Tuesday, December 24, 2019

The State of Ransomware in the US: Report and Statistics 2019

 
 
 
2019 may well become known as “The Year of Ransomware”.  Whereas up to this point, some folks were aware of Ransomware and what is was capable of, this year we have seen a *huge* increase of successful attacks.  These have crippled multiple sectors of business including healthcare.
 
The biggest problem is that the bad guys unleashing this on the public are (at this point) much more proficient and knowledgeable about spreading the threat than the rest of us are at stopping it.  
 
Criminals have discovered this is an easy way to make pile of money and until the victims find ways to shut this down, the scourge will only continue.  For those of you that are not immersed deeply into the world of digital security, this is the number one problem we all face.
 
If you would like a fascinating read on the entire situation head on over to the blog of my favorite Anti-Virus Company Emsisoft and read their report.  This is *highly* recommended...
 

Monday, December 23, 2019

NORAD Tracks Santa on Christmas Eve

 


Tomorrow is Christmas Eve and every year about this time I try to let my readers know about a great service that is provided by NORAD.

The government entity NORAD is a combined effort of the US and Canada that “provides aerospace warning, air sovereignty, and defense of North America”.  Basically it tracks anything in the air to make sure it is not a threat to North America and they’ve been doing that since 1958.  However, since they are uniquely qualified to track aircraft, the organization also is uniquely qualified to track Santa!!!

To follow Santa on his journey around the world bringing toys to all the boys and girls, go to the NORAD Santa Tracker.  For those truly interested in when Santa will arrive in their area, the trackers have a phone bank setup where they can answer those types of questions for you!  The trackers are real life soldiers who work at NORAD and they volunteer their time every year to provide this service.  The phone number to contact the troops tracking Santa is 1-877-HI-NORAD


I personally want to thank all of the folks in the armed forces who donate their time to this worthy cause every year.  Thanks for bringing Christmas joy to so many of us.  I’ve called and spoken with them before and it was a great experience for the kids involved with that call.  I cannot say enough about how grateful I am for all you do!!!  I’d also like to take this opportunity to thank all of the brave men and women who are serving our country and keeping the rest of us safe from those who would do us harm.  Your sacrifice is appreciated by me more than words can tell and will always be remembered by me and those I love.  There is no greater love than to lay down one's life for their friends and I will do everything I can to make sure those who benefit from your service will always be aware of what you do.

If you would like to read the complete history of how NORAD came to provide this valuable and FREE service to kids and families, Wikipedia has the whole history of the program here.  I’ve got to say it’s a pretty neat read and something that shows how a “happy accident” can bring joy to so many.

The good people at Google have also created a Santa Tracker that can be accessed by clicking here.

I don’t think they have a phone service like NORAD does, but their tracker is pretty neat. 

Thursday, December 19, 2019

Place. Twist. Done. with the Palodent® 360 Circumferential Matrix System




Dentsply Sirona, the world’s
largest manufacturer of professional dental products and
technologies, introduces the new Palodent® 360 circumferential
matrix system. This revolutionary new design allows clinicians to
achieve tight contacts with anatomically natural contours
without the use of an awkward retainer or applicator and all with
a simple twist of their fingers.

“The newest addition to the Palodent® family of
matrix systems will provide clinicians with all
the tools they need to easily conduct any Class
II restorations with complete confidence,” said
Paquita Poindexter, Product Marketing
Manager for Dentsply Sirona Restorative.” The
simplicity of the Palodent® 360 circumferential
matrix systems allows for simpler, quick
restorations for the clinician and the patient.”

Like the Palodent® Plus sectional matrix system, Palodent® 360
features an anatomically shaped matrix band to provide
predictable, tight contacts that replicate natural tooth anatomy.
The new system can be used for all Class II restorations including
difficult Class II cases, such as situations where there is no
adjacent tooth or there is a severely rotated tooth.

Furthermore, increase efficiency with the use of the Palodent®
360 system by decreasing the time needed for set up. Additional
benefits of the new simplified design include:

-  Ease of Placement
-  No retainer to obstruct access
-  Clear View of the Operating Field
-  No uncomfortable retainer

Palodent® 360 matrix bands are compatible with the Palodent®
Plus retaining rings and wedges to further assist in creating an
optimal seal or additional space in situations where there is a
tight interproximal space. With the addition of the Palodent® 360
circumferential matrix system, the Palodent® family of matrix
systems can cover all posterior Class II restorations.
For excellent restorations, faster and easier than you ever
thought possible, turn to Palodent® 360. Success comes full
circle.

Wednesday, December 18, 2019

Weave & Curve Dental Announce Integration of Their Platforms

 



I’ve been using VOIP (Voice Over Internet Protocol) services from Weave for quite a few months now.  My experience has been incredible positive.  As an example, last Thursday my office (gasp) lost our Google Fiber Internet connection.  Since technology is the lifeblood of the practice, we were practically adrift for a few hours.  This also meant our Weave connection and phones went down as well.  With a phone call to Weave from a mobile phone, we were almost instantly rerouted so that our office lines were now ringing on the cell phones of my front desk team.  This continued until Google got our connection restored and we had the numbers rerouted back to standard.

Weave can do some amazing things for your practice.  If you’d like to find out more, give my article on VOIP a read over at Dental Products Report.  

Now I have exciting news about Weave and cloud based practice management system Curve Dental.

The 2 companies have announced a collaboration that makes Weave available inside the Curve platform.  Here’s the news:

Curve Dental recently announced its integration with Weave, the patient communication platform. Now Curve Dental customers can use Weave’s collection of communication tools.

“Patient experience is a top priority for most dental practices, with technology being a cornerstone of the modern experience,” said Dave Cormack, executive chairman of Curve Dental. “By partnering with a proven patient communications solution like Weave, Curve customers will have access to a modern, HIPAA-approved communications tool that aligns perfectly with today’s digitally-savvy patients.”

Curve’s practice management software, combined with Weave, allows dental practices to communicate more efficiently and effectively with patients and customers.

“Curve’s dedication to streamlining processes for dental practices closely aligns with our mission of bringing businesses closer to the people who use them,” said Brandon Rodman, CEO, and co-founder at Weave. “Curve brings flexibility and efficiencies to all dental processes and our integration will extend these capabilities to nurturing the patient relationship and experience. It’s game-changing for practice owners and their staff, and we’re really excited to see the impact on their businesses and patients.”

Curve Dental provides web-based dental software and related services to dental practices within the US and Canada. For more information, visit curvedental.com.

Weave provides communication software solutions for the entire customer journey. To learn more, visit getweave.com.

Tuesday, December 17, 2019

Add the Voice of Samuel L. Jackson to your Amazon Echo!

 


As a diehard geek and The Technology Evangelist, sometimes I get to do posts here that are just plain fun.  Today is one of those posts because I am delighted to give you access to the voice of legendary actor Samuel L. Jackson.

I was thrilled to find this info because, well if you ask me, Samuel L. Jackson is the coolest guy on the planet.  Besides being in some Star Wars movies he’s also Nick Fury in the Marvel world and those 2 claims alone make him practically a deity to me.  Never mind that the guy just has ice water in his veins and makes everyone of his characters infinitely re-watchable (and yes that includes SWAT and Snakes on a Plane… at least to me).

So as the guy that I would most like to hang out with, I could hardly contain my excitement when I learned that you can now give your Amazon devices the voice of the famous actor.

Just say to your device, “Alexa, introduce me to Samuel L. Jackson”.  She will ask you to confirm a 99¢ one time charge and then, let the games begin!

