is a member of the NJDA and an associate
dentist at Signature Smiles in Atlantic City, New Jersey. Narendra
Jayanth, BDS, is a general dentist in Anantapur, India.
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15 Volume 84, Number 4
D
entists encounter patients with facial pain every day in
their practices. The most common source of any facial pain
involves that of an odontogenic origin. This would include:
Teeth: caries, periapical pathology, root hypersensitivity,
fractured roots and tooth structure, failed restorations,
periodontal, non-carious lesions, occlusal traumatism
Oral Mucosal Lesions: aphthous, lichen planus, vitral, trauma,
mucous membrane disease
Burning Mouth Syndrome: hormonal influence,
medications, xerostomia
When the dentist or endodontist definitively rules out an
odontogenic source of facial pain, it is prudent to eliminate all other
possible considerations. Too often a TMJ/TMD origin is considered
without thoroughly investigating other possible non-odontogenic
sources of facial pain.
Facial Pain of Non-odontogenic Source:
Myogenous: Muscle spasm or edema; ligamentous or tendinous strain
Cervicogenic: Upper cervical spine misalignment involving Atlas bone
Neural and Vascular CompressionCervico-Trigeminal nerve
convergence pain into face
Neurogenous: Associated with Trigeminal, facial & sympathetic
nervous system dysregulationsNeurological (conditions of the
brain), Multiple sclerosis
Vascular/Glandular: Temporal arteritis, Vascular compression,
Glandular disease (Parotid and Submaxillary) Arthrogenous
(Structural Displacement TMJ): TMJ with disc displacement,
Condylar bone changes
Neoplastic (Obstructive): Neoplasm
Referred Source: Otologic, Paranasal Sinuses, Cardiac
We can consider a TMJ source if the patient presents with:
Temporal and frontal headaches
Preauricular and masseteric region pain
TMJ clicking and popping
Ear ringing and clogging
Sensitive teeth.
It is often thought that patients develop facial pain from bruxism.
However, grinding of the teeth can be a manifestation of an existing
structural problem. It may also develop from sources other than a
TMJ dysfunction.
The upper cervical spine is very typically misaligned in patients that
have a TMJ dysfunction. Often the same trauma that causes a TMJ
disc displacement can cause atlas misalignment. Atlas misalignment
contributes to subluxation and compression of the upper cervical
nerves. There is a convergence of the upper cervical nerves and
trigeminal nerve in the trigeminal nucleus caudalis. Therefore, facial
pain from an upper cervical spine source is very common due to this
convergence pattern.
There are several conditions where patients present with facial pains
and symptoms that mimic that of a TMJ source. Therefore, when
a primary TMJ source of pain is suspect, other conditions to
consider include Chiari malformation. This is a condition that
can be both congenital and acquired where the cerebellar tonsils
are located below the foramen magnum into the spinal cord.
Symptoms include headache, neck pains, dizziness, changes in
the gait, ear ringing and tingling into the face. (Fig.1)
A typical incidental finding would include styloid elongation. This
is a condition whereby the styloid bony process appears to be longer
than usual. The stylomandibular ligaments and/or the stylohyoid
ligaments undergo calcification and ossification and appear bone
like. Typical symptoms are preauricular pain, dizziness especially
with head turning, pain with swallowing and extending the tongue
and pain in the teeth. (Fig. 2)
Neurogenous pain sources would include trigeminal neuropathic
pain as in trigeminal neuralgia, herpetic or post-herpetic neuralgia,
(Fig. 3) multiple sclerosis and neoplasm. (Fig 4) Neurogenous pains
are typically described as sharp, shooting, stabbing, electric like,
tingling with numbness into the face and teeth unilaterally. These
can be of short duration and intermittent with pain-free episodes.
Facial Pain of Non-Odontogenic Origin
Louis R. Vita, DDS, FAGD
(Fig.1)
(Fig.2)
Volume 84, Number 4 16
An infectious source can be that of otalgic, mastoid (Fig. 5) or sinus
pathology. It is common for sinus disease, ear infections and cardiac
conditions to refer pain into the face.
