Professional cooperation between dentist and laboratory technician.

This case points out the importance of professional cooperation between the dentist and the technician because of the concept that implantology means specialized prosthetics including a surgical component. Success of any implant treatment depends on the professionally trained technician as a partner of the team. Clinical and technical treatment steps are intertwined. The dentist is responsible for the surgical procedure and must use his or her utmost skills and learning. In cases of proposed sinus elevation on both sides of the maxilla, the dentist must not necessarily collect autologous bone from the iliac crest because appropriate bone substitutes are available; also, tuber blades may be used to avoid sinus elevation. Unfortunately, at this time, the universities in Germany have not endeavored to pursue intensive scientific research concerning this important topic.     

Effective laboratory communication...it's a two-way street

Working as part of your team, your dental laboratory can increase your predictable success and decrease the stress of daily practice. This partnership should begin during the treatment planning phase and continue through to the insertion appointment. Many dentists are beginning to view their laboratory technician as a bonafide member of their patient care team. Thorough communication on both sides is crucial to reaching this predictable success. A trusting relationship will enable the dentist and the laboratory technician to communicate effectively. The laboratory must take the responsibility to communicate its concerns to the dentist, just as the dentist must take the responsibility to communicate effectively with the laboratory his or her needs and desires for each case. When effective communication techniques are followed, everyone is a winner. The dentist is more productive per hour and has reduced stress. The dental laboratory does not have to bear the burden of remakes, and spends less time on the phone or sending e-mail for routine cases. And most importantly, the patient receives an exceptional restoration that meets his or her expectations. In the end, the true measure of a great relationship between the dentist and the laboratory is happy patients who refer friends and family to your practice for years to come.     

Education for geriatric oral health promotion

Dentate older adults need to be aware that restorative procedures completed in the past do not guarantee their oral health now or in the future. By building on the strengths of their current behaviors, the elderly may see change as more manageable and may accept it more readily. Educational approaches aimed at the edentulous older patient should focus on the need for preventative oral health care. Thirty thousand new cases of oral cancer are reported each year, and of those, 50% are in patients above the age of 65. Progressive bone resorption, decreased nutritional intake, and poor oral health affecting self-esteem to the point of withdrawal from social circles can all be avoided through periodic assessment and timely intervention.
All health care professionals must be educated in the role that are required of them as health team members. Initial exams of elderly patients should include assessment of not only the patient's oral health but also his/her ability to perform oral hygiene. An accurate assessment of the patient's needs, desires, and abilities will help to eliminate many of the misconceptions that the care provider may harbor. Clinical training in more thorough oral exams and in methods of effectively educating patients concerning oral health is a prudent step for physicians, physician assistants, nurses, and nurse practitioners. Effective educational presentations must be tailored to the targeted group of older adults; not all strategies will work for all elderly people.     

Perceived or actual overlap between the scope of prosthodontics and other recognized dental specialties

Prosthodontics does not overlap with other specialties but is integrated with them. This essential difference between "overlap" and "integration" should be made abundantly clear. No one denies that most of the population's dental needs must be served by the general practitioner, and no specialist can be completely capable within even his or her own specialty. Nevertheless, the prosthodontist, as all specialists, must assume the role of treating patients who require unusual care. It is the prosthodontist who most frequently assumes the primary role in the management of patients who require complex, demanding restorative care, and it is the prosthodontist who has the most intimate understanding of the proper diagnosis, treatment planning, integration of therapy, patient management, and aftercare for these patients.     

Aesthetic smile evaluation--a non-invasive solution

Enhancement of the aesthetic zone is a common reason for patients to seek dental care. This article describes a protocol for the examination, assessment and treatment planning for a patient seeking a solution to an aesthetic concern. The technique of undertaking an intra-oral'mock-up' using resin composite as a diagnostic approach can be particularly helpful when planning for future prosthodontic rehabilitation. The latter can allow the operator and patient to visualize crudely what is aesthetically and functionally possible, given the constraints imposed by that patient. The patient has ultimately managed in a minimally invasive manner. CLINICAL RELEVANCE: It can be very tempting for a dental operator to impose his/her concepts of the'artistic ideal' when planning for care in the smile zone. Such ideals are largely based on established universal aesthetic principles of tooth colour, size, shape, form, position, symmetry and proportion. However, beauty is a very subjective matter. It is essential for the operator to listen attentively to his/her patient's concerns. Meticulous patient examination and assessment are absolutely critical factors in attempting to attain a successful outcome. The use of reversible, chairside intra-oral mock-up techniques can not only help with the transference of essential information to the dental technician when planning for restorative intervention in the smile zone, but can also allow the patient to gain an insight and indeed contribute his/her views to the possible restorative endpoint, respectively.     