You won’t get the full Alexa vocabulary so the device will switch back and forth, but to me that matters little.  My Echos will now converse with me using the voice of the coolest guy on the planet and that’s all the really matters to me.

Monday, December 16, 2019

Emsisoft Finds Bug in Decryptor of Ryuk Ransomware

 


In the past 6 months or so I have become a huge fan of the antivirus company Emsisoft.  Not only does the company make a first class antivirus product, but they also give back by running the Emsisoft Malware Lab which, among other things, releases free decryption keys for known Ransomware.

However, the good folks at Emsisoft are not the only ones who provide decryption keys.  There are other companies that do this as well.

Normally, that would be a good thing, but it seems that recently the bad guys have changed some things about the Ryuk Ransomware that make using the other free keys very risky.

One of the biggest problems with security is that it is a constantly shifting landscape… or a tremendously important cat and mouse game.  Hackers create malware, security professionals counter with solutions, and the hackers rework the malware to bypass whatever security professionals have done.  Currently this is exactly what has happened.

In the last 2 weeks hackers have changed the way Ryuk works.  The current versions that are striking victims uses code that only partially encrypts some files.  This allows the program to work faster and encrypt more data before it’s caught.  This is now causing problems for the existing free decryption solutions that are not created to deal with this new problem.  It means that victims may still be dealing with partially decrypted flies even after running a decryption key.

The good news is the Emsisoft has an updated decrypter that should provide for a smooth unencryption process.  

If you have been affected by Ryuk or you’d like more information, take a look at this post on the Emsisoft blog.  Also, the next time you need to renew your antivirus or you need to do an install on a clean system that needs antivirus, purchase Emsisoft.  That’s what I did...

Tuesday, December 10, 2019

What’s New at ALD 2020? The First “Laser 101” Full-Day Session

 


The Academy of Laser Dentistry (ALD), recently announced its first “Lasers 101” full day educational track at the upcoming 27th annual conference and exhibition, April 2-4 at the Paradise Point Resort in San Diego.

Specifically, the “Lasers 101” track is a day pass program entitled “So You Got a Laser. Now What?” This program will take place on Saturday, April 4th from 8:00 AM to 3:00 PM. According to ALD executive director, Gail Siminovsky, CAE, “This learning track is designed to excite clinicians interested in exploring laser dentistry or those who may be on the fence about it. By taking this course, clinicians put themselves in the driver’s seat with confidence when it comes to evaluating lasers clinically and using them. It’s another example of ALD’s innovative approach to laser education”.

Here’s the “So You Got a Laser. Now What?” program at a glance:

• 3 expert speakers:
• Michael Cataldo, CEO of Convergent Lasers. “Return on Your Laser Investment”
• Dr. Juliana Barros, “Let the Light Shine: A Brighter Day at the Office”
• Dr. Shalizah Patel, “Laser Protocols: Let the Evidence Guide You”
• Unbiased, scientifically relevant practical information
• 6 CE credits
• Full access to exhibit hall
• Breakfast and Lunch included
• Panel discussion
• Only $695 per attendee**
• This program is FREE when you register for the entire ALD 2020 Meeting**

Click http://bit.ly/2pWYBl3 to register for this one-day only program. Seating is limited!

The over-arching theme of ALD 2020 is “The Future is NOW: Integrating Technology into Your Practice”. The ALD 2020 experience is designed to transform careers by providing unbiased lectures and hands-on workshops on all types of lasers. Digital imaging, CAD/CAM, 3-D cone beam radiography, are all part of the curriculum, as well.

“ALD’s openly friendly and genuine approach will impress you. ALD’s discussions are lively and supportive.” says Siminovsky.”

What else is new and exciting in the laser world? ALD 2020 includes a strong educational track on one of the most exciting developments in laser dentistry; photobiomodulation or PBM, a form of low-level laser therapy which has been clinically proven to heal tissue and reduce pain. The complete schedule includes the highest caliber of informative and relevant sessions that make this conference “dentistry’s laser meeting.”

Lectures: Endodontics, Periodontics, Pediatrics/TOTs, Esthetics, Medically Compromised Patients, Sleep Apnea, Pain Management, Hygiene, Financial Planning, Wealth Management, Legal Protection

Workshops: Diode Laser Basics, Advanced Diode Lasers, Endodontics, Photography, Whitening, Hygiene, Laser Certification

New Trends: 3-D Imaging, Green Dentistry. Smile Design, Caries Prevention, Periodontal Endoscopy, Adjunctive Modalities for Laser Dentistry

Early Bird Discount:
For full conference program details and registration information, visit http://bit.ly/2NOgmcK.
An early bird registration discount of $150.00 is in effect until December 31, 2019. What’s more, during the Greater New York Dental Meeting, $200.00 tuition discount coupons will be distributed during the laser courses presented by Dr. Sam Low, Dr. Mel Burchman, Dr. Gerry Ross and Dr. Laura Braswell. Each of these coupons can be combined with the early bird discount for a total savings of $350.00 for total tuition of only $895.00.

About the Academy of Laser Dentistry:
The Academy of Laser Dentistry (ALD) is the only independent and unbiased non-profit association devoted to laser dentistry and includes clinicians, academicians and researchers in all laser wavelengths. The Academy is devoted to clinical education, research, and the development of standards and guidelines for the safe and effective use of dental laser technology. ALD was founded in 1993, with the merging of the International Academy of Laser Dentistry, the North American Academy of Laser Dentistry and the American Academy of Laser Dentistry. For more information, visit www.LaserDentistry.org.

* Hotel not included
** Additional workshops and hotel not included.

Monday, December 9, 2019

Ransomware at Colorado IT Provider Affects 100+ Dental Offices

 


This is another attack that has affected multiple offices in multiple states.  It seems that Complete Technology Solutions (CTS) a company based out of Englewood, CO was attacked and the hackers used this initial penetration to then infect client offices.

Many IT providers use remote access software to allow their support people to log into a dental office computer & fix problems when they arise.  While some companies set things up so that the dental office has to be at the computer and actually “allow” remote use by clicking “OK”, other companies setup remote control without a user’s permission simply because it is easier, faster, and can be done even when no one is in front of the computer needing to be fixed.

In this case however, since all of the client offices were setup to allow CTS log in without someone actually being at the computer, once hackers gained control inside of the CTS system, they then had access to every client computer.  This allowed the hackers to spread ransomware from CTS to all these client computers.  Basically once hackers had control inside of CTS, they *also* had control inside of every one of their clients computers as well.

Ransomware was installed and this brought over 100 client dental offices crashing down.  Since most of these clients were using CTS as their cloud backup solution as well, their backups were also encrypted and locked.  This attack demonstrates why backups should never all be held in one place.

I’m sure that many of these practices went home each night thinking their office was safe and that even if disaster struck, their data was backed up.  In this case the data *was* backed up but when your backups are also encrypted they are useless.

For years now I’ve been preaching that your backup protocol should be a “backup chain” and by that I mean it needs to have as many links as possible.  Having only ONE backup is not enough.  I would highly recommend at least two… and perhaps even more.  The concept of cloud storage and backups has given many people a false sense of security.  When you consider how important data is to your business ( and it IS the heart of your business) backing up should be one of the most important, if not THE most important part of your business plan.  If you only want to do cloud backup, then make sure you have 2 independent companies providing that service.  Backups are no good if you cannot retrieve them.

Over 500 hundred practices have been taken offline by ransomware since late August.  Do not think this cannot happen to you.  For all the details, checkout this article by security expert Brian Krebs.  