Another common complaint of facial pain involves a dysregulation
of the sympathetic nervous system. Commonly thought of as Reflex
Sympathetic Dystrophy, this condition is now referred to as Facial
Complex Regional Pain Syndrome, i.e., Facial CRPS. When there is
a disturbance in the sympathetic nervous system, patients can present
with constant burning pain in multiple areas of the head, face and
neck. Dental implications of Facial CRPS include hypersensitivity
of the teeth especially to cold, pulpal edema and pain even without
obvious dental causes as caries or large fillings, painful dental injections
from an exaggerated reaction to the stimuli, swelling and pain in the
gingiva, cheeks and nasal cavities (congestion). There can be oral and
tropic skin changes with tooth discoloration. Facial CRPS would
typically contribute to a reduced mandibular range of motion, tremors,
dystonia and parafunction as with bruxism and nebulous occlusion in
which maximum intercuspation position is not reproducible.
Therefore, when a patient presents with facial pain, the potential
odontogenic source must be initially eliminated. Once the health of
the oral cavity is determined, all other systems and conditions can
be investigated.
References
1. Mayo Foundation for Medical Education and Research (MFMER);
19982013
2. Zohar et al. 1986, Krennmair et al. 1994 Symptoms of
Styloid Elongation.
3. Janetta, Peter: Trigeminal Neuralgia, Oxford University Press, Inc.
2011. Diagnostic Criteria for Trigeminal Neuralgia; Table 7.1
Page 75
4. Melis, M et al. Complex Regional Pain Syndrome in the head and neck:
a review of the literature. J Orofac Pain 2002 Spring; 16(2): 93104
About the Author
Louis Vita, DDS, FAGD, has a general, family practice in Clifton, NJ.
He established and directs the Vita Head, Neck & Facial Pain Relief
Center and is a recognized authority on the subject. Dr. Vita serves as
an attending dentist and lecturer at Hackensack University Medical
Centers Dental Department where he instructs the residents in dentistry
and TMJ disorders.
(Fig.3)
(Fig.4)
(Fig.5)
17 Volume 84, Number 4
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WEDNESDAY, MARCH 19, 2014
THURSDAY, MARCH 20, 2014
THE SHERATON MAHWAH. MAHWAH, NEW JERSEY
Two full days of education
Morning, afternoon and evening seminars
Commercial Exhibits
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Free Breakfast and Free Buffet Lunch
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EXHIBIT HOURS: 9:30 a.m. to 7:00 p.m.
CONTINUING EDUCATION CREDITS WILL BE GIV-
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28th Annual
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Sponsored by
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1. MATERIALS AND ESTHETICS
Dr. George Bambara
Dr. David Clark
Dr. Howard Glazer
Dr. Richard Trushkowsky
Dr. Arthur Volker
Dr. Carlos Alfonso
2. ENDODONTICS
Dr. Douglas Lambert
Dr. J effrey Linden
3. PROSTHETICS
Dr. Michael DiTolla
4. PRACTICE MANAGEMENT
Dr. Matthew Krieger
Linda Lakin, RDH, MS
Christine Taxin
5. TECHNOLOGY
Dr. Paul Feuerstein
Dr. Gary Severance
6. INFECTION CONTROL
Dr. Harold Edelman
2014 Partial List of Speakers
7. RISK MANAGEMENT
Dr. Robert Peskin
Amy Kulb, Esq.
8. PATHOLOGY
Dr. Alvin Heller
Olga Ibsen, RDH, MS, FAADH
9. MEDICAL EMERGENCIES
Dr. Stanley Malamed
10. OPERATIVE
Dr. J oel Berg
11. DENTAL ASSISTING
Shannon Pace Brinker, CDA, CDD
12. FINANCE
Mr. W. Michael Prendergast
For further information, contact:
The Bronx County Dental Society
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email: bronxdental@optonline.net
Website: www.bigappledentalmeeting.us
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WEDNESDAY, MARCH 19, 2014
THURSDAY, MARCH 20, 2014
THE SHERATON MAHWAH. MAHWAH, NEW JERSEY
Two full days of education
Morning, afternoon and evening seminars
Commercial Exhibits
$25/$10 Discount Coupons for Purchases at the
Meeting
Free Parking: Indoors and Outdoors
Free Breakfast and Free Buffet Lunch
For Full Day Seminars
EXHIBIT HOURS: 9:30 a.m. to 7:00 p.m.
