Have you ever dissected why you do what you do within the walls of your operatory? Why do you feel compelled to perform an oral cancer exam on every patient? Why do you see signs of early perio disease but decide to do a prophy instead? Why do you recommend string floss to a patient with a history of non-compliance? Why does ‘selling’ products or presenting treatment services sometimes feel inauthentic and uncomfortable?

Finding a strong ‘why’, a strong reason to consistently implement new protocols, products or techniques is a key component to create lasting change that makes a real difference in your career and the lives of your patients. Even if treatment and homecare recommendations are backed by compelling research, without a strong, emotionally-based ‘reason to believe’ gaining patient acceptance is difficult.

This fast-paced webinar will walk participants through real-life examples of how Rachel has achieved ultimate success with her own patients and coaching clients through acceptance of compelling recommendations. Come and learn the how-to’s of crafting a strong ‘why’ behind your every-day clinical decisions and recommendations.

Special Spring Bundle Offer:
Buy "Finding Your Why" and receive a 50% Discount on your choice of any 2 currently available ineedce 2 credit hour courses.

All 3 Courses must be purchased at the same time.
To recieve discount enter Promotion Code: 3BUNDLE2013  Offer Expires 07/31/2013

 Evidence shows an association between oral disease and systemic vascular disease. Physicians need our dental colleagues’ help if we strive to optimally reduce our patients’ risk of suffering a heart attack or stroke. This four-part series will give dental professionals an understanding of the pathology of cardiovascular disease and describe how you can intervene to reduce risk in your personal life and your patients’ lives. Incorporating a cardiovascular health program in your practice will elevate your credibility as a true health professional, improve your ability to cure dental disease, and drive the much-needed collaboration between physicians and dentists. Part 1 of the series describes the epidemiology of cardiovascular disease and the anatomy, physiology, and pathology of plaque formation. You will also learn the best ways to detect disease at its earliest, most treatable stage.

 Evidence shows an association between oral disease and systemic vascular disease. Physicians need our dental colleagues’ help if we strive to optimally reduce our patients’ risk of suffering a heart attack or stroke. This four-part series will give dental professionals an understanding of the pathology of cardiovascular disease and describe how you can intervene to reduce risk in your personal life and your patients’ lives. Incorporating a cardiovascular health program in your practice will elevate your credibility as a true health professional, improve your ability to cure dental disease, and drive the much-needed collaboration between physicians and dentists. Part 3 of the series describes the many root causes of vascular disease. Root causes often make it difficult to optimally treat the direct causes previously described. They drive disease progression and events despite adequately controlled cholesterol, blood pressure, and diabetes.

Optical/digital scanning technology now replaces conventional VPS impression taking. The tooth movement technology of Invisalign can now be used with digital data derived from the iTero scanning device, improving accuracy, patient communication, streamlining work flow and reducing aligner delivery time. This article will review the development of the iTero technology, describe the iTero unit, and outline the differences in current scanning technologies. New iTero v4.05 enhancements and software such as the new “Simulated Outcome” tool are described in this article. The benefits of the iTero scanning device are detailed for both patient and practitioner. As highly accurate iTero polyurethane plastic models may be used to eliminate the stone medium, the article details many practical uses for these models, for example, as a matrix for the use of various thermoplastic materials. Model and modeless restorative solutions as well as the use of STL files will be discussed.

Patients continue to desire whiter teeth and demand for tooth whitening continues to grow. Options available include in-office tooth whitening with or without a lamp, office-dispensed home-use products, and a variety of over-the-counter products. In addition to being a procedure that patients want, tooth whitening is a great practice builder. Patients should be carefully assessed before starting a tooth whitening treatment; this includes examinations for erosion, caries, abrasion and defective restorations. The type of stain and its cause must be determined in order to make a determination of the likely success and speed of tooth whitening. Educating patients on their options, what is involved in a tooth whitening procedure, management of potential sensitivity, and what they will need to do are important components in the decision to whiten teeth and the likelihood of patient compliance and success. With good case selection, tooth whitening is straightforward, effective and a welcome adjunctive treatment.

Dentistry uses a wide range of cements to retain crowns, posts and fixed partial dentures to tooth structure. Dental practitioners should have a good understanding of the properties and categories of dental cements to ensure the long-term clinical performance of cemented restorations. Classes of dental cements have evolved from zinc phosphate to glass ionomers, resin modified glass ionomers, resin cements and lastly to self-adhesive resin cements. Self-adhesive resin cements require no bonding agents and simplify the cementation procedure. Since metal, porcelain-fused-to-metal, resin and all-ceramic restorations are used today, an understanding of cement performance is needed before selecting a material to use in a particular situation. This article gives a brief review of cement performance and introduces a new material to the class of self-adhesive resin cements.