Thursday, December 5, 2019

Curve Dental Releases ePrescribe, Allowing Doctors to Send Digital Prescriptions

 


One of the things that many dental management software systems have been lacking is the ability to ePrescribe.  The idea of paperless prescriptions has been available in the medical world for quite some time now, but it’s been lacking in dentistry.  Now comes great news from Curve Dental that their cloud based management system allows for this sought after feature.

Here are the details:

Dental practitioners can now send or renew prescriptions to pharmacies from any device, Curve Dental announced today. A new release of enhanced functionality for ePrescribe, a module within the Curve Cloud Platform, allows clinicians to send prescriptions to pharmacies from any digital device, including a smartphone or tablet.

In partnership with DrFirst, a leading provider of e-prescribing, price transparency, and medication management solutions, Curve Dental offers customers an efficient process for sending prescriptions from their everyday workflow within its cloud-based dental practice management solution.

The new release includes three prescribing options; ePrescribe, which allows doctors to manage electronic prescriptions with ease; iPrescribe, which allows doctors to write and send prescriptions from mobile devices; and Prescription Drug Monitoring Programs (PDMP) registration for Electronic Prescriptions for Controlled Substances.

With this new functionality, Curve’s ePrescribe module allows customers to streamline prescription writing and reduce prescribing errors using the SmartSuite™ feature. This feature minimizes the need to search for drugs by displaying commonly prescribed medications with complete sig based on historical prescribing behaviors.

Gary Long, Curve's Chief Revenue Officer explains, "Our combined EPCS and PDMP solution streamlines workflow and dramatically reduces the time it takes to check patient prescription history, document the PDMP check and complete the electronic prescription. It also helps eliminate the possibility of human error throughout the process. We are committed to doing our part to address the country's opioid epidemic and feel that our solution will help dentists do their part to support the PDMP initiative."

Curve Dental is a web-based dental software and services provider in the US and Canada. To date, Curve has 25,000 users in the US and Canada and strives to make dental software about the user experience. For more information, visit curvedental.com.

Wednesday, December 4, 2019

Hospital Chain Agress to $2.175 Million Settlement with Office of Civil Rights

 


There is a lesson in today’s post.  Reporting security breaches is required to be in compliance with HIPAA statutes.  Also consulting knowledgable experts can greatly help in these situations.

The situation I’m reporting on here includes a breach which was reported, but actually under reported.  You’ll get the idea after you read the information released by the Department of Health and Human Services:

In an agreement with the Office for Civil Rights (OCR) at the U.S Department of Health and Human Services (HHS), Sentara Hospitals (Sentara) have agreed to take corrective actions and pay $2.175 million to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Breach Notification and Privacy Rules.  Sentara is comprised of 12 acute care hospitals with more than 300 sites of care throughout Virginia and North Carolina.

In April of 2017, HHS received a complaint alleging that Sentara had sent a bill to an individual containing another patient’s protected health information (PHI). OCR’s investigation determined that Sentara mailed 577 patients’ PHI to wrong addresses that included patient names, account numbers, and dates of services.  Sentara reported this incident as a breach affecting 8 individuals, because Sentara concluded, incorrectly, that unless the disclosure included patient diagnosis, treatment information or other medical information, no reportable breach of PHI had occurred.  Sentara persisted in its refusal to properly report the breach even after being explicitly advised of their duty to do so by OCR. OCR also determined that Sentara failed to have a business associate agreement in place with Sentara Healthcare, an entity that performed business associate services for Sentara.

“HIPAA compliance depends on accurate and timely self-reporting of breaches because patients and the public have a right to know when sensitive information has been exposed.” said Roger Severino, OCR Director.  “When health care providers blatantly fail to report breaches as required by law, they should expect vigorous enforcement action by OCR.”

In addition to the monetary settlement, Sentara will undertake a corrective action plan that includes two years of monitoring. The resolution agreement and corrective action plan may be found at https://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/agreements/sentara/index.html

Tuesday, December 3, 2019

What’s New at ALD 2020? The First “Laser 101” Full-Day Session


 


The Academy of Laser Dentistry (ALD), recently announced its first “Lasers 101” full day educational track at the upcoming 27th annual conference and exhibition, April 2-4 at the Paradise Point Resort in San Diego.

Specifically, the “Lasers 101” track is a day pass program entitled “So You Got a Laser. Now What?” This program will take place on Saturday, April 4th from 8:00 AM to 3:00 PM. According to ALD executive director, Gail Siminovsky, CAE, “This learning track is designed to excite clinicians interested in exploring laser dentistry or those who may be on the fence about it. By taking this course, clinicians put themselves in the driver’s seat with confidence when it comes to evaluating lasers clinically and using them. It’s another example of ALD’s innovative approach to laser education”.

Here’s the “So You Got a Laser. Now What?” program at a glance:
• 3 expert speakers:
• Michael Cataldo, CEO of Convergent Lasers. “Return on Your Laser Investment”
• Dr. Juliana Barros, “Let the Light Shine: A Brighter Day at the Office”
• Dr. Shalizah Patel, “Laser Protocols: Let the Evidence Guide You”
• Unbiased, scientifically relevant practical information
• 6 CE credits
• Full access to exhibit hall
• Breakfast and Lunch included
• Panel discussion
• Only $695 per attendee**
• This program is FREE when you register for the entire ALD 2020 Meeting**
Click http://bit.ly/2pWYBl3 to register for this one-day only program. Seating is limited!

* Hotel not included
** Additional workshops and hotel not included.The over-arching theme of ALD 2020 is “The Future is NOW: Integrating Technology into Your Practice”. The ALD 2020 experience is designed to transform careers by providing unbiased lectures and hands-on workshops on all types of lasers. Digital imaging, CAD/CAM, 3-D cone beam radiography, are all part of the curriculum, as well.
“ALD’s openly friendly and genuine approach will impress you. ALD’s discussions are lively and supportive.” says Siminovsky.”

What else is new and exciting in the laser world? ALD 2020 includes a strong educational track on one of the most exciting developments in laser dentistry; photobiomodulation or PBM, a form of low-level laser therapy which has been clinically proven to heal tissue and reduce pain. The complete schedule includes the highest caliber of informative and relevant sessions that make this conference “dentistry’s laser meeting.”

Lectures: Endodontics, Periodontics, Pediatrics/TOTs, Esthetics, Medically Compromised Patients, Sleep Apnea, Pain Management, Hygiene, Financial Planning, Wealth Management, Legal Protection
Workshops: Diode Laser Basics, Advanced Diode Lasers, Endodontics, Photography, Whitening, Hygiene, Laser Certification

New Trends: 3-D Imaging, Green Dentistry. Smile Design, Caries Prevention, Periodontal Endoscopy, Adjunctive Modalities for Laser Dentistry

Early Bird Discount:
For full conference program details and registration information, visit http://bit.ly/2NOgmcK.
An early bird registration discount of $150.00 is in effect until December 31, 2019. What’s more, during the Greater New York Dental Meeting, $200.00 tuition discount coupons will be distributed during the laser courses presented by Dr. Sam Low, Dr. Mel Burchman, Dr. Gerry Ross and Dr. Laura Braswell. Each of these coupons can be combined with the early bird discount for a total savings of $350.00 for total tuition of only $895.00.

About the Academy of Laser Dentistry:
The Academy of Laser Dentistry (ALD) is the only independent and unbiased non-profit association devoted to laser dentistry and includes clinicians, academicians and researchers in all laser wavelengths. The Academy is devoted to clinical education, research, and the development of standards and guidelines for the safe and effective use of dental laser technology. ALD was founded in 1993, with the merging of the International Academy of Laser Dentistry, the North American Academy of Laser Dentistry and the American Academy of Laser Dentistry. For more information, visit www.LaserDentistry.org.