Ethics for orthodontists.

When treating children, important ethical issues may arise relating to the best interests of the child and decision making for minors. The case of a child with a cleft lip and palate whose parents failed to bring her in for medically indicated orthodontic care is presented. Ethical features of the case are discussed, including the need to benefit the patient, avoid harm, and respect the preferences of the parents. Ethical codes of the American Dental Association and American Medical Association are referenced. Ethical dilemmas include the conflict between the orthodontist's obligation to the child and the need to respect parental autonomy. Parental autonomy is respected up until the point at which significant harm to a child may result. The orthodontist's primary ethical responsibility is to the child, not the parents. The orthodontist providing medically indicated care should involve the craniofacial team or hospital social worker when parental decision making is in question.     

Role of psychologic factors in dental practice with siblings]

Results of a study of psychologic environmental factors and their effects on siblings in terms of fear from dental interventions are presented. Thirty pairs of siblings aged 6-15 years, treated at the Zagreb University Institute of Pediatric and Preventive Dental Medicine in Zagreb, were included in the study. The main criterion for inclusion in the study was the fact that one child accepted the treatment without reluctance, while the other child from the same family refused it or accepted it with considerable difficulties. According to this criterion, a cooperative group and a non-cooperative group of children were formed. The study was performed using a poll taken by means of a special questionnaire containing 22 questions. Results showed the psychologic environmental factors to have a marked but not most important role in the genesis of fear from dental interventions in children. Each child revealed himself/herself to be a person of his/her own, whereas environment, i.e. upbringing and education, was found to induce specific reactions in each of them. Therefore, care must be taken by a dental doctor-pedodontist to approach each little patient individually, fully respecting his/her personality.     

Care of adolescents with cleft lip and palate: the role of the general dental practitioner

Management of the adolescent with cleft lip and/or palate is ideally undertaken by a cleft palate team which has overseen care since birth, and which provides, in a paediatric hospital setting, the specialist medical, dental and ancillary care services necessary for optimal management. However, in some countries such a team is not available and individual dental practitioners and dental specialists have to undertake the necessary treatment. This is facilitated in Australia by the Federal Government's 'Cleft Lip and Palate Scheme', which subsidizes all medical and dental treatment related to the congenital defect up to 22 years of age. In such circumstances the general dental practitioner or paedodontist may need to assume an important coordinating role. The timing and integration of phases of general dental, minor oral surgical, orthodontic, periodontic and prosthetic treatment with plastic, ENT and maxillofacial surgery, speech therapy and audiology may become his responsibility. In addition, the provision of a high standard of preventive and general dental care for the cleft patient must be maintained. To carry out this coordinating role effectively, the general dentist must know his patient and family well; must understand the current concepts, objectives, treatment and investigatory techniques used in all aspects of cleft palate management; he should be aware of the genetics of the clefting conditions, medical problems which may commonly be associated with clefts and the cleft as one feature of a syndrome. Most importantly, he should be aware of the special social adjustment problems faced by many cleft adolescents in relation to their perceived 'different' facial appearance and speech.     

The expanding influence of computed tomography and the application of computer-guided implantology

Implant dentistry is changing. There are currently two types of computed tomogrophy (CT) scanners--multi-slice and cone beam--available to the dental professional. Computed tomography allows for proactive planning among the entire implant team and with the patient, a concept referred to as "collaborative accountability" In addition, CT surgical guidance that enhances accuracy and precision is available to ensure prosthetic outcomes. A logical and progressive approach is outlined that allows each clinician to assess how to embrace this paradigm shift in his or her clinical practice, and provide better and safer patient care.     