 Dentists today receive information from more sources than ever. It is increasingly difficult to determine how to prioritize information when it comes time to make important practice decisions such as purchasing imaging systems for the modern dental office. This series of articles is intended to provide the dentist with some basic information regarding modern imaging systems. Specifically, part one of this series is geared towards a review of intraoral digital radiography. In addition to digital radiography, we will offer a basic overview of the principles of x-ray production; radiation dose and selection criteria; attenuation and image quality. We will also discuss how these aspects of radiology are meaningful to the prac­ticing dentist. After completing this course, the dentist and dental auxiliary should have a better understanding of how intraoral dental radiography systems function and be better equipped to make a decision regarding which intraoral system to purchase.

 Dentists are obligated to document and report suspected cases of abuse in all states, and dental hygienists are similarly obligated in some, but not all, states. The obligation is not to prove abuse or neglect, just to report what is suspected. Each state has different regulations on mandatory reporting for healthcare and other professionals, as well as specific reporting requirements for private citizens. It is essential that dental professionals know the potential signs and symptoms of the various types of abuse, are able to identify these, and understand the mandatory requirements for reporting in the state(s) in which they live and practice. It is by identifying, documenting and reporting abuse that victims can be protected and perpetrators prevented from continuing abusive practices and patterns.

This continuing education course provides a comprehensive review of air polishing. The initial portion of the course reviews the history of air polishing. The course includes a description of how air polishing removes dental stain and plaque and the clinical techniques used for air polishing, and the Mohs hardness number of abrasive particles. The course material includes the identification of medical conditions that exclude patients from being candidates for air polishing and a description of facial emphysemas and how they can be a sequela from use of an air polisher. Surfaces of teeth and the types of dental restorative materials that can be effectively treated with air polishing procedures are also identified.

Americans consume an average of 400 calories per day of added sugars in their diet from high-fructose corn syrup, table sugar, honey, and all other sweeteners with calories! Today’s sugar consumption has jumped 20% over the past 30 years with a correlating rise in obesity, and the domino effect continues with an increased risk for cardiovascular disease, elevated triglyceride levels, liver disease and Type II diabetes. Soft drinks which are the greatest culprit of this growing “sugar obsession” are implicated in increased risk for dental caries and tooth erosion. This program gives a review of the literature related to sugar’s impact on overall health, but also provides good news for today’s clinician seeking methods to help reduce decay, remineralize tooth structure, and motivate patients to reclaim their health!

Program Format Note: This program is offered in both a Text based format (PDF) and an Audio Video Webinar format (Interactive).

Special Bundle Offer:
Buy "America’s Sweet Tooth Obsession and Its Impact on Oral and Systemic Health" and receive a 20% Discount on your choice of any 2 currently available ineedce 2 credit hour courses.

All 3 Courses must be purchased at the same time.
To recieve discount enter Promotion Code: 1BUNDLE2013
Offer Expires 12/31/2013

The widespread use of latex products in barrier infection control products has resulted in an increasing number of allergic reactions in patients and healthcare workers. There are several types of immune responses to latex that can occur, including life-threatening anaphylactic shock. Tests can determine whether or not a person is sensitive to latex, and the type of immune response. Latex sensitivity is particularly prevalent in healthcare workers and patients with Spina Bifida. If latex sensitivity is suspected in a patient or healthcare worker, alternative products that are latex-free must be used.

Today's clinician is extremely dependent on the handpiece to sustain a smooth-running practice. The handpiece is an incredibly sophisticated device that requires a diligent maintenance protocol to keep it running properly and safely; routine, repeated heat sterilization has the most adverse effect on the dental handpiece. Perhaps due to this dependency on handpieces, combined with the damage resulting from repeated routine sterilization and teh need for consistent maintenance, the handpiece has earned an undeserved reputation for excessive breakdowns. The dental team can keep handpieces functioning smoothly longer, and maximize the return on the significant investment the dentist has made in handpiece technology, through appropriate maintenance procedures. Careful selection from repair options is also required.

This review analyzes the current reports and publications involving the performance and clinical effectiveness of local anesthetics (efficacy) and the rare occurrence of post-operative prolonged numbness or tissue hypersensitivity (paresthesia, dysesthesia). No particular local anesthetic is scientifically singled out as causing this effect. Historically, scientific data on superior performance of one local anesthetic compared to another was lacking. One recently published report, however, showed the statistically significant and superior effectiveness of articaine in obtaining anesthesia of first permanent molars by infiltration when compared to lidocaine. The paresthesia debate regarding the potential of a 4% local anesthetic solution to be allegedly more neurotoxic than other currently administered local anesthetic solutions of lesser concentrations is examined. There is a lack of conclusive and experimentally reproducible evidence, of the cause and effect of specific local anesthetics to chemically result in post-operative sequelae such as paresthesia. An examination of the potential causative factors associated with paresthesia suggests mechanical and/or neurotoxic phenomena. Further evidence and scientific study are required to conclusively determine the significant role, or lack thereof, of each factor.