Monday, December 2, 2019

It’s Time For Health Insurance To Pay For Dental Care

 


The article quoted today could be a very slippery slope.  While I agree that dental care needs to be covered better by health insurance, I’m not sure that including it as *part* of health insurance is a good idea.  One of the biggest complaints is that the $1000-1500 deductible on today’s dental policies are the same maximum amount that was covered in the 1960s… and of course the costs of that treatment are no where near what they were back them.  The problem becomes that reimbursement of healthcare by insurance in the medical model is not what it should be either.  I don’t know that I want my treatment mixed in with all of the other aspects of the healthcare system.  How about just increasing the yearly maximums to what they would be adjusted for inflation?

Be that as it may, author Peter Ubel has a good point in his article.  You can read it in its entirety here.

Last time I checked, the mouth was still part of the human body. If I remember correctly, when people experience mouth problems, they ache just as much (often more) than if they experienced problems elsewhere in their bodies. So why do we still treat care of the mouth differently than other types of medical care? Why will my health insurer reimburse the cost of my annual physical but not the price of an annual dental check-up?

The insanity has to stop.

I am ranting on this topic today in part because of a study in the United Kingdom that demonstrates the tight connection between oral health and more general health. This study was focused on people with diabetes who also suffered from periodontitis—for what us non-dentists call “gum disease.” The researchers randomized people to usual care versus intensive periodontal treatment. Those receiving the more intensive dental care not only had better oral health at the end of study, they also had better diabetes control, as measured by a blood test called the A1C; the higher your blood sugar, the greater your A1C. A year into the trial:

Control patients:                                            A1C = 8.3%
People receiving intensive dental care:        A1C = 7.8%

Good dental care is part of good medical care. Because of a historical accident involving power struggles between physicians and dentists, health care insurance in the United States has not typically included dental care. That is a mistake. People deserve robust coverage for all their basic medical needs, including oral health.

Right now, it is easy for a physician to increase the dose of diabetes medications for their patients and expect decent insurance coverage for those treatments. But we could reduce the need for those expensive medicines if we just gave people better dental care. It is insane to pay to treat people’s diabetes while refusing to pay for dental care that will reduce the severity of that illness.

Wednesday, November 27, 2019

Clinical Trial of VOCO Admira Fusion X-Tra

 



I’m really excited about the future of operative dentistry.  In the last couple of years, we have seen tremendous progress in the development of highly aesthetic composite materials that require very little effort to create a nice shade match.

As composite technology has evolved, the industry has seen composites evolve in leaps and bounds.  Composites are a combination of resin and filler particles.  These fillers are what contribute to the aesthetics, polish-ability, and wear resistance.  Companies have been experimenting with these fillers, types, and ratios for years and have found several different combinations that work well in different circumstances.

The latest development has been spherical fillers.  In the past, fillers, when viewed under an electron microscope, looked like tiny pieces of gravel.  When light hit these particles, their shape caused the light to bounce around at all kinds of crazy angles and that meant that the resin holding the particles had to be embedded with a shaded material.  This meant that multiple shades were needed and sometimes shade matching was a challenge.

Spherical fillers do not have the same reaction when light hits them.  They allow the light to pass through the material and to then illuminate the surrounding tooth structure.  The reflection of the tooth structure is what gives the composite its shade… not some type of coloration added at the factory.  This allows for one material to handle every shade.  The other advantage of these materials is that since the light passes easily through them, the depth of cure is better.  Photons are not stopped by the color embedded in the resin so the light penetrates deeper into the composite.

A week ago I started to work with VOCO’s Admira Fusion X-tra which has spherical particles between 20-40nm.  While I have only been using the material for a few days, my overall impressions are extremely good.  The clinical case shown in the photos above are my second uses of the material.  The cases consists of a traditional MO on #4 (FDI 1-5) and a DO slot prep on #5 (FDI 1-4).  The margins were beveled using a #4 course round diamond.  Bonding was accomplished by using a 5th Generation Total Etch Technique with Ultra-Etch and Ultradent Peak Universal Bonding Agent.  Under normal testing circumstances I would have used a VOCO product, but I didn’t happen to have any available.  However, this also shows the variability of Admira Fusion X-tra as it is compatible with all conventional bonding agents.  

The matrix used was a Triodent Super Curvey band, held with a standard Triodent V3 Ring, and a Garrison Composi-Tight 3D Fusion Wedge.  The restorations were polished with an Ultradent Jiffy Original Composite System array of polishers.  

The material looked incredible immediately after placement.  Finishing was quick and easy because the aesthetics were so good.  I’m also impressed with Admira Fusion X-tra for a few other reasons as well.  The material has a depth of cure of 4mm (due to the lack of shading and the spherical fillers).  It also has a flat out incredible volumetric shrinkage of 1.25%.  This means that the margins stay intact; there are no “white lines” along the margins due to polymerization shrinkage.  

Since this is the first time I’ve worked with the material I’m going to be monitoring the restorations for the foreseeable future.  Any time I use a new material I’m always cognizant of the fact that I don’t know *for sure* how well they will wear and hold up to the everyday wear and tear that dental materials undergo.  However, I’m optimistic about the wear because the filler is ceramic-based which should allow for it to easily withstand occlusal forces without excessive material wear.

I’m just starting to work with Admira Fusion X-tra so you can expect to see more posts on it in the future.  At this point in my work I’m excited about the material.  I am really excited about the future of materials such as this and their ability to provide almost undetectable shade matching.  Any product that can provide gorgeous results that benefits the patient is something I’ll gladly do testing on...

Tuesday, November 26, 2019

Airway Summit at 2019 Greater New York Dental Meeting

 


Foundation for Airway Health returns to GNYDM for Third Consecutive Year


Are you attending the Greater New York Dental Meeting?  If so my organization The Foundation for Airway Health will be holding their third consecutive airway centered education program.

Screening for Airway and Sleep-Related Breathing Disorders is becoming the standard of practice for dentistry. In October 2017, the ADA approved a policy statement emphasizing dentistry’s role in screening for sleep-related breathing disorders. Learn what you need to know to meet this new standard of care or to exceed it and provide more for your patients and practice. Whatever your goal this presentation is for you and your entire team.
For the third year in a row, the Foundation for Airway Health will present a full day of airway-centered education. On Saturday, November 30, leading dental educators, scientific academy representatives, allied health organizations, representatives from industry and members of the public will offer information about what the dental team must know and can do to impact positive health change for patients. Learn from not one but 18 expert presenters. This is an excellent place to begin your sleep education as well as to expand it to new levels.
If you are a dentist, you should attend! If you practice in a different discipline or are a member of the public, encourage your dentist to attend. Every dentist who can screen for airway problems can affect the lives of hundreds each year.

To Register for the Airway Summit, visit the Greater New York Dental Meeting site.

Our presenters and topics:


Michael Gelb, Overview Airway Centric

Steve Lamberg, Screening

Steve Carstensen, Airway: The New Paradigm

Cyndee Johnson, Hygienist

Jeff Hindin, Physiological Dentistry

Richard Klein, TMD & Airway

Ben Miraglia, Early Intervention

Jill Meyer, Orthophics

Leslie Stevens, Early Airway Intervention

William Hang, Airway Orthodontics

Philip Neal, Readiness: The Army Sleep Initiative

Ben Waldman, Public Health Crisis

Barry Raphael, Airway Orthodontics

Mark Murphy, Scanning

Jerald Simmons, Medical Dental Connection

Payam Ataii, Clear Aligner for Airway Tx

Marc Moeller, Airway & Myofunctional Therapy

Vijay Parashar, The Role of Imaging in Airway Treatment

Julia Worrall, Airway Advocate Workshop

Monday, November 25, 2019

Security - Simply Put - Is Worth It

 


When you are running a business, costs have to be taken into consideration.  There is always a balance between costs and benefits.  Heck, that’s why there is a term referred to as “cost/benefit analysis” in the business world.