Comprehensive care for children with bleeding disorders. A physician's perspective.

As a result of recent advances in the understanding of hemostatic mechanisms--and the availability of more accurate diagnostic tests, effective replacement therapy and medications--most of the common bleeding disorders in children can be diagnosed and managed. Children with bleeding disorders often present with dental problems. Their comprehensive care requires specialized preventive and acute dental treatment. With improvements in dental care protocols and surgical procedures, the risk of excessive bleeding in these children as a result of dental procedures should be minimal, particularly if they are well prepared and treated beforehand. It is important for dentists to be familiar with these specialized dental care protocols and procedures, and knowledgeable about the medical treatment provided to children with bleeding disorders. This allows dentists to coordinate the care of a hemophiliac with his or her physician in a comprehensive manner.     

The 'secret' of success. Part 3

Practice success is defined across the four 'dimensions' of oral health, patient satisfaction, job satisfaction and financial profit. It is suggested that the 'secret' of success in dental practice is to make patient (customer) satisfaction the primary focus. Not a very earth shattering or surprising 'secret' perhaps! This is hardly a new idea, and not a concept restricted to dental practice. This principle applies to all businesses. This series of articles reviews evidence from across a broad spectrum of publications: from populist business publications through to refereed scientific papers, this 'secret' seems to be confirmed. The evidence for which aspects of our service are most important in achieving patient satisfaction (and therefore success) is explored. Clinical Relevance: Good oral health outcomes for patients are defined as the primary purpose of dental practice and, therefore, an essential dimension of success. The link between positive patient perceptions of general care and his/her own oral health to practice success is explored.     

Goal setting

I would not tell any individual what his or her goals should be or what the picture of one's life should look like. I strongly believe in human potential, and I love to see people achieve more of the things that are important to them. The Goal Curves exercise is probably one of the most powerful methodologies used to help individuals get the most out of their lives while enjoying every day; this exercise leads to much greater individual success. However, for it to be effective, one needs to develop his or her goals and then review and act on them on a regular basis.     

Dental management of the pregnant patient

The pregnant patient presents several considerations for providing dental treatment. Among these are that there are two persons involved in the dental treatment of a pregnant woman, the woman and the baby. Each presents a different set of problems. The mother basically presents no difficult problems for dental treatment. She needs to have routine dental treatment provided. All procedures can be done. Because of the fetus, certain precautions in the use of drugs and radiographs must be taken. If it is determined in taking the history that a person may be pregnant and she is not seeing an obstetrician, the dentist should urge her to see one at her earliest convenience. It is well documented that early and good prenatal care decreases the risk to the mother and to the fetus. Diabetes, hypertension, and anemias are frequently associated with pregnancy and produce a threat to the developing fetus. These diseases, along with any other systemic diseases and infections that pose threats to either the mother or the fetus, are normally detected with good prenatal care.     

Building the dental dream team: behavioral styles in the practice

There are four different behavioral styles evident in a dental team and in patients. The styles are based on observable behaviors relating to degrees of "assertiveness" and "responsiveness." The Behavioral Style model helps to clarify why some people relate positively with each other and why others may conflict. Using finely tuned observational skills and an understanding of these styles, interpersonal transactions can be more effective, dental teams become more cohesive, and patients will be more satisfied with service provided in the dental practice. Each member of the team should understand his/her own personal style and those of teammates. Once that understanding is gained by all, it may be effectively applied to understanding patients. Behavior modification is at the heart of this concept. Adjusting your own behavior to the needs of others enables a patient to achieve more comfort with the dental team, and they are more likely to hear your verbal messages.     

Discussing and evaluating professional behaviour. 3. Radboud University Nijmegen Medical Centre

Working professionally and professional behaviour are important issues in the practice of a medical profession. The Radboud University Nijmegen Medical Centre's Dental School recognizes their importance. The aims of the education in professionalism are that a student's professional behaviour can be seen to be improving during the study, that the student can reflect on his professional behaviour and that the student, working in a dental team, is able to deal with other people's responses to his professional behaviour. During the entire study, a 'Developmental plan of professional behaviour' is recorded digitally. This developmental plan is discussed and if necessary aspects requiring improvement are indicated.     