Detailed, accurate radiographs are a primary diagnostic tool as well as necessary for and during some treatments. Increasingly, digital radiographic imaging is being used with two types of available receptors. Anatomical variations and patient comfort must be considered when taking intraoral radiographs. In addition, recognizing common sources of errors is important to ensure that the clinician avoids them and knows how to correct them when they occur. Techniques, as well as devices and accessories, can be used that will enable accurate image acquisition and improve patient comfort.

All dental procedures provide an opportunity to transmit infectious pathogens directly or indirectly between patients and workers. The pathway of disease transmission between people is referred to as the “chain of infection,” and infection control programs focus on breaking this “chain.” This educational course addresses hand hygiene, instrument processing, environmental asepsis, and use of personal protective barriers relative to breaking the chain of infection, undertaking sequenced processes of cleaning prior to disinfection or sterilization, and using appropriate products correctly. Single-dose and disposable products as alternatives to bulk or re-usable items and their roles in addressing the goals of safety and efficiency are also considered.

Autism can severely impair the patient’s ability to communicate, interact with others and maintain normal contact with the outside world. Symptoms can range from very mild to very severe. One in 150 individuals is diagnosed with autism, with more than 24,000 children diagnosed each year. There is as yet no definitive etiology for autism. It is important that dental professionals seek out patients with autism and be able to recognize the signs and symptoms of autism spectrum disorders, both to refer patients to appropriate medical care, if necessary, and to enable dental treatment of these patients. Treating patients with autism can be both challenging and rewarding for dental professionals. It is crucial to introduce the patient to the dental environment and patient-appropriate care in a slow and gentle manner that builds trust and cooperation. Caries risk must be part of the initial assessment, and it is important that both the parent/caregiver and patient be introduced to a viable home care regimen that is tailored to the patient with autism.

Precision and accuracy of master impressions are critical to the overall excellence and marginal fit of definitive fixed restorations. CAD/CAM offers clinicians, patients and laboratory technicians methods that are reproducible and accurate, and allows for user- and patient-friendly clinical procedures. CAD/CAM systems are available that either digitally scan and create fixed restorations chairside or that capture chairside digital impressions that are then sent to a laboratory. In-office CAD/CAM allows clinicians to provide same-visit indirect fixed restorations that are accurate and esthetically pleasing. Chairside digital impression making allows for the creation of accurate models that can then be used for either traditional or CAD/CAM fabrication of restorations, and involves less chairside time. In the case of image verification and model milling in the manufacturer’s facility, standardized quality control procedures also benefit the final product. Compared to a traditional technique, in-office CAD/CAM does not require any communication with a laboratory, and chairside digital impressions enable seamless communication between the clinician and the laboratory technician. CAD/CAM dentistry is changing the way in which clinicians provide indirect restorations to patients, making the process more patient- and user-friendly, reliable and accurate.

The current approach to dental caries focuses on modifying and correcting factors to favor oral health. Caries management by risk assessment (CAMBRA) is an evidence-based approach to preventing or treating dental caries at the earliest stages. Caries protective factors are biologic or therapeutic measures that can be used to prevent or arrest the pathologic challenges posed by the caries risk factors. Best practices dictate that once the clinician has identified the patient’s caries risk (low, moderate, high or extreme), a therapeutic and/or preventive plan should be implemented. Motivating patients to adhere to recommendations from their dental professionals is also an important aspect in achieving successful outcomes in caries management. Along with fluoride, new products are available to assist clinicians with noninvasive management strategies.

Infection prevention is a key process in the dental office for the protection of patients and dental healthcare workers. The cycle of infection prevention is aimed at breaking the chain of infection, achieved by following a rigorous process with a series of clearly-defined steps. Only if the process is followed can there be an assurance of adequate infection control in the dental office setting.

Most of the commonly performed tasks in dentistry have benefited from the development of modern dental adhesives, which are used for a wide range of applications. Dental adhesives enable minimally invasive dentistry. It is believed that dental adhesives can reinforce weakened dentin or enamel, reduce marginal staining, reduce microleakage, and may also reduce postoperative sensitivity when used appropriately. The resin-based adhesive systems developed to date can be categorized as one of two types: etch-and-rinse (total-etch) adhesive systems and “selfetch” adhesive systems. Both systems result in a unique interface at the juncture of tooth surface and adhesive. In the last decade, most new developments in dental adhesives have been focused on simplifying the components required for the bonding systems and improving performance of the resulting self-etching adhesives. Enamel bonding is superior with etch-and-rinse adhesive systems, while self-etch systems may be more suitable for restorations with large areas of dentin. Careful consideration of several factors is essential in selecting an adhesive system.