However, sometimes in healthcare the situation can devolve into the old adage of being “penny wise and pound foolish”.  Often doctors are not well trained in business practices and certainly not trained in the “Best Practices” of IT, and because of that sometimes poor business decisions are made.  The potentially bad part of poor IT choices is that saving money on the front end could very well create problems that might, in the long run, cause greater expenditures.

Unfortunately in recent history, some of these mistakes have been made in the security sector.  Products such as reliable offsite backups, network security, and reliable antivirus systems have all been overlooked in an effort to save money.  This violates a rule that has been referred to as The Common Law of Business Balance.  This law is the basic demonstration of cost vs. benefit or even an explanation of the ancient idea of Yin and Yang.  For every positive there is a negative, for every plus there is a minus, in business for every benefit there is a cost.

The secret to business success is to find and maintain that balance!!!   The problem with this rule is that many people feel they can violate it and still find success.  In other words there is a segment that thinks “I can pay a tiny amount and get a huge benefit which all of my competitors are paying a huge amount for the same thing.”  One thing I love about physics is that math works every time.  Shooting it to you straight, this truly can’t be done.

There is a famous quote attributed to a British man named John Ruskin that goes like this, “There is hardly anything in the world that someone cannot make a little worse and sell a little cheaper, and the people who consider price alone are that person’s lawful prey. It’s unwise to pay too much, but it’s worse to pay too little. When you pay too much, you lose a little money — that is all. When you pay too little, you sometimes lose everything, because the thing you bought was incapable of doing the thing it was bought to do. The common law of business balance prohibits paying a little and getting a lot — it can’t be done. If you deal with the lowest bidder, it is well to add something for the risk you run, and if you do that you will have enough to pay for something better.”

Anyone want a great deal on a parachute or a lifeboat?  i just got done with having my IT team replace every computer in my office.  We’ve got over 20 workstations so you can imagine that this wasn’t something I paid for with change from the couch cushions.  I also upgraded my AntiVirus system with Emsisoft.  After doing my research, I knew I needed to have a more robust A/V system running to maintain security and I looked at some others.  I settled on Emsisoft for a number of reasons, but one that I did NOT consider was the price.  

I had a buddy recommend a much cheaper solution to me.  He thought I was crazy to spend around $450 U.S. for A/V protection.  My reply was "If malware takes over my office and/or my network, the money I saved would be quickly consumed by all the work expended and paid for to get me back online."

Between those costs and potential fines if my data is stolen, the money I paid was small… and well worth it.  In today’s threat landscape you cannot be too careful.  Having the best protection for the different aspects of your data is important.  Don’t skimp in areas where you need the best.

Thursday, November 21, 2019

Evaluation of CheckUp from BlueLight Analytics

 
Dentistry is a continually evolving field and one of the major parts of it is the branch referred to as “restorative”.  This is science of taking the existing teeth and “restoring” them to state of health when they are broken, decayed, etc.
As far as actual time spent, the average dentist spends more of their time performing restorative procedures than anything else.  Restorative has evolved and changed greatly in the last 10-15 years.  Today the majority of fillings that are placed in the U.S. and Europe and “white fillings” which are done using a composite resin material.  While studies have failed to prove that silver amalgam fillings are detrimental to patient health, they do have the negatives of polluting the environment and not being aesthetically pleasing.  Composites, on the other hand, don’t contain any mercury and are tooth colored. One of the other big positives for composite is that it chemically bonds to tooth structure which means that less tooth structure needs to be removed during restorative procedures.
However, everything has plusses and minuses… advantages and disadvantages.  For composite, the minus is mainly due to the fact that it is technique sensitive which means a dentists needs to be pretty meticulous while performing the procedures.  Paying close attention to details such as eliminating contamination and not over-drying are easy to replicate.  Yet since their invention over 30 years ago there has been one problem that has been difficult to overcome because it couldn’t be evaluated.
That one step is what it referred to as “photo polymerization”.  Composites contain a chemical which, when exposed to a certain wavelength of light, causes the material to rapidly polymerize or harden.  The advantages of this are obvious since patients can leave the office and eat on the fillings immediately without worrying about damaging them.  Yet, the process of polymerization was impossible to measure in a clinical environment because it was impossible to measure the output of the the light that causes the reaction. 
Measuring the light output precisely requires a rather expensive piece of hardware called a radiometer and they really haven’t been available for use in a clinical setting.
Now, however, that is all about to change thanks to a company named BlueLight Analytics and their product called CheckUp.  Now, for the first time, a doctor has the capacity to test their curing lights on a state of the art device that can provide the data necessary to ensure your curing light is operating properly.  The CheckUp device is a combination of a small piece of hardware (the CheckUp device) and an app that runs on your smartphone.  When the app is downloaded your phone will connect to the CheckUp hardware via a BlueTooth connection.  The app allows the user to select which curing lights they are using as well as what composites are in the office inventory.
In addition to CheckUp providing a digital readout of the intensity of the light, it also provides information on the composites being used by the doctor.  One of the amazing and problematic things about composites is that different materials (and even different shades of the *same* material) will absorb the photons of the light differently.  This means that even though your light may be incredibly bright you cannot use an approach of “one cure fits all”.  For example, a very light shade such as B-1 might only take 5 seconds whereas a much darker shade such as A-3.5 might require a 20 second cure.  But how would you know this?
Utilizing the CheckUp database of curing lights as well as the database of materials, the app tells you specifically the output of the light being tested and the recommended curing times of each brand and shade of composite.
CheckUp is now on the market and I really think you need to take a good look at it.  You can got all the info you need by following this link.  
I have been using the device for about 60 days now and have been very impressed with what I’ve learned from it.  I’ll be reporting back here in future posts with more info.  .  This is truly the only way to be able to ensure the light is performing as it should.

Wednesday, November 20, 2019

Dentsply Sirona’s First US installation of State-of-the-Art Student Simulator Units Starts at University of Missouri-Kansas City School of Dentistry


 


Here’s some exciting news from Dentsply/Sirona and my alma mater the University of Missouri - Kansas City School of Dentistry.  When I received my training we worked with desktop Tensor lamps and simple airlines that powered high speed handpieces.  The upgrades now in place will allow students to learn in the most advanced environment possible and to simulate real world working environments.

Over 100 new and modern Dentsply Sirona simulator units were fitted at University of Missouri-Kansas City (UMKC) School of Dentistry in a groundbreaking USD 4-million project, making UMKC dental training labs one of the country’s largest and most advanced education facility.

Charlotte/Salzburg, November 19th, 2019. Leading manufacturer of digital dental equipment and education systems Dentsply Sirona continues to shape young dentists of tomorrow with the successful installation of a simulation and technology lab for pre-clinical education at University of Missouri Kansas City Dental School (UMKC).The installation, led by Dentsply Sirona’s International Special Clinic Solutions (ISCS) division, introduced more than a hundred new and ergonomically accurate simulator units which enable UMKC dental students to practice on ‘close to real life’ models.