CONTINUING EDUCATION CREDITS WILL BE GIV-
EN TO ALL ATTENDEES. THESE CREDITS WILL BE
APPLICABLE FOR DENTIST AND DENTAL HYGIENIST RE-
QUIREMENTS AS ALLOWED BY STATE LAW.
SPECIAL BONUS FOR
ATTENDING OUR SEMINARS
A $25 exhibitors coupon will be given to each dentist for attend-
ing a full-day seminar and a $10 coupon to each dentist attending
a half-day or evening seminar. When presenting your $25 or $10
coupon for full day, half day and evening paid seminars any
purchase made at the exhibitors booth will be discounted at the
$25 or $10 rate. You will receive a coupon for every paid course
that you attend and no minimum purchase is required!
28th Annual
BIG APPLE
DENTAL MEETING
Sponsored by
The Bronx County Dental Society
1. MATERIALS AND ESTHETICS
Dr. George Bambara
Dr. David Clark
Dr. Howard Glazer
Dr. Richard Trushkowsky
Dr. Arthur Volker
Dr. Carlos Alfonso
2. ENDODONTICS
Dr. Douglas Lambert
Dr. J effrey Linden
3. PROSTHETICS
Dr. Michael DiTolla
4. PRACTICE MANAGEMENT
Dr. Matthew Krieger
Linda Lakin, RDH, MS
Christine Taxin
5. TECHNOLOGY
Dr. Paul Feuerstein
Dr. Gary Severance
6. INFECTION CONTROL
Dr. Harold Edelman
2014 Partial List of Speakers
7. RISK MANAGEMENT
Dr. Robert Peskin
Amy Kulb, Esq.
8. PATHOLOGY
Dr. Alvin Heller
Olga Ibsen, RDH, MS, FAADH
9. MEDICAL EMERGENCIES
Dr. Stanley Malamed
10. OPERATIVE
Dr. J oel Berg
11. DENTAL ASSISTING
Shannon Pace Brinker, CDA, CDD
12. FINANCE
Mr. W. Michael Prendergast
For further information, contact:
The Bronx County Dental Society
718-733-2031 718-733-0186 (fax)
email: bronxdental@optonline.net
Website: www.bigappledentalmeeting.us
Secure
online registration
on our website.
Oral Pathology Quiz #81
Presented by Rutgers School of Dental Medicine Biopsy Service
The NJDS oral pathology faculty are showing the clinical presentation of some relatively common lesions for readers to self-evaluate
their skills in clinical differential diagnosis. You are expected to choose the most likely clinical diagnosis on the basis of history and
clinical or radiographic appearance with the appreciation that definitive diagnosis requires microscopic examination of the specimen.
Case Number 1 Figures 1 and 2: Courtesy Drs. Daynet Fraga and Maano Milles, Rutgers University
A 32-year-old man complained of a painless swelling in his mouth, which he
said had been present for about a month. The dome-shaped lesion appeared
to arise from the left maxillary ridge, in the area of the premolars that had
been extracted 3 months previously. The enlargement was relatively soft in
consistency, red, and measured approximately 2 cm by 1.5 cm. Clinical and
radiographic examination revealed numerous carious teeth and an edentulous
left posterior maxillary ridge. There was a small defect in the floor of the
left maxillary sinus at the site of the extracted first premolar. The shadow of
the soft tissue enlargement is also visible on the radiograph. Which of the
following is the most likely diagnosis?
A. Maxillary sinus pseudocyst
B. Postoperative maxillary cyst
C. Herniated maxillary sinus
D. Epulis granulomatosum
Volume 84, Number 4 20
Answers on page 24
Case Number 4 Figure 5: Courtesy Dr. Roberta Grill Deutsch, New York, NY
Clinical examination of a healthy 63-year-old African-American male detected a compressible
area in the mucobuccal fold adjacent to his left maxillary lateral incisor and canine. The canine
was an abutment for a bridge. A periapical radiograph revealed a moderately well-defined,
unilocular radiolucency above the apices of the two teeth. It measured approximately one cm
in diameter. Root canal therapy had been performed on the canine 2 years earlier, with no change
in the size of the radiolucency. The lateral incisor was vital. Which of the following is the most
likely diagnosis?