The increased use of direct composite restorations can be mainly attributed to patient demand for esthetic restorations and the availability of composites with high strength and excellent esthetics. While early composites were weak and suitable only for anterior restorations, current composites are highly esthetic and offer high strength for their intended purposes. Techniques have also evolved, with sophisticated bonding techniques and single-shade, dual-shade, and multilayering techniques to optimize esthetics. It is important to consider not only the individual case, relative strength, and esthetics of different types of composites but also the technique to be used when selecting a restorative material.

One benefit of occlusal splint therapy is a reduction in masticatory muscle hyperactivity related to the development of an optimal programmed occlusion. This normalization of muscle activity can reduce the effects of cumulative adverse force on the teeth, periodontium, muscles, and temporomandibular joints. Current literature defines a therapeutic occlusion as multiple, bilateral posterior teeth contact with the mandibular condyles physiologically seated and immediate separation of the posterior teeth by the anterior teeth in all excursive movements. These contacts are usually identified by occlusal marking but research has shown that conventional identification of occlusal contacts with inked silk, paper, or plastic ribbon is not accurate. The rationale and application of computerized digital occlusal analysis to verify a therapeutic occlusion with occlusal splint therapy is presented. The advantages for clinical documentation and validation of research are discussed.

Temporization has become an increasingly common procedure, and may be required short-term or as an interim medium-term step. Excellent provisional restorations are a key component for the clinical success of definitive fixed restorations. Temporization requires consideration of the complexity of the case, length of time the provisional restoration is required, and esthetics. Indirect techniques offer reduced chairside time in comparison to direct techniques. Options for direct temporization have increased in recent years with the introduction of new materials and techniques.

The dental profession has long regarded fluoride as a primary element in the prevention of dental caries. Topical and systemic fluorides are regularly incorporated within the community, dental office, and home avenues. Despite the fact there are other preventive modalities, fluoride remains a well-established, evidencebased therapeutic intervention. This article will review the early history; mechanism of action; delivery methods for fluoride in private practice, home, and community; and the clinician’s role in optimizing best practices and safe use of fluoride.

Oral irritations and ulcerations occur frequently in the general population. Recurrent aphthous ulcers (RAU) are the most common. There are three types of RAU — minor, major and herpetiform, the most common being minor aphthae. The exact etiology of RAU is not known. Systemic and local factors, as well as infectious agents, have been proposed. Certain medications and foods are associated with oral ulcerations, and chemicals such as sodium lauryl sulfate (SLS) contained in dentifrices have also been implicated. RAU also occur in more serious systemic diseases and where appropriate patients should be referred for screening and medical care. Treatment of recurrent aphthous ulcers is palliative, based on the severity of the lesions. Both topical and systemic medications are available. Nutritional and oral hygiene advice should also be given, and if patients are sensitive to SLS, a low-dose SLS or SLS-free dentifrice should be recommended.

Interoperable electronic health records (EHRs) are promising tools to improve quality and efficiency in health care. This course will look at the tides of change and how dentistry became part of the interoperable EHR process. It will assess the impact of standards, coding, and systems being developed by the American Dental Association for EHR. The reader is given five simple steps that can be taken to help with navigating the choppy waters of adoption.

Dentinal hypersensitivity has been referred to as one of the most painful and chronic dental conditions, with a reported prevalence of between 4% and 57% in the general population and a higher prevalence in periodontal patients. It may also occur as a result of, or during, dental treatment. Clinicians must screen for dentinal hypersensitivity and diagnose by exclusion, determine appropriate treatment, and provide treatment and preventive recommendations. Consideration should also be given to treating dentinal hypersensitivity associated with dental treatment. Traditional treatments have included adhesive resins, fluoride varnishes, HEMA, iontophoresis, gingival grafts and desensitizing dentifrices. Other technologies include the use of bioglass particles, ACP, as well as 8% arginine and calcium carbonate paste.

Early examination enables the practitioner to identify at an early stage the specific problems discussed in this article, and to determine when to commence treatment and/or refer patients to an orthodontist. Orthodontic problems discussed in this article include crossbites, open bites, excess spacing, and Class II and III malocclusions. Treatment options for early interceptive orthodontics are also addressed.

In order to meet the challenges of safety, time management and asepsis, the dental health care provider must have a plan for infection control, including the use and care of dental instruments and disposables. Following the basic CDC guidelines can help to significantly reduce the risk of microbial transmission. After the patient is dismissed, the operatory must be prepared for the next patient, including the treatment of surfaces and instrument processing. There is a variety of methods available to properly reprocess instruments. Choosing a system that minimizes risk, maximizes productivity and preserves instruments is essential.

Medical emergencies can and do occur, not only in your dental office but any place and at any time. The entire staff and designated in-office emergency team must be trained, and emergency equipment and drugs must be available and current. The best way to handle an emergency is to start by being prepared.