A realistic environment to train future dentists

Last month, two UMKC training laboratories were equipped with 109 Intego student simulator units and two instructor units for its School of Dentistry students. The upgraded training labs now allow students to learn and practice in a realistic clinical setting from the very start as all dental procedures can be simulated under ergonomic conditions with correct instrumentation technique. The configuration of the workstations allows utmost flexibility, such as easy switching from right-handed treatments to left-handed. Thanks to its modular concept, the units are also suitable for both UMKC dental and dental hygiene curricula and include the option to add further functions and technological updates in digital dentistry in the future.

"The planning and research process were crucial to the success of this project at UMKC. Working closely with the university leaders to map their ideas and visions for the upcoming years allowed us to deliver an individually tailored product and training portfolio from start to finish,” says Peter Rössling, Dentsply Sirona Sales Director of International Special Clinic Solutions USA/Canada. “This is our first simulator installation of its kind in the U.S., and we look forward to bringing our technology to more students in the country.”

Universities and large clinics all around the globe from Germany to South Africa and New Zealand trust the long-term expertise of Dentsply Sirona’s ISCS division and its comprehensive approach. From consultation and planning to training and global support, ISCS ensures each customer’s unique vision is brought to life.

The high-quality equipment at UMKC has been designed and produced in Germany using particularly robust materials ideal for university settings.

UMKC – A world-class institution for excellence in oral healthcare education

Since 1881, UMKC School of Dentistry has been offering a varied and complete range of educational experiences for students of dentistry and dental hygiene, as well as students for Advanced Education and continuing education. The faculty comprises scholars, scientists and specialists – all dedicated to providing a high quality and comprehensive education, which is now enhanced by the new modern dental equipment from Dentsply Sirona. “The lab is spectacular. This will give our students more real-life experiences before performing dental care on people,” says Marsha Pyle, Dean of the UMKC School of Dentistry.

Tuesday, November 19, 2019

Vaping Illness Continuing to Be Reported - Death Toll Rising

 


The bad news on ENDS (Electronic Nicotine Delivery Systems or e-cigarettes) continues to grow.  As you regular readers know, yesterday I provided some info on a study that shows ENDS decrease the immune response of the lungs, and today I’ve got another post that deals with the dangers of vaping.

An article that was posted by Reuters on November 14, 2019 reports that lung problems associated with vaping continue to rise.  According to the CDC (Centers for Disease Control) the most recent statistics show 2172 cases of lung problems/infections have been reported as well as 42 confirmed deaths.

The condition has become so widespread that it now has a name.  It is being referred to as EVALI (e-cigarette Vaping Aassociated Ling Injury) 

About Patient Exposure:
All EVALI patients have reported a history of using e-cigarette, or vaping, products.Vitamin E acetate has been identified as a chemical of concern among people with e-cigarette, or vaping, product use associated lung injury (EVALI).


THC is present in most of the samples tested by FDA to date, and most patients report a history of using THC-containing e-cigarette, or vaping, products.


The latest national and state findings suggest products containing THC, particularly from informal sources like friends, or family, or in-person or online dealers, are linked to most of the cases and play a major role in the outbreak.

The information from the CDC is updated every Thursday.  To access the CDC webpage with all of the most current info, bookmark this link.

Monday, November 18, 2019

Electronic Cigarettes Disrupt Lung Lipid Homeostasis and Innate Immunity Independent of Nicotine

 


The US has seen a vaping crisis lately.  The problem began showing up around med-summer and continues to today.  The documented cases show that greater than 200 patients have been affected so far.

One of the frightening things about this problem is that it is showing up in young people who are normally expected to be in the prime of physical health.  The numbers are probably trending to youth simply because the vaping fad is heaviest in that demographic.  Current stats are showing that around 20 percent of high school students are vaping.

The disease/problem presents as a “pneumonia-type” situation.  Patients who are otherwise healthy are suddenly having trouble breathing.  Some are having chest pain, vomiting, and diarrhea.  The patients present with these problems and yet they test negative for bacterial and virus infections.  The only thing these cases seem to have in common is that every patient reported having recently used an e-cigarette.

Now a study published in The Journal of Clinical Investigation is showing that the body’s way of protecting the lungs is damaged by the contents of vape pods; even those that do not contain nicotine.

Here is the abstract:

Electronic nicotine delivery systems (ENDS) or e-cigarettes have emerged as a popular recreational tool among adolescents and adults. Although the use of ENDS is often promoted as a safer alternative to conventional cigarettes, few comprehensive studies have assessed the long-term effects of vaporized nicotine and its associated solvents, propylene glycol (PG) and vegetable glycerin (VG). Here, we show that compared with smoke exposure, mice receiving ENDS vapor for 4 months failed to develop pulmonary inflammation or emphysema. However, ENDS exposure, independent of nicotine, altered lung lipid homeostasis in alveolar macrophages and epithelial cells. Comprehensive lipidomic and structural analyses of the lungs revealed aberrant phospholipids in alveolar macrophages and increased surfactant-associated phospholipids in the airway. In addition to ENDS-induced lipid deposition, chronic ENDS vapor exposure downregulated innate immunity against viral pathogens in resident macrophages. Moreover, independent of nicotine, ENDS-exposed mice infected with influenza demonstrated enhanced lung inflammation and tissue damage. Together, our findings reveal that chronic e-cigarette vapor aberrantly alters the physiology of lung epithelial cells and resident immune cells and promotes poor response to infectious challenge. Notably, alterations in lipid homeostasis and immune impairment are independent of nicotine, thereby warranting more extensive investigations of the vehicle solvents used in e-cigarettes.

The study is a pretty fascinating read for those of you with a science or healthcare background.  The entire study can be accessed with this link.  

Thursday, November 14, 2019

BMC Oral Health Report on Dental Care During Pregnancy

 


As those of us in dentistry have been preaching for quite some time now, the mouth is connected to the rest of the body and what happens in the mouth can definitely have an affect on overall systemic health.

That’s why I was interested to see a study published by BMC Oral Health titled "Dental care during pregnancy based on the pregnancy risk assessment monitoring system in Utah”.  Problems and diseases of the oral cavity have been shown to have an affect on pregnant women and also on their unborn children.  Things like periodontal disease can lead to low birth weight and premature deliveries.  Those are just two of the reasons it’s important for pregnant women to seek out dental care.  It’s good for the health of the mom and also good for the health of the child.

Here’s a little of what the study had to say:

Poor dental hygiene and gum disease can increase the risk of heart attack, stroke, and adverse pregnancy outcomes. During pregnancy, a woman’s body goes through several changes that can cause oral health problems, including hormonal changes, fluctuation in oral hygiene practices and eating patterns. A 2012 national experts’ consensus statement concluded that dental care is both safe and effective throughout pregnancy, and that women should continue receiving treatment during their pregnancy. Research supports that routine preventive, diagnostic, and restorative dental therapy, and periodontal treatment, among pregnant women does not increase the risk of adverse pregnancy outcomes. Continued dental care during pregnancy is particularly important to avoid periodontal diseases  and subsequent risk of pre-eclampsia, preterm birth, and low birth weight infants.

Few studies have reported on the level of dental care received during pregnancy. However, those studies have shown lower levels of dental care during pregnancy. For example, in a study involving 2009–11 data from the Pregnancy Risk Assessment Monitoring System (PRAMS) in Hawaii, 50% had their teeth regularly cleaned before pregnancy compared with 33.4% during pregnancy. In a study involving 1998 data for four states from the PRAMS, 23 to 35% of pregnant women went to the dentist during pregnancy, 12 to 25% suffered from an oral health problem, and, of those with a problem, only 45 to 55% received care. The study further found that some women thought poor oral health during pregnancy was normal, believing that some types of dental care could harm their fetus. In a study involving 2004–08 data from PRAMS in Michigan, 26.0% reported that they needed dental care during their pregnancy, of which only 58.4% sought care. Low levels of care may be because of concern among patients, dentists, and obstetricians regarding the safety of dental care during pregnancy. Lack of dental insurance may also play an important role. A better understanding is needed as to how these factors contribute to the use of dental care during pregnancy, according to specific subgroups of the population.