A. Radicular (periapical) cyst
B. Dental (periapical) granuloma
C. Ameloblastoma
D. Globulomaxillary cyst
Case Number 2 Figure 3: Courtesy Dr. Daniel Barabas, Ridgewood
A 27-year-old healthy male presented with a solitary, painless, firm, pink, sessile, smooth-
surfaced papule on his lower labial mucosa, immediately to the right of the midline. It was 3
mm in maximum dimension. He reported that he had been aware of the lesion for 10 years,
but now wanted it removed and diagnosed as soon as possible because he was leaving the
United States. The most likely diagnosis is:
A. Pyogenic granuloma
B. Peripheral giant cell lesion
C. Traumatic neuroma
D. Verruca vulgaris
Case Number 3 Figure 4: Courtesy Dr. Andrew Yampolsky, Rutgers University
A 27-year-old female complained of slight buccal expansion in the left body
of her mandible. There was no pain or tenderness. She reported that she had
cyst surgery and extractions in her left lower jaw some time ago but did
not know what the diagnosis had been. The only teeth remaining in her left
mandible were the incisors and second molar. A panoramic radiograph revealed
a multilocular, radiolucent lesion in the edentulous canine-premolar region
of her left mandible. It measured approximately 2.5 cm mesiodistally by 1.5
cm vertically. The honeycomb lesion expanded the superior alveolar border
and extended inferiorly two-thirds of the way into the jaw. The patient was
otherwise healthy and there were no other significant lesions. Which of the
following is the most likely diagnosis?
A. Ameloblastoma B. Residual cyst C. Dentigerous cyst D. Lateral periodontal cyst
21 Volume 84, Number 4
NJDA Annual Golf Outing Recap
Golf is a game in which you yell fore, shoot six and write down five.
Paul Harvey
lr: Giancarlo Ghisalberti, and Drs. Luciano Ghisalberti, Thomas
Rossi and Gregory LaMorte.
lr: Drew Nagle, Sharon and Dr. Richard Riva, Scott Elias.
O
ld York Country Club in Chesterfield was the site of the
Associations annual golf outing in August. Eighteen holes
of golf, interspersed with occasional rain drops and bright
sunshine, brought out some of the Associations best golfers,
friends and business associates.
Here are this years winners: 1
st
place net, Cristos Gikas, 72; 2
nd
place
net, Drew Nagle, 72; and, 3
rd
place net, Giancarlo Ghisalberti,
72. First place gross went to Jimmy Arbef, 71; 2
nd
place gross, Ross
Selby, 77; and 3
rd
place gross to Dr. Luciano Ghisaberti, 81.
Dr. Ghisalbertis son, Giancarlo, also won the longest drive,
on hole #14. Dr. Ralph Baines won closest to the pin, on
hole #2, missing a hole-in-one by only 4 6. Winners of
Dr. Charlie Perles Putting Challenge, sponsored by
Delta Dental of NJ, were Dr. Rocco DiAntonio and Dr.
Paul Kaplan.
The annual event is sponsored by the Associations partners
and other corporate supporters, including: New Providence
Financial, Delta Dental, NJCAR, Medical Design Build,
The Dental Laboratory Group, CareCredit, PNC Bank,
AFTCO, Bank of America, Colgate, The Glove Club,
Henry Schein Dental, TD Bank, TDIC, Meadowbrook
Insurance, High Tech Innovations, FSI, Kuwata Pan Dent,
and Demandforce.
Volume 84, Number 4 22
R
ecently a patient of mine, who is a physician, told me he
sold his practice to Atlantic Health System. Atlantic Health
System owns a number of hospitals and also private, or
formerly private, medical practices. There is a trend for the same
companies that own hospitals to acquire private practices. The
more hospitals and doctors owned by the company, the stronger the
power to negotiate with insurers for higher reimbursement rates.
The insurer, in turn, raises premiums to cover any increases and
additional profit.
As a believer in quality healthcare, I become concerned when
decisions are taken away from doctors and other health
professionals, and their patients. While consolidation to a point
can lower costs and increase efficiency, the number one goal of any
corporation is to increase profits. So I question whether the long-
term effect of this arrangement offers any benefit to patients.
In the early days of medical insurance, doctors were happy receiving
a guaranteed payment of 80% or more of the now obsolete
terminology UCR (usual, customary and reasonable) fees, so they
were less concerned about collecting the remaining copayment.
Insurance companies realized this and started to set their own prices
through PPOs and HMOs.