Tooth extraction or tooth loss can often result in both alveolar ridge resorption and soft tissue collapse. Preservation of bone volume and soft tissue height at the time of tooth extraction is an important procedure that can facilitate implant placement and ensure that proper restorative goals are met. Proper management of extraction sites at the time of tooth extraction can reduce or eliminate the future need for advanced ridge augmentation procedures prior to implant placement. In addition, poor extraction site management may lead to esthetic and functional prosthetic complications.

When compared to their ancestors, composite restorative materials possess superior physical properties, come in a full range of vital shades and opacities, and polish to a gloss-like luster. Many of these materials are considered universal, suitable for both posterior restorative and esthetic anterior applications. Several factors have contributed to current trends in restorative and cosmetic dentistry. The latest advances in adhesive and restorative materials have led to the ability to use less invasive treatment modalities to yield highly esthetic and durable restorations, and the combination of minimally invasive techniques and modern biomimetic restorative materials has proven to be the state-of-the-art solution for practitioners and patients. Whereas early brands of composite offered only “body” shades based on the Vita shade guide and appeared dull and dense, contemporary materials offer an expanded range of shades and varying opacities designed specifically for layering of direct restorations. Recognizing the distinction in thickness, color and morphology of natural dentin and enamel, it is necessary to replicate these histological tissues in composite restorations. This requires the use of composite formulations that are optically similar to each layer, and sculpting these materials replicates the morphology of each in the area being restored.

Water fluoridation heralded the use of fluoride as an anti-caries agent. Since that time, both systemic and topical fluoride have become available and the use of fluorides has contributed greatly to reducing the level of caries seen in the population. Systemic fluoride supplements are available as tablets and drops, for use in accordance with the recommendations on fluoride supplement dosing.Vehicles for topical fluorides include in-office fluoride varnishes, gels, and foams, and home-use fluoride dentifrices, rinses and prescription products. The primary mechanisms of action involved with the use of topical fluorides are the prevention of demineralization and promotion of remineralization, by ensuring the ready availability of intra-oral fluoride.

Considerations in selecting an appropriate in-office and home-use topical fluoride protocol for individual patients include the patient's age, caries risk level, exposure to fluoride from all sources, and the current recommendations on professionally-applied topical fluorides. Other important considerations include product efficacy and safety, the patient's dental status as well as compliance with brushing and age-appropriate use of fluoride toothpaste, and clinician and patient preferences.

Chronic hand and wrist pain that can affect quality of life, productivity or career longevity is experienced by between 40 and 70 percent of dental professionals. Given that fewer dental professionals fully recover from hand pain than they do from neck, shoulder or elbow pain, it is imperative that injury be prevented. There are a number of risk factors for carpal tunnel syndrome that must be considered, as well as research-based ergonomic interventions. The use of ergonomic equipment and implementation of prevention techniques outside the operatory can help to reduce work-related pain and extend the career of the dental professional.

Hand hygiene is important for the protection of patients and healthcare workers, and the Centers for Disease Control and Prevention issued recommendations in 2003 that specifically includes guidelines for hand hygiene in dental settings. Several options exist for hand hygiene prior to nonsurgical dental procedures, and the selected method may vary according to the level of contamination, the desired antimicrobial activity and the type of procedure. The most significant difference between hand hygiene for routine procedures and for surgical procedures is the need for persistent antimicrobial activity in products used for surgical hand antisepsis. Appropriate selection of products as well as appropriate hand care helps prevent adverse effects related to hand hygiene in the dental setting. Selecting the products that suit the types of procedures performed in a given practice, and the needs of the healthcare personnel in that practice are important considerations. It is likely that a combination of soap, alcohol-based hand sanitizer and lotions will be required to meet the needs of all individuals.

 Dental handpieces and burs are among the most frequently used mechanical devices in dentistry. Handpieces have evolved from primitive cutting tools introduced in the nineteenth century to highly efficient and sophisticated devices. Traditional handpieces are either air-driven or electrically driven. A more recent introduction utilizes technology from both air-driven and electric handpieces, and includes a control mechanism to adapt torque to clinical situations. Burs for dental procedures typically are fabricated from tungsten carbide or diamond particle coatings, with ceramic and zirconia burs also available. Bur designs include many configurations and sizes, with bur selection depending on the type of procedure, the clinician’s preference and the bur’s overall effectiveness. The selection of an appropriate handpiece and appropriate burs is key for the safe and effective removal of dental hard tissues and caries in an efficient manner that also maximizes ergonomics for the clinician and minimizes patient discomfort. Handpieces and burs become contaminated during dental procedures. To prevent any risk of cross-infection from these devices, all handpieces and burs should be heat sterilized between patients in accordance with the recently published, updated guidelines from the Centers for Disease Control and Prevention.

More than 120 syndromes are associated with oligodontia, including ectodermal dysplasia. The signs and symptoms of ectodermal dysplasia include sparse hair; dry skin; few, malformed teeth; deficient sweat glands and dystrophic fingernails. Ectodermal dysplasia is most commonly the hypohidrotic X-linked version, affecting 80% of sufferers and the syndrome is carried by females. Knowing the signs and symptoms of ectodermal dysplasia may assist dentists and dental hygienists in identifying patients with the disease and possibly potential carriers.