Research shows that some dentists and obstetricians contribute to the low use of dental care among pregnant women. In one study, only 40% of pregnant women were advised by their obstetric provider to seek dental care during pregnancy, and 10% were refused care during pregnancy by their dentist. A recent survey of gynecologists found that they often mistakenly believed that dental x-rays (73%) and local anesthesia (59%) were unsafe for pregnant women.

Some healthcare workers are simply not counseling their patients about the importance of receiving dental care during pregnancy. In a study involving PRAMS data for 10 states in 2004–06, only 41% of pregnant women received oral health counseling [19]. A better understanding is needed of how such counseling impacts the use of dental care during pregnancy. Many dental and obstetrics workers may simply be unaware of the prenatal oral health guidelines, thereby causing them to not recommend dental care during pregnancy and to be less likely to talk with their patients about how to care for their teeth and gums during pregnancy. In a survey conducted in the United States of 60 dental school deans and 240 obstetrics and gynecology residency program directors 65% of deans and 45% of residencies were aware of prenatal oral health guidelines and 39% of residencies taught prenatal oral health [20]. In addition, it has been recommended that pregnant women should receive education on the importance of oral health care and safe medications during pregnancy in order to encourage home oral hygiene care.

Not having insurance coverage can limit dental care during pregnancy. Pregnant women with either private or Medicaid insurance are less likely to receive dental care during pregnancy than their non-pregnant counterparts. The type of insurance has also been associated with use of dental care during pregnancy. In a PRAMS study, pregnant women with Medicaid insurance were 24 to 53% less likely to receive dental care than those covered by private insurance . This is particularly concerning since Medicaid insurance for dental care during pregnancy, as it is available in most states, only provides coverage during their pregnancy and for 2 months postpartum, such that if dental care is delayed because of pregnancy, there may not be insurance to cover treatment later on.

Certain demographic characteristics and smoking and alcohol behaviors have been associated with failure to receive dental care during pregnancy. Research has shown that pregnant women are less likely to receive dental care during pregnancy if they are younger, a minority, not married, and have lower income and education. Women who smoke cigarettes or drink alcohol also have lower use of dental care during pregnancy.

From this previous research we can conclude that dental services are less frequently used among pregnant women, and that certain demographic groups, smokers, alcohol drinkers, and uninsured or publically insured pregnant women are least likely to use dental services. However, we know little about how knowledge of the importance of care during pregnancy and having a dental or health care worker talk with pregnant women about dental care influences whether dental care is received. In addition, we know little about the characteristics of pregnant women who are most likely to have dental insurance. The purpose of the current study is to identify the prevalence of dental services received (teeth cleaning and seeing a dentist for a dental problem) and factors related to receiving dental care (knowledge of the importance of care, having a dental or other health care worker talk with them about the importance of dental care, and insurance) among a group of women who completed the PRAMS survey in Utah. The impact of knowing the importance of receiving continued dental care during pregnancy, having a dental or other health care worker talk with them about such care, and insurance on actually receiving dental care during pregnancy will also be assessed.


To read the entire paper follow this link.

Wednesday, November 13, 2019

Omnichroma Results Continue to Impress

 


In Chicago this past spring (2019) Tokuyama introduced OmniChroma composite.  This has been a game changing restorative material for a lot of doctors.

I was fortunate enough to be able to beta test the material and I am now approaching about 13-14 months of clinical cases.  What I am seeing clinically is cases that are holding up well.  Margins are intact, material wear is minimal, they are still highly polished, and the shade match is still “spot on”.

For those of you who don’t know the details of Omnichroma, it is a composite resin that is designed to be a single shade to match all clinical situations.  The company accomplishes this through a pretty unique filler particle system.  Composites are normally resin with a mix of filler particles for strength and polishability.  Most composites use a variety of sizes of these particles, larger ones for strength and smaller ones for polish and under high magnification, these particles look like tiny pieces of gravel.

Because of the non-uniform shapes of these particles, light is bounced around at a myriad of different angles. 

What Tokuyama managed to do was to figure out a way to make filler particles that are round spheres.  These spheres cause the light the reflect and refract in uniform ways that allow the composite to pick up the shade of the surrounding tooth structure.  This means that Omnichroma comes in a single shade and, when the material is polymerized, that single shade picks up the nuances of the surrounding tooth structure to create a near perfect match.

When Tokuyama approached me about the product, I must admit I was a bit skeptical.  However some experimental time testing it on extracted teeth showed me that my concerns were unfounded.  Now 13-14 months into my usage of the material, I continue to be impressed with it.

If you are looking for way to simplify your restorative procedures, I definitely feel you should give Omnichroma a try.

Tuesday, November 12, 2019

In the World of Clinical Dentistry - Knowledge Is Power

 


I'm not sure who came up with the expression "Knowledge is Power" but whoever thought of it was a genius. Those three simple words are true in many different ways. By bringing knowledge into the equation, we become much more powerful in ways we never considered.
Research and development in a myriad of subjects is rapidly increasing the “bottom line” of our knowledge base. Now that we have computers and machine learning, the curve continues to accelerate.

According to Industry Tap Into News, Buckminster Fuller created the Knowledge Doubling Curve. He noticed that until 1900, human knowledge doubled approximately every century. By the end of World War II, knowledge was doubling every 25 years. Today things are not as simple, as different types of knowledge have different rates of growth.

For example, nanotechnology knowledge is doubling every two years and clinical knowledge every 18 months. But on average, human knowledge is doubling every 13 months. According to IBM, the build out of the “internet of things” will lead to the doubling of knowledge every 12 hours. Now, this may seem daunting at first, but if you think about it, having access to all of that knowledge can open doors and let us do things we would never have dreamed of.

In the beginning

It used to be that the general practice was sort of a “clearing house” of sorts for procedures. The GP performed basic restorative procedures and simple procedures such as basic extractions and easy one-canal endodontics. Anything more complicated ended up in the hands of one of the local specialists.
Back then, fluoride was not yet in all the places and substances it is now. Restorative needs of the patients was the “bread and butter” of most general practices. Doctors were so busy restoring large carious lesions they didn’t have the time to learn and implement other procedures into their practices. If the patient’s teeth were misaligned, a referral to the local orthodontist. Impacted third molars? A referral to a local oral surgeon.

As time passed, fluoride began to work its magic and the scope of the general practice began to change. Restorative procedures changed from amalgam and “bombed out teeth” to slot preps and conservative composite procedures, and doctors began to look at ways to expand their services.
The rapid proliferation of internet connections in the late 1990s allowed doctors to connect with other doctors as well as digital databases of research that previously were only available to university or government-based researchers.

This allowed “in the trenches” practitioners to gain access to tremendous amounts of data and leading-edge techniques which allowed them to operate more efficiently and with more predictability. Now a doctor could learn a new technique while eating breakfast and perform the procedure twice before lunch that same day.

This created a feedback loop that greatly changed the way we practice. Whether an online database, an email chain from friends, or one of many other sources of information, the knowledge base of clinical dentistry expanded rapidly.