Initially, dental insurance was a totally different entity. We also had
UCR fees, but insurance companies, along with our State Board,
ensured that copayments were collected. The true difference was,
and still is, the overall economics of dentistry vs. medicine. Dental
insurance has a maximum per year, where medical insurance
did not. In fact, I would propose that dental insurance shares
more similarities to auto insurance, with both deductibles and
maximums, than medical insurance. Also, the overall cost of dental
care is 100 times less than medical care.
I have been a dentist long enough to have seen the HIV scare
resulting in necessary improvements in infection control, OSHA,
HIPAA, and the effects of a recession on dentistry. So, in the past
where patients questions may have been about sterilization of
instruments, they are now much more concerned about cost of
treatment than any other issue. Since the average dental student
graduates these days with about $200,000 of student loan debt,
coupled with the substantial cost of buying or opening a practice, I
am concerned about my professions future.
There has to be a reasonable return on investment for students to
want to invest a minimum of 8 years of college and postgraduate
education and the associated cost of acquiring a dental practice,
or we risk becoming an employee profession of corporate health
systems. I do believe the current and primary form of solo dental
practice is an endangered species due to cost issues.
About the Author
Jeffrey A. Mermelstein, DMD, is a general practitioner with
offices in Livingston. A member of the Essex County Dental
Society, Dr. Mermelstein also is a member of the NJDA Council
on Annual Session.
Opinion:
The Economics of Healthcare and
its Implication for Dentistry
Jeffrey A. Mermelstein, DMD
X-RAY TRAINING FOR NJ LICENSE
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fulflls state license training requirements.
We have small classes with experienced
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Dental Assistants Available
We have trained assistants looking for
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njdentalassist@att.net
800-726-2137
The dental radiology course for dental assistants is accredited by
the New Jersey Radiologic Technology Board of Examiners
23 Volume 84, Number 4
Oral Pathology Quiz #81
Answers
Case Number 1 C. Herniated maxillary sinus
There is considerable individual variation in the thickness and density of bone between the apices of posterior maxillary teeth and the soft
tissue lining of the maxillary sinus. Oro-antral communication is most likely to occur as a consequence of extraction of posterior maxillary
teeth when the maxillary sinus floor extends beyond one quarter of the length of the roots of the teeth, or between the roots of adjacent
teeth. It has been suggested that a sudden increase in pressure within the sinus, such as post-extraction sneezing, may contribute to this
complication. Some small oro-antral communications will heal without the formation of a fistula or chronic sinusitis. Numerous factors
may interfere with spontaneous resolution, including the presence or absence of pre-existing infection and quality of post-operative care. It
is not clear why herniated maxillary sinus mucosa (C) developed in this case.
A biopsy of the soft tissue mass revealed mucosa that lines the sinus, but is not normally found in the oral cavity. The biopsy specimen also
revealed typical oral epithelium overlying inflamed connective tissue. That is consistent with epulis granulomatosum (D), which is also known
as post-extraction inflammatory mucosal hyperplasia. Hyperplastic tissue growing in an extraction socket is a relatively common event.
In this case, the entire soft tissue mass was removed and the oro-antral defect was surgically repaired.
Maxillary sinus pseudocyst (A) is a relatively common, asymptomatic, non-expansile lesion that presents radiologically as a smooth, non-corticated,
dome-shaped, slightly opaque hemisphere above sinus floor. Postoperative maxillary cyst (B) is also known as surgical ciliated cyst. This rare
entity is caused by displacement of part of the sinus epithelial lining, usually during surgery. The implanted epithelium then generates a true,
expansile cyst that appears radiologically as a well-defined, spherical, radiolucent lesion, within bone but separate from the maxillary sinus.
Te Oral Pathology Quiz is presented by faculty of the Rutgers University Rutgers School of Dental Medicine, Division of Oral
Pathology, Drs. Deborah B. Cleveland, Joseph Rinaggio, and Lawrence C. Schneider. Clinicians who have clinical pictures and/or
radiographs of cases suitable for future quizzes should call Dr. Schneider at (973) 972-4375. E-mail: Lawcschneider@aol.com.
Biopsy kits may be obtained without charge by calling (973) 972-1646. Faculty are available to answer questions Monday through
Friday, from 8:00 AM to 4:00 PM.
Answers from page 20
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