Government agencies regulate and make recommendations on instrument processing and occupational safety. There are a number of requirements and necessary steps involved in instrument processing, including preparation, cleaning and packaging of instruments for sterilization. The use of cassettes reduces the risk of exposure injuries for the operator, while simplifying and streamlining the process. There is a variety of instrument sterilizers for dental office settings including steam sterilizers (autoclaves), chemiclaves and dry heat sterilizers. Each has different features, advantages and disadvantages that must be considered when selecting sterilization equipment for your practice. Monitoring sterilization processes for sterility assurance requires the regular use of mechanical, chemical and biological indicators to assure that these processes and the equipment are providing effective sterilization. Sterility assurance monitoring must be documented to show compliance with regulations governing your practice.

Throughout history, medicine and dentistry have continually evolved via advances in technology and research. Breakthroughs in science allow dental professionals the opportunity to practice in new and exciting directions. What if breakthrough research assessed the benefits of an oral care device beyond just the visual inspection of brushing outcomes? What if the use of a power toothbrush could change the composition of dental biofilm to benefit the patient’s oral health? Dental biofilms are one of the major contributing factors for both periodontal diseases and caries infections. Through emerging research, we now know not all dental biofilm is bad. Novel and compelling science from Philips Sonicare demonstrates the ability of Sonicare* to transition the biofilm composition from a pathogenic state towards a benign state and eventually to a beneficial state. These research findings could significantly impact self-care regimens and long-term oral health. New technologies in novel chairside diagnostic/assessment products will also be explored.

Program Format Note: This program is offered in both a Text based format (PDF) and an Audio Video Webinar format (Interactive).

As general dental practitioners, we have the opportunity and responsibility to not only diagnose malocclusion, but also to have conversations with our patients to educate, motivate, and have them act on our recommendations to improve their oral health and reduce risk factors for systemic problems. Patients are often unaware of what is happening in their mouths and we as practitioners frequently do not understand the relationship between the clinical signs and symptoms and malocclusion. This course will outline the consequences of occlusal disease on the dentition, and the effects of periodontal disease on common systemic health issues. The basics of an idealized occlusion will be discussed which will allow the patient to have the best function, esthetics, and health, providing a better chance for sustainability of the dentition for a lifetime.

The posterior restorative material of choice depends on the individual clinical situation and patient. Amalgam has a long history of use and clinical success. Esthetic restorations are increasingly in demand, and include glass ionomers, compomers and composite resins. Fluoride release is a desirable attribute in a restorative material, as are wear resistance, low polymerization shrinkage and low polymerization stress. Recently, technologies have been incorporated into composite resins that lower polymerization shrinkage and stress.

This course describes the impact dental professionals have beyond the oral cavity through a discussion of novel concepts of periodontal disease. Topics covered include: bacterial invasion of the gingiva, gingivitis details, oral-systemic connections, risk factors, periodontal maintenance, total inflammatory burden, and providing individualized periodontal care through bacterial DNA testing.

Program Format Note: This program is offered in both a Text based format (PDF) and an Audio Video Webinar format (Interactive).

Everyday dentistry does not typically include full mouth reconstruction. Rather, minimally invasive dentistry, restoring one or two teeth or somewhat more complex cases comprises what we do on a daily basis. Though involvement and complexity can vary, the foundation principles that ultimately dictate success remain the same. A key component is the role that occlusion plays in achieving excellence in anterior esthetics. This presentation will focus on the principles that need to be addressed in order to achieve predictable long term success through an occlusion-based rationale toward natural esthetics.

Parafunctional activities associated with the stomatagnathic system include lip and cheek chewing, fingernail biting, and teeth clenching. Bruxism can be classified as awake or sleep bruxism. Patients with sleep bruxism are three to four times more likely to experience jaw pain and limitation of movement than people who do not experience sleep bruxism. Signs and symptoms of bruxism and parafunctional activity include hypertrophied masseter and temporalis muscles, myocitis of these same muscles, morning jaw stiffness, and sensitivity in a tooth or teeth. Additionally, migraine is associated with parafunctional activity. Dental professionals are responsible for diagnosing and managing parafunction. Patients can be managed with oral appliances of various designs.

SEER (Surveillance Epidemiology and End Results) data demonstrates a decline in oral cancer for tobacco related sites; however, there is a strong trend towards an increase in human papillomavirus (HPV) implicated sites. How does this affect our methods of screening for oral cancer and is the clinical oral examination predictive of histologic diagnosis at an early stage? Two-thirds of oral squamous cell carcinomas are discovered at an advanced stage with five year survival rates impeded significantly; 82.3 percent when the disease is discovered in stage I or II and only 33.5 percent when the cancer has metastasized. This presents a call to action to elevate our knowledge regarding examination of high risk areas and explore adjunctive screening methods to complement the traditional white light examination.