Sharing
As all of this knowledge expanded, the ability of the general practitioner to treat complicated cases also expanded. Because this expansion of knowledge was stored in a digital format, the ability to share and access that data became a simple matter of “point, click, learn.”

In truth, the doctor had the ability to not only learn, but to then provide immediate feedback to others. This allowed other doctors and educators to quickly evaluate and change procedures so everyone who was “in the loop” could quickly change protocols for the better.

As the operatory computer became the hub of the clinical technology wheel, doctors used their digital integrations to rapidly and reliably share clinical information. Procedures with complications could be tracked and solutions could be advised and attempted in practically real time. Sharing photographs, radiographs and clinical notes with others allowed for the rapid dissemination of clinical information.

For the full article, head on over to the Dental Products Report website.

Monday, November 11, 2019

Sleep and Pregnancy in the United States

 


I find it fascinating how citizens in the United States take for granted the amazing aspects of the statistics in our healthcare system.  We simply don’t even think about things like survival rates for procedures  or how predictable amazingly difficult procedures have become.  Recently a friend of mine had a hip replacement procedure performed.  Ten to fifteen years ago, this surgery would have required a hospital stay of a week or longer.  My friend also would have been flat on their back for several days before the staff even considered getting the patient mobile.  

Now by friend was gently gotten to his feet hours after the surgery.  Add onto that the fact that the surgery was done at 06:00 and my friend was released to go home that afternoon.  You read that right.  A weight bearing joint relationship surgery is now considered outpatient surgery!!!

So what does joint replacement surgery have to do with sleep and pregnancy?  Well just like outpatient hip replacement, we tend to take for granted how simple pregnancy and delivery can be.  

As I have become more and more interested in sleep and the affects it has on myriad aspects of our health, I’ve come across some pretty incredible statistics dealing with sleep and fertility.

Here are just a few of the things that have been noted regarding the differences in sleep between females and males:

Examples of sex and gender differences in sleep
A. Epidemiology of normal sleep in general population
 1. Sleep latency is longer in women than men;2
 2. Women <55 years report more sleepiness than men;2
 3. Older women report 20 minutes less sleep than men;2
 4. Women have more (106%) SWS and less NREM stage 1 sleep than men;3
 5. Men have more NREM stage 1 and stage 2 sleep than women;3
 6. Normalized delta activity in older women is lower than in older men.4
B. Normal sleep in animal models
 1. Female mice spend more time awake and less time in NREM than male mice;5
 2. Female rats show ∼50% decrease in REM sleep compared with male rats;6
 3. Slow wave activity during recovery dissipates more quickly in gonadectomized male rats compared female rats;5
 4. Restraint stress produces increase in REM sleep which is greater in male mice than females;7
 5. Sex-steroid modulation is greater in females than in male rats;6
 6. Young male fruit flies have bimodal (middle of the day and night) sleep and young female flies sleep mostly at night.8
C. Epidemiology of sleep disorders
 1. Women are at 40% increased risk for developing insomnia compared with men;9
 2. Women are at twice the risk for RLS compared with men;10
 3. Women with RLS are at higher risk for comorbid problems compared with men;11
 4. Antidepressant use is more strongly associated with RLS in men than in women;12
 5. Men are at twice the risk for OSA than women;13
 6. REM sleep disordered breathing is more prevalent in women and men (<55 years);14
 7. Depression is more strongly associated with apnea in women (OR 5.2) than in men (OR 3.4).15
D. OSA symptoms and presentation
 1. Women report different OSA symptoms than men;16,17
 2. Men consistently have higher apnea-hypopnea index compared to women across all ages;18
 3. Waist-to-hip ratio is more predictive of severity of OSA in men than in women;19
 4. Women have more partial obstructions compared with men;20
 5. Women have lower scores than men on Epworth Sleepiness Scale, which maybe be more sensitive to subjective sleepiness in men than in women;17
 6. Central nervous system white matter changes are more likely to occur in women with OSA than men.21
E. Treatment
 1. Women may require less CPAP pressure for OSA treatment of similar severity in men;22
 2. Women metabolize zolpidem 50% slower than men.23

Sex and gender differences exist in normal sleep and sleep disorders. Some examples discussed during the roundtable are listed.

CPAP, continuous positive airway pressure; NREM, non-rapid eye movement; OR, odds ratio; OSA, obstructive sleep apnea; REM, rapid eye movement; RLS, restless legs syndrome; SWS, slow wave sleep.

There is now very little doubt that the rest our bodies receive during sleep is incredibly important to how our bodies function.  Now we are seeing that even things such as fertility can be seriously affected.

Thursday, November 7, 2019

The Goetze Dental Family Celebrates 135 Yearswith New Fifth Generation Leadership!

 


Our world has changed a lot in the pst 20-30 years.  And it hasn’t just been the continuing extension and penetration of technology into every nook and cranny of our existence.  Unfortunately it has also been about the changes in business.  It seems that the small business environment has also suffered as “mom and pop” operations are forced out by large corporations that undercut on wholesale costs & put smaller competitors out of the landscape.

This has been apparent, not only in “normal” consumer brick and mortar businesses, but also in dentistry as well.  From a clinical standpoint the industry has seen a huge influx of corporate dentistry devouring or crippling the solo practice.  However, it’s also become commonplace on the supply side of the equation as well.  At one point in time small local solo practices in medicine and dentistry were supported by small local suppliers that were family owned and worked synergistically with each other for the good of the customer (the patient).

Yet, just as we’ve witnessed WalMart move into a town and quickly put local merchants out of business or buying them up, there has also been a tidal wave of small independent dental supply companies being purchased and absorbed by large supply companies.  These same large supply companies are also selling to corporate dental offices, but the prices they offer these corporate clinics are at a much lower price than those offered to the small traditional practice.

How does a smaller company like Goetze Dental manage to stay viable in today’s climate?  It’s a simple process really.  Goetze Dental realized that they are a 5th generation family owned company and that they owe this longevity to small family owned dental practices.  Because of that, they have chosen not to sell to corporate clinics and instead to support the customers that have supported them for 135 years.  Loyalty and treating customers like friends has been the secret to their continued success.

The good folks at Goetze Dental have a tremendous record of success that has come by treating their customers the way their customers deserve to be treated.  They also have an incredible team of dedicated employees that have incredible numbers of years of service and those numbers are just one more indicator of how their corporate culture extends from the customer to every employee.

Although I doubt I will be practicing when they celebrate their 270th anniversary, I hope they are still around to do so!  Congratulations Goetze, you deserve to celebrate a bit!

Goetze Dental turned 135 years old on September 24, 2019! We are so grateful to you and our entire Goetze Dental community for your trust and support over the years.

Marking the occasion, the fifth generation of leadership stepped into executive management with Ben Brunker named president and David Brunker named chief operating officer.  Owners and fourth generation family members, Don and Janet Brunker, will remain active in the business, with Don continuing on as chief executive officer and Janet as senior vice president, finance.

Ben Brunker joined the company in 2004 as a business analyst and in 2008 moved into the role of vice president of marketing.  He became vice president of sales and marketing in 2013.  Ben holds a bachelor's degree in finance from Missouri State University and an MBA in finance from The University of Missouri - Kansas City.

David Brunker began his career as a business analyst with Goetze Dental in 2014 and in 2015 he was named vice president of service.  David holds bachelor's degree in management and leadership from The University of Kansas.

Other leadership changes include role changes for longtime Goetze Dental employees Larry Dalrymple and Keith Lister. Dalrymple becomes vice president of merchandise and Lister becomes vice president of information technology and warehouse logistics.

It's been an exciting 135 years so far, and now the Goetze Dental family is sure the next are the best to come!