Helping people change: the magic of motivation

The consensus of the data and of the interviewed doctors was that the five most profound motivators of people in the workplace today are as follows: (1) Achievement of work well done; (2) Personal pride and satisfaction in being a part of quality treatment and excellent care of patients; (3) Continuing education; (4) Equitable compensation; (5) Respect, responsibility, and appreciation. When asked how important motivation is to the productivity of her practice, Dr. Stelly closes by saying, "Motivation is the most critical factor in productivity. Motivation is the key. If everyone is on the same page and if the doctor and key team members can continue to motivate and encourage others, then the sky is the limit. The key is to keep everyone goal-oriented, unified, and excited about the possibilities. Then you are going to have a team of consistent, long-term employees, you don't have turnover and with that kind of consistency, you are going to have increased productivity."     

Basic oral health needs: A professional priority?

The inadequacy of access to oral health care is a complex problem facing society. Many in society who need care are unable to obtain it or do not seek it for a variety of reasons. Most commonly, these are the unfunded, who simply have inadequate resources; the "unaccepted," who may not have dental coverage or have types of coverage that are not accepted by private practitioners; the inaccessible, who may be homebound or live in sparsely populated or low-income geographic areas without dental providers; the unconvinced, who may have resources but do not believe in or recognize the need for treatment; and the unmotivated, who may realize that they need care but for them it is not a priority. While the oral health care professions cannot be expected to shoulder the entire burden to "fix" inadequate access to care, we believe that they have important responsibilities. True professions have a unique relationship with society that places them in positions of trust. With this trust comes the responsibility for public policy advocacy and to actively participate in identifying realistic ways to reduce the access problem. The leadership of organized dentistry, as well as educational institutions, and practitioners themselves must be committed to improving access and thereby the health of those currently underserved.     

Ameloblastomas.

Ameloblastomas are slow-growing, destuctive lesions of the jaws. They have a wide age distribution and occur in both sexes. In considering the treatment of these lesions, one must take into consideration the patient's age, the patient's concern for his (her) functional, social and aesthetic requirements. It is not unreasonable to aim at a conservative approach first, then radical surgery when the lesion recurs. Small lesions can be treated by local block excision or curettage. For large lesions and recurrences in the mandible, jaw resection and immediate bone graft is indicated. In the author's experience, split iliac crest graft gives the best clinical result.     

Dental trauma: part 2. Managing poor prognosis anterior teeth--treatment options for the subsequent space in a growing patient

Part 1 concentrated on implications of dental trauma especially prior to and during orthodontic treatment. This paper examines the literature supporting various treatment options for poor prognosis anterior teeth and subsequent space generated when these teeth are lost. The role of an interdisciplinary team in managing this clinical situation is essential to obtain optimal results and an orthodontist is an essential member. Although some treatment options are not provided by orthodontists it is important that they have some knowledge of these and the latest research that support their use. Other techniques lie very much within the orthodontic remit. Treatment options can be split into maintaining the failing tooth or extraction and restoration of the edentulous gap. This paper reviews various treatment options including periodontal regeneration, surgical repositioning and distraction osteogenesis, composite build up to incisal levels and decoronation when maintaining a failing tooth. When extraction and restoration of edentulous gap is required the following treatment modalities are discussed: extraction technique to retain bone quantity, orthodontic space closure and opening (site development), autotransplantation, partial denture, resin bonded bridge and implants. All these options should be considered and available to an interdisciplinary team to ensure optimal care of children with anterior teeth of poor prognosis.     

Beyond cosmetics--the esthetic rehabilitative patient

The evolution of the esthetic movement has been sustained over time because it touches a base psychological need for most people to feel they are attractive, youthful, and a vital part of society. Through well-organized team diagnosis and treatment planning, patients can benefit from a solid diagnostic and prerestorative foundation that can more predictably produce consistent optimal treatment results. As the chief diagnostician and treatment supervisor, the restorative dentist must continue to advance his or her knowledge and training to provide the other team members with a concise treatment vision for the patient. With a newly developed synergy among the disciplines of dentistry for team treatment and tremendous advancement in dental markets and equipment, it is possible to create natural-looking, esthetic rehabilitative treatments.