Atraumatic dental extraction requires a complete preoperative assessment of the patient prior to surgery. The clinician must know the patient's medical status, and assess the level of difficulty of the extraction. During the extraction procedure, basic atraumatic surgical techniques must be followed and the clinician must be prepared to manage complications should they arise.

Recurrent aphthous stomatitis (RAS) is the most common idiopathic ulcerative condition seen today, affecting over 100 million Americans. Ulcers can be painful, slow to heal, difficult to treat, and at worst, cause impairments in eating, drinking, sleeping, and speaking. This review of the literature found many different treatment options whose effectiveness remains inconclusive, and to date, there is no one definitive treatment modality for RAS. Even though aphthous ulcers have been studied extensively, there are still many unknowns when it comes to their composition, pathophysiology, and manifestations in the oral cavity. Research does conclude that RAS may be the secondary issue of a more serious systemic infection in patients. This course will provide the most current research-based tools for for professionals who are trying to aid their patients suffering from RAS.

Periodontal disease is more prevalent and more severe in smokers than in nonsmokers. The host response in smokers is altered by a number of factors including increased gingival crevicular fluid, adhesion molecules and genetics. In addition, smokers are poor healers compared to nonsmokers and their response to periodontal therapy can be compromised which can result in continued progression of periodontal disease, or the need for more treatment.

Periodontal disease occurs in the presence of pathogenic bacteria— periodontopathogens or periodontal bacteria — in a susceptible host. The overall objectives of periodontal therapy are to halt disease progression, reduce pocket depths and, ideally, obtain clinical attachment gains. Following active periodontal therapy, periodontal maintenance is key for long-term positive clinical outcomes, involving both in-office maintenance and meticulous home care. Professional care is required to remove subgingival biofilm and deposits, and to prevent periodontal disease progression. The goal of daily oral hygiene procedures for periodontal maintenance is to remove dental biofilm before it matures so as to prevent the development of gingivitis and a mature subgingival plaque. Consideration should be given to techniques and protocols that aid compliance, and care should be taken to address each patient’s ability and willingness to perform daily oral hygiene as well as to address root caries risk and prevent unwanted sequelae.

The most frequently administered drugs in dentistry are local anesthetics. These provide relief from pain during procedures, leaving inconvenient residual numbness that takes some time to wear off following completion of dental procedures. Recently, a new drug has been approved for acceleration of the reversal of soft-tissue local anesthesia in patients age 6 and older. This new drug adds a new dimension to the pain management armamentarium of dentists.

Numerous healthcare experts have agreed that dental caries in the pediatric population is one of the most serious health concerns in this country.  Early prevention and intervention are the keys to ending this “silent epidemic”.  The American Academy of Pediatrics along with the American Academy of Pediatric Dentistry, both support a child’s first dental visit before their first birthday.  This online program will address the primary foundation of long-term oral health: early risk assessment.  Participants will learn how to perform both initial and on-going risk assessments on infants and toddlers in their practices.  After discussing risk, through the use of patient case studies, participants will learn how to implement new strategies in preventing oral disease.  Based on risk assessment, CE attendees will then learn how to implement various therapeutic chair-side and at-home products appropriate for infant and toddler disease control.  Establishing a lifetime of good oral health begins with the dental professional’s knowledge of risk assessment in order to predict prevention.

Program Format Note: This program is offered in both a Text based format (PDF) and an Audio Video Webinar format (Interactive)

Bruxism is a parafunctional occlusal activity, that may exist as either sleep bruxism or awake bruxism. Bruxers have more noticeable signs of dental attrition, abfractions, and occlusal pits on their natural teeth than other patients. Clinical approaches to managing bruxism can be categorized as acute, preventive and chronic, with the approach depending on the patient’s signs and symptoms. Preventive intervention is required if a patient presents with tooth wear. A primary preventive approach in the treatment of bruxism is the fabrication and utilization of a nightguard.

As the demand for tooth whitening increases and consumers are making their own diagnostic decisions regarding tooth whitening, it is important that this smile enhancing process become a part of dental hygiene clinical protocols. A focus on professional tooth whitening — whitening provided chair side or professionally dispensed — will be provided and includes the dental hygiene process of care. Maximizing and improving oral health through tooth whitening provides the rationale for dental hygienists to identify, implement, and maintain this esthetic opportunity.

The overall long-term health and comfort of the implant prosthetic patient requires the ability of the practitioner to replace the worn overdenture from a bar design to modern paralleled stud type attachments. Also many implants that are not parallel and in cases when a bar design is not doable the ability for the practitioner to correct the severe malalignment is made possible by having several angle abutment choices to choose from. This lecture will also demonstrate how to maintain the existing vertical and horizontal relationships while picking up retentive elements in the prosthesis.

Program Format Note: This program is offered in both a Text based format (PDF) and an Audio Video Webinar format (Interactive).

Endodontic treatment is a predictable procedure with high success rates. Success depends on a number of factors, including appropriate instrumentation, successful irrigation and decontamination of the root canal space to the apices and in areas such as isthmuses. These steps must be followed by complete obturation of the root canals, and placement of a coronal seal, prior to restorative treatment. Several irrigants and irrigation systems are available, all of which behave differently and have relative advantages and disadvantages. Common root canal irrigants include sodium hypochlorite, chlorhexidine gluconate, alcohol, hydrogen peroxide and ethylenediaminetetraacetic acid (EDTA). In selecting an irrigant and technique, consideration must be given to their efficacy and safety.

The incidence of periodontal disease is far greater than we have been led to believe, according to the latest CDC NHANES survey, yet dental offices are submitting relatively few claims for periodontal procedures. The disconnect may stem from the fact that so many practices are “treating” disease with prophylaxes instead of definitively diagnosing. Until relatively recently we depended on simply probing for clinical data, but we now have the ability to accurately determine the causative pathogens with a simple salivary test. This allows the clinician and the patient to understand the underlying causes of the clinical changes, and then provide definitive therapy for management. The discussion will cover the implications of the dental clinician forging a closer link to medical colleagues by using pathogen and genetic predisposition testing in a medical model, so as to allow for more targeted, personalized therapy.

Periodontal disease and caries are two of the most common diseases known to man. Periodontal disease estimates are indicative of the large clinical need for periodontal therapy to improve oral health. Scaling and root planing is central in the treatment of periodontal disease. Nonetheless, acceptance of treatment of periodontal disease. Nonetheless, acceptance of treatment is impacted by patient phobias and fears. This results in patients not receiving treatment that will improve their oral health status, and impacts standard and quality of care as well as practice building. Pain management is key to address the patient's fears and/or needs. In choosing the appropriate pain management technique there are several considerations, including patient and clinician preferences, onset time, depth of anesthesia and duration. From a practice building perspective it is important to consider the time saved by appropriate pain management and by the technique used, and from a broader perspective the ability to retain and attract patients for both essential and elective procedures. Effective Pain Management Techniques contribute to a stable and growing patient base, and effective and productive treatment of these patients.

Dental lasers are used for multiple dental procedures, including soft-tissue procedures. Soft-tissue lasers are available at varying wavelengths and powers and can be used for procedures that would otherwise be performed using a scalpel, or possibly an electrosurgical unit. Soft-tissue lasers enable safe and effective removal of soft tissue when used properly, and contribute to the efficiency and marketability of the dental office.

 Optical/digital scanning technology now replaces conventional VPS impression taking. The tooth movement technology of Invisalign can now be used with digital data derived from the iTero scanning device, improving accuracy, patient communication, streamlining work flow and reducing aligner delivery time. This article will review the development of the iTero technology, describe the iTero unit, and outline the differences in current scanning technologies. New iTero v4.05 enhancements and software are described in this article. The benefits of the iTero scanning device are detailed for both patient and practitioner. As highly accurate iTero polyurethane plastic models may be used to eliminate the stone medium, the article details many practical uses for these models, for example, as a matrix for the use of various thermoplastic materials. Model and modeless restorative solutions as well as the use of STL files will be discussed.

For several decades, the use of fluoride has been a mainstay in controlling dental caries. Preventing and treating dental caries requires an individualized approach that must consider a patient’s risk level, determined through a risk assessment. In-office topical fluorides were developed between the 1950s and 1970s, with considerable research conducted on ways to enhance the duration of contact and uptake of fluoride. Based on available clinical trials and evidence-based data, the American Dental Association Council of Scientific Affairs developed recommendations for the use of in-office topical fluorides. In addition, antimicrobials and calcium and phosphate technologies are available for use.

This course will discuss the types of mouthguards and mouthpieces currently available, and how these are fabricated. The indications for mouthguards will be addressed, including their use as protective mouthguards during contact sports, and an overview of their use in the treatment of bruxism, TMJ and sleep apnea. The latest research on the use of performance mouthguards and mouthpieces will also be discussed during this presentation.

Participants will be pleased to find the complete unedited question and answer session (Q&A) is included.

Inflammatory diseases share many common traits, including the ability to produce pro-inflammatory messengers called cytokines that travel throughout the body. Cytokines play an important role in physiologic regulation of many biological activities, but in inflammatory diseases, they are produced at levels that can have pathological consequences. In diabetes, cytokines can cause β-cell death and insulin resistance. In periodontal disease, the same cytokines are responsible for collagen destruction and alveolar bone loss. Because inflammatory diseases share a common biological denominator, they can often influence the progression of other inflammatory diseases.